Annual report 1964-1965 [1965]

ABOUT THE COVER : "GEORGIA 'S HEAlTH" is a slide series developed during this fiscal period by Health Education and Training Service to demonstrate clearly and concisely the role of public health in Georgia today.

State of Georgia

Department of Public Health

JOHN H. VENABLE. M. D., DIRECTOR

47 TRINITY AVE.

ATLANTA, GEORGIA 30334

Dr. John M. Martin, Chairman State Board of Health Atlanta, Georgia Dear Sirs:
I am honored to present to you the Annual Report of the Georgia Department of Public Health covering the fiscal period from July 1, 1964 through June 30, 1965.
The quality and variety of health services offered the citizens of Georgia has continued to expand in keeping both with technical and scientific advances and with the moving social and economic environment of the state.
An important milestone in the development of mental health services was the culmination of the two-year mental health planning project in June, 1965 and the publication of ~ Comprehensive Mental Health Plan for Georgia. An intensive planning project in the area of mental retardation with an emphasis on a non-institutional program of care at the community level was initiated during this period. Both programs are being developed as integral elements in the health department's goal of providing local services and facilities to supplement care in state institutions for the mentally ill and the mentally retarded in Georgia.

State of Georgia

Department of Public Health

JOHN H. VENABLE. M. D., DIRECTOR

47 TRINITY AVE.

ATLANTA, GEORGIA 30331

Another significant program developed in public health during the year was a study of environmental health services and facilities of the Augusta - Richmond County area. The study, which was only the second such study in the state and the southeast, was conceived as a tool for projecting and recommending preventive planning to assist the orderly and correct growth and development of urban areas in the state. Representatives in a broad range of the state, local, and federal agencies--and private citizens--participated in the project which was geared to stimulate such action from communities in other geographic areas.
The first of Georgia's new model civil defense emergency hospitals was installed in August, 1964. These 200 bed field type hospitals will help to temporarily offset the loss of health facilities and provide for anticipated casualties in a national emergency.
Established by the 1964 session of the General Assembly, the Georgia Water Quality Control Board has begun an active abatement program to protect Georgia waters. The Board and the State Health Department work closely to assure an abundant supply of clean water for industrial, recreational, and public

State of Georgia

Department of Public Health

JOHN H. VENABLE. M. D., DIRECTOR

47 TRINITY AVE.

ATLANTA, GEORGIA 30334

water supply users. To insure the most effective continuation of Georgia's
program of public health progress, individual members of the staff have pursued activities designed to increase eff~ciency and effectiveness. In addition 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.
With these highlights as evidence of the Department's desire to provide the best possible physical, mental and environmental health for every Georgian, I am proud to submit this annual summary of activities.
Sincerely yours,
~HtJ~~ J~n H. Venable, M.D.
Director

TABLE OF CONTENTS

DIVISION OF ADMINISTRATION AND FINANCE

Civil Defense Health Service.



1

Health Education and Training Service

4

Personnel Services . 8

Vital Records Service



.12

Patient Accounts Unit .



14

DIVISION OF EPIDEMIOLOGY

Epidemiologic Investigations Branch . . . . . . . 16

Veterinary Section.

.

. 21

Laboratory Branch . 22

DIVISION OF MENTAL HEALTH

Division of Mental Health. 27

Mental Health Planning Project.

.28

Mental Retardation Planning Project

29

Georgia Mental Health Institute

31

Georgia Retardation Center

33

Community Mental Health Service

34

Gracewood State School and Hospital

37

Milledgeville State Hospital

. . . . 46

Alcoholic Rehabilitation Service . 53

DIVISION OF PHYSICAL HEALTH

Branch of Dental Health Branch of Dental Health 58 Dental Public Health Service. 61

Environmental Health Branch

Housing Hygiene and Accident Prevention Service

.63

Metropolitan, Urban and Community Planning.

.66

Industrial Hygiene Service.

.68

General Engineering-Sanitation Service.

71

Water Resources Service . 76

Environmental Health Training

.78

Health Conservation Branch

Crippled Children's Service 80

Maternal and Child Health Service

82

. . . . . . . . . Nutrition Service

.. .

85

School Health Service

.88

Local Health Branch

Local Health Administration Service

and Local Health Branch .



. . 91

Northern Health Region. .

.93

Central Health Region . . .

.96

Southern Health Region.

.

. . 98

Preventable Diseases Branch

Cancer Control Section. .

101

Cardiovascular Disease Control Service 104

Employees Health Service. .

108

Occupational Health Service 111

Tuberculosis Control Service.

114

Venereal Disease Control Section . 117

Special Services Branch

Chronic Illness and Geriatrics Service .

Battey State Hospital



Medical Facilities Service

119 122 124

DIVISION OF
ADMINISTRATION AND FINANCE

CIVIL DEFENSE HEALTH SERVICE
Preliminary preparations were made this year to expand the orientation lectures for professional schools to include the two schools of pharmacy and the school of veterinary medicine. The purpose of these lectures is to inform the students of emergency health plans and programs, the role they are expected to play in the event of a major disaster, and to encourage them to provide leadership in preparing the community in which they elect to practice for both natural disaster and nuclear a~tack. It is anticipated that this program will prove extremely beneficial to communities throughout the State.
The Packaged Disaster Hospital Program continued throughout the year. The procedure followed in negotiating agreements was a presentation at meetings attended by District Directors of Public Health, County Commissioners, and--when appropriate-City Officials. The broad purpose of the Packaged Disaster Hospital Program, what the State and Federal governments would provide, and what the county would be responsible for were the topics of discussion.
Twenty-two of the forty-two 1962 Model Packaged Disaster Hospitals allocated to Georgia were received and placed in
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storage during the year, making a total of forty-eight hospitals now in the State, with twenty more planned for the coming year. Plans were prepared for the activation and operation of these hospitals, including selection of the buildings in which to operate, how each would be moved to the site, and how the hospitals would be staffed.
Each of the hospitals was inspected during the year. Deteriorated and outdated items were replaced, and equipment was serviced. They are now in excellent condition. This procedure will be repeated each year hereafter.
Negotiations were completed with the Public Health Service to provide a consultant during the summer months for the purpose of determining the proper approach to be taken in efforts to persuade officials of the many school systems throughout the State to add the Medical Self-Help Course to the curriculum of high schools.
Two more large school systems, Columbus, Muscogee County, and Savannah, Chatham County, agreed to add the Medical SelfHelp Course to their curricula. The Atlanta Federal Executive Board issued a Policy Statement that all Federal employees will take the Course, and the Governor issued a Proclamation urging State Departments and Agencies to require employees to
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take the coarse. All of this activity tends to support our belief that principles of Medical Self-Help should be learned by children as a matter of course just as they acquire any other basic and fundamental knowledge.
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HEALTH EDUCATION AND TRAINING SERVICE
The stimulation of personal and community interest in health, the promotion of an awareness of health needs, the expansion of a knowledge of the services and resources offered by the Health Department, the development of opportunities for people to learn about health, and the rendering of consultory services to educational institutions and state, local, and voluntary agencies are some of the numerous functions of the Health Education and Training Service. In this service are four sections: Health Education, Public Information, Visual Communications, and Training.
The Health Education section serves as education consultant within the service, determining needs for educational materials and assisting in the development of printed materials. During this fiscal year the section prepared many new printed materials, expanded the film library and developed audio-visuals (slidetype) for various programs. The section serves as consultant to the Georgia Department of Public Health in the Neighborhood Youth Corps project of Economic Opportunity Atlanta, to the Georgia Interagency Committee on Smoking and Health, and as consultant on numerous project proposals involving public
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health education. The section was instrumental in extending health education services on the local level by recruiting and filling three health education positions on the county level.
The Public Health Library assists public health personnel in their efforts to acquire rapidly expanding medical and technical knowledge. The library collected, disseminated, and exchanged, during the fiscal year 1964-65, 12,750 publications (an average weekly circulation of 245 publications) , answered 1,045 reference questions, furnished resource materials to aid in developing programs and projects, purchased 229 new books to bring the total collection to 16,446 volumes, prepared numerous bibliographies on special topics, and introduced new personnel to library facilities, resources, and services. Future plans include a more intensive study by the library staff of Departmental plans so that library facilities will be even more useful to its patrons.
The Public Information Unit serves as the voice of the Health Department in explaining (through mass media and publications) the many and varied departmental programs. Formal press releases, made as news stories broke, were issued to all state news outlets. Increased use of radio news "spots"
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supplied to local and state network stations sped up news distribution. Supplementing information carried by public media, health information on a variety of subjects was distributed in Georgia's Health, a free-subscription, monthly magazine, received by some 41,500 Georgians. Fax, a similar publication for public health workers, carried professional and personal news to some 6,500 employees.
Visual Communications is the technical section that assists all other sections of the Health Department in the preparation of visual aids. During the last fiscal year the Photography Unit produced 6 color film strips with recordings and completed 156 photographic assignments, 3505 prints, 4088 copy negatives,and 6077 slides. The Cartography Unit completed 4 maps, 5 exhibits, 578 ozalid prints, and 590 jobs of lettering, mounting, paste-ups, drafting, embosographing, mats, and transparancies. The Art Unit composed 1287 illustrations, layouts, lettering, paste-up, mountings, and embosographing.
The Training Section encourages and assists in departmental, interagency, and university and school health training. The training activities of this section included short-term orientation for 84 new employees, extended orientation for 27
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staff nurses and 44 sanitarians, 157 in-service training experiences for 1488 staff members at a local and state level, and academic training for 6 nurses in preparation for public health nursing and one sanitarian working toward a Master of Public Health. This fiscal year an Environmental Health Training Coordinator was added to the Training staff. The section served in a consulting position with schools, colleges, and the American School Health Association in the area of sex education and with the committee of the Georgia Teacher Educational Council in setting up criteria for teachers of health education in teacher education colleges.
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PERSONNEL SERVICES
Manpower engaged in full-time public health work in Georgia numbered more than 6,500 on June 30, 1965.
Most of these are employed in five fields of professional work fundamental to public health: medical, nursing, engineering, sanitation and laboratory science. Other health related professions are well represented -- nutrition, dentistry, education, social work, psychology, veterinary medicine, pharmacy, biology, chemistry, physics, chaplaincy, optometry, accountancy, industrial hygiene, biostatistics, and the various therapies. Each has responsibilities requiring considerable variety in terms of formal education and training: medical specialists may have ten or more years of education beyond the basic college degree; sanitarians can begin work after four years of college with a science major; other work, of nonprofessional nature, requires demonstrated ability in performance of duty, but less than a high school education.
The continued development of mental health as a part of the total public health program has pointed up more sharply the critical lack of manpower in this field. But, during this year, organization tables for manning the new Mental Health Institute
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were established , and a professional staff and other personnel were acquired for the November, 1965 opening of this hospital. The second development affecting the total Health Department, and therefore the composition of its work force, is the growing number of federally supported research and demonstration projects located in state, counties and institutions. Fortythree projects concerned with such activities as tuberculosis control, health problems in local communities, and attendant training at institutions, are in progress and largely account for an increase in employment of health investigators and clerical positions.
The organization of scientific and technical work in the Public Health Laboratory was analyzed and re-structured toward more effective operation. In county health departments, steps were taken in the second half of the year to bring approximately one hundred positions previously without merit system benefits (being paid entirely from local funds) into the State Merit System on July 1, 1965. In the institutions, Milledgeville State Hospital shows an increase of 179 which includes seven additional nurses and some 100 kitchen laborers who replaced patients and prisoners withdrawn from this work. There was a gain of 92 in employment at Gracewood. This figure contains
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42 summer students and 38 attendants, both of whom contribute to patient training or care. It is noticeable that the increase in overall employment at Milledgeville and Gracewood is little more than half what it was in 1964, in spite of increasing demands on their services. Employment at Battey State Hospital is about the same.
As part of a state-wide study to more nearly rectify organization and pay, the State Merit System will put into effect a changed pay scale on July 1, 1965.
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FULL-TIME EMPLOYMENT

Local Fulton County State
A. R. s.
Battey Gracewood Milledgeville
TOTAL

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

6-30-65 987 302 709 53 561 848
3120 6580

EMPLOYMENT ACTIVITY

*Accessions *Separations Net Gain Rate of Sep.

