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UNC-CH HEALTH SCIENCES LIBRARY H00338139R j HEALTH SCIENCES LIBRARY OF THE UNIVERSITY OF NORTH CAROLINA AT CHAPEL HILL Inside FDA Issues Warning About Artificial Sweeteners . . How It Was in the Old North State North Carolina Gets Chief Medical Examiner THE HEALTH BULLETIN First Published—April 1886 The official publication of the North Caro-lina State Board of Health, 106 Cooper Memorial Health Building, 225 North Mc- Dowell Street, Raleigh, N. C. Published monthly. Second Class Postage paid at Raleigh, N. C. Sent free upon request. Editorial Board John Andrews, B.S., Raleigh Glenn A Flinchum. B.S.. Raleigh Jacob Koomen. Jr., M.D , M.P.H., Raleigh John C Lumsden, B C HE., Raleigh H W Stevens. M.D., M.P.H., Asheville Editor: H. B. Rogers Vol. 84 January 1969 No. 1 Physical Therapy Assistant: A New Health Career . . Cover: Dr. R. Page Hudson Jr. takes the oath of office as North Caro-lina's first chief medical examiner. He will direct the first statewide system for post-mortem medicolegal examinations. MEMBERS OF THE NORTH CAROLINA STATE BOARD OF HEALTH James S. Raper, M.D., President Asheville Lenox D. Baker, M.D., Vice President Durham Ben W. Dawsey, D.V.M. Gastonia Ernest A. Randleman, Jr., B.S.Ph. Mount Airy Paul F. Maness, M.D. Burlington A. P. Cline, Sr., D.D.S. Canton Joseph S. Hiatt, Jr., M.D. Southern Pines J. M. Lackey Rt. 2, Hiddenite Howard Paul Steiger, M.D. Charlotte EXECUTIVE STAFF Jacob Koomen, M.D., M.P.H. State Health Director W. Burns Jones, M.D., M.P.H. Assistant State Health Director J. M. Jarrett, B.S. Director, Sanitary Engineering Division Martin P. Hines, D.V.M., M.P.H. Director, Epidemiology Division Ronald H. Levine, M.D., M.P.H. Director, Community Health Division E. A. Pearson, Jr., D.D.S., M.P.H. Director, Dental Health Division. Lynn G. Maddry, Ph.D., M.S.P.H. Director, Laboratory Division Ben Eaton, Jr., A.B., LL.B. Director, Administrative Services Division Theodore D. Scurletis, M.D. Director, Personal Health Division THE HEALTH BULLETIN January 1969 FDA Issues Warning About Artificial Sweeteners The U. S. Food and Drug Administration has warned against the unrestricted use of cyclamates, the most commonly used artificial sweeteners. FDA has issued a statement reflecting interim findings of the National Academy of Sciences, ivhich conducted a review of the safety of artificial sweeteners. An FDA spokesman said, "Our one concern is that children and adults not only drink artificially siceetened carbonated soft drinks hut also consume many other products containing artificial sweeteners such as gum, candy, puddings, cookies, etc." The text of the official FDA statement: Many kinds of foods and drinks sweetened with su-gar substitutes are now available in the stores. Be-cause of this widespread and growing use, FDA sometime ago asked the National Academy of Sciences to review the safety of these artificial sweeteners. An Academy Committee has now submitted an in-terim report advising that cyclamate sweeteners should not be used in total-ly unrestricted amounts. Cyclamates are the most commonly used artificial sweeteners. The Committee's rec-ommendation was made because of questions scien-tists still have about the effects of the cyclamates. However, the Committee did say this: An adult can consume up to five grams of cyclamate a day without any probable hazard. Chil- January 1969 THE HEALTH BULLETIN dren should use propor-tionately less. The smaller they are, the less they should use. The World Health Organization has recommended a daily limit based on weight. Its for-mula works out to a limit of about one and one-third grams of cyclamate a day for a 60-pound child. Here's one way to trans-late that into practical terms: Artificially sweet-ened carbonated soft drinks —which account for most of the cyclamate consump-tion by the average con-sumer— contain from one-quarter to a little more than one gram of cyclamate in each 12-ounce bottle. How It Was In The Old North State HOW TO SLEEP Here are a few common sense directions guaranteed to be bene-ficial in ninety-five out of every one hundred cases of insomnia. Get enough phvsical exercise during the day to tire you. Go to bed at the first urgent invitation of Morpheus. Be sure the bed is comfortable and the room is quiet. Think pleasant thoughts. Don't have the head of the bed lower than the foot. Be sure there is no other livestock in the bed with you; if there are, change boarding- houses. If you haven't bathed latelv, try a good application of soap and warm water just before retiring. This is said to work wonders in more directions than one. If vour neighbors' cats also have insomnia, throw them a few Jackson crackers. If this fails, a shotgun is known to be a sure remedy. Eat supper at least two hours before retiring. Eat a light supper and take nothing indigestible. Don't worry and don't take dope. If vou don't get to sleep right awav and if vou don't sleep quite as much as vou think vou should, remember that even lying awake in bed is very restful. — The Health' Bulletin, Vol. XXX, No. 3, June 1915 THE HEALTH BULLETIN January 1969 Dr. Hudson (right) checks a point with Associate Jus-tice Susie Sharp of the State Supreme Court fol-lowing sicearing -in cere-mony. Justice Sharp admin-istered the oath of office to the new chief medical examiner. North Carolina Gets Chief Medical Examiner "I shall not be sparing of my-self or others in an effort to seek the truth and contribute to justice." With these words, Dr. R. Page Hudson Jr. took office as North Carolina's first chief med-ical examiner. Associate Justice Susie Sharp of the North Carolina State Su-preme Court administered the oath of office at ceremonies December 6, 1968 in Raleigh. On the platform with Dr. Hudson and Justice Sharp were Dr. Jacob Koomen, State health director, and State Senator John J. Burney of Wilmington, author of the bill passed by the 1967 North Carolina General (Continued on page 8) State Senator John J. Bur-ney of Wilmington wrote the legislation enacted by the 1967 General Assembly creating North Carolina's first statewide medical ex-aminer system. January 1969 THE HEALTH BULLETIN Physical Therapy Assistant: A New Health Career in North Carolina BY NANCY L. DUCKETT Public Information Officer Department of Communty Colleges An educational program to train people to become physical therapy assistants is now avail-able for the first time in North Carolina. The pilot program is being offered by Central Pied-mont Community College in Charlotte. According to Robert L. Gos-sett, director of the Central Piedmont physical therapy as-sistant program, there are 11 students already enrolled in the six-quarter course, which began at the community college early in October. Even though all of the stu-dents presently enrolled are women, Mr. Gossett points out that the program is most desira-ble for men, too. To be admitted into the pro-gram, a student must be a high school graduate or he must have earned a high school equivalency certificate. Mr. Gossett explained that the physical therapy assistant curriculum is made up of gen-eral college courses and techni-cal offerings. So that the stu-dents are able to practice what they are taught at the com-munity college, they spend time away from the school in clinical areas. "This will begin mid-way through the second quarter," said Mr. Gossett. In no way should the physi-cal therapy program, which leads to an associate in applied science degree, be confused THE HEALTH BULLETIN January 1969 with those programs designed to prepare a person to become a physical therapist. A physical therapist must have, at the minimum, a baccalaureate de-gree. In addition, to meet the standards for qualification of the American Physical Therapy Association (APTA), a person must be licensed or registered by the state when licensure laws are applicable. The American Physical Ther-apy Association recently adopt-ed a policy statement support-ing the training and utilization of the physical therapy assist-ant. This resulted from the current inability of established programs for the education of physical therapists to produce numbers of professionals to meet the growing health needs, coupled with the realization that many patient care needs can be met by a type of worker who has formal training at the technical level. The 1967 policy statement de-fines the physical therapy as-sistant as "a skilled technical health worker who has com-pleted an educational program approved by the association." The statement continues to explain that "such an individu-al functions to assist the quali-fied physical therapist in pa-tient related activities. The degree of assistance depends, in part, upon the type of physical therapy service in which the assistant is employed and upon the health needs of the patient." Also, "He [the physical thera-py assistant] is capable of per-forming routine treatment pro-cedures in accordance with planned programs and of assist-ing the qualified physical thera-pist in carrying out complex procedures and programs. The physical therapy assistant works within a physical thera-py service administered by a qualified physical therapist who meets the standards of APTA. The assistant performs his duties with direction and supervision of the physical therapist to whom he is direct-ly responsible." Programs for the education of the physical therapy assist-ant are being established in many areas c ' *he nation. In North Carolina, the State Ad-visory Committee for the edu-cation of the physical therapy assistant was formed in 1967 by the Department of Commu-nity Colleges at the request of the State Physical Therapy As-sociation. This committee is made up of physical therapists and others interested in provid-ing better and more complete health care. In 1967 the laboratory division of the North Carolina State Board of Health was requested to distribute 84,690 doses of typhoid vaccine. The year before that, 82,220 doses were distributed. There were five new cases of typhoid in North Carolina in 1967. Typhoid immunization is indicated only if there is household contact with a known typhoid carrier, or if there is a common-source outbreak in a community, or if a person is traveling to a foreign country. January 1969 THE HEALTH BULLETIN THE HEALTH BULLETIN P. O. Box 2091 Raleigh, N. C. 27602 :.T\ A. K, CUNNINGHAM, EXEC, SEC. N.C. DENTAL SOC. BX. 11065 KORDECAI STA RALEIGH, N.C. If you do NOT wish to con-tinue receiving The Health Bul-letin, please check here | | and return this page to the address above. Printed by The Graphic Press, Inc., Raleigh, N. C Chief Medical Examiner (Continued from page 5) Assembly creating the state-wide medical examiner system. Among the 100 persons look-ing on were members of Dr. Hudson's family, colleagues from the campus of the Univer-sity of North Carolina at Chapel Hill, and associates from the State Board of Health adminis-trative staff. The office of chief medical examiner, a function of the State Board of Health, is housed on the university campus. It will operate in close collabora-tion with the UNC School of Medicine. Dr. Hudson recognized the oath-taking ceremony as a trib-ute to the extended concern for people by state and local gov-ernments in North Carolina, to determined cooperation of the legal and medical professions, and to enlightened public opin-ion. The medical examiner sys-tem, he said, will bring medical science and other sciences to the investigation of sudden, un-expected or unnatural deaths in North Carolina. There are some 9,000 such cases in the State each year. He declared four objectives for the medical examiner pro-gram : • protection of the innocent • recognition of homicide and suicide • unbiased medical evidence for criminal and civil courts • identification of public health and industrial haz-ards. 8 THE HEALTH BULLETIN January 1969 [HUOTH icial Publication Of The North Carolina State Board of Health Inside THE HEALTH BULLETIN First Published—April 1886 The official publication of the North Caro-lina State Board of Health, 106 Cooper Memorial Health Building, 225 North Mc- Dowell Street, Raleigh, N. C. Published monthly. Second Class Postage paid at Raleigh, N. C. Sent free upon request. Editorial Board John Andrews, B.S., Raleigh Glenn A. Flinchum. B.S., Raleigh Jacob Koomen, Jr., M.D., M.P.H., Raleigh John c Lumsden, B C.H.E., Raleigh Rubella Vaccine Being Tested 2 The 1969 Official Easter Seal Child 5 Revised Communicable Disease Regulations 7 Easter Seal Programs 12 Medicare Premium Stays Same 15 Research Triangle Facility Elevated 16 Editor: H. B. Rogers Vol. 84 February 1969 No. 2 Cover: Three years ago, when she was four, Donna Kay Howell was crippled by a rare childhood stroke which left the right side of her body completely paralyzed. She couldn't stand or walk, and she had a problem with her speech. Now, Donna Kay is seven. She is making a remarkable recovery, thanks to the skill of doctors and the physical, occupational and speech therapists at the Easter Seal Rehabilitation Center in Tal-lahassee, Florida. Donna Kay Howell is the 1969 official Easter Seal child. Her story is on page 5. THE HEALTH BULLETIN February 1969 German Measles Vaccine Being Tested One Test in North Carolina By DR. JOHN D. HAMILTON An effective vaccine for ru-bella— German measles—is now a very real possibility for the near future. And an experiment underway in North Carolina's Wake County is playing a ma-jor role in the developments. With few other vaccines has the potential for prevention of serious consequences been so great as with the rubella vac-cine now being tested. Although a relatively incon-sequential disease in itself, ru-bella may have devastating con-sequences for a pregnant wom-an— and for the child she is carrying. For many years the causes of cataracts, deafness, congenital heart disease and mental re-tardation were not known. But in 1941 a doctor reported for the first time that cataracts in a newborn infant can follow Dr. Hamilton is Epidemiology In-telligence Service Officer for the North Carolina State Board of Health. when the mother had German measles during pregnancy. In the years since that original re-port, the association of maternal rubella to the other conditions in newborn infants has been well documented. In 1964-65 the United States was hit by an epidemic of ru-bella. Experts say some 10,000- 20,000 infants may have been born with congenital malforma-tions as a direct result of mater-nal infection. The rubella virus was suc-cessfully cultivated in tissue culture in 1962. This opened the door to serologic studies — the groundwork in developing any vaccine. Soon afterwards, stu-dies began on a vaccine pre-pared by two physicians at the National Institutes of Health. Today, after several years of testing for both favorable and adverse effects, clinical trials of the Meyer - Parkman HPV-77 duck embryo vaccine are being conducted. One of the most ex- February 1969 THE HEALTH BULLETIN tensive trials has been under-taken in Wake County with the support of the Merck Institute for Therapeutic Research. The North Carolina rubella trial started last September. Dr. Joseph Pagano of the Depart-ment of Medicine at the Uni-versity of North Carolina at Chapel Hill and Dr. Richard Lipman of the Department of Pediatrics there directed and coordinated the project. Cooperating and collaborating with these investigators were Dr. Millard Bethel and Dr. Jane Wooten of the Wake County Health Department and their entire staff. Full cooperation also came from superintendents, principals and teachers in the Raleigh city and Wake County schools. In addition there were volunteers from the North Caro-lina State Board of Health in Raleigh and North Carolina Memorial Hospital at Chapel Hill. The trial has involved 63 schools in Wake County. Ap-proximately 5,200 first and sec-ond graders received a dose of the live rubella vaccine. Their reactions were documented by daily fever records taken in the schools. Home records were kept by the parents. Eight schools were involved in vaccine-serolosy studies. At these schools 671 families, in-cluding this same number of mothers and 1,077 of their chil-dren between the ages of 4-9, received the vaccine or placebo (artificial harmless fluid), ac-cording to a pre-arranged sche-dule. Acute serum blood sample was taken and careful records kept on the patients. In Novem-ber a follow-up blood sample was taken. Serologic evaluation of these patients will allow the investigators to determine and document the effectiveness of the vaccine in immunizing the children, and, at the same time, to measure the effectiveness of the vaccine in controlling the transmission of the disease from children to mothers. Any ad-verse reactions will be docu-mented by home and school records. The results of the Wake County trial will soon be avail-able. Previous studies suggest that the immunologic response will be excellent, and transmis-sibility and adverse reactions absent. In addition, the trial has allowed the effective immuniza-tion of a large segment of Wake County's primary school popu-lation. If all goes well, the results of the Wake County study and others underway in other places will lead to licensing of the ru-bella vaccine within a year — hoDPfully before the next lar?e rubella enidemic, which is pre-dicted in 1970. THE HEALTH BULLETIN February 1969 The 1969 Official Easter Seal Child Donna Kay Howell Donna Kay Howell, seven-years- old, of Tallahassee, Flori-da, has been named 1969 Na-tional Easter Seal Child. The campaign this year opens March 1 and continues to April 6. The pretty little brunette, victim of a rare childhood stroke, will help launch the Easter Seal appeal and take a nationwide trip. Hit by the stroke when she was four, Donna Kay suffered complete paralysis of the right side of her body. She was un- 1 able to stand or walk, and she had a problem with her speech. After a three-week period of hospitalization, Donna Kay was referred to the Easter Seal Re-habilitation Center in Tallahas-see. There, physical, occupa-tional and speech therapists be-gan working to help her over-come the crippling effects of the stroke. Donna Kay made a full recov-ery from her speech defect after a month of treatment. She still receives physical and occupa-tional therapy at the center once a week to correct a slight limp and restore full use of her right hand. Treatment includes muscle re-education, gait train-ing and electrical stimulation to the wrist. Donna Kay's father, Jack, is a draftsman and her mother, Opal, is a beautician. The cou-ple has one other daughter, Janice Lynn, three-years-old. February 1969 THE HEALTH BULLETIN Despite her handicap, Donna Kay is active, sometimes a tom-boy, sometimes a demure young lady. She runs and plays with neighborhood children and when it comes to climbing trees, one of her favorite activities, she can out-shinny almost every boy in the neighborhood. Donna Kay, a second grader in public school, is bright, alert and attentive in class. Easter Seal affiliates in every state, Puerto Rico and Washing-ton, D. C, provided direct treat-ment and other services to more than 253,000 crippled children and adults last year. Contribu-tions made during the annual appeal are the major source of financing for 2,844 Easter Seal facilities and programs. Short Course For Nurses A two-week short course for pro-fessional nurses who supervise per-sonnel in cardiac units will be given three times in the coming year at the University of North Carolina at Chapel Hill. The course, entitled Scientific Approach to Supervision of Cardiac Units—Personnel, Patients and Prac-tices, will be offered through the Continuing Education Program of the UNC School of Nursing. Federal traineeships are available. Starting dates for the course this _ vear are April 21 and November 3. A course will start February 2, 1970. Further information is available from : Susanna L. Chase, Director Continuing Education in Nursing The University of North Carolina at Chapel Hill Chapel Hill, N. C. 27514 Public Health Workers to Meet The 1969 meeting of the Southern Branch of the American Public Health Association will be held May 21-23 in Oklahoma City, Oklahoma. The 37th annual meeting of the organization is expected to attract public health workers from 16 states and the District of Columbia. The theme of the meeting will be "The Seventies—Decade for Decision." Keynote speaker will be Dr. Myron E. Wegman, dean of the School of Public Health at the University of Michigan. He will speak on "The Health Consumer—Needs and Wants." World Health Day ivill be observed April 7, 1969. The day will mark the anniversary of the coming into force of the World Health Organization (WHO). The theme of World Health Day this year is "Health, Labor and Productivity." THE HEALTH BULLETIN February 1969 Reportable Diseases Communicable Disease Regulations Revised By State Board of Health On the following four pages is a newly published summary of revised communicable disease regulations approved by the North Carolina State Board of Health last fall. The new regulations mark the first general revision since 1944. The main changes, according to Dr. J. N. MacCormack, con-sultant to the Communicable Disease Control Section of the State Board of Health, are in the isolation and quarantine regulations for individuals. Copies of the summary are available upon request from the Communicable Disease Control Section, North Carolina State Board of Health, Post Office Box 2091, Raleigh, N. C. 27602. February 1969 THE HEALTH BULLETIN CO s c 10 THE HEALTH BULLETIN February 1969 Adults and Children Are Beneficiaries of Easter Seal Programs '• An elderly stroke patient gets help along the road to recovery by a phy-sical therapist at an Easter Seal Center. It has been half a century since the National Easter Seal Society, a voluntary organiza-tion that now serves almost a quarter of a million crippled children and adults annually, first extended its services to one crippled child in a hospital in Ohio. The plight of the child, a boy who needed expensive surgery and therapy if he was to be able to stand and walk, came to the attention of Edgar F. Allen, an Elyria businessman whose own son had been injured in a street-car collision and died for lack of emergency medical facilities. Allen gave up his prosperous business, set about raising the necessary funds, and, in 1921, opened a hospital for crippled children. The hospital was not an im-mediate success. Parents of crippled children were slow to risk public exposure in order to bring their children to the new hospital for treatment. It took the patience and per-sistence of volunteers and pub-lic health nurses to seek out the children and persuade their par-ents to abandon their feelings of guilt and shame to get help for their offspring. 12 THE HEALTH BULLETIN February 1969 As parental resistence was broken, the hospital's staff found itself deluged with requests for treatment. Rotarians provided major support for the society's pro-grams of medical and referral care for crippled children in the early days. They also did much to bring about legislation estab-lishing state services for handi-capped children. But progress was slow. In 1924, three years after Allen founded the hospital, there were only 9,000 beds available in hospitals and other institu-tions to treat 289,000 children known to be suffering from con-genital defects, cerebral palsy and crippling caused by tuber-culosis and other conditions. Five years later — in 1929 — there were 23 state crippled children's societies, operating largely through making direct payments for the care, treat-ment and education of crippled children and seeking legislation for them. Easter Seal rehabilitee ion centers offer voca-tional training that can open the door to new life for accident victims by teaching them new trades. The National Society adopted Easter Seals as a fund raising device in 1934. That year, the Easter Seal appeal raised $47,- 052. In 1967, its income was more than $27 million. An era of expansion began with the National Society's move to Chicago in 1944. With Easter Seal societies in various stages of development in 40 states, the national organization soon included state and local affiliates in the 50 states, the District of Columbia and Puerto Rico. A national staff of profes-sional consultants in care and treatment organization, public education and fund raising was developed to serve these affil-iates and to formulate new na-tional projects and programs. The society's treatment pro-grams were extended and their emphasis changed to meet new health needs. Programs which formerly were centered around hospitals and convalescent care were redirected to rehabilita- February 1969 THE HEALTH BULLETIN 13 tion services at the community level. Having established care and treatment and education pro-grams in fulfillment of its ob-jectives, the Society, in 1953, established the Easter Seal Re-search Foundation, realizing a third major objective. Today, the Easter Seal So-ciety, with its hundreds of state and local affiliates, operating more than 2,000 facilities and programs, is the largest of its kind in the nation. Its affiliates offer help to handicapped chil-dren and adults through re-habilitation and treatment cen-ters; clinics; camps; sheltered workshops; home employment; physical; occupatio nal and speech therapy programs; and other related services. Physical therapy is an important first step to-ward rehabilitation for youngsters at Easter Seal centers. Heart Acts as Thermostat for the Body Your heart and blood play an important part in "thermal regulation," which helps keep you warm in cold weather and cool in hot weather, says the North Carolina Heart Association. Because the body's built-in thermostatic machinery takes time to adjust to weather extremes, you should be careful about jump-ing from one extreme to the other. Make the change gradually, if possible. Or, if you find yourself caught in a sudden change, try to rest before becoming active. This will give your body time to adjust to the different weather environment. 14 THE HEALTH BULLETIN February 1969 MEMBERS OF THE NORTH CAROLINA STATE BOARD OF HEALTH James S. Raper, M.D., President Asheville Lenox D. Baker, M.D., Vice President Durham Ben W. Dawsey, D.V.M. Gastonia Ernest A. Randleman, Jr., B.S.Ph. Mount Airy Paul F. Maness, M.D. Burlington A. P. Cline, Sr., D.D.S. Canton Joseph S. Hiatt, Jr., M.D. Southern Pines J. M. Lackey Rt. 2 , Hiddenite Howard Paul Steiger, M.D. Charlotte EXECUTIVE STAFF Jacob Koomen, M.D., M.P.H. state Health Director W. Burns Jones, M.D., M.P.H. Assistant State Health Director J. M. Jarrett, B.S. Director, Sanitary Engineering Division Martin P. Hines, D.V.M. , M.P.H. Director, Epidemiology Division Ronald H. Levine, M.D., M.P.H. Director, Community Health Division E. A. Pearson, Jr., D.D.S., M.P.H. Director, Dental Health Division Lynn G. Maddry, Ph.D., M.S.P.H. Director, Laboratory Division Ben Eaton, Jr., A.B., LL.B. Director, Administrative Services Division Theodore D. Scurletis, M.D. Director, Personal Health Division Medicare Premium Stays Same The monthly premium older people pay for the voluntary medical insurance part of Medi-care will remain at the present $4 for the period July 1969 through June 1970. The premium covers half the cost of protection that helps pay doctors' and surgeons' bills and a variety of other health care expenses. The other half is paid out of federal general revenues. Robert A. Flynn, social secur-ity district administrator in Ra-leigh, said that 95 per cent of the population aged 65 and over are now enrolled in the supple-mentary medical insurance pro-gram. Participation is up from the 91 per cent enrolled when Medicare began July 1, 1966. Flynn said a new enrollment period opened January 1, 1967 to provide another chance for people who missed out earlier to sign up for the medical insur-ance protection. For persons born on or before October 1, 1901, and for those who have been enrolled but dropped out before January 1, 1967, the new period will be the last chance to enroll. Older people who delay in en-rolling pay a premium that is 10 per cent higher for each full year they could have had the medical insurance protection but were not enrolled. And those who wait three years past their first chance to sign up can-not get the coverage at all. February 1969 THE HEALTH BULLETIN 15 THE HEALTH BULLETIN P. O. Box 2091 Raleigh, N. C. 27602 EXEC If you do NOT wish to con-tinue receiving The Health Bul-letin, please check here l l and return this page to the address above. Printed by The Graphic Press, Inc., Raleigh, N. C Research Triangle Park Facility Is Elevated The National Institute of Environmental Health Sciences (NIEHS) in North Carolina's Research Triangle Park has been established as one of the National Institutes of Health. The headquarters and re-search center of NIEHS operate under a budget of $17.8 million for the current fiscal year. The facility, directed by Dr. Paul Kotin, is the only major com-ponent of NIH located away from the parent organization's campus at Bethesda, Md. Scientists at the research cen-ter are working to identify harmful environmental agents, to determine the mechanisms by which those agents affect an individual's health, and to de-velop data on the effects of long-term, low-level exposures. NIEHS is also the hub for nationwide federal support of basic research and research training in the environmental health sciences. Former HEW Secretary Wil-bur J. Cohen said knowledge developed at the Research Tri-angle facility will provide a scientific base upon which meas-ures can be developed to help control or prevent environmen-tal health problems. He called this "a major priority for HEW." 16 THE HEALTH BULLETIN February 1969 can/a™ bqdqjui™ The Official Publication Of The North Carolina State Board of Health bu ,|o«d ^°n t° 3ie 's „„_„ March, 1969 Inside THE HEALTH BULLETIN First Published—April 1886 The official publication of the North Caro-lina State Board of Health, 106 Cooper Memorial Health Building, 225 North Mc- Dowell Street, Raleigh, N. C. Published monthly. Second Class Postage paid at Raleigh, N. C. Sent free upon request. Editorial Board John Andrews, B.S., Raleigh Glenn a. Flinchum, B.S., Raleigh Jacob Koomen, Jr., M.D.. M.P.H., Raleigh John c. Lumsden, B.C.H.E., Raleigh Editor: H. B. Rogers Social Security's Disability Program By Robert A. Flynn 3 Vol. 84 March 1969 No. 3 Man Can Function in Deep Water for Extended Period of Time 7 Cover: Certificate of live birth, Persons Examined in Cancer _. . „ . „ t, license and certificate of marriage, Detection Centers in North ° Carolina (Map) 10 certificate of fetal death, certified record of divorce decree granted, Vital Statistics in North certificate of death: the documents Carolina By Glenn Flinchum 11 that record the Vltal events of 0Ur lives. These are the makings of the Also Public Health Statistics Section of A reminder about heart the North Carolina State Board of disease 6 Health. Keeping tabs on the docu-ments for millions of North Caro- Tips for Parents of Young ... . ~. ~. ri . _ H s linians keeps Director Glenn Flm- Campers 9 chum and his staff busy. Mr. How it Was in the Old Flinchum tells the story, starting North State 13 on page 11. 