Annual report 1957 [1957]

Georgia Department Of Public Health

~tate of <Bcorgia
313epartment of ~ublir 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 1957

1957 was a year of real progress for public health in Georgia, Almost every area of the work was expanded and many new programs were started which will greatly benefit the people of our state in the years to come.
Mental health activities gained increasing attention because of the large number, both young and old, who are affected by mental and nervous disorders. A program was started whereby people can be treated for short periods in general hospitals around the state and returned to their homes without having to be committed to a mental institution.
More and more children whose ability as future citizens of our state might be curtailed because of crippling, burns, heart conditions, cerebral palsy or disfigurement are being rehabilitated through the Crippled Children's program, While additional funds granted by the Governor during the year insured care for many who might otherwise have had their treatment delayed, the need for more money for this purpose is still very great.
A project to study the problems of mentally retarded children and their families was begun. This beginning step will have far-reaching effects not only in helping to understand the causes of retardation but in helping all of these unfortunates and their families to greater usefulness.

Many new hospitals and health centers were completed in every section of 'the state and construction begun on many others, A survey of nursing homes was completed and the results presented to the 1958 General Assembly. The problems of our elder citizens demand our best efforts.
In general, maternal, infant and school health are the best we have ever known, Communicable disease rates are low and the mortality figures, except for the degenerative diseases, dropped again. Tuberculosis and cancer are still with us, but progress is being made continuously in our fight against them, Heart disease and home and highway accidents are the leading causes of death among our citizens,
A Health Department budget of $6,758,500 for the fiscal year 19 57-58 made possible all these public health services to every citizen, The Department administered over $6,469, 600 in hospital construction funds, over $3,910, 000 for tuberculosis sanatoria and $1,210,435 for aiding crippled children. A more detailed financial report is compiled for the State Board of Health at the close of each fiscal year.
The goals achieved this year in public health provide a mark which we will strive during the coming year to exceed. Continued progress is the real measure of success in public health.

RESUME
For convenience and ready reference, the following is a brief resume of the information in this report.
The number of full time employees increased by 66 during the year, making a total of 2, 585. The separation rate decreased for the second year, dropping from 31 percent to 28 percent (p. 1).
A total of 368,214 records including births, deaths, marriages, divorces and adoptions were processed. Live births reported dropped for the first time in three years below 100, 000; there were 32,373 deaths and 50,264 marriages (p. 3).
Admissions to TB hospitals totaled 1724, the second highest number in the history of the hospitals. Only 38 percent had far advanced tuberculosis compared with 45 percent last year. Hospital stay decreased from 371 days to 317 days (p. 5).
Through cooperation with other agencies and the use of every media of mass communication, efforts were made to keep the 'Citizens informed of health matters and ways and means of improving their individual and community health
(p. 7).
More than 415 public health people received training in at least 73 different short-term courses during the year. In addition to the approved field training centers in Fulton and DeKalb counties, an additional center was started in the Bibb-Jones-Twiggs District (p. 9).
Through funds provided by the Hill-Burton Act of 1946 and the Medical Facilities Act of 1954, construction was started on 10 new hospital or health centers and work was completed on 23. A survey of nursing homes was com-

pleted and the results presented to the 1958 General Assembly (p. 11). Approximately 666, 000 people in 53 communities are now receiving the
benefits of fluoridated water. A survey was completed to determine the extent of dental care needed by nursing home patients in the Atlanta area (p. 13).
Georgia has attained national recognition for being first to begin an "Honor Roll" in food sanitation. Three counties have already reached this status. Sanitation inspections were also continued on milk, housing, tourist courts, schools and hospitals (p. 15),
The 26 year record of no water-borne diseases in Georgia continued unbroken, Over 22, 700 samples were examined in the water laboratory and plans and specifications for 20 water supplies, 17 sewage works and 71 water-sewage construction projects were approved (p. 17).
To protect the health of workers in industries around the state, visits were made to 203 businesses employing 43, 300 people in 59 counties. The radiological health program was expanded to include both air and water samples (p. 19).
Every educational devise was used to make Georgians conscious of reducing accidents in the home. A survey of injuries by power lawn mowers was completed (p. 21).
There are now 562 nurses employed in 147 counties in the state, but there are still 12 counties without nursing service and many others need additional personnel (p. 23).
Two more health districts were activated, bringing the -total to 20 of a proposed 38. There were 25 health centers, 59 auxiliary health centers and 2 additions to existing facilities completed during the year (p. 25).

All 5 health regions reported progress in nursing, sanitation, nutrition and venereal disease services, Several counties were changed from one region to another and all regions need additional trained personnel (p. 27).
Health of mothers and children was improved both by conducting health department clinics and by helping with education of physicians, nurses, and staff members of hospitals and health departments (p. 37).
Nutrition education centered about mothers and children, and special attention was also given hospital and restaurant dietary instruction (p. 39).
In Georgia's schools, vision and hearing tests were continued; teachers and student teachers received instruction in health (p. 41).
Counseling of families of mentally ill persons increased; a big step forward was a $75,000 quarterly allotment by the Governor for hospital and professional services for medically indigent patients with mental disorders (p. 43).
More comprehensive care was offered for crippled children, as one new clinic opened in Macon and all clinics increased their range of services
(p. 45).
The decrease in cases of communicable diseases has not lowered the Department's alertness to their continuing threat to the population (p. 47).
The State continued to provide financial aid for treatment of cancer patients at a rate of about 4000 patients per year (p. 49).
Rabies increased only slightly, as foxes headed the list of rabid animals; reduction of fox population in strategic areas, and inoculation of all dogs continues as the rabies control method (p. 51).
Syphilis declined from a total of 4258 cases in 1956 to 3785 in 1957; this

decline indicates a leveling-off, However, an increase in primary and secondary syphilis cases reported is attributable to concentration on early case finding through new techniques {p. 53),
Protection of the health of employed people while at work continued through health services to industries and investigation of occupational diseases
(p. 55),
Tuberculosis deaths appeared to drop slightly after a rise in the previous year. However, it is still the leader in deaths caused by contagious diseases
(p. 57).
Heart disease remained the leading cause of death and disability, The Department attempts, through education and through cooperation with other organizations, to control the disease (p. 59).
With the Department's director serving as state director of Civil Defense Health Services, all Department employees are considered civil defense workers
(p. 61).
Laboratory examinations decreased slightly from the previous year's total, with some types of examinations increasing while others decreased (p. 63),

TABLE OF CONTENTS

STAFF SERVICE Division of Personnel Administration Division of Vital Records

Pages 3

SPECIAL SERVICE

Battey State Hospital

5

Division of Public Health Education

7

(Health Education Unit, Public Information

Unit and Library)

Division of Training

9

Division of Hospital Services

11

DENTAL HEALTH SERVICE

Division of Dental Health

13

ENVIRONMENTAL HEALTH SERVICE

Division of Public Health Engineering

15

Division of Water Quality

17

Division of Industrial Hygiene (See Occupational Health) 19

Accident Prevention Unit

21

LOCAL HEALTH SERVICE

Division of Public Health Nursing

23

Division of Local Health Organizations

25

Northeast Health Region

27

Northwest Health Region

29

Central Health Region

31

Southeast Health Region

33

Southwest Health Region

35

HEALTH CONSERVATION SERVICE

Division of Maternal and Child Health (Nutrition Unit)

37

Division of School Health

41

Division of Mental Hygiene

43

Division of Crippled Children

45

PREVENTABLE DISEASE SERVICE

Division of Epidemiology (Cancer Control and

47

Veterinary Activities)

Division of Venereal Disease Control

53

Division of Occupational Health (See Industrial Hygiene) 55

Division of Tuberculosis Control

57

Division of Chronic Diseases

59

Civil Defense Health Services

61

LABORATORY SERVICE

Division of Laboratories

63

STAFF SERVICE
Division of Personnel Administration Division of Vital Records

DIVISION OF PERSONNEL ADMINISTRATION

During 1957 the number of full time health workers increased by 66 to a

total of 2, 585. Most of these additional workers were in local health departments

with a total of 1, 101 persons employed at the end of the year in positions classi-

fied by the State Merit System Administration or the Fulton County Civil Service.

In addition to these employees and classified positions, local health departments

also employed over a hundred health workers paid entirely from local funds.

Full Time Employees in Public Health

1948

1950

1952

1954

1956

1957

Local

642

687

828

902

782

807

Fulton

282

294

State

503

524

629

574

570

592

Alto

177

191

15

0

0

0

Battey

595

759

859

856

885

892

1' 917

2, 161

2,331

2' 332

2,519

2,585

The separation rate for the entire group dropped slightly from 31 per

cent in 1956 to 28 per cent in 1957. The rate had been 32 per cent in the 2 years

prior to 1956. Employment in local health departments was relatively stable with

a separation rate of 19 per cent. The separation rate at Battey State Hospital

dropped markedly from 43 per cent in 1956 to 33 per cent in 1957. The separa-

tion rate in the State Office increased from 31 per cent to 33 per cent.

- 1-

Employee Turnover in 1957

Appointments

Separations

Net Gain

Local""

179

154

25

State

213

191

22

Battey

297

290

7

689

635

54

*Fulton County omitted, since appointments and separations are recorded by

Fulton County Civil Service. There was a net gain of 12 employees in the Fulton

County Health Department,

During the year an extensive review of salaries was conducted resulting

in pay adjustments for a majority of employees to current economic conditions,

Several new positions required for efficient operation of the program were de-

veloped and after considerable study, revisions were made in the Food and Milk

Sanitarian series, the Industrial Hygiene series, and a majority of the positions

in the Accounting and Mental Hygiene Divisions. During the year representatives

from 12 Georgia colleges met at the Health Department to discuss the recruitment

of graduates for health work. The recruiting pamphlets far laboratory workers

and sanitarians were revised. Booklets containing class specifications used in

the local health departments were assembled and distributed throughout the state.

A committee appointed by the State Merit System director with the personnel ad-

ministrator of the Health Department as chairman had a dozen meetings to review the present Merit System Rules and Regulations and discuss revisions.

