Annual report 1955 [1955]

~tate of <l3eorgia
l>epartment of:j_3ublic llealth
T. F. SELLERS, M. D., DIRECTOR ATLANTA

MEMORANDUM

To:

Honorable Marvin Griffin, Governor of the State of Georgia

Members, State Board of Health

The People of Georgia

Subject: Annual Report for 1955

We are now reaching the point in public health where most communicable disease can be controlled.
This has two important results. First, people are living longer, and are therefore suffering in larger numbers from other categories of diseases, such as heart trouble and cancer. Second, many people are not taking advantage of preventive service and knowledge available to them. This is particularly true of venereal disease and tuberculasis. Even diphtheria has attempted a mild comeback, This calls for more effort in education of the public.
As old threats decrease, new ones grow stronger. We can expect more trouble in the future, not only from heart disease and cancer, but also in mental illness, accidents, special illnesses resulting from industrial growth, and others,
Many dollars were required for public health services for the more than 3, 600,000 Georgians last year. The Health Department, in Fiscal Year 1955-56, operated on a budget of $5, 892, 500. It was also responsible for administering over $5, 892, 800 in hospital construction funds, over $3, 898, 000 for tuberculosis sanatoria, $990, 500 for crippled children and $3, 124, 000 for rentals and equipping of the new Eugene Talmadge Memorial Hospital at Augusta. Detailed financial reports for the Department are issued to the Board at the close of each fiscal year.

RESUME
For your convenience, here is a brief resume of this report's information: We continued to help communities provide improved hospitals and related services by administering federal and state grant-in-aid programs. During 1955, 12 projects were completed and 8 more begun. Hospital services included community survey and planning; construction; licensure; and consultation (p. 1). We worked toward 100 percent registration of births, deaths, fetal deaths, marriages, and divorces. For the second consecutive year there were more than 100, 000 live births (p. 4), The personnel turnover rate remained at 32 percent. We had 2, 355 employees, a net gain of 23 over the previous year (p. 6). We have continued to educate and inform the people about health and health department matters through every channel of mass communications as well as through state and community organizations (p. 8), Since we believe in improving our employees, we have given many of them either on-the-job training or additional academic training, in spite of a shortage of training funds (p. 11). Our library continued service to state, regional and local offices, with 16,275 books and other volumes available for circulation {p. 12) Progress in the fluoridation of public water supplies has been retarded by the half-truths and false statements of groups who oppose this safe and inexpensive way to prevent tooth decay. We have conducted dental clinics in 57 counties, but are limited by a shortage of personnel and private dentists (p. 13}. Engineering services were provided in the sanitation of milk, food, housing, schools, tourist courts, shellfish, hospitals, and impounded water (p. 16). For the 24th year no diseases traceable to water pollution were found, as health supervision of public water and sewage works, and industrial waste treatment, continued (p. 19).

Problems in industrial health were studied and consultative services given when indicated ( p. 21},
Insect and rodent control activities were coordinated with the work of other divisions concerned, and program development aid was given locally (p. 23),
Fact-finding studies in home safety were conducted to obtain statistical information to be used in the overall education program, Special literature was prepared to assist local communities (p, 25),
We had at least one public health nurse in 147 of our 159 counties, with 530 nurses employed at the end of the year (p, 27),
Four health districts were activated in accordance with the state plan for 38 districts adopted by the State Board in 1954, with negotiations either completed or under way for several others (p. 30).
The five health regions devoted much effort to activation of new health districts, in-service training, and consultation services (p. 32).
Maternal and child health services included consultant aid in the areas of nursing, midwifery and health education, with a special state-wide study of obstetric care among rural women, New regulations for certification of midwives will make chilcibirth safer in many cases (p,43},
Consultation services in nutrition were provided in connection with clinics, schools for food handlers were held, and educational work was continued(p, 45),
Teachers were encouraged to do child vision screening in classrooms, Regional meetings concerning the use of the new School Health Guide were held (p, 48),
With mental health patients occupying half of our nation1s hospital beds, we continued expanding our mental health program, We have added some staff members, and are providing educational service and in-service training (p, 51),
An increase in funds July 1 enabled crippled children s services to provide braces and appliances and to hospitalize many children on our waiting list (p. 53),

The polio program assumed the place in professional thinking that it has long occupied popularly. Confusion about safety reduced vaccine demand for a time. Diphtheria returned; banding of parakeets aided psittacosis investigations (p. 55),
The state aid program in cancer control carried about the same case load (4, .Z 13) as in 1954, Higher hospital rates became effective November 1, and may add about $50,000 to the cost of the program, which in 1955 was $351, 000 (p. 57),
Rabies increased slightly, as infected foxes outnumbered dogs almost two to one. A rabies control program began in Alabama, Georgia and Florida (p. 58).
Despite progress in new treatment, tuberculosis remains one of our most serious and costly health problems. While deaths decreased last year, there was no lessening of new cases, and tuberculosis is far from under control (p. 61).
For three years, the tuberculosis patient load decreased at Battey State Hospital. Modern drugs reduced hospitalization time, but far advanced cases continued to rise, showing need for continuous services and education (p. 64).
For the first time sine 1948 we saw a rise in reported cases of primary and secondary syphilis (581 over 508), probably due to increased case-finding. Since July 1, under a new morbidity reporting system, over half of syphilis reports came from private physicians. Total 1955 syphilis reported was 3550; in 1954 it was 2327 (p, 66).
The occupational health program dealt mainly with the 98 percent of industries that are small, and helped in development of Atlanta s Industrial Health Council (p. 69).
As modern medicine and public health make people live longer, chronic illnesses increase. Lack of personnel and finances have held us back, particularly in a heart disease control program, but we expect to hire a cardiologist in 1956 and get under way (p. 72).
We continued civil defense work with other organizations and continued a monthly health services school (p. 74).
For the second year since 1951 1s peak, lab examinations missed the million mark. Since this is due to ending the multiphase testing program, this report begins to reflect the normal growth of laboratory services (p. 76).

TABLE OF CONTENTS

ADMINISTRATIVE SERVICE Division of Hospital Services Division of Vital Statistics Division of Personnel - - - - - - - Division(s) of Health Education and Training (Health Education Unit, Public Information Unit, Training Unit and Library) - - - - - - - - - -

Pages 1 4 6
8

DENTAL HEALTH SERVICE Division of Dental Public Health - - - - - - - - - - - 13

ENVIRONMENTAL !EALTH SERVICE

Division of Public Health Engineering

16

Division of Water Pollution Control

19

Division of Industrial Hygiene - - - - -

21

(Also see Occupational Health)

Division of Insect and Rodent Control- -

23

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

25

LOCAL HEALTH SERVICE

Division of Public Health Nursing

27

Division of Local Health Organizations

30

Northeastern Health Region

32

Northwestern Health Region

34

Central Health Region

36

Southeastern Health Region

- - - - ..;.

38

Southwestern Health Region

41

HEALTH CONSERVATION SERVICE

Division of Maternal and Child Health (Nutrition Unit)- - 43

Division of School Health

48

Division of Mental Hygiene

51

Division of Crippled Children

53

PREVENTABLE DISEASES SERVICE

Division of Epidemiology, (Cancer Control and

Veterinary Activities)- - -

55

Division of Tuberculosis Control - -

61

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

64

Division of Venereal Disease Control

66

Division of Occupational Health -. -

69

(Also see Industrial Hygiene)

Division of Chronic Diseases

72

Civil Defense- - - - - - - - - -

74

LABORATORY SERVICE

Division of Laboratories

76

ADMINISTRATION SERVICE Division of Hospital Services Division of Vital Statistics Division of Personnel Division(s) of Public Health Education
and Training (Health Education Unit, Public Information Unit, Training Unit and Library)

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DIVISION OF HOSPITAL SERVICES
The broad function of the Division of Hospital Services is to help communities provide improved hospital facilities and related services for all citizens.
The Division is delegated, by the State Health Department, the responsibility of assisting local communities with the following leading activities:
A. The administration of Federal and State grant-in-aid programs to encourage local communities to improve their hospital facilities. B. The administration of the Georgia Hospital Regulations Act, (Georgia Laws, No. 623, 1946) to encourage existing hospital and related facilities to meet licensure standards. C. Survey and planning activities to study hospital problems and to determine the relative need throughout Georgia for improved medical care facilities. D. Consultation and educational services to assiE!t administrators, governing boards and community leaders with local hospital problems. The 1955 activities of the Division may be divided into the following broad categories: (a) community survey and planning, (b) construction, (c) hospital licensure, and (d) consultation service. In addition, members of the Division were active in various hospital and related association meetings, conferences, institutes, training programs and civil defense planning activities. Survey and Planning Activities. Survey personnel completed studies of the need for, and local ability to finance, medical care facilities in 26 communities interested in financial assistance under the Hospital and Medical Facilities Construction Program. Special studies were also made of patients in nursing homes, the need for nurse training facilities, and need for a Hospital Care Study Commission to meet the problem of indigent patients. A program of assistance was carried out to aid communi ties in obtaining

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the services of physicians; the annual revision of the State Hospital and Medical Facilities Plan was completed and many special requests for information and statistics relating to hospital facilities and services were answered.
Construction Program. The availability of Federal and State funds to match local funds has encouraged many communities to improve their medical care facilities. During 1955, 12 projects were completed and eight additional projects started construction. The regular Hospital Construction Program was implemented by the Medical Facilities Act, which provides matching funds for chronic illness hospitals, nursing homes, diagnostic-treatment centers, and rehabiliti3.tion facilities. The primary purpose of the Medical Facilities Act is to encourage general hospitals, which have been specializing in short term acute illness, to extend their services to include more adequate provisions for ambulatory and long term patient. The regulations established under the Act make it almost mandatory that these particular facilities be constructed in connection with, or as a part of, an existing general hospital.
Licensure Activities. Hospitals, nursing homes, and homes for the aged in Georgia are required to be inspected and licensed under Georgia Hospital Regulations Act of 1946. During 1955, all hospitals and nursing homes in the state were visited one or more times by the Licensure Section. A total of 576 visits were made by the Section in addition to 391 visits by the State Fire Marshal and 394 food handling and sanitary inspections by local health departments. Also tested were 51 hospitals, for explosion hazards in anesthetizing areas, and 60 hospital and nursing home P,ans were reviewed prior to new construction or plant improvement. As of December 31, 1955, 76 hospitals were granted full licensure approval, compared to 49 in 1954.
Consultative Services for Hospitals. The Division provided consultative services without charge to existing hospitals as well as to those under construction under the HillBurton Program. These services were in the fields of nursing, dietetics, administration,

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hospital plant operations, accounting, laboratory technology and medical records. Consultants not only assisted hospitals and nursing homes with operational problems but also sponsored instructional programs, workshops, institutes and the preparation of resource materials. Several educational programs were sponsored in laboratory technology, medical records, nursing and a uniform accounting system for hospitals.
Other Activities. Representatives of the Division,particularly the director and those performing consultative services, attended almost every regional council meeting of hospital administrators.
The Training Program in Hospital Administration, sponsored by the Division in conjunction with the State College of Business Administration, began its fourth year of instruction during 1955. Members of the Division assisted the program, serving as part-time instructors and securing the cooperation of hospitals in permitting students to obtain the required experience in hospital administration.

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DIVISION OF VITAL STATISTICS
This Division has been given the responsibility of administering the vital statistics laws of Geo rgiaJcooperating with other State agencies in the administration of related State laws. The ultimate aim of the Division is to achieve 100 percent registration of all vital events in the State as they occur.
For the second consecutive year, there were more than 100,000 live births in Georgia. Through December 31, only 98,584 completed certificates had been filed, compared to 100,069 for the same period during 1954. But more than 1, 500 incomplete certificates were in the office at the close of the year, which brought the total number of certificates received to over 100,000. The early recording of birth certificates continues to improve, and for this reason it is difficult to estimate the final number of births for 1955. However, it is believed to be slightly lower than 1954.
Through December, 29,732 death certificates h?-d been recorded for the year, a decrease of 789 over the same period of 1954. It is believed that the final recorded total will be proportionally lower than the 31,043 recorded in 1954.
The fetal death registration program is not fully understood by all the physicians in the State, but it has proved to be more effective than stillbirth registration. It was understood when the program was inaugurated in 1954, that it would take several years of continuous educational work to make it the effective working tool it was designed to be. Through December, 4, 159 fetal deaths had been recorded for 1955, a slight increase over the same period of 1954.
During 1955, a total of 28, 926 certifications of birth and death records were issued from 1954. The number of verifications of birth and death for public agencies continued to increase. Also the number of certificates for school admission increased in proportion to the ever- growing school enrollment. The need for allotment certificates

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for the dependents of service men and veterans remains a constant factor, and several thousand such certificates were issued. Requests for information on birth and death records increased until it was necessary to add a temporary clerk to the staff.
During 1955, a total of 26,009 birth certificates were filed by the delayed procedure, 10,753 more than in 1954. The greater part of this increase, 3, 768, was by the State procedure.
Marriage registration continued at a high level. There were 54, 316 marriages recorded, an increase of 2, 861 over 1954.
There was an improvement in divorce registration brought about by a continuous educational program, but there are still problems to be solved in the future. A total of 7, 245 divorces were recorded, an increase of 502 over 1954.
During the year, 1, 560 adoption decrees were received, and 1, 235 completed new birth certificates were filed for these children. Also, 899 new birth certificates were filed for children declared legitimate.
The field representatives continued their educational and promotional program toward better registration of all vital events. This has proven to be a worthwhile and effective program.
A complete statistical analysis of births, deaths, fetal deaths, marriages, and divorces for 1955, will be published later.

