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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. four days This JOURNAL may be kept ou t and is subject to a fine of FIVE CENTS a day thereafter. It ia DUE on the DAY Indicated below: he Phy and the Child" Laboratory Testing Well Baby Clinics Water Fluoridation ^^-r U'-(- Governor Dan K. Moore and a Local Health Director The State Legislative Building Where Public Health Laws Are Enacted and Administered The State Capitol Don't You Envy This Public Health Nurse? The Health Bulletin First Published—^April 1886 The official publication of the North Carolina State Board of Health, 608 Cooper Memorial Health Build-ing, 225 North McEtowell Street, Raleigh, N. C. Pub-lished monthly. Second Class Postage paid at Raleigh, N. C. Sent free upon request. EDITORIAL BOARD Charles M. Cameron. Jr.. M.D.. M.P.H. Chapel Hill John C. Lumsden, B.C. HE. Jacob Koomen, Jr., M.D.. M.P.H. Bryan Reep, M.S. John Andrews, B.S. Glenn A. Flinchum, B.S. H. W. Stevens. M.D.. M.P.H.. Ashevlle Editor—Edwin S. Preston, M.A., LL.D. Vol. 82 January, 1967 No. 1 THE HEALTH BULLETIN The Public Health Policy Makers The North Carolina State Board of Health with Governor Dan K. Moore Mrs. Dan K. Moore Has An Interest in Public Health Dr. Jacob Koomen, the State Health Director, conducted North Carolina's First Lady on a tour of many activities in the Health Buildings National Leaders of the Council on the Aging Older People Have Many Opportunities for Service THE HEALTH BULLETIN 'The Patient's Heart Has Stopped - But He Is Still Alive" Prize Picture Photo Courtesy of the B. F. Goodrich Company THE HEALTH BULLETIN THE HEALTH BULLETIN Inf-ensive Care and Correctional Treatment V?«(J(S-Immunization Prevention Is the Best Health Investment Dental Health This Young Man Has a Weight Problem The Public Health Nurse Goes Where the People Are ^ >~ V The "Little Jack Puppet Show" Teaches Good Dental Health National and State Public Health Leaders Confer The Lost Colony at Manteo Invites to Constructive Recreation Visit Our Beautiful Legislative Building MEMBERS OF THE NORTH CAROLINA STATE BOARD OF HEALTH Lenox D. Baker, M.D., President __^ Durham James S. Raper, M.D., Vice-President Asheville Ben W. Dawsev, D.V.M. Gastonia Samuel G. Koonce, Ph.G. Chadbourn Oscar S. Goodwin, M.D. Apex 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, Sar^itary 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 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. Acting Director, Personal Health Division 14 THE HEALTH BULLETIN The Handicapped Can Be Helped Starting Over with Help and Encouragement THE HEALTH BULLETIN 15 THE HEALTH BULLETIN P. O. Box 2091 Raleigh, N. C. 27602 LIBRARIAN DIVISION OF HEALTH AFFAIRS LIBRARY N.C. UE^f.. HOSP. U. N. C. CHAPEL MILL, 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. Public Health Gets Under Your Skin Find YOUR Piece of Service 16 THE HEALTH BULLETIN ^*> F^g n^^y UB8l«t Sanitarians Needed Excellent growth opportunities for ambitious professional sanitarians. The Engineering—Sanitation Section of A. P. H. A. has about 1,500 mem-bers and Fellows. Too few of these are sanitarians. Too few of the members are Fellows (either engineers or sani-tarians). Tomorrow's leadership wil come from those young men willing to give a small amount of time and money to advance the profession in which they practice public health. Maintain your interest and loyalty to your particular professional associa-tion. Sanitarians associations both local and national need and deserve your full support. You can help to further those in-terests through membership and active participation in the increasing en-vironmental health functions of the Engineering-Sanitation Section of the A. P. H. A. (William V. Hickey is chairman). For a membership applica-tion write to: Department M American Public Health Association 1740 Broadway New York, New York 10017 The two recent cases of typhoid fever reported from Burke County dem-onstrate the present epidemiology of typhoid. The patient, age 15, has lived all her life in the home of her aunt who had typhoid years ago. Positive stool cultures obtained from both the aunt and the patient were identified by serologic typing as Salmonella ty-phosa at the State Board of Health. Vaccination was recommended only for immediate household contacts. The society which scorns excellence in plumbing because plumbing is a humble activity and tolerates shoddiness in philosophy because it is an exalted activity, will have neither good plumb-ing nor good philosophy. Neither its pipes nor its theories will hold water. —John Gardner. Don't- Neglect Sore Throat Sore throat is nature's warning sys-tem that something in your body is out of order. Often a sore throat accompanies a common cold and the soreness passes in a few days with no further effect. But a sore throat also can be the symp-tom of a wide range of diseases, from diphtheria to leukemia, that require your doctor's skill, not your guessing, to diagnose. Allergies can cause sore throats. Cold, dry winter air can trigger it. So can extreme thirst, excessive smoking or mouth breathing—anything that dries out the throat and cuts off secretions that normally wash dust away. Virus infections of many types also are a cause of sore throat, and every-one who has had "flu" knows that this particular virus disease often causes the throat to hurt. "Strep throat" is a serious infection that occasionally leads to rheumatic fever and possible heart damage. Early treatment with penicillin or other anti-biotics offers an excellent chance of eliminating the potential threat of rheu-matic fever. There is little or nothing you can do to cure a sore throat at home. There are medications which bring temporary easing of the discomfort but the cure must be prescribed by your physician. American Medical Association THE HEALTH BULLETIN February, 1967 Glue Sniffing . . The Quest for Ecstasy A Georgia View (N. C. Senate Bill 135, introduced by Ellis and others, concerns this problem.) Glue-sniffing among teenagers, a relatively new means of enjoying quick thrills and adventure in unreality, seems to be gaining followers. Police authori-ties, a juvenile court judge, doctors and other health authorities were interview-ed to determine the extent of this prob-im in Georgia and its immediate and long-range effects on the glue-sniffer. Since the problem is a recent one, much about it is unknown. The following ac-count presents the problem and its dangers as seen by the authorities in-terviewed. With only a brown paper bag and a ]0i tube of glue a teenager is quick-ly caught-up in a fantastic world of vivid dreams and hallucinations. Enter-ing this world, like entering Dante's immortal hell, can be a step "into the eternal darkness, into fire and ice." It is a world from which some never com-pletely return. When the teenager first inhales glue fumes, he is exhilarated, "dizzy," ' "drunk," free from reality. Then he begins to act drunk; his speech is slur-red. He becomes depressed, mentally I confused. He may display bizarre be-havior. He may black out. Feelings of reckless abandon often lead to dangerous impulsive acts. One boy in his early teens is reported to have assumed a fighting stance before an oncoming train and narrowly es-caped death. Another young glue-snif-fer, convinced he could fly, leapt to his death from the top of a building. Teen-agers under the influence have joined in wild automobile rides in the night. What happens to the chronic glue-sniffer? Long range effects are not easy to assess, and doctors themselves do not always agree. The concentra-tion of the solvent in the glue, fre-quencey of glue-sniffing, the lapse between times of intoxication, and dif-ferences in the physiological makeup of individuals all contribute to determ-ining the chronic results to any indi-vidual. Extensive damage to the kid-neys seems to be the major effect, ac-cording to Dr. H. K. Sessions, Occupa-tional Health Service, Georgia Health Department. "Exposure over long pe-riods of time could also cause brain damage and blood dyscrasias with bleeding in the lungs," Dr. Sessions continued. Graver consequences—even death—result from glue-sniffing while drinking beer. Is glue-sniffing a serious problem in Georgia? It is, according to Atlanta Police Superintendent Clinton Chafin. Superintendent Chafin reports that dur-ing the 13-month period from January 1, 1966, to January 31, 1967, 176 teenagers were arrested who had been sniffing glue. The majority of the teen-agers arrested (43) were 15-year-old boys. An astonishing 39 were 12 years of age or under. Most of the arrests were made in lower income areas. Superintendent Chafin feels that the problem is increasing in the Atlanta area and that corrective measures must be taken. Fulton County Juvenile Court Judge Elmo Holt—who comes in daily contact with many varieties of juvenile offend-ers— substantiates the reports of a grow-ing problem with glue-sniffers. "We had never heard of glue-sniffers here until about three years ago," Judge Holt said. The problem first appeared February, 1967 THE HEALTH BULLETIN in the North and West, according to Judge Holt, and spread to this part of the country. Judge Holt also believes that the problem is primarily a low-in-come area problem. A survey was con-ducted in the Juvenile Detention Center in March, 1966. Of the 96 boys present at that time, 36 admitted having snif-fed glue. Some 30 were habitual glue-sniffers. Juvenile authorities suspect that an additional 10 boys had sniffed glue but would not admit it. These figures show that almost one-half of the boys in the Center at that time were glue-sniffers! What kind of trouble do these young people become involved in? "Every kind of trouble— burglary — robbery-shoplifting," Judge Holt says. Superin-tendent Chafin also reports teenagers arrested for burglary in connection with glue-sniffing. What causes a teenager to sniff glue? Dr. Charles K. Bush, a psychiatrist and director of the Hospital Services Branch of the State Health Department's Di-vision of Mental Health, has several theories about glue-sniffers. Dr. Bush would classify them with those who begin taking dope or smoking mari-juana. "It's done for kicks. It is pos-sible that they begin because it's the smart thing to do. A status symbol. The first thing they know, they are 'hook-ed.' "Teenagers who practice glue-sniffing are insecure with their peer group or family," Dr. Bush continued. "They lack security. A youth who feels good about his relationship with his family and his peers doesn't do this sort of thing." What can be done about this appar-ently growing problem? Several cities and states have passed ordinances re-stricting the sale of glue or making glue-sniffing illegal. Atlanta this month passed an ordinance forbidding the sale of glue to minors under eighteen years of age and restricting the retail sale of "model glue" to one medium sized container in a 24-hour period. The or-dinance further stated that "it shall be unlawful for any person to intentional-ly smell or inhale the fumes of any type of 'model glue,' or to induce any other person to do so, for the purpose of causing a condition of, or inducing symptoms of intoxication, elation, eup-horia. . . ." Is this the answer? Can legislation prevent teenagers from trying this tempting bout with danger? Will edu-cating teenagers to the permanent dam-ages of glue-sniffing discourage them from trying a fad? The answers are unknown. Much about the problem it-self is unknown. The need for research is evident. Only then may a light be cast on the problem.—From "Georgia's Health" The Health Bulletin First Published—April 1886 The official publication of the North Carolina State Board of Health, 608 Cooper Memorial Health Build-ing, 225 North McDowell Street, Raleigh, N. C. Pub-lished monthly. Second Class Postage paid at Ralefgh, N. C. Sent free upon request. EDITORIAL BOARD Charles M. Cameron, Jr.. M.D.. M.P.H. Chapel Hill John C. Lumsden. B.C. HE. Jacob Koomen, Jr., M.D.. M.P.H. Bryan Reep, M.S. John Andrews, B.S. Glenn A. Flinchum. B.S. H. W. Stevens. M.D., M.P.H.. Ashevlue Editor—Edwin S. Preston, M.A., LL.D. Vol. 82 February, 1967 No. 2 THE HEALTH BULLETIN February, 1967 The Problem of Hernia Hernia, while not an important cause of death, is a common impairment and a leading cause of hospitalization. Thus it is a significant factor in considering problems of hospital use and health care. Based on National Health Survey findings, it is estimated that approxi-mately 2,900,000 people in the United States—about 15 per 1,000—have a hernia.* The condition occurs most often at the extremes of life, in infancy for congenital reason and in old age as a result of weakened body tissues. It is reported three times more frequently among males than females, reflecting the generally more strenuous activities of men as well as their great vulner-ability to hernias affecting the groin. As the accompanying table shows, 23.2 per 1,000 males report a hernia com-pared with 7.1 for females. A distinct disparity by sex exists in every age group but is especially marked at ages 75 and older, where the prevalence of 123 per 1,000 among males is more than 6 times that for females. Hernia occurs least often in the teens and early twenties, its prevalence rising steadily thereafter. As a cause of hospitalization among males, hernia is exceeded only by resp-iratory conditions, injuries, and dis-eases of the heart. t The average length of hospital stay for men undergoing a hernia repair or correction is about a week. Women, who account for only a fifth of the hospitalized cases, stay on the average almost three days longer. Both frequency and duration of *Hernias Reported in Interviews, United States, July 1957-June 1959; National Cen-ter for Health Statistics, Series B.—No. 25, Washington, D. C, December 1960. fHospital Discharges and Length of Stay: '^hort-Stay Hospitals, United States, July i963-June 1964; National Center for Health Statistics, Series 10—No. 30, Washington, D. C, June 1966. V \ -7- HERNIA PREVALENCE AND MORTALITY IN THE UNITED STATES Age Perio (Yeorsl All Ages Under 1 1-14 15-24 25-34 35-44 . 45-54 55-64 65-74 75 and over ge Frevdience Rates peFj^^BI^^Mrge Death Rates per 100,000 5 July T 957-Jwne 1959 "WSj^^^f^: T962-64 T«fat Persons Males Femafef*^ 'total Persons Moles FerrtdJe's 14.9 5.6 4.1 9.4 12.1 19.0 32.2 49.5 64.6 23.2 8.2 6.4 12,4 17.7 28.1 51.8 86.5 122.9 7.1 3.0 2.1 6.7 6.9 10.2 14.1 17.0 19.9 1.8 1.9 1.7 15.7 hospitalization increase with age; al-most half the discharged patients are 45 and older, with the length of stay rising from 3.3 days at ages under 15 to 9.7 at ages 45 and older. Almost all of these hospitalizations are for surgery; indeed, hernia repairs are second only to tonsillectomies in the frequency of operations performed on males in short-stay hospitals in the United States. Surgery is the treatment of choice for most simple hernias un-less contraindicated by a patient's poor general health or advanced age. The surgical risk is extremely low; a study of 1,162 hernia patients operated upon during 1950-59 reported an operative mortality of only 0.3 percent. t After survery, recurrences are generally ex-perienced only by older people or those with weakened tissues. The accompanying table shows the death rates attributed to hernia during 1962-64, by age and sex. This infor-mation was made available by the National Center for Health Statistics •and is not "given in published mortality reports. On the average, there were 3,451 deaths from hernia annually dur-ing this period. This figure excludes deaths from intestinal obstruction with-out mention of hernia (I.S.C. 570). The hernia death rate, at all ages combined, is 1.8 per 100,000 popu-lation. Mortality is highest among in-fants and the elderly, and negligible at the school and early adult ages. Death rates are slightly higher for males than for females. It is noteworthy that about 60 per-cent of the hernia deaths reported dur-ing this period were due to conditions specified as gangrenous, incarcerated, irreducible, strangulated or causing ob-struction, indicating that hernia be-comes dangerous only when treatment is unduly postponed or when other factors increase the risk of surgery.— Statistical Bulletin, Metrolopitan Life In* surance Company. First Rabies Case in 2 Years The first case of dog rabies in more than two years was confirmed in the State Board of Health Laboratory in February. The dog appeared on a farm about four miles west of AAt. Airy and as the farmer was attempting, to run the dog away, the dog ran into a near-by farm and attacked a calf. The dog severely bit the calf on the legs and head. Shortly after attacking the calf, the dog died. After it was determined that the dog was rabid, the calf was sacrificed and buried. No human exposure occurred dur-ing this incident. However, this case of rabies served well as a fair warning and the activities of the rabies control program have been increased in Surry County. An additional dog warden has been employed by the county and em-phasis is being placed on the vaccina-tion of dogs and the elimination of strays. JRydell, W. B. Jr., Inqidnal and Fe-moral Hernias, Archives of Surgery, Vol. 87, pp. 493-499, September 1963. Birth Rate Down: The U.S. birth rate during 1966 reached the lowest level since 1936, and the total number of births was the lowest since 1950, re-ported the U.S. Public Health Service. The 1966 birth rate was 18.5 per 1.000 population, and births totaled 3,629,- 000. It was the ninth consecutive yearly decline in the birth rate. Measles: Secretary of Health, Edu-cation and Welfare John Gardner said a federally supported vaccination drive may eliminate rubeola from the United States this year. The program is under-written by $7 million in federal grants. THE HEALTH BULLETIN February, 1967 Decade of Progress In Public Healfh 1957-1966 Halifax County North Carolina By Robert F. Young, M.D. Halifax County Health Director During the decade 1957-1966 more progress was made in public health and more new programs were initiated than during the 37 previous years of the Halifax County Health Department's existence. At least ten major programs have been developed, while the staff, including the regular employees and those on special cooperative projects, has more than doubled from 19 to 41. Pediatric clinics were developed in 1957 in cooperation with the Halifax County Medical Society and with the Department of Pediatrics at Duke Medi-cal Center. These clinics which now number four each month provide serv-ices to medically indigent children from birth to ten years of age, but are de-signed primarily for infants and pre-school children. The next big development came in 1959 when the Mental Health Program was initiated with a position for a clinical psychologist. Dr. Carl Eisdorfer from the Department of Psychiatry at Duke was the first mental health spe-cialist to fill this position and has continued with the program through the years making an outstanding con-tribution. In the meantime, two addi-tional clinical psychologists and a psy-chiatrist from Duke have joined Dr. Eisdorfer. In addition to these men, there are four psychology interns and three graduate students in clinical psy-chology from Duke who visit in this county under the supervision of Dr. Eisdorfer and the other psychologists. A comprehensive Human Relations Cen-ter (mental health) is being planned at the present time. Another very signifi-cant development in mental health has been the proposed Suicide Prevention Program which will begin operation in the near future. Hard on the heels of this Mental Health Program came the Special Tu-berculosis Control Project which has been conducted in cooperation with the United States Public Health Serv-ice, State Health Department, the local medical profession and the State Sana-torium System. The Tuberculosis Asso-ciation also has aided in this program. It has been financed to the extent of approximately $85,000 by the Public Health Service since its inception. In Continued to Page 14 February, 1967 THE HEALTH BULLETIN An Inyifrat-ion The Western North Carolina Public Health Association especially invites you to their next annual meeting to be held in the Grove Park Inn, Asheville, North Carolina. PLEASE MARK THIS DATE ON YOUR CALENDAR. THE DATE IS MAY 18, AND 19, 1967. We expect to have an excellent sci-entific session and social events which you will thoroughly enjoy. At a later date, you will receive further announce-ments about this meeting, giving you a preview of the program and other events. We particularly wish to invite com-mittees, executive committees, boards of directors, and examining boards to hold their spring meeting with us. This would combine an interesting pub-lic health meeting with business mat-ters concerning related public health fields. If you happen to be a member of such a committee that can be in-vited to hold one of their regular spring sessions during or with the Western North Carolina Public Health Association, please advise me immed-iately. I will certainly contact the chair-man or president of such a committee or board and especially invite him to hold a session of his group with the WNCPHA Meeting. Remember-PUT THIS DATE ON YOUR CALENDAR. The air-conditioned city in the Land of the Sky is very beautiful during the month of May. For your reservations (get them in early) write to Reservation Manager, Grove Park Inn, Asheville, North Caro-lina, 28801. H. W. STEVENS, M. D., CHAIRMAN LOCAL ARRANGEMENTS P. O. BOX 7607 ASHEVILLE, NORTH CAROLINA 28807 i |9S THE HEALTH BULLETIN February, 1967 Grove Park Inn Welcomes You Any Time of Year February, 1967 THE HEALTH BULLETIN SOUTHERN BRANCH AMERICAN PUBLIC HEALTH ASSOCIATION 35th Annual Meeting - 1967 Sheraton-Jefferson Hotel May 10, n, 12 - St. Louis, Missouri PROGRAM THEME: REGIONALIZATION FOR PERSONAL HEALTH SERVICES Wednesday, May 10, 1967 FIRST GENERAL SESSION 9:30 A.M. Presiding H. P. Hopkins, Ph.D., President Invocation The Very Reverend William H. Mead Dean, Christ Church Cathedral, St. Louis Announcements and Early Business J. Earl Smith, M.D., Commissioner of Health, St. Louis Division of Health, and Chairman, Local Arrangements Committee Greeting C. Howe Eller, M.D., Dr. P. H., Commissioner of Health, St. Louis County Health Department, and President, Missouri Public Health Association Welcome Address L. M. Gamer, M.D., M.P.H., Acting Director, The Division of Health of Missouri Greetings from A.P.H.A. Milton Terris, M.D., President American Public Health Association Dr. Terris 10 THE HEALTH BULLETIN February, 1967 Introduction Robert F. Lewis, Ph.D., 1st Vice President President's Address H. P. Hopkins, Ph.D., President Introduction _ Albert V. Hardy, M.D., Director, Southern Branch, APHA, Continuing Education Project Keynote Address: "Planning: The Key to Regionalization' William L. Kissick, M.D. Director, Office of Program Planning and Evaluation Public Health Service Washington, D. C. Dr. Kissick Governing Council Luncheon—Baroque Room 12:15 p.m. SECTION MEETINGS 2:00-4:30 p.m. President's Reception—Boulevard Room 6:30-7:30 p.m. Thursday, May 11, 1967 SECOND GENERAL SESSION 9:30 A.M. Presiding Charles G. Jordan, B.S.C.E., Secretary-Treasurer Introduction '. _ John S. Neill, M.D., Chairman, Program Committee "Regionalization of Environmental Health Services" Franklin D. Yoder, M.D., Director of Public Health, Illinois Dept. of Public Health Springfield, Illinois Dr. Yoder February, 1967 THE HEALTH BULLETIN n Introduction. Edward M. Campbell, D.D.S. Co-ChairmaTi, Program Committee "Regionalizing Clinical Services for Personal Health" Robert Q. Marston, M.D. Associate Director, NIH, and Director, Div. of Regional Medical Programs National Institutes of Health Bethesda, Maryland Dr. Marston SECTION MEETINGS 2:00-4:30 p.m. Governing Council Meeting—Baroque Room 5:00 p.m. Banquet and Dance—Gold Room 7:30 p.m. Friday, May 12, 1967 THIRD GENERAL SESSION 9:30 A.M. Presiding H. P. Hopkins, Ph.D., President APHA Correlative Business Berwyn F. Mattison, M.D. Frederick W. Hering, M.S.P.H. i Business Session: Committee Reports Section Reports Introduction of New Officers Dr. Mattison Closing remarks and adjournment H. P. Hopkins, Ph.D. Executive Committee Meeting Immediately following - Arch Room 12 THE HEALTH BULLETIN February, 1967 "Black Market Medicine" On May 15, Prentice-Hall will pub-lish "Black Market Medicine," by Mar-garet Kreig. It is the chilling and shock-ing story of hoodlum infiltration into the drug industry that may be one of the most widely discussed books of 1967. "Black Market Medicine" reveals the heretofore unpublicized multi-million dollar counterfeit drug racket that threatens the health of nearly every person in the United States. Science reporter Margaret Kreig lit-erally took her life in her hands to ride with U. S. Food and Drug Admin-istration inspectors on the trail of the vicious gangsters who are polluting the health stream of America at its very source. Mrs. Kreig's first book "Green Medi-cine" gained national attention as a best-seller here and abroad. The au-thor has contributed to This Week, Reader's Digest, Good Housekeeping, Mademoiselle and other major national magazines. She is a member of the National Association of Science Writers, and the International Narcotics Enforce-ment Officers Association. Aging Population: By 1980, there will be 24.5 million people in the United States over the age of 65, the National Council on the Aging said. In 1966, acording to the Council, the U. S. had 18.5 million people over age 65. A Public Health Service official to-day cautioned people who wear paper clothing that they risk burning them-selves if they wear it near an open flame after it has been laundered, dry cleaned or worn in a soaking rain. Dr. Richard E. Marland, Chief of the Public Health Service's Injury Control Program within the National Center for Urban and Industrial Health, said any-one wearing this new type of garment should discard it once it becomes soil-ed. "The manufacturers themselves ac-knowledge that many of these paper dresses and other garments lose what-ever flame retardant finish they have after washing," Dr. Marland said. "In fact, we are asking the Bureau of Stand-ards to test samples of paper clothing to determine just how resistant these garments are to fire when they are new." Donald B. Perry (left) the Supply and Service Officer of the State Board of Health, was presented the Most Out-standing Service Award for 1966 by Bryan R. Reep, president of the Pub-lic Health Academy. February, 1967 THE HEALTH BULLETIN 13 Continued from Page 7 1965, a report was made on this pro-gram at the International Union Against Tuberculosis meeting in Munich, Ger-many. During this time the number of cases of tuberculosis had been cut in half in Halifax County. Then, in 1960 a new program was developed in the field of chronic dis-eases which provides services particu-larly to stroke patients. This program was developed in cooperation with the State Health Department, with a new position for a public health nurse be-ing added to the budget of the health department. Also, a physical therapist was provided by the State Health De-partment on a part-time basis to work with the local personnel. At the pres-ent time, a program has been develop-ed with the Department of Physical Therapy at Duke whereby a physical therapist visits this county once a week from that medical center. Two big research projects were con-ducted by the health department in cooperation- with the National Insti-tutes of Health, investigating an un-usual eye disease and cleft palate. Funds were provided for the salary and travel of a public health nurse during a two year period. One of the most important and ex-citing programs of the decade was be-gun in January, 1964, when Halifax County was selected as one of 21 com-munities throughout the Nation to par-ticipate in the Community Action-Stu-dies Project. This project was of three major programs of the National Com-mission on Community Health Services. Dr. Ralph Kilby, who was assigned to this department by the Army to serve a year's Residency in Public Health, served as co-ordinator for this impor-tant project. Later, when Dr. Kilby's residency was completed, Mrs. Lois Batton, one of the public health nurs-es, continued as the co-ordinator. Twenty-one leading citizens in the county served as members of the Hali-fax County Health Commission, the local official agency for this study, with Mr. Paul Johnston of Littleton serving as chairman. The results of this pro-gram were reported to the Nation at the National Health Forum in New York City in May, 1966. Several ma-jor community health projects were recommended for Halifax County by the locra! commission including, first, an increase in physicians and other medical personnel; second, the Human MEMBERS OF THE NORTH CAROLINA STATE BOARD OF HEALTH Lenox D. Baker, M.D., President Durham James S. Raper, M.D., Vice-President Asheville Ben W. Dawsey, D.V.M. Gastonia Samuel G. Koonce, Ph.G. Chadbourn Oscar S. Goodwin, M.D. Apex 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 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, Presonal Health Division 14 THE HEALTH BULLETIN February, 1967 Relations Center; and, third, a Rural Renewal Project. Partially, as a result of the detailed study of the county made during the Community Action-Studies Project, an intensive Maternity and Infancy Care Program was approved for this county by the Children's Bureau in cooperation with the State Health Department. The main objective of this program is to improve the way of life of the patients who are eligible for this service and to produce a more adequate product of life. Eleven new positions have been provided the Halifax County Health De-partment for carrying out this program, while additional personnel have been added on the state level including Dr. John King, pediatrician and project di-rector. Furthermore, there are 18 consultants in the various state agencies and at the Duke Medical Center who assist with the planning and operation of the program. The clinics for this program are staffed by Dr. L. C. McCampbell, obstetrician, and by Dr. Miles Gregory, pediatrician, of Roanoke Rapids, and by residents in obstetrics from the Duke Medical Center. This service includes in-tensive prenatal care for medically in-digent women and a specialized serv-ice in planned parenthood. Patients with complications are provided hospitaliza-tion at either Roanoke Rapids Hos-pital or the Duke Medical Center. During 1966, a cooperative program was developed with the Halifax Coun-ty School System with funds provided by the Elementary and Secondary Edu-cation Act which added four nurses. Later in the year four additional nurs-es were added by the cooperative pro-gram with the Multi-Service Center es-tablished by the Choanoke Area De-velopment Association. These eight nujses are under the direct supervis-ion of Mrs. Davis Clark, nursing direc-tor of this department. An additional servcie added by this Multi-Service Cen-ter is a bus which provides transpor-tation for patients attending the vari-ous clinics operated by the health de-partment. During 1966, the Halifax County Health Department was officially ap-proved as a Home Health Service Ag-ency to participate in Medicare. The highlight of the decade came when the Halifax County Health De-partment was given the Group Merit Award by the North Carolina Public Health Association in 1966. This award is given to the health department that is judged by the North Carolina Pub-lic Health Association as rendering the most outstanding service in North Ca-rolina for a given year. The health de-partment was given the Reynold's Award in 1951 for outstanding per-formance and particularly for develop-ing a new case finding procedure in tuberculosis control. In summary, then, the past decade has been a very rich and rewarding period for new public health programs in Halifax County. It is hoped fervent-ly that these services will not only add "years to the life", but more hope-fully, "life to the years" of the citi-zens in Halifax County, STATE HEART CONVENTION AT DURHAM TO FEATURE TOP HEART SPECIALISTS Nationally-known authorities on car-diovascular disease will participate in the North Carolina Heart Association's 18th Annual Meeting and Scientific Sessions to be held at the Jack Tar Hotel in Durham on May 17 and 18. The Scientific Sessions are designed to keep North Carolina physicians up to date on the latest clinical and lab-oratory findings in the cardiovascular field. February, 1967 THE HEALTH BULLETIN 15 THE HEALTH BULLETIN P. O. Box 2091 Raleigh, N. C. 27602 LIBRARIAN DIVISION OF FIEALTH AFFAIRS N.C. MEM. HOSP. u. N. C. CHAPEL liILL, 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. Money Making Ideas at Home Perhaps you can turn a hobby into a money making idea, using your own home as your workshop. Here are some ideas: If you have a phone and nice voice Assurance service—small fee to call stay-ins daily. Phone solicitation— notify local businesses that you will be glad to do this. Solicit customers for diaper service, magazine sub-scriptions, baby sitting, etc. If you are handy Fix-it shop— repair household ap-pliances, watches, clocks, auto-mobiles; refinish furniture; wood working; metal working. If you have business skills Typewriting and mimeographing —advertise; contact churches, clubs, small firms for overload. Addressing envelopes by hand and by machine. Part-time accounting for small firms. Employment agency (from home) Be income tax expert—contact in-individuals or accounting firms. If you sew Dressmaking Make handmade items in quantity, such as aprons, potholders, patchwork quilts, monograms, hand-loomed mat sets, braided rugs, hand-knitted baby clothes, doll clothes, or rag dolls. Promote your products through friends, articles in local paper; exhibit work at fairs, bazaars, hobby and craft shows. Contact local stores. Do Some Checking First Consult your local library for infor-mation. Size up your neighborhood needs. Write for Government Bulletins. Check any sales products with Better Business Bureau. Ask Chamber of Com-merce about license and other proce-dures. "Your Home Can Be Your Workshop" DYNAMIC MATURITY 16 THE HEALTH BULLETIN February, 1967 '>Aa>.