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HEALTH SCIENCES LIBRARY OF THE UNIVERSITY OF NORTH CAROLINA This Book Must Not Be Taken from the Division of Health Affairs Buildings. pqur days This JOURNAL may be kept outflHHHR and is subject to a fine of FIVE CENTS a day thereafter. It is DUE on the DAY indicated below: Vc ? ;^/ icia! Publication Of Th Partnership for Health ncpriy FO S 4 'i= MAR 9 1968 jF rMTu -TrMR^. HBRAR' Governor's Conference on Heolfh Stresses Comprehensive Planning (See page 2 and following) G^OVERNOR'S C0NreRE^ ON V\EWJH^ REMARKS BY GOVERNOR DAN MOORE AT GOVERNOR'S CONFERENCE ON HEALTH Thursday, January 25, 1968-11:00 A.M. Memorial Auditorium — Raleigh, North Carolina Thank you for coming today for this Conference on Health. I believe that this meeting will be a landmark in North Carolina's continuing effort to protect the health of its people and to provide adequately for the care and treatment of its sick and infirm. The public and private health-oriented organizations represent-ed at this Conference have cooperated through the years to provide for improvements in health care programs for the people of this State. In one sense, we have every reason to be thankful for the progress made in recent years in protecting the health of the people. Considerable gains are evident within our own lifetimes. Sanitation, once a major health concern, now .5 taken almost for granted. Many of the serious communicable diseases have oeen conquered. Medical treatment and hospital facilities have improved considerably and are more readily available to the people. And, the expected life span of man has increased by almost 20 years. In another sense, however, it is most evident that we cannot become implacent. Infant mortality rates in the United States are substantially higher fhan in many other advanced countries, and the rates in this State are among the highest in this country. Rejection of North Carolina military inductees for health leasons occurs with greater frequency than in many other States. The costs of medical care continue to climb adding increased hardship to many in need. The purpose of this Conference is to focus attention on these and other medical and health problems. I also want to report to you of our efforts to promote, protect, and conserve the health of the citizens—an essential factor in the total development of North Carolina. And, I want to ask for your support and your help in a new effort to coordinate the utilization of health resource to the end that every man, woman and child in this State has the finest in health care. THE HEALTH BULLETIN January, 1968 Of course, concern for the health of the people is nothing new for us. North Carolina pioneered in the Better Health Movement during the 1 940's and has never ceased its efforts to improve services. Under the leadership of the State Board of Health, an excellent system of local public health services has been developed. During this biennium a total of $800,000 was made available in State aid to local health departments. At the State level new programs are being implement-ed which will insure quality care in the transportation of the sick and injured and in genetic counseling. Existing programs for the control of salt marsh mosquitoes, for the inspection of food and lodging establishments and for the dental care program were strengthened. The fine system of local hospitals is a credit to many people who worked on the local. State and Federal levels under the coordination of the North Carolina Medical Care Commission. North Carolina now ranks 12th from the top among States in the number of hospitals and 15th in the number of hospital beds. The State ranks 7th in the nation in the number of hospital beds constructed and 3rd in the number of Public Health Centers developed under the cooperative financing program. North Carolina has at Chapel Hill the only State-supported medical center in the South, with major professional schools for medicine, dentistry, nursing, public health and pharmacy. January, 1 968 THE HEALTH BULLETIN A total of 271 students is preparing for health careers at Chapel Hill and other nnedical centers under State scholarships for medical and paramedical studies. Over 100 rural communities have benefited by the services of students receiving these State scholarships. Our system of mental health services, developed under the direction of the State Board of Mental Health, is recognized as being one of the finest in the country and is providing a pattern for other States. Appropriations for mental health are at an all time high this biennium with a total of $110 million going to provide care in the State mental hospitals and community mental health programs. Cost accounting programs have been implemented in the psychiatric hospitals and programs for alcoholism, mental retardation, and for prisoners in the State corrections system have been supported vigorously. Even with the assistance of the Medicaid program, many States do not yet provide the health services to welfare recipients as does the State Board of Welfare. During the past year payments to hospitals for the care of indigent patients were increased and rate increases were made for domiciliary and nursing home care for adult welfare recipients. The department is actively supporting cooperative programs in family planning throughout the State. Overall at least 1,100 fewer persons are now on public assistance rolls today than there were a year ago. The State is presently moving ahead with detailed advanced planning for the provision of better medical services to this decreasing group through the implementation of Title XIX of the Social Security Act. The Vocational Rehabilitation Division of the Department of Public Instruction is nationally recognized for its rehabilitation programs. And, we believe that a comprehensive study presently under way will bring about further improve-ments in vocational training for the handicapped. Environmental health continues THE HEALTH BULLETIN First Published—April 1886 The official publication of the North Caro-lina State Board of Health, 608 Cooper ^lemorial Health Building, 225 North ^Ic- Dowell Street, Raleigh, N. C. Published monthly. Second Class Postage paid at Raleigh, N. C. Sent free upon request. Editorial Board Charles M. Cameron. Jr . M D . M P H. Raleigh John C. Lumsden. BC.H.E. Jacob Koomen, Jr . M D.. M PH. John Andrews. B,S. Glenn a. Flinchum. B S. H W. Stevens. M.D,. M.P.H.. Asheville Guest Ed.—Edwin S. Preston, M.A.,LL.D. Vol. 83 January, 1968 No. 1 Governor Moore & Mrs. Sue Jones of Medical Care Commission. THE HEALTH BULLETIN January, 1968 to receive special attention from the Department of Air and Water Resources, the State Board of Health, the Department of Agriculture and other agencies. The Medical Division of the Commission for the Blind has increased and expanded its medical eye services, and last year 531 persons v/ere rehabilitated to gainful employment by this agency. This represents an increase of 75 over the previous year. The biennial budget approved by the 1967 General Assembly provided expenditures totaling over $124 million for health and hospitals. In addition, sizeable State allocations for health-related programs were provided for welfare, education, public safety, correction, and other special areas. Some of 45 State agencies are involved. The total expenditure of State Government in the health care field during the present biennium will be more than $150 million. This represents a sizeable increase over similar expenditures for the last biennium, and demonstrates the commitment of the State to providing for the health care of its citizens. These State programs and others which I have not mentioned complement a network of health services provided by private organizations, voluntary health agencies, and many, many dedicated individuals. Certainly, without this total effort, the five million people of North Carolina would not have the health and the medical well-being that they do today. It is evident, however, that we in North Carolina have a great opportunity to move forward rapidly in providing better health and medical services. Tremendous advancements are being made. All may not be as dramatic as the recent heart transplants, but all are important to better health and longer life. The people of this State deserve the advantages that modern science and concern can provide. And, while we cannot disregard the costs, we must not let them overshadow our purpose. These same factors, of course, are applicable to other State services. It was this broad concern for greater coordination of State resources and better utilization of Federal and State funds that led to my creating the State Planning Task Force early in the Administration. It is significant that one of the first studies undertaken by the Task Force dealt with State health services. This initial work by the Task Force, in effect, gave North Carolina a head start in health planning for the future. We were ready to move ahead when Congress enacted legislation providing for comprehensive health planning. Public Law 89-749. I designated the Director of the Department of Administration as the State official to work in implementing (Continued on page 10) Advisory Council for Comprehensive Health Planning. January, 1 968 THE HEALTH BULLETIN Mrs. Annie B. Edwards, who retired January 1 of this year after 48 years of service with the State Board of Health, during which she was secretary to four State Health Directors. She is shown being presented a certificate of appreciation by Dr. Jacob Koomen, State Health Director. THE HEALTH BULLETIN January, 1968 Upon his retirement from service with the State Board of Health, Dr. J. W. R. Norton received a Certificate of Appreciation from Dr. Jacob Koomen, State Health Director. Dr. Norton served for 17V2 years as North Carolina's State Health Director. January, 1968 THE HEALTH BULLETIN Retiring employees representing 409 years of service with the State Board of Health were honored at year's end in a special formal ceremony at Raleigh. Dr. Jacob Koomen, the State Health Director, expressed the appreciation of the fellow workers in public health to the sixteen persons who retired at the end of December. They averaged a quarter of a century in service to North Carolina through public health. The ceremonies were held in the John H. Hamilton Auditorium of the Laboratory Building of the State Board of Health. Mrs. Annie B. Edwards, Local Health Division, who entered on her duties in 1919, and has 48 years to her credit, led the list in length of service. She served as secretary for four State Health Directors. Not far behind was Marcus C. Allen, Laboratory Technician in the Ser-ology Section, with 43 years to his cre-dit. Charles M. White, Chief of the In-sect and Rodent Control Section, Sani-tary Engineering Division, had 34 years of service. Also retiring was Dr. J. W. R. Norton, former State Health Director. Other retirees with their length of service and Department are: C. E. Harrington, Laboratory Division, 32V2 years; William Murray Linker, Jr., Sani-tary Engineering Division, 31 V2 years; Oris Harris, Administrative Services Di-vision, 30 years; Miss Amy Fisher, Lo-cal Health Division, 28 years; Edna R. Jackson, Laboratory Division, 27 years; Mrs. Wilma H. Harrell, Epidemiology Di-vision, 25 years; Mrs. Golda Walker, Administrative Services, 23 years; Miss Doris Tillery, Local Health Division, I8V2 years; Eugene E. King, Sanitary Engi-neering Division, 15 years; R. F. Hill, Sanitary Engineering Division ISVa years; Miss Lena E. Simmons, Adminis-trative Services, 10 years; Jesse W. Har-rell, Sanitary Engineering Division, 8 years. State Boarj 409i From the left, seated — Mrs. Annie B. Ed Golda Walker and Miss Amy Fisher. Stami Eugene E. King; R. F. Hill; W. Murray I 8 THE HEALTH BULLETIN January, 1 968 ff Who Retired January First- 's Service Is Represented Edna Jackson; Mrs. Wilma H. Harrell; Miss Lena Simmons; Miss Doris Tillery; Mrs. cus S. Allen; Dr. J. W. R. Norton; C. E. Harrington; Oris Harris; Jesse W. Harrell; nd Charles M. White. January, 1968 THE HEALTH BULLETIN (Continued from page 5) this legislation. He, in turn, established an office of health planning which could function in close liaison with the State Planning Task Force and other State agencies. Dr. Charles Cameron of the School of Pubic Health at the University of North Carolina at Chapel Hill was granted a leave of absence to become the director of the Office of Comprehensive Health Planning. To assist Dr. Cameron in the designing of a preliminary plan for planning, a Technical Committee on State Health Planning and Health Services was established. It consisted of the heads of the Department of Health, Mental Health, Welfare, Public Instruction, and Personnel; the Medical Care Commission; the State Planning Task Force; and the Division of Health Sciences of the University of North Carolina. Their plan of study was submitted to the Public Health Service in the fall and was approved October 31, 1967. The Office of Comprehensive Health Planning has moved ahead in preparing to initiate the program of study and planning. To advise and assist the Office in its work, I am pleased today to announce the appointment of an Advisory Council which, by law, includes a majority of consumers of health services as well as representatives of the major health interests of the State. Members of the Council are: Clifton M. Craig, Commissioner, Department of Public Welfare, Raleigh Grady Ranson Galloway, Executive Director, Commission for Blind, Cary James A. Graham, Commissioner, Department of Agriculture, Raleigh Dr. Eugene Alexander Hargrove, Commissioner, Department of Mental Health, Raleigh. William Freeman Henderson, Executive Secretary, Medical Care Commission, Raleigh Dr. Jacob Koomen, State Health Director, Board of Health, Raleigh C. Arden Miller, Vice Chancellor, Health Sciences, University of North Carolina at Chapel Hill George Eugene Pickett, Director, Department of Water and Air Resources, Raleigh Dr. Henry Stuart Willis, North Carolina Sanatorium System, Chapel Hill Dr. Andrew Arthur Best, Greenville Herbert Clarence Bradshaw, Durham Dr. Amos Summer Bumgardner, Charlotte Senator Albert J. Ellis, Jacksonville William Harry Entwistle, Jr., Hanes Corporation, Winston-Salem James Clyde Gaither, Sr., Gaither's Restaurant, Inc., Brevard Mrs. Foy T. Goodin, President, North Carolina Extension Homemakers Associa-tion, Newton Mrs. Geneva Bass Hamilton, Goldsboro Thomas Royster Howerton, Wilson Robert Earle Jones, Agricultural and Technical State University, Greensboro State Representative Ernest Bryan Messer, Canton Dr. John Duncan Robinson, Wallace Wayland J. Sermons, Washington Carl Wilson Anderson, School of Social Work, University of North Carolina at Chapel Hill 10 THE HEALTH BULLETIN January, 1968 Dr. William George Aniyan, Duke University Medical Center, Durham William Charles Barrett, The State Bank, Laurinburg Reverend Cecil Bishop, Trinity AME Zion Church, Greensboro Senator John R. Boger, Jr., Concord Riley Wilson Clapp, Pleasant Garden Thomas Hightower Collins, Chapel Hill Thomas C. Day, Vice President, Citizens Bank and Trust Company, Hayesville Reginald Morton Fountain, President, North Carolina Association of County Commissioners, Tarboro George Watts Hill, Durham Dr. Frank W. Jones, Nev^^ton Mrs. Mary Edith Rogers, Gaston County Health Department, Gastonia Carlos Lowery Young, Shelby State Representative Kenneth C. Royall, Jr., Durham Alonzo Clay Edwards, Hookerton Mrs. William Francis Wolcott, Asheville Mrs. Joseph M. Hunt, Jr., Greensboro Charles Curtis Johnson, Jr., R. J. Reynolds Tobacco Company, Winston-Salem Mrs. Phebe Harlan Emmons, President, North Carolina Council of Women's Organizations, Raleigh James Gv^yn Gambill, West Jefferson Rabbi Joseph Asher, Greensboro Roger Hester Sloop, Warren's Drug Store, Rural Hall Dr. John Gentry Martin, Boone Charles Scott Venable, Jr., North Carolina Tuberculosis Association, Raleigh John Alexander McMahon, President, North Carolina Blue Cross and Blue Shield, Inc., Chapel Hill I am pleased to appoint Mr. John A. McMahon as Chairman, and Mrs. Phebe H. Emmons as Vice Chairman. These members of this Advisory Council have assumed a most important responsibility. Their duties include: —Advising the Governor, the Department of Administration, and the Office of Comprehensive Health Planning in the conduct of a comprehensive planning program for health. —Assisting the Office of Comprehensive Health Planning in the identification of problems, needs and developments both within the State and elsewhere which relate to our efforts to provide comprehensive health services to the citizens of North Carolina. —Recommending to the Governor, the General Assembly, the various boards and commissions dealing wtih health-related programs and private and public organizations, courses of action relating to the health needs and resources of the State. —Facililating communication and cooperation among agencies, organizations, professions, and the public in the cause of better personal and environmental health for North Carolinians. The work of this Advisory Council will be instrumental in the development of a State comprehensive health plan under the provisions of Public Law 89-749 —the Partnership for Health amendments to the Public Health Service Act. An award of $67,000 has been made to finance the initial steps for this fiscal January, 1968 THE HEALTH BULLETIN 11 year. The comprehensive study plan for health services in North Carolina is designed to serve four maior purposes. 1. It will provide for a comprehensive and coordinated approach to health planning with emphasis on the long-range investments which the State must make in such areas as health manpower, health facilities, and in the financing of health services. The study will help identify the underlaps and overlaps in the current spectrum of health services available in North Carolina. 2. It will provide access to the health planning process for consumers as well as a wide range of providers of health care. 3. It will provide for a new and more effective relationship among health and health-related groups. 