2 THE HEALTH BULLETIN March 1969 So-tied SeccciCtcft Disabled workers and their dependents can get financial help at the time they probably need it most. But they must know about the benefits and apply for them. By ROBERT A. FLYNN Disability, whether caused by injury or illness, can mean serious financial problems for any family. If your income stop-ped because of disability, would your family need help to meet the necessities of life? Social security disability in-surance benefits help replace lost income by paying monthly cash benefits when serious dis-ability strikes. Mr. Flynn is Raleigh district man-ager, Social Security Administrar tion. Each year about 300,000 dis-abled workers and their families begin receiving social security disability benefits. In recent months about two of every three disabled workers who ap-ply for benefits have been found eligible. Unfortunately, many disabled workers who could re-ceive benefits do not apply for them, often because they do not know these benefits are avail-able. Four of every five men and women age 25-64 can count on receiving benefits in the event March 1969 THE HEALTH BULLETIN the breadwinner suffers a severe and prolonged disability. This protection means that you can look to social security for financial help if you become severely disabled and cannot work. At a time when you would probably need help the most, social security disability benefits would be available to help you through the financial crisis. What Is 'Disabled? Just what does "disabled" mean? Well, you're disabled if you have a physical or mental impairment which prevents you from doing substantial work and which has lasted (or is ex-pected to last) twelve months or more. The payments can begin with the seventh month of dis-ability. Monthly benefits con-tinue as long as your disability prevents you from working. Payments for a disabled worker now range from $55 to $204 a month, depending on his average earnings under social security. And if you start re-ceiving benefits, your wife and children also may receive bene-fits as your dependents. Total family benefits can amount to as much as $415.20 a month at this time. A person who is over 31 when he becomes disabled can receive benefits if he has social security credit for five years of work in the ten years before he became disabled. Before 1968 the five-years-of-work rule applied to everyone. A change in the law early in 1968, however, reduced the amount of work credit needed by a worker disabled before 31. Now a worker who becomes dis-abled between 24 and 31 needs social security credit for only half the time between 21 and the beginning of his disability. Workers disabled before 24 need one and one-half years' credit in the three-year period before the disability begins. Dependent's Benefits There are two other impor-tant types of social security dis-ability payments; both go to de-pendents of workers after the worker has started receiving re-tirement or disability benefits or has died. These are benefits for adults disabled before 18 who continue to be disabled after 18, and benefits at 50 or later for disabled widows. Dis-abled widowers who were de-pendent on their wives for sup-port can also get benefits under this part of the law, as can some former wives who had been divorced but who were still re-ceiving support from their former husbands. Disabled widows 50-60 can get benefits based on their spouse's social security record only if they become disabled be-fore the worker's death or with- THE HEALTH BULLETIN March 1969 in seven years after his death. However, if a widow received social security benefits as a mother with children, she can get disabled widow's payments if she becomes disabled before those payments end or within seven years after they end. The seven-year period is in-tended to give her an opportun-ity to work long enough under social security to receive social security disability benefits on her own earnings. Childhood Disability Benefits A person who was disabled before 18 and has not married can get benefits based on the earnings of either of his parents. The payments begin at the time the parent covered under social security retires, becomes dis-abled, or dies. Each year about 25,000 peo-ple begin to receive these "child-hood disability" benefits. Some of them are in their fifties and sixties at the time benefits be-gin. A disabled widow, widower, or divorced wife may be consid-ered disabled only if she or he has an impairment so severe that it would ordinarily pre-vent a person from working. Other factors such as age, ed-ucation, and work experience may be considered in determin-ing whether a worker is dis-abled but are not considered for these survivors. At 62 a widow receives 82.5 per cent of her deceased hus-band's retirement benefit. If she starts receiving widow's dis-ability benefits at an earlier age, she gets a permanently re-duced amount. The amount depends on what the husband's retirement bene-fits would have been had he been 65 at the time of his death and how old the widow is at the time benefits begin. For ex-ample, if a widow starts to get benefits at 50, she receives 50 per cent of her husband's bene-fit (figured as though he was 65 at death). At 55 she receives about 60.75 per cent of the hus-band's amount. At 58, it is about 67 per cent. Objective Is Self-Support A major objective of the so-cial security disability program is to encourage disabled persons to undertake rehabilitation pro-grams and to become self-sup-porting. All disability applicants are considered for vocational re-habilitation services whether or not their claims are approved. The services are provided by State vocational rehabilitation agencies—usually at no cost to the disabled person. The agen-cies provide vocational counsel-ing training and help in finding a job, and medical services and supplies. State vocational rehabilita- March 1969 THE HEALTH BULLETIN tion agencies have so far report-ed about 100,000 disability claimants successfully rehabil-itated. Since the program began, more than 185,000 disabled beneficiaries have been taken off the disability benefit rolls because of recovery or return to work. Rehabilitation services are generally financed jointly by the State and the federal gov-ernment, with funds from gen-eral revenues. In some cases, however, social security pays the cost of rehabilitating peo-ple receiving disability benefits. These cases should save social security funds in the long run because the cost of rehabilitat-ing beneficiaries is less than the cost of paying them benefits. The social security disability program has helped millions of disabled workers in times of financial stress by providing a regular monthly income when the breadwinner could not work. Thousands of workers have been returned to produc-tive work through the joint ef-forts of the Social Security Ad-ministration and State vocation-al rehabilitation agencies. Your social security office will answer any questions you may have about social security's disability program. Call, write, or visit the office. The people there will be glad to help you. HEART DISEASE STILL EPIDEMIC The North Carolina State Board of Health, in its recently released report of vital statistics for the year 1968, indicated that there were 23,617 deaths attributable to cardiovascular-renal diseases. Overall deaths reported in the Tar Heel State for 1968 were 44,396. This points up that out of all deaths in North Carolina for the year 1968, 53.2 per cent were the direct result of cardiovascular-renal diseases. According to the State Board of Health report, of the 23,617 deaths attributed to heart and kidney diseases, heart disease was responsible for 15,768, stroke accounted for 5,747, atherosclerosis 639, nephritis 257, and other cardiovascular-renal diseases 1,206. The North Carolina Heart Association notes that while the total number of deaths from heart disease is still holding at about the same percentage of total deaths as in the past five years, the figure of 53.2 per cent is still indicative of the epidemic proportions of heart disease in our State. THE HEALTH BULLETIN March 1969 NEW EQUIPMENT TESTED—Chief Mur-ray Cato, one of the five divers who par-ticipated in Duke University's simulated dive to 1,000 feet beneath the surface of the sea, tests new underwater equipment in the hyperbaric chamber's "wet pot." At left is Chief Sam Smelko, also of the U.S. Navy. Frank Falejczyk of Scott Aviation Corp is on the right. Duke University Experiment MAN CAN FUNCTION IN DEEP WATER FOR EXTENDED PERIOD OF TIME The world that exists one thousand feet beneath the sur-face of the sea has been opened to human exploration by scien-tists and technicians on the landlocked campus of Duke Uni-versity at Durham, N. C. In an experiment lasting six-teen days last December, five divers entered the hyperbaric March 1969 THE HEALTH BULLETIN « MONITORING THE DIVE—Duke University Medical Center personnel listen to reports from five divers who spent 16 days in an experimental simulated dive at the Duke hyperbaric chamber. From left are Dr. Herbert Saltzman, director of the hyperbaric unit; Mrs. Laura Sheppard, chief medical technologist; Dr. John V. Salzano, associate professor of phy-siology- pharmacology; and Dr. Wirt W. Smith, assistant director of the hyperbaric unit. chamber at the Duke Medical Center and demonstrated that man can function effectively at one thousand-foot depths for extended periods. The divers, two from the uni-versity and three from the U.S. Navy, spent IIV2 hours at a simulated pressure of one thou-sand feet. The rest of the time was spent compressing down to the bottom depth and then re-turning to normal pressure. In the experiment the men breathed a mixture of gases containing 96 per cent helium, 3 per cent nitrogen, and 1 per cent oxygen. The normal con-centrations of nitrogen and oxy-gen in surface air are poisonous or narcotic at the depths to which the men descended. During their three days at the bottom, the divers under-went a battery of physical and psychological testing. The re-sults, while not yet conclusive, indicate that man can function at such depths with little or no impairment or discomfort. 8 THE HEALTH BULLETIN March 1969 The exercise tests, which used a calibrated cycle and in which blood gases, expired gas-es and atmosopheric gases were measured, indicated normal function. The psychological tests showed some anxiety on the part of the men, but only what was described as normal under the circumstances. Some of the divers experi-enced slight pain in their joints where the joints were fully ex-tended during exercises, but monitors considered this nei-ther significant nor unexpected. One of the divers experienced a slight case of the bends— a decompression sickness which occurs when divers ascend too rapidly. But the problem was quickly remedied. The divers were, from Duke: Delmar L. Shelton, hyperbaric chamber operator and techni-cian, and Frank J. Falejczyk of Scott Aviation Corp., working with the university; from the U.S. Navy Experimental Diving Unit: Lt. Cmdr. James Kelly, M.D., Chief Francis J. Smelko, and Chief Murray Cato. Dr. Herbert A. Saltzman is director of the hyperbaric unit. Lt. Cmdr. James Summitt is senior medical officer of the Navy's Experimental Diving Unit. TIP FOR PARENTS OF YOUNG CAMPERS Sending a child to camp this summer? It's always a good idea to check out the camp thoroughly, in advance. Take a close look at the camp site and physical plant, to be sure. But also evaluate carefully the food and water supply and the medical care and staff supervision. A good camp director will be eager to have you visit, to talk to staff members and campers, and to ask questions. March 1969 THE HEALTH BULLETIN ct oo UJ U3 10 THE HEALTH BULLETIN March 1969 VITAL STATISTICS IN NORTH CAROLINA BY GLENN FLINCHTJM In the minds of many people, the word statistics connotes an array of dull, dry figures which are of little interest to anyone but a statistician. If preceded by the word "vi-tal," however, we get a new meaning which becomes quite personal when we consider that all of us at one time or another counted in the statistics of life and death. The term "vital statistics" as used here applies to records of birth, death, marriage and di-vorce, as well as information derived from these records. North Carolina began record-ing births and deaths on a state-wide basis on October 1, 1913. The motivating force behind the action was the pressing need for birth and death information upon which to base public health programs. Dr. W. S. Rankin, State health officer at the time, gave this need number one priority in his legislative program. He stated his case as follows: ". . . We have reached the stage in public health work in this state from which we can make practically no advance until a vital statistics law is passed." He further stated that trying to administer public health without vital statistics was like fighting an unknown enemy in ambush: You fire a few shots here and there, never knowing if you're shooting at the right places. Following the enactment of the law by the General Assem-bly, the Bureau of Vital Statis-tics was established and work was begun on the appointment of over 1,400 local registrars in each town and township throughout the State. These registrars collected the certifi-cates for all births and deaths occurring in their districts, made copies for local use, and forwarded the originals to the State Board of Health each month for permanent filing. They also issued permits for burial and transportation of dead bodies. They received a fee for their services of 50^ per certificate, paid by the county. Helpful Information Within a short time, the vital statistics began to produce some basic information which was of tremendous help to the physi-cians and public health workers who were trying to make the (continued on page 12) March 1969 THE HEALTH BULLETIN 11 best possible use of their mea-ger resources. Though far from being precise measurements, the available statistics made it possible to get some answers to such questions as: What sec-tions of the state have the high-est death rates? What diseases are the greatest contributors to the death rate? What segments of the population are hardest hit by certain diseases? Within a few years it was also possible to determine the effectiveness of some of the public health measures that were put into effect. Today, the vital statistics reg-istration procedures are essen-tially the same as in 1913, ex-cept that in most counties the local health departments have taken over the responsibilities of local registrars. This change had several advantages. It was more economical and efficient to use the existing facilities of the local health departments as the central location for regis-tering births and deaths. Also, the local health director could consult with the physicians, midwives, and funeral directors in his county concerning any medical problems arising in the registration procedure. Anoth-er important advantage was the immediate availability to the health director of informa-tion concerning deaths from contagious diseases or any other causes which would require his immediate attention. Individuals Are Responsible In every county certain indi-viduals are charged with the responsibility for actually pre-paring and filing vital records. The attending physician or mid-wife is responsible for complet-ing the certificate of birth or fetal death (stillbirth). If no physician or midwife is in at-tendance, it is the duty of the father, mother, or owner of the premises to report the birth. Death certificates are pre-pared by the funeral director, or the person who takes charge of the body after death. The fu-neral director must also obtain from the attending physician his opinion as to the cause of death. If there was no physician in attendance, then the medical examiner or coroner must certi-fy to the cause of death. (continued on page 13) Springtime is check-up time for your car. How about you? You can trade in your old car, but your heart has to last you a lifetime. Help make it a long one, says the North Carolina Heart Association, by seeing your doctor regularly. 12 THE HEALTH BULLETIN March 1969 The central registration of fore 1958 if the county where divorces became effective on the divorce was granted was January 1, 1958. The clerks of unknown, it was necessary to court in each county report to inquire of all 100 counties in the State Board of Health each order to locate the record. In month all divorces granted in addition to their value to the their court during the preceding individuals, these records pro-month. Records are prepared vide valuable information con-in Raleigh and indexed by the cerning the extent of the di-names of both plaintiff and de- vorce problem in our State, fendant for easy reference. Be- (continued on page 14) HOW IT WAS IN THE OLD NORTH STATE RECREATION NECESSARY FOR HEALTH The Creator of the universe in His all-wise wisdom implanted in the minds of children the longing for play. Health and growth depend upon the exercise of muscles. The instinct for play, therefore, plays a large part in the development of each individual. After childhood has passed there is a tendency on the part of most of us to suppress, or forget, this instinct for play. We get so busy striving for wealth or fame, or just trying to make a living, that we are apt to think of play as something unobtainable, something that we have not the time for. Therein we make a great mistake .... Nearly all the degenerative diseases result from a lack of play. Mentally and physically we need recreation that really recreates, that relaxes tired muscles, that gives wearied nerves a chance to retain exhausted vitality. Exercise in the gymnasium is fine, but frequently it is too methodical, or else we overstrain. The more simple games, and particularly those that can be played out of doors, do the most good. In those we get the ideal combination of exercise of muscles, fresh air and sunshine, the combination which, taken regularly, means prolonged life and better life. Health is a state of physical and mental and moral equilibrium, a normal functioning of the body, mind and soul. It is the state when work is a pleasure, when the world looks good and beautiful and the battle of life seems worthwhile-. Health is the antithesis of disease, degeneration and crime. To maintain it we must obey the laws of nature which demand that there shall be a proper mixture of work and play, of rest and sleep. And of these we need to place particular stress on play.—R.B.W. —The Health Bulletin, Vol. XXXVI, No. 6, June, 1921. March 1969 THE HEALTH BULLETIN 13 some characteristics of the persons involved, and the num-ber of minor children. Marriages were added to the vital statistics family in Janu-ary 1962. The register of deeds in each county is the local offi-cial responsible for the initial preparation and issuance of the marriage license. After the mar-riage takes place, the minister or other officiant certifies to the date and place of the event, obtains the signatures of two witnesses, and files the com-pleted certificate in duplicate with the register of deeds. Each month the register of deeds for-wards one copy of each com-pleted certificate to the State Board of Health. Here again, much valuable data is obtained for use in public health, social and welfare programs. These statistics, when combined with other information, make it pos-sible to estimate or project fig-ures on migration, birth rates, housing needs, and changes in marriage trends. The tremendous value of these vital records to the indi-vidual citizen has become quite apparent in recent years. When World War II began, many peo-ple left their homes to work in defense plants or other war-re-lated industries. For security purposes they found it neces-sary to prove certain facts about themselves. The birth certifi-cate became the primary docu-ment used for proving age, place of birth, and citizenship. Today it is required for many purposes: entering school, ob-taining driver's license, employ-ment, and passport. The death certificate is an equally impor-tant document for settling es-tates, insurance claims, court cases, and social security bene-fits. Millions of Records The processing, storage, maintenance, and indexing of all vital records accumulated in the past 55 years (approximate-ly 7,000,000) adds up to a fairly complex job. When the State Board of Health was reorgan-ized in 1950, the former Bureau of Vital Statistics was incorpo-rated into what is now called the Public Health Statistics Section. Each month the section receives and processes records on approximately 8,000 births, 3,500 deaths, 4,000 marriages, and 1,000 divorces. In addition, more than 4,500 certified copies are issued monthly. A person born in this State may obtain a copy of his birth record by writ-ing to the State Board of Health and furnishing his name, date of birth, county of birth, and parents' names. The fee for this service is $1.00 per certificate. Certified copies may also be ob-tained from the register of (continued on page 15) 14 THE HEALTH BULLETIN March 1969 MEMBERS OF THE NORTH CAROLINA STATE BOARD OF HEALTH James S. Raper, M.D., President Asheville Lenox D. Baker, M.D., Vice President Durham Ben W. Dawsey, D.V.M. Gastonia Ernest A. Randleman, Jr., B.S.Ph. Mount Airy Paul F. Maness, M.D. Burlington A. P. Cline, Sr., D.D.S. Canton Joseph S. Hiatt, Jr., M.D. Southern Pines J. M. Lackey Rt. 2, Hiddenite Howard Paul Steiger, M.D. Charlotte EXECUTIVE STAFF Jacob Koomen, M.D., M.P.H. State Health Director W. Burns Jones, M.D., M.P.H. Assistant State Health Director J. M. Jarrett, B.S. Director, Sanitary Engineering Division Martin P. Hines, D.V.M. , M.P.H. Director, Epidemiology Division Ronald H. Levine, M.D., M.P.H. Director, Community Health Division E. A. Pearson, Jr., D.D.S. , M.P.H. Director, Dental Health Division Lynn G. Maddry, Ph.D., M.S.P.H. Director, Laboratory Division Ben Eaton, Jr., A.B., LL.B. Director, Administrative Services Division Theodore D. Scurletis, M.D. Director, Personal Health Division deeds in the county of birth. Those persons who were born prior to the enactment of the vital statistics law, or who for any reason did not have a cer-tificate filed at the time of their birth, may file a delayed certifi-cate of birth with the register of deeds in the county in which they were born. It is necessary, however, to furnish at least three written documents which will prove the facts concerning the birth. These documents may be school records, family bible records, insurance policies, and census records. Another important part of vital statistics work involves the correction and amendment of records. In the early years of vital statistics registration, many names were misspelled and sometimes important infor-mation was omitted. In order to make any changes on the origi-nal certificate, it is necessary for the registrant or parent to furnish proof as to the correct-ness of the requested change. In some instances, such as a change of father's name, a court order is required before a change can be made. When a child is adopted, or when an illegitimate child is legitimated by subsequent mar-riage of the parents, a complete-ly new birth certificate is pre-pared and no access to the old certificate is permitted except by order of a court. (continued on page 16) March 1969 THE HEALTH BULLETIN 15 THE HEALTH BULLETIN P. O. Box 2091 Raleigh, N. C. 27602 If you do NOT wish to con-tinue receiving The Health Bul-letin, please check here l | and return this page to the address above. KR„ A. v. CUNNINGHAM, EXEC. ! N.C. DENTAL SOC. BX. 11065 KORDECAI RALEIGri, N.C. Printed by The Graphic Press, Inc., Raleigh, N. C Vital Statistics in North Carolina (continued from page 15) In addition to the processing and handling of vital records, the Public Health Statistics Sec-tion prepares and publishes re-ports containing a variety of statistical data which is used not only by public health work-ers, but also by research work-ers, county and city planners, school officials, students, and many others. The section also collaborates with other agen-cies, such as the University of North Carolina, the State Medi-cal Society, and the U. S. Public Health Service in carrying out special studies and research projects. The large volume of records involved requires the use of electronic data process-ing equipment to produce the many detailed tabulations need-ed monthly, quarterly, and an-nually. As the population of North Carolina continues to increase, and as new public health pro-grams are developed, the Public Health Statistics Section staff will be facing new challenges and new opportunities of serv-ice. Such activities as compre-hensive health planning and regional medical programs gen-erate new demands for statis-tical data which must be met. The primary objective of the section, however, will continue to be to serve the citizens of North Carolina efficiently and well and to preserve for pos-terity the records of life's most intimate events. ran/a™ mum The Official Publication Of The North Carolina State Board of Health » APRIL 1969 MEDICAL LAB ASSISTANT THE HEALTH BULLETIN First Published—April 1886 The official publication of the North Caro-lina State Board of Health, 106 Cooper Memorial Health Building, 225 North Mc- Dowell Street, Raleigh, N. C. Mailing ad-dress: Post Office Box 2091, Raleigh, N. C. 27602. Published monthly. Second Class Postage paid at Raleigh, N. C. Sent free upon request. Inside Editorial Board John Andrews, B.S., Raleigh Glenn A Flinchum. B.S., Raleigh Jacob Koomen. Jr , M.D., M.P.H., Raleigh Camp Easter-in-the-Pines 3 john c lumsden. b.c.h.e.. Raleigh The Need for Family Planning Editor: H. B. Rogers in North Carolina ^mbm^^™^^^—^^»»- By C. Horace Hamilton 6 Medical Lab Assistants Vo l 84 April 1969 No. 4 By Margaret Darst Smith 13 ALSO Cover: Patricia Haire, a graduate of the medical laboratory assist- Food Can Be Dangerous ants pr0gram at Holding Technical . . . Sometimes 5 Institute, Raleigh, is a staff assist-ant today. Mrs. Haire received her Regional Rural Health Conference 5 diploma in August 1967. Margaret Darst Smith, director of Struvite and Canned Seafood 9 Public relations for Holding Tech, supplied the photograph of Mrs. How It Was in the Old North Haire, as well as the photographs State 14 that illustrate her story. THE HEALTH BULLETIN April 1969 CAMP EASTER-IN-THE-PINES North Carolina's Easter Seal Camp A boy bound to a wheelchair competes with other disabled children in a unique game of baseball in which the rules of the game are scaled down to fit the handicaps of the team mem-bers. Unusual? Not at Camp Easter-in-the- Pines, North Carolina's Easter Seal camp. Baseball, dock fishing, swim-ming, archery, a trip through the woods to discover wild flow-ers: rare treats, all, for the handicapped person — but all possible at Camp Easter-in-the- Pines. North Carolina's Easter Seal camp, located at Southern Pines, is open to all physically handicapped persons from 7 to 50 years of age who would benefit from a camping expe-rience. The handicaps repre-sented at the camp include those that have resulted from cerebral palsy, polio, visual and hearing defects, muscular dys-trophy, spina bifida, accidents, burns, amputations, rheumatic heart, and congenital defects. Young disabled campers get expert supervision from well-trained staff at Camp Easter-in-the-Pines. At Camp Easter-in-the-Pines everyone is on equal footing with everyone else, for all cam-pers are physically disabled. Every cabin has ramps ap-proaching it. Every building has wide doors. Wheelchair paths wind throughout the camp, from the arts and crafts building to the huge main lodge. The main emphasis at Camp Easter-in-the-Pines is recrea-tion, and a well-trained staff of instructors provides responsible leadership. In addition, a phys-ical therapist works with chil-dren in the lake every day. Camp Easter-in-the-Pines will offer four sessions in the sum-mer of 1969 to children and teenagers and adults. All phys-ically handicapped persons may be considered for admission. The cost of a two-week camp session is $90. Local Easter Seal societies, individual donors and civic groups have helped pro-vide "camperships" for children and adults. For application forms write: Camp Easter-in-the-Pines Drawer 1099 Southern Pines, N. C. 28387 Camp Easter-in-the-Pines is a facility of the Easter Seal So-ciety for Crippled Children and Adults of North Carolina, Inc. THE HEALTH BULLETIN April 1969 Food Can Be Dangerous . . . Sometimes Of the 100 outbreaks of hu-man salmonella infections at-tributable to specific sources in-vestigated by the National Com-municable Disease Center dur-ing the three-year period 1963- 1965, 61 were traced to foods, 21 to human carriers, and 18 to animal contacts. There were 51 other out-breaks which were investigated but which could not be traced to specific sources. Foodborne salmonellosis can most frequently be traced to eggs or egg products, poultry, or beef and pork products. A host of other foodstuffs have also been incriminated, how-ever, including such items as soya milk, dried yeast, coconut, cotton seed protein, cereal pow-der, and even a food coloring substance (carmine dye). Animal feeds have been wide-ly incriminated as potential sources of infection for domes-tic animals. Regional Rural Health Conference Child health and home health care are topics for the 1969 Regional Rural Health Conference sponsored by the Medical Society of the State of North Carolina. The conference will be held Thursday, June 12 at Lambuth Inn at Lake Junaluska, starting at 10:30 a.m. It will be open to medical peo-ple, laymen and interested citizens who wish to attend. Dr. Hugh A. Matthews, director of health affairs at Western Carolina University, will preside. Several speakers will participate. A special feature will be recognition of the 1968 4-H health king and queen and their families. April 1969 THE HEALTH BULLETIN The Need For Family Planning In North Carolina By C. HORACE HAMILTON Associate Director Carolina Population Center and Visiting Professor of Sociology and Biostatlstics The University of North Carolina at Chapel Hill Many counties, cities, and communities have some more or less systematically organized family planning programs. Moreover, the current down-ward trend in the birth rate is evidence that family planning is practiced by a large percent-age of North Carolina families. The practice of birth control has no doubt been facilitated by the development of the "pill" and other contraceptive meth-ods. Because of these trends and facts, many people are under the impression