«^^ l*^^*^ ^^'"^ Juanit'o M. Kreps, Ph.D. of Durham who presided at the Oilie A. Randall Award Dinner during the 16th Annual Meeting of the National Council on the Aging held in New York this sprirtg. Dr. Kreps is in the Department of Economics of Duke University, (see pages 2,8-13) Jusfice for All Men - Even the Aged AImighty God, Father of all creation, you constantl^^ confront us — whether in belief or disbelief — and make us uncomfortable. You battle and elude the grasp of our finite minds, yet you never move outside a concern and love for your creation. Help us to be concerned. Give us concern for those who are grown old. Not because they are old but because they are people — too often hurt �� whose gifts and strengths are frustrated, by other people, by frailty of body, by loneness, by poverty, by the unfulfilled promises of their youth, by uncertainty as to who they are or — why. Teach us compassion — wise, persistent compassion. Give us a passion Lord for justice, for all men — even the aged. Make us instruments of justice that in this great land they may enjoy thy bounty and the labors of their hands, to live secure, to have opportunity by right to live with dignity and to die with dignity, to be persons of worth, not cowering as un-persons without hope. Give us a passion Lord for justice. Dedicate us Lord: in the pattern of those who have given so much and done so much to bring some shining rays of hope to those grown old — They are leaders, persons of sensitive, generous, soaring spirit, unflagging zeal for ser-vice, often indignant, outraged at injustice, enriching us all with a deeper sense of compassion and justice. In honoring them tonight, let their achievements be our continuing inspiration. Dedicate us Lord — grant us grace to press for those things that are riaht and just in service to you who art eternal — Lord of Lords. Invocation delivered at the 1967 OIlie Randall Award Dinner in New York, Sixteenth Annual Meeting of National Council on the Aging, by Harold W. Reisch, Secretary for Special Ministries of the Board of Social Ministry, Lutheran Church in America. 2 THE HEALTH BULLETIN March, 1967 GOVERNOR MOORE PROCLAIMS SENIOR CITIZENS MONTH North Carolina's Governor presents to former Senator Roy Rowe a proclamation designating MAY as Senior Citizens Month. Rowe, second from left, is Chairman of the Governor's Coordinating Council on Aging. Many activities are being carried on in May honoring the older citizens of the State. Also in the picture are Dr. John S. Rhodes, Chairman of Senior Citizens Month for the Council, at left; and J. Eddie Brown, Executive Director of the Council, at right. Dr. Rhodes, the Chairman for Senior Citizens Month, is a former member of the State Board of Health and a past President of the Medical Society of the State of North Carolina. March, 1967 THE HEALTH BULLETIN Rheumatic Fever Accounts for Much Heart Disease in Children Rheumatic fever is said to account for much of the heart disease found in children and young adults. Rheumatic fever usually occurs be-tween the ages of 5 and 15, although adults can have it. It may affect any part of the body temporarily, but damage to the heart, which can be long lasting, is the greatest danger. Rheumatic heart disease results from the scarring of the heart muscle and valves by rheumatic fever. This may in-terfere with the vital work of the heart. Many patients recover without perma-nent injury to the heart valves, but the disease has a way of repeaing itself and each attack renews the chances of heart damage. Rheumatic fever Is preceded by a streptococcal infection such as strep sore throat, scarlet fever or a strep ear infection. It can be prevented by treat-ing the strep infection promptly and thoroughly with antibiotics. Because persons who have had rheumatic fever are susceptible rather than immune to repeat attacks, long-term preventive treatment is often prescribed for them. Regular doses of penicillin, under the direction of a physician, can prevent further strep infections and thus ward off subsequent attacks of rheumatic fever. You can protect your child against rheumatic fever by consulting your doc-tor if the child develops a sudden, se-vere sore throat, or if he has been exposed to someone with scarlet fever or another strep infection. A computer system that picks up in-audible speech changes in persons with early neurological disease and gives an immediate warning of their condition is now under development by the Pub-lic Health Service's National Center for Chronic Disease Control. The system is scheduled to be ready for use in multi-phasic disease-detection programs in three years. It will spot neurological disorders before other symptoms are evident. The first case of poliomyelitis to oc-cur in New York City since 1964 has been reported. The case is that of a 31 year old man who had a Salk vaccine series of injections ending five years ago. His wife and infant have been, or are in the process of, being immunized. The Health Bulletin First Published—April 1886 The official publication of the North Carolina State Board of Health, 608 Cooper Memorial Health Build-ing, 225 North McDowell Street, Raleigh. N. C. Pub-lished monthly. Second Class Postage paid at Raleigh, N. C. Sent free upon request. EDITORIAL BOARD Charles M. Cameron. Jr.. M.D.. M.P.H. Chapel Hill John C. Lumsden, B.C. HE. Jacob Koomen, Jr., M.D.. M.P.H. Bryan Reep. M.S. John Andrews, B.S. Glenn A, Flinchum, B.S. H. W. Stevens. M.D.. M.P.H., Ashevlle Editcr-Edwin S, Preston, M.A., Ll.D. Vol. 82 March, 1967 No. 3 THE HEALTH BULLETIN March, 1967 A Message By Acting Secretary Of Commerce Alexander B. Trowbridge Humanpower is a most precious resource. The waste of the tal-ents of 19 million Americans aged 65 and over is indefensible at a time when talent is in premium demand, when only one in five sen-ior citizens has a job, when five million elderly live below the pov-erty level, and when our senior population is growing at a rate of almost 4000 a day. Many people think of us as a Nation of youth. It is true our youth population is growing. But our over-65 population is also growing —and, thanks to the increase in human knowledge, living longer. In the last half century our older population has more than dou-bled. By 1985 we likely will have 25 million Americans 65 and over, and by the year 2000, more than 28 million. A busy, productive Na-tion —"a Nation on the move" as President Johnson has called it —cannot afford to waste this important reservoir of talent. It must not cast by the wayside any segment of our population because of the stigma of "overage." Ability has no age. We must not deny opportunity to those who wish to fill a productive role in our society. This may even include having jobs created for them, and providing facilities, where needed, for their retraining to meet work requirements of the technological age. The theme of Senior Citizens Month 1967 is "Meeting the Challenge of the Later Years". The talents, skills, and experience of our senior citizens have helped shape our country, make our economy strong, and give us the highest standard of living in the world. We need now and will need in years to come the example of their patience, stability, loyalty, and wisdom. This is the challenge "of the later years" that faces not only the older American but the Nation as a whole. March, 1967 THE HEALTH BULLETIN 5 MAY IS BEING OBSERVED AS SENIOR CITIZENS MONTH Theme: "Meeting The Challenge of the Later Years" Dr. John S. Rhodes, Vice Chairman, N. C. Governor's Coordinating Council on Aging and Chairman of N. C. Senior Citizens Month in North Carolina. Activities: The North Carolina Senior Citizens Convention in Greensboro — May 5th and 6th—Sponsored by N. C. Recreation Society. Visitation Days to Shut-ins—Hospitals Nursing Homes Private Homes Open Houses—Welfare Departments V. A. Hospitals Nursing Homes Senior Citizens Centers Housing for the Elderly Trips— Bus Trips Train Trips Religious— Sermons at Churches Social Activities— Craft Fairs Hobby Fairs Fashion Shows Dinners Luncheons Theater Parties Baseball Games Picnics, etc. 6 THE HEALTH BULLETIN March, 1967 Dr. Scurletis Appoinf-ed Director of Personal Health Division Dr. Jacob Koomen, State Health Di-rector, announced the appointment on March 21st of Theodore S. D. Scurletis, M.D., as the new director of the Per-sonal Health Division of the State Board of Health. Dr. Scurletis had been serv-ing as Acting Director of this Division since the death of Dr. James F. Donnel-ly last summer. The Personal Health Division, one of the seven divisions in the administra-tive structure of the Board, includes responsibility for Medicare, Maternal and Child Health, Chronic Disease, Crip-pled Children, the Medical Referral pro-gram for rejected draftees. Nutrition, and Nursing Home Licensing. Dr. Scurletis v/as born in Pittsburgh, Pa., and received his B. S. and M.D. degrees from the University of Pitts-burgh. After receiving his medical de-gree from the School of Medicine, Dr. Scurletis served his internship at Pitts-burgh Hospital. The University con-tinued him as instructor while for six years he was in private practice in pediatrics in Pittsburgh^ In 1961 Dr. Scurletis came to the State Board of Health as Pediatric Consultant in the Personal Health Di-vision and in 1963 was named Chief of the Maternal and Child Health Section. Upon the death of Dr. James F. Don-nelly last June, he was appointed as Acting Director of the Personal Health Division. Active in the Cerebral Palsy Associ-ation, the Association for Retarded Children and various medical organiza-tions. Dr. Scurletis makes a civic con-tribution beyond his professional duties. He married Christine Harrison in 1963 and they have two children, a boy and a girl. Dr. Theodore D. Scurletis (center) was appointed in March as Director of the Personal Health Division by Dr. Jacob Koomen (right) State Health Director. Dr. John T. King (left) was named chief of the Maternal and Child Health Sec-tion. March, 1967 THE HEALTH BULLETIN One of the concurrent- sessions during the T6th An-nual Meeting of the Notional Council on the Aging meeting in New York this Spring. TH€ HEALTH BULLETIN March, 1967 Secretary of Labor, W. Willard Wirtz (leff) accept-ing on behalf of President Johnson the OIlie A. Randall Award of the National Council on the Aging for Dis-tinguished Service to Older People. March, 1967 THE HEALTH BULLETIN North Carolina's Senior Citizens NORTH CAROLINA DEMOGRAPHY Over 65 In 1950 226,it25 persons 65 and older S-i>% of population In 1966 S'tg.OSS persons 65 and older 7.2^ of popul at ion In 1980 502,413 persons 65 and older In 2000 655,7'tl persons 65 and older Over 75 In 1950 65,000 persons 75 and over In i960 97,215 persons 75 and over 15,14't over 85 In 1980 180,977 persons 75 and over Men to Women (age 65 & over) 1955 122 women to 100 men i960 126 women to 100 men 1966 131 women to 100 men 2000 1^3 women to 100 men Longev i ty In 1949"1951 Life expectancy at 65 v/hite males 13-1 years Life expectancy at 65 white females 15-'* years Life expectancy at 65 nonwhite males 13-'* years Life expectancy at 65 nonwhite females 15-'* years In 1959-1961 Life expectancy at 65 white males 13-1 years Life expectancy at 65 white females 16. 1 years Life expectancy at 65 nonwhite males 12.5 years Life expectancy at 65 nonwhite females I'*. 7 years 10 THE HEALTH BULLETIN March, 1967 Senior Citizens in the United States (next three pages) FACT SHEET SUMMARY FROM 15 YEAR APPRAISAL DEMOGRAPHY OVER 65 In 1950 12,269,637 persons 65 and older In U.S. 8.1/^ of population In 1966 18,500,000 persons 65 and older 9'^i> of population In 1980 2l+, 500,000 persons 65 and over In 2000 26,000,000 persons 65 and over OVER 75 In 1950 3,85^,000 persons 75 and over In i960 5,562,500 persons 75 and over nearly 1 Million over 85 In 1980 9,382,000 over 75 t4EN TO V/0I4EM 1955 115 women to 100 men i960 121 women to 100 men 1966 129 women to 100 men 2000 II+8 women to 100 men STATE DISTRIBUTION 1950 Only New York had more than 1 million i960 New York, Pennsylvania, California had more than 1 million 1965 New Yorl:, Pennsylvania, California and Illinois had more than 1 million 1965 One-third of all over 65 lived in 1 of U states; New York, California, Pennsylvania or Illinois 1985 New York and California over 2 million Florida, Illinois, Ohio, Pennsylvania and Texas; over 1 million. 1950 New Hampshire 10. 8^0 over 65 (highest ) 1965 Iowa 12.5fo over 65 (highest) LONGEVITY In 1950 Life expectancy at 65 men 12.8 years Life expectancy at 65 women 15 years In i960 Life expectancy at 65 men 12.9 years Life expectancy at 65 women 16 years (Note: 1 entire year for women) March, 1967 THE HEALTH BULLETIN 11 Older vorl'.or defined as over k') 196'+ 5*5 million over h^ in population 29 million in work force 1980 66 million in population 3^+ million in work force (Mostly in U5-6U age group. Over 65 only about ^00,000 of increase of 5 million between 1964 and I980. ) SOCIAL SECURITY 1950 2,600,000 over 65 receiving benefits 1966 15,328,000 over 65 i-eceiving benefits 2,000,000 between 62 and 65 receiving benefits 1950 average monthlybenef it for workers h'i,86 average monthlybenef it for v/idows 36.5^ 1965 average monthlybenef it for workers 83.92 average monthlybenef it for v/idows 73.75 Between 195*+ and I965 wages increased by ^9.3^/0 - cost of living 2l,9fo - Social Security benefits llj-.l^c. OLD AGE ASSISTANCE 1950 About 25^ (3 million) receiving OAA averaging $^+3 per month (from $18 per month in Mississippi to $70 in Connecticut) 1967 About 11^4 (2 million) receiving OAA averaging $39.20 per month in Mississippi to $102 in California. MINORITY GROUPS NEGROES Life expectancy at birth 7-8 years less than whites. INDIANS Avei-age age at death ^3. HOUSING 1950 Q.k'fo of all over 65 lived in dilapidated housing. i960 19^ of all units occupied by elderly dilapidated. i960 Cornell University estimate ky/, living in unsuitable housing - h^ million units needed to overcome shortage and provide ap-propriate housing. 1950-1965 310,000 units of special housing for aged built. Nearly 66'^ of those over 65 ovm Lheir own homes, about 1+0'^ over 50 years old, 80^ over 30 yeai's old. 12 THE HEALTH BULLETIN March, 1967 racoME 1950 1965 1965 77^j over 65 had incomes less than $1000. per year. Median income for unrelated individuals $6U6. per year. Median income for familieG i/ith head over 65 $1903. per year. One-thix'd unrelated individual's Incomes less than $1000. per year Tliree-fifths unrelated individuals less than $1500 per year. One-fourth of families vith head over 65 less than $2000. per year. T^/o-fifths of families uith head over 65 less than $3000. per year. (Note: Poverty definitions $1500 for individuals. $1850 for couple. ) 31/f of all aged living in poverty by government definition. Half of aged widov;s and non-married women less than $1000. 3^3 had incomes of over $10,000. As aggregate persons over 65 represent a i+0 billion dollar consumer market. RETIREI.ffiNT INCOME If Bureau of Labor ."Statistics "modest but adequate" budget ($l800 for individual and $2500 for retired couple) is accepted as standard, 2 million retired couples and 6 million unattached re-tired persons do not have adequate standard of living. SOURCES OF INCOME 1950 i960 Emplojinent Social Insurance (mostly OASI) Old Age Assistance Private Pensions 3lf^ Are You Immunized Against 'Xockjaw'? With the advent of the spring sea-son of 1967 most of us are beginning to get out of doors again. There are gardens and lawns that need work and outdoor chores of all sorts that have accumulated during the winter. With the return of outdoor activities comes once again the hazard of minor accidents, cuts and scratches. Most often these aren't serious and will heal quick-ly if properly cleaned and protected. But sometimes these little scratches can be more serious. Sometimes they are the channel through which you could get tetanus (lockjaw). Tetanus-producing spores lie dor-mant in the soil of your garden, the dirt of your garage, and the dust in-side your house. These spores can in-fect you through the tiniest wound— a pin scratch, a bee sting or a small cut, says a pamphlet of the American Medi-cal Association. Tetanus spores may remain in your body for long periods without produc-ing the disease. Or, they may produce poison effects in five to fourteen days, even though the wound has healed. First signs of tetanus are irritability and restlessness. Muscles rapidly be-come rigid, eventually causing a clenched-jaw leer that gives tetanus its nickname—lockjaw. When symptoms appear, the outlook is grim, even with the best treatment. To avoid the deadly consequences, be sure you are immunized with tetanus toxoid. When you are immunized, your body manufactures antibodies that will fight tetanus toxin. A booster is need-ed every ten years and whenever you are injured. If you aren't protected, in an emerg-ency there is no time for immuniza-tion. If you have no built-in immunity, your physician may inject tetanus anti-toxin. An emergency shot, however, is not always effective. Your only long-range guarantee against tetanus is immunization with tetanus toxoid. Only one of every four Americans has this protection. Have you? — American Medical Association. MEMBERS OF THE NORTH CAROLINA STATE BOARD OF HEALTH Lenox D. Baker, M.D., President Durham James S. Raper, M.D., Vice-President Asheville Ben W. Dawsev, D.V.M. Gastonia Samuel G. Koonce, Ph.G. Chadbourn Oscar S. Goodwin, M.D. Apex A. P. Cline, Sr., D.D.S. Canton Joseph S. Hiatt, Jr., M.D. Southern Pines J. M. Lackey Rt. 2, Hiddenlte 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. j 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 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. Srurletis, M.D. Director, Presonal Health Division THE HEALTH BULLETIN March, 1967 PROGRAM OUTLINE EASTERN DISTRICT, N. C. PUBLIC HEALTH ASSOCIATION AT THE CAROLINIAN, NAGS HEAD — MAY 25-26 THEME: Public Health and The Public Thursday May 25 1:00-5:00 P.M. Registration 4:00 P.M. Business Meeting Tag Along Welcoming Coffee 6:00 P.M. Social hour 7:00 P.M. FIRST GENERAL SESSION Banquet—Informal Buffet Dance Fridav May 26 7:00-8-.?0 A.M. Breakfast 8:00-9:00 A.M. Ref?istration 9:00 A.M. SECOND GENERAL SESSION Presiding: Dr. Melvin F. Everman. President "Sarah Wilson" Panel: Dr. Ralph Boatman. Moderator Miss Sarah Goggins Mrs. Jean Lassiter Mr. William Shaw Dr. Karl Van Horn 12:00 Noon Lunch 1:30-3:30 P.M. SECTION MEETINGS Public Health Nurses—Anchor Room Presiding: Mrs. Rose Pugh Speaker: Miss Virginia Nelson. Department of Public Health Nursing, School of Public Health Subject: Team Nursing Joint Session—Sanitarians and Health Directors—Cypress Rooom Presiding: A. K. Glover Business Speaker: Charles J. McCotter Subject: Salt Marsh and Fresh Water Mosquito Control Secretarial—Statistical Section — Gaily Room Presiding: Mrs. Louise B. Barber Speaker: Dr. Lynn G. Maddrey, Chief Laboratory Division, State Board of Health 3:30 P.M. THIRD GENERAL SESSION Section Reports—Section Officers 1968 Door Prizes Adjournment March, 1967 THE HEALTH BULLETIN 15 BX. 2^9 THE HEALTH BULLETIN P. O. Box 2091 Raleigh, N. C. 27602 If you do NOT wish to con-«jtrr) tinue receiving The Health Bul-*^ ^ ». letin, please check here | i- Qp W and return this page to '—' V * the address above. c . ttftiBJftt The Graph! ILt l^. c c Press, Inc., Raleigh, N. C. DATES AND EVENTS May, 1967 sions, William Hilton Inn, Hilton Head May 15-16 — National Public Relations Island, S. C. Institute, Palmer House, Chicago, III. June, 1967 May 17-19 — 37th Annual State-wide June 4-8 — Public Health Symposium on Industrial Safety Conference, Wins- Program Planning, Philadelphia, Pa. ton-Salem. May 18-19 — Western North Carolina Public Health Association, Grove Park Inn, Asheville. May 20-24 - State Medical Society Meeting, Pinehurst. May 21 — National Tuberculosis Asso-ciation Meeting, Pittsburgh, Pa. May 21-26 — National Conference on Social Welfare, Dallas, Texas. May 24 — Conjoint Session of State Board of Health and Medical Society of the State of North Carolina, Pine-hurst. May 25-26 — Eastern North Carolina Public Health Association, Carolinian Hotel, Nags Head. May 26-28 — S. C. Heart Association- Annual Meeting and Scientific Ses- June 4-9 — American Water Works As-sociation, Atlantic City, N. J. June 11-15 — Air Pollution Control As-sociation, Cleveland, Ohio. June 16-17 — American Geriatric So-ciety, Claridge Hotel, Atlantic City. June 18-22 — American Medical Asso-ciation (Annual), Atlantic City, N. J. June 25-29 — American Society of Med-ical Technologists, Miami Beach, Fla. June 25-29—American Veterinary Med-ical Association, Nev^ Orleans, La. June 12-16 - Mental Health Workshop, Pisgah View Ranch, Candler, N. C. July, 1967 July 2-7 — American Physical Therapy Association, Miami Beach, Fla. July 10-13 - Institute: Tuberculosis and Other Respiratory Diseases (Blue Ridge Assembly), Black Mountain. 16 THE HEALTH BULLETIN March, 1967 The Officiar Publication Of T V^V^,^^ Oi^..-^ ' UT fifCf/VED ^^L 12 1^57 GOVERNOR DAN K. MOORE is presented a printed copy of the proceedings of the most successful meeting of the Governor's Conference on Child Abuse which was held late last year. An attendance of over 650 persons representing many disciplines working in private, voluntary and public areas attested to the wide interest and the quality of the program. In the picture taken in the Governor's Office are (from the left): Dr. Jacob Koomen, State Health Director; Dr. T. D. Scurletis, Chairman of the Coordinating Committee on Special Needs of the N. C. Health Council; Governor Moore; and E. N. Herndon, President of the N. C. Health Council. Two Percent of Nation's Counties Hold Key To Reduce Infant Mortality More than 30,000 infants a year might have lived to maturity if each of the nation's 3,130 counties had achieved the 18.3 per 1,000 live births infant mortality rate that 10 per cent of the counties reached. This is shown by a county-by-county study of infant mortality for the period 1956-60 by the Children's Bureau, Wel-fare Administration, Department of Health, Education, and Welfare. The study shows that less than 2 percent (56) of the nation's counties hold the key to any successful effort to sharply reduce the nation's infant mor-tality rate. A third of the deaths over the 18.3 rate achieved by counties with the best infant mortality rates occur-red in these 56 counties, which con-tain nearly all the densely populated urban areas in the nation. Among the 56 counties, the study found that in 21 of the most populated areas, including the ten largest cities, the average per year per city excess of infant deaths over the 18.3 rate was 400. With this knowledge, the Children's Bureau is focusing its special project grants for maternity and infant care on "high risk" mothers-to-be from the low-income neighborhoods in these key areas. The projects were authorized under the 1963 Maternal and Child Health and Mental Retardation Planning Amendments and now number 53. Al-most 200,000 maternity cases have been served in the projects, most of them considered "high risk." "It is among these maternity cases that studies show the highest rate of low birth weight infants being born. almost three times the national aver-age. Babies born to these mothers also have the highest infant mortality rates," said Dr. Arthur J. Lesser, Deputy Chief of the Children's Bureau. "Reports from these projects indi-cate that they may be having a signi-ficant effect on infant mortality rates," Dr. Lesser continued. "In Chicago, for example, among 14,380 infants born in census tracts served by the program in 1965, the infant mortality rate was 34.5 while among 9,044 births in si-milar low-income census tracts without the program, the infant mortality rate was 57.4." "Although we are extremely pleased with the results reported so far to the Children' Bureau from these special pro-jects," Dr. Lesser said, "We know that much more must be done. These special projects are only part of a whole struc-ture of services and programs— includ-ing medical care, housing, nutrition, better education and communication, adequate maintenance, and social wel-fare services—which must be made available if we are to make any real reduction in the rate of infant mor-tality and of premature births." Cigaret Testing: The Federal Trade Commission will begin testing cigarets for tar and nicotine content within the next two months, FTC Chairman Paul Rand Dixon told the House Commerce Committee. He said the agency has received excellent cooperation from the tobacco industry. Scientists at Tufts University, Med-ford, Massachusetts, will study the ad-vantages to the driver of using con-vex rear-view mirrors and other new types of rear-view display systems in an automobile instead of the conven-tional flat mirror. THE HEALTH BULLETIN April, 1967 Brains Across The Sea by Ronald Schiller Reprinted ivith permission from the March 1967 Reader's Digest. Copyright 1967 by The Reader's Digest Assn., Inc. If the United States continues to si-phon off the best scientific talent from other countries, the world, sadly out of balance, may become yet more un-evenly divided. A dilemma looking for a solution. If you are admitted as an emergency patient to a hospital in Delav^are, New Jersey, North Dakota or West Virginia, chances are that you will not be treated by an American doctor. Over half of the resident physicians in the accredit-ed hospitals of those states are foreign-ers who earned their medical degrees abroad. In certain hospitals in Illinois, Maryland, New York and Rhode Island, you might never even see an American doctor. Throughout the United States, 28 per-cent of all medical internships and resi-dencies are filled by foreigners—and a lucky thing for us. Each year our hospitals need 5500 more physicians than our medical schools graduate. Some 11,000 foreign interns and residents are now serving our nation's hospitals. Officially, they are here to further their medical education and to gain experience that will serve them when they return to their own coun-tries. Actually, at least 25 percent of them end up living here permanently. Of the physicians admitted to practice here last year, 1488—almost 17 percent —were foreigners. To replace them, we would need 15 new medical teaching centers, which would cost some $1 billion to