georgia department of public health annual report 1961--1962 State of Georgia Department of Public Health JOHN H. VENABLE, M. D., DIRECTOR 47 TRINITY AVE. ATLANTA 3, GEORGIA The Honorable Carl E. Sanders Governor of the State of Georgia State Capitol Atlanta 3, Georgia Dear Sir: It is my privilege to submit this Annual Report on behalf of the Board of Health. The report, covering the period July 1961 through June 1962 in which S. Ernest Vandiver was Governor, has been delayed because of numerous personnel changes. There have been many program changes, expansions and additions within this period. The expansion of local public health programs continues to be a major objective of the Department, with approximately one-third of the Department's available funds being used for direct assistance to counties for public health programs. The Health Department, with all state agencies, is operating in a period where transition and change are the norm rather than the exception. We are benefitting from the tremendous scientific break-through initiated by World War II and continuously expanded in the years that followed the war's end. With the new scientific advances have come new problems, problems that did not exist a few short years ago. As our laboratories modify and expand new techniques to prevent and combat disease through scientifically precise means we cannot ignore the less precise health problems of man in relation to his environment. The health picture is becoming the total human picture. Health workers must respond to this challenge by enlarging their individual skills. Physicians, nurses, sanitarians, health educators, public health engineers and all allied health disciplines are working in new areas, areas increasing in complexity. As Georgia grows in human and industrial population, air and water long taken for granted - become areas of increased health concern. International tensions, relaxed and then tightened, increase civil defense health responsibilities. Improved standards of living - diet, preventive medicine, new medications - are expanding our man power pool to include older citizens, still active and potentially productive. The mentally disturbed, once relegated to institutional custody, are returning to useful lives through growing scientific knowledge and growing public understanding of their problems. Infants and the young must reach their full potential with healthy minds and bodies. The traditional dividers between physical health and environmental health and mental health are becoming less well defined. Our goal must be maximum good health for all. The longer lives that science is providing us must be fruitful and productive. It is important that public health not limit its concern to new and emerging frontiers. It must also be concerned with maintaining surveillance over the older diseases if we are to enjoy total good health and all it means to productivity and to continued economic, social and personal development. ~896 307 43 *641 774 *436 2546 5643 ~~ Adjusted to show later information June 30, 1962 916 310 43 687 781 479 2545 5761 EMPLOYMENT TURNOVER June 30, 1962 Appointments Separations Net Gain Separation Rate Local Fulton A. R. S. State Battey Gracewood Milledgeville 155 45 8 243 153 122 440 1166 135 20 42 3 8 0 197 46 146 7 79 43 441 -1 1048 118 15% 14% 19% 30% 19% 17% 17% 18% - 5- VITAL RECORDS SERVICE During the fiscal year ending June 30, 1962, a total of 277, 370 records representing 224, 392 vital events were processed and recorded in the Vital Records Service. The events recorded were 99, 768 current live births, 35, 355 deaths, 3, 485 fetal deaths, 52, 978 marriages, 9, 307 divorces, and 23, 499 birth certificates filed by the delayed procedure. A total of l, 385 children born out of wedlock were legitimated during the year and four were delegitimated. New birth certificates were processed and filed for these children. Adoption orders for 2, 471 children were received and processed. New birth certificates were filed for l, 996 of these children. Superior court orders changing the legal names of 135 people were received and the birth certificates were amended in accordance with these orders. Over 7, 500 court orders to correct or amend errors in birth and/or death certificates were received, processed, and filed. During the year 39, 311 certified copies of birth and/or death records were issued and more than 100, 000 verifications of birth and/or death were made to parents, schools, welfare, and other governmental and private agencies. Microfilming the various records on file in the service has not proceeded as rapidly as hoped due to the difficulty in maintaining an adequate staff; however, considerable progress was made. Many technical - 6- problems involving the quality of film images of records obtained and the ability to reproduce these film images arise in a program of this type. These problems must and have been faced as they appear to the end that a maximum use of microfilm in the place of the original records will be possible. An internal reorganization of the service was begun during the year. This reorganization made it possible to render a more rapid and efficient service to the public. -7- PATIENT ACCOUNTS UNIT Working with the Department of Revenue the 1960 income tax returns on thousands of individuals were checked to determine the ability of the patient or other responsible persons, to pay some amount towards the cost of care and treatment of persons in institutions under the control of the State Health Department. Many letters have been written, telephone calls made and interviews conducted to determine the amount to be paid. -~ Most of the responsible persons are anxious to make payment for the patients but a few refuse and have requested the Hearing Officer to listen to their problems. Invoicing and collecting for Battey State Hospital was transferred to this unit in September, 19 61 and the Alcoholic Rehabilitation Service in January, 1962. There was an increase of 141% in the amount collected at Gracewood and an increase of 69% at Milledgeville over the previous fiscal year. The number of patients having the ability to pay is still small, seven per cent at Milledgeville and l 7% at Gracewood. The number paying at Battey, excluding those who have hospital insurance, is still very small. This is also true with the Alcoholic Clinics. More insurance companies are adding these diseases to their policies and as patients enter the institutions these companies should pay. In August, 1961 regular accounts were placed on IBM punch cards, making invoicing more simple. Due to some patients entering and leaving the institutions daily, much of the billing still has to be done by hand. - 8- Division of Physical Health '" r' dental health branch BRANCH OF DENTAL HEALTH Plans for the second year of the biennium anticipated an expansion in prevention, education, remedial and training services. The plans included provision for a clinical dental consultant and a dental hygiene consultant to be added to the staff. The new State Budget Act of 1962 which required advanced program and budget planning can be a serious obstacle to the implementation of emergency programs or to the inaugration of desirable services that are not included in the budget. In 1962 for the first time, the three regional dental consultant positions were filled. Progress of the total dental program is reflected in their relationship with the dental profession, local health departments and in their many community activities. There is a need, however, to establish a clinical dental service and to activate the dental public health service. The director positions of these two services need to be established and filled with qualified personnel. There are five full time public health dentists in district and local health departments, two of which are district directors of dental public health. Institutional dentists include eight at Milledgeville, three at Gracewood, and one full time and one part time at Battey. However, the positions at Milledgeville and Gracewood were fully staffed for only part of the year. The shortage of dentists in Georgia continues to prevent the full -9- staffing of public health dental clinics and institutional dental programs. Georgia ranks 46 in the nation with regard to the dentist-population ratio. Some interest has been shown in expanding dental school facilities in the State; however, there is a need also for a scholarship program to support the dental school training for qualified candidates who otherwise will not be able to enter the profession. There is also a need for training facilities both for dental hygienists and dental assistants. No accredited facility for such training exists in the State. The staff of the Branch of Dental Health conducted two accredited courses for the senior dental students at Emory University School of Dentistry: (one) a 16 hour course in public health, and (two) a 16 hour course in civil defense. The latter course included eight hours of the students 1 presentation of the medical self-help lectures. Two dental students and one recent dental graduate received general orientation in public health including experience in the dental survey conducted at Milledgeville State Hospital. In accordance with the established policy, professional and technical direction were provided to Milledgeville, Gracewood and Battey State Hospitals in the planning and operation of the dental programs. Staffing problems continue to exist in Milledgeville, especially the problem of maintaining the necessary complement of dentists throughout the year due to the short time and indefinite period of their employment. In order to plan more precisely for a program to meet the re- - 10 - sponsibilities for dental care services at Milledgeville, a survey of the dental needs of a sample of the institution's population was made. On the basis of detailed clinical dental examinations of l, 048 patients and prisoners, a plan is being completed including recommendations for personnel needs and treatment priorities. Employees and their dependents continue to utilize approximately one -fourth of the professional time of the dentists. Plans are being made for an evaluation of the dental program at Battey State Hospital, and perhaps at Gracewood during the next year. Upon the recommendation of a committee from the State Board of Health, the Local Health Branch contracted with District 28 to conduct a demonstration for the purpose of evaluating the potential of a full time dental director in extending and intergrating dental