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Ci)e ILititatp of t|)e Dtt)t$ion of l^ealti) affait0 OniDetjSitp of il^otti) Carolina This Book Must Not Be Taken from the Division of Health Affairs Buildings. This JOURNAL may be kept out TWO DAYS, and is subject to a fine of FIVE CENTS a day thereafter. It is DUE on the DAY indicated below: J^ DIVlflorOF HEALTH AFFAIRS LIBRARY N.C. KEM. HOSP. U. N. C. CHAPEL HILL, N.C. (i®Mb'!SiI PuUisKed bvm/TETflcmM smamw^RimR I TKis Bulletin will be szrd^f^^o dnn cilfzen of tke Stafe upon request I Entered as second-class nmt^at Postoffice at Raleigh, N. C. under Act of August 24, 1912 Published moiuirty at the office of the Secretary of the Board, Raleigh, N. C. Vol. 73 ^ JANUARY, 1958 No. 1 JAN 31 ic^'- DlVlSiOM HEALTHAFfWRSlff^,^ PENDER COUNTY HEALTH CENTER BURGAW, NORTH CAROLINA MEMBERS OF THE NORTH CAROLINA STATE BOARD OF HEALTH G. Grady Dixon, M. D., President Ayden John R. Bender, M. D., Vice-President Winston-Salem Charles R. Bugg, M. D. Raleigh Lenox D. Baker, M. D. Durham H. C. Lutz, Ph.G. Hickory Mrs. J. E. Latta Hillsboro, Rt. 1 John P. Henderson, Jr., M. D. Sneads Ferry Roger W. Morrison, M. D. Asheville Z. L. Edwards, D.D.S. Washington EXECUTIVE STAFF J. W. R. Norton, M. D., M.P.H., State Health Director John H. Hamilton, M. D., Assistant State Health Director, Director State Laboratory of Hygiene, and Editor Health Bulletin C. C. Applewhite, M. D., Director Local Health Division Ernest A. Branch, D.D.S. , Director Oral Hygiene Division A. H. Elliott, M. D., Director Personal Health Division J. M. Jarrett, B. S., Director Sanitary Engineering Division Fred T. Foard, M. D., Director Epidemiology Division E. C. Hubbard, B.S., M.P.H., Director Division of Water Pollution Control List of free health literature will be supplied by local Health Departments or on written request. CONTENTS Page Your Health and You 2 Notes and Comment 5 YOUR HEALTH AND YOU BY WILLIAM H. RICHARDSON State Board of Health Raleigh, N. C. There are many people, perhaps, who pose to give you some more which, on | are not informed as to what their the face of it, is beneficial to the health department can do for them — average citizen. what it is doing and what it will do Public health affords protection not j upon request. The State Board of only to the public in general, to par- Health publishes an informative eight- ents, little children and infants, but page booklet titled: "How Your Health also to the unborn baby, as well as its Department Serves You." While the mother. i publication is in condensed form, it The health department is working does contain much pertinent informa- toward health for mothers and babies. tion which the general public should Public health nurses make home visits have. We have referred to portions of for health supervision and encourage this booklet in the past, and now pro- expectant mothers to seek medical care January, 1958 The Health Bulletin early in pregnancy. Public health nui-ses will visit the home to teach mothers infant care. To aid in saving the lives of premature babies, special services, including transporta-tion and hospitalization, are provided for them through the health depart-ment. Many health departments hold well-baby clinics to provide medical super-vision for infants, to give immunizations and to offer information to parents on the growth and development of the infant and pre-school child. Pre-school clinics are held in cooperation with the schools and Parent-Teacher Associa-tions, to give booster immunizations and examine children for physical de-fects. The children are referred to their private physicians for medical care when indicated. Your local health department pro-vides public health nursing service for school children. Medical inspections are given to children referred by the teachers and public health nurses and to selected groups of other children. The children found to have physical defects are referred to their family physicians. Funds for correction of de-fects are available through the joint school and health departments' school health program for those families un-t able to pay for corrections. ' When necessary, the public health nurses make home visits to urge par-ents to have physical defects corrected. Special programs of hookworm, nutri-tion, chest X-ray examination, and other health programs are offered to teachers, school children and parents by many local health departments. The physically handicapped chUd 1 may come to the health department's I monthly orthopedic clinic for physical- ' ly handicapped children. The physi-cians holding the clinic are specialists ' in orthopedic work. ' Keeping the public informed about i health is an important part of the public health program. Every member of the health department staff does health education work as he or she carries on public health duties. Many health departments employ trained public health educators who work full-time on developing health education programs in the communities. The health educator and other public health workers will help communities organize to work on health problems. The development of health councils, neighborhood groups, adult study groups, and community health projects are all a part of a well-rounded pub-lic health program. The health educator and other pub-lic health workers can assist schools in developing units of study on health, aid schools with special health projects, work on programs of in-service train-ing for teachers and provide materials and films for school groups. Assistance is given to clubs, volun-tary and official agencies and indi-viduals in planning for health projects and programs and by providing them with materials and information on health. An effort is made to coordinate the program planning of groups to enable maximum benefits in the com-munity health program. The health educator and other staff members use the radio, newspapers, films, pamphlets, posters, exhibits, bul-letin boards and other media to pro-vide the public with accurate, up-to-date health information. Keeping the official record of births and deaths is one of the basic jobs of many health departments. Birth rec-ords are important for entrance to school, for employment and on other occasions when date of birth must be established. Death certificates are necessary in the settlement of insur-ance and legal matters. Certain diseases are reported to the health department by private physi-cians. This information enables the health department to plan immediate action to prevent communicable dis-eases from spreading and chart the progress of disease control. The local health department keeps records on the services provided to in-dividuals, families and the community. Studies of populations, causes of death, diseases occurring in the com-munity and studies of rates of disease and death are made use of by health departments and are also helpful to \ The Health Bulletin January, 195S schools, organizations and other agencies in planning long-range pro-grams. The public health program, just like modern medical care, must have the services of accurate laboratories. The public health laboratory services for your community may be in your local health department, or your health de-partment may use the services of the State Board of Health. Regular tests are made of milk sup-plies to safeguard the milk you buy. Public and school water supplies are tested for purity. Private approved water supplies will be tested upon re-quest to your local health department. Your health officer and your physi-cian can use the public health labora-tory service as an aid in diagnosis. Services for certain examinations of blood, feces, urine, sputum and other specimens are provided by the public health laboratories. Cancer detection and diagostic clinics are jointly sponsored by your local and state health departments, local and state medical societies and the local and state divisions of the American Cancer Society. The clinics are open to North Carolina citizens thirty-five years of age or over and citizens under thirty-five years of age who have symptoms of cancer. Ask your family physician or your local health depart-ment for information on individual examinations or for the meeting dates of the clinic nearest youi- community. The State Board of Health mobile X-ray trailers are available to carry on a chest X-ray survey in counties. Certain of the local health departments are equipped to make survey films on mobile or portable imits. Requests for the service must be made by your local health department. Clinics are open to citizens desiring guidance in emotional and mental hy-giene problems. Your local health de-partment can give you information about the clinic services nearest to you. The State Board of Health maintains a free film service to provide films, film-strips and slides on health sub-jects for use by health departments, clubs, schools and other organizations. Films may be requested through your local health department or directly from the State Board of Health. Consultation services of trained nu-tritionists and dietitians are available to schools, institutions and community groups from the State Board of Health upon the request of your local health department. The Oral Hygiene Division of the State Board of Health provides dental inspections for children under twelve years of age. Dental care is given to children under twelve years of age whose parents cannot meet the cost. This service is made available periodi-cally upon assignment from the Oral Hygiene Division. The School-Health Coordinating Ser-vice, supported jointly by the North Carolina State Board of Health and the North Carolina Department of Public Instruction, provides services to school and health department person-nel through: consultative services, field visits, in-service education, production and use of certain materials and re-sources in areas of health services, health instruction, school environment and physical education. This service may be requested through the local health officer or the local superinten-dent of schools. Your health department gives pro-tection against disease. The private physician and health department work together to control contagious diseases in your community. Your health de-partment holds clinics to give immuni-zation against whooping cough, diph-theria, smallpox and typhoid fever and also other immunizations. When a serious contagious disease occurs in a family, the public health nurse, at the request of the health oflficer or a private physician, will visit in your home. The nurse will teach the family how to carry out the doctor's instruc-tions, including how to give good home nursing care, and will instruct the family in isolation precautions to pro-tect other members of the family from catching the disease. Your local health department main-tains a register of all known cases of tuberculosis and their contacts and January, 1958 The Health Bulletin holds chest X-ray clinics for studying these cases, and contacts and the pub-lic at large. Persons with tuberculosis