Annual report 1968-1969 [June 30, 1969]

GEORGIA STATE BOARD OF HEALTH

B. W. Forester, M.D., Chairman

John M. Martin, M.D., Vice-Chairman

J. T. Mercer, D:V.M., Secretary

Harrison Bray

John E. Garner, Jr.

W. Frank McKem ie, M.D.

Wesley A. Carr, D.D.S.

Roy L. Gibson, M. D.

Lamar B. Peacock, M. D.

Lee Roy Claxton, R. Ph.

L. H. Griffin, M. D.

Carl E. Pruett

William A. Dickson, M. D.

John D. Marshall, R. Ph.

Richard H. Smoot, M.D.

P. K. Dixon, M.D.

Earl T. McGhee, M. D.

A. C. Tuck, D. D. S.

ANNUAL REPORT GEORGIA
DEPARTMENT OF
PUBLIC HEALTH
JULY 1, 1968 ~ JUNE 30, 1969

SERVICE - that's what public health is service to all people. Measuri.ng this service is difficult.
Public health results can never be totally measured by the numbers of people examined, tested, treated, immunized or institutionalized, nor can these efforts be evaluated in terms of the number of environmental health inspections made, rules and regulations passed, or laws enforced.
Public health statistics are merely indicative of the scope of activities of a health agency. In the reports that follow, some of these indicative figures are given. While the numbers of people receiving direct health services are significant, as are the kinds of services rendered, I would like to stress that they by no means tell the whole story.
There is no resident of this state whose quality of life is not in some way affected by public health services. The prevention and control of disease in the total population, certification and licensure of hospitals, maintenance of pure air and water and many other health concerns of ours are concerns of yours. In discharging our public health responsibilities, we serve each of the four and a half million people who now reside in the state.
The fact that we constantly strive for excellence in our service role will be apparent to all who take the time to review this report. I present it with pride to you, the people of Georgia.
John H. Venable, M.D., Director, Georgia Department of Public Health

WE SERVED 4,500,000
PEOPLE

Home health care programs were organized in eight more counties, bringing to 61 the number in which home care is offered.

A special coordinator was added to the staff to work on interagency health programs - programs being planned and implemented in conjunction with HUD , EOA, Model Cities, Neighborhood Service Centers, and other agencies.

Outpatient, consultative, educational and aftercare services were extended into 10 additional counties, bringing to 67 those with mental health programs.

Perhaps most significant of all, comprehensive health services based on a team approach were developed to replace categorical programs of the past. Health program representatives who were formerly assigned to tuberculosis control, vaccination assistance or venereal disease, for example, now work in all areas - an improved use of health manpower at the regional and local level.

SERVICE people.

that's what public health is service to all

WE EXPANDED
LOCAL PROGRAMS

Two new veterans' buildings at Central State Hospital, Milledgeville, opened - a recreation building and the Carl Vinson Veterans Home, a 150-bed residential unit.
Southwestern State Hospital, Thomasv.ille, opened two new units - the Rose Haven Medical Nursing Care Center, which provides 120 beds for bedfast retardates, and a Vocational Work Evaluation Center.
Two regional mental health hospitals were opened. The Georgia Regional Hospital at Atlanta began operations in the fall of 1968 and a parallel facility at Augusta admitted its first patients in April 1969. Together these hospitals added 850 beds- for a total of 13,225 - to those available to the men tally ill and the mentally retarded in the state.
Construction was completed on three new local health centers in Laurens, Hart, and DeKalb counties. The DeKalb Center includes a feature unique in Georgia - a health museum.
Each of these new facilities is important, not in terms of architectural design or dollar value, but in terms of the people it will serve.
SERVICE - that's what public health is - service to all people.

WE OPENED NEW
FACILITIES

At the end of the fiscal year, 9,518 people were full time public health employees - an increase of only 8.2% over the previous year despite program expansion, the opening of new facilities, and a greatly enlarged caseload of person seeking services.
The largest personnel increase was in the Division of Mental Health where the two new regional hospital added 334 employees. Central State's staff increased by 243; Southwestern, 20; and the Georgia Retardation Center, 16. Gracewood's work force decreased by 54 employees.
The state office staff was reduced by nine persons. Local Health increased its employee rolls by 44 workers.
The largest classification increase came in the sub-professional and technical ranks with the addition of 338 individuals. Recruitment efforts were less productive in professional ranks. We employed only 11 new nurses and three psychologists, for example, during the year.
As an adequate number of health workers is essential to handle an expanding patient caseload and to deliver quality care and service, manpower needs continue to carry a high priority rating.
SERVICE - that's what public health is - service to all people.

WE EMPLOYED
9,518 PEOPLE

Continuous, on-going training is an integral part of public health. Like public health's overall impact, training efforts are difficult to measure.
Some training experiences are measurable, in a limited way, by the numbers of persons who participate. When large numbers of health workers are included in instructional programs, it is indicative of an organization's desire to improve its utilization of manpower and to create reservoirs of competent personnel throughout the service area.
During the year, 136 students in health disciplines were given academic stipend support by this Department; 1,239 health workers attended 201 in-service training courses; 105 new employees received orientation training and one resident was trained . An approximate 1500 nursing staff, including registered nurses, licensed practical nurses, and nursing aides from nursing homes, small hospitals and public health agencies were given instruction in rehabilitative nursing techniques.
While the training of almost 3,000 health workers is significant, it is also factually incomplete. Every state institution, every service and every program of the Department provided training to its own employees and other health workers not mirrored by this total -training aimed at the improvement of health service to the people of Georgia.
SERVICE - that's what public health is service to all people.

WE TRAINED HEALTH
WORKERS

We spent $150 million on public health services in Georgia during the year - an average of about $33 for each man, woman and child in our 4.5 million population.

State appropriations amounted to $77,532,182 and
$73,158,178 came from federal and other agency sources and collections from patients' accounts.

In very broad terms, expenditures were:

$54,029,546 for state institutional care and treatment of the mentally ill, mentally retarded, and tuberculosis patients;

$61,913,342 for Medicaid program services;

$15,150,895 for construction and rentals;
$12,950,227 for state programs, goods and services, laboratories, administration, education and planning;

WE SPENT

$6,646,350 for local health programs. (Budgets of local health offices are shared by city and county governments and
some local income comes from the collection of modest service fees. These funds are not reflected in the Department's reported expenditures.)

$150,690,360

In today's inflationary economy, $33 a person a year obviously will not buy a great deal, particularly in the health field where goods and services have risen to all-time high cost levels. However, when programs are carefully budgeted and tightly controlled, even that small sum makes a sizeable contribution to the health and well-being of our people.
SERVICE - that's what public health is - service to all people .

State Funds: $77,532,182
Federal and Other: $73,158,178

GiNERAl ASSEMBLY OFGEORGIA
I
GOVERNOR

I STATE BOARD OF HEALTH

WATER QUALITY* CONTROL BOARD

I

DIRECTOR

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GEORGIA DEPARTMENT OF PUBLIC HEAlTH

AOM IN~~TRAT ION II --------- ----------------------------------,

DEPUTY DIRKTOR

OFFICE ***I

OFOFFICE lOCAl HEALTH

COMOFPFRIECHEENOSFIVE HE ALTH PLANNI NG

DIV ISION FOR GA .
WATER QUALITY CONTROL

DIVISION OF
MENTAL HEALTH

DIVISION OF
MEDICAL CARE ADMIN ISTRATION

DIVISION OF
EPDEMIOLOGY

DIVISION OF
PHYSICAL HEALTH

I
BRANCH
" TRAINING
A~D RESEARCH
GKIRGIA MENTAl tEALTH IHSTTTUTE
Gf~ RfTARDATKlH CENT!R

BRANCH
" HOSPITAL
SERVICES
HOSPITALS
UNTRAL STATE HOSPITAl
GRACIWOOO STATE SCHOOL & HOSPITAL
SOUTINIESTIRN STATE HOSmAL
llfGIONAL STAll OOSPITALS

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BRANCH
" COMMUNITY
SERVICES
OMMUNITY MENl.A. HEAl!~ RETARDA liON, AND ALCO
HOlK IERVKES

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BRANCH
" MEDICAl
AS SISTA NCE
SERVICE
CRIPP\.EOOtii..MEN" MEDICA.IO

BRANCH Hf.ALTH I"AOUTIES PLANNII-IG AND CONSTR UCl/ON
f'tANN tNG ANO CONSTRUCTION SUYICES

BRANCH
" CERTifiCATION
AND liCENSURE
CONSUt TAliON, CERTIFKATIOti ANO LICENSURE IERVKES

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BRANCH
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INVESTIGATIONS
SEll: VICE
SIOI.OGICSTI.X>IfS SECTION
DISEASE AND DISABILITY STIX>IES SCTION
PUBUC HEALTH VffiiiiNARY SllTION

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BRANCH
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LABORATORIES
Sf RVlCE
TWiNIC.Al PROGRAM CENTRAL AHO REGIONAL t.ABOAATOA:IS
TECHNICAL STAFF

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AIR POllUTION CONTROl
.6.1R QUAUTY EVAlUATION

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" HEALTH
CONSERVATION
SERVICE
MATERNAL HEALTH CHILD HEALTH

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TUBERCULOSIS SE RV I ( E
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BATIH STATE HOSPITAL
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BRANCH
" NVIRONMENTA
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ENVIRONM~N1At
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INDlJSTii:IAL HYGIHt
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CAROIOVASCUI.AR DISEAS E CONTROl.
CHRONK ClSEASI AND Gf~IATRICS
OCCUPATIONAL HEALTH SE HS SE(t!ON
VO CONTROl
CANCER CONTROl. S(TI{)H

l OCAl HEAlTH D!STRTCTS LOCAL HEALTH DE PA RT ME NTS

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STAT US 7/l/ 69

TABLE OF CONTENTS
DIRECTOR'S OFFICE Emergency Health Service Nursing Service . . . . . . .
OFFICE OF ADMINISTRATION Accounting ........ . Biostatistics ....... . Education and Training . General Staft Services Patient Accounts . Personnel Service Vital Records ...
OFFICE OF COMPREHENSIVE HEALTH PLANNING
OFFICE OF LOCAL HEALTH ...
DIVISION OF MENTAL HEALTH Branch of Training and Research Branch of Hospital Services ... Branch of Community Services .
DIVISION OF MEDICAL CARE ADMINISTRATION Branch of Medical Assistance . . . . . Branch of Health Facilities Planning and Construction . . . . . . . . . Branch of Certification and Licensure .
DIVISION OF EPIDEMIOLOGY Branch of Epidemiologic Investigations Branch of Laboratories . . . . ..
DIVISION OF PHYSICAL HEALTH Branch of Air Quality Control Branch of Health Conservation Branch of Tuberculosis . . . . Branch of Dental Health . . . Branch of Environmental Health Branch of Special Health Services
IN CONCLUSION . . . . . . . . . . .

Page
.1 .4
.5 .5 .6 .7 .8 .8 . 10
.. 11
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.. 17 . 21
. . 31
. 39
. 41 . 42
. 43 . 46
. 55 . 57 . 61 .. 63 . 65 .. 83
. . 93

Governor Lester Maddox, who has shown a strong and consistent concern for Georgia's health needs, meets with members of the State Board of Health during one of the Board's monthly meetings. Members of the 18-man Board shown at the Governor's left are Dr, P. K. Dixon and Dr. J. T. Mercer. On his right are Dr. Roy Gibson and Dr, Earl McGhee, and in the background, Dr. Elton S. Obsborne, Jr., deputy director of the State Health Department.

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The effectiveness of Georgia's Radiological Defense system depends on the operational condition of detection instruments. Periodic maintenance work, pictured here, insures serviceable instruments throughout the state.

EMERGENCY HEALTH SERVICE
Primaril y a planning, coordinating and instructional unit, this service has statewid e responsibility for both emergency service needs and commun ity disaster demands. Activities are carried on in four principal program areas - med ica l se lf-h elp, highway safety, radiological def ense, and packaged disaster hospital s.
While ongoing maintenance, inspection and training are basically the same from year to year, some of the more important accomp lishments of the service during this fiscal year follow.
MEDICAL SELF-HELP PROGRAM
Over 55,000 students completed the medical self -help training cou rse - the largest number ever trained in a single year. A program goal is the eventual training of at least one member of each family in Georgia in these essential life-sav ing techniques.
RADIO LOG ICAL DEFENSE PROGRAM
Emphasis was placed upon the creat ion of an operationally ready radiologi ca l monitoring, reporting and evaluating system capable of providing accu rate and timel y information on the extent, intensity and duration of rad iologi ca l fallout hazards shou ld a nuclear attack occur.
Of the 2,490 monitoring stations esta bli shed, 210 were reassigned to sites that offer more protection an d/or better geographic coverage. Approximately 800 monitors were trained and 27 well trained indivi duals were assigned as radi ological defense staff officers on the state and sub-stat e level s. Other activiti es of significance during the year were:
Radiological monitor instructors certified ...... 12 Radioactive training source licensees . .... .. .. . 5 Instruments inspected . . . .. . . ... .... .. 15,539 Instrum ents repaired . . . . . . . . . . . . . . . . . . 7,397 Instrum ents calibrated . . . . . . . . . . . . . . . .. 5,392

This dramatic Pulitzer prize winning photo shows a lineman who had touched a high voltage wire. He recovered because his co-worker knew mouth-to-mouth rescue breathing. ... .Photo Courtesy Rocco Morobito and the JACKSONVILLE HERALD

This youngster was found face down in a
I re~~~-e~e ~~~~~~o~~:~~ ~!~~~t~~~:ta: "' ing . . . . . .Photo courtesy METROPOLITAN LIFE INS. CO.

PACKAGED DISASTER HOSPITALS
Negotiations were conducted throughout the year with community hospitals for affiliation of packaged disaster hospitals, reserve disaster supplies and natural disaster hospitals. Sixteen packaged disaster hospitals are now affiliated with community hospitals. Thirtyfour others are strategically located throughout the state. Eleven community hospitals affiliated with the reserve supply (HRDI) program, adding 47,000 patient days of reserve supplies on hand in the state and bringing emergency medical stockpile supplies to a total of 232,000 patient days of care .
Two natural disaster hospitals were obtained and placed in Savannah.
All packaged disaster hospitals in the state were inventoried and found to be in excellent condition. Two hospitals were relocated to better storage during the year.
Planning for a packaged disaster hospital is a cooperative effort. Shown during installation of a new unit in Lafayette are: Oscar Hilliard; Adm. J. L. Hutcheson, Memorial Hospital, Ft. Oglethorpe; Dr. H. K. Sessions, Georgia Depart ment of Public Health; Dr. R. T. Jones, Lafayette physician; Dr. M. K. Cureton, District Health Director; Bob Jones, Asst. Adm., Hutcheson Memorial Hospital; and W. L. Abney, city-county Civil Defense Director.

Ambulance attendants pick up an accident victim.

HIGHWAY SAFETY PROGRAM
An overview of Georgia's resources and needs in the provision of emergency medical service, along with suggested improvements in service, was presented at a three-day conference at the University of Georgia. It was well attended by hospital administrators, physicians, public safety officials and health workers from all over the state. Proceedings of the con feren ce were published and widely distributed for local planners' use in upgrading emergency medical services in their own communities.
Numbers of funera l home directors announced their intention of discontinuing their ambulance services during the year. Counties facing this problem that of being completely without ambulance service once it was discontinued by funeral homes - required advice and assistance from Highway Safety Program personnel in planning replacement services. Highway safety projects to organize ambulance services for 10 counties were developed, approved, and submitted for funding . One project was approved for construction of a he\ iport.
Adequate ambulance service, provided by competent personnel trained in emergency medical techniques and procedures, is vital if lives of traffic accident victims are to be saved - many now die at the site of the accident or on the way to the hospital for want of proper care. Efforts to see that the state has these needed services is a major goal of this program, and a goal that merits statewide citizen support.