health services in the total district health program. Very favorable reports have been made during the first year of this project. A comprehensive evaluation will be made at the end of a two year period. - 11 - DENTAL PUBLIC HEALTH SERVICE Consultation and technical assistance were provided to local health departments, and to professional and community groups in the promotion of dental health. The Service continued to emphasize the importance of community water fluoridation, incremental dental care for children, and continuous dental health education. Preventive Services - Communities were encouraged to fluoridate their public water supply. Those communities fluoridating were urged to maintain fluoride in sufficient concentration to help insure effective protection against dental caries. Dental surveys, made in DeKalb County and in Athens after ten years of fluoridation and in Griffin after seven years, added evidence of the benefits of fluoridation. These studies pointed out the advantage of adding fluorides in sufficient amounts recommended by the Georgia Department of Public Health. The DeKalb report, which involved the findings of more than 13, 000 children, was prepared for publication in the Journal of the Georgia Dental Association. The Griffin study was submitted for publication in Public Health Dentistry, the official bulletin of the American Association of Public Health Dentists. Four additional water systems began fluoridating which brought the State total up to 46 fluoridated public water supplies serving more than 1, 076, 171 people in 108 communities and rural and suburban areas. - 12 - Base line dental surveys were made in Toccoa and Thomaston soon after fluoridation began for the purpose of obtaining data for future evaluation of the programs. Regional dental consultants provided consultation and technical assistance to district dental directors, local health departments, and dental societies in programs for prevention of dental injuries in contact sports. This program involves the fabrication of individually fitted mouth protectors for scholastic athletes who engage in such sports. Remedial Services - Dental care services for underprivileged children were provided in public health dental clinics in 71 counties. These services were provided by five full time public health dentists and 245 private dental practitioners on a part time basis. New facilities were installed in two counties; clinics were started or reactivated in seven. Nevertheless, because of the shortage of dentists or lack of local funds, 35 clinics failed to operate. Several continued to operate on a nine month instead of a 12 month basis. Education and Training Services - Continuous dental health education is a program goal in promoting the utilization of effective preventive dental health procedures. All staff members contributed to the educational program through (1) consultation and assistance to public health personnel, dentists, schools, colleges, teacher education classes, official and voluntary agencies; and (2) selection and preparation of educational resources such as pamphlets and audio-visual aids. - 13 - Annual observance of National Children's Dental Health Week in February continued to increase the demands for dental health education services and materials. Special Projects - A State-wide survey of dental x-ray machines was begun with the cooperation of Industrial Hygiene Service, local health departments, Georgia Dental Association and the U. S. Public Health Service. The first phase of the program consisted of locating the x-ray units and testing them through the use of a new method known as the Surpak. The Surpak is a sensitive sheet of film which when processed reveals the status of collimation and filtration. Although the program was a voluntary one, more than 1, 200 dental x-ray units were registered with the cooperation of almost 900 private dental offices, institutions, hospitals and clinics. The objective of this program is to reduce to a minimum the amount of radiation used in dental diagnoses without curtailing the use of dental x-rays or sacrificing quality of the films. Phase II of the program will consist of a follow-up with office visits and evaluations. Collimators and filters will be furnished for those machines needing modification. The film badge survey of a limited number of dental offices done previously was reported in the Spring issue (1962) of Public Health Dentistry. A docu-drama on fluoridation, a new audio-visual method designed to promote action on fluoridation has been developed with the Georgia - 14 - Center for Continuing Education under the sponsorship and technical direction of the U. S. Public Health Service and the Georgia Department of Public Health. The docu-drama has been field tested in several Georgia communities, and recommendations for revision of the script and modification of the device have been made to the Public Health Service before these educational aids are produced in quantity and distributed nation-wide. - 15 - environmental health branch HOUSING HYGIENE AND ACCIDENT PREVENTION SERVICE Based on a year 1s study of housing problems related to health, the Accident Prevention Section submitted a reorganizational plan to include a housing program. Approved July 1, 1961, the Housing Hygiene and Accident Prevention Service was established to include two sections: Housing Hygiene Section and the existing Accident Prevention Section. Loss of personnel during the year curtailed the effectiveness of the various programs of the Service. Accident Prevention Section - This Section concentrated its major efforts on the development of new materials based upon the requests, interest, and needs of local health departments. There was an increased interest in the areas of geriatrics, seat belts, poison prevention, and nursery school standards. Work with local health departments continued, but allied health groups were utilized to encourage more safety activities. Progress in poison control, a major program of this Section, was marked by the establishment of two additional centers, one in the Macon Hospital emergency room, Macon, Georgia, and the other in Floyd \ ' . Hospital emergency room, Rome, Georgia, bringing to ten the number of strategically located centers. All centers except one reported treatment cases and referred information to local health departments for follow-up. To emphasize the problem of accidental poisonings, extensive community programs were sponsored by the Section during Poison - 16 - Prevention Week through local health departments, Georgia Pharmaceutical Association, poison control centers and the medical societies of Georgia. Literature, news releases, radio and television spots and films were supplied with excellent response. A leaflet, "Wellbee's Pointers for Poison Prevention, " developed by the Section was well received by local health departments and given national mailing. Monthly mailings were continued to new physicians with information concerning the operation of the Georgia poison control program. Housing Hygiene Section - This Section's primary concern has been with the establishment of the administrative pattern including the necessary standards for conducting the program. The legal aspects, as they relate to housing hygiene and the regulatory provisions on both the State and local levels, have been tentatively defined through research with special reference given to the powers which are delegated to local Boards of Health for the adoption of regulations governing housing standards. These are being documented in a paper, "Legal Basis for Public Health in Housing, "with the aim of providing a procedure that may be followed by communities desiring to establish housing programs. A pilot demonstration project was established under the auspices of a local health department. Field procedures, program aids and evaluation techniques are being tested through this project for practical applications. The Section actively participated in the establishment of two local - 17- housing programs and the training of their personnel. A housing hygiene study committee, with representatives from six local health departments was organized to advise this Section on the effectiveness of the procedures employed in the various localities. Monthly reporting of housing activities was developed to provide a comprehensive report of health department activities in this field. The Section qualified for the use of the American Public Health Association's Housing Appraisal Technique by satisfactory completion of the requirements as set forth by the Association. - 18 - INDUSTRIAL HYGIENE SERVICE The Industrial Hygiene Service is to discover, define, evaluate, and control those envirorunental 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. The Industrial Hygiene Service has a staff comprised of a service director, two engineers, three chemists, three radiation technicians, four electronic technicians, one health physicist on loan from the U. S. Public Health Service, two bedding inspectors and two stenographers. These professional personnel are grouped into four sections and one unit; namely the Industrial Section, Air Pollution Section, Radiological Health Section, Mattress Sanitation Section, and the Electronic Service Unit. There are occasions when it is necessary to request the services of specialists from the Public Health Service and other allied Federal and State agencies. These services are available to us upon request, and with their assistance it is possible to evaluate most industrial health problems. The increase in industrialization in the State has brought increased responsibilities to the Health Department. The local health department is the official agency specifically charged with the responsibility of assisting these establishments and their employees in all health matters. Assistance from the State Health Department is available to local industries only - 19 - through their local health department. In carrying out the program for improvement of environmental sanitation in industry, Industrial Hygiene personnel made investigations in approximately 247 establishments employing approximately 31, 211 workers in 75 counties during the period January l, 1961 to July 1, 1962. These investigations covered a wide variety of industries. During these investigations 197 samples were taken for laboratory analysis and 212 field determinations were made. During 1961 the radiological health program was expanded to inelude milk sampling. Samples collected and analyzed by the Radiological Health Section included 402 air samples, 88 rain samples, 54 stream samples, 10 mud and silt samples, and 219 milk samples. In the period covered by this report, the Electronics Unit made 50 major repairs to x-ray equipment and installed four other machines. The Unit also repaired 143 audiometers. The state-wide air pollution survey was completed and the report of this survey published. Judging by the requests for copies, the report seems to be of considerable interest to the people of Georgia. Several preliminary studies have been done in the more populous areas of the State. In 1954, the Industrial Hygiene Service assumed the responsibility for the enforcement of the Georgia Mattress Sanitary Regulations. During the period covered by this report 246 bedding inspections were carried out. - 20 - PUBLIC HEALTH ENGINEERING SERVICE The Public Health Engineering Service furnishes consultative, advisory, promotional and technical services; program planning and inservice guidance; plans and specifications review; record forms and materials; liaison with other state and federal agencies, architects, engineers, local government officials, and with other Health Department Services. The second state-wide evaluation of enforcement of the Food Service Establishment Act of 1959 resulted in a score of 72. 