NORTH CAROLINA HISTORY OF HEALTH DIGITAL COLLECTION  

The Health Bulletin

Volume 64 (1949)

DOCUMENT NO. NCHH-04-064   

|| http://hsl.lib.unc.edu/specialcollections/nchealthhistory || This item is part of the North Carolina History of Health Digital Collection. Some materials in the Collection are protected by U.S. copyright law. This item is presented by the Health Sciences Library of the University of North Carolina at Chapel Hill for research and educational purposes. It may not be republished or distributed without permission of the Health Sciences Library.

The North Carolina History of Health Digital Collection is an open access publishing initiative of the Health Sciences Library of the University of North Carolina at Chapel Hill. Financial support for the initiative was provided in part by a multi-year NC ECHO (Exploring Cultural Heritage Online) digitization grant, awarded by the State Library of North Carolina, and funded through the Library Services and Technology Act (LSTA).

For more information about the collection, or to search other volumes, please visit:

|| http://hsl.lib.unc.edu/specialcollections/nchealthhistory || .

MEDICAL LIBRARY U. OF N. C N. Cjlj^ CHAPEL HILL. C

I This Bulletin wJl be sent free to on^dtizerv of the State vipon request!

Published monthly at the office of the Secretary of the Board, Raleigh, N. C Entered as second-class matter at Postoffice at Raleigh, N. C. under Act of August 24, 1912

Vol. 64 JANUARY, 1949 No. 1

Paul Pressley McCain, M. D.

1884-1946 MEMBERS OF THE NORTH CAROLINA STATE BOARD OF HEALTH

S. D. GILA.IG, M.D., President Winston-Salem G. G. DIXON, M.D., Vice-President : Ayden H. LEE LARGE, M.D Rocky Mount Fayetteville W. T. RAINEY, M.D., ,_„^_,„ ^. »...s HUBERT B. HAYWOOD, M.D '.;...... ; .;..... Raleigh - AsheviUe J. LaBRUCE WARD, M.D Kannapolis J. O. NOLAN, M.D , JASPER C. JACKSON, Ph.G ; Lumberton PAUL E. JONES, D.D.S Farmville

EXECUTIVE STAFF M.P.H., Secretary and State Health Officer J. W. R. NORTON, M.D., G. M. COOPER, M.D., Assistant State Health Officer and Director Division of Health Education, Crippled Children's Work, and Maternal and Child Health Service

, Director, Division Local Health Administration

, District Director, Local Health Administration

ERNEST A. BRANCH, D.D.S. , Director, Division Oral Hygiene JOHN H. HAMILTON, M.D., Director, Division of Laboratories Division of Sanitary Engineering J. M. JARRETT, B.S., Director, of industrial OTTO J. SWISHER, M.D., Director, Division Hygiene BERTLYN BOSLEY, Ph.D., Director, Nutrition Bureau FELIX A. GRISETTE, Director, Venereal Disease Education Institute C. P. STEVICK, M.D., M.P.H., Director, Division of Epidemiology and Vital Statistics, and Co-Director, School-Health Coordinating Service WILLIAM A. S.MITH, M.D., Director, Bureau of Tuberculosis Control IVAN M. PROCTER, M.D., Director, Bureau of Cancer Control Hill HAROLD' J. MAGNUSON, M.D., Director, Reynolds Research Laboratory, Chapel Hill JOHN J. WRIGHT, M.D., Director, Field Epidemiology Study of Syphilis, Chapel

FREE HEALTH LITERATURE The State Board of Health publishes monthly THE HEALTH BULLETIN, which will be sent free to any citizen requesting it. The Board also has available for distribution without charge special literature on the following subjects. Ask for any in which you may be interested. Adenoids and Tonsils German Measles Sanitary Privies Appendicitis Health Education Scabies Cancer Hookworm Disease Scarlet Fever Constipation ' Infantile Paralysis Teeth Chickenpox Influenza Tuberculosis Diabetes Malaria Typhoid Fever Diphtheria Measles Venereal Diseases Don't Spit Placards Padiculosis Vitamins Endemic Typhus Pellagra Typhoid Placards Flies Residential Sewage Water Supplies Fly Placards Disposal Plants Whooping Cough

SPECIAL LITERATURE ON MATERNITY AND INFANCY The following special literature on the subjects listed below will be sent free to any citizen of the State on request to the State Board of Health, Raleigh, North Carolina. Prenatal Care Baby's Daily Schedule Prenatal Letters (series of nine First Four Months monthly letters) Five and Six Months The Expectant Mother Seven and Eight Months Infant Care Nine Months to One Year The Prevention of Infantile Diarrhea One to Two Years Breast Feeding Two to Six Years Table of Heights and Weights Instructions for North Carolina .Midwives

CONTENTS Page Tribute Paid to Late Dr. Paul P. McCain 3 Introduction of Justice Rutledge 3 Paul P. McCain 4 Acceptance of Portrait of Doctor Paul McCain 7 The Health Department and the Food of the People 8 Narrative Report J3 Blood Derivatives Important for Medicine, Research lo The Kenfield Memorial Fund 16 Vol. 64 JANUARY, 1949 No. 1

State Health Officer H. M.D., Acting Editor J. W. R. NORTON, M.D., M.P.H., JOHN HAMILTON,

TRIBUTE PAID TO LATE DR. PAUL P. McCAIN

A portrait of the late Dr. Paul P. Mc- the ceremonies. Other members of the Cain was unveiled in the lobby of the family present were: John McCain of main building of the Sanatorium at Chapel Hill; Mrs. N. M. McCollum, of dedication ceremonies on Tuesday, De- Leaksville; Dr. Irene McCain McPar- cember 7. The portrait, a gift of the land, of Philadelphia; and Miss Jane State Medical Society, was unveiled by Todd McCain, student at Agnes Scott Sarah Johnson McCollum, only grand- College in Georgia, all children of Dr. daughter of Dr. McCain, and daughter and Mrs. McCain; and Mr. Charles Mc- of Mr. and Mrs. N. M. McCollum of Cain of Birmingham, Alabama, brother Leaksville, North Carolina. of Dr. McCain. The portrait was painted by Prank ,i)r. Paul F. Whitaker, chairman of Benson of the National Art Galleries .,th£ McCain Memorial Committee of in New York City. A bronze plaque the State Medical Society, presided over beneath the portrait has the inscrip- the dedication ceremony and presented tion, "In loving memory of Paul Press- Justice Wiley Rutledge of the United ly McCain, A.B., M.D., P.A.C.P., LL.D., States Supreme Court, who delivered 1884-1946; Guardian of Public Health, the dedication address. Warrior against tuberculosis, beloved -; Mrs. Paul McCain, wife of the late physician and friend of man, follower Dr. McCain, was the guest of honor at of the Great Physician."

INTRODUCTION OF JUSTICE RUTLEDGE

By Paul F. Whitaker, M. D., Chairman McCain Memorial Committee Medical Society of the State of N. C. Kinston, North Carolina

Ladies and gentlemen, members of have a small part in this occasion which the family and friends of Dr. McCain, honors the memory of a beloved col- members of the Medical Society of the league who lived so fully and so use- State of North Carolina, members of fully. As most of us know the portrait the Sanatorium Board, members of the to be presented today was made pos- Woman's Auxiliary and distinguished sible by the membership of the North guests: —As Chairman of the McCain Carolina profession, who loved, honored Memorial Committee of our Medical and respected Paiil McCain. Society, appointed by President Robert- I am sure that as your representative son, I am privileged and honored to on this occasion, you would want me to The Health Bulletin January, 1949 express thanks to a number of people kindness which is the essence of good- who have had a part in the eventuation ness, than was he. Certainly his mul- and consummation of this memorial. tiple accomplishments and his immor- To Dr. Donald Koonce, and the other tal spirit will be projected forever into members of his Committee who raised the future service of mankind. funds, and to every member of our It is now my privilege and honor to Society who contributed, we are grate- present the distinguished guest and ful. To President Robertson and Secre- speaker for this occasion. He was born tary McMillan our Committee expresses in the State of Kentucky. He graduated appreciation for their cooperation and at the University of Wisconsin. He spent support. To Dr. Stuart Willis, Super- a part of his boyhood in the beautiful intendent of the Sanatorium, Mr. Carolina coimtry around Asheville, He Charles Cannon of the Sanatorium travelled to the far West, and lived for Board, and to Mrs. McCain who met a time in New Mexico. He is a man who and advised with us often, we are also overcame disease and physical handi- grateful. And finally to Dr. Coppridge cap to obtain his present high position. and Dr. Hubbard, the other members Many accomplishments too numerous to of your Committee, who have so gen- enumerate have marked his life. He was erously given their time, their efforts a successful lawyer and an able teacher. and their thoughts, I express both per- He served as Dean of the Law School sonal and official thanks. I assure you of Washington University, and was also that this memorial has been a labor of Dean of the University of Iowa. He was love for all concerned, and that we are appointed by the late, President Roose- happy and grateful to have had this velt, to the United States Circuit Court experience. of Appeals, and at present he is a It is neither my purpose nor my member of the highest and greatest assignment to eulogize the memory of tribunal in our blessed and mighty our departed colleague. We have with Nation, and last, but not least, he was us a distinguished visitor who is priv- a friend and former patient of Paul ileged to honor himself and us, by this McCain. At this very busy and exact- assignment. Suffice it for me to say ing period in this year of his life, he that all of us loved and honored Paul has taken time from his manifold re- McCain, and that we are gathered here sponsibilities to honor us with his pre- today to pay himible tribute to his sence here today, and to pay tribute to memory, and to his warm and generous the memory of one whom he, like us, spirit. I know of no citizen who served loved and respected so much. We are his State more usefully. I know of no grateful for his presence. I am honored man who lived more beautifully than and privileged to present to you a he did. I know of no man who was more distinguished and useful leader and citi- devoted to truth, and I know of no zen, Mr. Justice Wiley Rutledge of the man who was more filled with human Supreme Court of the United States.

PAUL P. McCAIN By Mr. Justice Wiley Rutledge United States Supreme Court Washington, D. C.

"Greater love hath no man than this, their more literal and usual understand- that a man lay down his life for his ing. His life was taken away suddenly friend." John XV, 13. These words aptly and too early when and because he describe the life and the death of Paul was about his business of saving the McCain. That is true in the sense of lives of others. As truly as the man who January, 1949 The Health Bulletin

loses his life in some crisis by a heroic coldly, with mere efficiency. Scrupulously surrender to rescue another, he made honest, he gave the patient the facts his own sacrifice. painstakingly and most often fully. This But the words of our text have of itself inspired confidence. another, a deeper and truer meaning. Beyond his skill and integrity, he It does not detract from the heorism, knew that the patient's state of mind the courage, or the spontaneous unsel- was quite as important to his recovery fishness of him who leaps suddenly and or well-being as his physical state. His sacrificially to the aid of one endan- effort was always to alleviate fears gered. But the text applies as well, I where this could be honestly done and, think, to one who gives his life, not in any case, to bring composure. With- merely at its end, but his whole life out apparent effort, though it cost him to the saving of others! This, too, Paul much in time and energy, he created McCain did. He fulfilled the text in in each person a sense of understanding both of its meanings. Pew do. and courage. Where there was room for In speaking of another who has saved hope, he gave it. one's life, or had a large hand in doing It was due largely to his influence so, it is more appropriate to speak with that "The San," as we then called it, honest and sincere restraint than ful- became a place of cheerfulness, not of somely. For such words come too easily despondency, and of courage among and no words can repay the debt. In even the far-advanced. I remember with common with most of you here and what surprise I so shortly discovered thousands of others, I stand vmder this this, after being sentenced as I had debt and this duty. thought by one of his friends. Dr. It was thirty-two years last July since Pritchard of the Battle Creek Sani- I first came to this place and to Paul tarium, to a term of months if not years McCain's ministry. Then it was just or the remainder of my life in an well begun. I came fearfully, seriously institution hardly less attractive than stricken in body, downcast in mind a prison. and hope. Then in the early twenties, In this connection, I cannot forbear I learned that it is hard for the young to mention his wife, always to me Sadie, especially, with all of life before them, her father (then the Superintendent) to face slow death, worse perhaps to and her mother. For they too aided him stand in dread of lingering illness and constantly in his work of building hope pain. and courage in all sorts of ways. Often they would accompany him on his daily I do not wish to make this tribute rounds of the wards, to which every merely a personal history. But I cannot patient looked forward. They too forbear to say two or three things out brought hope, encouragement, and per- of an experience which can only have sonalized interest. been one in common with thousands of Finally, Paul McCain was deeply others, indeed with all who became his religious, but in no narrow sense. All patients during his long and devoted felt and understood this. All were in- career. fluenced by it. He was thus the ideal His ministry, for it was such, was physician, healer, comforter, inspirer, threefold, of the mind, the heart and friend. It would be hard to say in which the soul. In those days there were some of these aspects of his art he excelled. three hvmdred patients. Each received his personal attention and on a personal basis. None was merely "a case." Even Paul McCain was a pioneer in the then highly skilled in his professional field of public medicine. North Carolina art, he inspired complete confidence. If has been a forenmner among our states there was help for the stricken body in in two great things. One has been public the field of his specialization, he could education, the other public medicine. give it. But his aid was never given Even in the days of "Reconstruction", 6 The Health Bulletin January, 1949 the vision of a great North Carolina but a policy of spreading the disease. leader foresaw that amid all the con- For unfortunately it is true still, as it sequences of defeat and ensuing poverty always has been in fact, that the great the true and lasting reconstruction must majority of people contracting it have come from the people of the state them- not, and cannot get, the means which selves, not from the outside. The state will at once remove the certainty of caught his vision and followed it, their infecting others and give them slowly at first but with increasing mo- the chance of recovery. mentum as the years passed. The same thing is true of all com- I paused to pay tribute in this con- municable diseases, more particularly of nection, not comprehensively but only those requiring extended periods for by way of illustration, to one phase of rest or cure. One ill with such a disease the state's achievement flowing out of and without resources to protect him- this policy. I mean the creation of your self and others is a menance to all with system of higher public education and whom he comes in contact. Throughout especially the tridy distinguished Uni- your state and others rows of tomb- versity of North Carolina. stones in family lots, showing whole families wiped out in short periods of Its pre-eminence is not so much in years, prove this. The thing is so ob- grounds and buildings or physical assets, vious, indeed, that it needs no proof. for there are many other universities which equal or excel it in these respects. Yet, even in North Carolina with its But the greatness of a university is early start, the real beginning in this second found in its spirit. The soul of an insti- field did not come untU about the tution marks it with distinction or the decade of this century. It arrived almost real beginning lack of it. I know of no state university half a century after your and of few if any private ones, which in education. Perhaps this shows how have succeeded as have your own in slow is the ripening of the fruit of creating and maintaining the traditions that tree. But it shows also that fruit of free inquiry and free expression. will be borne, once the tree is planted, Without these no university can avoid and that the two plantings and bear- in some part that tyranny over the ings are not disconnected. mind of man which Jefferson denounced Since your beginning in public medi- him- as alien to the free spirit of man cine, you have made great strides for- self and of democratic institutions. That ward. The growth of this institution place of learn- you have created such a and the foundation of others like it in ing, wisdom and creative freedom is the intervening years, simply show what of your due not only to the founders can and will be done, once the necessity education. It general policy in public for meeting this public menace is recog- have flows also from the fact that you nized and the program to meet it gets selected a succession of great leaders, under way. including the University's present presi- much more humane, how much dent, who have stressed the independ- How more conservative in the true sense of ence of the mind and the spirit, and the word, is such a policy. For lives that you have followed their leadership. which otherwise would be cut off, most Beginning much later, but still well often early, with the loss of all they in the forefront of the states, you have might produce if salvaged, even in earn- gone far in developing your system of ings and taxes (to put the matter at public medicine. The day when tubercu- the lowest level), are saved, and restored losis was wholly a private misfortune, to productivity as well as to happiness. to be remedied if at all only by the means available to the stricken person, Among all the trends of our day to- has gone for North Carolina. Would ward mass devaluation and destruction that this could be said for all of our of human life, our people are still our states! That outmoded idea is in essence greatest asset. The conservation of hu- January, 1949 The Health Bulletin f

man life has become our greatest neces- as North Carolina and the nation live. sity. It is fitting for this building to be In all of your progress in this direc- dedicated by the State in his name tion until his death, Paul McCain was and to his memory. pioneer and leader. To this cause his The likeness presented whole life was given, quietly, unostenta- today by his professional associates cannot take his tiously and, if I knew him, without place. But it will be a constant thought of money or fame, only to serve reminder of him and his work, a his people and mankind. continuing in- spiration to others to carry Thus he also was public servant. That on and to expand that work in his work was not finished does not accordance with the people's need and the public neces- mean it has ended. He has built foimda- sity. tions for a structure that will rise higher and spread more widely by force I am grateful for having the privilege, of the momentum he has created in by participating today, of acknowledg- others which cannot recede or subside. ing my personal debt and of paying His work will last and will grow as long tribute to this public servant.

ACCEPTANCE OF PORTRAIT OF DOCTOR PAUL McCAIN

By Paul H. Ringer, M. D. 604 Medical Building Asheville, N. C.

LADIES AND GENTLEMEN: sought honors which were thrust upon It is a matter of sadness and pleasure him from all sides. North Carolina will for me to utter the few words that I not long remember what we say here, have to say—sadness, because this por- but North Carolina can never froget trait brings before me with great poig- what he did here. It is also fitting that nancy the memory of my dear old this portrait should hang in this lobby friend; and pleasure, because I am able so that former patients returning for a once again to pay tribute to one I loved visit, patients in the Sanatorium and so well. new arrivals, shall down the years be able to look at the likeness of This is an excellent portrait. The the one who made this institution artist is to be congratulated upon hav- and who, during his ing seized and shown so many of Paul incumbency, hovered over his McCain's characteristics — his humility, charges whom he sought with all his his shyness, his whimsiness, his trans- might to help in their fight for health. parent honesty, his charm: Fearless, faithful and true, he shrank from no duty which honor and right, "And thus he bore without abuse as he saw them, demanded but faced The grand old name of Gentleman. every task with the strenuous energy of Defamed by every charlatan a true man and the noble honesty of a And soiled with all ignoble use." true gentleman. Loving, he was beloved, It is fitting that this portrait should his presence was a joy and an encour- hang in the lobby of this building so agement; absent, he is a never-failing recently dedicated to his memory, this memory. And so, on behalf of myself lobby through which he passed count- and my colleagues on the board of di- less thowsands of times, going through rectors of the North Carolina Sanatoria it to his work, coming out of it often for Tuberculosis, I gratefully accept this to go to receive new and always un- portrait of Paul Pressley McCain. 8 The Health Bulletin January, 1949 THE HEALTH DEPARTMENT AND THE FOOD OF THE PEOPLE* CHAIRMAN'S ADDRESS

Robert H. Riley, M. D. Baltimore

field of It is difficult indeed adequately to one small sector of the whole express how deeply I appreciate the public health, that of human nutrition. honor of presiding over this section. In that field I shall try to review the For many years, bearing various names changes which have already occurred and under the chairmanship of a long and to look forward to the problems is pregnant, so list of distinguished physicians, the with which the future annual meeting of this group have far as they can now be foreseen. habits afforded a valuable opportunity for The changes in human food been those engaged in the administration during the last three decades have so powerful of official health agencies and those so rapid, so profound and effect on engaged in the practice of preventive in their actual and potential they medicine to meet together for a dis- the well-being of the race that understood than cussion of the problems which confront should be far better here can, them both. is now the case. Some of us food During the period of my connection for example, remember when the nation was in large part with this section, the fields of preven- supply of the produced within a few miles of the tive medicine and public health have its consumption. Some have, moved forward • so rapidly that only place of loaded a sack of corn on the those of us whose service covers a pe- in fact, back of a horse or mule and ridden riod of more than one or two decades mill and then can recognize how far we have come. with it to the grist the grain poured into the Every field of human knowledge, with watched and in a moment seen the the possible exception of mathematics, hopper smoothly back into the has made more scientific and techno- meal running sack from which the corn had just logic progress in the last few decades can't remember when than during the whole of previous his- been poured. I the fruits and vegetables on sale in tory, and public health and preventive were almost all pro- medicine have contributed more than the larger cities duced on nearby farms. They were their full share in this development. markets of the city and This new knowledge has resulted in brought to the consumer by the farm- profound alterations in the way of life there sold to the had themselves grown and of the human being, and the contribu- ers who harvested them. Tropical fruits were tion of preventive medicine to these available, except to the changes has been most important of a great luxury, very rich, only on very special occasions. all. The supply of milk was from varied It is my purpose at this time, how- only soiu-ces and was wholly imregulated. ever, to discuss developments in Many families in the cities kept one •Reprinted with permission from tlie or two cows for their own supply and Journal of the American Medical Associa- sold the surplus to their neighbors over tion. the back fence. These one-cow dealers, Department of Director, State of Maryland as they were called, were a problem of Health. serious moment in the early campaigns before the Section on Preventive Read of milk sanitation. For the rest, the Medicine and Public Health at the Ninety- public supply of milk was in great part Seventh Annual Session of the American in small dairies located with- Medical Association, Chicago, June 24, 1948. produced January, 1949 The Health Bulletin 9 in the city itself, or in the nearby sub- distribution of the food supplies of the xirbs, and sold by the producer from nation. The invention of roller mills his own wagon as he made the daily had made possible the production of rounds of his customers. Meat was also flour of more agreeable appearance a local product, from animals killed in than was possible under older methods, slaughter houses within the community and this flour rapidly drove from the and sold as soon as possible after market the product of the smaller local slaughter. mills. A few foods had of course always Similarly, the production of range come from distant sources; sugar, mo- cattle in the far West resulted in the lasses, spices and condiments were ar- establishment of great centers for the ticles of ocean commerce for centuries. slaughter of cattle and in the develop- The opening of the West moved the ment of methods for the shipment of center of the nation's grain supply and meat and meat products to distant con- of milling to west of the Mississippi. sumers. When "western beef," as it was The preservation of fruits and veg- called, was first introduced in the mar- etables by heating and sealing has a kets of the eastern cities, it was re- long history. The first experiments were garded with considerable disfavor. Con- made in France during the Napoleonic sumers imagined that they could taste Wars, and actual industrial canning the preservatives which they wrongly began in the United States in 1819. It believed had been used to make its was the perfection of this process that shipment possible. In the beginning only really began the revolution in food its lower price commended it to the habits. public.

But with these exceptions, the mass The crowding of the cities made it of the food of our fathers and grand- impossible to continue to produce an fathers was produced close to the place adequate amount of milk within or of its consumption and was subjected near the city limits, and technologic to the simplest and most necessary methods were devised for shipping milk processing only. long distances. Successfully to manage this business required the creation of We can, it is true, remember those early days without nostalgic longing large corporations and the development of for for their retiirn. The vegetables pro- depots collecting milk in rural duced on nearby farms were not always areas and for distributing it in the of good quality and except for cabbage cities. The use of refrigerated cars for and turnips were available only for a the shipment of meat led quickly to the brief season each year. The milk was shipment of citrus fruits and vegetables in dirty, of poor keeping quality and not the same way. It was soon found infrequently dangerous. The meat was profitable to raise each fruit or veg- etable in that part of the country where tough and stringy, and even its relative cheapness was not adequate consola- climate and soil were most favorable to its production, and although market tion for its poor quality. Fruits were limited in amount and were, except gardens near the cities have never quite bulk of fruit for apples, available only for a short disappeared, the great period each year. To those who lived in and vegetable production was moved to the places of those parts of the country where corn- areas far distant from maximum consumption. bread was a staple diet, it is only the corn meal of the old days the dis- These changes were the inevitable appearance of which is to be regretted. result of the advances in horticulture, About the time when Benjamin Har- in food technology and in transporta- rison became President of the United tion, and without them the develop- States, the tremendous increase in the ment of our present civilization could population of the cities began to pro- not have taken place. They brought, duce changes in the production and however, certain dangers to the health 10 The Health Bulletin January, 1949 of the people, which made necessary activities were in connection with meat the development of systems of pro- inspection. Foreign countries threaten- tection of equal complexity. The most ed to interdict the shipment to them pressing were, of course, those connect- of American meat products, because of ed with the production and distribution the fact that a large proportion of the shipped abroad at that time was of nulk. It was not difficult for the pork large corporations which engaged in foimd to be trichinous. It had not been the business of collecting and distribut- deemed necessary to inspect pork pro- ing mUk to produce a product far ducts in the United States, since it was cleaner and of better keeping quality the habit in America to cook pork long than that coming from the neighbor- enough to insure the destruction of hood dairies of the past. However, the trichinae. To meet this situation, the mingling of milk coming from many federal government established a sys- cows and its distribution by the larger tem of inspection for meat slaughtered companies to thousands or even hun- in the larger abattoirs of the country dreds of thousands of persons brought and destined for shipment overseas. It dangers which had previously not was not long before this inspection was existed. The occasional infection of extended to meat shipped interstate in these large supplies of milk and milk the United States. products gave rise from time to time In the very first years of the twen- to epidemics involving thousands of tieth century, Dr. Harvey W. Wiley, cases of typhoid, scarlet fever and sep- then the Chief of the Bureau of Chem- tic sore throat. The shipment of meat istry of the United States Department and of certain other products led to of Agriculture, interested himself in the the use of preservatives, not all of which question of the adulteration of foods were entirely innocuous. The great shipped in interstate commerce. Al- commercial orchards and truck farms though Dr. Wiley was a man of extra- began to use insecticides in large quan- ordinary energy and courage, it was tities, and some of these were highly only after many years of effort that toxic and at least potentially dangerous he succeeded in securing the passage to the health of those habitually using of the Federal Pood and Drug Act of of which these products in the growth 1906. The conditions which this act was poisons had been employed. designed to correct were not for the The health departments of the na- most part tremendously important by tion reacted promptly and, in general, modern standards, but it was an ex- effectively to the challenge of these new ceedingly fortunate thing that the act conditions. The almost complete control itself was passed and that standards of bovine tuberculosis, the inspection of of purity and freedom from deleterious all establishments where milk and its substances of our food supply were products were produced, distributed or established and enforced by the federal sold and the enactment of ordinances government. requiring pasteiurization of public milk The passage of the federal act was supplies soon resulted in so safeguard- followed, as is so often the case, by ing most of the nation's supply of milk parallel legislation on the part of the that the dangers of wide distribution states. Many of the state laws passed were almost completely controlled. The at this time, however, placed the en- improved safety and quality resulted in forcement of the whole system of food a large increase in the consumption of control in the hands of the department mUk, and a most significant contribu- of agriculture rather than that of tion was thus made to the public health. health. This fact, together with the of the older city depart- It was indeed fortunate that the long failui-e develop adequate federal government entered the field of ments of health to inspec- food control soon after the beginning and effective systems of food low a of this period of great change. Its first tion, gave food sanitation so January, 1949 The Health Bulletin 11 position in the minds of the public they had not before been known. In health profession that it has even now this war, new weapons are constantly not received the recognition it deserves. being developed and the old weapons The demonstration about this same are used in steadily increasing amounts. time of the tremendous importance of It was not very many years ago that the accessory food factors in the nutri- arsenic began to be used as a spray for tion of human beings and domestic apples. The danger that the average animals and the widespread popular- citizen would receive a toxic amount of ization of the facts have tended still arsenic was not at first sufficiently of con- more to obscure the importance serious to give rise to much concern. tinuous, complete and effective control Since this early beginning, however, it of all those foodstuffs which are pro- has proved necessary to use arsenic in cessed in anj' way before reaching the the commercial production of one after ultimate consumer. another of our fruits and vegetables, There is certainly no need in this and the danger to the consumer is company to review the arguments for thus constantly increasing. It seems an improvement in the diet of our peo- probable that Insecticides free from ple. The new knowledge of the impor- toxicity to human beings will in time tance of vitamins and of certain min- replace the present dangerous sub- eral substances to health and physical stances. It will always be necessary, vigor is now known to all intelligent however, for the health department to persons in every civilized country. The protect the interests of the individual task remaining is to apply this knowl- consumer who has no means of know- edge to those who have not yet been ing the danger to which he is subjected and is always poorly represented when reached by the flood of propaganda on any question of legislation is imder the subject which has been poured forth consideration. in recent years. The success of the British government in maintaining the When the replacement of the original health of its whole people and in ac- Federal Food and Drugs Act by what tually improving the physical status of is now called the Federal Food, Drug its children during the late war, in the and Cosmetic Act was pending before face of serious shortages of many foods, the Congress of the United States, the is proof positive of the need for the interests of the public were presented better utilization of the abundant food to the committee by the representative supplies of this country and in par- of the Federal Food and Drug Adminis- ticular of the enormous importance of tration, whose motives were plainly insuring to every expectant mother and suspect of the committee, and by the every growing child a diet which in three physicians who were called "the amount and content will make possible thi-ee professors," who appeared volim- the fullest and most healthful develop- tarily as witnesses in behalf of the bill. ment. This is the unfinished task in In opposition were several hundred nutrition. lawyers, lobbyists and technicians of food-producing and process- There are still, however, unfinished the various one of these tasks in connection with the safety and ing interests involved. Each of the sanitary quality of our food supply. paid lobbyists was fully aware The war waged by our growers of foods effect of the bill on the interests of his prepared to expend of all sorts on their insect enemies is own client and was all time, energy and money nec- never won, and it will probably con- the interests. tinue as long as there are both human essary to protect those No of&cer appeared beings and insects on this little planet. administrative health hearings. Modern transportation is being utilized at these as well by the insect as by the human What has been said about insecticides population of the earth, and new pests applies equally to a wide variety of are constantly appearing in areas where other chemical substances which have 12 The Health Bulletin January, 1949 been developed and which are now be- to great length, and, in addition, a ing used in the processing of food on a large number of new products are now commercial scale. Until Mellanby's de- being used experimentally. It should be monstration of the fact that fioiar made clear that up to this time there treated with nitrogen trichloride, the is no evidence that any of these sub- so-called "agene," produced hysteria in stances is known unfavorably to affect dogs, few if any even of our best in- the health of consumers of the product. formed health officers were aware of The Food and Drug Administration has the fact that a large proportion of all actively interested itself in the subject flour now sold on the American market and has formulated stringent regula- is treated with this powerful chemical tions for controlling the use of all such agent. There is as yet, of course, no substances. evidence that the "agenizing" of flour Surely it would seem that this situa- has produced any iU effects on our tion should be a source of concern to human population, but Mellanby's ob- every state and local health officer in servations have been confirmed and this country and that the efforts of the extended in this country, and no one federal government to control it should as yet knows the effect on human be- be aided and encouraged in every pos- ings of the prolonged and regular use sible way. When it is proposed to use a of "agenized" flour, or whether or not new substance of this kind, the repre- there will be remote and serious re- sentatives of the food industry are at sults from its occasional use by so large once mobilized and every possible scrap a part of the population. of evidence in favor of the use of the lime- "Agene" is very much in the product is assembled and presented to light at the moment, but it is by no the official agency. The millions of con- means the only substance used in this sumers whose health is placed in pos- country in the processing of flour. sible danger have no knowledge of the Chlorine, nitrosyl Chloride, benzoyl fact that their interests are in jeopardy peroxide and the oxides of nitrogen are and no means by which these interests all used for bleaching flour and for can be represented. This important field additional aging effect. Potassium bro- deserves far more attention at the hands mate is used as a conditioner, to make of all health officers than it has up to the flour easier to handle and to pro- now received. duce loaves of greater volume than is The nation's food is more than ever, possible without the addition of this therefore, the concern and responsibility agent. Sodium bicarbonate, calcium of our health officials. Its control has phosphate and sodium acid pyrophos- passed far beyond the condemning of are also added to certain flours phate spoiled meats, fruits and vegetables and another effect. to produce one or making perfunctory inspections of res- In the processing of evaporated milk, taurants. These classic functions must, disodium phosphate, sodiimi citrate and of course, continue to be performed and calcium chloride are used as stabilizers. should be done as well as our existing In the making of cream cheeses, gum facilities make possible. There is, how- karaya, gum tragacanth, carob bean ever, another and higher duty which gum, gelatin and algin are used to pre- we must recognize and another respon- vent the leakage of moisture from the sibility we must assume, and that is to product. In the making of preserves, make sure that in the enormous busi- jams and jellies, lactic, malic and tar- ness of producing, processing and dis- taric acids are used to increase the tributing the food supply of oiu- great acidity of the product and sodium cit- population, the interest of the consumer rate and potassium tartrate are used and particularly the health of the con- as buffer salts to prevent its too rapid sumer must always come before the jelling. This list of products now reg- convenience or the profit of those who ularly in such use could be extended supply it. January, 1949 The Health Bulletin 13

NARRATIVE REPORT

A. C. Bulla, M.D., Health Officer City of Raleigh and Wake County

January 10, 1949

Growing up to be a human being is certain than the roads traveled 20-10-5 not the hazardous and perplexing prob- years ago. He has the advantage of new lem today as it has been in the past due and useful tools which scientific re- largely to the progress made in re- search has provided. These scientific search, health education, better mater- preventive and curative agents are to- nity and infancy care, and the applica- day the most useful agents for the tion of known proven preventive meas- protection of life and the relief of sick- ures against sickness and suffering. ness and suffering that have ever been The infant, the child, the adolescent given to man. They have not and will is an ever changing individual within not solve all of the medical and public himself, and, too, his environment is health problems that we are confront- forever changing. In considering the ed with today, but they have given new growth and development of the human hope to this and other generations. being during his formative period, we The application of vaccines and sera are first concerned about his heredity for the prevention of disease is a dy- and his birth which determine to a namic science. This has been true from large extent the kind of individual he the day they were discovered down to may be. We are concerned about his the present time. It is the duty of environment which include all his sur- physicians and health departments to roundings, his family, his home, his see that the public receives these pre- teachers—every living thing, and every ventive measures in that age group in given situation no matter how small, which they are most effective. The pub- simple, and insignificant. It takes all lic should always be mindful of the fact these things plus intelligent guidance that these preventive measures cannot with care and the application of all the be effective unless it accepts them and benefits that have come down to us in uses them to the greatest capacity, the past to make it possible for an in- which means that no infant or child fant born today to live out his full days should be allowed to go unprotected of expectancy and reach the average life against those diseases for which there expectancy of 66 years with as little are proven vaccines and sera to prevent sickness and suffering as possible. their occurrence. Life is the adjustment of exterior and We have seen the number of com- interior relations. In other words, the municable diseases grow smaller and external battling against the internal. smaller and the death rate from all This constant adjustment and re-ad- causes reduced from 11.2 in 1937 to 7.7 justment is the process of living. A in 1948. The infant death rate per 1000 child is more than a biological organ- live births in 1937 was 83.9 and in 1948 ism; he is also a social being growing it was 31.3—^a decrease of 52.6. This is and adapting himself to specific en- worthy of note: in 1937, 55 percent of vironments. Yes, he is a part of hered- infant deaths occurred under one month ity and environment. Yes, he is made of age, and in 1948, 70 percent occurred up of hereditary tendencies and the en- under one month of age. Notwithstand- vironment in which he grows and de- ing this fact and that measures are now velops. He cannot escape these vital being instituted to try to reduce this influences and forces. high percentage of infant deaths occur- The road he must travel from infancy ring during the first month of life, as to old age is not in all cases an easy stated above, the death rate in the first one, but it is straighter, easier, and more year of life has been reduced from 83.9 14 The Health Bulletin January, 1949 in 1937 to 31.3 in 1948. This means that this large reduction in the infant death rate was from the end of the first month of life to the end of the twelfth month of life. Prematurity is responsible for approx- imately 53 per cent of the deaths occur- ring in the first month of life. A pro- gram for the entire state under the Division of Maternity and Infancy, di- rected by Dr. G. M. Cooper, is being worked out whereby premature infants may receive prematiire care in the best regulated hospitals of the state. The maternal death rate per 1000 live births has been reduced from a rate of 7.0 in 1937 to 1.5 in 1948—a de- crease of 5.5. We have seen the number of births increase from 1977 in 1934 to 3517 in 1948. The number of white births has increased from 1098 in 1934 to 2345 in 1948. The number of colored births has increased from 879 in 1934 to 1172 in 1948. The following figures show the com- parative attendance of births by phy- sicians for the years 1934 and 1948: City of Raleigh Residents Yr. Total Per White Per Color- Per cent cent ed cent 1948 1457 95.5 1067 100.0 390 83.8 1934 515 75.4 389 100.0 126 42.9

Gain 20.1 40.9 The comparative figures for hospital deliveries: 1948 1446 94.9 1063 99.6 383 82.2 1934 322 47.1 269 69.1 53 18.0

Gain 47.8 30.5 64.2 Wake Coimty Residents 1948 1507 89.0 1012 99.0 495 73.8 1934 929 72.0 668 95.8 261 44.4

Gain January, 1949 The Health Bulletin 15

and sanitation, I think, are two of the that powerful influence of education. outstanding problems that still confront The personal habits of an individual every health department in this state. may be termed as a personal thing. His Improvement in this direction is large- environment may or may not be so ly influenced by knowledge of what is termed, but both are vital to health and right from what is wrong, together with happiness.

BLOOD DERIVATIVES IMPORTANT FOR MEDICINE, RESEARCH

Fractionation of blood is providing Some of the products are important important products with which physi- for research. For example, one protein cians can treat disease and investiga- which has been crystallized from a tors can obtain a better understanding fraction of htunan plasma—the fluid of the functions of the human body, portion of the blood before clotting has according to a Harvard physician. occurred—accounts for the capacity of Writing in the current (Nov. 20) issue the plasma to transport iron. Isolation of The Journal of the American Medical of this protein in pure form has made Association, Charles A. Janeway, M.D., it possible to study its reactions with from the Department of Pediatrics, iron in the laboratory and to make Harvard Medical School and the Chil- parallel observations in patients. dren's Medical Center, Boston, reports Transmission of jaundice through in- that breaking up blood into specific fected pooled blood or pooled blood pro- components also effects a great economy ducts is a serious problem. Dr. Janeway in using blood donations. indicates that this problem may be Because a function of the blood is overcome by the sterilization of blood concentrated in each fraction, dona- and blood plasma on a large scale. tions which in the form of whole blood Although mass processing with ultra- could be used to treat only 20 patients violet in'adiation has not yet proved can be used as blood derivatives to treat successful, there is enough evidence of over 200 patients, he points out. its effectiveness to justify optimism, he Another important consideration. Dr. says. Janeway says, is that many of the blood Methods introduced for the separa- components undergo rapid deterioration tion of half the plasma protein, serum in whole blood. Separated and concen- albumin, from the remaining proteins trated, each may be packaged in a state can be used to obtain all the major best adapted to the preservation of its components of plasma. Such methods functional activity, ready for clinical have also been applied to the piu'iflca- use whenever and wherever it is need- tion of virus vaccines, toxoids, animal ed. serums, and tissue extracts. During the Army-Navy-Red Cross The value of plasma as an emergency blood program of World War II, slightly blood substitute in the treatment of more than two million blood donations shock due to blood loss is well estab- were subjected to fractionation, yielding lished. products which were used in part by Sixty-five per cent of the protein of the armed forces. Surplus products were fraction I is fibringen, a substance returned to the American people. which is used in attaching skin grafts Certain derivatives—plasma, fraction and in removing kidney stones. Fraction I, fibrin foam, fibrin film, gamma glo- I also contains other proteins, including bulin, isohemagglutinins, and serum al- antihemophilic globulin, so-called be- bimiin—have been established as valu- cause it will rectify the coagulation de- able agents in the treatment of disease, fect in hemophilia, an inherited condi- Dr. Janeway explains. tion. 16 The Health Bulletin January, 1949

Fibrin is a whitish protein which procedure are used in testing for blood forms the essential part of a blood clot. grouping and for Rh sensitization. It is vised in two forms: a foam to pre- Serum albumin was originally devel- vent bleeding in surgery and an elastic oped as a blood substitute for emerg- film substitute for the outer covering ency treatment of shock in the wound- of the brain in neurosurgery. ed. It is extremely effective in condi- tions which may develop from severe Gamma globulin—fraction II—is of infections, bxirns, peritonitis, or abdom- value in the prevention and modifica- inal operations. It has a place in the tion of disease. Its use in the prevention treatment of kidney disease and cirrho- of measles has become a standard pub- sis of the liver. Its use for patients who lic health practice, according to Dr. have had brain injuries or operations Janeway. It is valuable in preventing is under study. infectious jaundice, and is being in- Red cells contain the most important for use against scarlet fever vestigated blood protein, hemoglobin, which is re- globulin and German measles. Gamma sponsible for the vital function of oxy- from the blood of patients obtained gen transport. Red cell suspensions, whoop- convalescing from mumps and especially prepared concentrated pro- is against these diseases. ing cough used ducts, are useful in the treatment of Isohemagglutinins are substances anemia of all types, except those due which cause the blood cells of other to acute blood loss or severe infection. members of the same species to collect They supply hemoglobin, and a relative- into clumps. Certain isohemagglutinins ly large dose can be given safely with- obtained as part of the fractionation out overloading the circulation.

THE KENFIELD MEMORIAL FUND American Hearing Society 817 14th Street, N. W. Washington 5, D. C.

A sum of money was subscribed in B. Ability to read lips as certified up- 1937 in memory of Miss Coralie N. Ken- on examination by an approved in- field of San Francisco, California, a structor in lip reading. teacher who was known throughout the C. A bachelor's degree, or United States for her high ideals and Two years of college work plus advanced methods in teaching lip read- twelve semester hours of work In ing. This money was placed in the Ken- adult education, psychology of the field Memorial Fund. The interest pro- handicapped, voice production and vides a scholarship known as the Cora- control, sight conservation, social lie Noyes Kenfield Scholarship for service, or Teachers' Training Courses for Teach- Two years of successful experience ers of Hard of Hearing Adults. (The in teaching in public or private scholarship offered in 1949 is $100.00). schools, plus twelve semester hours The American Hearing Society is the of work in adult education, psy- trustee of the Kenfield Memorial Fund. chology of the handicapped, voice Applications will be considered from production and control, social ser- any prospective hard of hearing teacher vice, or kindred subjects. of lip reading to hard of hearing adults Applications must be filed between who lives in the United States and who March 1, 1949 and May 1, 1949, with: can meet the following requirements: Miss Rose V. Feilbach, A. Personal characteristics necessary Teachers Committee, for successful teaching. American Hearing Society. U. N. C MEDICAL Lia MEDICAL LIBRARY u. OF N. c. iOMay

i This Bulletin will be sent free to ony citizen of the State xjporv requesfl

Published monthly at the office of the Secretary of the Board, Raleigh, N. C. Entered as second-class matter at Postoffice at Raleigh, N. C. under Act of August 24, 1912

Vol. 64 FEBRUARY, 1949 No. 2 MEMBERS OF THE NORTH CAROLINA STATE BOARD OF HEALTH S. D. GRAIG, M.D., President Winston-Salcm G. G. DIXON, M.D., Vice-President Ayden H. LEE LARGE, M.D Rocky Mount W. T. RAINEY, M.D., Fayetteville HUBERT B. HAYWOOD, M.D Raleigh

J. LaBRUCE WARD, M.D . Asheville J. O. NOLAN. M.D Kannapolis JASPER C. JACKSON, Ph.G Xumbcrton PAUL E. JONES, D.D.S Farmville

EXECUTIVE STAFF

J. W. R. NORTON, M.D., M.P.H., Secretary and State Health Officer G. M. COOPER, M.D., Assistant State Health Officer and Director Division of Health Education, Crippled Children's Work, and Maternal and Child Health Service

, Director, Division Local Health Administration

, District Director, Local Health Administration ERNEST A. BRANCH, D.D.S., Director, Division Oral Hygiene JOHN H. HAMILTON, M.D., Director, Division of Laboratories J. M. JARRETT, B.S., Director, Division of Sanitary Engineering OTTO J. SWISHES, M.D., Director, Division of Industrial Hygiene BERTL'i'N BOSLEY, Ph.D., Director, Nutrition Bureau FELIX A. GRISETTE, Director, Venereal Disease Education Institute C. P. STEVICK, M.D., M.P.H., Director, Division of Epidemiology and Vital Statistics, wd Co-Director, School-Health Coordinating Service WILLIAM A. SMITH, M.D., Director, Bureau of Tuberculosis Control IVAN M. PROCTER, M.D., Director, Bureau of Cancer Control HAROLD J. MAGNUSON, M.D., Director, Reynolds Research Laboratory, Chapel Hill JOHN J. WRIGHT, M.D., Director, Field Epidemiology Study of Syphilis, Chapel Hill

FREE HEALTH LITERATURE

The State Board of Health publishes monthly THE HEALTH BULLETIN, which will be seiii free to any citizen requesting it. The Board also has available for distribution without charge special literature on the following subjects. Ask for any in which you may be interested. Adenoids and Tonsils German Measles Sanitary Privies Appendicitis Health Education Scabies Cancer Hookworm Disease Scarlet Fever Constipation Infantile Paralysis Teeth Chickenpox Influenza Tuberculosis Diabetes Malaria Typhoid Fever Diphtheria Measles Venereal Diseases Don't Spit Placards Padiculosis Vitamins Eiidemic Typhus Pellagra Typhoid Placards Flies Residential Sewage Water Supplies Fly Placards Disposal Plants Whooping Cough

SPECIAL LITERATURE ON MATERNITY AND INFANCY

The following special literature on the subjects listed below will be sent free to any citizen of the State on request to the State Board of Health, Raleigh, North Carolina. Prenatal Care Baby's Daily Schedule Prenatal Letters (series of nine First Four Months monthly letters) Five and Six Months The Expectant Mother Seven and Eight Months Infant Care Nine Months to One Year The Prevention of Infantile Diarrhea One to Two Years Breast Feeding Two to Six Years Table of Heights and Weights Instructions for North Carolina Midwive*

CONTENTS Page The North Carolina League for Crippled Children 3 Vital Statistics 10 Notes and Comment 12 Accidents Rank First As Destroyer of Working Years 13 Our Front Cover 16 ]jiI@sJMb@IB)M

LSJ PUBU5MED BY TML nOfg.TM CAgOuriA STATL BCAgC I

Vol. 64 FEBRUARY, 1949 No. 2

State Health Officer JOHN H. HAMILTON. M.D., Acting Editoi J. W. R. NORTON, M.D., M.P.H., THE NORTH CAROLINA LEAGUE FOR CRIPPLED CHILDREN

Dates and Progrram headings: (1) Inheritance, (2) Congeni- tal conditions,, (2) Birth injuries, (4) m -.v. -.^^-u ^v, -NT 4.V, Carolinar-i ^^nv,„ 14th year, the North ., . , For the ^ = -, t-.-o^„=.^ „»,^ tR\ Tr,f^ ^ . . , ^T.Mj • -4. n Accidents, (5) Disease, and (6) Iniec- League for Crippled Children invites all ^. ^^ ., ^ „„,-^!^i„^ <,v,ii^^or, of^f • • 4-1, tion. Among the crippled children X,- X i. J If ^^ of^f the4.v.„ those interested in the welfare _ ., „ ,. „ „ ^^^ w,„cf r^r..^ /i» • over ^^ must now de- ... J 4. I, .fiv, v,^^^ +u„ North Carolina, 85 handicapped to share m financing the <-, on the North-kj^^-u Carolma^„i5„„ LeagueTo„n^,= forf^,. 1 * iv, T „ ,^ rrn.^ Av.>.„oi -t^ocffl-,. pend work of the League. The Annual Easter ^ . ^ • r t,- v, are ex-««. _ , „ . -m u „^v,^„„+„^ u^ certain types of services which be- • Seal Campaign will be conducted ^ , , -c-, -^ ^ j *.-u „„ aids toward their re- 4. 4.1, ^4. „ ^f Tv/Tov^v, i-T+v. ov,^ tremely valuable habilitation. Many children with other iTrirnth handicapping conditions also look to The services of the North Carolina ^he. league for services they need but League for Crippled Children are plan- ^^'^^ ^'^ ^°t yet available else where, ned so that they supplement but do not duplicate those of any other Social Dui'ing the past year (1948) alone, the Agency, thus broadening the scope of county chapters of the North Carolina services available for handicapped child- League for Crippled Children provided ren. services for 5,129 handicapped children There are more than 250 causes of of the state at a cost of $45,361.78. Brief- crippling conditions but most of these ly, the direct services rendered to indi- fall under one of the following major vidual children include the following: SERVICES CHILDREN COST Transportation to Hospitals, Clinics, Schools 2,676 $ 7,953.76 Hospitalization 389 6,852.07 Appliances provided 411 6,816.53 Medical Treatments 208 6,963.24 Clothing 12 156.96 Supplementary food and Vitamin Tablets 34 397.60 Camping 44 1,772.16 Dental Care 22 218.85 X-rays 80 288.00 Convalescent Care 124 1,540.00 Special Shoes 28 240.00 Hearing Aids 6 1,050.00 Hospital Bed (Purchased) 4 90.00 Wheel Chair (Purchased) 6 120.00 Psychological and Audiometric testing 108 600.00 Special classes and individual instruction 973 10,258.61 School supplies 4 44.00

TOTAL SERVICES 5,129 $45,361.78 The Health Bulletin February, 1949

The above listed services were pro- other defect") —He deserves any help vided by the 50% of the funds which which the League may be able to pro- remained in the county where the funds vide. were contributed. But direct services to So, this report will show a wide variety individual crippled children is only a of services having been rendered to the portion of the League's activities. De- handicapped children of North Caro- monstration projects, prevention, legis- lina. Some were given to correct a de- lative, promotional, education and re- formity, others to prevent one from de- search programs make up the major veloping, while still others provided a portion of the work done by the State beginning stimulus toward a develop- Office of the League. ment of the facilities which the child During the past six years, the demon- has remaining and upon which he must stration projects have been in the area depend for life to produce for him a of education for handicapped children livelihood, and whatever measure of and have included special training for happiness he can attain from his sur- crippled children, hard of hearing child- roundings. ren, speech defected children, and cere- bral palsied children. Training classes Planning a New School, Church, Library, for teachers to prepare them for teach- or Other Public Buildings? ing handicapped children have also been included in the League's program. Last Before completing plans for a new year, more than 200 teachers had one or school building—and other public build- more classes in the area of special edu- ings—the North Carolina League for cation. Crippled Children would like to beg the local school boards to give some consi- The Leagrue's Work is Varied deration to the handicapped children in their Work among crippled children is not communities. Perhaps you feel that your is singularly a field within itself, it is a segment of community fortu- many fields, Any crippled (or other nate in that all the children living there are normal children, are sure handicapped) child needs all of the but you same things a non-handicapped child of that fact? Have you made any speci- plus the additional medical treatments fic effort to see if there are children who, although required to correct his handicap—or to not hospitalized, are un- able to for minimize it to the lowest degree possible cope with the routine nor- —and specialized education opportuni- mal school life? The United States OflBce of Education, ties designed to prepare him to use to in statistics released in 1937 a maximum degree all his existing facili- (would pro- bably higher now), North ties and thus be able to earn his own be quoted Carolina having 62,687 livelihood and have the privilege of be- as handicapped children in need of special consideration ing a useful and contributing citizen. in order to enable them to secure the For that reason, it is hard to give a of education to concise report of the work of the North type and amount needed develop their capabilities that Carolina League for Crippled Children so they may contribute their share to human as its program of activities must be as progress. With that many handicapped broad, and as varied as the total needs children in North Carolina it is reason- of life itself. able to believe that some of those child- The League takes a broad interpreta- ren will be living in every coimty of the tion of the word "CRIPPLED CHILD" state. for it feels that any child with a physi- cal limitation which prevents him from There are several types of handicap- getting an education thi'ough the nor- ped children whose needs it would be mal channels provided for non-handi- worthwhile to consider before starting capped children, is a potentially handi- to build a new school. capped adult. So, no matter how he (1) FOR CRIPPLED CHILDREN— came by his crippling condition, (or For this group it would be helpful to February, 1949 The Health Bulletin

have ground floor entrances, in larger area nearest the windows. Soft blues schools an unloading covered terrace or and greens are \isually used for the platform with guard rails on a level walls, with "sea-moss" green being con- with the building entrance, ramps, or sidered by many specialists as being elevators if classes are to be held on easiest on the eyes. Dark green black- more than one floor, non-slip floors, boards that are hung so they tip fur- hand-rails to assist with walking; little ther from the wall at the top than at (if any) fixed equipment, and that the bottom will prevent glare. should be adjusted to meet the needs (4) Children with Lowered Vitality of the individual child (for instance, and Cardiac Involvements, and many leg rests for the child who must of the children in the other groups

wear braces) ; full length mirrors will already mentioned, will need rest rooms help children improve their walking, equiped with cots. Lockers for each child and therapeutic departments if there is to store his individual blankets assigned a potentially large number of children to him add to the effectiveness of the with orthopedic handicaps. These thera- rest period. Open air classrooms and peutic departments should include treat- sheltered sun bathing porches would ment tables and other equipment needed be especially helpful. for physical therapy including a warm Besides these specific things which water pool. The pool also could be used will help the already handicapped child- for teaching swimming to the non- ren to secure educations, otherwise de- handicapped children during the hours nied them, there is one more need for when not needed for treatments. A room every careful consideration—the need where arts and crafts may be taught is to Plan for Preventing, wherever pos- especially helpful for crippled children. sible, the development of a physical lim- Besides teaching them the skills learned itation. A few items which would be there, the added help of improved co- helpful along this line would be; to de- ordination is a valuable aid toward help- corate carefully with a view to sight ing the child overcome his handicaps. saving; to give much attention to sun- (2) FOR HARD OF HEARING light and air, and at the same time CHILDREN—The floors of rooms to be eliminate drafts and glare; to build all used for this group should be hard- cabinets in the wall and grUl all radia- wood, air-spaced below to increase the tors so as to avoid the possibility of child's awareness of vibration. This is accidents; a special corrective gymna- an important avenue in developing the sium equipped with well designed and facUity of communication among child- carefully selected apparatus for exer- ren, who have seriously defective hear- cise and training tn remedial posture ing. Special wiring is needed so that classes; and numerous handrails for the mechanical devices and equipment for pupil who needs to steady himself occa- transmitting sound can be used to help sionally. Automatic light switches would retain all residual hearing a given child probably save more on electricity in a has. The ceiling should be acoustically short time than the extra cost of in- treated. stalling the switches and the saving of glasses in a few years later would be far (3) FOR THE PARTIALLY SIGHT- ED CHILDREN—The important item greater than the cost of installation and operation of a uniform lighting system. for this group is to secure maximum lighting, uniform and without glare or Do You Feel As I Do About Crippled shadows with automatic light switches which turn on lights as soon as needed ChUdren? and turn them off when not needed. The Do you feel the way I do about crip- switches can be arranged to tiirn on pled Children? Of course you believe one light when a corner gets dark, or that every Crippled Child has a right the row of hghts nearest the wall when to every service he needs at the time

a side of the room gets darker than the it will do him the most good . - . that —A

6 The Health Bulletin February, 1949

he has a right to Hve as near a nor- The League assists any Crippled mal life as his limitations will allow. Child regardless of cause of crippling Most Crippled Children need m-^ny —whether congenital, birth injury, di- expensive services to help them develop sease, infection, or accident as far as into normal adults and some of their its funds permit. With more money we needs are: could help more children—won't you Medical Care—the best available and help us help them? at the earliest possible time to so as "Today's ChUdren" correct deformities when possible and improve as much as possible those which "Today's children with their hopes cannot be entirely corrected. and fears, their problems and tears shall be the builders of a brighter Education—special classes or facilities world may be needed—but at least the type TOMORROW." of training which will help him use his What about Crippled Children in that abilities in the best way possible and March of Progress? Will they have a share thus become the best citizen his limited in the building of that better condition permits. world or do they have to sit on the sidelines and watch? Must a bright Guidance to help him better xmder- — mind be ignored because a leg does stand his problems and enable him to not function—must skilful hands lie idle develop into a strong character capable because the limbs will not carry the of accepting his limitations, the curio- hands to the place where they could be sity of other children, or the pity of useful? adults without embarrassment or hurt. Records from the past show that a Spiritual Training-—it is just as im- crippled arm, lame leg, a hearing de- portant that crippled children be trained ficit is often the spark which fires an to miderstand and live by the accepted individual to great accomplishment. moral and ethical standards of his com- Demosthenes overcame his stuttering munity as for any other chUd. to speak wisely to all generations; — Of course you think that these "rights Blind Milton produced "Paradise Lost"; of Crippled Children" are no different —A deaf Beethoven gave the world the than those of every child and you are 'Eighth Symphony"; —Half paralyzed, correct. All children have the same Louis Pasteur produced serums which basic needs for bringing happiness and have blessed the world; —Francis Park- for growing into useful citizenship but man, in such pain that he could work for Crippled Children some of these for only five minutes, who could see only needs are greater and more costly. to scrawl huge words, gave the world To provide as many of these needs 12 magnificient volumes of history; for as many Crippled Children as funds Ceasar, an epileptic built a great em- allowed has been the program of the pire; —Charles Steinmetz, the wizard of League for Crippled Children for years General Electric, was a hunchback; —to make it possible for all Crippled Thomas A. Edison, appreciated perhaps Children to have every service needed by more people than any other Ameri- at the time it would be most helpful can, was deaf in one ear; —Charles Dick- is the aim of the League. ens and Sir Walter Scott were lame. Every week, more requests are made What about the Cripple Children of for assistance than it is possible to give oui- generation? When the records are —Won't you help us reach those who written, will they show that we left are still waiting? They are growing them to shift for themselves, or that older each day they wait and their we encouraged them to accomplish all chances for best improvement are less- they could in spite of their limitations. ened! You wouldn't want any child to A few of them will grow up with cour- have to drag a brace or live in a wheel age within themselves to overcome de- chair if it could be prevented would spite their defects, but in the main a you? philosophical attitude toward one's February, 1949 The Health Bulletin handicap does not develop by accident resvilt of an injury to shoulders and —One of the aims and ideals of the neck. He was referred to an Orthopedic North Carolina League for Crippled Surgeon. Gene progressed so well dur- Children is that of social ad.iustment, ing his 4 weeks of specialized training to help those children accept the reality that a change of plan was made for of their limitations and, after taking him. Instead of being sent to the school stock of the thrna;s they cannot do, to for feeble minded he was placed in the live comfortably in tb° world which is home of a kindly couple. within their ability. Who knows from He was provided with needed dental where the next most startling contri- treatments, and orthopedic care. After bution to the welfare of the world may that his improvement in school was re- come? Perhaps, a crippled child in markable. His speech gradually became North Carolina, or many of them may audible and his vocabulary increased be listed in the roll call of the famous. rapidly, — and one more handicapped Fame does not require physical beauty youngster has joined the ranks of those as a requisite—it is too evanescent. Only who will grow into self-supporting those achieve the heights of everlasting adults. honor who by their labors have bene- fitted mankind. It's June 17th The work of the North Carolina it's 17th." "Is League for Crippled Children is financed "Wake up, Ted, June almost entirely from the proceeds from it REALLY June 17th?" You wouldn't their annual Easter Seal Campaign. tease me about anything as important as that, would you?" "No, Ted, we * « * * wouldn't tease you. It actually is June HUMAN INTEREST ITEMS 17th. Hurry now and get dressed. Break- fast is ready and when you've finished eating we are going to start." Gene Attended the League's Education Ted did hurry to get dressed, but he Center refused to take time to eat for he said, Gene was 12 that summer, but he did "We'd better get going now 'cause it is not talk at all—depended on signs to 172 miles to Chapel Hill, and I have get him what he might want or need. to be treated at 1:30 you know." He was a ward of Juvenile Court at the Of course they knew the distance and time the school opened and tentative the time for his appointment and that plans of the court were to have him there was time for him to eat his break- admitted to the school for Feeble Mind- fast before starting but he was so anxi- ed at Kinston. Gene's home was pathe- ous they finally gave up and came along. tic and his family uncooperative with When it came time for lunch he in- the social agency which had been active- sisted that they not stop for fear it ly trying to help him for several years. would cause him to be late and he There had been times when the family wouldn't get to stay at the Educational sent Gene out to beg for them. He was Center being opened for children with taught to act "deaf and speechless" as physical handicaps. Ted had been born they felt his helpless appearance would with a cleft palate, and even though the add to the "take" that day. cleft in his mouth had been corrected All children enrolled in the summer by surgery, he still talks with a strong educational project of the League for nasal tone and had a decided speech Crippled Children were given mental defect. tests as well as speech and hearing Ted had attended the Center two tests. Gene' mental test showed that he years before when he was twelve, and was not feeble minded. had been a good student then, but his All children also were given physical determination to improve his speech at examinatiorls, and there Gene's pecu- 14 was much stronger than it had been 2 liar pKJsture was discovered to be the years before. O

8 The Health Bulletin February, 1949

Because of his haste to' arrive on time classes and thus help him continue to and his refusal to take time to eat improve his way of speaking. either of his meals that day, he ar- Ted has made a nice adjustment so rived almost an hour early, and even far as accepting his handicap is con- though severely fatigued from the long cerned. He has been known to have been drive without food, Ted entered the teased by boys of his own age and he Center wearing a smile of the type not takes it casually. He even explains that too often seen. The other children who he is imfortunate enough to have been had been scheduled to arrive during the handicapped all his life, while they morning had been given their lunch have been fortunate so far, but he re- and the dining room was closed so it minds them they could have an illness was not possible to secure food just then or an accident which could leave them for Ted but one of the workers learned with a more severe handicap than his that he had not eaten all day sent to is. a near-by drug store for a mUkshake When Ted's parents came for him, for him. they brought his younger brother (now Soon after that, Ted was called for 10) and while the two boys "swapped" his examination. First he saw the experiences, the younger boy expressed physician who found him to be very a desire to come to the Center next healthy even though fatigue was de- year, for he believed Ted had had more cidedly evident. Then, his hearing was fun during the month just passed than tested and found to be normal. Next he he had. Ted explained that it would not saw the speech correctionist who gave be possible for the brother to be admit- Jhis speech test and prescribed the line ted to the Center since he had no handi- of speech therapy which his teacher cap to be corrected. The brother then was to follow. His last test was the turned to a staff member (who had psychometric test and when the exami- been standing close enough that she ners met to discuss Ted (as they did all had overheard the conversation) and cases) his I.Q. was rated much below said, "If I'd walk up to Miss Honeycutt the level set for admission to the center. and stutter real bad whUe I asked her Fortunately, the director of the cen- to let me come with Ted to the Center ter had seen Ted at work two years be- next year, do you think she would let fore and knew he did have at least me in?" intelligence and even tho the average Speech— story about his anxiety to reach Chapel Hill and his refusal to take time to eat Among the equipment of one of the had not been given her, she felt some- therapists directing a speech correction thing was wrong, so insisted that the class next fall was a game called I.Q. score not be considered for the "Speech—O". The game is something present, and that he be kept, at least like lotto, only the word on the card temporarily. After a few days had pass- which is turned up must be pronounced ed, he was given a second mental test and the player is scored on the basis of and his rating, well above average, quite how well he says the word. justified the decision to have Ted stay, Since the game was entertaining, and as did his work during the four weeks the children thoroughly enjoyed playing duration of the Educational Center, it, the results from the time spent with Besides his speech classes, Ted went "Speech—O" were especially good. swimming, played baseball and other One day, about a month before Christ- games with his pals who had also come mas, one little lad confided to his teach- to the Center in order to try to improve er that he had written Santa asking their speech. On the last 2 days of the that a "Speech—O" game be included Center's program his parents attended among his Christmas gifts. He asked the Parents' Institute so that they could if the teacher could also send Santa help Ted continue at home some of the a note telling him that the little boy O" work he had started in his speech needed a "Speech— game. She assur- —

February, 1949 The Health Bulletin ed him that she would get in touch with cation—Leaflet No. 4) Santa and Santa did bring the "Speech Number of Children with Cerebral O" — game. Palsy. To every 100,000 population: 7 children are born each year with Plastic Ear Cerebral Palsy, or To be "different" in school brings 1 for every 215 births. many unhappy experiences to a child. Of these 1 out of the 7 dies in infancy One of the County Chapters of the or soon after. League for Crippled Children learned 2 out of the 7 are loneducable. that a little boy attending one of the 2 out of the 7 are mentally gifted. city schools had been born with only 2 out of the 7 are average mentally. one ear. The child's embarrassment 'Source: Dr. Winthrop M. Phelps was acute. "The Doctors Talk it Over." The Committee asked if it could help. According to the State Health Depart- It could, and did. The result was a ment 109,372 babies were born in North plastic ear. No longer was this little Carolina last year. Of these, 508 children boy thought "queer" by his school mates. (one out of every 215 births) sustained His social adjustment had improved im- brain injuries, and will be paralyzed to mensely, and the $75.00 the Committee some extent. Many of this 508 will be invested can only be measured in terms severely paralyzed, and the majority will of happiness. require much medical treatment, specia- lized care and training. 70 percent of Statistics all cerebral palsied children are capable of becoming self-supporting citizens, if Approximately 146,000,000 persons live given adequate training and opportuni- in the U. S. (Source: U. S. Census Bu- ties. reau, July, 1948.) One child out of every 800 is born 23,000,000 of these or one out of six with a cleft palate, making North Caro- has some type of handicap. About 97% lina's total for last year 124. Of every of all handicapped persons can be re- 1,100 births one baby has club feet, habilitated sufficiently for them to ob- which means North Carolina had 10 tain gainful employment. (Source: babies born last year with that defor- Baruch Committee on Physical Medi- mity. cine.) Statistics on osteomyelitis, polio, rheu- Accidents during 1947 required 1/10 matic fever, and the other 251 causes of all available hospital beds! Many of of crippling, show that North Carolina's the injured will remain permanently handicapped constituency is increasing, handicapped. 100,00 persons were killed as well as that of the rest of the nation. and 80,000 were injured in the United No one expects to become crippled, States. There were 500 accidents daily and no one expects to be born crippled, and these resulted in one death every or to become crippled as the result of 16 minutes during the year. (Source: disease, accident, or infection. Few fami- National Safety Council.) lies are financially able to adequately Children needing Special Education. meet the needs of a handicapped mem- On the basis of estimated population of ber, and to date no social agency, either the total number of Children in the public or private, has been able to pro- United States: vide all the needs of the handicapped 2% are blind or partially sighted. groups. 1.5% are deaf or hard of hearing. The objective of the North Carolina 1% are crippled. League for Crippled Children, Inc., is 1.5% have speech defects. to help those who became crippled last 2% are mentally retarded. year, and the years before, and those 0.2% are epileptic. who will become crippled in the years 2.5% are behavior problems. to come. The League does not have (Source: United States OfBce of Edu- funds to meet all the needs of all the 10 The Health Bulletin February, 1949 handicapped groups in the state, but what funds it does have, it has been by supplementing the services of other able to provide some of the services agencies, and by spending continuously needed for a small number.

