Annual report 1962-1963 [1963]

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ANNUAL REPORT
1962-1963

Four symbols are used throughout this Report to represent the four main Divisions of the Georgia Department of Public Health. They are ancient signs used in place of the written word.
The first sign, representing Administration and Finance, is a sign for order and maintenance of harmony.

The second sign, representing Epidemiology, pic lures the circle of man's life. The outer circle is corporeal man and the lines drawn within it means his strength and intellect. The center point is man's soul.
The third sign, representing Mental Health, shows the figures of two men, their arms interlocked, i.e., man's inter-dependence with his fellow man.

*

The fourth sign, representing Physical Health, is the sign of the union of man's body and man's soul in harmony with the world about him.

' 0 ""-../1~ Department of Public Health

1~

47 T'liNITY AY~ S W ATLANTA, GEORGIA 30303

State of Georgia

Department of Public Health

JOHN H. VENABLE, M. D.. DIRECTOR

47 TRINITY AVE.

ATLANTA, GEORGIA 30303

The Honorable Carl E. Sanders Governor of the State of Georgia State Capitol Atlanta 3, Georgia Dear Governor:
I am honored to present to you the Annual Report of the Georgia Department of Public Health for the fiscal period covering July 1, 1962 through June 30, 1963. It is my pr.ivilege to do so on behalf of the State Board of Health,
This Report reveals important changes in the Department 1s plans and programs during the last fiscal year -- changes that have been many and varied. All activity has been geared to keep pace both with technological and scientific advances and with the moving social and economic environment of Georgia.
In 1963, the important addition of a new Division of Epidemiology was made to the Department's three original Divisions of Physical Health, Mental Health, and Administration and Finance, This fourth Division incorporates the Laboratories Branch and the Branch of Epidemiologic Investigations. In Services and Branches within the Four Divisions, programs have been expandc>l both at State and Local levels. Forward progress has be en the by-word in every phase of this Department 1s activities.
Members of the staff have, as a part of their individual efforts to continue this forward progress, undertaken many activities designed to increasP their individual efficiency and effectiveness. Many have availed themselves

of opportunities in graduate programs, Participation in the activities of publie health oriented or connected associations, organizations and affiliations has been strong in every field.
I am proud to submit this Annual Report as evidence of the State Health Department 1s concern for the good health of the people of the State as its contribution to Georgia's continued economic and social development.
Sincerely yours,
<\A.~ 11 \),__._, ,_,{,~
John H. Venable, M.D. Director

GEORGIA

ORGANIZATION OF Tr<E
DEPARTMENT OF PUBLIC

HEALTH

I I GENERAL ASSEMBLY OF GEORGIA
l I GOVERNOR
STATE BOARD OF HEALTH

DIRECTOR

*

GEORGIA DEPARTMENT OF PUBLIC HEALTH

DEPUTY DIRECTOR

ASSISTANT TO THE DIRECTOR

I

DIVISION

I

I

MENTAL' HEALTH

SERVICE
ALCOHOLIC REHABILITATION
COMMUNITY MENTAL HEALTH
GRACEWOOD STATE SCHOOL 8 HOSPITAL
MILLEDGEVILLE STATE HOSPITAL

I
BRANCH c;
SPECIAL SE.RVICES
SERVICE
CHRONIC ILLNESS a
GERIATRICS
MEDICAL FACILITIES
BATTEY STATE HOSPITAL

I
BRANCH
Cl PREVENTABLE. DISEASES
SERVICE
CARDIOVASCULAR DISEASE CONTROL
OCCUPATIONAL HEALTH S. E. H. S. SECTION
T. B. CONTROL
CANCER CONTROL SECTION
V.D. CONTROL SECTION

I

I
DIVISION

I

PHYSICAr HEALTH

I

I
BRA"lCH
01 DENTAL HEALTH
SERVICE
DENTAL PUBLIC HEALTH

I
BRANCH 01
ENVIRONMENTAL HEALTH
SERVICE
HOUSING HYGIENE AND ACCIDENT PREVENTION
INDUSTRIAL HYGIENE PUBLIC HEALTH
ENGINEERING WATER RESOURCES

BRANCH 01
LOCAL HEALTH
SERVICE LOCAL HEALTH
ADMINISTRATION
REGIONAL OFFICES

I
BRANCH 01
HEALTH CONSERVATION
SERVICE
CRIPPLED CHILDREN'S MATERNAL AND
CHILO HEALTH
NUTRITION SCHOOL HEALTH

I

I

DIVISION
" EPIDEMIOLOGY

I

I

I
BRANCH 01
EPIOEMIOLOGIC INVESTIGATIONS
SERVICE
DISEASE AND DISABILITY STUDIES SECTION
BIOLOGIC STUDIES SECTION
PUBLIC HEALTH VETERINARY SECTION

I
BRANCH
01 LABORATORIES
SERVICE
CENTRAL LABORATORY
FIELD LABORATORY REGIONAL LABORATORIES

I

DIVISION

" m ADMINISTRATION ~

SERVIC
ACCOUNTING BIOSTATISTICS GENERAL STAFF HEALTH EDUCATIC
AND TRAINING PERSONNEL VITAL RECORDS
PATIENT ACCOUN SECTION

I I LOCAL HEALTH DISTRICTS LOCAL HEALTH DEPARTMENTS /l2

TABLE OF CONTENTS

DIVISION OF ADMINISTRATION AND FINANCE

Civil Defense Health Service Program,

.1

Health Education and Training Service.

.4

Personnel Service . . . .

.s

Vital Records Service ..

11

Patient Accounts Section.

12

DIVISION OF EPIDEMIOLOGY

Division of Epidemiology . . . . . . . . . . . . . . . 13

Branch of Epidemiologic Investigations

Branch of Epidemiologic Investigations

14

Veterinary Section. . . . . . . . . . .

17

Branch of Laboratories Branch of Laboratories

. . . . . . . . . . . . . . 19

DIVISION OF MENTAL HEALTH

Alcoholic Rehabilitation Service

25

Community Mental Health Service . .

28

Gracewood State School and Hospital.

31

Milledgeville State Hospital . . . . .

37

DIVISION OF PHYSICAL HEALTH

Branch of Dental Health

Branch of Dental Health

41

Dental Public Health Service.

44

Environmental Health Branch

Housing Hygiene and Accident Prevention Service

47

Industrial Hygiene Service . . . . . . . . .

49

General Engineering and Sanitation Service

52

Water Resources Service.

55

Health Conservation Branch

Crippled Children's Service

57

Maternal and Child Health Service

60

Nutrition Service School Health Service .

Local Health Branch

Local Health Administration Service.

Northern Health Region

. . .

Central Health Region

Southern Health Region

..

Preventable Diseases Branch Cancer Control Section Cardiovascular Disease Control Service Georgia State Employees Health Service . Occupational Health Service . Tuberculosis Control Service . Venereal Disease Control Section .

Special Services Branch Chronic Illness and Geriatrics Service Battey State Hospital. . . Medical Facilities Service . . . . . .

63 . 65
68
70
73 75
78
80 . 84
87
. 89 92
... 94
97 99

diVISIOn 0~ adm1n1stQat1on and ~1nance

CIVIL DEFENSE HEALTH SERVICE PROGRAM
Civil Defense Health Service assumed a role of greater importance this year and as a result, a separate office was established in the Office of the Director. A full-time Program Director was employed, and arrangements were completed to have a full-time representative assigned by the Public Health Service.
A committee <:omposed of key personnel of the Department was appointed (a) to analyze the health problems that would be imposed on the State by a national emergency, (b) to determine what must be done to meet the problems, and (c) to assist the new Program Director in establishing programs and goals. The Civil Defense Health Service annex to the Georgia Operational Survival Plan was revised and updated, and the Biennial State Plan was revised to refleet the new programs and goals.
The twenty- six civil defense emergency hospitals, which have a total of 5, 200 beds and approximately $520,000 worth of back-up supplies and equipment, were inspected by a team of experts. Corrective action was accomplished on all storage deficiencies found and all hospitals are now ready for immediate use. Action was also undertaken to obtain sufficient additional supplies to extend operating capability from three days to thirty days. This program is scheduled to be completed during the second quarter of fiscal year
1964.
- 1-

A building was obtained for the purpose of establishing a "Training Center" to familiarize the personnel who will be assigned to the civil defense emergency hospitals with the austere and field-type supplies and equipment, and to inform them of the advance planning that must be completed.
Twelve hundred additional Medical Self-Help kits were obtained and each county now has at least two kits. Plans were prepared to make an extensive drive to obtain state-wide acceptance of the program and to have it added to high school health and first aid programs at the junior and senior level. The drive will begin as soon as publicity materials are completed.
An agreement was reached with the State Civil Defense Director on a program to step up radiological defense activities. This includes selection and assignment of experts to each Civil Defense Area to plan and coordinate training of monitors, establish monitoring stations, and assist in the development of county radiological defense plans, It also included the establishment of a facility capable of repairing and calibrating detection and measuring instruments prepositioned in the counties on a periodic basis,
An effort was made to encourage the counties to organize an emergency health service and to prepare emergency health plans. This met with great success and all but six counties now have written approved plans. The same success is anticipated in efforts to get them to prepare radiological defense plans.
-2-

The special talents and knowledge of local health department and district personnel have not been utilized fully heretofore in the various civil defense health service programs, so a policy was established to convert responsibility for all programs to the district and local health departments. This will increase effectiveness and progress appreciably, and will insure that district and local health departments are aware of all emergency health activities and programs within their area of influence.
- 3-

HEALTH EDUCATION AND TRAINING SERVICE
The Public Information Unit, working at various times with most Health Department Services, continued its basic job of keeping the general public rapidly and accurately informed of public health programs in Georgia.
An attempt is being made to give continuity to the information programs regarding specific long-range departmental projects. If successful, this approach will coordinate media contacts to fully exploit all avenues of public communications: television and radio; daily and weekly newspapers; magazines or specialized publications. Booklets, exhibits, printed programs serve to fill gaps in information released through public media.
The broad goal of the Information Unit is to acquaint the general public with the many and diverse ways in which individual lives and welfare are improved by Health Department programs.
It is felt that amount of information disseminated is secondary to quality and appropriateness. Pickup by media of information released and their further development, independently, of ideas suggested by the Information Unit seem to bear out this premise.
The two publications prepared and is sued monthly by the Information Unit, GEORGIA'S HEALTH and FAX, serve to give continuity to the information program and strongly augment efforts directed to public media.
-4-

Continued education as a supplement to academic preparation has as-

sumed additional meaning in the public health program of the present day.

Since its institution just ten years ago as a formal part of the program

of the Department, the training function has evolved into a vital link between

the theory and findings of the university and laboratory and the public health

practitioner. Over these few years the Training Section, which coordinates

the training activities of other organizational units, has grown to include the

activities presented here.

(1) Short term in- service specialization courses for state and local

staff members numbered 128 with 1, 110 persons participating.

(2) Twenty- seven professional public health workers from 16 foreigri

countries visited the state and various local health departments.

{3) Stipend-supported training for the year is summarized in the

following table:

STIPEND-SUPPORTED TRAINING July 1, 1962 - June 30, 1963

Academic

Orientation

Administrator

3

Bacteriologist

3

Dietary Consultant

1

Director, Field Laboratory Services

1

Engineer

1

1

Health Educator

1

Instructor, Elementary School

2

Junior Industrial Hygienist

1

- 5-

Nurse Physician Psychologist Psychology Intern Sanitarian Social Worker Veterinarian Residencies
Radiology Psychiatry

6

37

6

4

--

{

12

10

18

1

1 5

{4) With the addition of Walker County (District 2 7} in the summer of

1962, Bibb, DeKalb, Fulton {District 38) and Muscogee continue

to function as areas for field experience for public health personnel.

In conjunction with an interdepartmental training committee which meets

regularly, two training officers coordinate the field experiences of public health

nurses and sanitarians, the two largest groups to be trained each year.

The Public Health Library has during the past year assisted in the ad-

vancement of medical and related sciences by the collection, dis semination and

exchange of scientific and other information important to the progress of public

health. There were 215 new books added to the present collection; 1, 029 pub-

lications were circulated to staff personnel, local health departments, other

libraries, and interested persons; 925 reference questions were answered; re-

source materials were searched for current information concerning topics of

special interest in developing programs and research projects; special emphasis

has been placed on introducing new personnel to the Library, its facilities,

resources and services.