32 indicating a general decline in sanitation compliance. Besides program status evaluation and organized group training, consultant services were rendered on many specialized problems such as mobile operations, floating food service operations, nursing homes, ventilation, vocational training, college food service operations, hospital dietary department sanitation, preconstruction plan reviews, hot water problems and dishmachines. More than 3400 contacts in 97 counties were made in the interest of food sanitation. Seventy-two health departments, through local regulations, are engaged in milk sanitation activities. Twenty official sanitary surveys were made by Service representatives, and 31 spot checks of milk sheds were completed. Twenty-four sheds enjoy "Honor Roll" listings and it is estimated that greater than 90% of all fluid milk consumed in Georgia is produced on these sheds. More than 95% of milk consumed in the state is - 21 - produced and processed under supervision of local health departments. It is significant that the percentage points of individual milk samples violating milk regulation requirements in coliform count (8. 84), standard plate count (6. 82) and phosphatase test (0. 20) are the lowest in nine years. Sediment testing (8. 72) has been added for the first time this year as routine procedure. One mobile milk laboratory has been in use in four sheds to assist with technical problems including control of psychrophillic, thermoduric and coliform organisms in milk. The Service continues to review preliminary plans (228), working drawings and specifications (283) and final plans and specifications for final approval (248) of sanitation aspects to the Office of School Plant Services, State Department of Education. One hundred ninety-five of 350 subdivisions, reviewed to determine adequacy of water and sewerage facilities, were new tracts. The remaining 155 were in the nature of follow-ups or additions to existing subdivisions. One community water system was given tentative approval. Central sewerage was provided in 14 subdivisions; six of the treatment facilities were "package" plants of the aerobic digestion type and eight were oxidation ponds. Sewage disposal for 16 low-rent housing projects of the Public Housing Administration were reviewed. These, now in various stages of planning and construction provide for one oxidation pond, four small "package" plants, two covered sand filters and nine septic tanks with tile - 22 - fields. Additional sewerage was reviewed for 13 commercial and industrial locations, two shopping centers, four convalescent homes, two boarding schools, four trailer parks, six recreational areas, one jail and one research laboratory. Individual sewage disposal systems numbering 1853 and water systems numbering 129 were reviewed for endorsement to the Federal Housing Administration and the Veterans Administration. Tourist courts numbering 1270 were registered and permits issued to 1149. Permits were withheld on 42 pending completion of corrections, and no applications or inspections were received from local health departments on 79 courts registered in previous years. Sixty-three were reported closed and 16 remained in uncertain status. Recreational area sanitation operations were stepped up coordinating the work closely with the State Parks Department in their expansion and improvement of sanitation facilities in Georgia State parks. Sanitation investigations were made at 57 marinas and camps of various descriptions located in 38 counties. Standards for public swimming pools proposed for adoption by the State Board of Health were completed. Thirteen staff members of the Service participated in a 11crash" program during June in a sanitary survey of Lake Sidney Lanier, gathering information at homes within 500 feet of the government taking line, picnic areas, tent camp areas, clubs, marinas, garbage and refuse dumps, mosquito breeding, municipal and industrial wastes, swimming areas, island sanitation and food service establishments. - 23 - The refuse collection and disposal consultant made 150 visits to 63 cities and 91 visits to 32 counties in the interest of sanitary refuse handling facilities. Eleven shucker-packer oyster plants, two shell-stock dealers and one repacker were certified for interstate shipment of oysters. One plant was closed because of operations below standards. The State-PHSIndustry Cooperative Program is embarking on a new evaluation plan which is requiring closer cooperation between the State Game and Fish Commission and State Health agencies and increased sanitary surveys of areas adjoining shellfish growing areas. hnpounded water permits were issued to 807 individuals and agencies. Four hundred and sixty permits were issued to farmers under the ASC farm practice program. Mosquito control programs are being continued on four Georgia Power Company lakes, one Crisp Power Commission lake, five U. S. Army Engineers lakes, and surveillance is practiced on three Tennessee Valley Authority lakes and on the U. S. Engineer Lake Sidney Lanier. Training of sanitation personnel for local health departments has required approximately seven weeks participation by various members of the staff besides the full six-months time of the Branch Training Coordinator. Preparing basic and sanitary survey maps, charts, forms, diagrams, floor plans, engineering drawings, exhibits, equipment, Ozalid - 24 - prints, photographs, film, prints and slides (color and black and white), are major achievements of the Mapping, Cartographic and Photographic Unit. Charts for 13 major river basins in connection with the Federal Southeastern River Basins Study Commission were drawn. The Lake Lanier Sanitation Survey accomplishment would have been impossible without the rapid conversion of aerial photographs into mosaics and maps for the use of field parties engaged in this crash program. - 25 - WATER RESOURCES SERVICE The Water Resources Service was established July 1, 1961, for the purpose of expanding Departmental water resources programs, and bringing together several facets of the Department responsibility in water resources. This was necessary in order to meet the increasing emphasis that is being given to this broad program area. This Service incorporates the responsibilities and activities of the former Water Quality Service. Programs of this Service are: Water Supply; Stream Quality; and Water Analysis. Water Supply - Plans and specifications were reviewed and approved for 38 additions and improvements to water supply facilities. Consuiting services were provided to municipalities and industries concerning water quantity, quality and treatment problems that are or may be encountered. Stream Quality Sewerage Projects - Projects currently being carried out by municipal and county governments have received a major part of the time and attention of the staff. Plans and specifications for 30 sewerage projects were reviewed and approved. Construction was completed on 18 new municipal sewage treatment plants. Federal funds in the amount of $1, 121, 500, for financial assistance under the Federal Water Pollution Control Act, Public Law 660, were allocated by the Georgia Department - 26 - of Public Health. Industrial Waste Treatment - The increasing industrial ex- pansion in the State has caused a greater emphasis to be placed on the necessity for proper waste disposal practices by industry. Four major industrial firms completed construction of facilities to provide waste treatment. As a result of stream surveys and investigations, 15 industrial firms were notified to abate stream pollution. The success of this program requires close cooperation between industrial interests and the State. Stream Surveys - Several watersheds in the State were surveyed to determine possible sources and extent of pollution. A total of 166 sampling stations have been established on 18 streams. Major streams sampled were the Coosa River, Chattooga River, Oostanaula River, Etowah River, Withlacoochee River, and Long Cane Creek. Samples were collected to determine the physical, chemical, and bacteriological characteristics of the water. Significant data has been recorded on all of these watersheds and has already proved to be invaluable. An inventory of public water supplies, industrial and municipal waste discharges into waters of the State has been completed by major river drainage areas. This inventory enumerates every major public water supply and source of polluting material, treated or untreated. Areas which require stream surveys or other work are thus delineated. Water Analysis - In addition to making the water analyses necessary - 27 - for the statewide water quality and stream quality programs, the Water Resources Laboratory is charged with the responsibility of the laboratory work connected with swimming pool and shellfish sanitation programs. The data and information derived from the tests were used by public health personnel, plant operators, municipalities, institutions, industries, consulting engineers, and private citizens in solving many of the problems in.herent in a statewide water resources program. No cases of water-borne diseases attributable to the approximately 650 community water supplies were reported during the year. Twenty eight thousand, nine