-2-

DIVISION OF VITAL RECORDS
A total of 368,214 records were recorded in the Division of Vital Records during the year. These consisted of 99,355 live birth certificates, 99,355 confidential medical reports of birth, 32,373 deaths, 3, 575 fetal deaths, 50, 264 applications for marriage license, 50,264 marriage license, 7, 4 75 divorces and 25, 553 delayed birth certificates.
There were 1, 734 adoption orders reported and new birth certificates completed on 1, 381 adoptions, A total of 830 legitimations were processed and 7 de legitimations. Superior court orders changing 110 legal names were received and processed.
Over 33, 500 birth a~d death records were certified. No record is maintained on the number of free verifications of birth and death records to parents, schools, and other public agencies but over 100,000 would be a conservative estimate.
A planned program for the preservation of the old birth and death records in the Division was continued through the year. This includes the lamination of mutilated and worn records, microfilming all records and rebinding them. This project has been more complicated, therefore, slower than anticipated.
A new accounting procedure was inagurated in the Division on the first of December. The ultimate goal of this new procedure is to enable the Division to render a faster and more direct service when called upon.
The field staff continued their educational and promotional program toward better and more rapid registration.
- 3-

The total number of births reported from January through December was slightly lower than the number of births reported during the same months of 1956. However, the 103, 581 current birth certificates processed during 1957 was the largest number ever processed in Georgia during a calendar year. The final number of births that will be recorded for 1957, will not be available for several months yet, but indications are that the figure will show a small decrease compared to 1956.
Indications are that the final total of deaths in Georgia for 1957 will follow the national pattern and show an increase over 1956.
Fetal death registration continues to lag and it appears that the final total for 1957 will show a decrease over 1956.
While the marriage records for 1957 are not complete, it appears Georgia will show a decrease over 1956 which is true of the national pattern for 1957.
Divorce registration was generally better in 1957 than in 1956. This was due to the excellent work of our field staff in promoting registration in counties previously not cooperating.
A complete statistical report for 1957 wi 11 be published after July 1, 1958.
- 4-

SPECIAL SERVICE
Battey State Hospital Division of Public Health Education
(Health Education Unit, Publi"c Information Unit and Library)
Division of Training Division of Hospital Services

BATTEY STATE HOSPITAL
The Battey State Hospital annual report has included statistical data for Muscogee County Sanatorium and Savannah Sanatorium since 1951 regarding admissions and discharges of patients,
Admissions, During 1957, 1818 applications for admission were processed with 1627 patients admitted to Battey, 43 to Muscogee County Sanatorium and 54 to Savannah Sanatorium, totaling 1724 admissions, This was the second highest number of admissions for any year in hospital records. There were 1737 patients admitted in 1954, only 13 more than in 1957, Thirty-eight per cent had far advanced tuberculosis; 33 per cent had moderate! y advanced; 3 per cent had primary tuberculosis; 8 per cent had minimal; 2 per cent had other forms of tuberculosis and 15 per cent were admitted for diagnosis and evaluation, Seventy-three per cent of these people were between the ages of 20 and 60, the most productive and responsible years of life, One of every four admissions was a readmission,
Treatment: Patients entering the hospital are carefully studied and treated, All patients with active disease are given anti-tuberculosis drug therapy. If this is not sufficient, major chest surgery is made available and there were 137 patients who had this surgery during the year, Many minor and major surgical procedures were completed, The consultant staff in various specia1tie s continued their services to the patients, The dental program was intensified and increased. A health education program for the patients was begun,
- 5-

i
Research. An active clinical research program continued with Battey State Hospital participating in the USPHS chemotherapy studies and follow-up on patients previously started in special studies. Clinical research also continued in the following highly specialized fields~ tuberculous meningitis, bone and joint tuberculosis, healed cavities, open negative status of discharged cavitary cases, the atypical acid-fast infections, a correlation study on planography and resected specimens, a study on maternal and infant mortality and illness, surgical investigation on induced thrombocytopenic purpura, a combined clinical laboratory study on serum bio-assays. Some of this work was reported at national and state meetings concerned with chest diseases during the year.
Discharges. There were 1812 patients discharged and the great majority were to continue drug therapy at home. Of those discharged, 129 or 7 per cent, were dead; 10 per cent did not have tuberculosis; 12 per cent were unimproved, but 71 per cent of those discharged were inactive or improved; 30 per cent were irregular discharges; and 16 per cent had positive sputum at the time of discharge. The average hospital stay was 317 days.
Cost. The average daily census for the year was 1, 336 patients with an average daily cost of $8. 40. This program was accomplished with an average ratio of 10 employees for every 15 patients. At the end of the year 1, 583 beds were occupied at the hospital.
- 6-

DIVISION OF PUBLIC HEALTH EDUCATION

Health Education Unit

Providing personnel, techniques and material toward the goal of sound

health attitudes and good health habits is a basic purpose of the Health Education

Unit.

Consultation to other clivi sions and local health departments remains one

of the chief services of the Unit. In cooperation with the Public Information Unit, aid was provided the above groups in in-service education, material development and in the planning and execution of various health programs.
The Unit has certain responsibilities in the educational phases of civil defense and in orientation of foreign visitors. Additional responsibilities in the Department's training program were shared with the Training Division this year.

Joint planning of programs with various health-related organizations is a major function of the Unit. Some examples are teacher training institutions,

voluntary health agencies, and the PTA.

The use of TV in health education continued, and one series of 15 halfhour TV programs plus others, were produced in cooperation with the Public

Information Unit.

Public Information Unit

The Public Information Unit worked to inform as many citizens as pos-

sible of health and health programs by preparing material for use in the press,

radio, TV, and in Department publications.

In addition to operating a film library, circulating several hundred

films throughout Georgia, the Unit produced spot TV films, radio tape recordings,

- 7-

and worked with Health Education Unit to produce 15 half-hour TV shows. Georgia's Health, a monthly bulletin of health articles, was published
and mailed to about 17, 000 Georgians; and Fax, a news style employee publication, was issued monthly.
The Unit worked with Health Education to produce exhibits, posters, and pamphlets, and served other divisions in editing and speech writing. The Unit edited and published the Department annual report from division reports.
Of special note was a 40-foot water exhibit for the Southeastern Fair in Atlanta. This was prepared jointly with the Water Quality Division and the Atlanta Water Works.
The Unit helped divisions and local health departments in planning information and public relations programs.
Library The report of the library includes the books, pamphlets, periodicals and journals located in the Central Library, Division offices, Regional offices and branch laboratories. There were 17,106 books and bound volumes at the end of 1957. Periodicals by subscription, gift or exchange totaled 539. Circulation of publications from the main Library was 5, 236, with an attendance of 6, 293. There were 3, 106 reference calls handled during the year from every division in the Department and many sources outside the Department. The number of books purchased, circulation, reference calls handled and attendance all increased over the 1956 figures.
-8-

DIVISION OF TRAINING
1957 marked the first full year of operation of the Fulton and DeKalb Health Departments as approved field training centers. Most of the minor organizational problems have been ironed out and these centers now operate effectively in training entrance level nurses and sanitarians.
During the year, an additional field training center in a different part of the state was needed and arrangements were completed for the approval of a center in the Bibb-Jones-Twiggs District with headquarters in Macon.. This District Health Department will begin training the same categories of personnel in the spring. A contract between the State Health Department and the Emory University School of Nursing which provides that student nurses will be placed by the State Health Department for their field experience continued in effect. Similar agreements were continued with Peabody School of Nursing, the University of Georgia School of Nursing, and North Carolina College.
In short-term specialization and refresher training, more than 415 public health people received training in at least 73 different short-term courses,
The demands for training of foreign visitors decreased slightly, but there were still some 47 visitors from 26 nations who visited the Department for observational training within the state or local health departments.
A great deal of planning has been done and is continuing in further development of short course intensive training for various types of personnel in various program areas.
The following table presents statistics on the number of individuals
- 9-

receiving stipend supported training during the year:

JanuaryJune

NURSES

Academic

10

Orientation

7

SANITARIANS

Academic

3

Short Course in Environmental

Sanitation

8

ENGINEERS Academic

PHYSICIANS

Academic

1

Orientation

NON-MEDICAL ADMINISTRATORS Academic

PSYCHOLOGIST

Academic

1

31

JulyDecember
8 13
2 9 1
1
2
1 37

Total
18. 20
5 17
1
1 1
3
2 68

- 10 -

DIVISION OF HOSPITAL SERVICES
To aid communities in the continuing task of providing adequate hospital and related medical facilities, the Division of Hospital Services provided a broad and varied service in 1957. There was much construction planning for communities still without adequate hospitals and other medical care facilities, and for expansion of those already in existence. Consultation and educational work were carried on to improve the operation of hospitals and other facilities and to help maintain enough trained workers.
During the year 27 communities were surveyed to determine the need for new or expanded medical care facilities, Meetings were held prior to community surveys, with newly organized.hospital authorities, and guidance was given in all phases of initial planning. Approval was given for construction of 4 new hospitals, one nurse training facility and one addition to an existing hospital, Considerable time was also given to communities interested in projects under the Medical Facilities Act of 1954, which supplements the Hill-Burton hospital construction program by providing matching funds for chronic illness hospitals, nursing homes, diagnostic-treatment centers, and rehabilitation facilities.
Construction began on 10 new projects and was completed on 23 projects. Over 5 million dollars in Federal and State funds went to project sponsors through 173 payments. In addition to numerous consultations, 322 inspections of sites and buildings were made by members of the technical staff.
To insure the effective operation of hospitals and medical care facilities throughout the state, consultants in administration, accounting, dietetics, disaster
- 11 -

planning, clinical laboratory operation and nursing service offered their as sistance. Numerous visits were made to hospitals to discuss problems and new procedures. Consultants also conducted institutes and training programs. Since 1952, staff members have also assisted in the training program for hospital. administrators sponsored jointly by the Division of Hospital Services and Georgia State College in Atlanta.
Hospitals, nursing homes and homes for the aged are required to be inspected and licensed under the provisions of the Hospital Regulations Act. To accomplish this, field representatives from the Division made 887 visits to all such institutions last year. Recent years have brought an encouraging trend toward an increased number of institutions able to meet licensure requirements.
At the request of the 1957 General Assembly, the Department of Public Health undertook a survey of all nursing homes in the state providing care for the aged. The task of gathering data and compiling a report was assigned to the Division of Hospital Services, This report was completed and presented to the 1958 General Assembly.
Applications are now on hand for 56 projects, approval of which depends upon availability of State and Federal matching funds, The applications are for 42 new hospitals or additions, and 14 other medical care facilities including nursing homes, rehabilitation centers, diagnostic and treatment centers, chronic care facilities and nurse training facilities. Special emphasis will be placed in 1958 on encouraging sponsors of the most urgently needed facilities such as those for nursing homes and chronic care.
- 12 -