- 6-

The Visual Communications Section joined Health Education and Training Service on May 1, 1963. From this date to the end of fiscal 1963, the Art Unit completed 183 odd jobs, such as illustrations, layouts, lettering, paste-ups and painting. The Cartography Unit performed a total of 184 jobs in mapping, lettering, drafting, embosograf engraving and other odd jobs, not including 428 ozalid prints. In the Photography Unit, a total of 2, 315 prints, photography, copy, processing, slides and other photographic duties was completed.
-7-

PERSONNEL SERVICE
At the end of the fiscal year there were nearly 6, 000 people in full-time classified positions. In addition, many counties have employees paid entirely from local funds. A wide range of services are performed -- from manual labor to highly specialized scientific research. Educational attainment varies from less than grammar school graduation to completion of ten or more years of graduate study.
Total employment increased 175 in the twelve month period. However, it decreased in the state office and at Battey Hospital. Progress in out-patient therapy reduced the number of admissions to Battey, and improved methods of treatment further shortened the average hospital stay per patient. Consequently, there was a decrease of 78 employees; the reduction was gradual and the main groups involved were institutional nurses and institutional workers serving as nurses' aides and orderlies.
The number of full-time workers in local health departments and the other institutions increased. Primarily, the increases were in the field of scientific and professional services and direct personal care of patients. Local health departments added five more nurses and nine more sanitarians. In the increase of 143 at Milledgeville, there were 10 additional physicians, 93 more attendants and 4 additional psychologists. The attention by Georgians to the mentally retarded at Gracewood is shown by staff increase of 110; there the patients
- 8-

and students had the benefit of care by 14 more nurses, 3 more dentists, and 32 more clinical assistants. Two nurses were added at the Georgian Clinic.
Some of the occupational classes reviewed during the year were in mental health, epidemiology, dentistry, nursing, and data processing.
The new plan for employees 1 health insurance was put into effect; this plan provides for major medical benefits as well as the usual coverage for medical and surgical expense; the cost is shared by the employee and the department.

FULL-TIME EMPLOYMENT

6-30-62

6-30-63

Local

916

943

Fulton

*303

303

State
A. R. s.

687

658

43

45

Battey

781

703

Gracewood

479

589

Milledgeville Totals

-2-54-5-
5754

2688 5929

*adjusted from last year 1s report

- 9-

EMPLOYMENT TURNOVER 6-30-63

Local

*Appointments 212

*Separations 185

- - - Net Gain Separation Rate

27

20o/o

Fulton

63

63

0

2lo/o

State

203

A. R. s.

15

232

-29

13

2

34o/o 30o/o

Battey

135

213

-78

29o/o

Gracewood

209

99

110

19o/o

Milledgeville

604

461

143

18o/o

Totals

1, 441

1,266

175

22o/o

*These are gross figures which include those affecting employees on temporary

assignment and those in leave status. The percentage would be smaller if

these were not included.

- 10 -

VITAL RECORDS SERVICE
A total of 282, 300 records representing 227, 220 vital events were processed during the year and recorded in the Vital Records Service. The events recorded were 100,436 current live births, 38,634 deaths, 3, 322 fetal deaths, 55,089 marriages, 10,249 divorces, and 19,700 delayed birth certificates.
A total of 2, 716 certificates of adoption were received, processed, and new birth certificates for 2, 347 adopted children were completed and filed. Legitimation proceedings for 813 children born out of wedlock were completed and new birth certificates filed for these children.
Superior court orders changing the legal names of 160 people were received and birth certificates were amended in accordance with these orders. Over 6, 000 orders to correct errors in or amend birth, death, marriage, and divorce records already recorded were received, processed, and filed.
More than 175,000 requests for the certification and/or verification of birth, death, marriage, and divorce records were received from family members, attorneys, schools, welfare agencies, other governmental agencies, and private agencies. These requests were processed, resulting in the issuance of 42,291 certified copies of birth or death records and the verification of more than 100, 000 recorded records. Requestors of copies or for the verification of records not recorded were instructed to the end their needs could be met.
The microfilming of all birth records on file was completed, microfilm being used almost exclusively in providing certified copies and/ or verification of birth records on request received by mail.
- ll -

PATIENT ACCOUNTS SECTION

The primary function of the Patient Pay Section is to determine the amount each patient or responsible person should pay towards the cost of care and treatment of a patient in an institution under the control of the Board of Health, and to follow through to see that this payment is made. At the present time, in addition to resident patients, charges are being made for day patients in the Alcoholic Clinics but there are plans to open evaluation centers and day treatment centers in Milledgeville and Gracewood for which charges will be made.
Collections for the institutions continued to increase during the past year. This was due to higher per diem cost and to the fact that more people were meeting the requirements for paying. The number of patients for whom funds were paid in each institution was still small compared to the total patient load. It is very desirable that changes be made in the law so payments to be made will be on a more equitable basis. The Assessment Act is based only on taxable income. Thus, in some cases, persons with large assets invested in non-taxable items cannot be assessed to pay any amount toward the cost of care and treatment of a patient in a State Institution.
Many persons appear to feel no responsibility for patients who have been in the institutions for years and for whom no payments have ever been made, but the majority desire to make payment if they have financial ability. Many desire to pay although they lack funds. In some of these cases, no payment could be

expected.

- 12 -

diVISIOn 0~
ep1dm1oloqy

DIVISION OF EPIDEMIOLOGY With the relatively recent assumption by the Department of responsibilities in the mental health field, the need for epidemiological studies of mental illness, mental retardation and alcoholism is pressing. For some time the need for evaluating total community health programs and needs from a broad sociological viewpoint has been apparent. In order that vigilance in mitigating the more traditional public health problems not be lessened, increased emphasis on well-planned and thorough disease and disability studies is necessary. Consequently, in order to strengthen and broaden the epidemiological foundation of public health practice, a new Division of Epidemiology was established July 1, 1962. Such is the initial step in a far-reaching responsibility to provide the knowledge necessary to protect and preserve the health of this state. Presently, within this Division are contained the Branches of Epidemiologic Investigations and Laboratories.
- 13 -

BRanch o~ p1dmJoloqJc 1nvestJqat1ons

BRANCH OF EPIDEMIOLOGIC INVESTIGATIONS
The Investigations branch of the Division of Epidemiology is concerned with the collection and correlation of information relating to the prevalence and incidence of infectious and non-infectious disease, to other causes of morbidity, and to certain ecologic problems. This information is not easily available and special investigative procedures and research are necessary in order to elicit it. The problem has been approached in the following ways:
-- morbidity reporting systems of two kinds: ( l) a post card or telephonic communication procedure used by physicians to report through local 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 32nd year. The newest, for salmonellosis, is in its second year.
-- surveys of absenteeism from schools to determine the prevalence of epidemic disease, such as influenza.
intensive field studies to determine the actual extent of disease in a group or the health status of a group. In 1962, a community-wide study was made of an outbreak of keratoconjunctivitis in an effort to determine the
- 14 -

actual morbidity involved and the pas sible effectiveness of gamma globulin in protecting family contacts.
-- research studies intended to reveal the nature, fundamental characteristics, and sources of various diseases. Three major research investigations are in progress, two were brought to a close in 1962, and several others continue in reduced form.
These research studies include the following: -- longitudinal studies of viral infections of animals which
will infect man. In 1962, EEV became abundant in mosquitoes and numerous horse cases developed. As was predicted on the basis of past performance, human cases did not develop. Possible relationships of such infections to chronic and degenerative disease of man are also a concern.
-- a study of the basic bacteriology and ecology of the breadfiller-cellophane wrapper system formed by a wrapped sandwich is being continued with the aid of an NIH grant.
-- a controlled study of a new Staphylococcus vaccine is being made as part of a continuing investigation of means of enhancing immunity to staphylococci. This represents the sixth antigen investigated,
-- studies (a) on gamma globulin administered by eye instillation, (b) on the effectiveness of certain prophylactic drugs in institutional shigellosis, and (c) on ecologic and chemical factors producing a slime growth nuisance in
- 15 -

a major Georgia river have been essentially completed and are being reported.

The latter study has been of particular value in helping to define a new slime

problem developing in connection with a recently established mill.

Summary of Reported Communicable Diseases 1962 (With Comparisons with Earlier Trends)*

Median 1951-55

Regular Median Reporting 1957-61 1962

Sampling 1962

Amebiasis Brucellosis Diphtheria Encephalitis, unspec. Hookworm Infectious hepatitis Influenza Measles Meningitis, unspec. Meningococcal infections Poliomyelitis Psittacosis Rheumatic Fever Rocky Mountain spotted fever Salmonellosis Shigellosis Streptococcal infections Tetanus Trichinosis Tuberculosis Tularemia Typhoid fever Typhus fever Whooping cough

63 210
15 15,447
357 6,058 6,743
NR 93 505
6 84 14 150 328 712 30
1,985 41 58 32
398

11 20 101 17 8, 131 149 498 496 93 31 70
2 23 21 280 502 422 23
1,627 22 31 8 90

14 47 26 5, 157 272 1' 098 431
32 20
13 10 357 499 419 14
1' 398 19 21 5 8

140 30
150 140
2,030 72,290
2,210
90
470 10
530 880 58,440
60 60 130 40 30
650

*This represents the work of several divisions, particularly Epidemiology and Biostatistics.

- 16 -

VETERINARY SECTION
In contrast to the decreasing incidence of the previous three years, the Veterinary Public Health Service has noted a sharp increase in animal rabies during the past fiscal year. While rabies in domestic animals and pets continues at an all-time low, rabies in wildlife has reached epizootic proportions in South Central Georgia. Raccoons, a previously unimportant host of rabies, have exceeded all other species in the number of reported cases. Although it is difficult to evaluate wildlife population densities, a number of species seem to be sufficiently abundant to perpetuate the epizootic for some time to come. Wildlife control measures are not anticipated at the present time.
Among special studies made by the Service in fiscal 1963 are listeria, atypical mycobacteria, and ve sticular stomatitis.
Laboratory Branch and U.S. Public Health Service personnel assigned to the Veterinary Public Health Section have conducted a series of investigations relative to the incidence of naturally occurring listeriosis in foxes in selected areas of the state, A number of serotypes have been isolated and identified for the first time in these species, The results of these investigations are currently being prepared for publication.
Field and laboratory investigations of the atypical mycobacteria of animals have continued on a limited basis. Bacteriologic examination of tissues from tuberculin reactor cattle have yielded Group III non-photochromogens, In
- 17 -

the absence of other acid-fast bacilli, these organisms are strongly incriminated as sensitizing agents to Old Tuberculins employed as animal diagnostic antigens,
Epidemiologic investigations of human populations associated with cattle infected with vesticular stomatitis virus were again made during this fiscal year. Although significant antibody levels have been demonstrated in a number of persons residing on infected farms, the public health significance of vesticular stomatitis is still speculative. Arthropod collections have been made in epizootic areas to continue the ecologic studies of their potential role in the transmission of the disease.
- 18 -

BQanch o~ laBoQatoQJS

LABORATORIES BRANCH

The Laboratory Branch, consisting of the Central Laboratory Service

in Atlanta, and the Regional Laboratory Service with laboratories in Albany,

Macon, and Waycross, performed a total of 980,293 examinations in fiscal 1963,

an increase of 29, 925 over fiscal 1962. Included were diagnostic, special and

consultative services. The diagnostic services were performed in five sections

in the Central Laboratory as follows: Microscopy, Microbiology, Sanitary

Microbiology, Serology and Virology. Supporting services were provided by the

Preparation Section, Reports and Records Section, and Service and Supply Section.

With the exception of a virology section, the three regional laboratories operated

with the same organizational structure. Table A compares examinations made

in the two services and the individual laboratories during fiscal years 1962 and

1963.

TABLE A

Examinations Performed by Central and Regional Laboratories Fiscal 1962 and Fiscal 1963

Unit

Fiscal 1963

Fiscal 1962

Total

Per Cent Total

Per Cent

Central Laboratory Service Field Laboratory Service
Albany Laboratory Macon Laboratory Waycross Laboratory Total Branch Total

562,394 57
135, 182 14 157,535 16 125, 182 13 417,899 43 980,293 100

543,966 57

135, 166 14

150,655 16

120,581

13

406,402 43

950,368 100

- 19 -

Further analysis of the workload according to type of examination is shown in Table B. The high percentage of the microbiological examinations (62 percent) in the regional laboratories was due primarily to a large number of throat cultures routinely made for streptococci in the Albany Regional Laboratory requested by private physicians. The high percentage of syphilis serology -{62 percent} made in the Central Laboratory was probably due to the more densely populated areas serviced.