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DIVISION OF PERSONNEL ADMINISTRATION

In 1955) there was a net increase of 23 full-time health workers in the State..

A small increase in local health departments, coupled with an increase at Battey State

Hospital required by greater demand for plant maintenance, was. offset by a substantial

decrease in the number of employees in the. State office. In addition to these employees

in whose salaries the State participated, local health departments employed about 235 health workers paid entirely from local funds.

1949

Local

650

State

521

Alto

183

Battey 658

2,012

Full Time Employees in Public Health

1950

1951

1952

1953

1954

687

724

828

870

902

524

608

629

608

574

191

163

15

0

0

759

832

859

830

856

2, 161

2,327

2,331

2, 308

2, 332

Net Gain,

1955

1955

907

5

558 -16

0

0

890

34

2,355

23

The turnover rate, 32 percent, remained unchanged from 1954, after a decrease

from 39 percent in 1953.

Employee Turnover in 1955

Local State Battey

Appointments 175 165 443 783

Separations 170 181 409 760

Net Gain 5
-1 6 34 23

During the year, a revised series of class specifications for medical technology

was activated. A study of the bacteriological laboratory classes was brought to a sue-

cessful conclusion effective January 1, 1956. A study of the nursing series was begun.

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The increasing complexity of employment procedures made it necessaryfor the authority for personal services contracts to be centered in the Personnel Office. A training school for division secretaries resulted in the publication of a "Secretary's Manual" for easy reference to common procedures. Arrangements were made with the Professional Examination Service of the American Public Health Association to provide examination material to assist in the selection of the best qualified applicants in the several professional fields.

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DIVISION (S) OF HEALTH EDUCATION AND TRAINING
"Health education is the translation of what is known about health into desirable individual and community behavior patterns by means of the educational process."
The Division's objectives are to provide personnel, techniques and materials to help achieve this goal.
The Division was reorganized in 1955 to consist of a public health education unit, a public information unit, and a training unit, each having a director responsible to the Division director.
The health education unit provides consultative services. It offers aid in material development, including pamphlets, exhibits, posters, etc., to divisions, local health departments, and other official and private groups.
The public information unit does publications, art work, operates a film library, prepares news material for press, radio and tetevision, and provides consultation on these matters and on public relations.
The training unit evaluates the need for training and promotes the recognition of this need; it offers training experience to staff members and foreign visitors, and supervises professional training.
Because a rather large area of common interest is shared by the public information and health education units, many of their responsibilities are jointly shared.
Personnel of the health education unit include health education consultants, librarian, and stenographic and clerical workers. In addition, local health educators receive general guidance from this unit.
Public information unit personnel include public information specialists, editorialist, illustrator, film librarian and clerical personnel.
Training personnel include at present the Division director and stenographic

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and clerical workers. The Division hopes to continue to expand its services in areas where most
needed. Health Education Unit
The Health Education Unit was involved in a wide variety of activities during 1955. The following list, although by no means exhaustive, is indicative of the scope of activities carried on by the unit.
The unit worked in a consultant capacity with otrer agencies interested in health, such as teacher education faculties, teacher workshops and other school groups in the area of curriculum development; Parent-Teacher Associations in planning health projects; high school faculty and administrative personnel in initiating health and human relations programs; assisted local health workers and others interested in the or ganization of local health councils.
Personnel of the unit assisted with in-service programs for health department workers, and participated in regional and local staff conferences.
Unit personnel also provided consultant services to a committee of the Teacher Education Council studying elementary education.
The Unit aided in the overall preparation of the recently published "School Health," and in preparing the script for the new venereal disease film, "The Invader," and the accompanying Teachers Guide.
Personnel from the unit worked with the Agricultural Extension Service in developing a general questionnaire for farm families which was designed as a provocative and educational experience aimed at improving farm living conditions.
The unit provided technical and consultative services for other divisions and for local departments in the area of material development.
The organization and execution of Civil Defense courses is becoming an

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increasing responsibility of the unit, with emphasis being given to helping local departments conduct their own programs in Civil Defense.
The aim of health education personnel is to provide increasingly better services. Toward this end, the unit invites requests for services, together with challenging comments and suggestions.
Public Information Unit The public information unit helped promote a better public understanding of health and health programs through preparing informational material for use in as many channels as possible, chiefly the organized institutions of mass communications -press, radio, television, and Department publications. The most frequently used subject for news releases was polio, to help local departments keep the public informed of the vaccination program. The unit produced spot films and slides for television, and tape recorded radio spots, and programs. At relatively low cost, information was given to thousands who would not have been reached by pamphlets, newspapers and other media. A public inquiries service was operated, in which mail not specifically addressed to a division was acknowledged and given proper referral. Educational films, from over 150 titles, were distributed to local health departments for use with local audiences. Georgia's Health, a monthly bulletin of health articles, was mailed, upon request, to about 17, 000 Georgians; and FAX, a news -style publication, was issued monthly for health workers. The unit produced exhibits, posters and pamphlets for special occasions or uses. General service was given other divisions in editing and speech-writing. The unit assembled and edited the Department annual report from Division reports. In special projects, the unit worked with the Division of School Health and the Photo LalJ to

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produce a training film in eye-testing; most of this film was completed in 1955, A special pictorial edition of Georgia's Health was published as a report to Georgians on how health dollars were used in 1954. The unit assisted with editing of the School Health Guide, and with publication of a teacher's guide for "The Invader," a new venereal disease film.
Divisions, local health departments, and individuals are invited to request help in plans for public information and public relations.
Training Unit The new Divisional reorganization has made it possible for Training to do a
' much more effective job, particularly in relationship to the experiences offered to foreign visitors.
In 19551 there was approximately three times as much academic training on stipend as in 1954, although the number of individuals was slightly less. This was due primarily to the significant decrease in the number of sanitarians enrolled in the 12week course at the Communicable Disease Center.

Summary of Stipend Training

Jan.- JulyJune Dec. Total

Jan.- JulyJune Dec. Total

NURSES

Academic

4

Orientation

9

SANITARIANS Academic Short Course in Env. Sanitation 4

ENGINEERS Academic

BACTERIOLOGISTS

9

13

Academic

1

1

5

14

PHYSICIANS

Academic

1

1

2

4

4

Orientation

4

4

4

8 STATISTICIAN

Academic

1

1

19 29 48

1

1

Over 200 people attended 37 short term courses in mother and baby care, clerical training, supervision for nurses, hospital methods, occupational health, epidemi-

ology, dental health, hospital safety, tuberculosis, and others.

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The number of foreign visitors was slightly smaller than in the previous year. Experiences were provided in public health of from one day to several weeks for more than 46 visitors representing 18 countries in the Far East, the Middle East, and South America.
A small committee representing Nursing, Environmental Health, Health Education, and Training, formulated plans for a field training center, to be presented to the Advisory Committee of the Division early next year. These plans concerned only the entrance level nurses and sanitarians and will be expanded as soon as possible to
include other professional categories and training needs beyond the entrance level.
There is real interest and cooperation in all Divisions, With such significant contributions, training programs will continue to improve and advance.
Library At the end of the year, the Library had a total of 16,275 books and other volumeE compared to 15, 708 in 1954. These publications were at the main library of the State Health Department, division offices, regional offices and branch libraries. Circulation of publications from the main library was 5, 2 72 and attendance was 8, 911. In addition, the main library handled many reference calls from different divisions and from outside the Department.

DENTAL HEALTH SERVICE Division of Dental Public Health

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DIVISION OF DENTAL PUBLIC HEALTH
Steady advances in Dental Health Services have been noted in preventive, corrective and educational phases of the program during 1955. Fluoridation.
The progress made in preventive services was primarily in the field of fluoridation. Five communities began fluoridation of their public water supplies during the year. More than 550,000 people are now using fluoridated water from 16 water systems serving 40 communities in Georgia, On the other hand, almost 2, 000,000 people in Georgia should be receiving these benefits but aren't, because they fail to recognize the safety, effectiveness and economical value to be derived from the process.
Despite all the favorable reports from completed studies showing the benefits and safety of fluoridation, the opposition continues to blast away with its suppositions, half-truths and false statements, all of which have retarded progress, making community acceptance much slower than we in public health wish to see. At the present rate, it will take at least 15 years for Georgia to have state-wide coverage of its water systems. Clinical Programs .
. Pre-fluoridation surveys have shown that dental caries has increased in the State over the past 10 years by almost 25 percent for all young age groups. At the same time, these surveys show the need for more corrective services, which necessarily means more dentists and auxiliary dental personnel to do the job.
There are some 800 dentists in Georgia, out of 3 1/2 million people, or one dentist for about every 4, 000. The national ratio is one to every 1, 700. With this low ratio of dentists, it is easy to understand that the health department's load is increased with public demands much greater than in other sections of the nation. A total of 197 dentists

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worked 23,327 hours in 101 clinics located in 57 counties. Only two dentists devoted full time to this work. This is an increase of only one county over the previous year. However, the increase in the number of clinics was seven, While it is true that these part-time dentists were busy with their private practices, they found time to do this community job for a small honorarium.
All new admittances to these dental clinics were confined to children under seven years of age, with the understanding that they would be recalled at frequent intervals for check-up and necessary corrections. Older children already admitted were recalled, and during the year, 41,010 children received care in these clinics. The cost to the State and county was a little more than $2.00 per child, not counting the cost of supplies, office space or the funds expended independently by Fulton County. The average child received about three treatments each, which included fillings, extractions and treatments of the supporting tissues. If there were an adequate number of dentists and funds to do the job, clinical services could be expanded tenfold, and there would still be a backlog. With an adequate number of clinicians, it would be possible to increase the number of centers and clinics by almost one-fourth with very little increase in plant facilities. Dental Health Education.
Dental health education continues to be a major activity in Georgia's Dental Health Program. Professional and lay groups are provided with authentic dental health information for pe.rsonal use, and educational aids are furnished to groups for teaching purposes along with guides for developing community dental health programs, The selection and distribution of dental health educational publications and films serves an important purpose at all times, but particularly since Georgia's regional and district health departments do not have dental consultants.
In addition to working with the State Department of Education and allied groups

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such as teacher education schools, the Dental Health Educational director serves as a member of the Board of Managers of the Georgia Congress of Parents and Teachers and works with other state-wide groups such as the Georgia Education Association, Adult Education and the Agriculture Extension Service to promote dental health education. Recordings.
Preventive services continues to be the program that will accomplish the most lasting results, and emphasis must be placed on this program. With the increased demand for dental services, clinical programs should be expanded by the employment of full time dentists who would help remove the backlog and keep up the corrections of new cavities that are developing more rapidly than in previous history. There should be a plan to extend the program to older age groups who need dental services and to provide services in nursing homes, chronic disease centers and for industry. Dentists should be employed in the new district health departments. Their duties could cover more than the dental health activities, since their training in general health administration as well as dental public health would qualify them as excellent ancillary administrators.

ENVIRONMENTAL HEALTH SERVICE Division of Public Health Engineering Division of Water Pollution Control Division of Industrial Hygiene
(Also see Occupational Health) Division of Insect and Rodent Control Home Safety Unit

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PUBLIC HEALTH ENGINEERING DIVISION
Food Sanitation. Forms, materials, visual aids and advisory services were provided for use in local food sanitation programs. Research in such areas as health card requirements and hot water demand, reviews of literature, and release of technical data increased the Division's leadership status. An official evaluation in 1955 revealed that a county program in Georgia was rated third highest in the nation. Direct assistance in food sanitation was rendered in about 40 counties during the year.
Hospital Sanitation. The Division provides reports obtained through local and regional personnel on water, sewage, food, and milk at hospitals and nursing homes to the Licensure Section of the Hospital Services Division. As a member of tre Committee on Hospital Facilities, Engineering Section of APHA, the director, with the assistance of the Hospital Services Division, was able to furnish the basic data for the Committee Report on "Solid Wastes Collection and Disposal at Hospitals," for which there has been a very active demand.
Housing. All housing financed by the Federal Housing Administration requires individual water supply and sewage disposal systems to be approved by the State Health Department. The Veterans Administration has attempted to obtain the same satisfactory installations by requiring local approval only. This practice has produced partial improvement but has not led to the uniformity obtained by State office guidance. State Department approval is now required by both FHA and VA on all subdivisions where individual or community water supply and/or sewage disposal systems are contemplated. Consideration is given to public sewer and water availability, topography, soil formation, lot sizes and shapes. Consultation regarding sewage disposal was given to the Public Housing Administration on multiple housing projects which are dependent on systems other than public sewers. These activities lead quite naturally to the relation of 'the health department to community planning for development, conservation, demolition

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and redevelopment of housing. Mapping and Photography. New maps were prepared and existing maps were
brought up to date for several cities and one county. Considerable work was done in preparing drawings for study in the relocation of health department offices pending completion of the new office buildings. New water and sewer maps were prepared for the Division of Water Pollution Control, During the year, 1250 of the 8 1/2" x 11" negatives were prepared for reproduction purposes. on the multilith press; 530 lantern slides were made; 2404 photo prints ranging from 4 11 x 5" to 40 11 x 40 11 were made; photographs were made for identification cards for Health Department personnel; 410 ozalid prints and 588 other charts on ozalid paper were prepared; exhibit materials mounted on hard board were prepared.
Milk. Programs operated by 50 local health departments, with 83 state and local health personnel participating, extended into 144 counties and are estimated to include 99 percent of all fluid milk distributed. A total of 2031 farm dairies and 136 pasteurization plants are represented, 11 Honor Roll 11 listing with the U" S. Public Health Service was had by 30 programs. During the year, 30 pasteurized products and 371 farm dairy permits were suspended because they failed to meet Grade A standards. Approximately 35, 000 milk and milk product samples were examined in State and local health department laboratories, including the mobile milk laboratories. Analysis of these reports showed a 14. 97 percent violation of bacterial standards, an improvement of 25 percent over 1953. In 1950, 32. 3 percent of all samples showed added water. This was reduced to 3. 48 percent for 1955. Pasteurized milk and milk products samples examined for coliforms showed 24. 3 percent with excessive coliform organisms, a 22 percent reduction from 1953, and pasteurization violations of 2. 09 percent, a 47 percent im.provement over 1953.