NURSING SERVICE
Over the hills of Dade and Rabun, under the pines of Seminole and Echols and down to the shores of Glynn county, quietly but steadily public health nurses have continued to make skilled nursing care a reality to Georgia people. Through revisions in the orientation and training of new nurses, and repeated stress on inservice education, public health nurses are becoming more knowledgeable in the provision of comprehensive patient care.
Rehabilitative nursing, including some clinical practice, and the nurse's role in the care of patients and families with mental illness, mental retardation and alcoholism were particularly emphasized this year. Both the numbers of patients added to nursing caseloads and the "success stories" reported by health agencies speak eloquently of the effectiveness of this training.
The extended role of the public health nurse in child health supervision is being studied in at least one he aIth district. Consultation was provided throughout the year to improve present nursing services to mothers and children .
Nursing follow-up of patients on control drugs was facilitated by completion of the computerization of the rheumatic fever and tuberculosis registries .
Nursing staff for two new regional hospitals opened to serve the mentally ill, the retarded and the alcoholic -were employed, in addition to a Director of Nursing Service for the Georgia Retardation Center. Despite these institutional additions, and the expansion of program services throughout the state, the net gain in registered nursing staff during the year was insignificant. The most appreciable gains were in licensed practical nurses and non-1 icensed staff. The level of professional nursing supervision remained at a dangerously Iow level.
A depth study of nursing classifications was completed during the year. Recommendations based on the study provide for recognition of preparation and experience, recognition of continuing education for promotion, upgrading of grossly inadequate salaries, differential pay for evening and night shifts, and reorganization of nursing services in the state office. At the close of this reporting period, indications are that most of the recommendations will be implemented during fiscal 1970 - with a resultant improvement and expansion of nursing services all over Georgia .
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OFFICE OF ADMINISTRATION
While some direct services to health consumers are provided by units of the Office of Administration, its major responsibility is to other programs and services within the State Health Department. How efficiently Administration and its component parts function has considerable bearing on both the quality and the quantity of people-to-people health services rendered by the Department. Improvements effected during this reporting period are significant for that reason the contribution they made to an overall enhancement of public health services to Georgia's 4.5 million people.
ACCOUNTING SERVICE
Expenditures for which Accounting maintained fiscal records this year were over $150 million -the largest amount ever expended by the Department. Funds were received from 15 different state appropriations as well as a number of federal agencies. Records were also maintained for 42 active projects.
Effective July 1, 1968, an accrual accounting system was begun for all state departments. In close cooperation with the Data Processing Section, necessary changes were made to a! ign our system with the statewide system.
BIOSTATISTICS SERVICE
Biostatistics coded, analyzed and presented data generated by the year's vital events - births, deaths and other important occurrences of life - for the entire state. Based on data compiled, the following annual reports were prepared, published and distributed to health agencies, groups and organizations, and to individuals upon request:
1) Georgia Vital and Morbidity Statistics 2) Annual Statistical Report (Departmental) 3) Medical Directory of Georgia by County 4) Estimated Population by Race, Sex, Age 5) Annual Statistical Report of Outpatient
Psychiatric Clinics
Consultative services to program and project personnel increased during the year in both number and complexity of requests, a probable continuing trend as staff become more knowledgeable in their use of Iife and health data. The collection and analysis of data on characteristics and treatment provided patients in institutions now underway illustrates this expanding service role. From this material, mental health workers will one day be able to determine the comparative efficacy of various treatment techniques as they apply to specific patient groups.
Biostatistics is primarily an internal service unit; nonetheless, it has positive relation to the Department's pub! ic health role as it tends to reflect program effectiveness and to chart the direction in which public health services must go in the future.
5

EDUCATION AND TRAINING SERVICE
Growing interest on the part of health workers . media representatives and others - much in evidence throughout the year -indicated that health is not only "big business"; it is a major item of concern to all people. Ultimately, this increased interest and demand for more and more health information should improve individual and community health, and have an environmental impact as well.
Some specific achievements of the five units that make up this Service follow.
HEALTH EDUCATION
Two inter-disciplinary workshops were sponsored during the year - one in Program Planning and Evaluation and one in Family Life Education. Emphasis in both conferences was on better preparation of state and regional staff in their provision of professional services.
Consultation was continued to departmental program directors in planning and implementing the health education aspects of their services. Numerous visits were made to district and local health depart ments to work with staff in developing health education goals and ways of meeting them. Other activities focused on colleges and universities, within and without the University System, to plan for improved health education curricula in general and that of future health teachers, in particular.
Films, booklets, brochures and other educational materials were screened and appropriate ones bought. Budget Iimitations were restrictive. Purchases had to be tightly controlled, based on priority needs, and largely limited to those materials that would be useful to professional people in the health field.
LIBRARY
During the past year, the Library served public health workers and the public by collecting, organizing and distributing literature concerned with the improvement of medical care. Holdings of the Library increased to 17,785 books, 4,236 bound volumes and around 1,000 pamphlets and government documents.
Specific services included answering 1,095 reference questions, furnishing resource materials used in developing programs and projects, preparing bibliographies on special topics, compiling a union list of the serial holdings of the Departmental libraries and the devetopment of a brochure describing each of the libraries.
Needed indexes and reference materials for the State Library and materials for Central State, Gracewood, and Southwestern institutional libraries were purchased under a continuing fund grant from the National Library of Medicine.
Future plans include participation in the Regional Medical Library Program and increased service to paramedical students in the area.
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PUBLIC INFORMATION
The public information unit provided the mass media some 100 news releases and health features in addition to numerous specially prepared radio and television scripts.
Special concentration promotions included: a program to reactivate back into medical service, medical technologists who had left the field for various reasons; publicity support to the Vaccination Assistance Project and to local health departments in support of compulsory immunization of public school children; a joint effort with the Department of Public Safety on automotive accident prevention; and a statewide, coordinated publicity campaign for the Air Quality Control Board and local health department air pollution abatement programs.
During this period, the 12-week television program on environmental health in Georgia was completed by the staff, working with WGTV, the state's educational television station.
Major revision and updating of the Department's slide presentation, "Georgia's Health", was completEd - including its development into two different length programs.
Continued monthly publication of GEORGIA'S HEALTH and FACTS was carried out by this unit.
TRAINING
A total of 136 people underwent academic training in fields related to public health, such as nursing, sanitation, administration and epidemiology. A total of 201 inservice courses were attended by 1,239 people from throughout the Department. Orientation and training, ranging from one day to several weeks, was arranged for 25 visitors from 19 foreign countries.
Special courses to fit key needs of the Department were set up to provide instruction in program evaluation, written communication for executives, report writing for environmental health personnel, and conference leadership.
VISUAL COMMUNICATIONS
This unit provided illustrations, layouts, lettering and paste-ups for printed materials produced by the Service and the Department. Additional services to staff included cartography, drafting, and the production of ozalid prints, signs and exhibits.
The Photographic Lab completed over 60 assignments ranging from a single shot to 150 pictures, processed the film and provided the needed prints or slides. In addition, the lab turned out positives for use in overhead projectors and made some 6,556 copy negatives.

GENERAL STAFF SERVICE
Although the majority of General Staff Service personnel have little or no direct contact with individual health consumers, there is a definite correlation between their work and the caliber of health service provided in the state.
All of the news releases that go out to inform the public of threats of disease, to encourage protective immunization and the like must be produced, addressed and mailed through units of this Service. All of the drugs and sup pi ies furnished by the State Health Department must be purchased, checked in, stored, assembled and shipped out by units of this Service. While the operation is strictly a "behind the scenes" one, it still makes a definite contribution to the health and well being of Georgia people.
Seven distinctly separate units comprise the General Staff Service. During the year, goods and services provided by each unit increased in number and in dollar value.
CENTRAL RECEIVING
This unit checked all Departmental purchases delivered to the State Health Building. The approximate value was $966,000. Many of these items were iater dispensed to individuals and to local health offices.
Mail service, an integral part of the unit, daily handled around 850 pieces of interoffice mail, 3,880 pieces of incoming mail and 8,000 pieces of outgoing mail.
Miscellaneous duties included preparing for mailing or storing those materials produced in the Print Shop and providing pickup and delivery services to state offices.
CENTRAL SUPPLY
The storage center for office forms and supplies used by state offices and for forms, drugs and biologicals furnished local health departments, hospitals, physicians and clinics that provide individual health services, Central Supply received and handled 37,800 requisitions during the year. These requests included drugs valued at $350,700; 1,200,000 Medicaid program forms; 380,000 rabies vaccination tags and links; materials for 725,000 immunizations and numerous other items. Over 74,000 separate packages were shipped to requisitioners in fiscal 1969.
PRINT SHOP
The Print Shop handled 2,795 orders, representing a total of more than 25,000,000 pieces of material which were produced. Included were 93 different educational items for distribution to the general public and four publications mailed periodically to 60,000 Georgians.

RECORDS UNIT
This unit studies the initiation, reproduction, utilization and storage of departmental forms, publications and files in an effort to insure practical and efficient usage of these forms. Currently, the Department is using 1,121 forms which have been studied. In addition to routine duties this year, Records Unit personnel served on the task force for standardization of patient forms used in state mental institutions.
PROCUREMENT OFFICE
Procurement handled 32,789 purchase requisitions for an estimated $13 million from the Department's central offices, hospitals and institutions which were processed and forwarded to the State Purchasing Department for obtaining vendor bids. State office personnel also assisted staffs of new facilities, including the Georgia Regional Hospitals at Atlanta and Augusta and the Georgia Retardation Center, in setting up their procurement operations.
PROPERTY CONTROL
This unit continued to maintain a current inventory on the 22,735 items - 1,735 of which were purchased this fiscal year - owned by the department. Consultative services were also provided institutions and hospitals in adapting to new computer inventory procedures.
SWITCHBOARD AND INFORMATION DESK
Through thre_e switchboards, this unit handled approximately 2,000 incoming calls and 240 (WATS Iine) long distance calls daily, and also sup pi ied information and directions to around 100 visitors each day.
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PATIENT ACCOUNTS SERVICE
This service maintained records and collection reports on patients in all hospitals and institutions managed by the Department and the State Board of Health. Progress was made in the number of payments made during the year, as well as in the amount of payments received from patients, persons legally responsible for patients, insurance companies, Medicare and Medicaid programs, Social Security and other sources.
An increase of 47% in collections, this year over last, resulted.
PERSONNEL SERVICE This was an active year in Personnel Services as initial staffing continued at the regional hospitals at Atlanta and Augusta and recruitment efforts intensified to fill positions at the Georgia Retardation Center. A core staff was also employed for the Georgia Regional Hospital at Savannah, preparatory to its opening in early 1970. Total full-time employment as of June 30, 1969 was 9,518, an increase of 8.2% over the previous year. Table 1 shows the distribution of employees by location and Table 2 illustrates the variety of occupational fields which these employees represent. A shortage of skilled manpower persisted throughout the year. Non-competitive pay rates, aggravated by an inflationary economy, remained the rule rather than the exception. As a partial solution to hiring problems, numerous classifications were reviewed and pay rates revised. The Engineer and Activity Therapies were reworked, and a new Nursing series was developed and approved for implementation next year. A study of the Professional Medical Series was begun, with a target date for implementation in late fall, 1969.
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TABLE 1: FULL-TIME EMPLOYEES BY LOCATION

Organizational Unit
State Office Local Health Fulton County Alcoholic Rehabilitation Atlanta Regional Hospital Augusta Regional Hospital Battey State Hospital Central State Hospital Georgia Mental Health lnst. Georgia Retardation Center Gracewood State School and
Hospital Savannah Regional Hospital Southwestern State Hospital
Total
*Merged with Georgia Mental Health Institute, October, 1968

June 30, 1968
926 1293 314
60 20
4 496 3645 370
9
1145 0
503
8785

June 30, 1969
917 1337
312 0*
197 161 542 3888 423
25
1091 2
623
9518

TABLE II: FULL-TIME EMPLOYEES BY OCCUPATIONAL CATEGORY

Category

June 30, 1968

Physicians Dentists Graduate Nurses Therapists Engineers Sanitarians Physical Scientists Nutritionists Education & Information Specialists Psychologists Social Workers Other Professions Sub-professional & technical Managerial Clerical Agricultural Trades & Crafts Services Laborers Miscellaneous

189 21
905 44 36
215 106
15 53 33 74 67 3505 141 1433 55 535 625 718 15

Total

. 8785

June 30, 1969
203 19
916 46 49
233 121
17 74 36 84 88 3843 186 1524 48 577 726 716 12
9518
9

VITAL RECORDS SERVICE
A total of 291,068 records representing 230,181 vital events were processed during the year and recorded in the Vital Records Service. These records consisted of 90,668 current births, 42,175 deaths, 2,970 fetal deaths, 60,887 marriages, 15,782 divorces, and 17,617 delayed birth certificates.
Georgia's marriage and divorce statistics coincide with the national trend by reflecting a continued increase in the number of marriages and divorces. However, the small increase in births is in contrast to a decline in the national birth rate. Current births for the Fiscal Year increased in Georgia 3,192 or approximately 4% over the previous Fiscal Year while the number of marriages increased 1,568 or 3% and the number of divorces increased 538 or 4% from the previous year.
Adoption orders for 4,475 children were received and processed. New birth certificates for 3,901 adopted children were completed and registered. Legitimation procedures for 2,500 children born out of wedlock were completed and new birth certificates were registered for these children. The number of children both adopted and legitimated continues to increase each year.
Superior court orders changing the legal name of 254 persons born in Georgia were received and their birth certificates amended accordingly. Over 8,500 applications for amendments correcting errors on birth and/or death certificates were received resulting in 5,720 certificates being amended and almost 2,800 still in process.
More than 295,000 requests for certification and/or verification of birth, death, marriage, and divorce records were received from individuals, family members, attorneys, schools, welfare agencies, research groups, other governmental agencies, industries and private agencies -a 7% increase over the previous fiscal year. Of these requests, 86,529 were for certified copies of records which were processed resulting in the issuance of 70,269 certified copies. This is an incr~ase of 2,520 in certified copy requests and an increase of 1,504 certified copies issued over the previous year.
10

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Dr. Thomas J. Anderson, Jr., Atlanta, physician Mrs. J. Mac Barber, Athens, Future Homemakers of America State Advisor Dr. J. Gordon Barrow, A t lanta, Director of Georgia Regional Medical Program Dr. Louis C. Brown, Atlanta, physician Mr. A. E. Burel l, Smyrna, business executive Mr. Norman D. Burkett, Dalton, hospital administrator Mr. Wil liam H. Burson, Atlanta, Director of Georgia Department of Family and Children Services Mrs. Hunter M. Clay, Savannah, civic leader and housew ife Hon. John L. Cromartie, Mayor of Gainesvil le and business executive Mrs. R. M. Hair, Jr., Buena V ista, newspaper associate editor Mr. Boisfeui ll et Jones, Atlanta, private foundati on president Miss Eugenia Lee, Augusta, nursing educator Mr. Harold Lummus, Colum bus, business executive Mr. Natt Maddox, Toccoa, pharmacist Mr. Ernest Napier, Moultrie, restauranteur Dr. Jack P. Nix, A t lanta, State Superintendent of Schools Dr. R. Glenn Reed, Jr., Marietta, dentist Mr. Glen P. Robinson, Jr., Atlanta, business executive Dr. George L. Simpson, Jr., Atlanta, Chancellor of State University System Mr. J. V. Skinner, Macon, banker Dr. Horace Tate, Atlanta, Executive Director of Georgia Teachers and Educational Association
Mr. R. L. Tindol, Jr., Atlanta, business executive
Miss Mary Webb, Atlanta, Executive Director of Georgia Easter Seal Society Mr. H. Oliver Welch, Atlanta, State Planning Officer Mr. Jack Williams, Jr., Waycross, newspaper publisher

OFFICE OF COMPREHENSIVE HEALTH PLANNING

Since the initial annual report made by this office last year, the staff and its advisory council, a 25-member group appointed by the Governor and known as the Georgia Comprehensive Health Planning Council, have worked together on a variety of important health-related problems in Georgia. A planning process that will relate directly and effectively to the health needs of the people of the state received particular emphasis.
Because of the present fragmentation of health services being offered by state and federal agencies, volunteer organizations, private and local agencies, improved coordination is a prime need. Concerted attempts were made during the year to achieve this needed coordination. A workshop on comprehensive health planning for the state's voluntary health agencies was held, and most of the professional organizations were visited for the purpose of discussing and planning multiple objectives. The establishment of direct lines of communication between health groups represents progress in itself, as it is sometimes true in the health field as in other areas of public life, that the "left hand" does not know what th'e "right hand" is doing.

A continuous study of health insurance developments as they relate to rising health care costs was launched; a health planning library was established; and considerable assistance was given a professional task force group working on a study of Georgia's physician manpower shortage. Progress was made toward the establishment of community planning organizations. An application for a five-year planning grant to the Atlanta area is being considered and a grant was made to the Brunswick area for health planning.
Through this wide variety of activities, the staff and its advisory council was provided a basis for establishing a sense of direction and a process (see Chart I) for state level comprehensive health planning. Such planning is extremely complex but its rewards promise far-reaching benefits to Georgia's total population. How quickly these benefits will be realized will depend upon how rapidly the people of Georgia - health professionals and laymen (or "consumers") alike -move in forming a true "Partnership for Health" by actively supporting the concept and those who are working toward its implementation.

CHART 1

THE PLANNING PROCESS GEORGIA OFFICE OF COMPREHENSIVE HEALTH PLANNING

GOAL: To Organize Systems of Operation for the Office

GOAL: To Identify the Elements of the Current Health System in Georgia

GOAL:

To Determine the Existing and Desired Level of Health of the People of Georgia

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The model doll house, "House of Hazards," was designed and constructed by the DeKalb County Medical Auxiliary with consultation provided by GDPH 's Accident Prevention Section. Illustrating home hazards and poisonous plants in and around the home, it is on permanent display at the new DeKalb County Health Center, Winn Way, Decatur.