VITAL STATISTICS

William H. Richaedson State Board of Health Raleigh, N. C.

Frequently, Bulletin articles have been slight increase in reported incidence devoted to a discussion of vital statistics each year since that date. Rocky Moun- small —that is, the number of people who tain spotted fever has made a are born and who die during certain increase each year except one since 1941. specified periods of time. Vital statistics The rate at that time was 0.6 cases per might properly be referred to as the 100,000 population and is now 2.4. The bookkeeping of life and death. tularemia rate in 1944 was 0.3 and has The State Board of Health also keeps increased to 2.0 in 1947. another important set of records, deal- In addition to the above, chancroid has ing with the number of persons suffer- shown increases for the past two years, ing from 35 diseases, practically all of reaching 14.3 cases per 100,000 popula- which are capable to being transmitted tion in 1947, as compared to 11.8 in from person to person, under certain 1945. The highest chancroid rate in the circumstances. Some of these diseases past ten years was 18.4 in 1943. Tuber- are more contagious than others. Many culosis has shown an increase in re- of them are controllable, through the ported cases for the past three years, application of modern scientific dis- probably largely due to improved case coveries. It is perfectly logical to say findings. The 1947 morbidity rate of 96.6 that when diseases are controlled or together with the mortality rate for the prevented, the death rates from such same year of 28.4, presents the most diseases are, or should be, reduced. favorable ratio of cases per death in A morbidity report reveals the number North Carolina for many years. There of people who become ill. A majority of has been an increase in the percentage those who go down with almost any of reported minimal active tuberculosis disease get well, with certain exceptions. cases from 14.7 in 1945 to 16 in 1947. Others die. Those who become ill are Undulant fever increased from 9 cases included in morbidity reports. Those in 1946 to 21 cases in 1947. who die are included in vital statistics In 1947, poliomyelitis cases reached reports. We propose at this time to dis- the third largest number ever reported. cuss morbidity in North Carolina. The majority of the cases were confined The sixteenth bulletin of North Caro- to three south central counties in the lina morbidity statistics, covering the state and occurred relatively late in the calendar year 1947, contains the same season. tabulations of the thirty-five reportable Gonorrhea and syphilis remain the diseases as are contained in the previous largest single cause of morbidity among bulletins. the reportable communicable diseases; There are three diseases which have however, encouraging declines occurred shown some increase during the past in 1947. The gonorrhea morbidity rate few years: granuloma inguinale. Rocky has been steadily rising in this state, Mountain spotted fever, and tularemia. as reporting and case finding have im- Granuloma inguinale, which was not proved. Ten years ago the reported gon- made reportable until 1945, has shown a orrhea morbidity rate was 82 cases per February, 1949 The Health Bulletin 11

100,000 population. This rate increased portable diseases caused 38,016 individ- steadily to 421 in 1946. This past year ual illnesses. During the year there shows the first sizeable decline that has were 14,169 cases of gonorrhea reported taken place during this period with a to the State Board of Health; 8,724 rate of 381. Syphilis morbidity reports cases of syphilis; 3,484 cases of pulmo- rose steadily for many years until 1939 nary tuberculosis; 4,978 cases of measles, when a peak of 877 cases per 100,00 pop- and 2,983 cases of whooping cough. In ulation was reported. Following that spite of the fact that diphtheria can be year, syphilis morbidity declined an- prevented, and despite the fact that nually until 1946, when the rate again immunization of babies between 6 rose to 242. In 1947, the rate declined months and a year old is cumpulsory, to 235. Whether or not this decline re- there were 751 cases of diphtheria re- presents a renewal of the downward ported during the calendar year. Fortu- trend in syphilis morbidity, interrupted nately, however, there were only 33 by demobilization, remains to be seen. diphtheria deaths. Diphtheria morbidity rose slightly The above 38,016 cases of illness repre- over the record low established in 1946; sent only 35 diseases. Ailments which however, pertussis morbidity was the cause the greatest number of deaths, lowest recorded since 1936. Typhoid fever however, are not in the reportable class. cases reached a record low of 47 cases, For example, 2,777 people died of cancer having declined without interruption in North Carolina last year; 7,487 were since 1935. victims of heart diseases; 3,379 died of An interesting decline has taken place apolplexy; 2,614 died of Bright's disease, in scarlet fever morbidity during the and 1,307 of pneumonia. These figures, past two years. Prior to 1945, the rate remember, represent death from some fluctuated between 60 and 80 cases per of the diseases which are not reportable. 100,000 population over a period of at There were thousands afflicted with these least ten years without any tendency to known reportable diseases who did not decline. In 1946 the rate dropped to 40, die last year. We must keep in mind the lowest recorded. In 1947 the rate that the degenerative diseases referred dropped still fui'ther to 31. to above are not preventable. At the The hazard of war-born malaria and same time, however, they are not con- amebic dysentery appears to be steadily taigous, but, combined, they kill more diminishing. While reports of malaria people every year than do all the con- in veterans are being received, the over- taigous and reportable diseases. all recorded malaria hiorbidity rate de- Now, back to the reportable diseases, clined from 9.6 cases per 100,000 last for oui- conclusion. You have been given year to 3.7 in 1947. The rate for amebic the number of cases, last year, of gonor- dysentery remained unchanged at 0.5 rhea, syphilis, pulmonary tuberculosis, cases per 100,000 population. diphtheria, and whooping cough. Let us, Murine typhus fever declined to 1.4 then, make a comparison of the number cases per 100,000 population, making the of cases and the number of deaths in fourth consecutive year of decline. This each instance. As previously stated, is the lowest rate recorded for this there were 33 diphtheria deaths among disease since 1934. Meningococcus men- the 751 children who were down with ingitis declined to the lowest point since that disease last year. During 1947, there 1942, having decreased each year since were reported to the State Board of 1943. The rate that year was 13.2 the Health 256 syphilis deaths among the highest recorded in many years, and 8,724 cases reported. While 3,484 cases may have been a result of large popula- of pulmonary tuberculosis were reported, tion movement during the war. The there were 983 deaths. We shall not un- 1947 rate is 2.6. dertake to compare current tuberculo- Now, for an over all picture of mor- sis deaths with currently-reported cases, bidity statistics in North Carolina dur- because it is certain that many of those ing the calendar year of 1947. The 35 re- who died last year contracted the disease 1949 12 The Health Bulletin February, before 1947. Some of them probably had but the most advanced stages. Let us had tuberculosis for years and were not conclude then, by urging everyone to diagnosed until it was too late to effect have a chest X-ray made, at the earliest a cure. This should serve as an incen- possible moment. The fight against the tive to all to make sure they have not white plague now is on in earnest. Only the disease—not even in its incipiency the people who have the opportunity to —by having their chests X-rayed. This avail themselves of benefits of the pre- ^ service is now available, without cost. sent case-finding program are to blame Case-finding machinery already has if they wait too long. There are more been set up in many counties and, it avenues to suicide than guns, knives, is safe to say, many lives have been and poison drugs. They work quickly saved because of early diagnosis and it is true. Neglect is a slower but none treatment. Medical science now knows the less effective means of self-destruc- how to take care of tuberculosis in all tion.

NOTES AND COMMENT

Public Health Nurse Chosen as American Nurses' Association". Representative The American Nurses' Association will present the Award to one outstanding nurse in each state who graduates from an accredited school of nursing and be- comes registered during the period August 1, 1948, through July 1, 1949. The Award will be granted on the basis of achievement, scholarship, aptitude for nursing, devotion to duty, leader- ship, appearance and personality. So long as she is registered, a professional nurse, it makes no difference in which field the contestant is employed. She may be engaged in private duty or hos- pital staff work, in public health, indus- trial, school, army or navy nursing, or of any other branch of the profession. The Award will be furnished by the American Nurses' Association and will consist of a bronze medal bearing the likeness of Linda Richard and carry the inscription on the*observs "Diamond Jubilee of American Nursing 1948-1949"; and in the center of the reverse " (name of nurse) Award of Achievement"; at the top of the primeter "American Nur- Association", and at the bottom Miss Lida Grey Bissette, Registered ses' Carolina State Nurses' Associa- Nurse in Public Health of the Wilson "North City and County Health Department, tion". and a recent graduate of the Woodard The Award will be presented to the Herring Hospital, has been chosen by North Carolina winner at the forty- that hospital to represent it in the seventh annual convention of the North contest to receive the Linda Richard Carolina Nurses' Association, which will Award, which will be one feature of a be held in High Point the week of Octo- "Diamond Jubilee Program of the ber 23, 1949. February. 1949 The Health Bulletin 13

ACCIDENTS RANK FIRST AS DESTROYER OF WORKING YEARS

CHICAGO—A complete cure for heart Actually ,the high death rate of per- diseases or cancer would have added sons 65 years of age and over from the fewer working years to the life expec- "older" causes of death is an indication tancies of the American people in 1945 of the progress that has been made in than would have been added by pre- extending the lifetimes of many per- vention of all fatal accidents, accord- sons who formerly would have died in ing to the Bui'eau of Medical Economic young or middle age from these diseases, Research of the American Medical the authors point out. Association. In the "younger" group of diseases, Writing in The Journal of the Ameri- pneumonia fatalities have been sharply can Medical Association, Frank G. Dick- reduced by the "wonder" drugs, such as inson, Ph.D., director of the bureau, and sulfanilamide, sulfadiazine, and peni- Everett L. Welker, Ph.D., associate in cillin. mathematics, say that fatal accidents Dr. Dickinson and Dr. Welker's classi- now cut more years from the working fications of the seven leading causes of lifetimes of the people of the United deaths were taken from the Manuel of States than do deaths from any one the International List of Causes of natural cause. Death, compiled by the United States The total numbers of deaths, which National Office of Vital Statistics, Wash- show heart diseases and cancer to be ington, and published in 1946. They number one and number two "killers," were—diseases of the heart, including are not alone an accurate measurement rheumatic heart disease, which is mostly of the number of working years—those a disease of children and young persons; between the ages of 20 and 65—which cancer and other malignant tumors; in- are lost by death, they say, because tracranial lesions of vascular origin; mere numbers conceal wide differences nephritis; pneumonia and influenza; in the average ages at death from diffe- tuberculosis; and accidental deaths. rent causes. Using these classifications, Dr. Dickin- Neither can the loss to the produc- son and Dr. Welker developed two new tive and military strength of the nation measures for ranking the causes of from any one cause of death be accur- death. Both take into account the age ately determined by this one measure as well as the number of persons dying in the present period of declining mor- from each cause. tality, long life, and a rapidly aging One measure, working years lost, is population, they point out. based on the concept of a working life- These conclusions are not based upon time as the period between the 20th an alarming rise in the number of fatal and 65th birthdays. Everyone below age accidents, but upon man's conquest of 65 has a certain number of "unrealized" disease — medical progress against the working years ahead of him which are "younger" and some of the "older" destroyed if he dies before the custo- causes of death — the article empha- mary retirement age. When the unrea- sizes. The leading causes of death are lized working lifetimes of all persons divided into "younger" and "older" dying from each of the causes are added causes because the average age of per- together, the various causes can be com- sons who die from heart disease, can- pared in terms of the amounts of the cer, intracranial lesions of vascular ori- nation's productive capacity which they gin, and nephritis is 22 years more than destroy, the authors explain. that of persons who die from pneumonia The other measure, life years lost, is and influenza, accidents, and tuberculo- the same as the first except that it con- sis, the article indicates. siders the leisure as well as the work- 14 The Health Bulletin February, 1949 ing years destroyed by death and is The public must also, as patients, co- based upon the average hfe expectancy operate with physicians, and must con- of the American people at death rather tinue to support medical research and than upon the arbitrary designation of education if the accelerated rate of the working years.' medical progress is to be maintained, the Applying these two new measures to article points out. guide to the use of the two new the leading causes of death in 1930, 1935, As a measures. Dr. Dickinson and Dr. Welker 1940, and 1945, as listed by the National say that " if the retired, leisure years Office of Vital Statistics, Dr. Dickinson major consideration, life years and Dr. Welker found that in 1945, a are a are recommended as the better of year of nationwide gasoline rationing, lost the two measures. If economic conside- fatal accidents were first in terms of rations are paramount, use of the se- working years lost, although heart di- cond measure, working years lost, is sease killed over four times and cancer nearly twice as many persons. Accidents advised." complete story of Dr. Dickinson held this same rank in 1940, were se- The Dr. Welker's study may be found cond in 1935, and third in 1930. Acci- and their recent published monograph, dental deaths accounted for 7 percent of in "What Is the Leading Cause of Death?" all deaths in each of the four years bureau plans to make a second studied. Young white men are the The using similar criteria to measure chief victims of accidents, the article study the loss to society from disability re- says. sickness and injury, both In 1945 the number of working years sulting from fatal non-fatal. The authors be- lost from accidental deaths was 1,750,- and lieve that the common cold will rank 000, which may be compared to 1,680,- leading causes of dis- 000 from heart diseases. 1,110,000 from high among the pneumonia, and 1,040,000 from cancer ability. in the same year. Pneumonia deaths which held first place in 1930 and 1935 as a cause of working years lost, dropped FUNDS MEAGER FOR RESEARCH to third place and tuberculosis, which ON HEART CONDITIONS held second place in 1930, dropped to fifth place. An editorial in Hygeia states: The authors developed these two new "Today in the United States heart measures to evaluate the loss to society disease is the new captain of the men resulting from the causes of death, and of death; fifty years ago it was tuber- chi'onic point out that neither is designed to culosis. Once the acute and gauge the importance of any one cause infectious diseases were far greater as of to the individual. As a whole, the study a menace to mankind than diseases shows that the people of the nation are the heart, high blood pressure and hard- living longer and dying during old age ening of the arteries. when their working lifetimes are largely Today tuberculosis is seventh among pressure over. In 1945 no leading cause of death the causes of death. High blood struck primarily at the young, mortality and hardening of the arteries are re- all cases of from diseases which kill before middle sponsible for 45 percent of age had decreased rapidly, and the heart disease in adults. tech- majority of heart and cancer deaths The prolongation of life by the resulted occurred after age 65. nics of modern medicine has The findings that fatal accidents are from the manner in which the diseases a greater menace to the nation's eco- of childhood have been brought under live far longer nomy and security than is any one natu- control. People today ral cause of death suggest that persons than they did in 1900. who plan health improvement programs Rheumatic heart disease is the lead- children be- do well to place more emphasis on a.oci- ing fatal disease among dent prevention. tween the ages of 5 and 19. Many of February, 1949 The Health Bulletin 15 those who die of heart disease as they lems of diseases of the heart. grow older represent children who have Many of these scientists are the had rheumatic heart disease and who teachers in our medical schools. If we then suffered, more or less, disability look forward as we should to the future, for their remaining years. they must be given opportunity to train Thus heart disease takes its toll in young men in the knowledge of their sickness and disability as well as in sciences so as to make them available death. Thousands of men in the prime for research in the future. of life whose economic value to society Today the attack on disease requires is tremendous are stricken when they teamwork. The medical personnel in- are beginning to make theii' richest cludes physicians, technicians, statis- contribution. ticians, nurses and social and clerical From the facts here recited, the out- workers. The facilities include clinics, look may seem dismal. Perhaps the hospital wards, research laboratories, apathy of most people toward heart administrative offices, sanitaria, and disease and the acceptance of the in- rest camps. Both personnel and facil- evitability of deaths from diseases of ities are inadequate to meet the need. the heart are largely responsible for A comprehensive program of research our failure to meet the challenge. on problems of diseases of the heart The American people contribute mil- means more facilities for the care and lions of dollars to the control of tuber- study of patients, more laboratories for culosis, cancer, infantile paralysis, and research, more trained personnel. The many other easUy dramatized diseases. need is established. America can and The funds for research on conditions should meet that need." affecting the heart are pitifully meager. Already scientific medicine has done much in its advances against heart di- AVERAGE AGE OF PHYSICIANS sease. The development of surgery of AT DEATH RISES STEADILY the heart in recent years has been among the most striking of medicine's CHICAGO—The average age of phy- great accomplishments, yet far more sicians in the United States at death remains to be done than has already has risen steadily during the past four bfjen accomplished. years, according to American Medical What has been achieved is merely the Association statistics. proof of how much could be accom- In 1948 the average age of physicians plished if the men and the facilities and at death was 67.4 years, says an edi- the funds so sorely needed could be torial in The Journal of the American made available. Medical Association. In 1947 it was Every year during the past decade we 66.7 years; in 1946, 66.1 years; and in have increased oui- knowledge of the 1945, 65.3 years. coronary arteries. The development of Heart disease is the number one the radioactive isotopes and of technics killer among physicians, The Journal for catheterizing the heart and research figures for 1948 show. Coronary throm- with the electrocardiogram have permit- bosis, angina pectoris, rheumatic heart, ted studies to be made that go far be- and other heart conditions accounted yond anything that could be imagined for 41 per cent of the 3,230 deaths of twenty years ago. Yet for these studies physicians reported by The Journal the funds available are pitifully small. during the year. Already the scientists who devote Diseases of the nervous system were themselves wholly to the basic medical second, causing 412 deaths, cancer and sciences, anatomy, physiology, bateri- other malignant tumors third, account- ology, pathology, biochemistry, and ing for 348 deaths, and accidents fourth, pharmacology among others, are ready accounting for 173 deaths. and capable of extending their fun- Falls caused more deaths than did damental research into vmsolved prob- any other type of accident, and motor —

16 The Health Bulletin February, 1949

vehicle accidents caused more than Harold G. Wolflf, M. D., from the New twice as many deaths as did air trans- York Hospital and the Departments of port accidents. Medicine and Psychiatry, Cornell Uni- Other major causes of death among versity Medical College, made a study physicians were diseases of the respira- of migraine headache. tory system, accounting for 163 deaths, The typical sufferer from migraine and diseases of the digestive system, headache, they found, is ambitious and accounting for 114. tends to be a perfectionist. Twenty-three physicians of the 3,- Describing the personality of persons 230 total were killed in action during suffering from migraine, the physicians World War II, and 33 died while in say: military service. "They are tense driving persons who have found that doing more than and EMOTIONAL STRESS better than their fellows brings a good CAUSES MOST HEADACHES deal of satisfaction. However, this end in en- CHICAGO — Most headaches are is accomplished at a great cost ergy. They become resentful because caused by emotional stress, five New they cannot keep up with the load York physicians indicate in The Journ- which the world and themselves impose. al of the American Medical Association. "The natural outcome is tension, Three of the physicians—Arnold P. fatigue, and exhaustion; in this setting Friedman, of the Headache Clinic Sec- headache makes its appearance. Rage, tion, Mental Hygiene Service, Veterans are often Administration, and Charles Brenner resentment, and frustration denominators of the emotional and Sidney Carter, from the Division common preceding an attack of of Neuropsychiatry, Montefiore Hos- derangement migraine. However, dramatic events pital, and the College of Physicians not precede headache many fol- and Siu-geons, Columbia University need — low long periods of so-called routine conducted special headache clinics. They with slowly accumulating ten- foimd that headaches for which there living sion." is no apparent physical cause and the doctor can make the headaches following head injuries were Although patient aware of the cost of by far the most common among pa- migraine such of life, the decision of what tients. a way it is the patient's, the phy- Treating 494 patients with headaches to do about sicians emphasize. of these kinds, the three physicians found that 50 to 60 per cent responded favorably to almost any medicine given OUR FRONT COVER — Graham D. them, and nearly as well to placebos, Canfield, son of Mr. and Mrs. Norman harmless but effective substitutes for S. Canfield, Morehead City, North Caro- drugs. lina, born July 25, 1947 with no right Treatments used included psycho- leg below the knee and no toes on left therany, pain-relieving drugs, sub- foot. He was taken to the Orthopedic stances to constrict and dilate the blood Clinic at Greenville, North Carolina. vessels, vitamins and hormones. When about a year old he was hos- Results of the study strongly suggest pitalized under the supervision of Dr. that the effectiveness of the medica- Hugh A. Thompson, Orthopedic Sur- tions was caused primarily by the pa- geon, Raleigh, North Carolina. An ar- tient's psychologic reaction to the treat- tificial leg, constructed by J. E. Hanger ment situation in general and to hav- of Raleigh, North Carolina, was fitted ing a "remedy" from the doctor, the on Graham when he was thirteen article says adding: months old. He started using it when "Both types of headache probably he was fourteen months old. The pic- are responses of the body to distributing ture was taken one month later when psychologic stress." he was walking and running as well as Robert M. Marcussen, M. D., and a normal child of his own age. MEDICAL LIBRARY

U. OF N. C . CHAPEL HILL. N. C. 1

i This Bulletin. wiJl be sgr\t free to ony citizen of the State upon request!

Published monthly at the office of the Secretary of the Board, Raleigh, N. C. Eniered as secund-class mattct at Postoffice at Raleigh, N. C. under Act of Aueu't 24. 1912

Vol. 64 MARCH, 1949 No. 3

ARTHUR G. RAYMOND, JR. MEMBERS OP THE NORTH CAROLINA STATE BOARD OF HEALTH

S. D. GRAIG, M.D., President Winston-Salem G. G. DIXON, M.D., Vice-President Ayden H. LEE LARGE, M.D Rocky Mount W. T. RAINEY. M.D Fayetteville HUBERT B. HAYWOOD, M.D Raleigh

J. LaBRUCE WARD, M.D Ashevillc J. O. NOLAN, M.D Kannapolis JASPER C. JACKSON, Ph.G Lumberton PAUL E. JONES, D.D.S Farmville

EXECUTIVE STAFF

J. W. R. NORTON, M.D., M.P.H., Secretary and Slate Health Officer G. M. COOPER, M.D., Assistant State Health Officer and Director Division of Health Education, Crippled Children's Work, and Maternal and Child Health Service

, Director, Division Local Health Administration

, District Director, Local Health Administration

ERNEST A. BRANCH, D.D.S. , Director, Division Oral Hygiene JOHN H. HAMILTON, M.D., Director, Division of Laboratories

J. M. JARRETT, B.S., Director, Division of Sanitary Engineering OTTO J. SWISHER, M.D., Director, Division of Industrial Hygiene BERTLYN BOSLEY, Ph.D., Director, Nutrition Bureau FELIX A. GRISETTE, Director, Venereal Disease Education Institute C. P. STEVICK, M.D., M.P.H., Director, Division of Epidemiology and Vital Statistics, and Co-Director, School-Health Coordinating Service WILLIAM A. SMITH, M.D., Director, Bureau of Tuberculosis Control IVAN M. PROCTER, M.D., Director, Bureau of Cancer Control

HAROLD J. MAGNUSON, M.D., Director, Reynolds Research Laboratory, Chapel Hill JOHN J. WRIGHT, M.D., Director, Field Epidemiology Study of Syphilis, Chapel Hill

FREE HEALTH LITERATURE

The State Board of Health publishes monthly THE HEALTH BULLETIN, which will be sent free to any citizen requesting it. The Board also has available for distribution without charge special literature on the following subjects. Ask for any in which you may be interested. Adenoids and Tonsils German Measles Sanitary Privies Appendicitis Health Education Scabies Cancer Hookworm Disease Scarlet Fever Constipation Infantile Paralysis Teeth Chickenpox Influenza Tuberculosis Diabetes Malaria Typhoid Fever Diphtheria Measles Venereal Diseases Don't Spit Placards Padiculosis Vitamins Endemic Typhus Pellagra Typhoid Placards Flies Residential Sewage Water Supplies Fly Placards Disposal Plants Whooping Cough

SPECIAL LITERATURE ON MATERNITY AND INFANCY

The following special literature on the subjects listed below will be sent free to any citizen of the State on request to the State Board of Health, Raleigh, North Carolina. Prenatal Care Baby's Daily Schedule Prenatal Letters (series of nine First Four Months monthly letters) Five and Six Months The Expectant Mother Seven and Eight Months Infant Care Nine Months to One Year The Prevention of Infantile Diarrhea One to Two Years Breast Feeding Two to Six Years Table of Heights and Weights Instructions for North Carolina Midwives

CONTENTS Page School Hearing Conservation Activities in North Carolina 3 Window Operation For Deafness 5 Your Pond—A Public Health Responsibility 7 Notes and Comment 13 Vol. 64 MARCH, 1949 No. 3

State Officer H. M.D., Acting Editor J. W. R. NORTON, M.D., M.P.H., Health JOHN HAMILTON,

SCHOOL HEARING CONSERVATION ACTIVITIES IN NORTH CAROLINA By

C. P. Stevick, M. D., M. p. H., Co-Director School-Health Coordinating Service

School health work in North Carolina I. Hearing testing of the school popu- is the responsibility of schools and local lation health departments. In the conduct of II. Medical care for the children with this work the local agencies receive hearing defects the State Department assistance from III. Special education for those need- Instruction and the State of Public ing it because of their handicap Board of Health. IV. Vocational rehabilitation in select- Much can be taught in our public ed cases will enable the student not schools that The fii'st step in the actual carrying he graduates only to be healthier when out of the hearing work in the schools school, but also to know what from high is to find the children with hearing de- to preserve his health he needs to do fects. The human ear is capable of hear- for the remainder of his own life, and ing a wide range of sound, from very insure good health for his children. low notes in the musical scale to ex- Learning is frequently accomplished tremely high notes. Due to the way in most easily by doing, and our school which the nerve of the ear is con- health program in North Carolina in- structed, it is possible for a person to certain nurs- cludes—where available— lose the ability to hear high notes or facilities that provide ing and medical low notes, but to hear all other notes physical for the finding of children with fairly well. In other words, the ear can and mental defects; and, at the same be damaged by disease so that certain children valuable time, give the educa- sounds can still be heard, but others tional experiences in health. cannot. This fact is important in test- The school health service we wish to ing the hearing of children. A child discuss briefly here pertains to the con- may hear certain sovmds well, but have servation of the hearing of our school difficulty understanding speech. A par- children. This is a program that the ent or teacher may know that the child School-Health Coordinating Service, a hears thunder or music and, because joint Division of the State Departments of this, fail to recognize that the child of Health and Public Instuction, is help- does not hear speech well. It is also ing to develop throughout the State. possible for a child to hear speech well, Hearing conservation in the public and yet have a loss of hearing in the schools can be divided into four closely range of sound that is higher in pitch related activities: than the human voice. The Health Bulletin March, 1949

Certain apparatus has been diesigned giving the test then turns a switch on to test hearing accurately. This appa- the audiometer that reproduces a low ratus is able to detect loss of the ability pitched musical note in the receiver. The to hear any part of the full range of audiometer also has a volume control sound. It is obvious that tests of hear- which is adjusted so that the musical ing that are not carried out by means note is exactly as loud as it should be of such apparatus are not complete or for the normal ear to hear. If the child very accurate. Because of the expense hears the sound, he raises his hand. of this apparatus and the time involved The switch on the machine is then in using it, this phase of school health turned to the next note in the scale. A work in North Carolina has only re- total of eight separate tones are used cently received wide-spread attention. in testing each ear. The tones are select- The following counties and cities now ed so as to cover the complete range of have audiometers—as they are called, hearing. If the child is unable to hear for testing hearing in the schools. In any two of these tones, or musical notes, some cases, the purchase was made by he is then scheduled for a more com- interested civic clubs, such as the Ex- plete test at a later date. At the time change or Kiwanis Clubs. In other in- of the retest, the volume control is ad- stances, the schools or health depart- justed for each tone until it is found ments purchased the equipment. The exactly how loud the sound miost be counties and cities are: Alamance, Bun- before the child can hear it. In this way, combe, Burke, Catawba—Lincoln and the exact degree of hearing loss can be Alexander, Cleveland, Gaston, Halifax, determined and the type of sounds that Moore, New Hanover, Pasquotank—Per- cannot be heard are also clearly evi- quimans and Camden, Rowan, Vance dent. Wake, Wayne, Asheville, Charlotte, This type of test is performed with Greensboro, High Point, and Rocky one child at a time. There is another Mount. type of tests that can be carried out There may be one or two other coun- with 25 or 30 children at a time by ties or cities that should be included in means of multiple ear pieces connected this list, but for which the School- to a phonograph. The phonograph test Health Coordinating Service does not is not as accurate as the test in which have complete information. the separate tones are used and is not It can be seen from this list that only used as widely now as formerly. part of the State is covered by the pro- In those counties where testing has per equipment. It is hoped that addi- been started in the schools for the tional fimds for school health work will first time, approximately 3 to 5 per cent be available soon for assisting the coun- of the children have been found to ties in pvu-chasing audiometers and pro- have defective hearing requiring refer- viding personnel to operate them. ral to a physician. In the case of many In those counties having machines, of these children, prompt medical care the nurses and teachers or technicians restores the hearing to normal. This is working in cooperation with the nurses, why the hearing program is officially test the children in a carefully selected spoken of as a hearing conservation room in the school where as much noise program. If foimd early enough, a is excluded as possible. Tests require large number of children with ear about two minutes per child and can be trouble can permanently preserve their given to children in all grades. The normal hearing ability. As mentioned ideal program provides for testing every above certain children who are able to child every other year. hear conversation easily may not be The test with one type of audiometer able to hear high pitched sounds. Such ("puretone") is carried out as follows: a child is just as badly in need of The child holds the receiver of the medical care as those having an in- audiometer to his ear just as if he were ability to hear conversation because the listening to the telephone. The person loss shows that some disease process is March, 1949 The Health Bulletin

present and the damage done to the in Raleigh, and the white school is at upper tones only may become progres- Morganton. sive and later affect the speech range of The State Vocational Rehabilitation hearing. It is only by means of the service of the State Department of "puretone" audiometer tests that this Public Instruction is able to provide type of child can be located and referred special medical care and vocational for medical care. training for many persons over 16 When a child is found with certain years of age, who are otherwise unable degrees of deafness, his educational to receive it. The objective of this pro- care must be planned in addition to gram is to assist worthy persons in his medical care. In mild cases, seating learning vocations in which their physi- near the teacher is all that is required. cal defects are not a handicap. Many In more serious cases, lip reading in- well paid jobs can be done as well or struction is needed. For children with better by handicapped persons as by a progressive hearing loss, it is impor- persons without defects of any kind. tant that lip reading be taught before From what we have outlined here, it all of the hearing is lost, since it is can be seen that the hearing program much easier to learn to read someone's requires the cooperation of schools, lips if his voice can also be heard at the health departments, civic clubs, and same time. Speech correction is neces- many other agencies. We have made a sary for some children who, because of good beginning in North Carolina, and their inability to hear speech clearly, when funds become available to buy do not speak clearly themselves. For additional equipment and employ addi- those children who are unable to pro- tional nurses, teachers and other person- gress satisfactorily in our public schools, nel the program can move forward the State has excellent schools for the rapidly as one of the many phases of deaf. The colored school for the deaf is a well rounded school health program.

WINDOW OPERATION FOR DEAFNESS By James W. Ballew, M. D. Raleigh, N. C.

Sound is vibrations in various wave for interpretation or action is located lengths. The normal himian being is in a hard bony capsule located in the capable of intercepting and interpret- base of the skull. This capsule also ing a certain range of wave lengths in houses the mechanism concerned with the sound spectrum. When this sound our balance and equilibrium. The part is transmitted to our brain, and there concerned with balance is called the interpreted by the conscious mind—we labrynth, and that part concerned with hear. The segment of the sound spect- hearing is called the cochlea. The coch- rum audible to the human varies from lea is named for a spiral shaped shell- about the low of the bullfiddle or base fish, which it resembles. The labrynth horn: to the highest pitches of the vio- suits its name too. There are two flex- lin—a watch tick—or a cricket's chirp. ible openings to this bony capsule. One The normal conversational range of the of these is called the round window, human voice is approximately the mid- and the other is called the oval window. dle half of the sound segment. The round window is covered by a thin The mechanism for changing the membrane, and the oval window is clos- vibrations of sound to the nerve im- ed by the footplate of the Stapes. The pulses that are carried to our brain Stapes is one of the bones serving to The Health Bulletin March, 1949 transmit the vibrations of sound from In performing this operation, the the ear drum to the fluid of the lab- surgeon cuts thru the outer ear, and rynth. The whole capsule is filled with opens the mastoid bone. He then locates fluid in which floats the soft tissues of the part of the bony capsule (labrynth) the nerves and organs of hearing and known as the horizontal semicircular balance . canal. This canal is concerned with our Normally the vibrations of soimd balance mechanism, but as noted pre- entering at the oval window causes the viously, the fluid in which the soft tis- fluid within the capsule bathing the sues float communicates freely with sensitive endings of the nerve of hear- those bathing the organ of hearing. The ing to vibrate and move. It is theorized surgeon then makes a new opening that the thin membrane covered round into the bony capsule on the anterior window serves as a valve to allow the end of the canal. Meanwhile, he has fluid to move freely and quickly. This carefully dissected free the skin cover- vibration of the fluid is picked up by ing the back of the external ear canal, the nerve endings—changed to nerve which leads from the outer ear to the impulses and transmitted to various driun. He leaves this attached to the parts of our central nervous system. ear drum. At the end of the operation, Normally, the footplate of the Stapes he covers his new window with the upper moves freely in the ,oval window. But part of the ear drum and this skin. in a certain group of people there is an This skin is the only thing that has overgrowth of bone in this area. And been successful in keeping the window the edge of the oval window overgrow from closing. This skin is tissue paper the narrow space to the footplate and thin, and contains no oil or sweat gland, fix the Stapes so that it can no longer and no hair follicles. move freely. Vibrations are no longer The operation is not as simple as it transmitted freely to the fluid of the may sound. It is tedious and difl&cult labrynth. Thus altho the nerve of to perform, and in vmskUlful hands may hearing itself may be in perfect condi- lead to permanent injury to the patient. tion, the individual no longer hears The surgeon must be quite skilled In well. This condition is known techni- ear surgery of other kinds before cally as Otosclerosis. attempting the fenestration operation. Otosclerosis can and does occur at Even skilled ear surgeons spend much practicing the operation any age, but the larger per cent of time on cada- before attempting it on live pati- cases needing help to hear is the 25 vers to 45 year group. These people are in ents, even under supervision. the most active and productive period As with any new experimental surgi- of their lives. This fact, plus others in- cal procedure, many patients were spired much work on some surgical operated upon in the early days, whom procedure that might help these people. we would not now consider suitable for Many attempts were made, but failed. this method. The operation is now limit- The greatest cause for failure in even ed to those patients whom we know by well devised technics was infection experience to have an excellent chance following operation. This is serious be- to regain serviceable hearing. Suitabi- cause infection in the labrynth usually lity for operation can only be determined causes profound or total loss of hearing by careful examination. As would be in the affected ear. And it was almost expected, the window operation is not certain to be complicated by a meningi- successful in any cases of nerve deaf- tis. The advent of the sulfa drugs and ness. This was realized from the incep- the antibiotics, such as penicillin caused tion of the operation. The few operations new thinking and activity in the field. performed on these people were uni- In the late thirties, Dr. Julius Lempert formly unsuccessful. Many resulted in worked out the basic technic for the even further loss of hearing in the operation known as the fenestration or operated ear. No surgeons are now ope- window operation. rating on these cases. March, 1949 The Health Bulletin

The operation is most successful when tion. The sole criteria is the status of performed on those people with a pure the nerve of hearing itself. SuccessfvQ conduction deafness without any degree operations have been performed on of nerve involvement. This patient is patients in the seventies, but this is only occassionally seen. Almost all show quite unusual. Children are usually not some degree of nerve involvement. operated upon until after the age of The second group presents a well pre- eight. This is because of the difficulty of reliable served nerve, but there is some loss of examination in a yoimger child. nerve acuity, as shown by lowered bone In even the most successful cases, a conduction of sound, in the middle lower certain percent will grow new bone frequencies. Unforttmately, this is the over the window. This causes the hear- most important part, because this is ing to return to the preoperative level. the range of the human voice frequen- Unfortunately, nothing has yet been cies. These patients can be promised devised to make certain that the win- probability of a good result. If the nerve dow will remain open. There is no way acuity has not dropped below a certain of telling which cases will remain open, level, there is a good expectancy that and which will close. If the window, the hearing by air conduction will rise remains open for a year, few will close. to a serviceable level. In any series of Practically none that remain open for cases, this group will comprise the two years close. largest group. Reoperation can be performed in those cases in which the window closes. The third group on whom operation The reoperation is not as difficult, nor may stUl be performed is that group in does it take as long as the original which the nerve ftmction in the middle opera- tion. However, a very high percent low (conversational frequencies) frequ- of these patients close again. encies has dropped below the level where In summary, the fenestration or win- a good conversational hearing result dow operation is performed on patients may be obtained. But the nerve acuity with otosclerosis, a form of conduction is good in the very high and very low deafness. In carefully selected patients, frequencies. Altho these patients usually a good immediate result can be expected must continue to wear a hearing aid, in almost all cases. But a certain per- they are able to hear doorbells, tele- cent of these successful cases will grow phones, alarm clocks, etc. Many patients new bone over the window. The opera- elect to undergo the operation solely tion is difficult to for this benefit. perform, and requires a high degree of skill on the part of the. Age in itself is no bar to the opera- surgeon.

YOUR POND—A PUBLIC HEALTH RESPONSIBILITY By Chakles M. White State Director, Malaria Control N. C. State Board of Health

What is Malaria? In 1880, a French Army surgeon The word "malaria" is derived from named Lavaran fovmd small organisms two Italian words: "mal" meaning bad, in the blood of patients suffering from and "aria" meaning air. As its etymology the disease: Later, they were proved by Indicates, the term was originally used him to be the parasites which cause to show the connection between the malaria. In 1897, Sir Ronald Ross, an disease and the foul air emanating from English Army surgeon, proved that in marshes and swamps. avian malaria these parasites were 8 The Health Bulletin March, 1949

Clean ponds with steep shore lines seldom become public health problems. transmitted from one bird to another but if an infected person should move through the bite of a mosquito. It was into the community or merely stay is bitten by malaria later demonstrated by Grassi, an Italian overnight and this mosquito becomes a scientist, that malaria parasites were mosquito, transmitted by mosquitoes from one hu- potential spreader of the disease and man being to another. Even though it may infect several other persons who was discovered that the term "malaria" in turn will infect other mosquitoes. embraces several diseases caused by Eventually, the entire community may separate species of closely related para- become infected. sites, the name has been retained. Mosquitoes There is only one known natural method by which malaria can be trans- Over fifty different kinds of mosqui- mitted from one person to another— toes have been found in North Carolina. through the bite of an anopheline mos- When viewed under a microscope, the quito. In North Carolina only one spe- different mosquitoes look no more alike cies, the Anopheles quadrimaculatus, than the various species of birds re- can carry this disease. As the malaria semble each other. Their breeding, fly- mosquito is not able to pass the infec- ing, and feeding habits also vary greatly tion from mother to offspring, the only with different species. Some will breed method by which she can become in- only in receptacles having artificial bot- fected is by taking a blood meal from toms—such as, tin cans, flower vases, or a person suffering from the disease. If old rubber tires containing water. Many a community is free of malaria, the species breed in foul water or water jnosquitoes will not become infected. having a high acid content, while others March, 1949 The Health Bulletin 9 prefer large bodies of reasonably fresh, as well as in the eastern section of the clean water. Certain species of mos- state. Industrialization and improvement quitoes will fly 30 or 40 miles, while in transportation resulted in the aban- others rarely go over a quarter of a donment of most of these mills. The mile from their breeding places. dams' gradually washed out and the The mosquito which carries malaria number of ponds became smaller and in North Carolina seldom flies more smaller. A recession in malaria followed than a mUe if a blood meal can be found in the Piedmont area. In recent years, nearer. They breed in ponds, ditches, the high incidence of the disease has and other bodies of reasonably fresh, been confined almost entirely to the stUl water where the acidity is not too eastern part of the State where nimier- high. Where the shade is not too dense, ous natural breeding places for malaria they are often found breeding in mosquitoes existed. swamps. Conditions favorable for the In the following table the deaths re- breeding of malaria mosquitoes are: a ported clearly illustrate that a marked constant water level, collections of flot- diminution has taken place in the inci- age and other debris, aquatic vegetation dence of malaria in North Carolina. It which pierces the water surface, little or will be seen that the reported deaths no wave action, slightly alkaline or from the disease have gradually fallen neutral water, and the absence of natu- from 150 in 1936 to in 1948. For the ral enemies of mosquito larvae, such as first in history of vital statistics, a top minnows. whole year has elapsed without a single death from malaria being reported. The cases reported do not draw as clear a picture of the decline; neither are they as accurate. Increased interest follow- ing the initiation of control measures In a locality frequently results in a climb in reported cases of malaria. This does not necessarily mean that non-existent malaria is reported, but cases that hitherto would have failed to receive recognition assume greater importance in the eyes of the reporting ofiicials. The blood slide results shown in the table were obtained from slides taken on routine surveys among school child- ren through the first six grades in coun- ties regarded as being malarious. The Malaria History in North Carolina picture drawn here closely parallels that shown under mortality. For several centuries, after North From the blood slide Carolina was colonized, most of the data, it would appear that population depended entirely upon the malaria disappeared from the State in pursuit of agriculture. Transportation 1946. The blood slides taken outside facilities were poor, making it necessary the routine surveys show that this is that practically all articles of food or not true. In 1946, 1263 slides were clothing be produced locally. Almost examined by us at the request of prac- every community had a water mill that ticing physicians ground the wheat and corn raised by to confirm their diag- the surroimding farmers. The ponds nosis. Fifty-six of these were positive for furnishing the power for these mills malaria. In 1947, 1094 such slides were were ideal places for the propagation of examined, 33 of which were positive. In malaria mosquitoes, causing malaria to 1948, of 976 slides examined, malaria be prevalent throughout the Piedmont parasites were present in only 3. 10 The Health Bulletin March, 1949

Cases Year

1936 1937 1938 1939 1940 1941 1942 1943 1944 1945 1946 1947 1948 March, 1949 The Health Bulletin 11

Pond Construction: with the regulations, requiring that the pond constructed During recent years, pond building be and maintained in such a manner that it will on a large scale has been underway in not produce anopheline mosquitoes and become a North Carolina. This is largely due to menace to the public health. promotional efforts on the part of the U. S. Soil Conservation Service and When an application is received, other governmental agencies. someone from the Malaria Control Unit of the North Carolina State Board of Health or the local health department inspects the site. If it is found to be satisfactory, a Construction Permit is given the owner. This permit merely authorizes him to build the dam and prepare the basin, but does not permit the impoundage of water. After the construction is completed, another in- spection is made to determine whether or not all the requirements have been met. If the construction meets the re- quirements, an Impounding Permit is issued. This permit can be revoked in the future if the pond is not satisfac- torily maintained. In 1948, 489 applications were received v«; and 292 Impoimding Permits were granted. Through March of 1949, 204 ap- plications have been received. Construc- tion has not been completed on some of the ponds for which permits were ap- plied and others have not been finished in accordance with the State Board of 372 miles of canals were constructed Health Regulations. At this time, there with heavy machinery. are 1,845 new ponds on record in addi- In order to prevent the creation of tion to 230 old ponds for which permits the type of ponds which might invite are not required. Applications for ponds malaria mosquito breeding (ponds con- that have already been built or are taining constant water level, drift, flot- now being constructed show that they age, or vegetation), a regulation was have a combined area of 18,459 acres. adopted requiring the prespective pond- These ponds provide a water surface builder to secure a permit from the 18.8% as great as that which was elimi- N. C. State Board of Health. This law nated by the drainage program pre- concerns any body of water formed by viously conducted as mentioned above. the construction or excavation of a ba- If the present rate of construction con- sin or the obstruction of a stream flow tinues, in a few years new potential in such a manner as to cause the col- malaria mosquito-breeding surfaces may lection of a body of water which would equal in area or surpass that which was not have formed under natural condi- destroyed on the drainage program. tions. Ponds covering less than M of This is a situation to be viewed with an acre are not included in these regu- alarm. The extent and scattered loca- lations. Before issuing a permit, the tion of these ponds preclude the pos- State Board of Health requires that an sibility of their being given adequate application be submitted on a form pro- inspection and supervision by the pub- vided by them. This application pro- lic health authorities. It is becoming vides for a description of the pond and more and more necessary that the own- includes an agreement for complying ers realize their responsibilities and be 12 The Health Bulletin March, 1949 in a position to carry their own main- tioned previously, practically eliminates tenance without constant public health the malaria mosquito-breeding problem. supervision; otherwise, it is highly pro- A special effort should be made to pre- bably that satisfactory maintenance will vent the introduction of aquatic plants, be neglected. This could easily result in such as bulrushes, cattails, and parrot a climb in the incidence of malaria feather. Periodic iiispections should be made around the edges of the pond and to a point never reached before. if aquatic vegetation is found, it should The North Carolina State Board of be removed at once to prevent spread- Health and local health departments ing. A few bulrushes or cattails can be have no desire to discourge the construc- pulled up and removed from the pond tion of ponds which are properly de- with very little trouble. If they become signed, constructed, and maintained, established on a large scale, their re- the public to do but it is their duty to moval will constitute a difficult and ex- crea- everything possible to prevent the pensive undertaking. tion of malaria hazards. Fluctuation of the water level aids Unless judgement be exercised in the greatly in discouraging the growth of selection of the site, as well as the de- vegetation. During the winter and sign and construction of the pond, satis- spring months the elevation of water factory maintenance can become a very in the pond should be held at the maxi- expensive problem. The topography of mum imtU the beginning of the mala- the site should be such that when the ria mosquito-breeding season, which is water is impounded very little or no usually around the middle of April or shallow water of less than 2 ft. in depth the first of May. Then by dropping the lies within the area. elevation sharply for one or two feet, In the area to be occupied by the much objectionable flotage will be stranded. Fluctuation should be con- impovmded water, all trees, under- tinued with a gradual draw-down growth, logs, stumps, and other objects, throughout the summer and early fall. which if not removed would float or should periodically raised collect flotage on the surface of the im- The water be and lowered within the fluctuation li- pounded water, and all of the above mits. By holding it up for about a week, material that is lying on the ground which would probably cause the collec- much of the terrestrial vegetation along drowned. tion of flotage, should be removed, the margin would be When burned, or otherwise satisfactorily dis- it is lowered, the drying out will kill large part of the aquatic vegetation. posed of. All trees and other growth a which would pierce the water surface Each time the water is raised, the eleva- tion should be one or two inches below at^minimum low water level should be the previous high level. cut down or cut off at least one ft. below such water surface to prevent the col- In ponds which are kept clean of lection of drift or flotage. vegetation and flotage, small fish, such as the Gambusia or top minnow, if kept A bottom drain or other means must in the pond in sufficient numbers, will be provided which will permit the re- destroy mosquito larvae before they de- moval of the water and flashboards or velop into adult mosquitoes. other means provided so that the fluct- On small ponds it should not be neces- uation of the water level can be con- sary to use larvicides if they are pro- trolled at any season of the year. perly constructed and kept clean. Seve- Pond Maintenance: ral toxic materials can be successfully On small ponds which have been applied to mosquito-breeding areas. properly planned and constructed, satis- Paris green mixed in the proportions of factory maintenance can usually be ac- one to twenty with an inert dust, such complished by keeping the shoreline as talc or lime, is very effective for the free of drift, flotage, and marginal control of anopheline mosquitoes, but vegetataion. A "clean" pond, as men- kills very few of the other species. As March, 1949 The Health . Bulletin 13 only this genus feeds at the water sur- Health before building a F>ond in ex- face, petroleum oils, such as kerosene cess of 1/4 acre. or No. 2 fuel oil, when applied to the During the last 15 years, under the surface, kill all types of mosquito larvae supervision of the N. C. State Board of and for that reason are usually pre- Health, 98,606 acres of water surface has ferred. The oils can be applied with been drained and 72 acres eliminated by various types of equipment designed for filling. that purpose. On small ponds an ordi- The rate of pond construction is nary knapsack sprayer, equipped with constantly increasing. The N. C. State a Bordeaux nozzle, has been found to Board of Health has records of 1,845 be very satisfactory. new ponds and 230 old ponds with a combined area of 18,459 acres. This is Summary: 18.8% of the water surface eliminated by draining and filling. Ponds containing vegetation and trash The incidence of malaria has declined or which have no fluctuation of the considerably during the last 15 years. water level are favorable for malaria It is essential that ponds be designed, mosquito breeding. constructed and maintained correctly The law requires that a permit be or a recurrence of high malaria rates obtained from the N. C. State Board of seems likely.