that we need no longer be seriously concerned about the problem of overpopu- Reprinted from the University of North Catolina News Letter, Vol. LIII, No. 3, September 1968. lation or of the need for invest-ing public funds in family plan-ning programs. If there is any complacency over the need for family plan-ning, a look at the latest avail-able facts about births in North Carolina should dispel any idea that we can now relax and for-get about the problem. During the calendar year 1966, accord-ing to the Statistics Section of the State Board of Health, there were 92,727 births and 42,218 deaths. The difference between births and deaths, i.e., natural increase, was 50,509. Thus, from one point of view, in 1966, the state had 50,509 more births than were needed to maintain the population at a stable level. THE HEALTH BULLETIN April 1969 A similar excess of births over deaths has existed through-out our state's history. As a re-sult of the relatively high rate of natural increase, North Caro-lina has experienced a heavy out-migration and, at the same time, has increased in popula-tion. Most people, intuitively, think that population growth is a good thing, but that heavy out-migration is a bad thing. Just how bad and how good these trends are is a matter of opinion, but it is not the pur-pose of this paper to discuss population policy. It suffices to point out that rapid population growth, not only in other coun-tries but also in our own state and nation, is creating serious social and economic problems. There are many ways to mea-sure the need for family plan-ning, although there may be some disagreement as to how many children a family should have. In a free and democratic society the decision on family size is considered to be the pre-rogative of individual families. Yet many surveys show that most married couples do not want more than two to four children. (In order to maintain a stable population, only about 230 children per hundred mar-ried couples are needed to main-tain the population.) In spite of the fact that most women in this country no lon-ger want the very large fam-ilies which were common in the rural areas of our nation for many generations, the current birth statistics show that a sub-stantial percentage of North Carolina families are still giving birth to more children than they can provide for even at a mod-est standard of living. In 1966, the vital statistics show that more than a fourth of the babies were born to North Carolina mothers who already had three children. However, a more re-fined and accurate estimate of the number of "excess" births may be arrived at by taking into consideration the age of the mother. On the basis of known rela-tionships between maternal and child health and the timing and number of births, we shall de-fine as "excess" births all those born to mothers either under 15 years or over forty years of age. For all other age groups, we shall define as excessive all births occurring during 1966 to mothers in the following age and birth order groups: Age of Mother Although these assumptions are made partly for the purpose of establishing some sort of rea-sonable and convenient statis-tical criterion, it can also be argued that such limits are in the interest of both the individ-ual family and of society which must pay part of the cost of ex-cessively large families among the low income groups. Actually our definition of ex-cess births is more on the lib-eral than the conservative side. tive number of women with zero, one or only two children should increase, there would need to be some increase in the number of mothers with three or more children. On the basis of the above as-sumption, it is found that 33,- 033, or 35.6 percent of the 1966 births were excessive, and most of them were probably unwant-ed by the parents. This number of excessive births may be broken down by age of mother TABLE 1 Number and Percentage of Excess Birlhs By Color and Age of Mother, North Carolina, 1966 Age of Mother attainment, and occupational level, irrespective of race. The county differences (see Table 2) in the number and per-centage of excess births, indica-tive of the need for family plan-ning, also reflect differences in the social, economic, and educa-tional characteristics of the population. Counties with high percentages of farm people have high percentages of excess births; and the large metropoli-tan and urban counties have re-latively low percentages of ex-cess births. Greene County, an eastern North Carolina agricultural county, has the highest percent-age of excess births. Practically all of the other counties ranking high in excess births are also found in eastern North Caro-lina. Among white mothers the highest percentages of excess births are found in the rural mountain counties, such as Madison, Clay, Alleghany, Gra-ham, and Ashe. Among nonwhite mothers, the highest percentage of ex-cess births are found in such predominantly a g r i c u 1 1 ural counties as Greene, Halifax, Edgecombe, Jones, and Nor- Struvite Crystals and Canned Seafood Glass in your canned shrimp? Probably not. From time to time people in the canned seafood industry and at the Food and Drug Administration get complaints from consumers who believe they've found glass in their canned seafood—especially shrimp. Examination, however, usually reveals it isn't glass at all, but "struvite" — crystalline magnesium ammonium phosphate to the chemist — which occasionally forms in canned seafood from normally present constituents. While struvite isn't actually desirable, it doesn't affect the safety of the food at all, according to FDA. Seafood canners have devoted considerable attention to the problem of struvite formation, but they still haven't been able to prevent it. If you do happen to find a hard, clear crystalline bit of material in canned seafood, here's a simple test to distinguish between struvite and glass. Simply place the material in warm vinegar for a while. The struvite crystals will dissolve; glass of course, will not. April 1969 THE HEALTH BULLETIN V TABLE 2 Estimates of the Number and Percentage of Excess Births In North Carolina Counties, 1966 State and 48. thampton. Urban metropolitan counties, such as Wake and Mecklenburg, in general have low percentages of excess births, but even in these counties the percentage of excess nonwhite births is greater than the white. In Wake County only 18.8 percent of the white births are classed as ex-cess. +her counties having a low percentage of excess white births are Orange, Tyrrell, Le-noir, Durham, Mecklenburg, Hertford, Chowan, Gates, and Pasquotank. Among nonwhite mothers having lower than av-erage percent excess births are those of Durham, Chatham, Lee, Guilford, Pamlico, Orange, Ran-dolph, Stanly, Onslow, and Cho-wan counties. The data presented in this issue of the News Letter are of great significance from the point of view of developing an effec-tive family planning program. Since nearly all babies are now delivered by physicians in hos-pitals, the counseling of mothers needing family planning and clinical services can most effec-tively be carried out by physi-cians and other professional health personnel at the time a mother is having either an un-wanted or a higher order birth. Unfortunately, very few hos-pitals and physicians (except at the three medical schools in North Carolina) have developed effective programs for guiding mothers in modern family plan-ning practices. Since these data apply only to women at child birth, we must not overlook the fact that many women who do not give birth to a child during any particular year may also be in need of family planning. However, by combining data on births by age of mother and birth order for several years, a more complete picture of the overall need for family planning in a county can be derived. A complete program of family planning in any county involves also a consideration of the so-cial, educational and economic status of the county's popula-tion. Many counties now have local family planning commit-tees; and they work closely with the health and welfare depart-ments. However, a survey of family planning programs in the counties shows that health and welfare departments simply do not have an adequate supply of health personnel to do the kind of job required. More effective family plan-ning, in both public and private programs, will help to: ( 1 ) raise the level of living; (2) improve the health of both mothers and children; and (3) improve the overall quality of life—the hu-man dividend — for all North Carolinians. 12 THE HEALTH BULLETIN April 1969 MEDICAL LAB ASSISTANTS Classroom Study Clinical Training Peggy Fish (left) of Raleigh and Marie Straley of Mt. Pleasant, Michigan, peer into the dual teaching microscope at Holding Tech. Miss Stra-ley's father, a medical technician, sent his daugh-ter to Holding Tech for the medical laboratory assistants course because he knows of the out-standing reputation the school enjoys. By MARGARET DARST SMITH The second largest medical laboratory assistants program in the United States is offered in North Carolina by Holding Technical Institute at Raleigh. The author is director of public re-lations for Holding Tech. Holding Tech, a local and state tax-supported member of the North Carolina Community College System, began its med-ical laboratory assistant pro-gram in 1964 with a total of 19 students. Last fall the enrollment April 1969 THE HEALTH BULLETIN 13 Etheleen Hartsfield of Bunn, N. C. uses the spectrophotometer to measure homoglobin. HOW IT WAS IN THE OLD NORTH STATE GARDEN PRODUCES THREE CROPS "Plant a Garden" has become a new health slogan. A garden has so many health possibilities that no home should be without one. Among the health products of a garden may be mentioned sun-shine, fresh air, and exercise as the first crop. The second crop is the supply of those early vege-tables that are so essential to health, in spring and summer — spinach, mustard, lettuce, toma-toes, radishes, peas, beans, squash, onions, etc. The third is a reduced market bill which leaves a neat little sum on which to take a two weeks' vacation in summer. The Health Bulletin, June, 1915, Vol. XXX, No. 3. totalled 50 men and women. These 50 started the one-year diploma program in September. Another group began in March of 1969. This is the only diploma or degree course offered by Hold-ing Tech in which there are two new classes starting each year. It is made possible by the fact that students spend six months of the course in the classrooms at Wake Memorial Hospital and the final six months of the course in clinical training at various hospitals throughout eastern North Carolina. During the final six month period, stu-dents are rotated through the different departments of the hospital in order to develop skills in all laboratory func-tions. As currently enrolled stu-dents leave the classroom, an-other group may begin the classroom phase of the training. The curriculum for the med-ical laboratory assistants course was designed jointly by medical technologists, pathologists, and educators for the purpose of giv-ing the students the necessary knowledge and laboratory prac-tice during the first six months of instruction to enable them to move into a hospital laboratory with a minimum of orientation. Each of the laboratory courses provides experiences similar to those the student can expect to (continued on page 16) 14 THE HEALTH BULLETIN April 1969 MEMBERS OF THE NORTH CAROLINA STATE BOARD OF HEALTH James S. Raper, M.D., President Ashevllle Lenox D. Baker, M.D., Vice President Durham Ben W. Dawsey, D.V.M. Gastonia Ernest A. Randleman, Jr., B.S.Ph. Mount Airy Paul F. Maness, RI.D. Burlington A. P. Cline, Sr., D.D.S. Canton Joseph S. Hiatt, Jr., RI.D. Southern Pines J. RI. Lackey Rt. 2, Hlddenlte Howard Paul Steiger, RI.D. Charlotte EXECUTIVE STAFF Jacob Koomen, RI.D., RI.P.H. State Health Director W. Burns Jones, RI.D., RI.P.H. Assistant State Health Director J. RI. Jarrett, B.S. Director, Sanitary Engineering Division Rlartin P. Hines, D.V.M., RI.P.H. Director, Epidemiology Division Ronald H. Levine, RI.D., RI.P.H. Director, Community Health Division E. A. Pearson, Jr., D.D.S., RI.P.H. Director, Dental Health Division Lynn G. RIaddry, Ph.D., Rl.S.P.H. Director, Laboratory Division Ben Eaton, Jr., A.B., LL.B. Director, Administrative Services Division Theodore D. Scurletis, RI.D. Director, Personal Health Division Two teenagers and a housewife study together in the medical laboratory assistants course at Holding Tech. They are (left to right) Pat John-son of Raleigh, Anna Whitener of Raleigh (for-merly of Haverton, Pa.) and John Davison of Garner, N. C. April 1969 THE HEALTH BULLETIN 15 THE HEALTH BULLETIN P. O. Box 2091 Raleigh, N. C. 27602 «R A. «. CUNNINGHAM. E> R.C. ^NTAL SOC. ^ BX. U0fa5 RAUEIGHt N.C. If you do NOT wish to con-tinue receiving The Health Bul-letin, please check here | | and return this page to the address above. Printed by The Graphic Press, Inc., Raleigh, N. C Medical Lab Assistants Program (Continued from page 14) meet when they move into their clinical training. The medical laboratory assist-ant works under the direct su-pervision of a medical technol-ogist or a medical doctor. The assistant is taught to collect specimens, prepare slides, and perform routine laboratory tests. Although most of the graduates will be employed in a hospital, many will be hired by doctors to work in their offices, or by agencies conducting med-ical or industrial research. Only persons with a high sense of responsibility and the ability to do careful, scientific work should consider entering the field. Graduates of the cur-riculum are eligible to take the national examination of the Board of Certified Laboratory Assistants. Upon successfully completing this examination they are awarded the title of Certified Laboratory Assistant. Holding Tech's students in the medical laboratory assistant program are assigned during the six month clinical phase of the course to leading hospitals and to the Duke University chemistry department labora-tory, county health depart-ments, the State Laboratory of Hygiene, and doctors' offices and clinics. 16 THE HEALTH BULLETIN April 1969 con/rai ®mmi The Official Publication Of The North Carolina State Board of Health Helicopter Moves Burn Victim A burn victim is gently placed in the Chicago Fire Department's Bell 47J helicopter for transfer to a special burn center for treatment. Depart-ment Pilot Robert Hack has participated in a number of rescues involv-ing the agency's three helicopters. The ships are used to assist victims of traffic accidents, fly aerial patrol on Lake Michigan, serve as a com-mand post for large fires and work as an emergency supply/medical vehicle. (See article on page 7) MAY 1969 Inside Freedom from Want — Food as a Health Need Helicopter Ambulance Service—To The Rescue THE HEALTH BULLETIN First Published—April 1886 The official publication of the North Caro-lina State Board of Health, 106 Cooper Memorial Health Building, 225 North Mc- Dowell Street, Raleigh, N. C. Mailing ad-dress: Post Office Box 2091, Raleigh, N. C. 27602. Published monthly. Second Class Postage paid at Raleigh, N. C. Sent free upon request. Editorial Board John Andrews, B.S., Raleigh Glenn A. Flinchum, B.S., Raleigh Jacob Koomen, Jr., M.D., M.P.H., Raleigh John c. Lumsden, B.C. HE., Raleigh Guest Editor: Edwin S. Preston, M.A., LL.D. The Home Swimming Pool — Happy Hours or Tragic Ones n Vol. 84 May, 1969 No. 5 Cover: Helicopters are becoming a ALSO necessary means of transportation for the sick, the accident victims Treat Electricity as a Friend 12 and the | ife.saving needs of the _ . . „, .,, „ „ . military in Vietnam and elsewhere. Driving Skills of Senior Motorists 14 Photos and story courtesy Bell Helicopter, Fort Worth, Texas, one How It Was in the Old North , A1 .. .. of the largest suppliers of hehcop- State 15 ters for the United States in Viet- Safeguards for Children 16 nam. (Article on page 7) 2 THE HEALTH BULLETIN May 1969 Freedom From Want Food as a Health Need By Elizabeth W. Jukes Chief, Nutrition Section N. C. State Board of Health Are you old enough to re-member World War II and the Four Freedoms? It was said that there were four freedoms worth fighting for: Freedom of Speech and Religion; Freedom from Want and Fear. Most of us would agree that these free-doms are still worth working for. Now we call it Freedom from Want, Freedom from Hunger, and, perhaps, over simplify the situation. But our understanding of the importance of food to health has grown and deepened con-siderably in the twenty-five years since those four freedoms were pronounced. We are learn-ing about relationships between growth patterns of children and the protein in the food they eat; about the importance of ade-quate food to the maximal men-tal development of very young children; about the importance of having combinations of food values in the intestinal tract at the same time in order that the body can use its food supply ef-ficiently; about the importance of a regular food supply to the child's development of trust in other people. Trust is, after all, one basis on which every so-ciety depends. As important as food is, food alone cannot bring freedom from want. In this day, when so many have so much, it is hard for us to believe that families living in the same county do not have what we consider the es-sentials of life: a secure house, sufficient clothing for decency and protection, an adequate food supply, clean water, elec-tricity, a cook stove. Somehow we do accept the idea that some people do not have any toilet facility, as necessary as this is to health. In our country, where food supplies are still more than ade-quate to feed all of our popula-tion, there are some programs that intend to provide the food May 1969 THE HEALTH BULLETIN needed. These include the dis-tribution of commodity foods (sometimes called surplus foods), the food stamp program, emergency food and medical program, emergency food order, and supplementary food pro-gram. Counties have an option of choosing to administer either the commodity food program or the food stamp program. The commodity foods are available to people certified by the county Department of Welfare to be eligible at a warehouse, usually at the county seat. The food stamp program is a plan for in-creasing the food buying power of eligible families. Again, the county Department of Welfare certifies families on the basis of income and size of family. A family may pay $24.00 and re-ceive $36.00 worth of stamps. These may be spent for foods in grocery stores that agree to ac-cept the stamps instead of cash. The Emergency Food and Medical Program is available in certain counties as part of their Office of Economic Opportunity Program. The Emergency Food Order is part of the budget of county welfare departments. It provides immediate availablity of food for people with immedi-ate needs. The Supplementary Food Program is a new idea. From time to time, public health workers have expressed con-cern that although drugs and services are available for low income patients, food was not available to all patients who had need for it. As a means of meeting this need, arrange-ments have been made jointly by the U. S. Department of" Agriculture, the Children's Bureau of the Department of Health, Education, and Wel-fare, and the Office of Economic Opportunity for foods to be made available to certain high risk groups in our population. For the first time, it is the responsibility of health depart-ments and physicians providing free or reduced cost services to patients to prescribe foods. The physician or the professional worker who acts for the phy-sician certifies that the patient would benefit from the foods prescribed. Provided that the patient is already receiving medical services free or at re-duced cost, there is no other limitation on who can receive the food. High risk is a term used to designate people who are in greater than average risk of ac-cident, disease, or death. For the purposes of this program, these people are children from the time of birth to school age and women who are pregnant or who have had an infant with-in a year. Any of these people who are receiving below cost medical care may have foods prescribed for them. Since good food is necessary for everyone, especially the people in this vulnerable or THE HEALTH BULLETIN May 1969 high risk group, who should re-ceive this additional food? Let us take just one example. An-emia is so common among in-fants that iron is added to some commercial formulas and cere-als intended for infants, and some physicians routinely pre-scribe iron for infants. Much of this need for iron could be pre-vented if the mothers' diets had been adequate before they be-came pregnant, or remained adequate during their pregnan-cies. In that case, the baby would have stored enough iron in his body to protect him until he was old enough to eat foods like cereal, bread, meat, eggs, and green leafy vegetables. These foods would provide his iron needs as they do yours and mine. Therefore, in prescribing the foods, workers should consider not only the patients' current food intake, but their long-term food habits. Our bodies are strong or weak because of food habits of our entire life span, not because of the current diet with which we are living temp-orarily. In other words, every portion of our lives depends upon the condition of all the former portions. Or, to put it another way, the children of mothers who were sick or poor-ly fed during pregnancy could benefit from supplementary food. This does not necessarily mean a diagnosis of malnutri-tion, but rather the recognition that the patient would benefit from additional foods. Foods may be ordered by kind and amount, according to five age groupings. Infants from birth through the third month may be given evaporated milk, corn syrup, fruit juice, and fortified farina. Infants from four months through one year are given the same foods, plus scrambled egg mix. Children 13 months, through two years, are given evaporated milk, fortified farina, fruit DISTRIBUTION GUIDE FOR SUPPLEMENTAL FOODS-(HEALTH) juice, scrambled egg mix, can-ned meat, canned vegetable or fruit, instant potatoes, dried milk. Children three years through five years are given all these foods, plus peanut butter. Pregnant women, nursing and post-partum mothers are given all the foods given to three to five year age group, plus chocolate milk beverage mix. Since these foods are ordered as a prescription, certain foods can be reduced or deleted from the order. Maximum amounts which can be prescribed for each age group are set by the U. S. Department of Agricul-ture. Standards for eligibility are relatively simple and do not exclude individuals receiving other forms of financial or food assistance. This program is not intended to provide the only nourishment for "starving fami-lies," but is intended to pro-vide supplemental nourishment for those living under physio-logic stress, or, in other words, the stress of rapid growth. This is the first time food is available as a treatment for a health need. People need to be encouraged to accept and eat the food prescribed not as a charity, but as a remedy. When money is available to the fami-lies, they should be encouraged to buy and use the same kinds of foods. Pood does make a difference. It can contribute to Freedom from Want. Gaston County Hospital Budget Approved Gastonia—A proposed capital outlay of $544,235 and an op-erating budget of $58,359 for the first year 1969-70 have been approved by the Gaston County Hospital board of trustees. The board has also approved archi-tectural drawings for the new hospital. Dr. McPheeters, Former Wayne County Director, Dies GOLDSBORO — Dr. Samuel Brown McPheeters, 88, former director of the Wayne County Health Department, died in May. Suriviving: his wife, Mrs. Virginia Gibbes McPheeters, and a sister, Mrs. F. W. Jar-nagin of Nashville, Tenn. Dr. McPheeters came to Wayne County from Charlotte in 1937 as director of the health department, which he headed for nearly 20 years. Under his direction the department was expanded from four to 26 em-ployes. In the 1940s he was re-sponsible for the erection of the present county health depart-ment building. Following his retirement he was instrumental in the organi-zation of the Wayne County Mental Health Association. He was a graduate of Washington and Lee University. THE HEALTH BULLETIN May 1969 Helicopter Ambulance Service - To the Rescue A 41-year-old man falls asleep while smoking in bed, touching off a fire resulting in 70 per cent burns over his body. Two teenagers are critically injured in a freeway traffic mis-hap. Snow in record proportions blankets a city, halting all sur-face traffic. A young man, walk-ing through a park, falls on ice, paralyzing his legs. Each of the cases is critical in nature and demands rapid em-ergency response. Fortunately, in Chicago where they occurred, fast medical evacuation to a hospital was available. In each instance a Chicago Fire Depart-ment Bell helicopter responded to the emergency call. Public officials around the country are becoming increas-ingly aware of the advantages available through use of heli-copters in medical evacuation work. In addition to Chicago there are air ambulance pro-grams underway in such states as Pennsylvania, North Caro-lina, California, Michigan and Montana. One boost for such efforts comes from the medical com-munity which has seen the heli-copter used effectively as an ambulance in Vietnam. Crew of Superior Ambulance Company carries "patient" from its Bell 47J helicopter after land-ing at University of Michigan Hospital, Ann Arbor during dem-onstration of the first private helicopter ambulance service in U.S. May 1969 THE HEALTH BULLETIN The U.S. Army's 92nd Air Medical Service in Vietnam op-erates more than 100 Bell UH- 1D "Hueys". To date these air-craft have evacuated over 182,- 000 patients from remote battle sites to field hospitals. Of this total, only two per cent reach-ing the hospital have died. In World War II the mortality rate was 4.5 per cent; in Korea where helicopters were first used this dropped to 2.5 per cent. The even lower rate of Vietnam is a record in military history. Military officials in Vietnam now boast that no man, any-where in the country, is more than 30 minutes from medical aid. American civic and medical officials are questioning why this cannot be the case at home today. It is unfortunately true that auto accident victims daily succumb on crowded freeways or remote highways while sur-face ambulances struggle to reach the scene and return to a hospital. Over a 20-month period in 1966-67 an average 137 U.S. servicemen died weekly in Viet-nam combat. During that same period 1,020 Americans died weekly on the nation's high-ways. This does not represent the burn victims, drownings and other emergency situations that call for fast response. The first helicopter medical "rescue" mission was recorded on Jan. 3, 1944 when an ex-plosion rocked a Navy destroy-er loading ammunition at Sandy Hook, N. J. Cmdr. Frank A. Erickson delivered plasma to the accident site and was credit-ed with saving many lives. Since then the heliborne med-ical mission has become a routine, if not sufficiently wide-spread, practice. For example: —This year the first private helicopter ambulance service in the United States was founded. Superior Ambulance Service of Wyandotte, Mich., a Detroit suburb, now operates a Bell 47J in addition to its large fleet of surface ambulances. One of the firm's first airborne missions was the transfer of a brain tumor patient from Dayton, Ohio to Ann Arbor, Mich., a 200-mile trip. —During the 1968 Indian-apolis 500-mile Memorial Day Classic and earlier preliminary trials seven persons were air evacuated by Bell's litter-equip-ped JetRanger from the track to a nearby hospital. —Nineteen crew members of an off-shore oil rig 25 miles out in the Gulf of Mexico were pick-ed up by helicopters after a spectacular explosion and flown to a New Orleans hospital. Within minutes all were given emergency treatment. No lives were lost. One roadblock to greater usage of the helicopter in this role has been the lack of heli-ports across the nation. The 1967 edition of the Ver- THE HEALTH BULLETIN May 1969 tical Lift Aircraft Council's Di-rectory of Heliports/Helistops states there are 1,225 approved landing sites in the United States, Canada and Puerto Rico with another 93 proposed. Hospital heliports have mul-tiplied from only 34 in mid- 1965 to 70 today with another 10 planned. However, leading government and medical au-thorities warn that the number of hospital heliports around the country is inadequate to proper-ly serve the American public. By 1972, the Department of Transportation's National Safe-ty Bureau estimates, highway accidents will result in 75,000 The U.S. Army's 92nd Air Medical Service in Vietnam operates more than 100 Bell UHID "Hueys". To date these aircraft have evacuated over 182,000 patients from re-mote battle sites to field hos-pitals. deaths annually. In fact, more traffic accident victims occupy hospital beds than do cancer and heart ailments combined. Compared to the life-saving rates achieved in Vietnam, it is apparent the American public must begin to place the same emphasis on saving lives and limbs during peace-time as it does on the battlefield. In some areas action is under-way. The Montana Aeronautics Commission last year inaugur-ated a program where it offer-ed to construct hospital heli-ports anywhere in the state if hospital administrators would May 1969 THE HEALTH BULLETIN provide usable ground or roof-top space. Once the area is al-located the commission designs, develops, constructs and marks the new heliport. In the first five months the program was initiated the commission re-ceived 14 hospital responses. The U.S. military's helicop-ters also are being utilized in a limited manner. Hospital de-tachments at Fort Rucker, Ala. and Fort Sam Houston, Texas evacuated more than 70 high-way accident victims last year. A Department of Transporta-tion official recently said there is a strong likelihood the mil-itary may make some 200 of its helicopters based around the nation available to the public as rescue vehicles. And the Trinity Hospital of Minot, N. D., has purchased a Bell helicopter to be piloted by a local flying service for hand-ling emergencies within a radius of up to 100 miles of the hospital. The aircraft is the first hospital-owned helicopter am-bulance in the nation. While this is progress there is much work still to be done. Medical spokesmen point out that the general public is, in al-most all instances, unprepared for the emergency situation. There is a need to have more persons trained in first aid. One partial solution recommended has been to place former mil-itary corpsmen in helicopters to serve as a medical aide when the aircraft goes on an emer-gency call. There is a need for faster communications, particularly in remote sections. The Bell Tele-phone system has taken one step to correct this with the recent announcement it will have a central nationwide em-ergency number, 911. And, as previously mention-ed, there is a need for a new awareness by local government officials, city planners and hos-pital administrators to provide adequate emergency facilities and procedures, one of which is heliports. Scientists Win Awards Dr. Solomon C. Goldberg, As-sistant Chief of the Psychophar-macology Research Branch of the National Institute of Mental Health, Chevy Chase, Md., shar-ed with two former NIMH scientists the Lester N. Hof-heimer Prize for Research con-ferred at the recent 125th an-niversary meeting of the Amer-ican Psychiatric Association at Bal Harbour, Florida. Other recipients of the award were Dr. Jonathan O. Cole, now Superintendent of Boston State Hospital and Professor of Psy-chiatry at Tufts University, Boston, and Dr. Gerald Kler-man, now Director of the Con-necticut Mental Health Center and Associate Professor of Psy-chiatry at Yale University, New Haven. 