TABLE B Examinations During Fiscal 1963 by Sections and by Laboratories

Section
Microscopy Microbiology Serology Milk Virology

Total Number

Central Laboratory
Number P-e-r -C-en-t

Regional Laboratories
Number -Pe-r-C-en-t

211,980 49,363
609,697 100,466
8, 787

105, 108 50 18,998 38
377' 245 62 52,256 52 8, 787 100

106,872 50 30,365 62
232,452 38 48,210 48

TOTAL 980,293

562,394 57

417,899 43

A surprising increase in tuberculosis bacteriology requests appeared in fiscal 1963. It occurred comcomitantly with a steadily declining tuberculosis morbidity and mortality, and is explained by multiple factors. The concerted effort of numerous groups to "eradicate" tuberculosis has produced an awareness of tuberculosis, thus a demand for more diagnostic specimens. Closer follow-
- 20 -

up of discharged Battey patients in clinics and by CDI personnel has increased laboratory examinations. Employment of more rapid and thorough laboratory procedures has encouraged the submission of specimens for study.
Recognition of the increasing role of viruses in disease and the rapid development of new procedures has resulted in requests for more services. Examinations have increased continuously from 583 in 1958 to 8, 787 in fiscal 1963, Thus, concentration has been on expansion from an essentially enterovirus diagnostic service to a service competent in all phases of respirovirus and arbovirus (arthropod-borne) laboratory tests. Most virology services are directly concerned with surveys or investigation of outbreaks of interest to the Epidemiologic Investigations Branch. General agreement is that more real progress in the virology field is made by selected studies in certain diseases or certain population groups than by routine testing of specimens submitted by hospitals or private physicians. These same principles might be applied to the more common communicable diseases as they occur today.
A recently developed laboratory procedure, the fluorescent antibody technique, affords a frequent opportunity for more rapid and specific identification of disease-causing agents. Necessary microscopic equipment for the procedure has been secured for use in the Central and three regional laboratories. This method is presently used in the laboratory diagnosis of rabies. It provides a safeguard in human exposure cases and a more sensitive method of maintaininr
- 21 -

rabie-s surveillance in animals. Evaluation of this technique in the laboratory

diagnosis of syphilis will be completed during the current fiscal year.

The laboratory continues to offer assistance in the rabies diagnostic and

surveillance program. In fiscal 1963, a total of 1, 427 animal heads were

examined, of which 38 were positive, There were 95 treatments for human ex-

posure. This was an increase in animal head examinations, The number of

positives was due almost entirely to the occurrence of rabies in raccoons in the

southern counties bordering Florida. Twenty- seven of the 38 positives in 1963

were attributable to raccoons.

A sharp rise in the number of examinations concerning salmonellas in

gastro-intestinal diseases is especially noteworthy. Salmonella typhi {typhoid

fever} isolations in fiscal 1963 were as follows:

Total confirmed cases: 15

Total isolations:

21

Carriers:

Total old

ll

Total new

6

Total isolations 52

Diphtheria is another communicable disease which showed the effective-

ness of immunization and control procedures available, For the entire year,

the total number of specimens received in all laboratories for examinations was

1, 631; the number of initial isolations, 127; and the number of repeat isolations,

147, Not all initial isolations represent laboratory confirmation of clinical

diphtheria, since many were contacts of diagnosed cases. Laboratory data does

- 22 -

indicate that isolation of Corynebacterium diphtheriae is not a rare occurrence, and that August, September, October and November are the most active months, with a peak occurring in September.
Laboratory examinations were requested in 19 separate food poisoning incidents involving over 500 persons, A total of 78 food samples were examined with 67 associated specimens. Laboratory findings indicated that six outbreaks were due to staphylococci and one each due to Salmone~C: heidelberg, Salmonella typhinurium and Clostridium perfringens.
In 1963, the Central Laboratory Service and the Maternal and Child Health Service began participation in a national study of the Guthrie method of determining phenylke~ia (PKU} in the newborn. Laboratory and specimen collection supplies were provided by the Children's Bureau of the U.S. Public Health Service, Eight Georgia hospitals collected 3, 763 blood specimens from infants prior to discharge and submitted them to the Central Laboratory for testing. No previously unknown case of PKU has yet been detected, although PKU was confirmed in a sixteen month old child. This study will probably continue until a total of 20,000 newborns are tested.
The Microbiology Section cooperated with the Epidemiologic Investigations Branch in determining the incidence of ~isteria ~cytogene_::; in fox brains submitted for rabies examination. This bacterium has produced disease in many species of domestic animals but only a few have been reported in wild foxes.
- 23 -

An increase in human disease caused by this organism has recently been noted. An effort was made to determine the cause of peculiar behavior in those examined foxes found to be negative for rabies. Five fox brains out of 24 examined yielded positive cultures of Listeria monocytogenes,
The Serology Section conducted a comparative study, involving approximately 2, 000 specimens, between the newly developed RPR Card test and the currently used VDRL Slide test for syphilis. Results indicate a high degree of correlation, and the significance of this is being evaluated.
The Microscopy Section has been investigating the usefulness of a synthetic medium {Middlebrook 7Hl0) for culturing specimens for tuberculosis, This medium is claimed to permit more rapid growth and has advantages for sensitivity testing. The Battey State Hospital laboratory has also participated in this study.
Supportive services of the Preparation, Reports and Records, and the Service and Supply Sections were in great demand during fiscal 1963. These Sections responded readily to the need, The Preparation Section, in addition to preparing media and reagents, washing and sterilizing glassware, also produced 174, 000 ampules of 1% silver nitrate, 630, 000 doses of typhoid vaccine, and dilutions of Old Tuberculin sufficient for 720, 000 skin test doses,
The Laboratory Branch experienced a personnel turnover of over 20 percent in 1963, with 27 employees leaving the Service for various reasons.
- 24 -

diVISIOn 0~
mntal halth

ALCOHOLIC REHABILITATION SERVICE
The purpose of the Alcoholic Rehabilitation Service is to provide education and training, treatment and rehabilitation, public and professional information and research in the field of alcoholism, and to stimulate a better understanding of the alcoholic and acceptance of alcoholism as a treatable and preventable disease.
Alcoholism is a major public health problem and while this Service continues to provide quality rather than quantitative treatment, it does so with the realization that a large number (75, 000) of alcoholics in Georgia continues to exist. To help alleviate the problem of quantity, on July 1, 1963, a pilot Study Project was begun in conjunction with the Spalding County Health Department to determine the feasibility of treating alcoholism in the County Health Departments and utilizing local professional personnel. Four members of the professional staff of the Georgian Clinic now go to Spalding County weekly to provide consultation to the local group in the philosophy and techniques which have proven beneficial in this treatment. Hopefully this project will set the stage for similar programs throughout Georgia providing help for more alcoholics and their families in the local community before the illness reaches advanced stages requiring institutional care.
A continuous in- service training program is maintained for staff members and greater emphasis is being placed on training programs involving professional
- 25 -

personnel of all disciplines in other State and local agencies. More than five hundred people received this training at the Clinics during 1963, with a range in programs of one-day orientation to thirteen weeks of intensive training. These programs involved eight professional disciplines and were partially supported by federal grants.
The Alcoholic Rehabilitation Service co- sponsored a Southeastern School of Alcohol Studies, with five other Southeastern State Alcoholism Programs and the University of Georgia, in August 1963. Total enrollment was 237 students from eight Southeastern States, representing twelve different professional and lay disciplines.
The Service currently operates two full time treatment centers - the Georgian Clinic in Atlanta providing both resident and day care, and Chatham Clinic in Savannah, providing day-patient care. This year these Clinics provided treatment for patients from throughout Georgia as follows: _<;:~~1f~<:_r.:_ Clinic: Treated 266 patients at the resident center for a total of 12, 376 patient days, and 1,135 day-patients with a total of 18,370 visits. Families of patients received 1, 645 hours of counseling and group work. Chatham Clinic: Treated 242 day patients on a total of 5, 160 visits and patients 1 families received 401 hours of counseling and group work.
Records indicate that two-thirds of the Clinics 1 patients treated recovered sufficiently, with continued supportive therapy, to maintain jobs and
- 26 -

provide for their families without welfare assistance. Half of these maintain complete sobriety and other half gradually improve as their episodes of drinking become less serious, of shorter duration and further apart.
In 1962, 16, 891 pieces of literature were distributed upon request, in addition to that given to new patients. 34,000 copies of "New Life" were mailed to patients, organizations and individuals upon request.
Research is urgently needed and continues to be a major responsibility. This Service continually collects data for more specific observation and study. Drug research is an important part of the program at both clinics where the staff studies and evaluates drugs regularly. Projects involving therapy, drugs and evaluation of attitudes are now in the early development stages.
- 27 -

COMMUNITY MENTAL HEALTH SERVICE
In this Service's Community Mental Health Program, nine local programs in health departments continue to employ professional mental health staff for providing both direct service and mental health consultation with other agencies and professional groups in the community. During iscall963, these counties were Bibb (including Jones and Twiggs in a district program), Chatham, Cobb, DeKalb, Dougherty, Floyd, Fulton, Glynn, and Muscogee. Three other programs have been budgeted, in Clarke and Hall Counties, and in Lowndes County, including Berrien, Cook, and Echols in Public Health District 15. It is hoped that these programs will be activated during the current fiscal year.
The program of Nursing Services to the Mentally Ill continued on a statewide basis during this period. The program is going into its eleventh year of operation. A series of in- service education sessions for local public health nurses (five one-day sessions) continued in four public health districts, involving 20 sessions and 74 persons from 22 counties. This brings the total of participants in this program to approximately 200 from 77 counties in 55 sessions during the past two and one-half years.
Cooperative activity with the Georgia Association for Mental Health was carried forward with a series of eight meetings on a congressional district basis in the fall of 1962, attended by pairs of representatives from local health departments and local mental health associations. Stimulation of studies of
- 28 -

local needs and resources in community mental health have seen active partici-

pation in five counties, involving multiple agencies at both local and state levels.

A reporting service and consultation in the areas of school mental health and of

religion and mental health have continued. A change in the community education

for mental health phase of the program has involved discontinuation of supplying

free pamphlets and more emphasis on assistance in program planning at the

local level, with the provision of demonstration kits of materials to be used as

tools in educational programs.

The Community Hospital Psychiatric Program (formerly Intensive

Treatment Program} will complete its sixth year at the end of 1963. A fifth

hospital, Phoebe Putney Memorial in Albany, was included in the Program be-

ginning January 1, 1963. During the year ending June 30, 1963, applications

from voluntary patients referred by physicians through local health departments

included 866 applicants from 129 counties. The following summary shows the

applications, the admissions, and the total patient days for each of the five

hospitals:

First Appli- Admiscations sions

Total

Re-

Patient

Admissions Days

Talmadge Memorial, Augusta Columbus Medical Center Macon Hospital Grady Memorial, Atlanta Phoebe Putney, Albany

256 142

2

131

124

18

79

78

18

366 128

2

34

30

3

5721 2830 2385 6058
798

Total

866 502

43

17,792

- 29 -

Orientation programs for nurses from local health departments and regional offices throughout the state brought the total of persons attending the four-day courses at Talmadge and Grady Memorial Hospitals to 170 nurses from 66 counties during the two and one-half years ending June 30, 1963. This program will continue until all public health nurses in the state have been given the opportunity for this training and orientation.
During the year a change was made in the method of paying psychiatrists, shifting from a fee schedule to an hourly rate of compensation for all services rendered in connection with the Program. The decision was also reached to modify the Program during the next two years in the direction of providing a balance between local funds and state funds for support of this Program.
- 30 -

GRACEWOOD STATE SCHOOL AND HOSPITAL
Re-organization of staff has been a focal point around which expanded services at Gracewood State School and Hospital were planned during the fiscal year of 1963. On January 1, the Gracewood staff was administratively divided into three divisions:
(1) Central Administration (2} Plant Operations (3} Resident Care This division and subsequent definition of responsibilities has placed all personal services relating to care of the Gracewood resident under one organizational unit: the Division of Resident Care. The institutional program is further supported by the Division of Plant Operations, which has the responsibility of supervision, maintenance, and expansion of the Gracewood physical facilities, and the Division of Central Administration, which includes the administrative and operational functions of the Institution. Within this framework, services are being expanded and refined to the ultimate benefit of the Gracewood residents. The Evaluation and Rehabilitation Service in the Division of Central Administration made a study of the School's waiting list. This study revealed that 1, 364 applications for admission to Gracewood have accumulated. Of this number, 384 of the applicants are non-ambulatory and would require a bed in
- 31 -

an infirmary setting. To offset some of the pressure of the waiting list and to extend some service without, or before, admitting the applicant, the Evaluation and Rehabilitation section is arranging out-patient interviews to determine which on the waiting list are those in most urgent need of admission or service. The number of out-patients seen during the fiscal year totaled 373 in contrast to 254 seen during the previous fiscal year.
Gracewood had a net increase of ninety residents during the fiscal year, There were 164 new admissions and 65 discharges. Nine deaths occurred during this period.
Charts A and B reflect the population movement and characteristics in greater detail.
Chart A ADMISSIONS, DISCHARGES, AND DEATHS
By Race and Sex July 1, 1962 - June 30, 1963