DENTAL HEALTH SERVICE
Division of Dental Health

DIVISION OF DENTAL HEALTH
At the end of 1957, approximately 666, 0 00 people in 53 comm"l+nities were using fluoridated water. Five-year post-fluoridation studies in DeKalb County, Athens, Rome, and Monroe revealed an average of 6lo/o reduction of tooth decay in the 6 year olds, A valuable epidemiological study to determine the effectiveness of a low fluoride concentration in a water supply and the economic advisability of supplementing additional fluorides has been conducted and will be reported early in 1958.
A survey of nursing home patients in the Atlanta area revealed a need for extensive dental care and recommendations were made for improving services,
Plans to employ dentists in the health districts have developed unsatisfactorily, Only one additional district employed a dentist in 1957. Most local health departments use the lack of local funds as their excuse for not developing this program. Many dentists participated in clinics, however some felt the amount of their time and efforts available was too limited for the enormous dental problem, In other areas no dentists were available. There are 113 dental clinics established in 58 counties with 97 operating during 1957. Some 181 dentists gave service to 45,586 children, providing 102,843 treatments. Considering the low ratio of dentists to population and high demands for their services in private offices, this report speaks well for the dental profession of Georgia,
The cooperation of the dental profession with the public health program - 13 -

can be attributed in part to the public health and civil defense training given students of the Emory University School of Dentistry and to the relationship maintained by Dental Health Services with the dental profession. The Council on Dental Health of the Georgia Dental Association includes recommendations. to improve and strengthen dental public health services in its annual report of dental health activities to the Executive Council of the Association requesting approval and support.
The State Board of Health approved recommendations of its Dental Health Service Committee to strengthen and expand Dental Health Services. If these recommendations are activated, Dental Health Services will have a program more comparable to the other Services of the Department.
Only 7 local boards of health have dental members. Both the Georgia Dental Association and the State Board of Health recommended dental representation.
All educational devices and media have been utilized to keep the public informed about the value of regular visits to the dentist, approved preventive services, home care of the mouth and teeth and the importance of discovery and treatment for oral pathological conditions. Acceptance of and demand for improved dental health by public health workers and other groups such as teachers and parent-teacher associations, have been largely responsible for the recognition of dentistry as a basic health service. Michigan and North Carolina Schools of Public Health and the U. S. Public Health Service have selected Georgia as a field training area for public health dentists and dental interns.
- 14 -

EN

Divisio11 o~

J)ivision ::.1

QuaH

Ii'i"vi sion lso

L..~ccident Preventiun lJn.i

s V~CE

DIVISION OF PUBLIC HEALTH ENGINEERING
The diverse activities of the Division touched the lives of all Georgians and their guests at home, at play, at work, and in travel. Some phases of the work were inspections of eating establishments, shellfish plants, refuse collection and disposals, water impoundments, tourist courts, trailer parks, tourist homes, dairies and milk plants, hospitals, nursing homes, adoption and boarding homes for children, public housing, plumbing, insect control, hydro-electric developments, rodent control, summer camps and state parks, and commercial and industrial developments. Other phases included analysis of plans for recreational, school, swimming pool and subdivision construction regarding such things as water supply and sewage disposal. The Division also operated a mapping, drafting and photography laboratory.
Fringe area development is a major problem throughout the nation today. More than 500 real estate subdivisions, using individual wells, small community water systems, or septic tanks and absorptio!l systems were active in 1957. Special review and recommendations for water supply and sewage disposal on more than 250 lots not in subdivisions were made.
Sanitation details of 152 sets of plans and specifications for schools were reviewed and 144 were approved. Construction approvals on 148 improvements in school buildings were forwarded to the State School Building Authority.
The tremendous increase in construction of swimming pools requires an increasing amount of attention by the Division.
Tourist courts, motels, trailer parks and tourist homes are developing - 15 -

better and more attractive facilities each year. There were 1235 registered for supervision during 1957.
Georgia has attained national recognition for being first to begin an "Honor Roll" in food sanitation. Three counties have already reached this status. The Division made 1700 official evaluation survey inspections and held food service conferences in 21 counties.
Twenty-nine communities controlling over 90o/o of the fluid milk consumed in Georgia, made "Honor Roll" on the milk sanitation program. Sanitation surveys were made on 17 milk sheds. The mobile milk unit was loaned to health departments in Bartow, Polk, Whitfield, Spalding and Richmond Counties.
There are now 65 sanitary landfills in the state, an increase of 10. Consultation on refuse collection and disposal was given in 43 counties.
Supervision of mosquito control continued over 14 major hydro-electric projects. There are now over 1400 impounded water permits.
More than l, 000 samples of oyster- growing waters were taken and examined to determine pollution. Ten oyster shucking and packing plants are certified and under regular supervision,
Approximately 7, 000 maps, charts, negatives, prints, enlargements, slides, mountings and odd jobs of drafting and lettering for every division in the department were completed. These ranged from small slides to preparing a single map showing 516. 5 square miles, for use in radiation studies. The recent addition of color photography equipment has greatly increased the demand for educational and exhibition materials.
- 16 -

WATER QUALITY DIVISION
During 1957 the Division name was changed from Water Pollution Control, to Water Quality, which is more descriptive and appropriate to the Division's activities. The services and objectives of the Division including the Water Laboratory remained the same, however, with emphasis on the maintenance of the high quality of Georgia's water resources, The cooperative program with all local governmental agencies, industries, citizen groups and individuals which has for many years been the basis of the water quality program in Georgia remained intact and is being continually expanded, Effective operations and day by day attention of the agencies and persons in this cooperative program of public health protection added another year to the long record -- approaching 30 years -- with no water-borne disease from public water systems in Georgia.
The major objectives of the Water Quality Division are to maintain the high quality of Georgia waters consistent with their many uses and needs, The highest priority is given to water processed for drinking and all other purposes as is expected of public water supplies, The sources of water for the public systems included a large number of surface streams as well as underground supplies. A second major objective of the water quality program is to keep the surface streams in as good condition as their uses permit.
Many types of industries locating their manufacturing and processing installations in Georgia produce liquid wastes which must be given treatment in varying degree before discharge into the streams. Industrial managements are becoming increasingly aware of their responsibilities in using water without
- 17 -

doing unreasonable damage to its quality. Some very good research has already been made in this area and other research is now being carried on by certain industries with promising results, These progressive industries, by meeting their obligations as good corporate citizens, are demonstrating to others what they can do in relieving industry of the stigma of abusing the streams.
In accordance with the 1957 Georgia Water Quality Control Act the Georgia Water Quality Advisory Council was established, Upon recommendation of the Council, the Georgia State Board of Health passed water quality rules and regulations as provided in the Act.
The Division performed all of the functions placed upon it by Federal Public Law 660, 84th Congress, applying to financial grants-in-aid for construction of municipal sewage treatment plants.
The Water Laboratory continued its statewide program of water sample examination and consultation. Over 22,700 samples were examined.
The construction of public water supply and sewage facilities is at a high rate. The Division approved plans and specifications for 20 water supplies, 17 sewage works and 71 water-sewage construction projects. Many projects in the planning stage assure continued progress in the Georgia Water Quality program.
- 18 -

DIVISION OF INDUS TRIAL 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, well-being, and efficiency of the workers and to teach the workers to protect themselves from all known health hazards.
Organization and Relation to Other Programs. Carrying out such a program requires a well-trained professional staff. The Division is fortunate in having such a staff composed of a Division Director, 2 engineers, 4 chemists, and one stenographer. This staff, although administratively separate from the Division of Occupational Health, continues to operate as a team with its co-division.
Even with the well-trained staff available in the Division there are occasions when it is necessary to request the services of specialists from the U 0 So Public Health Service and other Federal and State agencies. These services are freely available to us upon request, and with their assistance it is possible to evaluate most industrial health problemso
The increase in industrialization in the state has, of course, brought increased responsibilities to the health departmentso The local health department is the official agency specifically charged with the responsibility of assisting industries and their employees in all health matterso Assistance from the State Health Department is available to local industries only through their local health departmenL
Accomplishments and Methods of Operations with Typical Examples 0 In carrying out the program for improvement of environmental sanitation
- 19 -

in industry, Industrial Hygiene personnel made investigations in 203 establishments employing 43,300 workers in 59 counties during 1957. These investigations covered a wide variety of industries.
During 1957 the radiological health program was expanded. In addition to air samples already being taken the sampling of certain surface waters of the state was started. These activities are aimed at obtaining the so-called "normal background" of radiation before the starting up of two proposed nuclear reactors in the state. To perform analyses of such samples, gas flow proportional counters, a single channel gamma spectrometer and various accessories were purchased. Thus 148 samples were obtained and 2363 analyses were performed.
Since the beginning 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 Unit. This assistance was continued in 1957. In the routine work of the laboratory 573 samples were processed and 859 analyses were done.
In 1954, the Division of Industrial Hygiene assumed the responsibility for the enforcement of the Georgia Mattress Sanitary Regulations. During 1957 at least two visits were made to each of the mattress manufacturers and renovators in the State.
Major Projects of 1958 Include: 1. Survey of hospitals for radiation hazards from x-ray, radium and
radioisotope usage. 2. In cooperation with the Division of Water Quality the program to
obtain information pertaining to background level of radiation of certain surface water in Georgia will be expanded. The air sampling program for radiation will also be expanded.
- 20 -

ACCIDENT PREVENTION UNIT

During 1957 the American Public Health Association in a resolution

cited accidents as the greatest single cause of loss of productive years of life

and called on state and local health departments to give "high priority to the

orientation and training of staff members in accident prevention and inaugurate

prevention programs as rapidly as available funds and personnel will permit."

This Unit of the Georgia Department of Public Health, functioning in

its fourth year, during 1957 attempted to increase its effectiveness in all appro-

priate areas of accident prevention activities, working principally through the

local health departments.

Staff of Five. Devoting full time to the accident prevention program

are five State Health Department employees: A director (on educational leave

until June 1958), nurse consultant, health education consultant, and two cleri-

cal personnel,

Field Activities.' The Accident Prevention Unit provides to local health

departments, and community groups through the local health departments, direct

and consultative service, educational aids (films, posters, leaflets, etc,), and

program suggestions.

Research and Studies, The Unit participates in certain research and

study programs relating to the accident problem. It represents the Health

Department in the Georgia-Cornell Automotive Crash Injury Research study,

a project which seeks to determine if certain engineering features available on

late-model cars are effective in reducing the severity of injuries received in

automobile accidents.