build, plus at least $100 mil-lion a year to operate. This consider-ably exceeds the medical assistance that we now dispense to the rest of the world. "In effect," says Sen. Walter F. Mon-dale of Minnesota, "the richest nation on earth is being subsidized by the poorer nations." Particularly disturbing is the fact that almost 80 percent of our foreign phy-sicians come from developing nations whose medical needs are vastly greater than ours—from India, Pakistan and Thailand, where there is one physician per 5000 to 9000 of the population; from the Philippines, Turkey, Colombia and Peru, where each doctor serves an average of 2000 to 3000 people. In 1963, South Korea, half of whose coun-ties do not boast a single physician, sent us 207 medical graduates. Moreover, our importation of phy-sicians is accelerating. Each year some 18,000 medical graduates throughout the world pay to take the day-long ex-aminations— administered twice yearly— which qualify them to practice in the United States. Approximately 7000 doc-tors pass the tests every year, repre-senting a reservoir of talent that we can call upon. April, 1967 THE HEALTH BULLETIN Widening the Gap. Physicians repre-sent only one wave in a massive tide of skilled professionals now sweeping from the poorer to the richer coun-tries. The demand for educated talent among the most advanced Free World nations is spiraling upward at a rate faster than all of their fast-growing universities can meet it, either now or in the foreseeable future. Thus, last year alone, the United States wel-comed 5479 graduate engineers and scientists, 5164 teachers and profes-sors, 1623 accountants, 4247 nurses, 2552 technicians, and tens of thousands of others with advanced training. These were permanent immigrants; others en-tered on working visas. This "brain drain" has become a source of increasing anxiety through-out the world. Ultimately it poses a threat to world peace. For without substantial resources of trained and educated manpower everywhere, the gap between the rich and poor nations cannot be narrowed. "Regions failing intellectually," states scientist Lloyd V. Berkner, "will remain chronically poor, in colonial status to more advanced na-tions." The irony is that no other country approaches the United States in the amount of effort and money spent to educate the people of the developing nations. Approximately 100,000 stu-dents come to U. S. universities for ad-vanced training every year—to be edu-cated for service in their own coun-tries. But an estimated 90 percent of the Asian students, 50 percent of those from the Near East, Greece and Egypt, and large proportions from Africa and Latin America never return home. Further, by eliminating national quo-tas and giving piority to professionals, the U. S. Immigration Act of 1965, whose commendable purpose was to end discrimination based on race or national origin, had the unforeseen ef-fect of accelerating the brain drain. The year the new law went into effect, the number of professionals immigrat-ing from India jumped from 54 to 1750; from South Korea, from 51 to 400. The influx cancels out the effec-tiveness of our foreign-aid, technical-assistance programs. Put and Take. The United States is not the only beneficiary of the world-wide braindrain, nor are the poorer countries its exclusive victims. Nor-way, Switzerland, Italy, the Netherlands and West Germany have been heavy losers in Europe. In actual numbers, however, no country has suffered more than Great Britian. British newspapers and professional journals blaze with advertisements from U.S., Canadian, New Zealand and Australian companies seeking specialists of every kind. U.S. firms offer "transportation costs . . . advanced study in your field . . . op-portunities for speedy advancement," and salaries usually double those that can be earned in Britain. In 1964 alone, 5900 British teach- The Health Bulletin First Published—April 1886 The official publication of the North Carolina State Board of Health, 608 Cooper Memorial Health Build-insT, 225 North McDowell Street, Raleigh, N. C. Pub-lished monthly. Second Class Postage paid at Raleigh, N. C. Sent free upon request. EDITORIAL BOARD Charles M. Cameron. Jr., M.D.. MP H. Chapel Hill John C. Lumsden, B CHE. Jacob Koomen, Jr.. M.D., M.P.H. Bryan Reep, MS. John Andrews, B.S. Glenn A. Flinchum. B S. H. W. Stevens, M D,, M P H.. Ashevlle Editor—Edwin S. Preston, M.A., LL,D. Vol. 82 April, 1967 No. 4 THE HEALTH BULLETIN April, 1967 ers, 4400 nurses, 4200 engineers and 1200 physicians—equivalent to 40 per-cent of that year's graduates—emigrat-ed. But sympathy for the nation's plight is tempered by the fact that in the same year, Britian acquired 3300 teachers, 1600 engnieers, 1300 nurses and 300 physicians from less privileged nations. A startling 40 percent of the medical personnel serving in the British National Health Service came from such areas as Pakistan, India and the West Indies. Similarly, France has received more professors and physicians from her former colony, the new African nation of Togo, than she has sent to that country. France also provides employ-ment to an estimated 3500 university-trained South Vietnamese, who are desperately needed in their own hard-pressed nation. To compensate for the flight of their own technologists, the nations of Western Europe employ more scientists and engineers from Turkey and the Arab nations than do their own countries. And Canada, which lost 920 engineers to the United States in 1964, admitted 2000 from abroad that year, including many hired sight unseen from Spain and Argentina. Skimming the Cream. More signific-ant than the quantity is the quality of the professionals who migrate. "Every country is short of the brightest people because God didn't make enough," says Harry S. Hoff, consultant to the United Kingdom Atomic Energy Authority. But it is these very people who are lured away. British science will not easily re-place 38-year-old medical reseacher Ian Bush, who in 1964 left for the Worcester (Mass.) Foundation for Med-ical Research with his entire staff of scientists and technicians. The Japanese electronic industry suffered an equally severe setback when Dr. Leo Esaki, developer of electronic devices used throughout the world, took a job with a U.S. firm. No nation can afford the continual loss of its most brilliant and productive minds without suffering severe eco-nomic consequences. The effect of such loss on the less developed countries amounts to "a national catastrophe," in the words of Charles V. Kidd, President Johnson's scientific adviser. Many of the nations of the world are so short of trained manpower that a university de-partment may be forced to close when a professor leaves, children go untaught when a teacher moves, and thousands be deprived of medical atention when a physician migrates. Further, in emerg-ing nations the professionals contitute that sliver of the population which pro-vides leadership. They are the catalytic agents for improvement without whom the nation stagnates. Farewell With Regret. A major moti-vation in the flight of talent is the desire for an adequate income. "The scientist is enabled to study thanks to the efforts of all his countrymen—farm-ers, laborers and intellectuals alike," Bernardo Houssay, Nobel Prize-winning biologist, reminded his fellow Argen-tinians. "He owes it to them to repay that debt." But the 206 scientists who left Argentina last year—some of whom earned less than $2000 annually—felt they could not afford to heed his plea. An Italian mfcrobiologist at Massa-chusetts Institute of Technology wrote his sponsors in anguish to explain why he was breaking his promise to return home: "I do not expect to live in luxury, but at 32, with two degrees, ! cannot live even decently on the $290 a month offered me in Italy." "I love Britain, and would like to stay," was the comment of a 40-year-old heart surgeon to official pleas that he remain. "But Britain won't afford to keep me." April, 1967 THE HEALTH BULLETIN Yet these countries are not so impov-erished that they cannot provide a bet-ter living for their professionals. A second reason for leaving is the difference in working facilities. "Al-though my salary will be doubled," said Dr. John Raison, a leader in re-search on the heart-lung machine, "that is not the reason I am leaving England. I have 20 years more work ahead of me which I cannot do with the facilities avaliable in Britian." A senior Italian physicist says, "I myself encourage young scientists to go. There is nothing for them to work with here." Yet, he observes, Italy has the funds; what it lacks is a belief in the importance of research. In several emerging nations, the problem is underemployment of pro-fessionals. The enthusiasm with which governments plunge into ambitious ed-ucational programs backfires when they neglect related industrial development. Jobless engineering graduates of Sud-an's Khartum University came close to rioting because there was nothing for them to engineer. It is estimated that 40 percent of Burma's scientists and en-gineers cannot find jobs in their pro-fessions, nor can 35,000 university graduates in the Philippines. Comments a Yale University graduate dean: "I find it difficult to advise an engineer from India, who is offered a $1 0,000-a-year job here or in Canada, to go back to his country where he may be a clerk-typist for the next ten years." Imperative: Close the Gap. A drastic ban on migration or foreign study would, in effect, be a Western version of the Berlin Wall. But U.S. agencies are now making efforts to reduce the number of foreign students allowed to remain here after completion of train-ing. These agencies are also trying to persuade industry, universities and hospitals to modify their recruitment efforts abroad. Another step would be for foreign countries to require students to concentrate on courses vital to their homelands; and to have adequately-paid jobs waiting for them, permitting them to make use of the skills acquir-ed. President Lyndon Johnson has ad-vocated that we help build multination-al institutions for advanced training in science and technology— in South Am-erica, Africa and Asia—so that fewer students will have to go to advanced nations to study. Brazil and Uruguay have already earmarked funds for the project. Senator AAondale has urged that U.S. aid organizations spend more of their money on projects specifically designed to use the talents of unem-ployed professionals abroad. U.S. private industry is beginning to establish some of its engineering and scientific research facilities in Europe and the Middle East to take advantage of surpluses of trained manpower there. This arrangement stands to benefit everybody. The U.S. company gets re-search findings; the home country gets the investment and the salaries paid, plus the increase in knowledge and skill acquired by the professionals. Most important, these professionals are not lost to their homelands: they may well be re-employed by local industries when needed. "World security, and American secur-ity, depend on development of the less privileged countries at sufficient speed to satisfy at least a portion of their na-tional aspirations," says Secretary of De-fense Robert McNamara. If the most talented members of the poor nations continue to be absorbed by the rich societies, we shall never begin to close the gap that finds the per capita in-come at $3000 a year in America, while in more than half of the rest of the world it averages only $120. THE HEALTH BULLETIN April, 1967 Day Care Health Needs Information Now Available Detailed information about the health needs of children in day care is avail-able for the first tinne in a new pub-lication of the Children's Bureau, Wel-fare Administration, Department of Health, Education, and Welfare. In announcing the publication, "Chil-dren in Day Care—with focus on health," Mrs. Katherine B. Oettinger, Chief of the Children's Bureau, said to-day, "A number of excellent textbooks and pamphlets have been written on child health in general, but never before has it been studied specifically for the child in day care." Written by Mrs. Laura Dittman of the Committee on Day Care, Maternal and Chlid Health Section, American Public Health Association, the pamph-let makes it clear that in order to as-sure comprehensive health care for each child in a day care program, a complete picture of that child and his environment must be obtained. Every aspect, geographical, socioeconomic, and physical, which might influence his development must be considered when outlining a health plan for him. "Chil-dren in Day Care," therefore, studies the special needs of different ages and groups of children and relates them to day care. For example: —Since an infant is particularly vul-nerable to infection and disease, day care workers should check with the child's parents to make sure he has received proper preventive medication including immunization. —A child's third and fourth years are crucial in arresting permanent dental, hearing, and visual defects. Professional screening should therefore be an integral part of every day care program for pre-schoolers. —Special precautions should be taken to prevent accidents in a day time program which cares for children of school age, for accidents are the largest single cause of death among school age children. —A handicapped child must be given every opportunity to care for him-self. Such normally routine activi-ties as eating, dressing, toileting, and washing can be of great value to such a child as physical, mental, and emotional therapy. —The child of migrant workers will require particularly strict nutritional supervision while in day care. His regular diet usually consists of hastily prepared foods, low in nu-tritional value, and varies as his parents follow the crops. Copies of the publication may be purchased for 50(Zl each from the Su-perintendent of Documents, U. S. Gov-ernment Printing Office, Washington, D. C, 20402. Thalidomide Charge: Nine officials of Chemie Grunenthal, the German chem-ical firm that produced thalidomide, were charged with deliberately caus-ing bodily harm and with manslaugh-ter through neglect. The public prose-cutor of Aachen charged that the of-ficials had placed the drug on the market even though preliminary tests showed it caused damage to the ner-vous system. He said about 5,000 chil-dren had been born with deformities after their mothers took thalidomide during pregnancy. April, 1967 THE HEALTH BULLETIN National Pesticide Monitoring Site ^^> I I / •8 ALASKA i o HAWA I Pesticides Monitoring Journ/ 57 FISH i_ SHELLFISH & IT ESTUARIES i PEOPLE MARKET " BASKET SURVEY « SOIL REGIONAL (i) FOOD COMMODITY • ^^^^^ SAMPLING >^ WILDLIFE ® I Vol. I, No. 1, June 1967 Archery Lesson — A Counselor shows Campers how fo hit the target at Camp Easter-in-the-Pines at Southern Pines. Imagine Your Other Self of Camp Eoster-ln-The-Pines Summer itineraries of many physical-ly handicapped children in North Caro-lina are pointing toward Camp Easter-in- the-Pines at Southern Pines. The at-traction is the camping program that will be operated by the North Caroli-na Society for Crippled Children and Adults through Easter Seal contribu-tions. H. L. Hawley, Executive Director of the Society, announced that dates for the 1967 camping season are June 18, to August 10, with three two-week ses-sions for crippled children. The last two weeks of the season, beginning July 30, will be given over to a camping session for handicapped adults. The Easter Seal Camp, operated by the Society since 1964, provides re-creation specially modified and adapted for the crippled. Stairways are replaced by ramps; handrails are installed, door-ways are wide enough to permit easy passage of wheelchairs, and shower stalls are easily usable even though campers may not be able to walk with-out the aid of special appliances. But otherwise. Camp Easter-in-the- Pines is pretty much like any other summer camp. Children have the chance to swim, shoot, hike, boat and sleep under the stars just like children with-out handicaps. It may seem impossible to some that 10 THE HEALTH BULLETIN April, 1967 children in wheelchairs, with braces on their legs, or restricted to crutches could take part in outdoor activities at camp. But rehabilitation experts agree that Camping offers the physically han-dicapped therapy they could not re-ceive in a clinic. The excitement of going to Camp seems to work wonders on children who are barred from many normal ac-tivities at home. Their eagerness to participate helps them move a little closer to overcoming their handicaps. Here, they have the chance to experi-ence nature first-hand and many are "on their own" for the first time. As the needs grow, Camp Easter-in-the- Pines is being expanded to meet them. Last year the Society added a second 4-cabin and bathhouse complex. But needs are even greater, and plans call for more improvements next year so that a stay at Camp Easter may be possible for more crippled children and adults. Anyone who may know of a physi-cally handicapped child or adult who would benefit from wholesome out-door activities at Camp should write to: Coordinator, Camp Easter-in-the- Pines, P. O. Box 1099, Southern Pines, North Carolina. The first laboratory confirmed case of dog rabies in more than two years recently occurred in Surry County. Al-though no human exposures occurred from this case, it should serve as a reminder that rabies remains an en-zootic disease in wildlife and can spread to epidemic proportions in an unimmunized dog population. In Sur-ry County it was estimated that only ten percent of the dog population had been immunized against rabies. Seventy percent of a community's dog popula-tion must be immunized against rabies to preclude the possibility of an epi-demic situation. New Drug May Benefit Manic-depressive Psychosis A potentially effective drug treat-ment for one of the most serious formis of mental illness was outlined re-cently by a National Institute of Men-tal Health scientist. The disorder, man-ic- depressive psychosis, affects many people and is present in a sizeable pro-portion of the Nation's 25,000 suicides a year. Dr. William E. Bunney, Acting Chief of the Institute's Section on Psychoso-matic Medicine, confirmed the finding that lithium carbonate, an inexpensive white powder, effectively controls this illness in many patients. It checks the intense manic excitement, and overac-tive, irritable patients become calm under its treatment. Dr. Mogens Schou in Denmark, one of the principal investigators of the therapeutic usefullness of lithium, has recently reported that the drug seems to act as a preventive of both manic and depressive attacks. These are prob-ably two aspects of a single underly-ing process. Dr. Bunney explained. If further research bears out present find-ings, lithium will become an important weapon in the fight against this very severe mental illness. However, in contrast to lithium's ac-tion in mania. Dr. Bunney said, a ques-tion remains about its usefulness in acute depressive episodes. This area is now undergoing intensive study. The Institute's research, which ex-tends the work of earlier investigators— particularly that of Dr. Schou, was de-scribed before the Missouri Institute-of Psychiatry in St. Louis. April, 1967 THE HEALTH BULLETIN 11 Consider this case: American Medical Associafion Begins A New Section //Medicine and Religion// Consider These Reasons Physicians have long been troubled by the knowledge that playing the role of healer sometimes requires them to "play God," too. A 10-year-old Louisiana boy is dy-ing from kidney disease. The physician knows it's possible to transplant a kid-ney from the boy's healthy twin broth-er, leaving the healthy twin with one kidney. Sometimes the operation fails, but in a number of cases, it succeeds; more than 500 people are alive today with transplanted kidneys. Regardless of whether the sick boy recovers, however, the physician is haunted by one thought: suppose some-thing goes wrong with the healthy twin's remaining kidney. A person can live a normal life with one kidney— that's what supports the theory of transplantation from live donors—but one cannot live without any kidneys. Disease could cut down the boy at any time. By deliberately removing a healthy, functioning part of the boy's body, has the physician consigned him to possible future death? Or are the parents responsible? They gave permission for the operations. Was the physician merely a technician, car-rying out their orders? And what of the healthy boy? He's a minor. Does he have any rights in the matter? Could there be a case in which parents used unusual coercion on such a child to save the life of another? These are some of the questions that trouble medical men of conscience on transplantation. Other areas of medicine present similar questions of ethics and morality. This is why the Journal of the Ameri-can Medical Association is beginning a new section, "Medicine and Religion," designed to discuss these issues. The first question-and-answer section (on tranplantation) appears in the April 10 Journal. 12 THE HEALTH BULLETIN April, 1967 Here's part of what Joseph E. Mur-ray, AA.D., a Boston surgeon, had to say about the problem of the lO-year-old twins: "Organ transplants, as a therapeutic maneuver to prolong life, are certainly justified as far as the recipient is con-cerned. "The source of the kidney, however, provides a major moral, legal, and ethical problem," Dr. Murray said. "If the source is a recently deceased indi-vidual whose nearest relatives have voluntarily donated the kidney, there is no problem. If the source is an elec-tive (kidney removal) for the benefit of another human being, and a kidney is used which would otherwise be dis-carded, again, there is no problem. However, when the donor is a living healthy volunteer, either a member or a nonmember of the family, a definite problem arises. Here we are embarking on a major surgical operation with a slight, but definite, risk from anesthesia, operation, or postoperative complica-tions. "This procedure is not for the bene-fit of the person being operated on, but for someone else. All previous medical and surgical training has been geared to weighing the advantages and disadvantages in any one patient of a proposed therapeutic measure. In this instance, however, for the donor a physiological deficit will always occur, and no possible good can accrue to him physically." Dr. Murray pointed out, however, that the kidney donor may derive "a certain spiritual benefit" from the do-nation, which is "probably the purest form of charity next to the giving of one's life." "For a truly unpressured volunteer, this spiritual satisfaction can more than compensate for the physical trial of a nephrectomy." Hess Gets Federal Award The National Civil Service League has named Arthur E. Hess, Deputy Commissioner of Social Security, as one of the year's 10 outstanding public servants in the Nation, Robert M. Ball, Commissioner of Social Security, an-nounced today. "Career Service Awards" are given annually by the League to recognize career public employees for outstand-ing contributions to the general wel-fare, and to stimulate able young peo-ple to choose careers in Government. The National Civil Service League is a nonpartisan, non-profit citizens' or-ganization founded in 1881 "to pro-mote efficiency in Federal, State, and local government." The Awards pro-gram was first established in 1954, with the 130 winners to date constitut-ing a roster of top excellence in the Federal service. Commenting on the award. Commis-sioner Ball said, "The League's recog-nition of Art Hess' contributions to the programs within the responsibility of the Social Security Administration, and through them, to the security and inde-pendence of millions of Americans, comes as no surprise to those of us who have worked closely with him over the years. "Whenever there has ever been a very big job of implementing a program just enacted by Congress, we have had a way of turning to Art Hess and assigning him a leading role in transforming the legislative blue-prints into effective working realities. This was the case with both the disa-bility insurance program, first enacted in 1954, and the medicare program, passed by Congress in 1965. The smoothness of the start of each pro-gram, and their early arrivals at a level of efficient and economical op-eration are due in no small measure to the administrative talent of Art Hess." April, 1967 THE HEALTH BULLETIN 13 Hess, now 50 years of age, and a native of Reading, Pa., began his ca-reer in social security 27 years ago shortly after his graduation from Prince-ton University. While engaged in re-search activities for the agency, he studied for and earned a law degree fronn the University of Maryland in Baltimore, and was accepted as a mem-ber of the Maryland bar. After 1 1 years as Director of the Bureau of Disability Insurance, he was named Di-rector of the Bureau of Health Insurance in 1965, where he played a leading role in bringing medicare to over 19 million older Americans. He has just been promoted to the position of De-puty Commissioner of Social Security, where he will continue to have a hand in the administration of medicare while also assisting the Commissioner of Social Security in overseeing the Ad-ministration's other programs. Other 1967 "Career Service Award" winners are: Philip N. Brownstein, De-partment of Housing and Urban De-velopment; Horace D. Godfrey, Depart-ment of Agriculture; Donald G. Mac- Donald, Agency for International De-velopment; William H. Smith, Depart-ment of the Treasury; O. Glenn Stahl, U. S. Civil Service Commission; David D. Thomas, Federal Aviation Agency; Floyd LaVerne Thompson, National Aeronautics and Space Administration; Barbara McClure White, U. S. Informa-tion Agency; and Marjorie J. Williams, M. D., Veterans Administration. The awardees will be honored at a dinner ceremony in Washington, D. C, on April 21, 1967, at which the prin-cipal address will be delivered by John W. Gardner, Secretary of Health, Edu-cation, and Welfare. In addition to the League's recognition of their individual excellence in public service at the Fed-eral level, the awardees are tendered a $1,000 tax-free cash award by the program. Hess and his wife, the former Nancy Davis of Wilkes-Barre, Pa., and their two youngest daughters reside at 4805 Woodside Road, Baltimore, Maryland. Birth Control: About 11 million wo-men— at least half of them Americans— now use oral contraceptives, according to a report from Planned Parenthood- World Population. MEMBERS OF THE NORTH CAROLINA STATE BOARD OF HEALTH Lenox D. Baker, M.D., President Durham James S. Raper, M.D., Vice-President AsheviUe Ben W. Dawsev, D.V.M. Gastonia Samuel G. Koonce, Ph.G. Chadbourn Oscar S. Goodwin. M.D. Apex A. P. Cline, Sr., D.D.S. Canton Joseph S. Hiatt, Jr., M.D. Southern Pmes J. M. Lackey Rt. 2, Hiddenite Howard Paul Steiger, M.D. Charlotte EXECUTIVE STAFF Jacob Koomen, M.D., M.P.H. State Health Director \V 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 Health Division Lynn G. Maddrv, 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, Presonal Health Division 14 THE HEALTH BULLETIN April, 1967 Community Hospitals Offered Disaster Care Items A thirty-day supply of critical medi-cal items for disaster care is being of-fered to community hospitals in North Carolina. These items, known officially as the Hospital Reserve Disaster In-ventory (HRDI), w\\\ augment normal hospital shelf inventories to the extent of providing the acute care medical sup-ply needs for approximately thirty days. it is anticipated that eventually every hospital in the State v^'ill be eligible to participate in the HRDI Program. Initial-ly hospitals participating in this pro-gram will be selected by the Public Health Service in accordance with cri-teria and standards established for emergency planning and location. To be eligible for the HRDI Program, com-munity hospitals must meet the follow-ing criteria: 1. Be located within fifty (50) miles of the city limitis of the central city of a Standard Metropolitan Statisitical Area (SAASA) having 250,000 or more population, 2. Having fifty (50) or more beds; and 3. Have the operational capability to establish a comprehensive disas-ter program. The two major advantages in stock-piling medical supplies in community hospitals are (1) they will assist the hospitals in their primary responsibili-ties of patient care and community health and will assure the availability of supplies for a thirty-day period if regular supply channels are disrupted, and (2) it provides an opportunity to ro-tate supplies that might deteriorate in storage. The hospital will utilize these emergency supplies in its daily opera-tions and will continue to purchase such supplies on its regular schedule thus maintaining its normal inventory at the same time. The North Carolina State Board of Health is the State agency having pri-mary responsibility for the Medical Stockpile program in North Carolina. Therefore, contracts that are negotiated between the Public Health Service and the hospital participating in the HRDI Program will be coordinated with the State Board of Health to insure the continuity of emergency health service operations both at the State and loCal level. At the present time there are fifty (50) Packaged Disaster Hospitals (PDH) in North Carolina. These hospitals, on a selective basis, will be affiliated with community hospitals. By providing com-munity hospitals with PDH's as well as HRDI Units, it will insure the State a minimum amount of essential stockpile medical items necessary for any type of disaster. The plan to assign the re-sponsibility for each PDH to a com-munity hospital is a step toward insur-ing operational capability for each pre-positioned hospital. Community hospitals agreeing to af-filiate with a PDH will be asked to (1) develop a utilization plan for the PDH, and (2) rotate pharmaceuticals in a PDH with their regular stocks, if prac-tical. The contract covering PDH rota-tion items and utilization planning will be between the community hospital and the Public Health Service. The contract covering the major components of the PDH will continue to be negotiated between the North Caro-lina State Board of Health and Public Health