Annual report 1963-1964

georgia departDient
of
publie health
ANNUAL REPORT 1963-1964

State of Georgia

Department of Public Health

JOHN H. VENABLE, M. D., DIRECTOR

47 TRINITY AVE.

ATLANTA, GEORGIA 30334

To the Chairman of the State Board of Health and Honorable Members Dear Sirs:
It is my privilege to present to you the Annual Report of the Georgia Department of Public Health for the fiscal period covering July 1, 1963 through June 30, 1964.
As the report will reveal, there have been numerous modifications, expansions and additions of the Department's plans and programs during the year just past .. all designed to keep pace with technological and scientific advances as well as the social and environmental climate engendered by the rapid growth and economic development of Georgia.
One of the most significant additions in 1963 was the establishment of a Mental Health Planning Project Team to develop, by July of 1965, a statewide plan to provide mental health services and research and professional training facilities for Georgians. Another advance in the mental health field was the development of two physical facilities--the Georgia Mental Health Institute and the Georgia Retardation Center .. the first nearing completion and the second in design and planning stages with property already purchased.
The Civil Defense Health Service as well as the Chronic Illness and Geriatrics Service have greatly expanded their programs to provide respectively for Georgia's safety in the event of nuclear attack or other disaster and to meet the needs of an ever growing number of aged citizens.

GEORGIA

ORGANIZATION OF THE
DEPARTMENT OF PUBLIC HEALTH

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

DIRECTOR

*

llOII!IA DlNIIf.flll Of' "*.It 1!-"l.'nl

DE PUTT

r

OIRECTCNI'

DIVISION
" MENTAL HEALTH

l
HOSPITALS
IHOitGIA ltlllNTAI.. Ht:ALTH IMSTIT\ITI
c;IIIACEWOOO STAT[ SCHQOL .. MOSI"ITAL
ltllllbt:DGt:vtU.l STATt
HOS~TAL

l
S E Ill VICE
ALCOHOLIC II[HAI ILITATION
COMMUNITY MENTAL. HEALTH
- - - III[NTAL HEALTH PI..AJUUHG III[NTAL III[TAitDATION

I
8R.&NCH
" SPECIAL SER\IICES
S E R JliC[
CHRONIC ILL"f[S$ .. Ci[i'tiATAICS
M[OrCA'_ ~ACiliT>ES
!ATT[Y STATE HOSPITAL

I 'I BRANCH
" PREVENTABLE OISEASlS
I s E Ill .... I c
CAIIIOIOVASCULAR QI\C;[AS[ CONTROL
OCCUPATIONAL HEALTH S.E H.S SECTION
- - - - T 8 CONTIIOL
CANCER CONTROL SECTION
V 0 CONTROL SECTION

. CIVIL O[FliBl ~ALTH U.II:VICES PRO.PU.M
STATUS 7/1/63

r " DIVISION PHYSICAL HEALTH

I

DIVISION
" EPIDEMIOLOGY

J

DIVISION

I

" ADMINISTRATION ( fiNANCE

BRANCH
LOCAL HEALhl
Lt....!!..JL..L
LOCAL HEALTH ADMIHISTRATION

BRANCH
ENVIRONMENTAL H[ALTH
~....L.I.. GENERAL EHGINEERIH!i-
SANITATION HOUSING HYGIENE AND
ACCIOENT l"fft[V[NTION INDUSTRIAL HYGIENE WATER RESOURCES

BRANCH
HEALTH CONSERVATION
S (, "V I ~'
CRIPPLED CHILD"EN'S IIIATERNAL AND
CHILO HEALTH IIUT,.ITION ICHOOL HEALTH

BRANCH
['IOflltOLO&IC IIIY[ST"-'TIOIIS
S E R V IC~ BIOLOGIC STUDIES
SECTION DtSEAS[ANDDISA81LITT
STUDIES SECTION PU8LICH[ALTH
V[HRINARYSECTION

BRANCH
LABORATORIES
~ E R V I C (, C[i'oiHIAL LABORATORY FIELD LABORATORY
REGIONAL LABORATORIES

~ ACCOUNTIN$ IIO!TATISTICI
HMtltAL ITA" HPLTH tDUCATION
ANO ntAIMII5 ~.....MtL VIT~
PATI[NTACCOUNTS SECTION

-I LOCAL HEALTH DISTRICTS
LOG~~_ -~-EAL TH DEPARTMENTS

TABLE OF CONTENTS

DIVISION OF ADMINISTRATION AND FINANCE

Civil Defense Health Service Program. Health Education and Training Service . Personnel Service . . . . Vital Records Service . . Patient Accounts Section.

1 4
8 .11 . . 13

DIVISION OF EPIDEMIOLOGY

Epidemiologic Investigations Branch

.15

Veterinary Section. . .

.19

Branch of Laboratories ..

.20

DIVISION OF MENTAL HEALTH

Division of Mental Health... Mental Health Planning Project. Community Mental Health Service Georgia Retardation Center ... Gracewood State School and Hospital Georgia Mental Health Institute . Milledgeville State Hospital ... Alcoholic Rehabilitation Service.

.25
26
.28 .31 .32 .38 . .39 . .48

DIVISION OF PHYSICAL HEALTH

Branch of Dental Health Branch of Dental Health . . . . Dental Public Health Service ..

. . 52 . . 55

Environmental Health Branch

Housing Hygiene and Accident Prevention Service . . . . 58

Addendum - Housing Hygiene and Accident Prevention Service.61

Industrial Hygiene Service ..

:64

General Engineering and Sanitation Service.

.67

Water Resources Service . .

. 70

Environmental Health Training . . . . . .

.73

Health Conservation Branch

Crippled Children's Service

.75

Maternal and Child Health Service .

.77

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 .......

.80 .83
.86 .88 .91 .92
.94 .96 . 100 . 104 107 110
. . 112 115 119

division of administration and finanee

State of Georgia

Department of Public Health

JOHN H. VENABLE. M. D., DIRECTOR

47 TRINITY AYE.

ATLANTA, GEORGIA 30334

The increase in industrialization within the state as well as the growth of towns and cities has caused the services of the Environmental Health Branch to expand. Planning for the future is of utmost importance if communities are to provide a healthy environment for their citizens. A program designated "Metropolitan, Urban and Community Planning for Environmental Health" has, with Health Department coordination, drawn in many state, local and federal agencies--and private citizens-- to study Georgia's present and long range human needs.
Not only do we note the progress of the Health Department's programs, but also we note our employees' rich contributions to them through individual achievement of high standards of professional and personal development. Many of the staff have availed themselves of opportunities in graduate programs or seminars in their respective fields as well as participation in public health oriented organizations.
Though the Department's goals appear vast and varied, our primary aim is to help each and every citizen attain the best possible physical, mental and environmental health climate so that he may develop to his fullest pote...tial. With this in mind, I am pleased to submit this annual report as evidence of our contribution to Georgia's successful development.
Sincerely yours,
~.-L If. J~.Ak-
John H. Venable, M. D. Director

CIVIL DEFENSE HEALTH SERVICE PROGRAM
Two major health problems confronting Georgians in the event of a nuclear attack have been indicated by recent studies and programs to solve each of these were implemented or expanded during this past fiscal year by the Civil Defense Health Service Program.
The first is that citizens injured will not have time to seek professional assistance before they must go to a fallout shelter; therefore, a Medical Self-Help Program was initiated with the goal of training at least one member of each household in the state. A drive was inaugurated to persuade superintendents and principals to add Medical Self-Help to each high school's curriculum. The program was widely accepted and most of the students who graduate from high school henceforth will have completed the course.
The second problem is that heavily populated areas, in which are located most of the larger hospitals in the state, are expected to be prime targets. To offset the potential loss of from 50 to 70 per cent of existing hospitals in an attack, the service continued the program of acquiring Civil Defense Emergency Hospitals. In fiscal 1964, 42 of these were added to total sixty-eight 200-bed hospitals stored at strategic locations throughout the state. Each hospital has sufficient supplies to operate for approximately 30 days. A hospital consists of 660 boxes requiring 1,200 square feet of storage space and is valued
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at over $45,000. In addition, a manual was drafted for use in the emergency hospital "training center," and several hundred people attended a three-hour course that outlined the measures necessary to prepare an emergency hospital for activation and operation. With the comments and criticisms of the students and with the knowledge gained through the teaching experience and study, a final draft will be prepared for use as a guide. The training will be extended to include those responsible for management or support of these hospitals.
The State was divided into seven areas for Civil Defense purposes and individuals were selected to staff each area headquarters with an organization similar to Civil Defense Health Service at the State level. This arrangement is much more practical from an administrative and communications standpoint, but is proving rather difficult from a professional viewpoint as it spreads available resources thin.
The Governor approved the use of the buildings at the University of Georgia in Athens as an alternate location for the State government if it should become necessary to move during a national emergency. The Biological Sciences Building was assigned for use by the State Health Department.
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The Governor also appointed two Task Groups, one for Health Resources and one for Water Resources, to study the problems that a national emergency would impose on the State. They will seek solutions to the problems and develop plans for the control of resources during an emergency.
This past year a policy was established to familiarize students of professional schools with the provisions of the State Emergency Health Plan and programs which support it. This year, senior students of the schools of nursing were briefed; next year other schools will be included.
Funds were obtained by the Service and two positions were authorized for the establishment of a facility to repair and calibrate the radiological defense instruments that are stored in each of the counties throughout the State. This will insure that they will be in good operating condition when and if they are ever needed; the program will also reduce considerably the expense of instruments lost through improper maintenance and storage.
-3-

HEALTH EDUCATION AND TRAINING SERVICE
The creation of personal and community interest in health, the promotion of an awareness of health needs and the development of opportunities for people to learn about health is the charge of Public Health Education. Several methods are employed to accomplish these broad aims of health education and are outlined in the balance of the report.
During fiscal 1964, the service sought to aid further the development of "groups for health action". By working with and through local health department personnel, voluntary agencies, school systems, other state agencies, civic and professional associations and interested citizens; health educators stimulated these groups to take action in their communities for better physical, mental and environmental health. Many new programs have been and are being implemented as a result of the enthusiasm and work of these groups.
The Public Information Unit, working with most Health Department Services during fiscal 1964, continued to provide the general public with accurate and timely news relating to local and statewide public health programs in Georgia. The unit also aids in educating the public in many general public health matters.
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The Information Unit utilizes all avenues of public communications - television and radio, daily and weekly newspapers, magazines and specialized publications -as well as using booklets, exhibits and personal appearances. In addition, two publications, GEORGIA'S HEALTH and FAX, are prepared and issued monthly to give continuity to the information program and augment efforts directed to the public media.
The Training Section, since its institution 11 years ago as a formal program of the Health Department, serves as a vital link between the theory and findings of the laboratory or university and the work of the public health practictioner. OVer these years, the Training Section, which coordinates the training activities of other organizational units, has grown to include the services presented here:
(1) Short term in-service specialization courses for state and local staff members numbered 133 with 1,049 persons participating.
(2) Twenty-two professional public health workers from 12 foreign countries visited the state and various local health departments.
(3) Stipend-supported training for the year is summarized in the following table:
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STIPEND-SUPPORTED TRAINING

July 1, 1963 -June 30, 1964

Academic

Orientation

Nurses

7

23

Sanitarians

33

Engineers

1

Physicians

2.

Social Workers

19

Psychology Intern

12

Psychologist

3

Instructor Elementary Education

4

Optometrist

1

. ~:

Biostatistical Analyst

1

Music Therapist

1

Residencies

Pediatrics

2

Pathology

1

Psychiatry

3

Pedodontics

1

The Public Health Library has served public health personnel by making available to them the latest information in books and periodicals, so that the current advances and trends can be adapted and applied to public health programs in Georgia.
A brief summary of some of the Library Staff activities during fiscal 1964 include: 219 new books were purchased bringing the total collection to 16,217 volumes; 1,030 reference questions were answered; 12., 700 publications were circulated or an average of 225 publications were circulated weekly to staff personnel; numerous bibliographies were completed on special topics; resource materials were furnished for work-

-6-

shops involving staff members; information was compiled to aid in developing programs and projects; and new personnel were introduced to the library facilities, resources and services.
The Visual Communications Section performed the following numerous services during fiscal 1964. The Art Unit completed 361 jobs such as illustrations, layouts, lettering, paste-ups, exhibits and miscellaneous. The Cartography Unit performed 455 jobs such as mapping, lettering, drafting, embosograf engraving, and exhibits. Photography, prints, copy work, slides, processing and other duties produced a sum of 3,913 jobs performed by the Photographic Unit.
-7-

PERSONNEL SERVICE
Fiscal 1964 brought the number of personnel employed in fulltime classified positions to over 6,000 . an increase of 333 over the previous year. Included in this number are those employees with responsibility to the counties, such as the local sanitarian, nurse and health officer; those employed in institutions devoted to particular health problems, and those who direct or otherwise deal with specialized programs for the whole State. In accord with their differing responsibilities, these health workers represent a variety of training and experience, ranging from less than grade school education to a dozen years of graduate study in science or medicine.
The major increase, 253, occurred in Milledgeville State Hospital while the largest decrease was from Battey Hospital. Milledgeville added 16 physicians, 5 therapists, and 135 manual laborers whose jobs were formerly performed by State prisoners. The second largest increase was at Gracewood State School and Hospital, with 6 more teachers and 109 additional attendants caring for the children in cottages. Battey Hospital continued its planned decrease of personnel in response to the shortened hospital stay now required in treating tuberculosis; institutional workers and nurses (aides and orderlies) were again the groups most affected. Employment in the State office and in the counties remained relatively stable, with increases of 26 and 22 respectively.
~-

In preparation for the new pay plan, adopted by the State Merit System and effective July 1, 1964, all classes of positions used in the Health Department were reviewed by the personnel officers and the major administrative heads of the department. Many of the changes decided upon will, when budget resources are available, result in more efficient departmental operation.