- 21 -

The Unit during the year conducted a survey of power lawn mower injuries in Georgia during 1955 and 1956. The results of this survey, based on reports received from nearly 500 practicing physicians in the state, have been widely publicized both locally and nationally.
The State Health Department, with the support of the Georgia Department of Public Safety, during 1957 began a project which seeks to evaluate existing traffic accident records in Georgia. To assist in this project the Health Department received a grant from the National Institutes of Health. Tentative plans call for a more comprehensive study of the cause of traffic accidents following this initial project in the traffic-safety area. This study will use methods familiar to ~ealth workers in studying epidemics.
During 1956 and 1957 the Unit directed the Home Safety Inventory in Georgia as part of a national effort to determine and publicize the extent of participation in home safety by national, state and local organizations. Over 150 organizations in Georgia completed program summaries for the Inventory and as a result this state was listed by the National Safety Council as one of the top ten states in this undertaking.
Future Plans. During the coming year the staff plans to continue providing services to the local health departments by selecting interested counties for concentrated efforts in accident prevention to demonstrate value of improved recording, suitability of materials and community participation. The Unit anticipates increased activities centering around the development of poison control centers and the epidemiological study of traffic accidents.
- 22 -

LOCAl

SERVICE

Division of Public Health Nursing Division of Local Health Organizations Northeast Health Region Northwest Health Region Central Health Region Southeast Health Region Southwest Health Region

DIVISION OF PUBLIC HEALTH NURSING
There were 562 nurses employed in 147 counties in Georgia at the end of the year, There were public health nurses in all except 12 counties, which have a population of 115, 200 or about 3o/o of the total population of the State. Two hundred and eighty or 50o/o of the nurses employed had some academic preparation in public health nursing. Ninety-one have degrees in nursing and 22 of these are graduates of collegiate schools of nursing. Included in this group are 48 clinic nurses, which shows an increase in the number employed in this classification.
During 1957 there were 62 appointments with 40 resignations, 4 retirements and 1 death.
Sixty-five nurses secured the following training: 17 general public health nursing; 30 orientation; 3 alcohol studies; 2 premature care; 5 cardiovascular diseases; 3 epidemiology; 2 community mental health; and 2 principles
and practices of public health nursing. In addition to the above courses, 48
nurses from 7 counties took an off-campus course in school health given in Atlanta by Peabody College.
One nurse took courses in general public health at her own expense, and 6 nurses who took this training secured Federal traineeships.
Field experience was provided for 49 student nurses from Emory University, 3 from the Medical College of Georgia, 13 from Peabody College, and one from North Carolina College.
Members of the Division made 27 visits to regions and 147 visits to - 23 -

county health departments for program development, recruitment and personnel adjustment, and consultation in and the evaluation of in- service and post- graduate education.
Major activities of the Division included planning and conducting annual supervisors' workshop; development of supervisory guide; participation in the orientation program; preparation of supervisory staff for increased responsibility in Mother and Baby Care classes; relief in a regional health district; assisting 2 schools of nursing in developing courses in communicable diseases; arranging observation periods for 2 instructors from schools of nursing in local health departments; working with the State Board of Nurse Examiners and the Georgia State League for Nm;sing on their curriculum committees; development of a public health nursing recruitment brochure; and participation in planning and conducting interviewing institutes.
Other activities of the Nursing Division included planning and participating in the orientation of certain new public health workers; planning tours and instruction for 9 international visitors; giving a program on diabetes to students at G. S.C. W. ; participation in a two -day educational program for diabetic patients; participation in inter-agency activities such as the Joint HealthEducation Committee, Visiting Nurse Association, Fulton County Child Guidance Clinic, Council of State and Territorial Directors of Public Health Nursing, and the Atlanta Committee on Alcoholism.
Progress has been made in the preparation of nurses to teach the Mother and Baby Care classes. Four classes were held for instructor-trainers and 66 additional nurses were prepared as instructors for these classes.
- 24 -

DIVISION OF LOCAL HEALTH ORGANIZATIONS

Under the plan adopted by the State Board of Health in 1954 to provide

adequate local health services by establishing 38 health districts, District 27

(Catoosa, Chattooga, Dade and Walker Counties) and District 28 (Cobb, Douglas

and Paulding Counties) were put in operation during 1957, bringing the total to 20.

In addition, in April McDuffie County joined District 33. This county

had previously declined the district plan.

Plans were completed to activate District 8 {Crawford, Houston, Macon,

Pulaski and Peach Counties) on May 1, 1958, and a physician was in training for

position as district director of public health of this district.

During the year one commissioner of health retired, and one physician

completed training and was appointed director of a district, so the number of

local public health physicians remained at 31.

On December 31, 1957, local health departments had 1, 259 full-time

public health workers, an increase of 25 over December 31, 1956. Changes in

number of persons employed and area covered as of December 31 are reflected

in the following:

1956

1957

Counties in health districts
Per cent population in districts Counties with commissioners of health Fer cent population in these Counties with public health nurses Per cent population with public health nurses Counties with sanitation personnel Per cent population with sanitation personnel Counties without local public health personnel
- 25 -

60
58. 1o/o 11
9.2% 1 46
96. 4o/o 68 7 3. 5o/o
8

68
64. 8o/o 8 5. 6%
147 97.0o/o
100 81. 5o/o 8

Local health department expenditures for 1957 were $6,051,096. 69>!' an increase of 9.4o/o over 1956, Of the amount expended, $4,022, 101,84 was from local sources and $2,028,994.85 was State Health Department grant-in-aid to counties, including special grants to local health departments for mental hygiene, tuberculosis control, crippled children and VD control programs, The total ex-
penditures were $1.56 Y2 per capita, of which $1.04 was from local sources and 52 Y2 ~ from grant-in-aid funds, This was an increase of 3 Y2 ~ over 1956; 2 Y2 ~
of the increase was from grant-in-aid to counties. During 1957, health center projects were completed in Bibb, Bleckley,
Candler, DeKalb, Liberty, Lumpkin, Screven, Terrell, Upson, Walker and Washington Counties, Health centers or auxiliary centers were under construction in Clayton, DeKalb and Pierce Counties; the applications of 8 counties were in the final plan stage. The construction program has resulted in completion of 25 health centers, 59 auxiliary health centers and additions to 2 existing facilities,
This Division cooperated with the State civil defense authorities in the preparation of the Preliminary Operational Survival Plan, particularly those sections dealing with the public health branch of Civil Defense Health Services, Work is underway with a committee of district directors of public health to develop a model plan to be put into effect in case of disaster. This will become part of the operational survival plan for each county. This planning will be completed by April 1958,
*Estimated figure as audit of December reports of expenditure not completed. - 26 -

NORTHEAST HEALTH REGION
General. The shortage of well trained public health personnel continues to be the greatest problem. Several districts could be organized if personnel were available to place in district positions. The medical director of the AthensClarke County Health Department retired effective December I.
Various people in the Northeast Region have cooperated with the University of Georgia in educational programs this year.
The following counties, previously in this region, were transferred to the Central Region: Hancock, Baldwin, Wilkinson, Putnam, Jasper, Warren, McDuffie, Columbia, and Richmond. Five counties, Towns, Union, Lumpkin, Dawson, and Forsyth, were transferred from the Northwest Region to the Northeast Region,
Nursing. One consultant nurse transferred to the region from the Northwest Region. Nursing service in the counties has been quite stationary this year. Rabun County received a second nurse. One nurse left Habersham County for educational leave, but that county also received a second nurse. A staff nurse returned to Lumpkin County. Lincoln, Union, and Towns counties are still without any local health services. In Wilkes County, the health office is open, with sanitation and clerical personnel, but there has been no nursing service this year,
Sanitation. The sanitation program continued at a rapid, steady pace to meet the demands of the public, clearly showing the need for additional personnel.
The school building program is now progressing nicely, so more time can be spent on other phases of sanitation,
- 27 -

Home construction, with demand for percolation tests, which determine the ability of the soil to absorb liquids, held the spotlight this year, More people are becoming conscious of the problem of human waste disposal. Subdivisions have demanded much attention and consideration,
The tourist court, school lunchroom, and milk registers show steady improvement of sanitary facilities resulting from the concerted efforts of the sanitarians.
Nutrition. The nutrition services have continued with the same basic activities as the year before, The rearrangement of the counties in the regions brought new contacts and activities but took away some college and metropolitan work.-
The district nutritionist who joined the Chatham County staff this year came to this region for orientation. One foreign student from the Harvard School of Public Health came to Athens for field training experience.
The crippled children clinics in Augusta were attended regularly. Nutrition services are growing, as evidenced by the requests and interest of the local health departments,
Venereal Disease, The venereal disease rate in the region decreased greatly during the year. Primary and secondary syphilis decreased from 96 cases to 62. Early latent syphilis dropped from 159 to 116. There was a 19 per cent decrease in total syphilis from 450 cases to 361. The greatest drop was in gonorrhea which went from 600 cases last year to 338 this year, a decrease of 44 percent,
- 28 -

NORTHWEST HEALTH REGION

The Northwest Regional Office was without the services of a regional

medical director during 1957; therefore no attempt will be made to report on

activities normally conducted by a medical director,

During 1957, 2 districts were activated. This leaves only 3 counties

in the region out of the district plan and 2 of these have expressed willingness to

join when a district director is made available to them. Five counties were

transferred to the Northeast Region. Quarterly conferences of regional person-

nel were attended by staff. Administrative and consultative service was provided

for all counties by the regional engineer, nurses, nutritionists, V. D. investiga-

tor, and clerical field representative. Quarterly conferences for all personnel

were held. Our office staff held regular monthly conferences. The acting ad-

ministrative officer attended regular medical directors' meetings and civil

defense meetings in Atlanta,

Health centers were completed in 1957 in Walker and Lumpkin counties.

Health center application was signed for Chattooga, Whitfield, Cobb, Forsyth,

and Haralson counties, Negotiations are underway for Cherokee, Fulton, and

Gordon counties.

Nursing. Changes ;,yhich occurred in nursing personnel during 1957:

resignations 5; new nurses employed 7; re-employed 1; 5 nurses completed

orientation, 1 nurse at present in orientation; 1 consultant nurse transferred to

N,E. Region; transfers within the region 3; at present on educational leave 1;

reclassification by examinations 5; returned from maternity leave 2; and

returned from school 1.