10 THE HEALTH BULLETIN May 1969 The Home Swimming Pool Happy Hours or Tragic Ones The ever-increasing number of automobiles on our highways is one of the factors responsible for the growth of the home swimming pool industry. Today there are more than one-half million such home pools not counting the surface plastic and wading pools. Because of the desire to avoid traffic and crowded highways, there more than likely will be a continued upward trend in this industry. The home swimming pool can be the source of healthful and happy recreation but it can also result in tragedy. A 1965 study has indicated that there were almost 500 pool deaths in the United States and that most pool deaths occurred in resi-dential pools, such as pools in private homes, apartments or motels. Over half of the victims were youngsters of age four and under. Most of the tragedies re-sulted from the lack of super-vision, inadequate physical pro-tection, the inability to swim and a disregard for safety prac-tices. A youngster should never be left unattended in or near a swimming pool. The mother, father or an adult should al-ways be present. Children should never be entrusted to other children. In fact, even adults should not swim or work in a pool unless someone else is present. Slips, falls and physical attacks can be fatal. Every home swimming pool should be adequately fenced with the entire pool area visible from the home. Fencing should be of sufficient height to pre-vent entry by youngsters and make it difficult for older people to climb over the fencing and become atrespasser. There should be depth markings on the pool deck and sides and protective float lines to warn of changing depths from shallow to deep water. Items such as plastic boats, balls and floating toys can be fun for the youngsters but must be used with precaution. Swim-mers should never be allowed to rely on these objects as support May 1969 THE HEALTH BULLETIN 11 for deep-water areas. Pushing, shoving, ducking or running on pool decks should be strictly prohibited. Such practices can lead to disabling injuries and even death. Adults as well as youngsters should adhere to these safety measures. Further, adults should never attempt to swim after drinking alcoholic beverages, eating or taking drugs or medication. Cleanliness is very important to health and safety. Pool decks should be periodically scrubbed to prevent them from becoming slippery. Papers and other re-fuse which may lead to slips and falls should be placed in trash containers. Glass bottles should never be taken to the pool area. To prepare for possible em-ergencies, it is prudent to have a signal or some warning device in the immediate vicinity of the pool to summon help and a ring buoy to toss to a swimmer in trouble. A telephone should be readily accessible and all pool owners and users should be taught the technique of mouth-to- mouth resuscitation. Wheth-er or not a pool is used for night-time swimming, there should be an immediate source of emergency illumination. A handy wallet card prepared in cooperation with the Amer-ican National Red Cross and the U. S. Department of Health, Education and Welfare, con-taining safety tips, is enclosed for your usage. Treat Electricity as a Friend In this modern world of to-day we have a most valuable servant, steady, dependable and most powerful. As a friend it works through lights, applian-ces and modern kitchens. It lightens daily chores, brings you comfort and convenience and allows you leisure time to relax and enjoy your favorite radio or television programs. This friend and servant is elec-tricity but it has its rules which must be adhered to. It can be an obedient servant. Ignore its rule and it can become violent and a deadly killer. Severe or even fatal injuries result when electric energy flows through the body. The ex-tent of injury depends on the path and the amount of current flow. The flow can be fatal if its course is through a vital or-gan. When the flow of electric current does not pass through vital body organs, injuries are likely to be less severe. How-ever, the muscular reaction to a small shock can startle a per-son to the extent that he may lose his balance and fall. This involuntary motion may cause serious injury. While deaths due to misuse of electricial current are few in comparison to other causes, an undetermined number of deaths and burn injuries result from 12 THE HEALTH BULLETIN May 1969 nearly 140,000 fires throughout the nation caused by faulty electrical appliances, wiring and other electricial equipment. Statistics indicate that we now have available to us over 150 types of electricial applian-ces and with technological ad-vancements, many more are an-ticipated. Consequently, it may be well to mention something about the proper installation and maintenance of electrical equipment and appliances from a safety point of view. 1. Before plugging an appliance into an outlet, check the capacity of your home wir-ing circuit. Never connect more than 1600 watts on a general-purpose circuit un-less you know that the cap-acity of your home circuit can carry more than this cap-acity. 2. Cords with worn or crack-ed insulation should be re-placed. Never run cords over hot pipes, radiators or other hot objects. Use convenient wall outlets rather than ex-tension cords or light sockets for connecting appliances. 3. Never run a cord under a rug or door or hang the cord over a nail or sharp object. 4. Connect electrical appliances by putting cord or probe-type temperature controls in-to the appliance before plug-ging into the electrical out-let and always turn off the appliance whenever plugging in or disconnecting from the electrical outlet. Major ap-pliances should always be grounded. 5. Electrical equipment should not be handled with wet hands or when standing on a wet or damp surface. Avoid touching an appliance and a grounding source such as a pipe, radiator, faucet or sink at the same time. Common house current can be lethal. 6. Always disconnect applian-ces before oiling or cleaning. Clean and oil the appliances periodically if recommended by the manufacturer as car-bon particles and dirt can set up current paths to ex-terior paths. 7. Do not overload your cir-cuits. A normal household circuit will carry 15 amperes of electricity. If a 15 ampere fuse blows out continuously, you should add another cir-cuit to your home rather than replacing it with a high-er ampere fuse. 8. Wall outlets attract small children and they are temp-ted to insert hair pins or small objects into the outlet. When not in use, the wall outlet should be covered with a plastic cap or a piece of furniture should be placed in front of the outlet to keep it out of sight. Robert F. McDonald, Chief Injury Control Program Providence, Rhode Island May 1969 THE HEALTH BULLETIN 13 Driving Skills of Senior Motorists The results of a nationwide study into the driving records of senior motorists may well catapult the over-65 driver to a respected place on the high-way and make his current reputation as a "hazard" a myth of the past. A report on the accident in-volvement of the senior driver, released by the University of Denver College of Law, is so favorable to the senior motorist that Judge Sherman G. Fine-silver, head of the study team, believes it "will be pivotal in refuting current popular think-ing about older drivers." In the 31 jurisdictions for which data were available, senior drivers (persons age 65 and over) aver-aged 37 percent fewer accidents than would exist if their pro-portion of accidents were in di-rect ratio to their proportion of the driving population. Although senior drivers rep-resented 7.4 percent of all driv-ers in the states surveyed, they were involved in only 4.8 per-cent of all accidents in these states. They averaged lowest of all age groups in frequency of injury-producing accidents and 40 percent below their propor-tionate share of the driving pop-ulation. Judge Finesilver expressed the opinion that "the senior driver has been made a scape-goat, the senior driver is not only a good risk, but often may be among the safest motor-ists on the highway." . . . from More Life For Your Years, 5/69 MEMBERS OF THE NORTH CAROLINA STATE BOARD OF HEALTH James S. Raper. M.D., President Asheville Lenox D. Baker, M.D., Vice President Durham Ben W. Dawsey, D.V.M. Gastonla Ernest A. Randleman, Jr., B.S.Ph. Mount Airy Paul F. Maness, M.D. Burlington A. P. Cllne, Sr., D.D.S. Canton Joseph S. Hiatt, Jr., M.D. Southern Pines J. M. Lackey Rt. 2, Hlddenite Howard Paul Steiger, M.D. Charlotte EXECUTIVE STAFF Jacob Koomen, M.D., M.P.H. State Health Director W. Burns Jones, M.D., M.P.H. Assistant State Health Director J. M. Jarrett, B.S. Director, Sanitary Engineering Division Martin P. Hines, D.V.M., M.P.H. Director, Epidemiology Division Ronald H. Levine, M.D., M.P.H. Director, Community Health Division E. A. Pearson, Jr., D.D.S. , M.P.H. Director, Dental Health Division Lynn G. Maddry, Ph.D., M.S.P.H. Director, Laboratory Division Ben Eaton, Jr., A.B., LL.B. Director, Administrative Services Division Theodore D. Scurletis, M.D. Director, Personal Health Division 14 THE HEALTH BULLETIN May 1969 How It Was In the Old North State AN INDECENCY However chivalrous the purpose of the North Carolina Senate in its passage of an amendment to the marriage laws repealing the requirement of an affidavit of physical soundness on the part of the masculine member of the matrimonial partnership before the contract may be entered into, those voting for it have lent themselves to a mighty sorry business. A few years since this State had a marriage law that, while not perfect, was a testimonial to the intelligent respect which the more thoughtful of our men and women feel for their kind. Publication of the banns, health certificates for both bride and groom, protected them and the race. Of course a few nice youngsters in a hurry eloped to other states, as did some who could not have been certificated at home. Marrying magistrates of Virginia, South Carolina, and perhaps an occasional Tennessee or Georgia squire, picked up a few dollars which border counties would have liked to retain within their bounds; but what of it? We were making an honest effort to give to marriage that self-respect to which it as an institution is entitled. We were attempting to avert some of the tragedies resulting from the propagation of the species by its sorriest specimens. But the past two-three Legislatures have jested or worse at the ideals embodied in the best-contrived marriage law of this section of the United States. It was thought indelicate to require a mother of men to be examined by her family physician as to her fitness for motherhood. It was deemed perversive of public interest to require a notice to the public from those who desired to enter into the contract which most concerns the public. And now it would seem all bridegrooms of whatever age or physical condi-tion, must be considered Bayards, sans pen, sans re-proche, and fit for mating at the drop of a hat. — Greensboro News. The Health Bulletin, June 1935, Vol. 50, No. 6 May 1969 THE HEALTH BULLETIN 15 THE HEALTH BULLETIN P. O. Box 2091 Raleigh, N. C. 27602 U0b5 If you do NOT wish to con-tinue receiving The Health Bul-letin, please check here | | and return this page to the address above. Printed by The Graphic Press, Inc., Raleigh, N. C Safeguards for Children Patricia R. Hitt, Assistant Secretary for Community Field Services, Department of Health, Education and Welfare has urged enactment of legislation to protect children against elec-trical, mechanical, and thermal hazards of toys and other items intended for use by children. A bill now pending in Congress, which has been endorsed by the Food and Drug Administration would provide this protection. Action is sought on the basis of findings disclosed by the Na-tional Commission on Product Safety, appointed to make rec-ommendations to the President and Congress on ways to reduce the hazards of household pro-ducts. Under the existing Hazardous Substances Act, the law does not protect children against hazards such as sharp or pro-truding edges, fragmentation, explosion, strangulation, suffo-cation, asphyxiation, electric shock, electrocution, heated sur-faces, or unextinguishable flames. The urgent necessity for im-mediate action, the Assistant Secretary said, is clearly il-lustrated by the casualty fig-ures gathered by the Commis-sion. More than 15,000 children die each year from accidents. This figure is higher than child-hood deaths from cancer, com-municable diseases, heart dis-eases, and gastroenteritis com-bined. More than half of the children who died as a result of accidents in 1966 were pre-school children. . . . from HEW Field Letter 16 THE HEALTH BULLETIN May 1969 mmmmfi Official Publication Of The North Carolina State Board of Health DR. E. R. HARDIN Who retired July 1, 1969, after 50 years of continuous service as Health Director of Robeson County Health Department. (Story on page 3.) June 1969 Inside Dr. E. R. Hardin Retires after 50 years 3 Hodges Heads New State Health Move 7 Environmental Health Protection 9 THE HEALTH BULLETIN First Published—April 1886 The official publication of the North Caro-lina State Board of Health, 106 Cooper Memorial Health Building, 225 North Mc- Dowell Street, Raleigh, N. C. Mailing ad-dress: Post Office Box 2091, Raleigh, N. C. 27602. Published monthly. Second Class Postage paid at Raleigh, N. C. Sent free upon request. Editorial Board John Andrews, B.S., Raleigh Jacob Koomen, Jr., M.D., M.P.H., Raleigh John c. Lumsden, B.C.H.E., Raleigh Guest Editor: Edwin S. Preston, M.A., LL.D. Vol. 84 June, 1969 No. 6 ALSO Cover: Madge Pittman of the Robe- Malpractice Insurance Firm Advises Physicians son County Health Department on Birth Control Pill _ 8 sta ff sent us this photograph of retiring Health Director, Dr. E. R. Dental Irrigating Device Approved _ __11 Hardin, with this note: "This is our favorite photo of Dr. Hardin — Preventive for hope you like it too." We do! His Chicken Pox Reported 14 . . „ „„„,> o ; c <* story, beginning on page 3, is a profile of North Carolina's health Live German Measles Vaccine Licensed 16 progress in this past half-century. 2 THE HEALTH BULLETIN June 1969 Dr. Eugene Ramsey Hardin Retires After Fifty Years As Health Director Of Robeson County Here is the story of those years as told in Dr. Hardin's Nomination for The Rankin Award of the N. C. Public Health Association. Dr. Eugene Ramsey Hardin graduated from the University of Georgia Medical College in 1911. His grades secured for him an internship in Lamar General Hospital. At the end of this service he was appointed intern in Nursery and Child's Hospital, New York City, a pediatric and obstetric service. From there he interned in Wil-lard Parker Hospital, the larg-est contagious disease hospital in New York City. While there, he had the privilege of observ-ing Dr. Bela Schick, who was doing his experimental work in diphtheria. In 1915 he accepted the posi-tion of Health Officer of Samp-son County, N. C. After one and a half years, he resigned this position to begin private prac-tice there. This was interrupt-ed by the war, and in August of 1917, he entered training for the Army Medical Corps and was assigned to duty as a First Lieutenant at Camp Lee, Va. In October, 1918, he was sent overseas and landed in France, November 10, 1918, just in time to help the French celebrate the Armistice. After the Armistice, it was Army policy not to re-lease medical officers for sever-al months. It was July, 1919, therefore, before he returned to the United States and to North Carolina. He was discharged from the Army August 31, 1919. Dr. Hardin began work as Health Officer for Robeson County September 1, 1919. At that time, much pioneer work had been done by Doctors B. W. Page and W. A. Mc- Phaul, the first health officers, but there was still a vast num-ber of public health problems to be solved. The county, one of the largest in the state, had a population of more than fifty thousand people divided among three races, no paved roads, one hundred and fifty schools, one small hospital, no dairies, and a very low per capita milk con-sumption. There were 190 midwives practicing. The maternal and infant mortality was very high, as were deaths from infectious and contagious diseases. The water supply of most people in small towns and rural sections June 1969 THE HEALTH BULLETIN was obtained from open wells and shallow driven wells. Screens were practically un-known in the rural sections, and sanitary sewage disposal was extremely poor. Many schools did not have sanitary privies and obtained their water from one pitcher pump. Typ-hoid fever, infectious diarrheas, diphtheria, tuberculosis, mal-aria, pellagra, and hookworm disease were very prevalent, and thousands of people fell vic-tims to these diseases every year. Venereal disease was very prevalent. Smallpox was com-mon. In the beginning, the main attack of the health de-partment was directed against the major public health prob-lems of that time: Typhoid fever, diphtheria, tuberculosis, infantile diarrhea, hookworm disease, and the high maternal and infant death rate. Better sanitation, water sup-plies, and sewage disposal facil-ities were urged. The health department staff at this time consisted of the health officer and a secretary. TYPHOID FEVER has shown a steady decline since 1920. From 1920 through 1943 the health department Vacci-nated 66,030 against typhoid. Clinics were held in stores, private homes, country church-es, voting booths, tobacco barns, or anywhere people could as-semble. Now, typhoid fever has become a rare disease in Robe-son County. DIPHTHERIA: The health department began an intensive immunization campaign against diphtheria in 1925, shortly after the advent of the long-time diphtheria preventive toxin-anti- toxin. There has been no letup in the fight since that time. In the four year period 1920 through 1923, five hund-red and sixty-two cases of diphtheria with nineteen deaths were reported to the health de-partment. In the four-year peri-od beginning 1925 through 1943 the health department vaccinat-ed 27,505 babies and older chil-dren against diphtheria. During this time, more than ten thou-sand were given the Schick test to determine diphtheria susceptibility. The last case of diphtheria was reported in 1959. SMALLPOX: In the early years smallpox cropped up fre-quently, occasionally reaching the epidemic stage. Vaccina-tions over the years have con-trolled the disease. No smallpox has been reported since 1931. TUBERCULOSIS clinics were begun in 1920. Clinics were held by a doctor from the State Sanatorium. These clin-ics were continued every few years until about 1940, when the state mobile X-ray units were secured for several years. Realizing the need, Dr. Hardin was successful in organzing the Robeson County Tuberculosis Association in 1940. A few years ago, Dr. Hardin persuaded the county commissioners and the THE HEALTH BULLETIN June 1969 T. B. Association to purchase an X-ray machine that makes small and large films. This machine has provided Robeson County with complete coverage at all times. The Robeson Coun-ty T. B. Association also pays a part-time X-ray technician for the health department. The course of tuberculosis in Robeson County gives an ex-ample of the problems, the work, and the results of public health in the county. Dr. Hard-in had not only the problem of the rampant disease itself, but he had also to deal with the ignorance, superstitions, and fears that had been present for generations. Realizing that the only way to change people was through endless education, he wrote hundreds of newspaper articles, spoke at every possible P.T.A., church, or civic gather-ing, and visited endlessly with the greats, near-greats, and the nobodys-at-all throughout the county. That this work was not in vain is evidenced by the de-crease of deaths and cases. Ex-amination of contacts has been virtually one hundred per cent for years. Thousands of county residents come voluntarily to the health department each year to receive free chest X-rays. MATERNAL AND INFANT CARE: Robeson County has one of the outstanding pre-natal clinics in North Carolina. Until recent years, prenatal clinics were held once each month in each town in the county. Sever-al years ago all of these clinics were consolidated into one clin-ic held weekly at the health de-partment. Here the patients re-ceive excellent medical care, nursing supervision during the pre-natal and post-natal period, nutrition consultation, and necessary drugs. This has pro-duced healthier mothers and babies, as shown by the lower maternal and infant deaths, rates, and lower premature rate. When Dr. Hardin came to Robeson County, there were al-most two hundred midwives. An article on the history of the health department in the March 7, 1962, issue of the Robesonian described the work done by these midwives. "Midwives came under careful scrutiny. They were investigated and carefully screened. A course for them given in the early 1920's was attended by 130; 100 com-pleted the course. Each was aid-ed in assembling materials to be carried in a little bag. Each was trained in sterilization of materials, the use of antiseptics, the use of drops to be placed in babies' eyes. In those early years, three midwives were taken to court for failing to put drops in the eyes of newborn." The last of these midwives re-tired in 1962. The effectiveness of this pro-gram was recognized when it played a part in bringing the Merit Award of the N. C. Public June 1969 THE HEALTH BULLETIN Health Association to Robeson in 1958. VENEREAL DISEASE has always been a problem in Robe-son County. As early as 1920, the fight began and still con-tinues. In 1920 a venereal dis-ease campaign was organized with moving pictures, and a lecturer from the U. S. Public Health Service, here for a five-week tour. The truck moved into all parts of the county, reaching all segments of the population. The modern developments in the treatment of V.D. have, of course, been of help in the con-trol of this problem. In 1951 there was a county-wide blood testing program, in which clubs, and churches did their part in getting out everyone possible to be tested for possible infection. This blood-testing program was repeated in 1958. Treatments were arranged for those need-ing them. Through constant checks of persons involved in foodhandling and other related occupations, a check is kept on V.D. and possible contacts are found and treated. THE CRIPPLED CHIL-DREN'S CLINIC, which is held the first Friday of each month as regularly as clockwork, be-gan in the 1930's. In this work, Mrs. A. F. McLeod, head of the welfare department, was a strong partner for Dr. Hardin. The 30's were a period of de-pression and health needs of every type, including those in-volving handicaps of children, were great. The best doctors in their fields come each month to these clinics to examine new cases and to check on former cases. With the aid of the wel-fare department and other sour-ces, children who need medical care, surgery or the like are aided. Many a child in Robeson today is a better person phy-sically and emothionally be-cause physical handicaps have been alleviated by the Crippled Children's Clinic. PELLAGRA today is almost an unknown disease, but when Dr. Hardin came to Robeson it was one of the big problems. Great as it had been, it became even more of a menace in the de-pression years of the 30's. The county commissioners included enough money in the budget to purchase mineral yeast, a very effective agent to fight pellagra, but a most unpleasant sub-stance to take. Despite the un-pleasant taste, when people learned that yeast overcame pellagra, they came in droves for it. It is estimated that in the course of several years, several carloads were distributed, at the request of the people need-ing it. HOOKWORM is another poverty disease, but has far more overtones in the health picture since it can be trans-mitted to others. In the early years the fight began and still continues. There were checks, (Continued on page 12) THE HEALTH BULLETIN June 1969 Hodges Heads New State Health Move Needs In Medical Education To Be Evaluated By BEBE MOORE Staff Writer Former Gov. Luther H. Hod-ges is chairman of a new com-mittee which will promote health planning in North Caro-lina. The North Carolina Commit-tee for Better Health was form-ed in May, by some 30 persons who gathered at the Statler Hil-ton Inn here at Hodges's invita-tion to discuss health needs and the status and coordination of health planning. The committee's purpose, Hodges said, is "to come up with some ideas as to what we can do to achieve . . . the best health program that North Carolina can afford." He said such a program in-cludes training of medical per-sonnel, providing adequate fa-cilities, and making available "the best medical care possible at the most reasonable cost to the individual and the state.' " May Serve As Nucleus The committee may serve as the nucleus of a grassroots movement similar to the "good health movement" of the late forties, Hodges said. This movement was the fore-runner of the present active N. C. Health Council. The earlier movement has been described as the first great statewide thrust for health. It resulted in passage by unani-mous vote in the 1949 General Assembly of a package of 12 items that included creation of the four-year medical school at the University of North Caro-lina and appropriation of state funds to match federal (Hill- Burton) funds for construction of medical facilities. Several participants in the meeting Tuesday stressed the importance of public involve-ment in efforts to meet the state's health needs. Dr. Jacob Koomen, state health director and acting director of the Office of Comprehensive Health Plan-ning, said that citizens now "scream to the state legislature (to meet health needs), rather than to the federal govern-ment," as they did in the period of the forties. The committee will seek the best method of developing a comprehensive statewide health plan. Such a plan was recommend-ed in a statement from Watts Hill Jr., chairman of the State Board of Higher Education. June 1969 THE HEALTH BULLETIN The statement, read by high-er education board director Dr. Cameron West in Hill's absence, said that it is "difficult if not impossible" for the board to plan and promote ways of meet-ing health needs without a com-prehensive statewide plan. Hill also pointed out that a plan could assign to agencies and institutions involved in health care "responsibility for subsections within its area of special competence." and make it possible to weigh the needs in specific areas "against total needs and priorities." Ed Rankin, vice president and secretary of the North Caro-lina Citizens Association, was appointed chairman of a steer-ing committee to set directions for the larger committee. Others on the steering com-mittee are William Snyder, edi-tor of The Greensboro Daily News; Dr. Koomen; state Rep. Hugh Johnson, D-Duplin, who headed a Legislative Research Commission study of the state's doctor shortage; state Sen. Lindsay Warren Jr., D-Wayne; Dr. West of the board of higher education; Dr. James Musser, director of the North Carolina Regional Medical Program; Dr. Amos Johnson of Garland, former president of the Amer-ican Academy of General Prac-tice; and Asheville attorney Lamar Gudger. Raleigh News and Observer May 14, 1969. Malpractice Insurance Firm Advises Physicians On Birth Control Pill A Los Angeles firm dealing in malpractice insurance has ad-vised its 18,000 physician-clients to get patients request-ing birth control pills to sign statements acknowledging "awareness of the serious risks involved." The firm, the Nettleship Co., administers professional liabil-ity programs for 12,000 doctors in Southern California and for 6000 osteopathic physicians na-tionwide. It is the second larg-est company of its kind. In a "claims prevention let-ter" dated May 14, Nettleship's president John C. Allen told doctors of "the increasing awareness of potential compli-cations from contraceptive pills" and disclosed that his firm is "already handling law-suits dealing with some of these complications." The Government-approved instructions for prescribing the Pill say that it increases from seven to 10 times the risk of serious and fatal blood clotting compared with the rate in non-users. 3 THE HEALTH BULLETIN June 1969 Environmental Health Protection Charles C. Johnson, Jr. Administrator Consumer Protection and Environmental Health Service Public Health Service Excerpts from an address prepared for delivery at the Spring meeting of the Southern Regional Legisla-tive Seminar on Current Public Health Problems, sponsored by the Southern Conference of the Council of State Governments. We shape our environment, and then our environment shapes us. We have only to look around us to see that we are well on the way—particularly in our urban areas—to creating a world which can have the most serious adverse effects on human health. We are "engaged in a race be-tween catastrophe and the in-telligent use of technology, and it's not at all clear we are going to
Object Description
Description
Title | Health bulletin |
Other Title | Bulletin of the North Carolina State Board of Health; Bulletin of the North Carolina Board of Health |
Creator | North Carolina. State Board of Health. |
Date | 1969 |
Subjects |
Children--Health and hygiene Diseases Hygiene Public Health--North Carolina--Periodicals Sanitation |
Place | North Carolina, United States |
Time Period | (1945-1989) Post War/Cold War period |
Description | Volume 84, Issues 1-12. Issues for Feb.-May 1917 and for Jan.-July 1918 not published.Addresses by Walter Clark. |
Publisher | Raleigh,North Carolina State Board of Health. |
Agency-Current | North Carolina Department of Health and Human Services |