12

OFFICE OF LOCAL HEALTH

The primary functions of the Office of Local Health are the coordination of state and local programs and the management of state and federal resources (manpower and money) assigned to local health departments. In addition, the Office provided a broad spectrum of consultative services to local departments. Included were the initiation and operation of new programs at the local level - programs like home health care and vaccination assistance which are currently fostered in this manner.
These areas of responsibility made every facet of operation of the 159 autonomous county health departments in Georgia the concern of this office during the year - a concern expressed through a uniform approach and 21 meaningful thrust toward protecting and maintaining the good health of some 4,500,000 Georgians.
The submission of local program plans was significantly improved this year through introduction of a new form. Thirty programs were identified to adequately cover local efforts.
Financial support for the operation of local health departments totalled $15,602,797. Of this, state funds amounted to $6,241,355 and local money, $9,361,262. On a per capita basis, this local health investment represented $3.53 - $1.41 in state funds and $2.12 local dollars for each man, woman, and child residing in the state.
These funds supported on the average, one local public health worker for each 2800 people. By discipline, the ratio of trained local health workers to people was as follows:

Health Workers

Ratio to People

Nurses (graduate and professional)

1

Clerical assistants

1

Sanitarians

1

Undergraduate nurses

1

Health Program Representatives

1

Physicians

1

Social Workers

1

Administrators

1

Dentists

1

Engineers

1

Psychologists

1

Education and Information Specialists 1

Therapists

1

Veterinari-ans

1

Nutritionists

1

7,500 11 ,000 22,500 43,000 57,000 133,500 150,000 340,000 500,000 500,000 550,000 750,000 1 ,500,000. 4,500,000 4,500,000

Quite obviously, available manpower is deficient for an adequate delivery of even the most minimal of public health services to Georgia's total popujation, much less for the delivery of broad-based, comprehensive services. Remedial measures are urgent!

One plan developed during the year holds promise for extending the capabilities of physicians and nurses in public health programs. It provides for a comprehensive health services approach to replace the former categorical program delivery of services and makes improved use of health program representatives.
A plan for redistricting was also submitted for approval. This plan provides for grouping of counties into 13, 14, or 15 health districts instead of the 38 now existing. Included are provisions for increases in the types of disciplines included in district staffs to more adequately meet public health needs across the state.
Construction was completed on three new public health centers in DeKalb, Hart and Laurens counties and construction of three additional new centers for Early, Frankl in and Jefferson counties was approved. Equipment only projects were approved for Oglethorpe and Union counties for the health center area of HUD Neighborhood multipurpose buildings.
The emergence of the concept of comprehensive health care has increased federal, state, and local agency involvement. Coordination of these relationships with local health department activities is highly desirable and was recognized by this Office through assignment of a special coordinator for this purpose. Programs c'3veloped with such organizations and agencies as HU[;, Model Cities, the Office of Economic Opportunity and others, make a special effort to reach people who have not utilized established services, )lr for whom few services exist.
13

HEALT H INSURANCE under Sctto! Sewoty
Home health agency services are provided by nurses and other DeKalb-Rockdale counties public health personnel.
14

Home health care programs were organized in an additional eight counties, making this service now available in 61 counties having a total population of 2,686,600, or 61.5% of Georgia's people. Among this total, an estimated 318,408 are 65 and over. Of the latter group, 179,702 or 56.4% of those age 65 and over, are eligible for home health services. Approximately 7,000 patients, including 4,000 older persons, were cared for at home under the program during this fiscal period, .having received a total of 120,000 visits by health .personnel.
Steadily but surely, direct pubIic health services are becoming a reality to larger and larger numbers of people throughout Georgia. In the years to come, the gains made this year may be viewed as more significant than they now appear in that they have set precedents and established patterns for the delivery of care to public health service recipients .

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The past year was a year of major improvement in this Division.
The image of a moving, dynamic and progressive mental health program attracted the attention of the public as well as members of the General Assembly. The Governor, the State Board of Health and various public and private groups, including colleges and universities, gave the program continuing support.
This attitude bodes well for mental health concerns in Georgia as we approach some of the serious decisions that still have to be made with regard to the distribution of responsibility between the state and the counties for program impiRmentation and the sharing of financial support.
The professional staff of the U1vision looks forward to the future with both determination and hope, along with a firm belief that our program is sound both professionally and economically.
15

BRANCH OF TRAINING AND RESEARCH
This branch continued to operate during the year without a permanent director - a handicap which will hopefully be corrected in the near future with the addition of necessary funds.
A decision was made during the year to bring the Georgian Clinic, the Division's alcoholic rehabilitation unit, into the Mental Health Institute. There, it was established as the Georgian Clinic Division. Program improvement began and the clinic program for alcoholics gained two adult cottages that are being utilized for alcoholism patients.
Planning was completed for another major change in the Institute that will be implemented at the beginning of the next fiscal year. On July 1, 1969, professional direction of training programs in psychology, social work, sociology, nursing and chaplaincy will be returned to the Institute, rather than continuing with Emory University. This change was the result of intensive, and extensive, study and evaluation.
The Institute continued to suffer from inadequate staff - psychiatrists in particular - and from inadequate funding. Special efforts were made, and are continuing, to correct both deficiencies.
The Retardation Center Staff provided construction supervision throughout the year and worked hard at finding competent directors for its operating units and programs. This institution, as the only federally supported and university affiliated training center for the mentally retarded in the nation, presents a unique challenge to the Department and to this Division. With the opening scheduled for fall, 1969, staffing of the Center received priority attention and will continue to do so until its programs are operating at optimum level.
17

Research efforts now underway at Georgia Mental Health Institute in child psychiatry and other disciplines may one day point the way toward prevention of mental illnesses and aid treatment programs.
18

RESEARCH

Research activities were greatly expanded. Completion and opening of the fourth and fifth floors of the main building made possible the beginning of many planned research programs and projects. Laboratories in psychopathology, neurophysiology, sleep and dream research, sociology, behavioral assessment and change, social work, child psychiatry and human genetics all became operational. A staff of nationally recognized professionals have been employed to head the various research programs - staffing made possible through affiliation with Emory University Medical School's Department of Psychiatry. (All GMHI research section leaders hold Emory faculty appointments.)

PATIENT TREATMENT

Growth was shown in all patient categories due in part to the addition of the Georgian Clinic Division in October, 1968. The total patient census at the end of the year was over 1600, with the following figures reflecting new admissions:

Inpatients ...............................368 Night patients ..............................3 Day patients .............................570 Outpatients ............................ .482

TOTAL

1423

Of the total, 681 admissions were in the Adult

Division, Georgian

134 Clinic

in the Youth Division and Division. In addition, 253 full

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chiatric evaluations of applicants who were not ad-

mitted as patients were made.

GEORGIA MENTAL HEALTH INSTITUTE
The Institute expanded its threefold program goal of teaching, research, and patient treatment for the mentally ill during the year to include Georgian Clinic programs for alcoholism and drug dependency. Added to the Adult and Youth Divisions, the Georgian Clinic Division gives GMH I a more comprehensive service role to play in the state. Some of the more significant accomplishments of fiscal 1969 follow.
TRAINING
Academic training opportunities attracted an increased number of students. By discipline, total trainees in academic programs were:
Psychiatry (Residents and Child Fellows) .. , .... .40 Clinical Psychology (Interns) ....... , ....... , .15 Psychiatric Social Work .................... .14 Clinical Chaplaincy. . . . . . . . . . . . . . . . . . . . . . . .94* Psychiatric Nursing . , ................. , . . .20**
*Includes four workshops for ministers and three programs for seminary students in pastoral care, involving 75 of the total. **Includes nine mental health assistants in nursing division training programs.
Approximately 90 supplemental training programs for pub Iic health nurses, law enforcement officers and others who come in contact with the mentally ill in line of duty were conducted for some 4,000 persons.
A -special training program, jointly sponsored by Economic Opportunity Atlanta, Inc., and the Institute's Youth Division, was begun to prepare ten child care specialists for service in day treatment programs. Trainees selected were unskilled workers from poverty areas.

19

GEORGIA RETARDATION CENTER
Construction of the Center's main campus at Chamblee and of its Athens unit on the campus of the University of Georgia was essentially complete at the end of the year. In April 1969, the core staff moved into permanent offices in the Administration Building, Chamblee.
The first phase of construction of the principal facility will provide care for 480 residents and extensive outpatient services. Later construction will increase its inpatient capacity to 1 ,000 beds. First admissions are scheduled for early fall, 1969.
The Athens unit will provide day programs for 40 mentally retarded individuals and short-term (3 to 6 months) residential care for an additional 40. It will be utilized by a variety of academic departments at the University of Georgia for student training in mental retardation. Emory University, Georgia State, Atlanta University and the Interdenominational Theological Center will use the DeKalb county (Chamblee) facility for similar training programs. Together, these facilities will offer a training program for manpower development - the University Affiliated Program- unique in the nation.
In addition to developing program plans and operating procedures, the administrative staff was active throughout the year in community efforts to promote public understanding of the treatment, training and research components of the Retardation Center's total program.
20

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Savannah Regional Hospital under construction.

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BRANCH OF HOSPITAL SERVICES
This year saw the opening of two regional hospitals, construction progressing on a third, and planning nearing completion for two more.
The Georgia Regional Hospital at Atlanta opened two units to patients - Augusta opened one. As a direct result, most of the emergency cases and many of the urgent ones on the waiting list for admission of the retarded were admitted to service during the year. Some new adm!ssions went to the regionals; others were admitted to Central State Hospital and to Gracewood to take the place of patients transferred to the regionals.
Construction of the Georgia Regional Hospital at Savannah was two-thirds completed at the end of the reporting period, and should be finished by January 1970. Patients will not be accepted at Savannah before July 1970, however, for funding reasons.
Plans were almost completed for hospitals at Columbus and Rome but construction money for these facilities has not yet been appropriated. A medical-surgical building for Central State Hospital was also on the drawing board.
Much of the Brancn 's staff time was devoted to new mental health legislation and a new mental health law was enacted by the General Assembly.
A unit was approved for Medicare at Central State Hospital and several units were approved for Mediciad at Gracewood State School and Hospital.
Other significant accomplishments are recounted in the institutional reports which follow .


Dr. John H. Venable, director of the State Health Department; Dr. Addison M. Duval, director of the Division of Mental Health; the Honorable Carl Vin5on, former U. S. Congressman; and John E. Garner, Jr., member of the State Board of Health from Milledgeville, discuss plans for utilization of the Carl Vinson War Veterans Home at Central State Hospital.
22

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CENTRAL STATE HOSPITAL
Central State's resident population continued to decrease. A net drop of 412 patients was recorded for the year. The average daily patient population declined from 10,186 for the previous year to 9 ,645. Wards made available by this declining patient census were utilized for recreation, occupational therapy and other activities for which space formerly did not exist.
Personnel increased by 427 employees. Increases included 7 physicians, 3 therapists, 4 social workers and 89 attendants. Combined with the reduced resident population, these increases helped improve both the quantity and quality of care provided patients.
The new Carl Vinson War Veterans Home opened in April 1969, adding 150 beds to those available to veterans which now total 450. A new veterans' recreation building was also opened and two wards in the Cabiness Building were renovated and converted from dormitories to private rooms. Air conditioning of the flattop buildings was completed and in most of them, floors were tiled and wards painted.
The segregation of patients by diagnostic categories was completed in practically all units. Children's services were separated into two sections- one for emotionally disturbed youngsters, ages 5 to 11; another for adolescents. During the year, 71 children were admitted to the Children's Building while 161 youth entered the adolescent wards. Sixty~ix percent of the latter group were furloughed; only 10 returned to the hospital.
Vocational Rehabilitation Services initiated a new program. Known as PREP (Patient Rehabilitation Employment Program), it has already become effec-
tive in work behavior development. A total of 1,401
patients were added to vocational rehabilitation counselors' caseloads and follow-upservices were provided 879 patients in their home towns, or through residential facilities.
The Medicare unit ministered to 434 patients last year. Their average age was 74; their average stay, 38 days. Forty-eight percent were separated from the unit during the year.
Remodeling of the Binion Building was begun to separate court order patients from those under sentence or charge .
The pharmacy was reorganized into three sections to facilitate closer control of drugs and to improve patient care.

Hoxie Brothers' circus clown entertains a young Central State patient.
Like all of Central State's professional departments, the psychiatric training program continued to be fully accredited. Ten residents are added each year. Since its initiation in 1966, 25 psychiatrists have been graduated . Nineteen have remained at Central State; four others have stayed in Georgia, and only three have left the state. Training programs in social work, psychology, clinical chaplaincy, music therapy, occupational therapy, recreational therapy and nursing functioned at maximum levels in relation to available teaching staff.
A Department of Manpower Control was set up to ensure best use of staff resources .for patient treatment. One result - the reorganization of Medical Records -was that interviews of newly admitted patients became the responsibility of this unit, a change that speeds acquisition of patient information, improves accuracy, and greatly aids the treatment staff. At the end of the year, Central State had no delinquent medical records -a signal accomplishment for any hospital and particularly for one of Central State's size.
Full accrediation of the hospital remained a primary goal of Central State's administrative staff as fiscal 1969 drew to a close.
23

--
---..
Gracewood residents competed in Regional Olympics games for the retarded at the University of South Carolina, and earned 21 medals in these events.
24

GRACEWOOD STATE SCHOOL AND HOSPITAL

Gracewood trainees in Driver Education Program gain "feel" of operating auto.

At Gracewood this was a year of continued emphasis on program improvement and expanded services for residents and outpatients.
Diagnosis, consultation and recommendation services were provided to 412 outpatients, an increase of 22 over last year.
The intensive care unit, which provides treatment and training for residents with severely disturbed behavior problems, increased its patient capacity from 13to40.
Recreation programs were broadened both in terms of numbers participating and in scop,e of activities. Gracewood residents competed in regional Olympic games for the retarded at the University of South Carolina and ear'ned 21 medals in these events!
The vocational rehabilitation unit provided services to 169 residents. Of that number, 25 were employed in the community. Ah additional 100 received pre-vocational training directed toward local employment.
School activities during regular session enrolled 409 residents - the summer school program, 176. Learning experiences were also provided those not attending classroom sessions. Included were special language programs, training for the blind and partially sighted and off-campus activities.
A new approach to inservice training, the "attendant trainer'' method, was initiated by the nursing department. It employs experienced attendants to assist in training and demonstration of basic care skills - utilization that expands nursing care without increasing personnel. During the year, the pharmacy was certified as a drug vendor under the Medicaid program. In addition to approval of the infirmary, hospital C-wing, and Cottage 19 as a medical nursing home unit under Medicaid, eight cottages (total capacity 325 beds) qualified for licensure under the skilled nursing home classification.
Gracewood gained 41 budgeted positions during the year and employed 92 trainees in the summer student program -a program of great significance to the institution in that it provides a pool of workers from which future staff may be recruited.
The resident population at the end of the year was 1804, a decline of 30 over the previous year's total.

25

SOUTHWESTERN STATE HOSPITAL
Opened in 1966 to serve as a "pressure reliever" for the then overcrowded and understaffed Central State Hospital, Southwestern's patient population at both the Thom(lsville and Bainbridge branches has steadily increased. During the year it reached 1,267, an increase of 110 patients for the 12-month period. Of the 235 transferred patients received, some came from Central State, some from Gracewood.
Southwestern transferred 168 patients to other hospitals and admitted 70 new residents directly to Rose Haven Medical Nursing Care Unit. This 120-bed unit, which opened July 1, 1968 with an initial transfer of 44 patients from Central State and Gracewood, was approved almost immediately for Medicaid program participation.
Program emphasis at Southwestern continued to be on rehabilitation and remotivation of patients who, for the most part, had been long term residents of the parent hospitals. The success of these efforts may be partially determined by those placed on leave. On December 31, 1968,. approximately 29% of Southwestern's residents, excluding Rose Haven patients, were on leave. Of these, 49.8% had been hospitalized four years or longer. Of 50 patients placed on vocational rehabilitation leave during the year, only 16 returned.
To further enhance rehabilitation services, a "group action project" which is goal directed to responsible living by organized patient groups was begun. It proved to be very successful and was expanded. Motivation to work was aided immeasurably by the Canteen funded scrip program, a program that has had a stimulating "ripple" effect on other resident activities.
A full time dental program, with emphasis on prevention, began on February 3, 1969, replacing the former part time program. The three-member staff handled 1,541 sittings.
Nursing staff closely coordinated and programmed activities in a team approach with psychologists, social workers, and activity services (recreation, music, crafts) aimed at motivating patients to assume responsibilities. An expressive art outlet (finger painting) met the needs of retardates who had previously acted out their frustrations through peccadilloes and acts of vandal ism.
In addition to these and other improvements and refinements in services to residents, numerous plant repairs and improvements, both at Thomasville and Bainbridge, were made.
26

GEORGIA REGIONAL HOSPITAL AT ATLA NTA

During its first year of operation, the Georgia

Regional Hospital at Atlanta provided patient treat-

ment in the retardation program (120 beds) and the

adult mental health program (40 beds) . There were

154 total admissions, 10 discharges and f ive placed on

convalescent leave, with 139 resident patients remai n-

ing on June 30, 1969.