FULL-TIME EMPLOYMENT

6-30-63

Local

*939

Fulton

303

State
A. R. s.

*656 45

Battey

703

Gracewood

589

Milledgeville

2688

Totals 5923

6-30-64 961 306 682 44 566 756 2941
6256

*adjusted to show later information

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EMPLOYMENT TURNOVER 6-30-64

**Appointments **Separations Net Gain Separation Rate

Local

143

121

22

13%

Fulton

58

55

3

18%

State

213

187

26

28%

A. R. s.

10

11

-1

24%

Battey

95

232

-137

37%

Gracewood

343

176

167

26%

Milledgeville

847

594

253

21%

Totals 1709

1376

333

23%

**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.

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VITAL RECORDS SERVICE
During the fiscal year just past, a total of 277,301 records representing 219,401 vital events were processed and registered in the Vital Records Service. The events recorded were 103,237 current live births, 37,103 deaths, 3,128 fetal deaths, 57,900 marriages, 10, 915 divorces and 17,118 delayed birth certificates.
A total of 2,984 certificates of adoption were received, processed and new birth certificates for 2,936 adopted children were completed and filed. Legitimation proceedings for 1,498 children born out of wedlock were completed and new birth certificates filed for these children.
Superior Court orders changing the legal name of 197 people born in Georgia were received and the birth certificates amended in accordance with these orders. Court Orders from the Court of Ordinary correcting errors in 6,226 registered certificates were received and the certificates were amended.
More than 180,000 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, industry, and private agencies. These requests were processed, resulting in the issuance of 44,747 certified copies of birth or death records and
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the verification of more than 100,000 other records registered in the Service. Requestors of copies or for the verification of records not registered were instructed to the end their need could be met.
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PATIENT ACCOONTS SECTION
The amount of monies collected toward the cost of care and treatment of patients in institutions under the control of the Department of Public Health, during the past fiscal year, was considerably more than that of the previous year. The increase was due to a higher per diem and the fact that more persons were meeting the requirements that make payments an obligation. More was directly collected from the patients while a marked decline appeared in the amount collected from other persons liable for the cost.
The number of patients for whom funds were paid was still small compared to the total patient load. The Assessment Act of 1960 is based on taxable income only which creates an inequity in assessments. For example, numerous patients with large estates are not required to pay because there was no taxable income for the previous calendar year. The need for changes in the act are apparent so that responsible persons can be defined and assets considered in assessing. Most persons want to pay something towards the cost of care and treatment in Milledgeville and Gracewood even though they are not required to do so by law.
An attorney to serve as an Appeals Officer has now been employed by the Department. This gives those assessed for payment an opportunity
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to be heard and show cause why assessments should not be made or a determination made as to the amount required to be paid. This should help the assessment program if changes are made in the present law to provide for collection.
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division of epide 10iology

EPIDEMIOLOGIC INVESTIGATIONS BRANCH
The Investigations Branch of the Division of Epidemiology is concerned with the collection and correlation of information: (1) relating to the prevalence and incidence of infectious and noninfectious disease, (2) relating to other causes of morbidity, and (3) relating to ecologic problems that have public health significance.
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: (1) 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 effectiveness of reporting.
surveillance and confirmation of diseases on which laboratory work is done. The oldest formal surveillance system, that for Rocky Mountain spotted fever, is now in its 33rd year. The newest, for shigellosis, is in its first year.
-- surveys ofabsenteeism 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 1963, for
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example, a community-wide study was necessary in order to determine the significance of a locally acquired case of malaria. No other morbidity simulating malaria was discovered and the case was determined to be a highly coincidental transmission of a foreign malaria. Despite the presence of a population of Anopheles quadrimaculatus theoretically capable of maintaining malaria, the disease has not re-established a focus in Georgia although two locally transmitted cases have bem found since the end of the Korean War. Also, research studies intended to reveal the nature, fundamental characteristics, and sources of various diseases, are of utmost value. Three major research investigations continue in progress, two were begun in 1963 and others continued in reduced form which include the following:
-- longitudinal studies of viral infections of animals which will infect man. In 1963, EEV continued to be abundant in mosquitoes; WEV, California and Hart Park viruses were also found but no horse or human cases developed, The possible relationships of such infections and of VSV, which appears to produce numerous unrecognized infections, to chronic and degenerative disease of man are also a concern. A serologic survey for evidence of infection with these viruses in a characterized human population in a south Georgia county is being made as another major undertaking.
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-- a preliminary report of a study of the basic bacteriology and ecology of the bread-filler-cellophane wrapper system formed by a wrapped sandwich was published and the study is being continued with the aid of an NIH grant.
-- a controlled study of a new Staphylococcus vaccine is now in its second year as part of a continuing investigation of means of enhancing immunity to staphylococci. This represents the sixth antigen investigated.
-- studies (a) on gamma globulin instilled into the eye as a means of controlling infectious hepatitis are being continued and (b) a new series of studies intended to explore the possibility of using electron microscopy as a means of serologic indentification of viruses in cells has been under taken.
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Summary of Reported Communicable Diseases 1963 (With Comparisons with Earlier Trends)

Median 1952-56

Regular Median Reporting 1958-62 1963

Sampling 1963

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 Typhus fever Whooping cough

45 210
17 13,587
232 5,975 4,854
NR 84 390
9 70 18 191 328 1,596 29
1,880 39 49 27
398

11
14 64 26 6,950 272 498 491 94 31 30
2 16 15 298 502 413 15
1,439 15 27 5 21

2 17 26 18 4,176 177 2,313 226
42 26
3 9 15 481 459 194
11
1,369 31 14 1 18

140 30 20 100
1,170 89,510 10,370
120 20 10 450
720 410 56,080
10 150 280 50
1,290

(See reports of the Laboratory Branch, Vital Records, Venereal Disease Control, and Tuberculosis Control Services for data in addition to that contained in the above table.)

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VETERINARY SECTION
The incidence of animal rabies has continued to increase during the fiscal year with a total of 94 laboratory confirmed cases reported from 15 counties. The epizootic, presently confined to the southern tier of counties, has occurred almost exclusively in wild life species. Racoons have accounted for over 87% of the total cases reported. Lateral spread of cases from the initial focus of infection has been less than anticipated.
Sporadic cases of rabies in bats are reported from areas of the state that are free of the disease in terrestrial mammals. The role of bats in the epizootiology of rabies in Georgia is unknown.
Rabies was diagnosed in a opossum for the first time in Georgia during the fiscal year. This unusual finding was doubly confirmed by virus isolation and neutralization procedures.
In conjunction with a typhus survey in the metropolitan Atlanta area, 200 Norway rats were examined for rabies and for salmonellosis. All specimens were negative for rabies by fluorescent rabies antibody examination. Salmonella typhimurium was the most common serotype of the 12 isolations from cecal cultures.
Investigations of the more unusual zoonotic diseases have resulted in the diagnosis of fatal blastomycosis in a dog and generalized tuberculosis in a pet monkey.
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BRANCH OF LABORATORIES

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 1,013,998 examinations in fiscal 1964, an increase of 33,705 over fiscal 1963. 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, 1963, and 1964. Table B shows further analysis of the workload according to the five sections.

TABLE A

Examinations Performed by Central and Regional Laboratories Fiscal 1962., 1963, and 1964

Unit

Fiscal 1962

Fiscal 1963

Fiscal 1964

Total Per Cent Total Per Cent Total Per Cent

Central Laboratory Service 543,966 57

Field Laboratory Service

Albany Laboratory

135,166 14

Macon Laboratory

150,655 16

Waycross Laboratory

120,581 13

Total

406,402 43

Branch Total

950,368 100

562,394 57 583,173 58
135,182 14 146,258 14 157,535 16 165,158 16 125,182 13 119,409 12 417,899 43 430,825 42 980,293 100 1,013, 998 100

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TABLE B

Examinations During Fiscal 1964 by Sections and by Laboratories

Section

Total Central Laboratory Regional Laboratories Number Number Per Cent Number Per Cent

Microscopy

214,643 108,931

51

105 '712

49

Microbiology 61,162

21,423

35

39,739

65

Serology

624,403 383,207

61

241,196

39

Milk

103,872

59,694

53

44,178

47

Virology

9 918

9 918 100

T<YrAL 1,013,998 583,173

58

430,825

42

Food samples from 20 food poisoning episodes were examined for bacterial etiologic agents. In two outbreaks ham was incriminated; Brunswick Stew and canned sausage were responsible for two other incidents.
The Laboratory and Epidemiologic Investigations Branch cooperated with the Veterinary School, University of Georgia, in a study of staphylococcus infections and carrier states in veterinary students and associated animals. Phage typing studies were made on 293 staphylococcus isolations. In addition to phage typing for hospital laboratories in the surveillance of hospital infections, staphylococcus control cultures for the sandwich study have been monitored.
The Sanitary Microbiology Section continued with its wrapped sandwich research project and examined 4,427 sandwiches during the fiscal year.

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A joint project was conducted by the Georgia Department of Public Health, the Communicable Disease Center and the Fulton County Health Department in trapping and studying 200 rats in the Atlanta metropolitan area. Fluorescent antibody examination for rabies failed to show any positives among the 200 samples; however, 12 rats were found to contain the following salmonella organisms: 8 S. typhimurium,
2 s. heidleberg, 1 S. derby, 1 S. infantis. No multiple infections
were seen. The Virology Section expanded its testing procedures in arbovirus
diagnosis to cope with the rising incidence of equine encephalitis in midsummer, 1963. Eastern encephalitis virus was isolated from 17 equine brains and serologic evidence of Eastern encephalitis infection was obtained on 9 horses. Cooperation with the Epidemiologic Investigations Branch and the Georgia Coastal Plain Experiment Station in the surveillance of arboviral encephalitis is continuing.
The Laboratory Branch cooperated with the Epidemiologic Investigations Branch in attempting to appraise the potential public health importance of vesicular stomatitis virus as an emerging zoonosis.
The Virology Section provided samples of human mumps positive sera to the Department of Preventive Medicine at Grady Hospital, for use in an investigation of the antigenic relations between mumps and the parainfluenza myxoviruses. Perhaps 50% of severe respiratory illnesses
-22-

in children may be due to parainfluenza viruses. The need for immunologic information prerequisite to the development of vacines is paramount.
In 1964 the Central Laboratory Service and the Maternal and Child Health Service continued their participation in a national study of the Guthrie method of determining phenylketonuria (PKU) in the newborn. Laboratory and specimen collection supplies were provided by the
Children's Bureau of the U. s. Public Health Service. Eleven Georgia
hospitals have collected a total of 13,402 blood specimens since the inception of the study and submitted them to the Central Laboratory for testing. One previously unknown case of PKU has been detected and placed under treatment.
Other laboratory findings that may be noted are: C. dipthererae was isolated from only 62 individuals in fiscal 1964 as compared with 127 in 1963; With a 6% increase in cultures for tubercle bacilli there was a 17% increase in M. tuberculosis isolations; Only eight typhoid cases were noted with 20 cultures having been isolated and phage typed; Surveillance of human rickettsial disease resulted in serologic confirmation of infection with Rocky Mountain spotted fever in 10 cases.
Supportive services of the Preparation, Reports and Records, and Service and Supply Sections were in great demand during fiscal 1964. The Preparation Section, in addition to preparing media and reagents,
-23-

washing and sterilizing glassware, also produced 120,000 ampules of 1% silver nitrate, 420,000 doses of typhoid vaccine, and dilutions of Old Tuberculin sufficient for 690,000 skin test doses.
The Laboratory Branch experienced a personnel turnover of approximately 13 per cent in 1964, with 16 employees leaving the service for various reasons. This was a reduction from the over 20 per cent figure in 1963 (27 employees).
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division of IDental health