NOTES AND COMMENT by

Acting Editor OUR FRONT COVER—Arthur G. Ray- tality rate was 1.3. Our maternal morta- mond, Jr., bom December 3, 1947, son lity rate in North Carolina was 2.0 in of Mr. and Mrs. Arthur G. Raymond. 1946 and 1.7 in 1947. Mrs. Raymond is the former—^Miss Ethel When we compare the niambers and Gray Clifton, pleasantly remembered as rates on page 15 we find that for 1947 being at the Information Desk at the only seven states had higher birth rates State Laboratory of Hygiene. than North Carolina and that South CHILD AND MATERNAL HEALTH— Carolina had the same birth rate as The year 1947 was a banner year for North Carolina—30.5. New Mexico had babies—not only were there more of the highest rate of 37.2; Alabama 31.0; them but a larger proportion of them Mississippi 31.7; Utah 33.9; Montana lived to celebrate their first birthday. It 30.9; and North Dakota 31.5. On page was also a good year for their Mothers, 16 you will find the provisional data for since relatively fewer died in the process North Carolina by counties for the year of bringing forth new human lives. These 1948. While these are not complete or statements are true for North Carolina final figures they are approximately and for the nation as a whole. In our right. In 1947 we had 112,877 babies ac- own State the birth rate rose from 27.7 in cording to the official figures given on 1946 to 30.5 in 1947. For the nation the page 15. Presumably the number for 1948 increase was from 23.5 in 1946 to 25.8 in is appreciably less, since only 107,155 had 1947. The infant mortality rate in North been recorded through January 1949. Carolina decreased from 37.2 in 1946 to We would dislike to think that we had 34.9 in 1947. In the nation infant morta- such poor reporting of births and deaths lity was 33.8 in 1946 and in 1947 it was in North Carolina that more than 5,000 32.2 The number of mothers who died births occurring in 1948 were not repre- in the process of giving birth to a new sented by birth certificates filed with life was 1.6 for the nation as a whole in youi- Bureau of Vital Statistics by the 1946. In 1947 the nation's maternal mor- end of January, 1949. —

14 The Health Bulletin March, 1949

With the problem of infant mortality, STUDY WILL SHOW SUPPLY AND the nation is making progress by reduc- DISTRIBUTION OF NATION'S ing the rate for all the states from 33.8 DOCTORS in 1946 to 32.2 in 1947. North Carolina is doing fairly well—In 1946 the State's CHICAGO—A study which will pro- 37.2 and 34.9 in 1947 but the rate was vide accurate information about the provisional rate for 1948 is up to 35.4. supply and distribution of doctors in According to official figures for 1947 the United States for the first time is there were 12 states with higher infant being made by Frank G. Dickinson, mortality than North Carolina. In 1946 Ph.D., Chicago, director of the American —14 states and the District of Coliimbia Medical Association Bureau of Medical had higher rates than we—while in 1945 Economic Research. —13 states and the District of Columbia Using information furnished by state had worse rates than North Carolina. and county medical societies, Dr. Dickin- In 1947 we lowered our infant deaths son has divided the nation into 757 but we have permitted other states to medical service areas, somewhat similar show greater improvement. Perhaps we to the trade areas that have been used can do better in 1949—at least we shall in studying buying and selling habits of try. With our program to save those the population. babies born prematurely or under weight Because doctors and patients often we should show our own people and cross state and county lines to give and those of the nation that we do not be- receive medical care today, the tradi- long in the lower third among the tional methods of computing the supply states of the nation. and distribution of doctors by counties North Carolina is doing something and states do not provide an accurate about its maternal mortality problem. pictui'e. The number of persons per doc- The State Medical Society has a Com- tor in any county is a meaningless mittee which investigates each maternal figure, and the state is too large to be death and endeavors to determine whe- used as a medical service area. ther that death could have been pre- A progress report on the study appear- vented. The activities of this Committee ing in the current (April 9) issue of has contributed much to the protection The Journal of the American Medical of motherhood in this State. Its work is Association shows that every person in reflected in the improvement of our the United States lives in one of these maternal mortality rate. When we re- 757 medical service areas and that there member that for the five year period are doctors in each area on whom per- 1932 to 1936 our rate was 7.1 and that sons in the area usually depend for for 1947 it was officially 1.7, we can their medical care. realize that the lives of a great many Although some persons live near the women have been saved. Improve as we border of each medical service area and may in North Carolina the states of some live in counties that have no doc- the nation also improve. The rate for tors, no one lives outside a medical ser- the nation in 1947 was 1.3 and only nine vice area. other states had higher maternal mor- People in each area obtain most of tality rates than North Carolina—whUe their medical care from doctors in that 3 states Oklahoma, Texas and Tennessee area. The average number of counties had the same rate as we. per area is four. The areas vary in shape As we face the future we should not and size and few of the boundary lines cast even a backward glance at our coincide with the boundaries of coun- accomplishments for our own gratifica- ties. Two hundred and twelve areas cross state lines and 545 are entirely tion but only for the purpose of develop- within states. The larger areas are in ing a better program for the protection the less densely populated western of our infants and our mothers as well states, including Texas, New Mexico, as all the people of North Carolina. Arizona, Nevada, and Idaho. March, 1949 The Health Bulletin 15

LIVE BIRTHS, INFANT MORTALITY AND MATERNAL MORTALITY

UNITED STATES. AND EACH STATE, 1947

(PLACE OF RESIDENCE)

Live Births Infant Mortality Maternal Mortality

Rate Rate Per Rate Per Number Per* Number 1,000 Number 1,000 1000 Pop. Live Births Live Birthi

United States 3,699,940 25.8 119,173 32.2 4,978 1.3 Alabama 88,116 31.1 3,301 37.5 231 2.6 Arizona 19,153 29.7 973 50.8 35 1.8 Arkansas 48,983 25.6 1,445 29.5 90 1.8 California 245,889 25.1 7,233 29.4 235 1.0 Colorado 32,874 28.7 1,234 37.5 42 1.3 Connecticut 45,581 23.1 1,150 25.2 31 0.7 Delaware 7,717 26.5 239 31.0 6 0.8 Dist. of Columbia.. 21,686 25.2 691 31.9 23 1.1 Florida 59,807 25.7 2,285 38.2 133 2.2 Georgia 94,944 30.3 3,251 34.2 241 2.5 Idaho 16,265 31.0 478 29.4 16 1.0 Illinois 196,007 23.3 5.672 28.9 204 1.0 Indiana 96,359 25.1 2,949 30.6 105 1.1 Iowa 63,858 24.6 1,817 28.5 59 0.9 Kansas 44,535 23.1 1,251 28.1 46 1.0 Kentucky 79,987 28.8 2,971 37.1 140 1.8 Louisiana 74,630 29.3 2,773 37.2 141 1.9 Maine 23,873 27.0 853 35.7 37 1.5 Maryland 56,687 26.5 1,794 31.6 59 1.0 Massachusetts 107,791 23.3 3,027 28.1 93 0.9 Michigan 161,085 26.5 5,080 31.5 173 1.1 Minnesota 75,577 26.2 2,165 28.6 46 0.6 Mississippi 66,450 31.7 2,448 36.8 173 2.6 Missouri 90,060 23.1 2,929 32.5 129 1.4 Montana 15,086 30.9 484 32.1 16 1.1 Nebraska 32,132 25.0 894 27.8 35 1.1 Nevada 4,041 29.1 134 33.2 5 1.2 New Hampshire 13,267 24.8 399 30.1 14 1.1 New Jersey 106,242 23.0 2,965 27.9 107 1.0 New Mexico 20,322 37.2 1,379 67.9 42 2.1 New York 323,250 22.8 9,123 28.2 325 1.0 North Carolina 112,877 30.5 3,938 34.9 192 1.7 North Dakota 17,064 31.5 523 30.6 19 1.1 Ohio 197,311 25.7 5,817 29.5 237 1.2 Oklahoma 53,684 23.5 1,733 32.3 89 1.7 Oregon 36,294 23.5 895 24.7 32 0.9 Pennsylvania 248,513 23.6 7,741 31.1 313 1.3 Island Rhode 18,536 24.9 522 28.2 17 0.9 South Carolina 59,470 30.5 2,352 39.5 155 2.6 South Dakota 16,539 28.6 511 30.9 17 1.0 Tennessee 86,619 28.0 3,144 36.3 150 1.7 Texas 198,662 28.0 8,161 41.1 306 1.5 Utah 21,724 33.9 545 25.1 17 0.8 Vermont 9,708 26.5 303 31.2 12 1.2 Virginia 85,740 28.6 3,142 36.6 144 1.7 Washington 58,481 24.8 1,643 28.1 63 1.1 West Virginia 55,085 29.3 2,091 38.0 88 1.6 Wisconsin 84,059 25.9 Wyoming 2,476 29.5 89 1.1 7,320 27.6 249 34.0 6 0.8 •Based on total population present in area —

16 The Health Bulletin March, 1949

INFANT AND MATERNAL DEATHS WITH RATES PER 1,000 UVE

BIRTHS AND BIRTHS BY COUNTY—1948

(PLACE OF RESIDENCE)

Total Total Infant Maternal Live Infant Maternal Live Mortality Mortality Births Mortality Mortality Births COUNTY Place of Place of Place of COUNTY Place of Place of Place of Residence Residence Residence Residence Residence Residence

No. Rate No. Rate No. No. Rate No. Rate No. Jones Alamance 38 21.0 1.1 1,807 14 40.7 344 Alexander 11 27.5 2.5 400 Lee .'.. 24 35.3 2.9 679 Alleghany 6 39.0 154 Lenoir 65 48.3 1.5 1,345 Anson... 29 36.0 1.2 806 Lincoln 23 31.1 739 Ashe 17 29.0 586 McDowell 20 36.4 i'.'s 550 Avery 8 19.9 2".5 402 Macon 19 41.9 2.2 453 Beaufort 52 53.5 972 Madison 13 26.8 485 Bertie 34 41.6 1.2 818 Martin 29 36.3 2.5 799 Bladen 24 27.5 4.6 874 Mecklenburg... 198 38.9 1.4 5,094 Brunswick 28 49.9 561 Mitchell 10 23.4 4.7 428 Buncombe 117 40.0 07 2,927 Montgomery ... 10 21.9 457 Burke 27 24.2 0.9 1,114 Moore 23 26.0 3.4 883 Cabarrus 44 27.4 1.2 1,607 Nash 87 50.6 4.1 1,721 Caldwell 42 32.3 0.8 1,299 New Hanover. 82 49.1 1.8 1,671 Camden 4 32.8 122 Northampton 21 24.7 4.7 851 Carteret 14 25.2 556 Onslow 29 38.7 5.3 750 Caswell 27 45.6 5.1 592 Orange 21 26.4 794 Catawba 31 18.9 0.6 1,641 Pamlico 9 31.8 3.5 283 Chatham 14 23.4 6.7 599 Pasquotank 25 41.4 3.3 604 Cherokee 23 44.1 1.9 522 Pender 25 49.5 2.0 505 Chowan 17 45.9 2.7 370 Perquimans 9 34.6 260 Clay _ 6 50.0 8.3 120 Person 17 22.3 2.6 761 Cleveland 49 26.3 1.6 1,863 Pitt 81 44.1 1.1 1 ,838 Columbus 73 52.7 0.7 1,384 Polk 8 31.6 253 Craven 55 46.1 2.5 1,194 Randolph 32 26.3 6.8 1,217 Cumberland- 91 31.3 2.7 2,911 Richmond 39 35.5 3.6 1,099 Currituck 3 24.0 125 Robeson 121 43.9 2.2 2,756 Dare 2 21.1 95 Rockingham.... 57 36.0 3.2 1,585 Davidson 58 37.6 0.6 1,542 Rowan 67 40.1 1.8 1,669 Davie 14 41.1 341 Rutherford 32 28.6 0.9 1,117 Duplin „. 44 35.5 4.8 1,241 Sampson 46 32.4 2.1 1,420 Durham 69 27.2 1.2 2,541 Scotland 39 50.6 2.6 770 Edgecombe.... 75 50.3 0.7 1,491 Stanly 33 33.1 5.0 996 Forsyth 109 30.0 1.9 3,635 Stokes 22 46.3 4.2 475 Franklin 41 50.9 2.5 805 Surry 37 27.9 0.8 1,326 Gaston 108 39.3 1.5 2,750 Swain 14 45.0 3.2 311 Gates 7 26.0 7.4 269 Transylvania.. 5 12.5 401 Graham 7 35.7 196 Tyrrell 1 8.1 124 Granville 27 32.3 i".2 836 Union 44 38.8 2.6 1,135 Greene 23 45.8 2.0 502 Vance 51 54.5 4.3 935 Guilford 124 27.5 1.3 4,511 Wake 105 31.6 1.8 3,319 Halifax 95 50.0 4.7 1,901 Warren 23 31.3 4.1 736 Harnett 41 32.3 3.1 1,270 Washington... 19 51.4 370 453 Haywood , 22 21.8 1,011 Watauga 18 39.7 Henderson 22 29.9 iz'.r 737 Wayne 56 37.0 0.7 1,514 Hertford 30 57.5 3.8 522 Wilkes 34 26.9 1.6 1,262 Hoke 18 42.0 2.3 429 Wilson 71 42.3 4.2 1,678 Hyde 6 35.5 169 Yadkin 14 26.7 525 Iredell 45 30.5 1,476 Yancey 10 23.8 1 2^4 421 Jackson 12 23.1 1.9 520 Entire State 3,791 35.4 205 1.9 107,155 Johnston 56 29.8 1.6 1,878

•Data are provisional receipts through January 1949 for 1948 occurrences. ^. - -. j^jSSBCAtM*^

i This Bulletin will be sent free to oimj citizerv of the State uporv reque^tt

Published monthly at the office of the Secretary of the Board, Raleigh, N. C. Entered as second-class matter at Postoffice at Raleigh, N. C. under Act of August 24, 1912

Vol. 64 APRIL, 1949 No. 4

Industrial Hygiene Mobile X-ray Unit. MEMBERS OF THE NORTH CAROLINA STATE BOARD OF HEALTH G. G. Dixon, M.D., President Ayden Hubert B. Haywood, M.D., Vice-President Raleigh H. Lee Large, M.D Rocky Mount John LaBruce Ward, M.D Asheville Jasper C. Jackson, Ph.G Lumberton Mrs. James B. Hunt Lucama, Rt. 1 John R. Bender, M.D Winston-Salem Ben J. Lawrence, M.D Raleigh A. C. Current, D.D.S Gastonia

EXECUTIVE STAFF J. W. R. Norton, M.D., M.P.H., Secretary and State Health Officer G. M. Cooper, M.D., Assistant State Health Officer and Director Division of Health Education, Crippled Children's Work, and Maternal and Child Health Service C. C. Applewhite, M.D., Director, Division Local Health Administration

, District Director, Local Health Administration

Ernest A. Branch, D.D.S. , Director, Division Oral Hygiene John H. Hamilton, M.D., Director, Division of Laboratories J. M. Jarrett, B.S., Director, Division of Sanitary Engineering Otto J. Swisher, M.D., Director, Division of Industrial Hygiene Bert Lyn Bosley, Ph.D., Director, Nutrition Bureau Felix A. Grisette, Director, Venereal Disease Education Institute C. P. Stevick, M.D., M.P.H., Director, Division of Epidemiology and Vital Statistics, and Co-Director, School Health Coordinating Service William A. Smith, M.D., Director, Bureau of Tuberculosis Ivan M. Proctor, M.D., Director, Bureau of Cancer Control Harold J. Magnuson, M.D., Director, Reynolds Research Laboratory, Chapel Hill John J. Wright, M.D., Director, Field Epidemiology Studv of Syphilis, Chapel HiU

FREE HEALTH LITERATURE The State Board of Health publishes monthly The Health Bulletin, which will be sent free to any citizen requesting it. The Board also has available for distribu- tion without charge special literature on the following subjects. Ask for any in which you may be interested. Adenoids and Tonsils German Measles Sanitary Privies Appendicitis Health Education Scabies Cancer Hookw^orm Disease Scarlet Fever Constipation Infantile Paralysis Teeth Chickenpox Influenza Tuberculosis Diabetes Malaria Tvphoid Fever Diphtheria Measles Venereal Diseases Don't Spit Placards Padiculosis Vitamins Fly Placards Pellagra Typhoid Placards Endemic Tvphus Residential Sewage Water Supplies Flies Disposal Plants Whooping Cough

SPECIAL LITERATURE ON MATERNITY AND INFANCY The following special literature on the subjects listed below will be sent free to any citizen of the State on request to the State Board of Health, Raleigh, N. C. Prenatal Care. Prenatal Letters (series of nine Baby's Daily Schedule. monthly letters). First Four Months. The Expectant Mother. Five and Six Months. Infant Care. Seven and Eight Months. Nine Months to One Year. The Prevention of Infantile One to Two Years. Diarrhea. Two to Six Years. Breast Feeding. Instructions for North Carolina Table of Heights and Weights. Midwives.

CONTENTS Page

Industrial Hygiene Services, Present and Future, in Nortli Carolina 3 Borden Mills Get New Gear 9 1949 Health Legislation 10 InlesJ

[ PUe>UV\CX) BY TMC riOR.TA CAeOUMA STATt. PQaJgO v^MtALTM lll£

Vol. 64 APRIL, 1949 No. 4

J. W. E. NORTON, M.D., M.P.H., Sute Health Officer JOHN H. HAMILTON, M.O., Acting Editof

INDUSTRIAL HYGIENE SERVICES, PRESENT AND FUTURE, IN NORTH CAROLINA

OTTO J. SWISHER, JR., M.D., Director, and EMIL T. CHANLETT,

Associate Professor of Sanitary Engineering of U. N. C. School of Public Health

The primary responsibility of an missions would be that these are industrial hygiene unit is the control rare indeed. But when the number of occupational diseases. Occupa- of cases is properly related to the tional diseases are those specific limited number of individuals ac- pathological conditions that result tually exposed to toxic materials at from the excessive exposure to toxic their jobs, the risk assumes large gases, vapors, fumes or dusts, or from proportions and requires that indus- unusual intensities of physical en- trial hygiene be included among ergy such as ultraviolet light, x-ray, health department services. Effective noise, or radioactive emanations. preventive methods are known and Common and notorious examples of are economical to apply in the vast causes of occupational diseases are majority of hazardous exposures, al- carbon monoxide gas, benzol vapor, though the introduction of new proc- lead fumes, and free silica and asbes- esses and materials confronts the tos dust. Exposure to these causative industrial hygienist with an imend- agents is not necessarily limited to ing series of nev questions. Beyond occupational activities, but the cir- these realistic facts that urgently rec- cumstances of prolonged exposure to ommend the prevention of occupa- concentrations that do not immedi- tional diseases, a matter of practical ately produce dramatic physiologi- administrative interest to health of- cal failures are characteristic of jobs ficers at all levels is that the activi- at industrial processes that have ties of the industrial hygienist can toxic substances as ingredients, pro- be made the path by which the ducts, by-products, or waste prod- broadening preventive medical serv- ucts, or are accompanied by the use ices of health departments can be and production cf high levels of haz- brought to the industrial and adult ardous forms of physical energy. population. A casual impression of the fre- As all workers are not engaged in quency of occupational disease cases processes using toxic substances it obtained from the number of cases is usual that only a few workers in encountered in general medical prac- each plant are under a potential haz- tice and even general hospital ad- ard. The evaluation of each hazard- The Health Bulletin April, 1949

Toxic fumes rise from ladle as molten brass is poured into molds. ous exposure requires very special- 50 governmental industrial hygiene ized knowledge and techniques of units in the United States and all the physician, nurse, engineer, and but four or five operate at the state chemist. As the number of persons level. Such industrialized centers as with these skills is limited, and as Cleveland, Los Angeles, and Balti- their highly time consuming activi- more have industrial hygiene units ties are required only in a few spots included in the local health depart- in each plant, it is possible to give ment services. An evident working state wide coverage for occupational necessity that can be providentially disease control through a relatively beneficial to all is a cooperative pro- small unit that is part of a state de- motion of the services of each other partment of health. There are about by the state industrial hygiene unit April, 1949 The Health Bulletin

and the local health unit. To do this, control through x-ray and physical the industrial hygiene unit must examination of workers in trades know the service activities that the covered by the Workmen's Compen- local health unit is prepared to ex- sation Act; and consiiltant medical tend to industry, and the local health and nursing service for the purpose unit must know what industrial hy- of diagnosing occupational disease, giene has to offer. and for the purpose of setting up or The North Carolina Division of improving a plant's own medical fa- Industrial Hygiene carries on field cilities which are maintained for investigations of potentially hazard- pre-placement physical examina- our exposure to toxic substances and tions, accident injuries, and dispen- physical energy forms; the medical sary handling of miscellaneous ill-

Collecting air dust sample with portable equipment to determine the exposure of stone cutter to injurious silica dust The Health Bulletin April, 1949

ness occurring dviring a day's work. these claims. The Division Director The present extent of these services and medical officer is the chairman is indicated by a review of the Divi- of the Advisory Medical Committee sion's activities during the past year. of the Industrial Commission and in this capacity he is the medical con- Supervision of the Dusty Trades sultant in all hearings of the Com- mission involving exposure to silica There are about 250 establishments and asbestos dust in the State engaged in asbestos tex- tiles, quarrying, mining and ore Industry Wide Surveys processing, founding and casting, and The initiation of occupational stone cutting that expose their em- dis- ease hazard surveys by analyses ployees to the potential hazard of of processes, workroom observation, air free silica and asbestos dust. Under sampling, and ventilation measure- the N. C. Compensation Act, silicosis ments is an accepted and effective and asbestosis are specifically com- way to introduce occupational dis- pensable disabilities. Under agree- ease control services to industry. In ment with the N. C. Industrial Com- the past year the Division mission, the Division of Industrial of In- dustrial Hygiene has initiated sur- Hygiene of the State Board of Health veys m fertilizer manufacturing is responsible for the continuous plants where acid medical and environmental supervi- vapors can be haz- ardous, in the hosiery mills and cel- sion of these establishments and lophane printing shops where their employees by physical exami- dan- gerously radioactive electro-static nations, x-rays, air sampling and controllers were being installed, and dust counts, and by study of pro- in the insecticide mixing plants posed and existing ventilation sys- where mgredients toxic to tems. In the past year the Engineer- man must be handled. The surveys of the fer- ing Section visited 140 of the 200 tilizer plants, cellophane establishments carrying on the nec- printing shops and hosiery mills have been essary air sampling. Reports of these completed, while that of the insecti- investigations are sent to manage- cide mixing plants continues in prog- ment, the Industrial Commission, the ress. The industry wide Labor Department, the Compensa- approach has been difficult to execute tion Rating and Inspection Bureau. in North Carolina due to the geographical The latter is a creation of insurance spread, the frequence of small sized companies to clear all available in- plants, and usual absence of man- formation useful in determining oc- agement trade associations that are cupational risks and premium load- helpful in sponsoring and rendering ings. such surveys permanently produc- Concurrently systematic physical tive. and x-ray examination of dust ex- Special Request Studies posed workers has been conducted. The medical director of the Division During the past year engineering maintains a complete file on all such studies were made in ten plants at workers since their entrance into the the request of management to evalu- dusty trades in this State. Such his- ate occupational disease hazards tories, coupled with the Engineering from contaminated air. The problems Section's records of dust counts and encountered and studied involved free silica determinations, are deci- such things as chromic acid mists, sive evidence in silicosis and asbes- lead and zinc fumes, spray paints, tosis claims. The N. C. Industrial other organic solvents, and siliceous Commission is dependent upon the abrasives. The plants included such Division for this evidence in judging diversified processes as manufactur- April, 1949 The Health Bulletin

X-ray diffraction unit used in the analysis of dust samples collected in the field.

ing of agricultural machinery, rub- trial plants has made it possible to ber products, mirrors, glue, storage offer management assistance in the batteries, electrical equipment and field of industrial nursing. The con- metal smelting. sultant nurse aids plants in estab- The part time services of a public lishing a nursing service, advises in- health nurse skilled in the orienta- dustrial nurses desiring to improve tion of nursing programs in indus- their programs and activities in the 8 The Health Bulletin April, 1949 plant, assists in the recruitment of sists of one physician, who is the nurses to the industrial nursing field, Director and medical officer; two en- and establishes a valuable contact gineers; one chemist; a psirt time between the activities of nurses in nursing consultant; and an x-ray public health and in industry. technician. The budgeted table of or- Such requests for services are sen- ganization is not filled. There are sitive measures of the success of the vacancies in each of the professional Division in promoting management's categories. recognition and understanding of oc- cupational diseas:e prevention. The Future Aclivilies of Ihe Division of number of such requests depends Industrial Hygiene on the quality of service rendered in the dusty trades and in industry- 1. There shall be no curtailment wide studies, but a moderate degree of the activities among the dusty of public explanation of the Divi- trades as the Division must dis- sion's services before management charge this State-wide responsibility and labor groups, and other State as its first obligation. Methods are and Local governmental agencies being tried for increasing the com- which serve industry on the func- pleteness and speed of compliance tions of the Division of Industrial with dust control recommendations. Hygiene would be helpful, and the 2. Studies of occupational disease stimulation of local management's hazards in the furniture factories, interest in occupational disease by and textile mills are needed and can the local health officers would be be initiated this year If an additional productive. person is added to the Engineering Section. Development of Methods and Personnel 3. A closer contact with local health units shall be maintained by the past year two new During calls on the local health officer when equipment that place the pieces of persons of the industrial hygiene analyses on a par Division's dust unit are carrying on studies within best in the country have with the the local jurisdiction. been put into use, a polarizing mi- 4. An experimental area shall be croscope and an x-ray diffraction sought in which the industrial hy- vmit. In-service training was made giene unit will carry on occupational possible through the Public Health disease hazard surveys among all Service for operating the latter piece the industrial establishments of a of equipment. Further training in single health unit, and means devel- measurement of_ radiation hazards oped for bringing together the ac- was secured through the Public tivities of industrial hygiene and Health Service to be ready to meet local public health units so that the industrial application of radio- maximum of health improvement active materials, and to better deal services can be brought to the adult with already present exposure prob- working population. lems from x-ray units, fluoroscopic an increase of shoe-fitting machines, and radioac- 5. There shall be from the Division tive electro-static controllers. The consultant work nurses in indus- need for an industrial nursing con- to physicians and in-plant medical and sultant has been satisfactorily met try to better consultation by the part-time services of one of nursing services. Such occupational disease the State's District Nurses who is is not limited to eminently qualified by training and problems, but extends to the pro- plant experience for these duties. The motion of new and improved ipresent roster of the Division con- medical services. April, 1949 The Health Bulletin 9 BORDEN MILLS GET NEW GEAR* Modernization of Goldsboro Plcuit Costs $250,000; More Planned By CHARLES BOND

Goldsboro. — Borden Manuiactur- equipment. Twelve skylights were ing Company, which will celebrate installed. its 50th anniversary early next year, In the No. 2 mill east of William has already speat $250,000 on mod- Street all nine winders had to be ernization and more expenditure moved 20 feet to make room for the is planned under the continuing new spinning frames. All floors were program. That was the estimate sanded, sealed and buffed with steel placed on the cost to date by Wil- wool. They will be sanded periodi- liam A. J. Peacock, superintendent, cally. and Harry Muir, personnel mana- A new air compressor was in- ger. stalled for cleaning mill and ma- The modernization was planned chinery daily. Offices were built several years ago and the machin- for overseers in both mills and can- ery ordered in 1941. The war de- teen installed in each mill where layed the process until last June employees can get light lunches. when new installations were started. New installations include open- Color Dynamics ing equipment, where the bales of All machinery has been painted raw cotton are opened; one new according to Pittsburgh color dynam- unit for picking, cleaning and feed- ics. Orange denotes danger points. ing; 10 new fly frames for putting Vista green is the color of the ma- twist into loose heavy string of chines. Fire equipment is red. Walls cotton and winding on bobbins; and are eyerest green. Various shades of 23 new spinning frames. Eleven of these colors are used with the soft- the new spinners are replacements ness of these pastels easing the eye and 12 are new, increasing produc- strain of employes. Work has started tion 16 per cent and requiring em- on painting beneath the machines ployment of 10 more workers and with an oil resistant gray. two supervisors. The company employs 224 people All machines in departments where and has a weekly payroll of ap- new equipment was added were proximately $8,000. The company overhauled and converted to the owns 67 houses, including one large same type as the new machines. An duplex. Last year $20,000 was spent automatic vacuum stripper was in- putting in new bathrooms in all the stalled to reduce the lint flying in houses. All houses have been re- the air. Twenty-toiir drawing frames roofed and painted in the past two were overhauled. These combine six years. Shrubbery was planted in heavy strings of cotton or sliders 1947. into drawing sliders. The mill was chartered January 6, 1900, by F. K. Borden, Sr., who Buildings Joined was first president; E. B. Borden, Jr., treasurer; F. J. Davis, To install the new picker, the vice-presi- dent and manager, and Frank opening and picking rooms of the Broad- hurst, secretary. In 1907 Bor- buildings were joined, taking in 10 Paul den became secretary more feet into the building from and treasurer. In 1921 E. B. Borden, III, the ground floor through the second who is president now, joined the floor. New 20-year roof has been company. put on the buildings housing the From News & Observer, March 20, 1949. 10 The Health Bulletin April, 1949

Growth of Company two opening iinits with four hoppers The company started with what each, four picking units, 97 cards, 94 spinning frames is now well known as Mill No. 1, the and nine winders. one west of William Street. There Mr. Muir said he wished more peo- were 5,000 spindles, one opener, two ple would visit and tour the mill. pickers, 15 cards, 18 spinning frames Plans are being shaped now for and four winders. Recent additions holding an open house in connection give the mill now 23,112 spindles, with the 50th anniversary next year.

1949 HEALTH LEGISLATION SENATE BILLS

1. SB 5 requires all State Depart- forms used by the National Of- ments and agencies making fice of Vital Statistics and per- rules and regulations to file in« mitting amendments by the dexed copies with each Clerk State Registrar. of the Superior Court and each 7. SB 113 reduces the price of member of the Legislature with- bedding inspection tags from in 90 days after March 17, all $10 for 500 to $8 for 500. amendments and new regula- 8. SB 147 extends injunctive pow- tions to be filed with the Su- ers to local health officers and perior Court Clerks within 15 the State Board of Health, in days after passage. revoking the licenses of cosmo- 2. SB 51 sets up a State Person- tologists who persist in violat- nel department, to which will ing sanitary regulations. be transferred certain duties 9. SB 167 establishes a single with regard to salary and per- Board and County Health De- sonnel classification formerly partment in Giiilford County in performed by the Assistant Di- place of three which have ex- rector of the Budget. isted; namely, Guilford County, 3. SB 96 defines a premature baby Greensboro and High Point. as one weighing less than 5^ 10. SB 297 is designed to permit pounds at birth and requires broader participation in cancer that each such baby be reported clinics by practicing physicians, to ihe local health officer in 24 by modifying requirements re- hours; bill designed to facilitate garding Board Diplomates. State Board of Health program 11. SB 320 regulates the distribu- for saving such babies. tion of milk and cream brought 4. SB 110 provides for the en- to North Carolina from other forcement of rules and regula- States and places enforcement tions of district health depart- with the State Department of ments and places these depart- Agriculture. ments on same basis with BILLS county departments with re- HOUSE spect to making and enforcing 1. HB 33—Public health appropri- health regvOations. ations: 5. SB HI provides that certified 1949-1950 — $1,939,386 copies of birth certificates be 1950-1951 — 1,937,581 issued in card form, omitting Appripriations for the coming names of parents except when biermiiim include an increase specifically requested. over those for the biennium now 6. SB 112 provides that birth and drawing to a close, which were: death certificates follow the 1947-1948 — $862,264 April, 1949 The Health Bulletin 11

1948-1949 — 860,904 ing chiropractors, as to meet- The $800,000 in new money ings of the Board of Examiners, voted for each year of the com- but a clause permitting chiro- ing biennium will be used for practors to issue death certifi- local health work which for cates was stricken from the bill. this biennium was allowed only 11. HB 835 provides for the ap- $350,000 a year. This amount pointment by the Governor of has been increased during the a Commission to consider ways next biennium to $1,150,000 a and means for improving the year. status of the mentally handi- 2. HB 203 provides new type cer- capped. tificates for adopted children 12. HB 913 provides for the issu- omitting the names of their real ance of bonds by municipalities parents and giving names of to finance sewer systems and adopted parents. sewage disposal plants. 3. HB 236 requires that copies of 13. HB 1064 allows counties parti- birth and death certificates of cipating in 3 district health de- non-residents be sent to the partment to voluntarily elect to counties of their residence. participate in local government 4. HB 411 requires the reporting employees' retirement systems of cancer to local health officers to the extent of the amount of within 5 days after diagnosis or salaries paid employees of such within 5 days after reasonable district by the county. evidence that one has cancer. 14. HB 1326, designed to regulate 5. HB 457 charges the method of lobbying by heads of State De- paying local vital statistics reg- partments, v;as defeated. istrars, counties paying all fees, The 1949 General Assembly, while cities being relieved of further it did not go as lar as we requested, financial responsibility. in the matter of appropriations, 6. HB 602 further strengthens and proved to be very cooperative in the clarifies the law placing the matter of health legislation. As to sale of barbiturates and certain appropriations for public health other hypnotics and pain reliev- work, the total authorized for the ing drugs under medical super- biennium of 1949-1950 was $1,939,- vision. 386 and for 1950-1951, $1,937,581. This 7. HB 623 provides for the im- represented an increase of $800,000 proved care of chronic alcoholics for each year over the amount rec- and carries an appropriation of ommended by the Advisory Budget $150,000 a year for the coming Commission. The appropriation for biennium. the present biennium was $862,264 for 8. HB 643, which would have per- 1947-1948 and $860,904 for 1948-1949. mitted cities and towns to use A summary of bills passed which surplus and unappropriated either had the active approval and funds to erect better public support of the State Board of Health health quarters, died on the or were introduced at its instigation Senate Calendar Committee is herewith presented: after it had passed the House. A very important amendment to 9. HB 686, which was given an the cancer law supported by the unfavorable committee report State Board of Health made cancer and did not reach the floor, a reportable disease. It was felt that would have permitted osteo- this would prove beneficial in the paths to administer drugs for prosecution of the cancer program the relief of pain. now well underv/ay. In addition to 10. HB 807 amends the law licens- making cancer reportable, an amend- —

12 The Health Bulletin April. 1949

ment also modifies the requirements cifying parentage except when spe- of the State Board of Health's Bu- cifically requested. reau of Cancer Control by providing Due to the fact that proceeds from that "each physician who shall staff the Bedding Inspection Fund can- such organization, board, or clinic, not be spent for any other purpose, must be a diplomate of the American but must be kept in reserve, except Board of the Medical Specialty in that portion spent for actual admin- which he is engaged, or one who istration of the inspection law, a bill has been approved by his County was introduced requesting the re- Medical Society or its duly appointed duction in cost of stamps from $10.00 representative and the Division of to $5.00. As finally passed, the fig- Cancer Control ci the North Caro- lore was fixed at $8.00, to take care lina State Board of Health." This par- of any contingencies which might ticular amendment will allow a arise. fioller participation in the Cancer A bill which imposes extra re- Control Program by local physicians. sponsibility on local health officers Several of the laws prepared by the and the State Board of Health has 1949 General Assembly had to do to do with cosmotologists. Hereto- with vital statistics. The first of fore, the revocation of licenses was these provided for a change in the purely a matter for the State Licens- method of paying local registrars. ing Board. As amended, the law pro- Effective March 11, 1949, the coun- vides that the State Licensing Board, ties pay all fees for registration the Local Health Officer the State the cities being relieved of further Board of Health may institute in- responsibility for payment. The sec- junctive proceedings and close shops ond Vital Statistics bill has to do if found to be continually violating with the birth and death of county sanitation regulations. non-residents. It requires the State One of the most beneficial and far Board of Health's Bureau of Vital reaching pieces of constructive leg- Statistics to forward copies of birth islation adopted by the 1949 General and death certificates of non-resi- Assembly was a bill sponsored by dents to the county of residence. This the State Board of Health and should be a help to health officers termed the prematiirity bill. This in follow up of new born infants and bill specifies the definition that all contagious disease deaths. infants who do not weigh in excess A third piece of Vital Statistics of five pounds, 8 ounces are prema- Legislation that was passed by the ture regardless of the period of ges- recent Assembly has to do with tation. The real purpose of this leg- adopted children. It provides for new islation was to make possible the birth certificates in such cases to be execution of a far reaching plan of issued so as not to reveal the names the State Board of Health for caring of the original parents, the attend- for premature babies. Under this law ing physician or place of birth. the physician or midwife who de- Another Vital Statistics bill pro- livers a premature child outside a vides that birth and death certifi- hospital is required to report the cates in the future be issued on birth to the Local Health Depart- standard forms adopted by the Na- ment within 24 hours after delivery tional Office of Vital Statistics with so that prompt arrangements can be such amendments as the State Reg- made for hospitalization. istrar shall adopt. The last piece of Two new laws enacted by the 1949 Vital Statistics legislation enacted General Assembly affect Local provides that the form of a certified Boards of Health. One provides for copy of birth certificate shall be that the enforcement of rules and regu- of a birth registration card not spe- lations of a District Health Depart- — —

April, 1949 The Health Bulletin 13 ment and places District Health De- other bills enacted into the law partments on the same basis as which have a bearing on the health County Health Departments with re- of the people. One of these places spect to enforcement, McDowell further restrictions about the sale County was excepted. The other al- of certain drugs, including amido- lows counties participating in a Dis- pyrine, barbituric acid, cinchophen, trict Health Depjirtment to volun- dinetrophenol, pituitary, thyroid, or tarily elect to participate in the Lo- their derivatives. Prescriptions con- cal Government employees' Retire- taining these drugs shall not be re- ment System to the extent of the filled, except on the specific author- amount of salaries paid to the em- ization of the prescribing physician. ployees of such District Health De- It is fui'ther provided, however, that partment by the County. nothing in the above section shall One of the bills enacted pertaining apply to a compound, mixture, or to local health units was that which preparation containing salts or de- created a Board of Health for Guil- rivatives of barbatiaric acid which is ford County. Up to now, there have sold in good faith for the purpose been three District Health Depart- for which it is intended and not for ments in Guilford County, which has the purpose of evading the provi- the largest population of any County sions of this Act. If in the State. Two of these had their 1. Such compound, mixture, or headquarters in Greensboro—that is, preparation contains a sufficient the County Health Department and quantity of another drug or the Greensboro City Health Depart- drugs, in addition to such salts ment, while High Point, a little more or derivatives, to cause it to pro- than a dozen miles to the South of duce an action other than its Greensboro, has had its own health hypnotic or effect somnifacient department. Thp new law provides action; or that the newly created Guilford 2. Such compound, mixture, or County Board of Health shall be preparation is intended for use composed of seven members. The as a spray or gargle or for ex- chairman of the Board of County ternal application and contains, Commissioners shall be ex-officio in addition to such salts or de- member of the Board of Health of rivatives, some other drug or Guilford County and the Chairman drugs rendering it unfit for in- thereof. The other six members shall ternal administration. be elected as follows: Three shall be There were two bills which were residents of Greensboro, one of opposed by the medical profession, whom shall be a physician recom- one of which was killed altogether, mended by the Guilford County the other passed in modified form Medical Society. Another shall be a after the objectionable features had dentist recommended by the Guil- been voluntarily withdrawn. The bill ford County Dental Society. Two that was killed in Committee was members shall be citizens and resi- that which would have permitted dents of High Point of whom one osteopaths to virtually practice med- shall be a physician recommended icine by writing prescriptions for by the County Medical Society and drugs to relieve pain. one shall be a citizen and resident The other measure had to do with of Guilford County living outside the the practice of chiropractic. The corporate limits of either Greensboro modified form in which the bill was or High Point. allowed to pass without opposition In addition to measures either from the medical profession applied introduced or sponsored by the State only to meetings of the Board of Board of Health, there were certain Chiropractic Examiners and did not 14 The Health Bulletin April, 1949

alter the practice of the profession cipalities in the erection of such itself. Before the offending clause plants. The Act is described in Sec- was withdrawn the bill would have tion I thereof as providing for the permitted chiropractors to sign death issuance of bonds "for the purpose certificates. of paying the cost of acquiring, con- One measure which was supported structing, extending, enlarging or and should have been enacted into improving a system for the collec- law was House Bill 643. It was cap- tion, treatment and disposal of sew- tioned "A bill to be entitled an Act age either within or without or to authorize the governing bodies of partly without the municipality and counties, cities and towns to pledge, to pledge to the payment of such encumber, or Lppropriate surplus bonds the revenues of the sewage funds, unappropriated funds and disposal system." proceeds from alcoholic beverage The Legislature rejected the pro- control stores for the purpose of con- posed stream pollution bill which structing public health centers and had the blessing of the Board of providing housing or quarters for Health. The matter twice ran the local health departments." This bill gauntlet and twice was defeated. was designed to promote the erec- Early in the session, a bill was tion of more adequate local health introduced and passed which pro- quarters in a number of counties. vided that every agency and admin- The Public Health Committee of the istrative board of the State of North House approved this legislation. It Carolina created by statute and au- was then re-referred to the House thorized to exercise regulatory, ad- Finance Committee, as it involved ministrative, or quasi-judicial func- the raising of funds by taxes. It tions must, within ninety days after passed the House, but died on the the ratification of the Act, file with Senate Calendar Committee. the Clerk of the Superior Court of An important measure sponsored each County in the State a certified, by the Hospitals Board of Control indexed copy of all general admin- and enacted into law by the recent istrative rules and regulations, or legislature provides for an appropri- rule of practice and procedure. The ation of $150,000 a year for the next second section of the Act provides biennium to open a center for the that, in addition to the original care and rehabilitation of alcoholics. statement filed with each Clerk of As originally introduced, this meas- the Superior Court, each agency or ure provided for a tax of one-half board above described must, within of one per cent on the retail sale of fifteen days after the adoption of all intoxicating beverages. However, any additional or amendatory rule it was amended so as to carry a or regulation, file with each Clerk fixed annual appropriation. of the Superior Court a certified, in- Another measure sponsored by the dexed copy of such new or amend- Hospitals Board of Control and en- atory rule or regulation. These rules acted into law provides for the ap- and regulations then becoming a pointment by the Governor of a part of the records in each County. Commission to make a study of the An important bill, of interest to care of older people with symptoms the State Board of Health in com- of mental sickness and of younger mon with all other agencies of gov- and middle aged people who are ernment, was that which established feeble-minded and not capable of re- what is known ar> a State Personnel ceiving normal training. Department. Some of the principal An Act designed to improve sewer provisions of the measure are as fol- and sewage disposal plants was that lows: to place certain grades and which broadens the powers of muni- classifications of State employees un- April, 1949 The Health Bulletin 1& der the jurisdiction of the State Medical Care Commission. It is Personnel Department; to establish authorized to receive and ad- annual increments for such em- minister any and all funds ployees; to provide for the progres- which may be provided by the sive development of personnel poli- General Assembly of North Car- cies and practices for State employ- olina and/or by the Congress of ees and to re-write Article II of the United States for the con- Chapter 143 of the General Statutes struction, operation and main- of North Carolina." The establish- tenance of hospitals, public ment of the Personnel Department health centers and related fa- relieves the Assistant Director of the cilities. Budget of some of the duties which 2. Amendment to H. B. 31. An act were formerly encumbered upon to make appropriations for Per- him, chiefly the regulation of sal- manent Improvements, etc., re aries, hours of work, periods of va- Medical Care Commission. The cation and sick leave, etc. This title of the Appropriation for measure was sponsored by the North the Medical Care Commission Carolina State Employees Associa- for the biennium to end Jime tion and had the endorsement of the 30, 1951, was changed from "To Governor and the Departments af- match the Hill-Burton Funds" fected by the measure. While hear- to read as follows: ings on the measure were lengthy "1. For the Biennium 1949-51 and detailed and several amend- for sharing in the cost of ments were made, it met with no construction of Local Hospi- serious opposition during its course tals and Health Centers — through the legislature. $6,826,972." It is interesting to note that House 3. Senate Bill 198 authorizes and Bill 1326 endorsed by Representative empowers the N. C. Medical Gantt of Durham and others relative Care Commission, at its discre- to lobbying by heads of State De- tion, to credit loans made to stu- partments was given an unfavorable dents of medicine, dentistry, report. pharmacy, and nursing for sat- One of the laws enacted by the isfactory service rendered in ru- 1949 General Assembly has to do ral areas on a basis to be pre- with regulating the distribution of scribed by the Commission. milk and grain brought into the State 4. Senate Bill 337 expands the au- of North Carolina from other states. thority of the Medical Care Enforcement of this law was placed Commission to license hospitals. in the Department of Agriculture. The licensing Act of 1947 made No bill was introduced which treated licensing mandatory for hospi- the production or distribution of milk tals that receive construction as a health problem. A Milk Study grants. Licensing was optional Commission appointed two years with other hospitals. The ago to draw up a suitable statewide amendments by the 1949 Legis- milk bill prepared a majority report lature makes licensing of all and a minority report was drawn hospitals in the State mandatory up, but neither found its way to the and a function of the Medical legislative halls for action. Care Commission, excepting Hospital Legislation Enacted by privately-owned and operated General Assembly of 1949. mental hospitals which have 1. House Bill 601. The second par- been and will continue to be agraph of subsection (c) of Sec- licensed by the State Depart- tion 131-120 was rewritten to ment of Welfare. The amend- clarify the authority of the ments of 1949 also eliminated 16 The Health Bulletin Apnl, 1949

the hospital licensing fee of $10. purposes, not to exceed ten 5. The 1949 Revenue Act, Chapter cents (10(f) on the one hun- 105, was amended so as to ex- dred ($100.00) dollars value empt from the sales tax building of property annually for the and equipment materials used purpose of financing the in non-profit hospitals, effective cost of operation, equip- July 1, 1949, Materials used in ment and maintenance of publicly-owned hospitals al- any public-owned or non- ready are exempt from the sales profit hospital or to guaran- tax. tee or secure the operating 6. Senate Bill 19 authorizes hos- deficit of any such hospital. pital districts created by the N. C. Medical Care Commission 8. House Bill 212 harmonizes por- tions of the Mxinicipal that consist of a portion of a Finance Act of 1921 with county to hold special elections provisions of the constitution of for the levy of taxes and /or to North Caro- issue bonds for hospital pur- lina. Purpose is to make the poses. hospital bond election and sup- porting tax levy effective 7. Senate Bill 197—Gives the gov- by an affirmative erning authority of any county, vote of a majority of the votes cast. city or town, in its discretion, special authority to: 9. Senate Bill 119 extends the Pledge, (1) encumber, or ap- time for selling bonds author- propriate fimds from surplus ized by counties and municipal- fimds, unappropriated funds ities. This Act is of interest to or funds derived from alco- hospital areas that have voted holic beverage control stores hospital bonds. for the purpose of guaran- teeing the operating deficit of any publicly-owned or 10. Senate Bill 42—Authorizes the non-profit hospital. Board of Trustees of the Uni- (2) Issue by counties, cities and versity of North Carolina to towns by special authority establish and operate a stand- of bonds, notes for the spe- ard Dental School in conjunc- cial purpose of building tion with the Medical School at and equipping any publicly- Chapel Hill. owned or non-profit hospital and for the purpose of fi- nancing the cost of opera- RADIOACTIVE tion, equipment and main- tenance of any such hospital Writing in the current issue of The or for guaranteeing any op- Journal of the American Medical As- erating deficit of any such sociation, Lieut. Comdr. Cronkite hospital, and to levy prop- says that although in recent years erty taxe.*? for the payment occupational hazards which may of said bonds and notes and produce radiation burns, ulcers, and interest thereon. cancer have been reduced, they have (3) The special approval of the not been entirely eliminated. General Assembly is hereby Scientists need to establish a "nor- given to the governing au- mal" range of the count of cells in thority of any county, city the blood to aid in diagnosis of or town for the levying of a tax on property in addition chronic exposure to radiation, he to other taxes for general believes. MEDiCAL LIBRARY ^ U. OF N. C. ^3.^*J^v2l CHAPEL HILL. N. C *.\C

I This Builetirv will be sent free to oraj citizerv of the State upon lequegll

Publiihed monthly at the office of the Secretary of the Board, Raleigh, N. C Entered as second-class matter at Postoffice at Raleigh, N. C. under Act of August 24, 1912

Vol. 64 MAY, 1949 No. 5

Coyte Bridges Dining Hall, Mars Hill College MEMBERS OF THE NORTH CAROLINA STATE BOARD OF HEALTH G. G. Dixon, M.D., President Ayden Hubert B. Haywood, M.D., Vice-President Raleigh H. Lee Large, .M.D. Rocky Mount John LaBruce Ward, M.D. Asheville Jasper C. Jackson, Ph.G. Lumberton Mrs. James B. Hunt Lucama, Rt. 1 John R. Bender, M.D. Winston-Salem Ben J. Lawrence, M.D. Raleigh A. C. Current, D.D.S. Gastonia EXECUTIVE STAFF J. W. R. Norton, M.D., M.P.H^ Secretary and State Health Officer G. M. Cooper, M.D., Assistant State Health Officer and Director Division of Headth Education, Crippled Children's Work, and Maternal and Child Health Service C. C. Applewhite, M.D., Director, Division Local Health Administration

, District Director, Local Health Administration Ernest A. Branch, D.D.S., Director, Division Oral Hygiene John H. Hamilton, M.D., Director, Division of Laboratories J. M. Jarrett, B.S., Director, Division of Sanitary Engineering Otto J. Swisher, M.D., Director, Division of Industrial Hygiene Bert Lyn Bosley, Ph.D., Director, Nutrition Bureau Felix A. Grisette, Director, Venereal Disease Education Institute C. P. Stevick, M.D., M.P.H., Director, Division of Epidemiology and Vital Statistics, and Co-Director, School Health Coordinating Service William A. Smith, M.D., Director, Bureau of Tuberculosis Ivan M. Proctor, M.D., Director, Bureau of Cancer Control Harold J. Magnuson, M.D., Director, Reynolds Research Laboratory, Chapel HUl John J. Wright, M.D., Director, Field Epidemiology Studv of Syphilis, Chapel Hill

FREE HEALTH LITERATURE The State Board of Health publishes monthly The Health Bulletin, which wUl be sent free to any citizen requesting it. The Board also has available for distribu- tion without charge special literature on the following subjects. Ask for any in which you may be interested. Adenoids and Tonsils German Measles Sanitary Privies Appendicitis Health Education Scabies Cancer Hookworm Disease Scarlet Fever Constipation Infantile Paralysis Teeth Chickenpox Influenza Tuberculosis Diabetes Malaria Typhoid Fever Diphtheria Measles Venereal Diseases Don't Spit Placards Padiculosis Vitamins Fly Placards Pellagra Typhoid Placards Endemic Typhus Residential Sewage Water Supplies Flies Disposal Plants Whooping Cough

SPECIAL LITERATURE ON MATERNITY AND INFANCY The following special literature on the subjects listed below will be sent free to any citizen of the State on request to the State Board of Health, Raleigh, N. C. Prenatal Care. Prenatal Letters (series of nine Baby's Daily Schedule. monthly letters). First Four Months. The Expectant Mother. Five and Six Months. Infant Care. Seven and Eight Months. Nine Months to One Year. The Prevention of Infantile One to Two Years. Diarrhea. Two to Six Years. Breast Feeding. Instructions for North Carolina Table of Heights and Weights. Midwives.

CONTENTS Page

Institutional Sanitation 3 Mars Hill College Dining Hall 3 Mars Hill 1949 Model College Cafeteria 8 First Experiences in the Field Program of the

Division of Vital Statistics • 10 E*reventive Medicine _- 15 [£l|| TMC flO&TM CAgQUMACAgpi 5TATL I PU&U5MCD BY BQMgD^MtAOH

Vol. 64 MAY, 1949 No. 5

State Health Officer JOHN H. HAMILTON, M.D., Acting Editof J. W. R. NORTON, M.D., M.P.H., INSTITUTIONAL SANITATION

J. M. Jarrett State Board of Health Raleigh, N. C.

In the general sanitation program of from improper food handling practices, the State and local Health Depart- in our institutions. ments, considerable attention has been One of the recently completed imits, given in recent years to the sanitation which is modern in every respect, and of institutions. Included in this group which could well be described as a are public and private hospitals, col- model for other institutions to follow is leges, schools, sanitoriums, rest homes, described below in articles prepared and other such places. by Mr. J. A. McLeod, Director of Pub- It has been extremely encouraging to licity for Mars Hill College, Mars Hill, note the progress made in recent years North Carolina, and W. A. Broadway, by the officials of these institutions in District Sanitarian, State Board of providing proper and adequate sanitary Health. facilities. Most progress has been made Mars Hill is a denominational Junior in connection with the food handling College located in Madison County in operations. New and modern kitchens the Western part of the State. The have been provided with the necessary officials of the college are certainly to imits of refrigeration and proper food be congratulated on the progressive storage, proper sterilization or sanitiza- step they have taken in protecting the tion of eating and drinking utensils, and health of their students not only in providing facilities for the serving through provision of facilities describ- of clean properly prepared meals. Con- ed below, but also by sponsoring and sequently, we have been fortunate in conducting food handlers' schools for having a minimum of sickness caused employees of the institution.

Mars Hill College Dining Hall by

J. A. McLeod Mars Hill College

The new Coyte Bridges Dining Hall college; B. H. Tilson, Superintendent of at Mars Hill College, opened last Buildings and Grounds; and the Archi- Thanksgiving Day and dedicated on tect, Henry Irven Gaines, of Asheville, May 28, was designed and constructed worked closely with William A. Broad- to meet the highest sanitary standards way, District Sanitarian of the North for the preparation and serving of food. Carolina State Board of Health, in Dr. Hoyt Blackwell, President of the planning the building. The Health Bulletin May, 1949

Dining Room, Mars Hill College

Serving Area from Behind Counter May, 1949 The Health Bulletin

With equipment the building cost a The flrst floor beneath the kitchen, little more than $300,000. The main connected with the upper floor by a dining room, with the mezzanine floor, full-sized elevator, contains four re- will seat 1200 persons. The food serving frigeration rooms and a deep-freeze and preparation facilities are designed room, a meat preparation room, and an, for continuous service if needed. The office. The flrst floor also contains the service area of the cafeteria, which ac- dishwashing facilities, a vegetable pre- commodates two lines, is floored with tile paration area, storage room, ice-mak- and has a high wainscoting of glazed ing equipment, garbage disposal room, tile. The specially designed serving washrooms for employees, and the stu- counters are made of stainless steel and dent center, which includes the book equipped with steam tables and refrige- store, the post office, and a recreation rated sections. room. This center is furnished with a The kitchen occupies the second floor fountain and facilities for a la carte of a wing in the rear of the building luncheon service. and is designed for maximum lighting The dishwashing equipment is one and ventilation. The tile floors and of the sanitary features of the building. wainscoting make frequent cleaning The dishes are brought to the dish- easy. The stoves and other cooking washing room by traveyors. They pass equipment are placed in the center of through the machines, which maintain the room, with ample space around a minimum temperature of 180 degrees them. All stoves and ovens are electric Fahrenheit. If the temperature of the and thermostatically controlled; the water drops below 180 degrees the ma- kettles and urns are heated by steam. chines cut off automatically. The dishes The areas for food preparation, pastry and glassware are returned directly to cooking, and salad making are each the serving area, where they are placed equipped with stainless steel sinks and in cabinets beneath the serving counters tables, refrigerators, and lavoratories. with a minimum of handling. After

Kitchen The Health Bulletin May, 1949

Kitchen

Meat Refrigeration May, 1949 The Health Bulletin leaving the dishwashers the glasses are hall and a number of student helpers touched only by the one serving the received foodhandlers' cards at the beverages before being placed on the close of the school. tray of the customer. Another sanitary feature of the build- ing is the location of washrooms and lavatories. The four tile washrooms for employees are fully equipped, including shower stalls. All food preparation areas are equipped with lavatories. Ad- joining the lobby to the dining hall are spacious, sanitary washrooms for stu- dents and other patrons. A foodhandlers' school was held at the college April 19-21, under the gener- al direction of Mr. Broadway, State District Sanitarian, North Carolina State Board of Health; Dr. H. C. Whims, Health Officer; R. M. McDaniel, State District Sanitarian; Miss Jennie Stout, Supervisor of Health Education; Marley M. Melvin, Executive Vice Presi- dent, North Carolina Restaurant Asso- ciation; and members of the college staff assisted in the school, which was the first to be held for a school in North Carolina. Ninety-eight per cent of the regular employees in the dining Handling Clean Glasses

Dish Washing and Glass Washing in Operation 8 The Health Bulletin May, 1949

MARS HILL 1949 MODEL COLLEGE CAFETiiRIA by William A. Broadway Jr. District Sanitarian, 407 Gates Building, Asheville, N. C.