- 29 -

Sanitation. Sanitation services for year included following inspections: hospitals, V, A., F. H. A. , schools, water impoundments, lunchrooms, tourist courts, milk plants and dairies, and general sanitation. Two regional office sanitarians transferred, 1 to a district, 1 to a county. Other changes in sanitation personnel were: resignations 1; reclassification 1; sanitarian employed by transfer from out-of-region 1; transfer within region 1; transfer out-of-region l.
Nutrition. A great deal of time has been spent in staff education. Nutrition was discussed with 4 groups of nurses in counties. Home visits have been made at least one time with all new nurses in region. Student nurses receiving public health training were given help. Participation in 3 orientation programs was given by personnel in state office. The regional nurses devoted one meeting to nutrition and the nutritionists helped with the planning and presentation.
Clerical. Three county clerks resigned and were replaced. Because of a heavy clerical load in 5 counties, an additional clerical worker was employed in each. One clerk resigned and was reappointed. One stenographer in the regional office resigned, Her replacement also resigned at the end of the year. The stenographers in the regional office attended their regular duties of correspondence, filing, answering telephone, compiling and checking reports, etc.
Venereal Disease. Continued assistance was given to all local health departments and physicians where needed.
There continues to be an acute shortage of public health workers. We have vacancies for sanitarians, nurses, district directors of nursing, district directors of public health, and district directors of environmental sanitation.
- 30 -

CENTRAL HEALTH REGION
The Central Region has increased by 9 counties to a total of 58, of which 38 have no local health commissioner. This keeps the regional staff busy with many direct services which will be discontinued when personnel are available to staff the districts and counties. Obtaining qualified workers continues to be our major problem.
We were happy to have had several new health centers dedicated this year, Adequate housing of the local health departments always brings about increased requests for services by the more substantial citizens. It goes without saying that these services can be much more readily and efficiently given in a suitable building.
We are having some interesting experiences in the new field of mental health. We are now emphasizing the nursing service to the families of the mentally ill and we feel sure that it will bear fruit over a period of time. We now have 20 counties carrying on this program and hope to add to the number as rapidly as possible.
Other nursing services continue to expand and more results are evident from our school and MCH programs. Of course, a major nursing activity has been the administration of polio vaccine.
Sanitation is progressing with more and more interest and attention being paid to subdivision development with its attendant problems of housing, water supply and sewage disposal. The importance of stream pollution is also receiving much attention.
- 31 -

The field of nutrition is receiving wider recognition as an integral part of all public health programs, as evidenced by an increased number of requests for the services of our nutrition consultants, An important activity has been work with medical students and nurses in training. Closer attention has been given to MCH and crippled children's clinic patients. We are proud of our two staff members in this field and particularly pleased that one is chairman of the Nutrition Section of the Southern Branch of the American Public Health Association.
Tuberculosis continues to be our major communicable disease problem; however, we see evidence that it is slowly yielding to the influence of the new drug therapy (see Division of TB Control).
We have had a few small outbreaks of diphtheria but were able to bring them promptly under control,
Even though the venereal diseases are much less widely spread it is evident that constant alertness must be maintained.
Our most powerful weapon in the field of communicable disease is continued and increasing emphasis on education of parents to use the proven vaccines at the proper age for their children,
- 32 -

SOUTHEAST HEALTH REGION
Health District Organization. The Region functioned during the past year as an organized region with 5 districts fully staffed, except for 2 district directors of public health nursing.
Foreign Public Health Physicians. Eleven foreign public health physicians received an average of 2-weeks training in basic sanitation during past year.
Public Health Education Via Radio. There were 306 weekly broadcasts of 15 minute programs prepared by the American Medical Association. These were broadcast from all district headquarters counties to half a million people.
Health Center Construction. Liberty County completed a new health center. Pierce County has a health center under construction.
Environmental Health Services. Milk control programs were much improved. Two major pasteurization plants converted from holding to short-time pasteurization methods; one shed converted from can to farm holding tanks; less than 1000 gallons of milk is being pasteurized daily by holding method. Milk samples increased 40o/o. There were 10 violations to phosphatase test. There was a small reduction in coliform contents.
Twenty-nine food service personnel conferences were held, total attendance 1695; 44 dish machines were checked; almost without exception corrections had to be made before 29 received approval of health department. An intensive effort was made to have all dish machines in the region meet the rigid standards of the National Sanitation Foundation. Aid to school construction was continued.
Nursing. Emphasis was placed on a planned school health program, All - 33 -

nurse supervisors attended an interviewing workshop; 3 nurses attended a short course on cardiac nursing at the University of North Carolina; one nurse supervisor took a course on alcoholism at Yale University. One director of nurses attended a workshop on nursing homes. Two nurses attended an obstetrical seminar at Daytona Beach; 14 mother and baby care classes were taught during year, with 961 in attendance. Nursing service analyses were made in 6 counties.
Nutrition, The region was fortunate in acquiring another nutritionist. The most interesting experience was serving on a team in Liberty County studying the emotional needs of the young child, The team was a psychiatrist, doctor, nurses, psychologists, social workers, welfare workers and nutritionist, There will be a follow-up on all cases. Communicable Disease Control. During 1957 two communicable disease investigators covered all counties in region, There was a 63 per cent increase in infectious syphilis from 35 in 1956 to 57 in 1957, Total syphilis was 239 cases each year, Gonorrhea showed a 30 per cent decrease, dropping from 414 in 1956 to 2 92 in 19 57. Clerical, A marked improvement was noted among county clerical personnel in promptness and acc~racy of reporting, budgets and orderliness of files. Much help was given at Berrien County from September-December due to replacement of a clerk. All reports were prepared and typed for Jeff Davis County, which has no clerk. Tuberculosis case registers were reviewed in 11 counties; x-ray clinic schedules were set up for all counties, In cooperation with GeorgiaCornell Automotive Crash Injury Research program valuable information concerning crash injuries was gathered and coordinated during a 6-months period,
- 34 -

SOUTHWEST HEALTH REGION
Location. Twenty-eight counties in southwest Georgia. Area. 10,594 square miles. Population. Approximately a half million. Rural 65%; urban 35%. Trends. Decreasing total and rural non-white. Increasing white and urban. Physicians. Approximately 250; Ratio - 1 to 2000 population. Dentists. Urgent need in more rural areas. Hospitals. Three counties without hospitals. Mental Health Facilities, None.
Full-Time Local Public Health Personnel. Medical officer - 4 for 8 counties; director of nursing- 1 for 3 counties; public health nurse supervisor 2 for 2 counties; public health staff nurses - 55 in 26 counties; director of environmental sanitation- 2 for 6 counties; sanitarian- 15 in 12 counties; clerks 29 in 24 counties.
Full-Time Regional Public Health Personnel. Medical director - 1; nurse consultants - 2; public health engineer - 1; sanitarians - 2; nutritionists1; communicable disease investigators (venereal disease)- 5; epidemiologistentomologist - 1; clerks - 4.
Personnel Needs. Medical officers - 3; director of environmental sanitation - 5; public health staff nurses - 45; sanitarians - 10; clerks - 15.
Communicable Diseases. Influenza and influenza-like disease increased cases; diphtheria - sporadic occurrence; typhoid fever - sporadic occurrence; hookworm disease - unchanged; tuberculosis - decreased mortality;
- 35 -

case rate unchanged; poliomyelitis - decreased case rate and mortality. Venereal Disease. Investigations - 6, 531. Found and brought to treat-
ment: primary and secondary syphilis - 141; early latent syphilis - 113; other syphilis - 541; gonorrhea - 951; other V. D. - 23. Reported primary and secondary syphilis- 100% increase in 1957,
Sanitation. Investigations, inspections and reports were made on special programs for school building services, school lunchrooms, F. H. A., V. A. , soil conservation, hospital service, and public welfare. Food or milk programs surveyed- 8, Foodhandler training courses - 3, Participation in school custodial clinics,
Nutrition, Good health and nutrition promoted and taught in MCH clinics, crippled children's clinics and schools through consultation, conferences, group classes and de mons trations,
Nursing. Supervision and consultation have stressed premature care, nursing responsibilities in tuberculosis and new bag technique. Advantage has been taken of special conferences, workshops and short courses. Motivation and interest improved.
Epidemiology- Entomology. Investigations and research - ticks, mosquitoes and fire ants. Eastern equine encephalomyelitis outbreak, and eye gnat's role in its transmission, Surveillance of large water impoundments for mosquito control,
In-Service Training. Conferences, group meetings, short courses. Two 2-day civil defense schools,
- 36 -

HEALTH CONSERVATION SERVICE
Division of Maternal and Child Health (Nutrition Unit)
Division of School Health Division of Mental Hygiene Division of Crippled Children

DIVISION OF MATERNAL AND CHILD HEALTH
In 1957 the medical, nursing and health education personnel of the Maternal and Child Health Division were active in the promotion of activities set forth in the proposed Five Year Plan of 1956 through 1961.
Particular emphasis has been placed on: ( 1) Developing educational programs for medical and nursing schools and for hospital and health department personnel in maternity and newborn care; (2) Promotion of more effective interviewing techniques through workshops; (3) Continuous medical and nursing supervision of the well child, including the infant, and of expectant mothers; and (4) Improvement of hospital-health department relations and understanding. Consultation was given to at least twenty hospitals in the state to improve facilities, policies, practices and services for mothers and newborn infants and children.
Program appraisals have been continued with local health department staffs, with special emphasis on maternal and child health activities. Staff members have been encouraged to follow through on this either directly or indirectly on each visit. There has been increased utilization by the staff, of the various elements of evaluation incorporated into records and forms that are used on a state-wide basis.
There has been an expansion of maternal and child health clinic activities to include more counties and staff. More counties should be included.
Special mention should be made of activities in the field of mental retardation. The addition of one full time physician to the staff materially imple-
- 37 -

mented program development. A state-wide plan was developed with emphasis on improving the total maternal and child health program through education and services, focusing on prevention and early detection of mental retardation, and providing counseling for the families of these children.
A special mental retardation project was approved by the Children's Bureau, U. S. Department of Health Education and Welfare. This was one of 28 such projects approved in the United States and involved an additional $40, 000. Great progress was made in prevention of retrolental fibroplasia, a condition which may develop in the eyes of premature infants who have received a high concentration of oxygen usually over a long period of time.
The staff worked wi.th the Medical Association of Georgia, Georgia League for Nursing, Parent-Teacher Association, the Department of Education, the Department of Welfare, Grady Memorial Hospital, Emory University, and the Medical College of Georgia, as well as every division of the State Health Department, and at least 60 local health departments, 57 hospitals, and 500 staff members of hospitals and health departments.
No progress has been made in expanding the nurse-midwife program, although this program is still being used to meet the maternity care needs in the state. Much needed training for lay midwives continues to be difficult, nonproductive in terms of numbers, and expensive, leaving much to be desired. Assistance from the Children's Bureau has been requested. A survey by the Division indicates many other states have similar problems. Local and national recognition, and understanding and cooperation are needed, particularly in the medical and administrative groups.
- 38 -