Rights | State Document see http://digital.ncdcr.gov/u?/p249901coll22,63754 |
Physical Characteristics | 61 v. :ill. ;23 cm. |
Collection | Health Sciences Library, University of North Carolina at Chapel Hill |
Type | text |
Language | English |
Format | Bulletins |
Digital Characteristics-A | 9,576 KB; 204 p. |
Digital Collection |
Ensuring Democracy through Digital Access, a North Carolina LSTA-funded grant project North Carolina Digital State Documents Collection |
Digital Format | application/pdf |
Related Items | Imprint varies: published later at Raleigh, N.C. |
Title Replaces | Bulletin of the North Carolina Board of Health** |
Audience | All |
Pres File Name-M | pubs_edp_healthbulletin1969.pdf |
Pres Local File Path-M | \Preservation_content\StatePubs\pubs_edp\images_master\ |
Full Text | UNC-CH HEALTH SCIENCES LIBRARY H00338139R j HEALTH SCIENCES LIBRARY OF THE UNIVERSITY OF NORTH CAROLINA AT CHAPEL HILL Inside FDA Issues Warning About Artificial Sweeteners . . How It Was in the Old North State North Carolina Gets Chief Medical Examiner THE HEALTH BULLETIN First Published—April 1886 The official publication of the North Caro-lina State Board of Health, 106 Cooper Memorial Health Building, 225 North Mc- Dowell Street, Raleigh, N. C. Published monthly. Second Class Postage paid at Raleigh, N. C. Sent free upon request. Editorial Board John Andrews, B.S., Raleigh Glenn A Flinchum. B.S.. Raleigh Jacob Koomen. Jr., M.D , M.P.H., Raleigh John C Lumsden, B C HE., Raleigh H W Stevens. M.D., M.P.H., Asheville Editor: H. B. Rogers Vol. 84 January 1969 No. 1 Physical Therapy Assistant: A New Health Career . . Cover: Dr. R. Page Hudson Jr. takes the oath of office as North Caro-lina's first chief medical examiner. He will direct the first statewide system for post-mortem medicolegal examinations. MEMBERS OF THE NORTH CAROLINA STATE BOARD OF HEALTH James S. Raper, M.D., President Asheville Lenox D. Baker, M.D., Vice President Durham Ben W. Dawsey, D.V.M. Gastonia Ernest A. Randleman, Jr., B.S.Ph. Mount Airy Paul F. Maness, M.D. Burlington A. P. Cline, Sr., D.D.S. Canton Joseph S. Hiatt, Jr., M.D. Southern Pines J. M. Lackey Rt. 2, Hiddenite Howard Paul Steiger, M.D. Charlotte EXECUTIVE STAFF Jacob Koomen, M.D., M.P.H. State Health Director W. Burns Jones, M.D., M.P.H. Assistant State Health Director J. M. Jarrett, B.S. Director, Sanitary Engineering Division Martin P. Hines, D.V.M., M.P.H. Director, Epidemiology Division Ronald H. Levine, M.D., M.P.H. Director, Community Health Division E. A. Pearson, Jr., D.D.S., M.P.H. Director, Dental Health Division. Lynn G. Maddry, Ph.D., M.S.P.H. Director, Laboratory Division Ben Eaton, Jr., A.B., LL.B. Director, Administrative Services Division Theodore D. Scurletis, M.D. Director, Personal Health Division THE HEALTH BULLETIN January 1969 FDA Issues Warning About Artificial Sweeteners The U. S. Food and Drug Administration has warned against the unrestricted use of cyclamates, the most commonly used artificial sweeteners. FDA has issued a statement reflecting interim findings of the National Academy of Sciences, ivhich conducted a review of the safety of artificial sweeteners. An FDA spokesman said, "Our one concern is that children and adults not only drink artificially siceetened carbonated soft drinks hut also consume many other products containing artificial sweeteners such as gum, candy, puddings, cookies, etc." The text of the official FDA statement: Many kinds of foods and drinks sweetened with su-gar substitutes are now available in the stores. Be-cause of this widespread and growing use, FDA sometime ago asked the National Academy of Sciences to review the safety of these artificial sweeteners. An Academy Committee has now submitted an in-terim report advising that cyclamate sweeteners should not be used in total-ly unrestricted amounts. Cyclamates are the most commonly used artificial sweeteners. The Committee's rec-ommendation was made because of questions scien-tists still have about the effects of the cyclamates. However, the Committee did say this: An adult can consume up to five grams of cyclamate a day without any probable hazard. Chil- January 1969 THE HEALTH BULLETIN dren should use propor-tionately less. The smaller they are, the less they should use. The World Health Organization has recommended a daily limit based on weight. Its for-mula works out to a limit of about one and one-third grams of cyclamate a day for a 60-pound child. Here's one way to trans-late that into practical terms: Artificially sweet-ened carbonated soft drinks —which account for most of the cyclamate consump-tion by the average con-sumer— contain from one-quarter to a little more than one gram of cyclamate in each 12-ounce bottle. How It Was In The Old North State HOW TO SLEEP Here are a few common sense directions guaranteed to be bene-ficial in ninety-five out of every one hundred cases of insomnia. Get enough phvsical exercise during the day to tire you. Go to bed at the first urgent invitation of Morpheus. Be sure the bed is comfortable and the room is quiet. Think pleasant thoughts. Don't have the head of the bed lower than the foot. Be sure there is no other livestock in the bed with you; if there are, change boarding- houses. If you haven't bathed latelv, try a good application of soap and warm water just before retiring. This is said to work wonders in more directions than one. If vour neighbors' cats also have insomnia, throw them a few Jackson crackers. If this fails, a shotgun is known to be a sure remedy. Eat supper at least two hours before retiring. Eat a light supper and take nothing indigestible. Don't worry and don't take dope. If vou don't get to sleep right awav and if vou don't sleep quite as much as vou think vou should, remember that even lying awake in bed is very restful. — The Health' Bulletin, Vol. XXX, No. 3, June 1915 THE HEALTH BULLETIN January 1969 Dr. Hudson (right) checks a point with Associate Jus-tice Susie Sharp of the State Supreme Court fol-lowing sicearing -in cere-mony. Justice Sharp admin-istered the oath of office to the new chief medical examiner. North Carolina Gets Chief Medical Examiner "I shall not be sparing of my-self or others in an effort to seek the truth and contribute to justice." With these words, Dr. R. Page Hudson Jr. took office as North Carolina's first chief med-ical examiner. Associate Justice Susie Sharp of the North Carolina State Su-preme Court administered the oath of office at ceremonies December 6, 1968 in Raleigh. On the platform with Dr. Hudson and Justice Sharp were Dr. Jacob Koomen, State health director, and State Senator John J. Burney of Wilmington, author of the bill passed by the 1967 North Carolina General (Continued on page 8) State Senator John J. Bur-ney of Wilmington wrote the legislation enacted by the 1967 General Assembly creating North Carolina's first statewide medical ex-aminer system. January 1969 THE HEALTH BULLETIN Physical Therapy Assistant: A New Health Career in North Carolina BY NANCY L. DUCKETT Public Information Officer Department of Communty Colleges An educational program to train people to become physical therapy assistants is now avail-able for the first time in North Carolina. The pilot program is being offered by Central Pied-mont Community College in Charlotte. According to Robert L. Gos-sett, director of the Central Piedmont physical therapy as-sistant program, there are 11 students already enrolled in the six-quarter course, which began at the community college early in October. Even though all of the stu-dents presently enrolled are women, Mr. Gossett points out that the program is most desira-ble for men, too. To be admitted into the pro-gram, a student must be a high school graduate or he must have earned a high school equivalency certificate. Mr. Gossett explained that the physical therapy assistant curriculum is made up of gen-eral college courses and techni-cal offerings. So that the stu-dents are able to practice what they are taught at the com-munity college, they spend time away from the school in clinical areas. "This will begin mid-way through the second quarter," said Mr. Gossett. In no way should the physi-cal therapy program, which leads to an associate in applied science degree, be confused THE HEALTH BULLETIN January 1969 with those programs designed to prepare a person to become a physical therapist. A physical therapist must have, at the minimum, a baccalaureate de-gree. In addition, to meet the standards for qualification of the American Physical Therapy Association (APTA), a person must be licensed or registered by the state when licensure laws are applicable. The American Physical Ther-apy Association recently adopt-ed a policy statement support-ing the training and utilization of the physical therapy assist-ant. This resulted from the current inability of established programs for the education of physical therapists to produce numbers of professionals to meet the growing health needs, coupled with the realization that many patient care needs can be met by a type of worker who has formal training at the technical level. The 1967 policy statement de-fines the physical therapy as-sistant as "a skilled technical health worker who has com-pleted an educational program approved by the association." The statement continues to explain that "such an individu-al functions to assist the quali-fied physical therapist in pa-tient related activities. The degree of assistance depends, in part, upon the type of physical therapy service in which the assistant is employed and upon the health needs of the patient." Also, "He [the physical thera-py assistant] is capable of per-forming routine treatment pro-cedures in accordance with planned programs and of assist-ing the qualified physical thera-pist in carrying out complex procedures and programs. The physical therapy assistant works within a physical thera-py service administered by a qualified physical therapist who meets the standards of APTA. The assistant performs his duties with direction and supervision of the physical therapist to whom he is direct-ly responsible." Programs for the education of the physical therapy assist-ant are being established in many areas c ' *he nation. In North Carolina, the State Ad-visory Committee for the edu-cation of the physical therapy assistant was formed in 1967 by the Department of Commu-nity Colleges at the request of the State Physical Therapy As-sociation. This committee is made up of physical therapists and others interested in provid-ing better and more complete health care. In 1967 the laboratory division of the North Carolina State Board of Health was requested to distribute 84,690 doses of typhoid vaccine. The year before that, 82,220 doses were distributed. There were five new cases of typhoid in North Carolina in 1967. Typhoid immunization is indicated only if there is household contact with a known typhoid carrier, or if there is a common-source outbreak in a community, or if a person is traveling to a foreign country. January 1969 THE HEALTH BULLETIN THE HEALTH BULLETIN P. O. Box 2091 Raleigh, N. C. 27602 :.T\ A. K, CUNNINGHAM, EXEC, SEC. N.C. DENTAL SOC. BX. 11065 KORDECAI STA RALEIGH, N.C. If you do NOT wish to con-tinue receiving The Health Bul-letin, please check here | | and return this page to the address above. Printed by The Graphic Press, Inc., Raleigh, N. C Chief Medical Examiner (Continued from page 5) Assembly creating the state-wide medical examiner system. Among the 100 persons look-ing on were members of Dr. Hudson's family, colleagues from the campus of the Univer-sity of North Carolina at Chapel Hill, and associates from the State Board of Health adminis-trative staff. The office of chief medical examiner, a function of the State Board of Health, is housed on the university campus. It will operate in close collabora-tion with the UNC School of Medicine. Dr. Hudson recognized the oath-taking ceremony as a trib-ute to the extended concern for people by state and local gov-ernments in North Carolina, to determined cooperation of the legal and medical professions, and to enlightened public opin-ion. The medical examiner sys-tem, he said, will bring medical science and other sciences to the investigation of sudden, un-expected or unnatural deaths in North Carolina. There are some 9,000 such cases in the State each year. He declared four objectives for the medical examiner pro-gram : • protection of the innocent • recognition of homicide and suicide • unbiased medical evidence for criminal and civil courts • identification of public health and industrial haz-ards. 8 THE HEALTH BULLETIN January 1969 [HUOTH icial Publication Of The North Carolina State Board of Health Inside THE HEALTH BULLETIN First Published—April 1886 The official publication of the North Caro-lina State Board of Health, 106 Cooper Memorial Health Building, 225 North Mc- Dowell Street, Raleigh, N. C. Published monthly. Second Class Postage paid at Raleigh, N. C. Sent free upon request. Editorial Board John Andrews, B.S., Raleigh Glenn A. Flinchum. B.S., Raleigh Jacob Koomen, Jr., M.D., M.P.H., Raleigh John c Lumsden, B C.H.E., Raleigh Rubella Vaccine Being Tested 2 The 1969 Official Easter Seal Child 5 Revised Communicable Disease Regulations 7 Easter Seal Programs 12 Medicare Premium Stays Same 15 Research Triangle Facility Elevated 16 Editor: H. B. Rogers Vol. 84 February 1969 No. 2 Cover: Three years ago, when she was four, Donna Kay Howell was crippled by a rare childhood stroke which left the right side of her body completely paralyzed. She couldn't stand or walk, and she had a problem with her speech. Now, Donna Kay is seven. She is making a remarkable recovery, thanks to the skill of doctors and the physical, occupational and speech therapists at the Easter Seal Rehabilitation Center in Tal-lahassee, Florida. Donna Kay Howell is the 1969 official Easter Seal child. Her story is on page 5. THE HEALTH BULLETIN February 1969 German Measles Vaccine Being Tested One Test in North Carolina By DR. JOHN D. HAMILTON An effective vaccine for ru-bella— German measles—is now a very real possibility for the near future. And an experiment underway in North Carolina's Wake County is playing a ma-jor role in the developments. With few other vaccines has the potential for prevention of serious consequences been so great as with the rubella vac-cine now being tested. Although a relatively incon-sequential disease in itself, ru-bella may have devastating con-sequences for a pregnant wom-an— and for the child she is carrying. For many years the causes of cataracts, deafness, congenital heart disease and mental re-tardation were not known. But in 1941 a doctor reported for the first time that cataracts in a newborn infant can follow Dr. Hamilton is Epidemiology In-telligence Service Officer for the North Carolina State Board of Health. when the mother had German measles during pregnancy. In the years since that original re-port, the association of maternal rubella to the other conditions in newborn infants has been well documented. In 1964-65 the United States was hit by an epidemic of ru-bella. Experts say some 10,000- 20,000 infants may have been born with congenital malforma-tions as a direct result of mater-nal infection. The rubella virus was suc-cessfully cultivated in tissue culture in 1962. This opened the door to serologic studies — the groundwork in developing any vaccine. Soon afterwards, stu-dies began on a vaccine pre-pared by two physicians at the National Institutes of Health. Today, after several years of testing for both favorable and adverse effects, clinical trials of the Meyer - Parkman HPV-77 duck embryo vaccine are being conducted. One of the most ex- February 1969 THE HEALTH BULLETIN tensive trials has been under-taken in Wake County with the support of the Merck Institute for Therapeutic Research. The North Carolina rubella trial started last September. Dr. Joseph Pagano of the Depart-ment of Medicine at the Uni-versity of North Carolina at Chapel Hill and Dr. Richard Lipman of the Department of Pediatrics there directed and coordinated the project. Cooperating and collaborating with these investigators were Dr. Millard Bethel and Dr. Jane Wooten of the Wake County Health Department and their entire staff. Full cooperation also came from superintendents, principals and teachers in the Raleigh city and Wake County schools. In addition there were volunteers from the North Caro-lina State Board of Health in Raleigh and North Carolina Memorial Hospital at Chapel Hill. The trial has involved 63 schools in Wake County. Ap-proximately 5,200 first and sec-ond graders received a dose of the live rubella vaccine. Their reactions were documented by daily fever records taken in the schools. Home records were kept by the parents. Eight schools were involved in vaccine-serolosy studies. At these schools 671 families, in-cluding this same number of mothers and 1,077 of their chil-dren between the ages of 4-9, received the vaccine or placebo (artificial harmless fluid), ac-cording to a pre-arranged sche-dule. Acute serum blood sample was taken and careful records kept on the patients. In Novem-ber a follow-up blood sample was taken. Serologic evaluation of these patients will allow the investigators to determine and document the effectiveness of the vaccine in immunizing the children, and, at the same time, to measure the effectiveness of the vaccine in controlling the transmission of the disease from children to mothers. Any ad-verse reactions will be docu-mented by home and school records. The results of the Wake County trial will soon be avail-able. Previous studies suggest that the immunologic response will be excellent, and transmis-sibility and adverse reactions absent. In addition, the trial has allowed the effective immuniza-tion of a large segment of Wake County's primary school popu-lation. If all goes well, the results of the Wake County study and others underway in other places will lead to licensing of the ru-bella vaccine within a year — hoDPfully before the next lar?e rubella enidemic, which is pre-dicted in 1970. THE HEALTH BULLETIN February 1969 The 1969 Official Easter Seal Child Donna Kay Howell Donna Kay Howell, seven-years- old, of Tallahassee, Flori-da, has been named 1969 Na-tional Easter Seal Child. The campaign this year opens March 1 and continues to April 6. The pretty little brunette, victim of a rare childhood stroke, will help launch the Easter Seal appeal and take a nationwide trip. Hit by the stroke when she was four, Donna Kay suffered complete paralysis of the right side of her body. She was un- 1 able to stand or walk, and she had a problem with her speech. After a three-week period of hospitalization, Donna Kay was referred to the Easter Seal Re-habilitation Center in Tallahas-see. There, physical, occupa-tional and speech therapists be-gan working to help her over-come the crippling effects of the stroke. Donna Kay made a full recov-ery from her speech defect after a month of treatment. She still receives physical and occupa-tional therapy at the center once a week to correct a slight limp and restore full use of her right hand. Treatment includes muscle re-education, gait train-ing and electrical stimulation to the wrist. Donna Kay's father, Jack, is a draftsman and her mother, Opal, is a beautician. The cou-ple has one other daughter, Janice Lynn, three-years-old. February 1969 THE HEALTH BULLETIN Despite her handicap, Donna Kay is active, sometimes a tom-boy, sometimes a demure young lady. She runs and plays with neighborhood children and when it comes to climbing trees, one of her favorite activities, she can out-shinny almost every boy in the neighborhood. Donna Kay, a second grader in public school, is bright, alert and attentive in class. Easter Seal affiliates in every state, Puerto Rico and Washing-ton, D. C, provided direct treat-ment and other services to more than 253,000 crippled children and adults last year. Contribu-tions made during the annual appeal are the major source of financing for 2,844 Easter Seal facilities and programs. Short Course For Nurses A two-week short course for pro-fessional nurses who supervise per-sonnel in cardiac units will be given three times in the coming year at the University of North Carolina at Chapel Hill. The course, entitled Scientific Approach to Supervision of Cardiac Units—Personnel, Patients and Prac-tices, will be offered through the Continuing Education Program of the UNC School of Nursing. Federal traineeships are available. Starting dates for the course this _ vear are April 21 and November 3. A course will start February 2, 1970. Further information is available from : Susanna L. Chase, Director Continuing Education in Nursing The University of North Carolina at Chapel Hill Chapel Hill, N. C. 27514 Public Health Workers to Meet The 1969 meeting of the Southern Branch of the American Public Health Association will be held May 21-23 in Oklahoma City, Oklahoma. The 37th annual meeting of the organization is expected to attract public health workers from 16 states and the District of Columbia. The theme of the meeting will be "The Seventies—Decade for Decision." Keynote speaker will be Dr. Myron E. Wegman, dean of the School of Public Health at the University of Michigan. He will speak on "The Health Consumer—Needs and Wants." World Health Day ivill be observed April 7, 1969. The day will mark the anniversary of the coming into force of the World Health Organization (WHO). The theme of World Health Day this year is "Health, Labor and Productivity." THE HEALTH BULLETIN February 1969 Reportable Diseases Communicable Disease Regulations Revised By State Board of Health On the following four pages is a newly published summary of revised communicable disease regulations approved by the North Carolina State Board of Health last fall. The new regulations mark the first general revision since 1944. The main changes, according to Dr. J. N. MacCormack, con-sultant to the Communicable Disease Control Section of the State Board of Health, are in the isolation and quarantine regulations for individuals. Copies of the summary are available upon request from the Communicable Disease Control Section, North Carolina State Board of Health, Post Office Box 2091, Raleigh, N. C. 27602. February 1969 THE HEALTH BULLETIN CO s c 10 THE HEALTH BULLETIN February 1969 Adults and Children Are Beneficiaries of Easter Seal Programs '• An elderly stroke patient gets help along the road to recovery by a phy-sical therapist at an Easter Seal Center. It has been half a century since the National Easter Seal Society, a voluntary organiza-tion that now serves almost a quarter of a million crippled children and adults annually, first extended its services to one crippled child in a hospital in Ohio. The plight of the child, a boy who needed expensive surgery and therapy if he was to be able to stand and walk, came to the attention of Edgar F. Allen, an Elyria businessman whose own son had been injured in a street-car collision and died for lack of emergency medical facilities. Allen gave up his prosperous business, set about raising the necessary funds, and, in 1921, opened a hospital for crippled children. The hospital was not an im-mediate success. Parents of crippled children were slow to risk public exposure in order to bring their children to the new hospital for treatment. It took the patience and per-sistence of volunteers and pub-lic health nurses to seek out the children and persuade their par-ents to abandon their feelings of guilt and shame to get help for their offspring. 12 THE HEALTH BULLETIN February 1969 As parental resistence was broken, the hospital's staff found itself deluged with requests for treatment. Rotarians provided major support for the society's pro-grams of medical and referral care for crippled children in the early days. They also did much to bring about legislation estab-lishing state services for handi-capped children. But progress was slow. In 1924, three years after Allen founded the hospital, there were only 9,000 beds available in hospitals and other institu-tions to treat 289,000 children known to be suffering from con-genital defects, cerebral palsy and crippling caused by tuber-culosis and other conditions. Five years later — in 1929 — there were 23 state crippled children's societies, operating largely through making direct payments for the care, treat-ment and education of crippled children and seeking legislation for them. Easter Seal rehabilitee ion centers offer voca-tional training that can open the door to new life for accident victims by teaching them new trades. The National Society adopted Easter Seals as a fund raising device in 1934. That year, the Easter Seal appeal raised $47,- 052. In 1967, its income was more than $27 million. An era of expansion began with the National Society's move to Chicago in 1944. With Easter Seal societies in various stages of development in 40 states, the national organization soon included state and local affiliates in the 50 states, the District of Columbia and Puerto Rico. A national staff of profes-sional consultants in care and treatment organization, public education and fund raising was developed to serve these affil-iates and to formulate new na-tional projects and programs. The society's treatment pro-grams were extended and their emphasis changed to meet new health needs. Programs which formerly were centered around hospitals and convalescent care were redirected to rehabilita- February 1969 THE HEALTH BULLETIN 13 tion services at the community level. Having established care and treatment and education pro-grams in fulfillment of its ob-jectives, the Society, in 1953, established the Easter Seal Re-search Foundation, realizing a third major objective. Today, the Easter Seal So-ciety, with its hundreds of state and local affiliates, operating more than 2,000 facilities and programs, is the largest of its kind in the nation. Its affiliates offer help to handicapped chil-dren and adults through re-habilitation and treatment cen-ters; clinics; camps; sheltered workshops; home employment; physical; occupatio nal and speech therapy programs; and other related services. Physical therapy is an important first step to-ward rehabilitation for youngsters at Easter Seal centers. Heart Acts as Thermostat for the Body Your heart and blood play an important part in "thermal regulation," which helps keep you warm in cold weather and cool in hot weather, says the North Carolina Heart Association. Because the body's built-in thermostatic machinery takes time to adjust to weather extremes, you should be careful about jump-ing from one extreme to the other. Make the change gradually, if possible. Or, if you find yourself caught in a sudden change, try to rest before becoming active. This will give your body time to adjust to the different weather environment. 14 THE HEALTH BULLETIN February 1969 MEMBERS OF THE NORTH CAROLINA STATE BOARD OF HEALTH James S. Raper, M.D., President Asheville Lenox D. Baker, M.D., Vice President Durham Ben W. Dawsey, D.V.M. Gastonia Ernest A. Randleman, Jr., B.S.Ph. Mount Airy Paul F. Maness, M.D. Burlington A. P. Cline, Sr., D.D.S. Canton Joseph S. Hiatt, Jr., M.D. Southern Pines J. M. Lackey Rt. 2 , Hiddenite Howard Paul Steiger, M.D. Charlotte EXECUTIVE STAFF Jacob Koomen, M.D., M.P.H. state Health Director W. Burns Jones, M.D., M.P.H. Assistant State Health Director J. M. Jarrett, B.S. Director, Sanitary Engineering Division Martin P. Hines, D.V.M. , M.P.H. Director, Epidemiology Division Ronald H. Levine, M.D., M.P.H. Director, Community Health Division E. A. Pearson, Jr., D.D.S., M.P.H. Director, Dental Health Division Lynn G. Maddry, Ph.D., M.S.P.H. Director, Laboratory Division Ben Eaton, Jr., A.B., LL.B. Director, Administrative Services Division Theodore D. Scurletis, M.D. Director, Personal Health Division Medicare Premium Stays Same The monthly premium older people pay for the voluntary medical insurance part of Medi-care will remain at the present $4 for the period July 1969 through June 1970. The premium covers half the cost of protection that helps pay doctors' and surgeons' bills and a variety of other health care expenses. The other half is paid out of federal general revenues. Robert A. Flynn, social secur-ity district administrator in Ra-leigh, said that 95 per cent of the population aged 65 and over are now enrolled in the supple-mentary medical insurance pro-gram. Participation is up from the 91 per cent enrolled when Medicare began July 1, 1966. Flynn said a new enrollment period opened January 1, 1967 to provide another chance for people who missed out earlier to sign up for the medical insur-ance protection. For persons born on or before October 1, 1901, and for those who have been enrolled but dropped out before January 1, 1967, the new period will be the last chance to enroll. Older people who delay in en-rolling pay a premium that is 10 per cent higher for each full year they could have had the medical insurance protection but were not enrolled. And those who wait three years past their first chance to sign up can-not get the coverage at all. February 1969 THE HEALTH BULLETIN 15 THE HEALTH BULLETIN P. O. Box 2091 Raleigh, N. C. 27602 EXEC If you do NOT wish to con-tinue receiving The Health Bul-letin, please check here l l and return this page to the address above. Printed by The Graphic Press, Inc., Raleigh, N. C Research Triangle Park Facility Is Elevated The National Institute of Environmental Health Sciences (NIEHS) in North Carolina's Research Triangle Park has been established as one of the National Institutes of Health. The headquarters and re-search center of NIEHS operate under a budget of $17.8 million for the current fiscal year. The facility, directed by Dr. Paul Kotin, is the only major com-ponent of NIH located away from the parent organization's campus at Bethesda, Md. Scientists at the research cen-ter are working to identify harmful environmental agents, to determine the mechanisms by which those agents affect an individual's health, and to de-velop data on the effects of long-term, low-level exposures. NIEHS is also the hub for nationwide federal support of basic research and research training in the environmental health sciences. Former HEW Secretary Wil-bur J. Cohen said knowledge developed at the Research Tri-angle facility will provide a scientific base upon which meas-ures can be developed to help control or prevent environmen-tal health problems. He called this "a major priority for HEW." 16 THE HEALTH BULLETIN February 1969 can/a™ bqdqjui™ The Official Publication Of The North Carolina State Board of Health bu ,|o«d ^°n t° 3ie 's „„_„ March, 1969 Inside THE HEALTH BULLETIN First Published—April 1886 The official publication of the North Caro-lina State Board of Health, 106 Cooper Memorial Health Building, 225 North Mc- Dowell Street, Raleigh, N. C. Published monthly. Second Class Postage paid at Raleigh, N. C. Sent free upon request. Editorial Board John Andrews, B.S., Raleigh Glenn a. Flinchum, B.S., Raleigh Jacob Koomen, Jr., M.D.. M.P.H., Raleigh John c. Lumsden, B.C.H.E., Raleigh Editor: H. B. Rogers Social Security's Disability Program By Robert A. Flynn 3 Vol. 84 March 1969 No. 3 Man Can Function in Deep Water for Extended Period of Time 7 Cover: Certificate of live birth, Persons Examined in Cancer _. . „ . „ t, license and certificate of marriage, Detection Centers in North ° Carolina (Map) 10 certificate of fetal death, certified record of divorce decree granted, Vital Statistics in North certificate of death: the documents Carolina By Glenn Flinchum 11 that record the Vltal events of 0Ur lives. These are the makings of the Also Public Health Statistics Section of A reminder about heart the North Carolina State Board of disease 6 Health. Keeping tabs on the docu-ments for millions of North Caro- Tips for Parents of Young ... . ~. ~. ri . _ H s linians keeps Director Glenn Flm- Campers 9 chum and his staff busy. Mr. How it Was in the Old Flinchum tells the story, starting North State 13 on page 11. 