are referred to their private physicians and, when necessary, arrangements are made for sanatorium care. Your health department makes diag-nosis of venereal disease cases and pro-vides adequate penicillin treatment where indicated. Each case of venereal disease is carefully interviewed for source of infection and for new con-tacts. When cases of certain communi-cable diseases occur, your health de-partment traces down the source of the diseases in order that additional cases may be prevented. Through education of foodhandlers and regular inspection by the sanitar-ian, safe methods of preparing, serving and handling food in restaurants, in meat markets, in abbattoirs, and in other food handling establishments are maintained. A grade sign, indicating the relative degree of sanitation, is posted in each food handling establish-ment. Every citizen should look for this sign when entering a food hand-ling establishment. Regular inspections are made of dairy farms and pasteuri-zation plants to assure production and processing of clean, safe milk. NOTES AND COMMENT BY THE EDITOR THE PREVENTION OF DISEASE The practice of preventive medicine is not an individual enterprise. Preven-tive medicine not only protects indi-vidual patients from acquiring disease but, of equal importance, sees to it that patients do not transmit their disease to the community at large. Complete health protection thus en-tails a dual responsibility which is more than one person or group can handle. At this time of year, in many areas, the local public health agency appears before its elected governing body to justify proposed budgetry requests. On the average, a health ofBcer asks for one to three dollars annually for each person residing in his assigned juris-diction. In most cases, due to the re-turn of federal and state tax monies through grants, only part of the funds requested comes from local taxes. This, of course, is not meant to imply a sav-ing of local tax monies; in fact, such subsidies tend to increase the overall cost as well as allow local politicians to dodge certain responsibilities. i There is no need to reiterate the ' many preventive health services a public health department can perform for the community and the medical professon. There is, however, a need for medical leadership in the support of adequate local tax appropriations to maintain necessary preventive health activities. It is a curious paradox that two branches of the medical profession show their worth so differently. A family physician is successful by his overt demonstration of skill and acu-men, while the success of a health de-partment depends on the disease or epidemic that never manifested itself. Because the medical profession can more clearly understand such health services, it is up to them to spearhead the financial backing needed for suc-cessful official health programs. Supporting a health department budget results in more than just en-vironmental protection; it is also, another means for professional guid-ance to the health department. When the medical society believes its local health department is satisfactorily participating in the over-all health program, it should not hesitate to show its appreciation. The greatest respect and tribute that can be paid to public health personnel by organized medicine is the recognition and back-ing of public health activities, properly performed. It should be obvious to tax money custodians that with medical society support only where applicable, inadequacies and incompetence wDl stand out as clearly as efficiency. Medi- The Health Bulletin January, 1958 cal society participation will promote health services that the community understands and accepts and at the same time will help to avoid duplica-tion and waste. As Dr. Gunnar Gundersen, Presi-dent- elect of the American Medical Association, pointed out in his recent address before the American Associa-tion of Public Health Physicians, "the success of public health programs de-pends, to a large degree, upon the practicing physicians and other medi-cal personnel and medical facilities in the community. A health department, unsupported by the medical profession, divorced from the community's hospi-tals and alienated from others in the community working toward similar goals, is a sorry thing indeed .... These responsibilities are civic obliga-tions. They must be met by all citizens and especially physicians who are doc-tors of medicine dedicated to rendering service to humanity." Editorial—The Journal of the Ameri-can Medical Association, January 4, 1958 ACTIVITY RECOMMENDED AS FATIGUE TREATMENT Rest is not "a universal panacea" for fatigue, even among aging persons, a New York physician said recently. In many cases, activity is a better remedy, especially when the fatigue results from "atrophy of disuse," Dr. Theodore G. Klumpp, president of Winthrop Laboratories, Inc., said. In the absence of specific disease as a cause of fatigue, it arises in older persons from the normal physiological processes of aging which reduce the body's endurance; from loss of incen-tive, motivation, and interest; from a decline of glandular activity, and from "atrophy of disuse." Fatigue is "a normal incident of normal living," but when its pattern changes radically or it interfers with ordinary activities, it becomes a serious problem and needs medical attention. Dr. Klumpp said in the Journal of the American Medical Association. His article is one of a series on aging. "For a long time, the approach to the problem of fatigue was thought to be simple. A brief history of the patient's mode of life was obtained with one objective in mind—to cut out some-thing. "It made little difference how little the individual was doing—if the patient was tired, something had to go ... if the patient did nothing more than sit in a rocking chair all day long, he was no doubt advised to stop rocking and go lie down," he said. Now physicians know better. Follow-ing the surgeons' practice of getting patients up soon after surgery, they now prescribe physical activity. The pattern of American life is especially designed to avoid physical activity and stress—to the point where physical exertion is virtually eliminat-ed, the author said. Young people are able to keep in relatively good physical condition through sports and play, but, as they grow older, they need to give up these things. With the help of "labor-saving devices, now including electric golfmobiles," they begin to suffer rapidly and too early in life from atrophy of disuse. This brings with it a loss of muscu-lar tone and functional reserve of all parts of the body, so that the slightest added stress causes undue fatigue. Maintaining an adequate physical re-serve against stress is the best preven-tive for such fatigue. Fortunately some degree of fitness can be regained through a program of graded exercise at any time, except where its loss is due to advanced organic disease. The exercise should be fun for the patient and should not be drudgery. Along with the exercise, the aging patient also needs an adequate amount of sleep at night and if neces-sary a short nap at midday. Undue fatigue occures more com-monly among overweight persons. In addition to the obvious diet, the doc-tor should prescribe some type of exercise, despite the aditional "hearsay to the contrary," Dr. Klumpp said. Its greatest value lies in its stimulating effect on endocrine gland activity and in overcoming the tendency "to sleep and snooze too much — a common January, 1958 The Health Bulletin counterpart of obesity." Dr. Klumpp also noted that much fatigue in aged persons occurs because they lose their incentive and interest in life. Then the doctor must help the patient find a "new and absorbing in-terest." RESIDENCY, INTERNSHIP TRAINING INCREASES More than 30 thousand physicians last year took graduate training either as an intern or as a resident. According to the annual report on internships and residencies, prepared by the American Medical Association's Council on Medical Education and Hospitals, the number of medical school graduates taking further training con-tinued to increase in 1956-57. There were 9,893 graduates serving internships in 1956-57, an increase of 290 over 1955-56, while 23,012 were serv-ing residencies, an increase of 1,587 over the preceding year. The training was offered by 1,372 approved hospitals. The percentage of available intern-ship and residency positions filled in 1956-57 remained the same as that of 1955-56. Respectively they were 83 and 81 per cent filled. The report in the Journal of the A.M.A. also showed: —During the past 10 years, there has been an increase of 6 per cent in the number of approved hospitals and an increase of 31 per cent in the number of internships offered. —The number of interns per hospital has increased from 11.3 ten years ago to 13.9 in 1956-57. —Federal hospitals offered 5.4 per cent of the available internships, while nonfederal governmental hospitals offered 32 per cent and nongovern-mental institutions the remainder. The federal hospitals had the highest rate of filled positions, with Army hospitals having no vancancies and Public Health Service hospitals having 99 per cent filled. County and state hospitals had occupancy rates of 91 and 89 per cent respectively. —There has been an increase in the average monthly cash stipend paid to interns. Hospitals affiliated with teach-ing institutions raised their stipends from an average of $87 in 1954 to $140 in 1956, while nonaffiliated hospitals raised their stipends from an average of $136 to $177. —The report listed those hospitals with the highest autopsy rates, point-ing out that the autopsy rate is regard-ed as "an index of the scientific inter-est of the medical staff in medical education and in the progress of medi-cine." Hospitals with low rates are being urged to increase the number of autopsies performed. —The National Intern Matching Pro-gram, which matches interns to the hospitals in which they wish to train, has matched more than 35,000 students in the last six years without an error. —There are 17 residency review and conference committees which function as joint liaison groups of the A.M.A. Council on Medical Education and Hospitals with various specialty boards and, in certain instances, the American College of Physicians, the American College of Surgeons, and the American Academy of General Practice. —Seven specialties accounting for more than three-fourths of all approv-ed residencies offered were surgery, internal medicine, pathology, obstetric-gynecology, radiology, psychiatry, and pediatrics. AMA ENDORSEMENT OF FLUORIDATION On December 5, 1957, the following recommendation proposed by the Reference Committee on Hygiene, Pub-lic Health and Industrial Health, was passed by the House of Delegates of the American Medical Association. "The Committee has carefully re-viewed the special report on fluorida-tion of public water supplies prepared jointly by the Council on Drugs and the Council on Foods and Nutrition and transmitted as supplemental Re-port G, to the Board of Trustees. The two Councils are to be commended on their extensive study of the question and the excellent bibliography and tables which have been appended. "After careful consideration of the report, printed material and testimony. 