DIVISION OF MENTAL HEALTH
The Division of Mental Health, created as a separate division in 1960, received its first permanent director in March, 1963. As of June 30, 1964, eight distinct programs, under the leadership of qualified directors, have been integrated into a total division program. Those units existing prior to fiscal 1964were: Milledgeville State Hospital, Gracewood State School and Hospital, Alcoholic Rehabilitation Service, and Community Mental Health Services. Added since that time have been: the Georgia Mental Health Institute, the Georgia Retardation Center (both located in metropolitan Atlanta), the Mental Health Planning Project and the Central Office.
Fiscal 1965 will see the addition of a one-year mental retardation planning project, bringing the total number of programs to nine. Scheduled for completion within a year, the purpose of this project is to develop a comprehensive state plan for the prevention and treatment of mental retardation and the rehabilitation of the mentally retarded. Personnel from both the mental health and the mental retardation planning projects will be retained as permanent division staff members upon completion of their respective programs.
The Director and the staff are encouraged by the steady progress being made in each of the component programs and look forward to the future with hope and expectation of developing better mental health programs in and for Georgia.
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MENTAL HEALTH PLANNING PROJECT
One of the greatest needs in mental health in Georgia today is to bring services to people in their own communities. To accomplish this requires extensive local as well as state level planning.
On July 1, 1963,matching state and federal funds were made available for a two year period to develop a comprehensive, statewide plan to provide mental health services for individuals in their own homes, in nursing homes, schools, correctional institutions, mental and general hospitals, institutions for the mentally retarded, for the alcoholic, the drug addict and the delinquent.
A staff of seven professional persons has been employed to carry out the necessary work involved in assessing Georgia's total mental health needs and resources, both private and public-tax supported. The methods being utilized to accomplish this include data collection and analysis, community organization and professional and public education.
Three committee structures have been appointed to advise and work with the planning staff. These include: the Technical and Scientific Advisory Committee, composed of representatives from various areas relating to mental health; the Inter-departmental Mental Health Coordinating Committee, made up of representatives from seven official state agencies; and the Intra-departmental Mental Health Advisory Committee, composed of representatives from other Divisions, Branches, and Services within the Health Department.
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To encourage local planning, a series of seven regional conferences attended by local citizens was held all over the state. Summer Planning Assistants have been employed by 18 district health departments throughout the state helping communities to identify their own mental health needs and resources.
The first issue of "Crossroads", a bi-monthly newsletter, was published in May of fiscal 1964; the total mailing list numbers close to 1,000. Over 6,000 copies of the pamphlet "Local Mental Health Planning - A Guide for Georgia Communities" have been distributed throughout the state.
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COMMUNITY MENTAL HEALTH SERVICE
Ten local health departments - Bibb, Chatham, Cobb, DeKalb, Dougherty, Floyd, Fulton, Glynn, Hall, Muscogee - continued mental health programs employing full time psychologists and psychiatric social workers and part-time psychiatrists for programs involving both direct and consultative services to other agencies and professionals in the community. Clarke County had all arrangements made to begin a program July 1. Lowndes County had funds budgeted, along with three other counties in District 15, but delayed employing staff until next year. Community Mental Health Service staff continued consultative services to the local programs and to other counties developing plans.
Assistance to several counties in studying local needs and resources was coordinated with the Mental Health Planning Project, and with the special Summer Planning Assistant Program of which the latter was a cooperative venture with the planning staff. Preliminary development of a program of Community Resource Reinforcement was furthered through a number of professional team consultations to local inter-agency case conferences.
Cooperatively with Biostatistics Service, a statewide reporting program was continued for mental health clinic activities. New standard record forms were developed with the local health department clinic programs.
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The five-day in-service training sessions for public health nurses were continued for nurses from 27 counties in five health districts.
Consultative support continued to the statewide program of public health nursing services to the mentally ill and their families. Reports indicated a case load of 7,064 Milledgeville State Hospital patients and 7,508 families. This compares with a 1961 figure of 3,524 patients and 4,726 families.
The Community Hospital Psychiatric Program, Georgia's program for general hospital psychiatric treatment of voluntary, medically indigent mental patients, continued into its seventh year. During the fiscal year a total of 824 applications from 121 counties were sent to the five hospitals participating in the Community Hospital Psychiatric Program.
As of June 30, 559 applications from 112. counties had been accepted or were still pending and 265 applicants from 57 counties had been rejected for various reasons, including limited total bed space in the hospitals.
During the fiscal year the five hospitals supplied the following volume of inpatient services to approximately 500 newly admitted patients and a relatively small number of readmissions.
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Hospital
Albany (Phoebe Putney) Atlanta (Grady) Augusta (Talmadge Mem.) Columbus (Medical Center) Macon Hospital
Total: Five Hospitals

July 1, 1963 to June 30, 1964

First

Total

Average

Admissions Patient Da:x:s DailX: Census

2.6

840

2.3

200

8237

22.6

129

4901

12.4

80

1673

4.6

41

-1-05-5

2. 9

476

16,706

45.9

Reports from local health departments indicated 2,234 CHPP patients and 1,969 families on public health nurse caseloads throughout the state. Comparable figures for 1961 were 1,980 patients and 1,849 families. Local follow-up service by the Division of Vocational Rehabilitation continued on a large number of selected patients. Four special research projects were begun, tied in with master's theses and doctoral dissertations in the Department of Sociology at Emory University. Regular four-day training sessions for public health nurses continued at both Talmadge Memorial and Grady Memorial Hospitals.

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GEORGIA RETARDATION CENTER
Three hundred thousand dollars has been appropriated to retire bonds for first phase construction of the Georgia Retardation Center. 98.6 acres of land for a construction site was purchased in DeKalb County at a cost of approximately $380,000. Preliminary architectural drawings are complete for first phase construction with a capacity of 505 beds. Estimated cost of this first phase of construction is $8,173,000. First phase construction will include the Medical Treatment building, housing the acute treatment unit, 220 beds for nonambulatory patients, research, therapies, central laundry, central kitchen, employees dining room, central receiving and storage, and maintenance. Other buildings in the initial construction project are: (1) Two cottages for severely retarded ambulatory children, (2) Three cottages for moderately retarded ambulatory children, (3) Administration building, and (4) Central heating and air conditioning plant.
Construction of this first facility is scheduled to begin early in 1965. Final construction, raising capacity to the total 1000 bed maximum. is expected to be completed in 1968. Total cost of the Center is estimated at $13,380,000.
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GRACEWOOD STATE SCHOOL AND HOSPITAL
Gracewood's problems this year, as in years past, are the pressing demands of the waiting list and the already over crowded facilities. Gracewood admitted 173 patients during fiscal year 1964, representing 4.3 admissions per 100,000 Georgians--a slight increase over that of the previous year. Other southern states showed, in a survey done by the Southern Regional Education Board, an average of 8.2. admissions per 100,000 population to their institutions for the mentally retarded.
Eighty-two new beds were filled at Gracewood during the year, making the total enrollment 1,794. Seventy-two residents were discharged, and there were 19 deaths. Two previously unopened wards in the Infirmary were put into service at the beginning of the fiscal year, and the renovation of building #19 into a facility housing 100 younger children was completed near the end of the year.
During this time 385 names were added to the Gracewood waiting list for admission. This is an average of over 30 new applications per month--many of which represent emergency cases.
Gracewood, recognizing the need for additional facilities and services, has wholeheartedly supported the Health Department's preparations for statewide planning for the mentally retarded. The superintendent has been a special consultant along with other Gracewood staff members in planning for the Georgia Retardation Center.
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The former assistant superintendent of Gracewood was assigned major responsibility for developing the new institution and for coordinating state planning on mental retardation.
Increased appropriations have permitted Gracewood to employ a larger staff. The budget for 1964 was $4,299,190.00. This brought a per diem expenditure of $6.69 for each resident in contrast to the 1963 per diem of $5.36. The rise in budget is reflected in expanded services.
There was a net gain of 167 new employees during the fiscal year with the number on the roster moving from 589 to 756 full-time employees. The employee-resident ratio gained only slightly from the 1963 figure of 1:2.90 to 1:2.37. Most of the new employees were attendant personnel who were assigned to work directly with the residents in a program emphasizing the training and development of the individual resident. Among additional key personnel were a social worker, a sanitarian, a full-time librarian, and a volunteer service director.
In October, 1963, the new Evaluation and Rehabilitation Center was opened and also housed Vocational Rehabilitation personnel in this facility. The number of outpatients seen jumped from 384 in 1963 to 556 in 1964. During the fiscal year a new agreement was made between Gracewood and the Division of Vocational Rehabilitation providing for expanded services to Gracewood residents who have vocational potential. The agreement also provided for comprehensive evaluation and prevocational training of mentally retarded people throughout the state.
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Expansion of the Vocational Rehabilitation program required an increase in staff from one special counselor and one stenographer to a project supervisor, a special counselor, a regular counselor, an evaluator, and three stenographers. Provisions were made for adding two personalsocial adjustment counselors, an additional stenographer, and four houseparents in anticipation of opening of the "Activities of Daily Living" cottages and the proposed rehabilitation building.
After moving into nel.y facilities, the Vocational Rehabilitation staff installed a "work sample" unit which is a new aspect of the evaluation process and allows for testing resident-clients in a great variety of work samples under varied conditions. Forty-four Gracewood residents referred to Vocational Rehabilitation this year, were placed in jobs or entered further job training outside the institution.
Two federal grants were received in fiscal 1964. One five-year grant totalling $104,980.00 was approved for the development of an attendant training program within the cottages. The other grant, awarding $300,000.00 for a three-year project, implements a cottage improvement program, within which a cottage unit system will be devised and tested. Its goal is to bring professional services closer to the individual resident and his family.
In continuing cooperative projects with the Medical College of Georgia, Gracewood signed an agreement to provide space for an animal care facility to be used for research purposes by the Medical College.
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Joint research projects between Gracewood and the M.edical College are being planned in psychology. M.edical research programs such as the study of biochemical defects,chromosome analysis of peripheral blood and the correlation of chromosomal aberrations with congenital cerebral defects, and the study of protozoan disease toxoplasmosis are being continued and expanded.
Research projects carried on with the Health Department include a special virus study of VSV and other animal-related viruses in human diseases, the field study of the efficacy of anti-amebic and antibacillary medications, and studies concerning epidemiology and prophylaxis of infectious hepatitis.
Plans with the Program for Exceptional Children at the University of Georgia have resulted in the appointment of a speech pathologist who will be assigned to work at Gracewood. He will develop a speech and hearing program at the institution and supervise the training of college students in this field.
Thro1~ a cooperative agreement with Vocational Rehabilitation, two old buildings on the Gracewood campus were completely renovated and developed into facilities called 11 Activities for Daily Living11 cottages. These cottages will provide residential space for rehabilitation clients who need guidance in preparing for independent or semidependent community life. A larger building has been selected for similar renovation in the near future.
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The Gracewood staff feels that inter- and intra-agency planning is essential to developing adequate services for the mentally retarded. Therefore, orientation sessions for the public health nurses at Gracewood is planned and liaison with the new School of Social Work at the University of Georgia has been established.
Emphasis on staff development has stimulated a number of Gracewood employees to pursue additional graduate training. Stipends leading to degrees in psychology and special education while residency programs in pediatrics and pedodontics have also been granted. Funds for staff training come from the Patient Pay program. Additional use of this money provided summer employment of college students representing various professional interests. Through this program, they are given the opportunity to test out vocational possibilities in the field of mental retardation. In addition to providing career stimulation, the program also contributes to an enriched summer program for the Gracewood residents. In fiscal year 1963, the student program began with 24 summer employees; this year 42 were employed and further expansion is anticipated.
Medical students paid from funds administered by the Medical College of Georgia increased the number of summer students working at Gracewood to 32 in 1963 and 50 in 1964. There were also three senior medical students who worked during April, May, and June as special clinical assistants during this fiscal year.
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Gracewood has played host to several large groups during the fiscal year, and this has given wider scope to the public information program. High School, college, nursing, and medical students have continued to come to the institution for orientation and instruction.
One of the new programs organized at Gracewood during the fiscal year was the volunteer service program. Having for the first time a person to devote full attention to this, the institution gained over 8,000 hours of volunteer service and a corresponding rise in the number and quality of gifts presented.
Other new programs developed or expanded during the year include a three-day orientation program for new employees, remedial reading classes for residents with specific reading problems, a recreation program for non-ambulatory residents, a new oral hygiene program in the Infirmary, dental evaluation for outpatients, and a training program for female residents in nursing services. New or renovated facilities include the sewerage disposal plant, the swimming pool, a new sewing center, and additional warehousing area.
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GEORGIA MENTAL HEALTH INSTITUTE The Georgia Mental Health Institute, a $12~ million psychiatric teaching and research center located on Briarcliff Road in Atlanta, is scheduled to be completed in the Spring of 1965. The Director and a small cadre of key employees have been recruited and are now actively planning for the opening of this facility as soon as possible after construction has been completed. When completed and fully activated, the Institute will provide about 250 beds for inpatient teaching and research, drawing from a statewide case load. Through the use of outpatient clinics and by accepting both day and night patients, this facility will actually accomodate a patient load comparable to that of a 500-bed hospital. The administration of the Georgia Mental Health Institute will be under the Division of Mental Health with teaching and research assistance provided by the Department of Psychiatry of the Emory University School of Medicine. This institution will provide adequate training for various types of mental health personnel for Georgia now so urgently needed in community and institutional programs throughout the state.
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MILLEDGEVILLE STATE HOSPITAL
Slow but continued progress in patient care and treatment education and research marked fiscal 1964 at Milledgeville State Hospital. The budget for the fiscal year was $16,000,000--an increase of $1,644,000 over the previous year. The hospital had additional income of $1,300,000 from varied sources bringing the total income to $17,300,000. The average per diem cost rose from $3.68 per patient per day in 1963 to $4.27 in 1964 with $3.83 being contributed by the state.
The old problems still exist--wards are 35 per cent overcrowded; the hospital is 50 per cent understaffed and even more than that in some of the vital areas such as nursing; outmoded buildings make the application of the new treatment techniques such as milieu therapy almost impossible; an inadequate general and surgical hospital; inability to recruit competent top level medical, nursing, and paramedical staff; a constantly rising flood of admissions; and lack of community-based pre-hospitalization and aftercare facilities.
During the year the hospital admitted a total of 6,786 patients. Of these 5,221 were first admissions and 1,565 were readmissions. During the year there were 4,040 returns from furlough making total gains of 10,826. This is an increase of 1,193 in the total gain figure over last year. The gain figure was balanced by 1,580 direct
-39-

discharges from the hospital, 8,049 patients placed on furlough and 1,114 deathso During the year 3,512 patients were discharged from furlough making a total of 5,092 patients discharged during the year. The average length of stay continues to remain at about 80 days.
Accredited residencies and internships are now available in psychiatry, clinical psychology, social work, ophthalmology, hospital administration, clinical chaplaincy, music therapy, recreation and occupational therapy. A three year accredited residency training program in psychiatry was approved in January, 1964, by the American Medical Association's Council on Medical Education and Hospitals. This program is now functioning in addition to those in cooperation with Emory University and the Medical College of Georgia. There are 24 resident psychiatrists in training in all three programs.
National accreditation was received from the American Psychological Association, the National Association of Music Therapy, Inc., the National Association for Schools of Music, and two of the national accrediting agencies for clinical chaplaincies.
The organization of the hospital into the unit system has been completed and inquiries have been received from many states regarding the organizational structure and operating and administrative procedures. The new building program is completed and is fully operative. This includes the staff dormitory and apartment complex, the 600 bed Arnall Building addition, the central kitchen, and the Yarbrough Rehabilita-
-40-

tion Center which recently played host to a five-state conference demonstrating the use of vocational rehabilitation techniques in the treatment of mental illness. Seven registered vocational training teachers are now conducting classes so that patients may return to their home communities with adequate skills with which to earn a living.
The new children's rehabilitation center is rapidly nearing completion and will be in operation in 1965. Expansion of the teaching staff for emotionally distrubed children has increased from two to twelve, classrooms from two to eleven.
A remotivation program is bringing new enthusiasm and treatment techniques to the psychiatric aide staff. A special disability program for the blind, deaf, and patients with speech defects in cooperation with the University of Georgia Speech Clinic began in March, 1964, and is now in operation.
More than 8,000 high school and college students, public health nurses, school counselors, health department directors and other personnel, visiting teachers, adult groups from churches, garden clubs, civic clubs, women's clubs, and similar organizations attended seminar programs at the institution over the past year.
The department of social work is now accredited by graduate schools at Florida State University, Atlanta University, and the University of Georgia as an accredited field training center for
-41-

graduate students. During the year the director of the department left to head up the new School of Social Work at the University of Georgia. New programs being developed include a public assistance unit at the hospital, a foster home care program for adults, and a program to move eligible patients from the hospital into community nursing homes and group care facilities.
The music therapy department has added five professional music therapists and two music therapy aides. With the additions of students in the clinical training program, the development of a summer student program, and the employment of a consultant in instrumental music for two months, has made possible a considerable expansion in the program of the music therapy department. Decentralization during the year has resulted in physical facilities for unit music therapy programs being made available in Units 1, 2, 3, 4, and 5.
Three hundred and twenty-two student nurses completed the affiliation course in psychiatric nursing and during the year the Hall School of Nursing at Gainesville, Georgia, was added to the affiliation program making a total of eight schools of nursing now included. One hundred and nine employees received psychiatric aide certificates, 116 employees received Civil Defense Self-Help Training certificates, and 73 received Red Cross certificates. Programs of remotivation and inservice education are now progressing on the unit level. There has been a small increase in the professional nursing staff during the year.
-42-

