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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. F0UR DAYS This JOURNAL may be kept oul and is subject to a fine of FIVE CENTS a day thereafter. It is DUE on the DAY indicated below: Pictures and Personal Sketches of 10 Outstanding Persons Honored for their contributions to Medical Science. Modern Medicine's 1965 Distinguished Achievement Awards (see following pages) To the men who make the great discoveries in medical science, to the men who apply them in practice, and to their teachers, Modern Medicine is privileged to say "well done" on behalf of the medical profession. The nominations for the Awards for Distinguished Achievement come from deans of medical schools, leaders of medical organizations, and members of the Modern Medicine editorial board. No honor has a merit higher than the merit of those who wear it, and this award has taken its luster from the names and achieve-ments of the men who have won it over the years. Reprinted with permission from Modern Medicine, the Journal of Diagnosis and Treatment, (January 4, 1965). Copyright 1965 by Modern Medicine Publications, Inc. The Health Bulletin MARY ANN farthing, m.s. Jacob Koomen, Jr., M.D., M.P.H. First Published—April 1886 Bryan Reep M.S. The official publication of the North Carolina State Board of Health, 608 Cooper Memorial Health Building, 225 North McDowell Street, Raleigh, N. C. John Andrews, B.S. Published monthly. Second Class Postage paid at Glenn A. Flinchum, B.S. Raleigh, N. C Sent free upon request. H. W. STEVENS, M.D.. M.P.H.. ASHEVILLE EDITORIAL BOARD Charles M. Cameron, Jr , M.D., M.P.H. Chapel Hill John T. Hughes, D.D.S., M.P.H. John C. Lumsden, B.C.H.E. Editor-Edwin S. Preston, M.A., LL.D. Vol. 80 January, 1965 No. 1 THE HEALTH BULLETIN January, 1965 Ten Outstanding Physicians and Medical Scientists Honored for Contributions to Medical Science Photographs and discussion on following pages Special recognition for their contribu-tions to medical science was given this year to 10 outstanding physicians and medical scientists as the Editors of Modern Medicine announced their 1965 Distinguished Achievement Awards. Nine men and one woman were se-lected from over 100 outstanding med-ical leaders nominated by deans of U. S. medical schools, leaders of pro-fessional medical organizations and members of the Modern Medicine edi-torial board. The announcement of the awards was made in the January 4 is-sue of the journal. January, 1965 THE HEALTH BULLETIN Initiated in 1934, the Modern Medi-cine annual awards honor those of the medical profession who make great and continuing discoveries in medicine. The 1965 winners join the 280 distinguished physicians and scientists who have re-ceived the awards during the past 30 years. The 1 965 winners are: Leona Baumgartner, M.D., assistant administrator for technical cooperation and research, Agency for International Development, Washington, D. C, for her concern with the health of man manifested by contributions to public health as a scientist and administrator in an increasing sphere of influence. Oscar Creech, Jr., M.D., professor of surgery and chairman of the department of surgery, Tulane University, New Or-leans. Dr. Creech was cited for his de-velopment of regional perfusion in the treatment of malignant diseases and for the impact of his work on cardio-vascular surgical techniques. Derek E. Denny-Brown, M.D., profes-sor of neurology, Harvard University, and director, neurological unit, Boston City Hospital. Dr. Denny-Brown was honored for his application of the ac-cumulated knowledge in basic biolog-ical sciences to the elucidation of ob-scure neurological disorders, giving hope for their ultimate control. A. Baird Hastings, Ph.D., professor of biological chemistry, emeritus, Harvard University, and head of the laboratory of metabolic research, Scripps Clinic and Research Foundation, La Jolla, Cali-fornia. Dr. Hastings received the award for his brilliant and imaginative discov-eries in biochemistry, coupled with a practical approach to their clinical use, and for his influence as a gifted teacher. Hudson Hoagland, Ph.D., executive director of the Worcester Foundation for Experimental Biology, Shrewsbury, Mass. He was selected for his organi-zation of an outstanding biomedical re-search institution and for his work as a scientist and a humanitarian bearing on the world's problem of an exploding population. Chester S. Keefer, M.D., professor of medicine, Boston University, Boston, was cited for broad talents as clinician, investigator, educator, and administrator that have significantly bettered medical teaching and practice. William J. Kolff, M.D., head of the department of artificial organs, Cleve-land Clinic, and professor of experiment-al medicine, Cleveland Clinic Educa-tional Institute. Dr. Kolff was singled out for his development of practical methods for effective hemodialysis and for investigation and development of mechanical substitutes for essential bio-logical structures. Joseph L. Melnick, Ph.D., chairman of virology and epidemiology, Baylor Uni-versity, Houston, was chosen for his work in basic virology especially with the enteroviruses, and the development of methods of stabilizing the poliomye-litis virus that enhance the safety of poliomyelitis vaccine. John P. Merrill, M.D., director, cardio-renal section of Peter Bent Brigham Hospital, and associate clinical profes-sor of medicine, Harvard University, Boston. Dr. Merrill was honored for pioneering in tissue transplantation and scientific studies of compatibility factors that have provided a biologically sound approach to kidney transplantation. Francis D. Moore, M.D., professor of surgery, Harvard Medical School, and surgeon-in-chief, Peter Bent Brigham Hospital, Boston. He received the award for extensive work on the basic patho-physiology of the surgical patient that has widened the surgeon's scope, im-proved operative results, and promoted the patient's comfort. THE HEALTH BULLETIN January, 1965 LEONA BAUMGARTNER, M.D. concern with the health of man manifested by contributions to public health as a scientist and administrator in an increasing sphere of influence Assistant administrator for technical co-operation and research, Agency for In-ternational Development, Washington, D. C. January, 1965 THE HEALTH BULLETIN OSCAR CREECH, JR., M.D development\of regional perfusion for the treatment of malignant disease and impact on cardiovascular surgical techniques William Henderson professor of surgery and chairman of the department of sur-gery, Tulane University, New Orleans. THE HEALTH BULLETIN January, 1965 S&*v^Sfe liii \ DEREK DENNY-BROWN, M.D. application of the accumulated knowledge in basic biological sciences to the elucidation of obscure neurological disorders, giving hope for their ultimate control James Jackson Putnam professor of neurology, Harvard University, and di-rector, neurological unit, Boston City Hospital. January, 1965 THE HEALTH BULLETIN 7 A. BAIRD HASTINGS, Ph.D. brilliant and imaginative discoveries in biochemistry, coupled with a prac-tical approach to their clinical use, and influence as a gifted teacher -*>-.*:«rv.:'-=i3 Hamilton Kuhn professor of biological chemistry, emeritus, Harvard University, Boston, and head of the Laboratory of Metabolic Research, Scripps Clinic and Research Foundation, La Jolla, Calif. THE HEALTH BULLETIN January, 1965 HUDSON HOfGLAND, Ph.D. organization of an (outstanding biomedical research institution and work as a scientist and a humanitarian bearing on the world's problem of an ex-ploding population • Executive director, Worcester Founda-tion for Experimental Biology, Shrews-bury, Mass. January, 1965 THE HEALTH BULLETIN CHESTER S. KEEFER, M.D. protean talents as clinician, investigator, educator, and administrator that have significantly bettered medical teaching and practice Wade professor of University. ledicine, Boston 10 THE HEALTH BULLETIN January, 1965 WILLEM J. KOLFF, M.D. practical methods for effective hemodialysis and investigation and develop-ment of mechanical substitutes for essential biological structures Head of the department of artificial or-gans, Cleveland Clinic, and professor of experimental medicine, Cleveland Clinic Educational Institute. January, 1965 THE HEALTH BULLETIN 11 JOSEPH L MELNICK, Ph.D. work in basic virology, especially with the enteroviruses, and development of methods of stabilizing the poliomyelitis virus that enhance the safety of poliomyelitis vaccine Chairman, department of virology and epidemiology, Baylor University, Hous-ton. 12 THE HEALTH BULLETIN January, 1965 JOHN P. MERRILL, M.D. pioneering in tissue transplantation and scientific studies of compatibility factors that have provided a biologically sound approach to kidney trans-plantation Director, cardiorenal section, Peter Bent Brigham Hospital, and associate clinical professor of medicine, Harvard Univer-sity, Boston. January, 1965 THE HEALTH BULLETIN 13 FRANCIS D. MOORE, M.D. extensive work on the basic pathophysiology of the surgical patient that has widened the surgeon's scope, improved operative results, and pro-moted the patient's comfort Moseley professor of surgery, Harvard University, and surgeon-in-chief, Peter Bent Brigham Hospital, Boston. 14 THE HEALTH BULLETIN January, 1965 Individual Air Conditioners Are Being Used An individual air conditioner provid-ing cool, clean air for workers exposed to heat is being used routinely on cer-tain jobs in industrial plants in the southern United States. The simple, low-cost device is de-scribed by W. F. Lienhard, M.D., San Diego, Calif., J. P. Hughes, M.D., Oak-land, Calif., and T. A. Brassette, AA. E., New Orleans, in the current (September) Archives of Environmental Health, pub-lished by the American Medical Asso-ciation. It could be particularly helpful for workers whose tolerance for heat has been reduced by aging, heart disease, or other physiological impairment. Comparable observations on acclima-tized workmen with and without the de-vice during periods of identical work in a severely hot environment resulted in a threefold reduction in heat loss, a 25 per cent reduction in total heart beat, and a 50 per cent reduction in the rate of body temperature rise for the air-conditioned man, according to the researchers. The entire weight of the personal air-conditioner is only 19 ounces, accord-ing to the report. The air is cooled by a vortex tube, invented in 1931 by a French metallurgist, George Ranque. Standard industrial compressed air is delivered through a hose to the tube attached by a belt to the man's waist. The tube converts compressed air at 120 degrees Fahrenheit to a steady flow at 65 F. Each worker has a "breakaway" coup-ling so he can detach himself from the air supply hose simply and quickly in case of danger. Hoses 150 feet in length provide the worker a high de-gree of mobility. None of the earlier systems proposed for individual air conditioning has been widely adopted in industry because in general they have been too complex and too costly for day-to-day use on most jobs, the researchers commented. Vortex tube units with accessory equip-ment are commercially available. The vortex tube alone costs less than $75. MEMBERS OF THE NORTH CAROLINA STATE BOARD OF HEALTH Lenox D. Baker, M.D., President Durham John R. Bender, M.D., Vice-President Winston-Salem Ben W. Dawsey, D.V.M Gastonia Glenn L. Hooper, D.D.S. Dunn Oscar S. Goodwin, M.D. Apex D. T. Redfearn, B.S. Wadesboro James S. Raper, M.D. Asheville Samuel G. Koonce, Ph.G. Chadbourn John S. Rhodes, M.D. Raleigh EXECUTIVE STAFF J. W. R. Norton, M.D., M.P.H. State Health Director Jacob Koomen, Jr., 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 W. Burns Jones, M.D., M.P.H. Director, Local Health Division E. A. Pearson, Jr., D.D.S., M.P.H. Director, Oral Hygiene Division Lynn G. Maddry, Ph.D., M.S.P.H. Acting Director, Laboratory Division Ben Eaton, Jr., A.B., LL.B. Director, Administrative Services J>iri James F. Donnelly, M.D. Director, Personal Health Division January, 1965 THE HEALTH BULLETIN 15 THE HEALTH BULLETIN P. O. Box 2091 Raleigh, N. C. 27602 LIBRARIAN DIVISION OF HEALTH APTAl N.C. ,VEM. ffOSP. U. M CHAPEL HILL, N.C. If you do NOT wish to tinue receiving The Health letin, please check here GOdfiM Official Publication Of The North Carolina Stare Board of Health j^A*** John Atkinson Ferrell, M.D., Dr.P.H. December 14, 1880 - February 17, 1965 Fe,b, fits' John A. Ferre The miraculous advance in a man's lifetime in public health in North Carolina and the world could be no better marked than by the service of Dr. John A. Ferrell who died here Wednesday night. He was, of course, as State Health Officer Dr. Roy Norton said, "one of the outstanding physicians of all time native to North Carolina." Perhaps the mark of his greatness was that in his quiet, useful, elder years here, as director of the State Medical Care Commission, many of the health dangers he confronted as a young man had all but disappeared. He was only a young Duplin County practitioner in his twenties when in the first decade of this century he became assistant State Health officer concerned with combatting such plagues as typhoid fever and hookworm. Not everybody approved when, working with the Sanitary Commission and the Rockefeller Foundation, he extended his work in the campaign against hookworm. Some Southern patriots resented statements that much backwardness in the South resulted from this parasite which attacked so many rural people. Some con-sidered the statements Yankee-financed slander. But understanding grew as health conditions improved. And Dr. Ferrell was called from the State by the Rocke-feller Foundation to carry the work to the world. That work would have been enough to place him in the company of the great physicians. But North Carolina was blessed when, as native after what might have been time for retirement, he returned to the State of his youth to help shape and direct Federal and State programs for hospital expansion in North Carolina. His was a long life filled with great service. He deserves re-membrance as one of the truly eminent men produced by North Carolina in this century. Editorial, Feb. 20, 1965, Raleigh New and Observer THE HEALTH BULLETIN February, 1965 Dr. Ferrell's Three Public Health Careers Come to an End Dr. John A. Ferrell, public health pioneer, died late Wednesday night, February 17, at Rex Hospital in Raleigh. Funeral services were conducted at 11:30 a.m. on Friday, February 19, at the Church of the Good Shepherd. The Rev. James Beckwith and the Rev. Louis Melcher officiated, and burial was at 3:30 p.m. in Elmwood Cemetery in Charlotte. John Atkinson Ferrell, physician and public health administrator, was born at Clinton, N. C, December 14, 1880, son of James Alexander and Cornelia (Murphy) Ferrell. His father (1832-1923) was a merchant-farmer; his mother was a daughter of Hanson Finla Murphy, M.D., of Pender County, N. C. The family has been in North Caro-lina since colonial times, the earliest known representative of the line being Rev. James Alexander Ferrell, a Baptist clergyman of Orange County, N. C, in the eighteenth century. From him the descent is traced through Anderson (1804-43) and Mary (Dixon) Ferrell, parents of James A. Ferrell, 2d. The maternal line also runs into colonial times, from Finla Murphy, who came from Arrau Island, Scotland, in 1747, through Hugh Murphy of New Hanover County, N. C, and his wife Catherine McMillan; through Cornelius and Catherine Murphy and Doctor Han-son Finla and Elizabeth Anne (Simpson) Murphy. Dr. Ferrell was educated in the Uni-versity of North Carolina, where he was graduated B.S., in 1902; and M.D., in 1907. Later, in 1919, Dr. Ferrell was graduated with the degree Dr. P.H. (Doctor of Public Health) by Johns Hopkins University School of Hygiene and Public Health, the first occas.on on which this institution conferred this de-gree and he was the one and only graduate that year. For three years, (1902-05), he was engaged in teaching and as superinten-dent of schools in Sampson County, N. C, and, during this time, entered upon the study of medicine. He began practice in Kenansville, N. C, in 1907 and, in the same year, was made superintendent of health of Duplin County. In 1909 John D. Rockefeller provided the funds for the control in the South of hookworm disease, which had been found so prevalent as to become a menace to the social and economic progress of that area. The Rockefeller Sanitary Commission was formed to carry out the purpose of the benefac-tion and Doctor Ferrell was chosen, early in 1910, to have direction of ed-ucational and control measures in North Carolina with the title of As-sistant Secretary of the State Board of Health. Although the disease, except among physicians, was little known, his pione-ering efforts resulted, during the period 1910-1913, in educating the people throughout the State regarding the dis-ease, its mode of spread and methods February, 1965 THE HEALTH BULLETIN for its prevention and cure, and in the microscopic examination of 320,872 persons, of whom 160,689 were found to be infected and were treated. Upon the organization in 1913 of the International Health Board of the Rocke-feller Foundation, to extend throughout the world such health work as had been conducted by the Rockefeller Sanitary Commission in the South and also to embrace activities in the whole field of public health, Dr. Ferrell was made Di-rector for the United States. In this, he directed the work which involves the giving of financial aid and counsel to official health agencies for the de-velopment of essential branches of the State services and also the develop-ment of county organizations on a per-manent basis. During his period of serv-ice, 331 full-time county organizations were established, toward 226 of which the Foundation contributed directly. Dr. Ferrell, although active in the general field of public health, featured the strengthening of the State Health Departments and especially the estab-lishment, development and extension of county health service. In the United States, the Foundation provided aid for training of more than 200 medical health officers to occupy directive positions in the official health agencies (1919-27). As Associate Director of Internation-al Health for the Rockefeller Founda-tion, Dr. Ferrell directed this Founda-tion's interests in the United States, Canada and Mexico until 1944. From 1944 to 1946, he served as Medical Director of the John and Mary R. Markle Foundation. On October 1, 1946, he began a span of over ten years as Executive Secretary of the North Carolina Medical Care Commission. In this position, he directed the use of Hill-Burton funds in this State in the construction of 127 hospitals with an overall capacity of 6,- 567 beds, 41 nurses' residences, 3 diagnostic and treatment centers and 76 health centers— a total of 247 health projects involving an expenditure of $95,931,033. He retired February 1, 1957, and he and his wife had been living in Raleigh, North Carolina, since that time. His activity in professional organiza-tions is illustrated by his membership in the American Medical Association (Chairman, Public Health Service, 1922- 23), the American Public Health As-sociation (Member of Council 1 926- 29), the Southern Medical Association, the North Carolina State Medical So-ciety (Secretary, 1911-13), the New Jersey State Medical Society, the Na-tional Malaria Committee (Chairman, 1924), and the Royal Society of Public Health. The University of North Carolina gave to Dr. Ferrell its Distinguished Service Award. He was the author of numerous The Health Bulletin First Published—April 1886 The official publication of the North Carolina State Board of Health. 608 Cooper Memorial Health Building, 225 North McDowell Street, Raleigh, N. C. Published monthly. Second Class Postage paid at Raleigh, N. C. Sent free upon request. EDITORIAL BOARD Charles M Cameron, Jr., M.D., M.P.H Chapel Hill John T. Hughes, D.D.S., M P H. John C. Lumsden. B.C.H.E. Mary Ann Farthing. MS. Jacob Koomen. Jr., M.D . M PH. Bryan Reep, MS. John Andrews. B.S Glenn A. Flinchum, B.S. H. W. Stevens. M.D., M.P.H., Asheville Editor— Edwin S. Preston, M.A., LL.D. Vol. 80 February, 1965 No. 2 THE HEALTH BULLETIN February, 1965 papers and booklets on public health subjects, among which are: "Medical In-spection of Schools and School Chil-dren" (1912); "Malaria of the South" (1924); "Careers in Public Health" (1923); "Health in Relation to Citizen-ship" (1924); "Trend of Preventive Medicine" (1923); "The Public Health Nurse and County Health Service" (1926); "The County Health Organi-zation in Relation to Maternity and In-fancy Work and Its Permanency" (1927); "Survey of Provincial and State Health Organizations"—with aid of staff— (1927) etc. Dr. Ferrell was married January 28, 1909 to Lucile Devereaux Withers, daughter of Benjamin F. Withers of Charlotte, N. C. They had one daugh-ter, Bettie Devereaux, and two sons, John Atkinson, Jr. and Benjamin With-ers (deceased). In tribute to Dr. Ferrell, Dr. J. W. R. Norton, State Health Director, said, "He was one of the outstanding physicians of all time native to North Carolina. His work here in early public health in the control of hookworm and typhoid set an example for the control of many other communicable diseases. His in-ternational service with the Rockefeller Foundation and his service with the John and Mary R. Markle Foundation made him uniquely qualified to direct the N. C. Medical Care Commission. In that responsibility he set a pattern for the ideal use of Hill-Burton funds in the development of the best hospital plan-ning and health center construction to be found in the nation." Death of Doctor Recalls Fight Hookworms Once Plagued Tar Heels by Bob Brooks Raleigh News and Observer Only the oldtimers remember the campaign to stamp out hookworm dis-ease in North Carolina. It started in 1910, when a hardy bunch of pioneers in public health armed themselves with microscopes and began probing the "stools" of school children and adults over the state. By slow train, buggy and horseback Dr. John A. Ferrell and his associates went into every county in a hookworm search that marked the beginning of ac-tive public health work in this State. Real Giant Dr. Ferrell's death here last month at 84 took from the State one of its real giants in the public health field. His direction of the hookworm control cam-paign, as assistant secretary of the State Board of Health, may have been his most notable contribution. It was a campaign which for the first time focused the Tar Heel public's attention on community-wide detection, cure and prevention of communicable diseases. Dr. Ferrell and his men con-ducted lectures on sanitation and per-sonal hygiene wherever they went. The hookworm, in the early years of this century, was a plague upon the rural South. The small worm attaches it-self to the lining of the upper part of the small bowel and sucks blood from its victim. An infected person may have several thousand worms in him. Rockefeller money helped in financ-ing the State's effort to wipe out February, 1965 THE HEALTH BULLETIN hookworm disease. The work was di-rected through the Rockefeller Sanitary Commission. Dr. Ferrell was the com-mission's State director. He had six field directors. Local governments were required to provide part of the cost. Their efforts at fighting hookworm on a matching fund basis led to the organization of local health departments. In the beginning, there was some-thing less than enthusiastic public ac-ceptance of "the hookworm theory." Some of the newspapers in the State re-ferred to hookworm infection as "the lazy disease" and "the fad." Hookworm in the larvel stage may enter the body through the thin skin between the fingers and toes. Having been given this knowledge, some folks said Rockefeller was going into the shoe business and the hook-worm campaign was a scheme to get southerners to wear shoes the year round. The News and Observer commented that "many of us in the South are get-ting tired of being exploited by ad-vertisements that exaggerate condi-tions." But the press and the people rallied to the support of the campaign when the microscopes of Dr. Ferrell and his men began ot produce evidence of what ailed a good many of the State's people. Carrying specimens in tin cans, the people stood in lines to await the at-tention of the microscopists. The infect-ed ones got three doses of thymol and their health was soon restored. The News and Observer said earlier skepticism about the hookworm cam-paign was not justified, and the paper joined in the effort to publicize the work. Among Dr. Ferrell's field directors was Dr. Benjamin E. Washburn, who many years later wrote a lively account of the hookworm campaign in North Carolina. His booklet was published in 1960 by the Rockefeller Foundation. Dr. Washburn was one of the most successful field men in badgering ap-propriations out of county boards of commissioners. He travelled the rugged western end of the State. In the end, he and his colleagues squeezed money out of 99 of the 100 county governments. Only Ashe refused to cooperate. "However, there were reactionaries," Dr. Washburn recalled. "At one place a member objected because he thought the money could better be expended in buying mules for the poorhouse farm. In another, in the county in which the State university is located, a member was shocked at the idea of paying a doctor to treat worms. He contended that a certain number of worms was necessary to aid digestive processes. . ." Dr. Washburn recalled that while money was being discussed with the Alamance County Board of Commis-sioners, two doctors told of a case of hookworm they had treated. Patient's Symptoms Among the invalid patient's symp-toms "was eating dirt, paper and chalk, and he was reported, as a youngster, to have eaten half of a Bible and an entire song book." After treatment, the book eater became a freight train fire-man. An "unfortunate incident" hampered the hookworm doctors work in Swain County. The doctor was giving his lec-ture at a church meeting before the preacher arrived. The preacher was de-layed and sent word for the doctor to keep on talking. A woman in the aud-ience dropped dead during the hook-worm disease lecture. "It may be that the lecture was too long," Dr. Washburn conceded. Some of their findings baffled the hookworm crews. In Haywood County, they came upon a situation which surely would produce a shocking rate of infec- (Continued on page 9) THE HEALTH BULLETIN February, 1965 Children Still Unprotected from Measles With the advent of the 1965 measles season (February through April), Sur-geon General Luther L. Terry, of the Public Health Service, Department of Health, Education, and Welfare, said recently, "only about 7 million chil-dren have been protected by measles vaccines, leaving about 20 million sus-ceptible children unprotected. "Measles is so common a childhood disease that 90 percent of our children get it before their fifteenth birthday. Nevertheless, it is not the harmless illness that most mothers seem to think it is," Dr. Terry warned. Although recovery is routine for most children, about 500 children every year die from illnesses stemming from it. These are caused by encephali-tis or pneumonia. About one out of every 1,000 cases is followed by en-cephalitis. Fifteen to 20 percent of the encephalitis cases are left with such after-effects as mental retardation, vis-ual or hearing problems, or behavior disorders, and about 10 percent of the encephalitis cases die. "Over 490,000 cases of measles were reported to the Public Health Service in 1964, and we suspect that only about one-tenth of the actual cases were re-ported," Dr. Terry said. Many cases are not even seen by a physician, he ex-plained, because so many parents think of it as an "innocent" disease. "Fortunately, effective vaccines are now available and vaccination can re-lieve the parents of worry about measles and its after-effects. Only a single dose is required. In the mean-time, any child that develops the tell-tale red splotches should be seen by a physician at once," Dr. Terry urged. Water Resources Curriculum to be Expanded An expanded curriculum in Water Re-sources Development, to be inaugurated in the Fall of 1965 at the University of North Carolina, is to be offered jointly by the Department of Environ-mental Sciences and Engineering and the Department of City and Regional Planning. Engineers would generally enroll in the department while plan-ners, economists ond administrators would enroll in the Department of City and Regional Planning. In addition, the resources of the Institute of Goverr-ment on this campus would be utilized. Dr. Maynard M. Hufschmidt, currently Director of Research in the Harvard University Water Program, will be join-ing the faculty this summer to head this curriculum. Ample funds are available for sup-porting graduate students in this pro-gram. If we can provide any additional information, please do not hesitate to write to Dr. Daniel A. Okun, Professor of Sanitary Engineering. The dates for the North Carolina ANNUAL WASTE TREATMENT PLANT OPERATORS SCHOOL will be May 31 to June 4. The sponsors are: North Caro-lina Water Pollution Control Associa-tion, North Carolina State Board of Health, and the Institute of Government and the Department of Environmental Sciences and Engineering of the Uni-versity of North Carolina at Chapel Hill. The School will be held in Chapel Hill. Persons desiring additional infor-mation may contact Professor George Barnes, Department of Environmental Sciences and Engineering, Chapel Hill, North Carolina 27515. February, 1965 THE HEALTH BULLETIN National Rural Health Conference Set for Miami Beach Means of providing full-range health services for the nation's 60,000,000 rural residents will be discussed at the 18th National Conference on Rural Health March 26-27 in Miami Beach. Among matters that will be discussed by farm and medical leaders will be implementation of programs for financ-ing hospital and doctor costs among rural residents. W. Wyan Washburn, M.D., Boiling Springs, N. C, chairman of the Ameri-can Medical Association's Council on Rural Health, which is sponsoring the meeting, said the program was de-signed with four goals in mind: * To develop ways to utilize com-munity health resources. * To improve methods of communi-cation in health education for rural people. * To emphasize the responsibility of each family in promoting the health and fitness of its members. * To more fully understand the in-terdependence of rural and urban areas for the improvement of the health of the people. The keynote address for the meeting will deal with "Health is a Way of Life." and will be delivered by Carl S. Win-ters, D.D., internationally known lec-turer from Oak Park, III. This will be followed by papers on "Preventive Dental Care," by Joseph Volker, D.D.S., vice president for health affairs of the University of Alabama, and "Safe Use of Agricultural Chemi-cals," by Forrest E. Myers, of the Flori-da Agricultural Extension Service. A feature of the March 26 afternoon session will be the panel discussion on "Practical Implementation of Health Care Programs." Participants will be Samuel P. Leinbach, M.D., Belmond, Iowa, the vice-chairman of the AMA council; Guithel L. Simpson, M.D., Greensville, Ky., chairman of the gov-ernor's Council on Indigent Medical Care; John L. Falls, M.D., Red Wing, Minn.; and John Allen, M.D., Madison, Wise, director of medical services in the State Dept. of Public Welfare. A series of elective discussion groups will follow. Topics will be "Improving Family Nutrition," "Communication to Improve Health Practices," and "Health of Migrant Workers." Edward R. Annis, M.D., Miami, past president of the AMA, will speak at a banquet that evening. The March 27 program will open with a play, "To Temper the Wind," which deals with homemaker services. This will be followed by a paper on "Medical Quackery," by J. Harvey Young, Ph.D., professor of history at Emory University, Atlanta, Ga., and a symposium, "Developing Community Health Resources." Participants will be Dr. Washburn; Gertrude Humphreys, Morgantown, W. Va., a state home demonstration lead-er; Sewall Mil liken, executive director, Public Health Federation, Cincinnati; J. Robert Anderson, Richmond, Va., di-rector of the state's Bureau of Health Education,- Peter Meek, executive di-rector of the National Health Council, New York City; and Eugene G. Peek, Jr., M.D., Ocala, Fla., president of the Florida State Board of Health. The summary speech, "The Challenge Ahead," will be given by Roy Battles, director, Clear Channel Broadcasting Service, Washington, D. C. 8 THE HEALTH BULLETIN February, 1965 Robeson County 4-H #ers Promote "Slow Moving Vehicle" Signs as Traffic Safety Measure Surveys show that many accidents in-volving slow moving vehicles are caused by the lack of adequate identi-fication and that this often happens when visibility is poor or at night. Club members are planning and working through the cooperation of Mr. Warren Mathers, safety co-ordinator with the Robeson County Health Depart-ment. The purpose, need and value of the "slow moving vehicle" signs are being explained to all 4-H Home Demonstra-tion and other civic clubs in an effort to create interest and desire among people of the county to the need to eliminate some accidents by properly identifying all slow moving vehicles, thus making our highways safer. The 4-H tractor project is being car-ried by many of the county's farm youth who are learning proper main-tenance and operation of farm tractors. Special emphasis has been placed on the importance of using these signs. By providing literature, giving radio programs, writing news articles and selling safety tags for slow moving vehicles, many people of Robeson County are being made more safety conscious. by Selwyn B. Sampson President of Pembroke's "Eager Eight" 4-H Club Mr. R. H. Livermore, President of Pates Supply Company in Pembroke, helps 4-H'ers start their campaign by buying signs to go on company trac-tors and other slow moving vehicles. The triangular signs, with bright red center outlined in deeper red, show up equally well during night or day. They are designed for farm, highway and other vehicles that travel 25 miles per hour or less on highways. HOOKWORM CAMPAIGN (Continued from page 6) tion. A survey showed the county had few sanitary privies. Open-type privies were placed over the many streams and springs. The springs were the source of drinking water in many places. Of the county's 15,436 population in 1910, 3,119 persons were exam-ined and only 200 were found to be infected with hookworm. The doctors didn't say so, but this seemed to be a high tribute to the rare qualities of Haywood's mountain air. February, 1965 THE HEALTH BULLETIN The Dental Care Program of Rowan County A Dental Care Program for the Med-ically indigent, long felt as a need by the Rowan County Health Department, is now a reality as a result of the sum of $10,500 bequeathed to the local health agency in the will of the late Judge R. Lee Wright of Salisbury. Indeed, a dream has been fulfilled as well as a need. For with the original construction of the Health Center in 1953, a room for a dental clinic was included, which provided such basic essentials as water supply and sinks. However, for want of funds for dental equipment, the room has been used during the intervening years as extra office space. Now it boasts the finest of equipment. "For use of the aged and infirm" were the terms of Judge Wright's will in designating his gift to the Health Department. As an appropriate use, the dental care program was selected jointly by Mrs. Sam Edwards, his niece, George R. Uzzell, trustee of his estate, and by the County Board of Commis-sioners. The general objectives of the pro-gram are to relieve pain, to promote health, and to provide dentures for the medically indigent. Specifically, and by established pol-icy, the persons being served are the medically indigent residents of Rowan County of over age 65 who are not reached by other currently operating programs, such as the Kerr-Mills Bill. Under the latter's provisions, the Wel-fare Department can pay only for fill-ings, extractions, and denture repairs (for the medically indigent of over 65). Particular attention is being concen-trated for the time being on that seg-ment of the eligible group who reside in any nursing, boarding, or rest home financed by Rowan County taxes. To date, all patients served have come from the boarding homes. The dental care is entirely free to the eligible. Incidental expenses are being met by the Chronic Disease Sec-tion of the North Carolina State Board of Health. No Rowan County funds are being used directly in the program. The Rowan County Dental Society has actively supported the program and assisted with the selection of equip-ment. In addition they will continue as the source of the personnel to provide the service. At present Dr. Bruce A. Ketner attends the patients. The clinic is in operation one half day a week, the current time being Wednesday mornings. In expressing his gratitude for this addition to the Health Department's services, Dr. Moffitt K. Holler, Director, commented that, to his knowledge, this is the only dental program of its kind in North Carolina. Also he ob-served that the Rowan County agency is the only Health Department in the State to have received a bequest of money for a Health Department func-tion. "We are indeed appreciative of Judge Wright's kindness and generos-ity," said Dr. Holler. "And we feel that this program will be a fitting and last-ing tribute to a fine gentleman, who was not only a leader in the civic, (Continued on page 12) (See Picture on Opposite Page) FREE DENTAL CLINIC-The aged and in-firm of Salisbury-Rowan are being af-forded free dental service through the cooperation of the State Board of Health and funds left to the county by the late Judge R. Lee Wright. Dr. Bruce Ketner, currently conducting the week-ly clinic, is shown with Mrs. Ben Bla-lock, a patient at a local rest home.— (Post Staff Photo by Barringer). 10 THE HEALTH BULLETIN February, 1965 February, 1965 THE HEALTH BULLETIN 11 DENTAL HEALTH (Continued from page 10) church, and professional activities of Salisbury, but who also rendered dis-tinguished service to the entire County during his years in the North Carolina General Assembly and Senate and as Superior Court Judge of North Caro-lina." Futilely, for some eleven years, the door of the clinic has borne the label "Dentist." Now at its entrance is a beautiful bronze tablet with the in-scription: This Room Equipped in Memory of Judge R. Lee Wright and Wife Sally Oakes Wright The tablet was composed and placed in accordance with the suggestions of Mrs. Edwards, who had made her home with Judge and Mrs. Wright ever since the death of her own parents when she was four years old. Poliomyelitis Vaccine Success Demonstrated The success of the poliomyelitis vac-cines is clearly demonstrated by three facts published recently by the Com-municable Disease Center. (1) Only 94 cases of paralytic polio-myelitis occurred in this country dur-ing 1964; this number is less than one fourth the number of paralytic cases reported during 1963, which was the previous record low year. (2) No seasonal pattern of increased incidence was noted during 1964. (3) There were no outbreaks of hu-man poliomyelitis reported anywhere in the United States during 1964. International Health Meeting In Madrid With the impulsive pressures of pop-ulation growing every day in every part of the world, how can people con-cerned with health and health education effectively contribute to immediate and long-range action? This is one of the central questions being asked by lead-ers of the International Union for Health Education as they met in Paris recently to complete planning for the 6th Inter-national Conference on Health and Health Education, to be held in Madrid, Spain, July 10-17, 1965. The theme of this world conference is "The health of the community and the dynamics of development." It com-bines concern with the various aspects of economic and social development with health and health education con-siderations. Also, it gives special at-tention to population problems and the migration into the urban cities— an "im-plosive" pressure in engineering terms. A large group from the United States is expected to participate in the Madrid meetings, which will include technical study groups and tours of health and educational facilities as well as the us-ual plenary and related meetings. The program, reflecting the growing aware-ness everywhere of the importance of health as a primary factor in national growth, is characterized by originality and variety. It will combine the scien-tific with the practical in its approach to the problem of how best to create solid bases for effective action to en-sure better health around the globe for all. Write to the Editor of the Health Bulletin if you are interested in going. 12 THE HEALTH BULLETIN February, 1965 Flim Flam Artists Are At Work Two flim-flam artists were at work in Haywood County trying to conjure money out of households through a health ruse. According to Sheriff Jack Arrington, who issued the warning, the gimmick works like this: Two white men—one about 45 and the other about 60—knock on a per-son's door and tell the householder that they are from the Haywood Coun-ty Health Department. The artists quickly explain that a new state law has been passed that requires each house to be sprayed in-side for tuberculosis germs. While one man is in the house spray-ing the rooms, the other man is outside cutting the telephone wires if there are any. This gimmick has already worked in the White Oak Community, according to the sheriff. He said an elderly man paid the pair $140.00 to spray his house. The sheriff's department learned about the incident after the man's son came home and found out what had happened. So the sheriff has asked all persons to be on the look-out for the pair and should they show up, the sheriff would like for the owner to get as much in-formation as possible— like color of their car, license number, description and such— and then refuse the service. After refusing the service, the sheriff said call his department or the nearest police department. He warned that the flim-flam artists are "slick" enough to get by with talking some people into a spraying job. People ought to only do business with people they know and then they would be safe," he added. Short Course In Accident Control The third annual short course in Pro-gram Development in Public Health Accident Control has been announced by the Department of Public Health Administration of the University of North Carolina School of Public Health. The course will be held at the School of Public Health in Chapel Hill, May 30 through June 4, 1965. The course has been designed for: • Administrators of state, city, or county health departments. • Directors, supervisors, or consul-tants in nursing, sanitation, edu-cation, and other allied programs in state, city, and county health departments. • Accident control workers in health departments. Course content will include: • Lectures on etiology, fact-finding, and program planning. • Problem-solving by small multi-disciplinary groups. For further information, write to the Department of Administration, School of Public Health, University of North Caro-lina at Chapel Hill, or the Accident Pre-vention Section, North Carolina State Board of Health, Raleigh, North Caro-lina. Herbert Shore, President of the Amer-ican Association of Homes for the Aging, has announced that AAHA's Fourth An-nual Meeting and Conference on "The Social Components of- Care" will be held from Nov. 1-4, 1965 at the Disney-land Hotel, Anaheim, California. Highlights of the meeting will in-clude the presentation of the annual AAHA Award of Honor and a Legisla-tive Breakfast Meeting on "The Aged in The Great Society". February, 1965 THE HEALTH BULLETIN 13 UNC Professor Loaned to the Philippines The World Health Organization (WHO) has selected a University of North Carolina professor as the public health nursing consultant for a National Seminar in Public Health Administration in the Philippines in February. Dr. Margaret L. Shetland, director of the Public Health Nursing Teacher Prep-aration Program at the UNC School of Public Health and UNC School of Nurs-ing, left in early January for her two-months assignment. She will be one of three consultants for the seminar in Baguio, the sum-mer capital of the Philippines. She will serve with Dr. F. Main of Northern Ireland and Dr. A. Yerby of New York City. Dr. Shetland was chief nursing con-sultant with the U. S. Overseas Mission and visiting professor of public health nursing at the University of the Philip-pines in Manila from late 1956 to early 1959. This will be her first visit to the area since 1959. The seminar in Baguio will be limited to provincial health officers in the Phil-ippines, equivalent to state health offi-cers in the U. S. The seminar staff will devote a month to field visits and program preparation. Seventh Recreational Institute The University of North Carolina, through its Recreation Curriculum, an-nounces that the Seventh Southern Reg-ional Institute on Recreation with the III and Disabled will be held in Chapel Hill, North Carolina on April 22, 23, and 24, 1965. The Steering Committee for this In-stitute met in Chapel Hill recently and formulated a very interesting, practical and progressive program. Detailed in-formation regarding the Institute was sent out in January. MEMBERS OF THE NORTH CAROLINA STATE BOARD OF HEALTH Lenox D. Baker, M.D., President Durham John R. Bender, M.D., Vice-President Winston-Salem Ben W. Dawsey, D.V.M Gastonia Glenn L. Hooper, D.D.S. Dunn Oscar S. Goodwin, M.D. Apex D. T. Redfearn, B.S. Wadesboro James S. Raper, M.D. Asheville Samuel G. Koonce, Ph.G. Chadbourn John S. Rhodes, M.D. Raleigh EXECUTIVE STAFF J. W. R. Norton, M.D., M.P.H. State Health Director Jacob Koomen, Jr., M.D., M.P.H. Assistant State Health Director J. M. Jarrett, B.S. Director, Sanitary Engineering Divisioyi Martin P. Hines, D.V.M. , M.P.H. Director, Epidemiology Division W. Burns Jones, M.D., M.P.H. Director, Local Health Division E. A. Pearson, Jr., D.D.S., M.P.H. Director, Oral Hygiene Division Lynn G. Maddry, Ph.D., M.S.P.H. Acting Director, Laboratory Division Ben Eaton, Jr., A.B., LL.B. Director, Administrative Services Division James F. Donnelly, M.D. Director, Personal Health Division 14 THE HEALTH BULLETIN February, 1965 Southern Branch, APHA To Meet In New Orleans "Health Support in Man's Changing Environment," is the theme of the 33rd annual meeting of the Southern Branch, American Public Health Association, to be held in New Orleans, La., April 7, 8, 9. Keynote speaker at the first general session will be Dwight F. AAetzler, C.E., M.S., president of the American Public Health Association. Miss Elizabeth S. Hol-ley, president of Southern Branch, will preside at the Wednesday and Friday sessions. Speaking Thursday will be Dr. Paul Q. Peterson, Assistant Surgeon General, Department of Health, Education and Welfare, who will discuss "Social and Physical Environment." Dr. Leroy E. Bur-ney, Vice President for Health Sciences, Temple University, will talk on "The Professional Environment: Scientific Knowledge, Technical Application and Fiscal Support." The third speaker will be Dr. Robert E. Coker, professor of Dr. Murray Grant of Washington, D. C. visited North Carolina early in Feb-ruary speaking to a Seminar at the School of Public Health in Chapel Hill. He also spoke to the staff of the State Board of Health and is shown in the picture with Dr. J. W. R. Norton, State Health Director. Dr. Grant is Health Di-rector of the District of Columbia which includes hospitals as well as other pub-lic health services in a budget of some $50 million. public health administration, University of North Carolina School of Public Health. His topic is "Organization for Support of Health." Dr. Russell E. Tea-gue, state commissioner of health, Com-monwealth of Kentucky, will preside Tuesday. Summarizing the program at the branch meeting April 9 will be Dr. Malcolm U. Dantzler, director for the Charleston, S. C, county health depart-ment. Program chairmen are Charles G. Jor-dan, engineering division, Dade County health department, Miami, Fla., and Dr. Robert F. Lewis, professor and head, division of biostatistics, Department of Tropical Medicine and Public Health, Tulane University, New Orleans, La. Hosting the Southern Branch meeting will be the Louisiana Public Health As-sociation, Inc., Miss Edna Irl Mewhin-ney, president. Local arrangements committee chair-men announced prizes for pre-registra-tion at the Jung Hotel, convention head-quarters, and plans for a shrimp boil, 6:30 p.m., Tuesday, April 6. In addi-tion, there will be Dixieland bands, sight-seeing tours, and other attractions to be found only in America's famed Mardi Gras city. February, 1965 THE HEALTH BULLETIN 15 THE HEALTH BULLETIN P. O. Box 2091 Raleigh, N. C. 27602 LIBRARIAN trbaR? DIVISION OF HEALTH AFFAIR LIBRARY N.C. U£%* HOSP. CHAPEL HILL, N.C U. N. C. If you do NOT wish to con-tinue receiving The Health Bul-letin, please check here | l and return this page to ' — the address above. Primed by The Graphic Press, Inc., Raleigh, N. C. DATES AND EVENTS March 21-24 — N. C. Association of Nursing Homes, Velvet Cloak Inn, Raleigh. March 22-26 — American College of Physicians, Chicago, III. March 26-27 — National Conference on Rural Health, Miami Beach, Fla. April 2-3 — Annual Meeting, N. C. Physical Therapy Association, Win-ston- Salem. April 4-9 — American Industrial Health Conference, Bal Harbour, Maine. April 5-9 — Southern Branch, APHA, Jung Hotel, New Orleans, La. April 7-9 — National Council on Alco-holism, Tulsa, Okla. April 9-15 — American Academy of General Practice, San Francisco, Cal. April 12-15 — American Society for Public Administration, Kansas City, Mo. April 20-22 - Eastern Branch, NCPHA, Blockade Runner Hotel, Wrightsville Beach. April 22-23 — Annual Meeting, N. C. Tuberculosis Association, Robert E. Lee Hotel, Winston-Salem. April 22-24 - Seventh Southern Re-gional Institute on Recreation with the III and Disabled, Chapel Hill. April 23-24 - Anual Meeting, N. C. Chapter of the American College of Surgeons, Blockade Runner Hotel, Wrightsville Beach. Charlotte's Occupational Health Con-ference, originally scheduled for March, has been postponed and tentatively set for October 7. CONTENTS John Atkinson Ferrell 1, 2, 3 Hookworms Once Plagued Tar Heels 5 Children Still Unprotected from Measles 7 Water Resources Curriculum to be Expanded 7 National Rural Health Conference Set for Miami Beach 8 Robeson County 4-H'ers Promote Safety 9 The Dental Care Program of Rowan County 10, 11 International Health Meeting in Madrid 12 Poliomyelitis Vaccine Success Demonstrated 12 Flim Flam Artists Are at Work 13 Short Course in Accident Control 13 UNC Professor Loaned to Philippines 14 Southern Branch APHA Will Hold Annual Meeting in New Orleans 15 16 THE HEALTH BULLETIN February, 1965 Eldercare L APR 29 1965 Versus DIVISION OF Medicare H£ALTH AFFAIRS L,BRARY Some Comments and Comparisons See page 2 and following Medicare Awaits Senate Action THE Medical Care of the Aged bill Congress is preparing for passage has a long, curious history. Hospitalization-nursing home portions first were proposed about fifteen years ago. The idea had support from President Truman but failed to materialize. Since then, the social security-financed plan consistently has been opposed by the American Medical Association and other professional and business groups. Until this session the bill never has been voted out of the House Ways and Means Committee. Thus, the House never has had an opportunity to act on it. The bill has now passed the House and is headed for several weeks debate in the Senate. This year, however, the climate has changed dramatically. The AMA, even in the face of almost certain defeat, waged its strongest campaign against the ad-ministration's Medicare bill. And the AMA pushed its own answer to health care for the aged—Eldercare—maintaining that it offered far greater benefits than did Medicare. This was disputed by Rep. A. Sydney Herlong, Jr., (D., Fla.), co-sponsor of the Eldercare bill, who called AMA advertising "Misleading." For the AMA to give the impression the bill provides complete coverage is not so, he said. "It just makes it available for the states to provide it if they want to." AMA's hard-hitting drive succeeded in part and perhaps not as the association intended. The campaign has succeeded, not in building opposition to Medicare as such, but in alerting the public to the fact that Medicare's benefits would be limited. Most letter writers to the House committee members said Medicare would not be enough. Democrats on the House Ways and Means Committee realized that Medicare alone would be a disappointment to many elderly persons. The committee decided to work out a comprehensive medical care bill for the aged to include payments for most drugs, medical devices, and physicians' fees. There would be some charge to prevent overuse of benefits, and an attempt would be made to work out a system for regaining part of the cost from wealthy elderly persons. The system would be voluntary. So the AMA successfully focused public attention on Medicare's deficiencies but did not succeed in stopping the bill. THE HEALTH BULLETIN March, 1965 How the AMA-Supported Eldercare Bill Compares with the Administration Sponsored Medicare Proposal Reprinted with permission from material prepared for publication in Modern Medicine, Copyright 1965 by Modern Medicine Publications, Inc. ELIGIBILITY Eldercare Bill Administration Bill Needy persons 65 and older. Partial All persons 65 and older, regardless of or total underwriting of health care in- need. About 16% million eligible un-surance determined by need limits set der social security or railroad retire-by states. AAAA estimates 11,800,000 ment plans; about 2 million others to are eligible depending on need, not be covered through general tax funds, counting persons covered by such pro-grams as Old Age Assistance (OAA) and Federal Employees Health Benefit Plan. CONTROL Eldercare Bill Administration Bill By state welfare or health agencies By Department of Health, Education, through existing Kerr-Mills channels and Welfare through existing social se-after acceptance by state legislature. curity channels, allocations to be kept in separate Treasury trust fund. COST Eldercare Bill Administration Bill Undetermined. One AAAA estimate of Estimated at $2 to $2.4 billion yearly, nearly $2 ]/2 billion yearly is based on $250 premium per person per year. Another AAAA estimate is "between $2 and $4 billion." March, 1965 THE HEALTH BULLETIN FINANCING Eldercare Bill Through state and federal funds. Per-centage of federal funds—52.5 to 84% —based on a state's per capita income, with lower income states getting a higher proportion. Funds are used by welfare or health departments to buy health insurance under guaranteed re-newable private plans. Income levels to qualify for assistance would be deter-mined by states, with the maximum at least as high as the highest level now required in the state under Kerr-Mills— presently ranging from $1,080 to $3,000 for individuals; $1,560 to $3,900 for couples. Persons above maximum would be ineligible for aid but could purchase the same noncan-celable policies. Those between maxi-mum and minimum would pay part of their premium on a sliding scale. Those below minimum would pay nothing. Administration Bill Through increased social security con-tributions. Total social security payroll deductions, including the portion for health care, from 1971 on, would be 10.4% (5.2% from employee; 5.2% from employer) or 7.8% for self-em-ployed, deductions to be made on the first $5,600 of salary rather than the current $4,800. Payments are made to hospitals or other service providers or to Blue Cross-type organizations repre-senting hospitals. Yearly outlay of some $250 million is anticipated from gen-eral tax funds for those not covered by social security or railroad retirement. The Health Bulletin First Published—April 1886 The official publication of the North Carolina State Board of Health, 608 Cooper Memorial Health Building, 225 North McDowell Street, Raleigh, N. C. Published monthly. Second Class Postage paid at Raleigh, N. C. Sent free upon request. EDITORIAL BOARD Charles M. Cameron, Jr., M.D., M.P.H. Chapel Hill John T. Hughes, D.D.S., M.P.H. John C. Lumsden. B.C.H.E. Mary Ann Farthing, M.S. 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., Asheville Editor—Edwin S. Preston, M.A., LL.D. Vol. 80 March, 1965 No. 3 THE HEALTH BULLETIN March, 1965 BENEFITS It is impossible to compare benefits of the two bills since specific Eldercare coverage depends on each state. However, the Herlong-Curtis bill is a modifica-tion of the Kerr-Mills mechanism, so present Kerr-Mills practices are of interest, even though no state is committed to follow these practices as a basis for partici-pation under Herlong-Curtis. Presently, 40 states, 3 territories, and the District of Columbia have operating Medical Assistance for the Aged (MAA) plans under Kerr-Mills. According to iatest AMA figures (April 1964), 176,000 persons were receiving assistance. HOSPITALIZATION BENEFITS Eldercare Bill Administration Bill Dependent on extent of insurance pur- Sixty days per benefit period. Patient chased by federal-state funds. pays a deductible equal to the cost of one day national average hospital care. Recipient is entitled to this every 180 days if there is an interval of 90 days without hospitalization. Kerr-Mills Experience. Of 44 states and territories offering hospitalization under existing Kerr-Mills program (AMA report, Dec. 23, 1964), duration of paid hos-pitalization varies from ten days per year (followed by review committee ap-proval for possible extension) to no fixed limit. Nineteen states have no fixed limit but leave determination of duration to the administering agency. In 15 states with a fixed limit and no review mechanism, duration varies from twelve to seventy days per year. Nine states have a fixed limit with reviewal for possible extension. Benefits in one state recently starting the program are unreported. NURSING HOME BENEFITS Eldercare Bill Administration Bill Dependent on extent of insurance pur- Sixty days per benefit period, no de-chased by federal-state funds. ductible. Recipients must be transferred from hospital to affiliated home or to one approved by HEW. Kerr-Mills Experience. Of 30 states and territories offering nursing home care under existing Kerr-Mills program (AMA report, Dec. 23, 1964), duration of paid care ranges from twenty-six days per year to no fixed limit. Eighteen states have no fixed limit and leave determination of duration to the administering agency. Twelve limit the stay to twenty-six to one hundred eighty days per year. Only five states and territories require such care to be immediately preceded by hos-pitalization. March, 1965 THE HEALTH BULLETIN 5 PHYSICIAN SERVICE BENEFITS Eldercare Bill Administration Bill Dependent on extent of insurance pur- None. Private insurance carriers invited chased by federal-state funds. to provide such insurance without dan-ger of antitrust involvement. Kerr-Mills Experience. Of 39 states and territories offering physician payment under existing Kerr-Mil Is program (AAAA report, Dec. 23, 1964), all have limi-tations. Some limit the number of calls per month or quarter, some have a ceiling on payment, and others limit the number of visits per hospitalization. Only 6 states limit physician payment to certain conditions, such as acute, chronic, or long-term illness. Four states do not pay physician fees under AAAA mechanism but care for such patients without charge as staff patients. DRUG BENEFITS Eldercare Bill Administration Bill Dependent on extent of insurance pur- Covers cost of drugs customarily fur-chased by federal-state funds. nished when patients are in hospitals or nursing homes. No coverage outside these facilities. Kerr-Mills Experience. Of 32 states and territories offering drug coverage under existing Kerr-Mills program (AAAA report, Dec. 23, 1964), most are determined by the administering agency. Four states have a cost limit: $120 a year, $150 a year, $15 a month, $10 a prescription. DENTAL CARE BENEFITS Eldercare Bill Administration Bill Dependent on extent of insurance pur- None, chased by federal-state funds. Kerr-Mills Experience. Of 26 states and territories offering dental care under existing Kerr-AAills program (AAAA report, Dec. 23, 1964), 14 are restricted to cer-tain dental conditions. One state has a $100 limit. Another limits care to patients in hospitals or nursing homes. The rest leave determination of benefits to the administering agency. 