8 The Health Bulletin January, 1958 your Reference Committee is of the opinion that fluoridation of water sup-plies is a safe and practical method of reducing dental caries during child-hood; it agrees with the conclusion of the joint committee of the above-named Council and recommends the approval of the report." The closing paragraph of the Com-mittee's 27 page report, which was also adopted by the American Medical As-sociation House of Delegates is as fol-lows: "Fluoridation of public water sup-plies should be regarded as a prophy-lactic measure for reducing tooth decay at the community level and is appli-cable where the water supply contains less than the equivalent of 1 ppm (parts per million) of fluorine." DRUG ADDICTION PICTURE NOT BLEAK, SAYS A.M.A. REPORT Frightening images of American youth being preyed upon by unscrupu-lous dope peddlers aren't very true to life, according to an article in the Journal of the American Medical As-sociation. The article, first of three consecutive ones scheduled to appear in the Jour-nal, says that while drug addiction among younger persons is a problem, it isn't as alarming as most people think it is. The third article in the series states that recent studies have shown that "active proselyting by drug peddlers plays a very small role in spreading addiction." Addiction apparently spreads, adds the article, from person to person, with addicts giving drugs to the beginner as a friendly gesture. The articles constitute the report of the A.M.A.'s Council on Mental Health in conjunction with its committee on narcotic addiction. The report was first presented to the A.M.A.'s Board of Trustees in November 1956, and was adopted by the A.M.A.'s House of Delegates last June. Generally speaking, the council mem-bers feel that drug addiction should be viewed as an illness. They also feel there should be a movement toward treating addicts medically rather than punitively. The group points out that in Great Britain, where the approach to the problem is more medical than that of the U.S., addiction is considerably less in terms of percentages. In the U.S., the report continues, "there are probably not more than 60,000 addicts . . . ." And, while addic-tion in persons under 21 years of age has increased since World War II, the problem isn't as great as many people think it is. Only about 13 per cent of known addicts are younger than 21. Nor is the problem of adolescent addic-tion a new one. A similar alleged in-crease of drug addiction among young people followed World War I. The council feels that while opiate addiction is undesirable, it is not near-ly as evil as the public and law en-forcement ofiBcers think it is. For one thing, "opiate addiction does not cause the degree of damage to physical health that other intoxica-tions tolerated by our society can cause." Also, opiates don't incite addicts to commit violent crimes which they would not commit without the drugs. Opiates are quieting drugs that repress hostile urges and depress sexual drives. Among the recommendations made in the report is one that the A.M.A. continue to study the problem and "to support reasonable proposals designed to improve the treatment and preven-tion of drug addiction." Such measures might include, adds the report: (a) Development of institutional care programs in cities and states with significant problems . (b) Study of various means to obtain institutional care in states with small addiction loads. (c) Development of programs for intensive postinstitutional treatment of addicts. (d) Development of methods for commitment of addicts to institutions by civil action rather than through actions in the criminal courts. (e) Continued support and expansion of mental health programs. January, 1958 The Health Bulletin The council strongly recommended that the policy of voluntary admissions for addiction treatment be continued and extended. The report also says that "in view of all available evidence," the establish-ment of clinics to supply drugs to addicts would not be a wise move. This latter opinion should, the report adds, be subject to review from time to time as new scientific knowledge be-comes available. FAMILY DOCTOR MAY HELP PREVENT MENTAL ILLNESS "Mood-altering drugs" combined with good nutrition may help prevent men-tally ill patients from being commit-ted to mental hospitals, a Michigan psychiatrist said recently. Writing in the Journal of the Ameri-can Medical Association, Dr. John T. Ferguson, Traverse City, Mich., said general practitioners "may well take the lead in preventive psychiatry" through the use of drugs and good nutrition and the practice of the art of medicine. He reported on the use of various neuropharmacological agents among patients with chronic mental illness at Traverse City State Hospital. The study has been conducted for four years. In that time the new drugs, "to-gether with the art of medicine as practiced by family doctors," have brought about many changes in the patients and the hospital. The number of wards for disturbed patients has been reduced from four to one and the number of open wards has been increased from three to four. The housekeeping is excellent, the nursing care has improved, and shock, sedation, and seclusion have been practically eliminated. The patients have taken a new interest in life and the atmosphere of the wards has be-come a happy one, although the num-ber and type of personnel remains the same. At the start of the program, only tranquilizers were used, but it was found that they helped only the over-active patients. Then analeptics (drugs that increase activity) were given to the more repressed patients. Eventually combinations of these drugs were given. They produced what may be called a "deep-change" in the patients. Dr. Ferguson said. It is a change within the patient that enables him to re-spond to other treatment methods and to participate In a rehabilitative pro-gram. The combination of tranquilizers and analeptics was especially effective in confused, disoriented, and mildly over-active elderly patients, although the reasons for it are not understood, he said. The improvement does, however, give the hope that further research and newer drugs will soon make it possible for doctors to lessen, control, and "even prevent mental changes now associated with senility," Dr. Ferguson added. Early in the program a direct paral-lel was noted between the physical well-being of patients receiving drugs and their rate and degree of improve-ment. Therefore, all medical and surgi-cal problems of the patients were found and treated. In addition, special diets and extra feedings high in minerals and vitamins were begun. Patients who had reached a "plateau" in improvement on drugs alone improved further when they were given supplementary diets. This was especially marked among elderly pa-tients. As the patients became more man-ageable, the attitude of the staff also changed. This brought about better understanding and more considerate treatment, which in turn benefited the patients. In conclusion. Dr. Ferguson pointed out that the drugs by themselves or even when incorporated into a total hospital program will not empty the mental hospitals of the country. How-ever, "by combining them with nutri-tional therapy, family doctors may hope to prevent commitment of mental-ly ill patients encountered in their home and office practices." 10 The Health Bulletin January, 1958 HOME IS BEST PLACE TO TEACH CHILD HOW TO MAKE FRIENDS The best time and place for learning how to make and keep friends is in childhood and at home, according to an article in Today's Health. Elizabeth B. Hurlock, Ph.D., outlined in the American Medical Association's popular health magazine some tips for parents on how they can help their children learn to make friends. If good foundations for getting along with others are laid in the home, a child's chances for being popular are greatly increased, she said. Some of her suggestions to parents are: —Set a good example for social re-lationships in the family, since child-ren quickly imitate patterns of be-havior they observe around them. —Supervise a child's early play with his brothers and sisters and with the neighborhood children. Show him how to get along with others and explain why a particular behavior is good or bad. As he grows older, discuss as a family what makes certain children popular and others unpopular. This should be kept on an impersonal level. —Encourage him to bring his friends home and help him learn how to enter-tain. —Watch for the first signs of jeal-ousy toward a brother or sister and correct the cause before it becomes a habit. —Play games with a child, so he can learn how. Since most contacts with other children will be in play, he must be able to play as well as they do if he is to be included in the group. —Give him an opportunity to talk when the family is together and help him to talk about things that are in-teresting to others. —Call on him for help. Children who develop the habit of helping at home rarely sit back and expect others to do all the work, nor do they grumble be-cause they feel they are expected to do more than their share. —Expect him to consider the in-terests and desires of the family. Teach him to laugh at himself. And make sure the home is a cheerful place. Being cheerful will become a habit and this goes a long way toward making anyone popular. Dr. Hurlock is former secretary-treasurer of the American Psychologi-cal Association's division on childhood and adolescence. DIAPERS DON'T CAUSE DIAPER RASH In spite of its name, diaper rash is not usually caused by diapers, accord-ing to an editorial in the Journal of the American Medical Association. Diaper rash is a general term for several types of skin eruptions in the "diaper region," the editorial said. The commonest cause of a rash is the formation of ammonia by bacteria after urea is broken down. Other erup-tions may be prickly heat, thrush, chaf-ing, allergy, and various types of der-matitis. All of these rashes are aggravated by lack of cleanliness and softening of the skin, which may occur if it remains too long. The best preventive for diaper rash is changing the diaper as soon as possible after it becomes wet or soiled. This prevents softening of the skin and the formation of ammonia. Since plastic or rubber pants increase the likelihood of ammonia formation, their use should be limited to those "brief social occasions when prompt changing would be inconvenient," the editorial said. Studies have shown that commercial laundering of diapers in much more effective than home laundering in re-moving and stopping the growth of ammonia-forming bacteria and in re-moving irritating detergents, the edi-torial said. The usual commercial pro-cess includes three initial warm and hot rinses, two