Ad missions Di scharges De aths

TOTAL 164 73 9

WHITE

MALE
f-

FEMALE

66

54

35

27

l2

3

NON-WHITE
MALE FEMALE
2~--

2

1

2I 2
I

- 32 -

Chart B
TOTAL POPULATION By Race, Sex, and Age
June 30, 1963

AGE GROUP

T712 IN YEARS
Total all ages

TOTAL

Under 5

38

6 - 10

181

11 - 15

386

16 - 20

458

21 - 25

273

26 - 30

125

31 - 35

84

36 - 40

84

41 - 45

33

45~

50

WHITE MALE FEMALE

864

721

21

12

97

44

179

155

240

190

150

121

68

57

51

33

33

51

5

28

20

30

l_

NON-WHITE
MALE FEM-A-LE- -

83

44

3

2

26

14

31

21

21

7

2

_

_

_

I
]I_

_

_

_

_

_

One hundred and ten new employees were added to the Gracewood personnel roster during the fiscal year. The majority of the new personnel was on the attendant level. This fact reflects the continuing Gracewood emphasis on providing a greater scope and depth of care to the individual resident. Total number of employees at the end of the fiscal year was 589.
Continuation of seeking better qualified employees and providing better orientation and information to all personnel has resulted in a further decrease in personnel turnover. The 15. 56 percent turnover in this fiscal year is a sig-

- 33 -

nificant decrease from 21. 5 percent m fiscal year 1962 and 31. 64 percent in fiscal year 1961.
Faithful Service Awards were made to thirty-three employees during the fiscal year.
Gains in the Gracewood professional staff came with the employment of an additional physician, nine registered nurses, another psychologist, a certified social worker, and another teacher. Several staff members were given educational leave to pursue higher degrees of certification and competence in their professional areas.
Gracewood's fusiness Office assumed the responsibility of the operation of the canteen and the switchboard. A central receiving department was also established to give better control over materials coming into the Institution. Supplies, materials, and basic furniture have been requisitioned for the projects under construction.
All departments and divisions of the Institutio:J. work cooperatively to provide informational services for a public information program. Attendance and participation in the various professional meetings; orientation for lay and professional personnel; tours of the Institution for college classes, special groups, and interested individuals; information to news media; speakers for civic and service groups throughout the State: all are methods of disseminating information. There were over 5, 000 visitors to the Institution during the year.
- 34 -

In addition to the maintenance and renovation tasks which Plant Operations routinely performs, there were other special accomplishments of this Division:
a. The fire department was re-organized. There is now a full-time chief, and a training program has been revised to instruct a corps of volunteers.
b, A second kitchen was staffed and opened to provide the varied diets required by infirmary patients in addition to serving the increased number of Gracewood employees.
c. Plant Operations works closely with the Division of Resident Care to prepare and train residents for vocational rehabilitation.
Improvements and additions to the campus property include: completion and operation of the Infirmary, completion of the Evaluation and Rehabilitation Center, renovation of "E" Wing in the Hospital for office space, swimming pool construction, additional warehouse space provided, paving in the campus area, and installation of street and campus lights.
For the Division of Resident Care, moving into the new infirmary building on January 2, 1963, was a milestone in upgrading physical facilities and providing better care for many Gracewood residents. There are approximately 300 patients in this building who are severely handicapped, and they require a program of almost total nursing care. Physio- and hydro-therapy are some of the expanded services offered in this facility.
The quality of care which an institutionalized person receives is largely
- 35 -

a measure of the preparation and competence of the person most closely associated with his life from day to day -- the attendant. Gracewood has provided an attendant training program for both new and old employees. The formal inservice education program began in September 1962, with the employment of a full-time supervising instructor. Fourteen attendants completed a 112-hour course of instruction in April 1963. In May 1963, two more full-time instructors and a part-time instructor were added to the staff, and the training course was revised and expanded.
Departmental programs are carefully planned to insure that a maximum of these services are offered, and there is a statistical increase in the areas of services. But more important is the Gracewood concept of the importance of the individual, regardless of his limitations, and the emphasis on collective efforts to provide a good environment for the mentally retarded.
- 36 -

MILLEDGEVILLE STATE HOSPITAL
The conclusion of fiscal year 1963 marks the fourth year that Milledgeville State Hospital has operated under the Georgia Department of Public Health.
During this period, new patients continue to be admitted at a rate of more than 500 a month; however, the average length of stay has now been decreased to 82 days so that the hospital population remains approximately the same as last year. An encouraging sign is an increase in the number of new patients who now enter the institution on voluntary admissions, as well as an increase in use of the 1960 Law by the county Courts of Ordinary. The resultant confidence in the effectiveness of the hospital's treatment program indicates that Georgians as a whole are becoming more aware of the need of the mentally ill for early hospitalization and supportive services in the community as a factor in continued treatment.
The per diem cost for the fiscal year has risen from $3.29 to $3. 68. The total income for the institution for fiscall963 was $18,607,230, of which $14, 702,640 came from state funds, the balance from institutional income of various kinds, department sales of farm products and estimated value of donated commodities. This was an increase in state appropriations of $1,716,441 over the previous year.
The employee-patient ratio is now 1:4. 41, but there is still a long way to go to get this figure within the 1:1 recommendation of the American Psy-
- 37 -

chiatric Association. Completion of the Unit System organization has created interest
around the country. Inquiries have been received from many states regarding the System's organizational structure and operating and administrative procedures. The new staff dormitory and apartment complex was completed and is almost fully occupied. Additional housing for top level personnel is essential. The Yarbrough Rehabilitation Center, the central kitchen and the Arnall Building addition are almost complete and will be dedicated this fall.
A total of 10 new physicians were added to the staff during the fiscal year. Accredited residencies and internships are now available in psychiatry, clinical psychology, opthalmology, social work, hospital administration, clinical chaplaincy, music therapy, and recreation. The hospital program is becoming nationally known and the number of applicants for residencies and internships has so increased that selection of the best candidates can now be made.
Four accredited clinical chaplains were added to the staff during the fiscal year. A registered music therapist, an instrumental consultant, a psychiatric aide, and a negro musician with a degree in music education were added to the Music Therapy staff.
Vocational Rehabilitation Division has a present staff of nine, including five rehabilitation counselors, three vocational evaluators, and a supervisor
- 38 -

of vocational training. With the opening of the Yarbrough Building, this division will be well staffed and its program will be unique in the state mental hospital field.
The Department of Social Services added one chief social worker and seven MSW's as well as eight social work aides and nine volunteers, The Volunteer Services Department supervised a total of 388 volunteers in 7, 288 hours of service,
The Department of Physical Health, a new separate unit in the Unit System, had a complete remodeling job in the operating rooms; however, this section still needs intensive remodeling and renovation. The Blood Bank was approved by the American Association of Blood Banks. Pathological techniques were surveyed by the College of American Pathologists and all results were very good to excellent.
The Department of Public Relations continues to sponsor seminar programs with high school and college students. Some 8, 000 of these visited the institution during the year in addition to numerous other groups. The hospital received mention in a number of national magazines, and an article of major proportion is now awaiting publication in a national psychiatric magazine. Television documentaries and scripts for radio programs were prepared, With the acquisition of a complete photographic laboratory in the Yarbrough Building, it will be possible to expand the hospital's public relations program
- 39 -

next year, National accreditation was received during the year from the American
Psychological Association, National Association of Music Therapy, Inc,, and the National Association for Schools of Music, The Department of Chaplaincy Services has received full accreditation by one national accrediting agency and provisional accreditation by another, representing the first such multiple accreditation received by a state hospital. The five chapels will be completed by December 1963.
- 40 -

diVISIOn 0~
phys1cal health

BQanch o~ dental health

BRANCH OF DENTAL HEALTH
In this fiscal period, staff members of the Dental Health Branch provided consultation to personnel in state, regional, district and local health departments, in institutions, and, upon request, to officials in other state agencies and to professional and voluntary organizations concerned with health.
The staff of the Branch of Dental Health conducted two accredited courses for the senior dental students at Emory University School of Dentistry in fiscal 1963. One was a 16-hour course in public health, and the other a 5-hour course in civil defense. Three dental students employed during the summer months received general orientation in public health and assisted in the state-wide survey of dental x-ray machines. The Branch cooperated with the University of Michigan School of Public Health by providing field experience for a graduate student who had completed his academic work for a master s degree.
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. There has been no essential change in the dental staff or program at Milledgeville at this time to conform to the recommendations based on the survey of needs for dental care services at the institutions or in keeping with their biennial plan. A study of the dental needs of a sample of the hospital patients at Battey was made. A final report with recommendations is still under consideration.
- 41 -

An evaluation was made at the end of the second year of a demonstration conducted in District 28 for evaluating the potential of a full-time dental director in extending and integrating dental health services in the total district health program. Favorable reports have been made. Recommendations for continuation of the project strongly suggest the value of including a district dental director as a part of the basic district health staff. One of the services being provided in this program is an oral exfoliative cytology project in cooperation with the U.S. Public Health Service for the early detection of cancer.
Upon request by the Department of Corrections to the Department of Public Health, the Branch of Dental Health conducted a study of the dental needs at the Georgia Industrial Institute, Alto, Georgia, and submitted a report with recommendations concerning the dental program.
A position for a dentist, full-time, was activated in the Bibb County Health Department, making the total of 6 full-time dentists in district and local health departments, three 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.
The shortage of dentists and inadequate budgets in Georgia prevent the full staffing of public health dental clinics and institutional programs. The staff problem at Milledgeville continues to exist; however, the turnover of dentists has not been as great this year.
- 42 -

The program staff remained unchanged except for the filling of a new position of dental hygiene consultant within the Dental Public Health Service, There continues to be a need to establish a clinical dental service and to staff the Dental Public Health Service. The director positions of these two services need to be filled with qualified personnel.
Georgia ranks 46 in the nation with regard to the dentist-population ratio and the State can support more dentists. In addition to the need for expanding dental school facilities in the state, there is need for a scholarship program to support the dental school training for qualified candidates. There is need for training facilities for hygienists and dental assistants, since no accredited facilities for such training exists in the state,
- 43 -

DENTAL PUBLIC HEALTH SERVICE
All Dental Public Health Service staff members are engaged in a continuous dental health education program. Its purpose is the attainment of good dental health for the individual, the family, and the community. Educational programs of this Service include: ( 1) consultation and assistance to public health personnel, dentists, dental hygienists, dental assistants, schools, colleges, teacher education classes, official and voluntary agencies, (2} selection and preparation of educational resources such as pamphlets and audio-visual aids and {3} interpretation of current dental health information for different grade levels.
During 1963, consultation and technical assistance were provided by the Service to regional, district, and local health personnel, and to professional and community groups for the improvement of dental health. Fluoridation of community water supplies, continuous dental health education and incremental dental care for children continued to receive major emphasis. The Service cooperated with other services and sections of the Department in advancing programs of mutual interest.
Communities were encouraged to fluoridate their public water supply. A dental survey made in Cartersville after six years of fluoridation added to the mass of evidence of the benefits of fluoridation. Dental surveys have proved to be of local significance, not only in justifying continuation of fluoridation in some
- 44 -

instances but in showing the importance of maintaining optimal fluoride concentration for maximum benefits, and in pointing up the advantages of fluoridation to neighboring communities.
Five additional water supplies are reported to have begun fluoridation, bringing the state total up to 51 fluoridated water systems serving about 25 percent of the total population and a little more than one-third of the people who could 1eceive fluoridated water.
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 involved fabrication of individually fitted mouth protectors for scholastic athletes. In most communities dentists and other volunteers participated in these projects as a public service.
Dental care services for underprivileged children were provided in public health dental clinics in 72 counties. Clinics in 6 counties either began operation or were re-activated during the year; whereas, clinics operating during the previous year in 5 counties failed to operate. Altogether, there were 28 counties with dental clinic facilities which did not operate because of shortage of dentists, lack of local funds, or other reasons. Several of the clinics continued to operate on a nine-month basis only. The policy for state financial participation in the dental clinic programs provides for services to eligible
- 45 -

children on an incremental basis, thus preventing a backlog of needs which resuits when dental care is neglected. Interruption in the local program or inadequate provision for increasing the services as the program progresses prevents the complete fulfillment of the objectives of an incremental program.
National Children's Dental Health Week in February continued to be a focal point of activity throughout Georgia. The highlights of this year 1s work were published in the Journal of the Georgia Dental Association.
Phase II of the state-wide program for radiation protection in the use of dental x-ray machines was carried out in cooperation with the U.S. Public Health Service, the Georgia Dental Association, Industrial Hygiene Service, and local health departments. This consisted of evaluating the collimation and filtration of previously tested machines. More than 1, 200 dental x-ray units were registered of which only about 30 percent met accepted recommendations. Modification of filters and collimators were made by personnel from the U.S. Public Health Service for more than 93 percent of the machines needing correction. Much credit should go to local health departments and practicing dentists for their participation in this health program.
- 46 -

nVtRonmntal halth BRanch

HOUSING HYGIENE AND ACCIDENT PREVENTION SERVICE
The Accident Prevention Section has been concerned primarily with the prevention of accidents in the home, but has been quite active in other interest areas. Creating an awareness of the accident problem as well as promoting the involvement of others in accident prevention activities, has been primary throughout the year. This has precipitated major activities, such as the following:
1. Cooperative work with para-medical groups, such as pharmacists in poison prevention.
2. Extensive work with the Accident Prevention Committee, Georgia Chapter, American Academy of Pediatrics, and General Practitioners in the prevention of accidents in small children as part of their private practice.
3. Utilization of resources of the University of Georgia in the development of educational media.
4. Operation as State Clearinghouse for the poison control centers in Georgia. The Section developed a tabulation on poison reports to give emphasis on specific problems in Georgia for poison prevention.
5. Close work with other State Health Department services in promoting the integration of accident prevention into other programs.
- 47 -