Service, and the County Civil Defense agencies and County Health Departments with the North Carolina State Board of Health. The eventual goal is to have every PDH in the State affiliated with a community hospital. April, 1967 THE HEALTH BULLETIN 15 THE HEALTH BULLETIN P. O. Box 2091 Raleigh, N. C. 27602 LtBRAR"51 ^ _.,,., AFFAIRS LlERARt DIVISION OF HSALIH A ^^ ^^ N.C. MEM. HO^P-CHAPEL llILl'. H.C. If you do NOT wish to con-tinue receiving The Health Bul-letin, please check here i | and return this page to ' — the address above. Printed by The Graphic Press, Inc., Raleigh, N. C. DATES AND EVENTS June 18-21 - N. C. Veterinary AAedi-ical Association, Durham, N. C. June 18-22 — American Medical As-sociation (Annual), Atlantic City, N. J. June 19-21 — North Carolina Hospital Association, Annual Meeting, Grove Park Inn, Asheville, N. C. June 25-29 — American Society of Medical Technologists, Miami Beach, Fla. July 2 - 7 — American Physical Therapy Association, Miami Beach, Fla. July 10-13 — Institute: Tuberculosis and Other Respiratory Diseases (Blue Ridge Assembly), Black Moun-tain, N. C. Aug. 9- 13 — Sixth Annual Southwide Lawyers & Physicians' Conference, Lake Junaluska, N. C. July 9-12 — American Veterinary Medical Association, Dallas, Texas. A baby in the United States today has less chance for survival than in 14 other countries. And the blame can be placed on poverty—with its concomit-ants of inadequate nutrition, lack of education, early pregnancies, illegiti-macy, and, especially, premature births. A computerized analysis performed at George Washington University shows that less than 2% of all coun-ties in this country account for Vs of the excessive mortality rates. CONTENTS Governor's Conference On Child Abuse 1 Key To Reducing Infant Mortality 2 Brains Across the Sea 3 Day Care Health Information 7 National Pesticide Monitoring Sites 8, 9 Camp Easter-ln-The-Pines 10 New Manic-depressive Psychosis Drug 11 New "Medicine-Religion" Section of AMA 12 Hess Gets Federal Award _• 13 Disaster Care Items 15 16 THE HEALTH BULLETIN April, 1967 [m\^ mmi'nm tiblicaf-ion Of The North Caroh'no State Board of Health <^:>,^^ M/^1 /?67 The First Fifty Years of Public Health in North Carolina Excerpts from "A History of the N. C. State Board of Health—1877 to 1925" by B. E. Washburn, M.D. The year 1909 proved to be an event-ful one in the history of public health of North Carolina. In that year, the General Assembly voted an increase in the annual appropriation of the State Board of Health, enabling it to employ a health officer for his full time. The State Board had been organized in 1877 and had been directed by two part-time secretaries who achieved re-markable success. The two secretaries of the State Board who conducted the pioneer health work so successfully were Dr. Thomas F. Wood from 1879 to 1892, and Dr. Richard H. Lewis from 1892 to 1909. A review of their activities is in-spiring. During this formative period, the ap-propriations had been woefully inade-quate, at times insufficient even to pay postage on the health literature they prepared and distributed. Under their direction, however, the North Carolina Board became recognized by health authorities throughout the na-tion; this is especially true of its or-ganization which largely removed it from politics and stresed the impor-tance of local (county) health organiza-tions. The Board being appointed joint-ly by the governor of the State and the State Medical Society, had been able to influence the Legislature to enact mea-sures important to public health. The recognition that disease preven-tion is the responsibility of society as a whole came to North Carolina in 1877 when its State Board of Health was created. The history of public health is re-flected in the progress of disease pre-vention carried out in North Carolina under the direction of the State Board of Health. At the time of the Board's organization in 1877, disease preven-tion was sought largely through im-provement of the environment; but ad-vances in medicine as they applied to the control of infectious diseases were readily adopted. With this came the im-portance not only of clean surround-ings but especially the provision of safe drinking water and sewage dis-posal by towns and cities. From its be-ginning, the Board recognized the need for vital statistics as a means of mea-suring progress. The inspection of state schools and institutions was carried out as well as the inspection of prisons and mental hospitals. Immediately following the Civil War, the State Medical Society discussed the need of a state board of health and advocated its provision. In this, the Society had the support of leading citizens throughout the State who had seen the terrible conditions brought about during the War due to the lack of organized health work and sanita-tion. A committee was appointed to place the matter before the Legislature; the members of the committee were Drs. S. S. Satchwell of Pender County; R. L. Payne of Davidson County; Marcellus THE HEALTH BULLETIN May, 1967 i*?^ * 4 % Thomas F. Wood, M.D. 1877-1892 AAay, 1967 THE HEALTH BULLETIN Whitehead of Rowan County; and George A. Foote of Warren County. The committee went to Raleigh in 1877 for the meeting of the General As-sembly and remained there for most of the session, being joined by Drs. Eugene Grisson and M. J. Pittman. These doctors were successful in secur-ing the passage on February 12, 1877 of a bill to establish the North Caro-lina State Board of Health. The Board of Health, as established by the General Assembly, was to con-sist of all the members of the State Medical Society who were to be the medical advisers of the State and as such give advice to the government "in regard to the location and sanitary man-agement of public institutions." An annual appropriation of $100 was made to meet the expenses of the Board. The organization of the State Board of Health was effected at the following annual meeting of the State Medical Society held at Salem on May 23, 1877. Dr. S. S. Satchwell was elected Presi-dent and Dr. Thomas F. Wood, Secre-tary and Treasurer. The annual appropriation of $100 made by the Legislature was ordered to be paid to the Treasurer of the State Medical Society. On March 14, 1879, the "Act Sup-plemental to an Act Creating the State Board of Health" passed both houses; and the Board thus created has function-ed ever since with, of course, many modifications and changes. Under provisions of the new act, the Board of Health was to be made up of nine members. Six of these were to be chosen by the State Medical Society from its active members and three to be appointed by the governor. It was specified that one of the members ap-pointed by the governor was to be a civil engineer. The members appointed by the Med-ical Society were to serve two for six years, two for four years, and two for two years; while those appointed by the governor would serve for only two years. A!l vacancies were to be filled by the Board of Health. The of-ficers of the Board were to consist of a president and a secretary-treasurer. The latter was to be paid for his serv-ices, the amount to be fixed by the Board. The general duties of this new board included all the items named in the 1877 act, these being included in the "Supplemental Act of 1879." In ad-dition, provision was made for the publication of bulletins whenever there occurred an outbreak of disease in epi-demic proportions, the object being to inform the public on how to prevent and stop the spread of dangerous dis-eases. Chemical examination and an-alyses of water were to be carried out; and auxiliary boards of health were to be organized in each of the 94 coun-ties of the State. The Health Bulletin First Published—April 1886 The official publication of the North Carolina State Board of Health, 608 Cooper Memorial Health Build-ing, 225 North McDowell Street, Raleigh, N. C. Pub-lished monthly. Second Class Postage paid at Raleigh, N. C. Sent free upon request. EDITORIAL BOARD Charles M. Cameron. Jr., M.D., M.P.H. Chapel Hill John C. Lumsden, B.C. HE. Jacob Koomen, Jr., M.D., M.P.H. Bryan Reep, M.S. John Andrews, B.S. Glenn A. Flinchum. B.S. H. W. Stevens. M.D., M.P.H., Ashevlle Editor-Edwin S. Preston, M.A., LL.D. Vol. 82 May, 1967 No. 5 THE HEALTH BULLETIN May, 1967 Richard H. Lewis, M.D. 1892-1909 ^ay/ 1967 THE HEALTH BULLETIN The State Board of Health was voted an annual appropriation of $200 to carry out these numerous items. Under the provision specified in the act, the organization of the State Board of Health took place on May 21, 1879 just a few weeks after the act had been passed by the General Assembly. The members of the 1885 Legislature were evidently impressed by the ef-forts being made by the State Medical Society, especially since the people of the State were showing interest in the matter. The General Assembly amend-ed the laws so as to make the county boards more efficient; the annual ap-propriation was increased from $200 to $2000; and a contingent fund of $2000 was set up to be expended with the ap-proval of the governor whenever an epidemic occurred; also, printing privi-leges not to exceed $250 annually were extended to the Board. As a result of the increased appro-priation and the added printing privi-lege, the Board began the publica-tion of a health bulletin, this being the first publication of this nature in the United States. The first issue of the monthly Health Bulletin appeared in April 1886 and contained reports from 26 counties, with tables made up from the reports of county superintendents of health giving the conditions of weather, the prevailing diseases, epidemics, diseases of domestic animals and the condition of public institutions, especially of the jails and poorhouses. The reports of the latter included, among other things, the number of inmates, the number who had been successfully vaccinated, the kind and the amount of food, the num-ber who could read and write, and a report of general sanitary conditions ex-isting in the county. Along with these reports were additional articles and edi-torials to instruct the people in hygienic matters. The Bulletin was widely distributed; being sent to state and county officials, public libraries and to all members of the State Medical Society, to mayors and health officers of cities and towns, and to any citizens who asked for it. It was intended to be, and was, the voice of the State Board of Health. Comment-ing on the first issue of the Bulletin, Dr. Jones, President of the Board, said to the North Carolina Medical Society at its meeting in 1886: "It will go out as a monthly messenger of glad tidings with healing in its wings, with words of truth and notes of cheer, or sounds of alarm if danger comes nigh." Dur-ing its early years, the Bulletin was pre-pared largely by Dr. Wood who alone decided what should be printed. Also, the wrapping and mailing of the peri-odical was done by the Doctor and his family. Miss Jane Wood has told of how she and her brother (later to be-come Dr. Edward Jenner Wood) helped their father with this work. She writes, "We grew to be very proud of the part we had in making good health a part of the State's task."* The favorable reception the Bulletin received and its success were due large-ly to the reports of the county super-intendents. These showed something of the health conditions existing in the different counties and enabled interest-ed officials and citizens to compare their county with others. At first, the county superintendents were negligent in sending in their reports, but in 1893 reports were received from 88 of the 96 counties in the State. Since seven counties had no board of health, only one county had failed to report. Dur-ing the first eight years, up to 1893, the Bulletin became an indicator of the progress being made in public health work in the State. Its articles were re-published and commented upon in the state press. THE HEALTH BULLETIN May, 1967 W. S. Rankin, M.D. 1909-1925 May, 1967 THE HEALTH BULLETIN The Act of 1893 greatly increased the status of the State Board of Health, which reacted with renewed activity. A well-equipped office was established in Raleigh for the Secretary who was given an annual salary of $1,000. When Dr. Thomas F. Wood of Wil-mington, the founder and first secre-tary of the State Board of Health, died on August 22, 1892, Dr. Lewis was elected to succeed him. Since the State Board of Health's annual appropriation up to 1907 was never more than $2000, the Board could not afford an office of its own, and most of its work was carried on in his office. The Act of the General Assembly of 1909 providing for the employment of a State Health Officer for his whole time made it necessary for Dr. Richard H. Lewis, the father of the bill, to culminate 17 years of patriotic devotion to the health of the people of North Carolina. At a called meeting of the Board of Health on March 30, 1909, he explained the amended law, stating that he could not afford to surrender his practice and was therefore tendering his resignation. The Board, after insist-ing in vain for the withdrawal of the resignation, reluctantly accepted it. Dr. Watson Smith Rankin of Wake Forest was elected to succeed him on July 1, 1909, at a salary of $3,000 per year. The annual appropriation of the Board was increased from $4000 to $10,500 in 1909. The General Assembly of 191 1 creat-ed County Boards of Health to take the place of the Sanitary Committees. The new legislation in 1911 enabled the State Board of Health to increase the circulation of the Bulletin from 11,- 500 to 20,000 copies per month. The Genera! Assembly of 1913 also amended several sections of the exist-ing health laws and raised the annual appropriation of the Board from $22,- 500 to $40,500 annually. In 1916 the monthly circulation of the Health Bulletin reached 51,000. Early in 1923, Dr. W. S. Rankin was invited by the "Committee of Municipal Health Department Practices" of the American Public Health Association to become Field Director in making a study of municipal health procedures. The Executive Committee of the State Board of Health granted the Secre-tary a year's leave of absence, and on November 1, Dr. Rankin assumed his duties and established official head-quarters in New York City. He con-tinued this work until November 1, 1924. A number of changes were made in 1923 in the organization of the State Board of Health as well as in its per-sonnel. On March 1, Dr. Cooper made Assistant Secretary and became official head of the staff. If it had not been for his almost total deafness, he undoubted-ly would have been selected to succeed Dr. Ranklin when the latter resigned a short time later. At the Conjoint Session of the State Board of Health and State Medical So-ciety held in Pinehurst on April 29, 1925, Dr. Rankin announced his resig-nation as State Health Officer, effective June 1, to accept directorship of the Hospital and Orphan Division of the newly created Duke Endowment. On May 30, at the meeting of the Execu-tive Committee of the Board, Dr. G. M. Cooper was unanimously made Assist-ant Secretary for an indefinite period of time. During his public health career. Dr. Rankin had been President of the Am-erican Public Health Association; Trus-tee of the American Hospital Associa-tion; first Chairman of the Charlotte Board of Health; Member of the North Carolina Medical Care Commission; Trustee of Wake Forest College; and he received honorary degrees from Duke University, University of North Caro- 8 THE HEALTH BULLETIN May, 1967 Chas. O'H. Laughinghouse, M.D. 1926-1930 May, 1967 THE HEALTH BULLETIN lina, Davidson College, and Wake Forest College. He also received, in 1956, the Distinguished Citizenship Award from the North Carolina Citizens Association. The City of Charlotte named their new public health building the "W. S. Ranklin Health Center" and this was dedicated on Dr. Rankin's 81st birth-day, January 18, 1960. Along with the founders of the State Board of Health, Drs. Thomas Fanning Wood and Richard Henry Lewis and Dr. W. S. Rankin, first full-time secretary, three doctors stand out in the develop-ment of public health work in North Carolina; Dr. John A. Ferrell, Director of the North Carolina Hookworm Com-mission, 1910-14, extended education-al and treatment campaigns throughout the State and later directed work which hastened the advent of county health departments; Dr. Louis B. McBrayer who directed and developed activities which brought about the control of tubercu-losis; and Dr. George Marion Cooper who may be called the "family phy-sician" of the State because of his care-ful study of health and social ills and the modern methods he devised to al-leviate them. On May 1, 1923, Dr. Cooper was appointed Assistant State Health Of-ficer and was made Editor of the Health Bulletin. He continued as Editor of the Bulletin until 1942 and was Acting State Health Officer on four different occasions. In the reorganization plan of 1950, Dr. Cooper became Director of the Division of Personal Health. Highlights of Progress To 1967 Excerpts from Biennial Reports 1926. On June 21 Dr. Charles O'H. Laughinghouse, a member of the Board, was elected permanent Secretary and State Health Officer to fill the unexpired term of Dr. Rankin. Dr. Laughinghouse accepted and took ofTice October 1. 1928. The educational work of the Board was of a high order during 1928. A thirty-two page BULLETIN was issued monthly, and a moving picture machine with several films on modern health subjects was exhibited in many sections of the state. 1929. On January 1 Dr. Earnest A. Branch accepted the appointment as di-rector of the Division of Oral Hygiene. Expenditures for the Board work this year reached the highest peak in the history of the Board, totaling about $486,000. 1930. On August 26, Dr. Chas. O'H. Laughinghouse, State Health Officer, died. Soon after his death, in a meeting of the board. Dr. H. A. Taylor was made Acting State Health Officer. 1931. A bill was introduced in the Legislature abolishing the State Board of Health as then constituted. This bill was passed and became law during the session of 1931. With the enactment of the new law the terms of the members of the old Board were automatically terminated. Under this new law governing the state health work, legislative machinery providing for the establishment of a new organization to carry on the public health work of the state was enacted. The Board still elects the State Health Officer, but it can only become effective upon the approval of the Governor. The term of the State Health Officer, along 10 THE HEALTH BULLETIN May, 1967 :^^ James M. Parrott, M.D. 1931-1934 with members of the Board of Health, was restricted to four years. On May 28, the new Board met and organized. On that day it unanimously elected Dr. James M. Parrott State Health Officer. Dr. Parrott took the offer under consideration for a period of two weeks. On June 1 1 the Board met again. Dr. Parrott accepted the election and agreed to assume office on July 1. 1932. The death rate in North Carolina for 1932 was 9.6 per 1,000 popula-tion. This is the lowest death rate ever before recorded in North Carolina. May, 1967 THE HEALTH BULLETIN 11 The infant mortality this year was 66.4 per 1,000 live births. This is so far the best record the state has ever made. Expenditures for this year for ail purposes by the Board were $315,276, of which $262,438 represented appropriations. This amount was just a little more than half the total expenditures made by the Board of Health for the fiscal year ending June 30, 1930. 1933. The event of outstanding importance to the Board of Health this year was the death of Dr. C. A. Shore, which occurred on February 10. A few weeks after the death of Doctor Shore, Dr. John H. Hamilton, director of County Health Work, of Vital Statistics, and of Epidemiology, was made di-rector of the laboratory work. 1934. The event of greatest importance to the State Board of Health and to the health work throughout the state in this year was the death of Dr. James M. Parrott and the election of Dr. Carl V. Reynolds as his successor. Dr. Carl Vernon Reynolds, of Asheville, on November 10, took the oath of office and immediately assumed his duties as Acting State Health Officer. 1935. At the annual meeting of the State Board of Health, which was held in Pinehurst May 7, 1935, Dr. Reynolds was unanimously elected State Health Officer. 1937. On December 16, 1937, following Legislative Provision in the 1937 session of the Legislature, $160,000 in bonds were sold for the purpose of build-ing a new plant for the State Laboratory on the grounds adjacent to the present State Board of Health building on Caswell Square, Raleigh. The total expenditures for the State Board of Health during the fiscal year end-ing June 30, 1937, were $881,484.01. Of this amount $287,747.04 was appro-priated by the Legislature. The total expenditures for the State Board of Health for the fiscal year ending June 30, 1938, were $1,041,895.98. Of this amount $353,953.55 was appro-priated by the Legislature. 1939. The total expenditures for the State Board of Health for the fiscal year ending June 30, 1939, were $1,215,056.80. Of this amount $364,506.25 was appropriated by the Legislature. 1940. The most important item in the field of public health in this State in 1940 was the completion and dedication of the central building known as the Clarence A. Shore Laboratory of Hygiene. The circulation of the HEALTH BULLETIN increased from about 52,000 to 60,000 monthly copies during the year. The total expenditures for the State Board of Health for the fiscal year ending June 30, 1940, were $1,380,174.90. Of this amount $370,057.67 was appro-priated by the Legislature. 1942. On January 1, 1942, Dr. G. M. Cooper was retired from the editorship of the State HEALTH BULLETIN and Dr. John H. Hamilton assumed the duties of acting editor. The total expenditures for the State Board of Health for the year ending June 30, 1942, were $1,791,878.11. Of this amount $370,150.59 was appropriated by the Legislature. In the autumn of this year the employees of the State Board of Health organ-ized and established what is officially known as the North Carolina Academy of Public Health at the State Board of Health. All employees of the State Board of Health are members of this Academy. 12 THE HEALTH BULLETIN May, 1967 Carl V. Reynolds, M.D. 1934-1948 The total expenditures for the State Board of Health for the year ending June 30, 1942, were $1,791,878.11. Of this amount $370,150.59 was appropriated by the Legislature. 1943. The total expenditures for the State Board of Health for the fiscal year ending June 30, 1943, were $1,880,230.62. Of this amount $406,993.29 was appropriated by the Legislature. 1947. The total expenditures for the State Board of Health for the year ending June 30, 1947, were $2,814,937.00. Of this amount $561,996.00 was appro- May, 1967 THE HEALTH BULLETIN 13 priated by the Legislature. 1948. The most conspicuous event taking place during this part of the biennium was the resignation of Dr. Carl V. Reynolds as State Health Officer effective June 30. Dr. Reynolds retired after serving a little more than 13V2 years. At the meeting of the State Board of Health in Raleigh on February 24, Presi-dent Craig read Dr. Reynold's letter of resignation as Secretary and State Health Officer effective June 30, 1948. Doctor J. W. R. Norton, native of Scotland County and Chief Health Officer of the TVA of Chattanooga, Tennessee, was elected State Health Officer. The total expenditures for the State Board of Health for the year ended June 30, 1948, were $2,648,277.00. Of this amount $794,774.00 was appropriated by the Legislature. On July 1, 1948, Dr. J. W. R. Norton assumed his duties as State Health officer. 1949. The year 1949 was destined to become a turning point in the Public Health program in North Carolina. The Legislature of that year did more for Public Health than any of its predecessors. There was a spirit of close cooperation between Public Health officials, the Governor and members of the General As-sembly. As an outcome of this, approximately $800,000 in new money was voted for each fiscal year of the new biennium for local health work, which had only been receiving $350,000 a year. This meant an increase to $1,150,000 in State funds for local health during the biennium. 1950. The year 1950 saw not only increased expansion in local health work, but also re-organization of the State Health Department so as to make operations less cumbersome. As of February 1, reduced the number of divisions to six, placed in charge of a director and designated the subdivisions as sections. 1951. The General Assembly, which met early in January, increased the appro-priations for Public Health to $2,214,591 for the fiscal year of 1950-1952 and $2,224,982 for the fiscal year of 1952-1953. On January 19, the State Board of Health confirmed the appointment of Dr. John H. Hamilton as Assistant State Health Officer, his term to run concurrently with that of Dr. Norton. MEMBERS OF THE NORTH CAROLINA STATE BOARD OF HEALTH Lenox D. Baker, M.D., President Durham James S. Raper, M.D., Vice-President Asheville Ben W. Dawsey, D.V.M. Gastonla Samuel G. Koonce, Ph.G. Chadbourn Oscar S. Goodwin, M.D. Apex 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 3. 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 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, Presonal Health Division 14 THE HEALTH BULLETIN May, 1967 J. W. R. Norton, M.D., M.P.H. 1948-1965 May, 1967 THE HEALTH BULLETIN 15 rHE HEALTH BULLETIN P. O. Box 2091 Raleigh, N. C. 27602 MEDICAL tlBRARY \j. OF N. C . CHAPEL HlLL./% _BX. 1020 If you do NOT wish to con-tinue receiving The Health Bul-letin, please check here i— 1 and return this page to '— ' the address above. /V Printed by The Graphic Press, Inc., Raleigh, N. C. 1954. Following the 1954 Conjoint Session of the State Board of Health and the State Medical Society the health department was moved from its old building to its new million dollar headquarters on Caswell Square. Jacob Koomen, Jr., M.D., M.P.H., assistant director of the Division of Epidemi-ology, was named Assistant State Health Director to begin that service October 1, 1961. The auditorium of the Laboratory Building was renovated and re-decorated and dedicated by the State Board as "The John Homer Hamilton Auditorium". Edwin S. Preston, M.A., LL.D., was named Editor of The HEALTH BULLETIN in May 1960 upon the retirement of Dr. John Homer Hamilton. Dr. J. W. R. Norton relinquished his position as State Health Director effective December 31, 1965, continuing as Director of the Local Health Division. Dr. Jacob Koomen, Assistant State Health Director was elected Acting State Health Director and in May 1966 became State Health Director with the approval of Governor Dan Moore. Dr. W. Burns Jones was elected as Assistant State Health Director. Appropriations for the continuation of existing activities of the State Board of Health were made in the amount of $6,232,867 for the first year of the biennium, 1967-69, and $6,308,776 for the second year, including amounts to implement a uniform fee schedule for medical fees and the payment of 90% of hospital reimbursable costs. Additional appropriations for special purposes included: Health aid to coun-ties—$ 400,000 for each year of the biennium (the first major appropriation for this purpose since 1949); Salt Marsh Mosquito Control—$70,000 for the first year and $100,000 for the second; Genetics Counseling Center—$1 00,000 for the second year; Scallop Inspection Program—$1 1 ,736 for each year; and $42,500 for each year to establish and maintain a Statewide Medical Examiner System. 16 THE HEALTH BULLETIN May, 1967 m!\^ ©raii^u The Official Publication Of The North Carolina State Board of Health nr \ ^LTH A CUTE RASCAL — BUT AN ENEMY in the article beginning on page 3, "The Insecticide That Turns the Bug Against Itself", this advice is given: To cope with him and others like him, use the Judo approach — don't whack away by main force; use the enemy's own strength against him. Disorganize the insect's growth by making use of the same chemicals the insect uses to regulate his growth. Miss Holley Receives Aword The first nurse to receive an Award of Merit for Outstanding Contribution and Meritorious Service in the field of Public Health and Preventive Medicine was presented to Miss Elizabeth Hol-ley, Chief Nurse, North Carolina State Board of Health, Raleigh, North Caroli-na at the 35th Annual Meeting of the Southern Branch, American Public Health Association held in St. Louis, Missouri 'as+ week. Miss Holley, a past president of the Association and representative to the national A.P.H.A., was selected frorr. among the 17,000 public health work-ers in 1 7 Southern states served by the Association which has its headquarters in Birmingham, Aia. In presenting the award. Dr. H. P. Hopkins, President, Nashville, Tenn., said "Miss Holley symbolizes the dedi-cation of the public health nurse and other public health workres in protect-ing the health of our nation through programs that prevent and control disease affecting people in every age group." Also elected were: President—Charles G. Jordan, B.S.C.E., Miami, Fla.; 1st Vice President—Hugh B. Cottrell, M.D., Atlanta, Ga.; 2nd Vice President—John M. Bruce, M.D., New Orleans, La.; 3rd Vice President— Fred Ragland, Jackson-ville, Fla.; Secretary-Treasurer—John S. Neili, M.D., Tampa, Fla. Executive Committee—Miss E. Alice Clark, R.N., M.P.H., Atlanta, Ga.; Miss Elizabeth Holley, R.N., M.A., Raleigh, N. C; H. P. Hopkins, Ph.D., Nashville, Tennessee; William J. Peeples, M.D., Baltimore, Md.; Miss Joella Sisler, Frankfort, Kentucky. Future annual meetings are sched-uled for May 28-31, 1968-Roanoke, Va., and May 20-23, 1969-Oklahoma City, Okla. The Health Bulletin First Published—April 1S86 The official publication of the North Carolina State Board, of Health, 608 Cooper Memorial Health Build-ing, 225 North ^^cC'o
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 | 1967 |
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 82, Issues 1-12. Issues for Feb.-May 1917 and for Jan.-July 1918 not published.Addresses by Walter Clark. |
Publisher | Raleigh,North Carolina State Board of Health. |
Agency-Current | North Carolina Department of Health and Human Services |