Mars Hill College, located in Madison Mr. Tilson, after many weeks of burn- County, 19 miles due North of Asheville, ing the midnight oil, finally had the was chartered by the General Assembly new cafeteria ready to lay the founda- on February 16, 1859, thereby becoming tion stone. Accordingly, in the summer the oldest education institution in con- of 1947 actual construction began. Ap- tinuous operation in Western North proximately enough students and faculty Carolina, and the first school in the ate their first meal in the completed state established by the Baptists west cafeteria on Thanksgiving Day of 1948, of the Blue Ridge Mountains. Located and the building was formally dedicated on a rolling, beautiful wooded track of on May 28 of this year. 120 acres at the southern edge of the Since it's opening hundreds of visitors, town of Mars Hill proper, this co-edu- including institutional heads, have been cational institution consists of twenty- greatly impressed with it's modern, con- nine buildings accommodating a student veniently arranged equipment, terrazoed body of approximately 1000. floors, tile walls, and the foresight of the men who conceived it. The building The most recent addition to the col- which started as a dream now repre- lege and the pride and joy of both stu- sents a sound institutional investment dents and faculty, is the new Coyte of over $300,000. Bridges Dining Hall. Like most institu- The main dining room with the mez- tions in previous years, the college pos- zanine floor will seat comfortably over sessed inadequate and obsolute food- 1200 persons. Private dining rooms ad- handling facilities. President Hoyt joining the main dining room have been Blackwell, Superintendent of Buildings provided for special parties and admini- and Grounds B. H. Tilson, and other strative units. Both construction and officials of the college were well aware equipment, some of which was especially of this major deficiency. As rapidly as designed, were installed to meet the possible after World War No. 2 these highest sanitary standards presently mountain Baptists got busy in order to known for the preparation and service realize their dreams. President Blackwell of food. scoured the highways and byways in his efforts to secure the necessary funds; Food serving preparation facilities Sprerintendent Tilson visited numerous were designed and are adequate for other institutional kitchens including continuous service, if needed. Two lines the majority of those in North Carolina, in service area of the cafeteria expedites conferred with architects, representa- service to students. Especially designed tives of the North Carolina State Board service counters made of stainless steel of Health, various equipment companies and equipped with properly covered and manufacturers, endeavoring to plan steam tables and refrigerated sections the last minute detail on paper before are easily disassembled for routine actual construction was initiated. Both cleaning purposes. men fully realized the value of good Many institution managers have en- construction, modern equipment, proper vied Steward Martin's conveniently ar- location and installation, and the fact ranged incinerator ports. These recept- that a line could be relocated on a blue- acles, located behind the counter, in the print much more easily than could a kitchen, and throughout the service de- permanent wall one constructed. Archi- partment, provide for the immediate tect Henry I. Gaines of Asheville, and incineration of paper and other waste May, 1949 The Health Bulletin contributing to the general untidiness stitutions. The student center includes oftentimes so noticeable in the average the book store, post office, and a recrea- establishment. tion room. This center is furnished with a soda fountain and modern facilities Complete Kitchen for a separate a la carte luncheon ser- The kitchen occupies a special wing vice. in the rear of the building on the same Notable among the carefully selected floor level the main dining room with equipment, and one of its outstanding lighting and is designed for maximum sanitary features, is the dishwashing floors and wains- and ventilation. Tile setup. Soiled dishware is brought direct- cleaning opera- cotting make frequent ly from the dining room to the dish- tions easy. Stoves and other cooking washing room by traveyors, thus never are located in the center of equipment entering the kitchen. Garbage is han- the room with ample space around dled in the same manner, having a sep- located them. Numerous strategically arate room and never coming in contact floor drains in this recessed area facili- with the food preparation areas. Eating tate the cleaning of this equipment, to- utensils are washed in especially design- gether with live steam hoses designed ed machines which maintain a mini- cleaning operations. for large equipment mum temperature of 180' F. in their All stoves and ovens employ electricity sterilization compartments, and if this and are thermostatically controlled, sterilizing temperature should drop be- while the kettles and urns are heated by low 180 degrees, these machines cut steam. In this modern departmentalized themselves off automatically. Sanitized kitchen food preparation, pastry cook- dishware and glassware are returned ing, salad making, etc., are each equip- directly to the cafeteria serving area by ped with stainless steel complete sinks, enclosed traveyors where they are plac- stainless steel tables, refrigeration, and ed in stainless steel cabinets beneath handwashing facilities. Sanitary Type the serving counter with a minimum of angle jet drinking fountains are another handling. After leaving the machines feature installed in convenient places glasses are handled only by the in- for the employees. dividual customer. The kitchen being glassed in on three Another sanitary feature of the build- sides receives the full benefit of the ing is the location of washrooms and cool mountain breeze. A huge stainless lavatories. The four tile wash rooms for steel hood equipped with an exhaust fan employees are fully equipped including covers the entire cooking area, removing shower stalls and lockers. On each side excess heat as rapidly as it accumulates. of the building's entrance and adjoining The ground level floor immediately the lobby of the main dining hall are beneath the kitchen, reached by a full- fully equipped sanitary wash rooms for sized automatic elevator as well as tile students and other patrons. stairways, contains four large refrigera- Employees' interest has noticeably im- tion rooms, a deep freeze room, meat proved and is reflected in increased preparation room, the incinerator, the efficiency, according to the manage- steam generating and ample hot water ment. Important chores formerly storage plant, and the manager's office. thought of as pure drudgery are now This floor also contains the dishwashing performed with alacrity and efficiency facilities, a vegetable preparation area, by some of the institution's most cap- storage room ice-making equipment, a able personnel. garbage disposal room equipped with Not content with having provided the washing and sterilizing devices, wash most modern complete and sanitary rooms for employees, and the student equipment and building that money center. Ample storage facilities have could buy, the college's officials further been provided so that Mr. Wells, the recognized the need for an educational purchasing agent, may buy in quantity training program in order to instruct and at a considerable saving to the in- employees in daily Grade A mainten- 10 The Health Bulletin May, 1949 ance and food handling methods. The of Madison County restaurant workers State Board of Health was again called also attended this school including the upon and a foodhandlers' school was managers of all the public school lunch- held at the college April 19, 20, and 21, rooms in the county. A similar tjT)e under the general direction of Mr. Wil- training program is presently being liam A. Broadway, State District Sani- planned by the institution on an annual tarian, Division of Sanitary Engineering. basis. In addition to Mr. Broadway other pub- An Aliminus of yesteryear recently lic health personnel assisting in this stood in front of the main administra- school were Dr. H. C. Whims, Bun- tion building looking down over the new combe-Madison District Health OflBcer; Bridges Memorial Dining Hall. Signi- Mr. R. M. McDaniel, State District Sani- ficantly enough he remarked, tarian, and Miss Jennie D. Stout, Super- "My pride and respect for the college visor of Health Education, of the West- has been heightened after inspecting ern District Office; Mr. Marley M. Mel- that magnificent new building. Values vin. Executive Vice-president of the such as better student morale, the as- North Carolina Restaurant Association, surance on the part of parents that their Raleigh; and members of the college children have the protection of a clean staff including Mr. Tilson and Dean modern sanitary foodhandltng establish- Lee. This school, incidently, had the dis- ment, and the increased attention made tinction of being the first of its kind possible in this building to better nutri- to be held for this type institution in tional practices, are far more important North Carolina. 98% of the regular em- to me than mere palatability of food. ployees in the dining hall and a number Institutions, like men, either grow and of student helpers received foodhandlers' progress gradually, or else they rot and certificates at the close of the school. decay. There is no such thing in life as 100% of the employees attended the an absolute standstill. My congratula- classes which pertained to their particu- tions to the students, faculty, and lar departments. A considerable number friends of Mars Hill College".

FIRST EXPERIENCES IN THE FIELD PROGRAM of the DIVISION OF VITAL STATISTICS by

Mrs. Ruth Mebane, Field Supervisor Division of Vital Statistics

Field work is the newest ventiure in of educational activities, and other the Division of Vital Statistics. Some duties require a good bit of office work. work was done along this line in the A summary of activities in the field spring of 1948, but it was not xmtil over this time, spring, of 1948 and from October, 1948 that it was made a full- October, 1948, through April, 1949, time job. The worker does not spend shows 55 counties were visited. her entire time in the field, not be- cause there is nothing to do, but be- COUNTIES VISITED cause registrar appointments, plarming (30 counties had two or more visits) May, 1949 12 The Health Bulletin May, 1949

tween the registrar and the home oflfice. that road but that he would be back in They are glad of an opportunity to two hours and to wait for him. This, discuss their problems and the person the field worker did gladly, but even Raleigh office gets insight from the an so the trip back was a little disturbing, into the problems of registration on the dark was coming fast, and the road was home front that would never occur to anything but velvet. In Ashe and Alle- the clerk behind her desk in the state ghany the cove roads wind in and out office. Most of them are interested in and up and down and a good many the handling of certificates after they visits to families whose children's birth reach the state office and are always certificates were being sought had to be amazed at the yearly total receipts. The made on foot. In the Socco Gap Section, field worker carries a sample bound Franklin, Topton, Graham, and Chero- volume of certificates, a strip of micro- kee, as well as many other places, visits film, a few photostat copies and various to the small settlements in the hUls is tables and they are always interesting. interesting though precarious. Try as goodly number of these registrars are A one will, dark will invariably catch you, women, homemakers, busy with their but to drive along those mountain roads work in the church and community, and catch glimpses of the lights of the Home Demonstration Clubs, etc. They little cabins in the hills is a sight to be are generally pretty well known in their remembered, particularly when you community and make an earnest effort think that in those cabins deaths and to births get and deaths reported. They births will occur and that those im- go in their cars and afoot over their portant events will be registered with district. They are always glad to go the State office. Perhaps the certificates with the field worker to get specific will come in altogether correct and if certificates corrected or filed. Sometimes so, no special attention is given to them, the family of three of four may have to but if incorrect or poorly made out, the go too, but it is all in a day's work. A clerks may fret not knowing imder what few days trip in the mountains of North conditions these same certificates were Carolina, in the isolated districts, off procured. In Eastern Carolina in the the "tourist routes" is an experience not isolated or sparsely settled areas one to be forgotten. In McDowell County has the sand or rutted road and the the field worker makes a trip to visit a distances. Some times in order to insure registrar on a dirt cove road just wide getting "through one has to stop and enough for Phoebe (the Ford) to travel. let the air out of the tires. Here, It was a road to a "transient" logging though as in the mountains, the neigh- mill. The question paramount in the bors or the small store, or the postoffice driver's mind was what to do should will give you directions and get you on another vehicle suddenly appear arovmd your way. Last fall in the late afternoon one of the continuous curves, for the the field worker stopped at a country mountain went up straight on one side store for gas and a "coke" and to get and there was a formidable mountain directions. She had been at the store stream on the other with the giant size early in the day and found them most rocks peculiar to mountain streams. accommodating. The impression must Sure enough aroiand a curve came an have been fair, for a father and young old light truck with steam pouring out son were most helpful in giving minute of the radiator. The driver stopped, directions as to how to get to my parti- jumped out of the truck, came over and cular spot. However, while the coke was looked over the situation, reassurred the being enjoyed, the son asked if the field field worker, then ran his truck up the worker liked the county, liked going side of the mountain leaving the rear around "doin this sort of thing". Per- sticking out in the road, then he engi- haps the answer was not entirely too neered the passing of "Phoebe" around reassurring for the day was almost the truck. He told the field worker that spent, and it had been hot, the worker there would be no more "passin" on not altogether adjusted to the new May, 1949 The Health Bulletin 13

order of things, for the son immediately matter. He, remembering all the trouble said that his father lived alone on that he had gone to trying to get the certi- big farm (pointing) and he wanted a ficate before bui'ial, is somewhat touchy wife, that he would be good to her, she about the matter. However, with two would not have to work, that he had exceptions, the undertakers visited seem- all the conveniences, even oil heat. He, ed to want to cooperate. the son, knew he would be good to her, There were 26 physicians visited for because he was good to his mother. specific reasons, either to collect death Father nodded very approvingly and put certificates they had not filled in and in a few words. But the worker saw the returned to the undertakers, or births large dairy herd and saw the oceans of they had not registered. In some of the milk and such and not liking cow pro- newly consolidated counties physicians ducts on the hoof said-she "would think were visited as a matter of routine. Even about it." Whether farm work would be though very busy, with a few exceptions, harder than the drives in the svm, rain the doctors seemed glad to cooperate and wind, the intense heat, over good and apologized for not having filed the and poor roads was something that certificates. Of course a few of them could not be threshed out all in a placed the blame on the State office, minute. In a western county the worker stating that they had filed the certifi- attended church and Sunday School one cates one or more times. When sifted Sunday morning and after services ate down, they might remember that they a picnic dinner with the members and had given the certificate to the father got in a little talk about the work. It of the child to send in instead of send- was a beautiful day, a beautiful spot ing it himself to the local registrar. One in the heart of the mountains, people visit to a doctor's office will long be had come in all sorts of conveyances, remembered for it took the worker back earnest, kind, sincere folk. The minister to the days of her childhood in the was most anxious that the worker de- country when she was "carried to the cide to settle in his community. So, doctor." This office was apart from the though long past the bloom of youth house in the rural mountain section of the field worker may still have a chance our state, the doctor has long been giv- to change occupations for better or for ing of his time and strength to the worse. mountain folk, serving them as doctor, There were 36 visits to undertakers, guide and priest. The office was cluttered some of which were just in routine, with all the various things that were others for specific violations. It is a in the average doctor's office some forty practice of the field worker to call on years ago. There was the old roll top as many undertakers as possible and desk groaning under its load of letters, discuss the necessity of the burial per- samples, advertisements of everything mit when in a community. The under- from road machinery up to the latest takers are quick to give reasons for the developments in medicine, samples, and non-compliance with the burial law and empty bottles. In one corner of the they have a good deal on their side. The room were the saddle bags and lantern chief complaint is that they lose so hanging overhead ready for the emer- much time finding the doctor, perhaps gency when the roads were not safe for having to sit in a doctor's office for an the tired old car in the barn. The exami- hour or more just to get certificates nation table, looking its years, was signed, or the doctor takes the certifi- cluttered up with fascinating bottles of cates and tells him to come back or all sorts. On a table nearby was a pair that he will see that it is mailed and of old apothecary scales, a mortar and then straightway forgets it. So the un- pestle. Even a half full bottle of lark- dertaker goes ahead and buries the de- spur lotion was close at hand. The ceased without a permit. Later the Ra- worker caught the doctor on the fly. He leigh office may get a complaint from had just come from "catching a baby" the registrar and write him about the as he had put it and was going to 14 The Health Bulletin May, 1949 another. In fact the worker while wait- a removal permit and secure the certi- ing for the doctor had been engaged in ficate from the undertaker any hour conversation with the young father and of day or night before releasing the body knew his anxiety. The doctor took time to him and this will, no doubt, be work- to sign certificates and to talk about ed out satisfactorily in the months to registration and promised to try to find come. time to file certificates promptly. On There have been approximately 60 his way off with the young man and visits to individual families regarding field worker, the young man tried to birth or death certificates. The parent explain his lack of ftmds for the event usually becomes interested in birth cer- and the doctor came back with "Well, tificates often with the result that they son, I guess I can wait, am still waiting want to know if all the children's births for your old man to pay me for getting have been properly reported, particular- you here." This particular doctor had ly those for whom they have not re- not reported approximately 40 births ceived the photostatic copies. and his only excuse was he just didn't Eleven midwife meetings have been have time. A goodly number of these held to which the field worker was in- birth certificates have since come in. vited to attend and to talk over registra- Thirty-nine hospitals have been visit- tion of births. These meetings are most ed and while the Administrator or helpful to the midwife and one has Superintendent and record clerks are to look far to find a group of people busy they are very glad to give an in- anywhere who are more serious about terview. To some an analysis of their their work. The meeting is usually a methods of keeping records and filing full day's work for the midwife. They certificates was an eye-opener to the listen attentively to the field worker and administrator or superintendent and on open discussion have all sorts of they were glad of suggestions to improve questions, for there are always new their methods. They, like the imder- problems regarding a particular regis- takers, complained of the laxness and tration. The midwives seem very pleased tardiness of the physicians in signing to have a "Raleigh lady" come to their certificates. Record clerks stated that meeting, and send her off with a boquet certificates would be completely filled of flowers or a little gift of their appre- in except for the doctor's signature and ciation and the sincere request that she would lie on the desk for days before come again. Having just recently attend- the doctor would take time to sign. ed a class of midwives on a return in- One suggestion which the field worker vitation the worker wondered what, if has made and which is being tried is anything would the midwife get from that the complete certificate be attach- this second visit. However, the worker ed to the chart board of the mother, was surprised to find that they got much so when the doctor is making his rounds, more out of the second visit than the giving directions, etc., that the certifi- first. They themselves had more ques- cate will be there on the chart and he tions to ask and were much more in- can easily sign it. The obstetrical nurse terested. They are interested, too, just then can send it down to the record as the registrar in the final disposition clerk completed. A few hospitals are of the certificates they file. Many of doing this and find it satisfactory. Some them did not have the remotest idea hospitals which had been sending certi- of why they filed certificates or what ficates to the doctors' offices to be sign- became of them. To get better certi- ed and routed are now holding them for ficates from the midwife she should doctors' signatures and sending them to know why she files a certificate and the registrar themselves. Handling of what it is used for and what finally be- death certificates in the hospitals is still comes of it. a weak link in our chain of registration, So far only two local registrar's meet- but hospitals are seeing the need of a ing have been held, one in Bladen, ar- sub registrar, some one who can issue ranged by the Register of Deeds of May, 1949 The Health Bulletin 15 that County, to which were invited worker, to make for better registration. undertakers, doctors, and midwives, as No one can do a good job until they well as registrars. It was a good meet- know something of that job and the ing, and every effort was made by the value of it. Simply collecting certifi- Register of Deeds to make it a success. cates and making all the various re- He was host to delightful refreshments p>orts the registrar is called upon to at the close of the meeting. The other make, and not knowing why, will never meeting was in Davidson County, called make for good registration. When the at the request of the Division and it was hospital, doctor, undertaker, midwife, well attended. These meetings are in- and local registrars see the need of it, valuable. It is an opportunity to dis- they will become interested and regis- cuss with the registrars individually tration in North Carolina will strike a and as a group, registration of birth and new high level. deaths. It forms a link with the home A worker could go in to many sec- oflBce and the registrar feels that he is tions of western and eastern North really an important part of the chain. Carolina and stay two to three months In going over the state one hears on on a stretch and find plenty to do. How- every hand that the registrar knows nothing of the state office, no one from ever, the worker usually runs out of ex- the state office has ever visited them, pense money and has to get back to It is obliged, so it seems to the field base.

PREVENTIVE MEDICINE WiLLL^M H. Richardson

State Board of Health Raleigh, N. C.

At the conjoint session of the North aids in his recovery, as best he can. On Carolina State Board of Health and the other hand, the public health worker the State Medical Society, at Pinehurst practices preventive medicine to keep in May, Dr. J. W. R. Norton, in his any of the population from contracting annual report, declared that public typhoid fever. This task may be per- health is dedicated to the practice of formed by a sanitary engineer who is preventive medicine and that it has not a medical doctor, but who does enough work in this field to keep it busy, practice preventive medicine, in the without any infringement upon private broad sense of that term. Thus, we see practitioners of medicine working in the the two working together; that is, the ciu-ative field. private practitioner of medicine, in the With this statement of Dr. Nox-ton's curative field, and the public health in mind, let us consider what is pre- worker, in the field of preventive medi- ventive medicine. In its broadest sense, cine. it is mass protection against those dis- How many of you have ever seen a eases known to be preventable or con- patient suffering with typhoid fever? The trollable. While key positions in public chances are that none of you ever saw health are held by medical doctors, such a person—if you are a young man there are many angles associated with or a young woman. On the other hand, this work which do not involve what is there may be many readers who have commonly conceived to be the actual passed middle life. In that event, you practice of medicine. When a person be- may have had typhoid fever yourself. comes ill with typhoid fever, he natural- If you have not and are an elderly per- ly sends for his private physician. The son, you have known many to die with physician, in turn, treats his patient and this disease, of which there were only 16 The Health Bulletin May, 1949

57 cases among North Carolina's more treat diseases. And so, you see, there Is than 3y2 million persons last year. Of not—certainly in the matter of mass this number, only six died! protection—any conflict whatever be- Many of you remember the fall of tween public health and organized 1918, the last year of World War I. medicine. There are certain things that During the fall and winter of that year, both the private practitioner of cura- literally thousands of persons both in tive medicine and the preventive medi- the armed services and in private life, cine practitioner do in common. For died of influenza and pneumonia. Dur- example, each may administer immuniz- ing the War Between the States and ing doses of anti-typhoid vaccine. The during the War With Spain, thousands private practitioner does not have ther died as a resiilt of typhoid fever. It has time to practice mass protection. been said, especially in connection with Another disease that is controlled the War With Spain, that we lost more through preventive medicine is diphthe- men from typhoid fever than from ria, most of the victims of which are Spanish bullets. little children, hundreds of whom form- Then followed the discovery of con- erly died of this disease, as compared trol methods, two in number—immuni- with the handful who now succumb. zation and sanitation. We will not un- Last year, there were, in North Caro- dertake to go into this subject in a de- lina, 485 cases of diphtheria, among tailed manner, but we all know that young children. The death toll was just tj^hoid fever has been reduced almost 26 more than should have been allowed to the vanishing point, but any relaxa- to die, and the 485 who had the disease tion of our efforts would mean a come- were just that many who should not back for this terrible disease. What we have contacted it at all. Diphtheria have said of typhoid fever is true of definitely is preventable, and for ten malaria, the cause of which is a very years now there has been a law on the definite insect known as the anopheles statute books of our State requiring im- mosquito. Consequently, the way to con- munization against this disease before trol malaria is to prevent the breeding a baby reaches its first birthday. Under of this insect. This has been done. In this law no child is allowed to attend former years, before control methods any public, private or church school were discovered, thousands of people who has not been vaccinated against contracted malaria in North Carolina diphtheria, a well as smallpox. every year, and hundreds died of this Speaking of smallpox, it is safe to disease. Last year, there were only 147 say that few readers ever saw a person cases of malaria reported in North Caro- with this disease. There were only three lina and not one single death, accord- such persons in North Carolina last ing to reports filed with the State Board year—less than one for every 1,000,000 of Health's Bureau of Vital Statistics. inhabitants, in contrast with former Compared with years gone by, this con- years, when thousands contacted the trast is little short of amazing! disease every year, and hundreds died Now let us get back, for a moment, of it. There have not been over three to Dr. Norton's statement concerning deaths from smallpox in North Carolina the line of demarkation between cura- in the past 10 or 12 years, but if we tive and preventive medicine. While our should relax our effort and lapse into doctors have continued to treat diseases an unvaccinated population, smallpox that are known to be preventable, it is would return. There was a time when not the doctor's place, nor has he the this disease was so prevalent that prac- time, if he would, to drain swamp lands tically every county in the State had to so that mosquitoes will not breed. go to the expense of maintaining an Neither is it the doctor's place to erect isolation hospital for smallpox victims, sanitary privies or otherwise insure but these were not dignified with the community cleanliness. The private name of hospital. They were called practitioner's job is to diagnose and pest houses. . MEDICAL LIBRARY

U . OF N. C CHAPEL HILL. N. C.

SMP'OllI PuUisKeJbv TflEMT/lCflKlM SHEBTlRD'flEALTA iyS£^=7iI TkisBuUetmwill be sent free to dntjcilizen of fKe Skii-e upon request J

Published monthly at the office of the Secretary of the Board, Raleigh, N. C. Entered as second-class matter at Postoffice at Raleigh, N. C. under Act of August 24, 1912

Vol. 64 JUNE-JULY, 1949 No. 6 & 7

J. W. R. NORTON, M. D., STATE HEALTH OFFICER MEMBERS OF THE NORTH CAROLINA STATE BOARD OF HEALTH G. G. DrxoN, M.D., President Ayden Hubert B. Hayw^ood, M.D., Vice-President Raleigh H. Let Large, M.D. Rocky Mount John LaBruce Ward, M.D. " Asheville Jasper C. Jackson, Ph.G. Lumberton Mrs. James B. Hunt Lucama, Rt. 1 John R. Bender, M.D. Winston-Salem Ben J. Lawrence, M.D. Raleigh A. C. Current, D.D.S. Gastonia

EXECUTIVE STAFF

J. W. R. Norton, M.D., M.P.H., Secretary and State Health Officer G. M. Cooper, M.D., Assistant State Health Officer and Director Division of Health Education, Crippled Children's Work, and Maternal and Child Health Service C. C. Applewhite, M.D., Director, Division Local Health Administration

, District Director, Local Health Administration

Ernest A. Branch, D.D.S. , Director, Division Oral Hygiene John H. Hamilton, M.D., Director, Division of Laboratories J. M. Jahrett, B.S., Director, Division of Sanitary Engmeering Otto J. SvvasHER, M.D., Director, Division of Industrial Hygiene Bert Lyn Bosley, Ph.D., Director, Nutrition Bureau Felix A. Grisette, Director, Venereal Disease Education Institute C. P. Stevick, M.D., M.P.H., Director, Division of Epidemiology and Vital Statistics, and Co-Director, School Health Coordinating Service William A. Smith, M.D., Director, Bureau of Tuberculosis Ivan M. Proctor, M.D., Director, Bureau of Cancer Control Harold J. Magnuson, M.D., Director, Reynolds Research Laboratory, Chapel Hill John J. Wright, M.D., Director, Field Epidemiology Study of Syphilis, Chapel Hill

FREE HEALTH LITERATURE The State Board of Health publishes monthly The Health Bulletin, which will be sent free to any citizen requesting it. The Board also has available for distribu- tion without charge special literature on the following subjects. Ask for any in which you may be interested. Adenoids and Tonsils German Measles Sanitary Privies Appendicitis Health Education Scabies Cancer Hookworm Disease Scarlet Fever Constipation Infantile Paralysis Teeth Chickenpox Iniluenza Tuberculosis Diabetes Malaria Typhoid Fever Diphtheria Measles Venereal Diseases Don't Spit Placards Padiculosis Vitamins Fly Placards Pellagra Typhoid Placards Endemic Typhus Residential Sewage Water Supplies Flies Disposal Plants Whooping Cough

SPECIAL LITERATURE ON MATERNITY AND INFANCY The following special literature on the subjects listed below will be sent free to any citizen of the State on request to the State Board of Health, Raleigh, N. C. Prenatal Care. Prenatal Letters (series of nine Baby's Daily Schedule. monthly letters). First Four Months. The Expectant Mother. Five and Six Months. Infant Care. Seven and Eight Months. Nine Months to One Year. The Prevention of Infantile One to Two Years. Diarrhea. Two to Six Years. Breast Feeding. Instructions for North Carolina Table of Heights and Weights. Midwives.

CONTENTS Page

Foreword 3 Departmental Reports 5 IPUBLI5AED BYTAE N'^RTM CAROLINA STATE B^ARD-/ AEALTAl

Vol. 64 JUNE-JULY, 1949 No. 6 & 7

J. W. R. NORTON, M.D., M.P.H., State Health Officer JOHN H. HAMILTON, M.D., Acting Editor

FOREWORD

By J. W. R. NORTON, M.D. State Health Officer, Raleigh, North Carolina

THE period covered in reports fol- various local health units. Budgetary lowing this foreword—that is, the requests for the biennium beginning calendar year of 1948—was not without July 1, 1949, were drawn up with this its discouraging features, even though, objective in view, and in the next con- as a whole, progress was noted. In mid- joint report to the State Medical So- year of 1948, North Carolina was visited ciety, the Board of Health will be able by the most widespread epidemic of to report ofBcially that $1,600,000 in new poliomyelitis in its history, and one of money was made available for improv- the worst ever recorded in the United ing the work in local health units, for States. During this epidemic, there were the biennium above referred to, as well 2,517 cases reported to the State Board as $600,000 for a new building for the of Health and 147 deaths. This situation State Board of Health in Raleigh, de- naturally delayed or otherwise interfer- signed to meet present and future needs. ed with other Public Health services. We will also be able to report that every However, the crisis was handled as well one of North Carolina's 100 counties was as could have been expected, with a organized for full time Public Health minimum of confusion and misdirected Services, as of July 1, this year, as well effort. as the establishment of a well-planned Personnel shortage continued to prove Field Training Program for public a deterring factor, with Public Health health workers. unable to obtain adequate professional This foreword, written for customary help at the salaries allowed for such publication in The Health Bulletin, is work. The gratitude of the State Health designed to focus attention upon the Department is expressed to those who reports from the various Divisions com- remained at their posts, in the face of prising the State Health Department, sometimes flattering offers to enter submitted to the conjoint session in other fields of service. This spirit de- Pinehurst, in May. These reports are monstrated their devotion to duty and given every simimer to the readers of those who remained are to be com- The Bulletin. mended. It might be well, however, to point Throughout the year, the future was out some of the things not covered in considered in the light of a keen desire these Divisional reports, including some on the part of those charged with the of the activities of the Division of administration of Public Health in Central Administration, of which the North Carolina to secure such financial Secretary and State Health OflBcer is assistance to improve the work in the the Director, and directly under whose The Health Bulletin June-July, 1949 supervision certain important services instances, large families read single are performed. Among the other mem- copies of this publication, which the bers of this Division is the budget ofl&- State Board of Health has been issuing cer, whose work is indispensable in the since April, 1886. It is published month- conduct of the Department's financial ly, and is sent free to all citizens re- and fiscal affairs. This official has questing it. Please report any change charge of placing of orders for the of address so that no copies will be various Divisions, as well as payroll missed. duties. With the intricacies of the pre- More and more, emphasis is being sent day, such as payroll deductions, placed on improving the work of the etc., the budget officer's work was great- local health units. It is necessary to ly increased. have a central unit, through which The Personnel Officer also works in legislative appropriations are channeled, the Central Administration. This work as well as Federal moneys made avail- has expanded during recent times and able for Public Health work, and cer- includes the keeping of accurate records tain work must be performed centrally on each employe—state and local, assist- such as vital statistics and laboratory etc. ance in recruitment, promotions, services but it must always be kept in Also included in the Central Adminis- mind that where the work actually tration is the work of the Senior Pub- is done is out where the people are licity Specialist, who writes the Depart- and not around desks or in confer- ment's news items and conducts a week- ence rooms in Raleigh. While planning ly radio broadcast over Station WPTF, is necessary, and while it is necessary known as "Your Health and You." Al- to employ division heads, clerks and though this official is a layman, he others, the individuals who to receive works under medical supervision and public health services are to be kept confines his activities to describing the uppermost in our minds. services made available by the State As in the matter of vital statistics, Health Department including immun- for example—and epidemiology—it is ization programs, etc. Each year he re- necessary to maintain a clearing house ports the proceedings of the State Med- at Raleigh, to which reports of births Society, through the papers and ical and deaths and the incidence of cer- press services. tain diseases are made. Here they are Included in the work of the Central compiled and put to such uses as are Administration is the filing system for necessary. Statistics are important, but correspondence and other official papers when simply taken as so many figures, of the entire Health Department. Fre- they lose their real importance, which pre- quent reference must be made to is to teach lessons. For example, reports vious correspondence and reports. This are made each month of the incidence work alone keeps two persons employed and deaths from preventable diseases. full time. This information is necessary, if we The purpose of making the State are to wage a successful fight against Board of Health's reports public, such diseases. In this connection, it through annual publication in The might be said that the 1949 Legislature Health Bulletin, is to acquaint readers took an important step when it made with just what their Health Depart- cancer a reportable disease. We must ment is doing for them, in affording know where cancer exists before we can mass protection and performing the va- wage a successful fight on it. The for- rious other functions for which the De- ward step above referred to was design- partment was established and is being ed to aid in the prosecution of the maintained. There are around 60,000 Board of Health's cancer case-finding names on The Bulletin's mailing list. program now in progress and about It is assumed that each copy is read which much already has appeared in "by more persons than the one whose the press and been heard over the radio. name appears on the label. In some And so, statistics do have a very definite June-July, 1949 The Health Bulletin

place in any preventive or correctional be expected to respond. That is why, program — when properly interpreted for example, the State Board of Health's and put to use. Without them, we would tuberculosis case-finding program, in not be able to make many of the val- which much progress was made during uable calculations necessary to any pro- the period of these reports, has been gram of progress. publicized in all sections of the State. During the period covered by the re- The objective of this movement is to ports to follow, an intensive effort was secure a chest x-ray picture of every made to bring a closer relationship be- person in North Carolina over 14 years tween the State Health Department in of age. If this is to be accomplished, Raleigh and the local health units, the public must be informed of the through a series of conferences, in advantages of such procedure. The peo- which views were exchanged and sug- ple must be made to understand that gestions made. This movement for clos- if we are to successfully fight tuber- ing any gaps of misunderstanding be- culosis, we must find those in whom the tween local and State health oflScials, disease exists, in order that they may, plus an intensive program for improv- if the disease is detected early enough, ing local health facilities, already has be treated and cured, or, if they are a borne fruit. This was conspicuously menace to others, they must be separ- evident during the last session of the ated from those they are likely to in- General Assembly, when a large ma- fect through continued contact. Refer- jority of our local health ofiBcers were ences to this and other Public Health so zealous in behalf of the needs of programs, concerning which full ac- their people, from a Public Health counts are given in the reports this standpoint, that they led in stimulating foreword is intended to introduce, are public health interest among their pub- not made for the purpose of repetition, lic spirited citizens who inspired their but for the sake of emphasis. legislators to do the same thing. The In looking over the record of our net result was that there was a grow- State Health Department, not only for ing consciousness on the part of our last year, but for the years that have representatives in the General Assem- come and gone since its establishment, bly, that the people not only were be- we find many things to inspire justifi- coming more health conscious, but had able pride. We have, in the main, made begun to put Public Health in its proper progress; we have also missed many relationship to other progressive move- opportunities, perhaps. But whatever ments. may have been the experience of the Cooperation is necessary to the prose- past, we undoubtedly, are entering into cution of any worthwhile program, but, a period that will be filled with greater to be cooperative, the group appealed responsibilities, which we would be pre- to or in whose behalf the program is pared to meet, if we are to achieve the being carried out, miast be informed. objectives for which the Board of Health Otherwise, they could not reasonably was created.

DEPARTMENTAL REPORTS

North Carolina State Board of Health

(January 1, 1948—December 31, 1948)

DIVISION OF PREVENTIVE MEDI- nal and Child Health Service, the CINE—G. M. Cooper, M. D., Director Crippled ChUdrens' Service, the Mail- ing Room, the Multilith Department, The responsibilities of the Division of and the individual medical informa- Preventive Medicine include the Mater- tional correspondence service. One of The Health Bulletin June-July, 1949 the important functions of the Board one of the most important activities of during the last few years has been the the State Board of Health. distribution of biologicals to the various Negotiations at this writing are un- local health departments who requested derway in an effort to obtain the ser- this aid. This service means that by the vices of a qualified obstetrician and utilization of funds allotted by the U. another pediatrician, the latter to aid in S. Childrens' Bureau for the operation the work of the Crippled Childrens' De- of these departments, biologicals free partment, which has been very heavy in of charge may be provided for the im- its demands on the director's time for mtmization against diphtheria and the last year or two. Just as soon as a whooping cough especially. This service pediatric consultant can be secured, ar- has been of material benefit to local rangements will be immediately put into health departments in enabling them to effect to establish a program for the provide free immtmizations to every care of rheiunatic fever patients which class of people. With a hvmdred covm- is sorely needed throughout the State ties having whole time health depart- at present. This crippling condition is ment arrangements, the four final pro- responsible for much suffering and a visions in as many coim^ties to become great many deaths, and there is up to effective July 1 this year, there will be this time no effective provision avail- no legitimate reason why any child able for their care. Many of these should fail to be immunized against patients are without means which would these diseases, as well as smallpox and enable them to secure the expensive care typhoid fever and other crippling dis- by specialists in properly equipped hos- eases, if the parents are willing to put pitals. themselves to some trouble to obtain The EMIC program is being gradual- such protection. ly liquidated. It will be recalled that The work was carried on dvu-ing 1948 more than 40,000 mothers and babies with no aid from physicians untn August had medical and hospital care provided 16, 1948, Dr. Robert J. Murphy, a quali- free of cost. By Act of Congress this fied pediatrician, became permanently service was ended June 30, 1947, but associated as a pediatric consultant with with a provision that the wife of any the department. Dr. Murphy's assistance eligible serviceman who was pregnant has been very valuable in setting up a at that time would receive aid and after program for the care of prematurely the birth of such baby, the baby would born babies. During the last two or receive free hospital and medical care three years about one-third of the when necessary for the first year of its of final re- babies dying under one year of age con- life. Therefore, something a port is herewith set forth covering the stituting the infant death rate of the activities of 1948. State has been on account of the babies being prematurely born and no provi- Maternity cases completed 1,053 delivery by sion made for the special care necessary Attended at doctors of medicine 917 if such babies are to survive. Special Attended at delivery by arrangements have been made with an interns and midwives 5 initial group of hospitals, some of which Cases completed before delivery. _ 131 have been required to expend a consi- Delivered in hospitals 877 derable sum of money to meet the mini- Delivered in homes 45 mum standards necessary to satisfac- Infant cases completed 379 torily carry on this work through and Cost: with the cooperation of local health de- Maternity cases $ 94,935.97 partments all over the State, with prac- Infant cases 29,524.44 ticing physicians and with the pediatri- cians of the State. It is expected within Total cost $124,460.41 a year or two that this service will be The work of the Maternal and Child June-July, 1949 The Health Bulletin

Health Service which contemplates pro- ciently meeting the peculiar demands in viding prenatal care, postpartiim exami- printing, along with the mimeograph nations and advice to mothers in pre- department of the mailing room, in natal and well baby clinics for all wo- order to satisfactorily care for the work men who are expectant mothers or who of the various divisions of the State have young babies who do not have the Board of Health. of private physician, the services a Crippled Childrens' Department: The clinics to provide medical examinations work of this department has been con- on a monthly basis followed by the ad- siderably expanded during the year. A the nurses un- vice of the doctors and larger number of children have availed of the der the general management themselves of the privilege of attending local health departments throughout the the clinics conducted by a qualified or- State, have been successfully carried on thopedic surgeon. Clinic facilities on a in 1948. During the year, 2273 M&I monthly basis with qualified specialists clinics were held In 64 counties and four in charge have been within reach of cities. The patients were attended by practically every family in the State, 217 different physicians. Broken down certainly within a maximum of fifty into actual figures, the attendance of miles distance for most of them. The ar- patients on these clinics were as fol- rangements for clinics to which parents lows: may bring their children and obtain White Colored Indian Total a free examination with at least a tenta- Prenatal 785 7876 47 8708 tive diagnosis and certainly with advice Postpartum _ 459 3062 5 3526 as to further procedures necessary have Infants 2121 7280 12 9431 been established and increased in num- Preschool 2868 4472 4 7344 ber gradually for the last thirteen years. In these clinics 54,613 booklets and The clinics are maintained on a coope- pamphlets relating to care of mothers rative basis with the Vocational De- and children were distributed to the partment of the State Department of individual patients attending the clinics. Education and in cooperation with the In the mailing room of this Division State Orthopedic Hospital at Gastonia. in which literature for all of the State Most of the clinics are conducted on a Board of Health is sent out, the follow- monthly basis. An exception of this is ing items relating to work of this de- the Gastonia clinic which is on a week- partment were sent out: ly basis, and the clinic in Asheville is Health Education 2,059,829 conducted twice a month and during the Prenatal Literature 23,199 year it became necessary to establish Infant Literature 90,790 a third clinic for service to discharged Miscellaneous Supplies 44,421 polio patients on account of the polio Miscellaneous Midwife epidemic occurring in the State during Supplies 6,344 the year. These clinics are open to years of age. Close cooperation is maintained children imder twenty-one the throughout the State with the cooperat- This applies to the limitations of this field. ing hospitals and specialists utilizing State Board of Health in available aids from such institutions. Under the term "tentative diagnosis", For example, the Negro Medical Social it is meant that an orthopedist in charge Workers provided for work in Duke of a clinic may see a large number of Hospital among Negro maternity cases crippled children and an occasional is continued in that work with satisfac- child is encountered in which a p>ositive tory results. Funds for the operation of diagnosis cannot be established in the aU such work and the field work con- short time necessary to devote to each nected with the clinic are provided by individual in the course of the day's allocation of money from the U. S. clinic and also for lack of facilities such ChUdrens' Biureau. as X-ray and laboratory aids. There- The Multilith Department is stiU efiB- fore, the department in such cases 8 The Health Bulletin June-July, 1949 authorizes care in a hospital for com- fore have been able to treat more plete examinations by the orthopedist patients. and the establishment of a positive diag- nosis, followed by whatever treatment DIVISION OF LOCAL HEALTH AD- is necessary. MINISTRATION—John H. Hamilton, These clinics are primarily for the M. D., Acting Director benefit of the poorer people of the State, Ninety-six of the one hundred coun- families that are not able to pay the ties in North Carolina, as of December high prices necessary and long hospital- 31, 1948 had developed some type of to say nothing of ization requirements, local health service. During 1948 local care in such cases. the nominal medical public health service in the ninety-six The patient is given the benefit of the counties were provided by seventy-one doubt. Welfare departments are required local health departments of the follow- to certify that these families are among ing types: (1) forty-nine county health the type who need this care and are departments; ( 2 ) nineteen district unable to provide it without at least health departments, and (3) five city some aid. In the case of small farmers health departments. or wage earners, certainly in all of the The serious shortage of qualified pro- tenant and sharecropper part of the fessional personnel available, particularly population, expensive hospitalization physicians and nurses, for public health and surgical treatment is out of the work during 1948 remained a major question without some aid from some problem. As of December 31, 1948 there quarter. Therefore, these funds have were 943 full-time budgeted positions been of inestimable value in aiding large with 65 full-time vacancies. Of this numbers of people every year since it number, 14 were full-time health officer was established. The following is a sum- vacancies, and 31 were public health mary of the volume of work carried on nursing vacancies. during the year: TRAINING PROVISIONS: During The clinics were open to any children 1948 the following number of public under 21 years of age for a free ortho- health personnel received, or were in pedic examination by the clinician in the process of receiving, special train- charge, 10,905 visits being made by child- ing under the program and policies of ren to clinics, the number of clinics be- the State Board of Health: ing held was 257. Total number of child- Health Officers 8 ren under hospital care dui-ing the year Division Directors 2 1948 was 1,462—191 having remained Public Health Nurses (Scholar- over from 1947. 1,271 were admitted to ships 34 hospitals during the year. There were Public Health Nurses (Orienta- 1,244 discharged from hospitals, leaving tion) 20 218 remaining at the end of the year Public Health Nurses taking spe- to be carried over into 1949. 92 children cial courses in various fields were given convalescent care and 12 of P. H. work 102 boarding home care. 340 appliances Hospital Nurses 4 which included such items as artificial Sanitary Engineers 1 legs and arms were purchased during Sanitarians 17 the year 1948. There were 529 outstand- Public Health Educators 6 ing authorizations as of December 31, Public Health Investigators 1 1948, and 469 applications pending as Nutritionists 2 of the same date. The number on the Bacteriologists 2 State register was 17,161. This is an Technical consultation and advisory unduplicated count and is greatly re- service to local health departments, duced from the previous year due to the joint planning with the other divisions fact that we have had more funds avail- of the State Board of Health and coop- able for carrying on the work and there- erative programs with other State agen- June-July, 1949 The Health Bulletin cies and organizations were carried out, joint project of the nutrition and nurs- prior to July 1, 1948 under the direction ing consultants. Seventeen nurses at- of Dr. R. E. Fox, Director of Local tended a two-weeks orientation course Health Administration, and Assistant in tuberculosis nursing at McCain. Thir- Director, Dr. William P. Richardson, ty-six nurses attended Venereal Disease and subsequent to July 1, 1948 under the Institutes at the Eastern Medical Cen- supervision of Dr. John H. Hamilton, ter, Durham. During July and August, Acting Director. the School of Public Health at Chapel In the Division of Local Health Ad- Hill offered a series of five-day courses ministration one of the most important in special fields—Cancer Control, Geria- objectives during the latter part of 1948 trics, Mental Hygiene, Orthopedics and was to provide for the establishment of Tuberculosis. One hundred and two pub- health services within the last four un- lic health nurses from North Carolina organized counties of the State, namely, were included in those registered for Madison, Brunswick, Jones and Pamli- these courses. co. (NOTE: I am happy to report that HEALTH EDUCATION: During 1948, three of the four counties having no the major activity continued to be em- organized health service as of Decem- phasis on strengthening local health ber 31, 1948 began operation March 1, education program development through 1949. The fourth and last county voted recruitment, training, and employment to establish local health service effective of qualified local health educators. As July 1, 1949). of December 31, 1948 there were thir- The nature and scope of outstanding teen local health educators working on a activities achieved by the Division of fvill-time basis with county, district and Local Health Administration during 1948 city health departments serving a total are as follows: of nineteen counties and three cities. In PUBLIC HEALTH NURSING: In addition, two of the five health edu- January 1948 there was a supervising cators employed by the State Board of public health nurse and three consult- Health continued working in their dual ing public health nurses with three capacities as local health educators and vacancies on the public health nursing area health education supervisors. Two staff. Mrs. Blanche Vincent was employ- health educators were assigned to the ed on September 27 as consulting public Division of Tuberculosis Control to as- health nurse with tuberculosis nursing sist with commimity organization and as her special field. health education aspects of the mass X-ray program, and another health edu- During the year, field visits were made cator continued working with the to local health departments for consul- School Health Coordinating Service. tation service to health officers and public health nursing staff. Two health During 1948, principal activities of departments added supervising public local health educators included such health nurses so that 17 of the 71 local activities as: assisting public health per- health departments now have supervis- sonnel with a variety of programs as ing nurses. In departments without a staff conferences, foodhandler classes, supervisor, the consultants have worked interpretation of available health de- with the public health nurses in home partment services, community study visits, clinics and in schools. Consider- groups, conferences, and institutes on able time was spent in recruitment of various health problems and others; new personnel . assisting with community organization In order to help improve the public activities as development of neighbor- health nursing service throughout the hood health committees, school health State, the consultants have planned a committees, community and countywide continuous staff education program. Re- councils; assisting with preparation, fresher courses in nutrition for public production, and distribution of health health nurses have continued to be a education materials as posters, pamph- 10 The Health Bulletin June-July, 1949

lets, exhibits, reports, and fliers; assist- State Board of Health. The present ing with arrangements for film show- plans are to send a copy to each health ings, radio programs, and allied activi- department for comments, criticism, ties. and suggestions before the final draft Six prospective health educators were is made and put in effect by January, recruited for one year of graduate study 1950. in public health and health education VENEREAL DISEASE CONTROL: at the School of Public Health, Univer- The program of venereal disease con- sity of North Carolina and North Caro- trol has emphasized largely the treat- lina College at Durham in Durham. ment of early syphilis in the two rapid During 1948, two Statewide health treatment centers located in Charlotte education conferences were held in Ra- and Durham. All cases are referred to leigh and two district staff conferences the rapid treatment centers by the local in Greensboro and AshevUle. In addi- health departments and by private tion, health educators attended the An- physicians. nual Working Conference in March, During the calendar year 1948 the 1948 at Chapel Hill sponsored by the total admissions to the two rapid treat- School of Public Health, University of ment centers were 7,534. As of December North Carolina. 31, 1948, since the centers opened 41,390 During 1948, there were an inncreas- patients have been admitted. Practically ing number of opportimities for coop- all of the gonorrhea cases have been erative health education and closely al- treated outside of the centers either by lied programs with several local and private physicians or local health de- State agencies and organizations and partments. The number of cases of with other divisions of the North Caro- syphilis reported during the year 1948 lina State Board of Health. was 7,313 as compared to 8,724 in 1947. FIELD REPRESENTATIVE SER- The number of cases of gonorrhea re- VICE: The staff of three Field Repre- ported during the year 1948 was 14,962 sentatives was decreased to two by the as compared to 14,169 in 1947. resignation of Miss Geneva Drye in Venereal disease reporting was simpli- August, 1948. fid by combining reporting of the cases The general plan of giving consulta- and its disposition by the use of one card tion and advisory service to local health rather than two separate cards as had department clerks and secretaries was been done previously. A simplified form continued. Whenever possible the nurs- for a transcript of the treatment sent ing consultants visited the local health by the rapid treatment centers to the departments with the field representa- physicians and local health departments tives and their assistance proved most was instituted. It includes a graphic re- helpful in interpreting reports to the cord for titer serology follow-up of the entire staff. patient indicating relapse before clinical signs appear. One of the major projects during the year has been to complete the prelimi- Three one week refresher institutes nary draft of a proposed new report. were held for nurses and public health This is designed to replace the present investigators. Instruction was provided statistical which has been in effect since by members of the staff of the school of 1936 and is based on the Evaluation Public Health at Chapel Hill and the Schedule of the American Public Health Eastern Medical Center at Durham. Association. Dr. William P. Richardson, In spite of vacancies on the staff, and Assistant Director of the Division of many other discoiu-aging difficulties, the Local Health Administration, laid the Division of Local Health Administration groundwork for this report before he has devoted loyal and faithful service in resigned in July, 1948. aiding local health departments. These In the late fall it was reviewed and local health departments themselves changes made by the directors of the have been confronted with many diffi- June-July, 1949 The Health Bulletin 11 cult and perplexing problems, neverthe- mately 10 percent of these materials less they have maintained a steadfast went to North Carolina State and com- determination to render a great service mimity agencies. It is significant that to the people of our State. They face the the rate of distribution during the later future confident that in the coming year months of the year was more than a definite step forward will be made in double the rate during earlier months. protecting the health of all the people A high light of the Institute's ser- in North Carolina. vices during 1948 included the prepara- ion of four comic books setting forth HEALTH PUBLICATIONS INSTI- the facts about the venereal diseases in TUTE—Mr. Capus Waynick, Director simple language for the special use of the Department of the Army and the Although its funds are derived from beginning of a research project for the the United States Public Health Service Department of the Navy to test the and from the Zachary Smith Reynolds educational value of printed materials. Foundation, Health Publications Insti- Until April 1, 1948, the Institute and tute, formerly as Venereal Dis- known the North Carolina Social Hygiene So- ease Education Institute, operates as a ciety, Inc., had been directed by Capus division of the Board of Health. State M. Waynick. As of that date Mr. Way- Its purposes are to: nick resigned and was succeeded by 1. Develop and produce methods and Felix A. Grisette. On November 1, Mr. materials for public education in the Waynick returned as director of the field of public health. Society but Mr. Grisette continued as 2. Evaluate such materials before and Diretcor of the Institute. after production. 3. Facilitate the distribution of tested REYNOLDS RESEARCH LABORA- health education materials. TORY—Harold J. Magnuson, M. D., The outstanding achievement during Research Professor of Syphilology 1948 was the change in name from Research Activities: The chief re- Venereal Disease Education Institute search activities of this laboratory have to Health Publications Institute to the been directed toward problems in the end that educational work in behalf of field of experimental syphilis, with parti- the venereal diseases might be more cular reference to problems of immunity effectively integrated with all aspects of in this disease. public health, and in order that the Work has also been done with certain Institute might more effectively fulfill antibiotic producing strains of Escheri- a demand for its type of services in all chia coli in an efifort to determine their fields of public health. importance relative to naturally occur- The corporate activities of the Insti- ing Shigella infections. tute are controlled by the North Caro- Chemotherapeutic activities have been lina Social Hygiene Society, Inc., a non- study of physical profit corporation, of which the State directed toward the and chemical factors influencing the Health Officer is a director. stability rate of rearrangement of The State of North Carolina makes and certain organmetaUic compounds, par- no appropriation whatsoever to the ticularly of antimony. budget of the Institute except to pro- vide quarters. In exchange for these Publications: "The Minimal Infecti- quarters the Institute makes available ous Inoculimi of S. Pallida (Nichols its educational materials to North strain), and a Consideration of Its Rate Carolina health agencies without of Multiplication in Vivo," Harold J. charge. Magnuson, Harry Eagle, and Ralph During the year 1948, a total of 3,986,- Pleischman, Am. J. of Syph., Gonor., 400 items of the Institute's materials and Ven. Dis., Vol. 32, pp. 1-18, Jan., were distributed to every state in the 1948. Union and 32 foreign lands. Approxi- "Studies with Antibiotic Producing 12 The Health Bulletin June-July, 1949

Strains of Escherichia Coli," S. P. Hal- nurses, and other students in the School bert and Harold J. Magnuson, J. of Im- of Public Health. munol., Vol. 58, April, 1948. "Bismuth Plus Penicillin in The Treat- FIELD EPIDEMIOLOGICAL STUDIES ment of Evperimental Syphilis," Har- OF SYPHILIS—John J. Wright, M. D., old J. Magnuson and Barbara J. Rose- Director nau. Am. J. of Syph., Gonor., and Ven. The field epidemiological studies of Dis., Vol. 32, pp 203-211, May, 1948. syphilis which have been in progress at of Development and Degree "The Rate the School of Public Health, University Acquired Immunity in Experimental of of North Carolina since 1940 under the Syphilis," Harold J. Magnuson and Bar- direction of Dr. John J. Wright, have bara J. Rosenau, Am. J. of Syph., continued to receive the support of the Gonor., and Ven. Dis., Vol. 32, 418- pp North Carolina State Board of Health 436, Sept., 1948. and the International Health Division "Ciu-rent Concepts of Immunity in of the Rockefeller Foundation. The Syphilis," Harold J. Magnuson, Am. J. study area used consists of the counties of Med., Vol. V. pp. 641-654, Nov., 1948. of Durham, Orange, Person and Chat- "The Treatment *;f Asymptomatic Neu- ham. This provides a satisfactory sample rosyphilis in the White Mouse," Harold of urban and rural living conditions J. Magnuson and Barbara J. Rosenau, and health departments typical of this J. Invest. Der., Vol. 11, pp. 435-441, Dec, area. Detailed and accurate data has 1948. been continuously gathered to provide "The Antagonism of ColLform Bacteria a base line of information regarding Against Shigellae," S. P. Halbert, J. of syphUis in the various sections of the Immounol. 58: Feb., 1948. population in the study area by race, "The Relation of Antagonistic Coltform age, sex, marital and socio-economic Organisms to Shigellae Infections. I. status. A good deal of information has Survey Observations," S. P. Halbert, J. also been collected relating to gonor- of Immunol., Vol. 60, pp. 23-36, Sept., rhea. Analysis of the data which have 1948. been acquired make it possible to deter- "The Relation of Antagonistic Coliform mine the effectiveness of control met- in Organisms to Shigellae Infections. 11. hods which have been use by health Observation in Acute Cases," S. P. Hal- departments. bert, J. Immunol., Vol. 60, pp. 359-381, During this year the bulk of the Nov. 1948. clerical tasks involved in preparing the large accumulation of data for detailed Administrative: As of July 1, 1948, analysis was completed. As a result, it this laboratory, formerly the Reynolds was possible to reduce the clerical staff Research Laboratory, became the Syphi- by two clerks who had previously been lis Experimental Laboratory, . of the U. employed on a temporary basis. The S. Public Health Service. As such, it is efforts of the study staff are now being operating as a field station of the Pub- concentrated upon the analysis of the lic Health Service, with the participa- data. At the same time, the accumula- tion of the University of North Carolina tion of basic data is going forward in and the North Carolina State Board of a routine fashion so that continuing Health in providing space and facili- studies may be carried out. ties. The following studies have been com- Teaching Activties: As in previous pleted and submitted for publication years, the laboratory serves as the De- during this year: partment of Exprimental Medicine in 1. An evaluation of case-finding mea- the School of Public Health, University sures in syphilis control. of North Carolina, and the director of 2. An evaluation of case-finding mea- the laboratory gives courses in venereal sures in multiple episodes of infectious disease control for the health officers. syphilis. June-July, 1949 The Health Bulletin 13

3. An evaluation of case-finding mea- niunber of such cases resulting from the sures in the control of gonorrhea. investigation of 100 male contacts.