4. It will provide for a strengthening of State and local decision-making in the health field through the comprehensive approach to health planning and through greater flexibility provided under the grant programs. In addition, this approach to comprehensive health planning will facilitate the coordination of work by the various State agencies now active in the health care field with each other and with the numerous agencies in the private sector. And, it will also improve the communication between health planners and those with responsibilities in other areas essential to the total development of our abundant resources in North Carolina. There is much to be considered by this Advisory Council. As I indicated earlier, vast progress is evident in health and medicine. But, there is a definite need for greater effort in many areas. There is often a gap between the potential for modern health care and the practice. And, unfortunately, not all citizens have the means or even the initiative to obtain good health care. Costs are increasing, medical and health manpower is more difficult to find, and adequate medical services are not readily available to all citizens. One of the early and high priorties facing this Council is a definition and projection of health manpower needs in order that the educational institutions in this State can make plans to fulfill these needs Study needs to be given the availability of health services in our less populat-ed areas, particularly in the East and the West. Deficiencies must be identified and recommendations made for their correction. The growing metropolitan areas have special problems which must be given attention. The complexity of agencies and services for health care often are confusing and difficult for the would-be consumer to identify. Clarification and simplification are necessary. Attention must be paid to the need for home health services, rehabilitation facilities, nursing homes and other services for the aged and chronically ill. Special services for school age children and emergency medical services for people injured in accidents must be given consideration. Increasing costs will mean increasing problems for the low wage earner and those on welfare. Ways must be found to insure that all have access to adequate medical care. There is an urgent need for a coordinated program of recruitment, develop-ment and placement of health manpower. Attention must be given to the distribution of available health manpower to areas of need with emphasis being given to insure its full and proper utilization. The means must be found for a greater exchange of views and greater understanding between the health services consumer and the provider. Programs to minimize and eliminate environmental health hazards must be stepped up. 12 THE HEALTH BULLETIN January, "l 968 This advisory Council must give careful attention in its planning to insure close coordination and cooperation among all agencies and organizations involved in health services. It is evident from the challenges confronting North Carolina in this area that we cannot afford the luxury of unnecessary duplication. The num-erous State agencies involved must join together with a new unity of purpose. And, the State must work hand in hand with local and Federal governments, private health-related organizations and individuals to get the necessary jobs accomplished. Ladies and gentlemen, today marks the beginning of a great new effort on the part of North Carolinians to insure the finest in health and medical care for all. It is a massive undertaking. Its size, however, is diminished by its importance. The burden of responsibility for the preparation of this Comprehensive Health Plan for the future is not limited to the Advisory Council named today. Nor is it limited to the Office of Comprehensive Health Planning and the various State agencies and departments which will contribute. Success in the planning phase, as in implementation, depends upon the active thought and participation of all concerned with the good health and well-being of their fellowmen. Your assistance, your suggestions, your participation are essential in the development of this Comprehensive Health Plan. We have an opportunity in North Carolina today to move ahead in planning for the attainment of the highest levels of health service for all citizens. With your help, we can succeed in planning and in providing a total health program second to none. Mrs. Kitty Ellington received the annual ,7>uch-coveted Outstanding Service Award from Glenn Flinchum, president of the Public Hea.'.*.'" Academy. January, 1968 THE HEALTH BULLETIN 13 Albert J. Klimas, who has been serv-ing as Director of the Cabarrus County Health Department since October. Klim-as is 37, a native of West Virginia, who completed his work for the M.S.P.H. degree from the University of North Carolina. He came to the North Caro-lina position from Colorado where he was Assistant Chief of the Chronic Dis-ease Section of the State Department of Public Health. 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 J. W. R. Norton, M.D., M.P.H. Director, Local Health Division E. A. Pearson, Jr., D.D.S., M.P.H. Director, Dental Healt>i J}ivision Lynn G. Maddry, Ph.D., M.S.P.H. Director^ Laboratory Division Ben Eaton, Jr., A.B., LL.B. Director, J<i',y,inistrative Services Division Theodore D. Scurletis, M.D. Director, Personal Health Division 14 THE HEALTH BULLETIN January, 1968 Stephanie Crane, Teenage Easter Seal Chairman Brown-haired, green-eyed Stephanie Crane, who was crowned Miss Teenage America before a nationwide television audience last November, has been nam-ed National Teenage Chairman for the 1968 Easter Seal Campaign, Mar. 1 to Apr. 14. Stephanie, who turned 18 in Decem-ber, is from High Ridge, Mo., a suburb of St. Louis, and she is a senior with a B-plus grade average at Cor Jesu Ac-ademy in that city. January, 1968 THE HEALTH BULLETIN 15 THE HEALTH BULLETIN P. O. Box 2091 Raleigh, N. C. 27602 LIBRARIAN DIVISION OF HEALTH AFFAIRS N«C, MEW. H03P, U. N. C. CHAPEL HILL, N.C, If you do NOT wish to con-tinue receiving The Health Bul-letin, please check here i i and return this page to the address above. Printed by The Graphic Press, Inc., Raleigh, N. C' DATES AND EVENTS March 1-2 — Health Careers Congress, Robert E. Lee Hotel, Winston-Salem March 1-3 — American Association of Pathologists & Bacteriologists, Chica-go March 6-7 — NLN Regional Confer-ence, Atlanta, Ga. March 7 — 3rd Annual Wilson Memo-rial Hospital Postgraduate Symposi-um, "Heart Disease in the Child and Adult," Wilson, N. C. March 11-13 - National Health Coun-cil, Los Angeles March 11-13 — 14th Annua! Sectional Meeting for Nurses and Doctors, American College of Surgeons, Wil-liamsburg, Va. March 18-20 — American Academy of Pediatrics, Atlanta, Ga. March 21-22 — Annual Convention North Carolina League for Nursing, Blockade Runner, Wrightsville Beach, N. C. March 22-23 — Annual Convention Stu-dent Nurse Association of N. C, Blockade Runner, Wrightsville Beach, N. C. March 22-23 - 2nd National Congress on the Socio-Economics of Health Care, The Palmer House, Chicago, III. March 25-28 — 6th Annual Meeting for Registered Nurses, Sponsored by Southeastern Surgical Congress, Sher-aton Park Hotel, Washington, D. C. April 3-5 — 4th Annual Migrant Health Conference, Reidsville April 4-6 — 3rd National Conference on Health Education of the Public, Pick Congress Hotel, Chicago, III. April 19-20 — Population Association of America, Boston, Mass. April 19-20 — American College of Surgeons, Blockade Runner, Wrights-ville Beach April 21-22 - Annual Meeting, N. C. Conference for Social Service, Sir Wal-ter Hotel, Raleigh April 30-May 1 — Tuberculosis Associ-ation Annual Meeting, Heart of Char-lotte Motel, Charlotte, N. C. 16 THE HEALTH BULLETIN January, 1968 \/, ^ / ^fr Jf^i^/ Lort and Lisa Yauch, 4-year-old identical twins, are 1968 National Easter Seal Children. The daughters of Mr. and Mrs. Gail Yauch of Detroit, the girls both are victims of cerebral palsy resulting in spastic paraplegia. But, with the help of skilled physical and occupational thera-pists at their Easter Seal treatment center, they are learning to over-come their handicap and preparing themselves for the demands of life. THE LONGEVITY OF DECEASED AMERICAN PRESIDENTS, VICE PRESIDENTS, AND CANDIDATES FOR PRESIDENT Presidents Excluding Those All Assassinated Average Number of Years Lived 68.5 70.7 Pre-Civll War 74.2 * Post-Civil War 63.4 66.6 Average Years Lived Above or Below Expectation of Life at Inaugurationt. -3.6 -1.5 Pre-Civil War +1.3 * Post-Civil War -7.9 -4.8 The North Carolina Human Bet-termenf League: An Idea Come of Age By Chester Davis The North Carolina Human Better-ment League, which celebrated its 20th anniversary this past year, is less impor-tant as an organization than as a sym-bol of an idea that has come of age. When the league was organized in 1947, birth control concerned a hand-ful of zealous reformers like Margaret Sanger and a very few, far-sighted men who suspected that Thomas Robert Malthus just might be right. Elsewhere there was either powerful opposition— that of the Catholic church, for ex-ample— or a public distaste for open discussion of such untidy matters as contraceptives, sterilization and abor-tion. Opposition Wavers While the opposition continues, it appears to be wavering. The tradition-al Catholic position on birth control is challenged now by growing and in-creasingly articulate forces within the church. And public distaste promises to become a relic of our prim Puritan past. The freedom with which we now discuss the pill and related matters is a measure of the change that has taken place, it is change born of reality—the reality of the population explosion which is no longer a prospect but a fact. Demographers report that when men and women first began experimenting with the geometric progression of birth it required half a million years or so— until about 1650, they say-for world population to reach the half billion mark. Then, in 200 years, it doubled, passing the billion mark by 1850. It doubled again in the next 100 years. By 1966, world population was put at 3.4 billion. The demographers estimate that by 2000-34 years away-there will be 6.8 billion people on earth. This has consequences which trans-late into terms of numbers and quality. February, 1968 THE HEALTH BULLETIN The Least Able The problem of quality results from the fact that the least fit are doing most of the breeding. In international terms, it is the so-called developing nations of Africa, Asia and Latin America which have the highest birth rates. These, of course, are the nations least able to feed their populations, much less their projected populations. In terms of individuals, the quality problem results from the fact the birth rate is the highest—about two to one— among those least qualified for parent-hood; the mentally, physically, genetic-ally, (and, for these reasons, the eco-nomically) scrub stock. As William Penn noted, we breed horses and dogs with greater care than we breed human beings. The long-range implications are not pleasant. The problem of sheer numbers— a problem now growing at the rate of 60 million a year—has even more immedi-ate and distressing implications. It will determine, for example: —How much we will have to eat. —The quality of our standard of living. —The degree and rapidity in which we foul our environment with our own wastes. The economic cost we pay because of our inability to check the run-away birth rate has not been totaled. It undoubtedly is staggering, because it includes the cost of famine, air and water pollution, and growing public health and public welfare costs. We have reached the crossroads Mal-thus predicted for us. Either we check the world's birth rate immediately and substantially or it will be done for us by what he described as the three ulti-mate population controls: War (prob-ably nuclear), famine and epidemic disease. In 1947, when the North Carolina Rules and Regulations Governing Ambulance Service Copies of Rules and Regulations gov-erning Ambulance Service of the North Carolina State Board of Health, adopted October 12, 1967, are available on re-quest, as a Supplement to the North Carolina Health Bulletin from the Acci-dent Prevention Section, Division of Epidemiology, North Carolina State Board of Health, Raleigh, North Caro-lina 27602. THE HEALTH BULLETIN First Published—April 1886 The official publication of the North Caro-lina State Board of Health, 608 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 Charles M Cameron. Jr., M.D., M.P.H. Raleigh John C. Lumsden, B.C.H.E. Jacob Koomen, Jr., M.D., M.P.H. John Andrews, B.S. Glenn A. Flinchum, B.S. H w. Stevens, M.D., M.P.H., Asheville Guest Ed.-Edwin S. Preston, M.A.,LL.D. Vol.83 February, 1968 No. 2 THE HEALTH BULLETIN February, 1968 Human Betterment League was organ-ized, the focus was on the problem of quality more than number. Dr. Clar-ence J. Gamble of Milton, Mass., a geneticist who built an international reputation at both Harvard University and at the University of Pennsylvania, was particularly concerned with genetic and economic folly in human breeding. Draft Rejectees In the period immediately after World War 11, Gamble became in-trigued by North Carolina's startling rejection rate (14 per cent in 1942 and 48 per cent in 1944) of draftees for reasons of mental illness or mental re-tardation. At Gamble's instigation. Miss Else Wulkop, a medical social worker, came to the state to explore the facts behind these statistics. With the assistance of Dr. A. M. Jordan, an educational psy-chologist at the University of North Carolina, the intelligence level of the school children of a rural county (Or-ange) was tested. The results of this test caught the eye of James G. Hanes, then president of the Hanes Hosiery Corp. Hanes asked that a similar study be made of the children of an urban county. This was done in Forsyth County. The results of the two studies—each reflecting an alarming incidence of mental problems, both illness and re-tardation— was combined with addi-tional data gathered by Miss Wulkop and resulted in the formation of the Human Betterment League in 1947. it was the first of a number of such leagues. Its essential purpose, then and now, was to educate the people of the state regarding the need for an effec-tive, intelligent program of birth con-trol and to instruct them regarding the tools — and the use of the tools — of birth conrtol. Broadens Emphasis Initially, the league emphasized the quality by concentrating on programs calculated to curb births, control the least fit. More recently the league has added its voice to those of similar or-ganizations around the world to preach the need to control human numbers lest we breed ourselves out of standing room. During its formative years, the league pushed for more effective use of the state's Eugenics Law. This law, adopted in 1933 and since amended, creates a Eugenics Board which consists of the secretary of the State Board of Health, the commission-er of public welfare, the attorney gen-eral, the chief medical officer of the State Hospital in Raleigh and one other medical officer from a public mental institution elsewhere in the state. The board, operating on a limited ($25,000 for the 1964-66) budget meets quarterly to pass on cases proposed for selective sterilization by the directors of the state's hospitals for the mentally ill and retarded and from the superin-tendents of the various county public health departments. The Eugenics Board can order steri-lization in four types of cases: —Where it is in the best interest of the patient, mentally, physically or morally. —Where the operation is ruled to be in the public interest. —Where there is a request made by the guardian of a mental patient. —Where hereditary mental or phy-sical ailments are likely to be trans-mitted to the child. Appeals from the board's orders to the courts are possible, but they are uncommon because the cases are care-fully selected. The operation is simple. For males February, 1968 THE HEALTH BULLETIN (the vasectomy), it consists of cutting and tying off the tubes through which sperm moves. For women (the salping-ectomy), it consists of cutting and tying the fallopian tubes through which the egg moves. In terms of sex, these operations have only one effect; they forever pre-vent conception. The sex function it-self is not in any way impaired. In fact, studies suggest that sexual grati-fication more often than not is en-hanced because of the removal of the fear of pregnancy. From 1934 until 1947, when the league was formed, a total of only 1 ,- 827 sterilizations had been performed under the state law: 1,214 patients were feebleminded, 385 insane, and 228 suffered from epilepsy and other heriditary afflictions. In 1947 this state ranked 17 among the 27 states having similar laws. Since then, and largely because of the educa-tional work done by the league. North Carolina rather regularly has led other states in protective sterilization. Even so, the number of cases—an average of something like 250 to 300 a year—processed under the state's eugenics program is not large. It is likely to increase somewhat in the im-mediate future because the 1963 Gen-eral Assembly amended the Eugenics Law to remove the possibility of a surgeon performing protective steriliza-tion being held guilty of mayhem, an ancient felony that has come down to us out of English common law. Moreover, the sterilizations perform-ed under the Eugenics Law represent less than 10 per cent of the total steril-izations performed each year in this state. A 1959 study of 83 hospitals in North Carolina indicated that an aver-age of 2,880 tubal litigations (protec-tive sterilizations) were being perform-ed each year. More than 90 per cent of these were voluntary, and most of them were done for the convenience of the patient and because the patient was unable to risk the burden and cost of more children. Results of Studies Studies indicate that for every 100 feebleminded women (and 200 men) who undergo this operation the