6. Service on Georgia Home and Farm Safety Council and Georgia Water Safety Council.
7. Development of ideas to stimulate accident prevention programming by local health departments.
The Housing Hygiene Section has continued to stimulate housing programs in local health departments by providing advisory and consultatory services to these departments; supplying forms for the classifying, tabulating, and reporting of data; assisting in organizing local surveys for the collection of data necessary for assessing and promoting regulatory controls. A Housing Hygiene Technician was added to the staff in order to meet increased demands for services. Liaison was established with the University of Georgia, Georgia Tech, Metropolitan Planning Agencies, HHFA, etc., to increase clearinghouse activities.
Studies were promoted to explore new areas of concern to the Section so that a continuous evaluation program could be maintained. As a direct result, the Section promoted a program of Metropolitan Planning which was approved by the Department as a responsibility of the Environmental Health Branch and delegated to the Housing Hygiene and Accident Prevention Service. The primary goal of the program is to study shifting needs and resources for planning the environment, not as an isolated agency, but as a member of all concerned groups. These groups include county and municipal authorities, voluntary agencies and institutions, industries, universities, and professional organizations.
- 48 -

INDUSTRIAL HYGIENE SERVICE
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.
The implementation of such a program requires a well-trained staff of professional personnel. The Industrial Hygiene Service is fortunate in having such a staff comprised of a Service Director, one engineer, three chemists, three radiation technicians, three state assignees in the Radiological Health Section on loan from U.S. Public Health Service, four electronic technicians, 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.
Even with the well-trained staff available in the Service there are occasions when it is necessary to request the services of specialists from the Public Health Service and other allied Federal and State agencies. These services are freely available upon request, and with their assistance it is possible to evaluate most industrial health problems.
The increase in industrialization in the State has, of course, brought increased responsibilities to the Health Department. The local Health
- 49 -

Department is the official agency specifically charged with the responsibility of assisting these establishments and their employees in all health matters. Assistance from the State Health Department is available to local industries only through their local health departments.
In carrying out the program for improvement of environmental sanitation in industry, Industrial Hygiene personnel made investigations in 637 establishments employing approximately 52, 018 workers in 80 counties during the period July 1, 1962 to July 1, 1963. These investigations covered a wide variety of industries. During these investigations 349 samples were taken for laboratory analysis.
Samples collected and analyzed by the Radiological Health Section during the period covered by this report included 1, 660 air samples, 65 rain samples, 95 stream samples and 540 milk samples. The Section also made X-ray and Isotope inspections and surveys as indicated below:

Isotope Inspections

22

X-ray Surveys

49

Radium Surveys

8

Surplus Property Surveys

6

Special Surveys

3

Classes {X-ray Technicians and Sanitarians)

2

In the period covered by this report, the Electronics Unit made 96 major repairs to x-ray equipment, in addition to minor repairs to such equipment as film dryers, tape recorders, movie and slide projectors, record

- 50 -

players, vision test units, radiation meters, etc. The Unit repaired 143 audiometers. In addition to the above activities, personnel assisted the T.B. Service and State Employees Health Clinic in their programs at various times due to the absence of technicians on leave.
In 1963, progress was made in the air pollution activities of the Industrial Hygiene Service. During the period between July 1, 1962 and July 1, 1963, 10 one-week studies were done at various localities in the State. During these studies, 488 samples were collected for laboratory analysis and 1, 496 field determinations were made.
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, 569 bedding inspections were carried out.
- 51 -

GENERAL ENGINEERING AND SANITATION SERVICE
At the beginning of the fiscal year, General Engineering and Sanitation Service in cooperation with other services of the Department and the local health departments of the five counties surrounding Lake Lanier had just completed the field work involved in the Lake Sidney Lanier Sanitation Survey. The compilation of data and preparation of the final report on this project was completed during September.
Among other beneficial results from this survey, the following changes have occurred: ( 1) Public Health District 25 has been fully activated. (2) Hall County has brought into full operation a sanitary landfill located at Oakwood and plans are underway to open another such landfill in the northern section of the County. (3) The Corps of Engineers are in the process of providing sanitary toilet facilities and drilled wells with approved type pumps at all public use areas. (4) The City of Flowery Branch has begun negotiations leading toward a sanitary sewerage system and disposal facility. (5) Forsyth County authorities are making needed corrections to public use areas on Lake Lanier leased for county use. (6) The Georgia Department of Public Health has assigned an engineer to work on a full-time basis with Federal and local authorities in developing adequate sanitary facilities at Lake Allatoona, Lake Lanier, Hartwell Reservoir and Clark Hill Reservoir.
- 52 -

Also during fiscal 1963, a consultant and evaluation program in Food Service was provided in 106 of the 159 counties. This included approximately 2, 600 inspections in the interest of food sanitation. There were 34 local food service programs having an evaluation rating of 90o/o or above. Base line surveys were completed in three counties in preparation for an intensive program and study to determine the feasibility of self-evaluation techniques in the food service sanitation program.
In the Milk Technology Program, there were 25 official rating surveys and 37 spot check surveys of milk sheds in the State which required 158 pasteurization plant inspections and 1, 650 dairy farm inspections. Twenty-two milk sheds obtained sanitation ratings of 90o/o or above and are listed by the U.S. Public Health Service as being "honor roll" milk sheds.
The Shellfish Sanitation Program included issuance of permits to 17 operators. 832 water samples were collected in Georgia's oyster growing areas for bacteriological examination by the State Health Department.
Working cooperatively with the State School Building Authority in review of school plans and construction, a total of 702 separate sets of plans, including preliminary plans, working drawings and final plans and specifications were reviewed by this Service. It is interesting to note that several school systems, particularly in the urban areas, have begun to use air-conditioning throughout s choo 1 plants.
- 53 -

In controlling vectors of human diseases, primary activity has been centered in proper refuse collection and disposal, proper construction of impoundments and mosquito control in hydro-electric power developments. 203 field trips to 60 municipalities and 33 counties were made in the interest of developing proper refuse collection and disposal. 1, 114 permits were issued for proper maintenance of impounded waters, primarily farm ponds. This Service cooperated closely with several companies, commissions, and authorities in setting up schedules for larvicidal activities on 14 major impoundments in this State. The major portion of this operation is done by use of airplane application.
In working with the development of subdivisions for residential purposes, the Service reviewed water and sewerage proposals for 271 suLdivisions scattered in 35 counties. Following construction, inspection by local and regional health offices of 1, 477 septic tanks made it possible for the service to endorse the tanks for FHA and VA. One hundred and fifty private water systems were also inspected in this program. Included in the water and sewage activity were the review of plans and specifications for 38 sewage oxidation ponds; 12 sewage aeration plants; 10 covered sewage and filters; 28 large septic tank systems; and 14 community water systems.
This Service had on its register 1, 279 tourist courts. 1, 163 permits were issued under the Tourist Court Act; 62 courts closed during the year. Thirtyone permits were withheld pending completion of repairs.
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WATER RESOURCES SERVICE
The Water Resources Service provides public health supervision over water supplies, sewerage projects, industrial waste treatment, stream quality and allied activities necessary to this program.
During the fiscal year 1963, plans and specifications were reviewed and approved for fourteen new water supplies, and improvements and extensions to fifty-two water supply facilities. Consulting services were provided to municipalities and industries concerning water quality, quantity and treatment problems that are or may be encountered.
Projects currently being carried out by municipal and county governments have received a major part of the time and attention of sewerage projects staff. Plans and specifications for eighteen new treatment plants and expansions for twenty- six plants or systems were reviewed and approved. Federal funds in the amount of $2,651, 319 for financial assistance under the Federal Water Pollution Control Act, Public Law 660, were allotted by the Georgia Department of Public Health.
The increasing industrial expansion in the state has caused a greater emphasis to be placed on the necessity for proper waste disposal by industry. Numerous new and potential industrial waste treatment facilities were reviewed. A total of twenty industries and six municipalities were notified by the Georgia
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Department of Public Health that steps must be taken to abate stream pollution created by them.
The Stream Quality Section continued the survey of watersheds in the state to determine sources and extent of pollution. Major streams sampled were the Coosa, Chattooga, Oostanaula, Etowah and Chattahoochee Rivers. Samples were collected to determine the physical, chemical and bio-chemical characteristics of the water. Data has been recorded on all these watersheds and has proved to be a valuable tool in assessing the over-all pollution problem.
Public education and promotion of water supply and waste treatment facilities have received the maximum possible attention by this Service. Numerous conferences with interested parties were held for the purpose of exchanging information and discussing interstate stream quality and airing specific problems.
In addition to making the water analyses necessary for the state-wide water quality and stream quality programs, the Water Laboratory of the Water Resources Service is charged with the responsibility for the laboratory work connected with swimming pool and shellfish sanitation programs. The data and information derived from the tests are used by public health personnel in solving many of the problems inherent in a water resources program.
No case of water-borne disease attributable to the over 650 community water supplies was reported during the year. 30, 304 bacteriological tests and 10,050 bio-chemical, chemical and sanitary chemical analyses, or a total of 40, 354 tests on water, sewage and industrial wastes were made.
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hdlth conseuvdtJon BUdnch
*