Local

163

137

26

14%

Fulton

58

62

-4

20%

State

281

A. R. s.

28

254

27

27%

19

9

39%

Battey

140

145

-5

25%

Gracewood

325

233

92

30%

Milledgeville 890

711

179

23%

TOTAL 1885

1561

324

22%

*These are gross figures which include those affecting employees on temporary assignments and those in leave status. The percentage would be smaller if these were not included.

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VITAL RECORDS SERVICE
During the year a total of 292,754 records representing 233,127 vital events were processed and registered in the Vital Records Service. The events recorded were 100,166 current live births, 38,238 deaths, 2,937 fetal deaths, 59,627 marriages, 11,124 divorces and 21,035 delayed birth certificates.
A total of 2,994 certificates of adoption were received, processed, and new birth certificates for 2,984 adopted children were completed and registered. Legitimation proceedings for 1,577 children born out of wedlock were completed and new birth certificates registered on these children.
Superior Court orders changing the legal name of 201 people born in Georgia were received and the birth certificates amended in accordance with these orders. Amendments correcting errors in 6,249 registered birth and/or death certificates were received, processed, and the certificates amended.
More than 195,000 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 53,285 certified copies of birth or death records
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and the verification of more than 125,000 other birth, death, marriage, and divorce records.
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PATIENT ACCOUNTS UNIT
Collection for cost of care and treatment in each institution under the control of the Georgia Department of Public Health increased this year. This is the fifth year since the Payment of Cost for care of Patients Act was passed, and each year has shown some increase in the total funds collected.
As patients are admitted to the institutions and pay towards cost of care and treatment, the law passed in 1960 becomes more widely understood, and a greater number of patients or persons liable for patients volunteer payments. The number of patients for whom funds were paid continues small compared to the total patient load. Many persons who have been in an institution for a number of years have no taxable income, and even though they may have wealth no payment is made. It is hoped many changes will be made in the law this coming year, so assessments may be made on assets of patients, particularly those who have no dependents. The State, it appears, should be entitled to receive money from patients who have been hospitalized for years, have an estate, and no dependents. The active work of organizations to have insurance companies include in group policies mental illness and treatment rendered in State Hospitals is beginning to see results. It is hoped that
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a very strong effort will continue to be made to increase these benefits.
The income tax returns have been checked on every patient, or persons liable for them, who entered the institutions during the year, and the returns of persons who have been hospitalized for a year were rechecked and a reevaluation of ability to pay made.
The Mental Health Institute is now receiving patients, and a method of paying has been established. This brings the number of institutions to six for which collections are made.
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DIVISION OF EPIDEMIOLOGY

EPIDEMIOLOGIC INVESTIGATIONS BRANCH
The Investigations Branch of the Division of Epidemiology is concerned with the collection and correlation of information: (1) that relates to the prevalence and incidence of infectious and non-infectious disease, (2) that relates to physical causes of morbidity, such as accidents and misuse of pesticides, and (3) that relates to natural and man-made biologic problems which have public health significance, such as rabies in wildlife, and the production of mosquitoes by game management practices.
This information is not easily available and intensive investigation and research are necessary to elicit it. The problem has been approached in the following ways:
-Morbidity reporting systems of two kinds: (1) a postcard or telephonic communication procedure used by physicians to report through local health departments and (2) three sampling procedures designed as sources of information and as measures of effectiveness of reporting.
-Surveillance and confirmation of diseases on which laboratory work is done. In Georgia, the oldest formal surveillance system, that for Rocky Mountain spotted fever, is now in its
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34th year. The newest, for shigellosis, is in its second year. -Surveys of absenteeism and collection of appropriate
specimens from schools to determine the prevalence and identity 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 1965, for example, a community-wide study was again necessary in order to determine the significance of a locally acquired case of malaria. No other morbidity simulating malaria was discovered and the cases were determined to be instances of 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 reestablished in Georgia.
Four major research investigations are in progress in the Branch:
1. Longitudinal studies of viral infections of animals which will infect man. In 1965, partial results of a survey for evidence of infection with these viruses in a characterized human population in Georgia became available. Approximately 26% of the sera examined showed antibodies against California encephalitis virus, a virus not known to exist in Georgia until 1963; 5% showed antibodies against another recent suspect,
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Western encephalitis virus; 2% against St. Louis encephalitis virus (possible acquired elsewhere), and 0.3% against Eastern virus. Previously, it had been supposed on the basis of mosquito studies in the hardwood swamps of South Georgia that the Eastern encephalitis virus was the only member of this group likely to have abundant contact with man. Epidemiologic correlations and field investigations are now in progress to determine the health significance of these findings. An adequate investigation of the possible association of these and other animal virus infections in man with chronic human illness will require years of patient epidemiologic, viral, and statistical study.
2. The second report in a series on a study of the basic bacteriology and ecology of the bread-filler-cellophane wrapper system formed by a wrapped sandwich is ready for publication. The study is being continued with the aid of a National Institutes of Health grant.
3. A controlled field trial of a soluble, polysaccharide, Staphylococcus antigen is now in its third year as a part of a continuing investigation of means for enhancing immunity to staphylococci. This represents the sixth and most promising antigen investigated.
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4. Studies on gamma globulin instilled into the eye as a means of controlling infectious hepatitis are being continued; parallel work is being continued on cooperative efforts to identify and characterize hepatitis viruses. A new series of studies intended to explore the possibility of using electron microscopy as a means of facilitating serologic identification of viruses in cells and of better identification of certain strains of bacteria have been undertaken.
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Number of Reportable Diseases, Median for 1959-1963, 1964 Regular Final, and 1964 Sampling

Disease

Median 1959-1963

Regular 1964

Sampling 1964

Typhoid fever Salmonellosis Brucellosis Shigellosis Amebiasis

27

27

321

589

14

16

502

624

7

2

Strept infections

174

682

Diphtheria

53

32

Whooping cough

18

19

Meningococcal infections

32

107

Tularemia

19

14

Tetanus

14

7

Poliomyelitis

26

4

Encephalitis, unspecified

18

20

Measles

431

222

German measles

85

497

Chickenpox

6

1

Infectious hepatitis

272

127

Rabies in man

0

Psittacosis

2

4

Typh~s fever

5

1

Rocky Mt. spotted fever

15

17

Hookworm Meningitis, unspecified Rheumatic fever Influenza Trichinosis Leptospirosis Botulism

6,680 92 14
498 1 0 0

3,818 79 30
503
1 1

Reported only on Sampling

Tuberculosis Syphilis Gonorrhea Chancroid Lympho-gran. Infectious conjunctivitis Staphylococcosis

10 400
50 340
90
43,220 60
990 240
20
250 8,010 13,310
130 390
50
10 410 15,250
20 10
140 580 6,400
80 60 3,030 6,390

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VETERINARY SECTION For the first time in three years the incidence of animal rabies has failed to show a marked increase over the preceding year. A total of 93 laboratory-confirmed cases was reported from 20 counties. The epizootic continues to be confined predominantly to wildlife species. Less than 7% of the reported cases was in dogs or other domestic animals. A guide for county rabies control rules and regulations was prepared and forwarded to each county board of health for use as an aid in formulating local regulations. A number of counties have subsequently adopted local rules and regulations under Chapter 88-15 of the 1964 Georgia Health Code. In cooperation with the Department of Microbiology and Preventive Medicine of the School of Veterinary Medicine, University of Georgia, field studies were initiated on the epizootiology of wildlife rabies and also on the relationship
of small rodents in the epizootiology of tularemia. u.s.
Department of Interior grants for these studies will continue two years and one year, respectively.
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LABORATORY BRANCH
When the annual summary of laboratory testing is examined, it is obvious that changes in disease patterns are taking place in Georgia. Less obvious are other forces which indirectly affect the laboratory. Innovations and improvements in materials and equipment have occurred which not only make possible more rapid and more accurate techniques but permit greater latitude in the knowledge requirements of the operator. Legal restrictions involving the department have been revised; with growing competition from various agencies more employees must receive more training; population shifts in the state have occurred which affect the distribution of the work load among laboratories.
Recognition of these factors prompted a realistic review of the unit's organization in 1964 including a detailed recording of all technical activities. These job descriptions showed the existence of three general levels of responsibility. With the help of the Personnel Service all classes were rewritten as Scientists, Technician-Assistants or Aides. Since recent experience has shown that selected persons with less than college background can give reliable technical assistance
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in numerous areas, this segment of the work force was expanded where adequate supervision could be provided. In the new organizational plan of the Laboratory Branch, made operational on July 1, 1964, an assistant director was appointed and the Branch divided into two services: Technical Program and Technical Staff.
In the Technical Program Service two sections, Microbiology and Microscopy, were combined to make a Diagnostic Microbiology Section, and a Biochemistry Section was formed. Activity in the latter section was rather limited pending the employment of a full time chemist; however, equipment for thin layer chromatography and automated spectrophotometry was obtained.
Early in the fiscal year the examination of animal brains for evidence of rabies was moved from the Microbiology Unit to the Virology Unit of the Central Laboratory. One hundred and twenty-nine fewer examinations were made during the reporting period. In spite of the use of more efficient fluorescent antibody techniques, a smaller percentage of these examinations showed evidence of rabies than was reported the previous year. This information plus the lack of positive findings in 215 animal brains from a wild life population sample suggests that the threat of raccoon rabies in south Georgia is less threatening than it was one year ago.
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Among the technique changes in this service, three

should be cited:

1. Fluorescent antibody testing was used in two new

areas - syphilis diagnosis and enteropathogenic

E. coli. identification.

2. A microtechnique (LBCF) for performing complement

fixation tests was adopted for routine use in the

Virology Section. With this technique a significant

saving is realized in expensive reagents as well

as time and space.

3. Serologic tests were offered during the year for

the diagnosis of Mycoplasma pneumoniae (Eaton Agent)

infection. This pleuropneumonia-like organism

(PPLO) has been shown to be the most common cause

of primary atypical pneumonia.

To illustrate the diverse trends of disease patterns

as reflected in requests for specific tests, total examinations

for three infections have been extracted from recent annual

summaries and are given as follows: 1962

1963

1964

1965

Throat swabs for diphtheria

2,317

1,632 1,104

857

Feces for intestinal parasites 104,018 104,109 99,065 101,012

Feces-urine for enteric pathogens

29,896 33,753 42,438 47,056

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Not since 1918, when 486 examinations were made for diphtheria, has the total dropped below 1,000. In 1965 there were isolations from 50 patients in 13 counties.
Microscopic examinations for intestinal parasite ova yield fewer positives each year but the demand for the test remains high.
The continued increase in bacterial cultures for enteric pathogens was less marked than in the previous year, but when 1962 totals are compared with 1965 a 57% rise is recognized.
Forty-five species of salmonella were represented in the 1,216 isolations. One-fourth of these were ~ typhimuriurn; 74 were ~ typhosa obtained from 25 carriers and 29 cases. The occurrence of a small typhoid epidemic in Mid-Atlanta accounted for 23 of the 29 cases. Shigellae were recovered from 742 stool specimens. An outbreak in the Macon-Bibb County area was responsible for nearly half these isolations. Two hundred and twenty cases were identified.
The Central and three Regional laboratories performed a total of 1,026,661 examinations in 1965, an increase of 12,000 over the previous year.
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The second newly formed service, Technical Staff Service, includes various supporting activities which are requisite to an efficient technical effort: reports and records, animal care, supply and maintenance, media preparation, glassware preparation and sterilization, biologics production and specimen outfit preparation. A new section, Training and Evaluation, was activated in July, 1964, as part of the service.
Although the health team in the regional areas has tended to become smaller, the laboratory remains a very active member. Nearly half the tests of the Laboratory Branch are done in these units, and they distribute biologics and vaccines to the surrounding health departments and physicians. The smaller volume of work in each regional laboratory (13-15% of the Laboratory Branch total tests) together with the increasing need for a variety of testing skills as in the Central Laboratory requires flexibility and versatility of the entire staff.
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DIVISION OF MENTAL HEALTH