2 THE HEALTH BULLETIN March 1969 So-tied SeccciCtcft Disabled workers and their dependents can get financial help at the time they probably need it most. But they must know about the benefits and apply for them. By ROBERT A. FLYNN Disability, whether caused by injury or illness, can mean serious financial problems for any family. If your income stop-ped because of disability, would your family need help to meet the necessities of life? Social security disability in-surance benefits help replace lost income by paying monthly cash benefits when serious dis-ability strikes. Mr. Flynn is Raleigh district man-ager, Social Security Administrar tion. Each year about 300,000 dis-abled workers and their families begin receiving social security disability benefits. In recent months about two of every three disabled workers who ap-ply for benefits have been found eligible. Unfortunately, many disabled workers who could re-ceive benefits do not apply for them, often because they do not know these benefits are avail-able. Four of every five men and women age 25-64 can count on receiving benefits in the event March 1969 THE HEALTH BULLETIN the breadwinner suffers a severe and prolonged disability. This protection means that you can look to social security for financial help if you become severely disabled and cannot work. At a time when you would probably need help the most, social security disability benefits would be available to help you through the financial crisis. What Is 'Disabled? Just what does "disabled" mean? Well, you're disabled if you have a physical or mental impairment which prevents you from doing substantial work and which has lasted (or is ex-pected to last) twelve months or more. The payments can begin with the seventh month of dis-ability. Monthly benefits con-tinue as long as your disability prevents you from working. Payments for a disabled worker now range from $55 to $204 a month, depending on his average earnings under social security. And if you start re-ceiving benefits, your wife and children also may receive bene-fits as your dependents. Total family benefits can amount to as much as $415.20 a month at this time. A person who is over 31 when he becomes disabled can receive benefits if he has social security credit for five years of work in the ten years before he became disabled. Before 1968 the five-years-of-work rule applied to everyone. A change in the law early in 1968, however, reduced the amount of work credit needed by a worker disabled before 31. Now a worker who becomes dis-abled between 24 and 31 needs social security credit for only half the time between 21 and the beginning of his disability. Workers disabled before 24 need one and one-half years' credit in the three-year period before the disability begins. Dependent's Benefits There are two other impor-tant types of social security dis-ability payments; both go to de-pendents of workers after the worker has started receiving re-tirement or disability benefits or has died. These are benefits for adults disabled before 18 who continue to be disabled after 18, and benefits at 50 or later for disabled widows. Dis-abled widowers who were de-pendent on their wives for sup-port can also get benefits under this part of the law, as can some former wives who had been divorced but who were still re-ceiving support from their former husbands. Disabled widows 50-60 can get benefits based on their spouse's social security record only if they become disabled be-fore the worker's death or with- THE HEALTH BULLETIN March 1969 in seven years after his death. However, if a widow received social security benefits as a mother with children, she can get disabled widow's payments if she becomes disabled before those payments end or within seven years after they end. The seven-year period is in-tended to give her an opportun-ity to work long enough under social security to receive social security disability benefits on her own earnings. Childhood Disability Benefits A person who was disabled before 18 and has not married can get benefits based on the earnings of either of his parents. The payments begin at the time the parent covered under social security retires, becomes dis-abled, or dies. Each year about 25,000 peo-ple begin to receive these "child-hood disability" benefits. Some of them are in their fifties and sixties at the time benefits be-gin. A disabled widow, widower, or divorced wife may be consid-ered disabled only if she or he has an impairment so severe that it would ordinarily pre-vent a person from working. Other factors such as age, ed-ucation, and work experience may be considered in determin-ing whether a worker is dis-abled but are not considered for these survivors. At 62 a widow receives 82.5 per cent of her deceased hus-band's retirement benefit. If she starts receiving widow's dis-ability benefits at an earlier age, she gets a permanently re-duced amount. The amount depends on what the husband's retirement bene-fits would have been had he been 65 at the time of his death and how old the widow is at the time benefits begin. For ex-ample, if a widow starts to get benefits at 50, she receives 50 per cent of her husband's bene-fit (figured as though he was 65 at death). At 55 she receives about 60.75 per cent of the hus-band's amount. At 58, it is about 67 per cent. Objective Is Self-Support A major objective of the so-cial security disability program is to encourage disabled persons to undertake rehabilitation pro-grams and to become self-sup-porting. All disability applicants are considered for vocational re-habilitation services whether or not their claims are approved. The services are provided by State vocational rehabilitation agencies—usually at no cost to the disabled person. The agen-cies provide vocational counsel-ing training and help in finding a job, and medical services and supplies. State vocational rehabilita- March 1969 THE HEALTH BULLETIN tion agencies have so far report-ed about 100,000 disability claimants successfully rehabil-itated. Since the program began, more than 185,000 disabled beneficiaries have been taken off the disability benefit rolls because of recovery or return to work. Rehabilitation services are generally financed jointly by the State and the federal gov-ernment, with funds from gen-eral revenues. In some cases, however, social security pays the cost of rehabilitating peo-ple receiving disability benefits. These cases should save social security funds in the long run because the cost of rehabilitat-ing beneficiaries is less than the cost of paying them benefits. The social security disability program has helped millions of disabled workers in times of financial stress by providing a regular monthly income when the breadwinner could not work. Thousands of workers have been returned to produc-tive work through the joint ef-forts of the Social Security Ad-ministration and State vocation-al rehabilitation agencies. Your social security office will answer any questions you may have about social security's disability program. Call, write, or visit the office. The people there will be glad to help you. HEART DISEASE STILL EPIDEMIC The North Carolina State Board of Health, in its recently released report of vital statistics for the year 1968, indicated that there were 23,617 deaths attributable to cardiovascular-renal diseases. Overall deaths reported in the Tar Heel State for 1968 were 44,396. This points up that out of all deaths in North Carolina for the year 1968, 53.2 per cent were the direct result of cardiovascular-renal diseases. According to the State Board of Health report, of the 23,617 deaths attributed to heart and kidney diseases, heart disease was responsible for 15,768, stroke accounted for 5,747, atherosclerosis 639, nephritis 257, and other cardiovascular-renal diseases 1,206. The North Carolina Heart Association notes that while the total number of deaths from heart disease is still holding at about the same percentage of total deaths as in the past five years, the figure of 53.2 per cent is still indicative of the epidemic proportions of heart disease in our State. THE HEALTH BULLETIN March 1969 NEW EQUIPMENT TESTED—Chief Mur-ray Cato, one of the five divers who par-ticipated in Duke University's simulated dive to 1,000 feet beneath the surface of the sea, tests new underwater equipment in the hyperbaric chamber's "wet pot." At left is Chief Sam Smelko, also of the U.S. Navy. Frank Falejczyk of Scott Aviation Corp is on the right. Duke University Experiment MAN CAN FUNCTION IN DEEP WATER FOR EXTENDED PERIOD OF TIME The world that exists one thousand feet beneath the sur-face of the sea has been opened to human exploration by scien-tists and technicians on the landlocked campus of Duke Uni-versity at Durham, N. C. In an experiment lasting six-teen days last December, five divers entered the hyperbaric March 1969 THE HEALTH BULLETIN « MONITORING THE DIVE—Duke University Medical Center personnel listen to reports from five divers who spent 16 days in an experimental simulated dive at the Duke hyperbaric chamber. From left are Dr. Herbert Saltzman, director of the hyperbaric unit; Mrs. Laura Sheppard, chief medical technologist; Dr. John V. Salzano, associate professor of phy-siology- pharmacology; and Dr. Wirt W. Smith, assistant director of the hyperbaric unit. chamber at the Duke Medical Center and demonstrated that man can function effectively at one thousand-foot depths for extended periods. The divers, two from the uni-versity and three from the U.S. Navy, spent IIV2 hours at a simulated pressure of one thou-sand feet. The rest of the time was spent compressing down to the bottom depth and then re-turning to normal pressure. In the experiment the men breathed a mixture of gases containing 96 per cent helium, 3 per cent nitrogen, and 1 per cent oxygen. The normal con-centrations of nitrogen and oxy-gen in surface air are poisonous or narcotic at the depths to which the men descended. During their three days at the bottom, the divers under-went a battery of physical and psychological testing. The re-sults, while not yet conclusive, indicate that man can function at such depths with little or no impairment or discomfort. 8 THE HEALTH BULLETIN March 1969 The exercise tests, which used a calibrated cycle and in which blood gases, expired gas-es and atmosopheric gases were measured, indicated normal function. The psychological tests showed some anxiety on the part of the men, but only what was described as normal under the circumstances. Some of the divers experi-enced slight pain in their joints where the joints were fully ex-tended during exercises, but monitors considered this nei-ther significant nor unexpected. One of the divers experienced a slight case of the bends— a decompression sickness which occurs when divers ascend too rapidly. But the problem was quickly remedied. The divers were, from Duke: Delmar L. Shelton, hyperbaric chamber operator and techni-cian, and Frank J. Falejczyk of Scott Aviation Corp., working with the university; from the U.S. Navy Experimental Diving Unit: Lt. Cmdr. James Kelly, M.D., Chief Francis J. Smelko, and Chief Murray Cato. Dr. Herbert A. Saltzman is director of the hyperbaric unit. Lt. Cmdr. James Summitt is senior medical officer of the Navy's Experimental Diving Unit. TIP FOR PARENTS OF YOUNG CAMPERS Sending a child to camp this summer? It's always a good idea to check out the camp thoroughly, in advance. Take a close look at the camp site and physical plant, to be sure. But also evaluate carefully the food and water supply and the medical care and staff supervision. A good camp director will be eager to have you visit, to talk to staff members and campers, and to ask questions. March 1969 THE HEALTH BULLETIN ct oo UJ U3 10 THE HEALTH BULLETIN March 1969 VITAL STATISTICS IN NORTH CAROLINA BY GLENN FLINCHTJM In the minds of many people, the word statistics connotes an array of dull, dry figures which are of little interest to anyone but a statistician. If preceded by the word "vi-tal," however, we get a new meaning which becomes quite personal when we consider that all of us at one time or another counted in the statistics of life and death. The term "vital statistics" as used here applies to records of birth, death, marriage and di-vorce, as well as information derived from these records. North Carolina began record-ing births and deaths on a state-wide basis on October 1, 1913. The motivating force behind the action was the pressing need for birth and death information upon which to base public health programs. Dr. W. S. Rankin, State health officer at the time, gave this need number one priority in his legislative program. He stated his case as follows: ". . . We have reached the stage in public health work in this state from which we can make practically no advance until a vital statistics law is passed." He further stated that trying to administer public health without vital statistics was like fighting an unknown enemy in ambush: You fire a few shots here and there, never knowing if you're shooting at the right places. Following the enactment of the law by the General Assem-bly, the Bureau of Vital Statis-tics was established and work was begun on the appointment of over 1,400 local registrars in each town and township throughout the State. These registrars collected the certifi-cates for all births and deaths occurring in their districts, made copies for local use, and forwarded the originals to the State Board of Health each month for permanent filing. They also issued permits for burial and transportation of dead bodies. They received a fee for their services of 50^ per certificate, paid by the county. Helpful Information Within a short time, the vital statistics began to produce some basic information which was of tremendous help to the physi-cians and public health workers who were trying to make the (continued on page 12) March 1969 THE HEALTH BULLETIN 11 best possible use of their mea-ger resources. Though far from being precise measurements, the available statistics made it possible to get some answers to such questions as: What sec-tions of the state have the high-est death rates? What diseases are the greatest contributors to the death rate? What segments of the population are hardest hit by certain diseases? Within a few years it was also possible to determine the effectiveness of some of the public health measures that were put into effect. Today, the vital statistics reg-istration procedures are essen-tially the same as in 1913, ex-cept that in most counties the local health departments have taken over the responsibilities of local registrars. This change had several advantages. It was more economical and efficient to use the existing facilities of the local health departments as the central location for regis-tering births and deaths. Also, the local health director could consult with the physicians, midwives, and funeral directors in his county concerning any medical problems arising in the registration procedure. Anoth-er important advantage was the immediate availability to the health director of informa-tion concerning deaths from contagious diseases or any other causes which would require his immediate attention. Individuals Are Responsible In every county certain indi-viduals are charged with the responsibility for actually pre-paring and filing vital records. The attending physician or mid-wife is responsible for complet-ing the certificate of birth or fetal death (stillbirth). If no physician or midwife is in at-tendance, it is the duty of the father, mother, or owner of the premises to report the birth. Death certificates are pre-pared by the funeral director, or the person who takes charge of the body after death. The fu-neral director must also obtain from the attending physician his opinion as to the cause of death. If there was no physician in attendance, then the medical examiner or coroner must certi-fy to the cause of death. (continued on page 13) Springtime is check-up time for your car. How about you? You can trade in your old car, but your heart has to last you a lifetime. Help make it a long one, says the North Carolina Heart Association, by seeing your doctor regularly. 12 THE HEALTH BULLETIN March 1969 The central registration of fore 1958 if the county where divorces became effective on the divorce was granted was January 1, 1958. The clerks of unknown, it was necessary to court in each county report to inquire of all 100 counties in the State Board of Health each order to locate the record. In month all divorces granted in addition to their value to the their court during the preceding individuals, these records pro-month. Records are prepared vide valuable information con-in Raleigh and indexed by the cerning the extent of the di-names of both plaintiff and de- vorce problem in our State, fendant for easy reference. Be- (continued on page 14) HOW IT WAS IN THE OLD NORTH STATE RECREATION NECESSARY FOR HEALTH The Creator of the universe in His all-wise wisdom implanted in the minds of children the longing for play. Health and growth depend upon the exercise of muscles. The instinct for play, therefore, plays a large part in the development of each individual. After childhood has passed there is a tendency on the part of most of us to suppress, or forget, this instinct for play. We get so busy striving for wealth or fame, or just trying to make a living, that we are apt to think of play as something unobtainable, something that we have not the time for. Therein we make a great mistake .... Nearly all the degenerative diseases result from a lack of play. Mentally and physically we need recreation that really recreates, that relaxes tired muscles, that gives wearied nerves a chance to retain exhausted vitality. Exercise in the gymnasium is fine, but frequently it is too methodical, or else we overstrain. The more simple games, and particularly those that can be played out of doors, do the most good. In those we get the ideal combination of exercise of muscles, fresh air and sunshine, the combination which, taken regularly, means prolonged life and better life. Health is a state of physical and mental and moral equilibrium, a normal functioning of the body, mind and soul. It is the state when work is a pleasure, when the world looks good and beautiful and the battle of life seems worthwhile-. Health is the antithesis of disease, degeneration and crime. To maintain it we must obey the laws of nature which demand that there shall be a proper mixture of work and play, of rest and sleep. And of these we need to place particular stress on play.—R.B.W. —The Health Bulletin, Vol. XXXVI, No. 6, June, 1921. March 1969 THE HEALTH BULLETIN 13 some characteristics of the persons involved, and the num-ber of minor children. Marriages were added to the vital statistics family in Janu-ary 1962. The register of deeds in each county is the local offi-cial responsible for the initial preparation and issuance of the marriage license. After the mar-riage takes place, the minister or other officiant certifies to the date and place of the event, obtains the signatures of two witnesses, and files the com-pleted certificate in duplicate with the register of deeds. Each month the register of deeds for-wards one copy of each com-pleted certificate to the State Board of Health. Here again, much valuable data is obtained for use in public health, social and welfare programs. These statistics, when combined with other information, make it pos-sible to estimate or project fig-ures on migration, birth rates, housing needs, and changes in marriage trends. The tremendous value of these vital records to the indi-vidual citizen has become quite apparent in recent years. When World War II began, many peo-ple left their homes to work in defense plants or other war-re-lated industries. For security purposes they found it neces-sary to prove certain facts about themselves. The birth certifi-cate became the primary docu-ment used for proving age, place of birth, and citizenship. Today it is required for many purposes: entering school, ob-taining driver's license, employ-ment, and passport. The death certificate is an equally impor-tant document for settling es-tates, insurance claims, court cases, and social security bene-fits. Millions of Records The processing, storage, maintenance, and indexing of all vital records accumulated in the past 55 years (approximate-ly 7,000,000) adds up to a fairly complex job. When the State Board of Health was reorgan-ized in 1950, the former Bureau of Vital Statistics was incorpo-rated into what is now called the Public Health Statistics Section. Each month the section receives and processes records on approximately 8,000 births, 3,500 deaths, 4,000 marriages, and 1,000 divorces. In addition, more than 4,500 certified copies are issued monthly. A person born in this State may obtain a copy of his birth record by writ-ing to the State Board of Health and furnishing his name, date of birth, county of birth, and parents' names. The fee for this service is $1.00 per certificate. Certified copies may also be ob-tained from the register of (continued on page 15) 14 THE HEALTH BULLETIN March 1969 MEMBERS OF THE NORTH CAROLINA STATE BOARD OF HEALTH James S. Raper, M.D., President Asheville Lenox D. Baker, M.D., Vice President Durham Ben W. Dawsey, D.V.M. Gastonia Ernest A. Randleman, Jr., B.S.Ph. Mount Airy Paul F. Maness, M.D. Burlington A. P. Cline, Sr., D.D.S. Canton Joseph S. Hiatt, Jr., M.D. Southern Pines J. M. Lackey Rt. 2, Hiddenite Howard Paul Steiger, M.D. Charlotte EXECUTIVE STAFF Jacob Koomen, M.D., M.P.H. State Health Director W. Burns Jones, M.D., M.P.H. Assistant State Health Director J. M. Jarrett, B.S. Director, Sanitary Engineering Division Martin P. Hines, D.V.M. , M.P.H. Director, Epidemiology Division Ronald H. Levine, M.D., M.P.H. Director, Community Health Division E. A. Pearson, Jr., D.D.S. , M.P.H. Director, Dental Health Division Lynn G. Maddry, Ph.D., M.S.P.H. Director, Laboratory Division Ben Eaton, Jr., A.B., LL.B. Director, Administrative Services Division Theodore D. Scurletis, M.D. Director, Personal Health Division deeds in the county of birth. Those persons who were born prior to the enactment of the vital statistics law, or who for any reason did not have a cer-tificate filed at the time of their birth, may file a delayed certifi-cate of birth with the register of deeds in the county in which they were born. It is necessary, however, to furnish at least three written documents which will prove the facts concerning the birth. These documents may be school records, family bible records, insurance policies, and census records. Another important part of vital statistics work involves the correction and amendment of records. In the early years of vital statistics registration, many names were misspelled and sometimes important infor-mation was omitted. In order to make any changes on the origi-nal certificate, it is necessary for the registrant or parent to furnish proof as to the correct-ness of the requested change. In some instances, such as a change of father's name, a court order is required before a change can be made. When a child is adopted, or when an illegitimate child is legitimated by subsequent mar-riage of the parents, a complete-ly new birth certificate is pre-pared and no access to the old certificate is permitted except by order of a court. (continued on page 16) March 1969 THE HEALTH BULLETIN 15 THE HEALTH BULLETIN P. O. Box 2091 Raleigh, N. C. 27602 If you do NOT wish to con-tinue receiving The Health Bul-letin, please check here l | and return this page to the address above. KR„ A. v. CUNNINGHAM, EXEC. ! N.C. DENTAL SOC. BX. 11065 KORDECAI RALEIGri, N.C. Printed by The Graphic Press, Inc., Raleigh, N. C Vital Statistics in North Carolina (continued from page 15) In addition to the processing and handling of vital records, the Public Health Statistics Sec-tion prepares and publishes re-ports containing a variety of statistical data which is used not only by public health work-ers, but also by research work-ers, county and city planners, school officials, students, and many others. The section also collaborates with other agen-cies, such as the University of North Carolina, the State Medi-cal Society, and the U. S. Public Health Service in carrying out special studies and research projects. The large volume of records involved requires the use of electronic data process-ing equipment to produce the many detailed tabulations need-ed monthly, quarterly, and an-nually. As the population of North Carolina continues to increase, and as new public health pro-grams are developed, the Public Health Statistics Section staff will be facing new challenges and new opportunities of serv-ice. Such activities as compre-hensive health planning and regional medical programs gen-erate new demands for statis-tical data which must be met. The primary objective of the section, however, will continue to be to serve the citizens of North Carolina efficiently and well and to preserve for pos-terity the records of life's most intimate events. ran/a™ mum The Official Publication Of The North Carolina State Board of Health » APRIL 1969 MEDICAL LAB ASSISTANT THE HEALTH BULLETIN First Published—April 1886 The official publication of the North Caro-lina State Board of Health, 106 Cooper Memorial Health Building, 225 North Mc- Dowell Street, Raleigh, N. C. Mailing ad-dress: Post Office Box 2091, Raleigh, N. C. 27602. Published monthly. Second Class Postage paid at Raleigh, N. C. Sent free upon request. Inside Editorial Board John Andrews, B.S., Raleigh Glenn A Flinchum. B.S., Raleigh Jacob Koomen. Jr , M.D., M.P.H., Raleigh Camp Easter-in-the-Pines 3 john c lumsden. b.c.h.e.. Raleigh The Need for Family Planning Editor: H. B. Rogers in North Carolina ^mbm^^™^^^—^^»»- By C. Horace Hamilton 6 Medical Lab Assistants Vo l 84 April 1969 No. 4 By Margaret Darst Smith 13 ALSO Cover: Patricia Haire, a graduate of the medical laboratory assist- Food Can Be Dangerous ants pr0gram at Holding Technical . . . Sometimes 5 Institute, Raleigh, is a staff assist-ant today. Mrs. Haire received her Regional Rural Health Conference 5 diploma in August 1967. Margaret Darst Smith, director of Struvite and Canned Seafood 9 Public relations for Holding Tech, supplied the photograph of Mrs. How It Was in the Old North Haire, as well as the photographs State 14 that illustrate her story. THE HEALTH BULLETIN April 1969 CAMP EASTER-IN-THE-PINES North Carolina's Easter Seal Camp A boy bound to a wheelchair competes with other disabled children in a unique game of baseball in which the rules of the game are scaled down to fit the handicaps of the team mem-bers. Unusual? Not at Camp Easter-in-the- Pines, North Carolina's Easter Seal camp. Baseball, dock fishing, swim-ming, archery, a trip through the woods to discover wild flow-ers: rare treats, all, for the handicapped person — but all possible at Camp Easter-in-the- Pines. North Carolina's Easter Seal camp, located at Southern Pines, is open to all physically handicapped persons from 7 to 50 years of age who would benefit from a camping expe-rience. The handicaps repre-sented at the camp include those that have resulted from cerebral palsy, polio, visual and hearing defects, muscular dys-trophy, spina bifida, accidents, burns, amputations, rheumatic heart, and congenital defects. Young disabled campers get expert supervision from well-trained staff at Camp Easter-in-the-Pines. At Camp Easter-in-the-Pines everyone is on equal footing with everyone else, for all cam-pers are physically disabled. Every cabin has ramps ap-proaching it. Every building has wide doors. Wheelchair paths wind throughout the camp, from the arts and crafts building to the huge main lodge. The main emphasis at Camp Easter-in-the-Pines is recrea-tion, and a well-trained staff of instructors provides responsible leadership. In addition, a phys-ical therapist works with chil-dren in the lake every day. Camp Easter-in-the-Pines will offer four sessions in the sum-mer of 1969 to children and teenagers and adults. All phys-ically handicapped persons may be considered for admission. The cost of a two-week camp session is $90. Local Easter Seal societies, individual donors and civic groups have helped pro-vide "camperships" for children and adults. For application forms write: Camp Easter-in-the-Pines Drawer 1099 Southern Pines, N. C. 28387 Camp Easter-in-the-Pines is a facility of the Easter Seal So-ciety for Crippled Children and Adults of North Carolina, Inc. THE HEALTH BULLETIN April 1969 Food Can Be Dangerous . . . Sometimes Of the 100 outbreaks of hu-man salmonella infections at-tributable to specific sources in-vestigated by the National Com-municable Disease Center dur-ing the three-year period 1963- 1965, 61 were traced to foods, 21 to human carriers, and 18 to animal contacts. There were 51 other out-breaks which were investigated but which could not be traced to specific sources. Foodborne salmonellosis can most frequently be traced to eggs or egg products, poultry, or beef and pork products. A host of other foodstuffs have also been incriminated, how-ever, including such items as soya milk, dried yeast, coconut, cotton seed protein, cereal pow-der, and even a food coloring substance (carmine dye). Animal feeds have been wide-ly incriminated as potential sources of infection for domes-tic animals. Regional Rural Health Conference Child health and home health care are topics for the 1969 Regional Rural Health Conference sponsored by the Medical Society of the State of North Carolina. The conference will be held Thursday, June 12 at Lambuth Inn at Lake Junaluska, starting at 10:30 a.m. It will be open to medical peo-ple, laymen and interested citizens who wish to attend. Dr. Hugh A. Matthews, director of health affairs at Western Carolina University, will preside. Several speakers will participate. A special feature will be recognition of the 1968 4-H health king and queen