CRIPPLED CHILDREN'S SERVICE
During the past year 10, 194 children, representing every county in the state, were treated through Crippled Children's Service. There was an average of about 300 applications per month, but only 2, 721 new children were accepted for treatment during the year. A large number of children are seen over a period of years for continuing care of their disabilities, such as the 770 old polio cases which require braces and oftentimes repeated operations, the 97 amputee cases which require adjustments and replacement of their artificial limbs as the children grow, and 146 paraplegic and quadriplegic children who will be paralyzed the rest of their lives and are so prone to complications.
Although the majority of the children treated through Crippled Children's Service have orthopedic disabilities, a number of other handicapping conditions are also being accepted for care. The cardiac program continues to grow both in size and cost, having cared for 606 children at a cost of $154, 504. 51 in 1962. Of these 606 children, 467 had congenital heart defects and 65 of these underwent heart surgery. Approximately 35 children were on the waiting list for heart surgery at the close of the year. Most of the remaining heart cases were acute rheumatic fever and required considerable convalescent hospital care due to the extremely poor home conditions of many of these poorly educated and very low socio-economic families.
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Children with epilepsy or seizures numbered 761, Most of these children's seizures were fairly well controlled and when understanding and cooperation of the families and school officials involved were obtained, the children were able to attend school and lead a reasonably normal life.
There were 5ll children with hearing impairment, Many of these improved with medical and surgical treatment. Others, where indicated, were provided with hearing aids which in many cases helped them to function in a near normal fashion.
Over 1, 000 children were treated in the plastic surgery program for harelip, cleft palate, and many other disfiguring and limiting conditions such as contractures resulting from old burns. The fresh burn cases were very costly, $168,151.57 having been spent on only 132 children. Due to lack of funds, only burned children from counties which had no hospital and medical personnel to care for them were accepted.
Among these 10,194 total patients was a fairly large number of mentally retarded and even a few mentally disturbed children who were accepted for care primarily for other handicapping conditions. They and their families were given considerable medical, nursing, social, and psychological support, In fact, a very positive approach to mental health was exercised in helping these many families recognize and cope with their problems associated with and resulting from their children. Most of these children generally are from the very low level educational and socio-economic group. The families offer
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little motivation to their children for improvement of their lots. Realizing that the handicapped child needs even more than average education and training in order to compete with others and earn his way, the Crippled Children's Service has tried to stimulate and encourage these children and enlist the aid of other agencies in their behalf.
The budget for the year was $1,705,264. An additional $73,744 was obtained from the Children's Bureau and $79,249. 35 was added by cash and insurance collections from the children's families for a total expenditure of $1, 858, 257. 35. Despite this sizeable amount of money, services had to be curtailed during the latter part of the year due to insufficient funds.
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MATERNAL AND CHILD HEALTH SERVICE
The Maternal and Child Health Service is charged by law to protect and promote the health of mothers and children. The focus of the Service has been on preventing and combating health factors which would help keep individuals from becoming economically dependent members of society.
In 1962 there were 99, 074 births of which 8, 369 were home deliveries oy 409 midwives. It is anticipated that approximately 2, 500 of these babies will be mentally retarded, 100 will be completely dependent and require institutional care, 400 will be semi-dependent, and 2, 000 will be marginal dependent.
In 1934 the maternal death rate was 78,2 per 10,000 live births, In 1962 this rate was reduced to 4. 8, Although there has been great improvement, Georgia must materially improve both the maternal and infant mortality rates in order to compare favorably with the national average.
The primary cause of maternal mortality last year was hemorrhage (16}, closely followed by infection (12} and toxemia {11}. These are all preventable causes of death. The great majority of congenital defects, both mental and physical, are directly associated with the complications of pregnancy. The primary effort is placed upon good prenatal care, terminating in hospital delivery by a physician, and continuous well-child supervision, To date, there are 17 community plans for indigent hospitalization, 3 of which have been recently initiated, and 5 more are under study.
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During the year 14, 749 patients were admitted to prenatal medical clinics, 17,114 to prenatal nursing clinics, 3, 663 to postnatal medical clinics, and 4,134 to postnatal nursing clinics. One hundred and six counties have maternal clinics with physicians' services. Stress has been placed on the prevention of iron deficiency anemia. All patients are now given oral iron as early in pregnancy as possible; 72 cases of extremely severe anemia were provided with parenteral iron where routine oral therapy was inadequate or impractical.
One hundred counties have well child conferences with physician participation. Twenty-three counties have nursing conferences for mothers and children. Over 97, 000 immunizations against diphtheria, tetanus and whooping cough were completed during infancy and through the first five years of life. About 43,534 in this age group received Salk polio vaccine,
Most health department clinics routinely use a urine test screening for phenylketonuria at the sixth or eighth week. A hospital screening program for this preventable cause of mental retardation has been set up in the newborn period. Hospitals with 1, 000 or more livebirths annually were invited to participate. By June 30, 37,637 bloods had been tested. An exhibit on preventable mental retardation used at the annual state medical meeting was well received by private physicians. A great number of conferences were held with groups, families and nursing staff at local level regarding problems of mental retar-
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dation. The demonstration project in mental retardation, sponsored by the Maternal and Child Health Service, Children's Bureau and the Muscogee County Health Department, is providing services to a twelve- county area,
The number of clinics for the infant auditory screening program, aimed at early detection of developmental and/or hearing problems, is increasing.
There has been an increasing awareness of the consequences of maternal deprivation, Two health departments are holding monthly meetings jointly with other agencies to discuss the needs of specific families and make recommendations.
Routine in- service training in maternal and child health is part of the basic work of the staff. The revised Georgia Mother and Baby Book was received from the printer on August 29, 1962. As of June 30, 1963, 40,793 had been requested.
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NUTRITION SERVICE
The Nutrition Service highlights this year included: personnel changes; a Nutrition Workshop for nursing directors, supervisors, and consultants, with emphasis on records; and a monthly news sheet for the district medical officers. The Service also made plans for {l) a survey of the child caring institutions, in cooperation with the Family and Children's Service; (2) a research workshop in cooperation with the Association of State and Territorial Public Health Nutrition Directors; and, (3} preparation of a supplement to the fatcontrolled diets issued by the American Heart Association. Numerous activities related to the Georgia Teen-Age Conference were carried out, such as the publication of the fact sheet, "Teentalk", plans for a TV program, "Teentrition'', and the continuation of the Home Care project in Dalton. One nutritionist planned a course for homemakers in a housing project. In addition, plans are in the processing stage for a joint project with the League of Nursing to develop a course for teaching dietitians in nursing schools.
Continued services to schools included participation in the Training in Depth Courses for school lunch personnel by several staff members, the revision of the mother-baby care course to better interest the teenagers, the Florida Citrus Commission project on better breakfasts in ten congressional districts, and work with science fair projects, 4-H Club students and the animal experiments in a number of areas.
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The Service cooperated in teaching (1) food service and nutrition to day-care groups and food service personnel in nursing homes, and (2} courses for practical nurses, midwives, prenatal groups, weight control classes, diet therapy classes, and talks to civic groups. The Service helped to orient new staff and foreign visitors.
Diabetes and Cardiovascular Disease Control received increasing attention. Work with groups of diabetics in several areas, teaching chronic disease investigators, and cooperating with the Atlanta group in the organization of the McLoughlin Diabetes Education Project were activities for diabetes control. The U.S. Public Health Service nutritionist prepared an exhibit to demonstrate the polyunsaturated- saturated ratio of selected margarines and fats, and an analysis of the fatty acid composition determined by gas chromatography. Work with cardiac clinics to promote cardiovascular disease control by dietary means was conducted.
Miscellaneous activities, such as a review of Crippled Children's records as a preliminary step toward improvement of the nutrition component of the service, cooperation with Medical Facilities in the "Food Service and Sanitarian Institute", and planning a study of sibling nutrition related to disease susceptibility with the Atlanta Tuberculosis Association were carried out.
In addition to the usual function of preparing materials for groups and Services, plans were and are being considered for improving the Service by a pilot project in one district in the State.
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SCHOOL HEALTH SERVICE
The year 1962-63 found School Health Service concentrating the major portion of its staff energy and time on hearing and vision conservation programs, and on two other projects, one in cooperation with Children's Bureau, and one in a local small city school system.
In the Vision Conservation Program, 275, 538 children from 98 counties in 657 schools had vision screening, with 11, 928 of the 22, 895 reported as having received follow-up care.
The Hearing Conservation Program offered individual puretone audiometric tests in 107 counties in 690 schools to 135, 321 children, 6, 853 failed; 3, 315 were reported as receiving medical care.
As a new feature of the hearing screening, clinics were set up in 13 local health departments for screening diagnostic examination by an otologist. 1,173 children from 17 counties received this service with the result that only 555 or less than half of the original failures were found to need medical or other specialty services (audiologic, psychometric, and/ or special education). By working cooperatively with a local health department and a medical school, the School Health Service was able to help put into operation the first speech and hearing clinic sponsored by a local health department. School Health Service lent the services of its part-time audiologist as a contribution to the establishment of this clinic.
- 65 -

School Health Service with the cooperation of Communicable Disease Center arranged for the local health departments in three counties to have teams cor e in for a school survey and a treatment plan for ringworm of the scalp. With B funds supplied by Children's Bureau, a special project health survey was carried out at the Georgia School for the Deaf at Cave Spring, Georgia, with each of the 281 children receiving a pediatric, otologic, audiologic and opthalmological examination. Eighty of these children received psychological examinations. The results of the findings were relayed to family doctors and local public health nurses for follow-up during summer vacation.
In a study at Americus, Sumter County Health Department, the Service field-tested a questionnaire for the detection by the teacher of emotional disturbances in children. In one elementary school of around 500 enrollment, 34 children who screened out positively received a psychological interview {brief) assessment. Plans are underway to test the instrument {as a statistically controlled study} in the Americus City and the Sumter County Elementary Schools to determine the value of the questionnaire as a screening tool in the course of the testing.
The School Health Service is constantly asked to help those children who do not progress satisfactorily in school, for any one of many reasons, the most probable of which is emotional disorder. Inasmuch as there is not avail-
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able from the Departments of Health, Education and Welfare, resources for determining the cause of academic failure of these many children, there needs to be some careful interagency planning to make available to every school child resources for diagnosis and treatment of problems, be they in the area of emotional disturbances, mental retardation, physical defects, economic disadvantages, or other combination of problems.
To provide the service of teaching Health in the schools, the Service's Nurse Instructor as sisted in the Mother and Baby Care Classes, a popular offering to the high school Home Economics classes. School Health Service has also offered consultative services to local health departments concerning the teaching of health subjects in the schools, and has worked closely with voluntary and other school related agencies.
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local health BRanch

LOCAL HEALTH ADMINISTRATION SERVICE
During the fiscal year 1963, considerable activity relating to district activation and staffing occurred. A total of three districts were activated: Health District 30 on August 1, 1962; and Health Districts 25 and 26 on January 1, 1963.
District Directors of Public Health for Districts 7, 25, 26 and 30 were placed in active service in this fiscal period. Two District Directors of Public Health who were in orientation during the year will be as signed to Districts 16 and 19 upon completion of their training.
Twenty-five districts with District Directors of Public Health were active at the end of fiscal 1963. A total of 30 out of 38 active districts with either District Directors of Public Health or District Directors of Environmental Sanitation and/or District Directors of Public Health Nursing were in existence, One District Director of Environmental Sanitation and five District Directors or Acting District Directors of Public Health Nursing were added, and one retired.
Efforts were made by regional personnel to establish health departments in Schley and Pickens Counties. The complement of local health department personnel was increased by 14 nurses, decreased by 14, the number of sanitarians, and increased by 8 clerical workers, and other full-time personnel.
A change in directorship of Local Health Administration Service occurred on March 1, 1963, when the former director was appointed to head another ser-
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vice in the Environmental Health Branch. At that time, an Assistant Director assumed leadership of this Service.
Considerable time was spent by the Service in anticipating utilization of grant-in-aid funds to local health departments. In addition to this, the neccessary plans were made during the month of June, 1963, for the transfer of all engineering and sanitation personnel from the regional offices to the various staffs in Environmental Health Branch, effective July 1, 1963.
There were four new health centers completed, four under construction, and seven approved for construction during this fiscal period.
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NORTHERN HEALTH REGION
In fiscal 1963, Northern Health Region came a step closer to its ultimate goal, activation of all proposed districts, when District #25 was activated on the first of January. With District #25, composed of Hall, Forsyth, Dawson, Lumpkin and White Counties, a total of ten out of thirteen planned districts were functioning as activated districts. Two counties (Union and Towns) proposed as part of District #25 had no local health departments.
The District Directors of Public Health of District #16 and #29 resigned as of July 1, 1962, leaving only eight districts with full time medical directors. A replacement was recruited for one of these districts to assume duties as of July 1, 1963. Seven of the activated districts had a district director of nurses and eight had a district director of environmental sanitation.
Thirty-three of the fifty-one counties comprising the Region were included in activated districts; fifteen were in unactivated districts; and three, Pickens, Towns and Union, had no organized local health services. Twenty-five {or almost one-half) of the counties in the Region had no full-time medical direction, being served on a part-time basis by the Regional Medical Director. These counties included two activated districts (8 counties) where the medical director served as Acting Director of Health, three unactivated districts (14 counties), and 3 counties without a health department. One of the latter, Pickens County, will
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organize a health department as soon as a qualified nurse can be recruited. On June 30, 1963, the Northern Regional office staff consisted of two
nurse consultants, two nutrition consultants, one engineer, one sanitarian, two stenographers, and one medical director. During the year, one sanitarian transferred to a local health department and one engineer to the General Engineering-Sanitation Service.
As of December 31, 1962, in the activated districts, there were employed a total of 11 physicians, 223.6 nurses, 99 sanitarians and engineers, 120. 6 clerical people, and 138 other employees in the various health departments throughout the Region. Twenty-one nurses, 5 sanitarians, and 16 clerks were employed in the unactivated districts. Five health investigators served the area. Ten organized counties operated without a local sanitarian and one county without a local nurse.
A total of 2, 224 visits by Regional personnel were made to local health departments. These visits may be classified as follows: physician- 131, nurse280, engineer and sanitarian - 516, nutritionist - 187, clerk - 19, and health investigator - 1, 091. The nurses, engineers and sanitarians were deployed in a wide range of activities in making these visits. Activities varied from local staff duty to supervision and consultation, depending upon the nature of local staffing. The nutritionists and clerk visits were of a consultatory nature to the local nurses and clerks. The health investigator visits were made for
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direct service to local health departments, mostly for the control of communicable diseases. The medical director gave part-time medical direction to twentytwo local health departments including two health districts. Promotional activities for the formation of health departments were conducted in three unorganized counties and for the activation of districts in two districts.
The Region assumed responsibility for the supervision and recommendation for licensure for 21 nursing homes located in areas having no district director of public health or sanitation personnel. Four nursing homes discontinued operation and three new ones opened. Two homes expanded operation by new construction and one was in process of opening at the end of the fiscal year.
Five in- service training conferences for local health department personnel were held in Monroe, Jefferson, Marietta, Winder, and Rome during 1962.
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CENTRAL HEALTH REGION
Among the continued programs underway during fiscal 1963 in Central Health Region was the study of blood pressure in Baldwin County. Expanded tuberculosis services in this Region, including the diagnostic and evaluation clinics serving 23 counties, were most active.
In- service education during this period for consultant nurses included attendance at programs on nutrition, the handicapped child, tuberculosis, alcoholism, civil defense and Red Cross community service. The Health Region planned and held in- service programs for local health department staffs concerning tuberculosis, mental deprivations, interviewing, family planning, MCH evaluations, records, and a three day crippled children's clinic. Assistance was also given in teaching a class of new midwives. Participation continued in Red Cross mother and baby care programs.
The regional sanitation staff continued to render direct services to counties without sanitarians. This work load was not appreciably decreased since the last fiscal report. With more interest in water supplies shown by cities and counties, sewage disposal and stream pollution, consultation requests made upon regional sanitation personnel increased. There were 14 counties without sanitarians during the period covered by this report.
A nutritionist from Nutrition Services, although not specifically assigned to this regional staff, has cared for the nutritive phase of public health in Central
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Region. Services rendered include work with schools, nursing homes, colleges and practical nursing schools, crippled children's clinics, institutional work and industrial work.
The number of venereal disease cases continued to increase throughout the Central Region. Non-incidence and low-incidence areas contributed to the upward trend. Lack of transportation for patients to diagnostic and treatment centers has posed a problem to which local practicing physicians have responded. The highest incidence is among the younger age groups and public unawareness makes the problem of control even more difficult.
During this period nine changes were made in clerical positions in local health departments due to retirement, resignation or newly established positions. Clerical field representatives were therefore required to place considerable emphasis on training new personnel. The methods and procedures governing reports, budgets, tuberculosis case registers, job descriptions and other routine clerical activities appear to be a never ending process. The LH0-7 report was a constant reminder of needed assistance to local health departments.
One month after the beginning of this report the regional medical director was transferred to a district. The remaining staff complement was constant.
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SOUTHERN HEALTH REGION
The staff of Southern Health Region conducted an overall guidance, supervisory, consultative, and educational service to individual counties and districts as needed during the past fiscal year.
During this period, one new health center was completed at Lyons and one at Ashburn, and new centers were begun in Irwin and Colquitt Counties. Wheeler County was reactivated after having been closed more than a year. Wheeler and Montgomery Counties submitted informal applications for new health centers. Lanier County obtained and moved into much improved quarters at Lakeland.
In the Region's work in Environmental Health Services, all milk sheds have continued to enjoy "honor roll" listing. Analyses of milk samples revealed a decrease in total bacteria count, coliform and additional water. Food sanitation has not progressed in all counties as was expected. Several oxidation ponds have been installed and are operating satisfactorily. There are several vacancies for sanitation personnel within the region.
One nurse consultant was added to the staff during this period and, several new nurses were employed in the region, including one in the newly activated Stewart County Health Department who resigned on March 29 due to illness. This same local department was kept open through the combined efforts of the clerical and regional staff. Family Service records have been
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introduced and maintained in more counties and districts, and nurses have found this method of keeping records to be helpful and convenient.
More emphasis was placed on the teenager this year in nutrition work. High school students were assisted with science projects, posters, nutrition term papers and animal experiments. Almost seventeen hundred students were shown nutrition films, filmstrips and slides. These were accompanied by talks regarding the importance of good diet.
Three hundred and seventy-four teenage diet histories were evaluated. The findings were in line with other such studies conducted in Georgia and the United States. Consumption of green and yellow vegetables, milk and Vitamin C was not up to the Recommended Dietary Allowances.
The Communicable Disease Control Section of Southern Region found a general decrease in infectious syphilis in this area. Other venereal diseases remained about the same.
When transportation was discontinued for patients in outlying counties, diagnosis and treatment problems arose. This was solved by local physicians treating patients in their respective communities.
Private physician cooperation has improved and public interest in the Region's control problem is better. Civic clubs have been of great help in this area. While maintaining an alert control program, the Region expects to gain still more private physicians' cooperation and improvement in public
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awareness during the coming year, Several new dental clinics have been established in the Southern area,
and still others were reactivated after remaining inactive for some time due to lack of qualified dentists to carry on the program. Savannah was the city in the Southern Region to be spotlighted during the National Children's Dental Health Week for the outstanding activities featuring dental educational programs. Several of the counties developed dental education booths at their county fairs. Additional interest toward fluoridation of water supplies has been stimulated in many areas throughout the region.
During the fiscal year, emphasis was placed on training new clerical personnel, and on improving record systems, In two counties, assistance was also given in furnishing and setting up the office. In cooperation with nursing personnel, assistance was given several counties in setting up family service records and individual index cards. This badly needed revision in record systems has already proven its value. Assistance was also given in such procedures as reports, budgets, tuberculosis case registers, job descriptions, and other routine matters.
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pRVntaBl dtSaSS BRanch