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Mosquito Control. This was maintained at 14 major hydro-electric reservoirs. Except at Spring Creek Reservoir, where Paris Green is still used, mosquito control is by larviciding with DDT in oil, Approximately 10 acres of hyacinths and considerable parrot feathers were removed by herbiciding from Lake Blackshear at Cordele. Farm ponds received 1700 impounded water permits, Existing environmental factors favorable for malaria, and the presence of encephalomyelitis in neighboring states, emphasizes the need for continued mosquito control vigilance.
School Sanitation. Jointly with the State Department of Education and the School Building Authority, 354 school improvement plans and specifications were reviewed for sanitation features and approval was issued on 319 sets. Underway were 589 school construction jobs, with 235 completions. This Division collaborated with the School Health Division and .the State Department of Education in preparing a "School Health Guide. 11 A second publication, Environmental Health and the School Plant, 11 primarily for school officials, architects, engineers, and public health workers, was written by the Engineering Division and the Division of School Plant Services, State Department of Education.
Shellfish Sanitation. Shellfish (oysters) control is a responsibility shared with the State Game and Fish Commission. Certified were 13 plants, thereby permitted interstate oyster shipment. A pollution survey resulted in limited extension of closed oyster removal areas. Chatham County Health Department made sanitary surveys along much of the county shoreline, at Division request.
Tourist Courts. Under current regulations, 1217 courts were registered; 904 of these complied; 155 had permits withheld; 119 were closed and 39 were assumed closed. Notices were served 11 courts, 9 of these made necessary adjustments and got permits; one hearing resulted in closing a court and one case is pending.
Other Work. The Division worked with many other agencies and organizations.

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DIVISION OF WATER POLLUTION CONTROL
Public health supervision of water supply, sewage works, industrial waste treatment, and allied activities is performed by the Water Pollution Control Division. The service is within a plan between the State Health Department and local governmental units, industrial communities and institutions publicly or privately owned. The cooperative plan has operated many years, with modifications for growth and increased services. Consistent adherence to it has assured citizens of safety against water-borne disease, and satisfactory sources of water for all industrial and domestic uses.
The objective of the statewide water pollution control program is a satisfactory quality balance among all the uses of water. This necessitates that drinking water of the public systems be of the highest quality, that sewage and industrial wastes be returned to the receiving streams after adequate treatment or with sufficient dilution to maintain the satisfactory sanitary balance, and that the quality of the intrastate and interstate streams of Georgia be maintained for present usage and preserved for future development. This involves the persistent application of the science of water quality control and the technical and allied administrative procedures.
The water pollution control plan of Georgia is generally understood and followed by the municipalities and industrial communities. The situations of the urban communities vary widely due to their size, location, accessibility to natural water supplies of adequate quantity, proximity to other communities -and other factors. The plan contemplates a local plan for each community. It was established and administered by the Water Pollution Control Division. Benefits of the comprehensive plan for local communities are received by them after providing the physical facilities for procurement, purification and distributuion of public water supplies and the collection and treatment of sewage and industrial wastes, all under the public health supervision of and with the

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technical assistance of the Water Pollution Control Division. There were no known or reported cases of water-borne disease from public
water supplies in Georgia in 1955--a record extending back 24 years. The fact that approximately two-thirds of the total water supplied to Georgia's cities, towns and counties, is taken from rivers and creeks (one -third from springs and deep wells) shows the generally high sanitary quality of the state's extensive system of surface streams.
The rules and regulations of the Georgia State Board of Health require that engineering reports, plans and specifications for water and sewage works projects be submitted to the Georgia Department of Public Health fer review and approval before construction is begun. This is a paramount activity and objective of the Water Pollution Control Division, involving many other procedures. Municipal officials are alert to the increased requirements for more water and sewage works facilities to serve their growing communities. The industrial expansion in Georgia is coordinated with and is actively participating in the stream pollution control program. Water and sewage works construction projects continued at a high rate during 1955. New industries seeking locations in Georgia must be fitted into the growth pattern of the state so as to produce the greatest economic and social advantages with the least damage to natural resources. This is the objective of the industrial plant location service. The Georgia Water and Sewage School is a part of the continuous local personnel training program.
The 'Water Laboratory, an integral part of the Division, performed a multiplicity of analyses during 1955, The data and information derived were used by municipalities, institutions, industries, consulting engineers, plant operators and private citizens, in solving many of the varied problems of a statewide water pollution control program,

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DIVISION OF INDUSTRIAL HYGIENE
The Purpose and Function of Industrial Hygiene is to discover, define, evaluate, and control those environmental factors in an industry which affect the health, wellbeing, and efficiency of the workers, and to teach the workers to protect themselves from all known health hazards.
Organization and Relation to Other Programs. The implementation of such a program requires a well-trained staff of professional personnel. The Division of Industrial Hygiene is fortunate in having such a staff, comprised of a Division director, two engineers, three chemists, and one stenographer. This staff, although administratively separate from the Divi sian of Occupational Health, continues to operate as part of a team with its co-division.
Even with the well-trained staff available in the Division there are occasions when it is necessary to request services of specialists from the Public Health Service and other Federal and State agencies. With their assistance it is possible to evaluate most industrial health problems.
There are more than 7300 factories and 15, 000 mercantile establishments in Georgia. More than 800, 000 non-agricultural workers are employed. The local health department is the official agency responsible for assisting these establishments and their employees in all health matters. Assistance from the State Health Department is available to local industries only through their local health department.
Accomplishments and Methods of Operations, with Typical Examples. In carrying out the program for improvement of environmental sanitation in industry, Industrial Hygiene personnel made investigations in 440 establishments employing 65,860 workers in 131 counties during 1955. These investigations covered a wide variety of industries. As an example, personnel from the Division made studies in

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foundries, paper mills, textile mills, paint companies, poultry processing plants, granite and other stone quarries as well as sheds and crushing plants, armed forces installations, an aircraft assembly plant, many county health departments, doctors' offices, and many others.
Since the inception of the Industrial Hygiene Unit of the Fulton County Health Department, it has been the policy of the State Industrial Hygiene Laboratory to carry out laboratory work for this county unit. This assistance was continued in 1955. In
,,
addition to the routine work, the laboratory collaborated with the American Conference of Governmental Industrial Hygienists on special methods for determining the presence of beryllium, sulphur dioxide, and arsenic.
In 1954, the Division of Industrial Hygiene assumed the responsibility for enforcement of the Georgia Mattress Sanitary Regulations. During 1955, at least two visits were made to each of the mattress manufacturers and renovators in the State. Several 11 spot11 checks were made of various retail outlets.
Major projects for 1956 include: 1. Investigation of the medical and industrial use of radioactive isotopes. 2. Intensified efforts to check retail outlets for compliance with Georgia Bedding Law. 3. Follow-up study of fluoroscopic shoe fitting devices. 4. Attempt to investigate more_ occupational disease reports. 5. Better follow-up of recommendations for control of environmental hazards.

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DIVISION OF INSECT AND RODENT CONTROL
The primary function of the Division is to coordinate insect and rodent control activities of the divisions of the State Health Department concerned with this phase of public health, to serve as liaison with other state agencies and federal agencies, and aid local health departments in organizing, conducting, and evaluating local community insect and rodent control programs.
Insect Control. During the year, entomological investigations were carried out in 42 counties. These activities included evaluating problems of mosquito and fly infestations and serving as consultant in formulating and carrying out plans for control operations. Considerable effort was devoted to the investigations incidental to the infestation of insects, and other complaints which had little or no public health significance, but were referred to us by county health departments with a request for assistance.
In addition to the 42 counties in which entomologic investigations were carried
out, 19 counties carried out some type of program for the suppression of fly and mosquito breeding.
Surveillance was continued on the anopheline mosquito breeding areas in southwestern Georgia, and with the exception of major impoundments, more than 90 percent of these areas were completely dry during almost the entire season.
The majority of the 1955 mosquito problems resulted from unusually heavy production of culicine species in certain areas. On the whole, the reduction of the anopheline breeding areas was accompanied by an increase in culicine breeding places so that the total mosquito population remained about the same.
An intensified study of the winter breeding activities of Culex quinquefasciatus was carried on through the winter in Columbus, Georgia, with the assistance of the Muscogee County Health Department.

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In order to promote a better understanding of the problems encountered by public health workers in activity, biologists addressed various civic and other groups, on medical entomology and related subjects.
Rodent Control. During the year, 17 counties reported rodent control activities mainly in rat eradication. The City of Atlanta reported the continuous operation of its ratproofing project, in operation since 1940, This is the only ratproofing project conducted in the state. About 41 local personnel worked in rodent control activities during 1955, The choice rodenticides are Red Squill and Warfarin, while DDT, in the powder form, is used for rat-flea eradication,
Refuse Collection and Disposal Activity. The continued use of the open refuse dump, along with insanitary refuse storage and collection practices, present an everlasting sanitation problem. The open refuse dump provides breeding places, food, and harborage for insects and rodents. It is a fire hazard and a constant source of obnoxious odors. The same problem exists wherever refuse is temporarily stored in a careless or insanitary manner.
The primary function of this activity is to assist local health departments and communities in raising their standards of environmental sanitation by reducing the insect and rodent population, This can best be accomplished by t~e elimination of open refuse dumps and the sanitary and economical handling of all refuse.
During 1955, the Refuse Collection and Disposal consultant made 110 field trips to meet with local health department personnel, county, and municipal officials in 42 counties and discuss construction of the sanitary landfill method of disposal, formulating of local ordinances and regulationsfor refuse sanitation, and improving present refuse programs. Sanitary landfills were begun by six communities, and six communities received technical assistance in moving their landfills to new locations and closing present sites. There are known to be 49 communities operating sanitary landfills.

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HOME SAFETY UNIT
Utilizing statistical information obtained in several fact-finding studies which were conducted in Georgia during 1954, this Unit increased efforts to promote action programs in as many counties as possible during 1955. Our records show that 105 of Georgia's 159 counties participated in some phase of home accident prevention during the year. There was increased emphasis on safety education during the second year of operation. A tabulation of local health department activity in home accident prevention showed that 94 counties had used safety education material developed by this office. This measurement of activity was undertaken to indicate the effectiveness of the Unit's emphasis on the educational phase of home accident prevention during 1955.
Programs complete enough to justify participation in the National Safety Council's Home Safety Inventory were developed by 24 local health departments. This nation-wide effort to tabulate all activity in home accident prevention features the presentation of Awards of Merit and Certificates of Commendation for outstanding programs to 19 health departments in the United States. Four of these awards went to Georgia three to local health departments and one to the State Health Department.
To assist local health departments in developing safety programs, the Unit, during 1955, prepared two special booklets, "A Guide to Home Safety," and "The Role of Public Health Workers in Home Accident Prevention." Both publications have been used extensively in in-service education for local health departments, and the Guide has been made available to other agencies and individuals planning programs in home accident prevention.
The Guide, which lists the leading causes of home accidents in Georgia, as well as preventive steps suggested for avoiding these accidents, has been favorably received within the state. In addition, it has been found helpful to other agencies out of the state that now have, or plan to undertake, a program in home accident prevention. To bring

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these publications before local health departments and to provide certain other guidance, the staff of this Unit made 145 visits to local departments during the year.
Great emphasis has been placed on promoting local activity because it is believed that accident prevention must be attacked as a community problem, using all resources available in a particular area. In addition to this work in local areas, the Unit staff has continued to seek new ways to integrate the principles of home accident prevention into other programs of the State Health Department. Guidance in this activity is received from the Home Safety Advisory Committee, consisting of a number of the service and division directors from the central office.
While less attention was given to statistical studies during 1955 than in the previous year, work continued in tabulating and making final reports on the 1954 accidental injury surveys, which have all been published. Also, an extensive study of accident records in one large county hospital was undertaken. These studies, together with fatality reports and information from national sources, have been the bases of our educational preventive program.
As the Unit goes into the final year of operation under funds received from the W. K. Kellogg Foundation, attention will be given to the future role of the State Health Department in home accident prevention. While careful study is made to determine if there is a downward trend in the number of fatal and nonfatal home accidents, it is felt that it is too early to expect any appreciable reduction. In the meantime, the Unit has launched a program to accurately tabulate the various activities in this field in local health departments and the various Health Department divisions. This will be done through special county folders, in which will be kept information on both successful and ineffective projects undertaken, as well as other data pertaining to the local program.

LOCAL HEALTH SERVICE Division of Public Health Nursing Division of Local Health Organizations Northeastern Health Region Northwestern Health Region Central Health Region Southeastern Health Region Southwestern Health Region

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NURSING DIVISION

During 1955, there were 60 nurses appointed to positions in Georgia. In the

same period 55 nurses were lost. There were 530 nurses at the end of the year, and

147 counties with at least one public health nurse.