Rights | State Document see http://digital.ncdcr.gov/u?/p249901coll22,63754 |
Physical Characteristics | 61 v. :ill. ;23 cm. |
Collection | Health Sciences Library, University of North Carolina at Chapel Hill |
Type | text |
Language | English |
Format | Bulletins |
Digital Characteristics-A | 9,514 KB; 210 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_healthbulletin1967.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. four days This JOURNAL may be kept ou t and is subject to a fine of FIVE CENTS a day thereafter. It ia DUE on the DAY Indicated below: he Phy and the Child" Laboratory Testing Well Baby Clinics Water Fluoridation ^^-r U'-(- Governor Dan K. Moore and a Local Health Director The State Legislative Building Where Public Health Laws Are Enacted and Administered The State Capitol Don't You Envy This Public Health Nurse? The Health Bulletin First Published—^April 1886 The official publication of the North Carolina State Board of Health, 608 Cooper Memorial Health Build-ing, 225 North McEtowell Street, Raleigh, N. C. Pub-lished monthly. Second Class Postage paid at Raleigh, N. C. Sent free upon request. EDITORIAL BOARD Charles M. Cameron. Jr.. M.D.. M.P.H. Chapel Hill John C. Lumsden, B.C. HE. Jacob Koomen, Jr., M.D.. M.P.H. Bryan Reep, M.S. John Andrews, B.S. Glenn A. Flinchum, B.S. H. W. Stevens. M.D.. M.P.H.. Ashevlle Editor—Edwin S. Preston, M.A., LL.D. Vol. 82 January, 1967 No. 1 THE HEALTH BULLETIN The Public Health Policy Makers The North Carolina State Board of Health with Governor Dan K. Moore Mrs. Dan K. Moore Has An Interest in Public Health Dr. Jacob Koomen, the State Health Director, conducted North Carolina's First Lady on a tour of many activities in the Health Buildings National Leaders of the Council on the Aging Older People Have Many Opportunities for Service THE HEALTH BULLETIN 'The Patient's Heart Has Stopped - But He Is Still Alive" Prize Picture Photo Courtesy of the B. F. Goodrich Company THE HEALTH BULLETIN THE HEALTH BULLETIN Inf-ensive Care and Correctional Treatment V?«(J(S-Immunization Prevention Is the Best Health Investment Dental Health This Young Man Has a Weight Problem The Public Health Nurse Goes Where the People Are ^ >~ V The "Little Jack Puppet Show" Teaches Good Dental Health National and State Public Health Leaders Confer The Lost Colony at Manteo Invites to Constructive Recreation Visit Our Beautiful Legislative Building MEMBERS OF THE NORTH CAROLINA STATE BOARD OF HEALTH Lenox D. Baker, M.D., President __^ Durham James S. Raper, M.D., Vice-President Asheville Ben W. Dawsev, D.V.M. Gastonia Samuel G. Koonce, Ph.G. Chadbourn Oscar S. Goodwin, M.D. Apex 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, Sar^itary 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 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. Acting Director, Personal Health Division 14 THE HEALTH BULLETIN The Handicapped Can Be Helped Starting Over with Help and Encouragement THE HEALTH BULLETIN 15 THE HEALTH BULLETIN P. O. Box 2091 Raleigh, N. C. 27602 LIBRARIAN DIVISION OF HEALTH AFFAIRS LIBRARY N.C. UE^f.. HOSP. U. N. C. CHAPEL MILL, 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. Public Health Gets Under Your Skin Find YOUR Piece of Service 16 THE HEALTH BULLETIN ^*> F^g n^^y UB8l«t Sanitarians Needed Excellent growth opportunities for ambitious professional sanitarians. The Engineering—Sanitation Section of A. P. H. A. has about 1,500 mem-bers and Fellows. Too few of these are sanitarians. Too few of the members are Fellows (either engineers or sani-tarians). Tomorrow's leadership wil come from those young men willing to give a small amount of time and money to advance the profession in which they practice public health. Maintain your interest and loyalty to your particular professional associa-tion. Sanitarians associations both local and national need and deserve your full support. You can help to further those in-terests through membership and active participation in the increasing en-vironmental health functions of the Engineering-Sanitation Section of the A. P. H. A. (William V. Hickey is chairman). For a membership applica-tion write to: Department M American Public Health Association 1740 Broadway New York, New York 10017 The two recent cases of typhoid fever reported from Burke County dem-onstrate the present epidemiology of typhoid. The patient, age 15, has lived all her life in the home of her aunt who had typhoid years ago. Positive stool cultures obtained from both the aunt and the patient were identified by serologic typing as Salmonella ty-phosa at the State Board of Health. Vaccination was recommended only for immediate household contacts. The society which scorns excellence in plumbing because plumbing is a humble activity and tolerates shoddiness in philosophy because it is an exalted activity, will have neither good plumb-ing nor good philosophy. Neither its pipes nor its theories will hold water. —John Gardner. Don't- Neglect Sore Throat Sore throat is nature's warning sys-tem that something in your body is out of order. Often a sore throat accompanies a common cold and the soreness passes in a few days with no further effect. But a sore throat also can be the symp-tom of a wide range of diseases, from diphtheria to leukemia, that require your doctor's skill, not your guessing, to diagnose. Allergies can cause sore throats. Cold, dry winter air can trigger it. So can extreme thirst, excessive smoking or mouth breathing—anything that dries out the throat and cuts off secretions that normally wash dust away. Virus infections of many types also are a cause of sore throat, and every-one who has had "flu" knows that this particular virus disease often causes the throat to hurt. "Strep throat" is a serious infection that occasionally leads to rheumatic fever and possible heart damage. Early treatment with penicillin or other anti-biotics offers an excellent chance of eliminating the potential threat of rheu-matic fever. There is little or nothing you can do to cure a sore throat at home. There are medications which bring temporary easing of the discomfort but the cure must be prescribed by your physician. American Medical Association THE HEALTH BULLETIN February, 1967 Glue Sniffing . . The Quest for Ecstasy A Georgia View (N. C. Senate Bill 135, introduced by Ellis and others, concerns this problem.) Glue-sniffing among teenagers, a relatively new means of enjoying quick thrills and adventure in unreality, seems to be gaining followers. Police authori-ties, a juvenile court judge, doctors and other health authorities were interview-ed to determine the extent of this prob-im in Georgia and its immediate and long-range effects on the glue-sniffer. Since the problem is a recent one, much about it is unknown. The following ac-count presents the problem and its dangers as seen by the authorities in-terviewed. With only a brown paper bag and a ]0i tube of glue a teenager is quick-ly caught-up in a fantastic world of vivid dreams and hallucinations. Enter-ing this world, like entering Dante's immortal hell, can be a step "into the eternal darkness, into fire and ice." It is a world from which some never com-pletely return. When the teenager first inhales glue fumes, he is exhilarated, "dizzy," ' "drunk," free from reality. Then he begins to act drunk; his speech is slur-red. He becomes depressed, mentally I confused. He may display bizarre be-havior. He may black out. Feelings of reckless abandon often lead to dangerous impulsive acts. One boy in his early teens is reported to have assumed a fighting stance before an oncoming train and narrowly es-caped death. Another young glue-snif-fer, convinced he could fly, leapt to his death from the top of a building. Teen-agers under the influence have joined in wild automobile rides in the night. What happens to the chronic glue-sniffer? Long range effects are not easy to assess, and doctors themselves do not always agree. The concentra-tion of the solvent in the glue, fre-quencey of glue-sniffing, the lapse between times of intoxication, and dif-ferences in the physiological makeup of individuals all contribute to determ-ining the chronic results to any indi-vidual. Extensive damage to the kid-neys seems to be the major effect, ac-cording to Dr. H. K. Sessions, Occupa-tional Health Service, Georgia Health Department. "Exposure over long pe-riods of time could also cause brain damage and blood dyscrasias with bleeding in the lungs," Dr. Sessions continued. Graver consequences—even death—result from glue-sniffing while drinking beer. Is glue-sniffing a serious problem in Georgia? It is, according to Atlanta Police Superintendent Clinton Chafin. Superintendent Chafin reports that dur-ing the 13-month period from January 1, 1966, to January 31, 1967, 176 teenagers were arrested who had been sniffing glue. The majority of the teen-agers arrested (43) were 15-year-old boys. An astonishing 39 were 12 years of age or under. Most of the arrests were made in lower income areas. Superintendent Chafin feels that the problem is increasing in the Atlanta area and that corrective measures must be taken. Fulton County Juvenile Court Judge Elmo Holt—who comes in daily contact with many varieties of juvenile offend-ers— substantiates the reports of a grow-ing problem with glue-sniffers. "We had never heard of glue-sniffers here until about three years ago," Judge Holt said. The problem first appeared February, 1967 THE HEALTH BULLETIN in the North and West, according to Judge Holt, and spread to this part of the country. Judge Holt also believes that the problem is primarily a low-in-come area problem. A survey was con-ducted in the Juvenile Detention Center in March, 1966. Of the 96 boys present at that time, 36 admitted having snif-fed glue. Some 30 were habitual glue-sniffers. Juvenile authorities suspect that an additional 10 boys had sniffed glue but would not admit it. These figures show that almost one-half of the boys in the Center at that time were glue-sniffers! What kind of trouble do these young people become involved in? "Every kind of trouble— burglary — robbery-shoplifting," Judge Holt says. Superin-tendent Chafin also reports teenagers arrested for burglary in connection with glue-sniffing. What causes a teenager to sniff glue? Dr. Charles K. Bush, a psychiatrist and director of the Hospital Services Branch of the State Health Department's Di-vision of Mental Health, has several theories about glue-sniffers. Dr. Bush would classify them with those who begin taking dope or smoking mari-juana. "It's done for kicks. It is pos-sible that they begin because it's the smart thing to do. A status symbol. The first thing they know, they are 'hook-ed.' "Teenagers who practice glue-sniffing are insecure with their peer group or family," Dr. Bush continued. "They lack security. A youth who feels good about his relationship with his family and his peers doesn't do this sort of thing." What can be done about this appar-ently growing problem? Several cities and states have passed ordinances re-stricting the sale of glue or making glue-sniffing illegal. Atlanta this month passed an ordinance forbidding the sale of glue to minors under eighteen years of age and restricting the retail sale of "model glue" to one medium sized container in a 24-hour period. The or-dinance further stated that "it shall be unlawful for any person to intentional-ly smell or inhale the fumes of any type of 'model glue,' or to induce any other person to do so, for the purpose of causing a condition of, or inducing symptoms of intoxication, elation, eup-horia. . . ." Is this the answer? Can legislation prevent teenagers from trying this tempting bout with danger? Will edu-cating teenagers to the permanent dam-ages of glue-sniffing discourage them from trying a fad? The answers are unknown. Much about the problem it-self is unknown. The need for research is evident. Only then may a light be cast on the problem.—From "Georgia's Health" The Health Bulletin First Published—April 1886 The official publication of the North Carolina State Board of Health, 608 Cooper Memorial Health Build-ing, 225 North McDowell Street, Raleigh, N. C. Pub-lished monthly. Second Class Postage paid at Ralefgh, N. C. Sent free upon request. EDITORIAL BOARD Charles M. Cameron, Jr.. M.D.. M.P.H. Chapel Hill John C. Lumsden. B.C. HE. Jacob Koomen, Jr., M.D.. M.P.H. Bryan Reep, M.S. John Andrews, B.S. Glenn A. Flinchum. B.S. H. W. Stevens. M.D., M.P.H.. Ashevlue Editor—Edwin S. Preston, M.A., LL.D. Vol. 82 February, 1967 No. 2 THE HEALTH BULLETIN February, 1967 The Problem of Hernia Hernia, while not an important cause of death, is a common impairment and a leading cause of hospitalization. Thus it is a significant factor in considering problems of hospital use and health care. Based on National Health Survey findings, it is estimated that approxi-mately 2,900,000 people in the United States—about 15 per 1,000—have a hernia.* The condition occurs most often at the extremes of life, in infancy for congenital reason and in old age as a result of weakened body tissues. It is reported three times more frequently among males than females, reflecting the generally more strenuous activities of men as well as their great vulner-ability to hernias affecting the groin. As the accompanying table shows, 23.2 per 1,000 males report a hernia com-pared with 7.1 for females. A distinct disparity by sex exists in every age group but is especially marked at ages 75 and older, where the prevalence of 123 per 1,000 among males is more than 6 times that for females. Hernia occurs least often in the teens and early twenties, its prevalence rising steadily thereafter. As a cause of hospitalization among males, hernia is exceeded only by resp-iratory conditions, injuries, and dis-eases of the heart. t The average length of hospital stay for men undergoing a hernia repair or correction is about a week. Women, who account for only a fifth of the hospitalized cases, stay on the average almost three days longer. Both frequency and duration of *Hernias Reported in Interviews, United States, July 1957-June 1959; National Cen-ter for Health Statistics, Series B.—No. 25, Washington, D. C, December 1960. fHospital Discharges and Length of Stay: '^hort-Stay Hospitals, United States, July i963-June 1964; National Center for Health Statistics, Series 10—No. 30, Washington, D. C, June 1966. V \ -7- HERNIA PREVALENCE AND MORTALITY IN THE UNITED STATES Age Perio (Yeorsl All Ages Under 1 1-14 15-24 25-34 35-44 . 45-54 55-64 65-74 75 and over ge Frevdience Rates peFj^^BI^^Mrge Death Rates per 100,000 5 July T 957-Jwne 1959 "WSj^^^f^: T962-64 T«fat Persons Males Femafef*^ 'total Persons Moles FerrtdJe's 14.9 5.6 4.1 9.4 12.1 19.0 32.2 49.5 64.6 23.2 8.2 6.4 12,4 17.7 28.1 51.8 86.5 122.9 7.1 3.0 2.1 6.7 6.9 10.2 14.1 17.0 19.9 1.8 1.9 1.7 15.7 hospitalization increase with age; al-most half the discharged patients are 45 and older, with the length of stay rising from 3.3 days at ages under 15 to 9.7 at ages 45 and older. Almost all of these hospitalizations are for surgery; indeed, hernia repairs are second only to tonsillectomies in the frequency of operations performed on males in short-stay hospitals in the United States. Surgery is the treatment of choice for most simple hernias un-less contraindicated by a patient's poor general health or advanced age. The surgical risk is extremely low; a study of 1,162 hernia patients operated upon during 1950-59 reported an operative mortality of only 0.3 percent. t After survery, recurrences are generally ex-perienced only by older people or those with weakened tissues. The accompanying table shows the death rates attributed to hernia during 1962-64, by age and sex. This infor-mation was made available by the National Center for Health Statistics •and is not "given in published mortality reports. On the average, there were 3,451 deaths from hernia annually dur-ing this period. This figure excludes deaths from intestinal obstruction with-out mention of hernia (I.S.C. 570). The hernia death rate, at all ages combined, is 1.8 per 100,000 popu-lation. Mortality is highest among in-fants and the elderly, and negligible at the school and early adult ages. Death rates are slightly higher for males than for females. It is noteworthy that about 60 per-cent of the hernia deaths reported dur-ing this period were due to conditions specified as gangrenous, incarcerated, irreducible, strangulated or causing ob-struction, indicating that hernia be-comes dangerous only when treatment is unduly postponed or when other factors increase the risk of surgery.— Statistical Bulletin, Metrolopitan Life In* surance Company. First Rabies Case in 2 Years The first case of dog rabies in more than two years was confirmed in the State Board of Health Laboratory in February. The dog appeared on a farm about four miles west of AAt. Airy and as the farmer was attempting, to run the dog away, the dog ran into a near-by farm and attacked a calf. The dog severely bit the calf on the legs and head. Shortly after attacking the calf, the dog died. After it was determined that the dog was rabid, the calf was sacrificed and buried. No human exposure occurred dur-ing this incident. However, this case of rabies served well as a fair warning and the activities of the rabies control program have been increased in Surry County. An additional dog warden has been employed by the county and em-phasis is being placed on the vaccina-tion of dogs and the elimination of strays. JRydell, W. B. Jr., Inqidnal and Fe-moral Hernias, Archives of Surgery, Vol. 87, pp. 493-499, September 1963. Birth Rate Down: The U.S. birth rate during 1966 reached the lowest level since 1936, and the total number of births was the lowest since 1950, re-ported the U.S. Public Health Service. The 1966 birth rate was 18.5 per 1.000 population, and births totaled 3,629,- 000. It was the ninth consecutive yearly decline in the birth rate. Measles: Secretary of Health, Edu-cation and Welfare John Gardner said a federally supported vaccination drive may eliminate rubeola from the United States this year. The program is under-written by $7 million in federal grants. THE HEALTH BULLETIN February, 1967 Decade of Progress In Public Healfh 1957-1966 Halifax County North Carolina By Robert F. Young, M.D. Halifax County Health Director During the decade 1957-1966 more progress was made in public health and more new programs were initiated than during the 37 previous years of the Halifax County Health Department's existence. At least ten major programs have been developed, while the staff, including the regular employees and those on special cooperative projects, has more than doubled from 19 to 41. Pediatric clinics were developed in 1957 in cooperation with the Halifax County Medical Society and with the Department of Pediatrics at Duke Medi-cal Center. These clinics which now number four each month provide serv-ices to medically indigent children from birth to ten years of age, but are de-signed primarily for infants and pre-school children. The next big development came in 1959 when the Mental Health Program was initiated with a position for a clinical psychologist. Dr. Carl Eisdorfer from the Department of Psychiatry at Duke was the first mental health spe-cialist to fill this position and has continued with the program through the years making an outstanding con-tribution. In the meantime, two addi-tional clinical psychologists and a psy-chiatrist from Duke have joined Dr. Eisdorfer. In addition to these men, there are four psychology interns and three graduate students in clinical psy-chology from Duke who visit in this county under the supervision of Dr. Eisdorfer and the other psychologists. A comprehensive Human Relations Cen-ter (mental health) is being planned at the present time. Another very signifi-cant development in mental health has been the proposed Suicide Prevention Program which will begin operation in the near future. Hard on the heels of this Mental Health Program came the Special Tu-berculosis Control Project which has been conducted in cooperation with the United States Public Health Serv-ice, State Health Department, the local medical profession and the State Sana-torium System. The Tuberculosis Asso-ciation also has aided in this program. It has been financed to the extent of approximately $85,000 by the Public Health Service since its inception. In Continued to Page 14 February, 1967 THE HEALTH BULLETIN An Inyifrat-ion The Western North Carolina Public Health Association especially invites you to their next annual meeting to be held in the Grove Park Inn, Asheville, North Carolina. PLEASE MARK THIS DATE ON YOUR CALENDAR. THE DATE IS MAY 18, AND 19, 1967. We expect to have an excellent sci-entific session and social events which you will thoroughly enjoy. At a later date, you will receive further announce-ments about this meeting, giving you a preview of the program and other events. We particularly wish to invite com-mittees, executive committees, boards of directors, and examining boards to hold their spring meeting with us. This would combine an interesting pub-lic health meeting with business mat-ters concerning related public health fields. If you happen to be a member of such a committee that can be in-vited to hold one of their regular spring sessions during or with the Western North Carolina Public Health Association, please advise me immed-iately. I will certainly contact the chair-man or president of such a committee or board and especially invite him to hold a session of his group with the WNCPHA Meeting. Remember-PUT THIS DATE ON YOUR CALENDAR. The air-conditioned city in the Land of the Sky is very beautiful during the month of May. For your reservations (get them in early) write to Reservation Manager, Grove Park Inn, Asheville, North Caro-lina, 28801. H. W. STEVENS, M. D., CHAIRMAN LOCAL ARRANGEMENTS P. O. BOX 7607 ASHEVILLE, NORTH CAROLINA 28807 i |9S THE HEALTH BULLETIN February, 1967 Grove Park Inn Welcomes You Any Time of Year February, 1967 THE HEALTH BULLETIN SOUTHERN BRANCH AMERICAN PUBLIC HEALTH ASSOCIATION 35th Annual Meeting - 1967 Sheraton-Jefferson Hotel May 10, n, 12 - St. Louis, Missouri PROGRAM THEME: REGIONALIZATION FOR PERSONAL HEALTH SERVICES Wednesday, May 10, 1967 FIRST GENERAL SESSION 9:30 A.M. Presiding H. P. Hopkins, Ph.D., President Invocation The Very Reverend William H. Mead Dean, Christ Church Cathedral, St. Louis Announcements and Early Business J. Earl Smith, M.D., Commissioner of Health, St. Louis Division of Health, and Chairman, Local Arrangements Committee Greeting C. Howe Eller, M.D., Dr. P. H., Commissioner of Health, St. Louis County Health Department, and President, Missouri Public Health Association Welcome Address L. M. Gamer, M.D., M.P.H., Acting Director, The Division of Health of Missouri Greetings from A.P.H.A. Milton Terris, M.D., President American Public Health Association Dr. Terris 10 THE HEALTH BULLETIN February, 1967 Introduction Robert F. Lewis, Ph.D., 1st Vice President President's Address H. P. Hopkins, Ph.D., President Introduction _ Albert V. Hardy, M.D., Director, Southern Branch, APHA, Continuing Education Project Keynote Address: "Planning: The Key to Regionalization' William L. Kissick, M.D. Director, Office of Program Planning and Evaluation Public Health Service Washington, D. C. Dr. Kissick Governing Council Luncheon—Baroque Room 12:15 p.m. SECTION MEETINGS 2:00-4:30 p.m. President's Reception—Boulevard Room 6:30-7:30 p.m. Thursday, May 11, 1967 SECOND GENERAL SESSION 9:30 A.M. Presiding Charles G. Jordan, B.S.C.E., Secretary-Treasurer Introduction '. _ John S. Neill, M.D., Chairman, Program Committee "Regionalization of Environmental Health Services" Franklin D. Yoder, M.D., Director of Public Health, Illinois Dept. of Public Health Springfield, Illinois Dr. Yoder February, 1967 THE HEALTH BULLETIN n Introduction. Edward M. Campbell, D.D.S. Co-ChairmaTi, Program Committee "Regionalizing Clinical Services for Personal Health" Robert Q. Marston, M.D. Associate Director, NIH, and Director, Div. of Regional Medical Programs National Institutes of Health Bethesda, Maryland Dr. Marston SECTION MEETINGS 2:00-4:30 p.m. Governing Council Meeting—Baroque Room 5:00 p.m. Banquet and Dance—Gold Room 7:30 p.m. Friday, May 12, 1967 THIRD GENERAL SESSION 9:30 A.M. Presiding H. P. Hopkins, Ph.D., President APHA Correlative Business Berwyn F. Mattison, M.D. Frederick W. Hering, M.S.P.H. i Business Session: Committee Reports Section Reports Introduction of New Officers Dr. Mattison Closing remarks and adjournment H. P. Hopkins, Ph.D. Executive Committee Meeting Immediately following - Arch Room 12 THE HEALTH BULLETIN February, 1967 "Black Market Medicine" On May 15, Prentice-Hall will pub-lish "Black Market Medicine," by Mar-garet Kreig. It is the chilling and shock-ing story of hoodlum infiltration into the drug industry that may be one of the most widely discussed books of 1967. "Black Market Medicine" reveals the heretofore unpublicized multi-million dollar counterfeit drug racket that threatens the health of nearly every person in the United States. Science reporter Margaret Kreig lit-erally took her life in her hands to ride with U. S. Food and Drug Admin-istration inspectors on the trail of the vicious gangsters who are polluting the health stream of America at its very source. Mrs. Kreig's first book "Green Medi-cine" gained national attention as a best-seller here and abroad. The au-thor has contributed to This Week, Reader's Digest, Good Housekeeping, Mademoiselle and other major national magazines. She is a member of the National Association of Science Writers, and the International Narcotics Enforce-ment Officers Association. Aging Population: By 1980, there will be 24.5 million people in the United States over the age of 65, the National Council on the Aging said. In 1966, acording to the Council, the U. S. had 18.5 million people over age 65. A Public Health Service official to-day cautioned people who wear paper clothing that they risk burning them-selves if they wear it near an open flame after it has been laundered, dry cleaned or worn in a soaking rain. Dr. Richard E. Marland, Chief of the Public Health Service's Injury Control Program within the National Center for Urban and Industrial Health, said any-one wearing this new type of garment should discard it once it becomes soil-ed. "The manufacturers themselves ac-knowledge that many of these paper dresses and other garments lose what-ever flame retardant finish they have after washing," Dr. Marland said. "In fact, we are asking the Bureau of Stand-ards to test samples of paper clothing to determine just how resistant these garments are to fire when they are new." Donald B. Perry (left) the Supply and Service Officer of the State Board of Health, was presented the Most Out-standing Service Award for 1966 by Bryan R. Reep, president of the Pub-lic Health Academy. February, 1967 THE HEALTH BULLETIN 13 Continued from Page 7 1965, a report was made on this pro-gram at the International Union Against Tuberculosis meeting in Munich, Ger-many. During this time the number of cases of tuberculosis had been cut in half in Halifax County. Then, in 1960 a new program was developed in the field of chronic dis-eases which provides services particu-larly to stroke patients. This program was developed in cooperation with the State Health Department, with a new position for a public health nurse be-ing added to the budget of the health department. Also, a physical therapist was provided by the State Health De-partment on a part-time basis to work with the local personnel. At the pres-ent time, a program has been develop-ed with the Department of Physical Therapy at Duke whereby a physical therapist visits this county once a week from that medical center. Two big research projects were con-ducted by the health department in cooperation- with the National Insti-tutes of Health, investigating an un-usual eye disease and cleft palate. Funds were provided for the salary and travel of a public health nurse during a two year period. One of the most important and ex-citing programs of the decade was be-gun in January, 1964, when Halifax County was selected as one of 21 com-munities throughout the Nation to par-ticipate in the Community Action-Stu-dies Project. This project was of three major programs of the National Com-mission on Community Health Services. Dr. Ralph Kilby, who was assigned to this department by the Army to serve a year's Residency in Public Health, served as co-ordinator for this impor-tant project. Later, when Dr. Kilby's residency was completed, Mrs. Lois Batton, one of the public health nurs-es, continued as the co-ordinator. Twenty-one leading citizens in the county served as members of the Hali-fax County Health Commission, the local official agency for this study, with Mr. Paul Johnston of Littleton serving as chairman. The results of this pro-gram were reported to the Nation at the National Health Forum in New York City in May, 1966. Several ma-jor community health projects were recommended for Halifax County by the locra! commission including, first, an increase in physicians and other medical personnel; second, the Human MEMBERS OF THE NORTH CAROLINA STATE BOARD OF HEALTH Lenox D. Baker, M.D., President Durham James S. Raper, M.D., Vice-President Asheville Ben W. Dawsey, D.V.M. Gastonia Samuel G. Koonce, Ph.G. Chadbourn Oscar S. Goodwin, M.D. Apex 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 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, Presonal Health Division 14 THE HEALTH BULLETIN February, 1967 Relations Center; and, third, a Rural Renewal Project. Partially, as a result of the detailed study of the county made during the Community Action-Studies Project, an intensive Maternity and Infancy Care Program was approved for this county by the Children's Bureau in cooperation with the State Health Department. The main objective of this program is to improve the way of life of the patients who are eligible for this service and to produce a more adequate product of life. Eleven new positions have been provided the Halifax County Health De-partment for carrying out this program, while additional personnel have been added on the state level including Dr. John King, pediatrician and project di-rector. Furthermore, there are 18 consultants in the various state agencies and at the Duke Medical Center who assist with the planning and operation of the program. The clinics for this program are staffed by Dr. L. C. McCampbell, obstetrician, and by Dr. Miles Gregory, pediatrician, of Roanoke Rapids, and by residents in obstetrics from the Duke Medical Center. This service includes in-tensive prenatal care for medically in-digent women and a specialized serv-ice in planned parenthood. Patients with complications are provided hospitaliza-tion at either Roanoke Rapids Hos-pital or the Duke Medical Center. During 1966, a cooperative program was developed with the Halifax Coun-ty School System with funds provided by the Elementary and Secondary Edu-cation Act which added four nurses. Later in the year four additional nurs-es were added by the cooperative pro-gram with the Multi-Service Center es-tablished by the Choanoke Area De-velopment Association. These eight nujses are under the direct supervis-ion of Mrs. Davis Clark, nursing direc-tor of this department. An additional servcie added by this Multi-Service Cen-ter is a bus which provides transpor-tation for patients attending the vari-ous clinics operated by the health de-partment. During 1966, the Halifax County Health Department was officially ap-proved as a Home Health Service Ag-ency to participate in Medicare. The highlight of the decade came when the Halifax County Health De-partment was given the Group Merit Award by the North Carolina Public Health Association in 1966. This award is given to the health department that is judged by the North Carolina Pub-lic Health Association as rendering the most outstanding service in North Ca-rolina for a given year. The health de-partment was given the Reynold's Award in 1951 for outstanding per-formance and particularly for develop-ing a new case finding procedure in tuberculosis control. In summary, then, the past decade has been a very rich and rewarding period for new public health programs in Halifax County. It is hoped fervent-ly that these services will not only add "years to the life", but more hope-fully, "life to the years" of the citi-zens in Halifax County, STATE HEART CONVENTION AT DURHAM TO FEATURE TOP HEART SPECIALISTS Nationally-known authorities on car-diovascular disease will participate in the North Carolina Heart Association's 18th Annual Meeting and Scientific Sessions to be held at the Jack Tar Hotel in Durham on May 17 and 18. The Scientific Sessions are designed to keep North Carolina physicians up to date on the latest clinical and lab-oratory findings in the cardiovascular field. February, 1967 THE HEALTH BULLETIN 15 THE HEALTH BULLETIN P. O. Box 2091 Raleigh, N. C. 27602 LIBRARIAN DIVISION OF FIEALTH AFFAIRS N.C. MEM. HOSP. u. N. C. CHAPEL liILL, 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. Money Making Ideas at Home Perhaps you can turn a hobby into a money making idea, using your own home as your workshop. Here are some ideas: If you have a phone and nice voice Assurance service—small fee to call stay-ins daily. Phone solicitation— notify local businesses that you will be glad to do this. Solicit customers for diaper service, magazine sub-scriptions, baby sitting, etc. If you are handy Fix-it shop— repair household ap-pliances, watches, clocks, auto-mobiles; refinish furniture; wood working; metal working. If you have business skills Typewriting and mimeographing —advertise; contact churches, clubs, small firms for overload. Addressing envelopes by hand and by machine. Part-time accounting for small firms. Employment agency (from home) Be income tax expert—contact in-individuals or accounting firms. If you sew Dressmaking Make handmade items in quantity, such as aprons, potholders, patchwork quilts, monograms, hand-loomed mat sets, braided rugs, hand-knitted baby clothes, doll clothes, or rag dolls. Promote your products through friends, articles in local paper; exhibit work at fairs, bazaars, hobby and craft shows. Contact local stores. Do Some Checking First Consult your local library for infor-mation. Size up your neighborhood needs. Write for Government Bulletins. Check any sales products with Better Business Bureau. Ask Chamber of Com-merce about license and other proce-dures. "Your Home Can Be Your Workshop" DYNAMIC MATURITY 16 THE HEALTH BULLETIN February, 1967 '>Aa>.