birth of 90 retarded children is prevented each year. The social and economic consequen-ces of this are apparent. The program helps reduce the birth rate among the least fit. And, accord-ing to the record, the term "least fit" has no racial connotation. Sterilizations under the Eugenics Law rather closely follow the white-Negro ratio of our population. The program also reduces welfare and health costs. Equally important, it protects unfit parents from the crush-ing burdens of family, and at the same time insures against the tragedy that results when a child of normal intel-ligence is born to retarded or insane parents. In recent years, as the league's in-terests came to encompass the sheer number of our birth rate as well as the quality of the children being born, em-phasis has been placed on local family planning clinics. North Carolina was the first state to include birth control—counseling about contraceptive devices— in its public health program. It was not, however, until the forma-tion of a family planning clinic in Mecklenburg County in 1960 that this program really began to roll. Large-Scale Control The oral contraceptive—the pill-greatly enhanced the prospects of large-scale birth control programs. By 1962, the Mecklenburg clinic had 99 women (each with a history of one to 12 preg-nancies and none able to support a child) taking Enovid, an oral contracep- THE HEALTH BULLETIN February, 1968 five which had proved highly success-ful in mass experiments in Puerto Rico. The cost was $2 a month for each pa-tient, and the director of the clinic said that in the first 13 months this pro-gram saved Mecklenburg taxpayers more than $20,000. Equally important, it saved 99 women from burdens they were incapable of bearing. In June 1964, thanks to spade work done by the league, by John McDowell, director of Forsyth's public welfare pro-gram, and Roger Sloop, a member of the local board of healtn, a similar clinic was established in Forsyth Coun-ty. Administered by the Bowman Gray School of Medicine and directed by Dr. Henry C. O'Roark II, this clinic had 200 participants in its first four months. That pace has accelerated. Similar clinics, few of them as large as those in Forsyth and Mecklenburg, now exist in some 90 local health and welfare departments in this state. Attitudes Changes This development reflects a funda-mental change in public attitude in the past two decades. This is not peculiar to North Carolina. The same change is occurring elsewhere. It is seen in many ways. For example: —Until recently two states—Mas-sachusetts and Connecticut—had laws which forbade anyone, including phy-sicians, from giving out information or devices related to birth control. The Connecticut law was declared uncon-stitutional by the U.S. Supreme Court in 1965. —At the state level, the trend is to-ward removing blocks to effective birth control programs. In 1967, for example, the North Carolina General Assembly greatly liberalized this state's abortion law. There is accumulating evidence of all sorts to indicate that we are evolving a planned society. There are few areas where this evidence is as clearly seen as in birth control. —In 1959, Dwight D. Eisenhower said that birth control was not a mat-ter that should interest the federal gov-ernment. In 1963, in an article in the Saturday Evening Post, Eisenhower firmly, clearly changed his position. —In fiscal 1966, the federal govern-ment spent $4 million on birth control. The amount was doubled in 1967. In August of this year, the Department of Health, Education and Welfare estab-lished an office to administer birth con-trol programs. In this same period, birth control was given increasing at-tention in anti-poverty programs. More Interest —Private foundations—the Ford Foundation for one—are becoming in-creasingly active in the family planning field. —Last year, the United Nations for the first time took an unequivocal, strong position endorsing an all-out, international effort to control popula-tion. This change results from two inter-acting causes: The dire predictions of Malthus have become realities; organ-izations like the North Carolina Hu-man Betterment League—and there are now many of them here and abroad —have opened the eyes of the world to an alternative to the cruel and ultimate population controls, war, famine and plague. It is the alternative of con-trolling our numbers and their quality by the intelligent use of the birth con-trol knowledge we possess. Since 1948, the American Heart As-sociation and its affiliates and subdi-visions, such as the North Carolina Heart Association, have chan^eled more than $120 million into research. The Heart Association is the largest source of non-governmental research support in the cardiovascular field. February, 1968 THE HEALTH BULLETIN Physician May Treat Minor's Venereal Disease It has long been held in most states that a physician who treats a minor without parental consent—except in a medical emergency—may be liable to charges of assault and battery. In North Carolina the attorney gen-eral ruled some years ago that "the situation when a person is infected with a venereal disease is quite different from that of other types of illness re-quiring treatment so far as a minor is concerned." The law (Section 130-96) states: "state and local health directors, or authorized agents under their super-vision within their respective jurisdic-tions, are hereby empowered and di-rected, when it is necessary to protect the public health, to make examinations of persons reasonably suspected of be-ing infected with venereal disease, and to detain such persons until the results of such examinations are known, and to isolate or quarantine persons with a venereal disease when it is neces-sary to protect the public health. Per-sons infected with a venereal disease shall report for treatment to a licensed physician and continue treatment until the disease is no longer communicable." In the attorney general's opinion "no parental consent is necessary for the physician's protection in administering treatment to a minor for a venereal disease because the above-quoted sta-tute furnishes the physician complete protection." Home Accidents Kill Nearly 30,000 Americans were killed and well over four million others in-jured in home accidents in 1966. That's why the National Society for Crippled Children and Adults has launched an all-out campaign to call attention to home safety. According to National Safety Council estimates, more deaths—some 40 per-cent— took place in bedrooms. But the greatest number of disabling injuries occurred in kitchens—well over a mil-lion persons were hurt in kitchen ac-cidents during the year. Major home accident categories, as detailed in the Easter Seal Home Safety Checklist, and the numbers killed dur-ing the year are as follows: « FALLS: The greatest home danger is from falling. An estimated 11,800 persons were killed during the year, and many thousands more received disabling injuries. • FIRE: A total of 6,800 persons died from fires, burns and related causes including asphyxiation, falls and falling objects related with home fires. • POISONING: A total of 2,800 per-sons died from poisoning in the home. Common causes were med-icines, household poisons, carbon monoxide. • SUFFOCATION: Some 2,500 persons died at home from choking on in-gested objects, smothering and strangulation. • FIREARMS: Gun accidents killed 1,500 persons at home. Many took place while cleaning or playing with weapons. OTHER: Miscellaneous accidents claimed 4,100 lives in American homes, including drownings, elec-trical shocks and other accidents. 8 THE HEALTH BULLETIN February, 1968 Nat-ional Policy For Elderly Proposed Establishment of national standards and goals for meeting the problems of older people in certain crucial areas was called for today by Milton J. Shapp, chairman of the public policy committee of the National Council On the Aging. In testimony before the Special Sen-ate Committee on Aging Mr. Shapp noted that many advances have been made since the first national confer-ence on aging, held in 1950. He sug-gested that the "time has now come to establish some national standards and goals for the elderly in certain crucial areas—to measure the need, to define ways of meeting the need, to estimate the cost, and to establish target dates." Among the specific recommenda-tions made by Mr. Shapp, a Pennsyl-vania industrialist who was the 1966 Democratic candidate for governor of his state, were: • launching of a national study to determine means by which federal support could be given to localities granting older people exemption from real estate taxes • another national conference on aging, preferably by the end of 1969, to establish national goals, to make recommendations for public policy to realize these goals, and to give direction to studies and smaller meetings in advance of the confer-ence • preparation by the special Senate committee on aging of estimated needs and costs involved in such a national effort • use of a consumer purchasing power index in establishing a price tag on the abolition of poverty. Mr. Shapp noted that the social secur-ity benefit increases proposed would increase the minimum to $840 a year for an individual and $1,260 a year for a couple. This would mean, he said, that the average social security benefit would still be slightly below the poverty level. In urging abandonment of the "piecemeal" approach to problems of older people in favor of a national policy, Mr. Shapp said: "These methods have brought results in war efforts, in space exploration, in public highway construction and—to an extent— in public education. "We can do no less with regard to human goals for the older people of the nation. "The elimination of poverty in old age," the NCOA spokesman said, "must have first priority as a national goal. It is now estimated that some five to seven million people over 65 in this country live in poverty. Forty percent of the women living alone or with non-relatives are poor. Non-white families are almost three times as likely to be poor as are the whte aged of the same family status." Mr. Shapp also emphasized the housing needs of older people noting that nearly three million older people in 1960 were living in dilapidated, de-teriorating housing, hazardous to health and contributing to social breakdown. Nearly four and a half million dwelling units are needed to overcome the acute shortage of appropriate housing for the elderly. February, 1968 THE HEALTH BULLETIN Physical Changes May Explain Relapses In Drug Habit The perplexing cycle of drug addic-tion, treatment, and relapse may be partially explained by physical changes in the body which compel addicts to resume their habit up to eight months after withdrawal. New findings reported at the Nation-al Institute of Mental Health Addiction Reserach Center in Lexington, Kentucky show that morphine withdrawal causes two distinct phases of physiological changes in the body which may also alter behavior. The physical effects of withdrawal were previously known to last only three or four weeks, but a series of studies in both rats and men indicates that the "withdrawal syndrome" may persist for up to 30 weeks. These findings may partially explain why 90 percent of the addicts who relapse do so within six months after treatment. Relapse of addicts is a seri-ous problem since some studies show that 80 to 90 percent of the treated addicts eventually return to the habit. The new findings show that patients have lower than normal blood pressure, slow pulse rate, and low body tempera-ture after about nine weeks of absti-nence, which is the opposite of early effects of withdrawal. These symptoms, as well as a marked decrease in the respiratory center's sensitivity to car-bon dioxide, last up to 30 weeks. Immediate withdrawal of morphine produces severe physical reactions, although gradual reduction of the drug and the use of medications can make withdrawal easier for the patients. How-ever, high blood pressure, rapid pulse rate, and high body temperature usual-ly persist for three or four weeks. Another related finding is the discov-ery of elevated levels of epinephrine in the urine of test subjects several months after withdrawal. Epinephrine is produced by the adrenal gland and may be liberated in excess quantities during stress. In addition, studies in rats indicate that the withdrawn subjects have a greater "appetite" for drugs than non-addicted subjects for a long period after withdrawal. The investigators. Dr. W. R. Martin and Dr. D. R. Jasinski, say that the find-ings suggest that dependence on mor-phine may cause changes in the central nervous system that last for several months and produce altered physiologi-cal functions, an altered psyche, and increased drug-seeking behavior. Dr. Martin is the chief of the Addic-tion Research Center and Dr. Jasinski is chief of the opiate unit at the Center. 10 THE HEALTH BULLETIN February, 1968 or "Run for your life—or jog—or walk-but don't just sit there!" One hears this advice increasingly these days, and therefore the U.S. |\m^ Public Health Service's National Center for Chronic Disease Control is engaged in examining what occurs if you follow those simple suggestions. rQi* In support of the hypothesis that some form of habitual physical activity helps reduce the chances of having a heart attack, the National Center's Heart ^^f\mnm Disease Control Program is coordinat-ing Center-sponsored physical exercise research programs, including projects at three State universities—Minnesota, I l£^ Wisconsin, and Penn State. At each of the universities exercise programs consist of walking, jogging or running, and calisthenics or modified game activities. All activities are sup-ervised by trained personnel. Participa-tion is on the basis of 45 minutes each day, three days a week. At Minnesota, I men were selected at random from two JOQ of the local census tracts. At Wisconsin, the group consists of middle-aged pro-fessors, while at Penn State, participants ^^^^__ include a cross-section of male uni-versity employees. These projects were designed to an- Q swer several questions: D**r — What is the most effective way to identify individuals in the community who are at greater than average risk I of developing coronary heart disease? tJUSi — What influences an individual's de-cision whether or not to participate in a physical activity program? And if he decides to participate, what influences ^OH I ^'"^ ^° continue to participate on a reg-ular basis over a long period of time? — What problems are involved in or-ganizing and administering group phy-sical activity programs? — What effects does participation in physical activity programs have on a person's health in terms of reducing his February, 1968 THE HEALTH BULLETIN 11 Sit There risk of developing a heart attack and in changing his health attitudes and health habits? A long range goal of the overall re-search effort is the eventual develop-ment of coordinated physical activity progranns in the nation's communities if future research demonstrates that in-creased physical activity reduces the number and severity of heart attacks. The projects, now entering their second year of operation, are providing university scientists and Heart Disease Control Program specialists the oppor-tunity to study the effects of various types of physical activity upon selected groups of individuals. Participating at- the three universities are approxi-mately 450 men between the ages of 40 and 59. As a group, all of these men were characterized by certain con-ditions or living habits that increased their chances of a heart attack. These include: — Overweight — High blood pressure — High cholesterol content in the blood — Cigarette smoking — Lack of major habitual physical activity In the studies, participants are di-vided about equally into two groups; one that exercises and one that does not. Periodically both groups are ex-amined to determine what changes, if any, have occurred in their health sta-tus attitudes and habits. Preliminary findings to date are en-couraging. All three schools point to improvements in the general health of the exercise participants. At the Uni-versity of Minnesota where the project has been in operation the longest, there has been among other things, consider-able improvement in "heart rate re-sponse"— the ability of the heart to withstand increasing amounts of phy-sical exertion at lower pulse rates. As one participant put it—"we aren't huff-ing and puffing as much as we used to." Perhaps the most significant finding to date, however, is the conclusion that individuals can be encouraged to ex-ercise on a regular basis over a con-tinuing period of time, provided: — They are properly oriented to op-portunities for exercise and the pos-sible health benefits to be derived. — The type of exercise to be per-formed is determined, at least partial-ly, by individual preferences. Of major concern at this time is the question of whether the present ex-ercise programs are sufficient to reduce the participants' risk of developing heart disease. Project directors also hope to find ways of motivating in-dividuals to continue some appropriate type of exercise after they leave or-ganized programs. Dr. Bruno Baike, director of the Uni-versity of Wisconsin project, believes the latter point may resolve itself, ex-plaining: "Many participants already are or-ganizing their own exercise groups against the day when our project ends." Dr. BaIke, along with project direc-tors at the other two universities. Dr. Henry L. Taylor, Minnesota, and Dr. Elsworth Buskirk, Pennsylvania State University, is convinced that data pro-vided by the present series of projects will become foundation blocks in the long range efforts, not only to prevent heart attacks, but also to help victims of heart attacks to recover from them. The doctor should be called immedi-ately when a stroke occurs so that he ' can determine the proper individualized ' treatment for each patient, the North Carolina Heart Association advises. 