Public Health Nurse - Population ratios are:

17 counties ------ 1 nurse to 5, 000 or less population

77

II

------ 1 II to 5, 000 to 10, 000 II

34 II

------ 1 II

to 10, 000 to 15,000 II

19

II

------ 1 II to more than 15,000 II

In addition to the 60 nurses who were appointed, there were inquiries from 54.

These nurses were not employed for the following reasons: unfavorable references, two;

failure to meet Merit System requirements, seven; interest in other types of positions,

nine; no vacancy in county in which they were interested, 11; did not return application

forms, 23; interested in scholarship only, one; and family conditions, one.

The following types of training were provided for nurses:

Number of Nurses

Type of Training

10

Public health nursing

1

Pediatrics and orthopedics

53

One week 1s course at Battey State Hospital

16

Three days 1 observation at Milledgeville State Hospital

1

Home accident prevention

2

Cardiac nursing

1

Maternity nursing

13

Two months 1 orientation

Thirteen additional nurses should have had orientation.

Continuous in-service education programs for public health nurses in all posi-

tions were promoted and participated in during the year. Well-planned orientation was

provided for nurses who had no post-graduate training in public health nursing prior to

appointment. Frequent evaluation of this orientation was done by an associate in this

Division, a consultant nurse on the regional staff and the sponsor of the student in the field.

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Quarterly meetings have been held with the specialized and generalized consultant nurses. Some of these meetings were centered around the topics of civil defense, eye health, growth and development of the public health nurse, and maternal and infant care programs. A five-day conference on supervision for consultants, directors of nursing in local areas and supervisors was held. Assistance was given in a staff meeting in the Atlanta Visiting Nurse Association on diabetes and also in planning for a joint in- service education program of the Visiting Nurse Association and DeKalb County Health Department nursing staff on chronic illness.
Patient education programs for diabetics were held in two counties. These programs were sponsored by the county health departments and medical societies and were given for white and colored patients on separate days. The programs included normal and modified diets, insulin injections, urinalyses, and care of the feet.
There were 168 field trips to 67 counties for the purpose of observation, consultation and evaluation in relation to in-service education and other training, personnel adjustment and program development. There were 29 visits made to the five regions.
New areas of emphasis which developed during the year are civil defense, alcoholism, and team..work in planning for orientation of public health personnel(nursing and sanitation).
Intensified emphasis has been put on the preparation of instructor-trainers in the mother and baby care classes. Three courses were given for the preparation of instructors in this important area, making a total of 112 nurses who are qualified to teach this course in Georgia. During the year, 49 such classes were taught and 828 parents received training in mother and baby care.
Concentrated effort has been given in the Southeastern Region by two of the nurses in this Division;due to the death of one of the consultant nurses in the area.

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Considerable emphasis has been given to nursing classifications with hopes that nursing salaries could be made commensurate with the responsibilities and duties of this group of public health workers.
Other projects which have been carried out with the cooperation of consultant nurses are: better utilization of nursing resources; consultations with schools of nursing to help with correlation of public health nursing aspects of nursing in the basic curriculum, and public health emphasis in the general Civil Defense program.
Members of the Division have participated in many programs of the Health Department and other programs in the State, for example: Conference on Rural Obstetrics; preparation of a manual on school health; committee for care of the premature infant at Crawford Long and Grady Hospitals; board of directors of the Atlanta Visiting Nurse Association; Joint Committee on Health and Education Departments; work conferences on problems of migratory laborers; chairmanship of program committee planning a two~eek.i course in occupational health, and diabetic institutes in several areas of the State.
Contributions were made to public health organizations on state, national and international levels such as participation as officers and committee members in the State and National League for Nursing, and as committee members of American Nurses Association and Georgia State Nurses Association.
The nursing staff assisted with the orientation of doctors from Korea, India and Thailand. Field experience was planned for 10 nurses from the following countries: the Philippine Islands, Thailand, Chile, Mexico, Iran and Costa Rica, One of these nurses had an additional month's experience in supervision,

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DIVISION OF LOCAL HEALTH ORGANIZATIONS
During 1955, four health districts were activated in accordance with the plan adopted by the State Board of Health May 20, 1954: Health District 14, Atkinson-ClinchCoffee-Ware counties,October l;Health District 21, Bartow-Cherokee-Gordon counties, December 1; Health District 24, Meriwether-Troup counties, November 1; and Health
District 33, Columbia-Richmond counties, October 1.
At the end of the year, negotiations were complete for the activation of four additional health districts on January 1, 1956: Health District 2, Appling-Bacon-LongPierce-Wayne counties; Health District 35, Chattahoochee-Harris-Muscogee counties; Health District 36, DeKalb-Rockdale counties, and Health District 38, Fulton County.
On December 31, 1955, county health departments had 1145 full time public health workers, 29 fewer than for the same date in 1954. The Georgia Department of Public Health was participating in the .salaries of 907 local health department employees, an increase of five over the same period of 1954. A total of 46 counties, with 56. 9 percent of the State's population, had commissioners of health; 146 counties, with 96.7 percent had public health nurses; 86 counties, with 78 percent had sanitation personnel; and 139 counties, with 95 percent had clerical personnel. This is an increase of one county with a commissioner of health, one county with a public health nurse, and five counties with clerical personnel. In training were Dr. Daniel H. G. Glover to accept employment as commissioner of health for Appling-Bacon-Long-Pierce-Wayne counties; Dr. H. H. Lancaster for Banks-Hall counties; and Dr. Leonard M. Davis for Decatur County.
The local health department expenditure for 1955 was $5, 380,001.49, of which $3,740,320.07 carne from local sources and $1,639,681.42 was State Health Department grants-in-aid to counties. The total was $1.56 per capita, with $1.08 per capita coming from local funds, and 48 cents per capita from grant-in-aid fundso The total local

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expenditure increased 19 cents per capita; that from local funds increased 15.7 cents per capita and the grants -in-aid increased 3. 3 cents per capita.
Seven health center projects were completed: public health centers in Baldwin, Laurens, and Houston counties and auxiliary centers in Coffee, Habersham, Long and Fulton counties. A health center or an auxiliary health center was under construction in each of the 10 counties: Bartow, Decatur, Hall, Hart, Cook, Tattnall, Morgan, Bacon, Talbot, and Monroe. Applications for assistance in the construction of health center projects were approved for Washington, Terrell, Upson, Walker, Bibb, Bleckley, Candler, DeKalb, Liberty, and Screven counties. Ware and Bullock counties' applications for assistance in construction of additions to existing facilities also were approved.
On December 31, 1955, local health departments, either fully or partially staffed, were operating in 149 of Georgia's 159 counties, representing 98 percent of the State's population.
Local health departments cooperated with the National Foundation for Infantile Paralysis and the Georgia Department of Public Health in making poliomyelitis immunization available to children of the first and second grades. When Federal funds made Salk vaccine available to Georgia, local health departments included the use of the vaccine in the general program of communicable disease control. During the year, 173,228 individuals received polio immunization (two injections).
Local health departments are generally maintaining as well-balanced public health programs as availability of personnel and funds permit. The Division of Local Health Organizations, during 1956, will place primary emphasis upon the recruitment of qualified personnel and the establishment of health districts. During 1956, we expect to activate 12 health districts in accordance with the plan to eventually have 38 local health districts.

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NORTHEASTERN HEALTH REGION
During 1955, the first serious. attempt was made toward district formation in accordance with the resolution passed by the State Board of Health on May 20, 1954, Columbia-Richmond District was formed.
The district composed of Baldwin, Hancock, Jasper, Putnam, and Wilkinson counties is ready for activation, with only the lack of a district director of health standing in the way. DeKalb-Rockdale District was to be formed in 1956.
Dr, Virginia H. Maley transferred from the Banks-Hall County District, and Dr, H. H. Lancaster was appointed to fill the vacancy.
A consultant nurse from the region transferred to the Maternal and Child Health Division in Atlanta, and a specialized nurse consultant transferred to the region from Atlanta and is in Rabun County as a staff nurse.
The Oglethorpe County Health Department opened in April with a county nurse and a clerk.
Four staff nurses left in the fall for educational leave at the University of North Carolina, and White and Franklin counties had new staff nurses during the year,
Inspections of water and sewerage systems and impoundments increased, conforming to State law to qualify for federal aid, Much time was given to tourist court inspections to comply with State law, School construction continued at a steady pace.
A one-day regional civil defense course was conducted. Surveys and foodhandling schools were held in some counties. Assistance was given to several county milk programs which have retained their status on the U. S. Public Health Service "honor roll." A survey also was made of food facilities at the sororities and fraternities of the University of Georgia, Periodic meetings of sanitation personnel were conducted as in-service training.

- 33 -
Clinic nutritionists were secured for five counties, to give food demonstrations in the Maternal and Child Health clinics, Much time was spent working with classes at the University of Georgia and Georgia State College for Women in the Home -Economics and Education Departments. A pilot project is in progress using foods and nutrition majors at the University and GSCW to work in the MCH clinics in the counties where the institutions are located.
In 1955, there was an increase in venereal disease activity over the previous year. There were 958 investigations, compared to 578 investigations in 1954, The results of the 958 investigations were as follows: primary and secondary syphilis - 78; early latent syphilis - 82; other syphilis - 49; gonorrhea- 107. In addition, communicable disease investigators were interviewing and bringing to treatment patients of private physicians, who failed to return for necessary treatment.

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NORTHWESTERN HEALTH REGION
On September 1, 1955, the Regional medical director retired, and therefore no attempt will be made to report on his activities, All outbreaks of communicable diseases were referred to the director of Local Health Organizations after that date. Shortage of medical, nursing, and sanitation personnel prevented better health services.
Employed were six new nurses, and six resigned; one transferred within the region; two were granted leave of absence; and one was granted educational leave. There were eight in-service education programs on a one-day monthly basis and one jointly with all regional disciplines. A one-week statewide workshop in nursing supervision was attended at Emory University.
Nursing supervision was provided in all nursing counties. Nursing consultation service was given in four counties and districts. Considerable direct nursing service was given in Bartow County on tuberculosis control program, Reorganization of Lumpkin County for improved public health services was participated in. Concentrated time was given to Polk County in its program for better use of nursing resources. Films and talks to lay groups were included in Floyd County activities.
Staff education was emphasized in the work done by the nutrition consultant. Home visits were made by 26 nurses in 18 counties, and by one student nurse, a consultant for DeKalb County Public Health Nurses' and Visiting Nurses' Association at three meetings. One VNA staff meeting was devoted to nutrition. Phases of nutrition were considered at nurse 1s staff meetings in Fulton, Chattooga, Floyd, Cobb and Whitfield counties. One group of 15 nurses studied nutrition in another meeting in Fulton County.
During 1955, three county clerks resigned and were replaced. One clerk went on maternity leave and was replaced for the period of her leave. Two counties, previously without clerical help, employed clerks.

- 35 -
The clerical field representative provided administrative and consultant services to all clerks in the local health departments. In- service training, in the form of monthly conferences, was held for the county clerks.
Continued assistance was given the school building program, by inspecting the sewage disposal systems at various stages of construction; school water systems and school lunchroom equipment.
Assistance was given municipalities, consulting engineers, architects, and individuals requesting assistance with sanitation problems. Technical guidance and assistance was given all field personnel in carrying out their sanitation programs. A total of 669 visits were made in the region by the three members of sanitation staff. Food surveys were made in four counties. A special survey was made of the food service area in Battey State Hospital, at the request of Battey officials. One legal hearing was conducted in Atlanta for an offending tourist court operator. Results -permit denied. Several new subdivisions were examined and many F. H. A. and G. I. home disposal and water systems were inspected. Water impoundments were inspected for maintenance permits. Workshop meetings held at several colleges in the region were attended by sanitation personnel serving on a panel to discuss environmental sanitation, health and physical education. Consultant services were rendered to all local health departments conducting milk sanitation programs. Five counties had official milk shed
11
surveys during 1955. Three counties were continued on the"honor roll listing, and one county was returned to the 11honor rod listing as results of these surveys. One county, which re-initiated its milk sanitation program, made much progress towardsHhonor rollU listing.
The V. D. Control activities for the Northwest Region in 1955 showed a marked increase over the previous year.
Also, Bartow-Cherokee-Gordon District was formed.

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CENTRAL HEALTH REGION
Although there was steady progress in the Region's health program, development continued to be hampered by a shortage of personnel, particularly medl.cal and sanitation.
Troup-Meriwether District was activated, and others will follow as soon as they get directors. There are only two counties, Schley and Heard, without local health departments, and changes in local personnel at all departments have been small.
There were no severe outbreaks of acute communicable diseases, but there was an increase in reported cases of venereal diseases. The increase was partly due to better reporting from private physicians.
Sanitation continues to be a major problem. Of 325 tourist courts inspected, permits were issued to 244. Food sanitation work is concerned mainly with educational programs for owners and operators of food establishments.
Efforts were made to develop more uniform collection and shipment of milk samples from the field to the laboratory. This was done to equalize the load of samples arriving daily.
One of the county health departments in the Region has obtained a rating by the U. S. Public Health Service in the third highest national level. Many communities are expanding or developing public water and sewer systems, and building new school buildings, which receive local health department assistance in planning.
Nursing activities increased during the year. In addition to such work as teaching mother and baby care classes, supervising hearing and vision testing in schools and handling much of the polio immunization program, county nurses attended a wide variety of meetings to better prepare for their work. Nurses in Harris County are increasing their mental health work, especially in referrals to Milledgeville State

- 37 -
Hospital. Muscogee County has begun a project to simplify nursing records. The nutrition program has expanded rapidly, especially with the help of other
agencies and groups. Much attention was devoted to the problem of over-weight people. There are now 28 counties in the Region which have health centers completed,
being constructed or in the planning stage, under the Hill-Burton program. Dental clinics have been well-attended, although the service needs to be expanded
with a dentist for the Region. Ground work was begun for increased work on chronic disease, mental health
and geriatrics. Much development is expected in these fields in the future.