«^^ l*^^*^ ^^'"^ Juanit'o M. Kreps, Ph.D. of Durham who presided at the Oilie A. Randall Award Dinner during the 16th Annual Meeting of the National Council on the Aging held in New York this sprirtg. Dr. Kreps is in the Department of Economics of Duke University, (see pages 2,8-13) Jusfice for All Men - Even the Aged AImighty God, Father of all creation, you constantl^^ confront us — whether in belief or disbelief — and make us uncomfortable. You battle and elude the grasp of our finite minds, yet you never move outside a concern and love for your creation. Help us to be concerned. Give us concern for those who are grown old. Not because they are old but because they are people — too often hurt �� whose gifts and strengths are frustrated, by other people, by frailty of body, by loneness, by poverty, by the unfulfilled promises of their youth, by uncertainty as to who they are or — why. Teach us compassion — wise, persistent compassion. Give us a passion Lord for justice, for all men — even the aged. Make us instruments of justice that in this great land they may enjoy thy bounty and the labors of their hands, to live secure, to have opportunity by right to live with dignity and to die with dignity, to be persons of worth, not cowering as un-persons without hope. Give us a passion Lord for justice. Dedicate us Lord: in the pattern of those who have given so much and done so much to bring some shining rays of hope to those grown old — They are leaders, persons of sensitive, generous, soaring spirit, unflagging zeal for ser-vice, often indignant, outraged at injustice, enriching us all with a deeper sense of compassion and justice. In honoring them tonight, let their achievements be our continuing inspiration. Dedicate us Lord — grant us grace to press for those things that are riaht and just in service to you who art eternal — Lord of Lords. Invocation delivered at the 1967 OIlie Randall Award Dinner in New York, Sixteenth Annual Meeting of National Council on the Aging, by Harold W. Reisch, Secretary for Special Ministries of the Board of Social Ministry, Lutheran Church in America. 2 THE HEALTH BULLETIN March, 1967 GOVERNOR MOORE PROCLAIMS SENIOR CITIZENS MONTH North Carolina's Governor presents to former Senator Roy Rowe a proclamation designating MAY as Senior Citizens Month. Rowe, second from left, is Chairman of the Governor's Coordinating Council on Aging. Many activities are being carried on in May honoring the older citizens of the State. Also in the picture are Dr. John S. Rhodes, Chairman of Senior Citizens Month for the Council, at left; and J. Eddie Brown, Executive Director of the Council, at right. Dr. Rhodes, the Chairman for Senior Citizens Month, is a former member of the State Board of Health and a past President of the Medical Society of the State of North Carolina. March, 1967 THE HEALTH BULLETIN Rheumatic Fever Accounts for Much Heart Disease in Children Rheumatic fever is said to account for much of the heart disease found in children and young adults. Rheumatic fever usually occurs be-tween the ages of 5 and 15, although adults can have it. It may affect any part of the body temporarily, but damage to the heart, which can be long lasting, is the greatest danger. Rheumatic heart disease results from the scarring of the heart muscle and valves by rheumatic fever. This may in-terfere with the vital work of the heart. Many patients recover without perma-nent injury to the heart valves, but the disease has a way of repeaing itself and each attack renews the chances of heart damage. Rheumatic fever Is preceded by a streptococcal infection such as strep sore throat, scarlet fever or a strep ear infection. It can be prevented by treat-ing the strep infection promptly and thoroughly with antibiotics. Because persons who have had rheumatic fever are susceptible rather than immune to repeat attacks, long-term preventive treatment is often prescribed for them. Regular doses of penicillin, under the direction of a physician, can prevent further strep infections and thus ward off subsequent attacks of rheumatic fever. You can protect your child against rheumatic fever by consulting your doc-tor if the child develops a sudden, se-vere sore throat, or if he has been exposed to someone with scarlet fever or another strep infection. A computer system that picks up in-audible speech changes in persons with early neurological disease and gives an immediate warning of their condition is now under development by the Pub-lic Health Service's National Center for Chronic Disease Control. The system is scheduled to be ready for use in multi-phasic disease-detection programs in three years. It will spot neurological disorders before other symptoms are evident. The first case of poliomyelitis to oc-cur in New York City since 1964 has been reported. The case is that of a 31 year old man who had a Salk vaccine series of injections ending five years ago. His wife and infant have been, or are in the process of, being immunized. The Health Bulletin First Published—April 1886 The official publication of the North Carolina State Board of Health, 608 Cooper Memorial Health Build-ing, 225 North McDowell Street, Raleigh. N. C. Pub-lished monthly. Second Class Postage paid at Raleigh, N. C. Sent free upon request. EDITORIAL BOARD Charles M. Cameron. Jr.. M.D.. M.P.H. Chapel Hill John C. Lumsden, B.C. HE. Jacob Koomen, Jr., M.D.. M.P.H. Bryan Reep. M.S. John Andrews, B.S. Glenn A, Flinchum, B.S. H. W. Stevens. M.D.. M.P.H., Ashevlle Editcr-Edwin S, Preston, M.A., Ll.D. Vol. 82 March, 1967 No. 3 THE HEALTH BULLETIN March, 1967 A Message By Acting Secretary Of Commerce Alexander B. Trowbridge Humanpower is a most precious resource. The waste of the tal-ents of 19 million Americans aged 65 and over is indefensible at a time when talent is in premium demand, when only one in five sen-ior citizens has a job, when five million elderly live below the pov-erty level, and when our senior population is growing at a rate of almost 4000 a day. Many people think of us as a Nation of youth. It is true our youth population is growing. But our over-65 population is also growing —and, thanks to the increase in human knowledge, living longer. In the last half century our older population has more than dou-bled. By 1985 we likely will have 25 million Americans 65 and over, and by the year 2000, more than 28 million. A busy, productive Na-tion —"a Nation on the move" as President Johnson has called it —cannot afford to waste this important reservoir of talent. It must not cast by the wayside any segment of our population because of the stigma of "overage." Ability has no age. We must not deny opportunity to those who wish to fill a productive role in our society. This may even include having jobs created for them, and providing facilities, where needed, for their retraining to meet work requirements of the technological age. The theme of Senior Citizens Month 1967 is "Meeting the Challenge of the Later Years". The talents, skills, and experience of our senior citizens have helped shape our country, make our economy strong, and give us the highest standard of living in the world. We need now and will need in years to come the example of their patience, stability, loyalty, and wisdom. This is the challenge "of the later years" that faces not only the older American but the Nation as a whole. March, 1967 THE HEALTH BULLETIN 5 MAY IS BEING OBSERVED AS SENIOR CITIZENS MONTH Theme: "Meeting The Challenge of the Later Years" Dr. John S. Rhodes, Vice Chairman, N. C. Governor's Coordinating Council on Aging and Chairman of N. C. Senior Citizens Month in North Carolina. Activities: The North Carolina Senior Citizens Convention in Greensboro — May 5th and 6th—Sponsored by N. C. Recreation Society. Visitation Days to Shut-ins—Hospitals Nursing Homes Private Homes Open Houses—Welfare Departments V. A. Hospitals Nursing Homes Senior Citizens Centers Housing for the Elderly Trips— Bus Trips Train Trips Religious— Sermons at Churches Social Activities— Craft Fairs Hobby Fairs Fashion Shows Dinners Luncheons Theater Parties Baseball Games Picnics, etc. 6 THE HEALTH BULLETIN March, 1967 Dr. Scurletis Appoinf-ed Director of Personal Health Division Dr. Jacob Koomen, State Health Di-rector, announced the appointment on March 21st of Theodore S. D. Scurletis, M.D., as the new director of the Per-sonal Health Division of the State Board of Health. Dr. Scurletis had been serv-ing as Acting Director of this Division since the death of Dr. James F. Donnel-ly last summer. The Personal Health Division, one of the seven divisions in the administra-tive structure of the Board, includes responsibility for Medicare, Maternal and Child Health, Chronic Disease, Crip-pled Children, the Medical Referral pro-gram for rejected draftees. Nutrition, and Nursing Home Licensing. Dr. Scurletis v/as born in Pittsburgh, Pa., and received his B. S. and M.D. degrees from the University of Pitts-burgh. After receiving his medical de-gree from the School of Medicine, Dr. Scurletis served his internship at Pitts-burgh Hospital. The University con-tinued him as instructor while for six years he was in private practice in pediatrics in Pittsburgh^ In 1961 Dr. Scurletis came to the State Board of Health as Pediatric Consultant in the Personal Health Di-vision and in 1963 was named Chief of the Maternal and Child Health Section. Upon the death of Dr. James F. Don-nelly last June, he was appointed as Acting Director of the Personal Health Division. Active in the Cerebral Palsy Associ-ation, the Association for Retarded Children and various medical organiza-tions. Dr. Scurletis makes a civic con-tribution beyond his professional duties. He married Christine Harrison in 1963 and they have two children, a boy and a girl. Dr. Theodore D. Scurletis (center) was appointed in March as Director of the Personal Health Division by Dr. Jacob Koomen (right) State Health Director. Dr. John T. King (left) was named chief of the Maternal and Child Health Sec-tion. March, 1967 THE HEALTH BULLETIN One of the concurrent- sessions during the T6th An-nual Meeting of the Notional Council on the Aging meeting in New York this Spring. TH€ HEALTH BULLETIN March, 1967 Secretary of Labor, W. Willard Wirtz (leff) accept-ing on behalf of President Johnson the OIlie A. Randall Award of the National Council on the Aging for Dis-tinguished Service to Older People. March, 1967 THE HEALTH BULLETIN North Carolina's Senior Citizens NORTH CAROLINA DEMOGRAPHY Over 65 In 1950 226,it25 persons 65 and older S-i>% of population In 1966 S'tg.OSS persons 65 and older 7.2^ of popul at ion In 1980 502,413 persons 65 and older In 2000 655,7'tl persons 65 and older Over 75 In 1950 65,000 persons 75 and over In i960 97,215 persons 75 and over 15,14't over 85 In 1980 180,977 persons 75 and over Men to Women (age 65 & over) 1955 122 women to 100 men i960 126 women to 100 men 1966 131 women to 100 men 2000 1^3 women to 100 men Longev i ty In 1949"1951 Life expectancy at 65 v/hite males 13-1 years Life expectancy at 65 white females 15-'* years Life expectancy at 65 nonwhite males 13-'* years Life expectancy at 65 nonwhite females 15-'* years In 1959-1961 Life expectancy at 65 white males 13-1 years Life expectancy at 65 white females 16. 1 years Life expectancy at 65 nonwhite males 12.5 years Life expectancy at 65 nonwhite females I'*. 7 years 10 THE HEALTH BULLETIN March, 1967 Senior Citizens in the United States (next three pages) FACT SHEET SUMMARY FROM 15 YEAR APPRAISAL DEMOGRAPHY OVER 65 In 1950 12,269,637 persons 65 and older In U.S. 8.1/^ of population In 1966 18,500,000 persons 65 and older 9'^i> of population In 1980 2l+, 500,000 persons 65 and over In 2000 26,000,000 persons 65 and over OVER 75 In 1950 3,85^,000 persons 75 and over In i960 5,562,500 persons 75 and over nearly 1 Million over 85 In 1980 9,382,000 over 75 t4EN TO V/0I4EM 1955 115 women to 100 men i960 121 women to 100 men 1966 129 women to 100 men 2000 II+8 women to 100 men STATE DISTRIBUTION 1950 Only New York had more than 1 million i960 New York, Pennsylvania, California had more than 1 million 1965 New Yorl:, Pennsylvania, California and Illinois had more than 1 million 1965 One-third of all over 65 lived in 1 of U states; New York, California, Pennsylvania or Illinois 1985 New York and California over 2 million Florida, Illinois, Ohio, Pennsylvania and Texas; over 1 million. 1950 New Hampshire 10. 8^0 over 65 (highest ) 1965 Iowa 12.5fo over 65 (highest) LONGEVITY In 1950 Life expectancy at 65 men 12.8 years Life expectancy at 65 women 15 years In i960 Life expectancy at 65 men 12.9 years Life expectancy at 65 women 16 years (Note: 1 entire year for women) March, 1967 THE HEALTH BULLETIN 11 Older vorl'.or defined as over k') 196'+ 5*5 million over h^ in population 29 million in work force 1980 66 million in population 3^+ million in work force (Mostly in U5-6U age group. Over 65 only about ^00,000 of increase of 5 million between 1964 and I980. ) SOCIAL SECURITY 1950 2,600,000 over 65 receiving benefits 1966 15,328,000 over 65 i-eceiving benefits 2,000,000 between 62 and 65 receiving benefits 1950 average monthlybenef it for workers h'i,86 average monthlybenef it for v/idows 36.5^ 1965 average monthlybenef it for workers 83.92 average monthlybenef it for v/idows 73.75 Between 195*+ and I965 wages increased by ^9.3^/0 - cost of living 2l,9fo - Social Security benefits llj-.l^c. OLD AGE ASSISTANCE 1950 About 25^ (3 million) receiving OAA averaging $^+3 per month (from $18 per month in Mississippi to $70 in Connecticut) 1967 About 11^4 (2 million) receiving OAA averaging $39.20 per month in Mississippi to $102 in California. MINORITY GROUPS NEGROES Life expectancy at birth 7-8 years less than whites. INDIANS Avei-age age at death ^3. HOUSING 1950 Q.k'fo of all over 65 lived in dilapidated housing. i960 19^ of all units occupied by elderly dilapidated. i960 Cornell University estimate ky/, living in unsuitable housing - h^ million units needed to overcome shortage and provide ap-propriate housing. 1950-1965 310,000 units of special housing for aged built. Nearly 66'^ of those over 65 ovm Lheir own homes, about 1+0'^ over 50 years old, 80^ over 30 yeai's old. 12 THE HEALTH BULLETIN March, 1967 racoME 1950 1965 1965 77^j over 65 had incomes less than $1000. per year. Median income for unrelated individuals $6U6. per year. Median income for familieG i/ith head over 65 $1903. per year. One-thix'd unrelated individual's Incomes less than $1000. per year Tliree-fifths unrelated individuals less than $1500 per year. One-fourth of families vith head over 65 less than $2000. per year. T^/o-fifths of families uith head over 65 less than $3000. per year. (Note: Poverty definitions $1500 for individuals. $1850 for couple. ) 31/f of all aged living in poverty by government definition. Half of aged widov;s and non-married women less than $1000. 3^3 had incomes of over $10,000. As aggregate persons over 65 represent a i+0 billion dollar consumer market. RETIREI.ffiNT INCOME If Bureau of Labor ."Statistics "modest but adequate" budget ($l800 for individual and $2500 for retired couple) is accepted as standard, 2 million retired couples and 6 million unattached re-tired persons do not have adequate standard of living. SOURCES OF INCOME 1950 i960 Emplojinent Social Insurance (mostly OASI) Old Age Assistance Private Pensions 3lf^ Are You Immunized Against 'Xockjaw'? With the advent of the spring sea-son of 1967 most of us are beginning to get out of doors again. There are gardens and lawns that need work and outdoor chores of all sorts that have accumulated during the winter. With the return of outdoor activities comes once again the hazard of minor accidents, cuts and scratches. Most often these aren't serious and will heal quick-ly if properly cleaned and protected. But sometimes these little scratches can be more serious. Sometimes they are the channel through which you could get tetanus (lockjaw). Tetanus-producing spores lie dor-mant in the soil of your garden, the dirt of your garage, and the dust in-side your house. These spores can in-fect you through the tiniest wound— a pin scratch, a bee sting or a small cut, says a pamphlet of the American Medi-cal Association. Tetanus spores may remain in your body for long periods without produc-ing the disease. Or, they may produce poison effects in five to fourteen days, even though the wound has healed. First signs of tetanus are irritability and restlessness. Muscles rapidly be-come rigid, eventually causing a clenched-jaw leer that gives tetanus its nickname—lockjaw. When symptoms appear, the outlook is grim, even with the best treatment. To avoid the deadly consequences, be sure you are immunized with tetanus toxoid. When you are immunized, your body manufactures antibodies that will fight tetanus toxin. A booster is need-ed every ten years and whenever you are injured. If you aren't protected, in an emerg-ency there is no time for immuniza-tion. If you have no built-in immunity, your physician may inject tetanus anti-toxin. An emergency shot, however, is not always effective. Your only long-range guarantee against tetanus is immunization with tetanus toxoid. Only one of every four Americans has this protection. Have you? — American Medical Association. MEMBERS OF THE NORTH CAROLINA STATE BOARD OF HEALTH Lenox D. Baker, M.D., President Durham James S. Raper, M.D., Vice-President Asheville Ben W. Dawsev, D.V.M. Gastonia Samuel G. Koonce, Ph.G. Chadbourn Oscar S. Goodwin, M.D. Apex A. P. Cline, Sr., D.D.S. Canton Joseph S. Hiatt, Jr., M.D. Southern Pines J. M. Lackey Rt. 2, Hiddenlte 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. j 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 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. Srurletis, M.D. Director, Presonal Health Division THE HEALTH BULLETIN March, 1967 PROGRAM OUTLINE EASTERN DISTRICT, N. C. PUBLIC HEALTH ASSOCIATION AT THE CAROLINIAN, NAGS HEAD — MAY 25-26 THEME: Public Health and The Public Thursday May 25 1:00-5:00 P.M. Registration 4:00 P.M. Business Meeting Tag Along Welcoming Coffee 6:00 P.M. Social hour 7:00 P.M. FIRST GENERAL SESSION Banquet—Informal Buffet Dance Fridav May 26 7:00-8-.?0 A.M. Breakfast 8:00-9:00 A.M. Ref?istration 9:00 A.M. SECOND GENERAL SESSION Presiding: Dr. Melvin F. Everman. President "Sarah Wilson" Panel: Dr. Ralph Boatman. Moderator Miss Sarah Goggins Mrs. Jean Lassiter Mr. William Shaw Dr. Karl Van Horn 12:00 Noon Lunch 1:30-3:30 P.M. SECTION MEETINGS Public Health Nurses—Anchor Room Presiding: Mrs. Rose Pugh Speaker: Miss Virginia Nelson. Department of Public Health Nursing, School of Public Health Subject: Team Nursing Joint Session—Sanitarians and Health Directors—Cypress Rooom Presiding: A. K. Glover Business Speaker: Charles J. McCotter Subject: Salt Marsh and Fresh Water Mosquito Control Secretarial—Statistical Section — Gaily Room Presiding: Mrs. Louise B. Barber Speaker: Dr. Lynn G. Maddrey, Chief Laboratory Division, State Board of Health 3:30 P.M. THIRD GENERAL SESSION Section Reports—Section Officers 1968 Door Prizes Adjournment March, 1967 THE HEALTH BULLETIN 15 BX. 2^9 THE HEALTH BULLETIN P. O. Box 2091 Raleigh, N. C. 27602 If you do NOT wish to con-«jtrr) tinue receiving The Health Bul-*^ ^ ». letin, please check here | i- Qp W and return this page to '—' V * the address above. c . ttftiBJftt The Graph! ILt l^. c c Press, Inc., Raleigh, N. C. DATES AND EVENTS May, 1967 sions, William Hilton Inn, Hilton Head May 15-16 — National Public Relations Island, S. C. Institute, Palmer House, Chicago, III. June, 1967 May 17-19 — 37th Annual State-wide June 4-8 — Public Health Symposium on Industrial Safety Conference, Wins- Program Planning, Philadelphia, Pa. ton-Salem. May 18-19 — Western North Carolina Public Health Association, Grove Park Inn, Asheville. May 20-24 - State Medical Society Meeting, Pinehurst. May 21 — National Tuberculosis Asso-ciation Meeting, Pittsburgh, Pa. May 21-26 — National Conference on Social Welfare, Dallas, Texas. May 24 — Conjoint Session of State Board of Health and Medical Society of the State of North Carolina, Pine-hurst. May 25-26 — Eastern North Carolina Public Health Association, Carolinian Hotel, Nags Head. May 26-28 — S. C. Heart Association- Annual Meeting and Scientific Ses- June 4-9 — American Water Works As-sociation, Atlantic City, N. J. June 11-15 — Air Pollution Control As-sociation, Cleveland, Ohio. June 16-17 — American Geriatric So-ciety, Claridge Hotel, Atlantic City. June 18-22 — American Medical Asso-ciation (Annual), Atlantic City, N. J. June 25-29 — American Society of Med-ical Technologists, Miami Beach, Fla. June 25-29—American Veterinary Med-ical Association, Nev^ Orleans, La. June 12-16 - Mental Health Workshop, Pisgah View Ranch, Candler, N. C. July, 1967 July 2-7 — American Physical Therapy Association, Miami Beach, Fla. July 10-13 - Institute: Tuberculosis and Other Respiratory Diseases (Blue Ridge Assembly), Black Mountain. 16 THE HEALTH BULLETIN March, 1967 The Officiar Publication Of T V^V^,^^ Oi^..-^ ' UT fifCf/VED ^^L 12 1^57 GOVERNOR DAN K. MOORE is presented a printed copy of the proceedings of the most successful meeting of the Governor's Conference on Child Abuse which was held late last year. An attendance of over 650 persons representing many disciplines working in private, voluntary and public areas attested to the wide interest and the quality of the program. In the picture taken in the Governor's Office are (from the left): Dr. Jacob Koomen, State Health Director; Dr. T. D. Scurletis, Chairman of the Coordinating Committee on Special Needs of the N. C. Health Council; Governor Moore; and E. N. Herndon, President of the N. C. Health Council. Two Percent of Nation's Counties Hold Key To Reduce Infant Mortality More than 30,000 infants a year might have lived to maturity if each of the nation's 3,130 counties had achieved the 18.3 per 1,000 live births infant mortality rate that 10 per cent of the counties reached. This is shown by a county-by-county study of infant mortality for the period 1956-60 by the Children's Bureau, Wel-fare Administration, Department of Health, Education, and Welfare. The study shows that less than 2 percent (56) of the nation's counties hold the key to any successful effort to sharply reduce the nation's infant mor-tality rate. A third of the deaths over the 18.3 rate achieved by counties with the best infant mortality rates occur-red in these 56 counties, which con-tain nearly all the densely populated urban areas in the nation. Among the 56 counties, the study found that in 21 of the most populated areas, including the ten largest cities, the average per year per city excess of infant deaths over the 18.3 rate was 400. With this knowledge, the Children's Bureau is focusing its special project grants for maternity and infant care on "high risk" mothers-to-be from the low-income neighborhoods in these key areas. The projects were authorized under the 1963 Maternal and Child Health and Mental Retardation Planning Amendments and now number 53. Al-most 200,000 maternity cases have been served in the projects, most of them considered "high risk." "It is among these maternity cases that studies show the highest rate of low birth weight infants being born. almost three times the national aver-age. Babies born to these mothers also have the highest infant mortality rates," said Dr. Arthur J. Lesser, Deputy Chief of the Children's Bureau. "Reports from these projects indi-cate that they may be having a signi-ficant effect on infant mortality rates," Dr. Lesser continued. "In Chicago, for example, among 14,380 infants born in census tracts served by the program in 1965, the infant mortality rate was 34.5 while among 9,044 births in si-milar low-income census tracts without the program, the infant mortality rate was 57.4." "Although we are extremely pleased with the results reported so far to the Children' Bureau from these special pro-jects," Dr. Lesser said, "We know that much more must be done. These special projects are only part of a whole struc-ture of services and programs— includ-ing medical care, housing, nutrition, better education and communication, adequate maintenance, and social wel-fare services—which must be made available if we are to make any real reduction in the rate of infant mor-tality and of premature births." Cigaret Testing: The Federal Trade Commission will begin testing cigarets for tar and nicotine content within the next two months, FTC Chairman Paul Rand Dixon told the House Commerce Committee. He said the agency has received excellent cooperation from the tobacco industry. Scientists at Tufts University, Med-ford, Massachusetts, will study the ad-vantages to the driver of using con-vex rear-view mirrors and other new types of rear-view display systems in an automobile instead of the conven-tional flat mirror. THE HEALTH BULLETIN April, 1967 Brains Across The Sea by Ronald Schiller Reprinted ivith permission from the March 1967 Reader's Digest. Copyright 1967 by The Reader's Digest Assn., Inc. If the United States continues to si-phon off the best scientific talent from other countries, the world, sadly out of balance, may become yet more un-evenly divided. A dilemma looking for a solution. If you are admitted as an emergency patient to a hospital in Delav^are, New Jersey, North Dakota or West Virginia, chances are that you will not be treated by an American doctor. Over half of the resident physicians in the accredit-ed hospitals of those states are foreign-ers who earned their medical degrees abroad. In certain hospitals in Illinois, Maryland, New York and Rhode Island, you might never even see an American doctor. Throughout the United States, 28 per-cent of all medical internships and resi-dencies are filled by foreigners—and a lucky thing for us. Each year our hospitals need 5500 more physicians than our medical schools graduate. Some 11,000 foreign interns and residents are now serving our nation's hospitals. Officially, they are here to further their medical education and to