12 THE HEALTH BULLETIN February, 1968 EASTER SEAL HOME SAFETY CAMPAIGN 1 . He's fascinated by fire, a major cause of home iniuries. The Easter Seal Home Safety Checklist shows how to make your home o safer place to live. 2. She's heading for a fall, the cause of nearly 12,000 deaths last year and a major contributor to the nearly Ao million disabling injuries. Get a copy of the Easter Seal Home Safety Checklist. 3. The medicine chest is a source of danger for younger children. The Easter Seal Home Safety Checklist will tell you how to protect your children from poisoning end other home threats. THE NATIONAL SOCIETY FOR CRIPPLED CHILDREN AND ADULTS 2023 W. Ogden Avenue Chicago, I Mlnois 6061 2 February, 1968 THE HEALTH BULLETIN 13 Senator Belk Receives Award The American Cancer Society has awarded its 1967 Distinguished Serv-ice Award to Charlotte businessman and former Senator from Mecklenburg Coun-ty, Irwin Belk. The award is the highest honor in the Society. Belk is the immediate past president of the North Carolina Division, Ameri-can Cancer Society, and has done volun-teer work for the organization on both the local and state levels. At present he serves as Chairman of the Nominating Committee as well as a member of the Division Executive Committee. He also serves as Chairman of the Committee to Study the Utilization of Local Facil-ities for the Improvement of Patient Care for the Governor's Cancer Com-mission. President of Belk Enterprises, Mr. Belk is the ninth person to receive this award. Other recipients are Dr. Ivan Proctor, Raleigh; Judge John D. Larkins, Jr., Trenton; Dr. H. Fleming Fuller, Kin-ston; Dr. Donald B. Koonce, Wilming-ton; Dr. H. Max Schiebel, Durham; Dr. John R. Kernodle, Burlington; Dr. Paul Kimmelsteil, Milwaukee, Wisconsin; and Mr. John R. Jordan, Jr., Raleigh. i\ In recent years, population studies have developed a "coronary risk pro-file " for high-risk America, the North Carolina Heart Association reports. With its assistance, physicians can readi-ly identify "coronary-prone" individuals years before open symptoms appear-and can suggest changes in their way of life or other measures to help ward off the potential heart attack or stroke. i 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. , ALP.H. Director, Epidemiology Division J. W. R. Norton, M.D., M.P.H. Director, Local 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. 3., LL.B. . Director, Adtninistrative Services Division Theodore D. Scurletis, M.D. 1. Director, Personal Health Division 14 THE HEALTH BULLETIN February, 1968 Heart Transplant- Conference Held The American Heart Association, in order to provide reassurance to the public and counteract any anxieties that heart transplant surgery might be pre-mature, called a conference early this year in New York City to clarify its position on the advisability of this ne\N surgical technique. The panel discussing the question of heart transplants was composed of Dr. Jesse E. Edwards, President of the American Heart Association and Clini-cal Professor of Pathology at the Uni-versity of Minnesota School of Medi-cine. Dr. Michael E. DeBakey, head of the world's largest cardiovascular center at Baylor University College of Medicine, Houston, and renowned for his accom-plishments in the development of mechanical boosting pumps to help faltering hearts; Dr. John P. Merrill, Director of the Cardio-renal Section, Peter Bent Brigham Hospital, Boston, and leading authority on kidney trans-plantation; Dr. John H. Gibson, Jr., one of the developers of the heart-lung machine which has made possible open-heart surgery and, ultimately, heart trans-plants; Dr. William L. Glenn, Professor of Surgery at Yale University School of Medicine, developer of surgical pro-cedures to relieve congenital defects, and a pioneer in pacemaker develop-ment; Dr. Earl B. Mahoney, Chairman of the American Heart Association's Council on Cardiovascular Surgery and a Professor in the Department of Sur-gery at Strong Memorial Hospital, Rochester, N. Y.; and Dr. Lewis E. Jan-uary, Immediate Past President of Amer-ican Heart Association, and Professor of Medicine at the State University of Iowa College of Medicine. The 17th Southern Water Resources and Pollution Control Conference will be held April 16-18, 1968, at the Uni-versity of North Carolina, Chapel Hill, North Carolina. This annual Conference is co-sponsored by the Department of Environmental Sciences and Engineering at the University of North Carolina, and Departments of Civil Engineering at North Carolina University and Duke University. The 17th Conference will feature presentations and discussions on the technology of water resources and water quality management with particular reference to the southeastern United States. A detailed program will be available about January 1, 1968. For additional information, please write to Dr. Charles M. Weiss, Chairman Operat-ing Committee, 17th SWRPC Confer-ence, Department of Environmental Sciences and Engineering, P. O. Box 630, Chapel Hill, North Carolina 27514. Rachel D. Davis, M.D., prominent Kinston physician and outstanding civic and educational leader, was elected President of the North Carolina Divi-sion, American Cancer Society. She succeeds Senator Irwin Belk of Char-lotte in this post. Deaths caused by high blood pres-sure have dropped 52 per cent in the past 20 years for Tarheel men between the ages of 45 and 64. The North Car-olina Heart Association says that ad-vances in the treatment of high blood pressure, made possible by Heart As-sociation- supported scientific research, is a major factor in this saving of lives. February, 1968 THE HEALTH BULLETIN 15 THE HEALTH BULLETIN P. O. Box 2091 Raleigh, N. C. 27602 LIBRARIAN DIVISION OF HEALTH AFFAIR:. LIEaA N.C* ME:!4. H03P. U* N- C. CHAPEL HILL, N.C. If you do NOT wish to con-tinue receiving The Health Bul-letin, please check here i i and return this page to the address above. Printed by The Graphic Press, Inc., Raleigh, N. C Dates & Events April 21-22 — Annual Meeting, N. C. Conference for Social Service, Sir Wal-ter Hotel, Raleigh April 30-May 1 — Tuberculosis Associ-ation Annual Meeting, Heart of Char-lotte Motel, Charlotte, N. C. May 9-10 - Western Branch, N. C. Public Health Association, High Hannpton Inn, Cashiers, N. C. May 13-17 — Biennnial Conven-tion: Annerican Nurses' Association, Dallas, Texas May 15-17 — Meeting: 38th Annual Statewide Industrial Safety Confer-ence, Jack Tar Hotel, Durham May 16 — N. C. Association of Indus-trial Nurses, Durham May 19-22 — Annual Meeting: Nation-al Tuberculosis Association, Houston, Texas May 27-31 — Annual Meeting: South-ern Branch, APHA, Roanoke, Va. Migrant Projects Fourteen migrant health projects, lo-cated in four states, have recently been av^arded Public Health Service grants totalling $1,797,812, Surgeon General William H. Stewart announced. The grants, authorized by the Migrant Health Act, will be used to improve health services to migrant agricultural workers and their families. Projects will use these funds to provide family health service clinics, medical and dental care, nursing and sanitation serv-ices, health education, and in-hospital care. Florida, a home-base area for many migrants, received the largest number of dollars, $908,588. Projects in Texas, another home area, were awarded $715,742. Colorado received $149,339; Louisiana $24,143. One hundred and fifteen projects in 36 states and Puerto Rico are now receiving Public Health Service support. Grants are made to State or local pub-lic agencies and to non-profit private organizations, which are required to contribute part of the cost of the proj-ects. 16 THE HEALTH BULLETIN February, 1968 %^^3 -iira-u- rofinnnRY? RECEIVED JUN 15 1968 DIVISION OF :alth affairs library Of The Carolina State Board of Health 1968 Distinguished Service Award Eugene Benson Crawford and Elisha Merriman Herndon, senior vice presidents of North Carolina Blue Cross and Blue Shield, Inc., will receive the 1968 Distinguished Service Award of the North Carolina Hospital Association. Selection of Mr. Crawford and Mr. Herndon to receive the award, which is given annually to an individual who has rendered outstanding service to the hospitals of North Carolina, was made by the NCHA Trustees. The two veteran Blue Cross leaders, who have given outstanding encouragement to the concept of prepaid voluntary health care since the movement began in North Carolina in 1933, will receive their awards jointly at the annual meeting of the Hospital Association on June 25 at Wrightsville Beach. Eugene Benson Crawford Elisha Merriman Herndon ARTHUR C. STERN APPOINTED TO UNIVERSITY OF NORTH CAROLINA FACULTY Arthur C. Stern, presently Assistant Director of the National Center for Air Pollution Control, Washington, D. C. has accepted an appointment as Pro-fessor in the Department of Environ-mental Sciences and Engineering of the University of North Carolina School of Public Health. His appointment in the Air and Industrial Hygiene program of the Department v^as facilitated by the Institute for Environmental Health Stu-dies at the University. For all of his professional life. Stern has been in the air and industrial hy-giene field. He was for thirteen years Chief of the Engineering Unit of the Division of Industrial Hygiene in New York State and for seven years was Chief of the Laboratories of Engineering and Physical Sciences of the Division of Air Pollution of the Public Health Serv-ice at the Robert A. Taft Sanitary Eng-ineering Center in Cincinnati. His edu-cational background includes the AA.E. degree in 1930 and the M.S. in 1933 from Stevens Institute of Technology. Stern is listed in Who's Who in Amer-ica, Who's Who in Engineering, and American Men of Science. He is also editor of the three-volume handbook "Air Pollution," published in its second edition this year. Stern in his new faculty position will provide a very close tie between the University and the National Center for Air Pollution Control which is in the process of moving to the Research Triangle of North Carolina only a few miles from the University. THE HEALTH BULLETIN March, 1968 Nationwide Cervical Screening Program Saves Lives Nationwide cervical screening pro-ects, supported by the Public Health Service's National Center for Chronic Disease Control, are responsible for saving or prolonging the lives of thous-ands of American women, according to an analysis of Center reports cover-ing a five year period starting in 1962. Dr. William L. Roberson, Medical Of-ficer responsible for review of the screening proects, said that over one million cytology examinations had been made at various hospitals throughout the country and that cervical cancer was found in more than 6,500 women. More than 4,000 cases of carcinoma in situ were detected. (Cancer is situ means that the malig-nancy is at "stage zero," and that there is no invasion of the normal adjacent tissue. If treated immediately and properly, such cancers are almost TOO percent curable.) There are 143 grant-supported pro-jects in 35 States, the District of Colum-bia, and Puerto Rico. Effort has been concentrated on the low socioeconomic groups because of their risk of cervical cancer. Dr. Roberson pointed out that the Center's Cancer Control Program also supports the American Academy of General Practice in its "Office Detected Cervical Cancer Program," now embrac-ing more than 4,000 physicians in 36 States and the District of Columbia. The Academy Program has been in effect since 1965 and more than 546,- 000 women have been screened, about one-third of them for the first time. A total of 1,059 carcinomas have been detected—865 in situ and 194 invasive, according to latest available reports. Cancer Detection in North Carolina PERSONS EXAMINED IN CANCER DETECTION CENTERS BY PLACE OF RESIOENCE: NORTH CAROLINA. 196? (Total persons examined - 9.552) CANCER DETECTION CENTERS are located in Asheboro Ourha'n El izabeth Ci ty Greensboro Loui sburg Hew Bern New I and North Ui Ikesboro Rdleigh Rocky Hount Rutherfordton Siler City Sylva Ui Imington Windsor The Center Program staff assisted in organizing the State academies for the study. Dr. Roberson said. The project calls for Pap examinations (a very simple cancer test). All patients with suspicious or posi-tive results are followed up to insure that they are disgnosed and treated if cancer is present. Those treated for cancer are scheduled for periodic checks to make sure the therapy is adequate and that there is no recurrence of growth. "The Academy Program establishes the general practitioner's office as an appropriate facility for carrying out this cancer detection project," Dr. Rob-erson said. "It alerts the private phy-sician to the need for adequate exami-nation and follow-up. It shows there is an impressive number of undiagnosed cases among the female population. Its continuation and expansion will mean much to the general good health of our country," Dr. Roberson stated. He added that the number of early cases detected and cured was highly significant and "supports our conten-tion that cervical cancer can be con-trolled if all women will have a pelvic examination and Pap smear at least once a year." Dr. Roberson estimates that about 26 percent of the women over 20 years of age in the United States were cytolog-ically examined in 1966, up from 15 percent in 1963 and 10 percent in 1961. In comparison, Dr. Roberson pointed to British Columbia, a province of Canada, where the annual exami-nation rate is about 65 percent. All screening projects supported by the NCCD subscribe to certain stand-ards such as tissue diagnosis, definitive treatment and adequate follow-up. In other respects, the projects are con-trolled and conducted by the institu-tions receiving the grants. Indian Plants Studied in Cancer Drug Search The Indian government's Central Drug Research Institute at Lucknow has renewed its agreement with the Na-tional Cancer Institute, National Insti-tutes of Health, to study native Indian plants as a source of potential anti-cancer drugs. A U. S. Public Health Service contract, using blocked dollars available under Public Law 480, is pro-viding $136,000 (1,020,400 rupees) to finance the next 3 years of investi-gation. Under the program the Indian re-search center, directed by Dr. M. L. Dhar, collects indigenous plants and from them prepares extracts for study by the National Cancer Institute in Bethesda, Maryland. Dr. Jonathan L. Hartwell, project officer for NC! and head of its Natural Products Section, has the extracts tested for their ability to inhibit animal cancers. THE HEALTH BULLETIN First Published—April 1886 The official publication of the North Caro-lina State Board of Health, 608 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 Charles M. Cameron, Jr., M D., M.P.H. Raleigh John C. Lumsden, B.C.H.E. Jacob Koomen, Jr., M.D., M.P.H. John Andrews, B.S. Glenn A. Flinchum, B.S. H. W. Stevens, M.D., M.P.H., Asheville Guest Ed.—Edwin S. Preston, M.A.,LL.D. Vol. 83 March, 1968 No. 3 THE HEALTH BULLETIN March, 1968 Improved Endoscopes Aid in Early Cancer Detection A contract for the development of five improved endoscopes for viewing internal organs of the body to aid in early detection of cancer has been an-nounced by the Cancer Control Pro-gram of the National Center for Chronic Disease Control, Public Health Service. Dr. William L. Ross, Chief of the Cancer Control Program, said the con-tract for development of the instru-ments is budgeted at $149,222 and v^/ill require approximately 18 months. The contract was awarded to the I IT Re-search Institute, an affiliate of the Il-linois Institute of Technology in Chi-cago. The instruments will be flexible fiber optic probes for viewing the throat, larynx, bronchial tubes, stomach and a portion of the colon which will enable doctors to view the interior of the body without performing surgery. Cancers in these 5 sites will cause al-most 100,000 deaths this year. The endoscopes also will assist doctors in diagnosing other diseases. The contract calls for the develop-ment of new synthetic fibers instead of glass to transmit light around curves in the body organs. The probes also will have a mechanical system allowing maneuverability and control by the ex-aminer. Though glass fibers are flexi-ble, they are not flexible enough to prevent occasional breakage when probes are flexed into sharp bends. Poly-Optics Systems, Inc., Santa Ana, California, will join IITRI in fiber de-velopment. Lighting the body's dar1< interior for examination will be achieved by send-ing light through one or more fiber optic bundles. Another optic bundle will transmit a magnified image back to the examiner through an eyepiece. Several of the instruments will have a channel for extracting biopsy speci-mens and provision for washing the lens without withdrawing the probe. Optical scopes for endoscopic ex-amination (examination of hollow or-gans of the body) were first used over 75 years ago, but their usefulness has been limited because of inflexibility, large diameters, and optical shortcom-ings. The new family of instruments will permit viewing internal areas which have been "blind" spots or entirely inaccessible with former probes. One glass-fiber endoscope for view-ing the lower intestine, which was de-veloped with CCP support, already has undergone tests at the University of Michigan Medical Center under the direction of Dr. Bergein F. Overholt (currently with New York Hospital, Cornell Medical Center, N.Y., N.Y.). Success achieved with the instrument, called a fibersigmoidoscope, prompted the proposed development of the family of five probes. Camera attachments for the instru-ments will permit photographing through them during examinations. The probes will range in length from 15 cm. for the throat probe (laryngo-scope) to 100 cm. for the stomach probe (gastroscope). Diameters will range from 6 mm. to 15 mm. Medical consultants, in addition to Dr. Overholt, who will work with IITRI and the Cancer Control Program in developing the endoscopes are Dr. George M. Conner, Henry Ford Hos-pital, Detroit; Dr. Daniel J. Fall, Uni-versity of Michigan, Ann Arbor; Dr. Jordon D. Mailer, Maimonides Hospital of Brooklyn and State University of New York College of Medicine; and Dr. Marvin Pollard, University of Michigan. March, 1968 THE HEALTH BULLETIN The Problem of Atherosclerosis The problem of atherosclerosis is one of the most crucial medical threats fac-ing the civilized world today, states the North Carolina Heart Association. Year by year, the scourge of this disease be-comes more evident and it knov\/s no class, color, or race distinctions. Exacavation in the Nile Valley has indicated that even the Egyptian pha-roahs of 2000 B.C. suffered from atherosclerosis. Just what is atherosclerosis? Athero-sclerosis, practically speaking, is the deposit of fat material, known as lipids, along the walls of the arteries and, more particularly, the vita! vessels of the heart, brain, kidneys, and extremi-ties. These lipids, usually composed of cholesterol, slowly reduce the diameter of the veins and arteries, making the passage of blood more difficult. In time, these cholesterol deposits may become so great that a vessel or artery is blocked entirely. The effect of atherosclerosis has often been likened to the problem en-countered in old pipes in water sys-tems. With passing years, corrosion and clogging often render pipes in a water system unuseable. When the arteries are blocked, depriving any given por-tion of the body of the blood and en-suing oxygen it needs to maintain life, death occurs in the portion so deprived. Atherosclerosis is known to be the chief cause of coronary artery disease and of cerebral vascular accident (stroke). Western NCPHA Meets at High Hampton Inn, Cashiers, N. C. MAY 9 & 10, 1968 APPLY: RESERVATION MANAGER, HIGH HAMPTON INN, CASHIERS, N. C. PACKAGE RATES: 1. $12.18 (3 to a room) 2. 