soapings, bleaching, and three rinses in hot water followed by two rinses in chemicals which stop the growth of ammonia-forming bacteria. Although commercial laundering is not essential to the prevention of diaper rash, the more a home launder-ing procedure is like that of com-mercial launderies, the better the pro-tection, the editorial said. January, 1958 The Health Bulletin 11 Ti'eatment of diaper rash varies ac-cording to the cause, but in any case, the diaper region should be kept dry and warm. Preventive measures must be con-tinued as long as diapers are worn, the editorial concluded. PHYSICIAN GIVES MEDICAL ADVICE ON FLYING Physicians can do a lot toward eas-ing the fear and discomfort some people associate with flying, an Air Force doctor said recently. Writing in a recent issue of the Journal of the American Medical As-sociation, Lt. Col. Frederick S. Spiegel (MC), U. S. Air Force, Washington, D. C, listed some of the things a doc-tor needs to know if he is to advise his patients about traveling by air. He pointed out that more and more people are flying each year. Last year over 25 million passengers traveled on U.S. domestic air lines. Many people have had no experience with flying and go to their doctor for advice. Among the things the doctor should know about airline regulations is that permission must be granted by the public health ofiBcials before any per-son with a contagious or communicable disease may be transported across state lines, the colonel pointed out. Diabetics requiring insulin may travel only if their insulin and syringe are kept in their hand baggage in the passenger cabin, he said. Physicians generally agree that a woman with an imcomplicated preg-nancy is not "sick" and can travel safely. However, if she wishes to fly in the very late stages of pregnancy, she must present a certificate from her physician stating that she will not deliver "for at least 72 hours," Colonel Spiegel said. Infants less than six weeks old are not generally transported by com-mercial carriers unless there are ex-tenuating circumstances. Then a pedia-trician's certificate is requested, stating that the infant is healthy and physi-cally fit to fly. Patients recovering from recent coro-nary thrombotic attacks or those suf-fering from coronary insufficiency need careful examination before being ad-vised to fly. Anemic patients and those with certain types of respiratory diffi-culty also need careful checking, the author said. "Children are only fair air travelers," the colonel said. Those under five years of age experience airsickness and ear trouble five to 10 times more frequent-ly than adults. The increased susceptibility to aii'- sickness may be related to insecurity and apprehension, while the ear dis-comfort is associated with the difficulty of teaching children to swallow while descending in an airplane. Airsickness in adults is no longer a major problem, but when it does occur, it is five times more frequent among women than among male passengers. As with children, this is probably due to anxiety and apprehension. Fear of airsickness hastens its development. There are several effective remedies for those who develop airsickness. The same drugs also prevent it if taken be-fore flight. The value of reassurance by the doctor in such cases cannot be over-emphasized, Colonel Spiegel con-cluded. ELDERLY PERSONS NEED TO REDUCE FOOD INTAKE Most aging persons do not need to alter their normal eating habits, ex-cept to decrease the amount they eat, a New York physician said recently. Basically the nutritional require-ments for the aged are the same as for younger adults. How^ever, older per-sons need fewer calories to maintain their normal weight, Dr. Herbert Pol-lack said in the Journal of the Ameri-can Medical Association. The article is one of a series prepared under the auspices of the A.M.A.'s committee on aging. Dr. Pollack, associate professor of clinical medicine. New York University Postgraduate School of Medicine, said the "obesity of the elderly is not due to gourmandizing," but to eating the same amount of food they did in their younger years when their bodies need-ed more food. 12 The Health Bulletin January, 1958 The body needs a decreasing amount of oxygen as it ages. When this is coupled with a decreased over-all physical activity, it means that the body needs fewer calories to maintain the same weight. Many religious rituals and certain food practices among groups of people indicate that they have long recognized the place of periodic fasting and limit-ed diets in the prevention of overeat-ing. Now scientific knowledge of nutri-tion and diet makes is possible to develop diets that are rich in the necessary nutrients but do not lead to overweight, Dr. Pollack pointed out. In some cases special diets must be devised for aging persons with chronic diseases which sometimes influence nu-tritional requirements. Dr. Pollack said. For instance, patients with Parkinson's disease (paralysis agitans) sometimes have trouble feeding themselves. They may need concentrated food in liquid mixtures as between-meal supplements. Limitation of physical activity be-cause of heart and circulatory diseases or arthritis means there must be a compensating decrease in caloric in-take. Dr. Pollack said. Otherwise weight gain is inevitable and this added weight causes a fui'ther load on the circulation and on weight-bearing joints. In setting up a diet, the doctor must also pay attention to the "mechanical state" of the food as well as to its nutritional content since many elderly people have difficulty chewing because of tooth or mouth disorders. Regardless of the type of patient re-ceiving the diet, the doctor must make certain that the diet "not only is nutritionally adequate on paper but is actually consumed by the patient," Dr. Pollack said. DRIVER TRAINING WOULD LOWER INSURANCE RATES Probably the best way to reduce automobile insurance rates is to teach teen-agers how to drive properly. This would increase the number of accidentless drivers which would help reduce insurance costs, a New York high school teacher has said. Writing in Today's Health, the American Medical Association's popu-lar health magazine, David Star, Floral Park, N. Y., said training would also help reduce the rising number of fatal accidents involving drivers under 25 years of age. Yearly 1,600,000 boys and girls reach legal driving age; 728,000 receive no training except what is picked up from friends and relatives. "If everyone of our 1,600,000 16-year-olds passed a driver training course, we could in a generation put more than 30,000,000 drivers on our highways who had been trained in safe and skillful practices," Star said. Since last February, Michigan has had a law that says no one under 18 can be licensed to drive unless he has passed an approved course of driver in-struction. The cost of instruction in the high schools is provided for from licensing fees and the course requires a minimum of 30 hours of classroom in-struction and six hours of driving. Among the subjects taught are the motor vehicle's effect on social and cultural life; the driver's physical re-quirements, mental attitudes and social responsibilities; characteristics of streets and highways; legal structures and codes; automotive mechanics and maintenance; automotive consumer education, and skills in driving. "We used to think anyone could just pick up driving, but we now realize that instruction and coaching are just as important in driving as they are in athletics, music, or bridge building," Star said. "When a youngster just picks up driving, he usually acquires bad atti-tudes from his parents or other drivers. Faulty attitudes are much more often at the bottom of young driver acci-dents than lack of skill." The more young drivers given knowl-edge and healthy driving attitudes at the beginning of their driving careers, the fewer unsafe drivers of all ages there will be in the years ahead, he concluded. DIVISION OF HEALTH AFFAIRS LIBRARY N.C. MEM. HOSP, U. N, C. CHAPEL HILL, N.C. RDtfCr.iViVtO 28 1958 I TKis BulJefm will be sent free to any ciiizen of ri\e 5kite upon reques-t J Entered as second-class matter at Postoffice at Raleigh, N. C. under Act of Angust 24, 1912 Published monthly at the office of the Secretary of the Board, Raleigh, N. C. Vol. 73 FEBRUARY, 1958 DR. J. MARTIN FLEMING 1867-1957 No. 2 MEMBERS OF THE NORTH CAROLINA STATE BOARD OF HEALTH G. Grady Dixon, M. D., President Ayden John R. Bender, M. D.. Vice-President Wlnston-Salem Charles R. Bugg. M. D. Raleigh Lenox D, Baker, M. D. Durham H. C. Lutz, Ph.G. Hickory Mrs. J. E. Latta Hillsboro, Rt. 1 John P. Henderson, Jr., M. D. -» Sneads Ferry Roger W. Morrison, M. D. Asheville Z. L. Edwards. D.D.S. Washington EXECUTIVE STAFF J. W. R. Norton, M. D., M.PJI., State Health Director John H. Hamilton, M. D., Assistant State Health Director, Director State Laboratory of Hygiene, and Editor Health Bulletin Robert D. Higgins, M. D., M.P.H., Director Local Health Division Ernest A. Branch, DJ).S., Director Oral Hygiene Division A. H. Elliott, M. D., Director Personal Health Division J. M. Jarrett, B. S., Director Sanitary Engineering Division Fred T. Foard, M. D., Director Epidemiology Division E. C. Hubbard, B.S., M.P.H., Director Division of Water Pollution Control List of free health literature wUl be supplied by local Health Departments or on written request. CONTENTS Page A Tribute to Dr. J. Martin Fleming 2 Recently approved Public Health Regulations 4 Notes and Comment 10 A TRIBUTE TO DR. J. MARTIN FLEMING BY ERNEST A. BRANCH, D. D. S. State Board of Health Raleigh, North Carolina The North Carolina State Board of that dentistry be included in the pro- Health and, indeed, the cause of public gram of the North Carolina State health in North Carolina have suffered Board of Health. This motion was a great loss in the death of Dr. J. carried, and North Carolina became Martin Fleming on December 18, 1957. the first State to have dentistry as an Dr. Fleming was a friend of public integral part of its public health pro-health, in general, and of public health gram. Prom that time on Dr. Fleming dentistry, in particular. It was he who gave generously of his time and ener- i made the motion in the meeting of gies to the enterprise, thus rendering , the North Carolina Dental Society in great service to his profession, to ; 1918 that the Society give its whole- public health, and to the people of ; hearted endorsement and approval to North Carolina. He favored and work-the suggestion of Dr. George M. Cooper ed for all legislation which promoted February, 1958 The Health Bulletin public health dentistry in the State. Dr. naming became the first dental member of the Wake County Board of Health in 1931 and served in that capacity until 1942. In 1942, when the younger dentists were called into armed service and a dentist could not be secured for position of school dentist with the Wake County Health Depart-ment, Dr. Fleming closed his office, took the job and served until his retirement in 1954. Dr. Fleming engaged in the