DIVISION OF MENTAL HEALTH
During the past year, the Division of Mental Health has moved steadily forward on all nine specific program fronts. These programs include the following:
1. Mental Health Planning Project 2. Mental Retardation Planning Project 3. Georgia Mental Health Institute 4. Georgia Retardation Center 5. Community Mental Health Service 6. Gracewood State School and Hospital 7. Milledgeville State Hospital 8. Alcoholic Rehabilitation Service 9. The Central Division Office
As the year ended a plan for reorganization of these programs into the Department's model - using Division, Branch and Service units - was completed to be made effective July 1, 1965.
The National Institute of Mental Health and the Governor's Commission for Efficiency and Improvement in Government made careful study and analysis of our programs during the year and provided very helpful recommendations for improvements.
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MENTAL HEALTH PLANNING PROJECT The two-year Mental Health Planning Project, financed with state and federal funds, officially terminated on June 30, 1965. The purpose of this project was to develop a comprehensive statewide mental health plan which emphasized the provision of mental health services at the local community level. Staffed by a team of seven full-time professionals, the planning project terminated with a statewide meeting, known as the Governor's Conference on Mental Health. At this conference the plan and its major recommendations were presented to more than 300 leading citizens, who, with few changes, endorsed the plan and commended it for implementation. Plans have been made to carry the recommendations and major concepts of the mental health plan to all Georgians through a series of regional meetings in different Georgia cities.
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MENTAL RETARDATION PLANNING PROJECT
Under Public Law 88-156, federal funds were made available for each state to survey existing programs, services and facilities for the mentally retarded and to develop a comprehensive plan for the prevention of mental retardation and the extention of services and facilities to serve all the state's mentally retarded.
The Georgia Department of Public Health was designated by the Governor as the state agency to receive these funds and develop Georgia's Comprehensive Mental Retardation Plan. These federal funds were matched by the Georgia Department of Public Health, the State Department of Education and the Georgia Association for Retarded Children, Inc., who are cooperating in the study. On July 1, 1964, Dr. James D. Clements, Assistant Director of Gracewood State School and Hospital, was named Director of the Mental Retardation Planning Project.
A fourteen-man Technical Scientific Advisory Committee representing a cross section of citizens and professional workers was formulated. Task Force Committees were appointed to study and make recommendations in the following areas: Etiology and Prevention; Social and Community Services; Clinical Services; Legislation and Finance; Public Information and
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Education; Research; Special Education; and Technical and Scientific Manpower.
These committees and their sub-committees are currently at work. Consultants from both official and non-official agencies are assisting in their studies. Each will submit a report of their finding by December 31, 1965. From these Task Force Reports will come the state's Comprehensive Mental Retardation Plan.
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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, was nearly completed at the end of the fiscal year. Furniture and equipment were purchased with delivery to begin as soon as construction is fully completed and the buildings accepted. Active recruitment for the necessary personnel in the professional and management categories is well under way to the point that operations can begin as the necessary equipment and supplies are received. As of June 30, 1965, 31 employees were on the Institute payroll and another 41 persons were expected to be employed on July 1. When completed and fully activated, the Institute will provide about 240 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
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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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GEORGIA RETARDATION CENTER The Georgia Retardation Center, a 1,000 bed institution for the mentally retarded, is to be built in DeKalb County, Georgia. 98.6 acres of land have been purchased for the site, and an architect has been selected to design the facility. The Superintendent of the facility was appointed in January, 1965, and architectural drawings for one half of the project completed in February, 1965. Architectural design has continued for the remainder of the fiscal year.
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COMMUNITY MENTAL HEALTH SERVICE
This was a transitional year for Community Mental Health Service. Anticipating reorganization of the Division of Mental Health at the beginning of the next fiscal year, new program development was subordinated to the emphasis on longrange planning. The three major program elements continued: (1) Local Health Department Mental Health Programs, (2) Local Public Health Nursing Services to the Mentally Ill, and (3) the Community Hospital Psychiatric Program. In addition there were several special projects and studies -- particularly the Summer Planning Assistant project in 18 health districts.
Local health department mental health clinic and consultation programs continued with full-time and part-time professional staff in ten counties: Bibb (Twiggs and Jones), Chatham, Cobb, DeKalb, Dougherty, Floyd, Fulton, Glynn, Hall, Muscogee. Three new local programs began in Thomas (Grady, Brooks) , Clarke and Lowndes (Cook, Berrien and Echols) . Clayton County employed staff to begin July 1. Whitfield County and Walker (Dade and Catoosa) presented plans for beginning, making a total of 14 districts with operating programs (three multi-county and 11 one-county) as of
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July 1, 1965, with two others planned. To the five hospitals cooperating on the Community
Hospital Psychiatric Program a sixth was added February 1, Chatham Memorial Hospital in Savannah. Hospital services rendered were as follows:

Hospital
Albany (Phoebe Putney Mem.) Atlanta (Grady Memorial) Augusta (Talmadge Memorial) Columbus (Medical Center) Macon (Macon Hospital) Savannah (Chatham Memorial)
TOTAL

July 1, 1964 -June 30, 1965

First

Total Patient Average Daily

Admissions

Days

Census

32

1,040

2.9

185

9,248

25.3

212

7,061

19.4

85

1,887

5.2

63

1,915

5.2

17

462

3.0 (5 mos.)

594

21,613

592. (12 mos.)

Special outpatient projects were begun in Floyd and Hall counties. Considerable planning was done relative to combining the Community Hospital Psychiatric Program into a total community mental health program jointly supported by state and local funds, even at the sacrifice of geographic coverage, and increasing local health department administrative responsibility. The operation of the Grady Memorial program overlapped with the developing staff and program of the