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SOUTHEASTERN HEALTH REGION
Staff Education. In-service training continued on the high level which was established four years ago. This program consisted of monthly staff conferences, quarterly regional conferences for all county personnel, the Quarterly Regional Personnel Conferences in Atlanta, meetings with district personnel, radio broadcasts, and instructions to the members of the local boards of health and county commissioners as to their duties in the public health program of the county.
Visits to Counties by Regional Personnel, Regional personnel made 1265 field trips, and of this number, 994 were requested by the counties.
Health Center Construction. All but three of 24 counties declared as having inadequate health centers have built new centers during this program.
New Health Districts. One new health district was organized and is in full operation, It is hoped that all five will be organized by April 1, 1956. All present districts have health officers,
Environmental Health Services. Inauguration of the new district plan and regrouping of counties created the need for additional sanitation personnel in three areas, which will be filled with current applicants by April 1, 1956, giving coverage in 21 or 22 counties. Three new sanitarians were employed, one where sanitation services were not previously rendered; a regional food sanitarian transferred to a local program, and a Berrien County sanitarian was granted educational leave.
Aid to school construction continued, with 23 schools completed, 34 begun and 65 sites and plans approved. Milk control programs were maintained satisfactorily, with reduction of the number of coliform organisms found. In-service training for all sanitation personnel, miscellaneous talks and special classes for food handlers were effective. Considerable improvements were made in public water supplies and sewage systems.

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There were extensive mosquito control projects in D';:,uglas, Baxley, Jesup and Lowndes counties at a total cost of $30,829.64. Rodent control projects were conducted in Berrien, Coffee, Lowndes,. Ware, Bacon, Wayne and Pierce counties.
Nursing. The region gained five new nurses and lost four. The Ware-CoffeeAtkinson-Clinch District was activated October 1 under the new district plan, with a district director of Public Health Nursing. The Mother and Baby Care Refresher Course in Brunswick was attended by nine nurses. Eleven Mother and Baby Care classes were taught in the region, including Savannah; one nurse attended a course on tuberculosis control at the University of Alabama and seven nurses attended the supervisor's conference in Atlanta.
Two new dental clinics were begun in the region, and the cardiac clinic in Brunswick was reactivated. The Salk vaccine immunization program was a major nursing activity during much of the year. Emphasis was placed on a school health program planned with local school personnel.
Nutrition. A nutritionist served as consultant at 18 preschool clinics and discussed the importance of good diets for the school child with 897 children and their parents. Nutrition problems were discussed with several P. T. A. and faculty groups.
Communicable Disease Control. In 1955, two communicable disease investigators covered 21 counties; 4669 Kahn tests were taken, an increase of 50 percent over 1954; 43 infectious cases of syphilis were uncovered, an increase of 50 percent over 1954 and 49 early latent cases were treated, compared to nine in 1954. A total of 157 cases of syphilis were brought or returned to treatment, compared to 81 in 1954,and 365 cases of gonorrhea were found, compared to 131 in 1954. Only 10 cases of L. G. U. and chancroid were reported, compared to 12 in 1954.
Clerical. A field representative continued work with county personnel. A survey was made of sanitation files in Chatham County, followed by recommendations and

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changes. Much time was spent on tentative and realistic district budgets, and in writing up the section on "Summary of Clerical Duties, Due Dates, etc. 11 for a clerical guide. Annual schedules were prepared for 14" x 17" and 70 millimeter x-ray clinics. Tuberculosis case registers, files and records were reviewed in all counties.

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SOUTHWESTERN HEALTH REGION
The Southwestern Health Region, with headquarters at Albany, is composed of 28 counties, with a population of 442,600, and 10,594 square miles of area, This region is bounded by Alabama on the west and Florida on the south.
This area.is served by 229 practicing physicians, an average of one physician to 1932 persons. However, three of the smaller counties have no physicians, and the need for dental care is quite urgent in some of the more rural areas.
There were three commissioners of health serving five counties which had 27,9 percent of the regional population; 18 sanitation personnel serving 13 counties with 70.7 percent; 55 nurses in 26 counties with 97.2 percent and 29 clerks in 24 counties served 94.3 percent. Of the population, 2. 7 percent in two counties had no health department service except that rendered by the regional and central office personnel. To activate and adequately staff the proposed districts, four additional medical directors are needed, as are seven directors of nursing, seven directors of environmental sanitation, 45 staff nurses and supervisors, 10 sanitarians and 15 clerks.
Official health agencies in this region, together with the State Health Department, spent more than $600, 000 for local health service during 1955. This was approximately $1.35 pe.r capita, which is far below what is needed for adequate health service, The range of expenditures was from $. 45 per capita in a small county to $3. 17 per capita in the largest county.
There were two small outbreaks o diphtheria during 1955. Elsewhere there was some increase generally. The necessity of early immunization with follow-up boosters was stressed,
Fox rabies made a strong comeback in 1955. Prompt attention to reducing the fox population in the affected areas was successful in controlling the spread to dogs and

- 42-
livestock, Hookworm infestation continues to be a problem in the rural areas, reaching as
high as 60 percent in some of tre schools. The cost of home sanitation facilities, lack of interest,and poor diets were responsible for lack of improvement in these areas.
There were 2, 467 investigations by the communicable disease investigators, 1, 062 new admissions to the diagnostic and treatment center in Albany, and 369 readmissions to this clinic. There were 121 cases of primary and secondary syphilis, 138 early latent cases, 365 of other syphilis, 539 of gonorrhea and 35 of other venereal diseases treated in the D & T center. Venereal disease continued to be one of the major problems,
Regional and local sanitation personnel spent a large percentage of their time with inspections and reports on special programs in cooperation with agencies such as School Building Services, School Lunchroom Division, Federal Housing Authority, Soil Conservation Service, Hospital Services Division, Veterans Administration and State Department of Welfare, A continuous program of health education has been maintained through the contacts made in these extensive inspection programs.
One new health center was completed during 1955, and plans for another were begun, Interest is developing in the district plan and some groundwork has been done for its promotion.
During 1955, the Southwestern Health Region showed progress in many areas because of the faithful devotion of its workers. The Regional Staff is confident that progress will continue in these areas and that practical solutions will be found for deficiencies. It is hoped that local coverage with basic public health personnel will be had at all levels.

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

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DIVISION OF MATERNAL AND CHILD HEALTH
Introduction, The Division of Maternal and Child Health is responsible for promoting the health and well-being of 100,000 or more expectant mothers and 500,000 infants and preschool children. Last year1 approximately 15, 000 infants in Georgia were delivered by local lay midwives, one in every four births. The nutritional well-being of the entire population of the state is also included in maternal and child health activities. (See Nutrition report.)
The staff consists of: one full-time physician-administrator; two public health nurse consultants, one each in maternity and pediatrics; part-time service of a public health nurse-midwife consultant; nutritionist; dietary consultant and a health educator executive. In addition to over-all program planning and administration, they are responsible for consultant service, in-service training and supervision, to the regional and local health departments.
All members of the staff have responsible relations with the various professional organizations active in areas related to the maternal and child health program.
Routine. Appraisals of local services and resources have continued. There has been good publicity, thought-provoking, and, in most instances, action-provoking within the Department, if not always on a broad community basis.
The second meeting of the "many interest" group to promote maternal and child health and welfare was held in April. Among the favoi'able outcomes have been ( 1) that the Division is now enabled to employ obstetric and pediatric physicians for technical assistance and consultation on a part-time basis; (2) that a permanent manyinterest voluntary group is being organized to follow through on the studies; (3) that the Medical Association of Georgia achieved the establishment of a Hospital Care Study Commission to be appointed by the Governor.

- 44 -
Subsequent to the 1955 Midwife Act, Rules and Regulations have been developed and accepted by the Board of Health, There are 29 counties employing public health personnel where over 2, 000 midwife deliveries occurred and where there is.no planned provision for medical supervision,
As for medical and nursing service to mothers and children in local health departments, the situation remains the same as reported in 1954 - too little continuous medical health supervision reported for prenatal and postpartal, for infants, and for preschool children, in comparison to the nursing activities. 1 s this a problem of health department administration or a problem of lack of physician understanding of the need? We feel both elements play a part to a varying degree.
Special. Nurse-Midwife Service - The three types of nurse-midwife activities were continued,
Course in Care of Premature and Newborn Infants -Although no graduate nurses received instruction in care of premature infants at Crawford Long and Grady hospitals, Atlanta, we feel that student nurses and house-staff personnel are getting better experience than if the two nurse instructors were not employed. Joint participation on their Advisory Committees by state and local health department personnel continues to offer opportunities for broadening and improving programs both on local and state-wide basis.
Prenatal Care Demonstrations - Grady decentralized prenatal care program continued as a demonstration, The Grady "Abnormal Clinic" for complicated prenatals, another demonstration, continues even though state participation was discontinued, This is good,
Training - A nurse -midwife is taking formal public health training to return to work directly in local health departments to strengthen their skills in teaching and supervision of midwives, Such need apparently will continue for a time.

- 45 -
Future. (I) Continue promotion of good nutrition practices; (2) Promote better preparation for parenthood: (3) Promote implementation of 1955 Midwife Act; (4) Promote utilization of the most modern concepts of medical and nursing pediatric and obstetric practices and procedures; (5) Promote improved quality and quantity of medical and nursing supervision during the prenatal, postpartal, infant and preschool periods, particularly where the mother is to be delivered by a lay midwife and where economic and/or educational factors and/or lack of personnel and/or facilities act as barriers to early, continuous, quality care; (6) Promote community action to make adequate physician and hospital services possible, particularly for abnormal obstetrics, premature infants and sick children,
Nutrition Unit Personnel included a director, a dietary consultant, and five regional consultants. The consultant in the Southeast Region retired July 1, and no replacement was found. The nutrition position in Fulton County remained vacant. The loss of personnel showed in a reduction of the amount of nutrition work reported. The greatest loss was in the number of fooddemonstrations reported. The least reduction was in work with tuberculous patients and in morbidity service. The declines in these amounted to slightly over four percent. Maternal and child health continued to be the biggest part of the nutrition program, with 85,595 consultations in maternity service, 90, 581 for infants and 75,726 for preschool children. Consultation was given at seven places in the state where Crippled Children's Clinics are held. Some of these were weekly, some bi-weekly and some monthly. Food demonstrations were given at one center. Nutrition consultation was given to 5, 906 crippled children. Working with the sanitary engineers, three classes were held for food handlers.

- 46 -
One regional nutritionist attended the Civil Defense Mass Feeding School. She and another, who had had this training previously, have assisted in conducting schools in their Regions. Another attended the Civil Defense Workshop for Women Leaders.
All the nutritionists have assisted with mother and baby care classes in evaluating diets, furnishing materials, a personal contribution, and in some cases helping with the teaching.
One Puerto Rican student, a nutritionist studying at the University of North Carolina, spent two months in the State for her field training. A half-day was spent with each group of student nurses getting field training in Fulton County. Each nutritionist has helped work with foreign visitors and with the orientation of new employees.
Six of the staff members continued with regular television shows every two weeks. The topics selected were on weight control, food fads, nutrition in schools, feeding the small child, preparation of vegetables and menu planning.
The dietary consultant and the regional nutritionists held community diabetic programs for patients and their relatives, reaching four counties. Each of these was held for two days, one day for white patients and one day for colored. They were held in cooperation with the local medical societies. Similar institutes are planned for 1956.
Help was given the Division of Hospital Services in conducting programs for hospital food service supervisors on the low-sodium diet. This was also given to a group of public health nurses to help them help the doctors' patients interpret orders.
Everyone has worked on the weight control problem. Besides the television shows, the biggest program was at Warner Robins requested by the medical officer. There were 280 who attended classes. Individual consultations were given later by the regional nutritionist, the dietary consultant and the Warner Robins nurse.
Requested help was given at Battey Hospital, to some nursing homes, to some child caring institutions and to some operators of day nurseries.

- 47 -
Assistance was given to schools of all levels and types. These included medical and nursing schools, teacher training institutions, high schools, and elementary schools. Considerable work was done with the Division of School Health.
Much time and effort have been given to groups such as the Georgia Nutrition Public Health Association, Home Economics Association, American Association of University Women, Visiting Nurses Association, P. T.A., civic clubs and others. Another major activity was work with the newly organized Georgia Council on Maternal and Infant Welfare.