13.50 (2 to a room) 3. 15.75 (single room) Package rates to include, lodging, buffet, banquet and dance, breakfast, and luncheon, including tax and tips. NON-PACKAGE For those not staying at the Inn. RATES: Banquet and dance $5.00 Luncheon 2.50 Breakfast 1.50 Registration begins Thursday, 2-7 P.M. and Friday 8-12 Noon. Registration is $3.00. Wives and/or husbands of members and nonpublic health guests register gratis. THE HEALTH BULLETIN March, 1968 Older Americans Spend Five Times the Medicine Cost for the Young Americans aged 65 years and older spent about five times as much for prescribed medicines in a one-year period as did young people aged 15-24 years, according to Wilbur J. Cohen, Acting Secretary of Health, Education, and Welfare. Mr. Cohen said persons 65 years and older spent an annual average of $41.40 compared to $8.10 by persons aged 1 5-24 years. He reported on a study which in-volved a nationwide sampling of the civilian, noninstitutional population by household interviews. Approximately 42,000 households were visited, com-prising about 134,000 persons. "The largest part of the average of $41.40 spent by persons 65 years and older was $7.10 for treatment of high blood pressure," Mr. Cohen said. The next largest amount was $5.70 for treatment of heart conditions. Women 65 years and older annually spent more on the average ($46.70) than men ($34.70) for prescribed med-icines, Mr. Cohen pointed out. Women spent the largest part ($9.70) for treat-ment of high blood pressure, followed by $5.50 for treatment of heart con-ditions. Men spent the most ($6.00) for treatment of heart conditions and $3.90 for treatment of high blood pressure. Prescribed medicines were defined in the study as: (1) medicines obtained by a physician's written prescription, including refills; (2) medicines prepared on the basis of a physician's telephone order to a pharmacist; and (3) med-icines given by a physician or his as-sistant to a patient to take home. The survey also obtained information on costs and uses of nonprescribed medicines—those obtained without pre-scriptions, including pills, tonics, salves, ointments, and first-aid supplies. For nonprescribed medicines, Mr. Cohen noted that persons 65 years and older spent on the average the largest amount ($2.30 per person) for aspirin and its compounds. The next largest amount ($1.70) was used for vitamins by this age group. Women 65 years and older on the average spent the largest part ($2.60) of their expense for nonprescribed med-icines to buy aspirin and its compounds, compared to $2 for men in the same age group. Again, the second largest amount was spent on vitamins— $1 .80 for men and $1.70 for women. Automated Test for Heart Disorders in Babies Doctors may one day call upon the computer to help detect heart disease in newborn infants and other young children. An automated system for analyzing the pediatric electrocardiogram (ECG)— a test for heart disorders in babies and children— is being developed by the Public Health Service's National Center for Chronic Disease Control, under the direction of Dr. Lowell W. Perry. "Each year an estimated 20,000 babies are born with congenital heart disease in the United States," according to Dr. Perry, chief of the Pediatric Sec-tion of the Center's Heart Disease Con-trol Program. "Deaths among these babies most often occur during the period shortly after birth, especially during the first month of life. In ad-dition, from one to two of every 1,000 school-aged children presently have undetected heart disease." March, 1968 THE HEALTH BULLETIN Where the Eastern District NCPHA Will Hold Its Annual Meeting June 6-7 at Atlantic Beach ^htett^ir^s. THE HEALTH BULLETIN March, 1968 EASTERN DISTRICT NORTH CAROLINA PUBLIC HEALTH ASSOCIATION ANNUAL MEETING John Yancey Motor Hotel, Atlantic Beach, North Carolina June 5 and 7, 1968 Preliminary Program THEME: Viewpoints of Comprehensive Public Health Planning in North Carolina ThurscJay, June 6 Registration 1:00- 4:00 P.M. First General Session 4:00- 5:00 Business Meeting Hospitality and Fun Session 8:00-11:00 P.M. Friday, June 7 Registration 8:30- 9:30 A.M. Second General Session 9:30-12:00 Noon Presiding I. S. Canady, President Elect Comprehensive Health Planning in North Carolina John Alexander McMahon, Chairman, Advisory Council on Comprehen-sive Health Planning; President, North Carolina Blue Cross and Blue Shield, Inc. Ten Minute Break Panel: Public Health From Three Angles Moderator Dr. Jacob Koomen, State Health Director Management of Public Health Personnel E. Clark Edwards, Personnel Director, State Board of Health Current Trends in Public Health Personnel Administration Claude E. Caldwell, Director, State Personnel Department Public Health Outlook as Viewed by County Commissioners John T. Morrisey, Executive Secretary, North Carolina Association of County Commissioners Section Meetings 1:30- 3:30 P.M. Third General Session 3:45 Reports and Announcement of New Officers Fourth General Session 6:30- 7:30 Happy Hour Buffet Banquet 7:30- 9:00 Adjournment 9:00 Dance ^ 9:00- 1:00 A.M. March, 1968 THE HEALTH BULLETIN That's What GRANDFATHERS Are Made Of BY BERNICE JANE HERMAN MY husband doesn't play the oboe, grow mushrooms in the basement or crossbreed guppies. He has no col-lections under glass, no enrichment hobbies. But he's not unsettled by semiretirement nor troubled about identity. He knows who he is and so do his grandchildren. He's a grand-father. Right now the scoreboard reads eight, but this is an ex-panding market and precise tabulation may not be accurate. My husband doesn't fret. He's having a great time. "Who's coming today?" he frequently asks. "Tommy," I answer, or Ellen or Bill, Matthew or Janie, Eric, John, Michael or any possible combination. Think of a name and we probably have it. If not, we will. "Fine," he says and cancels appointments, declaring he'll stay home and help with the grandchildren. This makes me purr as I sometimes feel engulfed when grandchildren visit in platoons. I welcome any help Grandpa can give. What is the why of grandfathers? As babysitting fathers, many of them were absolute duds. They may have been good providers and tender husbands, but child care was woman's work. My husband, faithful to the mores of his times, didn't dare to be a father. Only sissies pushed their own baby carriages. A man might push a neighbor's baby carriage if the neigh-bor was pretty, but an ail-American husband didn't take care of his own children. In those days husbands weren't conditioned by matricula-tion in and graduation from an expectant-parent course. They would have been frightfully discomfited bathing a naked doll in a basin in front of a coeducational class. They would have balked at homework that demanded studying a diaper-changing manual or instructions on how to time the labor pains. Most of them were embarrassed by pregnancy. Not one of them discussed it on the commuters' train. If they en-countered it on the street they looked the other way. Father-hood overwhelmed and frightened them. If they confided their expectancy they avoided a declaration of truth and whispered they were expecting a "surprise." Many of them reacted with gross responsibility. They worked double time and became overcautious, overinsured, overinvested and overtired. Reprinted by permission of Woman's Day Magazine. Copy-right (C) 1966 by Fawcett Publications Inc. 10 THE HEALTH BULLETIN March, 1968 I Happily, those fathers make splendid grandfathers. They seem to know that what you do with children isn't as im-portant as how you do it or what you say as important as how you say it. So they enjoy. My husband takes grand-children to the fire station. He spends more time there than a stray cat. As a boy he liked to stand just inside the door of the fire station, petting the Dalmatian with the red eyes and feeling fascinated by the spic-and-span floor, the highly polished brass and the smell of horses in their stalls. Always he waited for the rare times when the fire alarm rang and the firemen slid down the poles while the har-nesses, suspended from above dropped down on the horses. Perhaps grandfathers have never stopped waiting for the clang to sound. Perhaps they want to be with their grand-children when the fire bell rings and the firemen slide into their boots and ride away. Whatever the motivation, a grandfather's pleasure is pure. Sometimes it brings him an earned tribute. Recently a firemaa asked one of our grandsons, "What are you going to be when you grow up?" This little boy looked up at the big fire engine, studied the coiled hoses and patted the dark shiny boots. "I'm going to be a grandfather," he said. Grandfatthers are wonderful because they're natural. They have no facades. And they're not concerned with setting a good example. They are themselves. Although they don't have to bandage bruised fingers or dress and feed grandchildren, they know how to prevent a crisis. When our grandchildren are tired my husband out-maneuvers ennui. He takes out his lower plate. The chil-dren are transported. "Grandpa took out his teeth!" they report to everyone. Sometimes grandfathers are what they are because grand-children believe in them. Many years ago our oldest son told some of his playmates, "My father used to be a foot-ball player." "Are you kidding?" they jeered. "That old man!" Thirty-five years later the children we know best believe that Grandpa used to be a football player. "That's how he lost his teeth," one of these children explained to his friends. Grandfathers might never have had time to be fathers but they take time to be grandfathers. They take grandchildren to the zoo, the circus, the ball game, the barbershop and the park. They read them stories and ride them piggyback. They love their grandchildren on a straight person-to-person basis without having to stumble over themselves. That's why grandfathers are what they are. March, 1968 THE HEALTH BULLETIN 11 John C. Lumsden Named Occupational Health Chief P^ John C. Lums-den has been named Chief of the Occupational Health Section, Epidemiology Div-ision of the North %iM Carolina State ^.aF'W'Z ^'m ^°^^^ °^ Health, Pfcy / aJ according to an-nouncement by Dr. Jacob Koomen, State Health Director. Mr. Lumsden is known throughout North Carolina as a qualified and high-ly respected career public health work-er who has devoted almost twenty years' service as Industrial Hygiene Engineer for the State Board of Health. He is a graduate of North Carolina State University and a member of a number of professional organizations, among which are the American Aca-demy of Industrial Hygiene, the North Carolina Board of Refrigeration Examin-ers, the Governor's Council on Occupa-tional Health, the American Industrial Hygiene Association, and the North Carolina Society of Engineers. For a number of years, Mr. Lumsden has served as Chief Industrial Hygiene Engineer for the State Board of Health, during which period the Occupational Health Program has grown in scope and complexity. On July 1, 1967 he was appointed Acting Chief of the Oc-cupational Health Section and has served in this capacity until his recent promotion to Section Chief. Mr. Lumsden's long record of dedicat-ed, efficient service and his outstanding ability to work harmoniously and ef-fectively with people at all levels com-mend him to all who are interested in public health and assures a continua-tion of progressive growth for this im-portant public health program. Emphysema, The Battle to Breathe What it means to have emphysema, a progressive lung disease, is the sub-ject of "Emphysema, the Battle to Breathe," a new publication recently re-leased by the National Center for Chronic Disease Control, U.S. Public Health Service. "Emphysema, the Battle to Breathe," published by the Center's Chronic Res-piratory Diseases Control Program, is a reprint of an award-winning five-part series written by Frank E. Carey, As-sociated Press Science Writer and car-ried by AP in September 1966. The series generated strong public interest in the fast-mounting and little under-stood problems of chronic lung disease. "Emphysema, the Battle to Breathe" carries the reader into medical centers for the care and rehabilitation of em-physema patients and introduces actual patients, describing the way of life dic-tated by their breathing problems. The booklet presents what can be done for even those seriously crippled by the disease, to restore them to more useful and productive lives. Special attention is given to steps which the patient can be taught to clear his lung airways and to retrain breathing muscles, programs he can carry on in his own home. Mr. Carey's series also highlights research being conducted to uncover causes of chronic lung disease. Single copies of "Emphysema, the Battle to Breathe," PHS Publication No. 1715, are available from the Public Health Service, U.S. Department of Health, Education, and Welfare, Wash-ington, D. C. 20201. 12 THE HEALTH BULLETIN March, 1968 Increasing Family Income Results in More Visits to Physician The proportion of the female pop-ulation with obstetric or gynecologic visits to a doctor in a one-year period increases sharply with increasing family income. Where family incomes are be-low $2,000, only 2.8 percent have made such visits. At $2,000 to $3,999, 5.5 percent, and so on up to 12.5 per-cent at family incomes of $10,000 and above. For visits to a pediatrician the story is similar. At family incomes of under $2,000, only 7.5 percent of the pop-ulation under seventeen made such a visit in a one-year period. At $10,000 and above the proportion was 53.0 percent. The pattern of visits to a dentist is no different. Where family income was under $4,000, the num.ber of visits per person per year was 0.8. Between $4,- 000 and $7,000, it was 1.4 percent and so on up to 2.88 visits per person per year at family incomes of ten thous-ands dollars and over. The relatively low figure of use by low income families is not due to few-er disease problems. The number of chronic conditions and the annual ex-perience of days per person of restrict-ed activity, bed disability, and time lost from work are marked greater for per-sons with low family incomes. When hospitalized the average length of stay is longer among the lower income groups. Adapted From: The New England Journal of Medicine. Script for Radio Program on Chronic Disease This is Edwin S. Preston. Our guest today is Dr. John Henry of the Chronic Disease Section of the State Board of Health. 1. Dr. Henry, what are the "chronic diseases"? Dr. Preston, these are illnesses which cause disability over long periods of time. They include diseases of the heart, the lungs, the liver, and the kidneys and such diseases as cancer and diabetes. 2. Who is most likely to develop a chronic illness? Well, actually, persons of all ages are susceptible to these illnesses, although certain ones such as heart disease and cancer are found more often in people over the age of forty. 3. Can any of these illnesses be pre-vented? Yes, some of these can be complete-ly prevented. Others can probably be prevented if certain risks for the diseases are recognized early and preventive measure taken. However, even in the ones which cannot be prevented, such as diabetes, it is very important to prevent complica-tions and disability due to the ill-ness, and these complications may be prevented if the disease process is diagnosed eariy in its course and the individual is put under the care of his physician. 4. Are methods available for detecting risks and early signs of chronic ill-ness? Yes, there are. First of all, individ-uals should have regular medical checkups by their physician, even when they don't feel sick. The physician's questions and physical March, 1968 THE HEALTH BULLETIN 13 examination may reveal risks or signs of illness. In addition, multiple screening test programs or what we call "multiphasic screening" may as-sist the physician in his evaluation of the patient who feels healthy. 5. Multiphasic screening is an interest-ing term. What does it mean? Well, multiphasic screening is the performance of a broad group of measurements and laboratory tests on an individual. Abnormalities in the results of these tests provide general indicators to help physicians track down risks of illness or un-known illnesses. 6. What tests are included in a program of multiphasic screening? There are many possible tests for screening programs, but some of the basic ones include measurements of height, weight, blood pressure, and lung capacity, and examinations of the blood chemistries, a chest x-ray, a urine specimen, and a pap smear in women. Electrocardiograms, eye-ball pressure readings, and certain other blood tests are desirable. 