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Mental Health Institute in Atlanta. As statewide coverage continued on the nursing program
to the mentally ill and their families, a revised edition of the Nurses' Guide was provided. The four-day training programs at Talmadge Memorial and Grady Memorial Hospitals were continued for public health nurses.
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GRACEWOOD STATE SCHOOL AND HOSPITAL
Many progressive changes took place at Gracewood during the fiscal year 1965. Of particular significance were the several new programs implemented. Included among them were the following:
The training grants entitled 11 Development of a Comprehensive Cottage Life Program, .. which is aimed at developing improved programs and methods in cottage life, and 11 InService Training, .. which is a program for the training of cottage attendants. The first of these grants began in August, 1964, when a special project was begun in a unit of 5 cottages with 330 female residents. The overall purpose of this program has been to develop more effective methods for conducting a resident care program at the cottage level. The program is a continually changing one. New procedures have been tried, evaluated and modified in the ongoing process of developing more effective methods. The development of programming procedures and data collection is being performed in an increasingly systematic manner. A general trend toward more effective management and
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organization has benefited all cottage programs. The "In-Service Training" grant is under the supervision of the nursing education section, nursing services department. During the period of direct involvement in a cottage, many conditions were identified in the physical plant which interfere with patient care. Steps are presently being taken to remedy these conditions. The highlights of the findings during the first project year were identified as a better understanding of the feelings and attitudes of the attendant population, and of some of the conditions which foster them. As a result of this year's experience, future training efforts should be strengthened. The speech and hearing evaluation program in the E & R Center which is a cooperative program with the University of Georgia. This program provides evaluation services, teaching, and research. The opening of the two cottages for "Activities of Daily Living", a jointly administered program of the vocational rehabilitation unit and Gracewood State School and Hospital. In September of 1964 two small cottages were opened on the campus for the purpose of providing a
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suitable setting for intensive training in activities of daily living. Each cottage can accommodate eight people. These cottages are used for Gracewood residents on vocational rehabilitation rolls who need such training prior to leaving Gracewood. A total of 24 residents received ADL services during the year. Training of this nature will probably require an average of nine to 12 months, but should greatly enhance the residents' ability to more successfully cope with living away from Gracewood. The renovation and enlarging of an existing building on campus to house vocational rehabilitation agency referrals was begun during the year. Expected completion date is November 1, 1965. This building will allow the unit to engage in the evaluation and/or training of 32 clients at any one time. Four houseparents will be employed to provide supervision to the residents of this building. A program of special workshops for Georgia public health nurses at Gracewood. In January of 1965 a group of 12 nursing consultants from the State Health Department participated in a pilot orientation program at the institution. The purpose of their visit was to evaluate
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the appropriateness of this experience for future groups. Subsequent to this, the first area workshop was held in Atlanta February 15th through 17th. In March, 1965 the first group of 16 public health nurses participated in the approved week-long orientation program at Gracewood. A second group, numbering 16, was oriented to the institution during the week of May 10-14. Future orientation plans call for a one-week visit every other month from September through May of each year. A program of several physical therapy workshops aimed at improving the physical therapy program at Gracewood. The Georgia Department of Public Health, Cardiovascular Disease Control Service, sponsored a physical therapy workshop at Gracewood for registered nurses during the month of April. There were also subsequent conferences which were focused on: "Basic Skills Used by Attendants in Physical Therapy" and "Acquainting Summer Student Employees with Physical Therapy as a Career". A program of improved religious services which was marked by the assignment of a full time clinical chaplain to the Gracewood staff. Religious services and training
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became his responsibility February 1, 1965. Prior to this main responsibility for services was assumed by the Training and Recreation Department. On March 1, 1965, a therapy and recreation program was initiated for the 71 blind and partially sighted residents at Gracewood. A concentrated effort is being made to train these children. The program consists of walks, picnics, swimming, some class-room instruction, communication, self feeding, and toilet training. Existing programs continued to expand and improve. Outpatient evaluation services, which usually include medical, psychological, social, and speech and hearing evaluation, resulted in 448 persons being evaluated during the past year. The objective of the medical program, progress in research, education and service remained the same during the year. Improved care to the residents and growing service to all the mentally retarded are outgrowths of progress in these interrelated and interdependent segments. The close relationship with the Medical College of Georgia was strengthened during the last year. Two additional clinical assistants were placed on the staff, bringing the total to eight now employed by the institution. These clinical assistants are
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senior medical students who work full time during the summer and part time during the school year. The program of having all senior students serve as clinical clerks at Gracewood continued. They serve 2 weeks at Gracewood while on the pediatric service. The program began in 1955, and since that time nearly a thousand then senior students have participated. A total of 24 medical students spent the summer at Gracewood working as special clinical and research assistants. There was continued participation of the institution's medical staff in the following: a) The research study "Biochemical Defects in Mentally Retarded Children" supported by a grant from the National Institute of Child Health and Human Developments was continued. Surveys involving biochemical defects in the mentally retarded and studies of individual cases, including chromosome analyses are continuing. b) A research project undertaken in 1964 was a comparative study of skin tests produced by antigens from human tuberculosis strains and other acid fast organisms. Follow up studies were carried out this year and will continue. c) Chromosome analysis of peripheral blood and the correlation of chromosomal abberations with congenital cerebral defects. d) The study of the protozoan disease toxoplasmosis by members of the
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bacteriology department of the Medical College of Georgia in cooperation with the Gracewood medical and farm staffs. e) The long term study of the epidemiology and prophylaxis of infectious hepatitis in cooperation with the State Health Department's Epidemiology Branch and the University of Iowa.
The dental department continued to render maximum dental services consistent with the highest standard of practice. The oral hygiene program rendered by the dental hygienists is considered to be an important part of the services to residents. The staff of two full time dentists provides continuing services of examination and treatment. A total of 10,905 resident visits to the dental clinic was recorded during the past year.
In addition to its full nursing education programs, the nursing department continued to improve its operation and staffing of the 300 bed infirmary; two hospital wings (95 beds); a training cottage (100 beds); the hospital clinic; the physical therapy unit; central supply (including hospital, infirmary, and hospital linen room).
Enrolled in the school activities during the year were 425 residents. Trainable classes were attended by 103 residents, educable classes by 135, and arts, cra~ts, and vocational
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classes were attended by 187. Active recreation programs were provided for non-ambulatory and ambulatory residents.
The cottage life department was organized into a unit system in order to improve the services for the residents.
The psychology department was engaged in both outpatient and resident evaluations, research, and special projects.
Professional social work to outpatients and their families was increased with the addition of another graduate social worker. A qualified chief social worker was employed on July 1, 1964, to give professional direction to the department.
_Other activities of special significance during fiscal year 1965 included the annual Mayors' Motorcade with its numerous Christmas gifts for residents, the survey of the institution by the representatives of the Bowdoin Commission, the completion of a plan for the homogeneous regrouping of all residents, which also marked the completion of a plan for integration in compliance with the Civil Rights Act of 1964.
Resident population trends indicated 183 admissions and the separation of 119 residents for a net gain of 64 residents on the rolls. The waiting list indicated a total of 1598
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applicants at the end of the year. In the area of employee personnel, 92 persons were added to the payroll which made a total of 848 employees at the close of the year.
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MILLEDGEVILLE STATE HOSPITAL
Fiscal year 1965 can best be described as a year of evaluation, examination, reorganization, and consolidation. Following reports made by the Governor's Commission for Efficiency and Improvement in Government and a survey team from the National Institute of Mental Health, the hospital staff began immediate implementation of the recommendations included in these two reports.
The recorrmendation that the present unit system be organized on a geographic basis has been completed, and at the same time the hospital was brought into compliance with the Civil Rights Act so that assignment of incoming patients to the various units is now being made according to the county of residence and irrespective of race, creed, or color.
During fiscal year 1965, the hospital admitted 6,692 patients. Of these 4,868 were first admissions and 1,824 were readmissions including 4,072 returnin~ from furlough making total gains for the year of 10,764. Losses included 1,673 patients discharged directly from the hospital, 8,318 placed on furlough and 1,046 who died during the year making total losses of 11,037. For the first time in a number of years the hospital showed a decrease in resident population of 274
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patients. This was due to a decrease in admissions of 62 patients and an increase in discharges and furloughs.
The appropriation for fiscal year 1964-65 was increased from $16,000,000 to $17,500,000. In addition, a special appropriation of $100,000 was granted for fire safety improvements to various buildings so that certificates of occupancy could be obtained from the fire marshall's office. Based on gross expenditures of $18,808,762 and the average daily population of 11,982 patients, the percapita cost this year was $4.30 per patient as comvared to $4.20 last year.
The number of active, regular employees increased from 2,941 to 3,120 or an increase of 179 for the year. Most of this was in the manual labor category.
The seven million dollar building program in now completed, and all buildings are operative. These include the staff dormitory and apartment complex, the central kitchen, the 660-bed addition to the Arnall Building, and the Yarbrough Rehabilitation Center. Considerable remodeling and renovation has been done in the old patient domiciliary buildings and in the Jones Medical Hospital, but the recommendation of the Bowdoin Commission for a new surgical hospital remains to be provided as soon as possible.
In January 1964, the American Medical Association,s Council
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on Education and Hospitals approved a three year residency program in psychiatry. At the present time there are 23 residents on the Milledgeville program, five on the cooperative program with Emory University, and one with the Medical College of Georgia. This means that within the next three years 29 new psychiatrists will be available for the Georgia mental health program. The addition of 10 residents per year to the Milledgeville program will mean that once the program is fully implemented, 30 new psychiatrists every year will be graduating in addition to those provided by the Georgia Mental Health Institute training program as well as those at Emory and the Medical College of Georgia. Residences and internships accredited by national organizations are also available in clinical psychology, psychiatric social work, music therapy, occupational therapy, hospital recreation, clinical chaplaincies, opthalmology, and hospital administration.
All treatment programs continue to be improved and expanded as rapidly as funds become available. The new psychiatric outpatient clinic is now carrying a case load of approximately 3,000 patients with some 500 being seen weekly. An increase in the resident staff of clinical chaplains has developed a religious program second to none in the United States. An
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expanding remotivation program is bringing new enthusiasm and treatment techniques to the psychiatric aide staff. New orientation and in-service training programs have been established in accordance with the recommendations of the survey committees and financed by NIMH grants. A special disability program for patients who are blind, deaf, and have speech defects is operating in conjunction with the University of Georgia Speech and Hearing Clinic.
The hospital played host to more than 5,000 visitors during the year including high school and college students, public health directors, public health nurses, visiting teachers, members of church groups, garden clubs, civic clubs, women's clubs, and similar organizations.
The new children's building is partially operative with classrooms now being used for the School for Emotionally Disturbed Children. This program, conducted in conjunction with the Special Education Division of the State Department of Education, is now serving some 100 children of the elementary and high school age.
Development of a progressive program in the field of mental retardation has been initiated. Two buildings with a capacity of 1700 patients located in an area where the facilities
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are separated from other sections of the hospital are now being remodeled. The center will operate as an individual unit in a multi-service complex and will include a reception service, an evaluation program for broad coverage of patient study, provision for family treatment, and short-term patient treatment coverage. In-service training programs with emphasis on special education and other multi-level teaching programs sponsored by the Department of Education will be centered here.
A survey has been completed for the establishment of decentralized dental services located in each unit of the hospital, with dental suites provided on a unit basis. Progress is also being made in the organization of a centralized treatment center for alcoholics and drug addicts. New shops for wood working, automotive repair, and other heavy machine shop training programs are now completed and in operation.
Development of a Department of Psychodrama under the guidance of a trained psychodramatist on a volunteer basis is now underway. Expansion continues in volunteer programs for garden therapy, music therapy, social work, Alcoholics Anonymous, and art therapy.
Basic research is underway in neuro-psychopharmacology with investigations now being conducted in drug analyses,
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chemistry, radioisotopes, and pharmacodynamics. Medical genetics research programs include studies of chromosome classification of mongoloids, chromosome and progeny study of Huntington's Chorea, and surveys of hospital patients with studies of anthropometry, fingerprints, blood-groups, and haemoglobin. An NIMH supported research project studying the effects of tranquilizers in schizophrenic foxes continues.
The Vocational Rehabilitation Division is providing effective and early discharge of patients as well as equipping them with trade skills and jobs in their local communities. The establishment of two rehabilitation residences in Atlanta have aided materially in the effectiveness of this operation.
Some 180 geriatric patients have been placed in nursing homes as the result of the establishment of a unit of the Baldwin County Department of Family and Children's Services in the Social Service Department of the hospital. Visits to the patients in the homes show that they are adjusting well and are welcomed by the home operators.
Plans for the coming year include a careful evaluation of treatment programs with a view to increasing effectiveness as well as the utilization of emergent, modern treatment concepts. An evaluation program in communications, the establishment of
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departments of neurology and otolaryngology, an examination of existing in-service training programs as well as those under the direction of the Director of Education, and an accelerated effort to bring the hospital to a standard of operation consistent with modern state hospital psychiatric practice will direct the activities at Milledgeville State Hospital.
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ALCOHOLIC REHABILITATION SERVICE
The operation of the Georgian Clinic Rehabilitation Center in Atlanta and the Chatham Clinic in Savannah was continued at capacity, and the Spalding County Health Department continued its outpatient clinic for alcoholism with a steady increase in the number of patients treated and services rendered. 295 resident patients were treated at the Georgian Clinic for 13,029 patient days, and 1,269 day patients made 19,041 visits to the Clinic to receive 133,287 services. 1,100 hours of counseling was provided for patients' families.
Based on the experience gained at Spalding County, a new clinic was opened at the Floyd County Health Department at Rome. A new consultant team consisting of a psychiatrist, pastoral counselor and a nurse was developed to go to Rome weekly to work with the local group which included a social worker. The multi-discipline team at Rome was most enthusiastic, and the patient load grew fast - too fast. To more adequately meet the situation, members of the local team went to the Georgian Clinic weekly to receive extra training for their roles in the Rome Clinic.
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Chatham Clinic treated 369 patients who made 5,547 visits to the Clinic and received 38,829 services. 349 hours of family counseling wereprovided by a qualified social worker added to the staff on a part-time basis.
The State Vocational Rehabilitation Division has assigned a full time counselor to Alcoholic Rehabilitation Service for better coordination of efforts to aid the vocational and employment aspect of the patients' return to society as self supporting citizens. This is a new, but very vital service to patients.
The Georgian Clinic continued one-week intensive orientations into the problems of alcoholism, serving 159 professional people from local communities.
A federal grant was received for an accredited Chaplains' Training Program at the Georgian Clinic. Over 70 students have received training this year.
The grant was made for three years, and 85 graduate ministerial students and 1,000 undergraduates will receive training (200 of them intensively). A model for training ministers at different levels will be developed to demonstrate what can be done to more adequately prepare theological students and ministers as community resources. Levels of
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training are: Orientation and Introduction, Pastoral Counseling with the Alcoholic and his Family, and Internship in Pastoral Group Counseling.
In April, 1965, the treatment program at the Georgian Clinic was expanded by adding a limited number of beds for short term intensive treatment to provide greater flexibility in utilization of beds, including rapid evaluation and earlier initiation of intensive treatment. A night hospital was developed for patients who can maintain jobs during the day, but need therapy each day, which is anticipated to be as effective as the day patient care.
The consultant team from the Georgian Clinic began its visits to Columbus preparatory to opening a day patient treatment center there early in January, 1966. Funds were approved for this project on a matching State-County formula. The need for a Clinic here has been obvious for several years as the Georgian Clinic received more patients from Muscogee County than any other in the State. The matching funds have been raised and the facilities in the Medical Center provided by the community. The local professional team has been assembled, and the Clinic will be opened on schedule.
The School of Social Work of the University of Georgia
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is developing high caliber social work services for patients at the Georgian Clinic and will work to provide field placement experience in treatment of alcoholism for social work students. A full time faculty member will be assigned to the Clinic January 1, 1966.
G. Elliott Hagan, U. S. Congressman from Georgia's 1st
District, introduced a Bill on alcoholism in the U. s. House
of Representatives patterned after the one originally written for Georgia. This has created nation-wide demands for a more active role in treatment and prevention of alcoholism on the national level. Representatives from the Alcoholic Rehabilitation staff appeared in Washington as witnesses.
The annual Southeastern School of Alcohol Studies was again held at the Georgia Center for Continuing Education where over 949 students (physicians, law enforcement officers, public health personnel, nurses, social workers, rehabilitation counselors, clergymen and others) have received training.
The New Life has been continued quarterly and sent to some 8,500 interested people and patients as part of our follow-up with patients and former patients.
A number of national and international leaders, including representatives from England and Yugoslavia, have visited our
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facilities and observed our programs. National observers came from NIMH and the U. S. Public Health Service in Washington, Office of Economic Opportunity, state and private universities, schools of medicine, seminaries, general and mental hospitals.
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DIVISION OF PHYSICAL HEALTH

branch of dental health

BRANCH OF DENTAL HEALTH
Staff members of the Dental Health Branch provided consultation to personnel in the 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. The director of the Gracewood dental program completed his two-year residency training in pedodontics and returned to duty at the hospital just before close of the fiscal year.
A new position, Director, Special Dental Programs, was set up in the Branch for the purpose of planning and developing dental programs for special population groups such as mentally retarded, chronically ill, aged, homebound, and others.
The staff cooperated with the schools of public health of the University of North Carolina and the University of Michigan and with the U.S. Public Health Service to provide field experience for graduate students who had completed their academic work for Master's Degrees. Two graduate students from each of the universities were provided short
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term orientation in the dental services of the state and local health departments. Also, in cooperation with the Dental Health Center, U.S. Public Health Service, a oneyear residency in dental public health was approved, and a public health dentist was assigned.
The staff of the Branch conducted an 18-hour course in public health for senior students at Emory University School of Dentistry. The course emphasizes the responsibility of dentistry in general public health programs and the current methods employed in measuring and controlling dental diseases.
The demonstration program in District 28 for evaluating the potential of a full-time dental director was resumed after a temporary interruption due to resignation of the former director.
Earmarked federal funds for dental health were made available during the fourth quarter. Part of these funds were used to negotiate a contract between the Department of Public Health and the Georgia Dental Association to study the dental needs in Georgia with the view to identify dental problem areas, delineate health department responsibility, and make recommendations for improving the dental health of the citizens of the state.
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In cooperation with the U.S. Public Health Service and Emory University School of Dentistry a state-wide oral cancer detection program was begun. This program was an extension of a district-wide program previously carried out in District 28. Approximately 1/3 of the practicing dentists in the state attended at least one of the 19 lectures and demonstrations that were offered in 15 different locations in the state with the cooperation of the Oral Pathology Department of the Dental School.
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DENTAL PUBLIC HEALTH SERVICE
Fluoridation of community water supplies, continuous dental health education, and incremental dental care for children again received major program emphasis.
Six additional water supplies are reported to have begun fluoridation during the fiscal year, bringing the state total up to 64 water systems fluoridating. Still only about 39 percent of the population on public water supplies are receiving fluoridated water.
The Health Department entered into a cooperative agreement with the U.S. Public Health Service and local officials in a county to demonstrate the feasibility of the use of calcium fluoride (fluorspar) as a fluoridating agent. The cost of calcium fluoride is relatively low, and, if practicable, can reduce the cost of water fluoridation. A dental survey was made in connection with the project to establish a dental caries baseline for use in future evaluation.
Dental care services were provided to more than 29,000 underprivileged children who were treated in public heatlh dental clinics in 76 counties. These services were provided by six full-time public health dentists and 246 dentists in private practice who participated part time. Members of the
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staff provided consultation and assistance in dental health education to public health personnel, dentists, dental hygienists, teachers, nursing home personnel, and to personnel in professional and voluntary agencies. 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.
Nursing home administrators, nurses, and attendants received instruction in the importance of personal oral hygiene for patients and in the methods of maintaining care of the mouth and dentures.
A study project was continued in Pickens County to determine the effectiveness of a dental prophylaxis given by a dental hygienist using a prophylaxis paste containing stannous fluoride. The second round of prophylaxes were completed in the fall of 1964 and final examinations will be made in the fall of 1965. If this procedure proves to be effective in reducing tooth decay, it will be recommended for wide-spread use.
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environmental health branch