The division of physical treatment continues to provide a remarkable quality of service considering the small staff and inadequate facilities with which it has to work. Seventy-three thousand days of patient care were provided in the Jones Hospital and there were 49,000 visits to the out-patient department.
The occupational therapy department added one registered occupational therapist, six occupational therapy aides and one intermediate stenographer. A total of 2,671 patients were under treatment in occupational therapy clinics during the year. Evaluations show that approximately 48 per cent of these have shown a high degree of improvement. Since the hospital has 12,097 patients and 30 per cent should be candidates for occupational therapy, the patient case load was 8 per cent under goal. A number of new programs have been initiated particularly with selected, regressed patients in an attempt to improve them to the point where they can be included in the clinic programs.
The department of clinical psychology is now one of the largest in the country. It is nationally accredited by the American Psychological ASsociation at the highest level and now numbers approximately 70 individuals including psychologists, consultants, technicians, teachers of emotionally disturbed children, students on scholarships, interns, and clerical staff. The department now has a comprehensive internship program and is affiliated with the universities of Georgia, Florida, Tennessee, and Alabama. There are now 15 students and interns in this program.
-43-

The psychiatric out-patient clinic continues to meet an important need in the area of aftercare services to discharged patients. Since the clinic began operation, a total of 2,442 patients have been admitted to clinic service with 6,942 visits.
Volunteer Services has now been housed in a complete suite of offices and the program includes garden therapy, recreation, music therapy, occupational therapy, social services, Alcoholics Anonymous, junior volunteers, day rooms, an apparel shop, and the "forgotten patients" program as well as cooperation with the Christman "M Day" program.
With the opening of the Yarbrough Building, the Division of Vocational Rehabilitation has expanded its staffing considerably. Evaluations of a large number of patients who have had VR services and who have been out of the hospital from six months to two and one-half years--as compared with a similar number of control patients who did not have such services--showed that 78 per cent of the VR patients were now working or in training as compared with 35 per cent of the controls; 41 per cent now hold a better job than the job held prior to hospitalization as compared with 16 per cent of the controls; 79 per cent showed better restoration as compared with 39 per cent of the controls; 29 per cent of the patients who received vocational rehabilitation services were readmitted to the hospital as against 41 per cent who did not. The research study strongly indicates the great value of a comprehensive vocational rehabilitation program in a state hospital setting.
-44-

The department of religious services continues to be characterized by growth and development. Personnel was increased from six full-time and two part-time staff members to 16 full-time and two part-time employees. The ten new positions included three clinical chaplains, two intermediate stenographers, four chaplain interns, and one housekeeper. Recent visitors from the National Institute of Mental Health characterized this program as the best they had seen in the nation. Addition of the new staff members has more than doubled the services performed by this department and has reduced the chaplain-patient ratio from one chaplain per 3,000 patients to one chaplain per 1,700 patients. Efforts will be continued to further reduce the ratio to the American Psychiatric Association's recommended minimum of one chaplain per 500 patients. Thirteen students representing eight theological seminaries participated in a 12-week accredited program of clinical pastoral education, the first conducted in the hospital's history. Five seminary graduates were accepted in the internship program for a year of study and residence, and 24 students participated in two courses of instruction offered in cooperation with the Candler School of Theology at Emory and the Columbia Theological Seminary. Three workshops for community clergymen were conducted at the hospital during the year. The highlight of the year was the completion and dedication of the five chapels. Multiple services are scheduled each week in each chapel and a daily devotional service is conducted for employees just prior to the start of the work day.
-45-

The department of recreation added two employees during the year and instituted a clinical training program in hospital recreation with the first intern from Georgia Southern College in Statesboro. An enlargement of the volunteer program resulted in 30 volunteers providing various types of recreation services for small groups of patients on assigned wards. Expansion of programs to the Hc'ly Building where a group of blind patients are in recreation therapy three days a week, as well as to Yarbrough Building and the physical education program for the emotionally disturbed children has placed an additional load on the recreation staff.
The department of business administration opened the central kitchen. The employees' cafeteria is now also open and operating. Approximately 5,000 patients are now being fed from the central kitchen. It is anticipated that the complete operation will be in force by January 1, 1965. The use of white male prisoners was discontinued; they were transferred elsewhere and white and negro female prisoners were moved into the building. Eighty-four institutional work positions were approved for use in the central kitchen and laundries to replace the white male prisoners.
Transition of the hospital farms from row crops to grass and timber farms has now been completed. The central shops have been completed and the garage, woodworking shop, sanitation, and civil engineering depart-
-46-

ments have been transferred to the new facilities. The old garage and woodworking shop building will be remodeled as an annex to the Yarbrough Rehabilitation Center to train patients in the use of heavy woodworking equipment.
Renovation of the Howell Building has been completed and the male negro patients from the Ingram Building have been moved into the new quarters. Negro female patients from the Dupree Building have been transferred to the Ingram Building and the Dupree Building has been demolished.
-47-

ALCOHOLIC REHABILIT~ION SERVICE
To accomplish the goals of providing education, training, treatment, rehabilitation and research in this field, emphasis has been placed on education and training to try to provide community resources to help the alcoholic and his family.
A pilot study project was initiated at the Spalding County Health Department to gain experience in assisting a local health department develop a program of services for alcoholics and to test its value for possible statewide program development. A consultant team consisting of a psychiatrist, pastoral counselor, nurse and social worker, all well qualified and active in the on-going (treatment) program at the Georgian Clinic, went to Spalding County a half day each week to train local professional personnel in the elements of community treatment for alcoholism. Treatment and development of local program structure was the responsibility of the local team, which consisted of three ministers, a private physician, health investigator, four public health nurses and two case workers from Family and Children Services. All were trained by the consultant team prior to the opening of the Clinic to patients about September 1.
The consultant team visited the Clinic each week after the patient clinic day to discuss patients, procedures and philosophy, and to help the local team evaluate its work in the treatment program. Twenty-two
-48-

patients referred by physicians, Family and Children Services, the court and employers, received treatment in the nine month period; however, we expect the patient load to pyramid as the service becomes better known and techniques improved.
The treatment techniques patterned after those of existing clinics of the Alcoholic Rehabilitation Service, are medical evaluation, appropriate laboratory screening; medical management of underlying nutritional deficiencies, anxiety and/or depression; group therapy, social services, pastoral counseling; vocational rehabilitation assistance, and/or referrals to other agencies if indicated. Only one patient in this pilot study was referred to the Georgian Clinic for more intensive treatment.
At the end of the year the local team felt it could carry the program with one visit per month from the consultant team leaving the team free to establish a clinic in another area.
A federal grant for $15,501.00 was received for offering, in a practical and workable way, an intensive orientation into the problems of alcoholism for professional people in local communities. Included were ministers, health officers, nurses, social workers, rehabilitation counselors, probation officers and others administering to the alcoholic. Three hundred seventy-three received training of which five ministerial students received 57 hours of training.
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Treatment at the Georgian and Chatham Clinics remained at capacity with total of 23,309 visits to the clinics and 1471 hours family counseling. Patients receive multiple services on each visit which could amount to as much as five hours of treatment per visit. Services include medical management, group psychotherapy, psychiatric evaluation, appropriate laboratory screening, planned recreation, occupational therapy, special treatment movies with discussions and individual counseling.
Our greatest challenge is to provide treatment to more of Georgia's 75,000 alcoholics and their families than can be provided with present facilit~es. We propose to do this through clinics in the local health departments, similar to the pilot project, enabling alcoholics to seek and obtain treatment in the early stages of their illness before prolonged institutional care and welfare funds for maintaining his family are required.
Staff members served on school faculties, participated in seminars and institutes, and spoke to numerous professional and lay groups. Four faculty members and 55 students from Georgia attended the School of Alcohol Studies at the Georgia Center for which we were hosts this year.
We continued to publish the New Life quarterly; 35,000 copies were mailed and 10,350 copies of professional and lay material were
-50-

distributed upon request. Members of the staff also participated in radio and television programs throughout the state.
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division of physical health

braneh of dental health

BRANCH OF DENTAL HEALTH
Staff members of the Dental Health Branch continued to provide consultation to personnel in state, district, and local health departments; in institutions; and, upon request, to officials in other state agencies as well as to professional and voluntary organizations concerned with health. In accordance with established policy, professional and technical direction were provided to Milledgeville, Gracewood, and Battey State Hospitals in the planning and operation of the dental programs. Despite the recommendations for additional dentists at MilledgevillE:, based upon the survey of needs for dental care at the institution, the staff was not increased.
Because of the reduced patient load at Battey, the services of the half-time dentist were discontinued in February leaving one fulltime dentist.
The director of the Gracewood dental program completed his first year of residency training in pedodontics. This specialty training which will be completed in 1965 should enable the institution to provide better dental services to the mentally defective children and should provide the base for establishing a training program for dental interns and residents in pedodontics as well as serving as a resource for short courses, for dentists in general practice, in the care and handling of handicapped children.
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The Branch of Dental Health conducted a conference on 11Dental Health Problems of the Mentally Retarded and Physically Handicapped11 for in-service training of dentists in institutions and dental directors in regional, district, and local health departments.
The staff of the Branch of Dental Health conducted an 18-hour course in public health for the senior students at Emory University School of Dentistry. The staff cooperated with the Schools of Public Health of the University of Michigan and of the University of North Carolina by providing field experience for a graduate student from each of the schools who had completed his academic work for a master's degree.
The demonstration program in District 28 for evaluating the potential of a full-time dental director was interrupted temporarily until a replacement could be recruited to fill the vacancy created by the former director's resignation. One of the services being provided in the program is an oral exfoliative cytology project in cooperation with the U. S. Public Health Service for the early detection of cancer. During the year more than 500 smears were made of mouth lesions in over 8,000 patients examined in industry, nursing homes, and in private dental offices.
Staff members of the Department cooperated with a committee of the Georgia Dental Association appointed by the Governor to survey the dental programs, services, and dental manpower needs in Georgia. The Branch of Dental Health conducted a questionnaire survey of 468
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institutions in the state in which dental services might be provided in one manner or another such as hospitals, nursing homes, homes for children, institutions for the care of the chronically ill and the aged, and institutions of education with students in residence.
Questionnaires were received from 53 per cent of the institutions and a summary of the findings was prepared for use by the committee.
Upon request by the Department of Corrections to the Georgia Department of Public Health, the Branch of Dental Health conducted a study of the dental needs in the Georgia State Prison at Reidsville and submitted a report with recommendations concerning the dental program.
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DENTAL PUBLIC HEALTH SERVICE
Fluoridation of community water supplies, continuous dental health education, and incremental dental care for children continued to receive major emphasis by the Service during fiscal 1964.
Communities were encouraged to fluoridate their public water supply, and in order to facilitate such action, the policy of the Georgia Department of Public Health for the Fluoridation of Public Water Supplies was revised. The new policy, requiring only the plans and specifications for the installation and operation of the fluoridation process, reduced the number of documents which were formerly required for state approval. The policy imposes only those rules and regulations which are required by law, and are consistent with the rules and regulations required for other alterations in water plant installation, construction and operation.
Dental surveys made in Madison, which began fluoridating during the year, and in Rome, after more than 11 years of fluoridation, added to the mass of evidence of the benefits of fluoridation. Dental surveys have proved to be of local significance in justifying continuation of the fluoridation procedure and in showing the importance of maintaining optimal fluoride concentrations for maximum benefits, and also in pointing out the advantages of fluoridation to neighboring communities.
-55-