- 48 -
DIVISION OF SCHOOL HEALTH
I. OBJECTIVES. (Continuation of objectives set forth in 1954 annual report:) A. Develop uniformity, state-wide, in a planned program of school health for state, county, and the individual school. B. Strengthen consultative services to regional and local public health personnel doing school health and to area and county educational personnel, for the purpose of developing a stronger school health program, minimum standards of activities, and uniformity of local areas toward a state-wide program. C. Expand planned programs of school health as a part of the community-wide health program. D. Develop in-service facilities, such as workshops, institutes, and a standardized field center to develop greater knowledge, better participation and stronger cooperation in school health. A planned curriculum in the initial professional training in school health should be developed and strengthened. E. Develop methods for evaluating and defining school health programs and activities. F. Strengthen cooperation in the fields of vision and hearing conservation for professional workers and school personnel. Encourage vision screening of all children by the classroom teachers, using the Snellen chart. G. Strengthen cooperation and understanding between medical profession and school health programs, at state and county levels. ACTIVITIES. Vision and Hearing Conservation Programs. Improvement in coverage of this program was not quite up to expectation due to sick leave of the hearing testing instructor for two and one-half months and to resignation of the vision testing instruc-

- 49 -
tor in August, 1955, with no replacement available as yet. However, teachers were encouraged to do vision screening of children in classrooms. Planning of five regional meetings on eye health and vision screening by teachers for he~lth and education people was begun by a committee of school health, education, and nursing personnel.
Vision screening was reported in 90 counties (54 in 1953- 54) during the 1954-55 school year, with 140, 638 children tested and 12,432 referred for medical examination. The pamphlets, "Eye Health--For Use by the Teacher, 11 and "Instructions-Massachusetts Vision Test," were revised and a new pamphlet, "Films and Other Educational Aids on Eye," was published. A film on vision testing techniques for use in vision screening instruction was begun.
Hearing screening was reported in 58 counties (39 in 1953-54), with 63,906 children tested and 3, 718 referred for medical examination. Revision of tre manual on hearing testing was done but publication was delayed until anticipated purchase by the Division of the new audiometer in 1956 so as to include instructions for its use also. Planning was begun for a film on hearing testing comparable to that begun on vision screening.
Report of Special School Health Proj,ect. The report of the Special School Health Project was completed. Publication was delayed pending reading and approval by Dr. Marsh of Children's Bureau,
School Health Guide. The regional meetings for study and approval or revision of the Guide were continued (seven were held during February and March). The Guide was completed and sent to the publisher. It was promised by hrm for distribution the first of 1956.

- 50 -
Further Cooperation and Aid to Education People. Assistance was given through talks on school health at summer school health workshops at University of Georgia and Atlanta University, and at regional and local meetings of Negro education people on school health.
Cooperative relations with state and local education personnel are believed to have been improved and strengthened during the year.
The director of School Health Divisiqn resigned November 18, 1955. The director of Health Conservation Services is acting director until a replacement is available.

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MENTAL HYGIENE DIVISION
During 1955, the Mental Hygiene Division continued the programs that were being carried out in 1954, There was limited expansion and some addition of new areas of activi~y.
The project of public health services to families of the mentally ill was evaluated and as a result of the findings, authority was granted to incorporate this service as a regular part of local health programs. It was decided that those geographical areas which would be the first activated districts should be the next areas included in the program, Three new counties were added.
The maternal deprivation project was begun in Cobb County. In the period from May 1 to December 31, 1955, one complete cycle of case finding, screening, clinical evaluation and beginning family rehabilitation was completed.
A new service of consultation to rural areas on juvenile delinquency was begun and two consultation training institutes for all local mental health workers were held,
Two staff meetings, one in conjunction with the annual health officers 1 conference, were held. These two sta meetings were concerned with methods of evaluating all on- going local programs.
In addition there was a special evaluation meeting of the directors of the local health programs.
A comprehensive long-term evaluation of all local health programs including policies, content, administration and time study was begun,
Three new psychiatrists were employed in the program, one on a limited consultation basis to a rural program, and two on half-time basis in local clinics. Two new full-time psychologists were employed in local programs,
In addition, an advisory committee of three psychiatrists was organized to give

- 52 -

regular consultation to the Mental Hygiene Division concerning its program,

Three mental health workers completed their MPH and returned to the State.

The special grant to the College of Education at the University of Georgia has

been continued.

In addition to information and education services for the general public, in-

service training for professional groups, consultations and conferences with other

agencies, and participation in community planning and coordination, the three mental

health clinics operated by local health departments rendered the following services to

individuals:
M. Distribution of person-interviews
1. Number of interviews with patient 2. Number of collateral interviews
with parents (or substitutes)
3. Number of collateral interviews
with spouses
4. Number of c611ateral interviews with
other significant persons
5. Total number of interviews (sum 1 thru 4)

Total Patients
( 1)

Patients
Under
18 Yrs. 3/ (2)

4585

2319

831

823

1174

1147

183

182

6773

4471

Patients
18 Yrs. & Over 3/
(3)
2266
8
27
1
2302

L. Distribution of terminated patients by number of person-interviews with or about

him since latest admission (include ENTIRE clinic period since latest admission) 4/

l. Patients for wh.om there was one

person-interview

160

125

35

2. Patients for whom there were 2-4

person-interviews

172

132

40

3. Patients for whom there were 5-9

person-interviews

145

96

49

4. Patients for whom there were 10-24

person-interviews

175

124

51

5. Patients for whom there were 25-49

person-interviews

48

35

13

6. Patients for whom there were 50-99

person-interviews

11

8

3

7. Patients for whom there were 100-149

person-interviews

4

1

3

8. Patients for whom there were 150 or

more person-interviews

1

1

9. Total number of terminated patients

716*

521*

195*

*Interviews for 2 cases not reported.

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CRIPPLED CHILDREN'S DIVISION
During the first six months of fiscal year 1955, Crippled Children's Division operated under the severe handicap of reduced funds. Federal funds, which are allocated to the states on a fiscal year basis, had been dramatically reduced on July 1, 1954.
In spite of careful planning, it was impossible to meet all of the needs of the children referred to Crippled Children's Division. Consequently, we find that in the spring of 1955, few children were hospitalized and many children were denied new braces or repairs on old braces. Only the most pressing medical needs were met, although many local agencies and civic clubs made every effort to help with the problem and provided funds.
On July 1, 1955, we were in the happy position of having greatly increased funds from the State and Federal governments. We projected plans for the rest of the year to hospitalize children on the waiting list, to repair braces, to furnish new appliances to children who had been waiting for them and to step up the tempo of the entire program. Staff doctors gave generously of their time in examining and treating the many children waiting for their care, By the 'end of the calendar year, most of the children had received full or partial care. Of course, most of the children referred to the Division probably will need several surgical procedures as well as observation over a period of years. There is always a waiting list of children needing treatment.
Although no definite new areas of service were developed, an informal pilot study was conducted in the care of children with epilepsy. From the results obtained and the knowledge gained in this study, it was believed that it will be feasible during the coming year to develop a real program throughout the State for children with this tremendous handicap.

- 54 -
During the fall it was possible to add two public health nursing supervisors to the staff. It was also possible because of our finances, to have pediatricians in all of our organized clinics-- orthopedic, physical medicine, cardiac and plastic surgery.
A Medical Advisory Committee, composed of three staff doctors, functioned throughout the year. Their particular area of activity was in counseling with the medical director and administrative staff to find the best ways to meet the needs of children referred to Crippled Children 1s Division for care.
As 'was to be expected, fewer individual patients were treated than in the pre
vious year. Under active care were 5, 867 children-- a decrease of 88, More children were hospitalized, however, due to the upswing of activity during the last six months of the year, A total of 1, 013 individual patients were admitted to hospitals-an increase of 249. This represents the backlog of cases that could not be hospitalized during the previous months.
There continues to be an increase in the costs of hospital care. It is to be expected during the coming year that in spite of increased funds and careful planning, the number of patients treated cannot be appreciably larger. Crippled Children 1s Division will continue to make every effort to plan wisely so that funds may be spent to the best advantage of the children entrusted to us for care.

PREVENTABLE DISEASE SERVICE Division of Epidemiology (Cancer Control
and Veterinary Activities) Division of Tuberculosis Control Battey State Hospital Division of Venereal Disease Control Division of Occupational Health
(Also see Industrial Hygiene) Division of Chronic Diseases Civil Defense

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DIVISION OF EPIDEMIOLOGY

The true public health importance of any di-sease or morbid condition is a func-

tion of its prevalence and of its susceptibility to control by available measures. Thus,

in 1955, anterior poliomyelitis became the most important of all public health problems,

assuming for the first time the place in professional thinking that it had long occupied in

the popular mind.

Nothing in the history of medicine transcends the drama which attended the

nation-wide use of the Salk vaccine. The prologue to the scene was spoken by Franklin

Roosevelt in establishing the March of Dimes and the actors who followed have been

worthy of the introduction. The tragedy of the Cutter episode and the quasi-comic diffi-

culties that have ensued require no description.

The table below indicates the level of vaccinations as of December 31, The con-

fusion about the safety of the Salk vaccine influenced markedly the number of children

presented to public health clinics for immunization. For several months the supply far

exceeded the demand. But as this report is being written in March, 1956, occasional lots

of vaccine with expired dates are being returned while requests are so far ahead of sup-

ply that the giving of second immunizations only may have to be recommended. At this

date about one-fourth of eligible persons have received two injections. Injections of Vaccine NFIP and Federal Polio Grant April 17 - December 31

Groups Receiving Injections
1. Under 5 years 2. 5 through 9 3. 10 through 14 4. Age unknown 5. Total under 15 6. Expectant mothers 7. Total under 20 and
expectant

No. Receiving Injections

One only Two

Three

17,611 11,410

74

74,536 134,224 156

2,947

706

22

118

140

2

95,212 146,480 254

1,626

1,019

0

Total with One or More
29,095 208,916
3,675 260
241,946 2,645

96,838 147,499 254

244,591

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Diphtheria remains a problem in the Southeast despite its virtual disappearance from other parts of the country. Only Alabama {9. 9) and South Carolina {8. 5)have rates exceeding Georgia's 6. 7 cases per 100, 000. During the fall of 1954 and spring of 1955 a study was made of the immunization history of 100 consecutive cases of diphtheria verified by throat culture. Only one of these cases had received immunization within three years. Approximately 20 others had received some or all of an immunizing series even earlier and about 75 percent of the group had received none. Data assembled during the past five years indicate very little tendency toward a shift in age specific diphtheria morbidity in Georgia although the rate for 5 - 9 years is almost on a level with the rate for the 1 - 4 year group. Diphtheria in Negro children has remained remarkably constant in recent years and is now greater than that in white children.
Psittacosis: The Division investigated 53 suspected cases of psittacosis, obtaining complete laboratory confirmation on eight cases, strong presumptive findings on five and inconclusive results on 40. A total of 174 laboratory examinations were made on sera from these and a small additional group of suspect cases. Investigation has been greatly helped by the State Board regulation requiring banding of parakeets. Recent developments in treatment of birds with aureomycin or achromycin appear promising. It n.ow seems possible the banding provision can be used to require that birds be rendered free of infection before being offered for sale.
Systematic case follow-up studies were made on typhus, Rocky Mountain spotted fever and psittacosis. Malaria occurred only in military personnel. A number of outbreaks of food poisoning were investigated. The report of the Division of Insect and Rodent Control details the activities in this field carried on by Division of Epidemiology biologists.

- 57 -
Summary. Virus and rickettsial infections require an increasing share of the investigative facilities of the Division. Hookworm control has been continued but has not received emphasis. However, the introduction of a new method of using tetrachlorethylene may require a temporary step-up in direct assistance, Biological activities in insect control have been carried on without increase,

Cancer Control Service

The state aid program operated at about the same level in 1955 as it did during

the previous year, Actually, little change was anticipated since it was apparent by 1954

that efforts to reduce expenditures through a reduction in hospital care had accomplished

about all that could be expected, The table below compares the case loads, hospital days

and expenditures for the past 4 years,

Year 1952 1953 1954 1955

Case load 4,059 4, 116 4,353 4,213

Hospital days 26,597 2 3, 498 19,301 19,397

Total cost $385,255.98
358, 162. 35 334,900.02 351,730.22

The increase in cost during 1955 was due, in part, to a slight increase in the

number of hospital days but, more particularly, to an adjustment in rates for hospital

care. Also, .for three months during 1954, the Augusta Clinic was not participating in

the program.

Hospital rates. During the past two years, -hospital rates have been based on

cost statements for 1952. In July, 1955 the Advisory Committee voted to adjust rates to

the 1954 cost level, thus providing a general rate increase, The new rates became

effective November 1.

Without any increase in the current case load, the new rates will add an addi-

tional $50, 000 to the cost of the program.