These studies have focussed attention Studies are proceeding on the basis on the relative effectiveness of the ma- of which it is expected to complete re- jor case-finding procedures in different ports in the coming year dealing with types of cases and carry certain rather the following problems: definite implications so far as the act- 1. The effect of the military venereal ual administration of venereal disease disease educational program as reflected in programs is concerned. For example, it health department experience with was found that contact investigation gonorrhea. was responsible for bringing 38.1% of 2. Indices in the epidemiology of all the newly discovered cases of pri- syphilis. mary and secondary spyhilis to the at- 3. The cost of contact tracing in tention of the health departments. The syphilis control. effectiveness of contact investigation is 4. Trends in the syphilis attack and bringing new infectious cases of syphilis discovery rate. to diagnosis and control varied greatly 5. Syphilis in parturient women as an between the sexes. It was responsible for index to the trend of syphilis in the the discovery of 50.6 7o of the female general population. cases of primary and secondary syphi- 6. The probability of contracting lis as compared with 24.4% of the simi- syphilis by race, sex and age. lar male cases. In addition to the work of the Study itself, various members of the stafi have A similar analysis of case-finding pro- participated in educational activities re- cedures was done on a series of cases of lating to venereal disease control with infectious syphilis with lesions due special emphasis on the value of the either to relapse or re-infection, which epidemiologic approach. These have in- occurred in patients who had received cluded the assumption of some teaching previous treatment for syphilis. Inas- responsibilities in the School of Public much as all the patients in this series Health, University of North Carolina, had been given previous treatment, they the State Health Department, a number had all received a measui'e of directed of local Health Departments, the Rapid venereal disease education. It might, Treatment Centers of North Carolina, therefore, be expected that such indivi- and the Eleventh Venereal Disease Post- duals would present a different type so graduate Course given by the U.S.P.H.S. far as the relative effectiveness of var- at Hot Springs, Arkansas. In March and ious case-finding procedures was con- June, the professional members of the cerned. Our data did not bear out this Study Staff played an active role in the expectation. The problem of discovering planning and actual conduct of three and bringing under control those per- Institutes in Venereal Diseases Control sons who have multiple espisodes of in- held at the Eastern Medical Center in fectious syphilis was found to be es- Durham. Instruction was given in these sentially the same as discovering first institutes to fifty-nine nurses and vene- infections. real disease investigators representing In regard to the discovery of cases of forty-two health departments through- gonorrhea, our analysis showed that out the State. contact investigation was very effective and of crucial importance in bringing DIVISION OF EPIDEMIOLOGY AND female cases under control and was very VITAL STATISTICS—C. P. Stevick, much less effective among males. For M. D., Director example, it was found that the number of previously vmtreated cases of gonor- The most outstanding commimicable rhea brought under control as a result disease occurance in 1948 was an out> of the investigation of 100 female con- break of poliomyelitis that affected a tacts was more than four times the large part of the State. 14 The Health Bulletin June-July, 1949

A total of 2,513 cases was officially re- any year since 1936. The total was 43 ported, the largest number of cases of cases, which represents a continuation this disease ever recorded in North of the decline that has persisted since Carolina. One of the most imusual fea- 1944 when 231 cases were reported. tures of this outbreak was that the cen- Gonorrhea cases had been rising ters of highest incidence were within steadily up to last year due to better the same general area of the west cen- reporting and case-finding. In 1947, a tral part of the State as that involved sizeable decline occurred that was inter- in 1944 when the largest previous out- preted as possibly representing a be- break occurred, totaling 878 cases. ginning actual decline in the incidence On the basis of preliminary tabula- of this disease. There was a slight rise tions, there were no oustanding changes in 1948, the total of 14,169 cases still over previous outbreaks in regard to comparing quite favorably with the 16,- race, sex, and age distribution or sever- 082 of 1946. Apparently, additional time ity of the cases. The incidence increased will be required to determine whether or sharply during June and reached a not there has been any true decrease in peak approximately in the middle of gonorrhea incidence. July. The decline was slow and continu- Although malaria incidence has re- ed to the close of the year. There were mained at about the same low level for 147 deaths provisionally reported, re- the past several years, up to the pre- sulting in a case fatality rate of 5.8 sent time 1948 has brought no malaria percent. death reports, making it appear that The facilities of the Division were this will be the first year in our history taxed to the utmost in supplying infor- with no deaths from this disease. mation to the general public, the state Scarlet fever reports reached a new health agencies of other states, and to low in 1948. The mechanism of this de- private physicians and local health de- cline is not clear. Scarlet fever incidence partments of our own State. Assistance remained fairly uniform for many years was given in the planning of local and then in 1946 suddenly declined. health department policies with regard Additional declines have appeared in to the outbreak and in cooperating with 1947 and 1948. There is no reason to be- the National Foundation for Infantile lieve that the change is due solely to Paralysis in facilitating medical care. increasing lack of efficiency in report- Largely due to the efforts of the latter ing. The widespread use of penicillin organization, a network of hospital cen- and sulfa drugs may be a factor in re- ters had been established throughout ducing streptococcus infections in the the State during the previous thi'ee population generally. years where extra equipment was avail- Syphilis underwent a postwar rise able and for which additional person- in 1946, but then continued the decline nel was secured at the time of the emer- begun in 1939. The decline has now con- gency. The American Red Cross gave tinued for the second successive year, invaluable service in regard to nurse the 1948 rate being 196.7 cases per 100,- recruitment. 000 persons. This is the lowest rate since The communicable disease incidence 1936 and is a remarkable reduction from of the State with respect to other dis- the highest rate ever recorded, 876.8 in eases was generally favorable. Chanc- 1939. One of the most encouraging fea- roid cases totaled 381, the lowest num- tures of the 1948 decline is that the ber since 1941. Diphtheria established a number of early infectious cases has new record low with a total of 485 cases. been considerably reduced. The 1948 The previous record low was in 1946 total of primary and secondary syphilis when 584 cases were reported. The mor- cases is 2,992 as compared to 4,059 for tality rate for this disease was also at 1947. a new low. Endemic typhus fever re- Tuberculosis is also in the group of ports were smaller in number than for communicable diseases imdergoing a June-July, 1949 The Health Bulletin 15

steady decline. The decline has occurred The 1947 total of 111,282 births and in the fact of expanded case-finding the rate of 29.9 births per 100 popula- activities. .The 1948 provisional tuber- tion will probably not be surpassed by culosis mortality rate is 25.6 deaths per the final 1948 totals. Although a decline 100,000 or one-sixth as high as the rate did not occur during the past year, it when death registration began in 1918. was not as pronoimced as was expected There were 3.5 cases reported per death since the estimated birth total for 1948 in 1948. This compares very favorably is now set at approximately 110,000. The with the ratio of 1.2 cases per death in 1947 rate was the highest since 1924. 1943, five years ago, when the case-find- It is to be expected that our rate will ing program had not reached its pre- return in the near future to the pre- sent efficiency. war rate of approximately 25. Typhoid and paratyphoid fever show- The activities of the Division in pro- ed a slight increase in 1948. Except for moting commxinicable disease control this year and 1944, there has been a throughout the State have been con- steady decline in typhoid fever since tinued. Numero\as field consultations 1935. with health department staff members Whooping cough cases and deaths have been held. The typhoid carrier reached a new twelve-year low in 1948. register has had several names added It is of considerable public health im- during the year. At the close of 1948, portance to note that pertussis con- there were 95 names of carriers on re- tinues to be a more important cause cord. of death than diphtheria. The provi- A number of administrative improve- sional death totals for these two dis- ments were made in the vital statistics eases in 1948 are diphtheria 26 deaths work during 1948. In several additional and pertussis 50. counties, the registration of births and Among the other reportable com- deaths was taken over by the full-time health municable diseases, changes were not department in accordance with outstanding. Both Rocky Mountain the provisions of the State law. As of spotted fever and tularemia, which had January 1, 1949, there were thirty-seven risen to record high rates last year, de- counties in which the health officer was clined slightly in 1948. registrar. Field work to assist registrars, hospitals, physicians, and undertakers 1948 provisional death rate The show- in improving the efficiency of registra- ed no change over 1947. increase The tion was carried out much more widely in cancer and heart disease deaths have in 1948 than previously. A definite im- offset decreases that have taken place provement in the promptness and ac-

with respect to other diseases . curacy of reporting births and deaths Infant deaths have now declined to took place during the year. the provisional rate of 34.7 deaths per One of the most serious bottlenecks 1000 live births. The provisional mater- in the operation of the vital statistics nal mortality rate rose slightly to 1.9 office has been the lack of a usable in- deaths per 1000 live births over that dex with which to locate certificates for of 1947, which was 1.8. In 1947, there follow-up purpKjses and for the issuance were fourteen states with higher in- of certified copies. By taking advantage fant mortality rates and ten with higher of every opportunity, a sizeable part of maternal mortality rates. the index has been replaced in the last Among the causes that resulted in two years. As soon as additional work fewer deaths in 1948 than in 1947 are has been done, not only will service be automobile accidents, diabetes, pneumo- more prompt, but also personnel wiU be nia, nephritis, and prematurity. Causes available for improving the complete- showing an increase are accidents other ness of the statistical service. than auto, cancer, heart disease, homi- Increasing demands are being made cide, apoplexy, and suicide. on the Division for detailed morbidity 16 The Health Bulletin June-July, 1949 and mortality statistics. One of the cur- under the supervision of the North rent objectives is to expand the statisti- Carolina State Board of Health for the cal facilities so that health departments, elimination of malaria mosquito-breed- private physicians, medical schools, and ing areas. On this program 2,956 miles other appropriate agencies will be able of hand ditches were dug and 372 miles to secure more complete statistics. Such of machine canals constructed to drain a service will do much to help solve 98,606 acres of water surface. In addi- many of today's important problems tion, 72 acres of ponds were eliminated regarding public health and medical by filling. The reduction in malaria care. that has occurred in recent years is During the year the Malaria Control probably, to a large extent, due to these Unit of the Division of Epidemiology control measures. Applications for ponds and Vital Statistics took 2,203 blood that have already been built or are now slides during malaria surveys of school being constructed show that they have children. A total of 5,644 blood slides combined area of 18, 459 acres. These was examined, most of which were ponds provide a water surface 18.8 per taken diuring surveys the previous year. cent as great as that which was elimi- Practicing physicians were invited to nated on the drainage program. If the submit malaria blood slides to the unit present rate of construction continues, for the purpose of having their diagno- in a few years new, potential malaria sis confirmed. One thousand fifty-five mosquito breeding surface may equal or such slides were examined in addition surpass that which was destroyed on the to those on the regular survey. For the drainage program. This is a situa- tion past three years, there have been no to be viewed with concern. The extent positive slides among those taken dur- and scattered location of these ing regular school surveys. Scattered ponds will almost completely preclude positive slides obtained by private physi- the possibility of their being given ade- quate inspection cians are still being received, however. and supervision by Pond bunding continued on a large existing public health facilities. In the scale. This was chiefly due to promo- event of an economic recession, it is tional efforts on the part of the U. S. highly probable that satisfactory main- SoU Conservation Service and the State tenance would be neglected. This could Agricultural Extension Service. Both of easily result in a rise in the incidence these agencies cooperate fully with the of malaria to a point never before North Carolina State Board of Health reached. in seeing that ponds built under their The DDT residual spraying program supervision conforms as nearly as pos- continues to be the major activity of sible with the malaria control regula- this Unit. During the year 81,784 homes tions. were sprayed, using a total of 74,830 During the year 712 pond inspections pounds of technical DDT. The federal were made. Impounding permits were government contributed $105,025 to- granted to 292 individuals. One himdred wards the cost of this activity, and the ninety-seven other applications were state and local government provided received for ponds that have not yet $130,470, the average cost per house be- been built or have not been finished in ing $2.88. accordance with the regulations of the Unit continued the promotion, State Board of Health. Permits for these The are being withheld until the ponds are orangization, and general supervision of made to conform with the requirements. fly control projects in areas not served control residual Prom the advent of the work relief by the malaria spray- program in 1933 to the beginning of ing program. This activity expanded World War II, an extensive drainage greatly during the year. Eight thousand program was carried on with labor fur- five hundred sixty-six gallons of DDT nished by the CWA, ERA, and WPA concentrate were sold at cost to local June-July, 1949 The Health Bulletin 17 health departments for use in fly con- and Development, and all local Health trol. Departments. Some of the highlights of the various DIVISION OF SANITARY ENGI- activities are eniunerated below. NEERING—Mr. J, M. Jarrett, Director Sanitary Engineering: The coopera- tive program with the U. S. Geological Introduction: The following is a very Survey and State Department of Con- brief summary of activities of the per- servation and Development, in connec- sonnel of the Division of Sanitary Engi- tion with the chemical analysis of all neering during the calendar year, 1948. public water supplies, was continued. More complete reports of activities This project was completed during the have been submitted monthly to the year — 160 samples being examined. State Health Of&cer and members of Work was begun on a similar project the State Board of Health, therefore, which will cover all State Institutions. no attempt will be made in this report An inventory of all public water and to cover details of the work. sewerage systems was compiled for the Administration: Although our staff U. S. Public Health Service. This listing continued to become more stabilized, included names of towns, date plants or dvu"ing the year we had a number of systems started, the type or degree of resignations which interferred with the treatment afforded, streams used, wells operations, efficiency, and accomplish- or surface supplies, etc. ments of this Division. Two secretaries, Cooperation and assistance were given the office engineer, and one district the State Stream Sanitation and Con- sanitarian submitted their resignations. servation Committee in conducting stud- The office engineer has been replaced, ies of stream pollution problems. The another engineer has been employed to Director appeared as a witness in the replace the sanitarian resigned, and an court case—Smithfield vs the City of additional sanitarian was employed to Raleigh—but no decision has yet been fill a vacancy existing at the beginning rendered by the courts. of the year. Mr. Hendren and Mr. Lyle, Assistance was also given a number who had been assigned to the Lexington of towns, by the engineers, in locating milk shed, but who were paid from this or selecting sites for new wells; as well office, were transferred to the Davidson as assistance in connection with opera- County Health Department, effective tion and construction problems, and in July 1, as the local department was as- connection with proposed developments suming the milk control activities in or extensions to existing water and that area. sewerage systems. During the year, the usual number of The amount of actual construction conferences were held with officials of work undertaken during the year by the the Public Health Service and State municipalities has been very encourag- agencies concerned with sanitation ing. For several years we have been problems. Assistance was given the more in the planning stage, than in TVA, the Budget Bureau, the Depart- making actual improvements; however, ment of Public Instruction, the State this much needed work is now going Department of Public Welfare, the forward, and during the past year pro- State Highway and Public Works Com- jects in 41 separate cities were complet- mission, the Hospitals Board of Control, ed at an estimated cost of $8,161,000. and a number of State Institutions. These projects included all types of im- Close cooperation was maintained with provements from a new cover for the the above units, as well as with the elevated water tank at Ayden, costing State Department of Agriculture, the $2,000, to a new water plant and sewer School of Public Health at Chapel Hill, extensions at Burlington, costing $1,150,- the State College Extension Service, 000, and water plant improvements and the State Department of Conservation extensions at Charlotte, costing an esti- 18 The Health Bulletin June-July, 1949 mated $2,000,000. These improvements are so confused at present. A Study were long overdue, because of the re- Committee, authorized by the last Legis- strictions imposed dviring the war years, lature, made a superficial study of the and will greatly improve the existing problem and reported to the Governor facilities in the town where these im- at the beginning of the 1949 Legislative provements have been made. Session. No action has been taken on More attention was also given to the the Majority or Minority Reports sub- operation of water and sewage treatment mitted, and it appears now that none plants and problems, and assistance was will be taken during this term of the given in cormection with the Water General Assembly, Works Operators' Course which was Time was also given to working with held during the past year at the Uni- other states and the U. S. Public Health versity of North Carolina, School of Service in trying to develop some satis- Public Health. factory system regarding the interstate A program of municipal garbage dis- shipment of milk. The program of pro- posal by the sanitary land-fill method moting the establishment of local area was also inaugurated by the engineers. milk laboratories also progressed, and Considerable progress has been made some progress was made in establishing during the 12 months in connection with reciprocal milk shed inspections within this activity. the State. Too much concentration of Sanitation: A gi'eat deal of time was effort was not placed on this phase of devoted to the revision of regulations the program because, also, of the vui- pertaining to the meat and poultry in- certainty of the position to be played by the State of in dustry. Surveys were made of all known Board Health connection poultry processing and freezer locker with milk sanitation in North Carolina. plants, and conferences were held with Two new milk pasteurization plants the operators, and others concerned,- in were placed in operation. developing regulations for the sanita- The sanitarians assisted with food- tion of these places. Excellent coopera- handling improvements throughout the tion was received, and the results are State, and a real service was rendered now beginning to show the wisdom of in a number of cases through the de- this approach to the problem. At the velopment of plans, sketches, equipment layouts, etc. present time we have a list of 91 frozen locker plants, most of which have been All State Institutions were surveyed, built within the past four years. The and reports submitted to the proper sanitation of these places is, for the authorities. most part, very satisfactory. Close cooperation was given the Medi- There are 164 abattoirs now operating cal Care Commission in connection with in the State, and the regulations were hospital planning, and the provision of revised to improve the sanitation of proper sanitary facilities was incorpo- these places. rated in the plans for the units to be Poultry Processing Regulations were built. This activity has required consi- not put into effect until late in the year, derable time, but, in our opinion, is of most of the time being devoted to edu- great public health and sanitary signi- cational work, and assistance to the ficance, since we are placing oiirselves owners and operators. A large number in the position of helping to get the of new plants are now under construc- proper equipment and facilities con- tion, or planned, and the sanitation of structed, which will certainly make for this imit of the meat industry should better operations and more sanitary show marked improvement during the operations in years to come. next year. Assistance was given local Health De- With regard to milk sanitation, our partments and institutional staffs in efforts have been confined to assisting conducting classes for foodhandlers. local health units, since the Milk Laws Surveys were made of all hotels and June-July, 1949 The Health Bulletin 19 summer camps during the year, and tion and processing of FHA applications, considerable improvement was noted in as to water and sewage disposal at these this particular activity. residences. Svirveys were made of shellfish gi-ow- The Tj^Jhus Fever and Rodent Con- ing areas, and routine inspections made trol Program was continued in the same of all shellfish shucking houses. A lab- manner as last year. The availability oratory was placed in operation at of funds from the U. S. Public Health Morehead City, in cooperation with the Service controls the degree of expansion Division of Commercial Fisheries of the of this program. Individual property State Department of Conservation and owners spent $74,881 in the ratproofing Development. of buildings during the year. Much time was spent working with Bedding: This program has been car- committees on the preparation of bulle- ried on in a routine manner, as in past tins to be issued by the Department of years, with two men devoting full time Public Instruction relative to lunchroom to this activity. operation. A numerical summary of inspections Assistance was given the Federal and visits made by the personnel of the Housing Administration on the inspec- Division during the year is attached.

NUMERICAL SUMMARY OF ACTIVITIES

Jan. 1, 1948—Dec. 31, 1948

Engineering Filtration plant inspections 222 Chlorination plant inspections 64 Iron removal plant inspections 20 Well supplies inspected 138 Well sites examined and approved 43 Water samples collected and examined 100 Special investigations conducted (water supplies) 70 Treatment plant inspections 383 Sewer system inspections 64 Stream pollution problems investigated 38 Plant site investigations 99 Special investigations conducted (sewerage systems) 89 Sand analyses 27 Water supply plans approved 45 Sewage works plans approved 57 Swimming pool plans approved 6 Hospital plans approved 5 Sewage plant plans furnished 113 WeU house plans furnished 8 Swimming pool plans furnished 5 Grease disposal vuiit plans furnished 10 Miscellaneous plans prepared 47 Swimming pools investigated 48 Outdoor bathing places investigated 51 Hospital sites inspected 46 Existing hospitals inspected 5 Source of water supply examined for interstate carriers 24 Watering points examined 53 FHA developments investigated 53 Town or county board meetings attended 31 Special conferences with engineers, city & co. oflacials 356 20 The Health Bulletin June-July, 1949

Premises inspected for ratproofing and eradication 11853 Establishments ratproofed 740 Cost to owners for ratproofing $74881 Premises treated (eradication) 3160 Premises inspected for DDT dusting 58107 Premises treated (DDT) 33344 Pounds of DDT dust used 45308 Premises treated (poison) 22646 Local campaigns supervised (rat poisoning) 20

Sanitation

Milk plant inspections 200 Dairy farm inspections 1413 Milk surveys completed 47 Milk plant plans reviewed 23 Special investigations—milk 9 Milk samples collected 2026 Foodhandling establishments inspected 2057 School lunchroom inspections 80 Abattoir and meat processing plant inspections 194 Meat market inspections 788 Frozen food locker plant inspections 119 Poultry plant inspections 392 Plans reviewed for foodhandling establishments 397 Poodhandler schools held 26 Private water supply inspections 229 Private sewage disposal inspections 433 Privy inspections 299 Summer camp inspections 52 Institutions inspected 215 Hospital plans reviewed 40 Public school inspections 46 Swimming pool inspections 9 Hotel and tourist camp inspections 486 Complaints general sanitation 205 Special investigations 125 Special Meetings 322 Shellfish packing plants inspected 1,126 Retail seafood markets inspected 195 Water samples examined for shellfish-growing areas 157 Patrol inspections of restricted waters 114 Plans distributed 202 Number of FHA cases processed 757 Number of court cases 27

Bedding

Retail places inspected 2,312 Manufacturing plants inspected 3,634 Pieces of bedding condemned 4,372 :

June-July, 1949 The Health Bulletin 21

DIVISION OF ORAL HYGIENE—E. ducted by dentists trained in children's A. Branch, D. D. S., Director dentistry, child psychology, and methods of teaching; working under the super- From my experience as a City Health vision of the Director of the Division of Officer, I believe I have first hand Oral Hygiene. As State Health Officer, knowledge of the activities of the Divi- I covet this service for every county and sion of Oral Hygiene and I would like school in our State. to present this part of my report from The report for the year, 1948, is as the viewpoint of a county or city health follows officer. To my City, with an elementary Number of coimties receiving school population of approximately 5,- dental service 43 000 children, the white and Negro school Number of schools receiving dentists were assigned for a total of dental services 457 twenty weeks. During their stay they Total number of children re- were accepted as members of my staff. ceiving dental inspection 57,271 Prior to the dentists' arrival their tenta- Total number of children re- tive schedules in the schools were ar- ceiving dental corrections 26,296 ranged in conferences with the City Number of children referred Superintendent of Schools and the Prin- to local dentists 30,975 cipals, who were eager for the service. Niunber of lectures on Oral Hy- giene by school dentists 1,333 Briefly and statistically, their accom- Total attendance at lectures 59,994 plishments during a typical program were as follows. All of the nine City It should be noted that not quite one- schools were visited. The dentists taught half of the counties of our State partici- the importance of having clean, healthy pated in the service and no county re- mouths, as well as good dental health ceived as much time as was needed. practices, to 5,000 children in their own Both of these conditions were due to classrooms. The mouths of these child- the shortage of dentists on the staff. ren were inspected, and the necessary However, this year marked the greatest dental corrections were made for the increase in the staff since the war. Four 1,000 children, approximatly, who were well trained dentists were added to the classified by their teachers as being un- staff, and it is our hope and belief that derprivileged. The parents of the privi- this upward trend will continue. leged children, found to need dental at- The dental corrections made by the tention, received postal cards, signed by school dentists include amalgam and the school dentists, suggesting that cement fillings, silver nitrate treatments, they take their children to their own extractions, prophylaxes, and sodium family dentists. fluoride applications. This latter treat- As impressive as are these facts and ment was offered for the first time this figures, even more important are some year. In keeping with the recommenda- of the intangible benefits of the dental tions of the American Dental Asociation program. We cannot estimate the and the U. S. Public Health Service that amoimt of pain and illness, both dental a two percent solution fluoride be ap- and systemic, prevented by the early plied topically to the teeth of children detection and correction of dental de- as a preventive measure, the State fects. And it is difficult to realize the school dentists now give this treatment great values accuring to the individual to as many of the underprivileged child- and the community from the estab- ren as possible. lishment in the minds and attitudes of In cooperation with the Laboratory the children of a friendly feeling to- of Hygiene, the Division of Oral Hygiene ward the dentist and an appreciation of supplies the dentists in private practice good dental health. with the solution, upon resquest. The As City Health Officer, I recognized demand for the solution indicates that the advantage of such a program con- its use is widespread. 22 The Health Bulletin June-July, 1949

The educational part of the program of animal heads sent to be examined does not stop when the dentist leaves for rabies, but a decrease in the num- the school for, in addition to this teach- ber of those in which evidence of rabies ing in the classroom and at the chair, could be found either by microscopic the dentist has with him dental health search for Negri bodies or from animal teaching aids to give to the teachers. We inocvilations. realize that it is the classroom teacher There was an increase in the number who will make the dentist's message a of specimens of blood sent for culture part of the everyday living of the child- for typhoid and a decrease in the num- ren in her grade. This material is avail- ber of those in which the typhoid or- able, free of charge, to all of the elemen- ganism could be found. It would seem tary teachers in the State and is being that our Health Officers are more alert extensively used by them. in seeking to find typhoid carriers. There For further follow-up in the Mouth was an increase in the number of speci- Health Education Program Little Jack's mens of feces sent for typhoid culture puppet show completed its thirteenth and also an increase in the number in year. The show was witnessed, in 1948, which the organism . could be isolated. by 156,184 children. Thousands of these A decrease in the prevalence of diph- chidren wrote to Little Jack and receiv- .theria probably explains the decrease in ed answers from him. As further proof the number of throat cultures. of their friendship and admiration for There was a decrease in the number Little Jack hundreds of children on of urethral smears on microscopic slides their pilgrimages to the Capital City, which we were requested to examine for visited the dental health museum, the gonococci and a decrease in the known as "Little Jack's House," in the number of specimens we were requested Oral Hygiene Building. to culture for this organism; also in the From this summary of the work of number of positive cultures. the Division of Oral Hygiene one is im- Serological tests for syphilis still give pressed with the fact that the activities us our largest nmnber of specimen ex- are all directed toward the accomplish- aminations of a single type. There were ment of the goal and motto depicted in 402,224 serological tests for syphilis per- the mural in the Oral Hygiene Build- formed during the year—of these 2,089 ing, "Prevention through Education." were specimens of spinal fluid. We have continued our study of the STATE LABORATORY OF HYGIENE cardiolipin antigens and are using them John H. Hamilton, M. D., Director in our titered or quantitative serological tests for syphilis. These titered tests are The State Laboratory of Hygiene for restricted to those patients who have the year, 1948, can report an increase received Penicillin treatment for syphilis in the services which it renders to the outside the Rapid Treatment Centers public health cause. There has been an and to those infants who are suspected actual increase in the total nimiber of of having congenital syphilis—1,353 of laboratory examinations. A wider variety these titered serological tests for syphi- of biological products have been dis- lis were performed during the calendar tributed. year, 1948. As we look more closely we note in- Serological has also per- creases in the number of microscopic Our Group formed 449 complement fixation tests agglutination tests for typhoid fever, both rat and undulant fever, the rickettsial infec- for Endemic Typhus on tions. Tularemia and the heterophile human blood. antibodies. In 1948 we examined 9,075 specimens There has been a slight decrease in of water as compared with 8,091 in 1947. the number of specimens of feces ex- In studying the report of biological amined for intestinal parasites. products distributed during the year, There was an increase in the number 1948, it is possible to detect certain June-July, 1949 The Health Bulletin 23

trends; for instance, as compared with During the year the American Red the previous year, there is a decrease in Cross has provided use with Immune the amount of alum precipitated diph- Serum Globulin for use in the control theria toxoid which was distributed as of measles and has enabled us to dis- a single antigen. There is an increase tribute more than 9,000 packages of in the amoimt of diptheria toxoid com- Blood Plasma. We are assured that bined with pertussis vaccine and also an there will be a continuing supply of increase in the amount of triple antigen Immune Globulin but have been noti- containing diphtheria and tetaniis tox- fied that no further suppUes of Blood oids combined with pertussis vaccine. Plasma will be available for distribution. There was a decrease in the amount of During the year we distributed 19,268 pertussis vaccine distributed as a single cc of Rocky Mountain Spotted Fever antigen, although the volume still re- Vaccine which was furnished to the mains high. There were increases in Laboratory by the United States Public the amount of pertussis vaccine distri- Health Service. We have also been in- buted as a part of combinations with formed that the National Institute of diphtheria toxoid and in the triple Health has discontinued the prepara- antigen. The total number of immuniz- tion of Rocky Mountain Spotted Fever ing treatments distributed has increased Vaccine and that none of this vaccine not only for pertussis but for diphtheria will be available to us in 1949. and tetanus, if we total that used as In June of 1948 Dr. S. E. Miller, Sr. single antigens and that used as mul- Surgeon, U. S. Public Health Service, tiple antigens. The trend is definitely reviewed the activities of the State toward the use of multiple antigens. Laboratory of Hygiene. The following Since most of our deaths from whoop- excerpt from Dr. Miller's report forms ing cough are in children under four the basis on which we can report fur- months of age, we should continue to ther progress. urge that pertiissis vaccine be given "The equipment and supplies are also to children between two months and excellent, and the arrangement shows four months of age and that pertussis the results of much thought and good vaccine be included with the diphtheria planning. All this without a good tech- toxoid which is administered to children nical staff would be of no avail. How- from six months to one year of age. ever, there has been collected here a There was an increase in the amount number of thoroughly competent and of typhoid vaccine distributed in lOOcc and experienced persons, so that each vials but a decrease in the amount dis- working group has competent, constant tributed in lOcc and 50cc vials. With the supervision. increase in use of the intradermal The technical procedures, with but method of administering typhoid vac- minor exceptions are standard and the cine, it is almost impossible to give any best available." accurate estimate of the number of Among the improvements which persons receiving protective doses of the have vaccine. been made in conformity with Dr. Mil- ler's review are There has been a decrease, although added services in virus and rickettsial serology. State slight, in the amount of smallpox vac- The Lab- cine distributed. oratory of Hygiene was designated as one of several laboratories in the nation The number of antirabic treatments which would perform serological tests distributed has also decreased slightly. for epidemiological influenza. Some of The fact that we had fewer patients Dr. Miller's recommendations such as with diphtheria explains the decrease rendering of services in clinical patho- in the amount of diphtheria antitoxin logy would call upon us to depart from distributed. policies which we have followed in the There continues to be a decrease in past. the demand for neoarsphenamine. The laboratory staff now feels that 24 The Health Bulletin June-July, 1949 they can render increased service in and abilities worthwhile educational North Carolina's expanded health pro- goals. gram. Major Activities of Past Year: SCHOOL-HEALTH COORDINATING 1. Initiated a State- wide curriculum project in health education, physical SERVICE—C. P. Stevick, M. D., Co- education and safety. Director, Charles E. Spencer, M. A., Co-Director a. Approximately one hundred cities and counties have organized committees The North Carolina School-Health for local studies. Coordinating Service which is sponsored b. District meetings were held in by the State Department of Public In- six areas of the State for the Chairmen struction and the State Board of Health, of local committees, health department officially represented both agencies in representatives and for college repre- the school health and physical educa- sentatives. tion programs in North Carolina dur- c. Two State conferences have been ing the period January 1, 1948 to Decem- held for school and health department ber 31, 1948. personnel, for representatives from col- In carrying out this responsibility the leges that prepare teachers and for staff members worked with school su- representatives of other agencies, or- perintendents, principals and teachers, ganizations, and associations interested with public health department person- in the welfare of children. nel, and with representatives of other 2. Preparation and distribution of agencies interested in the health of teaching materials, standards, adminis- children, youth and adults. trative suggestions and special health Program of Health and Physical Edu- information of a current nature. cation: The program of the School- a. Four News Letters were prepared. Health Coordinating Serivce included: b. Materials for local health com- (1) Health Services, (2) Health and mittees were prepared and sent out. Safety Education and (3) Physical Edu- c. Several Mental Hygiene Bulletins cation. In practice these components have been prepared and distributd. are intimately coordinated. 3. Cooperated with other division of The health service phase of the pro- the State Board of Health and the State gram has been organized to achieve Department of Public Instruction. A few three objectives: (1) To find school examples are: children with health problems and ar- a. Participated in the preparation range for their correction, (2) To estab- of a School Lunchroom Guide. lish as healthful an environment as pos- b. Participated in a Family Life sible to protect the health of the popula- Program. tion, and (3) to promote the use of c. Worked with other groups on health services as teaching aids in Standards of Sanitation. health education. d. Worked with the State Education The health education activities are Commission. directed toward the establishment of e. Prepared recommendations for adequate health instruction of school the State Board of Education and State children so that they will develop the Board of Health to be used in preparing habits, attitudes and understandings budget request. necessary to maintain themselves at a f. Participated in the Supervisors' high level of general physical and men- Conference, the Superintendents' Con- tal health and to avoid the serious life ference, District and State Education time health hazards. Association Meetings, Public Health The physical education activites are Meetings, and Staff Conferences of aimed at promoting a program that will Health Education. reach all of the children of the public 4. Worked cooperatively with the Con- schools in terms of their needs, interests. ference of College and University Health June-July, 1949 The Health Bulletin 25 and Physical Education Personnel. This penses of others and for other expenses group was organized in May 1948 as a was given as indicated below: result of the efforts of the School- The North Carolina Tuber Health Coordinating Service to promote culosis Association $ 750.00 higher standards in institutions engaged Cleveland County Tubercu- in preparing teachers of health and losis Association 100.00 physical education. Considerable pro- Moore County Tuberculosis gress is being made in: (a) Recrmtment, Association 50.00 selection and placement of teachers of North Carolina Division of the health and physical education, and (b) American Cancer Society— 750.00 Setting up suggested standards for tea- State Board of Health 4590.00 cher preparation in health physical edu- cation and recreation. $6240.00 5. Visited schools to make surveys of Mental Hygiene: The mental hygiene needs and to make recommendations program, begun in 1947, has continued with respect to programs .building needs, to receive wide acceptance. An in-ser- persormel and facilities. vice training program for teachers and 6. Assisted in workshops, institutes administrators has been instituted on and conferences in city and county ad- as extensive a basis as present limita- ministrative units. tions of personnel will permit. Programs 7. Conducted, upon requests, demon- for classroom instruction in human re- strations particularly in screening pro- lations and for sex education have been cedures and physical education activi- initiated in several local school districts. ties. In all of the mental health services co- 8. Intensive work in Northampton, operation has been extended to and re- Warren and Beaufort Counties have ceived from community agencies whose been carried on by the Negro nurse and functions of health education overlap health educator. similar functions in the schools or Health Education Workshop: A Health health departments. Education Workshop was sponsored by Hearing Conservation: Audiometer the School-Health Coordinating Service testing of school children to detect early and the University of North Carolina at hearing defects has been greatly in- Chapel Hill from June 10 to July 20, creased during the past year in spite of 1948. The purpose of the Workshop was the loss of the special consultant. to provide opportunities for teachers, Twelve audiometers have been purchas- school administrators and health work- ed locally and programs have been ers (1) to study the major health prob- started by local personnel in these lems of children and adults; (2) to assist places. them in planning functional programs to meet the needs of their own particu- BUREAU OF NUTRITION—W. P. Ja- lar school-community situations; and cocks, M. D., Director (3) to gain basic information and a The work of the Nutrition Division mastery of skills and techniques esssen- has developed favorably during the year. tial to the best implementation of such This has been due largely to the pro- programs. gress which has been made in the pro- Six semester hours of graduate or un- gram in the past three years and to an dergraduate credit was given by the increase in staff. During the year, work University to those who completed the was conducted through the health de- work. partments, institutions and schools in Fifty-four scholarships in the amount the following twenty-six counties: of $85.00 each were given to the partici- Caswell, Rockingham, Guilford, Ruth- pants. erford, Mecklenburg, Cabarrus, Anson, Financial aid to provide scholarships, Scotland, Montgomery, Rowan, Surry, to employ consultants and to pay ex- Alamance, Martin, Duplin, Pender, New 26 The Health Bulletin June-July, 1949

Hanover, Halifax, Cumberland, Gaston, During the svmimer two field con- Cherokee, Clay, Burke, Wayne, Wilson, sultants attended workshops, one at Wake, Hoke. the University of North Carolina and The 1947 Legislature made it possible one at Sjracuse University. to offer higher salaries and as a conse- A limited amount of consultation ser- quence the staff has been increased. vice has been given to managers of some This is the first time since the Division industries. This has included surveys of was started that salaries somewhat com- food selection in mill owned cafeterias, parable to those in other states could be conferences on improving food service offered. It is expected that this will and educational work. assure a more stable staff. Negotiations Members of the staff prepared and are under way to employ six field con- published 7 magazine articles during sultants. This wUl make it possible to the year. fill some of the requests for service that Work With Nurses: The staff educa- have had to be postponed because of too tion program, planned jointly by the few consultants. nurses and the nutritionists, has been One candidate was granted a fellow- continued. Nutrition conferences were ship at Simmons College in September. held at regular quarterly intervals dur- She will join the staff on the completion ing the year with public health nurses of one year of study. throughout the State. The smallness of After three years as Director, Dr. W. the staff, for the major part of the year, P. Jacocks, resigned in September. He allowed only 43 such meetings in 1948 was succeeded at once by Dr. Bertlyn with a total attendance of 560 nirrses. Bosley who was formerly. Principal Among the subjects discussed at the Nutritionist, and who has returned to meetings were the following: results of the work after a year as Professor of the surveys of the dietary patterns of Nutrition at the Woman's College. Miss school children in different sections of Jana Jones, was employed as Principal the State; methods of presenting nutri- Nutritionist. She had served in a super- tion information to various groups of visory capacity in Tennessee for many people; nutrition during pregnancy; and years. Miss Sallie Mooring, the Con- newer developments in the field of nu- sulting Dietitian, formely Head Dieti- trition. tian at Morganton State Hospital, has Work With Teachers: The plan for had many years of experience in her giving special assistance to teachers up- field. The addition of Miss Corbett on request, has been described in pre- makes it possible to place a consultant vious reports. Eight hundred seventy- in the Western District ofBce for the seven teachers from nine counties have first time. Miss Mabel Todd resigned voluntarily attended these courses dur- to accept a teaching position in West ing the year. Following the courses of Virginia. instruction 601 teachers requested speci- A new development this year was the fic help in class room teaching and have employment in September, of a Con- conducted nutrition units with the child- sulting Dietitian, who will work with ren as a part of their health teaching. authorities of State and county institu- Some of these units included feeding tions, hospitals, sanatoria and schools experiments using rats and guinea pigs. nutrition on the improvement of food service and Consultants conducted kitchen management. The educational classes at summer conferences for tea- the University of North features of her work will be carried on chers held at Carolina Appalachian State Tea- jointly with the field consultants in and chers College. each district. She is also cooperating with the Division of Sanitary Engineer- Surveys: The plan of securing some ing in the review of the kitchen plans, information about the customary diet- with respect to their operational effici- ary pattern of a county by means of ency, for the Medical Care Commission. surveys has been continued. Before any June-July, 1949 The Health Bulletin 27 nutrition activities were begun in any fumes or dusts, or from unusual inten- county, three-day surveys werfe made sities of physical energy such as ultra- of 9-11 year old children. The plan of violet light, X-ray, noise, or radio active surveys has already been described. Dur- emanations. Common and notorious ex- ing the year, 118 children were inter- amples of causes of occupational diseases viewed for diet histories in 5 schools. are carbon monoxide gas, benzol vapor, In general the surveys revealed that the lead fumes and free silica dust. Exposure consumption of meat and meat sub- to these causative agents is not neces- stitutes, and cereals was high. The con- sarily limited to occupational activities, sumption of milk, citrus fruits, tomatoes, but the circumstances of prolonged ex- green and yellow vegetables did not meet posure to concentrations that do not im- the minimum recommended allowances mediately produce dramatic physiologi- considered important for good growth cal failures are characteristic of jobs at and health of children. industrial processes that have toxic sub- Clinics: As usual the services of the stances as ingredients, products, by- nutritionists were available in local products, or waste products, or are ac- Health Department clinics when staff companied by the use and production of would permit. Group discussions and in- high levels of hazardous forms of physi- dividual Instruction were used in the cal energy. pre-natal, well-baby, and preschool clin- A casual impression of the frequency ics. Other clinic patients were referred of occupational disease cases obtained to the nutritionist by the doctor or from the number of cases encountered nurse. Whenever possible, a simple de- in general medical practice and even monstration of food preparation to il- general hospital admission would be lustrate a way of meeting some specific that these are rare indeed. But when food needs was used in the group dis- the number of cases is properly related cussion. Twenty-six group discussions to the limitd number of individuals act- and 543 individual conferences were ually exposed to toxic materials at their held in clinics during the year. jobs, the risk assumes large proportions Arrangements were made for food and requires that industrial hygiene be and nutrition majors at the Woman's included among health department ser- College, under the supervision of the vices. Effective preventive methods are district nutritionist, to assist in clinic known and are economical to apply in demonstrations in Greensboro as a part the vast majority of hazardous expos- of their course work. This cooperative iires, although the introduction of new plan has had the enthusiastic support processes and materials confronts the of the college and has made possible an industrial hygienist with an unending extension of work in Greensboro. This series of new questions. Beyond these plan will be extended to other colleges. realistic facts that urgently recommend the prevention of occupational diseases, DIVISION OF INDUSTRIAL HY- a matter or practical administrative in- GIENE—O. J. Swisher, Jr., Director terest to health officers at all levels is that the activities of the industrial hy- The primary responsibility of an in- gienist can be made the path by which dustrial hygiene unit is the control of the broadening preventive medical ser- occupational diseases. Occupational dis- seases are those specific pathological vices of health departments can be conditions that result from the exces- brought to the industrial and adult pop- sive exposure to toxic gases, vapors. ulation.

Physical examinations and X-rays 3,197 Employees issued work cards 3,174 X-rays taken in non-dusty trades 776 Employees recommended to be removed from dusty trades 23 Employees recommended for further sanatorium study 9 :

28 The Health Bulletin June-July, 1949

Employees with tuberculosis '__ 9 1 questionable tuberculosis 1 bilateral moderately advanced tuberculosis with cavitation at right apex 1 cavitation of left lung suggestive of tuberculosis 1 advanced active tuberculosis 1 far advanced active tubercvilosis Employees with silicosis 14 2 first stage silicosis (early) 7 second stage silicosis (moderate) 5 third stage silicosis (advanced) Plants visited for examinations and X-ray of employees 34 Medical case histories submitted to the Industrial Commission 9 Supplementary medical case histories submitted to the Industrial Commission 17 Special physical examinations and X-rays as requested by the Industrial Commission 22 Diagnoses of the special examinations and X-rays 1 asbestosis, second stage 1 first stage silicosis (early) 6 second stage silicosis (moderate) 4 third stage silicosis (advanced) 1 emphysema 1 far advanced tuberculosis 8 E. N. (essentially negative) Court hearings attended 8 Conferences attended 27 (Weekly staff conferences attended in addition to above) Conventions attended 2

Future Activities of the Division of and means developed for bringing to- Industrial Hygiene: gether the activities of industrial hy- giene and local public health units so 1. There shall be no curtailment of the that maximum of health improvement activities among the dusty trades as the services can be brought to the adult Division must discharge this State-wide working population. responsibility as its first obligation. 5. There shall be an increase of con- Methods are being tried for increasing sultant work from the Division to physi- the completeness and speed of compli- cians and nurses in industry to better ance with dust control recommenda- in-plant medical and nursing services. tions. Such consultation is not limited to oc- 2. Studies of occupational disease haz- cupational disease problems, but extends ards in the furniture factories, and tex- to the promotion of new and improved tile mills are needed and can be initiat- plant medical services. These plant ed this year if an additional person is medical services offer a logical and pro- added to the Engineering Section. per point of liaison that the Division of 3. A closer contact with local health Industrial Hygiene can open to the gen- units shall be maintained by calls on the eral services of local health depart- local health officer when person of the ments, and other Divisions of the State industrial hygiene imit are carrying on health agency. studies within the local jurisdiction. 4. An experimental area shall be Eng^ineering: At the beginning of this sought in which the industrial hygiene year the engineering section of this unit will carry on occupational disease Division adopted what proved to be hazard surveys among all the industrial quite an ambitious program directed to- establishments of a single health unit, wards a more thorough investigation as :

June-July, 1949 The Health Bulletin 29 to extent of industrial health hazards personnel capable of performing these in North Carolina. Even a casual com- three types of analyses. parison of the statistical report of acti- Engineering Activities for year 1948 vities for the year will reveal a gratify- I. Field: ing increase in amount of services rend- A. Plants visited 202 ered industry over that of previous 1. Por routine inpsection 73 years. As in the past, it was necessary to 2. Por special Industrial Hy- sacrifice many services, normally render- giene Surveys 129 ed by an industrial hygiene unit, for a. Samples atmospheric con- obligations to the North Carolina In- taminants collected 265 dustrial Commission, i.e., supplying rou- (1) Dust 180 tine reports representing atmospheric (2) Other 85 dust concentrations being experienced 3. Number workers involved ^16,311 by all employees exposed to hazards of II. Laboratory: asbestos and silica dust. In addition to A. Analyses 402 fulfilling this obligation, investigations 1. Dust 261 were made relative to environmental a. Particle coimt 261 working conditions prevailing in such b. Particle size diversified industry as: c. Petrographic and X-ray _ 27 Battery manufacturing 2. Other contaminants 114 Brass foundry III. Miscellaneous: Dry cleaning A. Reports 129 Cotton Textiles 1. Routine inspections 26 Mirror manufacturing 2. Special Industrial Hygiene Fertilizer manufacturing Surveys 90 Paper printing 3. Monthly 12 Hosiery manufacturing Annual ' 1 B. Conferences and Meetings _ 9 Pound associated with these plants C. Papers presented 1 were employees exposures to such ma- terials as cyanide, lead, zinc, nitrous BUREAU OF TUBERCULOSIS— WU- oxide, sulphur dioxide, fluorides, am- liam A. Smith, M. D., Director monia, sulphur trixide, acids, radioactive materials, formaldehyde, carbon monox- 1. The Tuberculosis Division in the ide, perchloroethylene, Stoddards sol- State Board of Health emphasizes case vent and trichloroethylene. Prom the findings and home follow-up and is one statistical report given below it will be of the agencies in our State Government noted that these exposures were being which has to do with tuberculosis con- experiencd in a total of 202 plants em- trol as a whole. ploying 16,311 people. A total of 265 con- These agencies which are involved in taminated atmospheric samples were tuberculosis control and under the con- collected in the field, analyzed in our trol of the State Board of Health are laboratory and hazards evaluated. Re- a. Division of Local Health Adminis- ports of these findings, along with re- tration commendations for control of any estab- b. Division of Vital Statistics and lished hazards, were furnished all par- Epidemiology ties concerned. c. State Laboratory of Hygiene, and During the period covered by this re- d. Division of Tuberculosis Control port laboratory facilities were expanded Other State agencies who are involved to include X-ray diffraction with chemi- in the general tuberculosis program and cal and petrographic methods for ident- not under the control of the State ification of crystalline materials. With Board of Health are: the installation of an X-ray diffraction a. Department of Public Instruction, imit this Division holds the distinction which is concerned with Vocational Re- of being one of the very few health habilitation. vmits in the covmtry with facilities and b. State Board of Public Welfare, 30 The Health Bulletin June-July, 1949 which has to do with the protection of the follow-up activities conducted by patients against economic distress by the Sanatorium. cooperation with County Welfare Agen- 3. Activities: During the year mass cies, and county surveys were completed in coun- c. The Sanatoria Board which con- ties named below: trols the State Tuberculosis Sanatoria. Martin Macon In this general setup the Division of Cumberland SWain Tuberculosis Control and the State New Hanover Burke Sanatoria are closely concerned with the Johnston Caldwell problem of case finding; one agency be- Duplin McDowell ing imder control of the State Board of Haywood Rutherford Health and the other under the control Jackson Polk of the Sanatoria Board. The Tuberciilo- There were also 2 surveys in progress sis Control Division operates mobile but not completed during 1948. These X-ray units in the field making the first were Guilford and Rowan. contact with the patient, and the State Pour schools and colleges were sur- Sanatoria interprets the final 14 x 17 veyed by sepcial request, and other film and renders to the Local Health schools are routinely surveyed if re- Officer the diagnosis with recommenda- quested by local authorities during mass tions as to further treatment. This in- surveys of the county where such formation is transmitted in turn to the schools and colleges are located. Those patient and to his physician. colleges surveyed by special request The budget of the Tuberculosis Con- were: N. C. State College, Raleigh; trol Division is $222,989 of which $123,- Meredith College, Raleigh; N. C. School 000 is allocated to district and county for the Blind and Deaf, Raleigh and the health departments for the purpose of Appalachian State Teachers College, local tuberculosis control; a portion of Boone. the remainder of the budget is allocated Seven special surveys in counties were those divisions in the State Board of to carried out at the request of Local Health who are directly concerned with Health OflBcers. These surveys included tuberculosis control. chest X-ray of foodhandlers, industrial 2. Personnel and Equipment: At the workers in both large and small indus- beginning of the period covered by this try, teachers, school children and other report the Division was operating 5 mo- special groups. Counties in which such bile X-ray units and also cooperated surveys were conducted were: Wake, with Duke University Hospital in case Vance, Alleghany-Ashe-Watagua, Cher- finding through the installation of an okee-Clay-Graham, Cleveland, Forsyth, X-ray unit in the receiving section of and Davidson. that hospital for the purpose of making The number of films made in these chest plates on all persons who so de- locations varied from 1500 to 6000. sired. A total of 243,695 project films were At this time the Division has 7 mo- made by the Division, of which 1614 or bile units, 2 generators, tractors and 0.66% showed definite tuberculosis and other necessary accessories as well as 1614 showed other chest pathology, or a an additional X-ray unit which is to be total of 3,228 persons were discovered installed in a trailer for field work. Per- during the year who had some type of sonnel consists of 2 doctors, 2 health chest disease which required either ad- educators, 1 part-time consultant nurse, vice or treatment by a physician. 7 senior X-ray technicians, 8 photo- Since the last report there has been a fluorographic operators and trainees change in the method of follow-up acti- and 7 other personnel, or a total of 20 vities. Instead of the units and person- persons in the field, 6 persons in the nel leaving the area shortly after the Central Office and one clerk at the Mc- svu-vey, one mobile unit with one tech- Cain Sanatorium. This clerk assists in nician and a clerk remains in the area the processing of records pertaining to for the purpose of completing all follow- June-July, 1949 The Health Bulletin 31 up X-ray work lontil released by the Lo- County at Winston-Salem. Harmony, cal Health OfBcer. cooperation, and eflBciency has been an 4. Future Planning: Future planning outstanding feature from the date of in this Division consists of: opening. There has been no gross error a. Stimulation of routine chest exam- or major complaint reported at any inations of in-patients and out-patients time. in hospitals. Detection Centers are operating with b. Establishing tuberculosis clincis at a staff of four physicians and four al- County Health Units when funds are ternates. In a two-hour period, an aver- available. age of thirty-two applicants are ex- c. More X-rays of industrial groups. amined. A high percentage of the Diag- d. Conducting itinerant clinics. nostic-Staff members are present to- e. Continued study of methods of im- gether at each clinic session. During the proving follow-up activities. period April 27 to December 31, 2,085 applicants were examined in the three BUREAU OF CANCER CONTROL— Detection Centers. 665 were examined Ivan M. Procter, M. D., Director, Mil- in the Diagnostic-Management Centers. dred W. S. Schram, Ph. D., Field Di- 97 examinees were diagnosed cancer. rector. 673 showed benign pathology. All ap- plicants with benign pathology and can- On March 3, 1948, the Division of cer were referred to their personal Cancer Control began an active pro- physician for treatment. gram with Ivan Procter, M. D., Director, and Mildred Schram, Ph. D. Field Di- Thirteen X-rays were made. Biopsies were done. rector. 154 Prior to this date a plan of State- An amendment to the Cancer Law wide Cancer Control, including the has been passed by the General Assem- operation of Detection and Diagnostic- bly as follows: Management Clinics, had been perpared "The General Assembly of North in detail, and approved by the State Carolina do enact: Health Ofi&cer, the State Board of Section 1. Subsections 1, and 2 of Health, and the Cancer Committee of G. S. 130-285, as they appear in the 1947 the North Carolina State Medical So- Supplement to the General Statutes, are ciety. amended to read as follows: After the plan had been in operation '1. Meet the minimum requirements of for six months the progress was report- the Division of Cancer Control, North ed to the State Cancer Committee and Carolina State Board of Health. the Executive Committee of the State '2. Each physician who shall staff Medical Society, both of whom approv- such organization, board, or clinic, must ed the details of operation. be a diplomate of the American Board The first step in operation was the of the specialty of medicine of which he presentation of the control plan by the is engaged, or one who has been approv- Director to the following Coimty Medi- ed by his County Medical Society or its cal Societies for their consideration: duly appointed representative, and the Wake, New Hanover, Buncombe, For- Division of Cancer Control, North Caro- syth, Mecklenburg, Guilford, Durham- lina State Board of Health. Orange and Lenoir. In each instance Section 2. All laws and clauses of laws the membership of the Coimty Medical in conflict with this Act are hereby re- Society voted to approve the plan. pealed. Orders for adequate equipment and Section 3. This Act shall be in full instruments were placed with the State force and effect from and after its rati- Department of Pvirchase and Contract. fication." Major Cancer Centers have been A law requiring the reporting of sus- established and are in operation in New picious and proven cancer cases has Hanover County at WUmington; Bun- been passed by the General Assembly. combe County at Asheville; Forsyth A reporting card has been worked out 32 The Health Bulletin June-July, 1949

and approved, which corresponds with sentative, at Pinehurst in 1948. He also the U. S. Public Health classification, aided in the March of Dimes Campaign and can be used for comparison with and other movements to which Public other states. Health gives its endorsement. Technicians have been trained in the Cytological Laboratory at Duke PERSONNEL ACTIVITIES — IsabeUe Hospital, and this feature can be placed Richardson, Personnel OfBcer in operation as soon as a qualified lab- In 1948 many changes in the person- oratory director is available. nel of the State Board of Health and the local units occurred. At the same time PUBLIC HEALTH PUBLICITY — Mr. progress has been made in the field of William H. Richardson, Publicity Spe- personnel administration on both levels. cialist At the State level 116 appointments The Senior Publicity Specialist, who were made, of which 52 were in pro- is attached to the Division of Central fessional classifications. Separations at Administration and works vmder the the State level total 108, of which 45 direct supervision of the State Health were in professional classifications. In Ofi&cer, has reported the following ma- addition to the above personnel actions, jor activities for the calendar year of 25 reclassifications, the majority of 1948: which carried salary increases, and 27 Fifty-two regular weekly broadcasts additional salary advancements were were made over Station WPTF, cover- effected. As of December 31, 1948 there ing a wide range of Public Health sub- were 283 positions at the State Board of jects. A number of these broadcasts Health with 37 vacancies, of which 8 were devoted to infantile paralysis dur- were medical and 7 were nursing vacan- ing the period of last year's epidemic. cies. For a month or more, during the peak In the local health departments 435 of polio incidence in North Carolina, appointments were made while there the Publicity Specialist, at the request were 443 separations including 50 leaves of Station WPTF, appeared daily to of absence for educational purposes. In give the public oflBcial reports gathered addition 66 reclassifications were effect- by the Division of Epidemiology. ed. Five new full-time health ofiBcers Diiring the period covered by this re- were appointed while six resigned. Six F>ort, the Publicity Specialist has pre- health ofiBcers transferred from one pared, edited and distributed various local department to another. As of Dec- newspaper articles, including a number ember 31, 1948 there were 943 full-time of special features. It might be stated positions in local health departments in this conection that all material in- with 65 vacancies, of which 14 were tended for publication is given not only health officers and 31 were nursing vac- to the newspaper but also to the var- ancies. ious news gathering agencies such as Nine new classifications and quite a the Associataed Press and the United number of revisions in minimiim quali- Press. fications were prepared and adopted for For the past year or so, news releases use in local departments or at the State have also been cleared through the Board of Health. three Raleigh Radio Stations—WPTF, A Compensation Plan for Local Health WRAL, and WNAO. These stations have Departments was prepared, adopted and proved to be effective mediums of pub- made effective on a permissive basis licity. The pen may be mightier than January 1, 1948, and on a mandatory the sword, but the spoken word also basis July 1, 1948. Leave regulations for has its potent place in the spreading of Local Health Units were approved to be any message. effective January 1, 1948. Following a precedent set about eleven Personnel records of present em- years ago, our Publicity Specialist re- ployees and applicants have been re- ported the proceedings of the State organized and consolidated in the Per- Medical Society, as it accredited repre- sonnel Office. .

MEDICAL LIBRARY U. OF N, C

I TKis Bulletin vnll be seni free to dni| citizen of fKe Sktte upon request I

Published monthly at the office of the Secretary of the Board, Raleigh, N. C. Entered as second-class matter at PostofBce at Raleigh, N. C. under Act of August 24, 1912

Vol. 64 AUGUST, 1949 No. 8

FLUORIDE

in

NORTH CAROLINA WATER MEMBERS OF THE NORTH CAROLINA STATE BOARD OF HEALTH G. G. Dixon, M.D., President Ayden Hubert B. Haywood, M.D., Vice-President Raleigh H. Lei Lahge, M.D Rocky Mount John LaBruce Ward, M.D Asheville Jasper C. Jackson, Ph.G. Lximberton Mrs. James B. Hunt Lucama, Rt. 1 John R. Bender, M.D Winston-Salem Ben J. Lawrence, M.D Raleigh A. C. Current, D.D.S Gastonia

EXECUTIVE STAFF

J. W. R. Norton, M.D., M.P.H., Secretary and State Health Officer G. M. Cooper, M.D., Assistant State Health Officer and Director Division of Health Education, Crippled Children's Work, and Maternal and Child Health Service C. C. Applewhite, M.D., Director, Division Local Health Administration

, District Director, Local Health Administration

Ernest A. Branch, D.D.S. , Director, Division Oral Hygiene John H. Hamilton, M.D., Director, Division of Laboratories J. M. Jarrett, B.S., Director, Division of Sanitary Engineering Otto J. Swisher, M.D., Director, Division of Industrial Hygiene Bert Lyn Bosley, Ph.D., Director, Nutrition Bureau Felix A. Grisette, Director, Venereal Disease Education Institute C. P. Stevick, M.D., M.P.H., Director, Division of Epidemiology and Vital Statistics. and Co-Director, School Health Coordinating Service William A. Smith, M.D., Director, Bureau of Tuberculosis Ivan M. Proctor, M.D., Director, Bureau of Cancer Control Harold J. Magnuson, M.D., Director, Reynolds Research Laboratory, Chapel Hill John J. Wright, M.D., Director, Field Epidemiology Study of Syphilis, Chapel Hill

FREE HEALTH LITERATURE The State Board of Health publishes monthly The Health Bulletin, which will be sent free to any citizen requesting it. The Board also has available for distribu- tion without charge special literature on the following subjects. Ask for any in which you may be interested. Adenoids and Tonsils German Measles Sanitary Privies Appendicitis Health Education Scabies Cancer Hookworm Disease Scarlet Fever Constipation Infantile Paralysis Teeth Cfiickenpox Influenza Tuberculosis Diabetes Malaria Typhoid Fever Diphtheria Measles Venereal Diseases Don't Spit Placards Padiculosis Vitamins Fly Placards Pellagra Tvphoid Placards Endemic Typhus Residential Sewage Water Supplies Flies Disposal Plants Whooping Cough

SPECL\L LITERATURE ON MATERNITY AND INFANCY The following special literature on the subjects listed below will be sent free to any citizen of the State on request to the State Board of Health, Raleigh, N. C. Prenatal Care Prenatal Letters (series of nine Baby's Daily Schedule. monthly letters). First Four Months. The Expectant Mother. Five and Six Months. Infant Care. Seven and Eight Months. Nine Months to One Year. The Prevention of Infantile One to Two Years. Diarrhea. Two to Six Years. Breast Feeding. Instructions for North Carolina Table of Heights and Weights. Midwives.