6 THE HEALTH BULLETIN March, 1965 OTHER BENEFITS Eldercare Bill Administration Bill Dependent on extent of insurance pur- Up to 240 nonphysician home health chased by federal-state funds. care service calls per year. Diagnostic outpatient services with deductible in any one month of an amount equal to half the average nationwide cost of one day's hospital care. Services of radiol-ogists, pathologists, physiatrists, and anesthesiologists are included as hos-pital services. Kerr-Mills Experience. Under existing Kerr-Mills program (AMA report, Dec. 23, 1964), such services as home nursing, outpatient laboratory work, or diagnostic X-ray are offered by 33 states. Medicare Vs. Eldercare as viewed by Consumer Reports AFTER two decades of effort, 1965 appears to be the year for Medicare— a Federally-administered national hospital insurance plan, financed through Social Security contributions for persons over 65. This time the administra-tion's Medicare bill seems assured of passage. As usual, though, the American Medical Association has proposed a last-gasp substitute. A comparion of the two proposals is instructive. The Medicare bill may of course be altered in the legislative process, but its four basic provisions are not likely to be changed significantly. They can be out-lined briefly. For those over 65, Medicare would: • Pay the full costs of up to 60 days of hospitalization (in ward or semi-private accommodations), minus a first-day deductible, for each benefit period (which begins on the first day of hospitalization and ends whenever the patient has ac-cumulated 90 days out of the hospital within a period of 180 days). • Provide for an additional 60 days of post-hospital care for each illness in a convalescent or rehabilitation center operating under an agreement with a hos-pital (not an ordinary, custodial-care nursing home). • Pay for up to 240 home nursing visits a year under medical supervision, in programs organized by nonprofit voluntary or public agencies. • Provide payment for hospital outpatient diagnostic services and tests, minus a deductible that would exclude routine low-cost laboratory or other diagnostic procedures. March, 1965 THE HEALTH BULLETIN These provisions would be financed by an increase in the Social Security with-holding tax. Ultimately, a citizen would contribute (to a special, separate health care trust fund within the Social Security system) 0.45% of his earnings up to $5600, and his employer would contribute an equal amount. Special provision would be made for those now over 65 who are not covered by Social Security through the Government's general fund. The Medicare program gives the citizen free choice of physician and hospi-tal. It does not pay the costs of doctor bills, out-of-hospital drugs, prolonged or catrastrophic illness requiring long, continuous hospitalization, or extended custo-dial care in nursing homes. CU's medical consultants believe that this is, by and large, a sound basic package. The 60-day provision would encompass all but about 5% of the usual hospital stays of older persons, and the extended-care proposal would both re-lieve the pressure on general hospital beds and spur the construction of badly-needed convalescent and rehabilitation facilities in many communities. Services of this kind are essential in many illnesses following their acute stage and prior to the time a patient can return to his home or transfer (if necessary) to a custodial institution. The provision for organized home nursing services has obvious value: such services often preclude the need for hospitalization and permit earlier discharge from hospital or convalescent center. Out-patient diagnostic services also are capable of averting many costly hospitalizations by encouraging the early de-tection and treatment of disease—at a time when it may be cured or controlled by relatively simple short-term procedures. Since the heaviest health cost of the elderly is hospitalization, the Medicare coverage could make it financially possible for the first time for many citizens to purchase voluntary insurance (of the Blue Shield type) to cover physicians' bills and other supplementary costs. The AMA substitute for Medicare at first glance seems invitingly compre-hensive. (It is, in fact, a resurrection of proposals made during the Eisenhower administration that the AMA bitterly opposed at the time, and again just a few months ago at its House of Delegates meeting. The AMA now refers to its "new" proposal as a "redefinition" of policy.) The AMA substitute simply proposes the use of state and Federal funds to buy Blue Cross-Blue Shield or commercial health insurance for indigent persons over 65—it does not say how the funds would be raised, in the absence of a Social Security tax. The proposal does say, however, that a means test would be required to determine the eligible poor, with the states using state and Federal money to pay all, some, or none of the insurance premium cost, depending on the citizen's qualification under the means test. Means tests are—moral considerations aside— enormously expensive and difficult to administer. Furthermore, the program would be administered by the states, raising the possibility that there would be 50 different kinds of governmental machinery, eligibility standards, and pay-ment procedures. (Under some state rules setting eligibility for help under the current Kerr-Mills law, ownership of property or even ability of one's children to pay can make an old person ineligible.) The subsidized insurance would pay for physicians' and surgeons' bills and drug costs as well as hospital bills, and an AMA statement asserts that this would be "comprehensive health care" and not "limited to hospital and nursing home 8 THE HEALTH BULLETIN March, 1965 care representing only a fraction of the cost of sickness." As CU has pointed out, however, this "fraction" covers the heaviest, the most financially crippling share of the burden. Furthermore, since the AMA has not spelled out specifically what the private insurance would cover (and in existing voluntary insurance policies, cash benefits, days of coverage, and other provisions vary widely from plan to plan and from area to area), it is difficult to tell how "comprehensive" the pro-tection of the AMA's proposal would be. The current Medicare proposal, obviously, will not solve every aspect of the nation's health problems, even for those over 65. It does not and cannot guaran-tee good medical care to its beneficiaries, and it pays relatively little attention to the quality of the services it pays for (though the bill does contain a provision for periodic review, by the medical staffs of participating hospitals, of the neces-sity for hospitalization, length of stay, and other such features). However, it is a significant beginning. Reprinted with permission from Consumer Reports (March, 1965). Copyright 1965 by Consumers Union of U. S., Inc. Determining Medical Indigency Reprinted by permission from the American Journal of Public Health, copyright 1964 and 1965 by the American Public Health Association BASIC in the provisions of Eldercare, sponsored by the American Medical Association, is the principle that the health care shall be made available only to persons qualifying as being medically indigent. Determination of medical indigency is admittedly a difficult and costly process. The National Council on Aging presented a report on this subject at the 1964 meeting of the National Conference on Social Welfare. The report, entitled, "Prin-ciples and Criteria for Determining Medical Indigency", was published in full in the October, 1964 issue of the American Journal of Public Health. The principles set forth in this report of the National Council on Aging are reprinted here on the following pages through the courtesy of the American Jour-nal of Public Health, together with the comments of Milton I. Roemer, M.D., Pro-fessor of Public Health at the University of California, School of Public Health, in Los Angeles. Dr. Roemer was invited by the National Council on Aging to be one of the two discussants of this report at the National Council on Social Welfare and his comments carried in the March, 1965, issue of that publication. March, 1965 THE HEALTH BULLETIN 9 These principles are goals that will not be attained quickly; in many in-stances they call for changes in legisla-tion and policies and for training of personnel. Some changes could be made by revising administrative pro-cedure and regulations. Others will de-pend upon the public's conviction of the need to expend the necessary funds. The committee believes that carrying out the recommended principles will re-sult in conservation of human resources and in prevention of suffering now caused when handicapping policies and unsound practices obtain in the de-termination of medical indigency. Principles for the Determination of Medical Indigency 1. People who cannot afford medical care are entitled to it as a human right and as a sensible means of conserving human resources. 2. Neither race, creed, color, country of national origin, citizenship, nor length of residence should be criteria for determining medical indigency. Mental retardation, advanced age, or previous history of mental illness should not of themselves prejudice financial eligibility for needed medical care. 3. Determination of the amount and kind of medical care needed is a judg-ment of the health professions. The de-cision as to eligibility for aid in meet-ing this need should be a combined medical and social judgment, with due consideration given to implications of the illness or handicap for the family, estimated cost of care, relationship of the medical need to the patient's re-sources, medical or health needs of other members of the family, and spe-cial family needs. 4. Persons and families having in-comes and resources at or below speci-fied levels should be eligible for pay-ment for medical care automatically. Only for persons and families with in-comes above the specified levels need further inquiry be made. 5. Criteria applied in determining financial eligibility should be objective-ly established and should not result in family insolvency. 6. Income levels for use in the de-termination of medical indigency should represent a reasonable level of living. 7. In order to provide for his med-ical care, no claim or lien should be taken on a patient's home and furnish-ings or on equipment essential for earn-ing a living. 8. No arbitrary income ceiling should be set beyond which no patient can be judged medically indigent. 9. Legal or administrative policies specifying that relatives assume finan-cial responsibility are undesirable, ex-cept in case of the patient's spouse or the parents of a dependent child. 10. Community health and welfare agencies that provide or subsidize med-ical and dental care should collaborate in developing general policies as a framework within which each deter-mines medical indigency. 11. When several agencies are deal-ing with a patient who can partially pay for his medical care there should be joint agreement on the respective responsibilities and shares in the total patient funds available. 12. The agency that provides the sub-sidy for medical care should determine medical indigency. 13. General policies should be ad-ministered flexibly in relation to indi-vidual circumstances and problems. 14. Qualifying conditions of eligibil-ity should conform to social values of dignity, privacy, confidentiality, indi-vidual responsibility, and family unity. These should be taken into account both in regulations established and in proc-essing applications. 10 THE HEALTH BULLETIN March, 1965 15. A public agency or institution rendering or subsidizing medical care has the obligation to consider an ap-plication from any person within the group it serves and to take action on an appeal of the decision. These principles are fundamental to good administration of the determina-tion of medical indigency. Extraordi-nary situations may sometimes arise when one of the principles of a more practical nature will need flexible ad-ministration on an individual basis. Present-day experience indicates that such situations rarely occur. Dr. Roemer's Letter to the Editor of the American Journal of Public Health To the Editor: The report of the National Council on Aging entitled "Principles and Criteria for Determining Medical Indigency" and published in the October, 1964, issue of the Journal calls for comment. This important document was given its first public presentation at the Na-tional Conference on Social Welfare, as-sembled in Los Angeles on May 26, 1964. It happens that I was invited by the National Council on Aging to be one of the two discussants of the report, as it was presented by Mrs. Edith Alt. My remarks and those of the other dis-cussant (Mr. Carel Mulder of the Cali-fornia State Department of Social Wel-fare), however, have not been publish-ed. There are some very serious social policy implications to a formal crystal-lization of the whole concept of "med-ical indigency" that may be overlooked, while—with the best of intentions—one is trying to improve medical care for the poor. The fundamental question is "how should medical care for the poor be financed?" rather than "how should medical indigency be determined?" I tried to explore these conceptual prob-lems in my commentary on the report, which was as follows: There can be no doubt that this report on principles for determining medical indigency, produced by the National Council on the Aging and summarized so very well by Mrs. Alt, is a positive contribution to the tasks of administra-tion of medical care in the United States today. A variety of governmental and voluntary programs must now make such determinations, and effectuation of the principles advocated in this report would surely facilitate proper medical care and protect human dignity more than has often been the reality in the past. The principles proposed on key issues like property liens, residency re-quirements, relative's responsibility, court commitments, and so forth, would move us significantly further along the path from tribalism to social responsi-bility. Nevertheless, as I read through this fine report—exemplary in its careful workmanship and presentation— I be-came more and more unhappy about it. My disturbance was not for what it said, but for what it did not say. I am aware that the distinguished committee, representing as it did organizations of diverse sociopolitical philosophies, set itself a specific task, to define "criteria of medical indigency," from which it deliberately did not deviate. Yet it is the very posing of this task that I would like to comment on. Perhaps, as the "Foreword" of the report states, the project was 25 years March, 1965 THE HEALTH BULLETIN 11 overdue, but why was it undertaken just now? Surely it is not unrelated to the fact that in 1960 we acquired in the United States the first federal public assistance legislation in which the con-cept of "medical indigency" has been embodied as a statutory basis for aid. This emerged from a national debate on health insurance for all of the aged. Crippled children's programs, Veterans Administration medical services, and certain other programs, it is true, pro-vide federal funds for specific bene-ficiaries who are, in fact, "medically in-digent," and purely local or state funds have long been used for the "med-ically indigent" under the "general as-sistance" heading. But the Kerr-Mil Is program on Medical Assistance to the Aged was the first amendment to the basic structure of welfare services for the needy in which federal support for this concept became crystallized into law. The MAA amendments, of course, ap-ply only to persons past 65 years of age, but it is perfectly clear that certain groups would like to see the concept extended to all age levels, and indeed the NCOA Report specifically empha-sizes this wider applicability. The basic premise, therefore, is that the total pop-ulation may, for the purpose of financ-ing medical care, be divided into sev-eral more or less distinct classes. Based on the recommendations in the report, these would be essentially as follows (excuse my backward numbering which has its reasons): 5. The fully indigent—persons who need financial assistance for their basic living needs, as well as for all their medical care, in order to survive. 4. The wholly medically indigent-persons of such low income that, while they can eke out a subsistence life with respect to food, clothing, and shelter, need financial assistance for the medical care of any illness, if it is to be of adequate quality. 3. The partially medically indigent-persons whose income and family re-sponsibilities permit them to meet ordi-nary living requirements as well as the costs of minor illness, but who require financial assistance for the costlier med-ical care of serious or prolonged ill-ness. 2. The insured self-reliant— persons whose income and responsibilities per-mit them to meet ordinary living re-quirements as well as the cost of minor illness, and who are protected by some form of medical care insurance which covers the costs of major or prolonged (but not too prolonged) illness. 1. The fully self-reliant — persons who, with or without insurance, can meet without assistance all their living costs as well as all costs of medical care for any illness, minor or major. Even this subdivision of the Amer-ican population into five classes, intri-cate as it may seem, is really an over-simplification. As social workers know, there are various subclasses of fully indigent under Class 5. Under the prin-cipal "medically indigent" groups, Classes 4 and 3, there are numerous shadings and subdivisions depending on the type of illness, the availability of organized medical facilities, the attrib-utes of the family at the time and place, and so forth. Under Class 2, the combinations and ramifications of in-surance coverage and benefits would lead to another dozen or so subclasses, if the scene were fully analyzed. And even under Class 1, the definition would have to lead to numerous sub-classes, unless it were so strictly applied that only a handful of oil magnates or movie stars ended up in it. Yet, this is the kind of demographic gymnastics that we are led to by the conceptual premises of this report on "medical indigency." There are two di-mensions to medical indigency, as the reports brings out so well, (a) the per-son and (b) the medical requirements, 12 THE HEALTH BULLETIN March, 1965 and the range of variability along both these dimensions is very long, indeed. It is hard enough to make a sound judg-ment along the first dimension, but to do it along the second, and then along both in combination—if this is done scientifically and objectively— is an enor-mous administrative task. I was particu-larly struck by the somewhat cavalier brevity of the report on the need for "information and adequate interpreta-tion on . . . anticipated duration and estimated cost of medical care" for a pa-tient. Prognosis is tough enough for the soundest clinician, and attaching price tags to it as well calls for the com-bined wisdom of a William Osier and a John M. Keynes. Mrs. Alt cogently points out that 42 per cent of American families—with in-comes in the $3,000 to $7,500 range-are vulnerable to medical indigency; she believes that "a majority of these (fami-lies) will fall at some time within the medically indigent group." I suspect that this is a conservative estimate, but the administrative task is to identify which individual families in this "majority" and which dates within this "time" yield an affirmative decision on medical indigency. Small wonder that all these complexi-ties and uncertainties about the imple-mentation of the concept of medical in-digency have led most industrialized na-tions of the world to give it up com-pletely. In its place, they have substi-tuted systems of social insurance for medical care and networks of public clinics and hospitals for virtually all who come to their doors. Almost all countries have done this for the total population with respect to the costliest element in health service—care in a general hos-pital— including most recently our Ca-nadian neighbor to the north. The objection to the "medical in-digency" concept lies not only in its enormous administrative complexity— which must of course be translated into the costs and time and efforts of skilled professional personnel. These efforts could be far better spent on social case-work and other positive services. More important are its implications for the kind of medical care that people would and do receive in a class-structured sys-tem. A class-categorization of people for entitlement to medical care—whether into five levels as implied by this report or into ten levels or into two levels-leads inevitably into class-levels of med-ical service. The evidence for this is around us everywhere��� in the crowded public clinic compared with the private medical office, in the public ward surg-ery by the assistant resident versus the private room surgery by the board-certified specialist, in the dental ex-traction versus the root-canal therapy. This, of course, was certainly not the intention of the dedicated people who have produced the report that Mrs. Alt has summarized. But there is world-wide evidence that for reasons that are at once economic, political, and atti-tudinal this is where it leads us. We have been moving forward in America with a democratization of med-ical care through the vast growth of health insurance. We still have a long way to go, but progress is being made every day. Here in California, there is serious talk of emerging from our 19th century county hospital system for the separate care of the poor. The Social Security Act pension system was a mile-stone in helping to achieve economic in-dependence and dignity for nearly all aged persons, without a means test. I hope we do not now encourage a move-ment backward, along the path laid out by the Kerr-Mills amendment, into a legally frozen class-ridden pattern for an American's entitlement to general medical care. Milton I. Roemer, M. D. Professor of Public Health, University of California School of Public Health, Los Angeles, Calif. March, 1965 THE HEALTH BULLETIN 13 IMMUNIZATIONS START AT HOME Members of the Staff of the State Board of Health took their own medi-cine Monday morning when they lined up for needed immunizations as the State Board launched a 17 month State-wide program urging early immuniza-tion especially of the new-born and of pre-school age children. Shown in the picture is Mollie Murray, who operates the Snack Bar in the Cooper Memorial Health Building, receiving one of her shots from Mrs. Ruth L. Edwards, pub-lic health nurse of the Wake County Health Department. Looking on, from the left, are Dr. Jacob Koomen, Jr., As-sistant State Health Director; Dr. Ronald H. Levine, field epidemiologist of the State Board; and Dr. William E. Bellamy, Jr., of the Wake County Medical So-ciety. MEMBERS OF THE NORTH CAROLINA STATE BOARD OF HEALTH Lenox D. Baker, M.D., President Durham John R. Bender, M.D., Vice-President Winston-Salem Ben W. Dawsey, D.V.M Gastonia Glenn L. Hooper, D.D.S. Dunn Oscar S. Goodwin, M.D. Apex D. T. Redfearn, B.S. Wadesboro James S. Raper, M.D. Asheville Samuel G. Koonce, Ph.G. Chadbourn John S. Rhodes, M.D. Raleigh EXECUTIVE STAFF J. W. R. Norton, M.D., M.P.H. State Health Director Jacob Koomen, Jr., 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 W. Burns Jones, M.D., M.P.H. Director, Local Health Division E. A. Pearson, Jr., D.D.S., M.P.H. Director, Oral Hygiene Division Lynn G. Maddry, Ph.D., M.S.P.H. Acting Director, Laboratory Division Ben Eaton, Jr., A.B., LL.B. Director, Administrative Services Division James F. Donnelly, M.D. Director, Personal Health Division 14 THE HEALTH BULLETIN March, 1965 No Certainty In Eldercare The problem of the elderly ill who can not afford adequate medical care has been with us for a long time, but the latest Louis Harris survey puts it in clear perspective: It is the number one domestic issue in the country today. More than 32 per cent of all American families have an elderly member in need of special medical attention, and less than half of them can afford it, the Harris survey found. That helps explain President Johnson's determination to enact the Medicare plan that would provide guaranteed hospital care for the elderly under Social Security. It is the high cost of hospital services which overwhelms the meager financial resources of so many old people. The Medicare plan is under attack by the American Medical Association which proposes an alternative it labels as the "Eldercare" plan. This alternative would, the association says, authorize medical and surgical payments as well as pay-ments for hospital bills. It would indeed authorize a wide range of health care services. But it would guarantee very little. Under Eldercare, it would be up to the states to put up matching funds and decide the level of medical care provided. This could be as little as one day in a hospital and one visit annually from a doctor. Some state legislatures would enact a niggardly program because of dominant conservative control in state government. Many more, such as North Carolina, would do the same because they can afford no better. This is not the only grave fault of the Eldercare plan, but it is one of the bigger ones not even hinted at in the glowing AMA sales pitch. In contrast, the elderly would know what they were getting under Medicare and they could depend on it: Sixty days of post-hospital care, 240 days of home-health visits, and out-patient diagnostic service every year. Editorial in Raleigh (N. C.) News and Observer, March 2, 1965 March, 1965 THE HEALTH BULLETIN 15 THE HEALTH BULLETIN P. O. Box 2091 Raleigh, N. C. 27602 LIBRARIAN DIVISION OF HEALTH AFFAIRS LIBRAi N.C. K£M. H03P. U. N. C. CHAPEL HILL, N.C. If you do NOT wish to con-tinue receiving The Health Bul-letin, please check here |— | and return this page to '— ' the address above. Printed by The Graphic Press, Inc., Raleigh, N. C. DATES AND EVENTS April 20-22-Eastern Branch, NCPHA, Blockade Runner Hotel, Wrightsville, Beach. April 22-23-Annual Meeting, N. C. Tuberculosis Association, Robert E. Lee Hotel, Winston-Salem. April 22-24—Seventh Southern Regional Institute on Recreation with the III and Disabled, Chapel Hill. April 23-24-Annual Meeting, N. C. Chapter of the American College of Surgeons, Blockade Runner Hotel, Wrightsville Beach. April 23-24-Annual Meeting, N. C. Society of X-Ray Technicians, Ashe-ville. April 25-28—Southeastern Psychiatric Association, Annual Meeting, Pine Needles Lodge, Southern Pines. April 27-29-N. C. PTA Convention, Jack Tar Hotel, Durham. April 28-May 1—American College Health Association, Miami Beach, Fla. April 29-30— President's Committee on Employment of the Handicapped, Washington, D. C. May 1-5—Medical Society of the State of N. C, Queen Charlotte Hotel, Charlotte. May 1-7-National Mental Health Week. May 2-8-N. C. Special Week on Ag-ing. May 3-7— National League for Nursing (Biennial Convention), Civic Auditor-ium, San Francisco, Calif. May 4-5—Association of American Phy-sicians, Atlantic City, N. J. May 5-6—Annual Meeting, N. C. Die-tetic Association, Jack Tar Hotel, Durham. May 6-8—American Pediatric Society, Philadelphia, Penn. May 7—Annual Conference of N. C. Rural Safety Council, YMCA, Raleigh. May 9-15-National Hospital Week. May 1 0-1 2—American National Red Cross, Detroit, Mich. CONTENTS Medicare Awaits Senate Action 2 How the AMA Supported Eldercare Bill Compares with the Admin-istration Sponsored Medicare Proposal 3 Medicare Vs. Eldercare 7 Determining Medical Indigency 9 Principles proposed by National Council on the Aging Comments by Dr. Milton I. Roemer Immunizations Start at Home 14 No Certainty in Eldercare 15 16 THE HEALTH BULLETIN March, 1965 The Officio! Publication Of Carolina State Board of Health V, %Q*r flPZU i9bf in ' .