In the retardation program, wh ich serves th e pro-

foundly and severely retarded and physically handi-

capped, small training groups f orm ed du ring t he

spring taught two patients to walk, si x pat ients to

feed themselves, three patients to be toil et trained,

and one to dress himself.

Volunteer service workers train ed and ori en t ed

almost 900 community representatives in behavioral

principles and many of these (600) were used in pro-

viding retarded patient services. The Vol unteer News-

letter was regularly mail ed to over 1,000 persons, in-

forming them of hospital needs and activities, and

maintaining close contact with the community .

Collaboration was begun with several community

schools , including Atlanta Area Technical School,

DeKalb College and Emory UniverSity's Department

of Nursing, in provid ing training . The Clinical Chap-

laincy Training Program was accred ited by the Asso-

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ciation for Clin ical Pastoral Education.

I

In cooperation with Sen ior Citizen Services of

Metropolitan Atlanta, eight foster grandparents were

placed on the staff. They effectively demonstrat ed ,

during the year, the contributions the worker age 60

and above can ma.ke.

At the end of the year, plans for service program

expansion were being accelerated.

Self-he lp sk ills being taught you ng Georgia Regional Hospital patient by volunteer, Mrs. Mary Charles Strickland.

Retardation Cottage vo lunteer-sponsored school of Atlanta Regional taught by Mrs. Jordi Waggoner, with volunteer assistants.

Mrs. Carey Jones, secretary, clinical division, feeds her "adopted" child at a staffpatient picnic at the Georgia Regional Hospital, Atlanta.
28

GEORGIA REGIONAL HOSPITAL AT AUGUSTA
July 1, 1968 found the Georgia Regional Hospital at Augusta with four employees - the superintendent, business manager, personnel officer and a stenographer. Office space was "borrowed" and located in the Evaluation and Research Center at Gracewood. In November, the growing staff moved into the completed Therapy Building and in February, 1969, moved into permanent quarters in the Administration Building.
By April, 1969, a sufficient number of buildings had been received from the contractor and made ready for use, and a large enough staff recruited to permit admission of the hospital's first patients.
Designated to serve 13 surrounding counties, in-
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eluding Burke, Columbia, Glascock, Hancock, Jefferson, Jenkins, Lincoln, McDuffie, Richmond, Ta I iaferro, Warren, Washington and Wilkes, t:~e Augusta Regional had admitted a total of 47 patients by the end of the year and provided 1,131 patient days of care. Thirty-four of these patients were in residence on June 30, 1969; 11 had returned to their home communities; and two had been transferred to Central State Hospital.
As the year came to a close, personnel numbered 161, remaining buildings were nearing compl etion, and the hospital was looking forward to rapid expansion of service to the people of its service area. The faci.lity will have an eventual bed capacity of 350.

Open house at Georgia Regional Hospital at Augusta was held on Sunday, April 20, 1969.

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State Board of Health members Dr. P. K. Dixon and Lee Roy Claxton, al0ng with Dr. Beverly Forester, Board Chairman, put funding needs of regional mental heah:h hospitals

before the people of Georgia in a televised appeal for support.

30

BRANCH OF COMMUNITY SERVICES
COMMUNITY MENTAL HEALTH PROGRAMS
No increase in state money was budgeted for Community Mental Health Programs in Georgia for FY 1969 above what was budgeted for FY 1968. Despite this restraint, the program did expand in several areas. Well over 15,000 persons received services in community mental health programs during the year.
OUTPATIENT AND CONSULTATION AND EDUCATION SERVICES expanded into ten new counties, moving the total counties providing services to 67. Individuals, families, and groups received helping services for emotional and behavioral problems from over 40 full-time community mental health workers and over 100 part-time personnel. The programs placed increased emphasis on joining hands with school systems, courts, welfare programs, churches, and other community helping agencies to increase the helping skill of community caretakers.
AFTERCARE. Drug supervision and casework services for persons on convalescent leave from state hospitals was expanded into ten new counties, also. Sixty-seven counties provided aftercare services to over 4,000 people which (,yas made possible chiefly through the work of public health nurses.
PARTIAL HOSPITALIZATION. Fulton County became the first county to offer partial hospitalization with its day treatment program for individuals who are able to live at home at night.
EMERGENCY SERVICES on a 24-hour basis to meet crises as they arise, including suicide prevention, telephone service, crises hospitalization, home visitation, and walk-in clinics, were provided in a limited way in Fulton and DeKalb Counties.
INPATIENT SERVICES were provi,ded for psychiatric patients in general hospitals in Atlanta and Albany and Eugene Talmadge Memorial Hospital in Augusta.
COMPREHENSIVE COMMUNITY MENTAL HEALTH CENTERS. Nine communities continued construction progress toward Comprehensive Community Mental Health Centers. The following chart indicates the status of construction as of May, 1969.
31

Location
Athens Atlanta Augusta Decatur Gainesville Jonesboro Macon Thomasvi lie Valdosta

COMMUNITY MENTAL HEALTH CENTERS IN GEORGIA*

Applicant

Est. Cost

Construction Status

Approved Projects

Clarke County, H. A.

$1,684,744

Completion date, Dec. 1970

H. A. of Fulton County

935,257

Completion date, May 1970

Richmond County H. A.

2,064,245

Completion date, Nov. 1969

DeKalb County H. A.

1 ,486,381

Completion date, June 1971

Hall County H. A.

1,023,966

Bid Date, March 1969

Clayton County H. A.

934,701

Completion date, Jan. 1970

Bibb County H. A.

860,000

Bid date, Oct. 1969

J. D. Archbold Mem. ,Hosp.

1,147,658

Completion date, May 1970

Valdosta, Lowndes County

871,672

Completion date, Jan. 1970

Waycross, Tifton and Warner Robins continued planning activities toward the goal of compreh,msive mental health services. When in operation each center will provide six essential services - outpatient, consultation and education, aftercare, partial hospitalization, emergency services, and inpatient services.

32

COMMUNITY ALCOHOLISM PROGRAMS
LOCAL PROGRAMS AND PROJECTS. The Community Alcoholism Program continued development, coordination and evaluation of alcoholism clinics in Iocal health departments. Outpatient alcoholism clinics at Griffin, Rome, Dalton, Statesboro and Athens received periodic visits from a consultation team comprised of a psychiatrist, clinical chaplain, social worker and a nurse.
Staff consultation to the Apple Valley Center located in Ellijay, Gilmer County, began. This center will also serve Murray, Pickens and Fannin Counties. It is designed to provide a comprehensive alcoholism program involving an outpatient clinic at the Gilmer County Health Department, detoxification at the Watkins Memorial Hospital and employment and training in a sheltered workshop setting. This is a five -year demonstration project funded by an Appalachian Demonstration Health Grant to the Northwest Georgia! Regional Health Advisory Council, Inc.
The Newton County Health Department in Covington, Georgia began an outpatient clinic in May 1969. A consultation team worked throughout the year with day patient alcoholism clinics in Macon, Columbus and Savannah.
EDUCATION AND INFORMATION. The initial phase of weekly staff training sessions to develop a team of professional personnel and community leaders that can provide care and treatment for alcoholics and their families was started in January 1969.
"A Comprehensive Plan for the Prevention and Control of Alcoholism arid Drug Dependency in Georgia, Part I -Alcoholism" was published and distributed in April 1969 to Georgia legislators, local mental health associations, state and local Health, Education and Welfare agencies and interested professional groups.

A task force on drug dependence was appointed in April 1969 at the request of the State Board of Health. This group will gather data, dissE;)minate information, coordinate resources and develop a comprehensive plan for the prevention and control of drug dependence in Georgia.
The Georgia Department of Public Health and six other southeastern states jointly aponsored the Southeastern School of Alcohol Studies held annually at the University of Georgia in Athens. Over 60 Georgians involved in the delivery of services to the alcoholic and his family attended.
This Branch sponsored the first Community Alcoholism Clinics Conference ever held in the state. Convening in February 1969,70 representatives from 10 local health department alcoholism clinics, staff from the regional hospitals, Central State and the Division of Mental Health met to determine relationships between institutions and community clinics that would improve coordination and provide continuity of patient care.
PATIENT CARE AND TREATMENT. Ten alcoholism clinics in local health departments treated 6,014 outpatients during the year, representing total visits of 13,882 to individuals and 1,652 to familiesand provided 5,768 group therapy hours.

33

tNoewbMe enctoalnRsetrtuacrtdeadti. OI~n TrLaainwirnegncCeevniltleer,
Georgia.
34

COMMUNITY MENTAL RETARDATION
PROGRAMS
Fiscal year 1969 saw a small expansion of the program for purchasing training and care for mentally retarded individuals in private day facilities. A total of 15 centers located in 13 counties were approved to receive limited state financial assistance through local health departments. Service was purchased for approximately 69,000 retardate-days; the program reached an average of 315 financially eligible retardates for 220 days at a cost of $1.37 per day. The Department expended approximately $95,000 in this program. According to reports from the field, a number of training programs would not be able to remain in operation without this financial help.
Based on widespread need for broader pub Iic support of community mental. retardation services, county health departments were encouraged to initiate and operate training programs for retardates not eligible for or served by public school special education classes. Because of limited funds, only one facility of this type was supported during the past year. The Thomas County Training Center served 22 school-age retardates at a per diem cost of approximately $4.00, a figure less than half that of comparable institutional costs. The Department expended slightly over $12,000 in this program.
In the area of contruction and staffing grant applications, the Gwinnett County Association for Retarded Children was assisted in obtaining matching federal funds to build a new mental retardation training center in Lawrenceville. The facility will serve 70 retardates of all ages. Construction is scheduled to begin in August, 1969.
Three staffing grant applications were prepared with the assistance of the Branch, and have been submitted to the regional office of H. E.W. for approval. These include the Gwinnett program above, an expansion of the Bobby Dodd Sheltered Workshop in Atlanta, and staffing of a new county health department facility to serve 108 retardates in DeKalb County.
35

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DIVISION OF MEDICAL CARE ADMINISTRATION
The Division of Medical Care Administration, as an organizational unit, identified and assumed its functions and responsibilities for the second year.
The constantly changing picture of medical care was closely watched and studied. The programs of the Division were adapted and modified from time to time to keep abreast of growing public health needs. Exploration and implementation of all reasonable economic measures for greater efficienty in the utilization of available funds was a prime concern of the administration, along with constant emphasis throughout the division on quality of care. These major points are continuing goals of each of the three branches that comprise the Division of Medical Care Administration.
37

This winsome Georgia child was born with a cleft palate which not only marred his appearance, but made feeding difficult. After initial surgery, the defect is barely apparent. When treatment is completed, under a Crippled Children's Service plastic surgery pro gram, both function and appearance will be normal.
38

BRANCH OF MEDICAL ASSISTANCE
The Branch of Medical Assistance was organized effective August 15, 1067. The Branch consists of the Crippled Children's Service and the Medicaid Service. The director of the Branch of Medical Assistance also serves as Medical Director for both Crippled Children's and Medicaid Services.

CRIPPLED CHILDREN'S SERVICE
The Crippled Children's Service expanded patient services during FY 1969 although the rate was slower than in former years because funds, physical facilities and available personnel approached the saturation point.
As of June 30, 1969, the active caseload was 12,671 crippled children. A total of 29,745 were registered and accepted for care. At the end of the previous year, comparable totals were 12,663 active cases and 28,857 on the register.
Even though there was an increase of only eight active cases for the year, services to patients increased significantly. Each child's medical care plan was developed by representative personnel in all disciplines necessary to proper care -physicians, dentists, therapists, social workers, psychologists, for example. Each child's care plan was carried out through this same team approach, which resulted in more complete and better care for the children served.
Medical care for the children under the program was clinic oriented. Clinic sessions increased from 715 during FY 1968 to 734 in FY 1969. An additional 581 individual children attended clinic and clinic visits increased by 1,882 as compared to FY 1968. In all, a total of 12,118 children made 27,858 clinic visits during FY 1969 at eleven permanent clinics located throughout the state.
Medical services purchased for patients, in addition to clinic services provided, were extensive. There were 3,046 admissions to hospitals of 2,113 individual children for a total of 32,285 days of hospitalization. Appliances were purchased by the Service and fitted for 6,172 patients. Medical, surgical or dental conultations were purchased for 4,476 children along with paramedical and auxiliary services for 4,762 patients.
During FY 1969, referral demands for service received from physicians, agencies and hospitals sharply increased. At the same time, medical care costs continued to spiral upward. Increasing numbers of medical allied professionals notified the Service that current fee rates could no longer be accepted. Hospital costs continued to rise. The average expenditure for each child hospitalized was 60.2% higher by the end of the year than it was 26 months earlier.
Resolvmg this problem - that ot requests for the provision of more and more service to more and more children at ever-increasing costs -was viewed as the Service's major challenge as the year came to a close.
39

MEDICAID
Despite the necessity of having to absorb rising medical care costs and an increased eligible patient load, the Georgia Medical Assistance Program completed its second fiscal year of operation without exceeding its allocated budget of $61 ,793,530. Effective administration and excellent cooperation on the part of more than 4500 participating physicians contributed much toward meeting the goal of this fledgling program -to provide quality patient care within strict financial limits.
Significantly, the Georgia record is in contrast to the national Medicaid scene which encountered widespread public controversy as these same fluctuating cost-benefit factors forced many states to cut back their original programs to offset mounting budget deficits. As a result of the stability of the Georgia program, no eligible person was denied care nor were any authorized services curtailed or dropped from the program's coverage.
Approximately 265,000 individuals in Georgia were eligible for Medicaid services in fiscal 1969. Their eligibility was, or had previously been certified by the Department of Family and Children's Services based on four categorical programs of public assistance - Aid to the Aged (OAA), Aid to the Blind (AB), Aid to the Disabled (AD), and Aid to Families with Dependent Children (AFDC). Of those eligible, 217,133 received Medicaid services. Their identification by category of aid was:
OAA (65 years and over) ........... 89,062
Aid to the Blind ................... 2,466
Aid to the Disabled ................ 31 ,082
Aid to Families with Dependent Children
Dependent Children ............. 61,755 Parents and Second Adults ........ 32,768
40

From July 1, 1968 through June 30, 1969, a total of $60,907,769 was paid to providers of service under Medicaid. Payment to skilled nursing homes was the largest sum expended: $26,177,605, or 43% of the total expenditures. The amount paid for physicians' services totaled $10.412,258 or 17.1%. Other Medicaid expenditures and their corresponding percentages were:

Hospitals

$12,923,814

Drugs

6,588,291

Medicare deductibles

and co-insurance

4,686,985

Home Health Agencies

144,758

Durable Medical Equipment 132,463

Ambulance Services Prostheses

109,177 67,114

Appliances

54,519

Laboratory and X-ray Other

19 '134 3,627

21.2% 10.8
7.0 0.2 0.2 0.2 0.1 0.1 0.1

A total of 2,746,019 transactions were completed for the fiscal year -around 228,000 per month -at an average cost of $0.63 per claim.
The limitation of the present Georgia Medicaid plan is that services are provided only for the ill or injured, although the population served is a high risk group in terms of morbidity and mortality. A comprehensive, broadly based program that would include preventive care, well-person checkups and rehabilitative services is needed. Such a program would more adequately meet health needs of the covered groups and would also effect more meaningful returns to society through reduction of health-related social problems. A first step toward achieving this kind of return was projected .for 1970-71 - the incl usi on of family planning services for Medicaid eligible persons.

BRANCH OF HEALTH FACILITIES PLANNING AND CONSTRUCTION

The Branch of Health Facilities Planning and Construction continued a comprehensive program of service to the people of the State in the expansion and improvement of health care facilities. Direct services were provided through the following program activities: (a) community planning and project construction development in conjunction with Statewide planning; (b) architectural, engineering, and equipment review and approval to assure the construction of safe, properly designed and equipped facilities; (c) financial and project management in the administration of State and Federal grant-in-aid funds for the construction of health care facilities.
PLANNING
During the year, the' Branch of Health Facilities placed emphasis on the coordination of medical facilities planning with other planning ,activities in the State related to improved health services for the public. Effective working relationships, including the exchange of information and statistics, were developed with the Office of Comprehensive Health Planning, the State Planning Bureau, the Appalachian and Coastal Plains Regional Development Programs, and established Areawide Health Planning Agencies.
On June 30, 1969,71 applications for health facilities construction grants were pending in the Health Facilities Planning Section, ~ith an estimated cost of $96,000,000. In conjunction ,with the development of these applications, 17 Program Narratives were reviewed and approved; 22 applicants were assisted in making community surveys of need and resources for proposed hospital projects; and consultation was provided to 32 communities in the development of Program Narratives prior to review and approval. In addition, Program Narratives for 66 non-grant construction projects were reviewed and approved in cooperation with the State Hospital and Nursing Home Licensure Programs.
Three State Plans were developed in fiscal year 1969: (a) The Community Mental Health Centers Plan; (b) The State Plan for Community Mental Retardation Facilities; and (c) The State Plan for Hospitals and Related Facilities (Hill-Burton).