CONTENTS Page

Fluoride in Surface Waters and Public Supplies of North Carolina 3 Part I 3 Part II 20 [PUBLI5MED BYTAE N^RTA CAROLINA STATE B^ARD'/AEALTA

Vol. 64 AUGUST, 1949 No. 8

J. W. R. NORTON, M.D., M.P.H., State Health Officer JOHN H. HAMILTON, M.D., Acting Editor

Fluoride in Surface Waters and Public Supplies of North Carolina

PART I By

E. C. HUBBARD, Principal Sanitary Engineer Division of Sanitary Engineering Nortli Carolina State Board of Health

During recent years, considerable in- municipalities during the past few terest has developed among health and years. The Board is, however, of the water supply officials in connection with opinion that this treatment is still in the possible advantages of adding flu- an experimental stage and that munici- oride to public water supplies as a palities might reasonably wait until the means of preventing dental caries. The treatment has been demonstrated to be U. S. Public Health Service is at pre- beneficial before starting the applica- sent cooperating with several cities tion of sodium fluoride to their water throughout the country in conducting supply. As a policy, the State Board of experiments to determine if the artifi- Health will neither promote nor at- cial application of fluoride to public * tempt to prevent towns from starting water supplies will prove beneficial in the treatment prior to a definite state- reducing the incidence of dental caries. ment regarding the results of experi- The first such project started was at mental studies now under way in sev- Grand Rapids, Michigan, where ex- eral sections of the country. In the perimental studies were begun January event, however, the treatment is initiat- 25, 1945. This experiment was initiated ed in any city, the State Board of with the knowledge that eight to twelve Health will insist that it be carried on years would elapse before tangible evi- under the supervision of competent and dence of the benefit of such treatment well trained technical water plant oper- would be available; therefore, the fiu- ational personnel. The following policy ordination of public water supplies regarding the fluoridination of public must be looked upon as still being in water supplies was adopted by the State an experimental stage. Board of Health on December 16, 1943 Request for information on the treat- and is included with this article for ment of public water supplies with the information of the reader. sodium fluoride has been received by "Present information, as revealed in the State Board of Health from several a recent symposium on fluorine in The Health Bulletin August, 1949

supervise its drinking water, is that the presence nical personnel to of naturally occurring fluorides in application. drinking water, up to 1.5 parts per mil- 2. The proposed plan of the proce- lion, tends to inhibit dental caries. dure of application and of the Experiments are now in progress, and supervision of operation be sub- some are nearing completion, to deter- mitted to the State Board of mine whether or not the addition of Health for approval before its ap- fluorine will reduce the incidence of plication is begun. caries and, at the same time, dental 3. Chemical analysis of both the raw and have no ill effects on other tissues and finished waters be made daily structures of the body. by a laboratory technician approv- "The State Board of Health takes the ed by the State Board of Health position that this is still in the experi- to insure that the fluorine content mental stage and does not care to go of the flnished water does not ex- on record as unqualifiedly recommend- ceed 1.5 parts per million as estab- ing its use. We call especial attention lished in the U.S.P.H.S. drinking to the fact that there is a small margin water standards. safety between 1.5 parts per million of 4. The daily laboratory findings be and 2 parts which may be beneficial submitted to the State Board of mottling per million which may cause Health, monthly, with the regular of the enamel of the teeth. water purification plant operation "If the officials of municipal or other reports. wish to fluorinate their water suppliers "We also suggest that municipalities oppose this water supplies, we do not contemplating this measure first secure step, provided that: the approval of their local dental and

1. The city furnishes qualifled tech- medical societies."

PART II By

F. H. PAUSZEK, Chemist In Charge

U. S. Geological Survey Raleigh, North Carolina

Fluoride is rapidly gaining prom- before additions of fluoride are made, inence because results of recent investi- the fluoride content already present in gations have disclosed that varying a- water sources should be determined. mounts of fluoride affect dental health. The U. S. Geological Survey in co- Fluoride in water is known to be asso- operation with the North Carolina De- ciated with the dental defect known partment of Conservation and Develop- as mottled enamel, if the water is used ment and the State Board of Health for drinking by young children during is making a study of the chemical calciflcation or formation of teeth. Pre- quality of surface waters and public sent investigation indicates that the water supplies in North Carolina as incidence of dental caries-decay of part of a comprehensive study of water State. The chemical teeth—is less when there are small resources of the amounts of fluoride present in the data have appeared in various State water supply than when there is none. and Federal reports. However, because Investigations have been made to de- of increasing interest in fluoride in termine the feasibility of adding flu- natural waters, available information oride to public water supplies. However, on the fluoride content in surface wa- August, 1949 The Health Bulletin ters and public water supplies in North made of the composite, whereas the Carolina has been consolidated in this analysis of monthly samples represents report. the chemical quality of the water on Determination of fluoride was made the day of collection. The table is so by a modified zirconium-alizarin meth- arranged that for daily or monthly sta- od. (1) The analyses of the public water tions the maximum and minimum supplies were made by the chemists of values are given for the year as well the U. S. Geological Survey cooperating as the average. Where only a single with the North Carolina State Board analysis has been made the concentra- of Health and the analyses of the tion of fluoride is given in the column stream samples were conducted under for single analysis. Values for fluoride a similar program with the North are reported in parts per million. A Carolina Department of Conservation total number of 207 streams and rivers and Development. are included in the table. The names and locations of streams The fluoride content in public water and rivers which were investigated for supplies of North Carolina is given in chemical quality as part of the compre- Table II. The towns and cities having hensive program are listed alphabetic- public water supplies, the name of the ally in Table I with their fluoride con- county in which the municipality is tent. Streams and rivers where daily located, and the source of the supply or monthly sampling stations have been are given. The value for fluoride, in established and operated during suc- parts per million, of the water at the ceeding water years since 1943 are in- date sampled is given. In the last col- cluded, as well as miscellaneous samp- umn reference is made as to whether ling points where single samples were the water has received any treatment. taken for chemical analysis. The col- Two-hundred and sixty public water umn headed "Period" gives the date supplies are included. the sample was collected, or the year ended September 30 during which daily (l)Lamar, W. L., Determination of or monthly samples were collected. fluoride in water; a modified zirconium- Daily samples were composited over a alizarin method: Ind. Eng. Chem. Anal. ten-day period and an analysis was Ed. Vol. 17, pp. 148-149, 1945. Mi OOOi-iT-i.-(i-i.-i>-iOO.HOi-l Ot-hCQMOOOOO - U3 C

(M Q o s 1.) .Hi-HOi-l jOOiHr-li-iOi-IOO»-ICSl OO OOOOOOi-HOO 0»-t 00*0

M

o o o o

CO lO 94 e^

t-ooeoeo^eoeot-i« CD C- ^ in 00 CO CO CO CO CO ^th CO 'JH 00 ^r ^T^^^ ^p ^r^^ ^3^^^^ . . ^5^ ^5^ ^r ^^ ^^ ^3* ^^ ^3^ ^^^ ^ ^ ^ ^ s 5; TJH I I I ^ I I I T T 1 I I I Y O) eo CQ •* OS IM t- c- CD CO IM uo ' " in .-I CM a> CO ;^ o cJ. OS o * * t- CO o o i-H I Tji 1-1 (M (M •H CSI M (M '-' csi csi I •* esi ,H CM I "V I I I I C 00 OS OS * -^ 2 ^ CO CO m CO i-i Tt* «o cq OS coeoTHcorHrH eo'

>1 >> a o O au

o , S C2 o 60 >« I"—I I—lO"—I Oi-Hi—lOOOOOOlO(MOO>—1>—(i—II—li—lOOO"—iO>— t—li—li—t

> < a o

-a u s C

c- CO C- C- CD in CO « Q ^ '^ ^ ^ ^ C8 1* Tt< O I CO c «3 (M •*! IM (N 05 (M =? S «> * CSl CM

o Tzi >> >>

:3 ^' 1? a, C s -ifa 1^ M O 3 O o

3 o ^ s Q 2 < Hi ^ o HBi O (A O(L, z o < s

{2

o

c3 c!3

> > 05 S

cS c3 ^ & c3 cS •4J -4-3 a d o o MpCQ.-l.-lO .-lO O O .-( O r-l .-I O .-(.-lr-INOl-IOOTH.-l.-(T-l.-IO.-IO.-l

eo

1 OM'^esjOi-Hi-ir-ioj-ii-ioooc^iOi-iOi-ii-iMoo rH t-l T-l i-H l-l O

Q S o 3

CI

* D •* O ,-iiMTHco»Heoeoeoot-ii-i.-iooo O '-J'-jiM'-ii-iOi-iOi-iCl.-iOOi-l

pq 00

•* 00 t£> in CO C- CO CO CO 00 CO CO CO CO t- CO CO * c- CO c- ^ Tf ^ ^ ^ ^ ^ ^ ^ CO •rt< in I I I I I I I I I I I (M 05 CO I CSI I O O o CO Tt< ,i JL 05 C

>> >>

>5 >> o a o:2 O

i-Ht-(.-iM.-ii-ioco(MOeNior-iocoot-iTjHoc

> H < Q Oei

•T3

S e>« c C Uo

in CO 'i* C- CO C- CO CO as c- CO CO Tfl ^}^ ^5^ '^' 'sj' Tj* ^ ^ ^ Tf ^J^ ^I^ ^r 1 I I I I I I I I I I I I I T I I o o 00 O (M CSl oirH.-it.oTfirsMco CO rfi o o -H OS CO CO -* -:< in E2 .-I CQ i-H 00 IM I pa I—I (N >—I (N —I >— ^ I t-H I I I I 1 I I I I I I I CO . _, o» " in m CO CO U

O 73 >>>!>> 3 3 3 3 3 >> >. 3 3 3 o o o o ^ 3 :> >>>>>> 3 U O c^ o >> >> ;-• Si 3 O Qj a> (U_ 3 o o o 5 a s a O U o ^ O O 0^0" O bD faC bx) 0) 9 w t^ O 3 3 S-t o § 3 3 3 o >> S 3 3 2 o o o o ts < >§ r^ O Ui CO pq W ^ H HBS O b 3 O z o

I < U O .J .£3 Q Z f2 <: Id O s Z O ^

"§ > 1-1 I r 1 o o 1 CO o o CO 1—ii—ii—cc<)0000>—ii—ii—lOi-H 1—II—ii-Hi—ii—I I I J

CO

00 t- •<*<

I I C5 CQ I I CO CO I

T-< O O I—I I— t-HO»-io«sioPH >-H CM T-l o •-1 O O --I o o O CO O 1-1 i-H o T-i IMi-tOi-li-HOOOOO<-l»-< 1-1,-lrH

o o

N CO

on I

'^. ""1 -; "-! esi es] 'i "^ '^ 'R '"l 1^. ^ 5^ w o o o pq w o o o fH eq ih th i-i ih o

C<1 Id Q oPS 3 b1.)

u C eo c Uo * CO C- CO C- CO «3 inc-c-t-c-mc-c-D- ^ o ^ Tj* ^ ^j* TT ^r ^r ^3^ ^p ^r ^r "^J^ I I I I I I o I I I I I I I I I CO 03 O "tipqc^c^c-c^fHcooi O rH * r-l csi I CSl .-H .— Cq C^ fq ,-( eg CM S M CSl rt ^ ^ ^ s T-l CSl I o __.i05 rii'oiii I CSl .-( t-rHt-c-c-coiooococo^i-ieooo in uC3 •S

o ra >1 >> >1 >5 >S >, >1 >J >i G G >1 >5 >> >> C G r! G 3 3 G >. O O >> >J >1 >1 >> I ^ 3 ;3 3 3 G G >> G G !^ (A o o o u o o 3 3 3 G G G G 3 -fj 3 ° a O O O O O O G G 3 3 3 3 a^ Gg O G O o « 0) 0) OJ mw 3 ^ o o o o O O O O §^ O 3 O SI £> ^ u o o o O 3 •a "O "S) "S O O o U a s O O G C !^ ^ 3 a O O .3 .3 w O o o o § 3 c3 cS .3 Si o o o o G &g .a u g 'A '^ c6 r* s fl C! G ^^ G c3 3 3 3 -3 S-i CJ5 ^^ a pq PQ M M D w MS P O H

o [I. o z o H o(J Ji Q Z ^ < u S < z H t

ii— I.— MO'-

^T ^^ ^^ ^* ^^

I I I I

•<1< T* I I i O (M CSI O I I J. ' ' ' ' f M .-H rq .-H M I I I CO r-i la to in (£> I I I I t-coc-m'^co«jM'^'~'co'^*-' coir3cOrtoocD.-i'^iM-<*oeo'<*i^I

>»>»>>

C £5 C! fl C == 3 >1 -e >> == =2 ^ ^ O -4-2 >> >i >i >> G o O O ^ >->> -1-^ -4-i -(J +J Q G a a a 3 3 -a G G o § § S .2 >> >^ S -^ -4-:> -»-3 -t^ 3 3 3 3 § G G G G o o o o Is O Li o o o § fl G_P o jG jG O U 3 3 3 13 :=! 3 o o o o a> bJD M U U O o o o o G SO ° 4^ O O O G G 0) w G .S cS S « O O O o o g &00 ^ M CO ;::; C o G (U oj " .2 .SS .Sy .2^ « •- - - o 03 ?3 2 "O w ;a o O !m '>^ G CO 9 9 9 tl *;! & ca " .3 "-^ '^ CO ra Lh w w Co c3 c3 c3 tf pq O M CC h < < >^ Q P P P § § § § < M •<^o i~ au S G G G 5 -a o o 5 G G r: CO CO 0) s OJ o u u e > •a > a; ie iti > > CO CO u G O h-l •^ != •-5 '-5 CO CO • I— o Li a O O e 3 G G G G -^^ O O L. > o •r-l to CO CO 0) (U CO W to fan fac u u m +eG 03 a; •ss^S Q O o >^ 0) i-) G G G >> c3 O O G Li L^ •fH 'i-H •(-< 03 o3 -t^ g| Lh Lh a a cS fan 0) rt o3 03 Li '-' Qi ;h G 0) d) n a a ^ ^^5 o3 >> ci ,^ O) 03 '^ G G CO CQ CO CQ -1^ HO o3 (U •s M m > > > , CQ S CO > 0) G Lh tH a O O O CO •i-H -4^ tf tf 03 03 W CQ CQ ^ > > > (Ih »Ih o: > Q ^]h cS Li Li ^^ & ^ ^ tf -4J -(J .lO O) (U u Si OJ h^ tf tf G 0) 03 o3 OJ > a & cS O Qi G G u o3 03 G S o ^ O ^ 1^ —I Tl -r! -n ^ ^J ^ (U iA (U CD (U Q O^ O) > 1^ Li Li Ol flj O) Li cq 0) _- ^ Li CO ^^ 73v^ u^01 ^^ 0^ O o Li Lh Li O O Ci o o o O G O tf K ;-i ;h !h m QUO O G G a w 03 o3 o I— G ^ ,G fan faD fan OX) D s o 03 0) O 0) -G /3 ^ ^ ^ X3 ;G ^ £1 XI G G G o O O O > 1^ S G 3 3 3 3 Li Li o3 o3 a s § O . . o O o a a a -1-^ -M CO CO CO CO CQ CO CQ CO CO CQ CQ CQ CQ CQ CQ CQ CQ CQ CQ CQ CQ CQ CQ CO mm m 01 m CO CO CQ CQ CQ I

.-iC0O'>S*MOC^Oir5iftt-400OO'5j4TtiO>-iOt-i.-iOO>-iOOOO<-i»-iO>-(O t

!

a e Uo

•* CO CO rj* CO t- t- c- t- CO in m lO r*C -*! Tj* ^^ ^^ * •*! ^ ^ 'd^ Q * I I I o I •* .— CO rH ^ O 00 CD CO Ej CO «5 '^^^ "? =? CM CM C^ "? ^ I I ^ I I I 1,11 ^ ^ CM * <*l CO 2 0. 05 CO 2 lO 00 CM eocoMcoeocMcvscoO

o o o s 1^ a, (A P^ ^ ^ >> >i >> >> ,9 -u -u +3 -u CJ S C C! CI _, O Pu Oi fc d, fo Hai

< z CQOi-Hrt O'-l'-HT-llrtOOr-l^ O rHl-HO »-< C

o o p O

k- •a 73 Ti "O "O "O "O <1> (U (U 0) .U> .4-9 4^ .1^ Oj c^ c^ c^ T3 T3 T3 •a

C3

-1-3 H '53T3 TS'O'O'C'O'OTS'a'O'a'aTS'O'a'a'CTS'aTj a 13 "O t3 0) 0) O -k9 -t-> -1^ 03 cd ^ c3 U (U 0) 0) Sh tH Ih H H Eh •o

•C -d

•a a xs 0) •a -4J ID (U -4^ a c3 ci3 0) (U ID ;- S-i -4^ -4J -4J G G G G G G t3

*<*<

T5 p C c Uo X3 "O TJ n3 u s *-• a Uo

o u

o iz;

O CI M o as

u

o

K O "O "O

K^EDICAL LIBRARY

U , OF N . C . CHAPEL HILL. N. C.

^PuUy^gjby TOlMT/lCflKIlM Smum^^RimR ^ ^^ i^ ^^ I TKis BuUetin will be sent free to dni) citizen of tKe Skij-e upon request I

Published monthly at the office of the Secretary of the Board, Raleigh, N. C. Entered as second-class matter at Postoffice at Raleigh, N. C. under Act of August 24, 1912

VoL 64 SEPTEMBER, 1949 No. 9

GETTING READY FOR SCHOOL MEMBERS OF THE NORTH CAROLINA STATE BOARD OF HEALTH G. G. Dixon, M.D., President Ayden Hubert B. Haywood, M.D., Vice-President Raleigh H. Lee Large, M.D Rocky Mount John LaBruce Ward, M.D Asheville Jasper C. Jackson, Ph.G Lumberton Mrs. James B. Hunt Lucama, Rt. 1 John R. Bender, M.D Winston-Salem Ben J. Lawrence, M.D Raleigh A. C. Current, D.D.S Gastonia EXECUTIVE STAFF J. W. R. Norton, M.D., M.P.H., Secretary and State Health Officer G. M. Cooper, M.D., Assistant State Health Officer and Director Division of Health Education, Crippled Children's Work, and Maternal and Child Health Service C. C. Applewhite, M.D., Director, Division Local Health Administration

, District Director, Local Health Administration

Ernest A. Branch, D.D.S. , Director, Division Oral Hygiene John H. Hamilton, M.D., Director, Division of Laboratories J. M. Jarrett, B.S., Director, Division of Sanitary Engineering Otto J. Swisher, M.D., Director, Division of Industrial Hygiene Bert Lyn Bosley, Ph.D., Director, Nutrition Bureau Felix A. Grisette, A.B., Executive Director, Health Publications Institute C. P. Stevick, M.D., M.P.H. Director, Division of Epidemiology and Vital Statistics, and Co-Director, School Health Coordinating Service William A. Smith, M.D., Director. Bureau of Tuberculosis Ivan M. Proctor, M.D., Director, Bureau of Cancer Control Harold J. Magnuson, M.D., Director, Reynolds Research Laboratory, Chapel Hill John J. Wright, M.D., Director, Field Epidemiology Study of Syphillis, Chapel Hill FREE HEALTH LITERATURE The State Board of Health publishes monthly The Health Bulletin, which will be sen free to any citizen requesting it. The Board also has available for distribu- tion without charge special literature on the following subjects. Ask for any in which you may be interested. Adenoids and Tonsils German Measles Sanitary Privies Appendicitis Health Education Scabies Cancer Hookworm Disease Scarlet Fever Constipation Infantile Paralysis Teeth Chickenpox Influenza Tuberculosis Diabetes Malaria Typhoid Fever Diphtheria Measles Venereal Diseases Don't Spit Placards Padiculosis Vitamins Fly Placards Pellagra Typhoid Placards Endemic Typhus Residential Sewage Water Supplies Flies Disposal Plants Whooping Cough Epilepsy, Insanity, Feeble-mindedness, Mental Health and Habit Training. SPECIAL LITERATURE ON MATERNITY AND INFANCY The followinsr special literature on the subjects listed below will be sent free to any citizen of the State on request to the State Board of Health. Raleigh, N. C. Prenatal Care. Baby's Daily Schedule. Prenatal Letters (series of nine First Four Months. monthlv letters). Five and Six Months. The Expectant Mother. Seven and Eight Months. Infant Care. Nine Months to One Year. The Prevention of Infantile One to Two Years. Diarrhea. Two to Six Years. Breast Feeding. Instrvictions for North Carolina Table of Heights and Weights. Midwives. CONTENTS Page Getting Ready For School 3 The School-Health Coordinating Service 4 Health, Physical Education and Safety Curriculum Development 6 Suggestions For School Health Service 8 North Carolina Goes Forward In School Health 13 Mental Health In The Classroom 15 Health Education Workshop 16 'tW^

PUBLI5MED BYTAE NOftTA CAROLINA 5TATE B*>ARD'/AEALTA|

Vol. 64 SEPTEMBER, 1949 No. 9

J. W. R. NORTON, M.D., M.P.H,, State Health Officer JOHN H. HAMILTON, M.D., Acting Editor

GETTING READY FOR SCHOOL

The mother in the cover picture has children experiences that will dispel the included a very important item in get- fear of the dental oflace and implant in ting her child ready for school. We feel their minds a friendly feeling toward sure that this is typical of the back-:to- the dentist and an appreciation of good school preparations being made by dental health. many wise mothers who realize that Little Jack has long been a favorite regular visits to the will dentist contri- with the children. He, too, is getting bute not only to their children's health, ready for the new school year, his but also to their happiness and success fifteenth year in visiting the schools. in school. Making regular visits to the His new show will be enjoyed by ap- dentist for dental examinations and proximately 250,000 children this year. the early correction of dental defects is Parents and teachers assert that im- the first and most effective step in the proved practices, especially in regard to control of tooth decay and the preven- food selection and tooth brushing ha- tion of serious dental troubles. bits, follow in the wake of the puppet Fortunately, this is a fact that is show. coming to be known and accepted by The teachers in the elementary more and more of the school children schools are making the most of the in- of our State every year. They are learn- terest in dental health created by the ing it from Little Jack, the hero of the school dentists and the puppet show. dental health puppet show, and from To help them in their follow up teach- their friends, the school dentists on the ing, the Division of Oral Hygiene pre- staff of the Division of Oral Hygiene of pares and distributes dental health the State Board of Health. teaching aids consisting of a handbook The school dentists who have had for teachers, graded materials for class- special training in children's dentistry, room use, booklets, charts, posters, and child psychology, and methods of teach- news releases for school papers. The ing visit, each year, as many counties material is available to any teacher, and as many schools as possible. They free of charge, upon request to the go into the elementary schools over Division of Oral Hygiene. A postal card the State where they teach Mouth from the teacher giving the grade in Health, inspect the mouths of all of the which the material is to be used and children, make dental corrections for the approximate number of pupils is all many underprivileged children, and re- that is necessary. We are gratified at fer other children to their own dentists. the many requests for material being re- Most important of all, the school den- ceived from teachers throughout the tists make friends with the children. State and hope that many others will Every effort is made to provide for the avail themselves of this service. The Health Bulletin September, 1949

THE SCHOOL-HEALTH COORDINATING SERVICE

of the State Department of Public Instruction and State Board of Health

Prepared by Charles E. Spencer, Co-Director Annie Ray Moore, Health Educator School-Health Coordinating Service

Status Responsibilities and Objectives The School-Health Coordinating Serv- The School-Health Coordinating Serv- ice is administratively responsible to ice is responsible for administering, pro- the State Superintendent and the State moting, advising, assisting and cooperat- ing schools and health departments Health Officer. It is financed by the with state, through funds allocated to the in all phases of school health and State Department of Public Instruction physical education including: by the Legislatiore and by the State 1. Health instruction in elementary Board of Health with funds derived and secondary schools with respect to hygiene, either from the state or federal govern- personal and community com- ment. The International Health Division municable disease control, mental hy- and the General Education Board of giene, nutrition, family life education, the Rockefeller Foundation have con- safety and others. screening, tributed financially to the program. 2. Health services such as medical and dental services. Howf Organized 3. Healthful school environment. The School-Health Coordinating Serv- 4. Physical education and recreation. ice has been designed by the State The School-Health Coordinating Serv- Superintendent of Public Instruction ice has also been delegated by the State and the State Health Officer as a joint Health Officer and the State Superin- service unit of the State Department of tendent of Public Instruction the re- Public Instruction and the State Board sponsibility of coordinating to such an of Health to be responsible for the extent as is possible. general supervision, promotion and ad- The School-Health Coordinating Serv- ministration of the North Carolina ice has also been delegated by the State school health program. The personnel with the colleges and universities en- of the staff are employed, except for the gaged in the preparation of teachers in person paid from Foundation funds, by the areas of health, physical education either the State Department of Public and safety. Instruction or the State Board of Character of Organization and Resource Health. Personnel Available The service was originally set up ac- The School-Health Coordinating Serv- cording to a proposal drawn up and ice is an administrative division of the signed by the two departments and State Department of Public Instruction functions according to policies originally and the State Board of Health and, as agreed upon or revised from time to other divisions in the two departments, time by the State Department of Public offers its services on a state-wide basis. Instruction and the State Board of Personnel Available Health. An advisory committee compos- ed of five persons selected by the State Charles E. Spencer, Co-Director Health Officer and the State Superin- C. P. Stevick, M.D., Co-Du-ector tendent of Public Instruction acts in R. M. Fink, Ph. D., Consultant in an advisory capacity in setting policies. Mental Hygiene Sejjtember, 1949 The Health Bulletin

Miss Ruth O. Moore, Adviser in Physi- health in accordance with recognized cal Education needs and requests. Mrs. Annie Ray Moore, Health Edu- 12. Sponsors and conducts state, re- cator gional and county conferences with in- Mrs. Georgia W. Barbee (Negro) stitutes in accordance with needs and Health Educator available time. Mrs. Julia P. Harshaw (Negro) Nurse 13. Maintains a library of professional books and other materials which are Kind of Help Available available for loan to schools and health The following is a list of some of departments for certain professional the services offered by the various staff and in-service education. members. Selected Resource Material Available* 1. Advisory and consultative service to 1. Manual of Screening and Medical health officers, superintendents and Examination for Elementary Schools principals with regard to the organiza- 2. Health Appraisal Forms—@ .$2.50 tion, administration, and conduct of the per 1000 school health and physical education 3. "Twelve Areas for Health Educa- programs. tion" 2. Assistance to administrators with 4. Suggested 12 Year Program of their in-service training program by Health and Physical Education for the means of county and local conferences, Public Schools of North Carolina. workshops, institutes, study groups and 5. Criteria for Evaluating School other types of professional meetings. Health and Physical Education. 3. Technical and advisory service in 6. Curriculum material in health, survey of health facilities, services and physical education and safety will be instructional activities and recomLmend- available as soon as completed. ed improvements. 7. Bibliographies of materials on var- 4. Advisory and technical assistance ious phases of health. in health services such as screening, 8. Bulletin—Folk and Square Dance audiometer testing, medical examina- Material. tions and follow-up procedures. 9. Bulletin—Physical Education Acti- 5. Encourage and assist local and vities for Elementary Grades—Indoor county schools in preparation and se- Games. lection of materials for local use. 10. "Betty Jean is Ready for School" 6. In cooperation with certain colleges of interest to those concerned with pre- and universities jointly sponsor health school children; "Betty Jean Grows Up" education workshops for school and for adolescents. Price: Single copy 10^, health department personnel. 20 or more 5(J, $5.00 per 100. 11. "Human Relations in the Class- 7. Assist coimty and local schools in room" I and II. 1-5 copies the utilization of local, state, and fede- Book Book $2.50 ral resources for health improvement. —5 or more $2.40. 12. Mental Health Kit—price $1.55. 8. Cooperate with other agencies and 13. School Health Policies—Price 20(J organizations in worthwhile activities each. designed to conserve or improve the 14. Play—Sing a Song for Health—for health of children and adults. grades 1-3. 9. Cooperate with colleges and univer- 15. A limited number of the following sities in the improvement of their pro- committee reports: gram.s of health and physical education. a. Nutrition 10. Participate in professional meet- b. Sanitation ings of health and education organiza- c. Physical education tions. d. School Community Cooperation for 11. Prepare and distribute curriculum Better Health material, periodic bulletins and ma- *Literature Available from State Board of terials on special subjects relating to Health, see page 2. .

The Health Bulletin September, 1949

e. Healthful School Living 1. County, city and local groups in f Education for Family Living planning programs, conferences, work- g. Mental Hygiene shops and other professional meetings. h. Communicable Disease 2. In various types of surveys. 3. In the screening and health ap- to Request Help or Materials How praisal procedures. Requests for help or materials may be 4. In planning playground layouts, secured by writing or contacting Charles and in the selection of playground and E. Spencer and/or Dr. C. P. Stevick or physical education facilities. by writing or contacting the individual 5. Local groups in curriculum im- staff member whose services is desired. provement projects.

Specific Projects in which the School- 6. In the organization of health com- Health Coordinating Service Can Assist mittees and councils.

in Organizing and Developing. 7. Colleges and universities in develop- The School-Health Coordinating Serv- ing higher standards with respect to ice can assist: health, physical education, and safety.

HEALTH, PHYSICAL EDUCATION AND SAFETY CURRICULUM DEVELOPMENT IN NORTH CAROLINA SCHOOLS By Ruth O. Moore, Physical Education Adviser School-Health Coordinating Service

The North Carolina Health, Physical have materials prepared for a curricu- Education and Safety Curriculum Pro- lum bulletin in the areas of health, ject grew out of the need for increasing physical education and safety to be pub- the emphasis on health, physical educa- lished and distributed to the schools of tion and safety and rewriting the North the State. Caroliaa Health, Physical Education The first procedure was to invite and Safety Course of Study. state-wide participation. Each county The State Superintendent of Public and city school superintendent was in- Instruction, Dr. Clyde A. Erwin, ap- vited by the State Superintendent to pointed the following to direct and guide appoint in both the white and Negro the work of the local and State Curri- schools a general curriculum chairman culum Committees: Mr. Charles E. with three sub-chairmen, one for health, Spencer, Mrs. Annie Ray Moore and one for physical education and one for Miss Ruth O. Moore from the School- safety. These chairmen were asked to Health Coordinating Service and Mr. attend the district meeting which was John Cameron and Mr. John Noe from scheduled for their section of the State. the Division of Instructional Service, In the fall eleven district meetings, State Department of Public Instruction. six for white and five for Negro schools, The first and most important decision were held in the different sections of of the Steering Committee, concurred the State for the purpose of planing in by Dr. Erwin and Dr. Highsmith, local curriculum work. These meetings Director of the Division of Instructional were conducted by the members of the Service, was to make the curriculum Central Steering Committee. In addi- work a project which would (1) improve tion to the school committee chairman, the local school health, physical educa- principals, superintendents, supervisors, tion and safety programs, (2) serve as health department personnel and col- an inservice training program and (3) lege health and physical education per- September, 1949 The Health Bulletin

sonnel were invited to the district meet- 1. Rhythms ings. 2. Games In addition to the local committees a 3. Sports State Curriculum Committee of about 4. Stunts and self-testing activities 120 people was set up to: 5. Aquatics 1. Receive and assemble materials and 6. Outdoor and camping activities suggestions from the district and As in the health group, representa- local groups. tives were selected to serve on a coordi- 2. To prepare materials to send out to nating committee. local committees. The function of both the health and 3. To do the detail work of preparing the physical education coordinating the tentative material for the committees was to prevent overlapping course of study in the three areas of material and to assist in getting a of health, physical education and balanced program. safety. The safety education group organized The membership of the State Curri- their work into the following sub- culum Committee consisted of: committees: 1. Thirty-three elected representatives 1. Travel safety from the eleven district meetings. 2. Home and farm safety 2. Selected superintendents, princi- 3. Safety in recreation and sports pals, supervisors, elementary and 4. Fire prevention and protection high school teachers. 5. Safety in work 3. Representatives of local health de- 6. School safety partments. 7. First aid 4. Representatives from college de- In order to get the cooperation, in- partments of Health and Physical terest and assistance of all agencies and Education. organizations concerned with health, 5. Representatives from the State De- physical education and safety, a state- partments of Health and Educa- wide conference was held in Chapel tion. Hill. At this conference each agency was The first meeting of the State Curri- requested and given an opportunity to culum Committee was held in Chapel make recommendations for improving Hill on Friday, December 3, 1948. Fol- the school health program of the State. lowing a general session in which cer- During the school year the local com- tain policies were set up, the group was mittees kept the State Committee in- divided into areas of health, physical formed of their work by periodic re- education and safety to do more con- ports while summary statements of the centrated work in their particular areas. State meetings were sent to all local The health education group decided that chairmen. their work would be comprised of the The second round of district meetings following sub-areas: was held in February, six for white 1. Family life education schools and five for Negro schools. In 2. Communicable disease and sanita- these district meetings progress reports tion were made by each local chairman as 3. Mental hygiene to the work which was being carried on 4. Detection and correction of defects in his administrative unit. Those pre- 5. Personal health practices sent received much stimulation and in- 6. Community health spiration from the reports which were Members of the sub-committees se- made. The State Committee members lected representatives to serve on a present at each district meeting report- coordinating health committee. ed briefly to the group on the progress The physical education group decided and work which was being done by the that the following areas of activities State-wide Committees. should be taken into consideration in The State Curriculum Committees- writing up their materials: Health, Physical Education and Safety 8 The Health Bulletin September, 1949

—each held, in addition to the first project. The work of the local units de- general meeting, two additional meet- veloped in many patterns. Some schools ings during the spring. These meetings worked on all three areas, other units were planned at separate times so that selected only one area, and in still other all members of the Steering Committee units there were pilot schools or special would be able to attend each committee committees concerned with the curri- meeting. The coordinating committees culum work. A number of workshops, of the health and the physical education conferences, institutes and other types groups each met in May to go over the of professional meetings were held in work which had been done up to that connection with this program. time, and to make plans for future work Reports from many local chairmen for their respective committees. were sent in at the end of the school Committee on Organization and A year. These reports were excellent and Administration composed of representa- showed that a great deal of work and groups was also ap- tives from the three energy had been spent in working out pointed. This committee planned in the programs in these local units. The the general outline dealing with brief schools which participated received the organization and administration their greatest benefits from the im- phase of the State Curriculum Bulletin. provement of, and in some instances the This committee accepted the responsi- beginning of, a health, physical educa- bility to prepare this material. tion and safety curriculum planned to physical education and The health, meet the needs and interests of the safety personnel of the School-Health children in their own particular school Coordinating Service and the Division or administrative unit. of Instructional Service were kept very busy throughout the year working with A good curriculum is an ever chang- the committees. The interest that was ing one which meets the needs and shown and the amount of work that interests of our boys and girls. This not was in the county and city units and state-wide curriculum project was in the individual schools more than completed last year, but will continue 1949-50 re- justified the emphasis which had been during the school year with given to the curriculum development newed emphasis and interest.

SUGGESTIONS FOR SCHOOL HEALTH SERVICE

By C. P. Stevick, M. D., M. p. H. Co-Director, School-Health Coordinating Service

Introduction the school child by means of a safe and sanitary physical environment, and a School health programs are usually daily routine involving instructional described as having three basic ele- techniques and personal relationships ments, these are: I. Health Instruction, that incorporate the basic elements es- II. Healthful School Living, and III. sential for the promoting of good mental Health Service. Health instruction con- health. Health services consist of speci- sists of that part of the curriculum fic medical and allied procedure that that includes the teaching of basic are essential to preserve and improve health knowledge through organized the health of school children. courses and through proper utilization Although the above classification of of home, school and community experi- the three elements of the school health ences in health. Healthful school living program is commonly used it is very consists of safeguarding the health of important for teachers and public September, 1949 The Health Bulletin health workers alike to realize that the program of maternal and infant hy- school health program in actual opera- giene when properly carried out together tion is a combined whole. Health serv- with adequate private medical care pre- ices and certain features of the physical pare the child for school without special environment are extremely valuable from efforts directed solely at school needs. the instructional standpoint. At the same time measures to improve personal It is customary in this state to hold health or school and home environment a series of preschool clinics each spring may easily fall short of accomplishing to correct physical defects of children their potential benefit if not adequately not previously seen in well child clinics followed up by careful health instruc- or who have neglected to seek private tion. care. Immunizations are completed at the same time. It is considered satisfac- This particular discussion is of neces- tory in sity limited to health services. Excellent most cases to delay smallpox brief presentations of the other parts immunization until the age of 5 years. of the complete school health program In view of the state requirement that are given in the following pamphlets: smallpox immunization be completed "Improving the School Health Program before entering school it is reasonable In the Southern Region" which may be to expect large numbers of children to obtained from Mr. Orville Calhoun, wait until this age before receiving this State Department of Education, Talla- immimization. It is a serious mistake, hassee, Florida at thirty cents per copy however, for reliance to be placed on and "Suggested School Health Policies" the preschool clinics for doing the in- which may be obtained from the Health itial immtmizations for diphtheria and Educational Council, 10 Downing Street, pertussis. Pertussis vaccine should be given in the first three life New York 14, New York at a cost of months of twenty-five cents per copy. since this period brings the greatest School health services have three danger from this disease. Between six major purposes: and nine months diphtheria toxoid should be given, preferably in the mix- 1. Protection of the school child from ture containing both tetanus toxoid and health hazards normally present pertussis vaccine. The use of such a when groups of children are gather- mixture at six to nine months should ed together. not replace the use of plain pertussis 2. Correction of defects that will in- vaccine at three months or earlier, in- terfere with the child's learning stead the pertussis vaccine contained process and that may prevent him in the mixture is a very necessary from realizing his full physical and booster for the immunization given at mental capabilities as a citizen. the earlier age. 3. Developing habits and attitudes re- garding health service and acquir- The pre-school clinic affords an ex- ing information as an essential cellent occasion for giving booster doses part of general health education. of diphtheria toxoid. This should be done without Schick testing since it Preschool Service not only saves time and effort but also Just as school health service should because even in a Schick negative child be examined only as an essential part the booster does will definitely prolong of the overall school health program so the protection. We now know that diph- should the school health program be theria immunity declines steadily after examined as part of the life-time health the peak is reached and unless booster protection of the individual from birth doses are given or exposure to carriers through adult life. Actually preparation takes place the remaining immunity is of the child for school life should begin valueless after a few years. With our at birth with correction of defects, care- present low diphtheria rates exposure ful feeding, general care, and after a to carriers can no longer be relied on to few months immunization. Public health maintain immunity produced by an in- 10 The Health Bulletin September, 1949 itial immunization without one or more consider them in terms of the overall booster doses. family situation. In operating pre-school clinics every Following the pre-school program effort should be made to avoid long school health activities move into the tiresome waiting for parents and chil- school itself. Within the first few days dren and to offset the unpleasant ex- after school opens the district public perience of immunizing injections with health nurses should consult with the some interesting activity provided by principals of their respective schools the school staff or voluntary assistants. and outline the schedule of school visits for the year. Unless the principal The approximate number of pre- and teachers the nurse's schedule school children should be obtained in know and have arranged their own plans to fit in advance of the clinic date. If this num- closely with it much confusion ber is very large notice should be sent may arise, time is wasted, and the instruc- out that groups with last names start- tional opportunities provided the ing with certain portions of the alpha- by health services are largely lost. bet would be seen at one particular time and that others would be seen at other The district nurse next should con- scheduled hours. Families who are not tact individual teachers in the schools able to attend the clinic at the sche- and outline the plans in detail. This duled time should be invited to one of may need to be preceded by a meeting the regular health department well- of all teachers in the school to distribute child clinics. As a matter of fact, in general information. areas where transportation is not a The time needed to complete tfiese problem emphasis placed on attending preliminary plans for the school year regularly scheduled infant hygiene or should probably be taken at the tem- well-child clinics wUl make possible a porary expense of other activities in the reduction in the load of pre-school nurses schedule so that aU schools will clinics. be fully prepared shortly after school opens for the season's health service Follow-up by the nurses of the more program. The separate items of this serious defects located among pre- program can then be handled one by school children should probably take one by the teachers and nurses on place immediately while nursing time the basis of a certain number of regular- to follow-up less severe defects might ly scheduled hours weekly or monthly be saved imtil after school opened, the until they have been completed. The parents being instructed at the clinics nurses schedule should be made known how to use existing resources to have clearly to each school staff member and the defects corrected. followed carefully. Teacher-Nurse-Physician Teamwork The teacher-nurse conference during the planning period should include dis- In North Carolina as in most southern cussion of:

states school health service is rendered 1. Daily observation by public health departments and in 2. Isolation and exclusion addition the nursing service is carried 3. Screening out on the district plan. The district 4. Periodic examinations plan requires that each nurse in a 5. Medical emergencies health department be assigned a dis- The health department policies in trict of the county or city and that these matters as established by the within her district she carry out all health officers and his advisors on types of public health nursing includ- school health should be followed closely ing school work. This has distinct ad- by the nurse and any special problems vantages. First, it conserves travel and discussed with the health officer. He in time. Secondly, the nurse learns more turn will need to discuss the general about the families she serves. When program of school health service with school problems come up she is able to the superintendent of the school unit September, 1949 The Health Bulletin 11 in advance of the season and will also For this purpose if for no other it work out with him the solution of spe- is more advisable for the district nurse cial problems as they arise. Frequently to schedule frequent short visits to time will be given to the health oflQcer schools rather than longer visits at in- by the superintendent to outline the frequent intervals. A routine should be school health service program briefly worked out in each school so that mes- to all of the teachers at their first sages from teachers will be left at a county or city-wide meeting. designated point in the school ofBce for Daily observation of the children in the nurse. her grade should be carried out by each Screening is an intensification of daily teacher. This is done the first thing in observation that requires certain speci- the morning as the opening exercises fic procedures in addition to simple ob- proceed. Its purpose is to detect children servation. This is described in the with signs of acute illness. It is also pamphlet entitled "Screening and Med- continued during the day as the children ical Examination of School Children" work and play in order to note devia- prepared by the North Carolina State tions from normal that might indicate Board of Health and State Department physical defects or chronic illness. Such of Public Instruction. Copies of this observation should be come a habit with pamphlet may be obtained by writing the teacher and after she has worked to the School - Health Coordinating with the children for a week or two she Service, Box 2091, Raleigh. should be able to detect changes due to Here again the nurse assists the teach- illness as rapidly as an observant er in learning the techniques required mother. and in securing the materials necessary. The nurse can help the teacher be- After the teacher has completed the come familiar with various signs to screening of her class she leaves word watch for and to assist in planning for for the nurse. The nurse and teacher go action when illnesses are detected. over the screening records together and Isolation and exclusion of children any doubtful cases are rechecked by the with acute illnesses should be governed nurse. by a simple rule. "When a child is sick The nurse next plans for medical send him home as soon as possible." examinations of the children found to Many serious and highly contagious dis- have defects. Usually this will mean eases have no specific symptoms or scheduling a clinic at the school and in- signs other than those of fever and viting parents to be present while the general malaise. A room should be avail- health of&cer or clinician checks each able so that a sick child can be excluded child and confirms the need for medical from the classroom while waiting for referral. These examinations by the his parents to come for him or for physician are usually not intended to someone from the school to take him be complete but rather are a follow-up home. If possible the teacher should of the screening process. Defects found telephone the health department office are discussed with the parents and they to leave a message for the nurse regard- are assisted in making plans for having ing the excluded child so that a general the corrections made. public health follow up can be made if The nurse and teacher both need to indicated. When no telephone facilities make notes as to the nature of the de- are available the teacher can report to fect. The teacher makes any changes the nurse on the latters next scheduled necessary for the individual children in visit or write a note to her. the instructional routine. After a rea- In the case of children with head lice sonable time has passed the teacher and and other conditions that require nurse confer regarding the children prompt attention but not necessarily with defects and those not corrected exclusion word should also be sent to are followed by the nurse or teacher as the nurse so that she can attend to the mutually decided upon. matter on her next scheduled visit. Audiometer testing is a technical part 12 The Health Bulletin September, 1949

of screening that is handled separately, physiological and biological subject mat- usually by a person with special train- ter but in the upper grades should in- ing. The Massachusetts Vision Test may clude the broader aspects of medical also be used by trained personnel in lieu and dental care such as the nature and vision screening proce- of the standard place of the private practitioner and dure with Snellen charts. The Massa- public health agencies in our society, chusetts test is the only mechanical the importance of medical care during vision test recommended for school use pregnancy, before marriage and during at present and is not suggested as a childhood, middle life and old age. substitute for the Snellen test in this state vmless special attention to vision At the present time the general re- is desired by the local school and health commendation is that the periodic authorities and all other parts of the examination be carried out no more often school health program are being handl- than once every three years or about ed satisfactorily. foui" times during the school period. For Other specialized screening proce- athletes the examination should be dures such as tuberculin testing should yearly. In North Carolina with rather be planned with school authorities well limited facilities available the periodic in advance. Care should be taken not to examination might have to be scheduled emphasize special screening activities at even less frequently and if this is neces- the expense of the basic general pro- sary correlation should be attempted gram. with the ninth grade course in health Where indigency is a problem referral required in all schools. proper time to indicated is made at the The place where such examinations agencies for financial assist- community are held needs to be considered. To in having corrections made. ance achieve their ultimate in educational Periodic examination of selected value they should be held in the office of children should be carried out groups of the family physician or dentist. Ar- the screening program. in addition to rangements can probably be made in examination is intended to be more This some areas to have this done at a mode- screening device and should be than a rate fee paid privately or for indigents planned so as to have as high an edu- out of school health funds. In other cation value as possible. areas such examinations could be car- Prom the standpoint of the medical ried out in the health department ex- and dental professions this examination amining room or in remote areas in the constitutes a golden opportunity to in- individual schools. doctrinate children into the routine of Medical emergencies should be plan- private medical and dental care that ned for in each school. The first aid should be followed on a life-time basis equipment to be kept on hand should for the optimum preservation of health. be recommended by a physician and In other words, this can be public re- no treatment other than emergency lations at an impressionable age. With first aid should be rendered without such an objective in mind a friendly direction from a physician. The writer and interested manner on the part of once learned of a school first aid kit the examining physician or dentist is that included a hot water bottle. This highly essential. The examination was applied on one occasion to the should be as complete as possible in- abdomen of a girl with acute abdominal cluding a urinalysis, hemoglobin deter- pain without a physicians advice. Seri- mination and other laboratory proce- ous damage might have been done by dures as may be indicated. this simple treatment if the cause of the From the school standpoint the peri- pain had been appendicitis. odic examination constitues an excel- lent opportunity to reinforce classroom Standing orders for calling a physi- instruction at the various grade levels. cian and an advance agreement with a Such instruction could cover not only physician to take such calls should be September, 1949 The Health Bulletin 13 made to handle medical emergencies should qualify themselves in first aid where at all possible. The principal and if at all possible. The nurse or health all the teachers of each school should oflBcers might be able to arrange classes be familiar with the plan worked out. for various school personnel where One or more persons in each school necessary.

NORTH CAROLINA GOES FORWARD IN SCHOOL HEALTH By Chaeles E. Spencer, Co-Director School-Health Coordinating Service

Good health for all of the nearly plan must be submitted to the School- 900,000 North Carolina public school Health Coordinating Service for ap- children can't be bought like a commod- proval. However, since specific health ity. However, the officials of the State needs vary considerably in different sec- Department of Public Instruction and tions of the State and since certain the State Board of Health believe that health services are not available at any $876,211.00 will do much to aid schools price on a State wide basis, no attempt and health departments to meet some has been made to specify exactly the of the health needs of children. items of expenditure except that all The last General Assembly granted funds must be spent for school health. the request of the State Board of Edu- In communications sent to superin- cation for $550,000.00 to be used as tendents and health officers the follow- grants in aid to city and county school ing items of expenditures were listed: administrative units for school health 1. Medical, dental, nursing, educa- work. In addition, local health depart- tional, technical and allied per- ments will receive from the State Board sonnel. Helping teachers or super- of Health $326,211.00 for school health visors of health, physical education work. State Board of Education funds and safety may be employed but will be allocated to the school adminis- teachers for classroom instruction trative units on the basis of 50 cents should be paid as formerly. per pupil in average daily membership 2. Fees for clinicians services (exami- for the previous year. In addition $1,000 nations and other diagnostic serv- win be allocated to each county regard- ices). less of school membership. 3. Correction of physical defects for State Board of Health funds will be school children whose parents are allocated on the basis of 40 cents per unable to pay for health services pupil in average daily membership to and who are not otherwise provided county, city and district health depart- for. ments. 4. Travel of personnel and for trans- It is expected that the new funds to porting children to clinics and schools and health departments will not hospitals. be used to take over any health activi- 5. Supplies and equipment essential ties carried on heretofore by local for conducting a school health pro- schools and health departments but will gram. be used to expand and improve the 6. For approved in-service training health service rendered school children. programs. In order to help assure the wise ex- Planning a budget and employing ad- penditure of both funds local school ditional personnel is only the first step superintendents and health officers will in the development of an effective be required to get together and jointly school health program. Health officers plan how the money will be spent. This and superintendents will need the full 14 The Health Bulletin September, 1949 cooperation of principals and teachers solution of which depend largely on the in planning and carrying out the de- exercise of intelligent actions of in- tails of the total school health program. dividuals, are still major problems. For Since there are many other agencies example, deaths from accidents have in- and organizations besides schools and creased. Deaths from heart disease and health departments that are vitally in- cancer have also increased. The increase terested in the health of children it is from the latter two causes can be at- important that positive steps be taken tributed in large part to the increase in to get all groups to cooperate and co- the span of life due to decrease in deaths ordinate their efforts. In some instances from other causes. this has been achieved, at least in part, This means that we must more and through the organization and operation more depend upon education for de- of a community health council with creasing death rates and for improving representatives from the major com- the quality of life. munity groups interested in child Health education must be for children, health. youth and adults for effective results. It is more difficult to reach adults Health needs will vary in different much than children but health departments, counties and cities of the State and schools and other agencies should uti- within the counties and cities and the lize every avenue for educating out-of- relative seriousness of these problems school people regarding health and dis- will vary. Listed below are some of the problems that seem to be more or less ease. common to all parts of the State: The schools offer the easiest approach to the solution of many heatlh problems 1. Accidents for the reason that the children are in 2. Malnutrition school about six hours of each day. 3. Family life problems including sex children with respect to education and maternal and child Education of health should be through several ap- care. proaches: 4. Mental Hygiene problems including tensions, fears and maladjustment. 1. Health Education Through Health, 5. Communicable diseases including Physical Education and Safety In- intestinal and respiratory disease, struction. venereal disease and diseases spread In North Carolina health instruc- by insects and animals. tion is required in grades one 6. Alcoholism and narcotism. through eight. Thirty minutes per is 7. Non-communicable diseases such as day or the equivalent the time cancer and heart disease. allotment for health and an addi- of 8. Sanitation. tional thirty minutes per day required. 9. Personal health problems relating physical education are On to balanced living with respect to the high school level health and sleep, rest, recreation and work. physical education is required in 10. Inadequate health services for chil- the ninth grade and recommended dren, youth and adults, both public in grades ten, eleven and twelve. and private. Also, health instruction is included Considerable progress has been made as a part of such subjects as home in solving those problems that can be economics, biology, sciences and the solved by public health measures. For social studies. Driver training and example, by compulsory immunization general safety are offered in many smallpox and diphtheria have been schools. Health instruction to be practically eliminated. Also, typhoid has functional must not only teach almost ceased to be a serious public scientific information regarding health problem because of safe water health and disease but must deve- supplies, adequate sewage disposal and lop proper health habits and atti- proper handling of food and milk. tudes. Instruction should be graded However, those health problems, the to the educational level of the child September, 1949 The Health Bulletin 15

and should be based upon, as far a. Provide an educational experi- as can be determined, the immedi- ence for children by teaching them ate needs and probable future the value of such services. needs of the child and the com- b. Detect in the early stages many munity in is live. which he to of the physical and mental defects 2. Health Education Through Provi- through screening and observation sion for Healthful School Living. by teachers, and nurses and medi- Clean buildings, sanitary toilets, cal and dental examinations peri- adequate lighting and ventilation, odically. and adequate handwashing facili- c. Provide follow-up procedures to ties are as important for their edu- have the remediable defects cor- cational values as they are to pro- rected. tect children from hazards. The easiest and most economical meth- d. Assist in determining some of the od of educating the child with re- major health problems and their which need concerted school spect to certain health habits is by causes providing the kind of environment and community action. in which he can practice these 4. Health Education Through Com- habits. munity Health Activities. 3. Health Education Through Health The schools should actively parti- Services. cipate in community health activi- The health services such as screen- ties. They should not only cooperate ing, medical and dental examina- with other agencies but should also tions and follow up procedures are assume definite responsibilities for important educational procedures reaching parents of school chil- as well as important services. Op- dren. Often the parent is the key portunities of periodic medical ex- to solving the child health problem. amination should be provided in School health funds referred to in every elementary and high school. the first part of this article as well as Children and adults should become other school health funds should be used acquainted with all available ap- in such a manner as to get the greatest proved health resources both pri- good for the greatest number to meet vate and public. the greatest need. Cents spent for pre- The health service program should vention will mean dollars saved in cor- aim to: rection.

MENTAL HEALTH IN THE CLASSROOM By R. M. Fink, Ph. D. Consultant in Mental Hygiene School-Health Coordinating Service

"No one likes me in this school and if in Human Relations—"Overcoming Per- things don't get better I'm going to quit sonal Handicaps." What was the bene- school." fit to Eloise, who was unhappy at school? A sixth grade teacher in Forsyth Within two weeks other sixth graders County read this on a paper turned in were including Eloise in their group as by Eloise, a twelve year old girl. The they took snapshots. She ran all over sixth grade had just had a class in Hu- the school showing her picture to the man Relations. These boys and girls teachers—she was one of "the gang" were learning to understand themselves at last. and to get along happily with others. The teacher had one big question in A week later there was another class her mind—"Who benefited most? Eloise, 16 The Health Bulletin September, 1949 or her classmates who had learned to Our Pleasant Emotions help her to be happy?" Emotional Problems at Home Two hundred teachers in North Caro- Why Daydream? lina and several thousand throughout Colonel H. Edmund Bullis, Executive the country have taught classes in Hu- Director of the Delaware State Society man Relations to sixth, seventh, and of Mental Hygiene, author of Human eighth grade students. Pupils, teachers, Relations in the Classroom, is now pre- and parents are almost vmanimously in paring a series of lesson plans for use in favor of the classes. A committee of the the eighth grade. Group for the Advancement of Psychia- School administrators and teachers try has examined the lesson plans, visit- who are interested in these classes may ed some of the classes, and has stated secure asistance in organizing them by that the classes are of great importance requesting this service from the School- in the field of mental hygiene. Health Coordinating Service. In North Carolina, the School-Health A school superintendent who has in- Coordinating Service has included Hu- stituted Human Relations Classes in his man Relations Classes as a part of its district remarked, "We believe the Hu- program for mental health in the pub- man Relations classes will develop lic schools. closer ties between teachers and pupils Printed lesson plans and teacher aids and in turn, will tie up the school and are now available for use in the sixth home more closely. Several principals and seventh grades. Here are the titles have said that the course was worth of some of the lessons: as much to teachers as it was to pupils Our Inner Human Drives because they get better insight into the How Emotions are Aroused lives of the pupils and thereby are better Our Unpleasant Emotions able to teach them."

HEALTH EDUCATION WORKSHOP by Annie Ray Moore, Health Educator School-Health Coordinating Service

"This has been the most useful and grant from the North Carolina division most enjoyable svimmer school that I of the American Cancer Society to the have ever attended;" "I appreciate the University of North Carolina. The fol- information given, the helpfulness, and lowing local Tuberculosis Associations the freedom of work;" "This workshop awarded scholarships to participants has meant more to me than any work from their respective coimties and city: I've ever done in summer school;" Durham, Chatham, Rowan, and High "Every teacher should have the oppor- Point. in the workshop;" tunity to participate Each participant who completed the statements were copied from the —these entire period received 6 semester hours the participants who at- evaluation by graduate, undergraduate or certificate tended the 1949 Health Education Work- renewal credit according to his needs. shop. Again this summer the School-Health During the workshop session the par- Coordinating Service and the University ticipants were acquainted with new of North Carolina jointly conducted the scientific information, new techniques, Health Education Workshop at Chapel many resource personnel and new ma- Hill during the first session of summer terials. Each person received a generous school. supply of free and complimentary ma- The workshop was aided by a financial terials. MEDICAL LIBRARY

C . U . OF N . CHAPEL HILL, N. C m. MtMylld) lOMl

"iJ^ ^^ of fKe Skii^e request I I TKis Bulletin will be sent free to ani| citizen upon

Published monthly at the office of the Secretary of the Board, Raleigh, N. C. Entered as second-class matter at Postoffice at Raleigh, N. C. under Act of August 24, 1912

Vol. 64 OCTOBER, 1949 No. 10

CAREFULLY

WE CAN WAIT

GRIFFITH MONUMENT CO, MEMBERS OF THE NORTH CAROLINA STATE BOARD OF HEALTH G. G. Dixon, M.D., President Ayden Hubert B. Haywood, M.D., Vice-President Raleigh H. Lee Large, M.D Rocky Mount John LaBruce Ward, M.D Asheville Jasper C. Jackson, Ph.G Lumberton Mrs. James B. Hunt Lucama, Rt. 1 John R. Bender, M.D Winston-Salem Ben J. Lawrence, M.D Raleigh A. C. Current, D.D.S Gastonia

EXECUTIVE STAFF J. W. R. Norton, M.D., M.P.H., Secretary and State Health Officer G. M. Cooper, M.D., Assistant State Health Officer and Director Division of Health Education, Crippled Children's Work, and Maternal and Child Health Service C. C. Applewhite, M.D., Director, Division Local Health Administration

, District Director, Local Health Administration

Ernest A. Branch, D.D.S. . Director. Division Oral Hygiene John H. Hamilton, M.D., Director, Division of Laboratories J. M. Jarrett, B.S., Director, Division of Sanitary Engineering Otto J. Swisher, M.D.. Director, Division of Industrial Hygiene Bert Lvn Bosley, Ph.D., Director, Nutrition Bureau Felix A. Grisette, A.B.. Executive Director, Health Publications Institute C. P. Stevick, M.D., M.P.H. Director, Division of Epidemiology and "Vital Statistics, and Co-Director. School Health Coordinating Service William A. Smith. M.D., Director. Bureau of Tuberculosis Ivan M. Proctor, M.D.. Director. Bureau of Cancer Control Harold J. Magnuson, M.D., Director, Reynolds Research Laboratory, Chapel Hill John J. Wright, M.D., Director, Field Epidemiology Study of Syphillis. Chapel Hill

FREE HEALTH LITERATURE The State Board of Health publishes monthly The Health Bulletin, which will be sent free to any citizen requesting it. The Board also has available for distribu- tion without charge special literature on the following subjects. Ask for any in which you may be interested. Adenoids and Tonsils German Measles Sanitary Privies Appendicitis Health Education Scabies Cancer Hookworm Disease Scarlet Fever Constipation Infantile Paralysis Teeth Chickenpox Influenza Tuberculosis Diabetes Malaria Typhoid Fever Diphtheria Measles Venereal Diseases Don't Spit Placards Padiculosis Vitamins Fly Placards Pellagra Tvphoid Placards Endemic Tvphus Residential Sewage Water Supplies Flies Disposal Plants Whooping Cough Epilepsy, Insanity. Feeble-mindedness, Mental Health and Habit Training.

SPECIAL LITERATURE ON MATERNITY AND INFANCY The following special literature on the subjects listed below will be sent free to any citizen of the State on request to the State Board of Health, Raleigh, N. C. Prenatal Care. Baby's Daily Schedule. Prenatal Letters (series of nine First Four Months. monthly letters). Five and Six Months. The Exnect'ant Mother. Seven and Eight Months. Infant Care. Nine Months to One Year. The Prevention of Infantile One to Two Years. Diarrhea. Two to Six Years. Breast Feeding. Instructions for North Carolina Table of Heights and Weights. Midwives.