Six additional water supplies are reported to have begun fluoridation during the fiscal year bringing the state total up to 57 water systems fluoridating which serve about 39 percent of the population on public water supplies.
Dental care services were provided for more than 30,000 underprivileged children who were treated in public health dental clinics in 77 counties. Through the cooperation of the U. S. Children's Bureau and local health departments, bids were let for the procurement of air-driven high speed units for use in 80 public health dental clinics. This modern equipment should facilitate the dental care services rendered to underprivileged children.
All of the 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. The program includes: (1) consultation and assistance to public health personnel, dentists, dental hygienists, schools, colleges, teacher education courses, nursing homes, and professional and voluntary agencies, (2.) selection and preparation of education resources such as pamphlets and audio-visual aids, and (3) interpretation of current dental health information for different grade levels.
Regional dental consultants continued to provide consultation and technical assistance to district dental directors, local health
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departments and dental societies in programs for prevention of dental injuries in contact sports. The program involves the fabrication of individually fitted mouth protectors for scholastic athletes who engage in such sports. In most communities dentists and other volunteers have participated in these projects as a public service.
Consultation and demonstrations have been provided to nursing home administrators, nurses, and attendants in the importance of personal oral hygiene of patients, and in the methods of maintaining care of the mouth and dentures.
National Children's Dental Health Week continued to be a focal point of educational activity throughout the state. The highlights were again published in the Journal of the Georgia Dental Association.
A study project was initiated in Pickens County to determine the effectiveness of a dental prophylaxis given by a dental hygienist using a prophylaxis paste containing stannous fluoride. If the paste proves to be as effective in reducing tooth decay in practice as in the laboratory, it could be recommended for more widespread use.
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environDlental health braneh

HOUSING HYGIENE AND ACCIDENT PREVENTION SERVICE
The Accident Prevention Section has been promoting accident prevention with many official and non-official groups through activities such as those reported below.
1. Developing ideas, plans and programs as well as indoctrinating and training personnel to stimulate the integration of accident prevention activities with local public health programs.
2. Representing public health interests on state-wide groups such as the Georgia Home and Farm Safety Council and the Georgia Water Safety Council.
3. Serving as the state clearinghouse for a network of 11 poison-control centers located throughout Georgia. This is an especially productive program in view of the current complexity of the chemicals and pesticides marketed and easily purchased for home use.
4. Serving as Medical Coordinator for the Cornell-Georgia Automotive Crash Injury Research Program. This is a cooperative effort involving the Medical Association of Georgia, the Georgia Hospital Association, the Georgia State Patrol, Cornell University and the Georgia Department of Public Health. The
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first six month phase of the study was completed in Northeast Georgia during this fiscal year and the Southwest Georgia phase of the study was begun. 5. Working with the Accident Prevention Committee, Georgia Chapter, American Academy of Pediatrics, on accident prevention for the small child; and carrying on programs with Georgia pharmacists in poison prevention. Along with the routine duties of maintaining close liaison with housing hygiene programs in the state, rendering consultant service in problem solving, disseminating information to all units, and providing general consultant and advisory services, the Housing Hygiene Section has been active in providing county health departments with assistance and guidance in constructing the administrative and operational procedures necessary for administering and enforcing newly-adopted minimum housing codes. This assistance consists generally of aid in organizing and conducting an initial housing survey, furnishing all forms and working closely with local agency personnel in designing routine procedures and activities involved in administering minimum housing codes. The Housing Hygiene Section has been actively engaged in developing a screening type housing survey technique which can be standardized and made available to any community which is interested in assessing the
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quality of its available housing. This procedure was first tested in a rapidly growing urban county and modifications were subsequently made; a survey was then conducted in a city of less than 20,000 population and further improvements were made.
The active interest and participation of this Service in the metropolitan, urban and community planning for environmental health training program has proved very profitable in promoting the interest of local and state groups in housing hygiene as a public health activity. (See report addendum.)
In pursuing the responsibility of the Service to render consultant service to the local agencies in Georgia, the professional staff has made 214 field visits to 53 counties geographically covering the entire state.
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HOUSING HYGIENE AND ACCIDENT PREVENTION SERVICE (ADDENDUM)
METROPOLITAN, URBAN AND COMMUNITY PLANNING Our rapidly expanding technology has presented many new and
varied problems in environmental health. Such problems have become more apparent because of the increase in population and the continuing concentration of population in urban centers. Our urban centers have long been interested in and engaged in the correction of existing environmental hazards, but very little effort has been directed toward the over-all planning of our environment to avoid future problems. Efficient planning for environmental health is essential and the initial effort toward an organized program was started this year. The program designed to fulfill such an important need is a staff function of the Environmental Health Branch; however, responsibility for carrying out the program has been delegated to the Housing Hygiene and Accident Prevention Service.
The primary purpose toward which the Metropolitan, Urban and Community Planning for Environmental Health Program has been directed is to assist local health departments in becoming actively engaged in community planning to prevent future environmental health problems and to insure a safe and sanitary environment.
Planning for environmental health is a community action program involving many official and non-official groups. The complexity of the
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problem indicates that public health as an isolated agency cannot do the complete job. However, the official public health agency can furnish leadership in bringing together interested groups. Directed toward this objective, leadership has been furnished by personnel of this program to many local health departments through the following specific activities:
1. The initial planning, administration and coordinating activities connected with organizing the total program.
2. The indoctrination of the State Department of Public Health staff in the concept, techniques and expected results of such a program. This included formal in-service training for several staff members.
3. Contact with official and non-official groups seeking cooperation and support for the program. This resulted in active and specific cooperation from the University of Georgia's Institute of Community and Area Development, Institute of Law and Government and Center for Continuing Education; The U. S. Public Health Service; the Georgia Department of Industry and Trade; Georgia Municipal Association; Association County Commissioners of Georgia; Georgia Electric Membership Corporation; Georgia Power Company; Georgia Institute of Technology; Georgia League of Women Voters of
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Macon, Augusta and Atlanta; Macon and Bibb County; Augusta and Richmond County; Macon-Bibb County Health Department; and Richmond County Department of Health. 4. Planning and conducting the following specific phases of the total program: a. The Metropolitan, Urban and Community Planning for
Environmental Health Conference, February 10-14, 1964, held at the Georgia Center for Continuing Education, Athens, in which 145 persons participated. One hundred four trainees completed the week's course. b. The Macon Phase - Sessions 1 and 2 in which about 90 persons participated, 47 of which were trainees. 5. The development and refinement of methods and procedures for the encouragement of a unified community approach to planning for environmental health. 6. Stimulation of interest in this technique resulting in numerous requests for similar programs.
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INDUSTRIAL HYGIENE SERVICE
The purpose and function of Industrial Hygiene is to discover, define, evaluate, and control those environmental factors in 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 staff is 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 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 to us upon request, and with their assistance it is possible to evaluate most industrial health problems.
The increase in industrialization in the state has brought increased responsibilities to the State Health Department. The local
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health department is the official agency specifically charged with

the responsibility of assisting these establishments and their employees

in all health matters. Assistance from the State Health Department is

available to local industries only through their local health department.

In carrying out the program for improvement of environmental

sanitation in industry, Industrial Hygiene personnel made investigations

in 380 establishments employing approximately 32,430 workers in 86

counties during the period July 1, 1963 to July 1, 1964. These inves-

tigations covered a wide variety of industries. During these inves-

tigations 273 samples were taken for laboratory analysis.

Samples collected and analyzed by the Radiological Health

Section during the period covered by this report included 839 air

samples, 84 rain samples, 75 stream samples and 618 milk samples.

The Section also made X-ray and Isotope inspections and surveys as

indicated below:

Isotope inspections

22

X-ray surveys

280

Radium surveys

12

Classes (Sanitarians)

2

In the period covered by this report, the Electronics Unit made

81 repairs to X-ray equipment, in addition to 32 repairs to such equip-

ment as film dryers, tape recorders, movie and slide projectors, record

players, vision test units, and radiation meters. The Unit repaired 87

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audiometers. In addition to the above activities, personnel assisted the T.B. Service and State Employee Health Clinic in their programs at various times due to the absence of technicians on leave.
During the report period, the Air Pollution Section made nine one-week studies at various localities in the state. During these studies, 412 samples were collected for laboratory analysis and 868 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, 624 bedding inspections were carried out.
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GENERAL ENGINEERING AND SANITATION SERVICE
Fiscal year 1964 brought about several changes in working assignments of personnel that included: reduction of clerical staff to four in number; transfer of five sanitarian I positions and one regional engineer position from Local Healt'h Administration Service to this Service; reassignment of one person from milk activity to food sanitation activity and another from milk activity to shellfish sanitation fulltime. With the changes in personnel the Service assumed responsibility for direct sanitation services to 32 counties without local or district sanitation personnel.
Program activities in General Engineering included a review of 175 subdivisions including plats showing topography, engineering reports, percolation data, and other essential information in cooperation with local and district health departments. Approval was given for 25 oxidation ponds, eight "package" sewage treatment plants and 41 large septic tanks with dosing siphons and covered sand filters or tile fields to serve residential subdivisions, nursing homes, motels, highway rest stops, and shopping areas. Final approval was given on 207 sets of plans and specifications in our school construction review program. All of the construction work was given field review by appropriate local sanitation personnel or central office personnel where local staffing was inadequate. In the cooperative program with Federal agencies, 1314 septic tank systems and 229 water supply systems
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for individual properties were report~d through this off;.~,:! c> FHA and VA. We have completed a draft of d,~sign and construction standards for individual sewage disposal systems for adoption. We have prepared recommendations for the design, operation and maintenance of sewage oxidation ponds for publication by the Department. Refuse collection and disposal consultation was rendered state-wide through 159 field trips into 43 counties. Maintenance permits were issued covering 1000 water impoundments.
General sanitation continued expansion in effective liaison and working relationships with the State Parks Department, the US Forest Service, State Game and Fish Department, State Highway Department, and other allied agencies. Results were reviews of plans for four new water systems, improvements to 15 water systems, installation of 50 approved individual sewage disposal systems, field inspections of 92 gas heating units for venting and safety, routine water sampling program established in state parks and US Forest. Service recreational areas. Tourist court permits were issued to operate 1115 establishments; issurance of permits to 48 establishments delayed pending completion of corrections; 35 previously operating establishments were reported closed. Close cooperation was maintained with Medical Facilities Service in construction, remodeling and inspection of homes for the aged and nursing homes. School sanitation activities aimed
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primarily at the school lunchroom and at such sectors of the school environment as were brought to our attention by complaints through local health authorities from parents, teachers, and school officials. Mosquito control on large impoundments conducted by operating agencies and reported to this office included shoreline maintenance and larviciding.
Pilot studies in self-evaluation of the food service industry indicate that a satisfactory program may be ultimately developed. Food service training programs were conducted in cooperation with 25 county health departments. The shellfish sanitation program involved certification of 11 shucker packer plants, four repackers, four shellstock dealers and three reshippers handling 225,000 pounds of oyster meat from Georgia waters. A sanitary survey of approved waters is in progress. Bacteriological examination was made on 524 samples collected from shellfish waters. Official milk sanitation surveys were made on 24 milk sheds, and 29 spot checks of local milk supplies were completed, involving 129 inspections of pasteurization plants and 1246 inspections of farm dairies. There are 22 milk sheds listed on the honor roll by US Public Health Service.
This Service continues to participate in the training of public health sanitarians for employment in this state. The turnover of sanitation personnel in local health departments (94 appointed versus 71 separated since January, 1960) is such that continued intensive efforts must be made to train sufficient sanitation personnel to give adequate coverage at the local level.
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WATER RESOURCES SERVICE
The Water Resources Service provides supervision over water supplies, sewerage projects, industrial waste treatment, stream quality and other allied activities.
During fiscal year 1963-64 plans and specifications were reviewed and approved for 18 new municipal water supplies, nine sub-division or industrial water supplies, and extensions to 72 water supply systems. Consulting, engineering and chemical services were supplied to municipalities and industrial concerns in problems of water supply and treatment. Engineering review and approval of sewerage systems for 24 new municipal plants and 38 sub-divisions and industrial plants was completed. Extensions were approved for 45 municipal systems and five sub-divisions.
The amount of $2,108,009 was granted for sewage treatment plant construction under the Federal Water Pollution Control Act, Public Law 660. These funds were allotted to eligible municipalities through the Water Resources Service. An additional $1,512,600 was granted to 12 cities for both water and sewerage systems under the Accelerated Public Works program by the U. S. Government.
The stream quality program proceeded at an accelerated tempo. TWenty-nine sources of pollution were investigated and action inaugu-
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rated to abate the pollution from these sources. Major emphasis was placed on the Etowah and Chattahoochee Rivers. Samples were collected in order to determine the physical, chemical and biological characteristics of the water.
Public education and promotion of water supply and waste treatment facilities were intensified. Numerous conferences were held and public speeches made to exchange ideas on water supply and waste treatment problems.
An intensified program for improvement of small water supplies throughout the state was begun. Visits were made by engineers to all supplies which were either delinquent in sending samples as required by regulations, or whose samples were of questionable quality, or unsafe bacteriologically. Investigations were made and recommendations submitted for the correction of all deficiencies. Advice on treatment problems was supplied by a chemist and an engineer to all treatment plants which requested help or were found to be in need of such service.
The Water Laboratory, the Analysis Section of the Water Resources Service, made bacteriological, chemical and physical tests for water quality and water pollution control programs as well as all tests on shellfish for the General Engineering Service.
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A total of 68,724 tests were made, an increase of 43.6% over the previous year.
Of the 703 water supplies, 3.8% more supplies submitted samples regularly than during the previous year and 8.7% more supplies produced water of satisfactory bacteriological quality.
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ENVIRONMENTAL HEALTH TRAINING
The need for adequately trained personnel to meet the increasing complexities in the field of environmental health is a major problem facing all State Health Departments today. To meet this need, the Environmental Health Branch, in 1963, conducted or participated in training activities to a greater extent than in any previous year.
Realizing the need for specialized training in certain areas and the cost involved in sending personnel out of state to attend specialized courses, arrangements were made to have two of these courses conducted in Georgia by specialists from the Robert A. Taft Engineering Center, Cincinnati. The two courses conducted were:
1. "Water Quality Studies" 2. "Aquatic Biology" These courses were of one week's duration, with a total enrollment of 65 students. Thirty three sanitarians participated in an orientation course which consisted of twelve weeks of classroom work and seven weeks of supervised field training. One-day courses were conducted in Macon, Waycross, Albany, Athens, and Atlanta in "Making Inspection More Efficient", "Self-Evaluation in Food Service Establishments."
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It is felt that it will be necessary to plan more courses to be conducted in the field if the needs of the individual sanitarian are to be met. Consideration should also be given to requesting local health departments to set up an annual training budget to supplement the state program.
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health eonservation
braneh