7. How does multiphasic screening help the physicians and his patients? Screening tests provide additional in-formation to give helpful clues to physicians in their regular care of their patients. It may help to bring patients to early treatment for cer-tain illnesses. It should be emphasiz-ed that screening does not substitute for the physician's check-up, but attempts to provide extra informa-tion for such check-ups. 8. Is multiphasic screening being tried in North Carolina? Several pilot programs in multiphasic screening are being conducted throughout the state. These screen-ing programs are being conducted in local health departments or in a local hospital. Different groups of screening tests are being evaluated, and as pilot projects, the programs are being studied to determine how much unknown disease is being found. We believe many questions will need to be answered by these study programs, but we also think multiphasic screening offers tremen-dous opportunities in preventive medicine in the future. Our guest has been Dr. John Henry, of the Chronic Disease Section of the State Board of Health, This is Edwin S. Preston. 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 14 THE HEALTH BULLETIN March, 1968 Margaret Dolan Appointed Member of Health Insurance Benefits Advisory Council Wilbur J. Cohen, Acting Secretary of Health, Education, and Welfare, an-nounced the appointment of Charles L. Schultze, former Director of the Bureau of the Budget, as the new Chairman of the Health Insurance Benefits Advisory Council. Mr. Schultze is now Professor of Economics at the University of Mary-land and Senior Fellow with the Brook-ings institution. He succeeds Kermit Gordon, whose term as Chairman re-cently expired. The appointment of 6 new members was also announced, 3 to succeed mem-bers whose terms have expired and 3 appointed in accordance with recent legislation increasing the membership of the Council from 1 6 to 19. Mrs. Maragret B. Dolan, professor and head of the Public Health Nursing, School of Public Health at Chapel Hill, is one of these new members. The Council was appointed in No-vember 1965, to advise the Secretary of Health, Education, and Welfare on matters of policy in the newly enacted Medicare program. LSD Causes Opposite Moods LSD characteristically causes opposite moods at the same time: one can feel tense yet calm, or serious but silly with-in the same few moments, scientists at the National Institute of Mental Health, U. S. Public Health Service, have found. Dr. Martin M. Katz, NIMH psycholo-gist and senior investigator, described major findings of the study. Scientists selected 80 prison inmates of average intelligence who knew little about LSD as subjects in the project to pinpoint the drug's psychological effects. The prisoners were given either 50 micrograms of LSD, dextro-ampheta-mine, or plain sugar pills. None knew which of the three he was taking. The subjects were then asked to answer a carefully designed questionnaire on their responses to the drug, and to give their reactions to a series of pic-tures of people. In addition, their voices were recorded and analyzed for emo-tional clues. The results showed the LSD state to be a unique and puzzling one. Its primary characteristic consists of "very strong but opposing emotions occurring approximately at the same time" with-out any particular reason or outside stimulus. Dr. Katz noted. For example, one subject said "I feel jittery and nervous, but I also feel relaxed." An-other reported "1 feel serious but some-how everything seems funny and I feel like laughing." Other reactions included: 1) A feeling of one-'s emotions and thoughts being out of control. 2) A feeling of detachment from the real world. 3) A feeling of perceptual sharpness at the same time the outer world seems unreal. 4) A perception of others as friendly but suspicious. Dr. Katz found that subjects on the amphetamine felt they had increased control and improved motor reactions. Those on sugar pills showed little change from their normal moods. There were three main types of LSD reactions: One group felt moderately relaxed, happy, and peaceful; another, tense and jumpy; and the third, ambivalent, ex-periencing opposite feelings at the same time. March, 1968 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 i i and return this page to the address above. UlCF JUk, bi Ino 1968 Printed by The Graphic Press, Inc., Raleigh, N. C But nearly all subjects at some time showed a confusing mixture of positive and negative feelings. Dr. Katz said: "They reported a number of feelings to be occurring at approximately the same time which would appear to the rational observer as opposed and con-tradictory. One of the most dominant aspects of the experience, then, was the contrariness and intensity of the basic effects which take place in the early stages of the LSD reaction." Dr. Katz concluded that "this assem-blage of competing emotions and per-ceptual counterparts and the general intensity of the reaction would appear to create a very bizarre experience for most individuals in our culture to un-dergo— and one which may not be easily assimilated or integrated into their previous experience." The attempt to find meaning in such a paradoxical experience may help ex-plain some of the philosophical con-cepts reported by users on higher doses of LSD, the investigators suggested. The NIMH report, by Drs. Katz, Irene E. Waskow, and James Olsson, appears in the February 1968 issue of the Jour-nal of Abnormal Psychology. 16 THE HEALTH BULLETIN DATES AND EVENTS April 28-May 2 — Southern Psychi-atric Association, Southern Pines, N. C. April 29-AAay 24 — Rehabilitative Nurs-ing Workshop, Charlotte Rehabilita-tion Hospital, Charlotte, N. C. April 30-May 1st — N. C. Tuberculosis Association, Annual Meeting, Heart of Charlotte Motel, Charlotte, N. C. May 1-7 — Mental Health Week May 9-1 C - Western Branch, N. C. Public Health Association, High Hampton Inn, Cashiers, N. C. May 13-17 — Biennial Convention: American Nurses' Association, Dallas, Texas May 15-17 — Meeting: 38th Annual Statewide Industrial Safety Confer-ence, Jack Tar Hotel, Durham May 16 — N. C. Association of indus-trial Nurses, Durham May 19-22 — Annual Meeting: Nation-al Tuberculosis Association, Houston, Texas May 27-31 — Annual Meeting: South-ern Branch APHA, Roanoke, Va. March, 1968 RECEIVED JUN 5 196ti DIVISION OF HEALTH AFFAIRS LIBRARY Wilbur J. Cohen President Johnson's choice for a new secretary of Health, Education and Welfare to replace Dr. John Gardner, (see story on page 3.) Physicians' Attitudes Toward Venereal Disease Reporting Is revealed in a recently conducted survey by the National Opinion Re-search. In sunnmary the survey indicat-ed that "there are not two kinds of physicians: those who faithfully report each veneral disease case they treat and those who consistently fail to report. Though there are some physicians in each of these categories, the majority exercise their professional judgment in each case and, on the basis of a mul-tiplicity of factors, decide to report some patients and not to report others." To Determine The True Extent of Venereal Disease In this country, the American Social Health Association will on July 1 mail questionnaires to nearly 200,000 physi-cians and 13,000 osteopaths in private practice requesting them to report any veneral disease cases treated within the three-month period from April 1 to June 30. A similar survey conducted by ASHA six years ago revealed that private physicians were reporting about 11% of the infectious venereal diseas-es treated. The sponsoring organizations for the VD Incidence Survey are the American Medical Association, the Na-tional Medical Association, and the American Osteopathic Association, in cooperation with the U. S. Public Health Service. State and local medical societies are urged to acquaint their membership of the current survey. Reported Cases of Gonorrhea Continue to increase according to figures recently released by the U. S. Public Health Service. Gonorrhea in-creased by 13.7 per cent the first quar-ter of fiscal 1968 over the same period the previous year. And fiscal 1967 saw the second highest gonorrhea total in history! Southern Branch APHA Meets in Roanoke, Virginia "Elements of Total Family Health" will be one of the major addresses of the annual meeting of the American Public Health Association's Southern Branch May 28-31 in Roanoke, Virginia. The speaker will be Dr. John J. Han- Ion, President of the APHA. Dr. Han- Ion is the health commissioner of De-troit. His address will be delivered May 30, at the second general session of the meeting. Sharing the platform will be Dr. Paul D. Sanders of Richmond, Virginia, editor of the Southern Plant-er, who will discuss "Social and Eco-nomic Impact of Family Health on the Community." At the first general session, on May 29, Dr. Carl S. Winters, lecture staff consultant for General Motors Corpora-tion, will deliver the keynote address, based on the meeting theme of "Fami-ly Health is Community Wealth." Dr. Berwyn F. Mattison, APHA ex-ecutive director, will tell the third gen-eral session "What's New in APHA and Affiliates." The Southern Branch meeting is expected to draw members from 16 Southern states and the District of Co-lumbia to the Hotel Roanoke. Sectional meetings will be held on dental health, medical care, environ-mental health, nutrition, health educa-tion, public health nursing, personnel administration, and records and statis-tics. THE HEALTH BULLETIN April, 1968 Wilbur J. Cohen Nominated as New Secretary for HEW President Johnson's choice for a new secretary of Health, Education and Wel-fare to replace John Gardner has spent a third of a century building impressive credentials for the job. Wilbur J. Cohen came to Washington in 1934 as a research assistant to the executive director of President Franklin D. Roosevelt's Cabinet Committee on Economic Security, which drafted the original Social Security Act. And since that time he has had a major hand in nearly every piece of important social and education legislation passed by Congress. Mr. Cohen, 55, is an energetic liberal who has earned a reputation under three HEW secretaries — Abraham A. RibicofF, Anthony J. Celebrezze and Mr. Gardner — as a master legislative technician. He has been serving as act-ing secretary since Mr. Gardner's resig-nation took effect March 1. Except for a stint as a public welfare professor at the University of Michigan from 1956 to 1961, Mr. Cohen has de-voted his career to continuous govern-ment service at HEW and its predeces-sor agencies. In January 1961 he was appointed by President John F. Ken-nedy as HEW assistant secretary for legislation. During his four-and-a-half years in that post, some 65 legislative proposals passed by Congress bore his imprint. He was appointed HEW undersecre-tary by President Johnson on June 1, 1965, and served Mr. Gardner for two-and- a-half years as coordinator of major policy issues between the legislative and executive branches. During that time, he was a leading strategist in the enactment of medicare legislation. In many respects, Mr. Cohen has run the massive HEW agency — which em-ploys 100,000 persons and has a bud-get second only to that of the Penta-gon — during the tenure of the last three secretaries. As one observer put it, "Wilbur Cohen knows everything a-bout HEW." He is recognized as a skill-ed administrator who, like former De-fense Secretary Robert S. McNamara, has so thorough a knowledge of his subject that he can instantly produce facts and figures about programs that others run. Mr. Cohen is also known as an offi-cial who drives himself because his re-sponsibilities matter personally to him. In a magazine article last spring, Theo-dore H. White listed Mr. Cohen, along with John Gardner, McGeorge Bundy, James Conant and others, as one of the nation's, leading "action intellectuals." "After all his years in the capital," Mr. White wrote, "Cohen has lost none of his humanitarian glow — 'as though,' an acquaintance once said, "he feels every person in the country who is home alone sick is his personal re-sponsibility.' " Though he has made his mark most deeply in the fields of health and wel-fare, Mr. Cohen's achievements in fed-eral education legislation cannot be un-derrated. He sees a great need for the nation to extend federal education pro-grams to help solve the poverty-welfare cycle. "Education is a main part of the welfare problem," he once told an in-terviewer. "It is the central solution. The vast majority of these people on welfare have no education; they're grade school and high school dropouts. We've got to educate these people, train them for jobs." April, 1968 THE HEALTH BULLETIN Natural Disaster Hospitals Being Located Tornado and hurricane victims of the future may not have to go to a hos-pital— the hospital may go to them. Boxed units of emergency medical supplies and equipment are being posi-tioned by the Public Health Service in areas where natural disasters frequent-ly occur. When a disaster strikes, the unit can be loaded on a truck, rushed to the scene, and used to aid the vic-tims. The units are called Natural Dis-aster Hospitals (NDH). The first NDH has just been placed at Enid, Oklahoma. "Enid's vulnerable lo-cation in the tornado belt makes it a prime site for an NDH," said Dr. Henry C. Huntley, Director of the Division of Health Mobilization which coordinates the disaster services of the Public Health Servcie. In an agreement signed with DHM, the Garfield County (Oklahoma) Civil Defense Office has assumed responsi-bility for the storage and transportation of the unit. Staffing of the unit will be handled by the Garfield County Medical Associ-ation. The NDH is one phase of the Public Health Service's program to provide emergency medical supplies, equipment, and services quickly and efficiently in times of disaster. Packaged Disaster Hospitals (units of supplies and equip-ment necessary to establish a 200-bed hospital) and Hospital Reserve Disas-ter Inventories (30-day backup inven-tories of critical medical items for com-munity hospitals) are phases already in operation. The NDH serves a need dif-ferent from the other programs in that it is designed to operate as a short-term medical facility for up to 24 hours. In an emergency, the NDH can be quickly set up as a complete 50-bed unit. It can be used by a hospital to expand its facilities or it can be set up in a church, school or other available building to serve the emergency needs of approximately 300 casualties. The unit is small—83 cases of supplies and equipment; it is light-weight— 234 tons,- it is mobile— it can be transported in four station wagons or two pickup trucks. Its ability to go to the injured means that victims with slight injuries can be treated on the scene and released. Victims with grave injuries can be given essential treatment before being moved to permanent hospitals. If necessary, the NDH can provide sur-gery in the field. The Public Health Service plans to position 24 additional NDH's in high-risk natural disaster areas this year. The first group will be placed in the middle west in anticipation of the tornado season. The second group will be placed in the hurricane-prone areas of the coastal regions before fall. THE HEALTH BULLETIN First Published—April 1886 The official publication of the North Caro-lina State Board of Health, 608 Cooper Memorial Health Building, 225 North Mc- Dowell Street, Raleigh, N. C. Published monthly. Second Class Postage paid at Raleigh, X. C. Sent free upon request. Editorial Board Charles M, Cameron. Jr.. M D,, M.P.H. Raleigh John C Lumsden. B.C.H.E. Jacob Koomen, Jr.. M.D., M.P.H. John Andrews, B.S. Glenn A. Flinchum. B S. H W. STEVENS, M.D., M.P.H.. ASHEVILLE Guest Ed.