HOUSING HYGIENE AND ACCIDENT PREVENTION SERVICE
The activities of the Housing Hygiene and Accident Prevention Service are directed at reducing the accident-injury rate, reducing the severity of injuries, assisting in the provision of healthful housing, and promoting environmental health planning now for a satisfactory residential environment for the future.
Housing hygiene activities are concerned with three major program areas: planning and engineering, rehabilitation and codes, and special problems such as housing for the aged, handicapped and chronically ill. Specific activities have included the following:
(1) The provision of consultant services to personnel in state, district and local health departments, and other local government units.
(2) Surveys to provide basic information for local health departments to develop minimum housing standards code enforcement programs.
(3) Close cooperation with accident prevention activities involving home safety.
(4) Active participation in the environmental health
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planning program to promote the interest of local and state groups in housing hygiene as a public health activity. (5) Joint research with the Chronic Illness and Geriatrics Service on the relationship of chronic diseases to substandard housing. (6) Assistance in the development of a state plumbing code. Almost 3,000 needless deaths by accident occur annually in Georgia. Accidents are the fourth leading cause of death for all ages, and in the age grouping 1-24, accidents are the leading cause of death. Motor-vehicles, falls, and burns, in that order, account for the majority of these deaths. Accident prevention activities have included consultant assistance, training and promotion of accident prevention activities through many official and non-official groups. These activities involved: (1) Consultant training activities aimed at the integration of accident prevention activities into local public health programs. (2) Service as the state clearinghouse for the network of 11 poison control centers located throughout Georgia.
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(3) Service as medical coordinator for the CornellGeorgia Automotive Crash Injury Research Program. The Southwest, Southeast and Northwest sections of the State participated in this study during this fiscal year. Such basic research has led to seat belts, adequate door locks, safer steering wheels, the padded dash, padded sun-visors and many other automobile safety devices that are now appearing on automobiles.
(4) Continuing program activities in child safety and working with the Accident Prevention Committee, Georgia Chapter, American Academy of Pediatrics.
During the reporting period the service was reorganized to deal more effectively with the problems of accident control. This included the hiring of a professional with special training in public health accident control programming.
The activities of the Service have been directed toward the conservation of human resources and increased individual productivity. With the rapid trend toward urbanization, the benefits are increasingly important to the state as well as to the individual citizen.
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METROPOLITAN, URBAN AND COMMUNITY PLANNING
The Environmental Health Branch continued to promote a program of environmental health planning as coordination for organizations, agencies, and groups concerned with providing a healthful environment in Georgia.
During this fiscal year a week-long training session in urban planning for environmental health was held, including a survey in Augusta-Richmond County during August. About 75 persons, including a trainee roster of about 45, participated in the survey and discussions. A definitive report was prepared on the survey and covers basic facts relative to the environmental health status of the area now, expected future trends and recommendations for improvement. The same group of students and consultants later returned to Augusta to spend three days on basic implementation procedures. This involved cooperative work with the University of Georgia's Institute of Community and Area Development.
In June of 1965, the same procedure, but with different trainees, was carried out in Savannah-Chatham County, Georgia. A unique feature of the Savannah survey was that the University of Georgia's Institute of Community and Area Development had
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developed a community social analysis prior to the actual survey. This gave the implementation committee heretofore unassembled facts to consider in making their recommendations for implementation.
The environmental health planning concept illustrated by the above examples appears to be an excellent approach to solving complex environmental problems now and for the future.
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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 an industry which affect the health, well-being, and efficiency of the workers and to teach the workers to protect themselves from all known health hazards.
The professional personnel of the service are grouped into four sections and one unit: the Industrial Section, Air Pollution Section, Radiological Health Section, Mattress Sanitation Section, and the Electronic Service Unit.
The services of specialists from the Public Health Service and other allied Federal and State agencies are employed on occasion. These services are freely available upon request, and with this assistance it is possible to evaluate most industrial health problems.
The increase in industrialization in Georgia has, of course, brought increased responsibilities to the health department. The local health department is the official agency specifically charged with the responsibility of assisting these establishments and their employees in all health matters. Assistance from the State Health Department is available to local industries only through their local health department.
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In carrying out the program for improvement of environmental

sanitation in industry, Industrial Hygiene personnel made

investigations in 431 establishments employing approximately

56,542 workers in 98 counties during the period July 1, 1964,

to July 1, 1965. These investigations covered a wide variety

of industries. During these investigations 222 samples were

taken for laboratory analysis.

Samples collected and analyzed by the Radiological Health

Section during the period covered by this report included 487

air samples, 75 rain samples, 441 stream samples and 288 milk

samples. The Section also made X-ray and Isotope inspections

and surveys as indicated below:

Isotope inspections

47

X-ray surveys

208

Radium surveys

63

Classes (Sanitarians)

2

In the period covered by this report, the Electronics Unit

made 69 repairs to X-ray equipment, in addition to repairing

such equipment as film dryers, tape recorders, movie and slide

projectors, record players, vision test units and radiation

meters. The Unit repaired 75 audiometers. In addition to the

above activities, personnel spent 23 days assisting the

Tuberculosis Control Service and State Employees' Health Clinic

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in their programs at various times. During the year the Air Pollution Section made 8 one-week
studies at various localities in the State. During these studies 1875 samples were collected for laboratory analysis, and 1361 field determinations were made.
In 1954 the Industrial Hygiene Service assumed the responsibility for the enforcement of the Georgia Matress Sanitary Regulations. During the period covered by this report 716 bedding inspections were made.
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GENERAL ENGINEERING-SANITATION SERVICE
The fiscal year ending June 30, 1965, brought a change in the organizational pattern within the Service. There are now three sections within the Service: General Engineering Section functioning primarily in the engineering review of on-site water supply and sewage disposal facilities, subdivision developments, school plans, water impoundments, swimming pools, solid waste collection and disposal; General Sanitation Section functioning in the area of insect and rodent control, institutional sanitation, parks and recreational area sanitation, and the sanitation of tourist accommodations; and Food Control Section functioning in the area of food service establishment sanitation, shellfish sanitation, and milk sanitation. Service on our statewide programs in cooperation with federal, state, and local agencies has been accomplished with service also rendered to 34 counties not having sanitation personnel available at county or district organizational level.
With the beginning of this fiscal year, final approval of plans for oxidation ponds and sewage treatment plants serving such installations as residential subdivisions, nursing homes and motels became the responsibility of other organizational
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units within this department, and this Service after appropriate review forwarded to the final approving unit recommendations for appropriate actions. This activity included review of six package plants, and 15 oxidation ponds. Large septic tanks with dosing siphons and covered sand filters or tile fields continued to be reviewed and approved by this Service. on-site water supply and sewage disposal activities were primarily involved in our cooperative work with federal agencies, such as Federal Housing Authority and Veterans Administration in their mortgage insurance program. This activity resulted in 1,147 field reviews for on-site water supply and sewage disposal systems. Refuse collection and disposal activities were carried out on a statewide basis with 154 field visits for review and consultation purposes throughout the state. The water impoundment maintenance program resulted in the issuance of 858 permits.
Public swimming pool plans were reviewed and comments forwarded to the designing engineers. Plans were reviewed and approved for sanitation improvements at 36 recreational areas in the state and federal parks systems. Final approval was given to 234 sets of plans and specifications for the construction and/or major renovation of schools under our
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cooperative program with the State Department of Education and State School Building Authority. Inspection of the 1,115 tourist courts with permits is continuing, and the Service has prepared a revision of the "Tourist Court Regulations" to become known as "Tourist Accomodations" rule, under the new Georgia Health Code.
In the winter and spring months, the Service participated in an exhaustive investigation of a fly-breeding problem in Clayton County which was finally resolved in the Superior Court of the county. Continuing consultation, advice, and guidance are rendered to the individuals responsible for environmental sanitation at the institutions operated by the State Health Department. In the 34 counties for which this Service renders minimal sanitation activity, inspections were made of sanitation features in schools, nursing homes, hospitals, day care centers, food service establishments, tourist courts and water impoundments. The Service responded to requests for inspection required of prospective adoptive applicants through the State Department of Family and Children Services. Personnel of the Service participated in the Metropolitan Urban and Community Planning for Environmental Health Conference at Savannah.
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A statewide survey of the status of food service establishments was conducted involving inspection on a statistical basis of 402 establishments located in 22 counties, serving 113,029 meals per day. The results of this survey indicated 4.74 percentage increase in compliance with current rules and regulations. The Service prepared a draft of proposed food service establishment regulations for adoption by the State Board of Health under the 1964 Georgia Health Code.
The shellfish sanitation activity resulted in issuance of certificates to the State Game and Fish Commission showing areas approved for the harvesting of oysters along the Georgia coast. The Service prepared a draft of proposed shellfish regulations for adoption by the State Board of Health to bring the regulations into harmony with the current agreements in interstate shellfish shipping participated in jointly by the shellfish industry, state regulatory agencies, and the Public Health Service. Official milk sanitation surveys were made on 20 milk sheds and 25 spot checks of local milk supplies were completed. There are 23 local milk sheds listed on the U. S. Public Health Service Honor Roll.
In spite of the fact that our Service participates in recruitment and training for local health departments, there
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is a current need for sanitarians in 34 counties having no local sanitation coverage. The Service participated in a sanitarian training program having 15 students during this fiscal year.
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WATER RESOURCES SERVICE
The Water Resources Service provided supervision of water supplies, sewerage projects, industrial waste treatment, stream quality, and other allied activities. The Service, as a unit of the Environmental Health Branch, Physical Health Division, Georgia Department of Public Health, has direct responsibility for the water supply quality control, under Chapter 88-26, Georgia Health Code.
The pollution control activities were performed under contract to the Georgia Water Quality Control Board, under authority of the Georgia Water Quality Control Act.
During the fiscal year 1964-65 plans and specifications were reviewed and approved for 29 new water systems and extensions to 59 existing water systems. Consulting engineering and chemical services were supplied to the 727 public water supply systems throughout the State. Similar services were rendered to municipalities and industries in the field of waste treatment. Engineering review and approval of 29 sewerage systems and extensions to 59 existing sewerage systems were given during the year.
Under the Federal Water Pollution Control Act, Public Law
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660, the allocation of $1,973,558 to eligible municipalities, for the construction of sewage treatment plants, was handled by Water Resources Service.
The stream quality program collected samples of various streams and sources of pollution to determine physical, chemical and bacteriological characteristics. The major emphases were given to the Chattahoochee and Savannah Rivers.
Assistance to the management and operators of the water supply and waste treatment facilities continued. Schools were held at Athens and Americus for the instruction of operators in the latest techniques of water supply and waste treatment.
The program for improvement of the small water supplies throughout the state continued. Thirty-four (34) additional chlorinators were placed in service during this period. The number of delinquent samples was reduced, and a total of 92.8% of the plants were sending in samples as required by regulations. This was an increase of 6.1% over the previous year.
The Water Laboratory made bacteriological, chemical and physical tests for the water supply and water pollution control programs, as well as tests for the shellfish program. A total of 96,995 tests were made, or an increase of 41% over the previous year.
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ENVIRONMENTAL HEALTH TRAINING
Extended orientation was provided for 26 sanitarian trainees during the period June 22, 1964, through September 11, 1964, in the form of the "Environmental Health Training Course for Georgia Sanitarians". This course was repeated February 23, 1965, through May 14, 1965, to provide similar training for an additional 14 sanitarian trainees for a total of 40 new sanitarians trained during this reporting period. Four additional Sanitarian Trainees were enrolled in the Public Health Sanitation Course at East Tennessee State University on June 14, 1965.
Several significant in-service training experiences were provided, the most outstanding being the "Solid Waste Training Course" presented in Atlanta by the Environmental Health Branch and the U. S. Public Health Service Robert A. Taft Sanitary Engineering Center. A staff of specialists from both agencies assembled in Atlanta June 16-18, 1965, to present this three-day course to 41 environmental health personnel from the state, district and county levels.
Of equal significance, the Environmental Health Branch arranged for the "Training Institute on National Sanitation
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Foundation Standards" presented by that agency in Atlanta on December 10-11, 1964. This course was attended by 21 district and county environmental sanitation personnel as well as by the food sanitation staff at the State level.
Additional in-service training was provided for environmental health personnel through the facilities of the Communicable Disease Center in Atlanta in the form of short courses in several significant subject areas.
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hea lth con serva tion
bra nch