- 58 -
Increasing costs. During the past 10 years, the number of patients cared for under this program has doubled. Nevertheless, the major factor responsible for the increase in the cost of the program has been the upward trend in hospital rates. This may be shown by applying the 1955 case load against the rates paid in previous years. If, during 1955, hospital rates had been at the same level as in 1952, the cost of the program would have amounted to approximately $300, 000; if the rates had been similar to those in effect prior to 1945, the cost of the program would have been about $150,000.
Henry Grady Hospital. During July, Mr. Frank Wilson, director of the Henry Grady Memorial Hospital, formally requested financial participation by this program in the care of cancer patients from Fulton and DeKalb counties. His request was referred to the Advisory Committee for consideration. The Committee unanimously agreed that some financial assistance would be necessary in the future. Consideration is being given to the manner in which such assistance might best be rendered as well as to the extent to which assistance might be offered.
Cancer Registry. Beginning January 1, 1956, the American College of Surgeons will require cancer clinics to develop cancer registries as a prerequisite for approval. Registries must include all cancer patients admitted to the participating hospitals, private as well as service cases. During the latter part of the year, plans were initiated, in cooperation with the Advisory Committee and the Georgia Division, American Cancer Society, for assisting local clinics and hospitals in the establishment of suitable registries.
Veterinary Activities Rabies showed a slight increase in the total number of positive heads over that for 1954. The disease spread into the south central section of the state. There also

- 59 -
appears to be a gradual drift of the disease to the east. The total number of positive heads for the year does not give a true picture of
the disease, since there was a very drastic decrease in the number of dogs and a corresponding increase in the number of foxes with infection. In the fall there was a serious outbreak of fox rabies in Colquitt and Mitchell counties, with isolated cases occurring in a number of counties in the central portion of the state. The disease only reached epidemic proportions in Mitchell and Colquitt counties, where it was confined almost entirely to foxes.
The low incidence of dog rabies is very encouraging. During the latter part of 1955, reports of rabies in dogs had become a rarity. This was particularly noted in the metropolitan area of Atlanta, which formerly could be considered the rabies capital of Georgia. The last 1955 case of rabies in Fulton County was in August, and DeKalb County in June, This is the first time in many years in which there was no rabies reported in metropolitan Atlanta for a period of five or six months.
State supported dog vaccination programs were put on in three counties and were quite effective. In the remainder of the counties in which infection was known to exist, either the counties put on their own programs without state assistance or the activity was unable to have any action taken. As in the past, dog vaccination, in many counties, is not adequate to maintain a satisfactory reservoir of immune animals.
Since the disease was largely confined to the fox, much of the activity was devoted to its control in these animals. This was done in State, Federal and county cooperative fox-thinning programs. A total of 14 counties were involved, in some of which programs are still in operation. All these programs will be completed by May 1, 1956.
In September, 1955, a Tri-State rabies control program was inaugurated, in Alabama, Georgia and Florida. To facilitate the work, the U. S. Public Health Service

- 60 -

is furnishing the services of Dr. Robert Watson, who is assisting in state-wide control

programs for dogs and foxes. The State Game and Fish Commission has entered the

project and is furnishing a full-time warden, who is assisting in organizing and super-

vising wildlife control programs. In spite of the actual increase in the number of positive fox heads over 1954, the

situation as a whole looks very promising. Plans call for continuing the same program

through 1956 in an effort to bring the disease definitely under control.

The following is a brief summary of the positive heads, by species, reported in 1955.

Positive Heads - 1955

Dog
62

Fox 108

Cow 30

Others* Total

20

220

'~Others include cats, bobcat, monkey, raccoons, rat.

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DIVISION OF TUBERCULOSIS CONTROL
In spite of the enthusiastic reports of progress, particularly in treatment, tuberculosis remains one of our most serious and costly health problems, even though a very gratifying death decrease came in 1955, The provisional figure of 253 deaths as against 316 in 1954 indicates about a 20 percent decrease,
The Central Statistical Unit received reports of 1741 new cases. The register contains an additional 489 new cases, reports of which have not reached C, S, U, This indicates there is no lessening of development of new cases and that tuberculosis is far from under control.
Admissions to Battey State Hospital remain about as high as ever, although the census shows only 1500 beds occupied, There were 1361 living tuberculosis patients discharged during the year, Of these, 42 percent were discharged against medical advice or for disciplinary reasons, and 35 percent of these irregularly discharged patients had positive sputum when discharged, Over 90 percent of all patients discharged requite post-sanatorium treatment and have restricted exercise or work status. We furnish isoniazid and PAS to all recently discharged patients as recommended, when certain cooperation of the patients is assured. In the past year, 1389 discharged patients received drugs.
On December 31, 1955, our tuberculosis case register showed 1949 patients in tuberculosis hospitals and 7388 active and questionably active cases not hospitalized.
Local health departments admitted 9, 610 tuberculosis cases, 11,203 suspects, 20,676 contacts, and 44,714 other persons to their services in 1955, Over 339,000 x-ray pictures were made; over 63,000 field visits were made and 152, 000 office visits were held by local health departments, in the interest of tuberculosis control work, Also, 10, 408 pneumotherapy treatments and 30,422 tuberculin tests were given,

- 62 -
The State laboratory made over 128, 000 sputum examinations, the specimens largely coming from the local health departments.
Local health departments were furnished 14 11 x 17 11 x-ray films valued at more than $21,000, and over $16,000 was paid for pneumotherapy by the Division. The Division held 459 x-ray clinics in local health departments, in which 25,463 of the 14" x 17" chest pictures were made, and interpreted an additional 7, 887 chest x-ray pictures sent in by local health departments and physicians. In addition, the Division made and interpreted 137,204 of the 70 millimeter survey pictures, making a total of over 170, 000 x-ray pictures.
Tuberculosis nurse consultation work with local health departments was active. Six nurses orientation courses were organized at Battey and were attended by 52 nurses.
Rehabilitation and case work consultation service were maintained, demonstrating how better care of patients and better use of the commitment law might be made possible.
In general, commitment law enforcement has been disappointing. It is not used as widely as it should be because of failure of the local boards of health to take full advantage of it, and because there is a general feeling that committed patients are not confined proper! y. The law is difficult to apply because too much stress is put on the necessity of proving a case is infectious by means of sputum examinations, ignoring the presumptious evidence of infectivity of x-ray and clinical facts.
A change has been made whereby the 70 millimeter x-ray work of the Division is apportioned on an equable basis throughout the State through the regional medical directors, better medical consultation assistance to local health departments is being considered, and it is hoped that better local tuberculosis clinic services may be developed by employment on a part-time basis of interested local physicians.

- 63 -
The State Health Department participated in a Public Health Service-Muscogee County Health Department TB Study of over 70, 000 persons in 1950. Records of all the work done then and since have furnished very important facts, chief of which is that tuberculosis is hardly any rnore under control than it was five years ago, so far as development of new cases and spread of infection is concerned.
There can be no let-up in the fight against tuberculosis. 1. Case finding (diagnosis) needs to be enlarged and improved, 2. It must be made necessary that every patient has adequate and completed treatment instead of the partial treatment most patients now get. 3. It must be made possible to control every active case in order that the public be spared from infection. 4. Everybody should know what the tuberculosis situation really is and should read the following named recent articles, as well as other similar contributions, before deciding that tuberculosis is really being controlled, and before developing tuberculosis programs~ "Tuberculosis," by Floyd N. Feldmann, M.D. , Dr. P. H. , Public Health Reports, page 290, Vol. 71, No. 3, March 1956; "Can We Wipe Out TB," by H. Corwin Hinshaw, M. D,, Bulletin, National Tuberculosis Association, page 3, January 1956; "Home Care in Baltimore, 11 by Charlotte Silverman, M.D. , Bulletin, National Tuberculosis Association, page 27, February 1956; 11 Unhospitalized Patients, 11 by Edward T. Blomquist, M.D., Bulletin, National Tuberculosis Association, page 32, March 1956; "Philadelphia Out-Patients, 11 by Samuel C. Stein, M.D. , Bulletin, National Tuberculosis Association, page 45, March 1956.

- 64 -
BATTEY STATE HOSPITAL
On January 4, 1955, Battey State Hospital, for the first time, received full approval by the Joint Commission of Accreditation of Hospitals of United States and Canada,
During the year approximately 1, 635 patients were admitted, compared to 1, 7 37 during 1954 and 1,601 during 1953. As of December 1, 1955,there were l, 565 patients in Battey State Hospital, compared to l, 957 on January 1, 1953. This shows that during the past three years the hospital load has diminished approximately 400 patients--a very favorable trend,
All patients continued to receive modern drug therapy, surgical therapy if needed, nursing care, and all ancillary services, Many received drugs at state cost following discharge. As a result of modern drug therapy the length of time for a patient to remain in the hospital was shortened.
The number of far advanced cases admitted continued to increase numerically and percentage wise. As an example, in 1950, 556 patients, or 47 percent of those admitted had far advanced tuberculosis, while in 1954, 1,129 patients, or 65 percent had far advanced disease, showing a tremendous continuing need for the best treatment services the state can provide.
The hospital continued to pioneer in the treatment of tuberculosis, using the best current methods. The hospital also continued to participate in the United States Public Health Service clinical research programs, which add great knowledge to the fight against tuberculosis.
During 1955, a new 100-bed tuberculosis hospital for prisoners from Tattnall State Prison was completed and staffed at Battey State Hospital.
Water-proofing and painting of the entire exterior of the Hospital's 145 buildings

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was almost completed during 1955, at a cost of nearly $100,000, Additional painters were hired to repaint the interiors of the buildings, some of which have not been repainted since occupancy in 1946.
The culinary department was re-organized after the purchase of modern cooking and baking equipment at a cost of $27, 000. A well-prepared, appetizing diet is paramount in the treatment of tuberculosis.
Two homes for staff physicians were completed and a third was started, as a cooperative program with the State Penal System, since these homes were constructed with penal labor.
Many maintenance improvements--a constant necessity--were made, <::osting nearly $500,000 and not including the previously mentioned projects.
Battey State Hospital spent $3, 346, 000 for the hospitalization of patients with tuberculosis during the fiscal year ending June 30, 1954. For the fiscal year ending June 30, 1955, a total of $3,600,000 was spent. For the present year it is estimated that $3,710, 000 will be spent. The per diem day cost in 1950 was $5. 28, and in 1955 it will approximate $5.60 per day.

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DIVISION OF VENEREAL DISEASE CONTROL
Division Function To control venereal disease in the State of Georgia through effective programs
of case finding, treatment, and prevention. General
The Federal appropriation for venereal disease control was increased from $3, 000,000 for fiscal 1955 to $3, 500,000 for fiscal 1956. Of this amount, Georgia received- effective July 1, 1955- $85,000 for fiscal 1956 as compared with $50,000 for fiscal 1955. This increase in Federal project grants enabled us to add five communicable disease investigators to our case finding program, effective July 1, 1955. It also permitted us to institute a new and more effective system for private physicians and hospitals morbidity reporting.
The above increase in Federal funds has enabled us to do a much more effective job in venereal disease control, but the program is still suffering from inadequate financial support. Putting "first things first," practically our entire control program is now directed toward the detection and treatment of the attack rate (early infectious cases) of venereal disease. While this leaves much to be desired, we have been able to do a reasonably effective job of "holding the line" against rising incidence and prevalence of the venereal diseases in the state.
For the first time since 1948, we experienced a rise in reported cases of primary and secondary syphilis. This increase is, in our opinion, due to increased case finding efforts rather than to an actual rise in the attack rate of syphilis.
During 1955, our reports reflect marked increases in the volume of communicable disease investigation activity as well as outstanding improvement in the efficiency of this case finding program. Never before has so much been accomplished by so few with so little.

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Communicable Disease Investigator Program During the year, 20, 965 suspects were investigated by our communicable disease
investigators, from which 6, 365 previously unknown cases of venereal disease were brought to treatment. Of these, 483 were primary and secondary syphilis. This compares with 17, 509 suspects investigated during 1954, from which 5, 557 previously unknown cases of venereal disease were brought to treatment, of which 403 were primary and secondary syphilis.
Of the 581 cases of primary and secondary syphilis reported from all sources in the state for 1955, it is interesting to note that 483 of these cases were located and brought to treatment through the efforts of our communicable disease investigators.
In addition to the above activities, our investigators in their "ultra selective quota blood testing program" tested a total of 29,761 persons with 1, 446 (5 percent) reactive results. From this testing, 261 new cases of syphilis were brought to treatment and 194 inadequately treated cases were returned to treatment.
Our speed zone gonorrhea control project at the Fulton County Health Department was continued with outstanding investigative efficiency. Of the named "in jurisdiction" contacts, 88 percent were located and brought to treatment. We initiated a similar speed zone gonorrhea project in the Muscogee County Health Department. In this project 95 percent of the "in jurisdiction" contacts were located and brought to treatment. In the Muscogee project the number of male volunteers reporting for diagnosis and treatment of gonorrhea was reduced to approximately 50 percent of the number reporting during 19 54. Diagnostic and Treatment Centers - Classification of Patient Load
During the year, 15, 068 patients were treated for venereal disease in our five diagnostic and treatment centers. Of these, 1, 185 were previously unknown and untreated syphilis; 12, 372 were gonorrhea, and 561 were other venereal diseases. This

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compares with 14, 897 patients treated in these centers during 1954, of which 1, 320 cases were previously unknown and untreated syphilis, 12, 100 were gonorrhea , and 547 were other venereal diseases. New Venereal Disease Cases Reported
During the year, 3, 550 cases of previously unknown and untreated syphilis were reported , of which 581 were primary and secondary infections. This compares with 2, 327 reported during 1954, of which 508 were primary and secondary infections. There were 15,012 reported cases of gonorrhea, compared to 15,014 reported during 1954. Reported were 589 cases of other venereal diseases, compared to 610 reported during 1954.
The marked increase in syphilis morbidity is attributable to our improved morbidity reporting system for private physicians and hospitals. During the last half of 1955, private physicians reported more than one-half of the total syphilis cases. More than 90 percent of the physicians submitting serologic specimens to our laboratories voluntarily reported their diagnoses to us as requested on our new morbidity report