-'" «'. llH A promising theory of modern cancer research holds that certain indi-viduals (represented by the shaded fiingerprints on our cover) share symptoms indicative of a high cancer risk. If this proves true, doctors will be able to identify, among a typical group like the one below, persons who are most likely to develop cancer and who therefore need more frequent and more specialized treatment. For more, see page 3. THE HEALTH BULLETIN April, 1965 "I have a theory that virtually all agents which can produce cancer, produce other types of changes first . . . The problem has been to launch an all-out search for such symptoms, which is just what we're doing in the cancer prevention study." "In a fundamental sense, all health is one nowadays. The battle against cancer in-evitably involves fresh insights into what it takes to live and be healthy in a shrinking and increasingly complex world. Evolution has not adapted us to many of the things we are introducing into our environment, tensions as well as drugs . . ." AVisit With Cuyler Hammond By JOHN E. PFEIFFER We call on the head of the American Cancer Society's Statistical Research Station who tells how the disease is being studied with statistics, surveys and data processing. Reprinted by permission from THINK Magazine, Copyright 1965 by International Business Machines Corporation. IN the last analysis, all medical pro-gress can be traced to clinical find-ings, to the recognition of significant differences between people who come down with a particular disease and people who don't. A classical example is the 18th century "superstition" that April, 1965 THE HEALTH BULLETIN milkmaids were protected from small-pox by previous infections of a related but far milder disease, cowpox, a notion that led to the development of success-ful vaccines. Today, as in times past, advances continue to come from shrewd observations, which are often based on highly sophisticated methods of gather-ing data and making inferences. Such methods are being used in the increasingly intensive fight against can-cer, in many ways the most challenging medical problem of our times. For more than forty years, the leader in this fight has been the American Cancer Society, Inc., which, in addition to sup-porting laboratory and hospital research, has launched large-scale surveys de-signed to provide new knowledge about the causes and prevention of cancer—an activity directed by E. Cuyler Hammond, head of the Society's Sta-tistical Research Station and an inter-nationally noted master of the subtle art of evaluating facts. A Yale graduate and former indus-trial health investigator at the National Institutes of Health, Hammond is most widely known for findings on smok-ing and health. But his interests ex-tend beyond the problem of lung can-cer, as I learned when I spoke with him recently in New York, where Am-erican Cancer Society headquarters are located. Hammond is a quietly intense, lean-faced man in his early 50's. He chooses his words carefully before responding to a question and then starts talking at a rapid rate, looking at you with sharp eyes and usually punctuating the end of his answers with a smile. Dedicated to the full-time job of an-alyzing ideas that can be expressed pre-cisely and tested (he works most nights and every weekend), he approaches cancer problems from a broad point of view. "The greatest achievement of the last hundred years," he told me, lighting up his pipe, "isn't the hydrogen bomb or space travel or more washing machines. These things and a good deal more are all by-products of a more basic devel-opment, the spectacular improvement in health which has given us time for longer periods of education and for longer productive lives. If you look back at the records for this country you can see that the big killers were, as they still are in some parts of the world, infectious and parasitic diseases such as malaria, smallpox and tuber-culosis. The huge decline in death rates has been above all a result of preven-tive medicine, slum clearance and san-itation and vaccines and other public health measures. "Our biggest problems today are heart disease, cancer and other degen-erative illnesses which generally take years or decades to develop and tend to The Health Bulletin First Published—April 1886 The official publication of the North Carolina State Board of Health, 608 Cooper Memorial Health Building, 225 North McDowell Street, Raleigh, N. C. Published monthly. Second Class Postage paid at Raleigh, N. C. Sent free upon request. EDITORIAL BOARD Charles M. Cameron, Jr., M.D., M.P.H. Chapel Hill John T. Hughes, D.D.S., M.P.H. John C. Lumsden, B.C.H.E. Mary Ann Farthing, M.S. Jacob Koomen, Jr., M.D., M.P.H. Bryan Reep, M.S. John Andrews, B.S. Glenn A. Flinchum, H. W. Stevens, M.D. B.S. M.P.H., ASHEVILLE Editor—Edwin S. Preston, M.A., LL.D. Vol. 80 April, 1965 No. 4 THE HEALTH BULLETIN April, 1965 •';:-> "The past thirty years or so have seen a notable increase in cure rates, one major reason being the American Cancer Society's public education program." strike later in life—and here again a central goal, together with improved treatments and cures, is prevention. As in the past, we must draw heavily on the techniques of epidemiology, the study of circumstances under which dis-ease occurs in the human population. We want to discover critical causative factors, factors which increase the prob-ability of sickness and death." Accent on Statistics Hammond is well aware of the dif-ficulties of such research. For relatively minor ailments like athlete's foot, new treatments may be tested on patients without running serious risks. But when it comes to major diseases, investigators can't perform extensive experiments on human beings. Furthermore, animal experiments conducted under strictly controlled laboratory conditions have only a limited, remote bearing on the uncontrolled and complex conditions of everday life. So the accent is neces-sarily on statistics based upon obser-vations rather than experiments. Since it is quite possible to draw invalid con-clusions from valid facts, I asked about the pitfalls of the statistical approach. "Let me give you an example," Ham-mond replied, as he paused to relight his pipe. "During World War II, I was stationed at the Air Force School of Aviation Medicine in Texas, and we were all very much concerned with the extremely high accident rate among pilots undergoing training. Some psy-chiatrists had the theory that most of the accidents were occurring among 'accident-prone' men, individuals psy-chologically predisposed to carelessness resulting in accidents. So, pilots recently involved in aircraft accidents were ask-ed detailed questions about their child-hood accidents—and they recalled a great many falls, broken bones and other mishaps. On the other hand, pilots who had never been involved in an aircraft accident reported very few childhood accidents. Apparently the ac-cident- prone theory had been confirm-ed. "I was immediately suspicious, how-ever. For one thing, the results were too darned good. Hardly anything seem-ed to have happened during the child-hoods of pilots with no training ac-cidents, while everything seemed to have happened to less fortunate pilots. I suspected that there might have been some bias in response, because an air-craft accident can be a terribly shaking experience. A man may be in such a state of confusion and guilt afterwards that you could probably get him to 'confess' to beating his own mother. This is always one of the problems with the 'retrospective' or historic sur-vey, that is, a survey involving people April, 1965 THE HEALTH BULLETIN who are already victims of the condition you are trying to learn about. Emo-tionally upset people cannot be count-ed on to give unbiased reports. "So we decided to do a prospective or follow-up survey, questioning about twenty-five hundred consecutive pilots-to- be before they went into training. Then we put the records away in a safe. More than a year later, we went back and compared the records of pilots who had been in accidents during their first year of training and pilots who hadn't. As far as the number and severity of childhood mishaps were concerned, absolutely no significant dif-ference existed between the two groups. In other words, it was useless to question applicants about their child-hood accidents as a means of eliminat-ing men most likely to be involved in an aircraft accident. "This experience was very much on my mind 15 years ago, when we knew much less about smoking and cancer, and most of our statistics were based on retrospective surveys. But many of us, aware of the possibility of a bias factor and other problems, were frankly skeptical." Hammond explained that the next step, as in the Air Force study, was an ambitious prospective survey—the first of its kind in this country and a task which only an institution like the American Cancer Society could under-take. In 1951, it mobilized more than 22,000 volunteers, many of them form-er cancer patients, to obtain complete information about the smoking habits of some 188,000 presumably healthy men between the ages of 50 and 70. In or-der to avoid possible bias on the part of the volunteers, the men were not in-terviewed; they were simply asked to fill out questionnaires. Having built up considerable good will among physi-cians and hospital authorities over the years, the Society had ready access to medical details on those who died of cancer. When the time came for follow-up studies two years later, 1 1,870 men had died, 2,249 of them from cancer. Analysis of the records confirmed retrospective studies in showing a de-finite association between cigarette smoking and cancer. "Just as impor-tant," says Hammond, "we had shown that follow-up studies were feasible on a very large scale, if you have a good organization behind you and plenty of volunteers. If we'd had to pay them what they were worth, it would have cost us several million dollars. "Soon we began thinking about our ultimate objective: means of preventing many if not all types of cancer. In or-der to obtain information directed to-ward this goal, an even more extensive epidemiological study was required, one which would deal with other factors as well as smoking, other forms of cancer, and women as well as men. We worked out a most thorough questionnaire. Among other things it included occupa-tion, details of present health status, education, eating and drinking habits, hours of sleep per night, and so on. The survey started more than five years ago, with 68,000 volunteers this time. The plan was to interview some million people aged 30 or older, and to follow up every one of them six times at an-nual intervals. "Right now we're finishing our fifth follow-up and are beginning to analyze the data. We already have about three hundred bits of information about each person, so you can appreciate the mag-nitude of our task and why we've had to develop special ways of using elec-tronic computers. In our work spectac-ular calculating speeds aren't nearly as important as effective man-machine communications. Since I like to plan as I go, what matters to me is how long it takes from the time I get an idea— a hunch, if you will—to the time I see an THE HEALTH BULLETIN April, 1965 actual printed table. Then I want to be able to modify my idea, or try another one in a reasonable time, and get a quick answer again. It's something like having a conversation with the comput-er." What are the objectives of the cur-rent survey? "Part of the story is indicated in the official name, 'Cancer Prevention Study.' The past thirty years or so have seen a notable increase in cure rates, one major reason being the American Can-cer Society's public education program. The emphasis on danger signals, per-sisting symptoms such as hoarseness or unhealing sores which may result from early stages of the disease, has certain-ly helped alert people to the impor-tance of prompt treatment. But we want to do better than that, to carry the offensive one step further. "What we would like to do is dis-cover complaints that appear before the disease process has a chance to establish itself. I have a theory that virtually all agents which can produce cancer, produce other types of changes first. For example, lung cancer is al-ways preceded by an appreciable in-crease in the number of cell layers in the bronchial tubes, more mucus and other effects which very probably de-velop years or decades before cancer. It also happens that such tissue changes within the body may be associated with symptoms like coughing and shortness of breath. All-Out Search "The problem hbs been to launch an all-out search for such symptoms, which is just what we're doing in the cancer prevention study. We are looking for signs on the broadest possible basis because, as things stand now, we don't know exactly where to look. We have asked our million persons how much exercise they get (none, slight, mod-erate, heavy), which of six medicines they use (never, seldom, often), wheth-er they experience various degrees of some two dozen physical complaints, and a host of other questions. We hope to discover that certain of these factors, "In a fundamental sense, all health is one nowadays. The battle against can-cer inevitably involves fresh insights in-to what it takes to live and be healthy in a shrinking and increasingly complex world." April, 1965 THE HEALTH BULLETIN or "clusters of factors, may serve as warnings of impending cancers." To Save More Lives Nothing of this scope has ever been t|ied before, and Hammond pointed out that it is still much too early to predict just how the new approach will work out. But the American Cancer Society is conducting other important statistical studies, and he cited one of them as an example of future possibilities. A pro-spective or follow-up study is under way involving the occurrence of cervical cancer among more than eighty thou-sand women in Toledo, Ohio. The main purpose is to investigate a tentative finding which, if confirmed, might mean the saving of many lives. "Earlier studies had suggested the existence in the population of a group of 'high-risk' women—women who re-ported any kind of cervical complaint such as discharge or bleeding. Remem-ber that, as far as medical science can tell, they were absolutely free of cer-vical cancer. Yet follow-up observations indicate that they are 10-to-15 times more likely to contract the disease than women who did not have such com-plaints. Another important point is that they made up a small proportion of the total group, about one out of seven women. "Now we're checking these results, among others, with the aid of an elec-tronic computer and expect to have our answers within six months or so. As-suming that our preliminary findings are indeed valid, we shall make a strenuous effort to persuade these high-risk wo-men to report for special medical ex-aminations every six months. You can see the possibilities here. Most cer-vical cancer seems to occur in a group that can be identified beforehand, and the chances are good that by focusing on this group we may be able to lower death rates appreciably. Furthermore, our large-scale cancer prevention study is designed to locate other high-risk groups, if they exist. "This may also be the best way to get back to basic causes, a central aim of all our research. If high-risk groups are found and examined two or more times a year, medical investigators will have a unique opportunity to follow more closely than ever before the long and intricate process whose last stages are what we call cancer. According to one theory, the one I favor, this process depends ultimately on a special kind of genetic change. "Think of the body's cells as popula-tions of living things. They are con-tinually dying and being replaced by newborn cells and, as in all popula-tions, there are mutations or 'sports' in every new generation. Among the mutants some cells have the potential ability to multiply abnormally. They will not do so, however, unless condi-tions are right—that is, unless their en-vironment inside the body is altered in a suitable way. For example, tobacco smoke may alter the environment so as to favor lung-cell mutants capable of malignant growth at the expense of normal tissue. A kind of natural selec-tion may be working in the body, and our research will help us evaluate this theory and others." Toward the end of our talk, Ham-mond emphasized the widening scope of the current large-scale survey. The primary purpose is naturally to cure and prevent cancer, but a prospective study by its very nature provides signi-ficant information about a variety of conditions. For example, out of the mil-lion persons originally interviewed five years ago about forty-five thousand have already died—and, as expected, a large proportion of them died from heart and circulatory diseases. So it is hardly surprising that results are of con-siderable interest to specialists in many fields. THE HEALTH BULLETIN April, 1965 "An enormous amount of data will have to be processed here, with im-plications for the social as well as the medical sciences. Many of our subjects have moved, and in tracing them and obtaining their records we are collect-ing material about the shift of people from country to city, about the effects of migration on health and the family. In other words, we shall have an in-credibly large number of associations of significant relationships to explore. We receive requests for information from business schools, sociologists, psy-chologists and many other sources. But we have hardly scratched the surface as far as a full analysis of the data is con-cerned. That could take another decade, or another generation. All Health Is One "In a fundamental sense, all health is one nowadays. The battle against cancer inevitably involves fresh insights into what it takes to live and be healthy in a shrinking and increasingly com-plex world. Evolution has not adapted us to many of the things we are intro-ducing into our environment, tensions as well as drugs and other chemicals. We must adjust culturally .and a most important example of that is the con-tinuing drive to prevent disease and raise health levels everywhere. This is the challenge which confronts us all, and if past successes are any indication, I believe we can look forward to sig-nificant progress in the future." Research Being Done in Public Health Practices Progress on organizing research into the evaluation of public health practices was reported at the annual meeting of the American Public Health Association last year by Dr. Vlado A. Getting. The paper presented by the Professor of Public Health Practice at the University of Michigan's School of Public Health was developed by members of the mul-tidisciplinary research team which is conducting the study under a grant from the Public Health Service. Presently-used methods of evaluation were declared to be of little value be-cause many depended in large part on arbitrarily established standards or measurement of effort which is equated with accomplishment. Another criticism was that standards which might be suit-able in one place or under one set of circumstances might not be in another. The study at the University of Michi-gan was set up, Dr. Getting said, to work toward: "the development of tools for the evaluation of program ef-fectiveness, the exploration of factors that motivate people to follow health recommendations, and the identifica-tion of factors that influence an or-ganization's ability to make desirable program changes." In further definition of the objec-tives of the study, Dr. Getting stated the evaluation methods which it sought to develop should: permit a true assessment of the extent to which ob-jectives are attained; be in such form as to permit a self-evaluation by the April, 1965 THE HEALTH BULLETIN operating agency; be applicable to any public health program regardless of size or complexity; and reveal the prob-able source or location of program weaknesses where such exist. "Such evaluation devices will permit different localities to use the same methodological approach to evaluate quite different health programs," Dr. Getting said. "Each locality can assess what it has achieved with respect to its own locally defined objectives and needs." The task of the study group has been divided into three steps, Dr. Getting stated: describe programs in precise terms as to their objectives; measure actual accomplishment, bearing in mind the difficulty of measuring directly some of the qualities of an objective, and whether any improvement noted may be due to causes other than the pro-gram under consideration; validate measurement devices by use on exist-ing programs. To date, Dr. Getting indicated, the group's work has consisted mainly of "developing means of describing pro-gram objectives and activities in a manner that will permit subsequent evaluation." For this purpose a "Guide for Identification of Program Activities and Objectives" for use by program personnel of health agencies has been developed. "In this guide," Dr. Getting said, "the work that constitutes the program to be evaluated must be locally defined. The instructions suggest only one caution: If a program is unusually large and complex, it may be better to subdivide it and treat the parts as individual pro-grams." The agencies are asked to list program activities and their com-ponents, and the objectives of each activity. Definition of objectives is re-quested in "statements that are precise and complete enough to permit an ac-curate measurement of the extent to which they are being accomplished." According to Dr. Getting, the expres-sion of program objective should meet these requirements: "The statement must refer to a need, situation or con-dition that is external to the person or agency conducting an activity ... It must be stated with sufficient precision to indicate both quantitative and quali-tative aspects of desired outcomes." Dr. Getting said further that "it may be necessary to identify the validity of assumptions that underlie the use of particular activities to achieve particular objectives, and the assumptions that link together the several program ob-jectives and sub-objectives." There is a probability, Dr. Getting said, "other approaches to evaluation of public health practice, such as the expert survey technique, will be tested at some future time." Several other studies were also men-tioned. Among these were investiga-tion of the most effective way of de-termining people's health beliefs and their actions to protect their health, and identification of key factors in-fluencing health agencies to adapt to meet changing conditions and needs. Summing up, Dr. Getting stated that "the program includes research on the program effectiveness and on the con-ditions under which health organiza-tions are able to modify their programs and organization in the interest of in-creased effectiveness. Other research seeks to throw light on personal de-cision- making processes in health areas, and to develop a better understanding of how people are persuaded to change their health practices. The research pro-gram is beginning to produce experi-mental tools which will have to be field tested over a period of years but pro-gress to date indicates that the results will be useful in the difficult but high-ly important task of strengthening community health practices." 10 THE HEALTH BULLETIN April, 1965 Choose Your Own attitude toward their use, says To-day's Health, the magazine of the American Medical Association. Today, hair color is not just accept-able— it is high fashion, says the mag-azine article, prepared by a noted der-matologist and a cosmetic chemist, in consultation with the Committee on Cutaneous Health and Cosmetics of the AMA. This year Americans are expected to spend one hundred million dollars on hair-coloring products. While women are the principal users, many men also use hair color. Hair color can be modified in one of two ways. The natural pigment of the hair can be bleached, and thereby light-ened, or artificial coloring can be ap-plied. Often both operations are car-ried out to produce the desired effect. The importance of reading and ob-serving the directions for using all hair-coloring products cannot be over-emphasized. This is especially true of IQI* the permanent colors. They are most difficult to remove. Modern hair-color-ing products will give excellent results for most users, but only if the instruc-tions are carefully followed. One of the major causes of dissatis-faction by home users is the mistaken belief that a single application of hair color will produce any desired shade. This is not so. It is quite simple to cover gray hair or to color light hair a darker III shade, but it is not yet possible for a single application of any hair coloring to change black or dark brown hair to a pale blond. Peroxygen compounds, especially hydrogen peroxide, are widely used in bleaching hair. Six per cent hydrogen peroxide solution is the standard strength, and is safe, if proper pre-cautions are observed. Stronger concen- The last few years have seen a flood trations can produce burns and blister-of new hair-coloring products, and ing of the scalp. Excessive bleaching hand-in-hand came a change in public can leave the hair harsh, strawlike and April, 1965 THE HEALTH BULLETIN 11 Coh of Hoi brittle. Largest and most important group of hair dyes are those based on synthetic organic chemicals. These are in three categories—oxidation dyes, semi-permanent dyes and temporary rinses. Oxidation dyes are the most widely used. Most professional hair coloring or tinting is now done with oxidation dyes, and they also have become pop-ular for home use. They are the only products that color the hair quickly and yet produce all varieties of natural hair shades which are lasting. The biggest question about oxida-tion dyes is their hazard. It has been estimated that about one person in 50,- 000 will have an unpleasant reaction, such as a skin rash, swelling about the eyes, redness and crusting of the face and neck, plus itching and discomfort. The victim, while uncomfortable, should be aware that this is not a serious ill-ness and that she will recover. Included with each package, accord-ing to federal regulations, are instruc-tions for performing a patch test before using oxidation dyes, to determine whether there is an allergy. The test should be repeated before each applica-tion of the dye. And the dyes should not be used on eyebrows or eyelashes, because of possible danger to the eye. In addition to the oxidation dyes, there also are semi-permanent dyes, which usually will wash out with one shampoo; acid color rinses, using harmless organic acids; vegetable dyes, principally henna, and metallic dyes, no longer as popular as in the past. If you decide to change the color of your hair, and if you decide to do it yourself rather than seek a professional job, the important thing to remember is to read the instructions on the label and the package insert, and follow them carefully. These are for your own safety and protection. Film On Occupational Health Is Now Available The Occupational Health Division of the U. S. Department of Health, Educa-tion and Welfare has made available to the State Board of Health a new motion picture, "The Hidden Hazards." This film is obtainable on loan from the Film Library of the State Board, Box 2091, Raleigh. "The Hidden Hazards" tells the story of occupational health. It shows how man has progressed from the early trades with obvious dangers, today's complex operations, in which the haz-ards may be less evident. See what is being done to protect employed men and women from those health hazards which arise in the course of their work. Starting on a dramatic note—the near fatal poisoning of a metal shop worker -the HIDDEN HAZARDS depicts the growth of occupational health. The film traces the change in attitudes and practices over the years. The apathy of ancient times, when slaves carried on the dangerous trades, has gradually been replaced by action to safeguard worker health. Today everyone recognizes that cer-tain kinds of work are more hazardous than others. Sometimes the danger comes from the conditions under which men work. Sometimes it lies in the materials they use. Often workers are surrounded by dangers they cannot see. Occupational health presents a chal-lenge of vital concern to all Americans. It is our hope that this new 28 1/2- minute, 16 mm, black-and-white, sound film will be widely used for showings before civic and fraternal organizations, women's clubs, and business and labor, as well as professional, groups. It may also be of interest to secondary school students from the standpoint of career opportunities. 12 THE HEALTH BULLETIN April, 1965 HOPE FOR HEARTS-When the former Hope Cooke, newly crowned queen of the tiny Himalayan kingdom of Sikkim, recently visited her cousin, Mrs. R. Phillip Hanes of Winston-Salem, alert Heart Association volunteers posed Her Majesty with a "Hope for Hearts" post-er. "Hope for Hearts" is the theme of the North Carolina 16th Annual Meet-ing and Scientific Sessions (Durham, May 20-21) which will feature special sessions for the general public and lay Heart Association Volunteers as well as for family physicians. DIAL "H" FOR HEART — Five-year-old Sheila Dial, who recently underwent heart surgery at Duke University Medical Center, receives a surprise visit from North Carolina's Heart Mother of the Year, Mrs. Walter S. Cobb, herself a "graduate" of heart surgery. Mrs. Cobb is one of several hundred North Carolina Heart Association Volun-teers who will be in Durham on May 20-21 for the State Heart Group's 16th Annual Meeting. Looking on, above right, is Mrs. Mel-vin Dial, young Sheila's mother. April, 1965 THE HEALTH BULLETIN 13 Community Safety Courses Being Offered Educational opportunities at both the graduate and continued education level in the field of community safety were announced recently by the Department of Public Health Administration, School of Public Health, University of North Carolina at Chapel Hill. Expanding a program initiated three years ago, the department will enroll six graduate students in the curriculum leading to a Master of Public Health degree for the academic year beginning September 1965. Up to 30 students will be accepted for the short course dealing with program development techniques in accident control, which will be held May 31 -June 4, 1965. "The graduate program is open to persons from the fields of education, nursing, engineering, social science, medicine, and allied fields of interest who are seeking careers as accident control specialists in a local, state, or national health agency or in a private organization," Dr. Charles Cameron, Professor and program director, said. "Through a special grant from the U. S. Public Health Service, financial support is available for qualified stu-dents who are accepted in the master's program," stated Dr. Cameron. "Inter-ested persons are urged to contact the department without delay." Applications are now being accepted for the 1965 short course, according to Miss Janice Westaby, Assistant Profes-sor and co-director of the program. In-formation can be obtained by writing to the Accident Control Program, De-partment of Public Health Administra-tion, UNC School of Public Health, Drawer 229, Chapel Hill, North Caro-lina. MEMBERS OF THE NORTH CAROLINA STATE BOARD OF HEALTH Lenox D. Baker, M.D., President Durham John R. Bender, M.D., Vice-President Winston-Salem Ben W. Dawsey, D.V.M Gastonia Glenn L. Hooper, D.D.S. Dunn Oscar S. Goodwin, M.D. Apex D. T. Redfearn, B.S. Wadesboro James S. Raper, M.D. Asheville Samuel G. Koonce, Ph.G. Chadbourn John S. Rhodes, M.D. Raleigh EXECUTIVE STAFF J. W. R. Norton, M.D., M.P.H. State Health Director Jacob Koomen, Jr., 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 W. Burns Jones, M.D., M.P.H. Director, Local Health Division E. A. Pearson, Jr., D.D.S., M.P.H. Director, Oral Hygiene Division Lynn G. Maddry, Ph.D., M.S.P.H. Acting Director, Laboratory Division Ben Eaton, Jr., A.B., LL.B. Director, Administrative Services Division James F. Donnelly, M.D. Director, Personal Health Division 14 THE HEALTH BULLETIN April, 1965 Pesticides Are Dangerous— Follow the Directions No matter how often you use a pes-ticide— for home, garden, or farm—or how well you think you know the di-rections, READ THE LABEL each time be-fore you start work and FOLLOW THE DIRECTIONS EXACTLY. The other im-portant rule is KEEP PESTICIDES AWAY FROM CHILDREN. Other suggestions for safe and sen-sible use of pesticides are: 1. Use a pesticide only when you are sure it is needed and then use the one best suited to your needs. The label on the product explains the proper uses. 2. Keep pesticides in plainly labelled container, preferably the one in which it was bought. Never trans-fer pesticides to unlabelled or mis-labelled containers. 3. Store pesticides under lock and key away from food items and OUT OF THE REACH OF CHILDREN, pets, and people who might not be able to understand their danger. 4. Avoid inhaling dust and fumes and avoid getting materials on the skin when handling, mixing, or apply-ing pesticides. 5. If there is an accident, most pes-ticide labels advise washing the affected area with lots of fresh water in cases of external exposure. Check the label of the product before using so you know what to do quickly if there is an accident. Also, call a doctor or get the pa-tient to a hospital immediately. 6. People who suspect special sen-sitivity to pesticides should consult an allergist and, if necessary, take steps to avoid any exposure to the offending agent. 7. Wash hands thoroughly after using pesticides and before eating or smoking. 8. Get rid of used containers in a way that will not leave package or leftover contents as a hazard to people—particularly children— ani-mals, or plants. 9. Work in well-ventilated area to avoid inhalation of fumes. 10. Do not spray into the wind. 11. Wear protective clothing, such as gloves, aprons, goggles, respira-tors, and masks, when so directed. 12. Change clothing after each day's operations and bathe thoroughly. If clothing or skin become con-taminated, wash the skin and change to clean clothing. Wash contaminated clothes before reus-ing. 13. Avoid the fire hazard caused by smoking,
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 | 1965 |