hundred and thirty one of these were bacteriological tests and 6, 964 were biochemical, chemical and sanitary chemical analyses. A total of 35, 895 tests on water, sewage and industrial wastes were made in 1961-62. Allied Activities - Conferences with adjacent states were held for the purpose of exchanging information, discussing interstate stream quality, and airing specific problems relating to stream quality. Public education and the promotion of water supply and waste treatment facilities received maximum attention. - 28 - ". . "-:.' \ ,, '. \ l health conservation branch ~~~ t'i CRIPPLED CHILDREN'S SERVICE During the past year, clinic space and offices have been improved. The Elks of Georgia added an area to the building increasing the floor space by two-thirds. This contains separate offices for nurses and social workers and space for clerical staff. While in the planning stage several years ago, the space seemed more than ample. However, it is already out-grown. The Cardiovascular Disease Control Section installed a vectograph and a heart sound recorder and an up-to-date x-ray unit with closed circuit television was purchased. The Macon City Hospital is allowing us to use a large room in the sub-basement for a clinic. This is by far the most adequate space we have had since we opened our clinic in Macon. An x-ray machine has been installed in the Hall County Health Department. Prior to this installation the children had to be transported to a hospital for x-raying and the x-rays then brought back for reading. The Chatham County Health Department provided adequate and functional offices and clinic space in their new building. We moved into the building during the winter. The case load of seizure patients has grown so large that it seemed expedient to set up separate seizure clinics rather than seeing the children in the general clinic where a preponderance of orthopedic cases are handled. This is being done in Columbus, Macon, and Savannah. Others - 29 - will be developed during the coming year. A pediatrician is chief of each clinic. Cases needing a more complete work-up than can be done in local clinics are referred to the central seizure clinic. In February, a neurological seminar was held to acquaint the pediatricians with the latest methods in handling seizure patients. The hearing program has been in operation since 1958 but not until this year has a well organized central hearing clinic been put into operation. Children are screened in the general clinic and if more definitive diagnostic workup is needed than can be obtained locally, they are referred to the central clinics. The team here is composed of a pediatrician, an otologist, an audiologist, a psychologist, a hearing technician, a social worker and a public health nurse supervisor. If a hearing aid is indicated, the patient is sent to the Atlanta Speech School for evaluation and fitting of the aid. Participation continues in the research project on prostheses with the National Research Prosthetic Board. The Georgia program is one of 17 facilities in the United States participating in this program. Careful evaluation of the patient, correct fitting of the prosthesis and close follow up are components of this project. - 30 - MATERNAL AND CHILD HEALTH SERVICE Basic activities included medical and nursing supervision for mothers and children and promotion of hospitalization for delivery. In orientation of new nurses and in actual practice, special attention was given to health practices in day care centers, to the care of premature infants, and to infants and preschool children with special problems, such as mental retardation, maternal deprivation and auditory deficiencies. Family planning and classes for expectant parents were other basic elements of the program. Detection and increased frequency of hospital deliveries for prenatals with Rh sensitivity has been fruitful in reduced morbidity and mortality of the infants. Plans for a program for mass screening of the newborn for phenylketonuria have been completed. New publications in use include "Common Problems of Early Childhood", "Desirable Standards for Day Care Centers", "So Your Child is Going to a Day Care Center", "Georgia Mother and Baby Book" (revised), "Care of Premature Infants in the Horne - Guide for Public Health Nurses", and the manual for teaching midwives. Vital Statistics - Although the premature birth rate rose significantly, the death rate decreased to an extremely favorable low. The infant mortality rate also decreased in the neonatal and post-neonatal period. The maternal death rate increased due to a rise in the white race. In 1961 there were 100, 444 births of which 9, 359 occurred in the - 31 - home, and were delivered by midwives. Clinics - One hundred nine counties have maternal clinics with phy- sicians 1 services, and 100 counties have well child conferences with physician participation. Seventeen counties have nursing conferences for mothers and children. In 1961, 26, 296 expectant mothers received public health nurse supervision, and 16, 708 were registered in the clinic for medical supervision. These women averaged three and a half visits to the physician. In the same year, 43, 110 infants were given nursing supervision, and 17, 325 received medical health guidance. However, these averaged less than two and a half visits for medical supervision. In 1961, 60, 537 preschool children, ages one through five, were registered for public health nursing supervision, and 21, 553 for medical health supervision. They averaged one and a half visits for medical supervision. Immunizations - Nearly 90, 000 immunizations against diphtheria, tetanus and whooping cough were completed during infancy and through the first five years of life. About 63, 000 in this age group received Salk vaccine, 19, 321 during the first year of life. Special Project in Mental Retardation - The Child Development and Evaluation Center, designed to serve 12 counties as a demonstration of what can be done to diagnose and evaluate preschool children with limited intellect, and what can be done to assist the families in the home care and - 32 - training of these children continues, despite staff limitations. There is an increasing proportion of referrals from private physicians. There have been six formal public health nurse training programs this last year. Student nurses at the local hospital have also profited from teaching experiences with the project staff. The Interagency Committee on Prematurity - This committee has been active in all phases of prematurity, including family planning, prenatal care, hospital-home care and follow-up, and planning for one or more institutes for institutional nurses. Twenty per cent of the premature births reported in the State occur at Grady Hospital, where seven per cent of the live births occur. Prematurity contributes heavily to the case load of mental retardates and multi-handicapped children. - 33 - NUTRITION SERVICE The Nutrition Service has worked on the development of a training plan which will encourage recruitment and retention of young graduates to fill vacancies in regional and state positions. This plan received high priority and the Service cooperated with the Personnel Service to formulate a series of job descriptions to implement the plan. The state institutions and the Service met to begin joint planning to solve their mutual problems. Two additional persons joined the staff, a medical director and a junior nutritionist. The dietary consultant returned from educational leave. The public health activities of the Service include the following: Schools - Educational activities included rat experiments, films, talks to children, parents and other civic groups, dietary evaluations, and teaching mother-baby care classes in high schools. Education - The health officers and the director met to plan the nutrition guide which the health officers requested, A committee was appointed to determine the needs which the guide will meet. Group education and training was given to district nursing staffs, nursing classes 1n hospitals, college groups, practical nurses, aides and social workers, nursing home personnel, pre-school associations, Food Service Institutes and Institutes for Blind Homemakers. Patients and Clinics - Consultation with parents of over 700 - 34 - crippled and cardiac children in seventy-odd clinics was the single largest activity of the Service. The nutritionists counseled 256 prenatals and 55 mothers of infants in MCH clinics. One member taught four classes of unwed mothers at the Florence Crittenton Home. Other assistance included special classes for diabetics to aid them in solving their dietary problems, individual consultations with the obese, the chronically ill and the older citizen, work with those receiving surplus commodities and low income families. Interagency Cooperation - Nutritionists worked with visiting nurses, the Alcoholic Rehabilitation Center, hospitals, and the Welfare and Education departments. Nutritionists also participated in training courses for day care personnel conducted by the University of Georgia. Materials and Publicity - The Service distributed educational rnaterials, wrote articles for publications of various sorts, made television and radio appearances, and talked to civic groups. In-Service Education - Two members went to the Community Nutrition Institute at Syracuse University, and two to the Institute on Nutrition on Chronic Diseases and Aging at Chapel Hill. Several individuals served on the Geriatric Task Force and one participated in the Home Care Project at Dalton. The dietary consultant returned after securing a Master's degree in Public Health from California. Future Objectives - To organize a Community Nutrition Program which will care for all segments of the population, and to secure training facilities which will supply personnel necessary to carry out programs. - 35 - SCHOOL HEALTH SERVICE Hearing Conservation Program - The program continues to serve about the same number of children, but since services to children with hearing losses have become available through Crippled Children's Service, there is more genuine interest in medical and rehabilitative follow-up. For the school year 1961-62, 92 counties reported that 110,449 children were tested, 6, 103 failed the tests, and 2, 400 were seen by the doctor. In an effort to refine the case load of the public health nurse and to eliminate unnecessary and costly over-referrals, hearing screening clinics manned by an otologist were held in four counties. The otologist rapidly examined 