—Edwin S. Preston, M.A.,LL.D. Vol. 83 April, 1968 No. 4 THE HEALTH BULLETIN April, 1968 Parents of Creaf-ive Boys Treat Them With Respect The parents of creative boys treat them like responsible adults; they regard their adolescent sons with respect and let them make their own decisions, according to the youngsters themselves. These facts were reported by scien-tists of the National Institute of Mental Health, U.S. Public Health Service. Dr. Lois-ellin Datta and Morris Parloff, Institute psychologists, asked 1,039 teen-age boys who had scored high in the Westinghouse Science Talent Search to describe how their parents had treated them from childhood to the present. The boys were divided into two groups—the more and the less cre-ative— according to how the judges had rated the originality of their science projects. The two groups of boys appeared to be similar in many ways. Slightly more than half had fathers who were employed in professional occupations, they did not differ in scientific aptitude, reported similar interest in becoming scientists and had equally high scores on the scholastic aptitude test. However, the more creative students were more likely to come from the Northeastern States (44 versus 38 per-cent), from metropolitan areas (51 versus 41 percent), and from Jewish families (46 versus 38 percent). In answer to NIMH questionnaires, both the creative young scientists and the controls said their parents were moderately affectionate, non-rejecting, and encouraged their intellectual inde-pendence. But replies from the more creative boys shows that they had been given much more latitude and subjected to considerably less discipline than the less creative teen-agers. One boy said "They allowed me as much responsibili-ty as they felt I could handle ... I felt I was trusted." Another said "Rules, what rules? I was treated as a respon-sible adult." A third remarked, "I was simply allowed to make my own deci-sions." In contrast, one of the less creative boys complained that "My father has a April, 1968 THE HEALTH BULLETIN set of rules that makes the penal code look like a picnic." The study also showed that the more creative students considered their moth-ers as somewhat less rejecting and authoritarian than the less creative boys did. However, relationships with fathers appeared to be more important to early scientific creativity in the boys than that with the mothers. One creative boy suggested that his group may have represented fewer dis-ciplinary problems than the average teenager, making the parent's task an easier one. He said "As ! never had any desire to smoke, drink, stay out late, ride in a fast car, or do any other unde-sirable things, my mother never found it necessary to condemn my avocations and habits." However, Dr. Datta emphasized that the parents did not appear to practice a disinterested hands-off policy. She explained that the more creative boy was "more likely to perceive both parents as providing a 'no-rules' situa-tion in which his integrity and respon-sibility were assumed rather than one in which expectations were enforced by authoritarian control and punish-ment. The results suggest that creative behavior may be significantly related to expectations communicated in ways that the child sees as trust in his ability to choose rationally, thus enhancing his ability and desire to achieve by in-dependence." Dr. Datta noted that 41 percent of the more creative boys but only 26 percent of the less creative ones later enrolled in six top colleges— M.I.T., Harvard, Princeton, Yale, Columbia Uni-versity, and California Institute of Tech-nology. The report by Drs. Datta and Par-loff appears in the Proceedings of the 75th Annual Convention of the Amer-ican Psychological Association. Cities Chosen for Narcotic Addict Aftercare Three cities have been selected as the first sites of Federal aftercare con-tract negotiating offices for narcotic ad-dicts. The cities are Los Angeles, Chi-cago, and New York. These metropolitan area offices are the first of a proposed national net-work which will arrange for the treat-ment of narcotic addicts discharged from the inpatient units of the NIMH Clinical Research Centers at Fort Worth, Texas and Lexington, Kentucky. NIMH officials said these cities were selected because of their large addict populations. Additional cities will soon be added to complete the network. The purpose of the program is to reduce the high relapse rate of patients who have been treated for narcotic drug addiction. Meeting Stresses Better Health Care for Migrants Providing better health services to migratory agricultural workers is the concern of over 200 persons who at-tended the Eastern States Migrant Health Conference in Orlando, Florida. Sponsored by the U.S. Public Health Service, the meeting focused on the problem of making health care avail-able to the 80,000 migrants who har-vest crops along the Eastern Seaboard. Participants from eleven States in-cluded representatives of national. State and local governments, voluntary or-ganizations, migrant health projects and growers' associations. THE HEALTH BULLETIN April, 1968 A "Cold n That Wosn't A "Cold#/ And then there was the 39-year-old waitress who complained for six months about her "cold." She had a low-grade fever almost every day. She suffered from chills, lack of sleep, and irritability. After losing 20 pounds, she weighed 107 when admitted to a Philadelphia hos-pital. Her trouble? Too much coffee-drink-ing. She drank 15 to 18 cups a day, the woman told her physician. Her cold symptoms disappeared after five days in a hospital, during which she was limited to one cup of coffee a day. A report on this case of caffeinism appears in a recent (Dec. 18) Journal of the American Medical Association. The author is Hobart A. Reimann, M.D., of Hahnemann Medical College and Hos-pital, Philadelphia. Several common household items can cause illness if used excessively. Dr. Reimann points out, and the illness can be mistaken for other disease. Coffee, tea, dentifrices, and even peanuts contain chemicals called xan-thine alkaloids and can induce illness sometimes mistaken for other disease, he said. A cup of coffee contains about one-tenth gram of caffeine. A single one-gram dose of caffeine causes mental confuision, shivering, tremor, vomit-ing, and diarrhea. Ten grams of caf-feine is said to be fatal. The waitress's caffeine intake was probably more than 1 V2 grams a day. The intake was spread over several hours, however—probably the reason she was not more seriously ill. The woman also smoked more than a pack of cigarettes a day, and reg-ularly took sleeping pills. The nicotine and drugs also may have affected her reactions to caffeine. Dr. Reimann said. A main point of his report is that great effort can be wasted on testing for diseases which a patient does not have, but whose symptoms are similar to those caused by excessive use of caffeine and other stimulants. In the waitress's case. Dr. Reimann happened to note that her fever rose after that daily cup of hospital coffee, but de-clined later. It was then that further questioning disclosed how much coffee she drank. "The cause (of illness) is easily over-looked unless a patient's habits are dis-covered," Dr. Reimann said. "Prompt recognition (eliminates the need for) much clinical effort, laboratory testing, unnecessary therapy, and expense." Reactions to caffeine are influenced by a person's age, emotional or nervous state, "or by the idiosyncrasies of peo-ple," Dr. Reimann said. Its effect is widely variable, often opposite in dif-ferent people or even in the same per-son at different times. "Caffeinism is said to be current among intellectual workers, actresses, vyaitresses, nocturnal employees, and long-distance automobile drivers," Dr. Reimann said. "Illness otherwise un-explained may be caused by excessive intake of the xanthine alkaloids (caf-feine), including those in coffee, tea, cocoa, and those in other popular beverages." "Removal of the cause is the cure," he said. April, 1968 THE HEALTH BULLETIN Franklin Institute Offers Sculpture Award for Best Original Achievement in Control Created by J. Daatselaar under a com-mission from the Dollinger Corporation of Rochester, New York, this sculptured work signifies the newly established Lewis L. Dollinger Pure Environment Award. According to the artist, "The burnished aluminum in its simplicity of geometric shape symbolizes modern day industrial technology. The ceramic representation of the human embryo within the industrial society suggests purity and life support. "The boldness of industrial strength," Mr. Daatselaar points out, "surrounds and supports all of contemporary life. Thus, the motion of the sculpture is generated by this contrast of strength with huddled dependence, giving way to man's realization that his natural en-vironment must be protected if his future life is to be maintained." The world's scientific, industrial and academic communities will be scanned for the "best-judged original contribu-tion, available in print or otherwise, reflecting significant achievement in the recognition, detection and abate-ment or control of environmental pol-lution." The recipient of the sculpture Award, who will also receive a cash honorarium of $2,500, will be selected by the Committee on Science and the Arts of The Franklin Institute, Phila-delphia, Pennsylvania, America's oldest science institute. of Environmental Pollution See opposite page THE HEALTH BULLETIN April, 1968 Lewis L. Dollinger Pure Environment Award 1968 Awarded by Franklin Institute April, 1968 THE HEALTH BULLETIN Whooping Cough in Teenagers and Adults is Disabling Illness Whooping Cough in teenagers and adults is a disabling illness character-ized by a severe persistent paroxysmal cough occasionally culminating in vom-iting. This often lasts for weeks or months. The illness exists in mild forms and is often simply called bronchitis. A public health laboratory in Michi-gan is carefully culturing and studying persons with whooping cough. In 1967, 1,060 cases occurred in Michigan. A study of persons exposed to whoop-ing cough reveals that 21% of persons who were vaccinated 0-3 years previ-ously develop whooping cough. The corresponding attack rate for persons vaccinated 4-7 years previously is 47%, for 8-11 years previously is 65%, and for 12 or more years previously is 95%. Studies in Michigan reveal that 55% of positive pertussis cultures come from the 10-19 year old age group. Twenty percent come from persons 20 years old or older. Analysis of the serotypes which have been isolated suggests that infection with organisms devoid of number 2 antigen are becoming more frequent. It seems likely that the antigenic com-ponents of the pertussis vaccine may one day have to be altered. Although pertussis is now a disease of teenagers and adults (in immunized communities), it is not clear whether teenagers should receive another "booster" vaccination. The neurologic sequelae after vaccination, though rare, may be more frequent in adults. The North Carolina Supreme Court According to a UPI report has de-clared unconstitutional a Charlotte ordi-nance designed to outlaw massages by members of the opposite sex. The 1966 ordinance was passed at the request of police who complained of "lewd mas-sages" and prostitution in the city's massage parlors. The ordinance exempt-ed the YMCA, the YWCA and barber and beauty shops. Supreme Court Jus-tice Susie Sharp, writing for the majori-ty, said the exemptions made the ordi-nance discriminatory. Motorcycle Riders Beware Motorcycle riders are sometimes killed or injured because automobile drivers or pedestrians refuse to share the road with them. The above statement can be found in a new, revised edition of the pam-phlet, "Motorcycles in the United States." The pamphlet is published by the injury Control Program of the Pub-lic Health Service's National Center for Urban and Industrial Health in Cincin-nati. Other causes of motorcyclist injuries and deaths, according to Dr. Richard E. Mariand, Chief of the Center's Injury Control Program, are: (1) many new riders lack adequate training and ex-perience in controlling their vehicles, and (2) many riders have not been suf-ficiently informed of the dangers of riding motorcycles and are unprepared to deal with hazardous situations. The new pamphlet includes informa-tion on motorcycle registrations, the importance of wearing helmets and other protective clothing, as well as benefits of wearing reflective materials for night visibility. 10 THE HEALTH BULLETIN April, 1968 An 1827 French A Sfrange Alliance '"9 ^^^ third factor in LaPlace's law. But the question was not answered A Soap Bubble ^^ ^° whether this law of physics could be put to practical use in terms of the human heart. Dr. Hood and his associ-ates have been investigating LaPlace's p, . . 'aw of physics and its relationship to rhySICIST heart patients. Evidence to date seems to support the fact that LaPlace's law A Modern Computer does have clinical usefulness. The UNC researchers have found that in response to valve obstruction or leakage the left What do a soap bubble, a French ventricular wall normally thickens "ap-physicist who died in 1827, and a propriately" so that tension tending to computer have to do with modern rupture the wall is minimized. If the open-heart surgery? At the University wall does not thicken "appropriately," of North Carolina School of Medicine, it usually means the heart muscle is William Hood, M.D., Charles Rackley, weak and the pumping ability of the M.D., and Ellis Rolett, M.D., with the heart is impaired. help of North Carolina Heart Associa- What does this mean to those indi-ton Heart Fund dollars are putting these viduals who may need to undergo sur-three seemingly unrelated pieces to- gery to replace a valve damaged gether to add significantly to our through disease? If the heart muscle of knowledge of how the heart works. such patients is weak, they may not In the early 1800s, Pierre Simon de improve even though their valvular dif- LaPlace formulated a law of physics ficulty is completely corrected. By eval-v/ hich can be used to calculate the sur- uating the appropriateness of the left face tension of a soap bubble. Its prin- ventricular wall thickness, Dr. Hood ciple guides engineers today in the ^""^ ^'^ associates hope to be able to design of containers which hold com- P'edict which patients have good pressed gas. The law of LaPlace relates enough pumping action to benefit from the tension on the wall of a chamber surgery. to the size and shape of the cavity, the """^s necessary calculations have been pressure within the cavity, and the greatly facilitated by the use of com- Ihickness of the wall. puter programs specially developed in About five
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 | 1968 |
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 83, 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 | 8,330 KB; 190 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_healthbulletin1968.pdf |
Pres Local File Path-M | \Preservation_content\StatePubs\pubs_edp\images_master\ |
Full Text | HEALTH SCIENCES LIBRARY OF THE UNIVERSITY OF NORTH CAROLINA This Book Must Not Be Taken from the Division of Health Affairs Buildings. pqur days This JOURNAL may be kept outflHHHR and is subject to a fine of FIVE CENTS a day thereafter. It is DUE on the DAY indicated below: Vc ? ;^/ icia! Publication Of Th Partnership for Health ncpriy FO S 4 'i= MAR 9 1968 jF rMTu -TrMR^. HBRAR' Governor's Conference on Heolfh Stresses Comprehensive Planning (See page 2 and following) G^OVERNOR'S C0NreRE^ ON V\EWJH^ REMARKS BY GOVERNOR DAN MOORE AT GOVERNOR'S CONFERENCE ON HEALTH Thursday, January 25, 1968-11:00 A.M. Memorial Auditorium — Raleigh, North Carolina Thank you for coming today for this Conference on Health. I believe that this meeting will be a landmark in North Carolina's continuing effort to protect the health of its people and to provide adequately for the care and treatment of its sick and infirm. The public and private health-oriented organizations represent-ed at this Conference have cooperated through the years to provide for improvements in health care programs for the people of this State. In one sense, we have every reason to be thankful for the progress made in recent years in protecting the health of the people. Considerable gains are evident within our own lifetimes. Sanitation, once a major health concern, now .5 taken almost for granted. Many of the serious communicable diseases have oeen conquered. Medical treatment and hospital facilities have improved considerably and are more readily available to the people. And, the expected life span of man has increased by almost 20 years. In another sense, however, it is most evident that we cannot become implacent. Infant mortality rates in the United States are substantially higher fhan in many other advanced countries, and the rates in this State are among the highest in this country. Rejection of North Carolina military inductees for health leasons occurs with greater frequency than in many other States. The costs of medical care continue to climb adding increased hardship to many in need. The purpose of this Conference is to focus attention on these and other medical and health problems. I also want to report to you of our efforts to promote, protect, and conserve the health of the citizens—an essential factor in the total development of North Carolina. And, I want to ask for your support and your help in a new effort to coordinate the utilization of health resource to the end that every man, woman and child in this State has the finest in health care. THE HEALTH BULLETIN January, 1968 Of course, concern for the health of the people is nothing new for us. North Carolina pioneered in the Better Health Movement during the 1 940's and has never ceased its efforts to improve services. Under the leadership of the State Board of Health, an excellent system of local public health services has been developed. During this biennium a total of $800,000 was made available in State aid to local health departments. At the State level new programs are being implement-ed which will insure quality care in the transportation of the sick and injured and in genetic counseling. Existing programs for the control of salt marsh mosquitoes, for the inspection of food and lodging establishments and for the dental care program were strengthened. The fine system of local hospitals is a credit to many people who worked on the local. State and Federal levels under the coordination of the North Carolina Medical Care Commission. North Carolina now ranks 12th from the top among States in the number of hospitals and 15th in the number of hospital beds. The State ranks 7th in the nation in the number of hospital beds constructed and 3rd in the number of Public Health Centers developed under the cooperative financing program. North Carolina has at Chapel Hill the only State-supported medical center in the South, with major professional schools for medicine, dentistry, nursing, public health and pharmacy. January, 1 968 THE HEALTH BULLETIN A total of 271 students is preparing for health careers at Chapel Hill and other nnedical centers under State scholarships for medical and paramedical studies. Over 100 rural communities have benefited by the services of students receiving these State scholarships. Our system of mental health services, developed under the direction of the State Board of Mental Health, is recognized as being one of the finest in the country and is providing a pattern for other States. Appropriations for mental health are at an all time high this biennium with a total of $110 million going to provide care in the State mental hospitals and community mental health programs. Cost accounting programs have been implemented in the psychiatric hospitals and programs for alcoholism, mental retardation, and for prisoners in the State corrections system have been supported vigorously. Even with the assistance of the Medicaid program, many States do not yet provide the health services to welfare recipients as does the State Board of Welfare. During the past year payments to hospitals for the care of indigent patients were increased and rate increases were made for domiciliary and nursing home care for adult welfare recipients. The department is actively supporting cooperative programs in family planning throughout the State. Overall at least 1,100 fewer persons are now on public assistance rolls today than there were a year ago. The State is presently moving ahead with detailed advanced planning for the provision of better medical services to this decreasing group through the implementation of Title XIX of the Social Security Act. The Vocational Rehabilitation Division of the Department of Public Instruction is nationally recognized for its rehabilitation programs. And, we believe that a comprehensive study presently under way will bring about further improve-ments in vocational training for the handicapped. Environmental health continues THE HEALTH BULLETIN First Published—April 1886 The official publication of the North Caro-lina State Board of Health, 608 Cooper ^lemorial Health Building, 225 North ^Ic- Dowell Street, Raleigh, N. C. Published monthly. Second Class Postage paid at Raleigh, N. C. Sent free upon request. Editorial Board Charles M. Cameron. Jr . M D . M P H. Raleigh John C. Lumsden. BC.H.E. Jacob Koomen, Jr . M D.. M PH. John Andrews. B,S. Glenn a. Flinchum. B S. H W. Stevens. M.D,. M.P.H.. Asheville Guest Ed.