NUTRITION UNIT (Maternal and Child Health Division)
Personnel. The nutrition staff remained the same during the year, with the addition of one district nutritionist. An additional dietary consultant was employed by the Heart Disease Control Program but works chiefly under the direction of the Nutrition Unit.
Post-Graduate Training. Three nutritionists attended out-of-state training courses.
Staff Activities. There have been no major changes in the work of the unit. Major emphasis continues to be on work with mothers and children, either through other public health P.ersonnel or through a limited amount of direct service, There were 3 meetings with nurses in the regions and one district meeting on prenatal care. A new leaflet, "Low Salt Diet in Pregnancy," was prepared, Work with midwives was continued as an additional way of helping pregnant women.
Work was continued with crippled children both in clinics and in home visits. All staff members took part in 3 growth and development conferences arranged by the Crippled Children's Division.
All of the nutritionists participated in one of the workshops on interviewing sponsored by the Divisions of Maternal and Child Health, Mental Hygiene, and Nursing. All have made and criticized tape recordings of interviews with patients.
The dietary consultant worked on the advisory committee for the course to train food service supervisors for small hospitals. She and s orne of the
- 39 -

nutritionists lectured to this group. The dietary consultant helped instruct a course for lunchroom managers. Training on diet therapy was given to a group of student practical nurses.
The nutritionists and dietary consultant worked with sanitarians in. courses to 4 groups of restaurant personnel, and with the Division of Hospital Services in institutes for food service personnel. One institute was held for diabetic patients and their families. Home visits were made as a follow-up.
Consultation was given to some children's homes and it is hoped that this work will be expanded. Managers of one juvenile detention home were trained in making menus. Work was continued with the 2 Florence Crittenton Homes and with a group of visually handicapped women in Atlanta.
Nutrition education was done in medical and nursing schools, colleges and universities, elementary and secondary schools and day nurseries, and in public health orientation of new nurses.
Two of the nutritionists worked in 2 mental health projects on maternal deprivation.
Interagency. All of the nutritionists worked with other agencies, such as the Georgia Nutrition Council, the Georgia Home Economics Association, and the Georgia Dietetic Association.
Services to Schools of Public Health. One nutritionist was given a 3 -month leave of absence to teach in a school of public health.
Research and Studies. Much time has been spent in planning and getting started on 2 studies on heart disease control.
- 40 -

DIVISION OF SCHOOL HEALTH
There are now fine staff members--the director, the consultant nurse (attending the University of Minnesota to obtain a Master of Public Health degree), two audio-visual testing instructors, and a secretary.
Health Services, 1956-57 school year, total enrollment, 939, 104, Hearing tests, 89, 329; failures, 4, 579. Vision tests, 161, 398; failures, 13,427, The vision and hearing manuals were revised. The audio-visual instructors made 56 visits to regional and 176 visits to county health departments, 154 to schools, and instructed 122 groups or 1, 020 people, Visits were made to 14 local health departments to review or begin school health programs,
Health Instruction, The Division took part in health instruction workshops in teacher training colleges to help teachers become better qualified to teach health, The Division worked with the State Department of Education and its coordinator of physical education, recreation and health as well as the Joint Committee of the Health and Education Departments on problems concerning both departments, The Division worked with Health Education Division using newspapers, radio and TV to provide health information for parents.
In-Service Education, The Division arranged for medical speakers on school health topics at the annual meeting of the Georgia Public Health Physicians' Association, A course on audiometry and speech at the University of Georgia was attended by the director and audio-visual ins~ructors, The director audited a course in public speaking at Emory University to help the staff and others interpret more effectively school health services and policies to the public.
- 41 -

The director also assisted in a course on school health for nurses in the Atlanta area, presented by Peabody College,
Other Agencies, Worked with the Medical Association of Georgia, the Georgia PTA Council and individual PTA groups, the Georgia Optometric Association, and the National Society for the Prevention of Blindness,
Future Plans, The recent formation of a school health committee in the Medical Association of Georgia brings private physicians into a closer relationship with the school health program,
Cooperative efforts will be made toward uniformity of laws requiring a periodic physical examinations of all teachers,
A film on vision testing procedures will be made with the assistance of Health Education Division and the Communicable Disease Center, U. S, Public Health Service,
School Health and Crippled Children's Divisions will start clinic centers for diagnosis and treatment of hard of hearing children. Successful programs throughout the country are being studied and some visited to choose the best plan,
Increasing incidence of diphtheria in older children has pointed up the need for more emphasis on immunization of this age group, The Health Department now has two types of diphtheria-tetanus vaccines, one for children under 10, and one for children above 10.
The Division director is a committee member of the Georgia Heart Association, The Division and the Heart Association will use every facility to alert parents and teachers about the importance of detection and control of rheumatic fever in school age children,
- 42 -

MENTAL HYGIENE DIVISION
The Mental Hygiene Division drew up a plan in 1952, revised 1955-57, for carrying out its activities in the State and it continued to follow this plan during 1957.
Personnel. A director, a psychologist and 2 social workers have been added to the staff. One social worker transferred from a regional office,
Child Guidance Clinics. Bibb, Chatham, DeKalb and Fulton counties operate clinics, Muscogee County has obtained a psychologist as director of their mental health program which will include a child guidance clinic, Rome and Brunswick have obtained local funds and are recruiting personnel. Athens, Augusta, Albany and Valdosta are interested in beginning a similar program,
Services to the Mentally Ill. Patients and families are counseled by the public health nurse through all stages of the patient's illness. This service is offered now in 22 counties, and 10 additional counties will begin the service in 1958. This program will continue to be expanded until it includes every county.
Intensive Treatment Program in General Hospitals. Beginning in July, $75,000 was allotted quarterly for hospital and professional services for medically-indigent patients with emotional disorders. The program includes only those patients who might otherwise require commitment to the Milledgeville State Hospital and who are likely to be helped by short term intensive treatment in the psychiatric ward of a general hospital. Talmadge Memorial Hospital has be gun to admit patients and Macon Hospital and the Medical Center in Columbus
- 43 -

will be gin soon. Geriatrics Unit. A director was employed in 1957. Special Projects. A workshop on juvenile delinquency was held with
representatives of education, welfare, health, probation, and police from 9 counties. Follow-up was done in most of the counties and a pilot project planned to study juvenile delinquency problems in Spalding County.
The Division 1s Maternal Deprivation project including case finding, screening, clinical evaluation and beginning family rehabilitation was expanded to Liberty County. A seminar was presented to Cobb County to show the results of a repeat clinic on cases seen originally in 2 other clinics of the Maternal Deprivation project.
Consultation and Educational Services. The following services were given by the State office to counties or districts not having local services: collection and dissemination of resource information; conducting study courses and group discussions; in-service training for professional workers; and providing films and educational material in cooperation with the Divi sian of Health Education.
Research and Evaluation. A statistical survey was made of 3 child guidance clinics. A special project will begin in DeKalb County to evaluate screening methods used to locate children with severe emotional disorders.
Cooperation with Other Public Health Programs. The Division participated in 5 interviewing workshops, the planning of growth and development workshops and in the staff conferences of the Crippled Children's Division.
- 44 -

DIVISION OF CRIPPLED CHILDREN
The year 1957 was one of further expansion for the Crippled Children's Division. In April, an office was opened in Macon and a clinic started to serve Bibb and fourteen surrounding counties. A nurse and clerks are in the office and an orthopedic surgeon and pediatrician are on the medical staff. The office is located in the Central Region Health Office and the clinics are held in the Macon City Hospital. There are now nine clinics located in Macon, Albany, Atlanta, Augusta, Columbus, Cordele, Savannah, Thomasville and Waycrosso
During the year, the Division reviewed the activities and changes in procedures for the past ten years as a basis for future planningo
Taking medical care nearer the patient has meant the opening of new clinic centers or holding itinerant clinics. This increases the cost of equipment, personnel and travelo
More comprehensive care is being given in the clinicso Pediatricians now attend all clinics and psychologists, physical therapists and speech therapists attend as needed. All these are paid fees.
Staff physicians have shown a greater concern to rehabilitate each patient to the maximum degree. This has included not only medical consultation but also convalescent or boarding home placement where certain factors such as change of home environment or psychiatric care were needed.
Children referred to the Crippled Children's program have increased from 60 to ZOO per mo"nth. Better care means good publicity and referrals
- 45 -

always increase in direct proportion. There has been a growth of 700 per cent in the number of children
treated. The cost of hospital care has risen 165 per cent, The budget has increased only 65 per cent.
In spite of rising costs and increased demand, expenditure per child has dropped 25 per cent due to better planning.
The professional staff of nurses, medical social workers and physical therapists has remained almost the same.
Future expansion is now largely dependent on finding additional staff to administer the program and in increasing the budget.
- 46 -

PREVENT ABLE DISEASE SERVICE
Division of Epidemiology (Cancer Control and Veterinary Activi ties)
Division of Venereal Disease Control Division of Occupational Health
(Also see Industrial Hygiene) Division of Tuberculosis Control Division of Chronic Diseases Civil Defense Health Services

DIVISION OF EPIDEMIOLOGY

General Considerations. Although the position of the Division has

changed materially with the decline of the mortality rates and reported morbidity

rates attributed to the acute communicable diseases, many of the problems re-

erred to the Division appear to differ only in degree from those encountered in

the heyday of infectious disease. This situation arises in part from the lessened

emphasis given to communicable disease activities by the Divisions of the De-

partment other than Epidemiology and the Laboratory. It also arises in part from

the apparent inherent ability of disease organisms to maintain themselves in

human populations despite improved preventive and therapeutic measures. It

sometimes seems that ''the more things change, the more they remain the same."