private practice of dentistry in Raleigh from 1895 to 1942. He was one of the best known and best loved dentists in North Carolina. He exerted a great and good influence in the affairs of the North Carolina Dental Society, and this Society conferred on him many honors. He served as president of the Society in 1903-1904. Dr. Fleming made an outstanding contribution to dentist-ry as a member and president of the State Board of Dental Examiners from 1914 to 1926. In this capacity he had an opportunity to encourage and in-fluence many young dentists. For many years, when the molding and making of dentistry in North Carolina was in the process. Dr. Fleming was chairman of the Ethics Conunittee. To him membership on this committee, as well as on the Board of Dental Examiners, was a mandate to uphold the standards of the profession and also to protect the rights of the people of North Carolina to have the best in dental service. It can be truly said that. In carrying out this mandate, he brought honor to himself and to dentistry in North Carolina. Dr. Fleming believed in hewing to the line himself, and he expected the same of others. Those who knew him well realized that his seem-ing sternness was tempered with kind-liness and a rare sense of himaor. Perhaps Dr. Fleming's greatest ac-complishment was writing the HISTORY OF THE NORTH CARO-LINA DENTAL SOCIETY. This scholarly work was the result of years of painstaking research and of collect-ing, compiling and editing material. The "History" is an interesting and invaluable book which will be a lasting memorial to his untiring and imselfish service to the profession. Though born in Arkansas, whUe his North Carolina parents were living temporarily in that State, Dr. Fleming lived most of his life in North Carolina. He received his A. B. degree from the University of North Carolina in 1891 and his D.D.S. degree from the Uni-versity of Maryland in 1895. He was made a Fellow of the American College of Dentists in 1929. He held member-ship in the Raleigh and Fourth Dis-trict Dental Societies, the North Carolina Dental Society and the American Dental Association. Fimeral services were held for Dr. Fleming in the Edenton Street Metho-dist Church of Raleigh, of which he had been a faithful and devoted mem-ber, having served for many years on the Board of Stewards. It can truly be said that he was a public spirited citizen, a Christian gentleman and a true friend and counsellor. The Health Bulletin February, 1958 RECENTLY APPROVED PUBLIC HEALTH REGULATIONS The following regrulations affecting public health, approved by the State Board of Health February 7, 1958, are published in The Health Bulletin in accordance with legislation passed by the 1957 Session of the North Caro-lina General Assembly. —Editor, The Health Bulletin. NORTH CAROLINA STATE BOARD OF HEALTH Rules And Regulations Governing State Aid Mosquito Control Districts Or Other Local Governmental Units Engaged In Mosquito Control Under-takings. For the purpose of administering State funds received by the State Board of Health to aid mosquito con-trol districts or other local govern-mental units engaged in mosquito con-trol imdertakings, pursuant to the provisions of Chapter 832, Session Laws of 1957, the North Carolina State Board of Health adopts the following rules and regulations governing: State aid to mosquito control districts or other local governmental units en-gaged in mosquito control imdertakings. SECTION I. CREATION OP ZONES For the purpose of administering these rules and regulations, the State of North Carolina is divided into three zones as follows: A. Zone I shall be comprised of those counties in which the studies of the Salt Marsh Mosquito Study Commis-sion showed a salt marsh mosquito problem to exist, and shall include the following counties: Beaufort, Brunswick, Camden, Carteret, Chowan, Craven, Ciurituck, Dare, Hyde, Jones, New Hanover, Onslow, Pamlico, Pas-quotank, Pender. Perquimans, Tyrell, and Washington. B. Zone II shall be comprised of those counties not in Zone I where the highest probability of mosquito-borne disease outbreaks exists, and shall include the following coimties: Gates, Hertford, Bertie, Martin, Pitt, Lenoir, Duplin, Sampson, Bladen, Columbus, Robeson, Ciunberland, John-ston, Wayne, Greene, Wilson, Nash, Edgecombe, Halifax, and Northampton. C. Zone IH shall be comprised of those counties not included in Zone I, or Zone II. SECTION II. ALLOCATION OP STATE FUNDS OR FACILITIES-GENERAL Before aid is given in the form of cash, or other items of monetary value, the county, tov^n, or other government-al unit applying for such aid shall submit a project application to the North Carolina State Board of Health on a form provided for that purpose. Project applications shall hst the cash, materials and supplies, equip-ment, and other facilities that will be provided by the applicant during the fiscal year. In computing the monetary value of local fimds and facilities provided by the applicant, in order to de-termine the amoimt of State aid that can be given on a matching basis credit will be allowed for labor, materi-als, and general operating expenses, as well as rental on equipment that has been approved for use on the project by the representative of the State Health Director. The rental rates will be established by said representative of the State Health Director. No credit will be allowed for money spent to repay loans or to pay interest, pur-chase equipment or real estate, nor for overhead expenses such as cleri-cal help, office and storage space rental, etc. State funds shall not be spent by local governmental units to purchase equipment, make repasTnents on loans, pay interest on borrowed money, pur-chase real estate, pay clerical person-nel, rent storage or office space, nor for any purposes other than those directly connected with the application of mosquito control operations. February, 1958 The Health Bulletin Embodied in project applications shall be such assurances and agree-ments as may be required by the of-ficial of the North Carolina State Board of Health who is responsible for the administration of this activity. These shall include: (a) The assumption by the applicant of all responsibility for claims for damage resulting from the operation of the project. (b) An agreement to submit such plans as may be required to the North Carolina State Board of Health, and perform all work in conformity with the plans that are approved by the appropriate representative of the North Carolina State Board of Health. (c) An agreement to use funds pro-vided by the North Carolina State Board of Health and those shown on the project application as being pro-vided by the applicant exclusively for mosquito control, in accordance with these rules and regulations and the approved plan, (d) An agreement to perform all mosquito control under the direction of a competent supervisor whose quali-fications meet the approval of the North Carolina State Board of Health. (e) An agreement to submit reports at the end of each month showing work performed during the month, expenditures made, facilities utilized, and materials expended. (f) An agreement to submit a certi-fied financial statement to the North Carolina State Board of Health no later than ten days after the last day of December and June of each year. Such statement must include an item-ized account of expenditures during the preceding six months, of both local and State funds, as well as an itemized accoimt of other assets and facilities that have been utilized to carry out the mosquito control project. Such supporting documents as may be re-quired by the North Carolina State Board of Health shall be included. (g) An agreement to return to the North Carolina State Board of Health at the end of December and June of each year all State funds not matched by local expenditvtres for mosquito control purposes during the preceding six months. In Ueu thereof the State Health Director may allow the excess of State funds over local fimds expend-ed during the preceding six-months' period to be deducted from the State aid given the applicant during the next six-months' period. In Zone I, if the application for State aid is made by a county, the ap-pUcation must be signed by the local Health Director, and the project must be operated under his direction. If the application is made by a local governmental unit other than a county, a resolution must be adopted by the governing board of such governmental imit designating an official to sign necessary papers in connection with the mosquito control project. In such cases, operation of the project shall be under the direction of the designat-ed official, but approval of the project by the local Health Director shall be reqiiired. In Zones II and III, the project application shall be signed by the local Health Director, and the project shall be carried out under his direction. The provisions of these regulations requiring that the local Health Director sign, approve, or direct a project shall not apply to any application made by, or project conducted by a Mosquito Control District established under the provisions of Chapter 1247, 1957 Session Laws. SECTION III. ALLOCATION OF FUNDS A. Zone I. Seventy-five per cent of the State funds available for allocation to local mosquito control projects shall be set aside for aid to local govern-mental units within Zone I. If sufficient State funds are avail-able, the amounts provided by local appropriations for mosquito control projects in Zone I shaU be matched on a fifty-fifty basis for temporary control measures, and on a basis of twice the amount of local appropri-ations, or the monetary value of other facilities provided locally, for drainage, filling or dyking. If insufficient State 6 The Health Bulletin February, 1958 funds are available for matching on this basis, the State aid is to be allocated to local projects in any one county as follows: the first one thousand dollars ($1,000.00) of State aid is to be on a fifty-fifty basis; thereafter, the State aid is to be allo-cated on a pro rata basis to be de-termined by dividing the total remain-ing appropriations and monetary value of other facilities provided (above the one thousand dollars ($1,000.00) match-ed on a fifty-fifty basis) by all of the local governmental units in Zone I into the total remaining State aid available for projects in that Zone. In no case is the State aid to all projects within a county to exceed fifteen thousand dollars ($15,000.00) when there are insufficient funds to match on a fifty-fifty basis. Two or more governmental vmits in Zone I may jointly employ a supervisor to look after mosquito control activi-ties. The North Carolina State Board of Health may match fimds to pay the travel and salary of such super-visors on a fifty-fifty basis, if State funds are available. The qualifications of supervisors employed under this provision must be approved by the re-presentative of the State Health Director. B. Zone II. The local Health Director shall be the official in Zone II who is recognized by