CONSTRUCTION
The Branch of Health Facilities reviewed 144 sets of plans and specifications submitted for health facilities construction, including plans for 24 Hill-Burton grant projects and 104 non-grant projects. The Branch also provided sponsors and their architects written consultation regarding functional design, structural, electrical and mechanical engineering and equipment. One hundred and twenty-six inspections were made to the projects that were under construction. The frequency of field visits to grant projects increased during the year, resulting in a marked improvement in the completion of projects.
As of June 30, 1969, there were (a) 25 Hill-Burton projects in pre-construction stages; (b) 23 under construction; and (c) 17 completed and awaiting equipment. Seven projects were completed and placed into operation during the year.
FINANCIAL AND PROJECT SUMMARY
A total of 17 new grant projects with an estimated construction cost of $10,556,497.00 were placed on the 1969 construction schedule. These projects were approved for an allocation of $5,446,251.00 in grant funds {$4,583,586.00 federal and $862,665.00 state).
The 1969 construction schedule included 3 general hospital projects with the addition of 138 beds and the renovation or replacement of 92 beds; 7 long term care facilities of 365 beds; 4 public health center projects; 1 mental retardation facility; 1 rehabilit2tion center; and 1 diagnostic and treatment center.

41

BRANCH OF CERTIFICATION AND LICENSURE

One of the primary responsibilities of the Certifi-

cation and Licensure Branch is to upi)rade the

quality of care provided the people of Georgia in its

hospitals and nursing homes. This is achieved through

on-site surveys of facilities to determine that stan-

dards for the physical plants, patient care and admini-

strative operations are in compliance with rules and

regulations established by the State Board of Health

and federal agencies. Another goal is to encourage

hospitals, nursing homes, home health agencies and

laboratories to participate in the Medicare, Medicaid

and Intermediate Care Programs. Through such

efforts, more beds and additional services are made

available to citizens covered by these programs.

At the close of this fiscal year, 283 facilities had

been approved for participation in the Medicare Pro-

gram- an increase of 31 over the previous year.

During the year, physical plants, nursing care and

administrative aspects of provider facilities were im-

proved -a result of consultative and advisory services

provided by Branch personnel who made 567 sep-

arate visits to participating and potential Medicare

providers.

Twenty-one additional nursing and persbnal care

homes were licensed during the year, representing an

increase of 2,682 beds. The table that follows reflects

the increase in Medical Nursing Care Home facilities

that resulted from the opening of new homes and

upi)rading of the quality of care in lower categories.

Homes

Beds

Medical Nursing Care Homes +23

+ 2,331

Skilled Nursing Care Homes + 3

+ 442

Nursing Care Homes

-5

- 121

TOTAL (Nursing Homes) +21

+2,652*

Personal Care Homes

0

TOTAL (All Homes)

+21

30 + 2,682

*Includes the addition of 884 beds at Gracewood State School and Hospital.

The hospital picture changed slightly in fiscal 1969, reflecting 10 new openings, six closings, and a few changes in classification. These r::hanges represent a decrease of 169 beds, the result of conversion of 884 beds at Gracewood State School and Hospital to nursing home beds which more than offset beds offered by newly opened hospitals. At the end of the year, Georgia's hospital count stood at 210.
Since Georgia's Medicaid Program went into effect in October 1967, nursing homes and 154 hospitals have been approved for participation in the program. This has made 13,493 nursing home beds and 15,718 hospital beds available to Medicaieligible persons. The majority of these facilities - all 187 of the nursing homes and 93 of the hospitals - were approved during the 1969 fiscal year.
42

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Epidemiology is a biological accounting system. It tries to measure the biological damage done by each particUlar disease and disability and the biological effectiveness of existing or proposed remedies.
The Epidemiologic Investigations Branch is responsible for finding out how much disease exists in Georgia, who has it, where and when it occurs, and most important of all, what causes it and how it gets from person to person. Much of this"investigation" is done by helping one of the other branches of the Department that has direct responsibility for control of a disease. For example, the Investigations Branch helps Cardiovascular Disease Control by assisting in planning investigations that Cardiovascular Disease Control will carry out.
The every day part of the job, however, is done by asking doctors to report disease and by assisting them and their patients in getting the proper specimens to the laboratory. Often, a laboratory report, and especially a flurry of reports of the same disease, is the first notice that something is occurring that should be checked thoroughly, called to the attention of other doctors and to the attention of local health departments in the areas involved. This pattern can be re-

versed; that is, a local health department may ask if a disease trend in their area is limited to that area or is occurring in other sections of the state. No matter how or where the need for an investigation originates, experienced investigators are sent to help local personnel when a need has been established.
Reports from physicians are received via weeklv morbidity reports from local health departments. These, however, constitute a small part of the information available. Most reports come in from a ten percent sample of physicians queried weekly. This is supplemented by use of Laboratory reports and by two special, experimental reporting systems, one a daily sampling system used in DeKalb county and the other a voluntary system involving mec, upolitan area peditricians. The results of these reports, by calendar years, are shown on the table which follows_ As it is summarized by the Biostatistics Service from reports forwarded by this Branch, by calendar year, it covers only the first half of this reporting period. It is illustrative of the incidence of disease in Georgia's population with which Epidemiology concerns itself on a continuing basis.

1964

MORBIDITY SAMPLING Calendar Years

1965

1966

1967

1968

5 Year Median

Amebiasis Conjunctivitis,
infectious German Measles Infectious
Hepatitis Influenza Measles Salmonellosis Shigellosis Staphlococcosis
Pulmonary Superficial Wound Streptococcosis Rheumatic Fever Scarlet Fever Sore Throat Whooping Cough

90
3,030 13,310
390 15,250
8,010 400 340
420 5,970 1,480
410 1,690 41,530
990

190
3",650 1,480
330 43,730
7,650 400 240
220 5,220 2,270
460 2,460 49,590
760

170
3,250 1,140
640 30,380
3,320 580 200
340 3,460 1,450
290 1,4W 39,790
480

80
3,320 1,460
810 805,000
1,290 220 330
150
3,880 1,380
220 1,950 32,860
440

950
13,270 2,020
2,610 114,850
760 1 1190
430
440 14,380 4,420
800 730 71,900 300

170
3,320 1,480
640 43,730
3,320 400 330
340 5,220 1,480
410 1,690 41,530
480

SOURCE: Georgia Department of Public Health. Biostatistics Service
43

VETERINARY SECTION
The Vet~rinary Section is responsible for surveillance and investigation of the zoonoses; the diseases transmissible from animals to man.
Consultations with health officials, veterinarians, physicians, and the public concerning this group of diseases is a daily occurrence of the section staff. Advice is given pertaining to diagnosis, treatment, and control. Epidemiologic investigations are made into selected cases.
The disease entity requiring the greatest amount of the departmental veterinarian's time is rabies. The accompanying graph, "Rabies in Georgia", illustrates the number of cases reported for fiscal year 1969 and also shows the number of humans that received treatment following exposure to rabid or suspected rabid animals.
In over 80 of the 92 human treatments, the Veterinary Section consulted and advised physicians and health officials in regard to rationale of treatment in these cases. Approximately 500 additional bite cases received individual attention and concerned individuals were advised with regard to treatment .
In cooperation with the School of Veterinary Medicine , Agriculture Extension Service, and local health departments, the Section sponsored rabies clinics in 45 counties. Over 21 ,000 dogs were vaccinated at these clinics.
A large display on rabies was exhibited by the Veterinary Section at the Southeastern Fair in Atlanta. Many thousands viewed this display .
Surveillance and investigations were also carried out in other disease problems such as: Rocky Mountain spotted fever; Psittacosis; Leptospirosis; Brucellosis (undulant fever); Tularemia: and other humananimal health related activities.
44

Rabies display at the 1968 Southeastern Fair.

RABIES IN GEORGIA - FY 1969 Animals Positive - Humans treated

Animals Positive Humans treated 16

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Raccoon

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liiil - Fox - Other - Humans treated

14

12

10

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6

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July Aug. Sept. Oct. Nov. Dec. Jan. Feb. Mar. Apr. May June

"l."n"

1968

1969

BRANCH OF LABORATORIES
On the pages that follow, laboratory services rendered the people of Georgia during the fiscal year, the costs of these services, and the training program efforts of this Branch are graphically illustrated.
Both public health clients and private physicians' patients were served through the central laboratory in Atlanta and by the regional laboratories located at Albany, Macon and Waycross.
46

An Animal Head for Rabies Test

Culturing of Fecal Specimens for Diarrhea Causing Organisms

Pre.natal Syphili1 Srology
and Blood Typing 22%
I I I I I I I I I I I I I

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Diagnostic Syp hil i1 Serology 34%

SERVICES

Technicians surrounded by Test Tubes while doing Serologic Test for Syphilis

Part of t he 2,840 Specimens received each work day by mail. Each Specimen represents a Public Health Clinic or Private Physician Patient.

A Young Couple picking up their

Premarital Syphilis Sero logy Certi

ficate. Their doctor will complete

the examination after which they

then can obtain their Marriage

License.

47

Training of new Laboratory Workers

Laboratory & Outtid e Agenc:y 9,331 houn 51 lfudenh

Medical Technologists Enrolled in Retraining Prior to Returning to Clinical Laboratories After a Long Absence.

EVALUATION

EVALUATION STUDIES SENT AND RECEIVED

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FY1969

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EVALUAnON UIJECT

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49

COST

Scientific Service1 Section
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AUTOMATION
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RESEARCH

With the ever increasing volume of Specimens and cost of testing, automated procedures are being applied wherever possible.

Applied Research is regularly carried out in Public Health Laboratories. Here pictured, is an Electron Microscope being used in deve loping tests for identification of viruses.
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DIVISION OF PHYSICAL HEALTH
This Division continued to function without a fulltime director during fiscal 1969. Despite that fact, significant gains in programs and services were made under the Department's Deputy Director who served as Acting Director of the Division.
In its second year of operation as a separate Branch, Air Quality Control moved rapidly toward establishment of standards and developed enforcement procedures designed to limit pollution of Georgia's air.
The reorganized Br~nch of Health Conservation expanded existing programs such as cancer screening, and began implementation of a well-child comprehensive health care team apprach that enlarges the role of the public health nurse in the provision of those services.
The Branch of Tuberculosis completed the computerization of Georgia's TB registry - a signal accomplishment in the provision of aftercare services to discharged patients of Battey State Hospital and other victims of tuberculosis.
Cardiovascular Disease Control. Service, a unit of the Branch of Special Health Services, also completed computerization of Georgia's Rhuematic Fever Registry and began monthly distribution of this needful information to local health departments for surveillance and follow-up of these patients.
Other important gains are reviewed in the individual Branch reports which follow.
53

Air Quality Control Branch Director William Hansell views "museum materials" collected at open burning sites across the state-a collection being made to determine various pollutants being released into the air.
54

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Auto exhausts that discharge harmful particulates and gases into the air are responsible for an estimated 45% of Georgia's air pollution problem.

BRANCH OF AIR QUALITY CONTROL
Through the Air Quality Evaluation Service of the Branch, eleven air sam piing network stations operated during the year from which filter pads were received indicating the suspended particulates in each station area. Each sample covers a 24-hour period and the summary table, "Georgia Air Sampling Network Results", which follows, documents findings for calendar year 1968.
It is believed that there is a direct correlation between the amount of suspended particulates in the ambient air and the respiratory and heart problems endured by people living in these areas of the state-
a population of c. proximately 1,011 ,000 individuals.
The conditions that prevailed throughout 1968 -including the first half of this fiscal reporting period revealed only slight .increases in pollutants over three previous sampling years.
In order to reduce or eliminate excessive pollutants in Georgia's air, the Service visited 140 major industrial sources of air pollution during the year. Forty-two of these agreed to eliminate or effectively control the discharge of particulates and other harmful materials into the air. In general, the working relationship between industrial and commercial interests; and Air Quality Control has been good. This was particularly true, in FY 1968-69, of 'the larger pollution sources scattered throughout the state.
Slower to cooperate were some local governmental agencies. Open burning at city and/or county owned and operated solid waste disposal sites continues to be a prime air pollution problem. Resultantly, two Air Quality Control ("cease and desist or show cause") Orders were issued. In each case, cooperation in eliminating open burning was promised .
As the year came to a close, an overall increase in enforcement activities related to local agencies and to recalcitrant commercial and industrial polluters appeared inevitable if this Branch is to discharge its responsibility to the people of Georgia- that of giving them clean air to breathe.

55

Much of Georgia's future is dependent upon health conservation, including the protection of mothers and children like these, shown here with Dr. Olin Shivers, an Atlanta pediatricia n.
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56

BRANCH OF HEALTH CONSERVATION
The Health Conservation Branch with its two Services, Child Health and Maternal Health, is responsi b Ie for statewide pub Iic health programs for mothers and children.
The Child Health Service continues supervision of the child from birth through adolescence. Primary effort over the past year has been directed toward expansion of screening services through more involvement of public health nurses in screening infants and preschool children with appropriate medical referral.
Emphasis over the past year in Maternal Health Service has been the promotion of the Family Planning Program and expansion of the Cervical Cancer Screening Program with a better reporting system for both. The Cervical Cancer Screening Program steadily increased with clinics and services to patients spread virtually over the entire state. The results have been gratifying in that 81% of the cases found were preinvasive and the invasive cases found have been in lesser stages of invasion while there is still time for adequate treatment.
Cited in the service reports that follow are a few of the year's most significant achievements.
MATERNAL HEALTH SERVICE
Although 87,322 live births in 1968 represented an increase of 853 over those reported the previous year, the birth rate continued its decline to 19.1 per 1,000 population, the lowest birth rate in over forty years. Of greater interest is the decline in the gross fertility rate by race, especially in the past four years. The white rate declined from 101.5 in 1964 to 80.1 in 1968, a decline of 21 percent. The gross fertility rate for non-whites declined from 147.9 in 1964 to 108.6 in 1968, a decline of 27.6 percent. Thirty maternal deaths were reported for a ratio of 3.4 per 10,000 live births.
Prenatal supervision in local health department clinics were provided to 15,885 women and 11 ,628 returned for post partum examination. The outcome of pregnancy in these cases and the results of this prenatal care are unknown. Severe iron deficiency anemia, a significant cause of maternal and newborn morbidity was treated with injectable iron in 760 cases.
Four thousand and fifty-four deliveries attended by midwives in 1968 represent a 20% decrease from 1967. There were 226 midwives registered to practice in 1969, 10% less than in 1968.

FAMILY PLANNING: Computer evaluation of progress in family planning services provided meaningful data and assisted materially in improving follow-up at local levels. Initial family planning Services were given to 21,269 new patients in local health departments throughout the state. A tota I of 58,451 follow-up visits were provided to these and to women admitted in former years. Three out of four patients were non-white. At the end of the fiscal year, approximately 12'12 percent of the estimated population at need were receiving continuous adequate contraception in health department clinics.
It had been predicted that as a result of a progressive family planning program employing modern methods, the births in birth order of sixth and more would decline in both white and non-white live births. The table showing percent of live births to women with five or more children indicates that this prediction was correct.
PERCENT OF LIVE Bl RTHS
IN ORDER OF 6th OR MORE

1962 1966 1967 1968

WHITE
9.0% 7.1% 6.2% 5.9%

NON-WHITE
29.0% 23.3% 20.4% 17.6%

Futhermore, the decline in gross fertility rate of approximately 6 percent for both races between 1960 and 1964 - before the use of modern contraceptive methods - should be compared with the decline of 21% in the white rate and 27.6% in the non-white rate during the 4 years following the introduction of modern methods into the statewide program.
lnservice training in family planning and other Maternal Health programs was given to more than 300 public health and clinic nurses by staff members of the Maternal Health Service. lnservice training in family planning information and education was also provided 30 midwives throughout the state.