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 80, 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 | 9,716 KB; 214 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_healthbulletin1965.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. F0UR DAYS This JOURNAL may be kept oul and is subject to a fine of FIVE CENTS a day thereafter. It is DUE on the DAY indicated below: Pictures and Personal Sketches of 10 Outstanding Persons Honored for their contributions to Medical Science. Modern Medicine's 1965 Distinguished Achievement Awards (see following pages) To the men who make the great discoveries in medical science, to the men who apply them in practice, and to their teachers, Modern Medicine is privileged to say "well done" on behalf of the medical profession. The nominations for the Awards for Distinguished Achievement come from deans of medical schools, leaders of medical organizations, and members of the Modern Medicine editorial board. No honor has a merit higher than the merit of those who wear it, and this award has taken its luster from the names and achieve-ments of the men who have won it over the years. Reprinted with permission from Modern Medicine, the Journal of Diagnosis and Treatment, (January 4, 1965). Copyright 1965 by Modern Medicine Publications, Inc. The Health Bulletin MARY ANN farthing, m.s. Jacob Koomen, Jr., M.D., M.P.H. First Published—April 1886 Bryan Reep M.S. The official publication of the North Carolina State Board of Health, 608 Cooper Memorial Health Building, 225 North McDowell Street, Raleigh, N. C. John Andrews, B.S. Published monthly. Second Class Postage paid at Glenn A. Flinchum, B.S. Raleigh, N. C Sent free upon request. H. W. STEVENS, M.D.. M.P.H.. ASHEVILLE EDITORIAL BOARD Charles M. Cameron, Jr , M.D., M.P.H. Chapel Hill John T. Hughes, D.D.S., M.P.H. John C. Lumsden, B.C.H.E. Editor-Edwin S. Preston, M.A., LL.D. Vol. 80 January, 1965 No. 1 THE HEALTH BULLETIN January, 1965 Ten Outstanding Physicians and Medical Scientists Honored for Contributions to Medical Science Photographs and discussion on following pages Special recognition for their contribu-tions to medical science was given this year to 10 outstanding physicians and medical scientists as the Editors of Modern Medicine announced their 1965 Distinguished Achievement Awards. Nine men and one woman were se-lected from over 100 outstanding med-ical leaders nominated by deans of U. S. medical schools, leaders of pro-fessional medical organizations and members of the Modern Medicine edi-torial board. The announcement of the awards was made in the January 4 is-sue of the journal. January, 1965 THE HEALTH BULLETIN Initiated in 1934, the Modern Medi-cine annual awards honor those of the medical profession who make great and continuing discoveries in medicine. The 1965 winners join the 280 distinguished physicians and scientists who have re-ceived the awards during the past 30 years. The 1 965 winners are: Leona Baumgartner, M.D., assistant administrator for technical cooperation and research, Agency for International Development, Washington, D. C, for her concern with the health of man manifested by contributions to public health as a scientist and administrator in an increasing sphere of influence. Oscar Creech, Jr., M.D., professor of surgery and chairman of the department of surgery, Tulane University, New Or-leans. Dr. Creech was cited for his de-velopment of regional perfusion in the treatment of malignant diseases and for the impact of his work on cardio-vascular surgical techniques. Derek E. Denny-Brown, M.D., profes-sor of neurology, Harvard University, and director, neurological unit, Boston City Hospital. Dr. Denny-Brown was honored for his application of the ac-cumulated knowledge in basic biolog-ical sciences to the elucidation of ob-scure neurological disorders, giving hope for their ultimate control. A. Baird Hastings, Ph.D., professor of biological chemistry, emeritus, Harvard University, and head of the laboratory of metabolic research, Scripps Clinic and Research Foundation, La Jolla, Cali-fornia. Dr. Hastings received the award for his brilliant and imaginative discov-eries in biochemistry, coupled with a practical approach to their clinical use, and for his influence as a gifted teacher. Hudson Hoagland, Ph.D., executive director of the Worcester Foundation for Experimental Biology, Shrewsbury, Mass. He was selected for his organi-zation of an outstanding biomedical re-search institution and for his work as a scientist and a humanitarian bearing on the world's problem of an exploding population. Chester S. Keefer, M.D., professor of medicine, Boston University, Boston, was cited for broad talents as clinician, investigator, educator, and administrator that have significantly bettered medical teaching and practice. William J. Kolff, M.D., head of the department of artificial organs, Cleve-land Clinic, and professor of experiment-al medicine, Cleveland Clinic Educa-tional Institute. Dr. Kolff was singled out for his development of practical methods for effective hemodialysis and for investigation and development of mechanical substitutes for essential bio-logical structures. Joseph L. Melnick, Ph.D., chairman of virology and epidemiology, Baylor Uni-versity, Houston, was chosen for his work in basic virology especially with the enteroviruses, and the development of methods of stabilizing the poliomye-litis virus that enhance the safety of poliomyelitis vaccine. John P. Merrill, M.D., director, cardio-renal section of Peter Bent Brigham Hospital, and associate clinical profes-sor of medicine, Harvard University, Boston. Dr. Merrill was honored for pioneering in tissue transplantation and scientific studies of compatibility factors that have provided a biologically sound approach to kidney transplantation. Francis D. Moore, M.D., professor of surgery, Harvard Medical School, and surgeon-in-chief, Peter Bent Brigham Hospital, Boston. He received the award for extensive work on the basic patho-physiology of the surgical patient that has widened the surgeon's scope, im-proved operative results, and promoted the patient's comfort. THE HEALTH BULLETIN January, 1965 LEONA BAUMGARTNER, M.D. concern with the health of man manifested by contributions to public health as a scientist and administrator in an increasing sphere of influence Assistant administrator for technical co-operation and research, Agency for In-ternational Development, Washington, D. C. January, 1965 THE HEALTH BULLETIN OSCAR CREECH, JR., M.D development\of regional perfusion for the treatment of malignant disease and impact on cardiovascular surgical techniques William Henderson professor of surgery and chairman of the department of sur-gery, Tulane University, New Orleans. THE HEALTH BULLETIN January, 1965 S&*v^Sfe liii \ DEREK DENNY-BROWN, M.D. application of the accumulated knowledge in basic biological sciences to the elucidation of obscure neurological disorders, giving hope for their ultimate control James Jackson Putnam professor of neurology, Harvard University, and di-rector, neurological unit, Boston City Hospital. January, 1965 THE HEALTH BULLETIN 7 A. BAIRD HASTINGS, Ph.D. brilliant and imaginative discoveries in biochemistry, coupled with a prac-tical approach to their clinical use, and influence as a gifted teacher -*>-.*:«rv.:'-=i3 Hamilton Kuhn professor of biological chemistry, emeritus, Harvard University, Boston, and head of the Laboratory of Metabolic Research, Scripps Clinic and Research Foundation, La Jolla, Calif. THE HEALTH BULLETIN January, 1965 HUDSON HOfGLAND, Ph.D. organization of an (outstanding biomedical research institution and work as a scientist and a humanitarian bearing on the world's problem of an ex-ploding population • Executive director, Worcester Founda-tion for Experimental Biology, Shrews-bury, Mass. January, 1965 THE HEALTH BULLETIN CHESTER S. KEEFER, M.D. protean talents as clinician, investigator, educator, and administrator that have significantly bettered medical teaching and practice Wade professor of University. ledicine, Boston 10 THE HEALTH BULLETIN January, 1965 WILLEM J. KOLFF, M.D. practical methods for effective hemodialysis and investigation and develop-ment of mechanical substitutes for essential biological structures Head of the department of artificial or-gans, Cleveland Clinic, and professor of experimental medicine, Cleveland Clinic Educational Institute. January, 1965 THE HEALTH BULLETIN 11 JOSEPH L MELNICK, Ph.D. work in basic virology, especially with the enteroviruses, and development of methods of stabilizing the poliomyelitis virus that enhance the safety of poliomyelitis vaccine Chairman, department of virology and epidemiology, Baylor University, Hous-ton. 12 THE HEALTH BULLETIN January, 1965 JOHN P. MERRILL, M.D. pioneering in tissue transplantation and scientific studies of compatibility factors that have provided a biologically sound approach to kidney trans-plantation Director, cardiorenal section, Peter Bent Brigham Hospital, and associate clinical professor of medicine, Harvard Univer-sity, Boston. January, 1965 THE HEALTH BULLETIN 13 FRANCIS D. MOORE, M.D. extensive work on the basic pathophysiology of the surgical patient that has widened the surgeon's scope, improved operative results, and pro-moted the patient's comfort Moseley professor of surgery, Harvard University, and surgeon-in-chief, Peter Bent Brigham Hospital, Boston. 14 THE HEALTH BULLETIN January, 1965 Individual Air Conditioners Are Being Used An individual air conditioner provid-ing cool, clean air for workers exposed to heat is being used routinely on cer-tain jobs in industrial plants in the southern United States. The simple, low-cost device is de-scribed by W. F. Lienhard, M.D., San Diego, Calif., J. P. Hughes, M.D., Oak-land, Calif., and T. A. Brassette, AA. E., New Orleans, in the current (September) Archives of Environmental Health, pub-lished by the American Medical Asso-ciation. It could be particularly helpful for workers whose tolerance for heat has been reduced by aging, heart disease, or other physiological impairment. Comparable observations on acclima-tized workmen with and without the de-vice during periods of identical work in a severely hot environment resulted in a threefold reduction in heat loss, a 25 per cent reduction in total heart beat, and a 50 per cent reduction in the rate of body temperature rise for the air-conditioned man, according to the researchers. The entire weight of the personal air-conditioner is only 19 ounces, accord-ing to the report. The air is cooled by a vortex tube, invented in 1931 by a French metallurgist, George Ranque. Standard industrial compressed air is delivered through a hose to the tube attached by a belt to the man's waist. The tube converts compressed air at 120 degrees Fahrenheit to a steady flow at 65 F. Each worker has a "breakaway" coup-ling so he can detach himself from the air supply hose simply and quickly in case of danger. Hoses 150 feet in length provide the worker a high de-gree of mobility. None of the earlier systems proposed for individual air conditioning has been widely adopted in industry because in general they have been too complex and too costly for day-to-day use on most jobs, the researchers commented. Vortex tube units with accessory equip-ment are commercially available. The vortex tube alone costs less than $75. MEMBERS OF THE NORTH CAROLINA STATE BOARD OF HEALTH Lenox D. Baker, M.D., President Durham John R. Bender, M.D., Vice-President Winston-Salem Ben W. Dawsey, D.V.M Gastonia Glenn L. Hooper, D.D.S. Dunn Oscar S. Goodwin, M.D. Apex D. T. Redfearn, B.S. Wadesboro James S. Raper, M.D. Asheville Samuel G. Koonce, Ph.G. Chadbourn John S. Rhodes, M.D. Raleigh EXECUTIVE STAFF J. W. R. Norton, M.D., M.P.H. State Health Director Jacob Koomen, Jr., 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 W. Burns Jones, M.D., M.P.H. Director, Local Health Division E. A. Pearson, Jr., D.D.S., M.P.H. Director, Oral Hygiene Division Lynn G. Maddry, Ph.D., M.S.P.H. Acting Director, Laboratory Division Ben Eaton, Jr., A.B., LL.B. Director, Administrative Services J>iri James F. Donnelly, M.D. Director, Personal Health Division January, 1965 THE HEALTH BULLETIN 15 THE HEALTH BULLETIN P. O. Box 2091 Raleigh, N. C. 27602 LIBRARIAN DIVISION OF HEALTH APTAl N.C. ,VEM. ffOSP. U. M CHAPEL HILL, N.C. If you do NOT wish to tinue receiving The Health letin, please check here GOdfiM Official Publication Of The North Carolina Stare Board of Health j^A*** John Atkinson Ferrell, M.D., Dr.P.H. December 14, 1880 - February 17, 1965 Fe,b, fits' John A. Ferre The miraculous advance in a man's lifetime in public health in North Carolina and the world could be no better marked than by the service of Dr. John A. Ferrell who died here Wednesday night. He was, of course, as State Health Officer Dr. Roy Norton said, "one of the outstanding physicians of all time native to North Carolina." Perhaps the mark of his greatness was that in his quiet, useful, elder years here, as director of the State Medical Care Commission, many of the health dangers he confronted as a young man had all but disappeared. He was only a young Duplin County practitioner in his twenties when in the first decade of this century he became assistant State Health officer concerned with combatting such plagues as typhoid fever and hookworm. Not everybody approved when, working with the Sanitary Commission and the Rockefeller Foundation, he extended his work in the campaign against hookworm. Some Southern patriots resented statements that much backwardness in the South resulted from this parasite which attacked so many rural people. Some con-sidered the statements Yankee-financed slander. But understanding grew as health conditions improved. And Dr. Ferrell was called from the State by the Rocke-feller Foundation to carry the work to the world. That work would have been enough to place him in the company of the great physicians. But North Carolina was blessed when, as native after what might have been time for retirement, he returned to the State of his youth to help shape and direct Federal and State programs for hospital expansion in North Carolina. His was a long life filled with great service. He deserves re-membrance as one of the truly eminent men produced by North Carolina in this century. Editorial, Feb. 20, 1965, Raleigh New and Observer THE HEALTH BULLETIN February, 1965 Dr. Ferrell's Three Public Health Careers Come to an End Dr. John A. Ferrell, public health pioneer, died late Wednesday night, February 17, at Rex Hospital in Raleigh. Funeral services were conducted at 11:30 a.m. on Friday, February 19, at the Church of the Good Shepherd. The Rev. James Beckwith and the Rev. Louis Melcher officiated, and burial was at 3:30 p.m. in Elmwood Cemetery in Charlotte. John Atkinson Ferrell, physician and public health administrator, was born at Clinton, N. C, December 14, 1880, son of James Alexander and Cornelia (Murphy) Ferrell. His father (1832-1923) was a merchant-farmer; his mother was a daughter of Hanson Finla Murphy, M.D., of Pender County, N. C. The family has been in North Caro-lina since colonial times, the earliest known representative of the line being Rev. James Alexander Ferrell, a Baptist clergyman of Orange County, N. C, in the eighteenth century. From him the descent is traced through Anderson (1804-43) and Mary (Dixon) Ferrell, parents of James A. Ferrell, 2d. The maternal line also runs into colonial times, from Finla Murphy, who came from Arrau Island, Scotland, in 1747, through Hugh Murphy of New Hanover County, N. C, and his wife Catherine McMillan; through Cornelius and Catherine Murphy and Doctor Han-son Finla and Elizabeth Anne (Simpson) Murphy. Dr. Ferrell was educated in the Uni-versity of North Carolina, where he was graduated B.S., in 1902; and M.D., in 1907. Later, in 1919, Dr. Ferrell was graduated with the degree Dr. P.H. (Doctor of Public Health) by Johns Hopkins University School of Hygiene and Public Health, the first occas.on on which this institution conferred this de-gree and he was the one and only graduate that year. For three years, (1902-05), he was engaged in teaching and as superinten-dent of schools in Sampson County, N. C, and, during this time, entered upon the study of medicine. He began practice in Kenansville, N. C, in 1907 and, in the same year, was made superintendent of health of Duplin County. In 1909 John D. Rockefeller provided the funds for the control in the South of hookworm disease, which had been found so prevalent as to become a menace to the social and economic progress of that area. The Rockefeller Sanitary Commission was formed to carry out the purpose of the benefac-tion and Doctor Ferrell was chosen, early in 1910, to have direction of ed-ucational and control measures in North Carolina with the title of As-sistant Secretary of the State Board of Health. Although the disease, except among physicians, was little known, his pione-ering efforts resulted, during the period 1910-1913, in educating the people throughout the State regarding the dis-ease, its mode of spread and methods February, 1965 THE HEALTH BULLETIN for its prevention and cure, and in the microscopic examination of 320,872 persons, of whom 160,689 were found to be infected and were treated. Upon the organization in 1913 of the International Health Board of the Rocke-feller Foundation, to extend throughout the world such health work as had been conducted by the Rockefeller Sanitary Commission in the South and also to embrace activities in the whole field of public health, Dr. Ferrell was made Di-rector for the United States. In this, he directed the work which involves the giving of financial aid and counsel to official health agencies for the de-velopment of essential branches of the State services and also the develop-ment of county organizations on a per-manent basis. During his period of serv-ice, 331 full-time county organizations were established, toward 226 of which the Foundation contributed directly. Dr. Ferrell, although active in the general field of public health, featured the strengthening of the State Health Departments and especially the estab-lishment, development and extension of county health service. In the United States, the Foundation provided aid for training of more than 200 medical health officers to occupy directive positions in the official health agencies (1919-27). As Associate Director of Internation-al Health for the Rockefeller Founda-tion, Dr. Ferrell directed this Founda-tion's interests in the United States, Canada and Mexico until 1944. From 1944 to 1946, he served as Medical Director of the John and Mary R. Markle Foundation. On October 1, 1946, he began a span of over ten years as Executive Secretary of the North Carolina Medical Care Commission. In this position, he directed the use of Hill-Burton funds in this State in the construction of 127 hospitals with an overall capacity of 6,- 567 beds, 41 nurses' residences, 3 diagnostic and treatment centers and 76 health centers— a total of 247 health projects involving an expenditure of $95,931,033. He retired February 1, 1957, and he and his wife had been living in Raleigh, North Carolina, since that time. His activity in professional organiza-tions is illustrated by his membership in the American Medical Association (Chairman, Public Health Service, 1922- 23), the American Public Health As-sociation (Member of Council 1 926- 29), the Southern Medical Association, the North Carolina State Medical So-ciety (Secretary, 1911-13), the New Jersey State Medical Society, the Na-tional Malaria Committee (Chairman, 1924), and the Royal Society of Public Health. The University of North Carolina gave to Dr. Ferrell its Distinguished Service Award. He was the author of numerous The Health Bulletin First Published—April 1886 The official publication of the North Carolina State Board of Health. 608 Cooper Memorial Health Building, 225 North McDowell Street, Raleigh, N. C. Published monthly. Second Class Postage paid at Raleigh, N. C. Sent free upon request. EDITORIAL BOARD Charles M Cameron, Jr., M.D., M.P.H Chapel Hill John T. Hughes, D.D.S., M P H. John C. Lumsden. B.C.H.E. Mary Ann Farthing. MS. Jacob Koomen. Jr., M.D . M PH. Bryan Reep, MS. John Andrews. B.S Glenn A. Flinchum, B.S. H. W. Stevens. M.D., M.P.H., Asheville Editor— Edwin S. Preston, M.A., LL.D. Vol. 80 February, 1965 No. 2 THE HEALTH BULLETIN February, 1965 papers and booklets on public health subjects, among which are: "Medical In-spection of Schools and School Chil-dren" (1912); "Malaria of the South" (1924); "Careers in Public Health" (1923); "Health in Relation to Citizen-ship" (1924); "Trend of Preventive Medicine" (1923); "The Public Health Nurse and County Health Service" (1926); "The County Health Organi-zation in Relation to Maternity and In-fancy Work and Its Permanency" (1927); "Survey of Provincial and State Health Organizations"—with aid of staff— (1927) etc. Dr. Ferrell was married January 28, 1909 to Lucile Devereaux Withers, daughter of Benjamin F. Withers of Charlotte, N. C. They had one daugh-ter, Bettie Devereaux, and two sons, John Atkinson, Jr. and Benjamin With-ers (deceased). In tribute to Dr. Ferrell, Dr. J. W. R. Norton, State Health Director, said, "He was one of the outstanding physicians of all time native to North Carolina. His work here in early public health in the control of hookworm and typhoid set an example for the control of many other communicable diseases. His in-ternational service with the Rockefeller Foundation and his service with the John and Mary R. Markle Foundation made him uniquely qualified to direct the N. C. Medical Care Commission. In that responsibility he set a pattern for the ideal use of Hill-Burton funds in the development of the best hospital plan-ning and health center construction to be found in the nation." Death of Doctor Recalls Fight Hookworms Once Plagued Tar Heels by Bob Brooks Raleigh News and Observer Only the oldtimers remember the campaign to stamp out hookworm dis-ease in North Carolina. It started in 1910, when a hardy bunch of pioneers in public health armed themselves with microscopes and began probing the "stools" of school children and adults over the state. By slow train, buggy and horseback Dr. John A. Ferrell and his associates went into every county in a hookworm search that marked the beginning of ac-tive public health work in this State. Real Giant Dr. Ferrell's death here last month at 84 took from the State one of its real giants in the public health field. His direction of the hookworm control cam-paign, as assistant secretary of the State Board of Health, may have been his most notable contribution. It was a campaign which for the first time focused the Tar Heel public's attention on community-wide detection, cure and prevention of communicable diseases. Dr. Ferrell and his men con-ducted lectures on sanitation and per-sonal hygiene wherever they went. The hookworm, in the early years of this century, was a plague upon the rural South. The small worm attaches it-self to the lining of the upper part of the small bowel and sucks blood from its victim. An infected person may have several thousand worms in him. Rockefeller money helped in financ-ing the State's effort to wipe out February, 1965 THE HEALTH BULLETIN hookworm disease. The work was di-rected through the Rockefeller Sanitary Commission. Dr. Ferrell was the com-mission's State director. He had six field directors. Local governments were required to provide part of the cost. Their efforts at fighting hookworm on a matching fund basis led to the organization of local health departments. In the beginning, there was some-thing less than enthusiastic public ac-ceptance of "the hookworm theory." Some of the newspapers in the State re-ferred to hookworm infection as "the lazy disease" and "the fad." Hookworm in the larvel stage may enter the body through the thin skin between the fingers and toes. Having been given this knowledge, some folks said Rockefeller was going into the shoe business and the hook-worm campaign was a scheme to get southerners to wear shoes the year round. The News and Observer commented that "many of us in the South are get-ting tired of being exploited by ad-vertisements that exaggerate condi-tions." But the press and the people rallied to the support of the campaign when the microscopes of Dr. Ferrell and his men began ot produce evidence of what ailed a good many of the State's people. Carrying specimens in tin cans, the people stood in lines to await the at-tention of the microscopists. The infect-ed ones got three doses of thymol and their health was soon restored. The News and Observer said earlier skepticism about the hookworm cam-paign was not justified, and the paper joined in the effort to publicize the work. Among Dr. Ferrell's field directors was Dr. Benjamin E. Washburn, who many years later wrote a lively account of the hookworm campaign in North Carolina. His booklet was published in 1960 by the Rockefeller Foundation. Dr. Washburn was one of the most successful field men in badgering ap-propriations out of county boards of commissioners. He travelled the rugged western end of the State. In the end, he and his colleagues squeezed money out of 99 of the 100 county governments. Only Ashe refused to cooperate. "However, there were reactionaries," Dr. Washburn recalled. "At one place a member objected because he thought the money could better be expended in buying mules for the poorhouse farm. In another, in the county in which the State university is located, a member was shocked at the idea of paying a doctor to treat worms. He contended that a certain number of worms was necessary to aid digestive processes. . ." Dr. Washburn recalled that while money was being discussed with the Alamance County Board of Commis-sioners, two doctors told of a case of hookworm they had treated. Patient's Symptoms Among the invalid patient's symp-toms "was eating dirt, paper and chalk, and he was reported, as a youngster, to have eaten half of a Bible and an entire song book." After treatment, the book eater became a freight train fire-man. An "unfortunate incident" hampered the hookworm doctors work in Swain County. The doctor was giving his lec-ture at a church meeting before the preacher arrived. The preacher was de-layed and sent word for the doctor to keep on talking. A woman in the aud-ience dropped dead during the hook-worm disease lecture. "It may be that the lecture was too long," Dr. Washburn conceded. Some of their findings baffled the hookworm crews. In Haywood County, they came upon a situation which surely would produce a shocking rate of infec- (Continued on page 9) THE HEALTH BULLETIN February, 1965 Children Still Unprotected from Measles With the advent of the 1965 measles season (February through April), Sur-geon General Luther L. Terry, of the Public Health Service, Department of Health, Education, and Welfare, said recently, "only about 7 million chil-dren have been protected by measles vaccines, leaving about 20 million sus-ceptible children unprotected. "Measles is so common a childhood disease that 90 percent of our children get it before their fifteenth birthday. Nevertheless, it is not the harmless illness that most mothers seem to think it is," Dr. Terry warned. Although recovery is routine for most children, about 500 children every year die from illnesses stemming from it. These are caused by encephali-tis or pneumonia. About one out of every 1,000 cases is followed by en-cephalitis. Fifteen to 20 percent of the encephalitis cases are left with such after-effects as mental retardation, vis-ual or hearing problems, or behavior disorders, and about 10 percent of the encephalitis cases die. "Over 490,000 cases of measles were reported to the Public Health Service in 1964, and we suspect that only about one-tenth of the actual cases were re-ported," Dr. Terry said. Many cases are not even seen by a physician, he ex-plained, because so many parents think of it as an "innocent" disease. "Fortunately, effective vaccines are now available and vaccination can re-lieve the parents of worry about measles and its after-effects. Only a single dose is required. In the mean-time, any child that develops the tell-tale red splotches should be seen by a physician at once," Dr. Terry urged. Water Resources Curriculum to be Expanded An expanded curriculum in Water Re-sources Development, to be inaugurated in the Fall of 1965 at the University of North Carolina, is to be offered jointly by the Department of Environ-mental Sciences and Engineering and the Department of City and Regional Planning. Engineers would generally enroll in the department while plan-ners, economists ond administrators would enroll in the Department of City and Regional Planning. In addition, the resources of the Institute of Goverr-ment on this campus would be utilized. Dr. Maynard M. Hufschmidt, currently Director of Research in the Harvard University Water Program, will be join-ing the faculty this summer to head this curriculum. Ample funds are available for sup-porting graduate students in this pro-gram. If we can provide any additional information, please do not hesitate to write to Dr. Daniel A. Okun, Professor of Sanitary Engineering. The dates for the North Carolina ANNUAL WASTE TREATMENT PLANT OPERATORS SCHOOL will be May 31 to June 4. The sponsors are: North Caro-lina Water Pollution Control Associa-tion, North Carolina State Board of Health, and the Institute of Government and the Department of Environmental Sciences and Engineering of the Uni-versity of North Carolina at Chapel Hill. The School will be held in Chapel Hill. Persons desiring additional infor-mation may contact Professor George Barnes, Department of Environmental Sciences and Engineering, Chapel Hill, North Carolina 27515. February, 1965 THE HEALTH BULLETIN National Rural Health Conference Set for Miami Beach Means of providing full-range health services for the nation's 60,000,000 rural residents will be discussed at the 18th National Conference on Rural Health March 26-27 in Miami Beach. Among matters that will be discussed by farm and medical leaders will be implementation of programs for financ-ing hospital and doctor costs among rural residents. W. Wyan Washburn, M.D., Boiling Springs, N. C, chairman of the Ameri-can Medical Association's Council on Rural Health, which is sponsoring the meeting, said the program was de-signed with four goals in mind: * To develop ways to utilize com-munity health resources. * To improve methods of communi-cation in health education for rural people. * To emphasize the responsibility of each family in promoting the health and fitness of its members. * To more fully understand the in-terdependence of rural and urban areas for the improvement of the health of the people. The keynote address for the meeting will deal with "Health is a Way of Life." and will be delivered by Carl