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DIVISION OF OCCUPATIONAL HEALTH
The Division of Occupational Health's 1955 program has been concerned mainly with health service to small industries in Georgia. Of Georgia industries, 98 percent are small (under 500 employees) and have no plant health service. The remaining two percent are large and have in-plant health service. An adequate industrial medical service does not necessarily imply a self-contained medical department. In many instances the size, location or resources of the industry may not permit this. The same ends can be reached by other means: industrial health councils, central group clinics geared to handle a number of small enterprises, or by private physicians acting in an industrial capacity.
Industrial Health Council of Greater Atlanta, Incorporated, One of the continued projects over the last several years, with the help of labor, management, and the professions, has been the development of the Industrial Health Council of Greater Atlanta, During the closing months of 1954, industrial and business leaders contributed $12,000 and the Council employed a full-time executive director. The Bank of Georgia donated a $9,000 Healthmobile in 1955, and the Council began its health testing in December, 1955, The Council offers the following health screening tests: Clinitron blood sugar test, test for syphilis, chest x-ray, height and weight, hemoglobin, urinalysis, blood pressure, and vision, The program includes a plan of employee health education, which will become one of the most important steps in bringing about improved community health.
Occupational Health Work Course. A two weeks' Occupational Health Nursing Course was held October 3- 14, 1955, at the Georgia State College of Business Administration. It was sponsored by the Occupational Health Work Committee, which is composed of members from Georgia Association of Industrial Nurses; Georgia State Nurses

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Association; Georgia State League for Nursing; Department of Nursing, University of Georgia, and the Occupational Health Division, Georgia Department of Public Health. It was designed to give the nurse in industry a broad background of information, both in therapy and observational experiences, so that she can assist the company in the conducting a more comprehensive plant health program, Mrs. Eleanor Bailey, U. S. Public Health Service 1 conducted the course.
Health Maintenance for State Employees. A preventive program to provide preplacement and periodic health screening tests and health education for state employees is to be set up soon. This service will be located on the third floor of the new State Office Building. It will give emergency care for illness, and treatment for occupational injuries, with referrals to private physicians of the employee's choice. Personnel for the service will include a medical director, professional registered nurse, clerk, and medical technician.
Kaolin Study. There are approximately 2, 000 Georgians employed in the mining, processing, and manufacturing of kaolin. During 1955, further study was done in several kaolin industries. Chest x-rays and occupational histories of the employees were taken. The study will aid in determining the effect of kaolin on the health of the employees.
Civil Defense. The acting director of Occupational Health is also the deputy director of Civil Defense Health Services for Georgia, He continued his work in this capacity.
Georgia Section American Industrial Hygiene Association. The consultant nurse and the acting director of Occupational Health are also members of the Georgia Section, American Industrial Hygiene Association. The Section conducted several meetings in 1955 with prominent speakers, regarding the noise problem in industry.

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Major Projects for 1956. 1. Legislation:
A. A more inclusive statewide occupational disease law. B. A State radiation protection act. An act for the control of radiations from machines and radioactive materials for the purpose of protecting health. C. Second injury fund act to aid in the employment of handicapped persons. 2. Adoption of uniform industrial hygiene code by the county boards of health. Previously adopted by the Fulton and DeKalb County Boards of Health. 3. A field practice center for observation of occupational health nursing. 4. Increased facilities for a program of health screening tests and health education for small industries in Georgia. 5. Cooperation with industrial, medical, and nursing associations--local, state and national. 6. Increased follow-up of occupational diseases reported.

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DIVISION OF CHRONIC DISEASES
It is hoped that a full chronic disease program can be activated as soon as financial and personnel arrangements can be made. Restrictions in these items limited activity in 1955.
Heart Disease Control Program During the year, the Heart Disease Control Program continued as a part of the Division of Chronic Disease, Preventable Disease Service . Dr. C. D. Bowdoin served as director of the program until his untimely death in September, 1955. Since that time, the program has been without an immediate director. Close cooperation was continued with many other agencies, particularly the Georgia Heart Association; the Medical Association of Georgia; Chronic Disease Program, U. S. Public Health Service; Department of Vocational Rehabilitation, Georgia Department of Education; Welfare Department, State of Georgia; local health depart. ments, and other official and non-official agencies; Valuable assistance and advice was rendered by members of these agencies, especially the officers and Clinic Committee of the Georgia Heart Association in carrying forward the program. In general, the functions of the program were: (l) Administrative -As in the past, it has been the policy to work with other agencies in planning and promoting comprehensive programs. Also as in years past, this function was somewhat restricted by limited finances. Members of the staff held numerous (informal) conferences with representatives of other agencies, and participated in the Annual Clinic Tour and a two-day "workshop" on heart disease in Savannah. (2) Educational - During the year numerous requests were filled for educational films and printed matter on heart disease. Approximately 2500 copies of the "Heart Bulletin" were distributed to private physicians, medical schools, and college libraries.

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Educational materials went to private physicians, local health departments, schools, lay groups, and other agencies. Near the end of the year three prints each of four new heart films were purchased and made available for distribution.
(3) Clinical - The clinical functions of the program centered primarily in the Georgia Heart Clinic System. During the year 14 such clinics were active, located in these strategic areas of the state: Albany, Athens, Atlanta (3), Augusta, Brunswick, Columbus, Jesup, LaGrange, Macon, Savannah, Thomasville, and Waycross. Equipment such as fluoroscopic and EKG machines was furnished as well as drugs (Bicillin) for research. Local health departments and hospitals provided clinic space. Clerical personnel were furnished by the Georgia Heart Association and its local chapters. The welfare departments assisted in the program by investigating the needs of prospective patients and lending financial assistance where indicated. Local physicians staffed the clinics without compensation. Special studies and treatment for cardiac patients were made available at the Atlanta and Augusta clinics, in cooperation with the Crippled Children's Division, State Health Department; the Medical Aid Program; and the Department of Vocational Rehabilitation. In addition, the Division of Public Health Nursing and the nutrition staff, Division of Maternal and Child Health, supplied a consultant nurse on heart disease and a consultant nutritionist, respectively, to assist these clinics.. The major problem of the heart clinics remained that of financing transportation and medication for indigent patients, especially those from other counties.
Plans and Needs. It is anticipated that the program will secure a well-qualified cardiologist to head the activities during 1956. When this is realized, the program should make tremendous strides and many of the past goals should be realized. Much depends upon adequate financing, but it is anticipated that the coming year will see significant progress. To meet the challenge of heart disease, this progress must be made!

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CIVIL DEFENSE
The Georgia Department of Public Health and the Civilian Preparedness Committee of the Medical Association of Georgia again worked in close cooperation,
The regular monthly Civil Defense Health Services School was continued at the Fulton County Medical Society's Academy of Medicine.
Civil Defense Health Services took part in the following key activities: 1. Lectured on Georgia Civil Defense Medical Services Plan to the Public
Health Civil Defense Laboratory Course given by the Communicable Disease Center in Atlanta July 18-23, 1955. Representatives from many states participated in this course. 2. Participated in the organization and instruction of the course on Castastrophic Injuries and Diseases instituted by the Emory University School of Dentistry as a regular course for senior dental students. This is now a regular 30-hour course in Civil Defense and represents the most complete course of its kind in the nation. Undoubtedly other dental schools will follow this example and we will thus soon have dentists scattered widely in many communities who can instruct other dentists in this vital work as assistant surgeons for civil defense. 3. Prepared two important papers: a. ROA and Civil Defense - presented at the annual June meeting of the
Reserve Officers Association in Boston. The article outlined specific recommendations for utilizing the know-how of medical reserve officers in civil defense instruction. The Chairman of the Committee was elected National Surgeon of the Reserve Officer Association to implement this program.

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b. Proposed Creation of the Position of Deputy Director for Hospital Civil Defense in all Community Hospitals in Georgia - the initial tentative draft was presented at the December 3, 1955 meeting of the Georgi.a Civil Defense Health Services School and the revised draft was presented at the annual February meeting of the Georgia Hospital Association.
4. Advised extensive distribution of the Obstetrical Manual and Personnel Kit prepared by Dr. R. A. Bartholomew for care of obstetrical patients in civil defense emergencies.
5. Participated in the coordination activities of the Implementation Committee for Region Three (Southeastern States) of the Federal Civil Defense Administration.
6. Worked with the Civil Defense Emergency Hospital Pilot project of Emory Hospital, DeKalb County.
7. Participated with the staff of the U. S. Public Health Service in the first Civil Defense-Public Health Course designed by the Public Health Service for training public health workers in their general civil defense responsibilities. Some of the i1,1structors and all the students for this course were recruited from the Georgia Department of Public Health and the Atlanta Metropolitan area health departments. Students in the initial course furnished the personnel for teaching subsequent courses. A subsequent course was conducted by the Georgia Department of Public Health in Atlanta in 1955 and another course in the Northeast Health Region.
8. Established a committee to reorganize the Georgia Department of Public Health and the Civil Defense Health Services so that overlapping functions will be eliminated.

LABORATORY SERVICE
Division of Laboratories

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DIVISION OF LABORATORIES

The number of examinations made in the Division of Laboratories had been

gradually receding since the peak load of 1, 372, 216 in 1951. This recession was due to

the gradual curtailment and final discontinuation of the multiphase testing program which

had resulted in a large volume of specimens for syphilis and blood sugar test. In 1951

and 1952, these specimens made up about 400,000 or 30 percent of the entire laboratory

load. For the first time since the multiphase testing program began in 1947, the current

report reflects the normal growth of laboratory services.

A total of 1, 024,390 examinations made in 1955 is a gain of 24,556 over 1954.

Examinations made in the various laboratories, with the percentage change from the pre-

vious year, are shown as follows:

Total 1, 024, 390 ( 2. 5) Albany 138, 396 ( 1. 9) Waycross 112, 326 ( -0. 5)

Central 505, 956 ( 1. 5) Macon 157, 165 ( 2. 9} Battey

110,547 ( 10. 5)

The greatest numerical and percentage gain occurred in the Battey Laboratory,

chiefly due to the clinical examinations made in conjunction with drug evaluation studies.

Microscopic examinations for tuberculosis declined from 80, 006 to 74, 810 with

a proportionate decrease in positive findings. Cultures for tuberculosis done principally

in the Central Laboratory, however, increased 15.9 percent but animal inoculations

decreased 23 percent. The total of 3, 718 examinations for diphtheria represents a

decrease of approximately 4 percent with a corresponding drop in positives. Of the

1, 091 blood specimens examined for malaria, a single positive, plasmodium vivax, was

found in a Korea veteran.

In l, 110 examinations for rabies, 201 were positive1 compared to 175 positives in 1, 205 examinations in the previous year. Heretofore, the number of positive dogs has

exceeded other animals, with foxes in second place, but this year a marked shift occurred, showing 91 foxes and 52 dogs with evidence of rabies. Of unusual interest was the

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positive microscopic finding of rabies in a brown rat by the Macon Laboratory, which was confirmed by animal inoculation. A total of 315 courses of antirabic treatment was distributed in 82 counties compared to 425 treatments supplied for patients in 80 counties in 1954. No case of rabies in humans occurred and for the tenth consecutive year, no case of postvaccinal paralysis was reported.
There was a 5, 5 percent increase in the confirmation and typing of salmonella, shigella, brucella, and typhoid organisms for the regional, hospital, and private laboratories. A total of 947 specimens of blood were processed and referred to the Communicable Disease Center for viral and rickettsial disease tests. This indicates a need for establishing this service as a part of our program. Salmonella isolations increased by 79J or 26 percent in an increase of 43 patients. S. typhimurium continues to be the most prevalent type, with 117 isolations from 81 persons. There were 24 cases of laboratorydiagnosed typhoid fever, the same number as for 1954. Fifteen new typhoid carriers were found. Shigella isolations increased by 42 from 311 persons involved. S. sonnei was the predominant type in contrast to the S. Flexneri2 the most prevalent in 1954.
The laboratories made 67, 818 examinations on 19, 498 samples of milk and 52 samples of ice cream, a gain of about 1 percent, which suggests a leveling off in the receipt of samples. The statistical report alone, however, does not fully portray the activity of the Milk Units since a number of studies and investigations were made with the view of improving and enlarging the service. Provision has been made to detect the illegal practice of vending reconstituted milk as fresh milk. A program was instituted for the certification of county health department laboratories examining dairy products. One problem in the routine examination of milk has been the scheduling of samples so as to avoid the almost insurmountable peak load at times. Conferences with the sanitarians who collect the samples, are helping to solve this problems.
A moderate increase occurred in the serologic tests for syphilis, Rh test, and 0

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blood group tests in all of the laboratories, as well as in the heterophile antibody test performed only in the CentrStl Laboratory. Reactive results in the serologic test for syphilis dropped from 4. 1 percent in 1954 to 3. 9 percent. A total of 53, 132 specimens of blood, with 2. 8 percent reactive results, were examined for premarital purposes, an increase of 2, 124 over 1954. The Central Labo'ratory participated in the National Serology Evaluation Study with the Kahn, Kline, Kolmer, and Mazzini tests and achieved commendable ratings in sensitivity, specificity, and reproducibility. Of the 94 laboratories participating in the State Serology Evaluation Study, 84 were granted approval. One laboratory did not request approval, five withdrew from the study, and four could not be approved. In connection with this study, 36 inspection visits were made and refresher courses of instruction were given to 12 technicians.
Distribution of silver nitrate ampules and Koch's old tuberculin increased moderately but a significant drop occurred in the demand for typhoid vaccine and immune globulin. In April, polio vaccine distribution began, and 674,271 cc. were supplied through local health departments.
Resignations occurred as follows: technical 26 (38 percent) with 20 replacements; skilled-non-technical 10 (34. 5 percent) with eight replacements; non-skilled seven (20 percent) with seven replacements. Such an enormous loss of experienced personnel and the indoctrination of new personnel imposes a most difficult burden on the supervisors in the various units. Proposals for salary raises in several technical positions were therefore prepared for presentation to the Merit System Board at its January meeting.