and their families. April 1969 THE HEALTH BULLETIN The Need For Family Planning In North Carolina By C. HORACE HAMILTON Associate Director Carolina Population Center and Visiting Professor of Sociology and Biostatlstics The University of North Carolina at Chapel Hill Many counties, cities, and communities have some more or less systematically organized family planning programs. Moreover, the current down-ward trend in the birth rate is evidence that family planning is practiced by a large percent-age of North Carolina families. The practice of birth control has no doubt been facilitated by the development of the "pill" and other contraceptive meth-ods. Because of these trends and facts, many people are under the impression that we need no longer be seriously concerned about the problem of overpopu- Reprinted from the University of North Catolina News Letter, Vol. LIII, No. 3, September 1968. lation or of the need for invest-ing public funds in family plan-ning programs. If there is any complacency over the need for family plan-ning, a look at the latest avail-able facts about births in North Carolina should dispel any idea that we can now relax and for-get about the problem. During the calendar year 1966, accord-ing to the Statistics Section of the State Board of Health, there were 92,727 births and 42,218 deaths. The difference between births and deaths, i.e., natural increase, was 50,509. Thus, from one point of view, in 1966, the state had 50,509 more births than were needed to maintain the population at a stable level. THE HEALTH BULLETIN April 1969 A similar excess of births over deaths has existed through-out our state's history. As a re-sult of the relatively high rate of natural increase, North Caro-lina has experienced a heavy out-migration and, at the same time, has increased in popula-tion. Most people, intuitively, think that population growth is a good thing, but that heavy out-migration is a bad thing. Just how bad and how good these trends are is a matter of opinion, but it is not the pur-pose of this paper to discuss population policy. It suffices to point out that rapid population growth, not only in other coun-tries but also in our own state and nation, is creating serious social and economic problems. There are many ways to mea-sure the need for family plan-ning, although there may be some disagreement as to how many children a family should have. In a free and democratic society the decision on family size is considered to be the pre-rogative of individual families. Yet many surveys show that most married couples do not want more than two to four children. (In order to maintain a stable population, only about 230 children per hundred mar-ried couples are needed to main-tain the population.) In spite of the fact that most women in this country no lon-ger want the very large fam-ilies which were common in the rural areas of our nation for many generations, the current birth statistics show that a sub-stantial percentage of North Carolina families are still giving birth to more children than they can provide for even at a mod-est standard of living. In 1966, the vital statistics show that more than a fourth of the babies were born to North Carolina mothers who already had three children. However, a more re-fined and accurate estimate of the number of "excess" births may be arrived at by taking into consideration the age of the mother. On the basis of known rela-tionships between maternal and child health and the timing and number of births, we shall de-fine as "excess" births all those born to mothers either under 15 years or over forty years of age. For all other age groups, we shall define as excessive all births occurring during 1966 to mothers in the following age and birth order groups: Age of Mother Although these assumptions are made partly for the purpose of establishing some sort of rea-sonable and convenient statis-tical criterion, it can also be argued that such limits are in the interest of both the individ-ual family and of society which must pay part of the cost of ex-cessively large families among the low income groups. Actually our definition of ex-cess births is more on the lib-eral than the conservative side. tive number of women with zero, one or only two children should increase, there would need to be some increase in the number of mothers with three or more children. On the basis of the above as-sumption, it is found that 33,- 033, or 35.6 percent of the 1966 births were excessive, and most of them were probably unwant-ed by the parents. This number of excessive births may be broken down by age of mother TABLE 1 Number and Percentage of Excess Birlhs By Color and Age of Mother, North Carolina, 1966 Age of Mother attainment, and occupational level, irrespective of race. The county differences (see Table 2) in the number and per-centage of excess births, indica-tive of the need for family plan-ning, also reflect differences in the social, economic, and educa-tional characteristics of the population. Counties with high percentages of farm people have high percentages of excess births; and the large metropoli-tan and urban counties have re-latively low percentages of ex-cess births. Greene County, an eastern North Carolina agricultural county, has the highest percent-age of excess births. Practically all of the other counties ranking high in excess births are also found in eastern North Caro-lina. Among white mothers the highest percentages of excess births are found in the rural mountain counties, such as Madison, Clay, Alleghany, Gra-ham, and Ashe. Among nonwhite mothers, the highest percentage of ex-cess births are found in such predominantly a g r i c u 1 1 ural counties as Greene, Halifax, Edgecombe, Jones, and Nor- Struvite Crystals and Canned Seafood Glass in your canned shrimp? Probably not. From time to time people in the canned seafood industry and at the Food and Drug Administration get complaints from consumers who believe they've found glass in their canned seafood—especially shrimp. Examination, however, usually reveals it isn't glass at all, but "struvite" — crystalline magnesium ammonium phosphate to the chemist — which occasionally forms in canned seafood from normally present constituents. While struvite isn't actually desirable, it doesn't affect the safety of the food at all, according to FDA. Seafood canners have devoted considerable attention to the problem of struvite formation, but they still haven't been able to prevent it. If you do happen to find a hard, clear crystalline bit of material in canned seafood, here's a simple test to distinguish between struvite and glass. Simply place the material in warm vinegar for a while. The struvite crystals will dissolve; glass of course, will not. April 1969 THE HEALTH BULLETIN V TABLE 2 Estimates of the Number and Percentage of Excess Births In North Carolina Counties, 1966 State and 48. thampton. Urban metropolitan counties, such as Wake and Mecklenburg, in general have low percentages of excess births, but even in these counties the percentage of excess nonwhite births is greater than the white. In Wake County only 18.8 percent of the white births are classed as ex-cess. +her counties having a low percentage of excess white births are Orange, Tyrrell, Le-noir, Durham, Mecklenburg, Hertford, Chowan, Gates, and Pasquotank. Among nonwhite mothers having lower than av-erage percent excess births are those of Durham, Chatham, Lee, Guilford, Pamlico, Orange, Ran-dolph, Stanly, Onslow, and Cho-wan counties. The data presented in this issue of the News Letter are of great significance from the point of view of developing an effec-tive family planning program. Since nearly all babies are now delivered by physicians in hos-pitals, the counseling of mothers needing family planning and clinical services can most effec-tively be carried out by physi-cians and other professional health personnel at the time a mother is having either an un-wanted or a higher order birth. Unfortunately, very few hos-pitals and physicians (except at the three medical schools in North Carolina) have developed effective programs for guiding mothers in modern family plan-ning practices. Since these data apply only to women at child birth, we must not overlook the fact that many women who do not give birth to a child during any particular year may also be in need of family planning. However, by combining data on births by age of mother and birth order for several years, a more complete picture of the overall need for family planning in a county can be derived. A complete program of family planning in any county involves also a consideration of the so-cial, educational and economic status of the county's popula-tion. Many counties now have local family planning commit-tees; and they work closely with the health and welfare depart-ments. However, a survey of family planning programs in the counties shows that health and welfare departments simply do not have an adequate supply of health personnel to do the kind of job required. More effective family plan-ning, in both public and private programs, will help to: ( 1 ) raise the level of living; (2) improve the health of both mothers and children; and (3) improve the overall quality of life—the hu-man dividend — for all North Carolinians. 12 THE HEALTH BULLETIN April 1969 MEDICAL LAB ASSISTANTS Classroom Study Clinical Training Peggy Fish (left) of Raleigh and Marie Straley of Mt. Pleasant, Michigan, peer into the dual teaching microscope at Holding Tech. Miss Stra-ley's father, a medical technician, sent his daugh-ter to Holding Tech for the medical laboratory assistants course because he knows of the out-standing reputation the school enjoys. By MARGARET DARST SMITH The second largest medical laboratory assistants program in the United States is offered in North Carolina by Holding Technical Institute at Raleigh. The author is director of public re-lations for Holding Tech. Holding Tech, a local and state tax-supported member of the North Carolina Community College System, began its med-ical laboratory assistant pro-gram in 1964 with a total of 19 students. Last fall the enrollment April 1969 THE HEALTH BULLETIN 13 Etheleen Hartsfield of Bunn, N. C. uses the spectrophotometer to measure homoglobin. HOW IT WAS IN THE OLD NORTH STATE GARDEN PRODUCES THREE CROPS "Plant a Garden" has become a new health slogan. A garden has so many health possibilities that no home should be without one. Among the health products of a garden may be mentioned sun-shine, fresh air, and exercise as the first crop. The second crop is the supply of those early vege-tables that are so essential to health, in spring and summer — spinach, mustard, lettuce, toma-toes, radishes, peas, beans, squash, onions, etc. The third is a reduced market bill which leaves a neat little sum on which to take a two weeks' vacation in summer. The Health Bulletin, June, 1915, Vol. XXX, No. 3. totalled 50 men and women. These 50 started the one-year diploma program in September. Another group began in March of 1969. This is the only diploma or degree course offered by Hold-ing Tech in which there are two new classes starting each year. It is made possible by the fact that students spend six months of the course in the classrooms at Wake Memorial Hospital and the final six months of the course in clinical training at various hospitals throughout eastern North Carolina. During the final six month period, stu-dents are rotated through the different departments of the hospital in order to develop skills in all laboratory func-tions. As currently enrolled stu-dents leave the classroom, an-other group may begin the classroom phase of the training. The curriculum for the med-ical laboratory assistants course was designed jointly by medical technologists, pathologists, and educators for the purpose of giv-ing the students the necessary knowledge and laboratory prac-tice during the first six months of instruction to enable them to move into a hospital laboratory with a minimum of orientation. Each of the laboratory courses provides experiences similar to those the student can expect to (continued on page 16) 14 THE HEALTH BULLETIN April 1969 MEMBERS OF THE NORTH CAROLINA STATE BOARD OF HEALTH James S. Raper, M.D., President Ashevllle Lenox D. Baker, M.D., Vice President Durham Ben W. Dawsey, D.V.M. Gastonia Ernest A. Randleman, Jr., B.S.Ph. Mount Airy Paul F. Maness, RI.D. Burlington A. P. Cline, Sr., D.D.S. Canton Joseph S. Hiatt, Jr., RI.D. Southern Pines J. RI. Lackey Rt. 2, Hlddenlte Howard Paul Steiger, RI.D. Charlotte EXECUTIVE STAFF Jacob Koomen, RI.D., RI.P.H. State Health Director W. Burns Jones, RI.D., RI.P.H. Assistant State Health Director J. RI. Jarrett, B.S. Director, Sanitary Engineering Division Rlartin P. Hines, D.V.M., RI.P.H. Director, Epidemiology Division Ronald H. Levine, RI.D., RI.P.H. Director, Community Health Division E. A. Pearson, Jr., D.D.S., RI.P.H. Director, Dental Health Division Lynn G. RIaddry, Ph.D., Rl.S.P.H. Director, Laboratory Division Ben Eaton, Jr., A.B., LL.B. Director, Administrative Services Division Theodore D. Scurletis, RI.D. Director, Personal Health Division Two teenagers and a housewife study together in the medical laboratory assistants course at Holding Tech. They are (left to right) Pat John-son of Raleigh, Anna Whitener of Raleigh (for-merly of Haverton, Pa.) and John Davison of Garner, N. C. April 1969 THE HEALTH BULLETIN 15 THE HEALTH BULLETIN P. O. Box 2091 Raleigh, N. C. 27602 «R A. «. CUNNINGHAM. E> R.C. ^NTAL SOC. ^ BX. U0fa5 RAUEIGHt N.C. If you do NOT wish to con-tinue receiving The Health Bul-letin, please check here | | and return this page to the address above. Printed by The Graphic Press, Inc., Raleigh, N. C Medical Lab Assistants Program (Continued from page 14) meet when they move into their clinical training. The medical laboratory assist-ant works under the direct su-pervision of a medical technol-ogist or a medical doctor. The assistant is taught to collect specimens, prepare slides, and perform routine laboratory tests. Although most of the graduates will be employed in a hospital, many will be hired by doctors to work in their offices, or by agencies conducting med-ical or industrial research. Only persons with a high sense of responsibility and the ability to do careful, scientific work should consider entering the field. Graduates of the cur-riculum are eligible to take the national examination of the Board of Certified Laboratory Assistants. Upon successfully completing this examination they are awarded the title of Certified Laboratory Assistant. Holding Tech's students in the medical laboratory assistant program are assigned during the six month clinical phase of the course to leading hospitals and to the Duke University chemistry department labora-tory, county health depart-ments, the State Laboratory of Hygiene, and doctors' offices and clinics. 16 THE HEALTH BULLETIN April 1969 con/rai ®mmi The Official Publication Of The North Carolina State Board of Health Helicopter Moves Burn Victim A burn victim is gently placed in the Chicago Fire Department's Bell 47J helicopter for transfer to a special burn center for treatment. Depart-ment Pilot Robert Hack has participated in a number of rescues involv-ing the agency's three helicopters. The ships are used to assist victims of traffic accidents, fly aerial patrol on Lake Michigan, serve as a com-mand post for large fires and work as an emergency supply/medical vehicle. (See article on page 7) MAY 1969 Inside Freedom from Want — Food as a Health Need Helicopter Ambulance Service—To The Rescue THE HEALTH BULLETIN First Published—April 1886 The official publication of the North Caro-lina State Board of Health, 106 Cooper Memorial Health Building, 225 North Mc- Dowell Street, Raleigh, N. C. Mailing ad-dress: Post Office Box 2091, Raleigh, N. C. 27602. Published monthly. Second Class Postage paid at Raleigh, N. C. Sent free upon request. Editorial Board John Andrews, B.S., Raleigh Glenn A. Flinchum, B.S., Raleigh Jacob Koomen, Jr., M.D., M.P.H., Raleigh John c. Lumsden, B.C. HE., Raleigh Guest Editor: Edwin S. Preston, M.A., LL.D. The Home Swimming Pool — Happy Hours or Tragic Ones n Vol. 84 May, 1969 No. 5 Cover: Helicopters are becoming a ALSO necessary means of transportation for the sick, the accident victims Treat Electricity as a Friend 12 and the | ife.saving needs of the _ . . „, .,, „ „ . military in Vietnam and elsewhere. Driving Skills of Senior Motorists 14 Photos and story courtesy Bell Helicopter, Fort Worth, Texas, one How It Was in the Old North , A1 .. .. of the largest suppliers of hehcop- State 15 ters for the United States in Viet- Safeguards for Children 16 nam. (Article on page 7) 2 THE HEALTH BULLETIN May 1969 Freedom From Want Food as a Health Need By Elizabeth W. Jukes Chief, Nutrition Section N. C. State Board of Health Are you old enough to re-member World War II and the Four Freedoms? It was said that there were four freedoms worth fighting for: Freedom of Speech and Religion; Freedom from Want and Fear. Most of us would agree that these free-doms are still worth working for. Now we call it Freedom from Want, Freedom from Hunger, and, perhaps, over simplify the situation. But our understanding of the importance of food to health has grown and deepened con-siderably in the twenty-five years since those four freedoms were pronounced. We are learn-ing about relationships between growth patterns of children and the protein in the food they eat; about the importance of ade-quate food to the maximal men-tal development of very young children; about the importance of having combinations of food values in the intestinal tract at the same time in order that the body can use its food supply ef-ficiently; about the importance of a regular food supply to the child's development of trust in other people. Trust is, after all, one basis on which every so-ciety depends. As important as food is, food alone cannot bring freedom from want. In this day, when so many have so much, it is hard for us to believe that families living in the same county do not have what we consider the es-sentials of life: a secure house, sufficient clothing for decency and protection, an adequate food supply, clean water, elec-tricity, a cook stove. Somehow we do accept the idea that some people do not have any toilet facility, as necessary as this is to health. In our country, where food supplies are still more than ade-quate to feed all of our popula-tion, there are some programs that intend to provide the food May 1969 THE HEALTH BULLETIN needed. These include the dis-tribution of commodity foods (sometimes called surplus foods), the food stamp program, emergency food and medical program, emergency food order, and supplementary food pro-gram. Counties have an option of choosing to administer either the commodity food program or the food stamp program. The commodity foods are available to people certified by the county Department of Welfare to be eligible at a warehouse, usually at the county seat. The food stamp program is a plan for in-creasing the food buying power of eligible families. Again, the county Department of Welfare certifies families on the basis of income and size of family. A family may pay $24.00 and re-ceive $36.00 worth of stamps. These may be spent for foods in grocery stores that agree to ac-cept the stamps instead of cash. The Emergency Food and Medical Program is available in certain counties as part of their Office of Economic Opportunity Program. The Emergency Food Order is part of the budget of county welfare departments. It provides immediate availablity of food for people with immedi-ate needs. The Supplementary Food Program is a new idea. From time to time, public health workers have expressed con-cern that although drugs and services are available for low income patients, food was not available to all patients who had need for it. As a means of meeting this need, arrange-ments have been made jointly by the U. S. Department of" Agriculture, the Children's Bureau of the Department of Health, Education, and Wel-fare, and the Office of Economic Opportunity for foods to be made available to certain high risk groups in our population. For the first time, it is the responsibility of health depart-ments and physicians providing free or reduced cost services to patients to prescribe foods. The physician or the professional worker who acts for the phy-sician certifies that the patient would benefit from the foods prescribed. Provided that the patient is already receiving medical services free or at re-duced cost, there is no other limitation on who can receive the food. High risk is a term used to designate people who are in greater than average risk of ac-cident, disease, or death. For the purposes of this program, these people are children from the time of birth to school age and women who are pregnant or who have had an infant with-in a year. Any of these people who are receiving below cost medical care may have foods prescribed for them. Since good food is necessary for everyone, especially the people in this vulnerable or THE HEALTH BULLETIN May 1969 high risk group, who should re-ceive this additional food? Let us take just one example. An-emia is so common among in-fants that iron is added to some commercial formulas and cere-als intended for infants, and some physicians routinely pre-scribe iron for infants. Much of this need for iron could be pre-vented if the mothers' diets had been adequate before they be-came pregnant, or remained adequate during their pregnan-cies. In that case, the baby would have stored enough iron in his body to protect him until he was old enough to eat foods like cereal, bread, meat, eggs, and green leafy vegetables. These foods would provide his iron needs as they do yours and mine. Therefore, in prescribing the foods, workers should consider not only the patients' current food intake, but their long-term food habits. Our bodies are strong or weak because of food habits of our entire life span, not because of the current diet with which we are living temp-orarily. In other words, every portion of our lives depends upon the condition of all the former portions. Or, to put it another way, the children of mothers who were sick or poor-ly fed during pregnancy could benefit from supplementary food. This does not necessarily mean a diagnosis of malnutri-tion, but rather the recognition that the patient would benefit from additional foods. Foods may be ordered by kind and amount, according to five age groupings. Infants from birth through the third month may be given evaporated milk, corn syrup, fruit juice, and fortified farina. Infants from four months through one year are given the same foods, plus scrambled egg mix. Children 13 months, through two years, are given evaporated milk, fortified farina, fruit DISTRIBUTION GUIDE FOR SUPPLEMENTAL FOODS-(HEALTH) juice, scrambled egg mix, can-ned meat, canned vegetable or fruit, instant potatoes, dried milk. Children three years through five years are given all these foods, plus peanut butter. Pregnant women, nursing and post-partum mothers are given all the foods given to three to five year age group, plus chocolate milk beverage mix. Since these foods are ordered as a prescription, certain foods can be reduced or deleted from the order. Maximum amounts which can be prescribed for each age group are set by the U. S. Department of Agricul-ture. Standards for eligibility are relatively simple and do not exclude individuals receiving other forms of financial or food assistance. This program is not intended to provide the only nourishment for "starving fami-lies," but is intended to pro-vide supplemental nourishment for those living under physio-logic stress, or, in other words, the stress of rapid growth. This is the first time food is available as a treatment for a health need. People need to be encouraged to accept and eat the food prescribed not as a charity, but as a remedy. When money is available to the fami-lies, they should be encouraged to buy and use the same kinds of foods. Pood does make a difference. It can contribute to Freedom from Want. Gaston County Hospital Budget Approved Gastonia—A proposed capital outlay of $544,235 and an op-erating budget of $58,359 for the first year 1969-70 have been approved by the Gaston County Hospital board of trustees. The board has also approved archi-tectural drawings for the new hospital. Dr. McPheeters, Former Wayne County Director, Dies GOLDSBORO — Dr. Samuel Brown McPheeters, 88, former director of the Wayne County Health Department, died in May. Suriviving: his wife, Mrs. Virginia Gibbes McPheeters, and a sister, Mrs. F. W. Jar-nagin of Nashville, Tenn. Dr. McPheeters came to Wayne County from Charlotte in 1937 as director of the health department, which he headed for nearly 20 years. Under his direction the department was expanded from four to 26 em-ployes. In the 1940s he was re-sponsible for the erection of the present county health depart-ment building. Following his retirement he was instrumental in the organi-zation of the Wayne County Mental Health Association. He was a graduate of Washington and Lee University. THE HEALTH BULLETIN May 1969 Helicopter Ambulance Service - To the Rescue A 41-year-old man falls asleep while smoking in bed, touching off a fire resulting in 70 per cent burns over his body. Two teenagers are critically injured in a freeway traffic mis-hap. Snow in record proportions blankets a city, halting all sur-face traffic. A young man, walk-ing through a park, falls on ice, paralyzing his legs. Each of the cases is critical in nature and demands rapid em-ergency response. Fortunately, in Chicago where they occurred, fast medical evacuation to a hospital was available. In each instance a Chicago Fire Depart-ment Bell helicopter responded to the emergency call. Public officials around the country are becoming increas-ingly aware of the advantages available through use of heli-copters in medical evacuation work. In addition to Chicago there are air ambulance pro-grams underway in such states as Pennsylvania, North Caro-lina, California, Michigan and Montana. One boost for such efforts comes from the medical com-munity which has seen the heli-copter used effectively as an ambulance in Vietnam. Crew of Superior Ambulance Company carries "patient" from its Bell 47J helicopter after land-ing at University of Michigan Hospital, Ann Arbor during dem-onstration of the first private helicopter ambulance service in U.S. May 1969 THE HEALTH BULLETIN The U.S. Army's 92nd Air Medical Service in Vietnam op-erates more than 100 Bell UH- 1D "Hueys". To date these air-craft have evacuated over 182,- 000 patients from remote battle sites to field hospitals. Of this total, only two per cent reach-ing the hospital have died. In World War II the mortality rate was 4.5 per cent; in Korea where helicopters were first used this dropped to 2.5 per cent. The even lower rate of Vietnam is a record in military history. Military officials in Vietnam now boast that no man, any-where in the country, is more than 30 minutes from medical aid. American civic and medical officials are questioning why this cannot be the case at home today. It is unfortunately true that auto accident victims daily succumb on crowded freeways or remote highways while sur-face ambulances struggle to reach the scene and return to a hospital. Over a 20-month period in 1966-67 an average 137 U.S. servicemen died weekly in Viet-nam combat. During that same period 1,020 Americans died weekly on the nation's high-ways. This does not represent the burn victims, drownings and other emergency situations that call for fast response. The first helicopter medical "rescue" mission was recorded on Jan. 3, 1944 when an ex-plosion rocked a Navy destroy-er loading ammunition at Sandy Hook, N. J. Cmdr. Frank A. Erickson delivered plasma to the accident site and was credit-ed with saving many lives. Since then the heliborne med-ical mission has become a routine, if not sufficiently wide-spread, practice. For example: —This year the first private helicopter ambulance service in the United States was founded. Superior Ambulance Service of Wyandotte, Mich., a Detroit suburb, now operates a Bell 47J in addition to its large fleet of surface ambulances. One of the firm's first airborne missions was the transfer of a brain tumor patient from Dayton, Ohio to Ann Arbor, Mich., a 200-mile trip. —During the 1968 Indian-apolis 500-mile Memorial Day Classic and earlier preliminary trials seven persons were air evacuated by Bell's litter-equip-ped JetRanger from the track to a nearby hospital. —Nineteen crew members of an off-shore oil rig 25 miles out in the Gulf of Mexico were pick-ed up by helicopters after a spectacular explosion and flown to a New Orleans hospital. Within minutes all were given emergency treatment. No lives were lost. One roadblock to greater usage of the helicopter in this role has been the lack of heli-ports across the nation. The 1967 edition of the Ver- THE HEALTH BULLETIN May 1969 tical Lift Aircraft Council's Di-rectory of Heliports/Helistops states there are 1,225 approved landing sites in the United States, Canada and Puerto Rico with another 93 proposed. Hospital heliports have mul-tiplied from only 34 in mid- 1965 to 70 today with another 10 planned. However, leading government and medical au-thorities warn that the number of hospital heliports around the country is inadequate to proper-ly serve the American public. By 1972, the Department of Transportation's National Safe-ty Bureau estimates, highway accidents will result in 75,000 The U.S. Army's 92nd Air Medical Service in Vietnam operates more than 100 Bell UHID "Hueys". To date these aircraft have evacuated over 182,000 patients from re-mote battle sites to field hos-pitals. deaths annually. In fact, more traffic accident victims occupy hospital beds than do cancer and heart ailments combined. Compared to the life-saving rates achieved in Vietnam, it is apparent the American public must begin to place the same emphasis on saving lives and limbs during peace-time as it does on the battlefield. In some areas action is under-way. The Montana Aeronautics Commission last year inaugur-ated a program where it offer-ed to construct hospital heli-ports anywhere in the state if hospital administrators would May 1969 THE HEALTH BULLETIN provide usable ground or roof-top space. Once the area is al-located the commission designs, develops, constructs and marks the new heliport. In the first five months the program was initiated the commission re-ceived 14 hospital responses. The U.S. military's helicop-ters also are being utilized in a limited manner. Hospital de-tachments at Fort Rucker, Ala. and Fort Sam Houston, Texas evacuated more than 70 high-way accident victims last year. A Department of Transporta-tion official recently said there is a strong likelihood the mil-itary may make some 200 of its helicopters based around the nation available to the public as rescue vehicles. And the Trinity Hospital of Minot, N. D., has purchased a Bell helicopter to be piloted by a local flying service for hand-ling emergencies within a radius of up to 100 miles of the hospital. The aircraft is the first hospital-owned helicopter am-bulance in the nation. While this is progress there is much work still to be done. Medical spokesmen point out that the general public is, in al-most all instances, unprepared for the emergency situation. There is a need to have more persons trained in first aid. One partial solution recommended has been to place former mil-itary corpsmen in helicopters to serve as a medical aide when the aircraft goes on an emer-gency call. There is a need for faster communications, particularly in remote sections. The Bell Tele-phone system has taken one step to correct this with the recent announcement it will have a central nationwide em-ergency number, 911. And, as previously mention-ed, there is a need for a new awareness by local government officials, city planners and hos-pital administrators to provide adequate emergency facilities and procedures, one of which is heliports. Scientists Win Awards Dr. Solomon C. Goldberg, As-sistant Chief of the Psychophar-macology Research Branch of the National Institute of Mental Health, Chevy Chase, Md., shar-ed with two former NIMH scientists the Lester N. Hof-heimer Prize for Research con-ferred at the recent 125th an-niversary meeting of the Amer-ican Psychiatric Association at Bal Harbour, Florida. Other recipients of the award were Dr. Jonathan O. Cole, now Superintendent of Boston State Hospital and Professor of Psy-chiatry at Tufts University, Boston, and Dr. Gerald Kler-man, now Director of the Con-necticut Mental Health Center and Associate Professor of Psy-chiatry at Yale University, New Haven. 