Morbidity. The adaptability of communicable diseases makes careful

watch upon their behavior desirable, This is especially true since morbidity

reporting by physicians is now spotty and inconsistent and does not reflect the

average experience, In order to supplement reported data, case investigations

are now made of:

Poliomyelitis

Influenza

Infectious Hepatitis Rocky Mountain Spotted Fever Brucellosis (in part)

Malaria Leptospirosis Psittacosis

Typhus

Eastern and Western Equine Encephalomyelitis

All animal-borne diseases transmissible to man

Aseptic Meningitides (generally)

To this list, diphtheria has now been added since the occurrence .of the disease is consistently higher in Georgia than in certain other states and higher in 1957 than in 1956. The reasons for this apparently avoidable morbidity obviously need
- 47 -

to be ascertained. As influenza increased last fall, the available data showed little geo-
graphical relationship to the incidence of disease as described in newspaper accounts. A query sent to all county health departments requested data on schools, on industrial absenteeism, and on the opinions of selected physicians. The response was satisfactory in all respects and made it possible within a few days to define the characteristics of the influenza outbreak in Georgia. Following this example, plans are being made to test a reporting system based on periodic queries to a representative sample of general practitioners and pediatricians selected at random.
Field Studies. The Georgia Department of Public Health is collaborating with the University of Wisconsin and the U. S. Department of Agriculture in a study of rapid field methods for the isolation of viruses which affect animals and man.
Assistance was rendered in the planning and establishment of a Heart Disease Control research project on the relationship between diet and atherosclerosis. Also considerable time has been required toward the establishment of Poison Control Centers and the development of studies on the epidemiology of highway accidents.
In summary, the functions of the Division of Epidemiology are essentially unchanged. The difference lies in the evaluation of factors which impair human effectiveness in terms not of patent disease but of their relationship to health.
- 48 -

DIVISION OF CANCER CONTROL
During the past few years, the state -aid cancer control program has operated at a fairly constant level. There has been a slight upward trend in the case load and it is expected that this trend will continue. However, no major variation in the case load or expenditures is anticipated in the immediate future.
Since 1952, the case load has been slightly above 4000 cases per year and about 75 per cent of the cases are malignant. Although the general trend has been upward, the number of cases diagnosed and treated in 1957 was approximately the same as those for 1956. Moreover, expenditures during 1957 showed a moderate decline. This was accomplished through continued efforts to reduce the number of days in the hospital. Expenditures continue at a rate of approximately $400, 000 per year.
Hospital Rates. The actual cost of providing hospital care has not increased appreciably during the past few years. However, newer accounting methods at many hospitals have led to the discovery of hidden costs which were not previously included in the per diem rate. This, in turn, has led to requests from numerous hospital directors for a revision of the rates paid for state~aid patients. In August, 1956 the executive committee of the Cancer Commission of the Medical Association of Georgia, which serves as an advisory committee to the Division,approved an adjustment in rates which became effective January 1, 1957. No further revisions were made during 1957 but it is anticipated that a slight adjustment will be necessary in 1958.
New Clinics. In December, 1957 the Tumor Clinic at the Hall County
- 49 -

Hospital, Gainesville, Georgia was approved as a state-aid treatment center, The clinic had been notified previously by the American College of Surgeons that it met the College's minimum requirements, With this approval, there are now 20 state-aid clinics participating in the program,
Eugene Talmadge Memorial Hospital. This hospital is playing an increasingly active role in the treatment of state-aid patients. It is now possible to transfer to this hospital without delay patients from other clinics where facilities are not adequate to provide the necessary therapy. Moreover, late in 1957 the hospital authorities asked to have some of the more common types of cancer referred to them for teaching purposes. Following a meeting with hospital staff representatives, arrangements were made for referring such cases directly to the hospital,
Cancer Registries, The establishment of cancer registries in hospitals with tumor clinics progressed during the year, Dr. William Vogler, U. S. Public Health Service physician assigned to Emory University, served as a consultant in the establishment of registries throughout the year. An increasing interest in the development of suitable registries resulted in about two-thirds of the hospitals having adequate cancer registries at the end of the year,
Professional Education, The Division of Cancer Control continued to distribute the Cancer Bulletin to all physicians in the state, This publication has interested physicians considerably and the advisory committee considers its continued distribution well worthwhile.
- 50 -

VETERINARY ACTIVITIES (Division of Epidemiology)

Rabies incidence has remained almost static for the past 2 years although

there was a slight increase in 1957. This was due largely to wildlife rabies in

several counties in southeast Georgia during the fall of 1956 and the spring ofl957.

As was expected wildlife rabies burned itself out in the above counties

but spread north into counties heavily populated with wildlife, notably Bulloch,

Jenkins, Candler, Berrien and Cook. Fox rabies was present in North Florida

in epidemic proportions and spread over into the adjoining areas in Thomas,

Brooks and Lowndes. Control programs are in operation or being planned in

Bulloch, Candler, Jenkins and Berrien.

Rabies in dogs increased over 1956 due to outbreaks in the summer and

fall in Pike, Spalding, Clayton and Fulton Counties. Free state-county dog im-

munization programs were completed in Spalding, Pike, Lamar and parts of Ful-

ton and Fayette Counties, The disease appears to be checked except in Fulton

County partially because of organized opposition to recognized methods of control.

There was only one bat with rabies reported in Georgia in 1957.

The following is a brief summary of the positive heads (indicating rabies),

by species, reported in 1957:

Dog

Fox

Cow

Cat

Horse

Bat

Total

67

97

12

15

3

1

195

Brucellosis. There were 23 proven cases of undulant fever in Georgia in

1957 evidenced by positive agglutination tests. Br. suis was isolated from 4 and

Br. abortus from 3 of the cases. As in the past, most of the patients resided in

- 51 -

middle or south Georgia, Georgia is the largest hog producing state in the country except some of the midwest corn belt states. Br. suis will continue to be a public health problem in south Georgia until swine infection is brought under control,
Leptospirosis. Leptospirosis continues to be common in dogs and cattle and occasionally in other animals. This is predominantly due to~ canicola and L. pomona, One 16 year old child was found to be positive for~ australis, a strain previously found only in Australia and in raccoons. This case is still under investigation, It has been reported in raccoons in southeast Georgia and in raccoons and foxes in North Carolina, The nature of the infection is such that control or eradication is difficult or impractical. Happily human infection is comparatively rare except following swimming in contaminated stagnant swimming pools or ponds.
Encephalitis. The investigation of encephalitis and vesicular disease reported in 1956 is still in progress.
Asiatic Influenza. Because of presumptive evidence of this virus being found in swine and that these animals may act as a reservoir of the infection, some work has been done on attempts to isolate the virus from swine herds affected with clinical influenza, This phase of the infection is still under investigation,
One reported loss of cattle near Warrenton was investigated because of the allegation that their death was due to chlorine content of effluent from the city sewerage disposal plant. The circumstances involved and symptoms reported indicated that chlorine had no significance in the reported deaths. It is hoped that this had prevented any legal proceedings.
- 52 -

DIVISION OF VENEREAL DISEASE CONTROL
New Venereal Disease Cases Reported. Total syphilis cases reported for 1957 were 3785, showing a decrease over the 4258 cases reported for 1956.
The 630 cases of primary and secondary syphilis reported for 1957 shows a marked increase over the 556 cases reported for 1956 (13o/o increase).
The 12,385 cases of gonorrhea reported for 1957 shows a slight decline from the 13,831 cases the previous year.
There were 378 cases of other venereal disease reported during 1957 as compared with 485 cases reported last year.
The above decline in total syphilis reported is considered a direct indi~ cation of the leveling-off in total syphilis in Georgia.
The marked increase in primary and secondary syphilis cases reported for 1957 is attributable to concentration on early case finding through "cluster testing," a new case finding technique.
Communicable Disease Investigation Program. The communicable disease investigators completed 30,212 investigations during 1957 as compared with 23,318 for 1956.
From these investigations 6086 cases of previously unknown and untreated venereal disease were brought to treatment as compared with 6860 brought to treatment during 1956. This indicates a true decline in total venereal disease morbidity.
Of these 542 were primary and secondary syphilis cases as compared with 427 primary and secondary syphilis cases for 1956.
- 53 -

This established an unprecedented record for both volume of investigations and production of early infectious cases.
It is interesting to note that 542 of the total 630 primary and secondary syphilis cases reported for 1957 were brought to treatment through the efforts of the communicable disease investigators.
Diagnostic and Treatment Centers. During 1957, 11,543 cases of venereal disease were treated in the diagnostic and treatment centers. This shows a decline from the 13,287 patients treated in these centers during 1956.
This continued decline in patients treated in the diagnostic and treatment centers is attributable to the increased number of patients being treated by private physicians.
Gonorrhea Speed-Zone Projects. These are speeded-up epidemiologic studies within specified zones, made in an attempt to reduce gonorrhea within the zones. During 1957 the gonorrhea speed-zone projects of Fulton and Muscogee Counties and the program of gonorrhea epidemiology on a state -wide basis indicates that the same epidemiologic procedures that have applied to syphilis over the years are effective in gonorrhea control. The project in the ColumbusMusco gee area has been particularly successful.
Needs. The most urgent current need is for more good diagnostic and treatment centers and a few more good investigators. The recent salary adjustment should make the recruitment of investigators less difficult.
- 54 -

DIVISION OF OCCUPATIONAL HEALTH
The Division's primary function is to protect the health of employed people in relation to their work and working environment. This is achieved through promotion of health services to industries and investigation of occupational diseases.
Georgia State Employees Health Service, The State Employees 1 Health Service strives to impress upon each State employee a responsibility for his own health and to encourage him to do some thing about any defect in his health by informing him of the services available in his community for maintaining health. This is done by a series of health screening tests offered to employees annually on a voluntary basis. During 1957, there were 1507 employees who took the health tests. State Employees Health Service also provides emergency treatment for accidents and illnesses which occur during working hours.
Occupational Health Field Training. Three students from the Medical College of Georgia School of Nursing had a one month observation training course in occupational health nursing. Two weeks of this course were spent in the Georgia State Employees 1 Health Service,
Professional Schools, The Acting Director of Occupational Health was appointed as Associate Professor in the Department of Preventive Medicine and Community Health recently established at Emory University. He will teach junior medical students the medical applications of occupational he<;~.lth, Interns will receive training and experience in the State Employees 1 Health Service. The consultant nurse in Occupational Health was appointed to the faculty of the
- 55 -

Medical College of Georgia School of Nursing. Educational Programs. A workshop for industrial nurses was held at
Radium Springs in September. A symposium for industrial nurses was held in Atlanta in May. Subjects for this symposium were, "Workmen's Compensation," "Safety," and "Returning the Cardiac to Work." At the request of the Georgia Association of Industrial Nurses, a program on "Safety in Action" was held at the Georgia Institute of Technology. Thirty-five persons received certificates
for satisfactory completion of 6 weekly sessions.
Civil Defense. The Acting Director of Occupational Health is also the Deputy Director of the Civil Defense Health Services, and continued work in this capacity.
Industrial Health Council of Greater Atlanta, Inc. The Division continued cooperation with the Council regarding health tests screening in commerce and industry. The Council screened 10,699 employees in 1957.
Projects for 1958. 1. Investigation of occupational diseases. 2. Maximum allowable concentrations of dusts, fumes, mists, gases, and
vapors recommended by the American Conference of Governmental Industrial Hygienists and Georgia Department of Public Health to be approved as a guide by state and local boards of health. 3. Research projects on blood sugar and kaolin. 4. Approval by local medical societies and local boards of health of multiple health screening of employees in commerce and industry. 5. The early establishment and maintenance of occupational health programs in all local governmental agencies for their employees.
- 56 -