S. Win-ters, D.D., internationally known lec-turer from Oak Park, III. This will be followed by papers on "Preventive Dental Care," by Joseph Volker, D.D.S., vice president for health affairs of the University of Alabama, and "Safe Use of Agricultural Chemi-cals," by Forrest E. Myers, of the Flori-da Agricultural Extension Service. A feature of the March 26 afternoon session will be the panel discussion on "Practical Implementation of Health Care Programs." Participants will be Samuel P. Leinbach, M.D., Belmond, Iowa, the vice-chairman of the AMA council; Guithel L. Simpson, M.D., Greensville, Ky., chairman of the gov-ernor's Council on Indigent Medical Care; John L. Falls, M.D., Red Wing, Minn.; and John Allen, M.D., Madison, Wise, director of medical services in the State Dept. of Public Welfare. A series of elective discussion groups will follow. Topics will be "Improving Family Nutrition," "Communication to Improve Health Practices," and "Health of Migrant Workers." Edward R. Annis, M.D., Miami, past president of the AMA, will speak at a banquet that evening. The March 27 program will open with a play, "To Temper the Wind," which deals with homemaker services. This will be followed by a paper on "Medical Quackery," by J. Harvey Young, Ph.D., professor of history at Emory University, Atlanta, Ga., and a symposium, "Developing Community Health Resources." Participants will be Dr. Washburn; Gertrude Humphreys, Morgantown, W. Va., a state home demonstration lead-er; Sewall Mil liken, executive director, Public Health Federation, Cincinnati; J. Robert Anderson, Richmond, Va., di-rector of the state's Bureau of Health Education,- Peter Meek, executive di-rector of the National Health Council, New York City; and Eugene G. Peek, Jr., M.D., Ocala, Fla., president of the Florida State Board of Health. The summary speech, "The Challenge Ahead," will be given by Roy Battles, director, Clear Channel Broadcasting Service, Washington, D. C. 8 THE HEALTH BULLETIN February, 1965 Robeson County 4-H #ers Promote "Slow Moving Vehicle" Signs as Traffic Safety Measure Surveys show that many accidents in-volving slow moving vehicles are caused by the lack of adequate identi-fication and that this often happens when visibility is poor or at night. Club members are planning and working through the cooperation of Mr. Warren Mathers, safety co-ordinator with the Robeson County Health Depart-ment. The purpose, need and value of the "slow moving vehicle" signs are being explained to all 4-H Home Demonstra-tion and other civic clubs in an effort to create interest and desire among people of the county to the need to eliminate some accidents by properly identifying all slow moving vehicles, thus making our highways safer. The 4-H tractor project is being car-ried by many of the county's farm youth who are learning proper main-tenance and operation of farm tractors. Special emphasis has been placed on the importance of using these signs. By providing literature, giving radio programs, writing news articles and selling safety tags for slow moving vehicles, many people of Robeson County are being made more safety conscious. by Selwyn B. Sampson President of Pembroke's "Eager Eight" 4-H Club Mr. R. H. Livermore, President of Pates Supply Company in Pembroke, helps 4-H'ers start their campaign by buying signs to go on company trac-tors and other slow moving vehicles. The triangular signs, with bright red center outlined in deeper red, show up equally well during night or day. They are designed for farm, highway and other vehicles that travel 25 miles per hour or less on highways. HOOKWORM CAMPAIGN (Continued from page 6) tion. A survey showed the county had few sanitary privies. Open-type privies were placed over the many streams and springs. The springs were the source of drinking water in many places. Of the county's 15,436 population in 1910, 3,119 persons were exam-ined and only 200 were found to be infected with hookworm. The doctors didn't say so, but this seemed to be a high tribute to the rare qualities of Haywood's mountain air. February, 1965 THE HEALTH BULLETIN The Dental Care Program of Rowan County A Dental Care Program for the Med-ically indigent, long felt as a need by the Rowan County Health Department, is now a reality as a result of the sum of $10,500 bequeathed to the local health agency in the will of the late Judge R. Lee Wright of Salisbury. Indeed, a dream has been fulfilled as well as a need. For with the original construction of the Health Center in 1953, a room for a dental clinic was included, which provided such basic essentials as water supply and sinks. However, for want of funds for dental equipment, the room has been used during the intervening years as extra office space. Now it boasts the finest of equipment. "For use of the aged and infirm" were the terms of Judge Wright's will in designating his gift to the Health Department. As an appropriate use, the dental care program was selected jointly by Mrs. Sam Edwards, his niece, George R. Uzzell, trustee of his estate, and by the County Board of Commis-sioners. The general objectives of the pro-gram are to relieve pain, to promote health, and to provide dentures for the medically indigent. Specifically, and by established pol-icy, the persons being served are the medically indigent residents of Rowan County of over age 65 who are not reached by other currently operating programs, such as the Kerr-Mills Bill. Under the latter's provisions, the Wel-fare Department can pay only for fill-ings, extractions, and denture repairs (for the medically indigent of over 65). Particular attention is being concen-trated for the time being on that seg-ment of the eligible group who reside in any nursing, boarding, or rest home financed by Rowan County taxes. To date, all patients served have come from the boarding homes. The dental care is entirely free to the eligible. Incidental expenses are being met by the Chronic Disease Sec-tion of the North Carolina State Board of Health. No Rowan County funds are being used directly in the program. The Rowan County Dental Society has actively supported the program and assisted with the selection of equip-ment. In addition they will continue as the source of the personnel to provide the service. At present Dr. Bruce A. Ketner attends the patients. The clinic is in operation one half day a week, the current time being Wednesday mornings. In expressing his gratitude for this addition to the Health Department's services, Dr. Moffitt K. Holler, Director, commented that, to his knowledge, this is the only dental program of its kind in North Carolina. Also he ob-served that the Rowan County agency is the only Health Department in the State to have received a bequest of money for a Health Department func-tion. "We are indeed appreciative of Judge Wright's kindness and generos-ity," said Dr. Holler. "And we feel that this program will be a fitting and last-ing tribute to a fine gentleman, who was not only a leader in the civic, (Continued on page 12) (See Picture on Opposite Page) FREE DENTAL CLINIC-The aged and in-firm of Salisbury-Rowan are being af-forded free dental service through the cooperation of the State Board of Health and funds left to the county by the late Judge R. Lee Wright. Dr. Bruce Ketner, currently conducting the week-ly clinic, is shown with Mrs. Ben Bla-lock, a patient at a local rest home.— (Post Staff Photo by Barringer). 10 THE HEALTH BULLETIN February, 1965 February, 1965 THE HEALTH BULLETIN 11 DENTAL HEALTH (Continued from page 10) church, and professional activities of Salisbury, but who also rendered dis-tinguished service to the entire County during his years in the North Carolina General Assembly and Senate and as Superior Court Judge of North Caro-lina." Futilely, for some eleven years, the door of the clinic has borne the label "Dentist." Now at its entrance is a beautiful bronze tablet with the in-scription: This Room Equipped in Memory of Judge R. Lee Wright and Wife Sally Oakes Wright The tablet was composed and placed in accordance with the suggestions of Mrs. Edwards, who had made her home with Judge and Mrs. Wright ever since the death of her own parents when she was four years old. Poliomyelitis Vaccine Success Demonstrated The success of the poliomyelitis vac-cines is clearly demonstrated by three facts published recently by the Com-municable Disease Center. (1) Only 94 cases of paralytic polio-myelitis occurred in this country dur-ing 1964; this number is less than one fourth the number of paralytic cases reported during 1963, which was the previous record low year. (2) No seasonal pattern of increased incidence was noted during 1964. (3) There were no outbreaks of hu-man poliomyelitis reported anywhere in the United States during 1964. International Health Meeting In Madrid With the impulsive pressures of pop-ulation growing every day in every part of the world, how can people con-cerned with health and health education effectively contribute to immediate and long-range action? This is one of the central questions being asked by lead-ers of the International Union for Health Education as they met in Paris recently to complete planning for the 6th Inter-national Conference on Health and Health Education, to be held in Madrid, Spain, July 10-17, 1965. The theme of this world conference is "The health of the community and the dynamics of development." It com-bines concern with the various aspects of economic and social development with health and health education con-siderations. Also, it gives special at-tention to population problems and the migration into the urban cities— an "im-plosive" pressure in engineering terms. A large group from the United States is expected to participate in the Madrid meetings, which will include technical study groups and tours of health and educational facilities as well as the us-ual plenary and related meetings. The program, reflecting the growing aware-ness everywhere of the importance of health as a primary factor in national growth, is characterized by originality and variety. It will combine the scien-tific with the practical in its approach to the problem of how best to create solid bases for effective action to en-sure better health around the globe for all. Write to the Editor of the Health Bulletin if you are interested in going. 12 THE HEALTH BULLETIN February, 1965 Flim Flam Artists Are At Work Two flim-flam artists were at work in Haywood County trying to conjure money out of households through a health ruse. According to Sheriff Jack Arrington, who issued the warning, the gimmick works like this: Two white men—one about 45 and the other about 60—knock on a per-son's door and tell the householder that they are from the Haywood Coun-ty Health Department. The artists quickly explain that a new state law has been passed that requires each house to be sprayed in-side for tuberculosis germs. While one man is in the house spray-ing the rooms, the other man is outside cutting the telephone wires if there are any. This gimmick has already worked in the White Oak Community, according to the sheriff. He said an elderly man paid the pair $140.00 to spray his house. The sheriff's department learned about the incident after the man's son came home and found out what had happened. So the sheriff has asked all persons to be on the look-out for the pair and should they show up, the sheriff would like for the owner to get as much in-formation as possible— like color of their car, license number, description and such— and then refuse the service. After refusing the service, the sheriff said call his department or the nearest police department. He warned that the flim-flam artists are "slick" enough to get by with talking some people into a spraying job. People ought to only do business with people they know and then they would be safe," he added. Short Course In Accident Control The third annual short course in Pro-gram Development in Public Health Accident Control has been announced by the Department of Public Health Administration of the University of North Carolina School of Public Health. The course will be held at the School of Public Health in Chapel Hill, May 30 through June 4, 1965. The course has been designed for: • Administrators of state, city, or county health departments. • Directors, supervisors, or consul-tants in nursing, sanitation, edu-cation, and other allied programs in state, city, and county health departments. • Accident control workers in health departments. Course content will include: • Lectures on etiology, fact-finding, and program planning. • Problem-solving by small multi-disciplinary groups. For further information, write to the Department of Administration, School of Public Health, University of North Caro-lina at Chapel Hill, or the Accident Pre-vention Section, North Carolina State Board of Health, Raleigh, North Caro-lina. Herbert Shore, President of the Amer-ican Association of Homes for the Aging, has announced that AAHA's Fourth An-nual Meeting and Conference on "The Social Components of- Care" will be held from Nov. 1-4, 1965 at the Disney-land Hotel, Anaheim, California. Highlights of the meeting will in-clude the presentation of the annual AAHA Award of Honor and a Legisla-tive Breakfast Meeting on "The Aged in The Great Society". February, 1965 THE HEALTH BULLETIN 13 UNC Professor Loaned to the Philippines The World Health Organization (WHO) has selected a University of North Carolina professor as the public health nursing consultant for a National Seminar in Public Health Administration in the Philippines in February. Dr. Margaret L. Shetland, director of the Public Health Nursing Teacher Prep-aration Program at the UNC School of Public Health and UNC School of Nurs-ing, left in early January for her two-months assignment. She will be one of three consultants for the seminar in Baguio, the sum-mer capital of the Philippines. She will serve with Dr. F. Main of Northern Ireland and Dr. A. Yerby of New York City. Dr. Shetland was chief nursing con-sultant with the U. S. Overseas Mission and visiting professor of public health nursing at the University of the Philip-pines in Manila from late 1956 to early 1959. This will be her first visit to the area since 1959. The seminar in Baguio will be limited to provincial health officers in the Phil-ippines, equivalent to state health offi-cers in the U. S. The seminar staff will devote a month to field visits and program preparation. Seventh Recreational Institute The University of North Carolina, through its Recreation Curriculum, an-nounces that the Seventh Southern Reg-ional Institute on Recreation with the III and Disabled will be held in Chapel Hill, North Carolina on April 22, 23, and 24, 1965. The Steering Committee for this In-stitute met in Chapel Hill recently and formulated a very interesting, practical and progressive program. Detailed in-formation regarding the Institute was sent out in January. MEMBERS OF THE NORTH CAROLINA STATE BOARD OF HEALTH Lenox D. Baker, M.D., President Durham John R. Bender, M.D., Vice-President Winston-Salem Ben W. Dawsey, D.V.M Gastonia Glenn L. Hooper, D.D.S. Dunn Oscar S. Goodwin, M.D. Apex D. T. Redfearn, B.S. Wadesboro James S. Raper, M.D. Asheville Samuel G. Koonce, Ph.G. Chadbourn John S. Rhodes, M.D. Raleigh EXECUTIVE STAFF J. W. R. Norton, M.D., M.P.H. State Health Director Jacob Koomen, Jr., M.D., M.P.H. Assistant State Health Director J. M. Jarrett, B.S. Director, Sanitary Engineering Divisioyi Martin P. Hines, D.V.M. , M.P.H. Director, Epidemiology Division W. Burns Jones, M.D., M.P.H. Director, Local Health Division E. A. Pearson, Jr., D.D.S., M.P.H. Director, Oral Hygiene Division Lynn G. Maddry, Ph.D., M.S.P.H. Acting Director, Laboratory Division Ben Eaton, Jr., A.B., LL.B. Director, Administrative Services Division James F. Donnelly, M.D. Director, Personal Health Division 14 THE HEALTH BULLETIN February, 1965 Southern Branch, APHA To Meet In New Orleans "Health Support in Man's Changing Environment," is the theme of the 33rd annual meeting of the Southern Branch, American Public Health Association, to be held in New Orleans, La., April 7, 8, 9. Keynote speaker at the first general session will be Dwight F. AAetzler, C.E., M.S., president of the American Public Health Association. Miss Elizabeth S. Hol-ley, president of Southern Branch, will preside at the Wednesday and Friday sessions. Speaking Thursday will be Dr. Paul Q. Peterson, Assistant Surgeon General, Department of Health, Education and Welfare, who will discuss "Social and Physical Environment." Dr. Leroy E. Bur-ney, Vice President for Health Sciences, Temple University, will talk on "The Professional Environment: Scientific Knowledge, Technical Application and Fiscal Support." The third speaker will be Dr. Robert E. Coker, professor of Dr. Murray Grant of Washington, D. C. visited North Carolina early in Feb-ruary speaking to a Seminar at the School of Public Health in Chapel Hill. He also spoke to the staff of the State Board of Health and is shown in the picture with Dr. J. W. R. Norton, State Health Director. Dr. Grant is Health Di-rector of the District of Columbia which includes hospitals as well as other pub-lic health services in a budget of some $50 million. public health administration, University of North Carolina School of Public Health. His topic is "Organization for Support of Health." Dr. Russell E. Tea-gue, state commissioner of health, Com-monwealth of Kentucky, will preside Tuesday. Summarizing the program at the branch meeting April 9 will be Dr. Malcolm U. Dantzler, director for the Charleston, S. C, county health depart-ment. Program chairmen are Charles G. Jor-dan, engineering division, Dade County health department, Miami, Fla., and Dr. Robert F. Lewis, professor and head, division of biostatistics, Department of Tropical Medicine and Public Health, Tulane University, New Orleans, La. Hosting the Southern Branch meeting will be the Louisiana Public Health As-sociation, Inc., Miss Edna Irl Mewhin-ney, president. Local arrangements committee chair-men announced prizes for pre-registra-tion at the Jung Hotel, convention head-quarters, and plans for a shrimp boil, 6:30 p.m., Tuesday, April 6. In addi-tion, there will be Dixieland bands, sight-seeing tours, and other attractions to be found only in America's famed Mardi Gras city. February, 1965 THE HEALTH BULLETIN 15 THE HEALTH BULLETIN P. O. Box 2091 Raleigh, N. C. 27602 LIBRARIAN trbaR? DIVISION OF HEALTH AFFAIR LIBRARY N.C. U£%* HOSP. CHAPEL HILL, N.C U. N. C. If you do NOT wish to con-tinue receiving The Health Bul-letin, please check here | l and return this page to ' — the address above. Primed by The Graphic Press, Inc., Raleigh, N. C. DATES AND EVENTS March 21-24 — N. C. Association of Nursing Homes, Velvet Cloak Inn, Raleigh. March 22-26 — American College of Physicians, Chicago, III. March 26-27 — National Conference on Rural Health, Miami Beach, Fla. April 2-3 — Annual Meeting, N. C. Physical Therapy Association, Win-ston- Salem. April 4-9 — American Industrial Health Conference, Bal Harbour, Maine. April 5-9 — Southern Branch, APHA, Jung Hotel, New Orleans, La. April 7-9 — National Council on Alco-holism, Tulsa, Okla. April 9-15 — American Academy of General Practice, San Francisco, Cal. April 12-15 — American Society for Public Administration, Kansas City, Mo. April 20-22 - Eastern Branch, NCPHA, Blockade Runner Hotel, Wrightsville Beach. April 22-23 — Annual Meeting, N. C. Tuberculosis Association, Robert E. Lee Hotel, Winston-Salem. April 22-24 - Seventh Southern Re-gional Institute on Recreation with the III and Disabled, Chapel Hill. April 23-24 - Anual Meeting, N. C. Chapter of the American College of Surgeons, Blockade Runner Hotel, Wrightsville Beach. Charlotte's Occupational Health Con-ference, originally scheduled for March, has been postponed and tentatively set for October 7. CONTENTS John Atkinson Ferrell 1, 2, 3 Hookworms Once Plagued Tar Heels 5 Children Still Unprotected from Measles 7 Water Resources Curriculum to be Expanded 7 National Rural Health Conference Set for Miami Beach 8 Robeson County 4-H'ers Promote Safety 9 The Dental Care Program of Rowan County 10, 11 International Health Meeting in Madrid 12 Poliomyelitis Vaccine Success Demonstrated 12 Flim Flam Artists Are at Work 13 Short Course in Accident Control 13 UNC Professor Loaned to Philippines 14 Southern Branch APHA Will Hold Annual Meeting in New Orleans 15 16 THE HEALTH BULLETIN February, 1965 Eldercare L APR 29 1965 Versus DIVISION OF Medicare H£ALTH AFFAIRS L,BRARY Some Comments and Comparisons See page 2 and following Medicare Awaits Senate Action THE Medical Care of the Aged bill Congress is preparing for passage has a long, curious history. Hospitalization-nursing home portions first were proposed about fifteen years ago. The idea had support from President Truman but failed to materialize. Since then, the social security-financed plan consistently has been opposed by the American Medical Association and other professional and business groups. Until this session the bill never has been voted out of the House Ways and Means Committee. Thus, the House never has had an opportunity to act on it. The bill has now passed the House and is headed for several weeks debate in the Senate. This year, however, the climate has changed dramatically. The AMA, even in the face of almost certain defeat, waged its strongest campaign against the ad-ministration's Medicare bill. And the AMA pushed its own answer to health care for the aged—Eldercare—maintaining that it offered far greater benefits than did Medicare. This was disputed by Rep. A. Sydney Herlong, Jr., (D., Fla.), co-sponsor of the Eldercare bill, who called AMA advertising "Misleading." For the AMA to give the impression the bill provides complete coverage is not so, he said. "It just makes it available for the states to provide it if they want to." AMA's hard-hitting drive succeeded in part and perhaps not as the association intended. The campaign has succeeded, not in building opposition to Medicare as such, but in alerting the public to the fact that Medicare's benefits would be limited. Most letter writers to the House committee members said Medicare would not be enough. Democrats on the House Ways and Means Committee realized that Medicare alone would be a disappointment to many elderly persons. The committee decided to work out a comprehensive medical care bill for the aged to include payments for most drugs, medical devices, and physicians' fees. There would be some charge to prevent overuse of benefits, and an attempt would be made to work out a system for regaining part of the cost from wealthy elderly persons. The system would be voluntary. So the AMA successfully focused public attention on Medicare's deficiencies but did not succeed in stopping the bill. THE HEALTH BULLETIN March, 1965 How the AMA-Supported Eldercare Bill Compares with the Administration Sponsored Medicare Proposal Reprinted with permission from material prepared for publication in Modern Medicine, Copyright 1965 by Modern Medicine Publications, Inc. ELIGIBILITY Eldercare Bill Administration Bill Needy persons 65 and older. Partial All persons 65 and older, regardless of or total underwriting of health care in- need. About 16% million eligible un-surance determined by need limits set der social security or railroad retire-by states. AAAA estimates 11,800,000 ment plans; about 2 million others to are eligible depending on need, not be covered through general tax funds, counting persons covered by such pro-grams as Old Age Assistance (OAA) and Federal Employees Health Benefit Plan. CONTROL Eldercare Bill Administration Bill By state welfare or health agencies By Department of Health, Education, through existing Kerr-Mills channels and Welfare through existing social se-after acceptance by state legislature. curity channels, allocations to be kept in separate Treasury trust fund. COST Eldercare Bill Administration Bill Undetermined. One AAAA estimate of Estimated at $2 to $2.4 billion yearly, nearly $2 ]/2 billion yearly is based on $250 premium per person per year. Another AAAA estimate is "between $2 and $4 billion." March, 1965 THE HEALTH BULLETIN FINANCING Eldercare Bill Through state and federal funds. Per-centage of federal funds—52.5 to 84% —based on a state's per capita income, with lower income states getting a higher proportion. Funds are used by welfare or health departments to buy health insurance under guaranteed re-newable private plans. Income levels to qualify for assistance would be deter-mined by states, with the maximum at least as high as the highest level now required in the state under Kerr-Mills— presently ranging from $1,080 to $3,000 for individuals; $1,560 to $3,900 for couples. Persons above maximum would be ineligible for aid but could purchase the same noncan-celable policies. Those between maxi-mum and minimum would pay part of their premium on a sliding scale. Those below minimum would pay nothing. Administration Bill Through increased social security con-tributions. Total social security payroll deductions, including the portion for health care, from 1971 on, would be 10.4% (5.2% from employee; 5.2% from employer) or 7.8% for self-em-ployed, deductions to be made on the first $5,600 of salary rather than the current $4,800. Payments are made to hospitals or other service providers or to Blue Cross-type organizations repre-senting hospitals. Yearly outlay of some $250 million is anticipated from gen-eral tax funds for those not covered by social security or railroad retirement. The Health Bulletin First Published—April 1886 The official publication of the North Carolina State Board of Health, 608 Cooper Memorial Health Building, 225 North McDowell Street, Raleigh, N. C. Published monthly. Second Class Postage paid at Raleigh, N. C. Sent free upon request. EDITORIAL BOARD Charles M. Cameron, Jr., M.D., M.P.H. Chapel Hill John T. Hughes, D.D.S., M.P.H. John C. Lumsden. B.C.H.E. Mary Ann Farthing, M.S. 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., Asheville Editor—Edwin S. Preston, M.A., LL.D. Vol. 80 March, 1965 No. 3 THE HEALTH BULLETIN March, 1965 BENEFITS It is impossible to compare benefits of the two bills since specific Eldercare coverage depends on each state. However, the Herlong-Curtis bill is a modifica-tion of the Kerr-Mills mechanism, so present Kerr-Mills practices are of interest, even though no state is committed to follow these practices as a basis for partici-pation under Herlong-Curtis. Presently, 40 states, 3 territories, and the District of Columbia have operating Medical Assistance for the Aged (MAA) plans under Kerr-Mills. According to iatest AMA figures (April 1964), 176,000 persons were receiving assistance. HOSPITALIZATION BENEFITS Eldercare Bill Administration Bill Dependent on extent of insurance pur- Sixty days per benefit period. Patient chased by federal-state funds. pays a deductible equal to the cost of one day national average hospital care. Recipient is entitled to this every 180 days if there is an interval of 90 days without hospitalization. Kerr-Mills Experience. Of 44 states and territories offering hospitalization under existing Kerr-Mills program (AMA report, Dec. 23, 1964), duration of paid hos-pitalization varies from ten days per year (followed by review committee ap-proval for possible extension) to no fixed limit. Nineteen states have no fixed limit but leave determination of duration to the administering agency. In 15 states with a fixed limit and no review mechanism, duration varies from twelve to seventy days per year. Nine states have a fixed limit with reviewal for possible extension. Benefits in one state recently starting the program are unreported. NURSING HOME BENEFITS Eldercare Bill Administration Bill Dependent on extent of insurance pur- Sixty days per benefit period, no de-chased by federal-state funds. ductible. Recipients must be transferred from hospital to affiliated home or to one approved by HEW. Kerr-Mills Experience. Of 30 states and territories offering nursing home care under existing Kerr-Mills program (AMA report, Dec. 23, 1964), duration of paid care ranges from twenty-six days per year to no fixed limit. Eighteen states have no fixed limit and leave determination of duration to the administering agency. Twelve limit the stay to twenty-six to one hundred eighty days per year. Only five states and territories require such care to be immediately preceded by hos-pitalization. March, 1965 THE HEALTH BULLETIN 5 PHYSICIAN SERVICE BENEFITS Eldercare Bill Administration Bill Dependent on extent of insurance pur- None. Private insurance carriers invited chased by federal-state funds. to provide such insurance without dan-ger of antitrust involvement. Kerr-Mills Experience. Of 39 states and territories offering physician payment under existing Kerr-Mil Is program (AAAA report, Dec. 23, 1964), all have limi-tations. Some limit the number of calls per month or quarter, some have a ceiling on payment, and others limit the number of visits per hospitalization. Only 6 states limit physician payment to certain conditions, such as acute, chronic, or long-term illness. Four states do not pay physician fees under AAAA mechanism but care for such patients without charge as staff patients. DRUG BENEFITS Eldercare Bill Administration Bill Dependent on extent of insurance pur- Covers cost of drugs customarily fur-chased by federal-state funds. nished when patients are in hospitals or nursing homes. No coverage outside these facilities. Kerr-Mills Experience. Of 32 states and territories offering drug coverage under existing Kerr-Mills program (AAAA report, Dec. 23, 1964), most are determined by the administering agency. Four states have a cost limit: $120 a year, $150 a year, $15 a month, $10 a prescription. DENTAL CARE BENEFITS Eldercare Bill Administration Bill Dependent on extent of insurance pur- None, chased by federal-state funds. Kerr-Mills Experience. Of 26 states and territories offering dental care under existing Kerr-AAills program (AAAA report, Dec. 23, 1964), 14 are restricted to cer-tain dental conditions. One state has a $100 limit. Another limits care to patients in hospitals or nursing homes. The rest leave determination of benefits to the administering agency. 