57

The Department ofPublic Health and Department of Family and Children Services continued to cooperate to broaden the extent of family planning available throughout the state. Training in family planning information and education was provided by Maternal Health Service personnel to 286 new Family and Children Services workers during their orientation. Iri addition, visits to about 30 Family and Children Service county offices were made by Maternal Health Service staff members for the purpose of continuing the up-grading of case workers in Family Planning, and stimulating activities in referral and follow-up. During the year contacts were made with several CAP Districts of the Office of Economic Opportunity and approximately 150 OEO Community Action workers and VISTA workers were trained in family planning information and education.
By mutual agreement the role and mission of each agency has been broadly outlined. The Department of Public Health provides supplies, patient services and has a role in case finding and follow-up. The Department of Family and Children Services and the Office of Economic Opportunity through their county agencies have primary responsibility for case finding, referral and follow-up, and in many instances can provide transportation services to patients. All three agencies participate in promotion of service and education at different levels depending upon their capabilities. A series of one-day joint training sessions held throughout the state for agency personnel and other persons interested in family planning improved program outlook and outreach.
The Hall County Health Department was assisted by the Maternal Health Service in preparing a family planning project under the Model Cities Program and the project was funded in June of 1969 to begin operating in July of 1969.
CANCER DETECTION: During the fiscal year, 21 ,675 Pap smears were done to provide cervical cancer detection screening throughout the state. Since the inception of the program 40,506 Pap smears have been done and 418 women referred for follow-up and treatment. Of this number 71 have yet to be diagnosed; 93 were found to have preinvasive carcinoma of the cervix and treated; and 25 were diagnosed and treated for invasive carcinoma of the cervix. The significance of the ratio of four preinvasive to one invasive carcinoma can be understood when one considers that prior to the start of the state cervical cancer detection screening program the average patient admitted for treatment of cervical carcinoma to state-aided tumor clinics had a Stage Ill carcinoma and a five-year survival chance of less than fifty percent.
58

__

CHILD HEALTH SERVICE

The Child Health Service continued to provide

consultation services to county health department

personnel in their programs for preschool and school

children. Emphasis was placed on the screening of

infants and preschoolers for remediable physical de-

fects and on the more effective utilization of nursing

manpower in evaluation of the health status of chil-

dren.

Nursing appraisal of children in child health con-

Health education for school children was pro-

ferences has been adopted as a means of conserving

moted by public health nurses who worked closely

physician time in clinic attendance. Only children re-

with teachers in order to provide students with the

ferred by the nurse are seen by a physician. This pro-

fundamentals of sound health knowledge. In these

gram of increasing nurse responsibility in child health

efforts, public health nurses gave a total of 2,374

::--'

appraisal and evaluation is a modification of the Uni-

classroom talks to students on health subjects. In-ser-

;:-'

versity of Colorado plan for pediatric nurse prac-

vice workshops to assist public health nurses in these

titioners. DeKalb County , the first county to set up a

educational efforts consisted of the following : (1)

well-organized program of nursing evaluation con-

Sex education and family living, 3 days, 30 partici-

ferences, ,was the site of a six-month survey study

pants; (2) Hearing screening, 2 days, 16 participants;

designed to evaluate the effectiveness bf the modified

(3) Mental retardation, 3 days, 100 participants.

plan . The results of this study will be used in planning

future in-service workshops for nurses of other coun-

ties as they prepare to set up similar programs.

MENTAL RETARDAT ION: Consultation to local

In FY 1969, 152 counties reported seeing infants

health department personnel who actively work with

and preschoolers; however, 22 of these saw less than

retarded children and their families continued to be

25 children during the year. Physicians saw 29,907

given. Prevention was emphasized. An expansion of

children and nurses 71,308. In addition, 31,914

the 11Jhenyl ketonuria newborn testing program from

school children (ages 6-15) were evaluated by public

60% of infants tested to 74% tested occurred . Fol-

health nurses for specific health p_roblems.

low-up of many infants discharged from hospitals be-

COMMUNICABLE DISEASE: Immunizations

fore phenylketonuria screening could be done con-

were given to children in county health departments

tinued to be performed by the public health nurses,

as follows : 169,229 OPT, 144,810 poliomyelitis,

The roster of families with known cases was kept

89,324 measles, ahd 81,826 smallpox. Tuberculin

current and visits to these families were made periodi -

skin testing of 111,667 children was done with 510

cally by the Specialized Nurse Consultant. At the pre-

new reactors being detected and 8 children being

sent time, there are 69 known cases of PKU in 53

diagnosed by X-ray as having active tuberculosis.

families in the state. Dietary management of infants

SCHOOL HEALTH: The school hearing and vision

was facilitated by provision of the special milk substi-

screening program continued in 136 counties of the

tute Lofenalac by the Service. Dietary consultative

state. Hearing tests were given to 175,336 children,

services were also provided these families by the Nu-

10,060 failed in the test, and 4,941 failures were seen

trition Consultant.

by physicians. Vision tests were given to 281,320

Three Diagnostic and Eva Iuation Centers for chi 1-

children; 22,701 failed the test; 12,940 were seen by

dren with suspected retardation continued to func-

physicians, with glasses being prescribed for 7 ,990. In

tion with funds made available through the Children's

addition, preschool hearing and vision screening was

Bureau. Consultation w as provided by Child Health

begun in the Summer Head Start programs and public

Service staff to the centers, located in De Kalb ,

health nurses tested, or trained volunteer groups to

Muscogee, and Chatham Counties , where children

teSt, 2,059 four and five year olds. Further efforts to

were given comprehensive eval uations, diagnoseswere

expand preschool testing for hearing and vision are

made , and the families were advised as to the best

under way.

method of management of their children.

59

As nursing appraisal and evaluation programs of the Child Health Service expand and spread through the state, the average child's concept of public health may change. Ricky, above, shows what he generally expects from public health nurses as he is tested for tuberculosis.
60

BRANCH OF TUBERCULOSIS

Any improvement in the problem of tuberculosis

in the community is essentially dependent upon the

rapid transmission of enormous quantities of signifi-

cant information. To meet this need, the Tuberculosis

Branch has placed major emphasis on updating infor-

mation on the State Tuberculosis Register, and on

deve Ioping a computerized central Tuberculosis

Register System.

As of June 30, 1969, the entire central case regis-

ter for the State of Georgia had been computerized.

The Tuberculosis Control Service provides the health

departments in each of Georgia's 159 counties with

pertinent data on a monthly basis. In addition to a

printout reflecting the status of the total register for

each county, a second printout is provided each

month Iisting those patients for whom specific ser-

vices are due the following month. For each patient

on this "Services Due" roster, an individual patient

record is provided which has been pre-printed by the

computer with biographical information, as well as

the most recent medical, roentgenographic, bacteri-

ologic, and treatment data.

Provision of this information, which is followed

up, routinely, by local health department personnel,

insures former patients of receiving the kind of con-

tinuing care that formerly could only be sporadically

given. It reduces re-admissions to the hospital, im-

proves recovery rates, and aids overall community

control of tuberculosis.

In fiscal year 1969, there were 1,032 new cases of

active tuberculosis reported in Georgia for a new ac-

tive case rate of 22.9 per 100,000 population per

annum 1 ,099

-a cases

6.1 were

percent decrease reported. During

ftrhoemye1a9r6t8~bwerhceun

losis was the cause of death of 74 individuals, for a

tuberculosis mortality rate of 1.6 per 100,000 pop-

ulation per annum. Of the 1,212 patients admitted to

Battey State Hospital in fiscal 1969, 955 were ad-

mitted for the first time. Only thirteen counties in

the state admitted 20 patients or more to Battey

State Hospital during the year. These counties ac-

counted for 56 percent of all admissions, and repre-

sented 47 percent of the population of Georgia.

The drug therapy program - the cornerstone of any total program to attack the problem of tuberculosis - has continued to be most successful. Of all patients discharged during fiscal year 1969, 9.7 percent left the hospital against medical advice yet only 1.9 percent of those discharged were unimproved. Only 56 or 4.4 percent of patients leaving the hospital demonstrated bacteriology which was positive for M. tuberculosis at the time they were discharged. Of these 56 patients, 39 left the hospital against medical advice. The average length of stay in the hospital for patients with tuberculosis was 125 days, as compared with 141 days during the previous fiscal year.
As of June 30, 1969 there were 5,886 non-hospitalized cases of tuberculosis requiring observation and management. Of those, only 27 were known to have a positive bacteriologic status. On that date, 97 active cases at home were not on chemotherapy who should have been. There were 7,006 contacts identified during fiscal year 1969, of which 6,166 were examined; 45 new active cases of tuberculosis were found among those contacts, for a case finding rate of 7.3 cases per 1000 contacts examined. There were 801 tuberculosis suspects examined during calendar year 1968, among which 334 new active cases of tuberculosis were identified -a yield of 41.7 percent.
At least 120,000 school children and their associates were tuberculin skin tested, and appropriate follow-up was initiated for positive reactors. There were 36,326 x-ray films taken by mobile x-ray units and interpreted at Battey State Hospital during fiscal year 1969, and approximately 8,204 patient visits to Diagnostic and Evaluation Clinics held throughout the State.
61

COMMUNITY CONTROL: A new concept in tuberculosis casefinding was i"ntroduced in January 1969 at Grady Memorial Hospital in Atlanta. Since ov-:T 25 percent of the state's tuberculosis problem emanates from the Metropolitan Atlanta area, and since over 50 percent of the tuberculosis patients followed by the Fulton County Health Department have been previously seen in the outpatient clinics of the hospital, an x-ray screening clinic was established in the General Admissions Clinic at the hospital.
During its six months of operation, this clinic took a total of 12,743 screening films, among which 982 (7.7 percent) tuberculosis suspects were identified. Of the 763 suspects for whom a satisfactory disposition has been obtained to date, 15 new active cases of tuberculosis were identified. This represents a casefinding rate of 19.7 cases per 1000 suspects exami ned, anci :.; new active case rate of 117.7 per 100,000 screened population -over 5 times the new active case rate for the State as a whole.
In addition to its validity as a tuberculosis casefinding medium, this program's relevance as part of a truly comprehensive health program is readily apparent. The screening project at Grady Memorial Hospital clearly reflects the flexibility which has been built into the overall program of the Tuberculosis Branch, perm1tt1ng each program element to be tailored to specific community needs in each local area.
62

BRANCH OF DENTAL HEALTH
Consultation was provided to state, district and local health department personnel, to staff members 'Jf hospitals operated by the Department, to other governmental officials and to members of professional and voluntary organizations.
FLOURIDATION: A significant public health accomplishment was realized with the beginning of fluoridation of Atlanta's water supply which serves approximately 600,000 people. This brings the state total to 68 fluoridated water systems and raises the total population in Georgia on fluoridated water to almost 2 million.
DENTAL CARE SERVICES: More than 35,000 underpriviledged children, age 3-14 years, received dental care in local health departments. Preventive and corrective dental services were provided in public health dental clinics in 70 counties by 8 full time dentists, 8 dental hygienists, and more than 200 private dental practitioners.
DENTAL HEALTH EDUCATION: Selected educational materials were sent to all dentists, to local health departments, and to local communities to assist in promoting dental health on a continuing basis with special empl;wsis during National Children's Dental Health Week. Educational activities stressed during this week of celebration were coordinated with activities of the Georgia Dental Association. Cooperation and participation of civic and school groups with dental and public health personnel highlighted these educational efforts.
An article 'Why Fluoridate Your Community's Water Supply?" was featured in Georgia's Health. Public interest in "Georgia Dental Doings", a publication by the Department, was reflected in the increased number of requests for this leaflet.
A dental survey was made of third grade students in the public schools in Macon to reinforce the educational efforts of the Bibb County Health Department in promoting dental health in the school system. The findings confirmed the anticipated disparity between dental care experience in children from high and low socioeconomic school areas. A report was made to the Bibb County Health Department and to the Bibb County Schools.

RESIDENCIES IN DENTAL PUBLIC HEALTH: Stipends were provided by the U. S. Public Health Service, under the Public Health Traineeship Program, for two Residents in Dental Public Health appointed for one year. The program, approved by the American Dental Association, is designed to prepare dentists for positions of leadership in public health practice. Georgia is one of the few states that provides such training which fulfills one of the requirements for eligibility for examination for specialty board certification. More than half of the residents trained in Georgia under this program now occupy responsible public positions in the State.
RESEARCH AND STUDIES: A state-wide survey of dental needs and dental treatment recommendations was made of residents of nursing homes in Georgia. The findings will allow computation of treatment costs for dental health program planning for this population group.
A study was made to evaluate two methods of oral hygiene instruction at the Georgia Academy for the Blind. The purpose was to determine if special personal demonstration of toothbrushing procedures was more effective in improving oral hygiene in a blind population than a conventional auditory type of instruction.
63

Fluoridated Water Systems
STATE OF
GEORGIA
Total Population Served 2,000,000
Water Systems
64

BRANCH OF ENVIRONMENTAL HEALTH
Growing concern over the quality of the environment in which Georgia's 4.5 million people live and work, coupled with increasing environmental hazards associated with urbanization, recreation, highway travel, radiological exposure, and industrial development focused a spotlight on activities of the Branch during fiscal 1969.
Solutions to environmental problems with which environmentalists have grappled for years have suddenly become imperative. In Georgia, as elsewhere, improvement of the environment has achieved top priority status among public health concerns.
In each of the five services -Environmental Sanitation, Housing Hygiene and Accident Prevention, Industrial Hygiene, Radiological Health, and Water Supply - the Branch made progress toward improving the environment of individuals and of the population as a whole. The role each of these services played and some of the more significant accompfishments of the year are covered QY the reports which follow.
As the fiscal year ended, there was an increased awareness on the part of Branch staff not only for intensified efforts within the department directed toward solving the more urgent environmental problems, but for increased pubIic understanding, and a re-evaluation of public health resources and capabil ities. These needs were identified and written into program plans for the coming year.
65

ENVIRONMENTAL SANITATION SERVICE
Environmentalists working at both state and local levels were deeply involved in the lives of Georgia people during fiscal 1969.
Individual water supply and sewage disposal systems; recreational area sanitation and tourist accomodations; institutional, milk, food and shellfish sanitation; solid waste management and insect and rodent control were areas of concern for the men who made up the staff of this Service.
In the development of standards and through onsite inspections to determine that standards set by the State Board of Health were being met, environmentalists contributed much toward improving Georgia's environment, controlling disease and preventing epidemics.
To illustrate the far-reaching effects of sanitation services, a health department photographer accompanied by Ricky and Lisa, two Georgia youngsters, took a minature tour of sites and scenes which typify the places, the people, the homes, facilities and the items that received attention from this Service in fiscal 1969. The scant statistics given pertain to statelevel inspections and services, only. These figures may be mentally multiplied a hundred times over to reflect activities of sanitarians and engineers who worked out of local health departments throughout the state during the year.
66

Sheltering 1,900,000 people,365,000 homes in Georgia are served by individual wells and water supply systems. Many are mobile homes like these, located near Lake Lanier in Hall County. To insure safe quality water, environmentalists inspected and approved 186 individual water supplies in 1969.
67

1,700,000 Georgians live in 475,000 homes that are served by individual sewage disposal systems. For the protection of those living in homes served by these systems - as well as their neighbors - 201 private sewage disposal systems were inspected.
68

Visitors to Georgia's 44 state parks, 114 U. S. Forest Service recreational areas, seven Corps of Engineers' Lakes, to Jekyll Island and Stone Mountain totaled 35,000,000 last year. For their protection, 22 plans were reviewed; 58 site inspections were made; 64 recreational area water supplies were inspected; 19 sewage disposal systems were approved.
69

---:---: --
For the control of insects and rodents, the Service conducted investigations, provided technical assistance and regulated construction of water impoundments during the year a service that helps to keep areas like the one Lisa seems to be enjoying, above, free of flies, mosquitoes and rats.
70

To provide school children, adoptive children, pre-schoolers in day care centers, inmates of prisons and older persons living in nursing homes with a safe environment, this Service works closely with the Department of Family and Children's Service, State Department of Education and the State Board of Corrections on construction plans, maintenance and general sanitation. During FY 1969, 547 plans for school construction of new buildings, like the one housing the lavatory, above, where Ricky paused to wash his hands, were reviewed; 90 penal institutions and five foster homes were inspected.
71

To reduce risks of discomfort, disease, accidents or death , routine inspections were made of food source, storage facilities, preparation and service. As Georgia has more than 10,000 food service establishments that regularly serve over two million meals a day, these inspections were a vital part of the service rendered by environmentalists last year.
72

For the consumers of approximately 200,000 pounds of oysters produced in Georgia annually , the Food Sanitation Section keeps constant watch over shellfish growing waters of the state, conducts sanitary surveys of the industry, makes hydrographic studies, and provides laboratory testing of both the products and the waters in which they grow.
73

For the protection of persons who consume the 375,000 gallons of milk produced daily in Georgia - consumers like the nursing home residents above - this Service provided consultation to local health departments regarding milk plant inspection, surveillance of 1,400 dairy farms, and the routine sampling of raw and pasteurized milk and milk products. During the year, 20 program reviews of local milk sheds were conducted and 11 offical milk sanitation surveys made.
74

Annually, 18,250,000 persons occupy Georgia's more than 1,200 motels, hotels and

other tourist facilities. In 1969, the Service conducted 155 inspections of tourist accomo-

dations. These inspections related to swimming pools, food service, water and sewage

systems, solid waste disposal, heating and ventilation, insect control and general premise sanitation.