CRIPPLED CHILDREN'S SERVICE
During the fiscal year 1965, Crippled Children's Service added depth to the program offered Georgia's children. One of these areas is in the treatment of the severely handicapped such as paraplegics and quadriplegics. In the past they were hospitalized and only at the point of discharge did the Service begin planning for home care. The present plan is to delay treatment, except in emergency situations, until the home has been visited and evaluated. A team of nurse, physical therapist, social worker, and the local public health nurse carefully assesses the physical environment for width of doors if a wheel chair is to be used, steps leading in the house, bed space, and other special needs. The capacity of the family to accept and carry out medical plans is studied. Community resources are investigated. Beginning at the first visit and continued during treatment is an assessment of the strengths and weaknesses of the patient himself. All information is relayed to the attending physician to help him plan realistically for the patient.
Certain Federal funds have been appropriated and allocated for the treatment of physical defects in children with mental retardation. Since care must be taken to avoid labeling any
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child mentally retarded unless there is good evidence that he is, the number of psychological evaluations has increased markedly. These are brought to the attention of the doctor, and added to his own findings a recommendation may be made to report a diagnosis of mental retardation. As a result, the whole child is now being more carefully scrutinized. Some children who have been labelled "M.R.'' in the past have been found in retesting to have higher IQ's so that this often damaging diagnosis can be removed.
Cooperation continues with the National Council for Research in Juvenile Prostheses in our amputee program. This past year three upper extremity prostheses designed for children with bilateral amputations of the arm were made. Georgia has been given one of these. This is called a "feeding arm" and is externally powered with carbon dioxide. Certain movements of the shoulder cause the arm to lift and bend and place the hand or hook in such a position that the child can feed himself from fork or spoon without dropping the food.
The continuing shortage of qualified nurses has been a handicapping factor in program expansion.
A hearing clinic has been opened in Macon and plans are being made for a plastic surgery clinic.
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MATERNAL AND CHILD HEALTH SERVICE
The Maternal and Child Health Service is charged by law to protect and promote the health of mothers and children in Georgia. The Service focuses upon those health factors which would help families to become economically independent members of society.
In 1964 there were 100,581 births of which 7,372 were home deliveries by 321 midwives. It is anticipated that 2,500 to 3,000 of these approximately 100,000 babies will be mentally retarded, with 100 completely dependent and requiring institutional care, 400 semi-dependent, and 2,000 marginally dependent.
As late as 1934 the maternal death rate was 78.2 per 10,000 live births. In 1964 it was reduced to 4.7. Even though this is an astounding improvement, Georgia must materially improve both the maternal and infant mortality rates to compare favorably with the national average. In the last eight years there has been an alarming and persistent rising death rate among the one through 11 months age group which in turn has raised the infant mortality rate.
A majority of congenital defects, both mental and physical, are directly associated with the complications of pregnancy and
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heredity. Therefore, primary emphasis is placed upon promotion of family planning and good prenatal care, terminating in hospital delivery by a physician, and upon continuous well child supervision.
Maternal Care: During the year, 14,194 patients were admitted to prenatal medical care, 23,627 to prenatal nursing care, 3,873 to postnatal medical care. One hundred and six counties have maternal clinics with physicians' service.
As of June 14th the State Board of Health gave approval to a plan and policy for expanding the family planning program to include the more modern methods.
Well Child Care: Ninety-six counties have well child conferences with physicians in charge. There are nursing conferences in 17 other counties. In the one through four age range over 61,569 immunizations against diphtheria, tetanus and whooping cough were given. In this same age group almost 18,803 received oral polio vaccine. There are clinics in 163 towns and cities of Georgia.
Mental Retardation: More than 300 public health nurses from 114 counties over the state attended one of three regional Workshops on Mental Retardation held in 1965 in Atlanta, Albany, and Macon. After attending one of the workshops the nurse is
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then eligible to attend a one week course at Gracewood State School and Hospital which is taught by their staff.
There are two maternal and infant care projects for high risk prenatal patients, one centered at the Medical College in Augusta, and one centered at Emory-Grady in Atlanta. There are two child development and evaluation centers, one located in Muscogee County, serving 12 counties; the one in DeKalb serves two counties. A fifth special project in mental retardation, a child development and evaluation center in District #37 with a risk registry designed toward prevention and early detection, has been accepted and funded by Children's Bureau as of July 1.
The voluntary hospital newborn screening program continues for phenylketonuria, a preventable cause of mental retardation. Twenty-seven of the hospitals in Georgia screen babies born in the hospitals. Fourteen thousand three hundred and fiftyeight were tested last year. Two were found by this method and are being treated by dietary management. Three cases were found by urine tests on older children.
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NUTRITION SERVICE
The two phase workshop for teachers of nutrition in 22 nursing schools was a major accomplishment this year. Thirty scholarships were awarded from a U.S.P.H.S. Grant. The Georgia League for Nursing and the Georgia Dietetic Association joined with the Health Department to improve the curricula for these schools.
Another important activity was the workshop for teachers of health in the elementary, junior high, and high schools under the sponsorship of the Florida Citrus Commission with the advice and counsel of the Health Department, the Education Department and the University of Georgia.
The completion of the Child Caring Survey of 34 state institutions, jointly with the Family and Childrens Services, was followed by three statewide workshops emphasizing two points; first, the meaning of food to children with its emotional overtones, and second, the basic nutritional needs of children. These were well received and future workshops were requested. Plans are underway for publishing a report of the project.
The increasing diabetes problem has occupied the service
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in many ways, participating in the Diabetes Seminar, supporting the Atlanta and Georgia Diabetes Associations, the Savannah classes for diabetics, and meetings with newly discovered diabetics.
The Nutrition Service survey of the food habits of children in Americus who failed to achieve optimally in school revealed the disturbed family patterns of these children.
In South Georgia the nutritionist and the worker from Family and Children's Services were very active in promoting Surplus Food Commodities. Four counties began to use the Food Stamp Plan, and nutritionists cooperated with the local agencies in promoting this program.
Two nutritionists taught over 1,000 individuals who were to carry on the "Head Start Project" and also did some followup work with the families of the children.
The Service also assisted Family and Children's Service in promoting better food service in day care centers.
The dietary consultant participated in the Mental Retardation Workshops over the state in cooperation with the Maternal and Child Health Service, and the Nutrition Service recruited and oriented the nutrition consultant for the Mental Retardation Project in DeKalb County.
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Work with older persons included meetings in housing projects with groups who eat poorly, the Home Care Project in Dalton, and work with food service in nursing homes.
The consultant nutritionist at the Children's Bureau is assisting in the plans for improving dietary counselling for the phenylketonuric child.
The Director of the Service and several staff members participated in various professional workshops, institutes and seminars during the year.
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SCHOOL HEALTH SERVICE
The School Health Service concentrated the major portion of its staff time on the hearing and vision conservation programs. A project to test the validity of a questionnaire (used by the teacher) to detect emotional disturbance in children has been funded by the National Institute of Mental Health. However, the original site for the project must be changed, and is now being investigated. The staff has also been engaged in a project in a local health department and city school system for children failing to progress in school. Consultative services have been offered to local health departments concerning innovation and updating of school health programs and the teaching of health subjects in the schools. Consultation has also been given to official, voluntary and school-related agencies (P.T.A.) and teacher-training institutions.
Vision Conservation Program: 264,470 children in 1,066 schools in 93 counties had vision screening. Of the number tested, 21,347 failed, and 11,106 were reported to have received follow-up care. Two vision clinics, with examination by ophthalmologists, were held; 55 children were seen. The Georgia Lions Lighthouse Foundation finances vision corrections
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for many of the medically indigent. Hearing Conservation Program: In 1,117 schools in 105
counties, there were 147,070 children who had hearing screening by puretone audiometer. Of those tested, 7,283 failed, and 4,294 were reported to have received medical care. In 42 clinics with hearing screening examinations by otologists, 1,955 children were seen. This service has been well received, and is judged helpful to local health departments.
In one local health department (Glynn County) consultation continues in the establishment of a second speech and hearing clinic; the first clinic was established in Fulton County.
Tuberculin Testing: School Health Service joined with the Tuberculosis Control Service to initiate interest in more tuberculin testing. The Tuberculosis Control Service received the following results of testing: 92,729 school children were tested; 3,047 (3.3) reacted positively, and 46 had active disease. An additional 68 cases were found in contacts of school children.
Program for Children Failing to Progress in School: The first year of this program, carried out by the Sumter County Health Department staff, has been completed, the data tabulated and analyzed. After being worked up by the local health and
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education departments, 33 children received laboratory workup and pediatric and psychological examinations by visiting specialists. The complete case records, including the recommendations of the specialists, were placed in the hands of the family doctors, whose responsibility it became to assist the families in developing remedial services for the children. The majority of the services needed fell within the mental health category.
In-Service Education: The School Health Service sponsored a five-day course in the principles of audiometry and hearing conservation for public health nurses, held at the Georgia Center for Continuing Education.
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local health branch