gain experience that will serve them when they return to their own coun-tries. Actually, at least 25 percent of them end up living here permanently. Of the physicians admitted to practice here last year, 1488—almost 17 percent —were foreigners. To replace them, we would need 15 new medical teaching centers, which would cost some $1 billion to build, plus at least $100 mil-lion a year to operate. This consider-ably exceeds the medical assistance that we now dispense to the rest of the world. "In effect," says Sen. Walter F. Mon-dale of Minnesota, "the richest nation on earth is being subsidized by the poorer nations." Particularly disturbing is the fact that almost 80 percent of our foreign phy-sicians come from developing nations whose medical needs are vastly greater than ours—from India, Pakistan and Thailand, where there is one physician per 5000 to 9000 of the population; from the Philippines, Turkey, Colombia and Peru, where each doctor serves an average of 2000 to 3000 people. In 1963, South Korea, half of whose coun-ties do not boast a single physician, sent us 207 medical graduates. Moreover, our importation of phy-sicians is accelerating. Each year some 18,000 medical graduates throughout the world pay to take the day-long ex-aminations— administered twice yearly— which qualify them to practice in the United States. Approximately 7000 doc-tors pass the tests every year, repre-senting a reservoir of talent that we can call upon. April, 1967 THE HEALTH BULLETIN Widening the Gap. Physicians repre-sent only one wave in a massive tide of skilled professionals now sweeping from the poorer to the richer coun-tries. The demand for educated talent among the most advanced Free World nations is spiraling upward at a rate faster than all of their fast-growing universities can meet it, either now or in the foreseeable future. Thus, last year alone, the United States wel-comed 5479 graduate engineers and scientists, 5164 teachers and profes-sors, 1623 accountants, 4247 nurses, 2552 technicians, and tens of thousands of others with advanced training. These were permanent immigrants; others en-tered on working visas. This "brain drain" has become a source of increasing anxiety through-out the world. Ultimately it poses a threat to world peace. For without substantial resources of trained and educated manpower everywhere, the gap between the rich and poor nations cannot be narrowed. "Regions failing intellectually," states scientist Lloyd V. Berkner, "will remain chronically poor, in colonial status to more advanced na-tions." The irony is that no other country approaches the United States in the amount of effort and money spent to educate the people of the developing nations. Approximately 100,000 stu-dents come to U. S. universities for ad-vanced training every year—to be edu-cated for service in their own coun-tries. But an estimated 90 percent of the Asian students, 50 percent of those from the Near East, Greece and Egypt, and large proportions from Africa and Latin America never return home. Further, by eliminating national quo-tas and giving piority to professionals, the U. S. Immigration Act of 1965, whose commendable purpose was to end discrimination based on race or national origin, had the unforeseen ef-fect of accelerating the brain drain. The year the new law went into effect, the number of professionals immigrat-ing from India jumped from 54 to 1750; from South Korea, from 51 to 400. The influx cancels out the effec-tiveness of our foreign-aid, technical-assistance programs. Put and Take. The United States is not the only beneficiary of the world-wide braindrain, nor are the poorer countries its exclusive victims. Nor-way, Switzerland, Italy, the Netherlands and West Germany have been heavy losers in Europe. In actual numbers, however, no country has suffered more than Great Britian. British newspapers and professional journals blaze with advertisements from U.S., Canadian, New Zealand and Australian companies seeking specialists of every kind. U.S. firms offer "transportation costs . . . advanced study in your field . . . op-portunities for speedy advancement," and salaries usually double those that can be earned in Britain. In 1964 alone, 5900 British teach- The Health Bulletin First Published—April 1886 The official publication of the North Carolina State Board of Health, 608 Cooper Memorial Health Build-insT, 225 North McDowell Street, Raleigh, N. C. Pub-lished monthly. Second Class Postage paid at Raleigh, N. C. Sent free upon request. EDITORIAL BOARD Charles M. Cameron. Jr., M.D.. MP H. Chapel Hill John C. Lumsden, B CHE. Jacob Koomen, Jr.. M.D., M.P.H. Bryan Reep, MS. John Andrews, B.S. Glenn A. Flinchum. B S. H. W. Stevens, M D,, M P H.. Ashevlle Editor—Edwin S. Preston, M.A., LL,D. Vol. 82 April, 1967 No. 4 THE HEALTH BULLETIN April, 1967 ers, 4400 nurses, 4200 engineers and 1200 physicians—equivalent to 40 per-cent of that year's graduates—emigrat-ed. But sympathy for the nation's plight is tempered by the fact that in the same year, Britian acquired 3300 teachers, 1600 engnieers, 1300 nurses and 300 physicians from less privileged nations. A startling 40 percent of the medical personnel serving in the British National Health Service came from such areas as Pakistan, India and the West Indies. Similarly, France has received more professors and physicians from her former colony, the new African nation of Togo, than she has sent to that country. France also provides employ-ment to an estimated 3500 university-trained South Vietnamese, who are desperately needed in their own hard-pressed nation. To compensate for the flight of their own technologists, the nations of Western Europe employ more scientists and engineers from Turkey and the Arab nations than do their own countries. And Canada, which lost 920 engineers to the United States in 1964, admitted 2000 from abroad that year, including many hired sight unseen from Spain and Argentina. Skimming the Cream. More signific-ant than the quantity is the quality of the professionals who migrate. "Every country is short of the brightest people because God didn't make enough," says Harry S. Hoff, consultant to the United Kingdom Atomic Energy Authority. But it is these very people who are lured away. British science will not easily re-place 38-year-old medical reseacher Ian Bush, who in 1964 left for the Worcester (Mass.) Foundation for Med-ical Research with his entire staff of scientists and technicians. The Japanese electronic industry suffered an equally severe setback when Dr. Leo Esaki, developer of electronic devices used throughout the world, took a job with a U.S. firm. No nation can afford the continual loss of its most brilliant and productive minds without suffering severe eco-nomic consequences. The effect of such loss on the less developed countries amounts to "a national catastrophe," in the words of Charles V. Kidd, President Johnson's scientific adviser. Many of the nations of the world are so short of trained manpower that a university de-partment may be forced to close when a professor leaves, children go untaught when a teacher moves, and thousands be deprived of medical atention when a physician migrates. Further, in emerg-ing nations the professionals contitute that sliver of the population which pro-vides leadership. They are the catalytic agents for improvement without whom the nation stagnates. Farewell With Regret. A major moti-vation in the flight of talent is the desire for an adequate income. "The scientist is enabled to study thanks to the efforts of all his countrymen—farm-ers, laborers and intellectuals alike," Bernardo Houssay, Nobel Prize-winning biologist, reminded his fellow Argen-tinians. "He owes it to them to repay that debt." But the 206 scientists who left Argentina last year—some of whom earned less than $2000 annually—felt they could not afford to heed his plea. An Italian mfcrobiologist at Massa-chusetts Institute of Technology wrote his sponsors in anguish to explain why he was breaking his promise to return home: "I do not expect to live in luxury, but at 32, with two degrees, ! cannot live even decently on the $290 a month offered me in Italy." "I love Britain, and would like to stay," was the comment of a 40-year-old heart surgeon to official pleas that he remain. "But Britain won't afford to keep me." April, 1967 THE HEALTH BULLETIN Yet these countries are not so impov-erished that they cannot provide a bet-ter living for their professionals. A second reason for leaving is the difference in working facilities. "Al-though my salary will be doubled," said Dr. John Raison, a leader in re-search on the heart-lung machine, "that is not the reason I am leaving England. I have 20 years more work ahead of me which I cannot do with the facilities avaliable in Britian." A senior Italian physicist says, "I myself encourage young scientists to go. There is nothing for them to work with here." Yet, he observes, Italy has the funds; what it lacks is a belief in the importance of research. In several emerging nations, the problem is underemployment of pro-fessionals. The enthusiasm with which governments plunge into ambitious ed-ucational programs backfires when they neglect related industrial development. Jobless engineering graduates of Sud-an's Khartum University came close to rioting because there was nothing for them to engineer. It is estimated that 40 percent of Burma's scientists and en-gineers cannot find jobs in their pro-fessions, nor can 35,000 university graduates in the Philippines. Comments a Yale University graduate dean: "I find it difficult to advise an engineer from India, who is offered a $1 0,000-a-year job here or in Canada, to go back to his country where he may be a clerk-typist for the next ten years." Imperative: Close the Gap. A drastic ban on migration or foreign study would, in effect, be a Western version of the Berlin Wall. But U.S. agencies are now making efforts to reduce the number of foreign students allowed to remain here after completion of train-ing. These agencies are also trying to persuade industry, universities and hospitals to modify their recruitment efforts abroad. Another step would be for foreign countries to require students to concentrate on courses vital to their homelands; and to have adequately-paid jobs waiting for them, permitting them to make use of the skills acquir-ed. President Lyndon Johnson has ad-vocated that we help build multination-al institutions for advanced training in science and technology— in South Am-erica, Africa and Asia—so that fewer students will have to go to advanced nations to study. Brazil and Uruguay have already earmarked funds for the project. Senator AAondale has urged that U.S. aid organizations spend more of their money on projects specifically designed to use the talents of unem-ployed professionals abroad. U.S. private industry is beginning to establish some of its engineering and scientific research facilities in Europe and the Middle East to take advantage of surpluses of trained manpower there. This arrangement stands to benefit everybody. The U.S. company gets re-search findings; the home country gets the investment and the salaries paid, plus the increase in knowledge and skill acquired by the professionals. Most important, these professionals are not lost to their homelands: they may well be re-employed by local industries when needed. "World security, and American secur-ity, depend on development of the less privileged countries at sufficient speed to satisfy at least a portion of their na-tional aspirations," says Secretary of De-fense Robert McNamara. If the most talented members of the poor nations continue to be absorbed by the rich societies, we shall never begin to close the gap that finds the per capita in-come at $3000 a year in America, while in more than half of the rest of the world it averages only $120. THE HEALTH BULLETIN April, 1967 Day Care Health Needs Information Now Available Detailed information about the health needs of children in day care is avail-able for the first tinne in a new pub-lication of the Children's Bureau, Wel-fare Administration, Department of Health, Education, and Welfare. In announcing the publication, "Chil-dren in Day Care—with focus on health," Mrs. Katherine B. Oettinger, Chief of the Children's Bureau, said to-day, "A number of excellent textbooks and pamphlets have been written on child health in general, but never before has it been studied specifically for the child in day care." Written by Mrs. Laura Dittman of the Committee on Day Care, Maternal and Chlid Health Section, American Public Health Association, the pamph-let makes it clear that in order to as-sure comprehensive health care for each child in a day care program, a complete picture of that child and his environment must be obtained. Every aspect, geographical, socioeconomic, and physical, which might influence his development must be considered when outlining a health plan for him. "Chil-dren in Day Care," therefore, studies the special needs of different ages and groups of children and relates them to day care. For example: —Since an infant is particularly vul-nerable to infection and disease, day care workers should check with the child's parents to make sure he has received proper preventive medication including immunization. —A child's third and fourth years are crucial in arresting permanent dental, hearing, and visual defects. Professional screening should therefore be an integral part of every day care program for pre-schoolers. —Special precautions should be taken to prevent accidents in a day time program which cares for children of school age, for accidents are the largest single cause of death among school age children. —A handicapped child must be given every opportunity to care for him-self. Such normally routine activi-ties as eating, dressing, toileting, and washing can be of great value to such a child as physical, mental, and emotional therapy. —The child of migrant workers will require particularly strict nutritional supervision while in day care. His regular diet usually consists of hastily prepared foods, low in nu-tritional value, and varies as his parents follow the crops. Copies of the publication may be purchased for 50(Zl each from the Su-perintendent of Documents, U. S. Gov-ernment Printing Office, Washington, D. C, 20402. Thalidomide Charge: Nine officials of Chemie Grunenthal, the German chem-ical firm that produced thalidomide, were charged with deliberately caus-ing bodily harm and with manslaugh-ter through neglect. The public prose-cutor of Aachen charged that the of-ficials had placed the drug on the market even though preliminary tests showed it caused damage to the ner-vous system. He said about 5,000 chil-dren had been born with deformities after their mothers took thalidomide during pregnancy. April, 1967 THE HEALTH BULLETIN National Pesticide Monitoring Site ^^> I I / •8 ALASKA i o HAWA I Pesticides Monitoring Journ/ 57 FISH i_ SHELLFISH & IT ESTUARIES i PEOPLE MARKET " BASKET SURVEY « SOIL REGIONAL (i) FOOD COMMODITY • ^^^^^ SAMPLING >^ WILDLIFE ® I Vol. I, No. 1, June 1967 Archery Lesson — A Counselor shows Campers how fo hit the target at Camp Easter-in-the-Pines at Southern Pines. Imagine Your Other Self of Camp Eoster-ln-The-Pines Summer itineraries of many physical-ly handicapped children in North Caro-lina are pointing toward Camp Easter-in- the-Pines at Southern Pines. The at-traction is the camping program that will be operated by the North Caroli-na Society for Crippled Children and Adults through Easter Seal contribu-tions. H. L. Hawley, Executive Director of the Society, announced that dates for the 1967 camping season are June 18, to August 10, with three two-week ses-sions for crippled children. The last two weeks of the season, beginning July 30, will be given over to a camping session for handicapped adults. The Easter Seal Camp, operated by the Society since 1964, provides re-creation specially modified and adapted for the crippled. Stairways are replaced by ramps; handrails are installed, door-ways are wide enough to permit easy passage of wheelchairs, and shower stalls are easily usable even though campers may not be able to walk with-out the aid of special appliances. But otherwise. Camp Easter-in-the- Pines is pretty much like any other summer camp. Children have the chance to swim, shoot, hike, boat and sleep under the stars just like children with-out handicaps. It may seem impossible to some that 10 THE HEALTH BULLETIN April, 1967 children in wheelchairs, with braces on their legs, or restricted to crutches could take part in outdoor activities at camp. But rehabilitation experts agree that Camping offers the physically han-dicapped therapy they could not re-ceive in a clinic. The excitement of going to Camp seems to work wonders on children who are barred from many normal ac-tivities at home. Their eagerness to participate helps them move a little closer to overcoming their handicaps. Here, they have the chance to experi-ence nature first-hand and many are "on their own" for the first time. As the needs grow, Camp Easter-in-the- Pines is being expanded to meet them. Last year the Society added a second 4-cabin and bathhouse complex. But needs are even greater, and plans call for more improvements next year so that a stay at Camp Easter may be possible for more crippled children and adults. Anyone who may know of a physi-cally handicapped child or adult who would benefit from wholesome out-door activities at Camp should write to: Coordinator, Camp Easter-in-the- Pines, P. O. Box 1099, Southern Pines, North Carolina. The first laboratory confirmed case of dog rabies in more than two years recently occurred in Surry County. Al-though no human exposures occurred from this case, it should serve as a reminder that rabies remains an en-zootic disease in wildlife and can spread to epidemic proportions in an unimmunized dog population. In Sur-ry County it was estimated that only ten percent of the dog population had been immunized against rabies. Seventy percent of a community's dog popula-tion must be immunized against rabies to preclude the possibility of an epi-demic situation. New Drug May Benefit Manic-depressive Psychosis A potentially effective drug treat-ment for one of the most serious formis of mental illness was outlined re-cently by a National Institute of Men-tal Health scientist. The disorder, man-ic- depressive psychosis, affects many people and is present in a sizeable pro-portion of the Nation's 25,000 suicides a year. Dr. William E. Bunney, Acting Chief of the Institute's Section on Psychoso-matic Medicine, confirmed the finding that lithium carbonate, an inexpensive white powder, effectively controls this illness in many patients. It checks the intense manic excitement, and overac-tive, irritable patients become calm under its treatment. Dr. Mogens Schou in Denmark, one of the principal investigators of the therapeutic usefullness of lithium, has recently reported that the drug seems to act as a preventive of both manic and depressive attacks. These are prob-ably two aspects of a single underly-ing process. Dr. Bunney explained. If further research bears out present find-ings, lithium will become an important weapon in the fight against this very severe mental illness. However, in contrast to lithium's ac-tion in mania. Dr. Bunney said, a ques-tion remains about its usefulness in acute depressive episodes. This area is now undergoing intensive study. The Institute's research, which ex-tends the work of earlier investigators— particularly that of Dr. Schou, was de-scribed before the Missouri Institute-of Psychiatry in St. Louis. April, 1967 THE HEALTH BULLETIN 11 Consider this case: American Medical Associafion Begins A New Section //Medicine and Religion// Consider These Reasons Physicians have long been troubled by the knowledge that playing the role of healer sometimes requires them to "play God," too. A 10-year-old Louisiana boy is dy-ing from kidney disease. The physician knows it's possible to transplant a kid-ney from the boy's healthy twin broth-er, leaving the healthy twin with one kidney. Sometimes the operation fails, but in a number of cases, it succeeds; more than 500 people are alive today with transplanted kidneys. Regardless of whether the sick boy recovers, however, the physician is haunted by one thought: suppose some-thing goes wrong with the healthy twin's remaining kidney. A person can live a normal life with one kidney— that's what supports the theory of transplantation from live donors—but one cannot live without any kidneys. Disease could cut down the boy at any time. By deliberately removing a healthy, functioning part of the boy's body, has the physician consigned him to possible future death? Or are the parents responsible? They gave permission for the operations. Was the physician merely a technician, car-rying out their orders? And what of the healthy boy? He's a minor. Does he have any rights in the matter? Could there be a case in which parents used unusual coercion on such a child to save the life of another? These are some of the questions that trouble medical men of conscience on transplantation. Other areas of medicine present similar questions of ethics and morality. This is why the Journal of the Ameri-can Medical Association is beginning a new section, "Medicine and Religion," designed to discuss these issues. The first question-and-answer section (on tranplantation) appears in the April 10 Journal. 12 THE HEALTH BULLETIN April, 1967 Here's part of what Joseph E. Mur-ray, AA.D., a Boston surgeon, had to say about the problem of the lO-year-old twins: "Organ transplants, as a therapeutic maneuver to prolong life, are certainly justified as far as the recipient is con-cerned. "The source of the kidney, however, provides a major moral, legal, and ethical problem," Dr. Murray said. "If the source is a recently deceased indi-vidual whose nearest relatives have voluntarily donated the kidney, there is no problem. If the source is an elec-tive (kidney removal) for the benefit of another human being, and a kidney is used which would otherwise be dis-carded, again, there is no problem. However, when the donor is a living healthy volunteer, either a member or a nonmember of the family, a definite problem arises. Here we are embarking on a major surgical operation with a slight, but definite, risk from anesthesia, operation, or postoperative complica-tions. "This procedure is not for the bene-fit of the person being operated on, but for someone else. All previous medical and surgical training has been geared to weighing the advantages and disadvantages in any one patient of a proposed therapeutic measure. In this instance, however, for the donor a physiological deficit will always occur, and no possible good can accrue to him physically." Dr. Murray pointed out, however, that the kidney donor may derive "a certain spiritual benefit" from the do-nation, which is "probably the purest form of charity next to the giving of one's life." "For a truly unpressured volunteer, this spiritual satisfaction can more than compensate for the physical trial of a nephrectomy." Hess Gets Federal Award The National Civil Service League has named Arthur E. Hess, Deputy Commissioner of Social Security, as one of the year's 10 outstanding public servants in the Nation, Robert M. Ball, Commissioner of Social Security, an-nounced today. "Career Service Awards" are given annually by the League to recognize career public employees for outstand-ing contributions to the general wel-fare, and to stimulate able young peo-ple to choose careers in Government. The National Civil Service League is a nonpartisan, non-profit citizens' or-ganization founded in 1881 "to pro-mote efficiency in Federal, State, and local government." The Awards pro-gram was first established in 1954, with the 130 winners to date constitut-ing a roster of top excellence in the Federal service. Commenting on the award. Commis-sioner Ball said, "The League's recog-nition of Art Hess' contributions to the programs within the responsibility of the Social Security Administration, and through them, to the security and inde-pendence of millions of Americans, comes as no surprise to those of us who have worked closely with him over the years. "Whenever there has ever been a very big job of implementing a program just enacted by Congress, we have had a way of turning to Art Hess and assigning him a leading role in transforming the legislative blue-prints into effective working realities. This was the case with both the disa-bility insurance program, first enacted in 1954, and the medicare program, passed by Congress in 1965. The smoothness of the start of each pro-gram, and their early arrivals at a level of efficient and economical op-eration are due in no small measure to the administrative talent of Art Hess." April, 1967 THE HEALTH BULLETIN 13 Hess, now 50 years of age, and a native of Reading, Pa., began his ca-reer in social security 27 years ago shortly after his graduation from Prince-ton University. While engaged in re-search activities for the agency, he studied for and earned a law degree fronn the University of Maryland in Baltimore, and was accepted as a mem-ber of the Maryland bar. After 1 1 years as Director of the Bureau of Disability Insurance, he was named Di-rector of the Bureau of Health Insurance in 1965, where he played a leading role in bringing medicare to over 19 million older Americans. He has just been promoted to the position of De-puty Commissioner of Social Security, where he will continue to have a hand in the administration of medicare while also assisting the Commissioner of Social Security in overseeing the Ad-ministration's other programs. Other 1967 "Career Service Award" winners are: Philip N. Brownstein, De-partment of Housing and Urban De-velopment; Horace D. Godfrey, Depart-ment of Agriculture; Donald G. Mac- Donald, Agency for International De-velopment; William H. Smith, Depart-ment of the Treasury; O. Glenn Stahl, U. S. Civil Service Commission; David D. Thomas, Federal Aviation Agency; Floyd LaVerne Thompson, National Aeronautics and Space Administration; Barbara McClure White, U. S. Informa-tion Agency; and Marjorie J. Williams, M. D., Veterans Administration. The awardees will be honored at a dinner ceremony in Washington, D. C, on April 21, 1967, at which the prin-cipal address will be delivered by John W. Gardner, Secretary of Health, Edu-cation, and Welfare. In addition to the League's recognition of their individual excellence in public service at the Fed-eral level, the awardees are tendered a $1,000 tax-free cash award by the program. Hess and his wife, the former Nancy Davis of Wilkes-Barre, Pa., and their two youngest daughters reside at 4805 Woodside Road, Baltimore, Maryland. Birth Control: About 11 million wo-men— at least half of them Americans— now use oral contraceptives, according to a report from Planned Parenthood- World Population. MEMBERS OF THE NORTH CAROLINA STATE BOARD OF HEALTH Lenox D. Baker, M.D., President Durham James S. Raper, M.D., Vice-President AsheviUe Ben W. Dawsev, D.V.M. Gastonia Samuel G. Koonce, Ph.G. Chadbourn Oscar S. Goodwin. M.D. Apex A. P. Cline, Sr., D.D.S. Canton Joseph S. Hiatt, Jr., M.D. Southern Pmes J. M. Lackey Rt. 2, Hiddenite Howard Paul Steiger, M.D. Charlotte EXECUTIVE STAFF Jacob Koomen, M.D., M.P.H. State Health Director \V 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 Health Division Lynn G. Maddrv, 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, Presonal Health Division 14 THE HEALTH BULLETIN April, 1967 Community Hospitals Offered Disaster Care Items A thirty-day supply of critical medi-cal items for disaster care is being of-fered to community hospitals in North Carolina. These items, known officially as the Hospital Reserve Disaster In-ventory (HRDI), w\\\ augment normal hospital shelf inventories to the extent of providing the acute care medical sup-ply needs for approximately thirty days. it is anticipated that eventually every hospital in the State v^'ill be eligible to participate in the HRDI Program. Initial-ly hospitals participating in this pro-gram will be selected by the Public Health Service in accordance with cri-teria and standards established for emergency planning and location. To be eligible for the HRDI Program, com-munity hospitals must meet the follow-ing criteria: 1. Be located within fifty (50) miles of the city limitis of the central city of a Standard Metropolitan Statisitical Area (SAASA) having 250,000 or more population, 2. Having fifty (50) or more beds; and 3. Have the operational capability to establish a comprehensive disas-ter program. The two major advantages in stock-piling medical supplies in community hospitals are (1) they will assist the hospitals in their primary responsibili-ties of patient care and community health and will assure the availability of supplies for a thirty-day period if regular supply channels are disrupted, and (2) it provides an opportunity to ro-tate supplies that might deteriorate in storage. The hospital will utilize these emergency supplies in its daily opera-tions and will continue to purchase such supplies on its regular schedule thus maintaining its normal inventory at the same time. The North Carolina State Board of Health is the State agency having pri-mary responsibility for the Medical Stockpile program in North Carolina. Therefore, contracts that are negotiated between the Public Health Service and the hospital participating in the HRDI Program will be coordinated with the State Board of Health to insure the continuity of emergency health service operations both at the State and loCal level. At the present time there are fifty (50) Packaged Disaster Hospitals (PDH) in North Carolina. These hospitals, on a selective basis, will be affiliated with community hospitals. By providing com-munity hospitals with PDH's as well as HRDI Units, it will insure the State a minimum amount of essential stockpile medical items necessary for any type of disaster. The plan to assign the re-sponsibility for each PDH to a com-munity hospital is a step toward insur-ing operational capability for each pre-positioned hospital. Community hospitals agreeing to af-filiate with a PDH will be asked to (1) develop a utilization plan for the PDH, and (2) rotate pharmaceuticals