75

.,,
-',;1
-1 I
Georgians generate 2,968 million tons of solid wastes each year. To minimize risks to health from this massive amount of garbage and waste, environmentalists maintain surveillance over the state's disposal methods and seek to promote proper waste handling through consultation with local governments, the provision of technical assistance, and periodic evaluation surveys.
76

HOUSING HYGIENE AND ACCIDENT PREVENTION SERVICE

HOUSING HYGIENE: Over 50%, or approximately 2,000,000 Georgians are housed in 486,961 substandard housing units and are exposed to one or more of the hazardous environmental conditions associated with substandard housing - inadequate and unsafe water supplies, insanitary sewage disposal, infestations of rodents and insects, improper garbage and refuse disposal, and improperly vented heating facilities.
Many of the activities of the Housing Hygiene Section were devoted to housing surveys and problems relating to substandard housing at the local level. A survey of Hall County was compiled and published which provided basic data for future program planning in housing and environmental health. As a preliminary step to the development of a housing program for the City of Waynesboro, the Housing Hygiene Section participated with the Burke County Health Department in a survey of over 1,300 dwelling units which house approximate~y 4,700 Burke County citizens. Assistance was given to local health departments in surveys of Dawson and Pickens Counties and to three model cities programs. Assistance to the model cities program afforded an opportunity to work closely with local governments to achieve maximum benefit from a concentrated housing improvement effort.
A State survey of the adoption and administration of codes and regulations pertaining to housing improvement by county and municipal government was begun in April, 1969. This will hopefully determine those communities which do not have adequate regulations and the diversity of regulations in communities which have adopted codes.

ACCIDENT PREVENTION: The ultimate goal in Accident Prevention is to reduce accidental injuries and deaths in Georgia. The immediate objectives are to reduce the accident potential and lessen the sever ity of injuries. In order to reach these objectives, the Accident Prevention Section was involved in the following activities:
Reviewed county health department program plans and assisted local health department personnel in integrating accident prevention into on-going programs at the local level.
Coordinated the operations of the eleven poison control centers which provide information and treatment facilities for physicians and hospitals throughout Georgia. Approximately 830 persons (390 under five years of age) were treated in poison control centers last year. Over 400 new product cards were added to the poison control center files.
Conducted orientation for environmental sanitation and Housing and Urban Development trainees on the role of the Health Department in Accident Prevention.
Provided consultation services and safety education materials to individuals, local health departments, and to local and State professional organizations. In an effort to increase public awareness of the accident problems in Georgia, numerous articles were released to the news media.
Co-sponsored a two-day seminar on "The Immediate Care of the Sick and Injured," held at the Medical College of Georgia. In addition to the first year medical students, approximately 200 others received basic training in the handling and treatment of accident victims.

77

PERCENT OF GEORGIA COUNTIES HAVING VARIOUS PERCENTAGES* AND NUMBERS
OF SUBSTANDARD HOUSING UNITS

Percent of Counties and of Substandard Housing Units in the State of Georgia

Number of Substandard Units in Thousands

30 Counties
25".
20 Substandard Housing Units

THOMAS WAYNE BARROW BALDWIN JACKSON COWETA GoRDON RABUN BARTOW DECATUR WALTON
TOWNS TOOMBS HENRY BUTTS BULLOCfl FANNIN BLECK LEY

PAULDING FRANKLIN LANIER MciNTO~H MONROE
EVANS MILLER
EMANUElTELFAIR WlLKJI:S JONES
PUTNAW: CANDLER BRANTLEY
MERIWETHEI PULASKI CHARLTON LINCOLN LONG JEFF DAVIS

150 140 130 120 llO 100 90

so

15 70

60

CLINCH

10

JOHNSON

so

QUITMAN

HEAJID

MONTGOMERY

TF.RRELL

40

BURKE

CALHOUN

30

5 20

10

0

0

PERCENT OF SUBSTANDARD UNITS BY COUNTY GROUPS *County names in each bar are arranged to reflect increasing percents
of substandardness from top to bottom.
SOURCE: 1960 Census

78

GEORGIA'S LEADING KILLERS AGES 1-44

Accidents From All Causes (46%)

Heart Disease (13%)
Cancer (11%)

All Other Causes (30%)

79

Georgia's number one killer of young people ages one through 44--the automobile!
80

RADIOLOGICAL HEALTH SERVICES
Charged with responsibility for planning, conducting and coordinating a statewide program for the evaluation and control of radiation hazards, this Service concentrated its fiscal year efforts on X-ray equipment control, radioactive materials management, and environmental surveillance of radioactivity levels.
746 X-ray equipment inspections were made to assure that each piece of equipment in use does not endanger either the patient or the technician. Pieces of equipment found to be satisfactory totaled 127 while 519 were ordered modified to bring them into compliance.
27 state-developed lectures and demonstrations were given in schools of X-ray technology, dental veterinary schools to improve the quality of teaching or radiation safety procedures. They were attended by 3,216 persons.
417 "early warning" atmospheric radiation tests were made in cooperation with local health departments.
17 pasteurized milk monitoring tests were made by staff personnel to measure levels of radiation in milk.
204 water tests were made to measure levels of fallout and nuclear reactor waste in public and private water systems, rain water, rivers and streams.

Results of atmospheric, milk and water tests during the year showed that radioactive fallout levels have fallen and all other vectors of radioactive contamination in Georgia remained below acceptable limits.
The problem of low energy X-ray emission from color television sets occupied the time of two staff members for several months. Over 200 sets were evaluated in field visits. Only in one or two cases were sets found where any significant hazard could be identified.
Assessment and control of hazards associated with the use of radium and artificially produced radioisotopes continued. A total of 52 radium inspections and 74 joint inspections with Atomic Energy Commission personnel were made in the last fiscal year. Disposal of five radium sources was achieved.
During the year, the State Board of Health adopted separate rules for the control of "X-ray" and "Radioactive Materials" -a significant action in relation to the general public as well as the operation of this Service. The rules became effective in March 1969, and initial registration of all X-ray equipment users will begin in August. Assumption of regulatory responsibility from the U. S. Atomic Energy Commission over by-product, source and special nuclear material, as the year closed, was scheduled for January 1970.

81

INDUSTRIAL HYGIENE SERVICE
An estimated 454,000 people were employed in Georgia's 6,400 manufacturing and processing plants in fiscal 1969. They comprised the target popula~ion for whom services were provided by Industrial Hygiene. Work site visits were made to roughly ten percent of all plants - 640 -to be sure that sanitary facilities were adequate, drinking water pure, the noise level not detrimental to health, and that employees were not being exposed to excessive concentrations of toxic dusts, fumes, gases, mists or vapors.
The Service col1ected 95 samples of air and of raw materials for laboratory analyses in connection with these inspections, and completed 191 field determinations to evaluate working conditions in plants involved. These evaluations covered such toxic agents as carbon monoxide, silicon dioxide, solvents, lead, formaldehyde, and chlorinated hydrocarbons and contributed to an improvement in the working environment of 24,831 persons.
During the first six months of the year - July through December 1968 - the Service conducted a survey to locate all continuous beam and pulsed beam laser systems in Georgia. Forty-eight were located. Two of the systems were in use in industrial establishments, one in a medical clinic, and the rest were in schools where they were being used for resf!arch and teaching purposes. Safety precautions around these laser systems varied from fair to good. Where safety hazards existed, recommendations for improvement were made.
In May 1969, the Service arranged for the U. S. Public Health Service to bring its new mobile testing laboratory to one of Georgia's largest granite processing plants. A four-day study was conducted with staff personnel participating. Audiograms of the men working in both the planf and the quarry were taken, and a noise survey made of plant operations. Approximately 260 employees were involved in the study, a part of a nation-wide effort to determine the feasibility of taking a mobile lab to the job site.
During the year, the Electronics Service unit did aa "total of 77 X-ray repairs and helped to move and install three X-ray laboratories. One hundred twelve audiometers and 58 miscellaneous pieces of equipment were repaired.

WATER SUPPLY SERVICE

The Water Supply Service is charged under the

Georgia Health Code, Chapter 88-26, with the respon-

sibility of insuring that adequate water of the highest

quality be supplied for water supply systems in the

state.

In discharging this responsibility, plans and specifi-

cations were approved during the year for 26 new

systems, 35 wells and improvements to 68 systems.

The total dollar value of plans reviewed and approved

was $24,726,900 -an increase of $8,221,900 over

the previous year.

The laboratory, which is maintained by this Ser-

vice for testing water samples from public supplies,

shellfish growing waters, swimming pools and, under

a contractual agreement with the Water Quality Con-

trol Board, stream samples, examined 37,506 water

samples during the year. Tests performed were as fol-

lows: 70,818 for bacteria in water from public or

community water supplies; 19,166 from shellfish

waters; 44,221 from streams, and 2,357 from swim-

ming pools. In addition, 28,171 chemical tests were

run on samples from water supplies and streams.

Water plants tend to have a high labor turnover

and it is necessary for this Service to maintain a con-

tinuous training program to upgrade operators' skill.

Two training schools were held during the year- one

in Macon for well operators and another in

Gainesville for surface operators. Total enrollment at

both schools was 96 students. At the conclusion of

the training sessions, examinations were held and cer-

tificates issued to operators who successfully com-

pleted one of the courses.



82

BRANCH OF SPECIAL HEALTH SERVICES

Cancer Control, Cardiovascular Disease Control, Chronic Disease and Geriatrics, Employees Health Service and Venereal Disease Control are the health services that comprise this Branch. Activities and principal achievements ot the fiscal year are included in the individual service reports which follow .

CARDIOVASCULAR DISEASE CONTROL SERVICE

In cooperation with local health departments,

RHEUMATIC HEART DISEASE PREVENTION:

;

other departmental services, Georgia Heart Associa-

Computerization of the rheumatic fever registry was

tion, Georgia Regional Medical Program, Field Inves-

completed during this FY with a total of 1,478 active

tigation Unit and Heart Disease Control Program of

patients now maintained on drug prophylaxis. Rheu-

the USPHS, this service provides stroke rehabilitation,

matic fever patients of 10 of the 14 Heart Clinics

rheumatic fever prophylaxis, lay and professional

have been added. It was found after the first year of

education and public health research in heart and

computer operation that 757 patients had been lost

blood vessel disease, including coronary artery dis-

to follow-up by the referring physician. Recurrences

ease, hypertension, and congenital heart disease.

of rheumatic fever will be followed closely to mea-

STROKE: At the request of private physicians and

sure effectiveness of the program . Preliminary anal-

in conjunction with public health nurses, a reduced

ysis show 11 recurrent and 38 initial attacks in 1968.

staff {2 full and 2 part-time physical therapists) made

Local PHNs gave valuable assistance in locating lost

2,264 consultative visits to homes , hospitals, clinics,

patients and counseling patients and family. The ac-

and nursing homes in 126 counties. One speech path-

companying chart illustrates new follow-up pro-

ologist gave 403 consultations to stroke patients.

cedures .

Stroke teams {nurses and therapists) conducted 35

training programs and three in-service review pro-

grams for PHNs, HNs, LPNs and aides. Approxi-

mately 735 attended. Three rehabilitation training

programs for PHNs were held at Battey State Hospital and six other IP.ctures given to RNs on rehabilitation and speech.

Health education exhibit of Cardiovascular Disease Service.

In cooperation with Johns Hopkins Schqol of Public Health, the cooperative study on geographic variations on stroke morbidity was completed; high mortality and morbidity from stroke in Georgia was confirmed - a true higher incidence than in other areas of the country. Papers have been submitted for publi cation.
HYPERTENSION: The pilot demonstration of community and publ ic health measures to control elevated blood pressure in the metro Atlanta area was approved by the Georgia Regional Medical Program, but funding has been delayed . Planning, testing of forms and proced ures and revision of methodology has continued . A one-year, partial contract was granted by USPHS in June 1969 for beginning this study in FY 70, but operations will not begin until approval of major funding by GRMP.
83

RHEUMATIC FEVER PROPHYLACTIC DRUG PROGRAM

co
~

CARDIOVASCULAR DISEASE CONTROL SERVICE

Alter Nine Months, Prescription Renewal Needed

At the end of three months

I
Prescription Renewal not returned

~
Renewal Returned

Active File

Contact Physician

Disco!tinue Med!cation

To receive

Medication
(1)' (2), (3) or (4)

Ren~ew-ed -------------~

medication every 3 months for one year

Withdrawals

I

Withdrawal

4

New

~ (Recurrence) <C!!~=I---- Prescription Renewal

Prescription Renewal returned

Prescription to CVDCS
!