6 THE HEALTH BULLETIN March, 1965 OTHER BENEFITS Eldercare Bill Administration Bill Dependent on extent of insurance pur- Up to 240 nonphysician home health chased by federal-state funds. care service calls per year. Diagnostic outpatient services with deductible in any one month of an amount equal to half the average nationwide cost of one day's hospital care. Services of radiol-ogists, pathologists, physiatrists, and anesthesiologists are included as hos-pital services. Kerr-Mills Experience. Under existing Kerr-Mills program (AMA report, Dec. 23, 1964), such services as home nursing, outpatient laboratory work, or diagnostic X-ray are offered by 33 states. Medicare Vs. Eldercare as viewed by Consumer Reports AFTER two decades of effort, 1965 appears to be the year for Medicare— a Federally-administered national hospital insurance plan, financed through Social Security contributions for persons over 65. This time the administra-tion's Medicare bill seems assured of passage. As usual, though, the American Medical Association has proposed a last-gasp substitute. A comparion of the two proposals is instructive. The Medicare bill may of course be altered in the legislative process, but its four basic provisions are not likely to be changed significantly. They can be out-lined briefly. For those over 65, Medicare would: • Pay the full costs of up to 60 days of hospitalization (in ward or semi-private accommodations), minus a first-day deductible, for each benefit period (which begins on the first day of hospitalization and ends whenever the patient has ac-cumulated 90 days out of the hospital within a period of 180 days). • Provide for an additional 60 days of post-hospital care for each illness in a convalescent or rehabilitation center operating under an agreement with a hos-pital (not an ordinary, custodial-care nursing home). • Pay for up to 240 home nursing visits a year under medical supervision, in programs organized by nonprofit voluntary or public agencies. • Provide payment for hospital outpatient diagnostic services and tests, minus a deductible that would exclude routine low-cost laboratory or other diagnostic procedures. March, 1965 THE HEALTH BULLETIN These provisions would be financed by an increase in the Social Security with-holding tax. Ultimately, a citizen would contribute (to a special, separate health care trust fund within the Social Security system) 0.45% of his earnings up to $5600, and his employer would contribute an equal amount. Special provision would be made for those now over 65 who are not covered by Social Security through the Government's general fund. The Medicare program gives the citizen free choice of physician and hospi-tal. It does not pay the costs of doctor bills, out-of-hospital drugs, prolonged or catrastrophic illness requiring long, continuous hospitalization, or extended custo-dial care in nursing homes. CU's medical consultants believe that this is, by and large, a sound basic package. The 60-day provision would encompass all but about 5% of the usual hospital stays of older persons, and the extended-care proposal would both re-lieve the pressure on general hospital beds and spur the construction of badly-needed convalescent and rehabilitation facilities in many communities. Services of this kind are essential in many illnesses following their acute stage and prior to the time a patient can return to his home or transfer (if necessary) to a custodial institution. The provision for organized home nursing services has obvious value: such services often preclude the need for hospitalization and permit earlier discharge from hospital or convalescent center. Out-patient diagnostic services also are capable of averting many costly hospitalizations by encouraging the early de-tection and treatment of disease—at a time when it may be cured or controlled by relatively simple short-term procedures. Since the heaviest health cost of the elderly is hospitalization, the Medicare coverage could make it financially possible for the first time for many citizens to purchase voluntary insurance (of the Blue Shield type) to cover physicians' bills and other supplementary costs. The AMA substitute for Medicare at first glance seems invitingly compre-hensive. (It is, in fact, a resurrection of proposals made during the Eisenhower administration that the AMA bitterly opposed at the time, and again just a few months ago at its House of Delegates meeting. The AMA now refers to its "new" proposal as a "redefinition" of policy.) The AMA substitute simply proposes the use of state and Federal funds to buy Blue Cross-Blue Shield or commercial health insurance for indigent persons over 65—it does not say how the funds would be raised, in the absence of a Social Security tax. The proposal does say, however, that a means test would be required to determine the eligible poor, with the states using state and Federal money to pay all, some, or none of the insurance premium cost, depending on the citizen's qualification under the means test. Means tests are—moral considerations aside— enormously expensive and difficult to administer. Furthermore, the program would be administered by the states, raising the possibility that there would be 50 different kinds of governmental machinery, eligibility standards, and pay-ment procedures. (Under some state rules setting eligibility for help under the current Kerr-Mills law, ownership of property or even ability of one's children to pay can make an old person ineligible.) The subsidized insurance would pay for physicians' and surgeons' bills and drug costs as well as hospital bills, and an AMA statement asserts that this would be "comprehensive health care" and not "limited to hospital and nursing home 8 THE HEALTH BULLETIN March, 1965 care representing only a fraction of the cost of sickness." As CU has pointed out, however, this "fraction" covers the heaviest, the most financially crippling share of the burden. Furthermore, since the AMA has not spelled out specifically what the private insurance would cover (and in existing voluntary insurance policies, cash benefits, days of coverage, and other provisions vary widely from plan to plan and from area to area), it is difficult to tell how "comprehensive" the pro-tection of the AMA's proposal would be. The current Medicare proposal, obviously, will not solve every aspect of the nation's health problems, even for those over 65. It does not and cannot guaran-tee good medical care to its beneficiaries, and it pays relatively little attention to the quality of the services it pays for (though the bill does contain a provision for periodic review, by the medical staffs of participating hospitals, of the neces-sity for hospitalization, length of stay, and other such features). However, it is a significant beginning. Reprinted with permission from Consumer Reports (March, 1965). Copyright 1965 by Consumers Union of U. S., Inc. Determining Medical Indigency Reprinted by permission from the American Journal of Public Health, copyright 1964 and 1965 by the American Public Health Association BASIC in the provisions of Eldercare, sponsored by the American Medical Association, is the principle that the health care shall be made available only to persons qualifying as being medically indigent. Determination of medical indigency is admittedly a difficult and costly process. The National Council on Aging presented a report on this subject at the 1964 meeting of the National Conference on Social Welfare. The report, entitled, "Prin-ciples and Criteria for Determining Medical Indigency", was published in full in the October, 1964 issue of the American Journal of Public Health. The principles set forth in this report of the National Council on Aging are reprinted here on the following pages through the courtesy of the American Jour-nal of Public Health, together with the comments of Milton I. Roemer, M.D., Pro-fessor of Public Health at the University of California, School of Public Health, in Los Angeles. Dr. Roemer was invited by the National Council on Aging to be one of the two discussants of this report at the National Council on Social Welfare and his comments carried in the March, 1965, issue of that publication. March, 1965 THE HEALTH BULLETIN 9 These principles are goals that will not be attained quickly; in many in-stances they call for changes in legisla-tion and policies and for training of personnel. Some changes could be made by revising administrative pro-cedure and regulations. Others will de-pend upon the public's conviction of the need to expend the necessary funds. The committee believes that carrying out the recommended principles will re-sult in conservation of human resources and in prevention of suffering now caused when handicapping policies and unsound practices obtain in the de-termination of medical indigency. Principles for the Determination of Medical Indigency 1. People who cannot afford medical care are entitled to it as a human right and as a sensible means of conserving human resources. 2. Neither race, creed, color, country of national origin, citizenship, nor length of residence should be criteria for determining medical indigency. Mental retardation, advanced age, or previous history of mental illness should not of themselves prejudice financial eligibility for needed medical care. 3. Determination of the amount and kind of medical care needed is a judg-ment of the health professions. The de-cision as to eligibility for aid in meet-ing this need should be a combined medical and social judgment, with due consideration given to implications of the illness or handicap for the family, estimated cost of care, relationship of the medical need to the patient's re-sources, medical or health needs of other members of the family, and spe-cial family needs. 4. Persons and families having in-comes and resources at or below speci-fied levels should be eligible for pay-ment for medical care automatically. Only for persons and families with in-comes above the specified levels need further inquiry be made. 5. Criteria applied in determining financial eligibility should be objective-ly established and should not result in family insolvency. 6. Income levels for use in the de-termination of medical indigency should represent a reasonable level of living. 7. In order to provide for his med-ical care, no claim or lien should be taken on a patient's home and furnish-ings or on equipment essential for earn-ing a living. 8. No arbitrary income ceiling should be set beyond which no patient can be judged medically indigent. 9. Legal or administrative policies specifying that relatives assume finan-cial responsibility are undesirable, ex-cept in case of the patient's spouse or the parents of a dependent child. 10. Community health and welfare agencies that provide or subsidize med-ical and dental care should collaborate in developing general policies as a framework within which each deter-mines medical indigency. 11. When several agencies are deal-ing with a patient who can partially pay for his medical care there should be joint agreement on the respective responsibilities and shares in the total patient funds available. 12. The agency that provides the sub-sidy for medical care should determine medical indigency. 13. General policies should be ad-ministered flexibly in relation to indi-vidual circumstances and problems. 14. Qualifying conditions of eligibil-ity should conform to social values of dignity, privacy, confidentiality, indi-vidual responsibility, and family unity. These should be taken into account both in regulations established and in proc-essing applications. 10 THE HEALTH BULLETIN March, 1965 15. A public agency or institution rendering or subsidizing medical care has the obligation to consider an ap-plication from any person within the group it serves and to take action on an appeal of the decision. These principles are fundamental to good administration of the determina-tion of medical indigency. Extraordi-nary situations may sometimes arise when one of the principles of a more practical nature will need flexible ad-ministration on an individual basis. Present-day experience indicates that such situations rarely occur. Dr. Roemer's Letter to the Editor of the American Journal of Public Health To the Editor: The report of the National Council on Aging entitled "Principles and Criteria for Determining Medical Indigency" and published in the October, 1964, issue of the Journal calls for comment. This important document was given its first public presentation at the Na-tional Conference on Social Welfare, as-sembled in Los Angeles on May 26, 1964. It happens that I was invited by the National Council on Aging to be one of the two discussants of the report, as it was presented by Mrs. Edith Alt. My remarks and those of the other dis-cussant (Mr. Carel Mulder of the Cali-fornia State Department of Social Wel-fare), however, have not been publish-ed. There are some very serious social policy implications to a formal crystal-lization of the whole concept of "med-ical indigency" that may be overlooked, while—with the best of intentions—one is trying to improve medical care for the poor. The fundamental question is "how should medical care for the poor be financed?" rather than "how should medical indigency be determined?" I tried to explore these conceptual prob-lems in my commentary on the report, which was as follows: There can be no doubt that this report on principles for determining medical indigency, produced by the National Council on the Aging and summarized so very well by Mrs. Alt, is a positive contribution to the tasks of administra-tion of medical care in the United States today. A variety of governmental and voluntary programs must now make such determinations, and effectuation of the principles advocated in this report would surely facilitate proper medical care and protect human dignity more than has often been the reality in the past. The principles proposed on key issues like property liens, residency re-quirements, relative's responsibility, court commitments, and so forth, would move us significantly further along the path from tribalism to social responsi-bility. Nevertheless, as I read through this fine report—exemplary in its careful workmanship and presentation— I be-came more and more unhappy about it. My disturbance was not for what it said, but for what it did not say. I am aware that the distinguished committee, representing as it did organizations of diverse sociopolitical philosophies, set itself a specific task, to define "criteria of medical indigency," from which it deliberately did not deviate. Yet it is the very posing of this task that I would like to comment on. Perhaps, as the "Foreword" of the report states, the project was 25 years March, 1965 THE HEALTH BULLETIN 11 overdue, but why was it undertaken just now? Surely it is not unrelated to the fact that in 1960 we acquired in the United States the first federal public assistance legislation in which the con-cept of "medical indigency" has been embodied as a statutory basis for aid. This emerged from a national debate on health insurance for all of the aged. Crippled children's programs, Veterans Administration medical services, and certain other programs, it is true, pro-vide federal funds for specific bene-ficiaries who are, in fact, "medically in-digent," and purely local or state funds have long been used for the "med-ically indigent" under the "general as-sistance" heading. But the Kerr-Mil Is program on Medical Assistance to the Aged was the first amendment to the basic structure of welfare services for the needy in which federal support for this concept became crystallized into law. The MAA amendments, of course, ap-ply only to persons past 65 years of age, but it is perfectly clear that certain groups would like to see the concept extended to all age levels, and indeed the NCOA Report specifically empha-sizes this wider applicability. The basic premise, therefore, is that the total pop-ulation may, for the purpose of financ-ing medical care, be divided into sev-eral more or less distinct classes. Based on the recommendations in the report, these would be essentially as follows (excuse my backward numbering which has its reasons): 5. The fully indigent—persons who need financial assistance for their basic living needs, as well as for all their medical care, in order to survive. 4. The wholly medically indigent-persons of such low income that, while they can eke out a subsistence life with respect to food, clothing, and shelter, need financial assistance for the medical care of any illness, if it is to be of adequate quality. 3. The partially medically indigent-persons whose income and family re-sponsibilities permit them to meet ordi-nary living requirements as well as the costs of minor illness, but who require financial assistance for the costlier med-ical care of serious or prolonged ill-ness. 2. The insured self-reliant— persons whose income and responsibilities per-mit them to meet ordinary living re-quirements as well as the cost of minor illness, and who are protected by some form of medical care insurance which covers the costs of major or prolonged (but not too prolonged) illness. 1. The fully self-reliant — persons who, with or without insurance, can meet without assistance all their living costs as well as all costs of medical care for any illness, minor or major. Even this subdivision of the Amer-ican population into five classes, intri-cate as it may seem, is really an over-simplification. As social workers know, there are various subclasses of fully indigent under Class 5. Under the prin-cipal "medically indigent" groups, Classes 4 and 3, there are numerous shadings and subdivisions depending on the type of illness, the availability of organized medical facilities, the attrib-utes of the family at the time and place, and so forth. Under Class 2, the combinations and ramifications of in-surance coverage and benefits would lead to another dozen or so subclasses, if the scene were fully analyzed. And even under Class 1, the definition would have to lead to numerous sub-classes, unless it were so strictly applied that only a handful of oil magnates or movie stars ended up in it. Yet, this is the kind of demographic gymnastics that we are led to by the conceptual premises of this report on "medical indigency." There are two di-mensions to medical indigency, as the reports brings out so well, (a) the per-son and (b) the medical requirements, 12 THE HEALTH BULLETIN March, 1965 and the range of variability along both these dimensions is very long, indeed. It is hard enough to make a sound judg-ment along the first dimension, but to do it along the second, and then along both in combination—if this is done scientifically and objectively— is an enor-mous administrative task. I was particu-larly struck by the somewhat cavalier brevity of the report on the need for "information and adequate interpreta-tion on . . . anticipated duration and estimated cost of medical care" for a pa-tient. Prognosis is tough enough for the soundest clinician, and attaching price tags to it as well calls for the com-bined wisdom of a William Osier and a John M. Keynes. Mrs. Alt cogently points out that 42 per cent of American families—with in-comes in the $3,000 to $7,500 range-are vulnerable to medical indigency; she believes that "a majority of these (fami-lies) will fall at some time within the medically indigent group." I suspect that this is a conservative estimate, but the administrative task is to identify which individual families in this "majority" and which dates within this "time" yield an affirmative decision on medical indigency. Small wonder that all these complexi-ties and uncertainties about the imple-mentation of the concept of medical in-digency have led most industrialized na-tions of the world to give it up com-pletely. In its place, they have substi-tuted systems of social insurance for medical care and networks of public clinics and hospitals for virtually all who come to their doors. Almost all countries have done this for the total population with respect to the costliest element in health service—care in a general hos-pital— including most recently our Ca-nadian neighbor to the north. The objection to the "medical in-digency" concept lies not only in its enormous administrative complexity— which must of course be translated into the costs and time and efforts of skilled professional personnel. These efforts could be far better spent on social case-work and other positive services. More important are its implications for the kind of medical care that people would and do receive in a class-structured sys-tem. A class-categorization of people for entitlement to medical care—whether into five levels as implied by this report or into ten levels or into two levels-leads inevitably into class-levels of med-ical service. The evidence for this is around us everywhere��� in the crowded public clinic compared with the private medical office, in the public ward surg-ery by the assistant resident versus the private room surgery by the board-certified specialist, in the dental ex-traction versus the root-canal therapy. This, of course, was certainly not the intention of the dedicated people who have produced the report that Mrs. Alt has summarized. But there is world-wide evidence that for reasons that are at once economic, political, and atti-tudinal this is where it leads us. We have been moving forward in America with a democratization of med-ical care through the vast growth of health insurance. We still have a long way to go, but progress is being made every day. Here in California, there is serious talk of emerging from our 19th century county hospital system for the separate care of the poor. The Social Security Act pension system was a mile-stone in helping to achieve economic in-dependence and dignity for nearly all aged persons, without a means test. I hope we do not now encourage a move-ment backward, along the path laid out by the Kerr-Mills amendment, into a legally frozen class-ridden pattern for an American's entitlement to general medical care. Milton I. Roemer, M. D. Professor of Public Health, University of California School of Public Health, Los Angeles, Calif. March, 1965 THE HEALTH BULLETIN 13 IMMUNIZATIONS START AT HOME Members of the Staff of the State Board of Health took their own medi-cine Monday morning when they lined up for needed immunizations as the State Board launched a 17 month State-wide program urging early immuniza-tion especially of the new-born and of pre-school age children. Shown in the picture is Mollie Murray, who operates the Snack Bar in the Cooper Memorial Health Building, receiving one of her shots from Mrs. Ruth L. Edwards, pub-lic health nurse of the Wake County Health Department. Looking on, from the left, are Dr. Jacob Koomen, Jr., As-sistant State Health Director; Dr. Ronald H. Levine, field epidemiologist of the State Board; and Dr. William E. Bellamy, Jr., of the Wake County Medical So-ciety. MEMBERS OF THE NORTH CAROLINA STATE BOARD OF HEALTH Lenox D. Baker, M.D., President Durham John R. Bender, M.D., Vice-President Winston-Salem Ben W. Dawsey, D.V.M Gastonia Glenn L. Hooper, D.D.S. Dunn Oscar S. Goodwin, M.D. Apex D. T. Redfearn, B.S. Wadesboro James S. Raper, M.D. Asheville Samuel G. Koonce, Ph.G. Chadbourn John S. Rhodes, M.D. Raleigh EXECUTIVE STAFF J. W. R. Norton, M.D., M.P.H. State Health Director Jacob Koomen, Jr., 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 W. Burns Jones, M.D., M.P.H. Director, Local Health Division E. A. Pearson, Jr., D.D.S., M.P.H. Director, Oral Hygiene Division Lynn G. Maddry, Ph.D., M.S.P.H. Acting Director, Laboratory Division Ben Eaton, Jr., A.B., LL.B. Director, Administrative Services Division James F. Donnelly, M.D. Director, Personal Health Division 14 THE HEALTH BULLETIN March, 1965 No Certainty In Eldercare The problem of the elderly ill who can not afford adequate medical care has been with us for a long time, but the latest Louis Harris survey puts it in clear perspective: It is the number one domestic issue in the country today. More than 32 per cent of all American families have an elderly member in need of special medical attention, and less than half of them can afford it, the Harris survey found. That helps explain President Johnson's determination to enact the Medicare plan that would provide guaranteed hospital care for the elderly under Social Security. It is the high cost of hospital services which overwhelms the meager financial resources of so many old people. The Medicare plan is under attack by the American Medical Association which proposes an alternative it labels as the "Eldercare" plan. This alternative would, the association says, authorize medical and surgical payments as well as pay-ments for hospital bills. It would indeed authorize a wide range of health care services. But it would guarantee very little. Under Eldercare, it would be up to the states to put up matching funds and decide the level of medical care provided. This could be as little as one day in a hospital and one visit annually from a doctor. Some state legislatures would enact a niggardly program because of dominant conservative control in state government. Many more, such as North Carolina, would do the same because they can afford no better. This is not the only grave fault of the Eldercare plan, but it is one of the bigger ones not even hinted at in the glowing AMA sales pitch. In contrast, the elderly would know what they were getting under Medicare and they could depend on it: Sixty days of post-hospital care, 240 days of home-health visits, and out-patient diagnostic service every year. Editorial in Raleigh (N. C.) News and Observer, March 2, 1965 March, 1965 THE HEALTH BULLETIN 15 THE HEALTH BULLETIN P. O. Box 2091 Raleigh, N. C. 27602 LIBRARIAN DIVISION OF HEALTH AFFAIRS LIBRAi N.C. K£M. H03P. U. N. C. CHAPEL HILL, N.C. If you do NOT wish to con-tinue receiving The Health Bul-letin, please check here |— | and return this page to '— ' the address above. Printed by The Graphic Press, Inc., Raleigh, N. C. DATES AND EVENTS April 20-22-Eastern Branch, NCPHA, Blockade Runner Hotel, Wrightsville, Beach. April 22-23-Annual Meeting, N. C. Tuberculosis Association, Robert E. Lee Hotel, Winston-Salem. April 22-24—Seventh Southern Regional Institute on Recreation with the III and Disabled, Chapel Hill. April 23-24-Annual Meeting, N. C. Chapter of the American College of Surgeons, Blockade Runner Hotel, Wrightsville Beach. April 23-24-Annual Meeting, N. C. Society of X-Ray Technicians, Ashe-ville. April 25-28—Southeastern Psychiatric Association, Annual Meeting, Pine Needles Lodge, Southern Pines. April 27-29-N. C. PTA Convention, Jack Tar Hotel, Durham. April 28-May 1—American College Health Association, Miami Beach, Fla. April 29-30— President's Committee on Employment of the Handicapped, Washington, D. C. May 1-5—Medical Society of the State of N. C, Queen Charlotte Hotel, Charlotte. May 1-7-National Mental Health Week. May 2-8-N. C. Special Week on Ag-ing. May 3-7— National League for Nursing (Biennial Convention), Civic Auditor-ium, San Francisco, Calif. May 4-5—Association of American Phy-sicians, Atlantic City, N. J. May 5-6—Annual Meeting, N. C. Die-tetic Association, Jack Tar Hotel, Durham. May 6-8—American Pediatric Society, Philadelphia, Penn. May 7—Annual Conference of N. C. Rural Safety Council, YMCA, Raleigh. May 9-15-National Hospital Week. May 1 0-1 2—American National Red Cross, Detroit, Mich. CONTENTS Medicare Awaits Senate Action 2 How the AMA Supported Eldercare Bill Compares with the Admin-istration Sponsored Medicare Proposal 3 Medicare Vs. Eldercare 7 Determining Medical Indigency 9 Principles proposed by National Council on the Aging Comments by Dr. Milton I. Roemer Immunizations Start at Home 14 No Certainty in Eldercare 15 16 THE HEALTH BULLETIN March, 1965 The Officio! Publication Of Carolina State Board of Health V, %Q*r flPZU i9bf in ' .