CONTENTS Page

Obesity _. 3 The Sanitarian __ 5 The Roanoke Mill Cafeterias 12 Notes & Coment 16 IPUBLI5AED BYTAE N^RTA CAROLINA STATE B**ARD^/AEALTA

Vol. 64 OCTOBER, 1949 No. 10

J. W. R. NORTON, M.D., M.P.H., State Health Officer JOHN H. HAMILTON, M.D., Acting Editor

OBESITY Charles W. Styron, M. D. Raleigh, North CaroUna

Obesity is the quality of being over- thyroid gland itself. In other words body weight due to the accumulation of ex- weight in the absence of diseases which cess body fat. This statement needs cause water accumulation, or tumor some elaboration, however, for there formation is due to one factor, and are certain conditions in which an in- one factor only, namely the amount of crease in weight above the normal is energy taken in as food. This statement not due to fat, or if such is the case, is is a fact. It has been demonstrated over due to the accumulation of fat in only and over again by chemical and me- certain areas of the body. The latter is chanical means in the human being. the case in the formation of fatty tu- Patients have been kept under observa- mors or fatty deposits in the body. For tion over long periods of time under example, overweight may be due to conditions which have enabled physi- certain diseases of the heart, kidneys, cians to prescribe exact quantities of and liver in which water accumulates various foods. It has been possible to in the system. Weight tables may aid make those patients lose or gain weight one in determining the normal weight at will by the number of calories given. for age, height, and sex but perhaps Furthermore the physician is able to the best index of obesity is appearance. tell the patient beforehand exactly how If one is to use weight tables as an much he will lose or gain on a certain index of normal weight it may be neces- caloric intake, and the physician will sary to add or subtract 10% of the not miss that calculation more than a weight designated in the table for the few ounces over a period of months. body build. If one is stocky with heavy This is to say that the human body bones 10% may be added whereas if one burns food much in the same way that has a small frame 10% may be sub- a gasoline motor burns gasoline. We tracted from the standard weight tables. know that a Chevrolet, let us say, will It must be emphasized that only one go 18 miles on a gallon of gasoline. The form of obesity exists. This is due to human body likewise will derive so the excessive consumption of food. much energy from 1000 calories, no Various disorders have been credited more and no less, and if this 1000 with causing obesity. For example, it is calories is not used as energy in entirety common to hear that one's obesity is then the remainder is stored in the due to the thyroid or glands. It would body—some as fat, some as protein, and be proper to say rather that one's some as carbohydrate. obesity accompanied disease of the thy- The above statements are necessary roid for it is certainly not due to the as preliminaries in any discussion of The Health Bulletin October, 1949

obesity. It is rare that such statements ought to be reason enough to seek the are accepted by the laity for there is cure, that is weight reduction. It is in- popular belief that the quality of being teresting to speculate on the effects of fat or thin is due to family trait, glands, distributing around the body fifty pounds or heredity. It is quite true, of course, of accessories and trying to do a day's that a fat mother and a fat father will work with those accessories hanging on. have as progeny fat children. If the It is not difficult to imagine the fatigue children are not fat, then later in life that might result from such an experi- they are apt to be. This has nothing to ment. Yet this is precisely what the do whatsoever with heredity but it has overweight patient does each day with- a great deal to do with environment. out thinking a great deal about it. The son will tend to copy his father's The sum of the above statements is choice of foods and the daughter will that obesity is undesirable, unattrac- tend to copy her mother's. Perhaps it tive, unhealthy, and unnecessary. There- would be more scientific to say that fore, one might ask what can be done children, regardless of sex, will follow about it. The rules are simple. Reduc- the example set by the parents. It is tion ought to be attempted only under an axiom that if a young suitor would medical supervision. The reasons for envisage his wife-to-be in years to the latter statement are as follows: come, then he must first study her rapid weight reduction is undesirable mother. This seems especially true in (1) because it is usually accompanied regard to weight. by fatigue and a sense of ill health; (2)

Obesity is a disease state because it because inadequate content of various of is a deviation from good health. This is types food may be necessary for such constantly in evidence. We know that reduction; and (3) because one may fat people do not live long. Few doctors not have time to readjust eating habits can remember a really fat patient who during short course reduction regimes, lived to 80, and only the rare fat patient thus accomplishes nothing in the long run. who lives to 70. Life insurance com- panies are well aware of the mortality What then is the course for one to statistics in the obese and adjust their pursue who seeks to reduce. He should rates accordingly. No matter what other first of all know that no associated dis- chronic disease the fat patient may ease is present, for example, heart dis- have the physician will invariably use ease, diabetes, or kidney disease, each as the first step in his treatment the condition which of itself requires cer- advice to reduce. And the fact is, fur- tain attention. He should then be start- thermore, that in a great many chronic ed on a diet designed to produce a diseases it may be the only treatment weight loss of about four to six pounds necessary. It is well known that over- a month. The diet should be well round- weight people become short of breath ed, palatable, adequate in minerals and readily on exertion. This is due to vitamins, and with not less than 150 several factors, the most important of grams of carbohydrate a day. At the which are the effects of the excess same time a minimum of one gram of weight on one's heart and circulation, protein per kilogram of desired body the fatigue of muscles induced by carry- weight is necessary and the fat content ing excessive burdens over and above is usually appreciably reduced. Water the burden for which muscles were de- may be used in any desired quantity signed by nature, and the inability of since no calories are present in water. overweight individuals to readily dis- Alcohol, of course, contains consider- pense with heat which accumulates in able energy, (7 calories for each gram the body with exercise. Accompanied or 35 calories for each teaspoon) and by a variety of symptoms associated is not allowed. with obesity are the frequent complaints It is well to warn individuals who are of aching feet and on occasion swollen planning to lose weight that such nos- ankles, symptoms which of themselves trums as are advertised in various popu- October, 1949 The Health Bulletin lar magazines are in general dangerous well in a short time and should not feel as a form of treatment for o'besity. the hunger that seems to bother so Some of these compounds have been many patients who have tried more known to produce a type of blood dis- rigid regimes. (The pronoun he is used order which produces death. Others advisedly because it is well known that have so depressed the bone marrow as it would be statistically more accurate to to make emergency treatment neces- use she!) sary. Occasionally thyroid and such Eating properly is a trait much to be medication as amphetamine sulfate are desired. For one who has had faulty used but should be used only under the eating habits over a period of years supervision of a physician. changing those habits will indeed re- And finally he should be checked quire character. But there is much to periodically to be certain that the de- be gained in health, even to the point sired results are being attained. With of adding many years to one's life such gradual weight loss he should feel expectancy.

THE SANITARIAN* H. E. Miller, B.S.C.E., M. P. H. Resident Lecturer in Public Health Engineering and Sanitation University of Michigan, Ann Arbor

Introduction made, it is helpful to look at some of the past history even at the hazard of Your planning committee has sub- lapsing into reminiscence. mitted three suggested topics from Administrative health authorities as which to choose a title for this discus- well as the public are inclined to be sion: lulled into a feeling that we have ar- 1. "Ethics, Qualifications, and Re- rived in Sanitation and become enamor- sponsibilities of the Sanitarian." ed of the newer and seemingly more 2. 'The Sanitarian — His Qualiflca- appealing things in public health. Let tidns, and Responsibilities." us never forget however that sanitation 3. "Professional Aspects of a Sani- is the wholesome bread and butter of tarian." public health while many other activi- It has been elected to utilize the ties more popular for the moment are privilege and cut across all authors the frostings which sometimes even avoid limitation the three. In order to cause administrative indigestion when to "The Sani- title has been reduced indulged in to excess. tarian." Local health departments grew from questions immediately occur, Certain local sanitation units. That was true in such as who is he, what is he, what the large cities whose first activities, does he do, how does he do it, what poorly conceived and directed as they which to it, what does he need with do were, nevertheless were aimed at en- recognition does he accomplish, what vironment. The history of the Yakima compensation, does he receive—as to apples and early hookworm campaigns professional, where does he wish and does not have to be recounted to this to go from here and what are the pos- sibilities. Address delivered at the Annual Inter- To understand what we have in the state Sanitation Seminar which was attend- ed by 325 men from Maryland, Virginia, sanitarian of today and to appreciate West Virginia, South Carolina and North the significance of the obstacles he still Carolina, the District of Columbia and United States Public Health Service at faces as well as the advances he has Blue Ridge Assembly, August, 1949. The Health Bulletin October, 1949 group to remind you that county health pendability, willingness to work, and the departments grew from county sanita- experience of salesman for something. tion units, staffed by a medical director The importance of this latter item lies and one or more sanitary inspectors. in that sanitation must be sold. It The work done by these pioneers was so necessitates dealing with people. With impressive that the people wanted more on the job training, direction, and back- of it, and these units expanded in their ing, these men did raise the level of the activities to the broader service. Curi- sanitary inspector as did many similar ously enough however, as the depression men in other states. They were the of the 30's progressed the number of backbone of public health in their time, sanitarians decreased until most county and some of them are key men in sani- health units had no sanitarians. tation even today. This was the situation which existed What we talk about today under in the early years of the depression. It qualifications is a far cry from these continued until malaria control and qualifications. Yet we are forced to re- sanitary privy projects began to take cognize that it was the work of such a prominent place in "made" work men in the earlier days of the develop- programs. Later in the approval of bud- ing health department practice that gets for federal funds allotted to local built the solid public health structures, health units, sanitation was accepted as resting upon the support of public one of the basic functions. opinion, in which we are able to sit You will note use af the term "Sani- today (sometimes in ivory towers I tary inspector" in this discussion of fear) and promulgate qualifications. the Sanitarian. The term means differ- More and more specificity of qualifica- ent things to different people yet to- tions is of course obviously necessary day. There was a time when it was and the character of the work requires practically an insult. As many of you more and more emphasis on technical know city councils commonly relegated knowledge, but we should not forget broken down spavin splinted worn out that it was the accomplishment of men policemen to duty with health depart- that could not meet most of our present ments as sanitary inspectors. Local ap- day qualifications who gave us the op- propriations of health departments have portunity to write qualifications. They frequently been obtained thru a promise learned the hard way what we insist to employ the county commissioner's now that newly inducted personnel nephew as sanitary inspector. One state must know. They learned what we now well known for local health service still need to teach sanitarians as training. uses this device of throwing the poli- They knew how to work with people. ticians this one small piece of political Having just gone thru an election red meat to forestall the demand for year and now located in a Republican employment of some local worn out but state I sometimes "view with alarm" politically acceptable physician as di- our growing tendency to surround our- rector. Obviously personnel of such ori- selves with qualifications. We must not gin rarely cast credit upon the position. allow ourselves to build up a high level Recognizing the poor standing of the of qualifications for qualifications sake title, and not being versatile enough to alone and lose sight of the fact that coin a new name, it was undertaken after all we should get some work done. here in North Carolina in 1919 and A few years ago the director of sani- other states of this region especially, tation of a state where most of the local to bring dignity to the position thru health units were manned with sani- the character of the work performed tarians either holding a degree in en- by the sanitary inspector. The qualifi- gineering or masters degree in public

cations sought in this state were , age health asked me to undertake to deter- sufficient to provide maturity but suffi- mine what was wrong with the local ciently young for aggressive activity, sanitation activities. The answer was good personality, integrity, honesty, de- fairly easily found but most shocking to October, 1949 The Health Bulletin the director and regarded as pure trained personnel appropriate to the heresy on the part of a member of the activity in each section. In fact some stafE of an educational institution. The universities have set up degree programs answer was simply this, "Your sani- leading to the masters and doctorate de- tarians have too much education." Now grees in "Sanitary science" for individ- don't understand that I underestimate uals who wish to pursue a highly specia- the value of training. On the contrary lized program of study of certain phases of it is basic to progress, orderly develop- of sanitation. With due recognition ment, and quality performance. The the need and place for specialists the point is they totally misconstrued what fact that the sanitarian of the average their advanced technical knowledge was department cannot be a specialist but supposed to do for them. They aspired must have a working knowledge of many to be pseudo health officers. They had things should not be overlooked. This is white collar itis. They couldn't show the area of training least satisfactorily a man how to do a thing because they served at this time. He must also know were above doing it themselves. Train- how to work with people. ing is intended to improve both the In view of many there is still a place quality and quantity performance in for the "Sanitary Inspector." A place, sanitation. All training and all trainees too, for a very high type person. Above should have this concept in mind. all his action should be dependable. To Health administrators of the late do his job well he must know how to thirties adopted a new term "Sanita- work with people and be thoroughly in- rian." There is considerable variation of formed in the interpretation of the opinion as to what the term signifies. standards he is employed to administer. differentiation Some say it is a more dignified designa- It is believed that the tion for the sanitary inspector. In fact should be based on whether the per- technical it is frequently so used. Still others con- formance involves special sider it a top title, first of all that it knowledge, capacity for technical analy- suggests an individual who is qualified sis and guidance, responsibility for plan- with appropriate technical training, not ning and development of activities to only to do the job, but to do it under- meet a need in the case of the sanita- standingly, and work from the basic rian, or the reliable execution of inspec- science involved to the solution of prob- tion vmder competant technical supervi- lems not listed in "the book." sion and guidance to determine con- formity with regulations in the case of Moreover it is increasingly suggested the inspector. A good health organiza- that sanitation should be understood to tion like a good ship requires a variety include all concern of the environment, of personnel suited to the work to be that it includes sanitary engineering for done. Unquestionably broad gauge en- instance, and does not just refer to non gineering direction is required at the engineering interests. Under this view, level and in the larger cities and sanitary engineers, sanitary chemists, state other populous or metropolitan bacteriologists, entomologists, and a long more type areas. The navy does not attempt list of other groups, would all come to ships by admirals alone, how- under one general term sanitarian in man ever, nor can a health department af- making their respective contributions in ford to do so. sanitation. In this connection there are several states that have carried out re- What He Does organizations in which there is no longer a bureau of engineering but a Bureau What the sanitarian does would take of sanitation headed by a qualified much space to enumerate, nor need it broad gauge public health engineer in be detailed to this group. His duties and which there are appropriate sections, responsibilities have however multiplied such as one devoted specifically to and become more complex with the de- water supply and sewerage, another to velopment of health practice. Keeping food and milk sanitation, with specially pace with a shifting need has necessitat- 8 The Health Bulletin October, 1949 ed increasing demands in his basic throughout the country he has been background to become a sanitarian and making cross connection and back- the necessity for special and inservice syphonage surveys and getting some- training. The "short courses" conducted thing done directly or indirectly. In the by the University of North Carolina and larger cities he has also undertaken air other schools have made monumental pollution abatement to clear up exces- contribution in filling in essential items sive smoke and "smog." He has to be of technical background. an authority on building illumination, The time was in this and neighboring ventilation and crowding, and the con- states when the big and all consuming trol of weeds that cause human dis- need in sanitation was the correction of comforts such as hay fever. If he is insanitary disposal of excreta. As a mat- smart he works with city and communi- ter of horse sense engineers and other ty planning committees. In the merry state and local sanitarians devoted go round of new demands insistant themselves during that period principal- pressure in housing is felt, and now it ly to maintaining safety of public water is being suggested that sanitarians lead supply, promotion of new systems of off in home accident prevention. water supply and sewerage and the With due regard to all these broader temporary stop gap of sanitary privies interest, the fact remains that the bed- where sewerage could not be secured. rock of sanitation in any community is This action had the desired effect, well protection of water and milk supplies, known to all of you in the almost com- waste disposal, food and food establish- plete disappearance of typhoid fever. ment sanitation, and insect and rodent Then in the late twenties the energies control in certain areas. of these same workers began to be shift- It is obvious that he not only has to ed to milk sanitation, food sanitation be an extremely well informed person, and in certain areas, to greater empha- versatile and ambidextrous in action, sis on malaria control, because these but that there are not enough of him. were the problems next in order of re- Emerson attempted to set standards lative significance. for number of personnel in his A.P.H.A. New knowledge and new techniques committee report on "Health Units for were required but the more experienced the Nation." WhUe we would be much men here have long realized that the better manned than we now are if we same basic approaches heretofore found had the personnel his report suggests it successful covild be used in new activi- is obvious that the basis he suggests ties. The sanitarian works with the fall far short of the need. people and for the people. The people, We are suffering today from a com- their recognition of a problem and their mon practice of directors of local health cooperation in its solution are essential administration working out a budget in the new activities as well as the old. with the local officials for a medical The "four horsemen" of North Carolina director, X number of clerks, one niirse and the "four horsemen" of Virginia for each 5,000 population and one sani- like the Johnson Barfield twins of Ten- tarian. They haven't always gotten one nessee, who earned their spurs in sani- nurse for each 5,000 population, but tary privy work, have dis:inguislied they had something authoritative to themselves in their respective states in shoot at and on the whole have come the way they developed and executed nearer reaching the goal in nursing per- programs in milk sanitation, food sani- sonnel than we have in reaching any tation and other fields. goal for sanitation personnel for we The sanitarian does still more. In re- have had none. The fault is ours. The cent years in this area he has under- nurses studied their problem and pro- taken rodent control. In some areas vided some guides to administrators, he studies problems of garbage and re- backed up by an impressive analysis of fuse disposal and provides the stimulous comprehensive data. and guidance in this field. Generally There is hope, however. Several ex- October, 1949 The Health Bulletin ploratory efforts have been made. While system stipulations nor by any degree there are no doubt many studies under- of technical knowledge. He must be way, I am familiar with a few of them. willing to work, hard and long. He can Happily these and other isolated efforts not observe union hours or the N.R.A. have helped to provide the plan of a five day week and get anything accomp- study being midertaken by the engineer- lished. We have arrived where we are ing section of A.P.H.A. It is expected as a result of the devoted efforts of that in the near future you will be asked men who believed in what they were to contribute in some way to this study. doing and applied themselves with a For your own benefit as well as for ad- missionery spirit. As C. C. Applewhite vancement of the study, I bespeak your says, "A sanitarian is no goou unless hearty cooperation. May I say in pass- he has the foolish glimmer in his eyes." ing that the willingness of the section He needs these personal attributes to- to embark on such an activity is largely gether with personality, good judgement, accounted for by the broader interest character above reproach, the ability of the section and its determination to and will to teach, and the capacity of serve the needs of all workers in sanita- leadership. More than any other mem- tion adopted at the Cleveland meeting ber of the health department he must in 1946. be at home in all social and technical And finally the competent sanitarian levels. His work requires him to meet does not necessarily do all these things business and professional people on himself. It is true that some other gov- their own level, and at the same time ernmental agency operates the sanitary that he be able to wear a pair of over- utilities, maybe a building inspection de- alls gracefully, "chaw tobaccer" with a partment does plumbing inspection and relish and have the dexterity to hit a of course the department of education fly at ten paces. What I mean is he has manages the schools, but it is the obli- to acquire and maintain the confidence gation of the sanitarian to accomplish and respect of all people in all levels, observance of appropriate sanitation thru channels they imderstand. More needs. As to how it is done depends upon people have their only contact with the his ingenuity, ability and resourcefull- health department thru the sanitarian ness. It is again a case of dealing with than any other member of the staff. people. The standing of the health department is therefore largely in his hands. One What He Needs To Work With other indispensable need, but which is Some of the things he needs to do beyond his control is the interested and all of this, have been mentioned. Fore- understanding council, and unfailing most of course, is appropriate and ade- backing of the director. quate knowledge of the technical con- Moreover he needs from an appropri- siderations and practical aspects of the ate agency in the state health depart- problems encountered, which involves ment—preferably the division of sanita- training, to which educators and ad- tion — technical guidance, assistance, ministrators are devoting diligent study. counsel, aggressive leadership, condol- Adequate technical knowledge has about ence on occasion, alert watchfulness as the same significance as the cake of to his professional and individual wel- yeast used in a mixture of flovir and fare and advancement, in short evidence water. Without the yeast the bread does that somebody does love him after all, not "rise." Without the technical know- recognizes his good deeds as well as his ledge the sanitarian may thresh around shortcomings and will help him over the aimlessly, but technical knowledge alone tough spots. does not assure performance. Framers of merit systems have attempted to re- What He Has Accomplished flect these needs in qualifications. What he has accomplished is specta- He needs some other things though cular, particularly in these states where that can not be guaranteed by merit typhoid fever and the other intestinal 10 The Health Bulletin October, 1949 diseases were major health problems in. rabies season, and is dispatched on all the memory of all of us. What manner of nuisances and runs the er- he accomplishes from now on is no rands for the department. If he must less important but much more do all of these things and still can do difBcult to evaluate. In a rapidly de- the creative and constructive work laid scending typhoid curve the accomplish- out for him in his spare time he must ment of sanitation is easily shown. be a super type of man, greater even Other indices will have to be determin- than "mighty mouse" himself. ed. What is too frequently overlooked Recognition is that relaxation in any phase of sani- Compensation tation may cause a reoccurance of dis- ease brought under control. Mere main- A look at the compensation, improved tenance of ground gained may be more as it is since the war years, but com- positions is important in some areas of concern than pared to other responsible measurable advances in certain other often deflating. The old idea of using to pay off a areas. just anybody, probably political debt, or employment of the Why should we get so excited over mayor's cousin to secure support for the geriatrics anyway? Everybody has to die appropriation, has had a tremendous some time. One significant reason we effect in holding down the salary scale. see such high rates of heart disease to- While I fervently hope for material ad- day is because we have done such a vance on this point, I do not believe it good job in sanitation that vast numbers should or can be attained through union have survived the old epidemic condi- tactics. Although certain political ele- tions and have lived on to an advanced ments and others disregard the law of age and become heart failures. supply and demand, it is believed that Just as effective sanitation has con- when the supply is capable efficient tributed a larger old age group it has work, it will be in demand, and event- been the basic element in paving the ually compensated accordingly. This way for full scale health organization necessitates aggressive action on the that now undertakes to deal with this part of the state agencies supervising wider range of problems. local heatlh work and in control of the Sanitation, interpreted as measures of funds for participation in local heatlh control of man's environment, however, department budgets. Moreover, it neces- must go far beyond communicable dis- sitates aggressive action on the part of ease control into general comfort and the health ofBcer, which cannot be ex- safety, which will require additional pected to precede demonstration of means of measurement of accomplish- value of service but may be expected to ment. follow such demonstration in some mea- Having looked at this individual and sure. concluded, from the requirements set Professional out for him to fulfill, that he must be some kind of a superman, moreover Professionally sanitarians have been having modestly acquiesced in the ap- in the dog house, largely because neither praisal of the contribution he has made they nor anyone else knew just what to the public health and the welfare of they were or should be. With the deve- mankind, it might be assumed that he lopment of qualification standards the enjoys a measure of appreciation, re- picture is somewhat clarified. cognition and esteem to which all would There have been several attempts at wish to aspire. orangization on the national scale. Unless health officers in this area are These have served some useful purposes, different than average, and unless con- mostly on a local or area basis, how- ditions in this and neighboring states ever, but have not fully met the need have materially changed since the early so far as development of professional thirties, he probably is the fellow the identity or furnishing a vehicle for ex- director sends out to put up quarantine pression, and advancement on a national signs, that serves as dog catcher in scale are concerned. October, 1949 The Health Bulletin 11

If it were not for the health depart- health worker who meets the associa- ment federal, state, and local, there tion's requirements for "Fellow" may would be no sanitarians. They are part become a fellow and may become aflBli- of the health department organization. ated with the section wherein his major What affects other units of the health interest lies. The mistake was in the department frequently impinges on their prevailing misunderstanding of the as- own interests as well. They are a unit sociation's provisions as to "Fellows." of a total profession which is public At the Cleveland meeting of the health. The only organization which A.P.H.A. opening the membership of serves this profession exclusively is the Fellow in the section to sanitarians American Public Health Association. other than engineers and broadening Granted that for many years sani- the activities and interests of the sec- tarians did not enjoy the privilege of tion were given extensive discussion, the sanctuary this organization provid- and resounding affirmative action. ed, that condition is now corrected. There is, therefore, a definite profes- Individuals and organized groups of sional home for sanitarians in the sanitarians made application to the A.P.H.A. Of course, not all sanitarians association for recognition in full mem- are eligible for "Fellow" in the A.P.H.A., bership status of "fellow", which carries but a great many are eligible who have the right to vote, hold office and other not yet made application for admission perogatives. to "Fellow" and assignment to the sec- First of all they were denied a separ- tion. Those who are eligible should make ate and additional section, which was application and when affirmed take an no doubt wise policy. The only existing active part in the affairs of the engi- section where there interests could pos- neering section, for their own benefit sibly and obviously should lie was the and furtherence of the interests of engineering section. Sanitarians who sanitation and all engaged in such work. were members but not "Fellows," made It is hoped that the time will come application for status of "fellow" and when sanitation sections of state public assigrmient to the engineering section. health associations will have official re- One at least was made a fellow but not presentation on engineering section admitted to the engineering section be- council as the affiliated state public cause it was then erroneously under- health association now has on the gov- stood that he must be an engineer to erning council of A.P.H.A. become a "Fellow" in that section. He In the meantime each state sanita- did, however, become affiliated with the tion has been asked to name a repre- education section. sentative to be appointed by the chair- About a dozen members of the engi- man of the section to membership of neering section got together aroimd an advisory policy committee composed three years ago and set out to: of such representatives. Working with 1. Get the "Fellow" requirements this committee, section council is over- changed so that qualified sanitarians hauling its program and outlook to the who are not engineers could have full end of serving adequately all types of "Fellow" status as well as membership sanitation interest and personnel. in the engineering section The establishment of regular corps 2. Broaden the scope of interest and and reserve commission status for sani- activity of the engineering section to tarians in the Public Health service is serve the technical and socio-profes- an important step in helping to fix the sional interests of workers in all phases status of the sanitarian professionally. of sanitation, and Future Possibilities 3. Change the name of the section if necessary. The National Sanitation Foundation, It soon developed that the first ob- to be discussed later, is an instrument stacle did not exist. Under long stand- that has almost unlimited possibilities ing rules of the association any public for advancing the interests of sanitation, 12 The Health Bulletin October, 1949

and it naturally follows the interests of Moreover the increasing demand for those engaged in sanitation work. More- sanitarians in industry provides a grow- over it offers the possibility of focusing ing opportunity for financial recogni- public attention on sanitation to the ex- tion. As industry becomes better in- tent that the sanitarian will enjoy much formed regarding the values of such more recognition than he has hereto- services, through their association with fore received. public health people and study of health The U.S.P.H.S. has greatly augmented phases of their own problem, as those resources for sanitation. The impact of who are sponsors of the National Sani- these additional resources should be felt tation Foundation are doing, more and opportunities for in all along the line. more employment industry will occiir. About 1916 and in the immediate years thereafter, the Service took its Summary first steps away from a cloistered hospi- The sanitarian has qualified himself tal service into the Public Health un- by training and experience for service known through sanitation. Altho it has to the public. His activities are basic and now traveled far into other areas of essential. He has earned, but has not public health, this might be an oppor- always received, a large measure of the tune time for spotlighting sanitation credit for the increasingly favorable again. position of public health. In addition No matter how much one may dis- to a wide variety of qualifications he needs better facilities for training and agree with the Emerson report, it has had an influence and marks a trend to- self development, together with the un- ward more adequate and better quali- failing backing of his superiors to carry responsibilities. His fied personnel for sanitation. As the de- out his financial mand for additional sanitarians grows, compensation is improving and it is more top positions develop to which believed will continue to do so as his qualified individuals with demonstrated function is better understood and he succeeds in improving the calibre of his ability may expect to advance. contribution. All good sanitarians, how- The development of qualification stan- ever, have had to depend on the per- dards through merit systems and the sonal satisfaction that comes from work of committees of professional or- knowledge of a job well done as a of ganizations and the development partial compensation, and will probably training facilities help to insure that have to continue to do so. those who have earned the right to serve The first real break in professional in better paid positions involving super- recognition has occurred. What the vision, the exercise of special skills, and future holds depends very much upon important responsibility will have a how he measures up to the responsibili- chance to do so. ties that these new privileges impose.

THE ROANOKE MILL CAFETERIAS By Miss Mary Brice Deaver Nutrition Consultant State Board of Health

In keeping with the latest beliefs that to obtain good food at minimum cost. only well nourished persons are capable These mills are located in Roanoke of putting their best efforts into their Rapids, North Carolina and employ ap- work, the Roanoke Mills are continuing proximately 1900 people. By operating to make it possible for their employees non-profit cafeterias at each of the October, 1949 The Health Bulletin

i ,^^ ^j'^* '-^ ^ mp ;r ^si ym^fgg

three mills, the company is offering ap- one to be in a state of well-being if he petizing, well-prepared meals to all em- is to do good work? The fact that poor ployees. Not only may any of the em- food habits may mean more sick days ployees eat there, but any members of taken and less work done applies equally the employees' families are entitled to as well as it did in 1942. the same privilege. We are fortunate in having an ex- Dui'ing the war, one heard comments cellent example of these principles be- on every side about nutrition in industry ing put into practice in Roanoke Rapids. and indeeed it was probably largely due The cafeterias were opened in 1944 and to the efforts started then, that we have been operating continuously since know as much as we do now about the that time. Under the able supervision of effect of food in regard to the work one Miss Lydia Deyton, the three cafeterias can do. For it was pointed out forcibly offer meals for each of the several shifts at that critical time when every possible at the plant. Miss Deyton, the supervis- effort was being made to bring produc- ing dietitian, has been on the job for tion to its peak that health was a the past two years and is eminently primary factor in working at maximum well qualified to hold this difficult posi- efficiency. tion. She is responsible for each cafe- Obviously good health and good nu- teria running smoothly and efficiently, trition go hand in hand. It would be a does the buying of all food and supplies shame to let such knowledge be for- for them, plans the menus, is respon- gotten and not used in time of peace. sible for keeping the necessary records, For isn't it essential at all times for is responsible for hiring and training 14 The Health Bulletin October, 1949

personnel to operate the cafeterias. In never an unsightly collection of used spite of her heavy duties finds time to dishes to detract from one's eating be a pleasant and charming hostess. pleasure. The counter itself is set up Each cafeteria has a supervisor who attractively and kept replenished with is in charge of meal service and who food at all times. usually serves as cashier as well. Other Since the steam tables are in the personnel employed such as cooks, coun- center of the counter, the salads and ter girls and dishwashers work imder desserts are reached first, then the cold the direction of the supervisor in each beverages such as milk and iced tea, case. All personnel are required to wear then the hot foods, followed by the uniforms and hairnets, in keeping with bread with the coffee urns at the end. general regulations for cleanliness. As the counter is not long, it is not The dining rooms are in pink and diflBcult to see the hot foods offered be- gray and present a soothing, restful fore taking salads and desserts and to atmosphere. Each table seats six per- plan one's meal accordingly. sons, and at no time during the serving In the kitchen, equipment, while not hours are there more people than can elaborate is certainly adequate. How- be taken care of comfortably. This ever, in some cases where buildings means that the usual rush for seats in a meant for other purposes have been cafeteria is lacking, and everyone takes converted to this use, the most con- time to get the food he wants, sits down, venient arrangement of equipment has and enjoys eating it. The tables are had to give way to other considerations. kept cleared of dirty dishes so there is It is hoped that in time some of these October, 1949 The Health Bulletin 15

inconveniences may be remedied, mak- using the cafeterias. This fact seems ing more effective working areas. even more strange since the cost of food in is With these points in mind, let us look the cafeteria kept at a minimum. at a typical day in a cafeteria. In the It is really hard to understand why early morning, for those who have had there is not greater patronage. Perhaps to leave home without eating breakfast; many do not realize exactly what the milk, fruit juice, coffee, and sandwiches cafeteria represents, for it is purely are available. True, these do not con- voluntary whether one eats there or stitute an ideal breakfast, but certainly not; there is no urging nor advertising some of these things would help carry done to get more patronage. one through the morning's work. Break- But what about the people who are eating here? they taking full ad- fast, actually, is one of the most import- Are ant meals of the day, and statistics show vantage of the opportunity to eat the that carelessness leading to accidents as protective foods so necessary to all of well as a tendency to slow down on the us? Are they spending their money in best for Recently, job and make mistakes often tie in with the way them? a whether one has had adequate nourish- week was spent in the cafeterias at the meal, checking the food purchased ment to begin the day. Breakfast is noon the most commonly neglected of all by each person. Perhaps you would be interested in what a summary of those meals and skipping it means that the person may have had nothing to eat findings indicates. Less than 10 perecnt for a period of twelve or more hours. of the total number served were buying milk; less than 20 percent bought a During mid-morning and mid-after- green or yellow vegetable; about 15 per- noon when the cafeteria lines are not cent bought a raw vegetable; approxi- open, there are snacks and drinks avail- mately 90 percent bought meat; around able through what is known as "store 16 percent fruit; and about 65 percent service." These are not meant to take bought vegetables other than the green the place of the hot meals offered at or yellow ones. What do these figures noon and night but simply as a re- show? According to the basic seven freshment during the working period. chart, which was started by the govern- About 11:30 A.M., the lines open for ment during the war as an easy means the lunch period. At this time a variety of checking food requirements, several of salads and desserts are offered as of the foods we need every day are ap- well as a hot plate consisting of a main parently being neglected by a majc»"ity dish and two vegetables. There are of the people. Perhaps they're getting several vegetables available, and one them at some other meal? True, that's may choose those preferred. Soup is quite possible, but when one has put in there in case anyone doesn't want meat, a full day working in the mill, how or he may choose a vegetable plate. Dur- many are going home and prepare a ing the afternoon, "store service" again meal which will meet the rest of the takes over and about 5:30, the night nutritional requirements for that day? meal is served, very similar in respect Most of us would be inclined to prepare to the foods offered at noon but the something quickly without much particular foods such as vegetables and thought or time being spent on it. Cer- meats are always different. From 8:00 tainly, we cannot say that it is a fact P. M. to midnight, beverages and sand- that these people are not meeting their wiches are available though there is daily food requirements on the basis of no hot meal served during the night. only one meal a day checked; but we Any employee may buy a meal and take can say here is an opportunity to it home to his family if he wishes. With a long toward being adequately these meals ready and waiting, the go way nourished with a minimum of effort next question is—how well are the cafeterias being patronized? Surprisingly and cost. enough, the answer is that only from Here, then, we can see a practical 20 to 25 percent of the employees are application of the theory surrounding —

16 The Health Bulletin October, 1949 nutrition in industry. It would also seem fying to know that such efforts to put that making food available is not good nutrition into practice are being enough; it is just as necessary to carry carried on in many industrial concerns, on an educational program in conjunc- and the Roanoke Mills may well be tion with the food program if the facili- ties provided are to be utilized to the proud that they have gone so far in this greatest advantage. It is certainly grati- new field. NOTES & COMMENT By Acting Editor

OUR FRONT COVER—When we re- authority for the statement that Blak- ceived the Arkansas Health Bulletin for iston's New Gould Medical Dictionary July, 1949, we saw a front cover which took five years to prepare and cost $287,- impressed us and which we thought 000. With a backgroimd of this sort one would render a most useful service in would expect an outstanding good dic- North Carolina. We wrote to the Editor tionary. Our own expectation did not and requested permission to reproduce lead to disappointment. that front cover on the front cover of Prom the preface we are informed our own Health Bulletin. The permission that the Editors and the Board of Con- was promptly given and they kindly sent sultants—"searched recent professional us a glossy print from which to have literature not only for new terms but our own cut made. Since we have al- also for evidence of the changes in us- ready killed more than 600 people and age which they felt were evident today injured more than 6000 on our highways, and so inadequately recorded in older so far this year we should have no reference works. More than three hund- difficulty in understanding the plea pre- red standard modern texts reflecting sented. Our thanks go to Little Jimmy current usage and nomenclature in all Underwood of Benton, Arkansas and the basic fields of medicine, surgery, and the Griffith Monument Company of the biologic sciences as well as the re- Little Rock. cognized journals, yearbooks, and stand- NEW MEDICAL DICTIONARY—To ard indexes of many specialties were one who found Gould's Medical Diction- critically and systematically examined. ary most helpful in his efforts to secure Such an investigation was, of course, the M. D. some 35 years ago, the an- a task far beyond the capacities of one nouncement of Blakiston's New. Gould editor or of a small group of editors. Medical Dictionary could not but arouse The user of this dictionary will readily interest and carry memories back to recognize the advantages of this board the days of his youth. The examination investigation." of this book is most convincing that it Particularly pleasing is the method by is new and not just a revision of Gould's which pronunciation is indicated. With Medical Dictionary. It is as new as this idea we should have much more "aureomycin" and as complete as nearly uniform pronunciation of our medical any one could desire who might be con- vocabulary. Most of the illustrations, 252, tent with a dictionary which is under- are located near the center of the book; neath two covers instead of in two or —129 are in color. In printing a stlye more volumes. The editors are Harold of type has been used which is easy to Wellington Jones, M. D., Washington, read. There is an index of tables and D. C; Normand L. Hoerr, M. D., Cleve- lists. The appendix of 140 pages carries land, Ohio; and Arthur Osol, Ph.D., a wealth of information in readily ac- Philadelphia, Pa. They were assisted by cessible form. The Blakiston's New an Editorial Board of 80 contributors Gould Medical Dictionary consists of whose names read like a digest of Who's 1294 pages and 5^^ povmds, of informa- Who in Science. "Time" Magazine is tion for $8.50. @Jii])10)lM

i I TKis BuUetin vnll be seni free to dnij cilizen of tKe Skii^e upon requcsi

Published monthly at the office of the Secretary of the Board, Raleigh, N. C. Entered as second-class ni ler at PostofTice at Raleigh, N. C. under Act of August 24, 1912

Vol. 64 NOVEMBER, 1949 No. 11

Buy Christmas Seals

Help Stamp Out TB MEMBERS OF THE NORTH CAROLINA STATE BOARD OF HEALTH G. G. Dixon, M.D., President Ayden Hubert B. Haywood, M.D., Vice-President Raleigh H. Lee Large, M.D Rocky Mount John LaBruce Ward, M.D Asheville Jasper C. Jackson, Ph.G Lumberton Mrs. James B. Hunt Lucama, Rt. 1 John R. Bender, M.D Winston-Salem Ben J. Lawrence, M.D Raleigh A. C. Current, D.D.S Gastonia

EXECUTIVE STAFF J. W. R. Norton, M.D., M.P.H., Secretary and State Health Officer G. M. Cooper, M.D., Assistant State Health Officer and Director Division of Health Education, Crippled Children's Work, and Maternal and Child Health Service C. C. Applewhite, M.D., Director, Division Local Health Administration

, District Director, Local Health Administration Ernest A. Branch, D.D.S., Director. Division Oral Hvsiene John H. Hamilton, M.D., Director, Division of Laboratories J. M. Jarrett, B.S., Director, Division of Sanitarv Engineering Otto J. Swisher, M.D., Director, Division of Industrial Hvgieiie Bert Lyn Bosley, Ph.D., Director, Nutrition Bureau Felix A. Grisette, A.B., Executive Director. Health Publicntions Institute C. P. Stevick, M.D., M.P.H. Director, Division of Epidemiologv and Vital Statistics, and Co-Director, School Health Coordinating Service WrLLiAM A. Smith. M.D., Director. Bureau of Tuberculosis Ivan M. Proctor, M.D.. Director. Bureau of Cancer Control Harold J. Magnuson, M.D., Director, Reynolds Research Laboratory. Chapel Hill John J. Wright, M.D., Director, Field Epidemiology Study of Svphill'is, Chapel Hill

FREE HEALTH LITERATURE The State Board of Health publishes monthly The Health Bulletin, which will he sent free to any citizen requestincr it. The Bonrd also has available for distribu- tion without charge special literature on the following subjects. Ask for any in which voLi may be interested. Adenoids and Tonsils German Measles Sanitary Privies Appendicitis Health Education Scabies Cancer Hookworm Disease Scarlet Fever Constipation Infantile Paralysis Teeth Chickenpox Influenza Tuberculosis Diabetes Malaria Tvphoid Fever Diphtheria Measles Venereal Diseases Don't Spit Placards Padiculosis Vitamins Fly Placards Pellagra Tvphoid Placards Endemic Tvphus Residential Sewns^e Water Supplies Flies Disposal Plants Whooping Cough Epilepsy, Insanity. Foeble-mindedness, Mental Health and Habit Training

SPECIAL LITERATURE ON MATERNITY AND INFANCY The followiiii? special literature on the subjects listed below will be sent free to any citizen of the State on request to the State Board of Health, Raleigh, N. C. Prenatal Care. Baby's Daily Schedule. Prenatal Letters (series of nine First Four Months. monthh' letters). Five and Six Months. The Expectant Mother. Seven and Eight Months. Infant Care Nine Months to One Year. The Prevention of Infantile One to Two Years. Diarrhea. Two to Six Years. Breast Feeding. Instructions for North Carolina Table of Heights and Weights. Midwives.

CONTENTS Page Tuberculosis Control in N. C. With Emphasis on Case Finding 3 Putting Tuberculosis to Flight 8 The Outlook in the Campaign Against Tuberculosis 10 Tuberculosis and the Negro 12 Drugs in Tuberculosis Treatment 13 PUBLI5A\ED 6YTAE NORTA CAROLINAA 5TATE B*>ARD^/AEALTAB*>ARD-/ AEALTA] B

Vol. 64 NOVEMBER, 1949 No. 11

J. W. R. NORTON, M.D., M.P.H., State Health Officer JOHN H. HAMILTON, M.D., Acting Editor

TUBERCULOSIS CONTROL IN NORTH CAROLINA WITH EMPHASIS ON CASE FINDING

By William A. Smith, M. D. State Board of Health, Raleigh, N. C.

General a. Case finding It may be said that concerted meas- b. Clinical services ures to control tuberculosis in North c. Nursing services Carolina began in 1904, when, during d. Hospital services a meeting of the State Medical Society, e. Health Education Dr. Lewis then State Health OflBcer an- f. Laboratory services nounced in his report that tuberculosis g. Rehabilitation was a real menance to the welfare of h. Vital statistics the State. i. Welfare services In the general organization of our Shortly afterwards the Legislature ap- State Government, there are 4 State propriated money for the construction agencies which have to do with tuber- of a State Sanatorium for the treatment culosis control. These are: of tuberculosis alone. Since that time a. Department of Public Instruction there has been a steady interest in the b. State Board of Public Welfare control of this disease and at this time c. Sanatoria Board there are 3 state sanatoria, which are d. State Board of Health being expanded, and in addition there The Division of Vocational Rehabilita- are 15 county sanatoria. There are also tion is an agency in the Department of five other tuberculosis hospitals oper- Public Instruction, and is responsible ated by other than State or County for training the tuberculosis patient Governments. after his discharge from Hospital. In 1904 the death rate of tuberculosis, The State Board of Public Welfare all forms, in the United States was 202 protects the patient's family against per 100,000 population; over 150,000 peo- economic distress by cooperation with ple dying on account of this disease in local County Welfare Agencies. a population of 76,000,000 persons, and The Sanatoria Board controls the 3 in 1947 the 100,- death rate was 33.5 per State Sanatoria and at this time the 000 persons and 48,000 died on account Central Sanatorium and Tuberculosis of the disease. Division cooperate in sui'veys, the Sana- Tuberculosis Control measures include torium furnishing the final diagnosis several services and agencies. Services with recommendations as to further include: treatment, and the Tuberculosis Con- : :

The Health Bulletin November, 1949 trol Division conducting the x-ray sur- therefore is strictly an administrative veys of the population. The Sanatoria, service agency, and clinical services are in addition to the regular hospitalization a duty of the State Sanatoria and Local of the tuberculosis patient, maintain a Health Departments. consultant service, controls streptomy- The principal duty of the Division is cin allocation, and furnishes free tuber- conducting Mass Chest X-Ray surveys, culin to local Health Units and physi- and such surveys, as a case finding pro- cians. cedure, has been termed by one of our In the general Tuberculosis control top Public Health Administrators, as set-up, the State Board of Health con- the "spearhead of the attack on tuber- trols : culosis." It must be remembered, how- a. The Division of Local Health Ad- ever, that once the attack has been ministration made, the ground won must be consoli- b. Division of Vital Statistics and dated and held by agencies in the local Epidemiology area. There must be an adequate follow- c. State Laboratory of Hygiene up, clinical services, nursing service and d. Division of Tuberculosis Control hospitalization, before a general survey The responsibilities of these divisions of a community can be termed as hav- are: ing been successful. Taking 20,000-30,000 x-ray pictures, a. Local Health Administration the interpretation, final diagnosis with 1. Liaison and cooperation with County Health Units recommendations as to future treatment is but the beginning; final success de- 2. Periodic inspection and report pends on the ability of local agencies on tuberculosis registers by a to either hospitalize the patient or give field representative him proper advice as well as to continue 3. Health education observation. 4. Consultant nursing service Mass Chest X-ray surveys have come 5. Maintaining a film library under criticism by many persons and b. The Division of Vital Statistics and authorities. This case finding procedure Epidemiology maintains morbidity has been studied thoroughly by many statistics and other required records tuberculosis specialists. To quote one on reportable diseases. well known authority, "For the econo- c. The State Laboratory of Hygiene mical recognition of tuberculosis in it's furnishes free laboratory service to early stages, routine chest x-rays of County Health Units, also to the groups carefully selected for probable State Sanatoria and private physi- incidence is the most effective method cians. yet developed. From the standpoint of d. The Division of Tuberculosis Con- case finding, the shift of age distribu- trol, in general has the following tion of tuberculosis mortality means responsibilities that greater emphasis must be placed 1. Conducts mass chest x-ray surveys on the examination of adult contacts of the general population and in- and on mass examination of groups dustry through County Health Offi- subject to the highest risks, such as cers. workers in hazardous industries and 2. Maintains consultants nursing serv- the lower income groups." ice. 3. Health education in connection History with publicity prior to and during North Carolina was one of the first surveys and maintains liaison with states to practice tuberculosis control a. State institutions for better case in cooperation with the U. S. Public finding, and with Health Service. Dr. Reynolds, former b. The Director State Sanatoria State Health Officer, and the late Dr. and the McCain recognized the value of case c. State Tuberculosis Association. finding through community mass x-ray The Division of Tuberculosis Control, surveys and in 1944 plans were com- November, 1949 The Health Bulletin pleted for the organization of a separate salaries outside the State Board of division for tuberculosis control in the Health and local Health Departments State Health Department. The function with the exception of the salary of the of this department woiild be primarily clerk at the Central Sanatorium whose that of case finding, and hence organ- duties are concerned with follow-up ized on somewhat different lines from activities. that of many other states in that all Morbidity, Mortality administrative or professional services concerned with tuberculosis control were In North Carolina it is estimated that not represented in the Division. about 10,000 persons have tuberculosis In the early days of the organization in some form. In 1920 the death rate there was the usual difficulty in secur- from tuberculosis all forms was 117.4 ing equipment and personnel and for a and the national average was 114.2. In national rate was 36.4 time it was necessary to combine with 1946 the death the Division of Industrial Hygiene. How- and the North Carolina death rate was ever, by early 1948 there were 5 com- 32.5. In 1947 our death rate was 28.4, a plete mobile units operating. For the total 1,056 people dying of the disease; first 2 years or until February 1947 the 411 white, 645 negro; the national rate in 1948 U. S. Public Health Service furnished was 33.5 with 48,064 deaths; the majority of personnel and equip- deaths in North Carolina were 956 with ment. At that time the U. S. Public a death rate of 25.6. The incidence in Health recalled all personnel except one North Carolina has fallen below the doctor and since May 1948, when this national average; the disease however doctor left, the Division has used it's is with us and a health problem above own personnel and equipment. The automobile accidents and Diabetes and equipment consists of 8 mobile x-ray 8th on the list of causes of death. In the units, 2 generators, 1 G. E. 200 MA unit 1920 it was 2nd on the list and was installed at Duke Hospital for routine leading cause of death in 1917. chest x-rays of in-patients and out- Although the death rate from Tuber- patients; and also tractors and other culosis in North Carolina has declined necessary accessories. Personnel con- from 117.4 per 100,000 in 1920 to 25.6 sists of 2 doctors, 2 health educators, 1 in 1948, we must not lose sight of the part time consultant nurse, 6 senior fact that the number of new cases in x-ray technicians, 9 photofluorographic the State has increased in the last five operators and trainees and 7 other per- years from 1,633 in 1943 to 3,591 in 1947, sonnel in the office and field or a total and 3,274 in 1948, all forms of tubercu- of 20 persons in the field and 6 persons losis, and during the same period the in the central office and one clerk at number of deaths decreased from 1,468 the Central Sanatorium. There are no to 956. It is also interesting to know that doctors for field duty, all 70 mm films during 1948 there were 620 minimal, are read at the central office and 14 x 17 1015 moderately advanced and 1052 far films at the Central Tuberculosis Sana- advanced cases of pulmonary tuberculo- torium at McCain. sis diagnosed by physicians for the first BUDGET—The 1949-1950 budget is time, and 131 cases, stage not specified. x-ray $308,000 and of this amount $100,000 is During the same period on mass allotted to Local Health Departments, survey there were found 409 minimal the remainder being used for salaries cases, 469 moderately advanced and 128 and equipment in the Division and also far advanced cases of tuberculosis of in for salaries in other Divisions within the the lung. These cases are included Board of Health and State Sanatorium the 3,274 new cases just noted, and it who perform work in connection with may be assumed that most of these Tuberculosis Control, such as in the cases were unknown prior to the survey are Division of Vital Statistics, Laboratory since known cases of tuberculosis for of Hygiene and Division of Local Health not encouraged to come to our unit Administration. No funds are used for x-ray. Hence many cases were up and The Health Bulletin November, 1949

about while in the contagious state. In more prevalent than in the west. The a recent survey, in which 31,563 70 mm. high eastern rate cannot be attributed films were taken, there were 24 cases to the high non-white rate because of tuberculosis who were advised to have curiously enough the non-white rate Sanatorium treatment, 17 of these were was lower than for the white. In all negro. In addition there were 11 ques- probability this was due to the fact that tionable cases and two possible lung non-white individuals x-rayed did not cancers, all (except one) new cases of constitute a representative sample of tuberculosis. the population. The white rate in the In one of the most populous areas in east was 171.9 and in the west it was the United States over 5 year period, 55.3. The non-white rate in the east was over 4,000 cases were discovered at 114.8 and in the west was 38.3. death, which meant that these persons The total number of tuberculosis cases had been walking the streets and found per 10,000 persons x-rayed was spreading the disease. The same report 148.7 in the east and 52.4 in the west. shows that among the new cases of Rate per 10,000 Films 70 mm. tuberculosis, diagnosed for the first time Total White Non-white in 1947 31% were in the minimal stage, 38% moderately advanced and 31% far East 148.7 171.9 114.8 advanced. These figures prove that tu- West 52.4 55.3 38.3 berculosis, although not the main killer Tuberculosis rates in industry and is still a menace and unless continual in agriculture are also of considerable effort is being made to control the dis- interest. Our figures in industry repre- ease, there is a possibility that the sent principally the textile industry. death rate might increase. In the United The survey of industrial occupation States in 1947 the new cases, however, shows the rate to be 62.3 cases per 10,- have risen to one of the highest numbers 000 films. The agricultural rate is 168.1. recorded in years namely 133,837 which These figures include both white and was 15,000 more than the year before. non-white. Broken down the white rate It is to be remembered, however, that in industry is 65.0 and the non-white in this country there has been an in- rate is 36.9. In agriculture the white tensification of case finding through rate is 204.6 and the colored rate 121.4. mass x-ray surveys. Such intensification From these figures it is seen that in of mass x-ray surveys, however, did not every 10,000 persons x-rayed there were begin in North Carolina until 1946-1947, 139.6 more white farmers who had tu- and during the three previous years berculosis than industrial workers, and 1943-1945 there were 5,658 new cases. there were 84.5 more non-white farmers The rise in the rate may not necessarily in every 10,000 persons surveyed who mean an increase in the incidence of had tuberculosis than non-white in- tuberculosis but a broader knowledge dustrial workers. as to its prevalance. While the death Tuberculosis Cases per 10,000 film 70 mm. rate may be leveling off or decreasing, Non- mere growth of population alone brings Total White white it's additional problems. Industrial occupation 62.3 ~65 36J In North Carolina x-ray surveys re- Agricultural " 168.1 204.6 121.4 presenting 165,000 persons of selected eastern and western counties are of con- Case Finding Procedure siderable interest. Counties in the east Our case finding procedures on mass surveyed were Beaufort, Craven, Duplin, x-ray surveys consist of: Hyde, Tyrrell, and Washington, and a. Certain preliminary activities prior those counties which were surveyed in to the arrival of the mobile units. the west were Cabarrus, Guilford, and b. Operation of the mobile units in Rowan. the area, and In the east, according to the survey, c. Furnishing the Health Officer with it was found that tuberculosis is far the final diagnosis and recom- November, 1949 The Health Bulletin

mendations as to management of of pathology are forwarded to our re- the case. cord analyst at the Health Center where conducted. Persons In the prehminary activities, two con- the survey is being are in- ferences are desirable in the area where who require the 14 x 17 plate as to the date and hour they the sui'vey is scheduled. The first con- formed report for further x-ray studies. ference is held 4 to 6 months prior to should Health the survey and the second conference 2 The plate is developed at the the Central to 3 months before the units enter the Center and forwarded to for interpretation. The Cen- area. At the first conference the Division Sanatorium Director meets with the: tral Sanatorium in turn forwards the diagnosis to the Health Officer who a. Local health officer and his staff. furnishes it to the doctor or the patient. b. A representative of the local Tu- Central Sanatorium in addition to berculosis Association. The the diagnosis makes recommendations c. A member of the county commis- to the Health Officer as to sputa exam- sioners. ination, intervals for further x-ray ex- d. Member or members of the local amination, whether hospitalization is medical society. indicated and all other information per- e. Members of the Board of Health. tinent to the case. f. Member of the school board. g. Local Power Co. representatives, When the regular schedule in the and area, which is being surveyed, has been h. Other interested persons. completed and the mobile units moved the next area, one mobile unit, a At this conference our policies govern- to clerk remain in the ing tuberculosis surveys are read in de- technician and a area under the supervision of the Local tail and each item examined. Such a Health Officer for the purpose of con- conference generally lasts about 1 hr. tinuing the 14 X 17 clinics and also for and a half, and is followed by a survey taking those unsatisfactory 70 mm. of the health department facilities. We still remain imtaken within endeavor to have the 2nd conference plates which the area. It has not been necessary in approximately 2 months prior to the every survey to retain the mobile unit survey and this is attended by the divi- time required for the sion director, a health educator, chief throughout the is released for technician and the consultant nurse, 14 X 17 retakes. The unit duty to the current survey but the tech- all from the State Board of Health. Locally the same persons attend who nician and clerk remain until released the Health Officer. were present at the first conference and by generally there are a larger number. In a recent sm-vey, 30,270 70 mm. films were made and a total of 624 people Following the conference the chief were recalled for re-examination, and of technician makes a preliminary survey these all returned to the clinic. There of sites and tentative locations of units, was a total of 172 cases diagnosed as electrical connections, roads, bridges re-infection tuberculosis, classified as and other matters pertaining to the follows: operation of mobile x-ray units. Pulmonary scar 46 The health educator begins activities Minimal Tuberculosis 64 about this time and the consultant nurse Mod. Advanced Tuberculosis 50 is available to the nursing staff. Par Advanced Tuberculosis 12 of Survey a County Or District Of the above cases, twenty-three were Our surveys generally require 5 units advised to have sanatorium care and operating simultaneously with one unit it was recommended that one ex- in reserve. During a full month of oper- patient, and ex-service man return to ation without interruption these units Oteen, N. C. for treatment. Cases of make 25,000 to 30,000 70 mm. films. questionable activity were recommended The 70 mm. films are read at the for sputum specimens, tuberculin tests Central Office in Raleigh and all reports and rechecks to determine activity. 8 The Health Bulletin November, 1949

Continual study is being made to im- the x-rayable population were x-rayed; prove the method of follow-up activities. in others a much lower percentage. Since September, 1948, we have employ- The number of pictures taken, how- ed 3 additional clerks for field duty. ever, is not an index as to the actual Summary benefit to the community, for a mass chest survey is a general educational Since the organization of this Divi- feature, and much knowledge concern- sion mass x-ray surveys have been con- ing tuberculosis is disseminated. ducted in counties, the total population During 1948, 243,695 chest pictures of which was approximately 1,900,000 were made and 1614 persons were diag- persons and over 800,000 70 mm. pictures nosed as having definite tuberculosis or have been made. 42 counties have been 0.66% of those x-rayed, and over 1600 surveyed and in other localities special persons showed "other chest pathology." surveys were conducted among industry, There were, therefore, 3228 persons dis- colleges, food handlers and special covered during the year by this Divi- groups. sion who required somes sort of treat- In some counties between 80-90% of ment or advice by a physician.