268 children for the purpose of medical and etiologic~! diagnoses. The Service provided staff to Maternal and Child Health Service to help develop a program for testing the hearing of infants, using Ewing techniques as practiced at Johns Hopkins. Vision Conservation Program - In the school year 1961-62, 93 counties reported 285,998 children were tested, 21,019 failed the tests, and 10, 833 were seen by the doctor. A study of our records shows that only a small percentage of Negro children ever reach diagnostic and treatment sources. In addition to children in regular schools, the Service helped in vision testing children at the Georgia School for the Deaf at Cave Spring. Ringworm of the Scalp - In several counties, the Service worked - 36 - with Communicable Disease Control and local health and education departments to do a detection study and treatment program in schools where this disease had become prevalent. Detection of emotionally disturbed children - A questionnaire for teachers to use as a tool in detection of emotionally disturbed children is being field tested in one school. This study is being done in conjunction with state and national mental health services. With the cooperation of the Health Education Service, the staff revised and published a manual on hearing testing and a flip chart on control of communicable diseases in children. In-service education - One staff member attended an Institute on Infant Audiologic Screening at Johns Hopkins; all of the staff participated in a similar session in Atlanta. All staff members attended a course on audiometry at the University of Georgia, sponsored by Crippled Children's Service. The director attended an Institute on Alcohol Education at Millsaps College in Mississippi. Out-of-state meetings - The director attended a meeting on Health Education Curriculum in Colleges and Universities, at the University of Florida; a three day meeting on safety, sponsored by Florida Health Department, U. S. Public Health Service, and National Safety Council, in Jacksonville; and the American Speech and Hearing Association meeting in Chicago. The Service worked closely with the State Department of Education - 37 - in many areas, including classes in health education for teachers in colleges and universities. The director participated in numerous conferences with agencies offering services to children, such as the National Society for Prevention of Blindness, the Georgia Heart Association, the Georgia Tuberculosis Association, the Parent-Teacher Association, and others; and served on various committees, such as the Committee for Children and Youth, Committee for Study of Diagnostic Centers for Multihandicapped Children, School Child Health Committee of the Medical Association of Georgia, and the hearing advisory committees of the State Departments of Health and Education. - 38 - laboratory branch LABORATORY SERVICES In addition to the testing service for the investigation and diagnosis of communicable and other diseases of public health significance and the examination of milk and dairy products to determine sanitary quality, auxiliary services were carried on. These included referral services in the critical identification of disease-producing organisms isolated in the Department and other laboratories in the State; the evaluation and approval programs to laboratories under the State premarital and prenatal laws; the milk certification program; preparation of typhoid vaccine and other biologics for the prevention of disease; the preparation of specimen outfits and the procurement and distribution of commercial antirabies vaccine. A closer working relationship was developed during the year with the Department 1s institutional laboratories and the local health department laboratories. Reviews of laboratory programs in the Gracewood and Aidmore institutions were made by our Director of Field Laboratory Services at the invitation of the superintendents. Initial steps were taken in the development of a standard laboratory report form and monthly and annual report forms for the institutional laboratories. Similar efforts will be made with the local health department laboratories. During the fiscal year there were 950, 368 examinations made in the four laboratories. This was a slight increase over the preceding fiscal year. Increases were noted in all laboratories, and in the - 39 - Microscopy, Serology and Virology Sections. Of especial interest was the lOOo/o increase in examinations made in the Virology Section. Unusual and noteworthy findings in the diagnostic work included: - seventy isolations of Salmonella typhi obtained from 29 cases of typhoid fever. Forty-five isolations made from 15 chronic typhoid carriers. Two new carriers were identified. Three cases were traced to three known carriers based upon epidemiologic data and phage types. - an unusual salmonella episode was the finding of S. tennessee in an outbreak associated with dyed "Easter chicks." Positive stool cultures were obtained from five children and two adults. Pet chicks from three homes yielded S. tennessee. -food samples and/ or patient specimens were examined in connection with 23 outbreaks of food poisoning (Central Laboratory, 17; Macon Laboratory, six). Causative agents isolated included coagulase positive staphylococci in four outbreaks and Shigella flexneri-6 in one. - a worm removed from a patient's mouth was identified as Gongylonema pulchrum (gullet worm). Only a few cases have been reported in the United States. One hundred and three laboratories participated in our evaluation program for laboratories performing serology tests for syphilis, including six State laboratories, 94 private laboratories and three others. Six of the private laboratories did not complete the study and two private laboratories were removed from the approved list. - 40 - Although the incidence of rabies remains at an all time low, 1, 212 animal heads were examined during the year. Ten showed positive evidence of rabies, an increase of four over the preceding year. The low incidence was also reflected in the distribution of commercial antirabies vaccine. Only 85 treatments (32-seven-dose and 53 14-dose) were furnished. Veterinarians and veterinary helpers received either threedose pre-exposure immunization (41) or one or two booster doses (36). During the year a number of special projects were undertaken, most of these being in cooperation with other Department branches and services. - the Virology Section and Special Syphilis Serology Unit participated in the evaluation of a new complement-fixation procedure being developed by the Communicable Disease Center. The test is called LBCF (Laboratory Branch Complement Fixation). - cat-scratch fever skin testing antigen was obtained and provided to eight physicians on special request. Case histories, suppurative material (when available), and skin test results were obtained and forwarded to the supplier of the antigen. Supplementary tests included LGV -CF on patients 1 serum, 0. T., and PPD-Y skin tests, and bacteriological and virological studies on suppurative material when available. - a review of the sandwich study was made in cooperation with the Epidemiologic Investigation Branch and the study was expanded to include examination for pathogens (staphylococci and salmonella), total bac- - 41 - terial and coliform counts, and determination of pH. There were 820 sandwich samples examined. - early in the fall of 1961, the Central Laboratory assisted the Epidemiologic Investigation Branch in determing the cause of a shrimpkill in the Brunswick area. Bacteriological examinations resulted in the isolation and identification of Pseudomonas ichthyodermis, shown to be associated with "brown spot" disease of shrimp. - a laboratory representative attended a special training program at Children's Hospital, Buffalo, New York, in preparation for our participation with Maternal and Child Health Service in a national program sponsored by the Children's Bureau of the Public Health Service in the detection of phenylketonuria (PKU) in the newborn. - the Virology Section cooperated with Epidemiologic Investigation Branch in a study of viral hepatitis. Paired blood specimens (391) from Gracewood State School and Hospital were shipped to Doctor Albert McKee, State University of Iowa for testing with his viral agent by means of the hemagglutination-inhibition and mouse neutralization tests. - poliovirus survey - an investigation of enterovirus prevalence among healthy young children, age 18 months to four years, from six housing developments in Augusta, Columbus, Macon, and Savannah resulted in the isolation of 98 enteroviruses from 461 stool specimens examined. Poliovirus 1 was obtained from two Savannah children and poliovirus three from one Augusta and one Columbus child. Viruses - 42 - isolated from 45% of the Augusta specimens showed that Coxsackie B3 viruses were abundantly present in this area at the time of the study. All other enterovirus isolates are being used for testing new methods of identification. - a preliminary study was started (49 specimens in fiscal 1962) in cooperation with Cardiovascular Disease Control Service to evaluate the possible significance of recent reports that rheumatic fever patients on penicillin prophylaxis develop penicillin resistant strains of oral bacteria (especially alpha streptococcus) which, upon subsequent dental manipulations, enter the blood stream and produce subacute bacterial endocarditis. Control studies were made on patients on sulfadiazine prophylactic programs. -- the Central Laboratory participated in the Atlanta Metropolitan Area Sabin oral polio vaccine immunization program to the extent of assisting in the procurement, storage, and distribution of the vaccine. On June 1, 1962, differential blood counts were discontinued. In September, 1961, the refractometer test for added water in milk was discontinued and a more accurate and efficient method utilizing the cryoscope for determing the freezing point was substituted. On July 1, 1962, the Media and Reagents Section was combined with the Sterilization and Glassware Preparation Section and given the name of Preparation Section. Early in 1962, Cardiovascular Disease Control Service was authorized to temporarily utilize three and a half - 43 - rooms on the seventh floor animal quarters area for the development of a lipid research laboratory. In addition to the overall training program routinely conducted for new untrained technical personnel, an experimental program of rotation was instituted on April l, 1962 and participated