not returned

( 1 )I
Patient died
(2)1
Changed diagnosis

Patient

Active File

, (3
(04t1per

Patient changed

~

re f to

cuosendtm. uephys1.c1. ans

Pat1ent

Medication -----------------~ Renewed

Patient moved

Relocate

Patient +11-------- refused

j Patient
sees

~~~-tinue I l Med"1cat1. on

__,...... Patient lost

Patient relocated Patient referred

to continue

h .. d P yslclan an

(1) '

(2 )

to follow-up Medication

to physician I

continues

or (3) Renewed

Medication

I

~---------::::-..L__..:.:.m.:.:e::::d:.:.ic::::a::t:.::io~n:.:,__ _.!W~1it:.!:h~d!!r!!aw~1a

discontinued

(1), (2), or

Recurrence
I

.".v

(3) or (4) Withdrawal

Mrenedewiceadtion --------41~>

Returns to Physician ~

..., ....

New

Prescription

Withdrawal

CARDIOVASCULAR NUTRITION: Original audiovisual material for teaching nutrition in heart disease, stressing weight control, fat modification and sodium restriction was designed and prepared. Lectures and films were presented to 50 groups of high school and college classes, athletic coaches, dietitians, doctors and nurses. Cooperative efforts in research with the Tulane Arteriosclerosis Study and the Trappist-Benedictine Monk Study continued. Assistance was given to state and federal agencies in compiling information on the problems of hunger and mal nutrition in Georgia.
CORONARY HEART DISEASE CARE: Under the direction of the CvDCS director, a Georgia Heart Association training program on Cardiopulmonary Resuscitation became fully operational this year. Twenty-five training sessions for instructors in CPR were held and 247 instructors were trained, who in turn trained 3,004 nurses, doctors, firemen, ambulance drivers and others in these emergency procedures. Efforts to organize and train instructors in all Georgia hospitals are continuing.
Staff regularly gave lectures as part of the training course for coronary care nurses at Georgia Baptist Hospital.
INTERAGENCY SUPPORT: The Cardiovascular Disease Control Service paid for 298 chest X-rays and fluoroscopies for indigent heart clinic patients in Georgia. Two EKG machines and dictating equipment were loaned to the clinics. Staff lectured on heart disease and related subjects to medical, dental and nursing students, civic and professional organizations throughout the state. Staff participated on GRMP task forces, in review and planning committees of
Comm~nity Council-Atlanta Area, Region IV Com-
prehensive Health Planning and other medical and paramedical groups.

CHRONIC DISEASE AND GERIATRICS
SERVICE
Health Program Representatives assigned to health districts continued to play a very important role in activities of county health departments. Working under the direct supervision of district medical directors, they offered much needed assistance in planning and implementing chronic disease and geriatrics programs and continued to assume certain administrative duties, thereby allowing the professional staff more time for the delivery of services to local health center patients.
Screening activities for diabetes, chronic obstructive pulmonary disease, and glaucoma, with surveys
of high risk areas for location of arthritis and P. T
clinics, continued, but on somewhat a reduced scale. Due to a shortage of nurses and physical therapists during fiscal 1969, consultation and services in all areas of activity were slightly lower than for FY 1968. In addition to mass screening, more on-going clinics were established in counties for regular screening. (See screening tables.)
Throughout the year, all activities were carried out in close cooperation with the Diabetes Association, Arthritis Foundation, Society for the Prevention of Blindness, Tuberculosis and Respiratory Disease Association, Regional Medical Program, medical societies, local physicians, and other agencies and community organizations.
All staff consultants (nurses, P.T.'s and dietary) continued their efforts to reach as many local health centers and nursing homes as possible, using the team approach as well as ;ndividual and group consultation. The one specialized nurse consultant, working in the health districts and county health departments, helped immeasurably in implementing additional chronic disease programs, expanding others, and in establishing additional on-going clinics for screening and instruction as part of follow-up activities. (See graphs A. through F. for details.)
In addition to the services offered as a team member for teaching, physical therapists provided consultation to the health districts and counties on an individual, referral basis. A total of 230 visits were made to county health departments; patient consultation was provided 1,012 individuals, and 63 training courses were presented in nursing homes and health centers.
The dietary consultant, in addition to working as a team member, visited 60 county health departments in 30 health districts for individual consultation, group instruction and teaching programs for diabetics.
85

Total Screened
258
Total Screened
5847
Total Screened 40,238

GLAUCOMA SCREENING (1969 -1969)

Total Referral
2

% Referral
.77

New Cases

%New Cases
.38

Previously Diagnosed
0

CHRONIC OBSTRUCTIVE PULMONARY DISEASE SCREENING (1968- 1969)

Total Referred
271

% Referral
4.63

New Cases
166

%New Cases
2.36

Previously Diagnosed
20

DIABETES SCREENING (1968- 1969)

Total Referred
829

9~
Referral
2.06

New Cases
535

%New Cases
1.33

Previously Diagnosed
10

Not Reported
0
Not Reported
30
Not Reported
33

Counties Screened and Surveyed (1968- 1969) . Counties Screened and Rescreened to Date On-going Clinics in Counties . . . . . . . .

.102 . 195 . 83

86

A TEACHING PROGRAMS
0 Total Teaching 0 Nursilg home teaching
100

90

80

70

':':

60

::

50 ..

40

30 20

10
0 1...-......IO.l"-L,---w"'-J.......I;.,;I,.,I,66-67 67-68 . 68-69

D FIElD ACTIVITIES DISTRIBUTION
125
100
75
n 50 r-
2o5....__,__ _~__..~
[3 No. of Teo:hng Ass9Jments 66
mJ No. of consu~otion md plm-
nng visits 125 ~ No. of visits to local health
depa1ments 83
0 No. of distrids visited 27

Institutions and Other Activities
B ATTENDANCE

1100

C3 Total

0 R.N.

1000

F1J LPN.

1111 Aide 900

800

700

600

c
R.N. TRAINEESHIP COURSE TEACHING
ffill No. R.N:s Attended D No. Hrs. of Instruction
0 No. of Nursng Hanes rep.

500

100

80

300

60

200

40

100
0 66.{)7 67.{)8 68-69

20

o--~~--~~~--~

66-67

67-68

Districts and local Health Departments

F ACTIVITY

E VISITS
50

mJ Consu~otion

50

a0 In-Service ProgrCill Closs Session-Diabetic Patients

40

40

30

30

20

20

10 0 ~......-...___.."'--_

Health Districts Visited
'WJ Visi to County Health Dept.

*Consu~otion was primori~ conarned with:
1. Follow-up of neN pt' s found in screening dnics
2.1dentify barriers that may linil adequate service to chronically ill and older people who ore ct home
Chronic Disease and Geriatrics Service Fiscal Year 1968-1969

87

EMPLOYEES HEALTH SERVICE
In FY 1969 the Employees Health Service conducted pre-employment physical examinations on 214 Department of Public Health employees; reviewed and passed on pre-employment physical examinations conducted by private physicians on 6,984 state employees; provided periodic multi-phasic screening tests for 2,034 state employees in the Atlanta area in whom 1,134 abnormalities were found; counseled and administered first aid to 2,709. Tonometry testing was started July 26, 1968.
The statistics that follow compare the activities of the Employees Health Service during the 1968 and the 1969 fiscal years, and indicate the results of screening tests.
EMPLOYEES HEALTH SERVICE ACTIVITIES

Pre-employment physical examinations
Pre-employment physical examinatjons reviewed
Screening visits
blood typing hemoglobin wbc serology blood sugar urine complete urine, sugar, albumin x-rays blood sugar tolerance test
Screening revisits
Counseling and first aid
Immunizations
Other
Tuberculin skin test
Tonometry tests
No. with borderline findings retested in six months
No. re-ferred to private physician
No. diagnosed by private physician as having glaucoma
Total visits and procedures
88

FY 1968 199
6636 2051 1050 2155 2093 2172 1940 2171
306 2232
13 905 2429 1023
42 1625
21
6 2
29,042

FY 1969 214
6984 2034
942 2133 2074 2157 2111 2191
313 2085
13 1186 2709 1081
71 1746
613
30,657

.i

RESULTS OF SCREENING TESTS DURING 1969 FISCAL YEAR
Total number screened Abnormalities found:
overweight underweight hypertension elevated glucose tolerance test hemoglobin, low x-ray pathology serotogy (sts) tbc skin test positive hearing defect in speech range defective distant vision defective near vision defective visual fields elevated two-hour post prandial
blood sugar elevated tonometry pressure

2034 1134 174
0 13 5 55
7
6 39 78 265 434 12 19
27

89

OCCUPATIONAL HEALTH SERVICE
Occupational diseases and working conditions that adversely affect employed persons are poorly reported in Georgia. This is not a situation peculiar to Georgia; it's true of most other states as well. Present sources of information available to this Service are insurance claims submitted to the Workmen's Compensation Board and death certificates filed with the Department's Vital Records Service.
During fiscal 1969, four death certificates listed silicosis as a contributory cause; one reported silicotuberculosis; one Iisted byssinosis and emphysems; one, asbestosis and one, pnuemoconiosis.
Claims filed with the Workmen's Compensation Board and reported to the Service totaled 42. These reports came from 29 employers in 18 counties -a continuing unexplained decrease over previous years. For dermatitis, 22 filed claims; for chemical injury to the eyes, one; for lead intoxication, 14; for pesticide poisoning, three; and for tetrachloride inhalation and undulant fever, one each.
Local health departments were notified of the occurrence of occupation-related diseases and deaths and were offered medical, nursing and engineering assistance in follow-up, with the Industrial Hygiene Service providing engineering services for field investigations.
In addition to local health centers, private physicians, employers and insurance carriers were given consultative services in occupational health. However, both services and activities associated with occupational disease surveillance and control were greatly restricted this year due to limited part-time staff. Like reporting problems, this situation is not peculiar to Georgia or to this Service.
A recent U. S. Public Health Service publication points out that America's labor force supplies approximately 60% of the nation's tax revenues, yet no more than 20% of these workers have a doctor or nurse on duty at their place of employment. Since it is estimated, according to this brochure, that over 300,000 workers each year suffer diseases related to their jobs, the seriousness of the occupational health problem becomes quickly apparent - yet most occupational illnesses are preventable diseases; most on-the-job health damage need not occur!
90

VENEREAL DISEASE CONTROL SERVICE
PREVIOUSLY UNTREATED CASES REPORTED AND TR.EATED: During fiscal 1969, 976 cases of Primary and Secondary Syphilis were treated and reported to the department. This is a 7.8% increase over Primary and Secondary Syphilis cases reported and treated in Fiscal 1968. Since we had a 6% decrease in reported cases of Primary and Secondary Syphilis dunng the first half of Fiscal 1969 all of the increase occurred during the last half of the fiscal year.
Early Latent Syphilis cases reported and treated during the fiscal year totalled 512 - an increase of 5.6% over cases reported for fiscal 1968.
During the fiscal year 2,734 cases of Total Syphilis were reported and treated - a 12.7% increase over similar cases reported for fiscal 1968.
Cases of Gonorrhea reported and treated were 22,392 -a 19.8% increase over similar cases for fiscal 1968.
During the fiscal year 123 cases of Other VD (Chancroid, G.l, and LG V) were reported and treated - 28.5% decrease over cases reported and treated for 1968.
EPIDEMIOLOGIC INVESTIGATION PROGRAM: During fiscal 1969, Health Program Representatives conducted 17,416 investigations. These investigations resulted in 3,052 previously unknown and untreated cases of venereal disease being brought to treatment. Of these, 809 were Primary and Secondary Syphilis cases. All cases of primary, secondary, and early latent syphilis reported during the fiscal year were interviewed for contacts and suspects by Health Program Representatives.
Health Program Representatives also investigated all reactive serologic specimens processed in public health, hospital and private laboratories in the State during the fiscal year.
DIAGNOSTIC AND TREATMENT SERVICES: During the fiscal year the private physicians of the State treated 24% of the Primary and Secondary Syphilis cases reported; 24% of the Early Latent Syphilis cases; 46.4% of the Total Syphilis cases; 14.3% of the Gonorrhea cases and 2.4% of the Other VD cases. HealthDepartment Area Diagnostic and Treatment Centers treated 76% of the Primary and Secondary cases reported; 76% of the Early Latent Syphilis cases; 53.6% of the Total Syphilis cases; 85.7% of the Gonorrhea cases and 97.6% of the Other VD cases.

CANCER CONTROL SECTION

Through 20 tumor clinics scattered over the state Cancer Control provided diagnostic and treatmen; services for 2,374 patients during fiscal1969. Benign diagnoses were given in 412 cases. Private physicians continued to donate their services. There was a small upgrading of fees for outpatient services beginning on July 1, 1968, representing the only increase since 1948.
Applicants eligible for Medicare and Medicaid were referred to the clinics in the usual manner. The clinics billed these programs for services - a procedure that has resulted in considerable savings and has made it possible for the state-aid program to serve cancer patients to a greater degree. This program paid those outpatient charges for patients not covered by Part B of Medicare and for services not covered by Medicaid.
The program continued to distribute the Cancer Bulletin to physicians of the state. Close liaison was maintained with the Georgia Division, American Cancer Society, concerning cancer patients.
The following reflects FY-1969 program services as compared with those of FY-1968:

1968 1969

Number of Applications Processed Approved Disapproved

1792 1762
30

1478 1445
33

Patients Reporting for First Time Diagnosed Benign Diagnosed Malignant

1549 651 898

1148 412 736

Patients Treated (new and returning)

3116 2374

Accrued Expenditures $464,964.54 $406,585.36

Insurance Refunds to Department:
$ 20,248.58 $ 23,037.30

91

In Conclusion . . . .
In a report such as this, with its necessary emphasis on goals and accomplishments of various organizational units, it is sometimes difficult to relate reports to people -yet the real emphasis is there, with people. Direct and indirect service to the people of this state is the prime concern and responsibility of the Georgia Department of Public Health .
For these reasons, five actual case histories conclude this fiscal year report. They are case histories about real events and real people whose names have been changed to protect their right to privacy. They are presented to underscore and explain public health's service role and overall contribution to the people of Georgia.
93

COMMUNITY MENTAL RETARDATION PROGRAM Larry had always learned more slowly than his brothers and sisters. He was late in speaking and in feeding himself, though his disposition was friendly and outgoing. Not until he was three years old did his parents become concerned and learned through their doctor that Larry was mentally retarded. Their shock and grief made it difficult for them to cope with the situation for several months. Slowly they came to realize that Larry depended upon them for whatever special help he might get. Gradually they came to realize the difficult role that parents of retarded children must fill. For this family, help was not too far away. A public health nurse provided follow-up counceling after Larry's evaluation, and a social worker in the local mental health clinic helped the parents work through their fears and confusion about retardation. At the age of five Larry was placed in a special day training center for the mentally retarded; it was operated by the local health department. There he learned to do many things - all designed to help him develop greater independence and greater ability to cope with his limited world. Larry may never need total institutional care because of his special training, and he will be a happier boy as well. In 1969, the Community Services Branch supported in part the training of nearly 350 retarded children like Larry. But almost 8,000 more were left unserved because of a lack of funds and programs.
95

CRIPPLED CHILDREN'S SERVICE
George is t he second child of a young, low income couple living in the mountain country of northeast Georgia. He was delivered by cesarean section following a full term, normal pregnancy. After birth h e was found to have multiple congenital defects, the most significant of which was a m yelomeningocele - a hernial protrusion of a part of the spinal cord and its membranes. An emergency operation was performed almost immediately to close the spinal cord opening to prevent accumulation of water in the brain.
Within a fe w days a second tragic event hit the family. George's mo ther developed complications from the cesarean section delivery and died, leaving George's fath er alone with one two-year old normal child and an infant with severe neurological, urologica l, and orthopedic defects. The hospital costs were staggering and made even worse by George's father's monthly income - less than $300.00. George would need years of highly specialized treatment and car e, and probably further surgery. He needed the Crippled Children's Service, and was referred to it by the public health nurse in his local county health department.
George was p icked up by Crippled Children's Service at the age of two months and seen in clinic his f irst day out of his local county hospital. The CCS clinician hospitalized him in Atlanta for an additional month, then began treating him in the CCS clinic on an out-patient basis.
George's progress was excellent. He thrived, although the odds against him were great. Each of h is legs and feet were deformed, and corrective casts were applied ever y two weeks to straigh ten them. X-rays were taken regularly to monitor their progress. His improperly developed lower extremity muscles were strengthen through expert physical therap y. Through consultations with a urologist his bladder problems were evaluated and corrective treatment begun. Pediatricians checked George's general health and other functions regularly. The CCS staff nurses and medical social workers trained George 's grandmoth er in caring for the child in the home setting. In short, George was receiving the full care o f the Crippled Children 's Service medical care team.
George will soon have his second birthday. He is alert and bright. He sits alone, drinks from a cup, and takes finger foods. His doctors are talking about how soon he will be able to walk with long-leg braces. Although George still faces possible surgery on his hip and a foot, he seems to be well on his way toward leading a relatively norma/life. Lik e so many other children he will be able to do so because of the help he received from Crippled Children's Service. George's problems may be more severe than those of many of the nearly 13,000 other children served b y CCS, but the quality of care he is receiving is typical of the care all of them receive from this health department unit.
97

CANCER SCREENING PROGRAM A routine Pap smear was done on Jennie James at a local health department's family planning clinic on March 12, 1968. The Pap smear was reported as Class Ill (suspicious), indicating further study for diagnosis and p ossible treatment. A conization (flattened cone shaped mass of tissue) of the cervix was done on March 25, 1968 and diagnosis established the presence of carcinoma-in-situ of the cervix (preinvasive cancer). At this stage, the lesion was strictly confined to the surface layer of the cervix and no other organ was yet involved. Mrs. James was referred to her private physician who performed the biopsy procedure and who recommended, on the basis of the established diagnosis, that major surgery (total hySterectomy) be performed. This surgery was done on April8, 1968 -less than a month after Mrs. James' condition was first discovered. The subsequent additional pathology study on the post-operative specimen indicated no evidence of invasion, which means that the probability of cure for Jennie is 100%. The outlook for Jennie James is especially significant in view of the fact that the 33-year-old housewife has nine living children - young children, whose dependence on her must be very grqat and who, wi thout their mother, would be shifted to relatives or friends or perhaps to foster care. Jennie will be encouraged to come to clinic for annual examinations and continued medical supervision will be given her, but, at this time, there is every reason to believe she has been spared from death by cancer through early detection and treatment. She is only one of many Georgia women whose future is far brighter than it might have been without the Health Department's cancer screening program.
99

EPIDEMIOLOGIC INVESTIGATIONS During 1969, several cases of Eastern viral encephalitis in horses were reported in a metropolitan area county. About the same time viral encephalitis was detected in the horses, a child died in an adjoining county of a disease which had caused brain damagea condition that accompanies (is symptomatic of) encephalitis. These events could have easily created a panic among persons living in the counties involved, and understandably so - encephalitis is an extremely dangerous disease that is difficult to treat. Prompt investigation of facts was required. The two-pronged study that resulted produced findings that showed the two occurrences - diagnosis of viral encephalitis in some horses, and the death of a brain-damaged child- to.be unrelated. Direct contacts with the physicians who had attended the young child established that this death had followed infection with an intestinal virus that was being spread from person to person. Investigative work was then begun to isolate and describe the intestinal virus which has caused an outbreak among children in the suburban community where the young victim had lived. The investigative work undertaken in the county where equine (Eastern viral) encephalitis had been discovet'ed showed that no mosquitoes of the type suspected of being the principal source of danger to man existed. (Since the disease is never transmitted from horse to man, but usually spreads by bird-biting mosquitoes, the absence of carrier-mosquitoes showed there was no cause for alarm.) The two events were clearly not related; panic was averted; and it was possible for the Health Department to plan control measures to cope with the problems that did exist Such occurrences are commonplace. They happen almost daily. In each case, the Branch of Epidemiologic Investigations works to establish the facts, and to give advice and counsel concerning control measures. Though in the instance cited, no lives were immediately at stake, the reassurance given to concerned people in the area was of vital importance to them. The incident is representative of the people-to-people services regularly rendered b~ the Branch of Epidemiologic Investigations.
101

VITAL RECORDS SERVICE Martha Samples, a widow, had become disabled and was no longer able to support her children and herself. She had applied for Social Security disability benefits but needed a birth certificate to prove her age. She had always used November 19, 1929 as her birth date. A staff worker, checking the vital records for Mrs. Samples' birth certificate, found that a set of unnamed female twins had been born to her parents on November 19, 1929. It was necessary that her name be added to her certificate. An amendment form was sent to her with a query as to whether she was the first or second born of these twins. Mrs. Samples returned the completed amendment form with ample proof of date of birth and name, but she stated she was not a twin but that she had twin sisters born on November 19, 1931. She said they were the fifth and sixth children born to her parents. In checking the records again, the fact was revealed that a male child was born to her parents on that date- November 19, 1931 -and that he was the seventh child. With the knowledge that Mrs. Samples was not a twin and that twin sisters had not been born to her parents in 1931, it was assumed that she must have been born prior to her twin sisters' birtb in 1929. Her birth was found, properly recorded, identifying her by name and showing she was born in September of 1927. This record was sufficient for the approval of her Social Security benefits. Working with Mrs. Samples on her problem enabled Vital Records to discover that the birth ofall the children of her parents had been recorded as they were born, but that each child in the family, for some unexplained reason, had used the birth date of the next born child as his or her official date of birth. This is typical of problems revolving around the certificates registered in the Vital Records Service that arise each day.
103