—Edwin S. Preston, M.A.,LL.D. Vol. 83 January, 1968 No. 1 Governor Moore & Mrs. Sue Jones of Medical Care Commission. THE HEALTH BULLETIN January, 1968 to receive special attention from the Department of Air and Water Resources, the State Board of Health, the Department of Agriculture and other agencies. The Medical Division of the Commission for the Blind has increased and expanded its medical eye services, and last year 531 persons v/ere rehabilitated to gainful employment by this agency. This represents an increase of 75 over the previous year. The biennial budget approved by the 1967 General Assembly provided expenditures totaling over $124 million for health and hospitals. In addition, sizeable State allocations for health-related programs were provided for welfare, education, public safety, correction, and other special areas. Some of 45 State agencies are involved. The total expenditure of State Government in the health care field during the present biennium will be more than $150 million. This represents a sizeable increase over similar expenditures for the last biennium, and demonstrates the commitment of the State to providing for the health care of its citizens. These State programs and others which I have not mentioned complement a network of health services provided by private organizations, voluntary health agencies, and many, many dedicated individuals. Certainly, without this total effort, the five million people of North Carolina would not have the health and the medical well-being that they do today. It is evident, however, that we in North Carolina have a great opportunity to move forward rapidly in providing better health and medical services. Tremendous advancements are being made. All may not be as dramatic as the recent heart transplants, but all are important to better health and longer life. The people of this State deserve the advantages that modern science and concern can provide. And, while we cannot disregard the costs, we must not let them overshadow our purpose. These same factors, of course, are applicable to other State services. It was this broad concern for greater coordination of State resources and better utilization of Federal and State funds that led to my creating the State Planning Task Force early in the Administration. It is significant that one of the first studies undertaken by the Task Force dealt with State health services. This initial work by the Task Force, in effect, gave North Carolina a head start in health planning for the future. We were ready to move ahead when Congress enacted legislation providing for comprehensive health planning. Public Law 89-749. I designated the Director of the Department of Administration as the State official to work in implementing (Continued on page 10) Advisory Council for Comprehensive Health Planning. January, 1 968 THE HEALTH BULLETIN Mrs. Annie B. Edwards, who retired January 1 of this year after 48 years of service with the State Board of Health, during which she was secretary to four State Health Directors. She is shown being presented a certificate of appreciation by Dr. Jacob Koomen, State Health Director. THE HEALTH BULLETIN January, 1968 Upon his retirement from service with the State Board of Health, Dr. J. W. R. Norton received a Certificate of Appreciation from Dr. Jacob Koomen, State Health Director. Dr. Norton served for 17V2 years as North Carolina's State Health Director. January, 1968 THE HEALTH BULLETIN Retiring employees representing 409 years of service with the State Board of Health were honored at year's end in a special formal ceremony at Raleigh. Dr. Jacob Koomen, the State Health Director, expressed the appreciation of the fellow workers in public health to the sixteen persons who retired at the end of December. They averaged a quarter of a century in service to North Carolina through public health. The ceremonies were held in the John H. Hamilton Auditorium of the Laboratory Building of the State Board of Health. Mrs. Annie B. Edwards, Local Health Division, who entered on her duties in 1919, and has 48 years to her credit, led the list in length of service. She served as secretary for four State Health Directors. Not far behind was Marcus C. Allen, Laboratory Technician in the Ser-ology Section, with 43 years to his cre-dit. Charles M. White, Chief of the In-sect and Rodent Control Section, Sani-tary Engineering Division, had 34 years of service. Also retiring was Dr. J. W. R. Norton, former State Health Director. Other retirees with their length of service and Department are: C. E. Harrington, Laboratory Division, 32V2 years; William Murray Linker, Jr., Sani-tary Engineering Division, 31 V2 years; Oris Harris, Administrative Services Di-vision, 30 years; Miss Amy Fisher, Lo-cal Health Division, 28 years; Edna R. Jackson, Laboratory Division, 27 years; Mrs. Wilma H. Harrell, Epidemiology Di-vision, 25 years; Mrs. Golda Walker, Administrative Services, 23 years; Miss Doris Tillery, Local Health Division, I8V2 years; Eugene E. King, Sanitary Engi-neering Division, 15 years; R. F. Hill, Sanitary Engineering Division ISVa years; Miss Lena E. Simmons, Adminis-trative Services, 10 years; Jesse W. Har-rell, Sanitary Engineering Division, 8 years. State Boarj 409i From the left, seated — Mrs. Annie B. Ed Golda Walker and Miss Amy Fisher. Stami Eugene E. King; R. F. Hill; W. Murray I 8 THE HEALTH BULLETIN January, 1 968 ff Who Retired January First- 's Service Is Represented Edna Jackson; Mrs. Wilma H. Harrell; Miss Lena Simmons; Miss Doris Tillery; Mrs. cus S. Allen; Dr. J. W. R. Norton; C. E. Harrington; Oris Harris; Jesse W. Harrell; nd Charles M. White. January, 1968 THE HEALTH BULLETIN (Continued from page 5) this legislation. He, in turn, established an office of health planning which could function in close liaison with the State Planning Task Force and other State agencies. Dr. Charles Cameron of the School of Pubic Health at the University of North Carolina at Chapel Hill was granted a leave of absence to become the director of the Office of Comprehensive Health Planning. To assist Dr. Cameron in the designing of a preliminary plan for planning, a Technical Committee on State Health Planning and Health Services was established. It consisted of the heads of the Department of Health, Mental Health, Welfare, Public Instruction, and Personnel; the Medical Care Commission; the State Planning Task Force; and the Division of Health Sciences of the University of North Carolina. Their plan of study was submitted to the Public Health Service in the fall and was approved October 31, 1967. The Office of Comprehensive Health Planning has moved ahead in preparing to initiate the program of study and planning. To advise and assist the Office in its work, I am pleased today to announce the appointment of an Advisory Council which, by law, includes a majority of consumers of health services as well as representatives of the major health interests of the State. Members of the Council are: Clifton M. Craig, Commissioner, Department of Public Welfare, Raleigh Grady Ranson Galloway, Executive Director, Commission for Blind, Cary James A. Graham, Commissioner, Department of Agriculture, Raleigh Dr. Eugene Alexander Hargrove, Commissioner, Department of Mental Health, Raleigh. William Freeman Henderson, Executive Secretary, Medical Care Commission, Raleigh Dr. Jacob Koomen, State Health Director, Board of Health, Raleigh C. Arden Miller, Vice Chancellor, Health Sciences, University of North Carolina at Chapel Hill George Eugene Pickett, Director, Department of Water and Air Resources, Raleigh Dr. Henry Stuart Willis, North Carolina Sanatorium System, Chapel Hill Dr. Andrew Arthur Best, Greenville Herbert Clarence Bradshaw, Durham Dr. Amos Summer Bumgardner, Charlotte Senator Albert J. Ellis, Jacksonville William Harry Entwistle, Jr., Hanes Corporation, Winston-Salem James Clyde Gaither, Sr., Gaither's Restaurant, Inc., Brevard Mrs. Foy T. Goodin, President, North Carolina Extension Homemakers Associa-tion, Newton Mrs. Geneva Bass Hamilton, Goldsboro Thomas Royster Howerton, Wilson Robert Earle Jones, Agricultural and Technical State University, Greensboro State Representative Ernest Bryan Messer, Canton Dr. John Duncan Robinson, Wallace Wayland J. Sermons, Washington Carl Wilson Anderson, School of Social Work, University of North Carolina at Chapel Hill 10 THE HEALTH BULLETIN January, 1968 Dr. William George Aniyan, Duke University Medical Center, Durham William Charles Barrett, The State Bank, Laurinburg Reverend Cecil Bishop, Trinity AME Zion Church, Greensboro Senator John R. Boger, Jr., Concord Riley Wilson Clapp, Pleasant Garden Thomas Hightower Collins, Chapel Hill Thomas C. Day, Vice President, Citizens Bank and Trust Company, Hayesville Reginald Morton Fountain, President, North Carolina Association of County Commissioners, Tarboro George Watts Hill, Durham Dr. Frank W. Jones, Nev^^ton Mrs. Mary Edith Rogers, Gaston County Health Department, Gastonia Carlos Lowery Young, Shelby State Representative Kenneth C. Royall, Jr., Durham Alonzo Clay Edwards, Hookerton Mrs. William Francis Wolcott, Asheville Mrs. Joseph M. Hunt, Jr., Greensboro Charles Curtis Johnson, Jr., R. J. Reynolds Tobacco Company, Winston-Salem Mrs. Phebe Harlan Emmons, President, North Carolina Council of Women's Organizations, Raleigh James Gv^yn Gambill, West Jefferson Rabbi Joseph Asher, Greensboro Roger Hester Sloop, Warren's Drug Store, Rural Hall Dr. John Gentry Martin, Boone Charles Scott Venable, Jr., North Carolina Tuberculosis Association, Raleigh John Alexander McMahon, President, North Carolina Blue Cross and Blue Shield, Inc., Chapel Hill I am pleased to appoint Mr. John A. McMahon as Chairman, and Mrs. Phebe H. Emmons as Vice Chairman. These members of this Advisory Council have assumed a most important responsibility. Their duties include: —Advising the Governor, the Department of Administration, and the Office of Comprehensive Health Planning in the conduct of a comprehensive planning program for health. —Assisting the Office of Comprehensive Health Planning in the identification of problems, needs and developments both within the State and elsewhere which relate to our efforts to provide comprehensive health services to the citizens of North Carolina. —Recommending to the Governor, the General Assembly, the various boards and commissions dealing wtih health-related programs and private and public organizations, courses of action relating to the health needs and resources of the State. —Facililating communication and cooperation among agencies, organizations, professions, and the public in the cause of better personal and environmental health for North Carolinians. The work of this Advisory Council will be instrumental in the development of a State comprehensive health plan under the provisions of Public Law 89-749 —the Partnership for Health amendments to the Public Health Service Act. An award of $67,000 has been made to finance the initial steps for this fiscal January, 1968 THE HEALTH BULLETIN 11 year. The comprehensive study plan for health services in North Carolina is designed to serve four maior purposes. 1. It will provide for a comprehensive and coordinated approach to health planning with emphasis on the long-range investments which the State must make in such areas as health manpower, health facilities, and in the financing of health services. The study will help identify the underlaps and overlaps in the current spectrum of health services available in North Carolina. 2. It will provide access to the health planning process for consumers as well as a wide range of providers of health care. 3. It will provide for a new and more effective relationship among health and health-related groups. 4. It will provide for a strengthening of State and local decision-making in the health field through the comprehensive approach to health planning and through greater flexibility provided under the grant programs. In addition, this approach to comprehensive health planning will facilitate the coordination of work by the various State agencies now active in the health care field with each other and with the numerous agencies in the private sector. And, it will also improve the communication between health planners and those with responsibilities in other areas essential to the total development of our abundant resources in North Carolina. There is much to be considered by this Advisory Council. As I indicated earlier, vast progress is evident in health and medicine. But, there is a definite need for greater effort in many areas. There is often a gap between the potential for modern health care and the practice. And, unfortunately, not all citizens have the means or even the initiative to obtain good health care. Costs are increasing, medical and health manpower is more difficult to find, and adequate medical services are not readily available to all citizens. One of the early and high priorties facing this Council is a definition and projection of health manpower needs in order that the educational institutions in this State can make plans to fulfill these needs Study needs to be given the availability of health services in our less populat-ed areas, particularly in the East and the West. Deficiencies must be identified and recommendations made for their correction. The growing metropolitan areas have special problems which must be given attention. The complexity of agencies and services for health care often are confusing and difficult for the would-be consumer to identify. Clarification and simplification are necessary. Attention must be paid to the need for home health services, rehabilitation facilities, nursing homes and other services for the aged and chronically ill. Special services for school age children and emergency medical services for people injured in accidents must be given consideration. Increasing costs will mean increasing problems for the low wage earner and those on welfare. Ways must be found to insure that all have access to adequate medical care. There is an urgent need for a coordinated program of recruitment, develop-ment and placement of health manpower. Attention must be given to the distribution of available health manpower to areas of need with emphasis being given to insure its full and proper utilization. The means must be found for a greater exchange of views and greater understanding between the health services consumer and the provider. Programs to minimize and eliminate environmental health hazards must be stepped up. 12 THE HEALTH BULLETIN January, "l 968 This advisory Council must give careful attention in its planning to insure close coordination and cooperation among all agencies and organizations involved in health services. It is evident from the challenges confronting North Carolina in this area that we cannot afford the luxury of unnecessary duplication. The num-erous State agencies involved must join together with a new unity of purpose. And, the State must work hand in hand with local and Federal governments, private health-related organizations and individuals to get the necessary jobs accomplished. Ladies and gentlemen, today marks the beginning of a great new effort on the part of North Carolinians to insure the finest in health and medical care for all. It is a massive undertaking. Its size, however, is diminished by its importance. The burden of responsibility for the preparation of this Comprehensive Health Plan for the future is not limited to the Advisory Council named today. Nor is it limited to the Office of Comprehensive Health Planning and the various State agencies and departments which will contribute. Success in the planning phase, as in implementation, depends upon the active thought and participation of all concerned with the good health and well-being of their fellowmen. Your assistance, your suggestions, your participation are essential in the development of this Comprehensive Health Plan. We have an opportunity in North Carolina today to move ahead in planning for the attainment of the highest levels of health service for all citizens. With your help, we can succeed in planning and in providing a total health program second to none. Mrs. Kitty Ellington received the annual ,7>uch-coveted Outstanding Service Award from Glenn Flinchum, president of the Public Hea.'.*.'" Academy. January, 1968 THE HEALTH BULLETIN 13 Albert J. Klimas, who has been serv-ing as Director of the Cabarrus County Health Department since October. Klim-as is 37, a native of West Virginia, who completed his work for the M.S.P.H. degree from the University of North Carolina. He came to the North Caro-lina position from Colorado where he was Assistant Chief of the Chronic Dis-ease Section of the State Department of Public Health. 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 J. W. R. Norton, M.D., M.P.H. Director, Local Health Division E. A. Pearson, Jr., D.D.S., M.P.H. Director, Dental Healt>i J}ivision Lynn G. Maddry, Ph.D., M.S.P.H. Director^ Laboratory Division Ben Eaton, Jr., A.B., LL.B. Director, J |