in by our eleven medical laboratory assistants. Basically the program involved staggered rotation on a three months basis among the six sections in the Central Laboratory. During the year nine staff members attended a total of 12 courses offered at the Communicable Disease Center of the U. S. Public Health Service in Atlanta. One staff member attended two courses given at the Sanitary Engineering Center of the U. S. Public Health Service at Cincinnati, Ohio. Two conferences and a seminar were held in the Central Laboratory. These were attended by Central Laboratory section chiefs and Regional Laboratory directors, the Department's institutional laboratory directors and local health department laboratory representatives. These were primarily for the purpose of reviewing programs, activities and new procedures. During the first conference held November l-2, 1961, the present status of fluorescent antibody techniques was reviewed and studied. Highlighting the second conference held April 11-12-13, 1962 was a visit to the Battey State Hospital Laboratory. A seminar on atypical mycobacteria organized in cooperation with the Epidemiologic Investigation Branch was held on January 20, 1962. - 44 - local health branch LOCAL HEALTH ADMINISTRATION SERVICE Considerable time and effort was expended in working with those persons responsible for drawing up a proposed revision of Public Health Laws. Despite the time and effort spent on this activity, the final bill presented to the State Legislature died in committee. Long range planning had been done to secure personnel to staff a local health evaluation team. However, efforts failed to recruit qualified personnel for the team. The physician selected to head the evaluation team was diverted into the position of Director of the Northern Health Region upon the retirement of Dr. J. Russell Thomas. Operations in local health districts were hampered by the untimely passing of Dr. Eustace H. Prescott, District Director of Public Health District 24, and Dr. James A. Thrash, District Director of Public Health District 35. We were able to recruit and place in active service, a District Director of Public Health in District 6 and a District Director of Public Health in District 27. At the close of the year, the number of health districts with District Directors of Public Health remained the same as of the close of the previous fiscal year, namely 24. Through continuing efforts of our regional staff, we were able to make preparations for reactivation of the Wheeler County Health Department, Stewart County Health Department, and the establishment - 45 - of a health department in Heard County for the first time. all on July l. 1962. During the year. there was a net increase in local health department personnel which included 19 nurses. 11 sanitarians. seven clerical workers and 15 other full-time local health personnel. Construction was completed on three health centers and three auxiliary health centers. At the close of the year. two health centers and two auxiliary health centers were under construction. and architectural plans were under way on four additional auxiliary health centers. The operations of Local Health Administration were considerably hampered by the resignation and untimely death of Mrs. Emily W. Bartholomai. who had served in the position of Public Health Administrator with the Service. We recruited a qualified administrator on July 1. 1962. increasing the effectiveness of our operations. Considerable effort on the part of the Service was put forth in the survey of Lake Lanier and surrounding areas. This survey called for the use of Northern Region and Central Office personnel of Local Health Administration Service during the month of June. with the field work being completed on the last day of June. - 46 - PUBLIC HEALTH NURSING SERVICE The director of Public Health Nursing Service retired December 1961. Public Health Nursing was reorganized January 1, 1962. The position of Coordinator of Nursing Services was established in Local Health Branch. Six hundred and ten public health nurses were employed in counties, regions, and the State Health Department as of June 30, 1962. Ten counties did not have public health nursing service. During this 12 month period, there were 73 appointments, 46 resignations, and four retirements. Thirty-nine nurses had orientation in public health nursing; 50 had orientation at Milledgeville State Hospital; and 79 had orientation at Battey State Hospital. Local health departments in Georgia provided field experience for 60 basic collegiate students and graduate nurse students from the following schools: Peabody College (three), Emory University (36) basic and (four) Master's degree, and Tuskegee Institute, Alabama (17). The Medical College of Georgia used Chatham County facilities for field experience. Other educational activities included academic preparation in public health and allied fields; short courses and seminars in audio-visual aids, epidemiology, physical rehabilitation, stroke rehabilitation, chronic disease and aging, alcohol studies, psychiatric nursing, venereal disease - 47 - control, tuberculosis control, medical self-help, training methods in communicable diseases, mental retardation, special fields in public health nursing, leadership training, principles of supervision, hearing testing of infants and preschool children, field training conference, and instructor course for mother and baby care classes. Visits were made to regional offices and county health departments to develop an additional field experience center. Staff members offered other consultation services including: assisting with evaluation of nursing services and of students during their orientation; participating in in-service education programs; preparing instructors in mother and baby care classes; counseling staff and supervisory nurses regarding experience or education needed for promotion; and assisting with nursing activities including personal and professional problems. A new field training center was opened in District 27, which included Walker, Catoosa, Chattooga, and Dade counties. The expansion of programs for the care of the chronically ill and aged require additional nursing personnel. Licensed practical nurses worked in a horne care program in Whitfield County. Progress has been made in the development of policies and procedures for the employment of practical nurses. The Annual Supervisors 1 Conference was devoted to the use of practical nurses in public health programs. Group activities included participation in the Departmental Advisory Council; State Health-Education Committee; Georgia Council on Para- - 48 - medical Education; Training, Epidemiology, Inter-Agency Premature, Library and Publications Committee; Geriatrics Task Force; and Georgia Organization Nursing Committee on Respiratory Diseases Including Tuberculosis. Assistance was given in developing curricula for training directors of day care centers. The Maternal and Child Health Section of the General Nursing Manual was revised and made available to public health nurses throughout the state. Recruitment of nurses was fostered through contacts with students and instructors in schools of nursing, public school counselors and others. Opportunities for employment and functions in the field of public health nursing were interpreted. Staff members were active in local, state and national professional organizations. Considerable work was done through other state and voluntary agencies including the Georgia Heart Association, Mental Health Association, Atlanta Social Workers' Club, Georgia Public Health Association, Georgia Tuberculosis Association, Red Cross and the Atlanta Visiting Nurse Association. - 49 - NORTHERN HEALTH REGION A total of nine out of thirteen planned districts were functioning, each with a district director of public health, as activated districts in the Region. Concentrated efforts were being exerted toward activation of District #25 and realization of its activation is almost a certainty within a period of six months. Six of the activated districts have a district director of nurses and seven have a district director of environmental sanitation. The Region is composed of 51 counties. Twenty-eight of these are included in activated districts; 20 are in unactivated districts; and three, Pickens, Towns and Union have no organized local health departments. Pickens County is showing more than average interest and may soon join the ranks of full-time health services. The Northern Region staff consists of: two nurse consultants, two nutrition consultants, two engineers, two sanitarians, two stenographers, and one medical director. A total of 15 physicians, 215. 6 nurses, 114 sanitarians and engineers, 112. 6 clerical people and 121 other employees were on duty in activated districts as of December 31, 1961. Thirty-two nurses, nine sanitarians and 23 clerks were employed in the unactivated districts. There continues to be a shortage of qualified public health personnel. Two counties are without public health nurses and nine counties are without sanitarians. - 50 - The status of construction of new health centers is as follows: Gordon, Cobb, and Rockdale counties each completed a health center under the Hill Burton construction program; an auxiliary health center was completed in DeKalb County. White, Wilkes and DeKalb counties submitted applications for construction of health centers. A total of 2, 639 visits by Regional personnel were made to local health departments. These visits may be classified as follows: Physician 99, Nurse - 328, Engineer and Sanitarian - 721, Nutritionist - 180, Communicable Disease Investigator - 1, 289, and Clerk - 14. These visits were made to provide assistance and consultation to district directors of Public Health, Nursing, and Environmental Sanitation in their health programs, and for the performance of direct service. Regional engineering and sanitation consultants furnished direct service to the counties without engineering and sanitation personnel; a minimum of direct service was provided to counties without nursing personnel by the nurse consultants. The medical director served as acting public health officer for 17 counties having no local medical supervision except from the physician member of the County Board of Health. The supervision and licensure of nursing homes became an increasing activity. The Region assumed this responsibility for 12 nursing homes located in areas with no district director of public health or without sanitation personnel. Four in-service