CRIPPLED CHILDREN'S SERVICE
At the beginning of fiscal 1964, Crippled Children's service had 221,993 children on its state register, of which 10,482 were treated during the year. The register is remarkably accurate through the close relationship with local county health departments; the service is kept informed of patients who move from the state, expire, or cannot be located. Children made 24,660 visits to clinics, (the average patient attends clinics three times a year) while 21,534 hospital days care and 13,250 days of convalescent care were offered by the Service.
The orthopedic and plastic surgery case loads reflected some growth as did the cardiac, amputee, and physical medicine patients. Cases of children with hearing problems and with seizure problems are increasing rapidly. Presently there are special seizure clinics in Cordele, Columbus, Savannah, Macon, and Atlanta. There are hearing clinics in Augusta, Macon, and Atlanta.
There are many supportive services in Georgia to help the crippled child. The Benevolent and Protective Order of Elks has for a number of years maintained a travel fund from which public health personnel can draw to pay transportation for children coming to clinics and hospitals. This fund is limited and county people work yery hard to find local resources for this purpose. The State Department of
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Education, Division of Exceptional Children, helps with the appropriate placement of many of our children in public schools. The Department of Family and Children Services is most helpful with children whose homes are not suitable for treatment to be carried out and arranges faster home care as indicated.
The Service's most effective resource is the local health department. Each time a child reports to a clinic, or to a hospital, a copy of notes made at that time are sent to the county of his residence. The personnel there are always kept up-to-date on what the Service is doing for the child. In turn, they keep the Crippled Children's Service informed of home situations and of problems arising to prevent the child from reporting to clinic or hospital. Local health departments are very active in helping parents plan for the care of a child in a cast or special apparatus. They draw on local resources so that the child can be adjusted to his social and educational environment in his local conununity.
The clinic team operating the Central Hearing Clinic has offered service to Cave Spring School for the Deaf. From time to time a clinic is held at Cave Spring where children are evaluated to determine whether or not hearing aids would be helpful to them; hearing aids already being worn are either repaired there or in Atlanta. Of the total student population at Cave Spring 64 children have been active at one time with Crippled Children's Service and is hoped that all of these can be activated and given whatever help they may need.
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MATERNAL AND CHILD HEALTH SERVICE
The Haternal and Child Health Service is charged by law to protect and promote the health of mothers and children in Georgia. The focus of the service has been upon preventing and combatting health factors which would keep individuals from becoming economically dependent members of society.
In 1963 there were 99,360 births, of which 7,68l~ were home deliveries by 382 midwives. We can anticipate that 2,500 to 3,000 of these approximately 100,000 babies will be mentally retarded, 100 will be completely dependent and require institutional care, 400 will be semidependent, and 2,000 will be marginalally dependent.
As late as 1934 the maternal death rate was 78.2 per 10,000 live births. In 1963 it was reduced to 5.3. Even though this is an astounding improvement, Georgia must materially improve both the maternal and infant mortality rates in order to compare favorably with the national average. There has been an alarming and persistent rising death rate among the one through 11 months age group in the last eight years, which has raised the infant mortality rate.
A majority of congenital defects, both mental and physical, are directly associated with the complications of pregnancy and heredity. Therefore, primary effort is placed upon family planning and good prenatal care, terminating in hospital delivery by a physician, and upon continuous
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well child supervision. To date, there are 18 community plans for indigent hospitalization for delivery, four of which have been recently initiated, and four more are under study.
During the year, 16,476 patients were admitted to prenatal medical care, 24,429 to prenatal nursing care and 4,182 to postnatal medical care; 106 counties have maternal clinics with physicians' services. Stress has been placed on the prevention of iron deficiency anemia. Almost all patients are now given oral iron as early in pregnancy as possible; 250 cases of extremely severe anemia were provided with parenteral iron, where routine oral therapy was inadequate or impractical.
The service assisted and promoted a special project of intensive antenatal, natal and postnatal care for the indigent and medically indigent high risk patients and their infants. This project is sponsored through the Richmond County Health Department and is a coordinated effort of the Hedical College of Georgia and 11 perimeter county health departments. The Children's Bureau provides 75% of the funds.
One hundred and thirty-one counties have well-child conferences with physician participation. There are nursing conferences for mothers and children in 19 counties. Over 52,990 immunizations against diphtheria, tetanus and whooping cough were completed during infancy and through the first four years of life. About 2.5,582 in this age group received Salk polio vaccine.
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A number of health department clinics routinely use a urine test screening for phenylketonuria at the sixth or eighth week. One case, a $100,000 life cost care problem if undetected in the first few months of life, was found by this activity. A hospital newborn screening program for this preventable cause of mental retardation has been set up. Hospitals have tested 13,402 infants. One case has been found by this method and is under dietary management.
A special project in mental retardation, the Child Development and Evaluation Center in Muscogee County Health Department, is providing services to a 12-county area. This, too, is a Children's Bureau underwritten activity. Plans have been submitted for similar projects in DeKalb, Rockdale and Chatham Counties.
The number of clinics for the infant auditory screening program, aimed at early detection of developmental and/or hearing problems, are increasing.
In-service training in maternal and child health is part of the basic work of the staff. An institute was held in hospital premature care and other less formalized experiences in family planning were held for nurses. A seminar on obstetrics and newborn care was sponsored for physicians.
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NUTRITION SERVICE
Planning for more effective coordination of Nutrition Services was emphasized this fiscal year. For this purpose, a committee cons:.:_sting of health officers, nurses, nutrition staff members and members from other state services reviewed the current situation and the history of the service to make recommendations for future steps.
In C(loperation with the Maternal and Child Health Service and the Georgia Jaycees, the nutrition staff promoted the use of surplus commodities to improve the health of mothers and babies through more adequate nutrition. The staff demonstrated the commodities to the Jaycettes at a state meeting in Macon. Georgia, which is the only state in the United States to use this program, has 36 counties participating.
The joint survey of child-caring institutions made with the Family and Children's Services is nearly complete and the results have been partially tabulated. ~fuen completed, some necessary training sessions wi 11 be planned.
The nutrition staff is also assisting in planning a correspondence course for supervisory food service personnel in small hospitals and also for annual regional institutes.
Other agencies such as the School Lunch Program, the Vocational Education Department, various colleges and schools, the Georgia Nutrition
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Council, the Teen-Age Project, the Diabetes Association and the Tuberculosis Association cooperated with the Nutrition Service in various joint projects.
The U. S. Public Health Service nutrition consultant in the cariovascular disease program developed materials for use by those requiring fat-controlled diets and low sodium diets. She also worked with the regional nutritionists and the dietary consultant in Medical Facilities Service to conduct in-service education programsfor local health departments.
The junior nutrionist in the Central Region was placed in District #26 for a period of 18 months to develop a comprehensive Community Th1trition Program. She worked with maternal clinics, schools, educational groups, low-income families, practical nurses and others to seek what problems are present and to make recommendations for better nutrition planning in the district.
The dietary consultant also engaged in joint planning with the League of Nursing for a workshop to occur next year to up-grade nutrition education in nursing schools. She also temporarily taught,for demonstration purposes,a group of nurses from the Medical College at Augusta who are being trained at Georgia State College.
The nutrition personnel participated in orientation, in-service training, Crippled Children's clinics, prenatal and well-child clinics, schools, classes for obese patients, consultations with other agencies
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on standards, individual patient conferences and classes for dental assistants, practical nurses, school lunch supervisors, and day care directors. They attended and participated in numerous national, state, and local conferences and workshops. A special workshop in Nutrition Consultation was also held for staff members.
Since many of the nutrition publications were out of date, the staff, with the help of a temporary nutrition consultant and a commercial artist, edited and reprinted several pieces used for education of the public. Next year additional literature will be up-dated and reprinted.
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SCHOOL HEALTH SERVICE
The School Health Service concentrated the major portion of its staff time on hearing and vision conservation programs. The staff has also been engaged in two other projects: one in cooperation with the Children's Bureau, and the otper in a local small city school system and health department. The Service also offered consultative services to local health departments concerning the teaching of health subjects in the schools. School Health answered requests of voluntary and schoolrelated agencies (P.T.A.) for talks and any other need the service was competent to fill.
Ninety counties representing 262,207 children in 2.25 schools had vtsion screening. Of the number tested, 20,043 children failed, and 9,607 were reported to have received follow-up care. The Georgia Lions Lighthouse finances vision corrections for many of the medically indigent children.
In 668 schools in 101 counties, there were 123,484 children whose hearing was screened by puretone audiometer. Of those tested, 6,296 failed, and 3,343 were reported to have received medical care. The new feature of the hearing program clinics with hearing screening examinations by otologists is now in its second year of operation and has proved to be popular and useful to local health departments. Twentynine clinics were held, and about 1,771 children from 43 counties received this service.
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School Health Service has continued to work cooperatively with a local health department and medical school in the operation of the first local health department sponsored speech and hearing clinic. In a second local health department the Service has done some planning for the purpose of submitting a special project to the National Institute of Health in October that would make possible the establishment of a second local health department speech and hearing clinic.
School Health Service assisted the Tuberculosis Control Service in initiating interest in more tuberculin testing. This year 81,665 school children were tested; 2,180 (2.7%) reacted positively, and 35 had active disease. An additional 63 cases were found in contacts of school children.
With funds supplied by the Children's Bureau, a health survey was carried out for the negro children at the Georgia School for the Deaf. Each of 164 children received a pediatric, otologic, audiologic, ophthalmologic, and psychological examination. Some of these children received medical and audiological follow-up services from project funds, and others received medical treatment from the Crippled Children's Service, voluntary agencies, and private resources. A study was conducted at Sumter Cbunty Health Department to test the validity of a questionnaire for the detection by the teacher of emotional disturbance in
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children and was submitted to NIH and was approved but not funded. Until such time as funds become available, School Health will attempt to carry out the project with its own budgetary allocation for pediatric and clinical psychological examinations for school age children.
A plan is being developed, with the cooperation of the School Child Health Committee of the Georgia Academy of Pediatrics, to make pediatric examinations and clinical psychological tests available to children who are failing to progress in school because of physical, mental or emotional problems.
The School Health Service sponsored a five-day course in the principles of audiometry for public health nurses, at the Georgia Center for Continuing Education.
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loeal health braneh

LOCAL HEALTH ADMINISTRATION SERVICE
During the past fiscal period considerable attention has been directed to the coordination of program development and expansion of existing programs in local health departments. Of the 159 counties of the state of Georgia, 114 are covered by district personnel with 42 other organized local health departments. At the present time Union, Pickens, and Towns Counties have no prospective local health department activity. Considerable effort has been expended in these counties to establish active local health departments, but the lack of qualified personnel has been a serious obstacle. There were 28 districts during this period with district directors of public health, with a total of 30 out of 38 districts active with either a district director of public health or district director of environmental sanitation, and/or a district director of public health nursing.
The matter of staffing in local health departments during the past fiscal year has been that all efforts in terms of recruiting, training, and orientation have, at best, only maintained the status quo.
There were six public health center projects approved during the 1964 fiscal year in the counties of Dougherty, Fulton- Roswell, Gilmer, Paulding, Troup, and Warren amounting to $858,000.
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July 1, 1964 was the effective date of the new pay plan covering positions of the State Merit System which involved considerable time on the part of the Branch of coordinating the adjustments as they affected local health department personnel.
Both the Branch and the Service have been involved in extensive studies relating to both grant financing and state-local relationships as they apply to distribution of available resources and area needs. It is anticipated that these efforts will be valuable in the planning and programming of health services to the people of Georgia.
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NORTHERN HEALTH REGION
Ten out of the 13 planned health districts in the Region were functioning as activated districts during fiscal year 1964. Districts 11, 22, and 23 remain unorganized districts although definite interest has been shown by vari0us counties in Districts 22 and 23 to organize. Encouragement for organizing has been withheld to some extent by a temporary moratorium on the formation of new districts. Among counties not having a full-time health department, Pickens County is ready to establish a health department as soon as a qualified public health nurse can be recruited. Towns County is showing definite interest and will probably establish one s~on. Union County is showing some interest and it is hoped this interest increases to a point sufficient to warrant more serious efforts of outside assistance.
A District Director of Public Health was employed for District 16 on August 1, 1963. Nine districts thus had full time medical directors. District 29 continued to be served on a part-time basis by the Regional Medical Director. Toward the end of the period a District Director of Public Health was recruited for District 29 and he is at present in orientation training. Seven of the activated districts were served by a district director of nurses and eight had a district director of environmental sanitation. The district nurse in District 31 retired and District 32 employed a district nurse during the period.
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On July 1, 1963, the engineering and sanitarian consultants of the Regional Office were transferred to the General Engineering Sanitation Service. Counties now having no sanitarians are served by personnel from the latter service on request from the counties or the Region through the Local Health Branch. One s e cretary was transferred to the Local Health Branch as part of this re-organization.
As of December 31, 1963, in the activated districts, the number of health workers employed in the various health departments throughout the Region was as follows: 12 physicians, 217 nurses, 92 sanitarians and engineers, 126 clerks, and 133 other employees. Twenty-two nurses, 6 sanitarians, and 16 clerks were employed in the unactivated districts. Six health investigators served the area exclusive of those doing special projects. Ten organized counties operated without a local sanitarian and one county without a local public health nurse. Regional office personnel consisted of two nurse consultants, two nutrition consultants, a medical director, and a secretary.
Construction of three new health center buildings under the Hill-Burton Program were completed in White, Catoosa and Wilkes Counties. The White County and Catoosa County centers were opened and Wilkes County Health Center will open shortly. Two new health
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center buildings were placed under contract (Hill-Burton); one in Paulding County and the other in Fulton County. Lincoln County is constructing health center space in an addition to the Court House Building financed in part under the Area Redevelopmen t Adm in istr ation Program.
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CENTRAL HEALTH REGION
Among the continued programs during fiscal 1964 was the blood pressure study in one of the counties in the region. In-service education for consultant nurses also continued with most training centers being located in or around Atlanta. In-service programs were planned for local health departments in such public health areas as tuberculosis, mental health, interviewing, family planning, maternal and child health evaluation and records. Tuberculosis services with diagnostic and evaluation clinics were reduced from 23 counties to eight with the majority of project workers being transferred to other areas.
Progress was made during the past fiscal year in curbing the spread of syphilis. Though it is increasing in some counties .. one of the larger counties in the region showed a 72 per cent decrease in reported cases. This is due primarily to epidemiological treatment of primary and secondary contacts. It is felt that these same results can be accomplished in the majority of counties in the region with little or no trouble.
At the beginning of fiscal 1964 all of Central Health Region engineers and sanitarians were transferred to the Atlanta office; thus, with this transfer the number of services offered to the public in this area was drastically reduced. Other loss of personnel included the transfer of the Regional Nutritionist and the resignation of the Regional Dental Consultant.
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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.
In addition to the Crippled Children's Institute held in June, 1963, three regional meetings were conducted. Topics were mental health, tuberculosis, review of immunization policies and an extensive discussion of records. Other short in-service activities covered the areas of stroke rehabilitation, heart, mental health and the Commission on Aging.
Our nurses, in addition to rout ine activ i ties, have concentrated on better records, better selection of patients for X-ray clinics, correction of defects found from vision and hearing surveys, promotion of Medical Self Help classes in the schools and community .. and continued teaching of Mother and Baby Care classes in schools.
Both Irwin and Turner Counties have new Hill-Burton buildings while Marion County moved into better quarters during fiscal 1964. Schley County opened its health department in July, 1963, and plans are currently underway for construction of a health center in Wheeler County, Alamo, Georgia.
During National Children's Dental Health Week, many of the cities in the Southern Region presented outstanding dental educational programs and were given state-wide publicity for their contributions. Featured
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activities included: public announcement of two new fluoridated water systems; two poster contests; essay contest; Junior League Follies presentation for dental health; School Science fair project--"The Effects of Mouth Bacteria on Tooth Decay"; a pre-fluoridation survey; and numerous talks on dental health before school and civic groups.
Our regional staff personnel fluctuated with the transfer to Atlanta of one Regional Engineer and two Regional Sanitarians; however, headquarters are yet maintained in Albany and Waycross. One Regional Consultant Nurse was transferred and two stenographers in Waycross and Albany offices resigned. Also, in July of 1963 the Administrative Officer in the Macon Regional Office was given the responsibility for direction of the Albany and Waycross offices.
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preventable diseases braneh