the North Carolina State Board of Health as authorized and empowered to sign and execute documents necessary in connection with applications for aid in the con-trol of mosquitoes, to carry out all agreements stipulated in the project applications, and perform other acts that are necessary in connection with the operation of the project. All State funds and other facilities provided for mosquito control projects in Zone II shall be disbursed through the local Health Director on a county basis. In Zone II, the first one thousand dollars ($1,000.00) of State funds allot-ted to local health departments for mosquito control project shall be allo-cated on a fifty-fifty basis with local fimds. Any additional funds are to be allotted on a basis of 30 per cent State fimds for 70 per cent local funds, with a maximiun allocation of two thousand doUars ($2,000.00) to any one coimty. C. Zone III. The local Health Director shall be the official in Zone III who is recognized by the State Board of Health as authorized and empowered to sign and execute documents neces-sary in connection with applications for aid in the control of mosquitoes, to carry out all agreements stipulated in the project applications, and perform other acts that are necessary in con-nection with the operation of the proj-ect. All State fimds and facilities provid-ed for mosquito control projects in Zone III shall be disbursed through the local Health Director on a county basis. In Zone III, State funds allotted to local health departments for mosquito control purposes shall be allocated on a fifty-fifty basis with local funds, with a maximum allocation of five hundred dollars ($500.00) to any one county. SECTION IV. AUTHORIZED CHANGES IN ALLOCATION RULES If at the end of a reasonable dead-line for submission of applications for State funds to aid in mosquito control in any zone the funds set aside for aid in that zone have not been applied for, and allocated to local government units in that zone, the State Health Director is authorized to utilize such funds for assistance to projects in other zones, and to change the allo-cation basis. If at the end of the second quarter of the fiscal year it is determined by the official of the North Carolina State Board of Health, who is respon-sible for the administration of this activity, that State funds allocated to any project will probably not be spent and matched by local expenditures, or other creditable assets by the end of the fiscal year, said funds may be re-allocated to other local projects on the basis of potential mosquito densities February, 1958 The Health BuixEmN and local participation. Other State funds that become avail-able for allocation to local projects from any source, after the end of the second quarter of the fiscal year, may be allocated to local projects in either of the three zones on the basis of potential mosquito densities and local participation. SECTION V. RKPEAL All rules and regulations heretofore adopted by the North Carolina State Board of Health in conflict with the provisions of these rules and regula-tions are hereby repealed. The regu-lations concerning State aid to local governmental imits for mosquito con-trol purposes, adopted by the North Carolina State Board of Health on July 18, 1957, are hereby repealed, and replaced by these rules and regulations. SECTION VI. EFFECTIVE DATE These rules and regulations shall be in full force and effect from and after February 15, 1958. The foregoing rules and regulations relating to the administering of State aid to assist local governmental units in carrying out mosquito control proj-ects were duly adopted at a meeting of the State Board of Health at Raleigh, North Carolina, on February 7, 1958. viously-used materials; the issuance of stamp exemption permits; and, the transfer of manufacturer's licenses and sanitizer's licenses. Rules And Regrulations Governing The Sanitizing Of Mattresses, Previously- Used Materials, Second-Hand Bedding, And Bedding Containing Previously- Used Materials; The Storage of Pre-viously- Used Materials; The Issuance of Stamp Exemption Permits; And, The Transfer Of Manufacturer's Licenses And Sanitizer's Licenses. For the purpose of carrying out the provisions of Article 16 of Chapter 1357 Session Laws of North Carolina, the North Carolina State Board of Health hereby adopts the following rules and regulations governing: the sanitizing of mattresses, previously-used materials, second-hand bedding, and bedding containing previously-used materials; the storage of pre- SECTION I. SANITIZING a. No person shall renovate any mattress without first sanitizing it in accordance with one of the processes authorized in subsection (e) below. b. Any sanitizing apparatus or pro-cess used to sanitize articles as required by Article 16 of Chapter 1357 of the 1957 Session Laws of North Carolina, or by these rules and regulations, must comply with the provisions of these rules and regulations. c. No person shall manufacture or sell in this State any bedding contain-ing previously-used materials without first sanitizing the previously-used materials in accordance with one of the processes authorized in subsection (e) below. d. No person shall sell any second-hand bedding or bedding containing any previously-used material imless it is sanitized, since last used, in ac-cordance with one of the processes authorized in subsection (e) below; provided, however, that this require-ment shall not apply to a mattress sold by the owner and previous user from his home directly to a purchaser for his own personal use, unless such mattress has been exposed to an in-fectious or contagious disease. e. Authorized sanitizing processes (1). Process Number 1 — Dry Heat In this process, the bedding must be heated at a temperature of 230° F. for a period of one hour. The chamber in which this process is performed must be Insulated suf-ficiently to insure maintenance of a imlform temperature of 230° F. Articles to be sanitized must be placed on racks, or other devices provided therein, in such a manner that a minimum space of 6" is left around each item being sanitized, and between such item and the walls, floor, ceiling and other items. Loose materials to be sanitized must be placed in tiers on slats, or on other arrangements that permit an even distribution of heat throughout the 8 The Health Bulletin February, 1958 material. A thermometer that has been checked for accuracy within 1° P. must be placed within the chamber at a point where it can be easily read at all times through a window provided for that purpose. (2) Process number 2 — Formaldehyde and Sulfur In tills process, the bedding must be exposed to formaldehyde and sulfiu-dioxide gas in a moist and warm atmosphere for at least 10 hours, using one pint of 37% formaUn and three pounds of sulfur to 1,000 cubic feet. Formaldehyde is generated from the formalin by adding potassium perman-ganate. Commercial fumigators which gener-ate an equivalent quantity of gas may be used. The chamber in which this process is performed shall be sealed in such a manner as to make it gas tight. The placing of bedding within the chamber shall conform with the re-quirements set out for process number 1 above. (3) Process number 3 — Washing In this process, the bedding is boiled for fifteen minutes, and washed with an approved soap or detergent. After drying, the bedding shall be clean to touch, sight, and smell. (4) Notwithstanding the provisions of subsections (e) (1) tlu'ough (e) (3) of this section, other methods of sani-tizing may be used after receiving the approval of the State Board of Health in writing, if it is demonstrated that they destroy pathogenic micro-organisms and arthropods, and remove dirt and filth. (5) Notwithstanding the provisions of subsections (e) (1) through (e) (4) of this section, second-hand bedding and previously-used materials that show evidence of contamination with feces, urine, pus, vomit, blood, mucus, or other filth, or are not reasonably clean, must be sanitized by process number 3 only. SECTION II. STORAGE OF PREVIOUSLY- USED MATERIALS When previously-used materials that have not been sanitized are stored in a bedding manufacturing establish-ment in the same room with new, or sanitized bedding or bedding materials, such previously-used materials must be segregated from the new, or sani-tized bedding or bedding materials, by partitions that are free of holes, cracks, or other openings. The top of the partitions must be at least one foot higher than the level of the vmsani-tized materials. SECTION III. STAMP EXEMPTION PERMITS (a) Any person who manufactures bedding in North Carolina or any person who manufactures bedding to be sold in North Carolina may, in lieu of purchasing and affixing the adhesive stamps provided for by Article 16 of Chapter 1357 of the 1957 Session Laws, annually secure from the State Board of Health a stamp ex-emption permit upon compliance with the provisions of said article and these rules and regulations. The holder of the stamp exemption permit shall not be required to purchase or affix ad-hesive stamps to bedding manufactured or sold in North Carolina. The cost of a stamp exemption permit is to be determined annually by the total num-ber of bedding items manufactured or sold in North Carolina by the applicant during the calendar year immediately preceding the issuance of the permit, at the rate of Eight Dollars ($8.00) for each five hundred pieces of bed-ding or fraction thereof. A maximmn charge of Four Hundred Dollars ($400.00) shall be made for pieces of bedding manufactured in North Caro-lina but not sold in North Carolina. (b) Applications for stamp exempt-ion permits must be submitted on forms supplied by the State Board of Health. No stamp exemption permit may be issued to any person imless he has done business in North Carolina throughout the preceding calendar year in compliance with the provisions of Article 16 of Chapter 1357 of the 1957 Session Laws, and unless he complies with these regulations, (c) Any person applying for a stamp exemption permit must include on the February, 1958 The Health Bulletin 9 application form furnished by the State Board of Health a statement in writing showing the number of bedding items that were, during the preceding calendar year: (1) manufactured in North Carolina and sold in North Carolina; (2) manufactured outside of North Carolina and sold in North Carolina; and (3) manufactured in North Carolina but not sold in North Carolina. Provided, however, that if the applicant's statement sets out the total nimiber of bedding items which such manufacturer produced during the preceding calendar year, it shall not be necessary for the applicant to set out what proportion of that total was manufactured inside or outside of North Carolina or sold inside or outside of North Carolina, in which case the cost of the stamp exemption permit will be determined as if the total production were manufactured in North Carolina and sold in North Carolina. The statement of the ap-plicant required by this subsection must