training conferences were held for local health de- - 51 - partment personnel. One of the two regional nutrition consultants attended an institute on Nutrition in Chronic Disease and Aging at the University of North Carolina. - 52 - CENTRAL HEALTH REGION During the period covered by this report, the region was fortunate to have a medical director. Staff complement during this period was reduced by the death of one consultant nurse and the retirement of another. These vacancies have since been filled. Two new projects which have been added are: a study of blood pressures in Baldwin County and expanded services to the 19 counties being served by Diagnostic and Evaluation Clinics in the Tuberculosis Service. Oral polio vaccine was distributed on a county-wide basis in Clayton County. Consultant nurses attended institutes on mental health (including intensive treatment), hearing conservation, and orientation for public health nurses. In-service training for local public health nurses included disaster nursing in civil defense, maternal and child care, family planning, care of stroke patients and a review of mental health services. New concepts in tuberculosis service were also presented. The work load (direct services) of the regional sanitation staff continues to increase because of transfers, resignations, and failure of the counties to employ sanitarians. Limited supervision continues in the counties with sanitation personnel. Past and current promotional work by the staff for municipal sewerage systems is beginning to show results in Crawford, Fayette, and Heard Counties. Towns in these counties have - 53 - employed engineering firms to draw up plans for sewerage systems. Water and sewer extensions in the majority of counties are increasing at a rapid rate. Venereal disease within the Central Region is still increasing. Four areas within the region have had early infectious syphilis epidemics. Health investigators at Macon, Augusta, Columbus, Savannah, and Atlanta are working to control these epidemics. The increase in venereal disease seems to be caused by the lack of knowledge or concern by the teen agers or their parents; the homosexual problem; and the general public 1s unawareness of the situation. Due to the lack of nutrition personnel on the regional staff, services of this nature were limited during the period covered by this report. - 54 - SOUTHERN HEALTH REGION The region is composed of 57 counties in South Georgia with an area of 24, 000 square miles (41% of State) and a population of 977, 000. There are 592 private physicians, 213 dentists, 57 hospitals with 3, 245 beds, 22 nursing homes in 13 counties - 999 beds. Six counties have no physician, 18 have no dentist, 16 have no hospital. Eleven of our 13 districts are operating under district directors. Six districts have directors of nursing and nine have directors of environmental sanitation. All 44 counties have public health nurses but only 37 have a local sanitarian. In the other 13 counties, which are not in an organized district, 11 have a nurse but only four have a sanitarian. Regional public health personnel include: one public health engineer-administrator, one sanitarian-administrative aid, three nurse consultants, two sanitarians, one dental consultant, one nutritionist, six health investigators (V. D.), one medical entomologist, two clerical field representatives, and six stenographers. There is a growing demand upon the regional office for assistance. Staff members made 3, 000 visits to the counties during the year. A continuous health education and promotional campaign was carried out to establish and expand local health facilities. Four new Hill-Burton centers were completed, three are under construction, four counties have submitted informal applications for financial aide. A local nurse was re- - 55 - cruited for training and will open a health department in Stewart County in late 1962, for the first time since 1944. Schley County officials agreed to let the citizens vote in September, 1962 whether to have a health department. A clerk was employed in Clay County for the first time. Wheeler County has reopened its health department with a complete staff. The two Albany regional nurse consultants completed a three weeks concentrated course in Supervision and Interpersonal Relationships. Two three day seminars on the care of the stroke patient were well attended. The Tuberculosis Diagnosis and Evaluation Clinic is of great value to the eight counties served. A mental health clinic was established in Dougherty County on an out-patient basis. Nursing activities from the Waycross office were reduced due to illness and resignation of the nurse. Dental clinics were opened in three counties and equipment is on hand for two others. Interest in fluoridating public water supplies was promoted throughout the region. A pilot Surpak Radiation Survey of private and institutional dental offices in the region was made. The nutritionist worked with Crippled Children s and Maternal and Child Health clinics, did hemoglobin tests and three day diet histories in several schools, and gave numerous talks on nutrition. All of the 12 milk sheds have a sanitation compliance of above 90%. Food sanitation has made progress against stubborn resistance due to financial problems, usually involving tenant-landlord situations in small volume establishments. District #14 made better than 90% compliance - 56 - with the food sanitation regulation. The regional engineer and sanitarians have assisted local health personnel and local officials and individuals in 16 non-sanitarian counties with surveys and evaluations of all local sanitation situations. There were 6, 643 venereal disease investigations which found and brought to treatment 151 new cases of primary and secondary syphilis, 53 cases of early latent syphilis, 115 cases of other syphilis and 283 cases of gonorrhea. Since January 1, 1962 there has been a steady decline in syphilis in the Albany region, while an increase is now indicated in the Waycross region. Four new health investigators have been trained at the Albany office, two being transferred later. The medical entomologist has been associated with the research program on the viral encephalitides and vesicular stomatitis in the Waycross area, and assisted with fly and mosquito problems region-wide. - 57 - preventable diseases branch CANCER CONTROL SECTION The cost of the state-aid program increased sharply during the year due to an increase in the rates paid for hospital care. Prior to fiscal 1962, this program paid for hospitalization at 7 So/o of the average per diem cost. Since July 1, 1961, however, payment has been made at 100% of cost. Since the budget for fiscal 1962 remained unchanged, the increased cost of hospital care made it necessary to interrupt the program temporarily in February, 1962 in so far as new patients were concerned. Mter an interval of three weeks, additional funds were made available and the program resumed operation. The original budget for fiscal 1962 was $400, 000. 00. When the hospital rates were adjusted as of July l, 1961, it was estimated that the new rates would result in an increase in the cost of the program amounting to $135, 000. 00 annually provided the case load remained at the same level as in recent years. However, during the first six months of 1961, the number of applicants for state-aid had materially increased and it appeared that this would provide an additional financial burden. As the year progressed the number of applications declined. Moreover, during a period of three weeks in February and March, 1962, no new applications were approved. As a result, the accrued cost of the program for fiscal 1962 amounted to only a little more than $500, 000. 00. - 58 - During the year, 2470 persons submitted applications for stateaid. This represents a sizable reduction in the number of applicants as compared with previous years when the annual figure was about 3000. This decline in the number of applicants may be accounted for, in part, by the fact that no applications were approved during a three week period beginning in February. However, following resumption of the program, the number of applicants per month remained well below the average figure observed in recent years. Including patients from previous years who returned for additional treatment, a total of 4179 persons received diagnostic or treatment services. In order to limit expenditures and keep the program operating without interruption through fiscal 1963, it was considered desirable to review the existing rules and regulations and make such modifications as might be indicated. A committee of three physicians assisted the Director in preparing a supplementary list of regulations. Subsequently, these were approved by the State Board of Health. With the hospital rates which are currently in effect, hospital care accounts for 85o/o of the total cost of the program. In recommending changes in the existing regulations, therefore, most emphasis was directed toward reducing the number of hospital days. The supplementary regulations do not differ in principle from those which have been in effect since the program was initiated. In certain - 59 - areas the new regulations are more explicit in outlining the circumstances under which patients may be admitted to the hospital and, also, in placing restrictions on the duration of the hospital stay. All of the approved cancer clinics continued operation throughout the year. There were no new clinics which met the minimum requirements for approval. - 60 - CARDIOVASCULAR DISEASE CONTROL SERVICE The Cardiovascular Disease Control Service cooperates closely with the Georgia Heart Association and the Heart Disease Control Program, U. S. Public Health Service and other private and public agencies to develop research and service programs designed to detect, correct and prevent heart disease. Twenty-four professional and non-professional personnel are presently engaged in the various programs being conducted by this Service in Georgia. Current Programs - Operating programs include hypertension, congenital heart disease, rheumatic heart disease, stroke rehabilitation, congestive heart failure, atherosclerosis and heart clinics. Hypertension - A county wide survey is under way in Baldwin County to determine the nature, level and extent of hypertension in a community and see if applied control measures might reduce the level. Another feature of this program is the enlistment of each heart clinic to provide standardized workups on indigent hypertensives to provide a