CANCER CONTROL SECTION
There was a substantial increase in the cost of operating the cat,cer program during fiscal 1964; therefore, it was necessary to transfer additional funds to the cancer budget in order to keep the program operating without interruption.
Total expenditures for patient care amounted to slightly more than $500,000. This represents an increase of approximately $50,000 over the figure for the previous year.
There was some increase in the case load but this alone was not sufficient to materially affect the cost of the program. During the year, 2509 patients submitted applications for state-aid as compared with 2470 during the previous year, an increase of about 1.5 per cent or $6,000.
While the continuing increase in the per diem rate paid for hospital care was a sub~tantial factor in contributing to an increased cost of approximately $1.::,000, a more important factor was a sharp increase in expenditures on the part of two clinics. The clinic cost increase was due to prolonged periods of hospitalization for certain types of patients; a~ a result of this experience, a quota has been assigned to each clinic for fiscal 1965.
All of the approved clinics continued to operate throughout the year. No additional clinics met the minimum requirements for approval.
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It has now been six years since a new clinic has applied for approval. Actually, the number of treatment centers now in operation is quite adequate to handle the existing load of indigent cancer patients.
In November, 1963, the clinic directors met at the Emory University Clinic for the purpose of discussing problems of mutual interest. The meeting was well attended and the general feeling was that the discussions were of definite value. A second meeting, which was also very productive, was held in Macon in April, 1964, during the meeting of the Medical Association of Georgia.
Present regulations require that hospital insurance be collected and either deducted from the patient's bill or refunded to this office. In the past, there has been some laxity in that connection, particularly on the part of several of the larger clinics.
As a result, more complete insurance collections were made and refunds during the past six months have increased about two and onehalf times over the figure for the corresponding period of the previous year. Present indications are that at least $25,000 in insurance may be collected.annually.
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CARDIOVASCULAR DISEASE CONTROL SERVICE
The Cardiovascular Disease Control Service cooperates closely with the Georgia Heart Association, the Heart Disease Control Program of the U. S. Public Health Service, and other public and private agencies in developing and continuing research and service programs designed to detect, correct and prevent cardiovascular abnormalities and diseases.
Thirty-two professional and non-professional service personnel were engaged in the various research and community service programs in Georgia this year.
The Atherosclerosis Study, initiated in 1957, is comparing two different religious orders, the Trappist and Benedictine monks, in an attempt to elicit the factors--dietary, social, psych0logical and others-which may contribute to the disease. The number of monasteries participating in the study rose this year to 29 with almost 2800 individuals.
The second phase of the Baldwin County Hypertension Study began on January 1, 1964. This study is designed to determine the incidence and prevalence of hypertension in a selected population and to demonstrate the applicability and effectiveness of public health measures in detection and control.
Hypertension clinics have also been established at Georgia Baptist Hospital in Atlanta and at Talmadge Memorial Hospital in Augusta for advanced diagnostic work-up on indigent hypertensive patients; these
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clinics operate primarily as referral facilities and accept patients from all areas of the state. The heart clinics system also has been encouraged to follow more Jf the hypertensive patients in its caseload.
The Stroke Rehabilitation Program has concentrated on education and consultation primarily. Programs are developed through lectures to medical societies and the training of para-medical personnel in local health departments, hospitals, nursing homes, nursing schools (registered and practical), and nursing associations. Specialized consultation has been provided upon request to physicians and public health nurses with difficult cases involving physical therapy; this year two physical therapists visited 544 patients in the state and a third therapist was added to meet the increasing work load.
The Congenital Heart Disease Program has continued to cooperate with the Crippled Children's Service in providing personnel and equipment for di.agnosis, treatment and care of afflicted children through clinics, laboratories and hospitals.
The Rheumatic Fever Prophylaxis Program continued through which prophylactic medication is furnished free of charge to private physicians and heart clinics for the protection of approximately 2,000 indigent patients against the recurrence of rheumatic fever.
Congestive Heart Failure Programs, designed to maintain treatment regimens of digitalis, digoxin and allied medications, are sup-
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ported and carried out through the heart clinics system. A specialized nurse consultant is now available to physicians and to nurses who have difficult or poorly controlled patients in their caseloads.
A training program in mouth-to-mouth resuscitation and closed chest cardiac message has been instituted and made available to hospital personnel and public health nurses.
The Cardiovascular Disease Control Service and the Georgia Heart Association continue to sponsor 15 heart clinics throughout the state for diagnostic evaluation, surgery, treatment, all types of care and medication for indigent heart disease patients.
A cardiovascular nurse consultant and a nutritionist were added to the staff which has resulted in expanding the services in each of the areas for consultation, assistance and training of nurses and paramedical personnel in problems related to cardiovascular diseases.
This past fiscal year a study was also undertaken to determine the value of using routine tuberculosis chest X-rays to discover unknown cases of heart disease and to return lapsed patients to treatment. Secondary screening clinics have been set up on a trial bases and patients whose X-rays reveal possible cardiovascular abnormalities are referred for re-examination and evaluation.
As part of the physician education effort, the service continues to furnish complimentary subscriptions to the Heart Bulletin to physicians,
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hospitals and medical students throughout Georgia. In addition, the service staff developed a nursing manual entitled "Care of the Stroke Patient at Home, A Guide for Public Health Nurses" as a supplement to the USPHS publication "Strike Back at Stroke". This booklet has been distributed to the public health nurses in Georgia and to about 300 nursing personnel in other states.
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GEORGIA STAIE 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 fulltime physician, two nurses, two medical technicians and two secretaries. This staff is considered adequate for the workload being undertaken. However, if a pre-employment physicial examination under the Merit System is implemented, additional staff members and increased working space will be required.
There were 1194 employees screened during the reporting period. This is a decrease of 103 over the preceding year. There were 1157
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abnormalities recorded among the number screened. As in previous

years, the majority of abnormalities were overweight and defective

vision and hearing. There were 19 employees who were found to have

hypertension. Abnormal hemoglobins were detected in 39 employees

and abnormal urinalyses in 30 others. These conditions were made

known to the employee with the recommendation that he or she seek

medical interpretation from his or her private physician.

Tabulated below are the statistics comprising the various

activities of the Employees Health Service during the fiscal year

1964 as compared with those of a like period for the preceding year:

FY 1963

FY 1964

Screenings

1297

1194

Screening Revisits

1473

772

Counseling and First Aid

3897

3876

Innnunizations

3164

577

Other

12

50

Total pt'ocedures

162.35

15711

Health literature picked up

5600

3137

Tuberculin skin tests

930

866

Various specific laboratory procedures have been tabulated and are 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. (Beginning 2/18/63)

49

FY 1964 454
132.6 1226
31 1012 ll05 1264
160 1557
32

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

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Results of Screening tests for Fiscal Year 1964 - Georgia State Employees Health Service