contain a certification by a certi-fied public accountant that he has examined the records of the applicant and finds that the statement correctly reflects the information contained in the records of the applicant. (d) The State Board of Health may require additional proof of the number of bedding items sold during the pre-ceding calendar year when it has reason to believe that the proof sub-mitted by the manufactiirer (whether in-state or out-of-state) is incomplete, misleading, or incorrect. (e) The stamp exemption permits issued pursuant to these regulations shall be valid from the first day of March of any calendar year through the last day of February of the follow-ing calendar year. SECTION IV. TRANSFER OP MANUFACTURER'S LICENSES AND SANITIZER'S LICENSES (a) If any person to whom a manu-facturer's license or sanitizer's license has been issued shall sell his manu-facturing or sanitizing establishment, he may transfer the license with the business, if such transfer is accomp-lished in accordance with the provisions of these rules and regulations. (b) In order to make such transfer, and before the purchaser may use such license of the seller, the pur-chaser must submit to the State Board of Health the following: (1) the name and address of the seller; (2) the location of the establishment being purchased; (3) the name of the establishment being purchased; (4) the name and address of the pur-chaser; (5) the effective date of sale; and, (6) whether the name of the establishment being purchased is to be changed, and if so, the name imder which it is to be operated by the purchaser. SECTION V. VIOLATIONS If any person shall wilfully violate any rule or regulation adopted by the State Board of Health pursuant to Chapter 1357 of the 1957 Session Laws, or shall wilfully fail to perform any act required by, or shall wilfully do any act prohibited by such rules and regulations, he shall be guilty of a misdemeanor and upon conviction thereof shall be punished by a fine not to exceed Fifty Dollars ($50.00) or by imprisonment for a period not to exceed thirty days (30), as provided in Article 22 of Chapter 1357 of the 1957 Session Laws. SECTION VI CONFLICTING RULES AND REGULATIONS REPEALED All rules and regulations heretofore adopted by the State Board of Health which are in conflict with the pro-visions of these rules and regulations are hereby repealed. SECTION VII. SEVERABILITY If any provision of these rules and regulations, or the application there-of to any person or circumstance, is held invalid, the remainder of the rules and regulations, or the applica-tion of such provision to other persons or circumstances, shall not be affected thereby. SECTION VIII. EFFECTIVE DATE These rules and regulations shall be in full force and effect from and after 10 The Health Bulletin February, 1958 February 15, 1958. The foregoing rules and regulations governing the sanitizing of mattresses, previously-used materials, second-hand bedding, bedding containing previously-used materials; storage of previously-used materials; the issuance of stamp exemption permits; and, the transfer of manufacturer's licenses and santizer's licenses were adopted at a meeting of the State Board of Health on February 7, 1958, at Raleigh, North Carolina. NOTES AND COMMENT BY THE EDITOR STRANGULATION FROM SWALLOWING TOY BALLOON Two small children of North Caro-lina parentage have lost their lives recently in a rather bizarre type of accident—strangulation from swallow-ing a toy boUoon. It appears that in each case, the child was trying to blow up the balloon, inhaled it, and strang-led to death. In both cases the children were between 2 and 214 years of age. A newspaper clipping reveals that two other children—a 2% year old in New Jersey and a 7 year old in New York — died under similar circumstances re-cently. Tlie tragedy of such deaths is that they are useless deaths. There is also irony in the fact that toys given to children to make them happy can also produce death and serious injury; a toy balloon is only one example. Pa-rents and others who buy toys for small children should be conscious of the dangers inherent in toys and should use great care in selecting them. THE RECOGNITION OF CHICK-EMBRYO ORIGIN RABIES VACCINE IN DOGS FOR A PERIOD OF THREE YEARS WHEREAS, the duration of immrm-ity against rabies in dogs following the administration of chick-embryo rabies vaccine has been shown to be effective for a period of at least thirty-six months by research conducted by the United States Public Health Ser-vice, and WHEREAS, this research has been recognized by nvmierous national and international veterinary and public health organizations (World Health Organization, United States Public Health Service, American Veterinary Medical Association, United States Livestock Sanitary Association), and WHEREAS, the local health officers of North Carolina have been informed of this proposal and recormnend its approval, and WHEREAS, the North Carolina State Veterinary Medical Association on June 28, 1956 passed a resolution recom-mending that the North Carolina State Board of Health officially approve chick-embryo rabies vaccine for a period of three years when administer-ed by a licensed veterinarian, and WHEREAS, the Attorney General in an opinion dated 6 March 1956 has ruled that the State Board of Health under G. S. 106 - 365 is authorized to specify how often a dog must be vac-cinated against rabies with the single restriction that vaccination may not be required oftener that once in each calendar year, NOW, THEREFORE, the State Board of Health in its official meeting, Feb-ruary 14, 1957, does hereby establish the time or times when a dog shall be vaccinated against rabies. "1. When rabies vaccine of nervous tissue origin is administered, the dog must be revaccinated annually. 2. When rabies vaccine of chick-embryo origin is administered by a licensed veterinarian the dog must be revaccinated every three years, except that a dog under 6 months of age receiving chick-embryo vaccine shall be revaccinated after a period of one year and every three years thereafter. Provided, however, when a district or county board of health or the State Board of Health adopts a resolution stating that in order to control rabies and protect the public health, annual vaccination is necessary within the February, 1958 The Health Bulletin 11 area over which they have jurisdiction, then the dog must be vaccinated an-nually regardless of the type vaccine used." THE N. C. COMMISSION ON PATIENT CARE You might be interested in the fol-lowing information regarding the above Commission for the Health Bulletin: There has been recently organized in North Carolina a North Carolina Com-mission on Patient Care. The major purpose of this Commission is to stimulate, implement, assist in, and sponsor activities which will contribute to the care of the patient. Membership consists of representatives of the Medi-cal Society of the State of North Caro-lina, the North Carolina Hospital As-sociation, the North Carolina League for Nursing, and the North Carolina Licensed Practical Nurses Association. Mr. George Harris of the Duke Foun-dation is Chairman. It shall be the intention of the Com-mission to obtain a better understand-ing of the problems and programs of all represented groups; to serve as a source of information on trends within the programs of the participating organizations; to facilitate the develop-ment of a more unified public relations approach by the participating organi-zations; to explore the needs for and stimulate studies in areas of patient care in which the organizations par-ticipate; and to perform such fimctions and carry on such activities contribut-ing to major objectives as may be mutually satisfactory to the appointing organizations and to the Commission. A. M. A. PAMPHLET TELLS DRIVER FITNESS RULES Even though a person has a good safety record and thinks he's in ex-cellent health, there are certain cir-cumstances imder which he shouldn't drive. Some of the things that can make a driver dangerous are listed in a new American Medical Association pamph-let, "Are You Pit To Drive?" The pamphlet, to be distributed through physicians' offices, was pre-pared by the A.M.A. Committee on Medical Aspects of Automobile In-juries and Deaths, in cooperation with the Center for Safety Education, New York University. A doctor can help answer the ques-tion of driving fitness. The pamphlet urges drivers to ask their doctors when they are In doubt about their fitness. Some of the things that make a driver dangerous are: —Emotional upsets. Unless a person can keep his mind on the wheel and not on his worries, he should not take the wheel. —The driver's attitude. Some drivers feel the other fellow is always wrong. Some are aggressive and intolerant when they get into a car. They need to be mature. —Sleepiness. A sleepy driver is as much a hazard as a drinking one. Dozing is not restricted to night driv-ing. When making long trips, a person should rest every two hours, drinking coffee or cola to stay alert. He should not take any medicine that makes him drowsy. —Medicines. Antihistamines, cold tablets, sedatives, tranquilizers, and some other drugs may dull reflexes or impair coordination. Stimulants may make a person nervous. The doctor should be consulted about the side effects of any drugs. —Faulty vision. A driver needs regu-lar eye examinations; if he notices any change in his eyes between exami-nations, he should see his eye doctor immediately. To reduce eye strain, he should wear properly fitted sunglasses, but not after dark. To avoid tiring the eyes, excessive night driving should be avoided if possible. Hay fever or the common cold can bliu: the vision dangerously. —Certain nerve and heart disorders. Some may -cause convulsions and others may result in occasional loss of consciousness. The doctor is the best judge of whether a patient with these should drive. 