in a PDH with their regular stocks, if prac-tical. The contract covering PDH rota-tion items and utilization planning will be between the community hospital and the Public Health Service. The contract covering the major components of the PDH will continue to be negotiated between the North Caro-lina State Board of Health and Public Health Service, and the County Civil Defense agencies and County Health Departments with the North Carolina State Board of Health. The eventual goal is to have every PDH in the State affiliated with a community hospital. April, 1967 THE HEALTH BULLETIN 15 THE HEALTH BULLETIN P. O. Box 2091 Raleigh, N. C. 27602 LtBRAR"51 ^ _.,,., AFFAIRS LlERARt DIVISION OF HSALIH A ^^ ^^ N.C. MEM. HO^P-CHAPEL llILl'. H.C. If you do NOT wish to con-tinue receiving The Health Bul-letin, please check here i | and return this page to ' — the address above. Printed by The Graphic Press, Inc., Raleigh, N. C. DATES AND EVENTS June 18-21 - N. C. Veterinary AAedi-ical Association, Durham, N. C. June 18-22 — American Medical As-sociation (Annual), Atlantic City, N. J. June 19-21 — North Carolina Hospital Association, Annual Meeting, Grove Park Inn, Asheville, N. C. June 25-29 — American Society of Medical Technologists, Miami Beach, Fla. July 2 - 7 — American Physical Therapy Association, Miami Beach, Fla. July 10-13 — Institute: Tuberculosis and Other Respiratory Diseases (Blue Ridge Assembly), Black Moun-tain, N. C. Aug. 9- 13 — Sixth Annual Southwide Lawyers & Physicians' Conference, Lake Junaluska, N. C. July 9-12 — American Veterinary Medical Association, Dallas, Texas. A baby in the United States today has less chance for survival than in 14 other countries. And the blame can be placed on poverty—with its concomit-ants of inadequate nutrition, lack of education, early pregnancies, illegiti-macy, and, especially, premature births. A computerized analysis performed at George Washington University shows that less than 2% of all coun-ties in this country account for Vs of the excessive mortality rates. CONTENTS Governor's Conference On Child Abuse 1 Key To Reducing Infant Mortality 2 Brains Across the Sea 3 Day Care Health Information 7 National Pesticide Monitoring Sites 8, 9 Camp Easter-ln-The-Pines 10 New Manic-depressive Psychosis Drug 11 New "Medicine-Religion" Section of AMA 12 Hess Gets Federal Award _• 13 Disaster Care Items 15 16 THE HEALTH BULLETIN April, 1967 [m\^ mmi'nm tiblicaf-ion Of The North Caroh'no State Board of Health <^:>,^^ M/^1 /?67 The First Fifty Years of Public Health in North Carolina Excerpts from "A History of the N. C. State Board of Health—1877 to 1925" by B. E. Washburn, M.D. The year 1909 proved to be an event-ful one in the history of public health of North Carolina. In that year, the General Assembly voted an increase in the annual appropriation of the State Board of Health, enabling it to employ a health officer for his full time. The State Board had been organized in 1877 and had been directed by two part-time secretaries who achieved re-markable success. The two secretaries of the State Board who conducted the pioneer health work so successfully were Dr. Thomas F. Wood from 1879 to 1892, and Dr. Richard H. Lewis from 1892 to 1909. A review of their activities is in-spiring. During this formative period, the ap-propriations had been woefully inade-quate, at times insufficient even to pay postage on the health literature they prepared and distributed. Under their direction, however, the North Carolina Board became recognized by health authorities throughout the na-tion; this is especially true of its or-ganization which largely removed it from politics and stresed the impor-tance of local (county) health organiza-tions. The Board being appointed joint-ly by the governor of the State and the State Medical Society, had been able to influence the Legislature to enact mea-sures important to public health. The recognition that disease preven-tion is the responsibility of society as a whole came to North Carolina in 1877 when its State Board of Health was created. The history of public health is re-flected in the progress of disease pre-vention carried out in North Carolina under the direction of the State Board of Health. At the time of the Board's organization in 1877, disease preven-tion was sought largely through im-provement of the environment; but ad-vances in medicine as they applied to the control of infectious diseases were readily adopted. With this came the im-portance not only of clean surround-ings but especially the provision of safe drinking water and sewage dis-posal by towns and cities. From its be-ginning, the Board recognized the need for vital statistics as a means of mea-suring progress. The inspection of state schools and institutions was carried out as well as the inspection of prisons and mental hospitals. Immediately following the Civil War, the State Medical Society discussed the need of a state board of health and advocated its provision. In this, the Society had the support of leading citizens throughout the State who had seen the terrible conditions brought about during the War due to the lack of organized health work and sanita-tion. A committee was appointed to place the matter before the Legislature; the members of the committee were Drs. S. S. Satchwell of Pender County; R. L. Payne of Davidson County; Marcellus THE HEALTH BULLETIN May, 1967 i*?^ * 4 % Thomas F. Wood, M.D. 1877-1892 AAay, 1967 THE HEALTH BULLETIN Whitehead of Rowan County; and George A. Foote of Warren County. The committee went to Raleigh in 1877 for the meeting of the General As-sembly and remained there for most of the session, being joined by Drs. Eugene Grisson and M. J. Pittman. These doctors were successful in secur-ing the passage on February 12, 1877 of a bill to establish the North Caro-lina State Board of Health. The Board of Health, as established by the General Assembly, was to con-sist of all the members of the State Medical Society who were to be the medical advisers of the State and as such give advice to the government "in regard to the location and sanitary man-agement of public institutions." An annual appropriation of $100 was made to meet the expenses of the Board. The organization of the State Board of Health was effected at the following annual meeting of the State Medical Society held at Salem on May 23, 1877. Dr. S. S. Satchwell was elected Presi-dent and Dr. Thomas F. Wood, Secre-tary and Treasurer. The annual appropriation of $100 made by the Legislature was ordered to be paid to the Treasurer of the State Medical Society. On March 14, 1879, the "Act Sup-plemental to an Act Creating the State Board of Health" passed both houses; and the Board thus created has function-ed ever since with, of course, many modifications and changes. Under provisions of the new act, the Board of Health was to be made up of nine members. Six of these were to be chosen by the State Medical Society from its active members and three to be appointed by the governor. It was specified that one of the members ap-pointed by the governor was to be a civil engineer. The members appointed by the Med-ical Society were to serve two for six years, two for four years, and two for two years; while those appointed by the governor would serve for only two years. A!l vacancies were to be filled by the Board of Health. The of-ficers of the Board were to consist of a president and a secretary-treasurer. The latter was to be paid for his serv-ices, the amount to be fixed by the Board. The general duties of this new board included all the items named in the 1877 act, these being included in the "Supplemental Act of 1879." In ad-dition, provision was made for the publication of bulletins whenever there occurred an outbreak of disease in epi-demic proportions, the object being to inform the public on how to prevent and stop the spread of dangerous dis-eases. Chemical examination and an-alyses of water were to be carried out; and auxiliary boards of health were to be organized in each of the 94 coun-ties of the State. The Health Bulletin First Published—April 1886 The official publication of the North Carolina State Board of Health, 608 Cooper Memorial Health Build-ing, 225 North McDowell Street, Raleigh, N. C. Pub-lished monthly. Second Class Postage paid at Raleigh, N. C. Sent free upon request. EDITORIAL BOARD Charles M. Cameron. Jr., M.D., M.P.H. Chapel Hill John C. Lumsden, B.C. HE. Jacob Koomen, Jr., M.D., M.P.H. Bryan Reep, M.S. John Andrews, B.S. Glenn A. Flinchum. B.S. H. W. Stevens. M.D., M.P.H., Ashevlle Editor-Edwin S. Preston, M.A., LL.D. Vol. 82 May, 1967 No. 5 THE HEALTH BULLETIN May, 1967 Richard H. Lewis, M.D. 1892-1909 ^ay/ 1967 THE HEALTH BULLETIN The State Board of Health was voted an annual appropriation of $200 to carry out these numerous items. Under the provision specified in the act, the organization of the State Board of Health took place on May 21, 1879 just a few weeks after the act had been passed by the General Assembly. The members of the 1885 Legislature were evidently impressed by the ef-forts being made by the State Medical Society, especially since the people of the State were showing interest in the matter. The General Assembly amend-ed the laws so as to make the county boards more efficient; the annual ap-propriation was increased from $200 to $2000; and a contingent fund of $2000 was set up to be expended with the ap-proval of the governor whenever an epidemic occurred; also, printing privi-leges not to exceed $250 annually were extended to the Board. As a result of the increased appro-priation and the added printing privi-lege, the Board began the publica-tion of a health bulletin, this being the first publication of this nature in the United States. The first issue of the monthly Health Bulletin appeared in April 1886 and contained reports from 26 counties, with tables made up from the reports of county superintendents of health giving the conditions of weather, the prevailing diseases, epidemics, diseases of domestic animals and the condition of public institutions, especially of the jails and poorhouses. The reports of the latter included, among other things, the number of inmates, the number who had been successfully vaccinated, the kind and the amount of food, the num-ber who could read and write, and a report of general sanitary conditions ex-isting in the county. Along with these reports were additional articles and edi-torials to instruct the people in hygienic matters. The Bulletin was widely distributed; being sent to state and county officials, public libraries and to all members of the State Medical Society, to mayors and health officers of cities and towns, and to any citizens who asked for it. It was intended to be, and was, the voice of the State Board of Health. Comment-ing on the first issue of the Bulletin, Dr. Jones, President of the Board, said to the North Carolina Medical Society at its meeting in 1886: "It will go out as a monthly messenger of glad tidings with healing in its wings, with words of truth and notes of cheer, or sounds of alarm if danger comes nigh." Dur-ing its early years, the Bulletin was pre-pared largely by Dr. Wood who alone decided what should be printed. Also, the wrapping and mailing of the peri-odical was done by the Doctor and his family. Miss Jane Wood has told of how she and her brother (later to be-come Dr. Edward Jenner Wood) helped their father with this work. She writes, "We grew to be very proud of the part we had in making good health a part of the State's task."* The favorable reception the Bulletin received and its success were due large-ly to the reports of the county super-intendents. These showed something of the health conditions existing in the different counties and enabled interest-ed officials and citizens to compare their county with others. At first, the county superintendents were negligent in sending in their reports, but in 1893 reports were received from 88 of the 96 counties in the State. Since seven counties had no board of health, only one county had failed to report. Dur-ing the first eight years, up to 1893, the Bulletin became an indicator of the progress being made in public health work in the State. Its articles were re-published and commented upon in the state press. THE HEALTH BULLETIN May, 1967 W. S. Rankin, M.D. 1909-1925 May, 1967 THE HEALTH BULLETIN The Act of 1893 greatly increased the status of the State Board of Health, which reacted with renewed activity. A well-equipped office was established in Raleigh for the Secretary who was given an annual salary of $1,000. When Dr. Thomas F. Wood of Wil-mington, the founder and first secre-tary of the State Board of Health, died on August 22, 1892, Dr. Lewis was elected to succeed him. Since the State Board of Health's annual appropriation up to 1907 was never more than $2000, the Board could not afford an office of its own, and most of its work was carried on in his office. The Act of the General Assembly of 1909 providing for the employment of a State Health Officer for his whole time made it necessary for Dr. Richard H. Lewis, the father of the bill, to culminate 17 years of patriotic devotion to the health of the people of North Carolina. At a called meeting of the Board of Health on March 30, 1909, he explained the amended law, stating that he could not afford to surrender his practice and was therefore tendering his resignation. The Board, after insist-ing in vain for the withdrawal of the resignation, reluctantly accepted it. Dr. Watson Smith Rankin of Wake Forest was elected to succeed him on July 1, 1909, at a salary of $3,000 per year. The annual appropriation of the Board was increased from $4000 to $10,500 in 1909. The General Assembly of 191 1 creat-ed County Boards of Health to take the place of the Sanitary Committees. The new legislation in 1911 enabled the State Board of Health to increase the circulation of the Bulletin from 11,- 500 to 20,000 copies per month. The Genera! Assembly of 1913 also amended several sections of the exist-ing health laws and raised the annual appropriation of the Board from $22,- 500 to $40,500 annually. In 1916 the monthly circulation of the Health Bulletin reached 51,000. Early in 1923, Dr. W. S. Rankin was invited by the "Committee of Municipal Health Department Practices" of the American Public Health Association to become Field Director in making a study of municipal health procedures. The Executive Committee of the State Board of Health granted the Secre-tary a year's leave of absence, and on November 1, Dr. Rankin assumed his duties and established official head-quarters in New York City. He con-tinued this work until November 1, 1924. A number of changes were made in 1923 in the organization of the State Board of Health as well as in its per-sonnel. On March 1, Dr. Cooper made Assistant Secretary and became official head of the staff. If it had not been for his almost total deafness, he undoubted-ly would have been selected to succeed Dr. Ranklin when the latter resigned a short time later. At the Conjoint Session of the State Board of Health and State Medical So-ciety held in Pinehurst on April 29, 1925, Dr. Rankin announced his resig-nation as State Health Officer, effective June 1, to accept directorship of the Hospital and Orphan Division of the newly created Duke Endowment. On May 30, at the meeting of the Execu-tive Committee of the Board, Dr. G. M. Cooper was unanimously made Assist-ant Secretary for an indefinite period of time. During his public health career. Dr. Rankin had been President of the Am-erican Public Health Association; Trus-tee of the American Hospital Associa-tion; first Chairman of the Charlotte Board of Health; Member of the North Carolina Medical Care Commission; Trustee of Wake Forest College; and he received honorary degrees from Duke University, University of North Caro- 8 THE HEALTH BULLETIN May, 1967 Chas. O'H. Laughinghouse, M.D. 1926-1930 May, 1967 THE HEALTH BULLETIN lina, Davidson College, and Wake Forest College. He also received, in 1956, the Distinguished Citizenship Award from the North Carolina Citizens Association. The City of Charlotte named their new public health building the "W. S. Ranklin Health Center" and this was dedicated on Dr. Rankin's 81st birth-day, January 18, 1960. Along with the founders of the State Board of Health, Drs. Thomas Fanning Wood and Richard Henry Lewis and Dr. W. S. Rankin, first full-time secretary, three doctors stand out in the develop-ment of public health work in North Carolina; Dr. John A. Ferrell, Director of the North Carolina Hookworm Com-mission, 1910-14, extended education-al and treatment campaigns throughout the State and later directed work which hastened the advent of county health departments; Dr. Louis B. McBrayer who directed and developed activities which brought about the control of tubercu-losis; and Dr. George Marion Cooper who may be called the "family phy-sician" of the State because of his care-ful study of health and social ills and the modern methods he devised to al-leviate them. On May 1, 1923, Dr. Cooper was appointed Assistant State Health Of-ficer and was made Editor of the Health Bulletin. He continued as Editor of the Bulletin until 1942 and was Acting State Health Officer on four different occasions. In the reorganization plan of 1950, Dr. Cooper became Director of the Division of Personal Health. Highlights of Progress To 1967 Excerpts from Biennial Reports 1926. On June 21 Dr. Charles O'H. Laughinghouse, a member of the Board, was elected permanent Secretary and State Health Officer to fill the unexpired term of Dr. Rankin. Dr. Laughinghouse accepted and took ofTice October 1. 1928. The educational work of the Board was of a high order during 1928. A thirty-two page BULLETIN was issued monthly, and a moving picture machine with several films on modern health subjects was exhibited in many sections of the state. 1929. On January 1 Dr. Earnest A. Branch accepted the appointment as di-rector of the Division of Oral Hygiene. Expenditures for the Board work this year reached the highest peak in the history of the Board, totaling about $486,000. 1930. On August 26, Dr. Chas. O'H. Laughinghouse, State Health Officer, died. Soon after his death, in a meeting of the board. Dr. H. A. Taylor was made Acting State Health Officer. 1931. A bill was introduced in the Legislature abolishing the State Board of Health as then constituted. This bill was passed and became law during the session of 1931. With the enactment of the new law the terms of the members of the old Board were automatically terminated. Under this new law governing the state health work, legislative machinery providing for the establishment of a new organization to carry on the public health work of the state was enacted. The Board still elects the State Health Officer, but it can only become effective upon the approval of the Governor. The term of the State Health Officer, along 10 THE HEALTH BULLETIN May, 1967 :^^ James M. Parrott, M.D. 1931-1934 with members of the Board of Health, was restricted to four years. On May 28, the new Board met and organized. On that day it unanimously elected Dr. James M. Parrott State Health Officer. Dr. Parrott took the offer under consideration for a period of two weeks. On June 1 1 the Board met again. Dr. Parrott accepted the election and agreed to assume office on July 1. 1932. The death rate in North Carolina for 1932 was 9.6 per 1,000 popula-tion. This is the lowest death rate ever before recorded in North Carolina. May, 1967 THE HEALTH BULLETIN 11 The infant mortality this year was 66.4 per 1,000 live births. This is so far the best record the state has ever made. Expenditures for this year for ail purposes by the Board were $315,276, of which $262,438 represented appropriations. This amount was just a little more than half the total expenditures made by the Board of Health for the fiscal year ending June 30, 1930. 1933. The event of outstanding importance to the Board of Health this year was the death of Dr. C. A. Shore, which occurred on February 10. A few weeks after the death of Doctor Shore, Dr. John H. Hamilton, director of County Health Work, of Vital Statistics, and of Epidemiology, was made di-rector of the laboratory work. 1934. The event of greatest importance to the State Board of Health and to the health work throughout the state in this year was the death of Dr. James M. Parrott and the election of Dr. Carl V. Reynolds as his successor. Dr. Carl Vernon Reynolds, of Asheville, on November 10, took the oath of office and immediately assumed his duties as Acting State Health Officer. 1935. At the annual meeting of the State Board of Health, which was held in Pinehurst May 7, 1935, Dr. Reynolds was unanimously elected State Health Officer. 1937. On December 16, 1937, following Legislative Provision in the 1937 session of the Legislature, $160,000 in bonds were sold for the purpose of build-ing a new plant for the State Laboratory on the grounds adjacent to the present State Board of Health building on Caswell Square, Raleigh. The total expenditures for the State Board of Health during the fiscal year end-ing June 30, 1937, were $881,484.01. Of this amount $287,747.04 was appro-priated by the Legislature. The total expenditures for the State Board of Health for the fiscal year ending June 30, 1938, were $1,041,895.98. Of this amount $353,953.55 was appro-priated by the Legislature. 1939. The total expenditures for the State Board of Health for the fiscal year ending June 30, 1939, were $1,215,056.80. Of this amount $364,506.25 was appropriated by the Legislature. 1940. The most important item in the field of public health in this State in 1940 was the completion and dedication of the central building known as the Clarence A. Shore Laboratory of Hygiene. The circulation of the HEALTH BULLETIN increased from about 52,000 to 60,000 monthly copies during the year. The total expenditures for the State Board of Health for the fiscal year ending June 30, 1940, were $1,380,174.90. Of this amount $370,057.67 was appro-priated by the Legislature. 1942. On January 1, 1942, Dr. G. M. Cooper was retired from the editorship of the State HEALTH BULLETIN and Dr. John H. Hamilton assumed the duties of acting editor. The total expenditures for the State Board of Health for the year ending June 30, 1942, were $1,791,878.11. Of this amount $370,150.59 was appropriated by the Legislature. In the autumn of this year the employees of the State Board of Health organ-ized and established what is officially known as the North Carolina Academy of Public Health at the State Board of Health. All employees of the State Board of Health are members of this Academy. 12 THE HEALTH BULLETIN May, 1967 Carl V. Reynolds, M.D. 1934-1948 The total expenditures for the State Board of Health for the year ending June 30, 1942, were $1,791,878.11. Of this amount $370,150.59 was appropriated by the Legislature. 1943. The total expenditures for the State Board of Health for the fiscal year ending June 30, 1943, were $1,880,230.62. Of this amount $406,993.29 was appropriated by the Legislature. 1947. The total expenditures for the State Board of Health for the year ending June 30, 1947, were $2,814,937.00. Of this amount $561,996.00 was appro- May, 1967 THE HEALTH BULLETIN 13 priated by the Legislature. 1948. The most conspicuous event taking place during this part of the biennium was the resignation of Dr. Carl V. Reynolds as State Health Officer effective June 30. Dr. Reynolds retired after serving a little more than 13V2 years. At the meeting of the State Board of Health in Raleigh on February 24, Presi-dent Craig read Dr. Reynold's letter of resignation as Secretary and State Health Officer effective June 30, 1948. Doctor J. W. R. Norton, native of Scotland County and Chief Health Officer of the TVA of Chattanooga, Tennessee, was elected State Health Officer. The total expenditures for the State Board of Health for the year ended June 30, 1948, were $2,648,277.00. Of this amount $794,774.00 was appropriated by the Legislature. On July 1, 1948, Dr. J. W. R. Norton assumed his duties as State Health officer. 1949. The year 1949 was destined to become a turning point in the Public Health program in North Carolina. The Legislature of that year did more for Public Health than any of its predecessors. There was a spirit of close cooperation between Public Health officials, the Governor and members of the General As-sembly. As an outcome of this, approximately $800,000 in new money was voted for each fiscal year of the new biennium for local health work, which had only been receiving $350,000 a year. This meant an increase to $1,150,000 in State funds for local health during the biennium. 1950. The year 1950 saw not only increased expansion in local health work, but also re-organization of the State Health Department so as to make operations less cumbersome. As of February 1, reduced the number of divisions to six, placed in charge of a director and designated the subdivisions as sections. 1951. The General Assembly, which met early in January, increased the appro-priations for Public Health to $2,214,591 for the fiscal year of 1950-1952 and $2,224,982 for the fiscal year of 1952-1953. On January 19, the State Board of Health confirmed the appointment of Dr. John H. Hamilton as Assistant State Health Officer, his term to run concurrently with that of Dr. Norton. MEMBERS OF THE NORTH CAROLINA STATE BOARD OF HEALTH Lenox D. Baker, M.D., President Durham James S. Raper, M.D., Vice-President Asheville Ben W. Dawsey, D.V.M. Gastonla Samuel G. Koonce, Ph.G. Chadbourn Oscar S. Goodwin, M.D. Apex 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 3. 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 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, Presonal Health Division 14 THE HEALTH BULLETIN May, 1967 J. W. R. Norton, M.D., M.P.H. 1948-1965 May, 1967 THE HEALTH BULLETIN 15 rHE HEALTH BULLETIN P. O. Box 2091 Raleigh, N. C. 27602 MEDICAL tlBRARY \j. OF N. C . CHAPEL HlLL./% _BX. 1020 If you do NOT wish to con-tinue receiving The Health Bul-letin, please check here i— 1 and return this page to '— ' the address above. /V Printed by The Graphic Press, Inc., Raleigh, N. C. 1954. Following the 1954 Conjoint Session of the State Board of Health and the State Medical Society the health department was moved from its old building to its new million dollar headquarters on Caswell Square. Jacob Koomen, Jr., M.D., M.P.H., assistant director of the Division of Epidemi-ology, was named Assistant State Health Director to begin that service October 1, 1961. The auditorium of the Laboratory Building was renovated and re-decorated and dedicated by the State Board as "The John Homer Hamilton Auditorium". Edwin S. Preston, M.A., LL.D., was named Editor of The HEALTH BULLETIN in May 1960 upon the retirement of Dr. John Homer Hamilton. Dr. J. W. R. Norton relinquished his position as State Health Director effective December 31, 1965, continuing as Director of the Local Health Division. Dr. Jacob Koomen, Assistant State Health Director was elected Acting State Health Director and in May 1966 became State Health Director with the approval of Governor Dan Moore. Dr. W. Burns Jones was elected as Assistant State Health Director. Appropriations for the continuation of existing activities of the State Board of Health were made in the amount of $6,232,867 for the first year of the biennium, 1967-69, and $6,308,776 for the second year, including amounts to implement a uniform fee schedule for medical fees and the payment of 90% of hospital reimbursable costs. Additional appropriations for special purposes included: Health aid to coun-ties—$ 400,000 for each year of the biennium (the first major appropriation for this purpose since 1949); Salt Marsh Mosquito Control—$70,000 for the first year and $100,000 for the second; Genetics Counseling Center—$1 00,000 for the second year; Scallop Inspection Program—$1 1 ,736 for each year; and $42,500 for each year to establish and maintain a Statewide Medical Examiner System. 16 THE HEALTH BULLETIN May, 1967 m!\^ ©raii^u The Official Publication Of The North Carolina State Board of Health nr \ ^LTH A CUTE RASCAL — BUT AN ENEMY in the article beginning on page 3, "The Insecticide That Turns the Bug Against Itself", this advice is given: To cope with him and others like him, use the Judo approach — don't whack away by main force; use the enemy's own strength against him. Disorganize the insect's growth by making use of the same chemicals the insect uses to regulate his growth. Miss Holley Receives Aword The first nurse to receive an Award of Merit for Outstanding Contribution and Meritorious Service in the field of Public Health and Preventive Medicine was presented to Miss Elizabeth Hol-ley, Chief Nurse, North Carolina State Board of Health, Raleigh, North Caroli-na at the 35th Annual Meeting of the Southern Branch, American Public Health Association held in St. Louis, Missouri 'as+ week. Miss Holley, a past president of the Association and representative to the national A.P.H.A., was selected frorr. among the 17,000 public health work-ers in 1 7 Southern states served by the Association which has its headquarters in Birmingham, Aia. In presenting the award. Dr. H. P. Hopkins, President, Nashville, Tenn., said "Miss Holley symbolizes the dedi-cation of the public health nurse and other public health workres in protect-ing the health of our nation through programs that prevent and control disease affecting people in every age group." Also elected were: President—Charles G. Jordan, B.S.C.E., Miami, Fla.; 1st Vice President—Hugh B. Cottrell, M.D., Atlanta, Ga.; 2nd Vice President—John M. Bruce, M.D., New Orleans, La.; 3rd Vice President— Fred Ragland, Jackson-ville, Fla.; Secretary-Treasurer—John S. Neili, M.D., Tampa, Fla. Executive Committee—Miss E. Alice Clark, R.N., M.P.H., Atlanta, Ga.; Miss Elizabeth Holley, R.N., M.A., Raleigh, N. C; H. P. Hopkins, Ph.D., Nashville, Tennessee; William J. Peeples, M.D., Baltimore, Md.; Miss Joella Sisler, Frankfort, Kentucky. Future annual meetings are sched-uled for May 28-31, 1968-Roanoke, Va., and May 20-23, 1969-Oklahoma City, Okla. The Health Bulletin First Published—April 1S86 The official publication of the North Carolina State Board, of Health, 608 Cooper Memorial Health Build-ing, 225 North ^^cC'o |