10 THE HEALTH BULLETIN May 1969 The Home Swimming Pool Happy Hours or Tragic Ones The ever-increasing number of automobiles on our highways is one of the factors responsible for the growth of the home swimming pool industry. Today there are more than one-half million such home pools not counting the surface plastic and wading pools. Because of the desire to avoid traffic and crowded highways, there more than likely will be a continued upward trend in this industry. The home swimming pool can be the source of healthful and happy recreation but it can also result in tragedy. A 1965 study has indicated that there were almost 500 pool deaths in the United States and that most pool deaths occurred in resi-dential pools, such as pools in private homes, apartments or motels. Over half of the victims were youngsters of age four and under. Most of the tragedies re-sulted from the lack of super-vision, inadequate physical pro-tection, the inability to swim and a disregard for safety prac-tices. A youngster should never be left unattended in or near a swimming pool. The mother, father or an adult should al-ways be present. Children should never be entrusted to other children. In fact, even adults should not swim or work in a pool unless someone else is present. Slips, falls and physical attacks can be fatal. Every home swimming pool should be adequately fenced with the entire pool area visible from the home. Fencing should be of sufficient height to pre-vent entry by youngsters and make it difficult for older people to climb over the fencing and become atrespasser. There should be depth markings on the pool deck and sides and protective float lines to warn of changing depths from shallow to deep water. Items such as plastic boats, balls and floating toys can be fun for the youngsters but must be used with precaution. Swim-mers should never be allowed to rely on these objects as support May 1969 THE HEALTH BULLETIN 11 for deep-water areas. Pushing, shoving, ducking or running on pool decks should be strictly prohibited. Such practices can lead to disabling injuries and even death. Adults as well as youngsters should adhere to these safety measures. Further, adults should never attempt to swim after drinking alcoholic beverages, eating or taking drugs or medication. Cleanliness is very important to health and safety. Pool decks should be periodically scrubbed to prevent them from becoming slippery. Papers and other re-fuse which may lead to slips and falls should be placed in trash containers. Glass bottles should never be taken to the pool area. To prepare for possible em-ergencies, it is prudent to have a signal or some warning device in the immediate vicinity of the pool to summon help and a ring buoy to toss to a swimmer in trouble. A telephone should be readily accessible and all pool owners and users should be taught the technique of mouth-to- mouth resuscitation. Wheth-er or not a pool is used for night-time swimming, there should be an immediate source of emergency illumination. A handy wallet card prepared in cooperation with the Amer-ican National Red Cross and the U. S. Department of Health, Education and Welfare, con-taining safety tips, is enclosed for your usage. Treat Electricity as a Friend In this modern world of to-day we have a most valuable servant, steady, dependable and most powerful. As a friend it works through lights, applian-ces and modern kitchens. It lightens daily chores, brings you comfort and convenience and allows you leisure time to relax and enjoy your favorite radio or television programs. This friend and servant is elec-tricity but it has its rules which must be adhered to. It can be an obedient servant. Ignore its rule and it can become violent and a deadly killer. Severe or even fatal injuries result when electric energy flows through the body. The ex-tent of injury depends on the path and the amount of current flow. The flow can be fatal if its course is through a vital or-gan. When the flow of electric current does not pass through vital body organs, injuries are likely to be less severe. How-ever, the muscular reaction to a small shock can startle a per-son to the extent that he may lose his balance and fall. This involuntary motion may cause serious injury. While deaths due to misuse of electricial current are few in comparison to other causes, an undetermined number of deaths and burn injuries result from 12 THE HEALTH BULLETIN May 1969 nearly 140,000 fires throughout the nation caused by faulty electrical appliances, wiring and other electricial equipment. Statistics indicate that we now have available to us over 150 types of electricial applian-ces and with technological ad-vancements, many more are an-ticipated. Consequently, it may be well to mention something about the proper installation and maintenance of electrical equipment and appliances from a safety point of view. 1. Before plugging an appliance into an outlet, check the capacity of your home wir-ing circuit. Never connect more than 1600 watts on a general-purpose circuit un-less you know that the cap-acity of your home circuit can carry more than this cap-acity. 2. Cords with worn or crack-ed insulation should be re-placed. Never run cords over hot pipes, radiators or other hot objects. Use convenient wall outlets rather than ex-tension cords or light sockets for connecting appliances. 3. Never run a cord under a rug or door or hang the cord over a nail or sharp object. 4. Connect electrical appliances by putting cord or probe-type temperature controls in-to the appliance before plug-ging into the electrical out-let and always turn off the appliance whenever plugging in or disconnecting from the electrical outlet. Major ap-pliances should always be grounded. 5. Electrical equipment should not be handled with wet hands or when standing on a wet or damp surface. Avoid touching an appliance and a grounding source such as a pipe, radiator, faucet or sink at the same time. Common house current can be lethal. 6. Always disconnect applian-ces before oiling or cleaning. Clean and oil the appliances periodically if recommended by the manufacturer as car-bon particles and dirt can set up current paths to ex-terior paths. 7. Do not overload your cir-cuits. A normal household circuit will carry 15 amperes of electricity. If a 15 ampere fuse blows out continuously, you should add another cir-cuit to your home rather than replacing it with a high-er ampere fuse. 8. Wall outlets attract small children and they are temp-ted to insert hair pins or small objects into the outlet. When not in use, the wall outlet should be covered with a plastic cap or a piece of furniture should be placed in front of the outlet to keep it out of sight. Robert F. McDonald, Chief Injury Control Program Providence, Rhode Island May 1969 THE HEALTH BULLETIN 13 Driving Skills of Senior Motorists The results of a nationwide study into the driving records of senior motorists may well catapult the over-65 driver to a respected place on the high-way and make his current reputation as a "hazard" a myth of the past. A report on the accident in-volvement of the senior driver, released by the University of Denver College of Law, is so favorable to the senior motorist that Judge Sherman G. Fine-silver, head of the study team, believes it "will be pivotal in refuting current popular think-ing about older drivers." In the 31 jurisdictions for which data were available, senior drivers (persons age 65 and over) aver-aged 37 percent fewer accidents than would exist if their pro-portion of accidents were in di-rect ratio to their proportion of the driving population. Although senior drivers rep-resented 7.4 percent of all driv-ers in the states surveyed, they were involved in only 4.8 per-cent of all accidents in these states. They averaged lowest of all age groups in frequency of injury-producing accidents and 40 percent below their propor-tionate share of the driving pop-ulation. Judge Finesilver expressed the opinion that "the senior driver has been made a scape-goat, the senior driver is not only a good risk, but often may be among the safest motor-ists on the highway." . . . from More Life For Your Years, 5/69 MEMBERS OF THE NORTH CAROLINA STATE BOARD OF HEALTH James S. Raper. M.D., President Asheville Lenox D. Baker, M.D., Vice President Durham Ben W. Dawsey, D.V.M. Gastonla Ernest A. Randleman, Jr., B.S.Ph. Mount Airy Paul F. Maness, M.D. Burlington A. P. Cllne, Sr., D.D.S. Canton Joseph S. Hiatt, Jr., M.D. Southern Pines J. M. Lackey Rt. 2, Hlddenite Howard Paul Steiger, M.D. Charlotte EXECUTIVE STAFF Jacob Koomen, M.D., M.P.H. State Health Director W. Burns Jones, M.D., M.P.H. Assistant State Health Director J. M. Jarrett, B.S. Director, Sanitary Engineering Division Martin P. Hines, D.V.M., M.P.H. Director, Epidemiology Division Ronald H. Levine, M.D., M.P.H. Director, Community Health Division E. A. Pearson, Jr., D.D.S. , M.P.H. Director, Dental Health Division Lynn G. Maddry, Ph.D., M.S.P.H. Director, Laboratory Division Ben Eaton, Jr., A.B., LL.B. Director, Administrative Services Division Theodore D. Scurletis, M.D. Director, Personal Health Division 14 THE HEALTH BULLETIN May 1969 How It Was In the Old North State AN INDECENCY However chivalrous the purpose of the North Carolina Senate in its passage of an amendment to the marriage laws repealing the requirement of an affidavit of physical soundness on the part of the masculine member of the matrimonial partnership before the contract may be entered into, those voting for it have lent themselves to a mighty sorry business. A few years since this State had a marriage law that, while not perfect, was a testimonial to the intelligent respect which the more thoughtful of our men and women feel for their kind. Publication of the banns, health certificates for both bride and groom, protected them and the race. Of course a few nice youngsters in a hurry eloped to other states, as did some who could not have been certificated at home. Marrying magistrates of Virginia, South Carolina, and perhaps an occasional Tennessee or Georgia squire, picked up a few dollars which border counties would have liked to retain within their bounds; but what of it? We were making an honest effort to give to marriage that self-respect to which it as an institution is entitled. We were attempting to avert some of the tragedies resulting from the propagation of the species by its sorriest specimens. But the past two-three Legislatures have jested or worse at the ideals embodied in the best-contrived marriage law of this section of the United States. It was thought indelicate to require a mother of men to be examined by her family physician as to her fitness for motherhood. It was deemed perversive of public interest to require a notice to the public from those who desired to enter into the contract which most concerns the public. And now it would seem all bridegrooms of whatever age or physical condi-tion, must be considered Bayards, sans pen, sans re-proche, and fit for mating at the drop of a hat. — Greensboro News. The Health Bulletin, June 1935, Vol. 50, No. 6 May 1969 THE HEALTH BULLETIN 15 THE HEALTH BULLETIN P. O. Box 2091 Raleigh, N. C. 27602 U0b5 If you do NOT wish to con-tinue receiving The Health Bul-letin, please check here | | and return this page to the address above. Printed by The Graphic Press, Inc., Raleigh, N. C Safeguards for Children Patricia R. Hitt, Assistant Secretary for Community Field Services, Department of Health, Education and Welfare has urged enactment of legislation to protect children against elec-trical, mechanical, and thermal hazards of toys and other items intended for use by children. A bill now pending in Congress, which has been endorsed by the Food and Drug Administration would provide this protection. Action is sought on the basis of findings disclosed by the Na-tional Commission on Product Safety, appointed to make rec-ommendations to the President and Congress on ways to reduce the hazards of household pro-ducts. Under the existing Hazardous Substances Act, the law does not protect children against hazards such as sharp or pro-truding edges, fragmentation, explosion, strangulation, suffo-cation, asphyxiation, electric shock, electrocution, heated sur-faces, or unextinguishable flames. The urgent necessity for im-mediate action, the Assistant Secretary said, is clearly il-lustrated by the casualty fig-ures gathered by the Commis-sion. More than 15,000 children die each year from accidents. This figure is higher than child-hood deaths from cancer, com-municable diseases, heart dis-eases, and gastroenteritis com-bined. More than half of the children who died as a result of accidents in 1966 were pre-school children. . . . from HEW Field Letter 16 THE HEALTH BULLETIN May 1969 mmmmfi Official Publication Of The North Carolina State Board of Health DR. E. R. HARDIN Who retired July 1, 1969, after 50 years of continuous service as Health Director of Robeson County Health Department. (Story on page 3.) June 1969 Inside Dr. E. R. Hardin Retires after 50 years 3 Hodges Heads New State Health Move 7 Environmental Health Protection 9 THE HEALTH BULLETIN First Published—April 1886 The official publication of the North Caro-lina State Board of Health, 106 Cooper Memorial Health Building, 225 North Mc- Dowell Street, Raleigh, N. C. Mailing ad-dress: Post Office Box 2091, Raleigh, N. C. 27602. Published monthly. Second Class Postage paid at Raleigh, N. C. Sent free upon request. Editorial Board John Andrews, B.S., Raleigh Jacob Koomen, Jr., M.D., M.P.H., Raleigh John c. Lumsden, B.C.H.E., Raleigh Guest Editor: Edwin S. Preston, M.A., LL.D. Vol. 84 June, 1969 No. 6 ALSO Cover: Madge Pittman of the Robe- Malpractice Insurance Firm Advises Physicians son County Health Department on Birth Control Pill _ 8 sta ff sent us this photograph of retiring Health Director, Dr. E. R. Dental Irrigating Device Approved _ __11 Hardin, with this note: "This is our favorite photo of Dr. Hardin — Preventive for hope you like it too." We do! His Chicken Pox Reported 14 . . „ „„„,> o ; c <* story, beginning on page 3, is a profile of North Carolina's health Live German Measles Vaccine Licensed 16 progress in this past half-century. 2 THE HEALTH BULLETIN June 1969 Dr. Eugene Ramsey Hardin Retires After Fifty Years As Health Director Of Robeson County Here is the story of those years as told in Dr. Hardin's Nomination for The Rankin Award of the N. C. Public Health Association. Dr. Eugene Ramsey Hardin graduated from the University of Georgia Medical College in 1911. His grades secured for him an internship in Lamar General Hospital. At the end of this service he was appointed intern in Nursery and Child's Hospital, New York City, a pediatric and obstetric service. From there he interned in Wil-lard Parker Hospital, the larg-est contagious disease hospital in New York City. While there, he had the privilege of observ-ing Dr. Bela Schick, who was doing his experimental work in diphtheria. In 1915 he accepted the posi-tion of Health Officer of Samp-son County, N. C. After one and a half years, he resigned this position to begin private prac-tice there. This was interrupt-ed by the war, and in August of 1917, he entered training for the Army Medical Corps and was assigned to duty as a First Lieutenant at Camp Lee, Va. In October, 1918, he was sent overseas and landed in France, November 10, 1918, just in time to help the French celebrate the Armistice. After the Armistice, it was Army policy not to re-lease medical officers for sever-al months. It was July, 1919, therefore, before he returned to the United States and to North Carolina. He was discharged from the Army August 31, 1919. Dr. Hardin began work as Health Officer for Robeson County September 1, 1919. At that time, much pioneer work had been done by Doctors B. W. Page and W. A. Mc- Phaul, the first health officers, but there was still a vast num-ber of public health problems to be solved. The county, one of the largest in the state, had a population of more than fifty thousand people divided among three races, no paved roads, one hundred and fifty schools, one small hospital, no dairies, and a very low per capita milk con-sumption. There were 190 midwives practicing. The maternal and infant mortality was very high, as were deaths from infectious and contagious diseases. The water supply of most people in small towns and rural sections June 1969 THE HEALTH BULLETIN was obtained from open wells and shallow driven wells. Screens were practically un-known in the rural sections, and sanitary sewage disposal was extremely poor. Many schools did not have sanitary privies and obtained their water from one pitcher pump. Typ-hoid fever, infectious diarrheas, diphtheria, tuberculosis, mal-aria, pellagra, and hookworm disease were very prevalent, and thousands of people fell vic-tims to these diseases every year. Venereal disease was very prevalent. Smallpox was com-mon. In the beginning, the main attack of the health de-partment was directed against the major public health prob-lems of that time: Typhoid fever, diphtheria, tuberculosis, infantile diarrhea, hookworm disease, and the high maternal and infant death rate. Better sanitation, water sup-plies, and sewage disposal facil-ities were urged. The health department staff at this time consisted of the health officer and a secretary. TYPHOID FEVER has shown a steady decline since 1920. From 1920 through 1943 the health department Vacci-nated 66,030 against typhoid. Clinics were held in stores, private homes, country church-es, voting booths, tobacco barns, or anywhere people could as-semble. Now, typhoid fever has become a rare disease in Robe-son County. DIPHTHERIA: The health department began an intensive immunization campaign against diphtheria in 1925, shortly after the advent of the long-time diphtheria preventive toxin-anti- toxin. There has been no letup in the fight since that time. In the four year period 1920 through 1923, five hund-red and sixty-two cases of diphtheria with nineteen deaths were reported to the health de-partment. In the four-year peri-od beginning 1925 through 1943 the health department vaccinat-ed 27,505 babies and older chil-dren against diphtheria. During this time, more than ten thou-sand were given the Schick test to determine diphtheria susceptibility. The last case of diphtheria was reported in 1959. SMALLPOX: In the early years smallpox cropped up fre-quently, occasionally reaching the epidemic stage. Vaccina-tions over the years have con-trolled the disease. No smallpox has been reported since 1931. TUBERCULOSIS clinics were begun in 1920. Clinics were held by a doctor from the State Sanatorium. These clin-ics were continued every few years until about 1940, when the state mobile X-ray units were secured for several years. Realizing the need, Dr. Hardin was successful in organzing the Robeson County Tuberculosis Association in 1940. A few years ago, Dr. Hardin persuaded the county commissioners and the THE HEALTH BULLETIN June 1969 T. B. Association to purchase an X-ray machine that makes small and large films. This machine has provided Robeson County with complete coverage at all times. The Robeson Coun-ty T. B. Association also pays a part-time X-ray technician for the health department. The course of tuberculosis in Robeson County gives an ex-ample of the problems, the work, and the results of public health in the county. Dr. Hard-in had not only the problem of the rampant disease itself, but he had also to deal with the ignorance, superstitions, and fears that had been present for generations. Realizing that the only way to change people was through endless education, he wrote hundreds of newspaper articles, spoke at every possible P.T.A., church, or civic gather-ing, and visited endlessly with the greats, near-greats, and the nobodys-at-all throughout the county. That this work was not in vain is evidenced by the de-crease of deaths and cases. Ex-amination of contacts has been virtually one hundred per cent for years. Thousands of county residents come voluntarily to the health department each year to receive free chest X-rays. MATERNAL AND INFANT CARE: Robeson County has one of the outstanding pre-natal clinics in North Carolina. Until recent years, prenatal clinics were held once each month in each town in the county. Sever-al years ago all of these clinics were consolidated into one clin-ic held weekly at the health de-partment. Here the patients re-ceive excellent medical care, nursing supervision during the pre-natal and post-natal period, nutrition consultation, and necessary drugs. This has pro-duced healthier mothers and babies, as shown by the lower maternal and infant deaths, rates, and lower premature rate. When Dr. Hardin came to Robeson County, there were al-most two hundred midwives. An article on the history of the health department in the March 7, 1962, issue of the Robesonian described the work done by these midwives. "Midwives came under careful scrutiny. They were investigated and carefully screened. A course for them given in the early 1920's was attended by 130; 100 com-pleted the course. Each was aid-ed in assembling materials to be carried in a little bag. Each was trained in sterilization of materials, the use of antiseptics, the use of drops to be placed in babies' eyes. In those early years, three midwives were taken to court for failing to put drops in the eyes of newborn." The last of these midwives re-tired in 1962. The effectiveness of this pro-gram was recognized when it played a part in bringing the Merit Award of the N. C. Public June 1969 THE HEALTH BULLETIN Health Association to Robeson in 1958. VENEREAL DISEASE has always been a problem in Robe-son County. As early as 1920, the fight began and still con-tinues. In 1920 a venereal dis-ease campaign was organized with moving pictures, and a lecturer from the U. S. Public Health Service, here for a five-week tour. The truck moved into all parts of the county, reaching all segments of the population. The modern developments in the treatment of V.D. have, of course, been of help in the con-trol of this problem. In 1951 there was a county-wide blood testing program, in which clubs, and churches did their part in getting out everyone possible to be tested for possible infection. This blood-testing program was repeated in 1958. Treatments were arranged for those need-ing them. Through constant checks of persons involved in foodhandling and other related occupations, a check is kept on V.D. and possible contacts are found and treated. THE CRIPPLED CHIL-DREN'S CLINIC, which is held the first Friday of each month as regularly as clockwork, be-gan in the 1930's. In this work, Mrs. A. F. McLeod, head of the welfare department, was a strong partner for Dr. Hardin. The 30's were a period of de-pression and health needs of every type, including those in-volving handicaps of children, were great. The best doctors in their fields come each month to these clinics to examine new cases and to check on former cases. With the aid of the wel-fare department and other sour-ces, children who need medical care, surgery or the like are aided. Many a child in Robeson today is a better person phy-sically and emothionally be-cause physical handicaps have been alleviated by the Crippled Children's Clinic. PELLAGRA today is almost an unknown disease, but when Dr. Hardin came to Robeson it was one of the big problems. Great as it had been, it became even more of a menace in the de-pression years of the 30's. The county commissioners included enough money in the budget to purchase mineral yeast, a very effective agent to fight pellagra, but a most unpleasant sub-stance to take. Despite the un-pleasant taste, when people learned that yeast overcame pellagra, they came in droves for it. It is estimated that in the course of several years, several carloads were distributed, at the request of the people need-ing it. HOOKWORM is another poverty disease, but has far more overtones in the health picture since it can be trans-mitted to others. In the early years the fight began and still continues. There were checks, (Continued on page 12) THE HEALTH BULLETIN June 1969 Hodges Heads New State Health Move Needs In Medical Education To Be Evaluated By BEBE MOORE Staff Writer Former Gov. Luther H. Hod-ges is chairman of a new com-mittee which will promote health planning in North Caro-lina. The North Carolina Commit-tee for Better Health was form-ed in May, by some 30 persons who gathered at the Statler Hil-ton Inn here at Hodges's invita-tion to discuss health needs and the status and coordination of health planning. The committee's purpose, Hodges said, is "to come up with some ideas as to what we can do to achieve . . . the best health program that North Carolina can afford." He said such a program in-cludes training of medical per-sonnel, providing adequate fa-cilities, and making available "the best medical care possible at the most reasonable cost to the individual and the state.' " May Serve As Nucleus The committee may serve as the nucleus of a grassroots movement similar to the "good health movement" of the late forties, Hodges said. This movement was the fore-runner of the present active N. C. Health Council. The earlier movement has been described as the first great statewide thrust for health. It resulted in passage by unani-mous vote in the 1949 General Assembly of a package of 12 items that included creation of the four-year medical school at the University of North Caro-lina and appropriation of state funds to match federal (Hill- Burton) funds for construction of medical facilities. Several participants in the meeting Tuesday stressed the importance of public involve-ment in efforts to meet the state's health needs. Dr. Jacob Koomen, state health director and acting director of the Office of Comprehensive Health Plan-ning, said that citizens now "scream to the state legislature (to meet health needs), rather than to the federal govern-ment," as they did in the period of the forties. The committee will seek the best method of developing a comprehensive statewide health plan. Such a plan was recommend-ed in a statement from Watts Hill Jr., chairman of the State Board of Higher Education. June 1969 THE HEALTH BULLETIN The statement, read by high-er education board director Dr. Cameron West in Hill's absence, said that it is "difficult if not impossible" for the board to plan and promote ways of meet-ing health needs without a com-prehensive statewide plan. Hill also pointed out that a plan could assign to agencies and institutions involved in health care "responsibility for subsections within its area of special competence." and make it possible to weigh the needs in specific areas "against total needs and priorities." Ed Rankin, vice president and secretary of the North Caro-lina Citizens Association, was appointed chairman of a steer-ing committee to set directions for the larger committee. Others on the steering com-mittee are William Snyder, edi-tor of The Greensboro Daily News; Dr. Koomen; state Rep. Hugh Johnson, D-Duplin, who headed a Legislative Research Commission study of the state's doctor shortage; state Sen. Lindsay Warren Jr., D-Wayne; Dr. West of the board of higher education; Dr. James Musser, director of the North Carolina Regional Medical Program; Dr. Amos Johnson of Garland, former president of the Amer-ican Academy of General Prac-tice; and Asheville attorney Lamar Gudger. Raleigh News and Observer May 14, 1969. Malpractice Insurance Firm Advises Physicians On Birth Control Pill A Los Angeles firm dealing in malpractice insurance has ad-vised its 18,000 physician-clients to get patients request-ing birth control pills to sign statements acknowledging "awareness of the serious risks involved." The firm, the Nettleship Co., administers professional liabil-ity programs for 12,000 doctors in Southern California and for 6000 osteopathic physicians na-tionwide. It is the second larg-est company of its kind. In a "claims prevention let-ter" dated May 14, Nettleship's president John C. Allen told doctors of "the increasing awareness of potential compli-cations from contraceptive pills" and disclosed that his firm is "already handling law-suits dealing with some of these complications." The Government-approved instructions for prescribing the Pill say that it increases from seven to 10 times the risk of serious and fatal blood clotting compared with the rate in non-users. 3 THE HEALTH BULLETIN June 1969 Environmental Health Protection Charles C. Johnson, Jr. Administrator Consumer Protection and Environmental Health Service Public Health Service Excerpts from an address prepared for delivery at the Spring meeting of the Southern Regional Legisla-tive Seminar on Current Public Health Problems, sponsored by the Southern Conference of the Council of State Governments. We shape our environment, and then our environment shapes us. We have only to look around us to see that we are well on the way—particularly in our urban areas—to creating a world which can have the most serious adverse effects on human health. We are "engaged in a race be-tween catastrophe and the in-telligent use of technology, and it's not at all clear we are going to |