CANCER CONTROL SECTION
The case load of the Cancer Control Section program has changed very little in recent years. During fiscal1963, the total number of patients who received diagnostic or treatment services amounted to 4, 125. Thus, the average cost per patient was approximately $109.00.
All of the approved cancer clinics continued to operate throughout the year. No new clinics met the minimum standards for approval. It was possible to operate the Cancer Control program without interruption in this fiscal period. Although the cost of hospitalization has continued to rise, the funds available for patient care have remained about the same. The total cost of the program amounted to approximately $450,000.00. This represents a decrease of about $50,000.00 below the corresponding figure for the previous year. The reduction in costs was accomplished through the adoption and application of a number of supplementary rules and regulations. By this means, more rigid control was exercised over hospital admissions, not only with reference to services for which hospitalization was permissible, but also in regard to the duration of the hospital stay.
Since July 1, 1961, payment for hospitalization has been made at 100 per cent of the average per diem cost. Whenever a hospital submits a cost statement, the rate paid to that facility is adjusted accordingly. Rates are continuing
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to rise. Since July 1, 1961, there has been an average increase of about $3. 00 per day. When this increase in rates is applied against the number of hospital days for which payment was made last year, it amounts to an increase of about $40, 000. 00 in the cost of the cancer program. Currently, hospitalization accounts for more than 85 percent of the total cost of the program.
During the year, several of the clinic directors expressed an interest in having an occasional meeting of all the directors in order to discuss policies and problems of mutual interest. When this proposal was brought to the attention of the other directors, there was almost unanimous approval. The first meeting will be held in the fall of 1963. It appears likely that the directors will arrange to meet annually or, perhaps, semi-annually thereafter.
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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 in developing research and service programs designed to detect, correct and prevent heart diseases. Thirty professional and non-professional personnel were engaged in the various programs conducted by this Service in Georgia this year.
Operating programs in the Service include Hypertension, Congenital Heart Disease, Rheumatic Heart Disease, Stroke Rehabilitation, Congestive Heart Failure, Atherosclerosis and Heart Clinics.
A county-wide study is under way in Baldwin County to determine the nature, level and extent of hypertension in a community. Its purpose is also to see if public health control measures might effectively reduce this level. Another feature of the program is the enlistment of each heart clinic to provide standardized workups on indigent hypertensives to furnish a baseline group for statistical and therapeutic studies. Basic developmental work on counting bacteria in urine specimens utilizing the Coulter Counter was initiated.
The Atherosclerosis study, comparing two different monastic orders, is attempting to determine the role of diet and other factors in atherosclerosis. A meeting was held in Atlanta of all the abbots and physicians of the monasteries
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involved to report on the progress of the project and to stimulate participation and cooperation.
The Congenital Heart Disease 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 project was carried out to evaluate the heart sound tape recorder as a casefinding technique. The results showed that this is not a practical technique in Georgia unless further modifications are made to reduce cost and increase sensitivity.
Continued provision of medication to private physicians and heart clinics is part of the Rheumatic Heart Disease program supplied as prophylaxis for approximately 1, 800 indigent patients against the recurrence of rheumatic fever. A study of bacterial flora in the mouths of patients on sulfa and penicillin prophylaxis was conducted which showed definite penicillin-resistant bacteria that could be associated with bacterial endocarditis. Further study is required next year to establish any casual-relationship.
This year, the Stroke Rehabilitation program shifted its emphasis to the development of community stroke programs through demonstrations at medical societies in conjunction with seminars and consultations for nurses, and nursing home and hospital personnel, etc. Also, a meeting of leaders in the field of physical therapy was held in Atlanta in cooperation with the Public
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Health Service to discuss the future role and relationships of physical therapists in public health, particularly community and hospital centered rehabilitation programs.
Programs to maintain treatment regimens of congestive heart disease, digitalis, digoxin, etc., are supported through the Service's Heart Clinics, More attention is being directed toward PHN assistance to the private physicians' patients in this area.
There are sixteen Heart Clinics, including the Crippled Children's Clinic in Atlanta, now functioning to provide diagnostic evaluation, advanced surgery and all types of care and medication for heart disease patients. The Clinics' Personnel meeting was attended by the Service staffs. Contracting for payment of x-rays and fluoroscopies is now taking place on out-of-county patients to alleviate what has been a problem in many clinics.
The Cardiovascular Disease Control Service continues to supply the Heart Bulletin to physicians and medical students in the state as an educational tool, although the possibility of replacing it with a newsletter or some type news release is being studied.
A training program for Heart Disease Control Program administrative personnel (Public Health Advisors) has been instituted.
A Public Health Service Nutritionist was as signed here to assist in the development of a program of nutritional counseling assistance to private physicians and patients of heart clinics.
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Preliminary investigation into program possibilities in the peripheral vascular field was begun.
Plans have been formulated for several one day presentations, "Heart Activities in Public Health", which would present the total Service programs available and subsequently lead to nursing workshops in the various cardiovascular diseases on a district level.
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GEORGIA STATE EMPLOYEES HEALTH SERVICE
The major objective of the Employees Health Service is to enable employees to better serve the State. This is accomplished through: {1) counseling employees on health practices; (2) providing annual screening tests; and (3) administering 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, hearing, plus a chest x-ray, urinalysis, hemoglobin, white blood cell count, serology, blood typing, and blood sugar determinations. 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,
During the reporting year, the staff has consisted of one full-time physician, two nurses, two medical technicians and two secretaries. This staff is considered adequate for the workload being undertaken, However, if pre-employment physical examination under the Merit System is implemented, additional staff members and increased working space will be required.
There were 1, 297 employees screened during the reporting period. This is an increase of 112 over the preceding year. There were 1, 058 abnormalities recorded among the number screened. As in previous years, the
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majority of abnormalities were overweight and defective vision and hearing.

There were 47 employees who were found to have hypertension. Abnormal

hemoglobins were detected in 24 employees and abnormal urinalyses in 9 others.

These conditions were made known to the employee with the recommendation

that he seek medical interpretation from a private physician.

There were no new programs carried out during the reporting period.

Tabulated here are the statistics comprising the various activities of

the Employees Health Service during the fiscal year 1963 as compared with

those of a like period for the preceding year:

FY 1962 FY 1963

Screenings

1186

1297

Screening Revisits

1146

1473

Counseling and First Aid

6409

3897

Immunizations

6957

3164

Other

86

12

Total procedures

15784

16235

Health literature picked up

5400

5600

Tuberculin skin tests (Sept. '62 - June '63}

930

Beginning November 26, 1962, various specific laboratory procedures were tabulated and set forth in the following table:

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November 26, 1962 - June 30, 1963

Blood Typing

331

Hemoglobin

856

W.B.C.