LOCAL HEALTH ADMINISTRATION SERVICE AND LOCAL HEALTH BRANCH
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 in Georgia, 114 counties are covered by district personnel with 42 other organized local health departments. There are now three counties which have no prospective local health department activity: Union, Pickens, and Towns. Considerable effort has been put forth in these counties to establish active local health departments, but the lack of available, qualified personnel has been a serious obstacle. It is anticipated, however, that these efforts will soon result in local health department activity. In fact, Union County will begin local health department activities on January 1, 1966.
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
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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 eight public health center projects approved during the 1965 fiscal year amounting to $751,000 in the counties of south Fulton (addition), Cherokee, Chatham (addition), Dodge, Newton, Henry, Walker - Rossville, and Fulton -Adamsville (addition).
July 1, 1965, was the effective date for several changes affecting local health department budgets. These included a salary adjustment program, a reclassification of the majority of the nursing series, and Merit System recognition of all employees in the local health departments. This involved considerable time on the part of the Branch in coordinating these changes 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
Pending studies on redistricting and financial assistance to local health units, Health Districts 11, 22 and 23 remain unorganized or inactivated. The remaining 10 Districts with the employment of a District Director of Public Health by District #29 on September 1, 1964, were fully functioning activated districts.
The Union County Board of Health approved the formation of a health department in Union County for activities to begin on January 1, 1966. The organization of a health department in Towns County originally approved by the Towns County Board of Health on September 30, 1964,to begin activities on January 1, 1965,was delayed by the anticipated completion of a tax evaluation study. Pickens County's efforts at establishing a local health department have been so far unfruitful because of the inability to recruit a qualified public health nurse. When these difficulties are overcome in Towns and Pickens Counties, all counties in the Northern Region will have fulltime local health departments.
At the district level, ten of the thirteen districts were served by a District Director of Public Health; six had a
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District Director of Nurses; and nine had a District Director of Environmental Sanitation.
At the regional level the staff remained the same during the year with a medical director, two consultant nurses, two nutrition consultants and a secretary. Consultation in general sanitation and the performance of direct sanitation services in counties which do not employ a sanitarian were received from the General Engineering/Sanitation Service on requests submitted by these counties either to the Northern Health Region or Local Health Branch.
As of December 31, 1964, in the activated districts, the number of health workers employed in the various local health departments throughout the region was as follows: 15 physicians, 233 nurses, 101 sanitarians and engineers, 130 clerks, and 143 other employees. Twenty-three nurses, seven sanitarians, and 15 clerks were employed in the unorganized or inactivated districts. Ten county health departments operated without a local sanitarian and had to receive direct service from the State Health Department.
Direct health services necessary under state law were provided the three counties not having local health departments and those organized but without full coverage in all disciplines
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of service. Included in such services were the supervision and licensure of nursing homes, the initial inspections of buildings proposed for conversion to nursing homes, approval of plans and specifications for proposed construction, and all other services which are needed from local health departments in the planning, construction, licensure and operation of such facilities, and in the investigation of unlicensed homes. Eight licensed nursing homes at the end of the fiscal year were under the supervision of the Region. A like number of proposed plans for construction and inspections for conversion of existing buildings into nursing homes was processed.
The services provided by the regional staff to the 51 counties comprising the Northern Region represented a wide range of activities from local staff duties to direction, supervision, consultation, and in-service staff training depending upon the extent of services required to meet the local need. The medical director gave part-time medical direction to the general health program in 18 counties which are not included in an activated district. The two nurse consultants and two nutrition consultants divided responsibilities throughout the region by giving each the responsibility for approximately 25 counties. A total of 1505 visits by regional personnel were made to local health departments.
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CENTRAL REGION
Continued programs during the fiscal year 1965 were the blood pressure program in one county and Project 506, Maternal and Child Health, in the 11 county Augusta area, the latter serving 10 counties in the Central Region. In-service programs for consultant nurses were held at intervals in the Atlanta area. In-service programs for local health departments were planned in public health areas such as tuberculosis, mental health, family planning, maternal and child health evaluation, and records. Tuberculosis control services with diagnostic and evaluation clinics were continued in eight counties. The Battey project in tuberculosis has been quite helpful to the local program. School health services continue to demand nursing time with tuberculin, vision, and hearing testing.
An engineer from Water Supply Service provided technical and consultant services for water supply problems related to public health.
Syphilis has shown a slight increase over the last fiscal year. Interviewing and re-interviewing of all infectious cases have demonstrated a source/spread success rate of 93% for the year in this region. Epidemiologic treatment of primary and
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secondary contacts is still practiced. More private physicians in the area are accepting epidemiologic treatment as good preventive medicine.
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SOUTHERN HEALTH REGION
During the reporting period one auxiliary health center was completed in Wheeler County and one health department moved into different and better quarters. One county has almost completed a Hill-Burton center and another county has made application for construction in 1966.
The nursing staff continues to give supervisory, consultative and overall guidance. Quarterly conferences, in addition to smaller group meetings, were held for county personnel on tuberculosis, stroke rehabilitation, mental health, mental retardation, maternal and child care, audiometry, epidemiology and care of the sick and injured.
The work load of the nutrition consultant remains heavy as she serves the entire region. Her services require attendance at workshops, surveys, conferences, work with patients, family and children services, institutional work public and private, crippled children's service, and other educational programs in nutrition.
Although no engineering or sanitation personnel are assigned to the regional staff in either office, the Albany area was fortunate in having the services of one environmental technologist permanently located in the regional office to care
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for the frequent requests for sanitation services. A water supply service engineer gives technical and consultant services on water supply problems related to public health.
During this period one full-time Crippled Children's Service charge nurse and one clerk was added to the staff of the Waycross office.
Two health investigators under the Battey Project were added to the Albany and Waycross office. Nursing time has been extended by the addition of these auxiliary investigators, and they have been of immeasurable assistance in getting recalcitrant patients in for x-ray and follow-up.
The health program representatives under Venereal Disease Control Section visited all counties in the region. All reactive seriologic specimens were followed-up as well as all contacts to early syphilis. The number of primary and secondary cases has remained somewhat stationary. The records on follow-up and interviewing showed improvement. Even though the venereal disease rate for the state as a whole will show an increase for this report period, there has been a decrease in the southern region. Intensive educational programs were conducted in high schools and other places as requested.
Although other personnel such as those assigned to Water
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Supply, General Sanitation, Venereal Disease, Battey Project, Health Referral Program, Epidemiology, and the Aedes aegypti program are not officially assigned to the regional staff, they are an important part of the overall public health program in the region. All concerned endeavor to conduct a program of guidance, supervision, consultation, individual aid and assistance, education and administration to all counties and county personnel in the region.
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preventable diseases branch

CANCER CONTROL SECTION
For a number of years, the state-aid program has continued to operate without any appreciable change in policy or administrative practice. During recent years, the most noticeable change in the program has been the increased cost, primarily reflecting an increase in the case load as a result of the rise in the incidence of cancer and the continuing increase in the per diem cost of hospital care.
Expenditures. Total payments to the various clinics during fiscal year 1965 amounted to $519,440.65. Accrued costs during the same period were somewhat higher and exceeded the comparable figure for the previous year by about $20,000. Of that increase, about $15,000 was caused by rises in hospital rates and the remainder by the increased case load.
Future trends. In view of the continuing increase in hospital rates as well as in the case load, it may be anticipated that the cost of the program during the coming fiscal year will exceed the figure for 1965.
During the fiscal year 1967, however, an appreciable decline in expenditures will result as the Medicare program becomes effective on July 1, 1966.
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The Medicare program will provide medical and hospital care for persons over 65 years of age. At the present time, approximately 40 per cent of all state-aid patients are in that category. Operation of the Medicare program, however, will not result in a 40 per cent decline in the cost of the state-aid program since a fairly large proportion of patients over 65 report with skin cancers which are the least expensive type to treat. After the Medicare program is in full operation, it is estimated that the annual saving to the state-aid program will approximate $150,000.
Hospital insurance. During the past few years, an increasing amount of effort has been directed toward urging the clinics to collect all hospital insurance. As a result, insurance collections have increased considerably and now approach $30,000 annually.
If the insurance is collected before the patient's bill is submitted for payment, it is common practice to simply deduct that amount from the bill. If collected after the bill has been submitted, the hospital forwards a check to the Health Department covering the amount paid by the insurance company. During fiscal 1965, the sum of $12,195.62 was deducted from the patients' bills, while refunds amounted to $16,782.13.
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Clinic activities. All of the approved clinics continued to operate throughout the year. No additional clinics met the minimum standards for approval.
The number of clinics now in operation is quite adequate to deal with the present load of indigent cancer patients. Moreover, with the advent of Medicare, the existing case load should be greatly reduced.
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CARDIOVASCULAR DISEASE CONTROL SERVICE
The Cardiovascular Disease Control Service cooperates closely with the Georgia Heart Association, the USPHS Heart Disease Control Program, and other public and private agencies in developing and continuing research and service programs designed to detect, correct and prevent cardiovascular abnormalities and diseases.
RESEARCH PROGRAMS - Atherosclerosis and Hypertension. The study of atherosclerosis in Trappist and Benedictine monks, on-going since 1957, has entered its final year. Twenty-eight hundred monks in 29 monasteries have been studied in an attempt to elicit by comparing the two religious orders those factors, dietary and other, which may be related to the development of atherosclerosis. All examinations have been completed, and efforts are currently directed toward data processing and evaluation of the results.
The home-care phase of the Baldwin County hypertension study will terminate in June, 1966. About 90 hypertensive subjects are being followed for a period of two years to demonstrate the applicability and effectiveness of public health measures in the detection and control of hypertension. Teaching patients
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to take their own blood pressures has been a major accomplishment of the past year.
SERVICE PROGRAMS - Cardiac Arrest, Congenital Heart Disease, Congestive Heart Failure, Heart Clinics, Public and Professional Education, Rheumatic Fever and Rheumatic Heart Disease, and Stroke Rehabilitation. All programs report significant increases in demands for consultation, training and orientation, speaking engagements, and various educational programs for lay and professional groups, requiring the continuous preparation of exhibits, visual aids, and various teaching or informational materials. A popular program available to public health nurses and hospital personnel has been the training course in mouth-to-mouth resuscitation and closed chest cardiac massage in which the film Pulse of Life and manikin "Resusci-Anne" are utilized as teaching aids. Complimentary subscriptions to the Heart Bulletin continue to be furnished physicians, hospitals, and medical students as a key tool in physician education.
The Service has continued to develop community stroke programs through lectures to medical societies and training of paramedical personnel and students. A team of three physical therapists, a nursing instructor, and a physician have succeeded
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in training a few personnel in almost every segment of the state. Moreover, the three physical therapists made well above 1,000 patient visits in consultation with nurses and physicians.
The Service continues to support 15 heart clinics over the state for diagnostic evaluation, surgery, treatment, all types of care, and medication for indigent heart disease patients. Continuing programs to maintain treatment regimens in cases of congestive heart failure are carried out through the clinics. In addition, the Service cooperates with the Crippled Children's Service in supplying personnel and equipment for diagnosis, treatment, and care of children with congenital and rheumatic heart disease through clinics, laboratories and hospitals, including hospitalization for acute cases. The rheumatic fever program furnishes prophylactic medication free of charge to heart clinics and private physicians for the protection of approximately 2,500 patients against recurrent rheumatic fever.
Much of the progress occurring in the heart disease programs may be due to an upsurge of interest originating at the national level. Georgia, along with many other states, was challenged to action by recommendations of the Second National Conference on Cardiovascular Diseases and the report
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of the President's Commission on Heart Disease, Cancer and Stroke, which prompted the appropriation of additional Federal funds to support and develop service programs at state and local levels. A special committee composed of representatives of the Medical Association, Heart Association, and Department of Public Health (including members of this staff) was organized to work with interested agencies and institutions in Georgia to plan follow-up programs to implement recommendations of these two national efforts and utilize, if possible, the new funds which have become available. The urge to "do something" is expected to gain impetus over the coming months, and if successful, these planning activities will ultimately affect the total cardiovascular disease program.
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EMPLOYEES HEALTH SERVICES
The major objective of the Employees Health Service is to provide a service that will enable the employee to serve his employer, the people of Georgia, in a better way. This is accomplished through: (1) counseling employees on health problems; (2) providing periodic multi-phasic medical screening tests; (3) administering first aid and emergency medical service; and (4) evaluating the physical status of applicants for employment by the state as reported by examining private physicians.
The purpose of counseling an employee on health problems is to educate him to the fact that the responsibility for his health is his own. Conducting and interpreting medical screening tests aids the employer, the employee, and the private physician in evaluating the health status of the employee. Conducting pre-employment physical examinations for the health department and evaluating pre-employment physical examinations for other departments enables the employer to obtain the best physically qualified personnel available for employment. The Employees Health Service is not an out patient clinic, and medical care beyond emergency care is not offered. Employees are encouraged to assume responsibility for their own health by seeking
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attention from a private physician. The total number of screenings during the past fiscal
year was 1,186. This is a total decrease of eight employees screened during the previous fiscal year. However, during the past five month period from July to November there have been 808 screenings conducted, which is an average of 63 more employees screened per month than previously screened.
Tabulated below are the various activities of the Employees Health Service during the fiscal year 1965 as compared with those of a like period for the preceding year:

Screenings Screening Revisits Counseling and First Aid Immunizations Other Total procedures Tuberculin skin tests

FY 1964 1194 772 3876 577 50
15711 866

FY 1965 1186 863 3818 522 50
16356 1009

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Laboratory investigations have included:

FY 1964

FY 1965

Blood Typing

454

639

Hemoglobin

1326

1302

W.B.C.

1226

1234

Differential

31

24

Serology

1012

1112

Blood Sugar
~1tt
Urine Complete

1105 1264

1507 1291

Urine Sugar

160

113

X-Rays

1557

1682

B.S.T.T.