PUTTING TUBERCULOSIS TO FLIGHT Frank W. Webster, Executive Secretary North Carolina Tuberculosis Association 215 Commercial Building, Raleigh, North Carolina

A dove in flight pictured on the 1949 Cause for pride? Perhaps, but how Christmas Seal symbolizes, in addition does the other side of the picture look? to the traditional peace of the holiday A communicable disease, caused by a season, the putting to flight of tubercu- germ, preventable, tuberculosis is kill- losis. ing 1,000 Americans a week, 125 persons It cannot be denied that progress has a day—at the rate of one person every been made. If the death rate from tu- 11 minutes. Tuberculosis is the only berculosis had continued at the rate it germ-borne disease that is still a leading was in 1904, when the National Tuber- cause of death. In this country it causes culosis Association was organized, 5,000,- one out of every 30 deaths. Of every 12 000 more people would have died of tu- deaths among Negroes, one is due to berculosis than actually have. Thus, the tuberculosis. 908 North Carolinians died lives of some 5,000,000 persons have been from this disease last year. Last year saved who would have died from tuber- 150,000 cases of tuberculosis were re- culosis in the past 45 years. In 1915 the ported in this country. With another death rate from tuberculosis in North 100,000 already reported and an esti- Carolina was 156.4 per 100,000 persons mate of 250,000 unknown cases, there and in 1948 it was 23.9. A low estimate were approximately half a million peo- of the cost to the community of each in- ple in this country with active tubercu- dividual who dies from tuberculosis is losis. In North Carolina 3,274 cases were $3,000. The reduction in the death rate reported last year and 3,591 the year as the result of the efforts already made before. 6,865 cases of active tuberculosis to control the disease have resulted in were reported in our state during the an annual saving in the State of more past two years. than 4,900 lives and of more than $14,- I do not wish to confuse you with 000,000. Tuberculosis Associations, how- statistics, but these figures are graphic ever, do not claim sole credit for this reminders of the seriousness of the tu- progress. It is the result of cooperative berculosis problem in this country to- efforts of many agencies. day. They are reminders, too, of the —

November, 1949 The Health Bulletin 9

tragic waste of tuberculosis, because it of tuberculosis and the responsibility of is a preventable disease. We know that the individual, the community, the state tuberculosis can be controlled. We have and the nation for taking the measures the weapons at our disposal. It is up to prevent its spread. The State Associa- to us to use them. tion recognizes there are two funda- An effective plan of tuberculosis con- mental jobs of health education. One is trol embraces these principal phases to inform and obtain action by in- case-finding and supervision, medical dividual health problems. The other is care and isolation, aftercare and re- to inform and secure action by the habilitation. A program which includes community on community problems. It these public health measures supported realizes that the two jobs overlap and by research and well-planned health intermingle and that both demand a education in each field of endeavor will basic understanding of tuberculosis and be certain to reduce tuberculosis mor- the measures for its control. Conse- bidity and mortality. To this end tuber- quently, a steady series of activities de- culosis associations are cooperating with signed to inform all the people in the official tax-supported agencies. A funda- state on the nature of tuberculosis is mental objective being, building ade- attempted at all times. quate public support for oflBcial tuber- Case-finding is essential to the con- culosis control. trol of tuberculosis. People with tuber- The North Carolina Tuberculosis As- culosis must be found and treatment sociation is a service agency. Its serv- provided for them. The State and local ices are rendered mainly to its 115 affili- tuberculosis associations cooperate very ated associations and committees and closely with the Division of Tuberculosis through its medical section, the North Control of the North Carolina State Carolina Trudeau Society, to the medi- Board of Health. Last year local affili- cal profession in the State. The State ates of the NCTA provided some $25,000 Association works through these 115 to assist this Division in mass X-ray affiliates to carry the program to the services. Field service was provided by people of the State. This Association the State Tuberculosis Association to will be designed as the NCTA through the Division of Tuberculosis Control in the remainder of this article. Profes- these services. Several local tuberculo- sionally trained staff members of the sis associations have purchased mobile NCTA work as field secretaries and as- X-ray units, while others have purchas- sist the affiliates in their programs of ed X-ray units for their local health health education, fact-finding, case- departments. finding and programs for special groups. Pact-finding is the first step in plan- The NCTA also provides training for ning a program. The Association is con- workers for local associations as well stantly engaged in assembling all the as holds institutes for volunteers. facts about the tuberculosis situation in The NCTA maintains as its chief aim the State. It has to be continuous be- the education of the public toward tu- cause facts change from year to year. berculosis. Continuous and unrelenting The NCTA and its local affiliates con- education and information, the funda- tinue to cooperate with the state and mental parts of the campaign to wipe local tuberculosis sanatoria in plans for out tuberculosis, must precede and ac- rehabilitation programs in their institu- company all tuberculosis projects. All tions. Two consultants from the Reha- the resources upon which we depend bilitation Service of the National Tu- for victory over the disease can neither berculosis Association were brought to be made available nor used unless the the State last year for conferences with public understands and supports the medical directors, rehabilitation workers plan of campaign. The tuberculosis as- and others interested in this phase of sociation has accepted the responsibility the program. These conferences result- of educating adults and boys and girls ed in a clearer understanding and a in school regarding the communicability deeper appreciation for this phase of 10 The Health Bulletin November, 1949

treatment. It is interesting to note that If all of the money raised from the five county sanatoria and one State Christmas Seal Sale last year had been have rehabilitation workers on their used for treatment, it would have pro- staffs this year. The three state institu- vided for only one week's hospital care tions have money in their budgets for for the people in this country with tu- three rehabihtation workers at each in- berculosis. stitution but as yet the trained person- The Association, therefore, engages in nel is not available. those activities which it can best per- The NCTA and 47 of its local affiliates form with the small voluntary contri- made a special contribution of $2,050 butions from thousands of individuals this year to the American Trudeau So- through the sale of Christmas Seals, its ciety for its continuous research pro- sole support. gram. Twenty-two grants have already The 1948 Christmas Seal Sale in been approved by this Society to aid North Carolina was $375,809.41. Five per specific tuberculosis research during cent of this amount or $18,790 was sent this fiscal year. Dr. David T. Smith of to the National Association. The other the Duke Medical School received one 95 per cent or $357,019.41 was kept for of these grants to continue his studies the work in North Carolina. $62,789.13 of chemical agents which appear to was budgeted to the North Carolina inhibit the growth of the tuberculosis Tuberculosis Association for its program germ. The State Association feels that and the larger portion or $294,230.28 will this support of research represents one be spent on local program in the coun- of the best possible investments made ties where the money was raised. for every community everywhere, since You will find listed below the expendi-. the findings benefit all mankind. tures of the NCTA for the last fiscal With the exception of treatment, these year. are the weapons being used by the tu- berculosis associations, the weapons for Health Education and which we are supplying the ammunition Information $27,934.44 when we buy Christmas Seals. Christ- Rehabilitation 2,400.00 mas Seal funds are not used for treat- Administration 5,923.94 9,361.35 ment, which is provided in tuberculosis Seal Sale hospitals maintained from tax funds. Field and Organization __. 12,942.60 2,000.00 Not only is this a function of govern- Research ment, but Christmas Seal funds would not begin to cover the cost of treatment. TOTAL $60,562.33

THE OUTLOOK IN THE CAMPAIGN AGAINST TUBERCULOSIS

By H. S. Willis, M. D. Superintendent, The North Carolina Sanatoria McCain, North Carolina

One year ago, the story was told in get request realistically and appropri- the pages of this Bulletin of the great ated almost all the money that was re- shortage of tuberculosis beds in the quested. This fact should enable the State, of long waiting lists, of people public to rejoice for. when the present build- dying while on those lists, of many appropriations are translated into never able to gain admission. Today ing, equipment and personnel, there list longer, and the talk is far different, for the General need be no waiting any Assembly of 1949 approached the bud- the citizen who is unfortunate enough November, 1949 The Health Bulletin 11 to develop tuberculosis may be hospita- Western North Carolina Sanatorium lized on the day of his diagnosis. This from 300 to 550 represents a great step forward, and it Eastern North Carolina Sanatorium should be brought to completion with- from 200 to 640 in the next year and a half. For the North Carolina Sanatorium from 600 present, what can be done for the pa- to 700 tient with tuberculosis is inadequate and it establishes a new sanatorium of but, come the fruits of the present pro- 100 beds at Chapel Hill to operate in- gram, his lot will be far better. dependently but in close cooperation The present situation has come about with the new University Medical School. gradually. The Board of Directors and Thus it increases beds operated by the the Superintendent, Doctor McCain, re- State from approximately 1100 to more cognized the magnitude of the program than 1950, together with the equipment earlier, and obtained appropriations for and personnel required. the creation of the Western Sanatorium The total cost of the program is about at Black Mountain and later of Eastern seven million dollars ($7,000,000). at Wilson to establish the present sys- More specifically the expansion pro- tem. Utility of these beds has been re- vides ractification of the deteriorated flected in the continual decline in the structures, cramped quarters, worn out death rate. However, the population is equipment, and indequate personnel increasing, case-finding efforts are pro- which the depression, war and war ducing larger numbers of tuberculosis scarcities imposed. At McCain, there cases, and the situation came to the will be a new quarters for employees, sorry past mentioned above. Recognition new dietary building, nurses home, of conditions stimulated the Board of utility building including laboratories, Directors of the Sanatoria last year to occupational therapy building, renova- establish a budget that was calculated tion and enlargement of wings of older to meet the needs of the foreseeable buildings, and many basic improvements future, to eliminate waiting lists and in services at the power house and in thus remove from home sources of fur- the kitchens. There will be added em- ther spread, and eventually to eradicate ployee living space at Western, along the disease from our midst. Such a with interior renovations, and the addi- budget was drawn: such a one was tion of a wing for 150 Negro patients as passed by the Legislature. well as additions to kitchen, power house At the hearing before the Advisory and laundry. The services at Eastern Budget Commission, Chairman Lee will be improved and enlarged by a Gravely presented a most eloquent and new nurses home and employees' build- dramatic plea for the budget as re- ing, kitchen and service building, re- quested. He set forth sound reasons for novation of the laboratory and X-ray the budget items, and cited cases which division, and new units for hospitalizing illustrated the justice and the urgency a much larger number of patients of of the issue. He had left his sick bed at both races. the Eastern North Carolina Sanatorium An added feature in the program of a few brief hours before he addressed expansion is the erection of a new the group, and he came as a tuberculous Sanatorium at Chapel Hill, which patient, pleading the cause of all such should provide for rotation of the per- patients. Everyone in the room was manent staffs of the other branches moved. Again he came before the Joint through its services in order to combat Appropriations Committee to recom- medical isolation and to give patients mend the approval of the budget as better medical care. Furthermore, it passed by the Advisory Budget Com- may be a recruitment station for young mission, and again he told effectively dietitians, nurses, technicians and physi- the story of the need. cians for all of the Sanatoria in the The budget provides for increasing system. In this way it should raise the beds in the several sanatoria as follows: level of medical care in all the sanatoria. :

12 The Health Bulletin November, 1949

And it will benefit the medical school the Board of Directors and the person- because students will have an opportu- nel in all the units accept with en- nity to observe and study tuberculosis thusiasm. it be repeated that, as few student bodies in the country In summary, may when the expansion program is com- can—all of which means better medical pleted, there need be no waiting list, service to the people. there need be no tuberculous patient This represents the program, and its remaining at home for weeks or months, aim is the control and elimination of infecting his family and losing his best tuberculosis from North Carolina. It is chance of recovery. That day will be a a challenge and a responsibility which welcomed day to the people of this State.

TUBERCULOSIS AND THE NEGRO

By Mrs. Velma Turnage Joyner Field Secretary North Carolina Tuberculosis Association Raleigh, North Carolina

It is generally agreed that the best ease among Negroes is misleading. The available single index as to the status fact that in 1945 for the first time in of tuberculosis in a community is the history Negro tuberculosis deaths fell mortality rate from the disease. This below 100 per 100,000; that in the 15-44 rate has long been a basic measuring age group the Negro tuberculosis mor- device. It has been used to determine tality rate is about five times that of the need for personnel and other fac- the white; that among Negroes, too, tu- ilities to detect and supervise the case, berculosis is in fourth place as a cause and it has been used to show what pro- of death has given rise to the belief that gress has been made and what remains more tuberculosis exists in the Negro to be done before tuberculosis finally population than in the white. But com- makes its exit. In fact, so much signi- munity wide surveys are revealing this ficance has been attached to death fallacy that death rates indicate. The rates that it is easy for one to forget number of active cases found among that death figures tell but one side of Negroes by survey is relatively small the story. compared to the number expiring an- J. Weber, Chief Tu- Those concerned with tuberculosis nually. Dr. Francis berculosis Control Division USPHS said control are fearful lest the downward is true that epidemiology has not trend in death rates should call forth "It the perplexing lack of complacency on the part of some and as yet resolved tuberculosis mor- the mistaken impression that fewer correlatioin between bidity and mortality in the Negro. Com- facilities are needed now or will be need- radiographic case-finding sur- ed in the future to bring this scourge munity reveal that the prevalence of the of mankind within control. With refer- veys Negroes is essentially the ence to this Dr. Herbert R. Edwards, disease among whites. However, when Executive Director, of the New York same as among take hold it is far Tuberculosis and Health Association the infection does likely to run a rapidly fatal course warns that, "The tuberculosis death rate more than in the white person." as a criterion of our needs and progress in the Negro in the control of the disease is of less This disproportionate morbidity and significance today than formerly." Simi- mortality rate has great significance for larly, the tuberculosis death rate as a persons doing health education and criterion of the prevalence of the dis- specifically tuberculosis education November, 1949 The Health Bulletin 13

throughout the State. First of all it is practicing the rules of healthy living a mistake to assume that because the should be stressed. These rules include Negro death rate is high there is a getting variety into the foods eaten correspondingly high degree of interest. every day so as to supply the body with The type of interest that will result in all the different food elements needed a change of attitudes and favorably in- for good health; exercising regularly out fluence behavior must be created. That of doors; getting enough sleep, rest, and is the task of health education. recreation; living and working in well- All too often individuals in their ventilated rooms; and wearing clothes eagerness to teach the basic facts about suitable to weather conditions. tuberculosis are guilty of "cramming From the days of the ancient Greeks health education down the recipient's and Romans to the present, diet has throat without any attempt made to been recognized as an important factor correlate it with his needs or desires." in the treatment of tuberculosis and In such an instance concentration is on there is persuasive clinical and epidemi- what one desires his audience to learn ological evidence that malnutrition les- rather than what he wants to learn. sens resistance to tuberculosis. Poor This is an attempt to say that the ap- nutrition operates especially among proach to tuberculosis education must Negroes. This may be due in part to be considered. Begin where the interest proverty and in part to cultural factors of the group lies no matter how remote influencing the choice of foods. What- it seems at the present from tuberculosis ever the cause, it presents a challenge control. It is also well to keep in mind, and should not be overlooked in pro- however, that the control of tuberculo- gram planning. sis cuts across many areas, and that all The importance of early diagnosis good general health programs will must be stressed over and often. Numer- eventually aid in the eradication of tu- ous studies have confirmed that pul- berculosis. monary tuberculosis is a severe and This brings us to the point where it rapidly fatal disease among Negroes. seems fitting to suggest that building Discovered early the chances for cure resistance to tuberculosis should be a are greater. There is a need for indoc- definite part of tuberculosis education. trination in the belief in this health This should be discussed from the stand- principle. point of building a good native resist- In summary, a tuberculosis and health ance. It is reasonable to assume that the education procedure is naturally a slow defense forces of the body have a much one. We are battling against complacen- better chance of keeping tubercle bacilli cy, deep rooted customs misconceptions, from establishing beachheads in the superstitions and prejudices, and we will lungs, increasing in numbers there, and succeed in proportion to the amount of causing serious trouble when a person participation we can encourage and as- is in good health. The importance of sure.

DRUGS IN TUBERCULOSIS TREATMENT

By H. CoRwiN HiNSHAw, M. D. Immediate Past President of the American Trudeau Society

Patients and physicians have always surgical operations, and that would longed for a drug capable of eradicating shorten the years of uncertainty, with tuberculosis infection, one that would fear of recurrent disease, after apparent obviate the need for long discouraging arrest of active tuberculosis. Uncritical months of bed rest, the risk and pain of stories and rumors of new drugs have 14 The Health Bulletin November, 1949 repeatedly aroused the hope that this simultaneously when serious progressive vision might become a reality in the disease is present. immediate future. New antituberculosis drugs have ap- Confused by account of uncertain au- peared and others are on the horizon. thenticity which suggest unbelievable Genuine advances in the treatment of properties of new "wonder drugs" and tuberculosis will be recorded in the curative procedures, patients are often months and years ahead, but how is the in a hopeless quandry. They do not bewildered patient to distinguish facts have ready access to technical litera- from fancies? ture, nor could they usually comprehend The prudent patient will not attempt, and apply to their own problems the as an amateur, to assay rumors or to mass of complicated, and at times con- trace sensational stories, but he will flicting, experimental studies recorded place his trust in a dependable physician in medical journals. of his choice. Pew people are so rash as Some salient facts have emerged from to trust their lives and property to their the many studies on drug treatment of own legal judgement when diflBculties tuberculosis which have been agreed arise with courts of law, but many have upon by numerous competent investiga- lost everything by choosing to ignore tors. It has been demonstrated repeat- sound medical advice. edly that the bacillus of tuberculosis The nationwide facilities of the Na- may be restrained in its growth and tional Tuberculosis Association, its state multiplication within the human body and local affiliates, and its medical sec- by means of newer drugs. This restraint tion. The American Trudeau Society, is not always complete and frequently have been used repeatedly to distribute it is operable for a limited period of time reliable information to physicians and only. to patients about new methods of treat-

Drug treatment is best omitted when ing tuberculosis. not truly needed, most physicians now Under National Tuberculosis Associa- believe. Not only are undesirable effects tion sponsorship, committees of scien- of treatment avoided, but treatment tists and physicians are constantly might be needed more desperately to studying new and unproved treatments, meet some subsequent crisis and un- hoping to render judicial opinions for fortimately such treatment often can the guidance of physicians in treating be employed but once. the patients for which they are respon- The physician must estimate the pa- sible. This committee work is one of tient's powers of resistance against the the activities supported by the Christ- infection and fortify them by every mas Seal funds and has been an im- means known. Rest, balanced nutrition, portant integrating influence in a shift- emotional serenity, and an indominable ing field of turbulent scientific activity. will to recover are priceless assets to every patient with tuberculosis. Surgery or lung collapse combined That older persons now constitute the with newer drug treatments may yield major focus of tuberculous infection is results greatly superior to those of pre- emphasized by recent autopsy studies vious years. To choose the best combina- which show that a relatively large num- tion of treatments, the physician must ber of persons supposedly succumbing estimate which tissues are destroyed and to diseases other than tuberculosis were which are only inflamed and capable of found to have this disease in active healing. This requires skill and experi- form. It is recognized that the disease ence, since there are nearly as many in older persons is frequently mild and different problems as there are patients. that the symptoms may be overlooked. The growing tendency is to train all —Statistical Bull., Metropolitan Insur- weapons upon the enemy microbe ance Co., No., 1948. November, 1949 The Health Bulletin 15

Deaths from Tuberculosis by County and Race: 1948 16 The He.\lth Bulletin November, 1949

Deaths f . MEDICAL LIBRARY

U . OF N. C

CHAPEL HILL, N. C . h^^ PutiisKed tv iRimiR cmm s[M.i°mD-^RimR ry&^^\I TKis Bulletin will be scni free fo dni| cilizen of iKe Sktj-e upon request I

Published monthly at the office of the Secretary of the Board, Raleigh, N. C. Entered as second-class matter at Postoffice at Raleigh, N. C. under Act of August 24, 1912

Vol 64 DECEMBER, 1949 No. 12

GEORGE M. COOPER, M.D. MEMBERS OF THE NORTH CAROLINA STATE BOARD OF HEALTH G. G. DrxoN, M.D., President Ayden Hubert B. Haywood, M.D., Vice-President Raleigh H. Ln Large, M.D Rocky Mount John LaBruce Ward, M.D AshevlUe Jasper C. Jackson, Ph.G Lximberton Mrs. James B. Hunt Lucama, Rt. 1 John R. Bender, M.D Winston-Salem Ben J. Lawrence, M.D Raleigh A. C. CxmRENT, D.D.S Gastonla EXECUTIVE STAFF J. W. R. Norton, M.D., M.P.H., Secretary and State Health Officer G. M. Cooper, M.D., Assistant SUte Health Officer and Director Division of Health Education, Crippled Children's Work, and Maternal and Child Health Service C. C. Applewhite, M.D., Director, Division Local Health Administration

, District Director, Local Health Administration

Ernest A. Branch, D.D.S. , Director, Division Oral Hygiene John H. Hamilton, M.D., Director, Division of Laboratories J. M. Jarrett, B.S., Director, Division of Sanitary Engineering Otto J. Swisher, M.D., Director, Division of Industrial Hygiene Bert Lyn Bosley, Ph.D., Director, Nutrition Bureau Felix A. Grisette, A.B., Executive Director, Health Publications Institute C. P. Stevick, M.D., M.P.H. Director, Division of Epidemiology and Vital Statistics, and Co-Director, School Health Coordinating Service William A. Smith, M.D., Director. Bureau of Tuberculosis Ivan M. Proctor, M.D., Director, Bureau of Cancer Control Harold J. Magnuson, M.D., Director, Reynolds Research Laboratory, Chapel Hill John J. Wright, M.D., Director, Field Epidemiology Study of SyphUlis, Chapel Hill

FREE HEALTH LITERATURE The State Board of Health publishes monthly The Health Bulletin, which wUl be sent free to any citizen requesting it. The Board also has available for distribu- tion without charge Sipecial literature on the following subjects. Ask for any in which you may be interested. Adenoids and TonsUs German Measles Sanitary Privies Appendicitis Health Education Scabies Cancer Hookworm Disease Scarlet Fever Constipation Infantile Paralysis Teeth Chickenpox Influenza Tuberculosis Diabetes Malaria Typhoid Fever Diphtheria Measles Venereal Diseases Don't Spit Placards Padiculosis Vitamins Fly Placards Pellagra Typhoid Placards Endemic Typhus Residential Sewage Water Supplies Flies Disposal Plants Whooping Cough Epilepsy, Insanity, Feeble-mindedness, Mental Health and Habit Training.

SPECIAL LITERATURE ON MATERNITY AND INFANCY The following special literatvire on the subjects listed below wUl be sent free to any citizen of the State on request to the State Board of Health, Raleigh, N. C. Prenatal Care. Baby's Daily Schedule. Prenatal Letters (series of nine First Four Months. monthly letters). Five and Six Months. The Expectant Mother. Seven and Eight Months. Infant Care. Nine Months to One Year. The Prevention of Infantile One to Two Years. Diarrhea. Two to Six Years. Breast Feeding. Instructions for North Carolina Table of Heights and Weights. Midwives.

CONTENTS Page Some Public Health Services To The People 3 Approaches To Urban Sanitation Education 6 Preventive Medicine and Mental Health 10 Research Program of the National Tuberculosis Association 13 International Relationship in Regard To Tuberculosis Control 15 uc

[HllPUBLISAED BYTAE N^RTA CAROLINA STATE B'^AaP-^ AEALTAl B

Vol. 64 DECEMBER, 1949 No. 12

f. W. R. NORTON, M.D., M.P.H., State Health Officer JOHN H. HAMILTON, M.D., Acting Editor

SOME PUBLIC HEALTH SERVICES TO THE PEOPLE

By William H. Richardson North Carolina State Board of Health Raleigh, N. C.

The State Board of Health and coun- Health was created in 1877. The first ty boards throughout North CaroUna pamphlet to be issued by this newly- receive frequent inquiries from those created Board, which, at first, consisteil who wish to know more about the serv- of the entire State Medical Society, was ices available to them through these "Timely Aid for the Drowned and Suf- agencies. For example, this question focated," and the annual appropriation has been asked: "Just what is Public was the magnificent sum of $100. We Health doing for the Negro population shall not undertake to give a chronolo- of the State?" The answer to this gical account of the development of sample question is that Public Health Public Health in North Carolina. This is performing the same services for the would involve too many details. Negro population of the State as it is For many years after its creation, the performing for the white population. State Board of Health performed use- Public Health observes no color line in ful services with the material in hand. the official administration of its work; However, most of the Board's work con- neither does it consider a man's religion sisted of holding consultations and is- or his economic status. It is true, how- suing pamphlets. In passing, it is inte- ever, that Public Health does more for resting to note that Public Health those who are unable to pay for certain records of the State show that, as early services. It also affords "Mass protec- as 1890, North Carolina was visited by tion" against preventable ills. On this a severe epidemic of influenza. It was point, there is the fullest cooperation then called "grip" or "La Grippe." The between organized medicine and public epidemic first appeared in Russia in health, for it must always be borne in November, 1889. By mid-December of mind that public health is a child of that year, 200,000 cases were reported organized medicine. in New York alone. The epidemic struck Public Health in North Carolina came North Carolina during January, 1890, into being as a full-time department of and in two weeks time was reported to government as a result of an Act of be raging in 68 counties. Back in those the General Assembly of 1909, which days, we had no adequate system of re- provided for a full-time State Health porting either the prevalence of certain Officer. Actually, the State Board of diseases or the number of deaths result- The Health Bulletin December, 1949 ing therefrom. One of the most useful which was "chalked up" during the last services Public Health is rendering to- session of the Legislature, to which pre- day is the adequate reporting of all vious reference has been made. After births and deaths, and the number of much discussion, the appropriating cases of 35 communicable diseases and body of the State provided approxi- cancer. mately $800,000 in new money for each At the turn of the century, Public year of this biennium. This money re- for Health in North Carolina began to look cently was allocated to the counties local Health work. up, but even then the means in hand improving Public increased services for were meager. It was not until 1907 that This means many "grass roots." There the annual appropriation of $2,000, the people in the services Public which began around 1885, was increased are so many which performs in this modern, com- to $4,000. Following the provision for a Health it almost dis- full-time State Health Officer, in 1909, plex age that would be either or tne appropriation was increased to $10,- criminatory to single one a group of these services for particular 500, and it has since then enlarged from time to time until this last Legislature discussion. increased it to nearly $2,000,000 a year, The past dozen or so years have thereby more than doubling any pre- witnessed an intensive and successful vious appropriations for Public Health campaign for the control and cure of work. This was done through close co- venereal diseases. Millions of dollars operation of our Public Health officials have been spent in North Carolina on in seeking the increase with the active tnis project alone, but the work of at- approval of Governor Scott. tacking syphilis and gonorrhea is no The year 1905 was a milestone in the longer spectacular and is carried on as Public Health history of North Caro- a routine part of Public Health in North also instituted pro- lina, for it was during that year that Carolina. We have the General Assembly voted to establish grams for the early detection and treat- the State Laboratory of Hygiene, which ment of tuberculosis and cancer. Our now not only has come to be one of the Public Health officials now are looking of finest institutions of its kind in the with longing eyes in the direction United States, but saves the people of that day when they will be able to North Carolina an estimated several participate successfully in movements million dollars a year in services rend- to conquer what we know as those de- ered. Before the Laboratory was estab- generative diseases which are respon- of deaths lished, for example, if a person were sible foT more than half the bitten by a dog known to be rabied, the occurring from all causes. Our Number nearest place he could receive treat- One killer today is heart disease, which ment was Richmond. The establishment has all but backed the former cham- of a Laboratory of our own made these pion, tuberculosis, off the boards. Atten- treatments possible right here in North tion also is being given to a more in- Carolina. That was just the beginning. tensive study of diabetes, nephritis, and The Laboratory today prepares and other diseases that take a tremendous distributes the agents for immunizing toll of life each year. the population against practically every It was not until 1911 that provision preventable disease. While time will not was made for county boards of health permit an enumeration of these dis- to take the place of county sanitary eases, with a discussion of each, it is committees, which operated prior to of importance to note that, coincidental that time and performed what few with the availability of immunizing local health services were available. On agents, death rates from preventable June 1 of that year, Guilford County diseases have all showTi remarkable de- inaugurated full time county health creases. work. The task of convincing the coun- One of the most important victories ties of the advantages of full time local ever achieved by Public Health was that health boards has not been easy at all December, 1949 The Health Bulletin

times, but the momentum gained was ices which, otherwise, could not be steady, even if slow at times. All of enjoyed by those needing them. Such North Carolina's 100 counties have now funds came into being and were made been organized, either as a local health available with the creation of the So- unit, or as a part of a public health cial Security Board in Washington. department. This means that everj' Such funds have been allocated to man. woman and child within the bord- North Carolina, as to other states, pure- ers of our State has all of the advant- ly on a pro rata basis. The influx of ages of Public Health close at hand. It Federal funds into North Carolina was might be pointed out that the benefits given impetus with the Reynolds Foun- of Public Health actually are administ- dation grant for an intensive campaign ered in the counties. While it is neces- against venereal diseases. In fact. North sary for an organization to be main- Carolina's pioneer work in this field tained at Raleigh, Public Health is stimulated Federal action all along the made available to the public within anti-V. D. front. As a break-down of their ow^n neighborhoods, and no at- available funds will show. North Caro- tempt is made by the Central Admin- lina now is receiving grants from the istration to dictate to any local health Federal government for many phases unit. Our people are as capable of self- of its Public Health activities. But the government in the matter of health as most encouraging sign of the time is they are in the matter of adopting local that the State itself appears to be wak- policies along any other line. ing up to its own responsibility for One of the encouraging signs of the the health of the people. It is well that this is assurance times in Public Health is the improve- so, because we have no will ment of local facilities, including the that Federal spending in the states housing of local health boards. These continue on its present scale indefin- units are gradually emerging from base- itely. We should, therefore, be prepared essential service ments, coming down from attics, and to carry forward any moving from back rooms to front rooms. in the event of a withdrawal of Federal Many of our county health departments funds. now occupy buildings dedicated solely to their needs. In this connection, it is well to point out that the last Legisla- ture, in the spirit of generosity which it manifested toward Public Health, ap- propriated $600,000 for a new State Board of Health building in Raleigh, in addition to the liberal increase it gave for county health work. In an address at Greensboro on the night of Septem- ber 16, 1949, Dr. Leonard A. Scheele, Surgeon General, U. S. Public Health Service, declared that when the 1949 Legislature practically doubled the State appropriation for Public Health, William Curtis Barbour when one year it put North Carolina way out in front old, son of Mr. & Mrs. William Albert in its relation to the entire sisterhood Barbour, Four Oaks, North Carolina. of states. He praised the support that No matter in which county of North Governor Scott gave the movement to Carolina you live, the time has come secure these additional funds. when you are the beneficiary of Public In addition to the State appropria- Health, and if there are other things tions that are made for Public Health, you would like to know about this im- the Federal government spends much portant subject, consult your local money in North Carolina every year, health officer. He will be glad to help helping to make available certain serv- you in any way he can. The Health Bulletin December. 1949 APPROACHES TO URBAN SANITATION EDUCATION*

William C. Gibson, Educational Director Sanitation Field Training School of Public Health University of North Carolina, Chapel Hill, N. C.

Problem Solving Approach. fective use of all of our community re- Sanitation divisions of public health sources for the solution of these prob- departments are overloaded with work. lems. This is the common complaint of the To assist in this basic analysis, in- smallest and largest units. An increas- creasing numbers of health depart- ing volume of service requests and nuis- ments and communities are making use ance complaints pour in every day. In of the APHA Sanitation Evaluation an effort to keep current with this de- Schedule in an effort to measure the mand the planned programs tend to be level of community sanitation; to ap- pushed aside. We find ourselves joining praise the effectiveness of existing pro- in the demand for additional personnel grams; to point out weaknesses; and in order to do an effective job of urban to provide a planning aid for the in- and rural sanitation in our communi- telligent use of local facilities to meet ties. sanitation problems in the order of Although statistical averages may their relative importance. This tool lead to erroneous deductions it is worth provides us with a method to make an noting that the average population ratio objective systematic study of the sani- per sanitarian in a group of nine states tation status of our community—both of the southeastern region is approxi- urban and rural. This tool enables us mately 24,000 to 1. In areas familiar to to put aside the empirical approach by the writer where the ratio is as low as giving us an understanding of the en-

7,500 to 1, the need for additional per- vironmental sanitation problems of our sonnel is also acute because of the de- own areas. mands of broadened programs sponsor- All good sanitation divisions make ed by these departments in an effort repeated inspections of a variety of to keep pace with new and increasing establishments; they collect and analyze environmental problems and health huge numbers of water, food, milk and hazards accompanying our complex sewage samples; they investigate stag- modern civilization. gering numbers of nuisance complaints; We must have additional well-trained and so on. Why? Because it is custom- personnel! However, this is only a part ary. It is the accepted practice. Schools of the answer to the increasing worK of Public Health teach it. Yes, Evalua- loads facing sanitation divisions. We tion Schedules demand it. We try to must pause and take stock of our com- carry on ail these activities with equal munity sanitation problems and ask emphasis and we add others to burden ourselves why we are not making pro- our load. This is the empirical practice gress faster in solving them. We must of sanitation control and it is a vicious analyze critically the distribution of cycle that grows bigger and bigger as our time and ask ourselves if our efforts the years pass. are being directed to the solution of the If we use the Evaluation Schedule major environmental problems of our areas. We must examine our approach to the solution of our sanitation prob- *Presented at Interstate Sanitation Seminar, lems to determine if we are making ef- Blue Ridge, N. C. August 24, 1949. December, 1949 The Health Bulletin merely to measure our work against a approach, we will make repeated in- national standard, that often does not dividual visits to those types of estab- apply, we gain only the satisfaction of lishments which have been found to knowing how our program rate in com- be amongst our major problems. parison with others. If, however, we Our personnel time for making estab- think of the Evaluation Schedule as lishment inspections will be budgeted a tool to help us analyze the sanitation according to the relative importance of problems of our areas we have an ef- the problem. The emphasis will vary fective aid for the development of pro- from community to community based grams aimed at our own needs. This is on the studies made of our own com- the opposite of the empirical practice of munity problems. sanitation! It is essential that we examine our If 10% of your community uses raw inspectional techniques to make each mik, that is a sanitation problem of contact of maximum educational value your community. If 25% of the homes to the operators and employees of in my community do not have munici- establishments inspected. Mr. Operator pal water and sewage connections, that is justified in wanting to know why he is my community problem which re- should make requested improvements. quires definite action. If 50% of our The fact that the law or regulation says food establishments are Grade C—if so does not satisfy him in these de- malaria, typhus, undulant fever, and mands upon his pocketbook. He expects hookworm cases are reported in our to learn from the Sanitarian the public communities, they define our problems health reasons for the requested im- —and we have the basis for a planned provements and the interpretation of sanitation program directed to these reasonable compliance. In his desire for specific problems. This is the problem this information exists the opportunity solving approach—the opposite of the for education of the operator and his empirical approach—and my under- employees through discussion, demon- standing of the fundamental approach stration, expert guidance and advice on to urban and rural sanitation education. handling methods, equipment pur- Through this approach we learn the chases,, layout diagrams, and so on. particular sanitation problems of our Almost any person can be taught to own communities so that we may at- fill out inspection forms. A measure of tack them in the order of their relative a good sanitation worker rests in his importance. This is the education of ability to use the results of the inspec- ourselves and our staff collegues that tion to obtain improvements through must come first before we can develop the development of an understanding a sound program. Through this ap- and desire by the establishment pro- proach we will arrive at the desirable prietor to carry on good sanitation quota of sanitation personnel for our practices. This approach establishes the communities and not alone by arbi- — sanitation worker as a teacher and a trary standards regardless of how liber- consultant. This is a high trust which al. carries a heavy responsibility to equip Individual Approach. ourselves properly to give sound guid- Sanitation personnel make countless ance on the "when", "why", "where", thousands of individual establishment "how", and "how much" angles of good inspections yearly. Much improvement sanitation practice. is accomplished by this routine. No Even this is not enough! The alert doubt this inspectional technique will sanitation worker must use the inspec- be continued as a principle activity of tion opportunity to analyze the de- sanitation divisions. Our sanitary codes ficiencies of the establishment in order and regulations demand that this serv- to assist the operator in the preparation ice can be rendered. Once we have de- of a time-improvement schedule. This fined our principle community sanita- technique places most important items tion defects by the problem solving first and gives the operator a logical —

8 The Health Bulletin December, 1949 time table to guide him in his improve- assist them in gaining the "know-how" ment program. The operators signature to discharge their sanitation respon- on this schedule is his pledge of good sibilities in an acceptable fashion. faith that he will correct each defi- Let me cite a few specific examples of ciency within the agreed time period. what I have in mind: Later inspections are pointed to assist- If in the basic studies of the status ing the operator in carrying out his of our community sanitation we find obligations accepted and defined in the that one of our major problems is the improvement schedule. This is the in- improper location and construction of dividual approach the problem solv- — private wells and/or septic tanks we ing approach applied to the individual can do much to prevent a future re- establishment. When each establish- petition of these defects by the educa- ment operator is working on his own tion of our well drillers, plumbers, and improvement schedule we have broad septic tank builders. It is far more pro- progress developing according to a plan ductive to devote our efforts to the pre- placing most important items first. In vention of these problems rather than due time we can shift our major em- to the correction of defects after health phasis to the next in the list of our hazards are created and nuisance com- key problems. Certainly this is not the plaints develop. Similar reasoning can empirical approach. This, I believe, is be followed pertaining to the problems another fundamental approach to sani- of cross-connections and interconnec- tation education the education of the — tions in the plumbing systems of our individual establishment operator. communities. Our efforts are produc- Group Approach. tively devoted to the elimination of Many of the individuals we deal with these hazards in future installations by contractors, in sanitation programs fall naturally working with our plumbers, into certain occupational groups. Be- waterworks officials, and city councils cause of this common interest we have towards an understanding of the haz- available to us another important ap- ards involved and their prevention adoption of proach to the solution of our major and ultimately towards the sanitation problems — the group ap- a regulartory code when all parties con- cerned have been properly educated to proach. This is the opportunity for the education of special groups allied to this end. public health — food handlers, milk We are all aware of the proven values handlers, water and sewage plant oper- obtained through well planned and con- ators, well drillers and plumbers, re- ducted classes for food and milk han- sort operators, school administrators, dlers. These classes have been most teachers, and janitors, septic tank productive in those areas where they builders, pest control operators, city have been conducted at the request of councils, and so on. the local organizations of food han- Many of these groups are already dlers and milk handlers rather than at organized at the national, state, and the sole insistance of the health depart- local levels. Several have already adopt- ment. We must extend these opportuni- ed excellent standards of practice re- ties to the other groups allied to the lated to sanitation. A number of the sanitation program. I am of the opinion groups conduct annual instructional that we should take still another step courses in cooperation with state acade- concerning such classes when we have mic institutions and public health the full cooperation and understanding agencies. of the food and milk plant operators Regardless of their individual or- through their respective local organiza- ganizational status, these groups are tions. We should devote our principle responsible in a large measure for the efforts to the education of the owners, level of sanitation in our communities. operators, managers, and other key We must help to make them more fully personnel of these establishments. They, aware of their responsibilities. We must in turn, must accept the primary re- December, 1949 The Health Bulletin 9

sponsibility for the instruction of their tion are wide open to sanitation work- subordinate personnel. They are in day ers who see the latent potentialities of to day contact with their employees this approach to work with groups. and are thusly in a much more effective Certainly, this is not empirical practice position to correct faulty work habits of sanitation. It is another fundamental and handling methods than the sani- approach to sanitation education—the tation worker who can make only re- education of special groups allied to latively few contacts. They, too, are the sanitation of our communities. psychologically in the proper position Community Approach. to insist on safe and sanitary practices. In the promotion of our sanitation By so doing we have placed the re- programs we must keep uppermost in sponsibility for good sanitation pract- mind the importance of an informed ice squarely on the shoulders of the community. We can expect to make real managerial group. We can then look to progress in the solution of important them for satisfactory compliance. community sanitation problems when The routine inspection of dairy farms the entire community is aware of the and the collection and analysis of farm problems. They will demand, through and plant milk samples is an under- their community leaders, a satisfactory taking of major size for every good solution. This is the American demo- sanitation division. It is high time that cratic pattern for progress. we look to the milk plants themselves Public health is vitally important to for the major portion of these com- our communities. We must do our com- pliance and quality checks. These serv- munity education in a manner that re- ices should be performed by field in- flects the importance of public health. spectors and laboratory personnel hired We cannot expect to receive appropria- by the plants. The activities of sanita- tions for a big job unless we convince tion divisions of health departments can our communities and our legislative and be more productively utilized in the appropriating bodies that attaining education of these plant employees, in good public health is a big job. assisting them with difficult problems, In the problem solving approach to and in making regular checks to assure our community health hazards we will high quality performance. Again, we employ every technique demonstrated look to plant management for compli- to be successful in formulating public ance with good sanitation practice in opinion. We will adopt many of the all milk handling operations on the ethical educational procedures of pro- farms and in the plant. This, again, is gressive sales organizations. placing the responsibility where it be- In the education of our communities longs—on the shoulders of plant man- to their important sanitation problems agers. we must adopt techniques to reach all This, I believe is the goal to be reach- levels of our public. We must use all ed in our work with special groups allied available publicity avenues—the news- to the sanitation program. Firstly, the papers, radio, our highway billboards education of these groups in coopera- signs, the neighborhood theatres, the tion with their local organizations to popular magazines, display signs in good sanitation practice, and secondly, public busses, and so on. I was impres- the placement of responsibility with sed recently with match folders that I them for the conduct of such practice picked up in Ohio which advertised in all of their operations and by all of services available from local health their employees. Without the prepara- agencies in Ohio for the control of tory education for these groups, the venereal disease. Why not? If it is a acceptance of responsibility is difficult big problem, let's attack it in a big way. to achieve. The avenues of cooperation I'm sure that we coilld use comic books with academic institutions and state and comic strips to sell good sanitation and local agencies for the development in an effective manner. It's worth a try. of this type of continuing adult educa- They reach our public. With good plan- 10 The Health Bulletin December, 1949 ning we can extend the written and broad plan adopted by the community spoken words about public health and health council. our community sanitation problems into This is the community approach to homes, factories, schools, movies, bars, sanitation problems. Certainly this is restaurants, highways, and so on. By not empirical sanitation practice. This these efforts we will obtain an informed is another fundamental approach to community—a community which will sanitation education—the education of demand Grade A signs in food estab- the community. lishments; pasteurized milk; municipal Conclusion. water and sewage connections; neigh- of addi- borhoods free from rats, flies, and mos- Yes, we need large numbers quitoes; schools and factories free from tional well-trained sanitation workers health hazards; and so on. I don't be- to do an effective job of community hy- giene. will come in increasing lieve there is any short cut to this end These as put aside the empirical if we want an educated community with numbers we control and us. approach to sanitation To be most effective this community adopt the problem solving approach. By approach must be well planned, focused so doing we will bring to the foreground on a key community sanitation problem our key community sanitation problems. and promoted by community leaders in We will attack these problems one by addition to staff members of the health one, in the order of their importance. agency. The community health coun- Through the individual approach and cil or some such advisory body, made the group approach we will push our up of representatives of the key groups efforts to the education of these directly and interests of the community, is a concerned to understand the problem means for obtaining organized com- and to accept their responsibilities. And munity effort. The concentrated im- meanwhile, by the community ap- pact of community service clubs, the proach, we will strive for an educated chamber of commerce, the labor unions, public that will meet and solve its the parent-teachers organizations, the health problems through its own or- youth groups, the newspaper editors, ganized leadership. These are the fun- the city councilmen, the medical so- damental approaches to sanitation edu- ciety, the church groups, and so on, can cation. These, I believe, are the real be directed to the solution of the select- challenges that face each of us engaged ed problem in accordance with the in sanitation work.

PREVENTIVE MEDICINE AND MENTAL HEALTH

North Carolina State Board of Health By William H. Richardson Raleigh, N. C.

The public's attitude toward the men- disorders in the same light as the pub- tally ill has been greatly modified since lic viewed smallpox before Jenner gave the word "insanity" has been thrown the world a vaccination against that into discard and a more charitable and disease. Prior to his discovery, inocula- understanding attitude assumed toward tion was practiced, in order to have the the inmates of our institution for the disease "over with" at some opportune mentally sick. Progressive thinkers in time. While there is but one approach the field of medicine, psychiatry and to the prevention of smallpox, and that Public Health no longer view mental by means of a definite immunizing December, 1949 The Health Bulletin 11

agent, the approach of the prevention care is being given the States mentally of mental illness is a more complicated ill. This is shown by the fact that there matter, involving theories and conjec- were 6.9 per employee in 1946 and only tures, many of which have not been fully 5.4 patients per employee in 1947-48. explored. However, it is encouraging to The cost of care, largely reflecting the note that mental illness now has be- higher cost of living, increased from come the object of attack through pre- $393 per patient in 1946 to $584 per ventive means. As long as we depended patient in 1947-48. Physical improve- upon emptying our mental institutions ment of State hospital buildings also is from the top, we made no progress being accomplished. Approximately $14,- whatever with the real problem. Con- 009,000, including Federal funds, was tinued dependence upon custodial care made available by the 1947 General means continued financial appropria- Assembly. Purchase of the Camp Butner tions for such care and continued wait- site and buildings under construction ing lists. already account for $4,000,000 of this. The morning light of hope and rea- The above reflects investments for son seems to be breaking at last, now care and treatment and not prevention, that mental illness definitely has be- but it is encouraging to note that more come an object of attack through pre- money is being put into this humani- ventive medicine and a recognized Pub- tarian service, which naturally means lic Health problem. Within the past few better care of the mentally sick and months, Governor Scott has designated happier surroundings for them. Hos- the State Board of Health as the State pital care, however, is nothing new. agency in North Carolina which will That has been going on in humane administer Federal funds made avail- states and countries for many decades. able in carrying on our mental health North Carolina has not always kept program, together with available State pace with progress in this respect. Hos- funds for that purpose. While the or- pital care is not enough for the mentally ganization of a Mental Hygiene pro- ill, any more than it would constitute gram has not been perfected, yet the a panacea for any other preventable ground work is being laid for an attack sickness. As was stated in the beginning to be waged against mental illness as of this discussion, Governor Scott has one of the present and future Public designated the State Board of Health as Health problems. the agency to be responsible in North Let us for a moment review the pre- Carolina for the execution of this sent mental health picture in North State's part in the nationwide Mental Carolina, as it is reflected in our in- Health Program now in progress and for stitutions for the mentally ill. According which North Carolina is receiving its to a recent fact sheet, there are now proportionate share of Federal funds, 9,550 persons hospitalized in this State made available for the purpose. While for mental defects, or illness. This, ac- the Board of Health's Mental Hygiene cording to the latest compilation, is program has not been fully formulated, just 125 short of the entire available a long range plan is being formulated, bed capacity of all general hospitals in looking toward attacking mental sick- North Carolina in May, 1948. Among ness from a preventive standpoint. those in our State institutions are 1,285 It is heartening to note that preven- feeble minded and 671 epileptics. There tive work now is being done through were 180 patients who received the first one school social worker and eight men- admissions to State hospitals for the tal health clinics partially supported by mentally sick in February, 1949, alone. State and Federal funds. These are lo- North Carolina is now providing more cated in two medical schools—two at hospital care for its mentally ill than Duke and one at Bowan Gray—and in in the past. Its average patient popula- Asheville, Charlotte, Durham, Wilming- tion in 1946 was 7,568 as compared with ton, and Raleigh. Assistance in financ- 8,552 in 1947-48. Furthermore, better ing mental health programs has been —

12 The Health Bulletin December, 1949 given by the National Mental Health ing custodial care over the institution- Act. On a matching basis, North Caro- alized segment of our population. Most lina receives $100,000 of Federal funds of the psychiatrists at the Asheville for training professional workers, and meeting were in uniform, as were al- for educational and clinical work. most all other physically and mentally A partial progress report happily can fit persons within the military age be made at this time. During the past group, at that time. However, their six months, 1,171 patients have received studies were based partly upon their help through the clinics above referred experiences in civil life, as our partici- to. In many instances each patient re- pation in the Second World War, at presents two, three, or four others, who, that time, had not advanced to the as parents, teachers and employers, point where we could make any sub- gained a better understanding of them- stantial, or permanent, findings con- selves and of other children and adults, cerning the mental health of those in as the clime helped them deal with the our armed services. What we are trying problems and needs of this one patient. to say, however, is that, for some time An additional 511 patients are under now, mental illness has been under con- treatment at this time. sideration as an object of attack on the part of preventive medicine. We shall Prevention is said to be comparatively not undertake to go into any of the not expensive. If two-thirds of those causes of mental defectiveness. Broadly admitted to State hospitals in February, speaking, early training and environ- alone, remain in hospital care one year ment, heredity and various other fac- —as a conservative estimate of time tors, have long been considered as it will cost North Carolina $70,080. This probable causes. But we shall neither sum would meet the cost of two almost dwell upon these nor enumerate any ideal, full-time mental health clinics. others which might suggest themselves, Up until recently, mental illness had as this discussion is given by a laymen not received the attention it should who refers to medical or psychiatric have received. There was about it a feel- terms merely to remain factual. It is ing of futility. But, with the advance- hoped that at some future time we may ment of sociological and other studies be able to give you a report on North affecting human behavior, the convic- Carolina's Mental Health Program that tion that mental illness, at least, could will reflect not only progress, but indi- be placed in the category of preventable cate that we have blazed new trails in diseases has grown. In other words, we this important field of human endeavor. now are, at least, beginning to make a try at it. Here are some facts to think about. As far back as 1942, there was held in Mental illness is no stigma, neither is Asheville what was known as the Na- it a disgrace. The hush-hush period of tional Corrections Congress, which had talking in whispers belongs to the past, to do largely with an exchange of ideas as it does in connection with such things by nationally prominent persons on how as venereal diseases, which were never to deal with people in correctional in- successfully attacked until they were stitutions, including those for the men- brought out into the open. The time has illness should be tally ill. The writer of this article spent come when mental a week in attendance upon the sessions everybody's business because it affects of this national gathering, at the re- the entire community in one way or quest of the Governor, and in associa- another, just like any other illness. In tion with the State Health Ofl&cer. It fact, it is more far reaching than any was his duty to attend meetings of the of the simple diseases can ever be. mental health section each afternoon If any of you who read this article and report the proceedings to the press, has any problem concerning mental as the Governor desired that all pos- illness, you are invited to write a card sible publicity should be given to this or letter addressed to Mental Health, distinguished meeting of those exercis- Care State Board of Health. December. 1949 The Health Bulletin 13

RESEARCH PROGRAM OF THE NATIONAL TUBERCULOSIS ASSOCIATION

By Esmond R. Long, M. D. Director, Medical Research and Therapy American Trudeau Society, Medical Section of the National Tuberculosis Association

In the fall of 1920 a small committee promising investigations are underway was appointed by the President of the on the genetics of the germ, hereditary National Tuberculosis Association, to variations in the resistance of animals develop a research program imder the to tuberculosis, factors concerned in Association's sponsorship. In his presi- native and acquired resistance to the dential address at the following annual disease, and factors responsible for the meeting Dr. Gerald B. Webb said, "We death and liquefaction of tissues in pro- must frankly state our knowledge of gressive tuberculosis. These studies are the disease, and also the extent of our of basic importance in understanding ignorance regarding tuberculosis, so that the development and course of tuber- we can more wisely guide the efforts culosis in the hioman body. Besides these made in prevention and cure, and direct investigations are a series of studies of research to bring further enlightment." immediate clinical interest, including In the succeeding 29 years the pro- researches on nutrition in tuberculosis, gram initiated in 1920 has expanded the value of certain drugs in experi- greatly, but the objectives have remain- mental treatment of the disease, the ed the same. Emphasis has been laid differential diagnosis of tuberculosis from the outset on fundamental re- from somewhat similar chronic diseases search that could be widely applied later of the Ivmgs, the treatment of tubercu- in practical investigations in the gener- losis in children, tuberculosis in nurses, al campaign for improved treatment and the value of bedrest as compared with control of tuberculosis. other forms of treatment, and physio- logical study of the effect of tuberculosis Fields of Investigation upon lung function. The National Asso- Among the earliest studies sponsored ciation also supports a bacteriological by the Committee on Medical Research culture depot from which other investi- of the National Tuberculosis Association gators can secure standard strains of were several on the chemistry and tubercle bacilli of known ancestry for growth of the tubercle bacillus. It was their own studies. This depot has been felt that they were fundamental for an widely used in the interest of uniformity understanding of the manner in which of basic material by investigators the tubercle bacillus multiplies and throughout the world. exerts its effects in the human body. These studies, stUl being continued, Relation of NTA to General Medical have been highly productive in deter- Research Program mining the manner in which the bacil- The medical research program of the lus derives its nourishment from the National Tuberculosis Association is only substances on which it feeds, and the a part of a much larger general pro- way in which it builds these materials gram of tuberculosis research through- into its own body constituents and out the nation. A recent study by Miss specific products, like tuberculin, which Virginia Cameron, Medical Research have a pronounced physiological effect Secretary of the National Tuberculosis upon the human host. Association, has shown that the finan- In addition to studies of the chem- cial assistance to research given by the istry and growth of the tubercle bacillus. National Association and its affiliates 14 The Health Bulletin December, 1949 amounts to only three per cent of the search who appear likely to continue total funds expended by the nation in to devote major attention to tubercu- the investigation of this disease. The losis. great majority of the total sum spent Geographic Location of Investigations for research on tuberculosis is devoted The Committee to studies of the effect of certain drugs, on Medical Research and Therapy of the National Tubercu- particularly streptomycin. However, it has been pointed out repeatedly that losis Association has adopted the view generally held while quantitatively, from the financial among sponsors of re- search throughout the standpoint, the contribution of the As- United States, that geographic location should not sociation and its affiliates is relatively be primary small, qualitatively the research pro- consideration in the award of grants. The objective or research grants gram of the Association is of the utmost is to stimulate productive importance, because many of the basic and fruitful facts used in applied research on the scientific investigation wherever the op- portunities are therapy of tuberculosis were learned in best. However, experi- ence has shown that fundamental investigations made pos- projects deserving support are sible through grants from the National scattered throughout the Tuberculosis Association. nation, and as an actual fact the 22 This perhaps answers the question projects sponsored by the Committee are frequently raised: Why does the Na- located in 14 states stretching lit- tional Tuberculosis Association not de- erally from Maine to California. vote a larger percentage of its resources Financing of Investigations to direct studies on the cure of tuber- Funds for the present medical re- culosis? The reply, as indicated above, search program of the National Tuber- is that the sums required for large- culosis Association are contributed in scale studies with costly drugs are so part by the National Tuberculosis Asso- great that they would be out of the ciation itself, and in part directly by range of the National Association. Only its state and local aflBliates. Within re- the Federal Government, state govern- cent years the boards of directors of ments and large manufacturing firms state and local associations have taken have resources sufficient for this pur- great interest in the medical research pose. Experience has shown the wisdom program, and have enthusiastically sup- of the plan of the Committee on Med- ported it. Many of these associations not ical Research and Therapy in devoting only contribute to the research program the major portion of its resources to of the Association as a whole by special basic investigation, and leaving to contributions to the National Associa- agencies supplied with greater much tion, but independently finance investi- funds, the bulk of investigation on the gations within their own communities. cure for tuberculosis. In each case the projects are studied Development of Investigators by the Committee on Medical Research The Committee on Medical Research and Therapy of the National Associa- tion, and before is and Therapy gives constant thought to approved support given the affiliates. the development of young and promis- by ing investigators who will carry on the In essence the research program of study of tuberculosis in the future. With the National Tuberculosis Association is this in mind the Association has de- designed to develop practical research veloped a program for research and on the control of tuberculosis through teaching fellowships. Such fellowships a long series of patient studies on the are granted to graduates of medical fundamental nature of the disease and schools in this country, who will con- basic principles concerned in its pre- tinue to carry out their work in the vention and treatment. The program United States. Emphasis is laid upon has led to the publication of more than the selection of young men and women a thousand scientific articles by invest- showing originality and ambition in re- ors receiving Association support. December, 1949 The Health Bulletin 15

INTERNATIONAL RELATIONSHIP IN REGARD TO TUBERCULOSIS CONTROL

By Betty MacDonald James E. Perkins, M. D., Managing Director National Tuberculosis Association New York, New York

Only since World War II have there In the fall of 1948 the Interim Com- been developed serious plans for con- mission of the World Health Organiza- trol of tubei'culosis on an international tion was replaced by the permanent scale. Prior to World War II there were secretariat of the WHO, in accordance certain attempts at international quar- with decisions made by the First World antine and exchange of information as Health Assembly meeting in Geneva to morbidity and mortality. There was, earlier in the year. The tuberculosis however, no international governmental work of the WHO is being guided by machinery to attempt international con- the advice of a committee of nine tu- trol of tuberculosis, and the voluntary berculosis experts, and the program is international anti-tuberculosis agency. being administered by a full-time con- The International Union Against Tuber- sultant and his staff, members of the culosis, confined itself principally to WHO secretariat. conducting periodic international tuber- The WHO helps advise the UNICEF culosis congresses, devoted largely to in its BCG program, and ultimately no developments in methods of treatment. doubt, will take it over. It has arranged During the latter part of World War for surveys of the tuberculosis situa- II and the early part of the postwar tion in several countries, and has given period, the United Nations Relief and advice as to desirable tuberculosis con- Rehabilitation Administration included trol programs in those countries based in its activities tuberculosis case-finding upon the findings of the surveys. It has and control, and upon its dissolution, the provided a limited number of traveling United Nations International Children's and training fellowships to physicians Emergency Fund picked up and expand- from various countries, particularly ed UNRRA's tuberculosis control activi- those which have serious tuberculosis ties so far as children are concerned. problems and which have not estab- The UNICEF program assumed the lished as yet control programs. It has form largely of mass tuberculin testing also made available to countries, upon of children, with BCG vaccination of request, tuberculosis experts from other those found to be non-reactors. Confined countries for advice upon specific tu- at first to the devastated countries of berculosis problems. Europe, this program has been extended The International Union Against Tu- by the Scandinavian Red Cross So- berculosis has been slow to arouse it- cieties, who are under contract by self from its necessary hibernation dur- UNICEF to supervise the program, to ing the past World War. The stage is the Near East and Asia. BCG for this now set, however, for the Union to em- purpose is produced in and distributed bark upon an expanded program and from the State Serum Institute in to take its rightful place working hand- Copenhagen, Denmark. The program is in-hand with WHO, if its member agen- being extended to North Africa as well, cies and secretariat wish to do so. At with BCG for this part of the program the 1948 meeting of its Council, an ex- coming from the Pastevir Institute in panded program was approved and Paris. established of a full-time executive : —

16 The Health Bulletin December, 1949 director authorized. At the 1949 Council 26 to Dr. George M. Cooper of North meeting, a sub-committee was appoint- Carolina and Dr. Carl G. Hartman of ed to seek suitable candidates for the New Jersey. Charles E. Scribner, Chair- position of executive dii'ector, and ex- man of the Planned Parenthood Federa- tensive changes in the constitution, tion of America, made the presenta- necessary for the implementation of tions at the Annual Luncheon of the the expanded program, were agreed Federation, held at the Hotel Roosevelt. upon for submission to the assembly Before an audience of 500, chiefly for approval at its first postwar session delegates to the Federation's Annual scheduled to be held in Copenhagen in Meeting and representatives of other September, 1950. These changes also health agencies, Mr. Scribner read the clarify relationships between the Union citation and WHO. Proper integration of the "To George M. Cooper, M.D., for his activities of the two agencies is further brilliant and humane leadership in assui'ed by appointment of the part- establishing birth control as an integral time honorary secretary-general of the part of the public health service of Union to the WHO Expert Committee, North Carolina, the first State in the and by the practice of the inviting the Union to take this step. As head of the tuberculosis consultant of the WHO sec- Division of Preventive Medicine, he dis- retariat to participate in all sessions of played extraordinary talent and vision the Council of the Union. as organizer, educator and administrator Adequate financial support of the in bringing the benefits of child spacing Union was pledged by the delegates of to under-privileged couples. To him we the various member agencies at the owe much of the improvement in ma- 1949 meeting of the Coimcil providing ternal and child health and family sta- a properly qualified full-time executive bility." dircetor is appointed and an expanded, effective program is established. The cause of the high prevalence of tuberculosis in mental hospitals is fail- DR. GEORGE M. COOPER ure to recognize or seek out cases of Dr. George M. Cooper, head of the tuberculosis among incoming patients Division of Preventive Medicine, North who then transmit the disease to other Carolina Health Department, honored patients during residence in the hospi- with a 1949 Lasker Award of the Plan- tal. The situation can be improved only ned Parenthood Federation of America by segregating and treating the tuber- for outstanding services in maternal and culous patients discovered by survey. child health and for his efforts in mak- Waldo R. Oechsli, M.D., Pub. Health ing his State the first in the Union to Rep., Jan. 7, 1949. include birth control in its public health services. The admission of tuberculosis patients Born in Clinton, N. C, he practiced to general teaching hospitals on a more there after graduation from the Uni- liberal basis than has become the custom versity College of Medicine, Richmond, would do more than any other measure in 1905. He was county physician for to improve medical education in tuber- Sampson County from 1909 to 1913, and culosis. In a teaching hospital the mere in 1915 joined the State health service. presence of a tuberculosis section is of In 1923 he was promoted to assistant educational value.—Carl Muschenheim, State Health Officer and to his present M.D., Am. Rev. Tuberc, July, 1949. post in 1931. The prevention of irregular discharge begins at the beginning of treatment. LASKER AWARDS IN PLANNED And treatment begins at diagnosis, at PARENTHOOD PRESENTED the time when the patient is first in- The Albert and Mary Lasker Founda- formed that he has tuberculosis.—Wil- tion Awards in Planned Parenthood liam B. Tollen. Ph.D., VA Pamphlet 1948. were presented in New York, October 10-27, Oct., (