800

Differential

33

Serology

588

Blood Sugar

797

Urine Complete

828

Urine Sugar or Albumin

123

X-Rays

1133

B.S.T.T. (beginning2/18/63}

49

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OCCUPATIONAL HEALTH SERVICE
The primary function of the Occupational Health Service is to protect the health of all employed people in Georgia through the promotion of good health practices, provision of a consultation service to private physicians, local health departments, management, and insurance carriers, and a preventive health service for state employees.
The staff consists of nine members: two physicians, two nurses, two medical technicians, and three secretaries. Seven of these staff members are employed in the State Employees Health Service.
There is considerable under-reporting of occupational diseases and conditions since the only sources of information are the insurance claims submitted to the Workmen's Compensation Board, and death certificates filed with the Vital Records Service. During fiscal year 1963, nine of the deaths reported were due to silicosis as a suspected contributory cause, and one to pneumoconiosis as a significant condition contributing to death.
Occupational disease claims filed with the Workmen's Compensation Board totaled 469. These reports were from 335 employers in 77 counties, and six out-of-state employers in six states. These reported conditions were as follows: dermatitis (including chemical injury to skin) - 264; chemical injury to eyes - ll4; overexposure to chemicals - 21 (10 of which involved organic phosphorus compounds}; inhalation of fumes and gases - 56 (1 reported as metal
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fume fever); possible lead intoxication - 7; carbon monoxide poisoning - 4; actinic ray ophthalmia - 1; exposure to radioactive source - 1; and myocardial infarction - 1.
These data are utilized for study in an effort to determine the best methods of control. When indicated, local health departments are notified of the occurrence of occupation-related mortality and morbidity, and offered assistance in follow-up, if needed. This assistance included both the medical and engineering aspects of field investigations. The latter is provided by the Industrial Hygiene Service and includes dust counts, air analyses, noise level determinations, and radiation detection plus a general evaluation of the total environment of the place of work.
A research program in the kaolin industries continued in the form of completing statistical correlation of findings. This project terminated in August 1962.
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TUBERCULO~SCONTROLSERVOCE
The ultimate goal of the Tuberculosis Control Service is the eradication of tuberculosis as a cause of illness and death. The intermediate goal for all communities is an average decline of at least ten percent in active case rates for the next ten years.
In response to requests, consultation, advice and assistance were provided by Tuberculosis Control Service to many county health departments during the past fiscal year.
There was an overall decrease of ll. 8o/o in new cases reported during the period July 1, 1962 - June 30, 1963. The breakdown shows a slight increase of 1. 4o/o in Group A (Active and Probably Active) and a decrease of 57. 2o/o in Group B (All Other Reportable Cases). There was a decrease in the number of deaths (18), a rate of 4. 3o/o per 100, 000 as compared with 4. 9o/o per 100, 000 the previous year.
The tools to eradicate tuberculosis are at hand: {1) modern treatment with drugs; (2) case detection; (3) program evaluation.
Both the number of x-ray clinics held in local health departments and the number of persons (contacts and suspects) attending these clinics showed an increase over the previous year. X-ray film examinations of such persons revealed a case rate of 3. 4 per one thousand films.
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Numerous county health departments requested and received assistance from the rehabilitation consultant in locating recalcitrant cases and returning them to treatment, utilizing commitment by court order, when indicated.
Effective July 1, the Georgia Department of Public Health discontinued supplying x-ray films to certain local health departments. In lieu of furnishing film, the department began participating in the salaries of qualified full time local health department x-ray technicians.
Free drugs were furnished to complete treatment begun in tuberculosis hospitals and to institute chemotherapy without hospitalization in selected cases. The categories of persons eligible for chemoprophylaxis was expanded. Consideration is being given to including all household contacts of positive sputum cases in this group, provided they are under adequate medical supervision.
Three additional evaluation centers were established. One was located in Griffin, Georgia, to provide competent medical assistance to nine health departments in that area, in managing their problem cases, The other two centers were established in Savannah and Thomasville, Georgia, to provide similar services to seven and eleven counties respectively, bringing the total for the state to 113 counties.
Satisfactory progress was attained in the tuberculosis control project in central Georgia. Studies have shown definitely that investigators are an effective means of strengthening the epidemiological approach to tuberculosis
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control. In several categories, program performance surpassed the standards set by the Ad Hoc Committee.
Future plans contemplate leaving three people in Macon to continue services of the Tuberculosis Control project in central Georgia, gradually moving the remaining investigators into four public health districts (14 counties) in northwest Georgia, which have high tuberculosis rates, and into the Atlanta metropolitan area.
Program evaluation was made possible through collection and analysis of data derived from an epidemiological report form developed and field-tested in the project area. This report is now being used throughout the entire State.
On the staff of this Service, the position of tuberculosis nurse consultant was deleted and some of the functions previously allocated to this position have been absorbed by the public health nurse consultant on the tuberculosis project.
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VENEREAL DISEASE CONTROL SECTION
In fiscal year 1963, 3, 237 cases of total syphilis were reported to the Department. This is a 9o/o decrease from the total syphilis cases reported for fiscal year 1962.
The 1, 016 cases of primary and secondary syphilis reported in fiscal year 1963 represent a 7o/o increase over the 1962 figures.
A lo/o increase in reported gonorrhea cases showed 10,019 cases in 1963. The 416 cases of Other VD (Chancroid, GI, and LGV) reported in fiscal 1963 show a 20o/o increase over fiscal 1962. The 7o/o increase in primary and secondary syphilis cases reported in fiscal 1963 represents a true increase in the incidence of syphilis. Since figures for the nation and for most countries of the world showed a much more alarming increase during this period, this increase of only 7o/o is most encouraging, During fiscal 1963, Venereal Disease Health Investigators made a total of 31, 527 venereal disease investigations. From these investigations, 2, 262 previously unknown and untreated new cases of venereal disease were brought to treatment. Of these, 897 were primary and secondary syphilis cases. It is remarkable that the efforts of these few investigators brought to treatment approximately 88o/o of the total primary and secondary syphilis cases reported to the Department in fiscal 1963.
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All of the 1, 016 cases of primary and secondary syphilis reported in fiscall963 were interviewed for contacts, suspects and associates by Venereal Disease Health Investigators. All of the 452 cases of early latent syphilis were also interviewed by these investigators for contacts, suspects and associates. This is the first year in which all reported early latent syphilis cases have been interviewed and brought into the epidemiologic processes.
All reactive serologic specimens processed in public health, hospital and private laboratories during fiscal 1963 were followed llp by Venereal Disease Health Investigators.
It is most significant that no private physician or health department refused permission to interview a primary, secondary or early latent syphilis patient or to follow up a reactive serologic specimen during the fiscal year.
During fiscal 1963, the private physicians of Georgia treated 58% of the total reported syphilis cases; 32% of the reported primary and secondary syphilis cases; 10% of the reported gonorrhea cases; 2% of the Other VD {Chancroid, GI, and LGV} cases reported. During fiscal 1963, this section's Area VD Diagnostic and Treatment Centers treated 42% of the total syphilis cases reported; 68% of the primary and secondary syphilis cases reported; 90% of the reported gonorrhea cases; and 98% of the reported cases of Other VD.
The above figures show that the private physicians of Georgia have again demonstrated complete cooperation with the Georgia Department of Public Health in an effort to bring syphilis under control.
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SpCtal SQVJCS BQanch
* **

CHRONIC ILLNESS AND GERIATRICS SERVICE
The Service of Chronic Illness and Geriatrics was instituted on July 1, 1962, with the Medical Director of the Branch as Acting Director. The staff consisted of a Nurse Consultant, a Nursing Home Management Consultant, a Chief Health Investigator, 5 Health Investigators, and a Senior Stenographer.
The first class of health investigators reported shortly after the beginning of the fiscal year. From August to January, the class underwent a period of training and orientation in proven epidemiological techniques which could be applied to casefinding and survey of needs in chronic illness problems in the community. Included in the final part of training was a study of diabetes mellitus conducted to determine to what extent this disease is a health problem in Georgia.
On January 28, 1963, the health investigators were assigned to health districts with headquarters in Griffin, Dublin, Decatur, and Athens. At the beginning of the second quarter of 1963, the health investigator at DeKalb County was transferred to Cardiovascular Disease Control Service for further training and to assist in the program activities. The Chief Health Investigator has been active in coordinating the training programs and establishing liaison between the state and local health departments.
Upon assignment to various health departments, the health investigators under the direction of district medical directors, assisted the staff in day-to-
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day activity in programs relating to chronic illness. They also assisted the medical director and staff in making surveys of local needs relating to chronic illness in implementing programs whereby these needs could be met.
In the fall of 1963, a series of nine institutes for nursing home personnel was presented in various areas of the state. In an effort to reach as many people as possible, the meetings were conducted in areas with the highest concentration of nursing homes. The subjects discussed at all institutes were medical records, rehabilitation, food service and sanitation, and recreation. Total attendance for the nine meetings was 336, of which 183 were nursing home personnel.
Recognition of recreation as a basic human need for the aged person emerged from this series of institutes and thus prompted the planning and presentation of a two-day workshop on "Recreational Activities" for nursing home personnel.
In May 1963, the workshop was presented at the Georgia Department of Public Health. The workshop began in a general session with two speakers, a psychiatrist and an occupational therapist. Workshop attendants were divided into three groups based on the size of the nursing home represented. Equal time was spent in each of the three planned sessions on handicraft, group activities, and the use of volunteers. The workshop was attended by 48 nursing home personnel representing 32 nursing homes.
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The Chronic Illness and Geriatrics Nurse Consultant spent time in teaching and nursing consultation activities related to chronic illness and rehabilitation. Educational activities was the subject of this teaching. It included demonstration of nursing care of patients in bed (including passive range of motion, assisting patients to get out of bed, and teaching self-care activities}. The groups reached were public health nurses, hospital nurses, Visiting Nurse Association staff nurses, licensed practical nurses and nurse aids. Three demonstrations were presented for nursing home personnel only, and one intensive course was taught in a nursing home.
Another major activity was frequent visits to the Dalton Home Care Project for the purpose of making a continuous evaluation,
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BATTEY STATE HOSPITAL
The treatment and results thereof in patients at Battey State Hospital continued to improve in fiscal 1963. Conversion of the sputum in newly admitted cases of tuberculosis was obtained in over 95 percent of those patients accepting prescribed therapy. Considerable strides were made in the retreatment of treatment failure and drug resistant cases of tuberculosis. Approximately eight percent of those patients discharged had thoracic surgery. Many patients with moderately advanced and advanced tuberculosis were treated with multiple drugs, according to alternating regimens. Controlled therapeutic trials continue and advances are still being made in the institution in the field of therapy. Results of therapy were given by staff members in U.S. Public Health Servicesponsored seminars in Michigan, Pennsylvania, and Massachusetts, and at meetings such as that of the National Tuberculosis Association.
The applications for the current year dropped from 1, 880 to 1, 738. The number of admissions decreased from 1, 754 to 1, 642. Of the 1, 219 patients admitted for the first time, 953 were diagnosed as having tuberculosis. This is a 10 percent decrease in comparison to the previous fiscal year when 1, 050 of those admitted for the first time had tuberculosis.
The average length of stay for patients was further reduced to 169 days. The year's discharge record was the best ever obtained. There were only two
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disciplinary discharges given during the entire year and only eight percent of the discharges were against medical advice.
The work load in radiology and the laboratory remains at about the same level as it has been for the last few years. There was again a very low turnover in personnel. The morale of the employees remains high.
The reorganization of Battey's culinary department was completed during 1963, and the new centralized food service system was put in use at the end of the year. Reorganization of the patient care areas continued, while major renovations of the steam plan were also completed.
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MEDICAL FACILITIES SERVICE
During 1962, Hospital Services continued to maintain a comprehensive program of assistance to local communities in order to improve patient care facilities and services. This assistance was provided through the following organized programs: (1) Community Survey and Areawide Planning Program to aid communities in planning for expanded and improved medical care facility services; (2) Architectural - Engineering and Equipment Program to review and approve plans and specifications to assure the construction of efficient, safe, and properly planned and equipped facilities; (3) Hospital and Nursing Home Licensure Program to inspect and encourage hospitals and nursing homes to meet standards established under the Georgia Hospital Regulations Act; (4) Consultative and educational services to administrators and governing boards with special operational and community problems.
Activities in the construction program showed a marked increase over the previous years. Regular appropriations remained about the same but were supplemented by Accelerated Public Works Program funds. The amount of construction and the number of projects increased during the year due to the supplemental APW Funds, and an increased utilization of "G" Grant Funds projects. The backlog of applications awaiting approval continued to increase during the year, as fifty applications now are pending for grant-in-aid funds at an estimated cost of $53, 858, 000. 00.
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Grant projects approved during Fiscal Year 1963 (including six Accele-

rated Public Works Grant projects) were as follows:

-T-Y-P-E-P-R-O-J-E-C-T

General Hospitals - Including Additions 14

Mental Hospitals

1

Public Health Centers and Auxiliaries

9

Nursing Homes - Including Additions

4

Rehabilitation Centers

1

29

748 105
308 56
1,289

$ 17,892,992.06 8,506, 376.32 688,765.80 3,878,275.00 551,059.33
$ 31,517,468.51

The Medi.cal Facilities Planning Section completed and published a comprehensive study of state planning procedures which resulted in some significant
revisions in the 1964 Georgia State Plan for Hospitals and Related Facilities.
There was a noted increase in interest in nursing homes sponsored by hospitals and the inclusion of outpatient departments in hospital expansion projects, The continued emphasis on comprehensive planning in u1banized areas resulted 1n the establishment of two additional areawide planning councils {Albany and Macon}.
The Medical Facilities Construction Section reviewed for approval all plans and specifications submitted for Hill-Burton projects as well as plans submitted for licensure purposes for hospitals, nursing homes, and homes for the aged. Plan reviews and on- site inspections included technical and consultative services in the fields of architecture; structural, electrical and mechanical engineering; equipment procurement, clinical laboratory, food service, and nursing administration and procedures,

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These services were rendered to a total of 54 medical facilities in the various stages of construction under the Hill-Burton Construction Program during 1963 - 64, In addition, these same services were rendered to a number of existing facilities. The dietitian also conducted a series of five one-day institutes throughout the State, as well as a correspondence course for all food service personnel in hospitals and nursing homes, The medical technologist, in addition to an extensive consultative service, assisted in establishing in nine larger hospitals the PKU testing program for the newborn for the early detection and possible prevention of mental retardation.
In Nursing Home Licensure, there was an evident marked increase in the quality of the personnel in nursing home facilities and of the quality of care they were capable of rendering. On June 30, 1962, there were 175nursing homes in Georgia, One hundred thirty-one homes were permitted with 4, 592 beds. At the close of this fiscal year the homes numbered 181 of which 150 containing 5, 366 beds were permitted. The greatest increase was in the number of homes capable of rendering the more skilled nursing care.
The Hospital Licensure Section also. reported upward improvement in the quality of hospital facilities and service in the state. During the year, nine new hospitals were opened and 15 old hospitals were closed, bringing the total number of licensed hospitals to 206. The number presently operating under full licensure permit is 143. Also, 63 hospitals were operating under provisional permits, most of which have physical plant problems to overcome. However,
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some are making good progress toward overcoming these problems. Three are scheduled to close when replacement facilities now under construction are complete.
A staff accountant held two accounting workshops for hospitals, continued to advise hospitals and nursing homes concerning financial problems, and supervised the publication of monthly comparative financial data collected from these facilities.
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