32

l4

An interpretation of the results of screening tests for fiscal

year 1965 reveals:

Total number screened

ll86

Defects:

Overweight

95

Hypertension

8

Hemoglobin

18

Glucose tolerance test

3

Chest X-Ray

36

Serological test for syphilis

2

TBC skin test

98

Hearing

49

Distant vision

164

Near Vision

333

Visual fields

14

Two hours post prandial blood

sugars greater than llSmg%

59

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OCCUPATIONAL HEALTH SERVICE
The primary function of the Occupational Health Service is to protect the health of all people employed in Georgia through the promotion of good health practices. Program services include the provision of a consultation service to private physicians, local health departments, management, and insurance carriers; and a preventive health service for state employees.
There is considerable under-reporting of occupational diseases and conditions, the only sources of information being the insurance claims submitted to the Workmen's Compensation Board and death certificates filed with the Vital Records Service. During fiscal year 1965, seven of the deaths reported were due to silicosis as a suspected contributory cause, two to silico-tuberculosis, one to asbestosis, and one to pneumoconiosis as a condition contributing to death.
Occupational disease claims filed with the Workmen's Compensation Board totaled 89. This is fewer than the 319 reported during the fiscal year 1964. The reports were from 75 employers in 38 counties, and three out-of-state employers in three states. The reported conditions were: dermatitis - 58;
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chemical injury to the skin - 11; chemical injury to the eyes 3; overexposure to organic phosphorous compounds - 4; inhalation of fumes and gases - 11; possible lead intoxication - 1; and carbon monoxide poisoning - 1.
These data are utilized for study in an effort to determine the best methods of control. When indicated, local health departments are notified of the occurrence of occupationrelated 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
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maintained through participation in 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 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 a great potential exists to utilize the occupational health approach to deal 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
During this past year consultation, advice, and assistance were provided a great many local health departments in response to an ever-increasing number of requests, especially with reference to location and referral of contacts, suspects, and cases overdue for medical examination. Fewer recalcitrant patients were committed during the year.
The number of x-ray clinics held in local health departments as well as the number of persons x-rayed was again greater than in the previous year.
Free drugs were furnished 3,022 patients to complete hospital instituted chemotherapy, a decrease of 137 over the previous year. Free Isoniazid chemoprophylaxis was provided for 4,453 persons, an increase of 1,945 over the previous year.
Diagnostic and evaluation clinics were in operation in 13 centers and provided service to 116 counties. In addition, this service was made available through local resources in several large urban areas. The cost of patient transportation to and from these clinics continued to be a problem, especially in rural areas.
Project activities were expanded to the metropolitan areas
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of Atlanta, Augusta, Brunswick, and Savannah, bringing the total project area to 76 counties. This comprises less than half of the counties (159) but about two-thirds (2,955,996) of the total population (4,000,000). Approximately half of the new 1,314 active cases reported in 1964 occurred in the nine metropolitan areas of Albany, Atlanta, Augusta, Brunswick, Columbus, LaFayette, Dalton, Macon and Savannah, which are all included in the project area.
Within the counties receiving project assistance 94.2% of the suspects referred were examined, with a rate of 192.6 new active cases per 1,000 suspects referred. 96.7% of the contacts of new active cases were examined, with a new case rate of 46.5 per 1,000 contacts examined, including primary activities; 659 of the contacts examined were put on chemoprophylaxis.
But in the counties where there has been no project assistance, 57.9% of the suspects received final disposition and 51.3% of the contacts of active cases were examined, with a new case rate of 39 per 1,000 contacts examined, including primary actives. Project assistance is anticipated for every one of the 159 counties in Georgia within the next two years.
There was an overall increase of 6.1% of new cases reported during the period July 1, 1964 to June 30, 1965, compared to
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the same period one year ago. Study of these new cases reveals an increase of 5.8% in Group A (Active and probably active), and an increase of 10.1% in Group B (All other reportable cases).
Thirty fewer deaths from tuberculosis occurred during the calendar year 1964, a percentage decrease of 20.4. The rate per 100,000 was 2.8 as compared with 3.5 for the previous year.
During the next five years, our Tuberculsis Control program will be oriented toward aiding local health departments, especially those in metropolitan areas, in providing services in accordance with the Surgeon General's Task Force recommendations.
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VENEREAL DISEASE CONTROL SECTION
Previously Untreated Venereal Disease Cases Reported In fiscal year 1965, 2,479 cases of total syphilis were
reported to the department. This is a 13.4% decrease from the total syphilis cases reported for fiscal year 1964.
The 1,067 cases of primary and secondary syphilis reported in the fiscal year 1965 represent a 10.9% decrease from the 1,197 cases of primary and secondary syphilis reported for the previous fiscal year.
The 10,969 cases of gonorrhea reported in fiscal year 1965 represent a 3.0% increase over gonorrhea cases reported for fiscal year 1964.
The 291 cases of other VD (chancroid, GI, and LGV) reported for this fiscal year represent a 31.0% decrease from the other VD cases reported in fiscal year 1964.
The 10.9% decrease in reported primary and secondary syphilis cases in fiscal year 1965 is attributable to continued improvement in the epidemiologic treatment of named sex contacts to primary and secondary syphilis cases. During 1965 91% of the named sex contacts to primary and secondary syphilis cases, who were clinically and serologically negative upon initial
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examination, received epidemiologic treatment. Health Investigation Program
During fiscal year 1965 Health Program Representatives made a total of 25,072 investigations. From these investigations 2,281 previously unknown and untreated new cases of venereal disease were brought to treatment. Of these, 989 were primary and secondary syphilis cases.
All of the 1,067 cases of primary and secondary syphilis reported for this fiscal year were interviewed for contacts and suspects by our Health Program Representatives. All of the 492 reported cases of early latent syphilis were interviewed by Health Program Representatives for contacts and suspects.
All reactive serologic specimens processed in public health, hospital, and private laboratories during the year were followed up by our Health Program Representatives. Diagnostic and Treatment Services
During fiscal year 1965 the private physicians of Georgia treated 49% of our total reported syphilis cases, 31% of the reported primary and secondary syphilis cases, and 10% of the reported gonorrhea cases. District Health Department Area VD Diagnostic and Treatment Centers treated 51% of the total syphilis cases reported, 69% of the primary and secondary syphilis cases reported, 90% of the Gonorrhea cases reported, and 99% of the other VD (chancroid, GI and LGV) cases reported.
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special serv1 ces
branch

CHRONIC ILLNESS AND GERIATRICS SERVICE
The use of health investigators in health districts to supplement the staff in local health centers has been so successful that a permanent training program has been established on a yearly basis. The training period was reduced from nine months to six, still giving adequate time for successful completion of the required course.
Requests for assignment of health investigators continued to outnumber the trained men available and approval was granted for training eight in place of six men for the next fiscal year.
These investigators, under direction of the District Medical Directors, assisted the staff in making surveys of local needs relative to chronic illness and geriatrics and made plans to implement programs to meet these needs. In the past two years the Health Investigators have been able to relieve the Public Health Nurse of some of her administrative duties, allowing more time for her required professional activities. With the increasing shortage of professional personnel, these men will play a very important role in health activities in the years to come.
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Visits to nursing homes by consultants individually or as a team (nurse, physical therapist, and dietitian) have increased, and additional personnel, especially nursing, will be needed to meet the ever increasing requests for in-service training and upgrading.
Working in conjunction and close association with the Arthritis Foundation, Georgia Diabetes Association, Society for the Prevention of Blindness, Community Services for the Blind, and the Commission on Aging, the Service continued to review the needs in the counties for screening and detection programs for arthritis, diabetes, glaucoma, and pulmonary diseases. Plans were also formulated for a state "Register for the Blind". In cooperation with the District Medical Directors and county medical societies, many new clinics were established and screening programs implemented during the year for secondary prevention of deformity, complications and resulting disability. The Service has more than doubled activities in this field during the past year.
Frequent visits were made to the Dalton Home Care Program for observation and follow-up. This program is now in its third year and has proven very successful in offering needed home care services to the home bound as well as to those needing
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professional and home care to avoid re-hospitalization and extended hospital care. Similar programs with a staff of registered nurses, licensed practical nurses, homemakers, or home health aides and social workers with consultation from a qualified physical therapist and dietitian are recommended. These programs can either be health department or hospital based, preferably health department based in close cooperation with the hospitals and county medical societies.
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BATTEY STATE HOSPITAL
Application for admission decreased from 1,506 in the previous year to 1,426. Admissions declined from 1,373 in the previous year to 1,275.
The patients admitted were classified as follows: nine percent minimal pulmonary tuberculosis, 30 percent moderately advanced, 39 percent far advanced, four percent primary, two percent other classifications of tuberculosis, 15 percent tuberculosis suspects, two percent non-tuberculosis. One thousand and one (1,001) of these patients were admitted for the first time. Six hundred and three (603) of them had positive bacteriological findings. One hundred and twenty-three (123) of 274 patients readmitted had positive bacteriological findings. There was no increase in primary drug resistance.
From the previous year, the number of patients discharged decreased from 1,498 to 1,328. Fifty-nine (59) patients, four percent of the live discharges, were excreting tubercle bacilli at the time of discharge. Thirty-eight (38) of these patients were excreting mycobacterium tuberculosis and 21 were excreting "atypical tubercle bacilli".
The average length of stay for patients with pulmonary tuberculosis was 166 days. The non-tuberculous and tuberculosis
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suspects were hospitalized for an average of 65 days. The overall average stay of the 1,328 patients discharged was 149 days. Twelve (12) percent of the patients discharged were diagnosed as being non-tuberculous.
One (1) patient received a disciplinary discharge during the year. One hundred and nineteen (119) patients left the hospital prior to a medical discharge--one out of 10 patients. One (1) of three people leaving against advice were excreting tubercle bacilli.
The treatment program, including both medical and surgical programs, continues to be very successful. The clinical research programs continue to function well and to provide interesting and useful information which formulate the guidelines for the therapeutic program.
The daily occupancy ranged from a low of 474 patients to a high of 547 patients with a daily average census of 498 patients.
The per diem day cost relative to patient care was $16.52.
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MEDICAL FACILITIES SERVICE
During fiscal year 1964-65, 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 organized programs of the service:
(1) Community Survey and Areawide Planning Program to aid communities in planning for new, expanded and improved medical care facilities and services.
(2) Architectural-Engineering 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.
At the end of the year, 84 applications were pending for
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grant-in-aid assistance with an estimated construction cost

of $88,695,000.

Grant projects placed on the construction schedule and

approved for grant-in-aid during Fiscal Year 1964-65 were as

follows:

TYPE PROJECT

NUMBER BEDS

TOTAL COST

General Hospitals - Including Additions

8

712 18,158,543.80

Psychiatric Hospitals

0

0

0

Public Health Centers and Auxiliaries

8

751,000.00

Nursing Homes - Including Additions

6

244 2,675,735.38

Rehabilitation Facilities

1

70 1,626,555.66

Diagnostic and Treatment Centers

1

1,015,216.40

Total

24

1,026 2412271051.24

The Medical Facilities Planning Section developed new planning policies, procedures, and methods of administration in the annual revision of the Georgia State Plan for Hospitals and Related Facilities. New methods of calculating hospital and nursing home bed needs were used in developing the State plan and area priorities for grant assistance.
The Medical Facilities Construction Section reviewed, according to established standards, all plans and specifications

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submitted for Hill-Burton projects and many other hospital and nursing horne projects constructed outside the program. Proposed sites were inspected with comments to sponsors and their architects. Plans and specifications, reviews and frequent on-site inspections provided the sponsors, architects and engineers with consultive services and recommendations relative to functional planning in architecture; structural, electrical, and mechanical engineering; equipment procurement and preventive maintenance.
In the Hospital Licensure Section there was also evidence of improvement in the quality of hospitals and hospital service. The number of hospitals operating under full licensure permit increased form 160 to 191. Four new hospitals were opened, one completely renovated and seven closed. The number of facilities operating under provisional permit decreased from 49 to 18.
In Nursing Horne Licensure there was continued evidence of increased quality and quantity in nursing horne facilities and personnel. The number of licensed institutions increased from 166 with a capacity of 6,641 beds to 188 with a capacity of 8,689 beds. The majority of the newly licensed facilities were of new construction and qualified for permits in the more
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skilled classifications - thus continuing the strong movement toward 24 hour nursing care. Of the 28 unlicensed homes representing 363 beds known to be in existence at the beginning of the year, 16 were brought into compliance. Six new unlicensed homes, however, were found in operation, leaving a residue of 16 known unlicensed homes with a capacity of 219 beds.
Consultation in clinical laboratory, food service and nursing administration and accounting procedures was also provided to medical facilities throughout the State.
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