-'" «'. llH A promising theory of modern cancer research holds that certain indi-viduals (represented by the shaded fiingerprints on our cover) share symptoms indicative of a high cancer risk. If this proves true, doctors will be able to identify, among a typical group like the one below, persons who are most likely to develop cancer and who therefore need more frequent and more specialized treatment. For more, see page 3. THE HEALTH BULLETIN April, 1965 "I have a theory that virtually all agents which can produce cancer, produce other types of changes first . . . The problem has been to launch an all-out search for such symptoms, which is just what we're doing in the cancer prevention study." "In a fundamental sense, all health is one nowadays. The battle against cancer in-evitably involves fresh insights into what it takes to live and be healthy in a shrinking and increasingly complex world. Evolution has not adapted us to many of the things we are introducing into our environment, tensions as well as drugs . . ." AVisit With Cuyler Hammond By JOHN E. PFEIFFER We call on the head of the American Cancer Society's Statistical Research Station who tells how the disease is being studied with statistics, surveys and data processing. Reprinted by permission from THINK Magazine, Copyright 1965 by International Business Machines Corporation. IN the last analysis, all medical pro-gress can be traced to clinical find-ings, to the recognition of significant differences between people who come down with a particular disease and people who don't. A classical example is the 18th century "superstition" that April, 1965 THE HEALTH BULLETIN milkmaids were protected from small-pox by previous infections of a related but far milder disease, cowpox, a notion that led to the development of success-ful vaccines. Today, as in times past, advances continue to come from shrewd observations, which are often based on highly sophisticated methods of gather-ing data and making inferences. Such methods are being used in the increasingly intensive fight against can-cer, in many ways the most challenging medical problem of our times. For more than forty years, the leader in this fight has been the American Cancer Society, Inc., which, in addition to sup-porting laboratory and hospital research, has launched large-scale surveys de-signed to provide new knowledge about the causes and prevention of cancer—an activity directed by E. Cuyler Hammond, head of the Society's Sta-tistical Research Station and an inter-nationally noted master of the subtle art of evaluating facts. A Yale graduate and former indus-trial health investigator at the National Institutes of Health, Hammond is most widely known for findings on smok-ing and health. But his interests ex-tend beyond the problem of lung can-cer, as I learned when I spoke with him recently in New York, where Am-erican Cancer Society headquarters are located. Hammond is a quietly intense, lean-faced man in his early 50's. He chooses his words carefully before responding to a question and then starts talking at a rapid rate, looking at you with sharp eyes and usually punctuating the end of his answers with a smile. Dedicated to the full-time job of an-alyzing ideas that can be expressed pre-cisely and tested (he works most nights and every weekend), he approaches cancer problems from a broad point of view. "The greatest achievement of the last hundred years," he told me, lighting up his pipe, "isn't the hydrogen bomb or space travel or more washing machines. These things and a good deal more are all by-products of a more basic devel-opment, the spectacular improvement in health which has given us time for longer periods of education and for longer productive lives. If you look back at the records for this country you can see that the big killers were, as they still are in some parts of the world, infectious and parasitic diseases such as malaria, smallpox and tuber-culosis. The huge decline in death rates has been above all a result of preven-tive medicine, slum clearance and san-itation and vaccines and other public health measures. "Our biggest problems today are heart disease, cancer and other degen-erative illnesses which generally take years or decades to develop and tend to The Health Bulletin First Published—April 1886 The official publication of the North Carolina State Board of Health, 608 Cooper Memorial Health Building, 225 North McDowell Street, Raleigh, N. C. Published monthly. Second Class Postage paid at Raleigh, N. C. Sent free upon request. EDITORIAL BOARD Charles M. Cameron, Jr., M.D., M.P.H. Chapel Hill John T. Hughes, D.D.S., M.P.H. John C. Lumsden, B.C.H.E. Mary Ann Farthing, M.S. Jacob Koomen, Jr., M.D., M.P.H. Bryan Reep, M.S. John Andrews, B.S. Glenn A. Flinchum, H. W. Stevens, M.D. B.S. M.P.H., ASHEVILLE Editor—Edwin S. Preston, M.A., LL.D. Vol. 80 April, 1965 No. 4 THE HEALTH BULLETIN April, 1965 •';:-> "The past thirty years or so have seen a notable increase in cure rates, one major reason being the American Cancer Society's public education program." strike later in life—and here again a central goal, together with improved treatments and cures, is prevention. As in the past, we must draw heavily on the techniques of epidemiology, the study of circumstances under which dis-ease occurs in the human population. We want to discover critical causative factors, factors which increase the prob-ability of sickness and death." Accent on Statistics Hammond is well aware of the dif-ficulties of such research. For relatively minor ailments like athlete's foot, new treatments may be tested on patients without running serious risks. But when it comes to major diseases, investigators can't perform extensive experiments on human beings. Furthermore, animal experiments conducted under strictly controlled laboratory conditions have only a limited, remote bearing on the uncontrolled and complex conditions of everday life. So the accent is neces-sarily on statistics based upon obser-vations rather than experiments. Since it is quite possible to draw invalid con-clusions from valid facts, I asked about the pitfalls of the statistical approach. "Let me give you an example," Ham-mond replied, as he paused to relight his pipe. "During World War II, I was stationed at the Air Force School of Aviation Medicine in Texas, and we were all very much concerned with the extremely high accident rate among pilots undergoing training. Some psy-chiatrists had the theory that most of the accidents were occurring among 'accident-prone' men, individuals psy-chologically predisposed to carelessness resulting in accidents. So, pilots recently involved in aircraft accidents were ask-ed detailed questions about their child-hood accidents—and they recalled a great many falls, broken bones and other mishaps. On the other hand, pilots who had never been involved in an aircraft accident reported very few childhood accidents. Apparently the ac-cident- prone theory had been confirm-ed. "I was immediately suspicious, how-ever. For one thing, the results were too darned good. Hardly anything seem-ed to have happened during the child-hoods of pilots with no training ac-cidents, while everything seemed to have happened to less fortunate pilots. I suspected that there might have been some bias in response, because an air-craft accident can be a terribly shaking experience. A man may be in such a state of confusion and guilt afterwards that you could probably get him to 'confess' to beating his own mother. This is always one of the problems with the 'retrospective' or historic sur-vey, that is, a survey involving people April, 1965 THE HEALTH BULLETIN who are already victims of the condition you are trying to learn about. Emo-tionally upset people cannot be count-ed on to give unbiased reports. "So we decided to do a prospective or follow-up survey, questioning about twenty-five hundred consecutive pilots-to- be before they went into training. Then we put the records away in a safe. More than a year later, we went back and compared the records of pilots who had been in accidents during their first year of training and pilots who hadn't. As far as the number and severity of childhood mishaps were concerned, absolutely no significant dif-ference existed between the two groups. In other words, it was useless to question applicants about their child-hood accidents as a means of eliminat-ing men most likely to be involved in an aircraft accident. "This experience was very much on my mind 15 years ago, when we knew much less about smoking and cancer, and most of our statistics were based on retrospective surveys. But many of us, aware of the possibility of a bias factor and other problems, were frankly skeptical." Hammond explained that the next step, as in the Air Force study, was an ambitious prospective survey—the first of its kind in this country and a task which only an institution like the American Cancer Society could under-take. In 1951, it mobilized more than 22,000 volunteers, many of them form-er cancer patients, to obtain complete information about the smoking habits of some 188,000 presumably healthy men between the ages of 50 and 70. In or-der to avoid possible bias on the part of the volunteers, the men were not in-terviewed; they were simply asked to fill out questionnaires. Having built up considerable good will among physi-cians and hospital authorities over the years, the Society had ready access to medical details on those who died of cancer. When the time came for follow-up studies two years later, 1 1,870 men had died, 2,249 of them from cancer. Analysis of the records confirmed retrospective studies in showing a de-finite association between cigarette smoking and cancer. "Just as impor-tant," says Hammond, "we had shown that follow-up studies were feasible on a very large scale, if you have a good organization behind you and plenty of volunteers. If we'd had to pay them what they were worth, it would have cost us several million dollars. "Soon we began thinking about our ultimate objective: means of preventing many if not all types of cancer. In or-der to obtain information directed to-ward this goal, an even more extensive epidemiological study was required, one which would deal with other factors as well as smoking, other forms of cancer, and women as well as men. We worked out a most thorough questionnaire. Among other things it included occupa-tion, details of present health status, education, eating and drinking habits, hours of sleep per night, and so on. The survey started more than five years ago, with 68,000 volunteers this time. The plan was to interview some million people aged 30 or older, and to follow up every one of them six times at an-nual intervals. "Right now we're finishing our fifth follow-up and are beginning to analyze the data. We already have about three hundred bits of information about each person, so you can appreciate the mag-nitude of our task and why we've had to develop special ways of using elec-tronic computers. In our work spectac-ular calculating speeds aren't nearly as important as effective man-machine communications. Since I like to plan as I go, what matters to me is how long it takes from the time I get an idea— a hunch, if you will—to the time I see an THE HEALTH BULLETIN April, 1965 actual printed table. Then I want to be able to modify my idea, or try another one in a reasonable time, and get a quick answer again. It's something like having a conversation with the comput-er." What are the objectives of the cur-rent survey? "Part of the story is indicated in the official name, 'Cancer Prevention Study.' The past thirty years or so have seen a notable increase in cure rates, one major reason being the American Can-cer Society's public education program. The emphasis on danger signals, per-sisting symptoms such as hoarseness or unhealing sores which may result from early stages of the disease, has certain-ly helped alert people to the impor-tance of prompt treatment. But we want to do better than that, to carry the offensive one step further. "What we would like to do is dis-cover complaints that appear before the disease process has a chance to establish itself. I have a theory that virtually all agents which can produce cancer, produce other types of changes first. For example, lung cancer is al-ways preceded by an appreciable in-crease in the number of cell layers in the bronchial tubes, more mucus and other effects which very probably de-velop years or decades before cancer. It also happens that such tissue changes within the body may be associated with symptoms like coughing and shortness of breath. All-Out Search "The problem hbs been to launch an all-out search for such symptoms, which is just what we're doing in the cancer prevention study. We are looking for signs on the broadest possible basis because, as things stand now, we don't know exactly where to look. We have asked our million persons how much exercise they get (none, slight, mod-erate, heavy), which of six medicines they use (never, seldom, often), wheth-er they experience various degrees of some two dozen physical complaints, and a host of other questions. We hope to discover that certain of these factors, "In a fundamental sense, all health is one nowadays. The battle against can-cer inevitably involves fresh insights in-to what it takes to live and be healthy in a shrinking and increasingly complex world." April, 1965 THE HEALTH BULLETIN or "clusters of factors, may serve as warnings of impending cancers." To Save More Lives Nothing of this scope has ever been t|ied before, and Hammond pointed out that it is still much too early to predict just how the new approach will work out. But the American Cancer Society is conducting other important statistical studies, and he cited one of them as an example of future possibilities. A pro-spective or follow-up study is under way involving the occurrence of cervical cancer among more than eighty thou-sand women in Toledo, Ohio. The main purpose is to investigate a tentative finding which, if confirmed, might mean the saving of many lives. "Earlier studies had suggested the existence in the population of a group of 'high-risk' women—women who re-ported any kind of cervical complaint such as discharge or bleeding. Remem-ber that, as far as medical science can tell, they were absolutely free of cer-vical cancer. Yet follow-up observations indicate that they are 10-to-15 times more likely to contract the disease than women who did not have such com-plaints. Another important point is that they made up a small proportion of the total group, about one out of seven women. "Now we're checking these results, among others, with the aid of an elec-tronic computer and expect to have our answers within six months or so. As-suming that our preliminary findings are indeed valid, we shall make a strenuous effort to persuade these high-risk wo-men to report for special medical ex-aminations every six months. You can see the possibilities here. Most cer-vical cancer seems to occur in a group that can be identified beforehand, and the chances are good that by focusing on this group we may be able to lower death rates appreciably. Furthermore, our large-scale cancer prevention study is designed to locate other high-risk groups, if they exist. "This may also be the best way to get back to basic causes, a central aim of all our research. If high-risk groups are found and examined two or more times a year, medical investigators will have a unique opportunity to follow more closely than ever before the long and intricate process whose last stages are what we call cancer. According to one theory, the one I favor, this process depends ultimately on a special kind of genetic change. "Think of the body's cells as popula-tions of living things. They are con-tinually dying and being replaced by newborn cells and, as in all popula-tions, there are mutations or 'sports' in every new generation. Among the mutants some cells have the potential ability to multiply abnormally. They will not do so, however, unless condi-tions are right—that is, unless their en-vironment inside the body is altered in a suitable way. For example, tobacco smoke may alter the environment so as to favor lung-cell mutants capable of malignant growth at the expense of normal tissue. A kind of natural selec-tion may be working in the body, and our research will help us evaluate this theory and others." Toward the end of our talk, Ham-mond emphasized the widening scope of the current large-scale survey. The primary purpose is naturally to cure and prevent cancer, but a prospective study by its very nature provides signi-ficant information about a variety of conditions. For example, out of the mil-lion persons originally interviewed five years ago about forty-five thousand have already died—and, as expected, a large proportion of them died from heart and circulatory diseases. So it is hardly surprising that results are of con-siderable interest to specialists in many fields. THE HEALTH BULLETIN April, 1965 "An enormous amount of data will have to be processed here, with im-plications for the social as well as the medical sciences. Many of our subjects have moved, and in tracing them and obtaining their records we are collect-ing material about the shift of people from country to city, about the effects of migration on health and the family. In other words, we shall have an in-credibly large number of associations of significant relationships to explore. We receive requests for information from business schools, sociologists, psy-chologists and many other sources. But we have hardly scratched the surface as far as a full analysis of the data is con-cerned. That could take another decade, or another generation. All Health Is One "In a fundamental sense, all health is one nowadays. The battle against cancer inevitably involves fresh insights into what it takes to live and be healthy in a shrinking and increasingly com-plex world. Evolution has not adapted us to many of the things we are intro-ducing into our environment, tensions as well as drugs and other chemicals. We must adjust culturally .and a most important example of that is the con-tinuing drive to prevent disease and raise health levels everywhere. This is the challenge which confronts us all, and if past successes are any indication, I believe we can look forward to sig-nificant progress in the future." Research Being Done in Public Health Practices Progress on organizing research into the evaluation of public health practices was reported at the annual meeting of the American Public Health Association last year by Dr. Vlado A. Getting. The paper presented by the Professor of Public Health Practice at the University of Michigan's School of Public Health was developed by members of the mul-tidisciplinary research team which is conducting the study under a grant from the Public Health Service. Presently-used methods of evaluation were declared to be of little value be-cause many depended in large part on arbitrarily established standards or measurement of effort which is equated with accomplishment. Another criticism was that standards which might be suit-able in one place or under one set of circumstances might not be in another. The study at the University of Michi-gan was set up, Dr. Getting said, to work toward: "the development of tools for the evaluation of program ef-fectiveness, the exploration of factors that motivate people to follow health recommendations, and the identifica-tion of factors that influence an or-ganization's ability to make desirable program changes." In further definition of the objec-tives of the study, Dr. Getting stated the evaluation methods which it sought to develop should: permit a true assessment of the extent to which ob-jectives are attained; be in such form as to permit a self-evaluation by the April, 1965 THE HEALTH BULLETIN operating agency; be applicable to any public health program regardless of size or complexity; and reveal the prob-able source or location of program weaknesses where such exist. "Such evaluation devices will permit different localities to use the same methodological approach to evaluate quite different health programs," Dr. Getting said. "Each locality can assess what it has achieved with respect to its own locally defined objectives and needs." The task of the study group has been divided into three steps, Dr. Getting stated: describe programs in precise terms as to their objectives; measure actual accomplishment, bearing in mind the difficulty of measuring directly some of the qualities of an objective, and whether any improvement noted may be due to causes other than the pro-gram under consideration; validate measurement devices by use on exist-ing programs. To date, Dr. Getting indicated, the group's work has consisted mainly of "developing means of describing pro-gram objectives and activities in a manner that will permit subsequent evaluation." For this purpose a "Guide for Identification of Program Activities and Objectives" for use by program personnel of health agencies has been developed. "In this guide," Dr. Getting said, "the work that constitutes the program to be evaluated must be locally defined. The instructions suggest only one caution: If a program is unusually large and complex, it may be better to subdivide it and treat the parts as individual pro-grams." The agencies are asked to list program activities and their com-ponents, and the objectives of each activity. Definition of objectives is re-quested in "statements that are precise and complete enough to permit an ac-curate measurement of the extent to which they are being accomplished." According to Dr. Getting, the expres-sion of program objective should meet these requirements: "The statement must refer to a need, situation or con-dition that is external to the person or agency conducting an activity ... It must be stated with sufficient precision to indicate both quantitative and quali-tative aspects of desired outcomes." Dr. Getting said further that "it may be necessary to identify the validity of assumptions that underlie the use of particular activities to achieve particular objectives, and the assumptions that link together the several program ob-jectives and sub-objectives." There is a probability, Dr. Getting said, "other approaches to evaluation of public health practice, such as the expert survey technique, will be tested at some future time." Several other studies were also men-tioned. Among these were investiga-tion of the most effective way of de-termining people's health beliefs and their actions to protect their health, and identification of key factors in-fluencing health agencies to adapt to meet changing conditions and needs. Summing up, Dr. Getting stated that "the program includes research on the program effectiveness and on the con-ditions under which health organiza-tions are able to modify their programs and organization in the interest of in-creased effectiveness. Other research seeks to throw light on personal de-cision- making processes in health areas, and to develop a better understanding of how people are persuaded to change their health practices. The research pro-gram is beginning to produce experi-mental tools which will have to be field tested over a period of years but pro-gress to date indicates that the results will be useful in the difficult but high-ly important task of strengthening community health practices." 10 THE HEALTH BULLETIN April, 1965 Choose Your Own attitude toward their use, says To-day's Health, the magazine of the American Medical Association. Today, hair color is not just accept-able— it is high fashion, says the mag-azine article, prepared by a noted der-matologist and a cosmetic chemist, in consultation with the Committee on Cutaneous Health and Cosmetics of the AMA. This year Americans are expected to spend one hundred million dollars on hair-coloring products. While women are the principal users, many men also use hair color. Hair color can be modified in one of two ways. The natural pigment of the hair can be bleached, and thereby light-ened, or artificial coloring can be ap-plied. Often both operations are car-ried out to produce the desired effect. The importance of reading and ob-serving the directions for using all hair-coloring products cannot be over-emphasized. This is especially true of IQI* the permanent colors. They are most difficult to remove. Modern hair-color-ing products will give excellent results for most users, but only if the instruc-tions are carefully followed. One of the major causes of dissatis-faction by home users is the mistaken belief that a single application of hair color will produce any desired shade. This is not so. It is quite simple to cover gray hair or to color light hair a darker III shade, but it is not yet possible for a single application of any hair coloring to change black or dark brown hair to a pale blond. Peroxygen compounds, especially hydrogen peroxide, are widely used in bleaching hair. Six per cent hydrogen peroxide solution is the standard strength, and is safe, if proper pre-cautions are observed. Stronger concen- The last few years have seen a flood trations can produce burns and blister-of new hair-coloring products, and ing of the scalp. Excessive bleaching hand-in-hand came a change in public can leave the hair harsh, strawlike and April, 1965 THE HEALTH BULLETIN 11 Coh of Hoi brittle. Largest and most important group of hair dyes are those based on synthetic organic chemicals. These are in three categories—oxidation dyes, semi-permanent dyes and temporary rinses. Oxidation dyes are the most widely used. Most professional hair coloring or tinting is now done with oxidation dyes, and they also have become pop-ular for home use. They are the only products that color the hair quickly and yet produce all varieties of natural hair shades which are lasting. The biggest question about oxida-tion dyes is their hazard. It has been estimated that about one person in 50,- 000 will have an unpleasant reaction, such as a skin rash, swelling about the eyes, redness and crusting of the face and neck, plus itching and discomfort. The victim, while uncomfortable, should be aware that this is not a serious ill-ness and that she will recover. Included with each package, accord-ing to federal regulations, are instruc-tions for performing a patch test before using oxidation dyes, to determine whether there is an allergy. The test should be repeated before each applica-tion of the dye. And the dyes should not be used on eyebrows or eyelashes, because of possible danger to the eye. In addition to the oxidation dyes, there also are semi-permanent dyes, which usually will wash out with one shampoo; acid color rinses, using harmless organic acids; vegetable dyes, principally henna, and metallic dyes, no longer as popular as in the past. If you decide to change the color of your hair, and if you decide to do it yourself rather than seek a professional job, the important thing to remember is to read the instructions on the label and the package insert, and follow them carefully. These are for your own safety and protection. Film On Occupational Health Is Now Available The Occupational Health Division of the U. S. Department of Health, Educa-tion and Welfare has made available to the State Board of Health a new motion picture, "The Hidden Hazards." This film is obtainable on loan from the Film Library of the State Board, Box 2091, Raleigh. "The Hidden Hazards" tells the story of occupational health. It shows how man has progressed from the early trades with obvious dangers, today's complex operations, in which the haz-ards may be less evident. See what is being done to protect employed men and women from those health hazards which arise in the course of their work. Starting on a dramatic note—the near fatal poisoning of a metal shop worker -the HIDDEN HAZARDS depicts the growth of occupational health. The film traces the change in attitudes and practices over the years. The apathy of ancient times, when slaves carried on the dangerous trades, has gradually been replaced by action to safeguard worker health. Today everyone recognizes that cer-tain kinds of work are more hazardous than others. Sometimes the danger comes from the conditions under which men work. Sometimes it lies in the materials they use. Often workers are surrounded by dangers they cannot see. Occupational health presents a chal-lenge of vital concern to all Americans. It is our hope that this new 28 1/2- minute, 16 mm, black-and-white, sound film will be widely used for showings before civic and fraternal organizations, women's clubs, and business and labor, as well as professional, groups. It may also be of interest to secondary school students from the standpoint of career opportunities. 12 THE HEALTH BULLETIN April, 1965 HOPE FOR HEARTS-When the former Hope Cooke, newly crowned queen of the tiny Himalayan kingdom of Sikkim, recently visited her cousin, Mrs. R. Phillip Hanes of Winston-Salem, alert Heart Association volunteers posed Her Majesty with a "Hope for Hearts" post-er. "Hope for Hearts" is the theme of the North Carolina 16th Annual Meet-ing and Scientific Sessions (Durham, May 20-21) which will feature special sessions for the general public and lay Heart Association Volunteers as well as for family physicians. DIAL "H" FOR HEART — Five-year-old Sheila Dial, who recently underwent heart surgery at Duke University Medical Center, receives a surprise visit from North Carolina's Heart Mother of the Year, Mrs. Walter S. Cobb, herself a "graduate" of heart surgery. Mrs. Cobb is one of several hundred North Carolina Heart Association Volun-teers who will be in Durham on May 20-21 for the State Heart Group's 16th Annual Meeting. Looking on, above right, is Mrs. Mel-vin Dial, young Sheila's mother. April, 1965 THE HEALTH BULLETIN 13 Community Safety Courses Being Offered Educational opportunities at both the graduate and continued education level in the field of community safety were announced recently by the Department of Public Health Administration, School of Public Health, University of North Carolina at Chapel Hill. Expanding a program initiated three years ago, the department will enroll six graduate students in the curriculum leading to a Master of Public Health degree for the academic year beginning September 1965. Up to 30 students will be accepted for the short course dealing with program development techniques in accident control, which will be held May 31 -June 4, 1965. "The graduate program is open to persons from the fields of education, nursing, engineering, social science, medicine, and allied fields of interest who are seeking careers as accident control specialists in a local, state, or national health agency or in a private organization," Dr. Charles Cameron, Professor and program director, said. "Through a special grant from the U. S. Public Health Service, financial support is available for qualified stu-dents who are accepted in the master's program," stated Dr. Cameron. "Inter-ested persons are urged to contact the department without delay." Applications are now being accepted for the 1965 short course, according to Miss Janice Westaby, Assistant Profes-sor and co-director of the program. In-formation can be obtained by writing to the Accident Control Program, De-partment of Public Health Administra-tion, UNC School of Public Health, Drawer 229, Chapel Hill, North Caro-lina. MEMBERS OF THE NORTH CAROLINA STATE BOARD OF HEALTH Lenox D. Baker, M.D., President Durham John R. Bender, M.D., Vice-President Winston-Salem Ben W. Dawsey, D.V.M Gastonia Glenn L. Hooper, D.D.S. Dunn Oscar S. Goodwin, M.D. Apex D. T. Redfearn, B.S. Wadesboro James S. Raper, M.D. Asheville Samuel G. Koonce, Ph.G. Chadbourn John S. Rhodes, M.D. Raleigh EXECUTIVE STAFF J. W. R. Norton, M.D., M.P.H. State Health Director Jacob Koomen, Jr., 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 W. Burns Jones, M.D., M.P.H. Director, Local Health Division E. A. Pearson, Jr., D.D.S., M.P.H. Director, Oral Hygiene Division Lynn G. Maddry, Ph.D., M.S.P.H. Acting Director, Laboratory Division Ben Eaton, Jr., A.B., LL.B. Director, Administrative Services Division James F. Donnelly, M.D. Director, Personal Health Division 14 THE HEALTH BULLETIN April, 1965 Pesticides Are Dangerous— Follow the Directions No matter how often you use a pes-ticide— for home, garden, or farm—or how well you think you know the di-rections, READ THE LABEL each time be-fore you start work and FOLLOW THE DIRECTIONS EXACTLY. The other im-portant rule is KEEP PESTICIDES AWAY FROM CHILDREN. Other suggestions for safe and sen-sible use of pesticides are: 1. Use a pesticide only when you are sure it is needed and then use the one best suited to your needs. The label on the product explains the proper uses. 2. Keep pesticides in plainly labelled container, preferably the one in which it was bought. Never trans-fer pesticides to unlabelled or mis-labelled containers. 3. Store pesticides under lock and key away from food items and OUT OF THE REACH OF CHILDREN, pets, and people who might not be able to understand their danger. 4. Avoid inhaling dust and fumes and avoid getting materials on the skin when handling, mixing, or apply-ing pesticides. 5. If there is an accident, most pes-ticide labels advise washing the affected area with lots of fresh water in cases of external exposure. Check the label of the product before using so you know what to do quickly if there is an accident. Also, call a doctor or get the pa-tient to a hospital immediately. 6. People who suspect special sen-sitivity to pesticides should consult an allergist and, if necessary, take steps to avoid any exposure to the offending agent. 7. Wash hands thoroughly after using pesticides and before eating or smoking. 8. Get rid of used containers in a way that will not leave package or leftover contents as a hazard to people—particularly children— ani-mals, or plants. 9. Work in well-ventilated area to avoid inhalation of fumes. 10. Do not spray into the wind. 11. Wear protective clothing, such as gloves, aprons, goggles, respira-tors, and masks, when so directed. 12. Change clothing after each day's operations and bathe thoroughly. If clothing or skin become con-taminated, wash the skin and change to clean clothing. Wash contaminated clothes before reus-ing. 13. Avoid the fire hazard caused by smoking, |