DIVISION OF TUBERCULOSIS CONTROL
There was a 4. 5 per cent increase in tuberculosis deaths during 1956, the first increase in 10 years. Provisional figures for 1957, however, indicate a return to the downward trend. Newly reported cases increased for the first time since 1953.
Tuberculosis remains a dangerous, insidious, chronic, and very costly disease, causing more deaths than any other contagious disease. Early diagnosis and hospitalization would prevent many new cases, as well as. reduce death rates, treatment expense, and rehabilitation and financial aid to patients and families. About 70 per cent of the active and probably active cases either hospitalized or at home are moderately or far advanced cases. Under 10 per cent of the active cases are found while still in the early stages.
The Division is quite concerned that hospitalization for active cases of tuberculosis continues a downward trend. Many beds at the tuberculosis hospital, maintained at great expense, are empty. There is an urgent need for a period of hospitalization for practically every case of active tuberculosis.
Of the 13,972 cases in the Central Tuberculosis Case Register at the close of the year, 2, 179 were hospitalized. There were 6, 323 active and probably active cases at home, however, many are not under treatment or adequate supervision. Free anti-tuberculosis drugs prescribed on discharge by the hospital were supplied to local health departments for post-hospital chemotherapy of 2, 158 patients.
There were 467 x-ray clinics held in 131 counties with 24,250 x-rays made. These, plus 6, 080 films sent in from various sources, were interpreted
- 57 -

by the Division. County health departments admitted 11,074 cases, 10,837 suspects, 20, 546 contacts, and 43, 994 others to tuberculosis service.
The Division continues to render technical x-ray services which save the state and counties many thousands of dollars yearly. X-ray films costing $42, 557 were supplied to local health departments for x-ray clinics, the state prison for x-ray of inmates, and 4 general hospitals for admission chest x-rays.
Rehabilitation and tuberculosis case work services have been in great demand and have been carried out as far as possible with limited personnel. The rehabilitation consultant also aided in arranging for legal commitment to Battey State Hospital of recalcitrant, contagious cases.
The Division's consultant nurse set up 5 new county case registers and helped keep 144 others up to date.
Three tuberculosis evaluation and diagnostic centers were established m 1957. The one for west central Georgia, started in July, is holding clinics monthly in Columbus and LaGrange ~ith aU. S. P. H. S. tuberculosis specialist in charge, In September, similar clinics were started in northwest Georgia with a clinician from Battey in charge, Clinics have been held twice monthly in each of 5 northwest Georgia health districts, Studies have been done on 278 patients; 20 new cases were diagnosed; and 158 known cases evaluated and counseled. Fourteen patients were classified as TB suspects, and scheduled for further study, There were 86, many of whom had long been classified as suspects, who were found to be negative of tuberculosis, An evaluation center in Augusta for east central Georgia was organized in late 1957. Similar centers for other parts of the State will be organize-d in 1958.
- 58 -

DIVISION OF CHRONIC DISEASES A full chronic disease program was not activated in 1957 because of restrictions in financial and personnel arrangements.
Heart Disease Control Program Heart disease continues to be the leading cause of death and disability m Georgia and every effort is being made by the Health Department to control as many phases of this disease as possible. The Heart Disease Control Program is a part of the Division of Chronic Diseases, and operates in close cooperation with many other agencies concerned with chronic diseases in Georgia and particularly with the Georgia Heart Association. Administrative. The administrative staff consists of a half-time director, a full-time physician assigned by the United States Public Health Service and a senior stenographer. Educational. The educational program has continued to be active with distribution of many films and printed materials on heart disease. The Heart Bulletin, a bimonthly publication of the Medical Arts Publishing Foundation, Houston, Texas, was distributed to all medical students and medical libraries in the State, as well as to all private physicians expressing a desire to receive it. A Directory of Cardiac Services in Georgia was compiled and sent to each physician in the State as well as other medical personnel. Clinical. The clinical functions of the program continued primarily in the Georgia Heart Clinic system. There were 15 active clinics at the beginning of the year and during the year a new clinic opened in Gainesville. The Heart Disease Control Program also contributed to the heart disease work of the
- 59 -

Crippled Children's Division. A major clinical program has been the distribution of drugs for the treatment of rheumatic fever. This is done through the clinic and through private physicians who have patients who cannot afford to purchase these drugs. During the year, a cardiovascular laboratory was cqmpletely equipped at Emory University Hospital by the Program for the use of the clinics throughout the state in studying their cardiac problems. This non profit laboratory is being operated for the first year on a demonstration basis by the Heart Disease Control Program. At the end of that year, it is anticipated that this laboratory will be self supporting.
Research. The need for research is evident in this Program. A project to study the epidemiology of atherosclerosis in Georgia was submitted to the United States Public Health Service and approval was granted for slightly over $200, 000 for a five year period to carry out the project. A full-time laboratory director, two full-time technicians, a maid and a full-time dietitian have been employed for this atherosclerosis study.
Plans and Needs. Major planning needs to be done for patients who are incapacitated by strokes and plans are to develop a rehabilitation program for these patients in cooperation with the Division of Vocational Rehabilitation, State Department of Education. Special attention will also be given during the year to development of the cardiac program of the Crippled Children's Division. All present programs will be continued during the coming year.
- 60 -

CIVIL DEFENSE HEALTH SERVICES
The staff of the Georgia POSP (Georgia Preliminary Operational Survival Plan) has worked out a plan outlining the course of action to be taken when a civil defense emergency threatens or has arisen, The Health Department worked with Major Tom Turbiville, POSP staff member, in the preparation of the health annex to the plan,
All civil defense health work can be classified as either medical care for the sick and injured, or as public health. The director of the Georgia Department of Public Health is also director of Civil Defense Health Services. Each employee of the health department is automatically a civil defense worker.
Medical Care, The physicians, nurses, medical technologists, and the many other professional and semi-professional persons concerned with the care of the sick and injured are organizing themselves for disaster preparedness, The community hospital is the natural ready- made organization for these people to use as a starting point, The hospitals have accepted their responsibility and are developing individual disaster plans, realistically emphasizing natural disasters, The Georgia Department of Public Health has a special consultant assisting them in these plans. This work has the support of the Georgia Hospital Association and its six hospital area councils,
The civil defense committees of the hospital area councils and the many individual hospitals are making excellent emergency preparations, including plans for pre-positioning of Federal Civil Defense Administration emergency hospitals.
Public Health, Public health is responsible for safe guarding the health - 61 -

of all our people from physical, chemical and biological hazards in the environment. This means safe ground, safe air, safe food, safe water. It works for control of infectious and occupational diseases, as well as accidents and poisons.
The Georgia Department of Public Health has accepted its responsibility for control of radiation.
Every science teacher and student in our high schools and colleges is asked to participate. The Health Department with the assistance of State and Federal civil defense departments is preparing to furnish training kits to cooperating science departments in our schools. The kits contain survey meters, comparison standards for food and water contamination measurements, dosimeters, chargers, and other items.
Activities. An intensive training course is being developed, using POSP as the basic test.
A 200-bed civil defense emergency hospital, transportable by truck, is stored at Emory-at-Oxford, in Covington. It will be used for training. The FCDA will supply, on approved request, an emergency hospital for each 100, 000 citizens in Georgia. Each hospital should be stored within a radius of 50 miles from the disaster area and attached to the parent hospital which normally serves the suppo.rt area. Such FCDA hospitals can be used only in major disasters designated by the President of the United States.
Application has been made to the FCC for licenses for a two-way radio communication system. Licenses are expected early in 1958.
The State Health Department and all local health departments participated in Operation Alert in July.
- 62 -

lAB ORATORY SERVICE
Division of Laboratories

----------~----------------
DIVISION OF LABORATORIES
Examinations totaled l, 020, 602 in 1957, a decrease of 20, 137 or 1. 9o/o from 1956.
The Microscopy Sections examinations increased 8, 034. A total of 1,200 animal heads were examined for rabies, 177 more than 1956. Positive findings rose from 167 to 195. For the 3rd consecutive year, more foxes than dogs were found rabid. A total of 345 antirabic treatments were furnished compared to 237 in 1956. Of 840 diagnostic throat cultures examined for diphtheria, 61 were positive, a 42. 1o/o increase over 1956. There were 54,659 TB cultures made in the Central and Battey Hospital laboratories, an increase of 1, 931. Positive cultures increased by 284, Two new tests were added: determination of catalase activity of tuberculosis cultures, and biological assay of sera for isoniazid content. One positive malaria was found in a returned missionary.
In the Culture Sections, 44 isolations of S. typhosa were made in 25 persons, of whom 12 were chronic carries and 13 were active cases. Ninetyphoid cultures from 5 patients and 2 carriers were typed for hospital laboratories, Other salmonella sera type determinations were made on 423 cultures. The state laboratories isolated and typed 179 shigellas and typed 61 shigella cultures from hospital laboratories. Over 400 specimens were processed and referred to the Communicable Disease Center, U, S. P, H. S. laboratories for serologic examinations. Examinations decreased from 48,772 in 1956 to 47,581,
Serologic tests for syphilis, totaling 27,861, decreased in all laboratories partly because of more selective specimen collections by communicable
- 63 -

disease investigators. Reactive results continued to decline. For the first time since the work began in 1947, Rh and blood group tests showed a slight decline. Of the 98 laboratories taking part in the serology evaluation study, 93 were approved, 3 dropped out and 2 did not request approval. Serology workshops were held in Atlanta, Rome, Columbus, Savannah, Augusta and Athens, Refresher courses were given 10 technicians and 19 laboratories were visited.
The Milk Sections performed 84, 339 examinations, an increase of 2, 520 over 1956. The penicillin inhibition test was started to detect penicillin in milk. The drug is used in the treatment of mastitis. Tests to detect reconstituted milk and sanitizing agents, used to lower bacteria counts, were added. The Central laboratory certified the Regional Laboratories and those in Muscogee, Chatham, Richmond, and Fulton counties to examine milk for interstate shipment.
A Virology S~ction was begun in August. The Asian influenza outbreak shortly thereafter concentrated diagnosis on this disease. Sixty isolations of A-Asian type virus were made from 186 throat washings. Of 201 blood specimens examined, 93 showed positive reactions for Asian influenza. Eighty-four specimens gave positive complement fixation reactions. Positive tests for influenza were obtained from 28 counties. There were 599 total examinations including the other virus and rickettsial diseases.
Preparation and distribution of silver nitrate ampules and tuberculin increased while typhoid vaccine decreased slightly. Over 900,000 specimen outfits, were prepared and distributed. The Biologic Section, which distributes biologics, drugs, and specimen outfits, was transferred to General Services Division. A 25% personnel turnover necessitated continual replacement instruction.
- 64 -