baseline group for statistical and therapeutic studies. One of the highlights of the year was a cooperative project with the U. S. Public Health Service, Georgia Heart Association and several local hospitals in presenting a hypertension seminar with internationally known authorities serving as the faculty. Atherosclerosis - The monk study has recently been approved for - 61 - another five years. This study, comparing two different monastic orders, is attempting to determine the role of diet and other factors in atherosclerosis. The cardiovascular laboratory set up for this project has now been transferred to health department facilities and serves the needs of the entire Service. Congenital Heart Disease - This program continues to cooperate with the Crippled Children's Service in providing personnel and equipment for diagnosis, treatment and care of afflicted children, through clinics, laboratories and hospitals. A plan has been formulated to evaluate the usage of heart sound tape recorders as a casefinding technique. Rhewnatic Heart Disease - This Service continues to provide medication to private physicians and heart clinics as prophylaxis for approximately 1, 200 indigent patients against the recurrence of rheumatic fever, together with furnishing facilities for acute and chronically ill patients. A study of bacterial flora in the mouths of patients on sulfa and penicillin prophylaxis is being made to determine whether or not resistant bacterial strains have developed. Stroke Rehabilitation - The "Stroke Team" consisting of one physician, a consultant nurse and two physical therapists has broadened the scope of this program to cover the entire state. Through teaching seminars for public health nurses, nursing home personnel, etc., there is now a vast reservoir of trained personnel capable and ready to assist the stroke patient and his family in simple rehabilitative technics. Consul- - 62 - tations on problems or unusual cases are available upon request. A meeting of physical therapists will be held in Atlanta in cooperation with the Public Health Service to discuss the future role and relationships of physical therapists in community and hospital centered rehabilitation programs. Congestive Heart Diseases - Programs to maintain treatment regimens of digitalis, digoxin, etc., are supported through the heart clinics. Heart Clinics - There are sixteen heart clinics, including the Crippled Children's Clinic in Atlanta, now functioning to provide diagnostic evaluation, advanced corrective surgery and all types of care and medication for heart disease patients. Regular clinic tours are conducted with the Georgia Heart Association staff to discuss local problems and seek solutions that will enable the clinics to function more efficiently and better serve the populations. We are now contracting for payment of x-rays on out-of-county patients to alleviate what has been a major problem in these clinics. Other Aspects -the Directory of Cardiac Services has been revised and distributed to every physician, health department, clinic, etc. , throughout the State. - we are continuing to supply the Heart Bulletin to physicians and medical students in the state as an educational tool. - 63 - - this Service has formed a "journal club 11 which meets one night each month to review current heart literature and discuss latest developments in order to keep abreast of modern research and scientific trends. Plans - The future direction and emphasis of this Service is to concentrate our efforts towards extending our services more effectively at the local level. - 64 - EPIDEMIOLOGY SERVICE The basic function of the Epidemiology Service is to act as a clearing house for information relating to the prevalence and incidence of infectious and non-infectious diseases and other causes of morbidity. The problem is one of careful classification and careful quantitation and has been approached in the following ways: -morbidity reporting systems of two kinds: (l) a standard morbidity card method for reporting by physicians to county health departments and (2) a sampling system designed as a measure of the effectiveness of reporting. - surveillance and confirmation of diseases on which laboratory work is done. The oldest surveillance system, that for Rocky Mountain spotted fever, is now in its 31st year. The newest, for Salmonellosis, is in its first year. - surveys of absenteeism from school to determine the prevalence of epidemic disease, such as influenza. - intensive field studies to determine the actual extent of a diseas~t in a group or the health status of a group. In 1961, one such continuing study further explored the possibility that food poisonings referable to the consumption of commercially prepared, wrapped sandwiches were being over -looked. A direct request was made to physicians for telephonic reporting of all cases of food poisoning in which sandwiches might be suspected. No illness was discovered. - 65 - - research studies intended to reveal the nature, fundamental characteristics, and sources of various diseases. Six major research investigations are in progress. These research studies include the following: - a study of certain consistently present virus infections of animals which have been found to infect man with or without recognized disease. In 1961, EEV was abundant in certain mosquitoes. - a study of the ecologic and chemical factors producing a slime growth nuisance on a major Georgia river. As a means of avoiding this problem a study is underway to determine the practicability of disposal by overhead irrigation of a planted acreage. - a study of the basic bacteriology and ecology of the bread-filler-cellophane wrapper system formed by a wrapped sandwich. Bacteria in this complex appear to be adversely influenced by low pH (or acetic acid ions) and in all probability by other factors. - a carefully controlled study of the immunogenic proper- ties, both serologic and epidemiologic, of various staphylococcus toxoid preparations with and without added bacterial protein in the prevention of institutional problems caused by "epidemic" strains of staphylococcus. - a study of the effectiveness of certain prophylactic drugs in controlling endemic diarrheal infections in institutions for children. - a study of the effectiveness of immune serum globulin when used as an eye instillation in the prevention of infectious hepatitis in institutional populations. - 66 - - longitudinal studies intended to work out through systematic, continued observations pertinent facts concerning chronic and degenerative disease. One continuing investigation involves the examination by extremely sensitive serologic screening tests of the sera of retarded children for evidence of infection with animal viruses, e. g., EMC, and an attempt to relate the findings to the patient's history. Exploratory field work was undertaken on mouse polyoma virus as an exercise in viral ecology. (See reports of the Laboratory, Vital Records, Venereal Disease Control and Tuberculosis Control Services for data in addition to that contained in the attached table. ) - 67 - Summary of Reported Communicable Diseases 1961 (With Comparisons with Earlier Trends) This represents the work of several divisions, particularly Epidemiology and Biostatistics. Median 1950-54 Amebiasis Brucellosis Chickenpox C onjunctiviti s, infectious Diphtheria Encephalitis, unspec. Hookworm Infectious Hepatitis Influenza Measles, German Measles, Red Meningitis, unspec. Meningococcal infections Poliomyelitis Psittacosis Rheumatic Fever Rocky Mt. spotted fever Salmonellosis Shigellosis Streptococcal infections Tetanus Trichinosis Tuberculosis Tularemia Typhoid fever Typhus fever Whooping cough 21 64 NR NR 220 15 15, 491 703 6, 058 NR 6, 743 NR 93 505 1 79 13 95 321 842 33 0 2, 085 44 64 41 398 Median 1956-60 Regular Reporting 1961 12 25 NR NR 101 17 9, 037 149 1, 621 NR 4, 854 93 38 93 3 49 21 280 325 3, 663 23 1 1, 576 22 31 8 135 4 14 6 1 64 17 6, 680 771 108 34 496 94 23 26 2 14 6 321 502 204 33 1 1, 627 15 34 8 12 Sampling 1961 200 30 1, 010 6, 740 90 80 5, 100 31, 660 4, 060 19, 140 70 140 60 20 1, 080 100 520 490 70, 090 80 170 240 20 40 610 Cases Reported by Sampling Only 1961 Leptospirosis Staphylococcus Pulmonary Superficial Wound 40 680 8, 980 3, 020 - 68 - GEORGIA STATE EMPLOYEES HEALTH SERVICE This Service has been in operation since late 19 56. Each year the mmber of employees taking advantage of the services offered has increased. fhis has meant adding personnel as a result of the increased workload. The major objective of the program is to enable employees to )etter serve the State. This is accomplished through: (1) counseling em)loyees on health practices; (2) providing annual screening tests; and (3) =idministering first aid and emergency service. The purpose of the screening tests is to aid both the employee and his private physician in evaluating the health status of the employee. These tests include checking weight, blood pressure, vision and hearing, plus a chest x-ray, urinalysis, hemoglobin, white blood cell count, serology, and blood typing. After a lapse of about two years, blood sugar determination was added as a routine screening test in March, 1962. Medical care beyond first aid, is not offered because the Service is designed to motivate employees to assume the responsibility for their own health, and seek medical evaluation and treatment from their private physician. In January, 1962, the part-time physician resigned and was replaced by a full-time physician. In addition the staff consists of two nurses, two medical technicians, and two secretaries. Among the 1, 185 employees screened in fiscal year 1962, 945 previously unknown and 313 known abnormalities were recorded. The - 69 - majority of these conditions were overweight and defective hearing and vision. Thirty-nine employees with previously unknown and six with known hypertension were referred to their private physician for evaluation. Abnormal hemoglobins were detected in 37 employees, and there were 34 abnormal urinalyses. These conditions were made known to the employee with the recommendation that he seek medical interpretation from his private physician. Visits and emergency calls for calendar years 1959 and 1960, and fiscal year 1962 are tabulated below: 1959 1960 1962 Screenings New screenings Repeat screenings Screening revisits Counseling and First Aid bnmunizations Other Total Visits Health Literature picked up 1500 344 1156 2985 826 524 5835 2892 1600 420 1180 1397 4401 346 377 8121 3448 1186 222 964 1146 6409 6957* 86 15, 7 84 5400 >!