Total number screened

1194

Defects: Overweight

76

Hypertension

19

Hemoglobin

39

Glucose tolerance test

11

Chest X-Ray

3

Serological test for syphilis 12

TBC skin test

87

Hearing

23

Distant vision

93

Near vision

191

Visual Fields

6

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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 department~, 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 Horkmen's Compensation Board, and death certificates filed with the Vital Records Service. During fiscal year 1964, seven of the deaths reported were due to silicosis as a suspected contributory cause, and two to pneumoconiosis as a significant condition contributing to death.
Occupational disease claims filed with the Horkmen's Compensation Board totaled 319. These reports were from 2.37 employers in 59 counties, and four out-of-state employers in two states. These reported conditions were as follows: dermatitis - 159; chemical injury
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to the skin - 47; chemical injury to eyes - 53; overexposure to organic phophorus compounds - six; inhalation of fumes and gases 46 (two reported as metal fume fever); possible lead intoxicationthree; carbon monoxide poisoning - one; actinic ray ophthalmia - one; pneumoconosis -one; tendonitis -one; and histoplasmosis, contracted while assigned to South America - one.
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. This assistance includes 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.
The research program in the kaolin industries continued in the form of completing statistical correlation of findings. This field project terminated in August, 1962.
The Director and Occupational Health Nurse Consultant continue to actively participate in national, state, and local meetings and seminars concerned with occupational health. Cooperation with schools of medicine and nursing has been maintained through participation in
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lectures and conferences. The promotion in district health departments of the idea of Local Government Employee Health Service, patterned after the State Employees Health Service, continues. There is great potential here for demonstrating effective prevention or early case finding of chronic illness on a large representative segment of the population. The probability of health districts finding sufficient funds to initiate such projects appears at present somewhat remote; even though theoretically they cannot afford to continue to ignore the occupational health approach which deals with those who produce the wealth we need as well as those who represent the population we serve.
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TUBERCULOSIS CONTROL SERVICE
Tuberculosis control showed continued progress during fiscal year 1964 through the application of the various programs in the service.
Evaluation clinic service was provided to 113 counties. In addition, this service was available from local resources in several urban areas. Difficulty in obtaining local funds to pay the patient travel costs has been reported in several instances.
The number of X-ray clinics held in local health departments as well as the number of persons (suspects and contacts) attending these clinics again showed an increase over the previous year.
The cost of X-ray film purchased by the Tuberculosis Control Service decreased approximately $32,000. This was due to the fact that the Department of Public Health discontinued supplying x-ray films to certain local health departments effective July 1, 1963. In lieu of furnishing film, the Department now participates in the salaries of qualified full-time x-ray technicians employed by local health departments.
Both the number of patients furnished free drugs to complete hospital instituted chemotherapy, and the number receiving chemoprophylaxis, showed an increase over the previous year. More Isoniazid and slightly less Para-aminosalicylic Acid was distributed.
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In accordance with previously reported plans, three people were left in Macon to continue service of our tuberculosis project in central Georgia. The remaining investigators were moved into four public health districts, (fourteen counties) in northwest Georgia, which have high tuberculosis rates. Excellent relationships have been established with district and county health personnel in the new area.
The problem case load has been considerably reduced in northwest Georgia. Ten per cent of the suspects referred from the 70 MM and 14 X 17 X-ray films are found to be active cases of tuberculosis.
Examination of contacts of newly reported cases still proves to be our most productive source of finding new cases.
Further plans contemplate assigning investigators to all public health districts with counties that fall within the Atlanta metropolitan area, as soon as additional investigators are available. One investigator has been assigned to District #30, in which Clayton County is a part of the Atlanta metropolitan area; and another is scheduled for assignment to District #29, in September,l964, in which Gwinnett County is a part of the Atlanta metropolitan area.
There was an overall decrease of 10.41o in new cases reported during the period July 1, 1963 -June 30, 1964, as compared to the same period a year ago. The breakdown shows a decrease of 6.21o in Group A (Active and Probably Active) and a decrease of 44.41o in Group B (All Other Reportable Cases).
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There was a decrease in the number of deaths (30), a rate of 3.5 per 100,000 was compared with 419 per 100,000 for the previous year.
There have been many requests from over the state for assistance in the local tuberculosis programs, but due to a limited staff, we have been unable to fill these requests.
The percentage of far-advanced cases being admitted to Battey is less than it was several years ago, but it still ranges from 191o to 441o of total new cases found in the larger counties. A probable solution would be to provide sufficient funds and personnel to find these cases early when treatment is most successful and before they become spreaders of disease.
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VENEREAL DISEASE CONTROL SECTION
In fiscal year 1964, 2,861 total syphilis cases were reported to the department. This is an 11.6% decrease from that reported for fiscal year 1963.
The 1,197 cases of primary and secondary syphilis reported in fiscal 1964 represent a 17.8% increase over the 1,016 cases reported for fiscal 1963.
The 10,652 cases of gonorrhea reported in fiscal 1964 represent 6.3% increase over cases reported for fiscal 1963.
The 422 cases of other venereal diseases (Chancroid, GI, and LGV) reported for fiscal 1964 represent a 1.4% increase over cases reported in fiscal 1963.
The 17.8% increase in primary and secondary syphilis cases in fiscal 1964 is attributable to a true rise in the incidence of syphilis. During the last half of fiscal 1964, we have increased the percentage of epidemiologic treatment of named sex contacts of primary and secondary syphilis fr0111 43% to appi'oximately 901.,. We believe that the closing of this loophole in the epidemiology of primary and secondary syphilis will result in decreased incidence of the disease in fiscal 1965.
During fiscal 1964 out health investigators made a total of 29,094 investigations. From these investigations 2,466 previously unknown and untreated new cases of venereal disease were brought to treat-
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ment. Of these, 1,086 were primary and secondary syphilis cases. All of the 1,197 cases of primary and secondary syphilis re-
ported for fiscal 1964 were interviewed for contacts and suspects by our health investigators. Of the 455 cases of early latent syphilis reported, 454 cases were interviewed.
All reactive serologic specimens processed in public health, hospital and private laboratories during fiscal 1964 were followed up by our health investigators. It is worthy of note that no private physician or health department refused our investigators permission to interview a lesion case of syphilis during the fiscal year.
During fiscal 1964 the private physicians of Georgia treated 461o of our total reported syphilis cases; 241. of the reported primary and secondary syphilis cases and 101. of the reported gonorrhea cases. Our Area VD Diagnostic and Treatment Centers treated 541. of the total syphilis cases reported; 761o of the primary and secondary syphilis cases reported; 901o of the gonorrhea cases reported; and 1001. of the other VD (Chancroid, GI and LGV) cases reported.
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CHRONIC ILLNESS AND GERIATRICS SERVICE
After organization of the Chronic Illness and Geriatrics Service July 1, 1962, plans were made for training of health investigators to supplement the staff in local health departments. The first class of five completed their training and were assigned to health districts in January, 1963.
In July, 1963,a medical director was recruited for the Service and reported for assignment and orientation in October, 1963. At this time recruiting was stepped up in order to fill existing vacancies in the Service and plans were made for active programs in the field of chronic illness and geriatrics.
In January, 1963, three health investigators were assigned to health districts in Griffin, Dublin, and Athens with one assigned as liasion investigator with the Cardiovascular Service to coordinate activities between the two Services. The chief health investigator remained active in planning and coordinating training programs fot the new class of five health investigators recruited for a nine months training period beginning July 1, 1963. One investigator resigned in
April to accept a position with the U. s. Public Health Service leav-
ing the three in Griffin, Dublin, and Athens.
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On April 1, 1964, after completion of nine months training, five additional nealth investigators were assigned to districts in Columbus, Dalton, Savannah, Augusta, and Moultrie, making a total of eight assigned to local health departments. These investigators, under the direction of the district medical director, assisted the staff in making surveys of local needs relative to chronic illness and geriatrics as well as planning and implementing programs to meet these needs. The health investigators have been able to relieve the public health nurse of some administrative duties allowing her more time for professional activities. As time goes on these activities will be expanded to further meet service objectives.
In May of 1964 six additional health investigators were recruited to begin training the first of July. It was found that the training period could be reduced from nine to six months, retaining everything essential to their work, thereby allowing earlier assignment in the field to supplement local health department staffs. Present plans are to train six investigators each year until at least one man is assigned to each district.
Recruiting of other personnel continued on an active basis with the addition of: a dietitian in March, nurse consultant in March, institutional nurse consultant in April, and a physical therapist in June. It is hoped that the staff will be complete for full
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activity early in the next fiscal year, with the addition of three nurse consultants, specialized nurse consultant, social worker and a second physical therapist. It was necessary to add the second stenographer during the year to handle the workload of a growing Service.
Frequent visits were made to the Dalton Home Care Project during the year as well as to the on-going home care program in Columbus.
After the first part of the fiscal year, teams were organized for visits to nursing homes and homes for the aged. These visits were made on request through the local health departments for the purpose of professional instruction, in-service training and upgrading when deemed necessary. Many requests were received from nursing homes prior to opening in order to brief the staff on operative procedures and techniques. It will be necessary in the next fiscal year to organize more teams in order to comply with the numerous requests received for this type service.
Working in close association with the Georgia Diabetes Association, Arthritis and Rheumatism Foundation and the Society for Prevention of Blindness, programs for diabetes, arthritis, and glaucoma have been worked out and will be implemented in as many areas as possible during the next fiscal year.
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MEDICAL FACILITIES SERVICE
During 1963, Medical Facilities Service continued its comprehensive program of assistance to local communities for the improvement of patient care facilities and services. This assistance was provided through the following: (1) Community Survey and Areawide Planning Program to aid communities in planning for new, expanded and improved medical care facilities and services; (2) ArchitecturalEngineering and Equipment Program to review and approve plans and specifications to assure the construction of efficient, safe, properly designed 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 communities, governing bodies, and administrators with special operational and community problems.
Federal and state appropriations for the construction program were slightly decreased from the previous year. This resulted in a reduction in the number and size of projects that could get under way during the fiscal year and increased the backlog of applications waiting approval. SixtY-nine applications were pending for grant-inaid assistance with an estimated construction cost of $73,364,000.
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Grant projects placed on the construction schedule and approved

for grant-in-aid during fiscal year 1963 were as follows:

TYPE PROJECT

NUMBER

General Hospital - Including Additions

9

Psychiatric Hospitals

1

Public Health Centers and Auxiliaries

6

Nursing Homes - Including Additions

6

Diagnostic and Treatment centers

2

~
453 52
355

T<JrAL COST
$ 9,257,460.00 745,771.36 858,000.00
3,278,597.25 1,374,195.62

Total

24

860

$15,514,024.23

The Medical Facilities Planning Section developed new planning policies and planning procedures in the annual revision of the Georgia State Plan for Hospitals and Related Facilities. Area utilization trends were given greater emphasis in the projection of hospital and nursing home bed needs. Revised medical trade areas were delineated and l>ongrange planning on an areawide basis was emphasized. Appropriate planning guides were developed for grant applicants in making surveys and preparing a "Program-Project Narrative." These pre-planning activities are now required of all sponsors, vrior to architectural drawings, cost estimates, and consideration for grant-in-aid approval.
The Medical Facilities Construction Section reviewed, according to established standards, all plans and specifications submitted for all eligible Hill-Burton projects and other hospital and nursing home projects. Proposed sites were inspected with comments to sponsors and

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their architects. Plans and specifications reviews and frequent onsite inspections provided the sponsors, architects and engineers with consultative services and recommendations relative to functional planning architecture; structural, electrical, and mechanical engineering; equipment procurement and preventative maintenance.
In the Hospital Licensure Section there was also evidence of improvement in the quality of hospitals and hospital services. The number of hospitals operating under full licensure permit increased from 143 to 160. Four new hospitals were opened, one completely renovated and two closed. The number of facilities operating under provisional permit decreased from 63 to 49. Some of these are making good progress toward correcting the deficiencies.
In Nursing Home Licensure there was continued evidence of in~ creased quality and quantity in nursing home facilities and personnel. The number of licensed institutions increased from. 150 with a capacity of 5,366 beds to 166 with a capacity of 6,641 beds. The majority of the newly licensed facilities were of new construction and qualified for permits in the more skilled classifications thus continuing the strong movement toward 24-hour nursing care in the nursing homes in the state. Of the 31 unlicensed homes representing 475 beds known to be in existence at the beginning of the year, eight were closed. Five new unlicensed homes, however, were found in operation, leaving a residue of 28 known unlicensed homes with a capacity of 363 beds.
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Consultation in clinical laboratory, food service and nursing administration and accounting procedures were provided to medical facilities in the state.
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BAITEY STATE HOSPITAL
The applications for admission to Battey State Hospital during the current fiscal year declined from 1,738 during the fiscal year 1962-63 to 1,506--a reduction of 13%. A newly established application review board screened those applications for patients thought to be non-tuberculous or not in need of hospitalization, with a resulting rejection of 120 applications (8% of the total number received). The decreased number of applications plus more stringent screening saw the admissions come down from 1,642 in 1962-63 to 1,373--a drop of 16%.
There was no appreciable change in the stage of disease of those patients admitted. Eleven per cent had minimal tuberculosis, 31% moderately advanced tuberculosis, 34% far advanced tuberculosis, 3% primary tuberculosis, 3% other types of tuberculosis, 14% were suspected but not proved cases of tuberculosis on admission, and 4.5% were proved non-tuberculous on admission.
One thousand eighty-four of the 1,373 patients were admitted for the first time (78%). Six hundred ninety-five of the 1,084 patients admitted for the first time had a positive sputum.
Admission sensitivity studies for isoniazid, streptomycin and PAS are routine. Those patients who had at least 20 colonies growing in the tube with the lowest concentration of the drug employed were resistant. This is not necessarily a completely true picture, as some of these patients
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had never received chis drug and these low concencrations did not mean that these patients would not respond to one of these drugs. This is the strictest criteria that can be used, even though from a clinical standpoint it is not necessarily completely accurate. There were only 20 patients who showed resistance to the three major drugs and only six who showed resistance to both isoniazid and streptomycin among the 664 newly admitted patients with infections due to M. tuberculosis (roughly 4%).
The treatment program continued to be highly successful. A sputum conversion rate of over 95% in the newly treated cases with cavitary tuberculosis is constant among those patients who will remain in the hospital and accept therapy. Follow-up studies on patients converted and discharged revealed that the relapse rate is about one per cent. A retreatment program of drug resistant cases was instituted in March of 1962. Ethambutol, a new experimental drug, ethionamide and kanamycin, three drugs never previously used in this institution, along with any other drugs to which the patient might still have drug susceptibility were employed in this program. At the end of the year we had obtained a sputum conversion rate in this group of patients of approximately 80%. This also resulted in the discharge of a number of patients with long periods of hospitalization and resulted in an increase in our average length of stay.
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There was not a thoracic surgical death during the year. The volume of cases decreased. Only six per cent of those discharged has major thoracic surgery.
The clinical research projects contribute greatly to the overall medical care program. Constant review of the results of therapy and application of these results are responsible for the high conversion rate and excellent therapy program. The hospital is currently engaged in three clinical trials, studying the new drug ethambutol, in conjunction with other drugs. Two of these trials are United States Public Health Service Therapy Trials and one is the retreatment drug resistant research project with Lederle Laboratories.
There was an increase in the amount of tuberculosis bacteriology work. All patients have a minimum of one sputum examination every two weeks. The total work load in the x-ray Department was slightly above that of the previous year. All patients are routinely x-rayed once a month.
An expansion of the hospital IBM system during the year enabled development of a system whereby a monthly medical audit on all patients within the hospital is available. This expanded system will also expedite installation of a complete inventory system for all departments.
The medical care program was completely reorganized to better utilize personnel and beds. This brought about a closure of a number of wards. The admission service was abolished as of January 1, 1964. After that date, patients were admitted in rotation to the remaining functioning
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wards and each physician was then responsible for total patient care. At the end of June, the medical program became one operating service rather than two separate services, one for colored and one for white patients. This was an administrative combination of services as the patients remained in the same wards as previously utilized.
On July 1, 1963, there were 689 patients, 701 full time paid employees, and 76 colored female prisoners assigned for work. At the end of the fiscal year Battey had 547 patients, 559 full time paid employees, and three working female colored prisoners. Major reductions in the work force came in nursing, housekeeping, food service, maintenance, poultry and farm operations, and laundry.
The food service department began converting from ward kitchen operations to central tray service on May 20, 1963, and as a result 19 separate cooking facilities were closed. The last was the special diet kitchen on August 5, 1963.
The reduction in personnel required that central tray service be reduced from two production lines to one; yet patient feeding is accomplished within one hour and fifteen minutes.
One thousand, four hundred ninety-eight patients were discharged from the hospital during the fiscal year. Only 10% of these patients were discharged against medical advice. Sixty-five of the discharged were death (4%). Only 17 of these 65 deaths were due to tuberculosis {1%). Twenty-three per cent of the patients discharged had minimal tuberculosis, 40% moderately advanced tuberculosis, and only 17% far
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advanced tuberculosis. Of the 121 patients discharged with a positive sputum, 34 had atypical tuberculosis and 87 had M. TBC infections. Twenty-two of these patients had positive cultures reported after discharge.
The average length of stay for patients discharged with a diagnosis of tuberculosis increased from 195 up to 208 days. This increase was due to the numbers of successfully treated drug resistant patients with long periods of hospitalization that were discharged. Completed discharge reports were mailed out from the hospital on the same day or within two days after the discharge of all patients. In addition to this, by the end of the year monthly reports were being sent to every health department on the status of each patient in the hospital.
Battey's per diem cost for the fiscal year 1962-63 was $15.81; for the fiscal year 1963-64 it was down to $15.37 a day. Due to a difference in fund allocation, monies spent for out-patient care were separated from monies spent for in-patient care this year. This would account for a reduction of nearly $1.25 per day. In addition to that, inventory was reduced from one designed for 700 to 800 patients to one designed for approximately 300 patients. It is believed that the reduction in inventory amounted to approximately $1.25 a day. In this coming fiscal year, when purchases will become more current again, per diem costs will show a definite increase.
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2M/l/65