12 The Health Bulletin February, 1958 —Diabetes. Insulin reactions may cause difficulties, but diabetic patients who follow their doctor's advice can be safe drivers. —Old age. After 65, reflexes and co-ordination tend to be a little slower, people tire more easUy, resistance to glare is lessened, and the ability to see at night is declining. Older drivers should schedule their trips at non-rush hours and should not spend long periods at the wheel. —And, of course, drinking. NEW THEORY ADVANCED ON SPEECH MECHANISM Recent French research has Indicat-ed that the brain—not the movement of air in the larynx—caxises the vocal cords to vibrate and produce soimd. This new and controversial theory of how man speaks was reported in Archives of Otolaryngology, an Ameri-can Medical Association publication, by Esti D. Freud, Ph.D. New York, a teacher of voice and speech patho-logy. The French researchers believe that vocalization results from the action of the brain on the nerves of the larynx which in tiu-n produce vibra-tions of the vocal cords. According to long-accepted theory, expiration of air from the trachea causes the thyroarytenoid muscle to vibrate and thus set up vibrations of the vocal cords. In a note preceding the article, Dr. Ernest M. Seydell, Wichita, Kan., a member of the Archives editorial board, pointed out that some of the article's contents were "very contro-versial," but they were published with the hope of stimulating research io "a phase of otolaryngology in which there is much to be proved." Dr. Freud said the French experi-ments have shown "beyond doubt" that vocal cords vibrate in the absence of an exhaled current of air, and that the vibrations seem to be governed by excitations deriving dir^tly from the recurrent laryngeal nerve. This means that the exhaled air current cannot be considered instru-mental in creating the vibrations of the vocal cords, hut only as a sound-carrying medium. The exact roles of air pressiure, air volume, and the breathing motions in vocalization are questions that still must be answered, she said. Dr. Freud also reported that French researchers have shown that singing and speaking, which produce different vibratory patterns in the vocal cords, originate in different centers of the brain, even though they are both ex-ecuted by the vocal cords. This helps explain why persons who stutter or who have lost their ability to speak can still sing without diffi-culty. Dr. Freud said. It also helps explain why a person with a tenor singing voice may speak with a very deep voice. Dr. Freud, a daughter-in-law of the late Sigmund Freud, is associated with New York Hospital, New York, and a Veterans Administration men-tal hygiene clinic in Newark, N. J. NEW HORMONE RELIEVES SCLERODERMA SYMPTOMS A new hormone that prevents pre-mature birth is also useful in the treatment of a rare skin disease, sclero-derma, two Florida physicians reported recently. The hormone is relaxin (Releasin), which is synthesized from an extract of the ovaries of pregnant sows. Work-ing with other hormones, relaxin in-fluences the contraction of tte uterus in pregnancy and labor. It also has an effect on the elasticity of the skin. This effect is important in the treatment of scleroderma, Drs. Gus G. Casten and Robert J. Boucek, Miami, said in the Journal of the American Medical Association. In scleroderma, the skin hardens, restricting movement. The blood supply is cut off, causing fingers, toes, and ankles to ulcerate. In addition to af-fecting the skin, the disease eventually attacks the internal organs. The Florida doctors gave relaxin to 23 patients. While it had no effect on the disease itself, it did cause "signifi-cant improvement." LIBRARIAN DIVISION OF HEALTH AFFAIRS LIBRARY N.C. MEM, HOSP. U. ^» C. CHAg£L^UlLL«^JL^C, I TKisBulletmynDb^^ntfre/fodlMj citizen of ri\e Sfai^e upon request I Entered as second-dlass matter at PostofEce at Raleigh, N. C. under Act of August 24, 1912 Published monthly at the office of the Secretary of the Board, Raleigh, N. C. Vol. 73 MARCH, 1958 No. 3 M^ vaSSVV-' CENTRAL BUILDING, STATE LABORATORY OF HYGIENE MEMBERS OF THE NORTH CAROLINA STATE BOARD OF HEIALTH G. Grady Dixon, M. D., President Ayden John R. Bender, M. D., Vice-President Wlnston-Salem Charles R. Bugg, M. D. Raleigh Lenox D. Baker, M. D. Diirham H. C. Lutz, Ph.G. Hickory Mrs. J. E. Latta Hlllsboro, Rt. 1 John P. Henderson, Jr., M. D. Sneads Ferry Roger W. Morrison, M. D. Afihevllle Z. L. Edwards, D.D.S. Washington EXECUTIVE STAFF J. W. R. Norton, M.D., M.P.H., State Health Director John H. Hamilton, M.D., Assistant State Health Director, Director State Laboratory of Hygiene, and Editor Health Bulletin Robert D. Higgins, M.D., M.P.H., Director Local Health Division Ernest A. Branch, D.D.S., Director Oral Hygiene Division A. H. EUiot, M.D., Director Personal Health Division J. M. Jarrett, B.S., Director Sanitary Engineering Division Fred T. Foard, M.D., Director Epidemiology Division E. C. Hubbard, B.S., M.P.H., Director Division of Water Pollution Control List of free health literature will be supplied by local Health Departments or on written request. CONTENTS Page Fiftieth Anniversary of the State Laboratory of Hygiene 2 Notes and Comment 5 FIFTIETH ANNIVERSARY OF THE STATE LABORATORY OF HYGIENE By JOHN H. HAMILTON, M. D., Director State Laboratory of Hygiene On February 28, 1958, the State supply, the fee to be used in paying Laboratory of Hygiene completed fifty the Department of Agriculture for years of existence and service as an this service which they had rendered institution. It could have been two since 1900. Still further back we find years older had the 1905 General As- that in 1896 the State Board of Health sembly which created it been a little passed a resolution requiring that more generous with their appropria- certain chemical and bacteriological tion. Only $500.00 and fees from water examinations be made at the Uni-analyses were made available that versity of North Carolina. Even in year. If one wishes to trace our history 1895 the Board had elected two further back, we would find that in physicians to serve as bacteriologists. 1903 the General Assembly enacted Before that, in 1893, laws had been a law authorizing the State Board of enacted for the purpose of protecting Health to charge $5.00 for each analy- the purity of public water supplies, sis of water from the public water The background for our beginning March, 1958 The Health Bulletin was undoubtedly the epochal 15-year period between 1876 and 1890 when such phenomenal progress was made in the development of bacteriology and our knowledge of infectious dis-eases. Then too, these outstanding ac-complishments in Europe were follow-ed by the establishment of public health laboratories in our United States, notably in New York City. Even though the 1905 General As-sembly gave us our name, it was the 1907 General Assembly which gave us our existence, for they appropriated $2,000 per year and established a schedule of fees which we are required to collect from public water supplies. This established a precedent which has persisted to this date that the Labora-tory must be partially self-supporting. There has been no change in the schedule of fees which public water supplies pay since the 1907 General Assembly; however, there has been some change in the definitions for public water supplies. The Laboratory has been at four different locations in the City of Raleigh; the first occupied March 1, 1908 consisted of three small rooms and a closet in the Agricultural Build-ing at the corner of Halifax and Eden-ton Streets. On January 1, 1909, the Laboratory was moved to more com-modious quarters on the third floor of the Holoman Building on Fayetteville Street. In January, 1917, the Labora-tory moved into its own building on Jefferson Street. This building was designed and constructed for labora-tory work. In February, 1940, the Laboratory was moved to its present plant. The Central Building is on Caswell Square, facing West Jones Street, where specimens are examined and biological products are prepared for distribution. The Laboratory Farm, 280 acres with seven buildings is located seven and one half miles west of the Capitol, on U. S. High-ways Numbers 1, 64 and 70A. Here are carried out the initial stages of the preparation of rabies vaccine and smallpox vaccine. Here too our larger animals are quartered, as well as our smaU animal colonies. , The Laboratory has participated actively in many of the battles which have been fought against communi-cable diseases in North Carolina. In 1907 many of the public water supplies were unsafe sources of drinking water. A considerable number of the munici-pal supplies were suitable only for fighting fires and flushing toilets. Most cities maintained wells at numer-ous locations within their boimdaries. Even the wells were frequently con-taminated. The Laboratory played an active part in the improvement of these public water suppliers to their present high standards, and they have practically ceased to be a source of infection. In 1916 typhoid fever was credited with causing 702 deaths. Since 1950 we have had only from 1 to 4 deaths each year from typhoid fever. In the fight against this disease the Labora-tory examined not only specimens of water but specimens from patients as an aid to the diagnosis of the disease or detection of carriers. In addition large voliunes of typhoid vaccine were manufactured and distributed. In 1916 there were 410 deaths from diphtheria in the State. Since 1952 there has been no year in which we have had more than nine deaths from this disease. Here the Laboratory assisted in the fight by examining specimens as an aid to the diagnosis of the disease, the detection of carriers, and the distribution of diphtheria antitoxin and immimizing antigens. In 1916 there were 13 deaths from smallpox in North Carolina. Since 1944 we have not had a single death from this disease. The Laboratory's only service in the fight against small-pox w-as the distribution of smallpox vaccine, but that service contributed to the immunization of millions. Shortly after the armouncement was made that there was hookworm infestation in North Carolina, the Laboratory confirmed the presence of hookworm disease in our State. By 1912 the Laboratory was not only making hookworm examinations at the rate of 22,000 per year; technicians were also trained in the Laboratory to make these examinations in the field. The salaries of these workers were The Health Bulletin March, 1958 paid by the Rockefeller Sanitary Com-mission. This hookworm campaign did much to reduce the prevalence of in-testinal parasites in the State and to establish public health as a worth-while procedure. The best known work of the State Laboratory of Hygiene is the exami-nation of dog heads for rabies. When-ever the name of the State Laboratory of Hygiene is mentioned at nearly any crossroads in North Carolina, people know that Is the place where dog heads are examined, although they may be unaware of any of oiu- other activities. In addition to aiding in the diagnosis of rabies in animals, the Laboratory as early as 1917 administered antirabic treatments to patients coming to Raleigh. By 1919 the Laboratory was distributing antirabic vaccine to phy-sicians who could administer it in their own offices. The largest nvunber of animal heads ever examined in a single year was in 1935 when some 2000 were received at the Laboratory. We are winning the fight against rabies, provided we do not relax our efforts. The largest activity ever undertaken by the Laboratory was in connection with the fight on syphilis. In 1918 we started making the Wassermann test. As with other procedures we have dis-carded the older tests and adopted newer ones whenever we were con-vinced that we were making improve-ment in our services. The largest number of blood tests we ever made in a single year was in 1941 when a total of 427,488 specimens were examined. Ninety-four thousand of these were from draft registrants being made ready for World War n. Here, too, we seem to be on the winning side, pro-viding the efforts which are now being made are sustained. During the first calendar year of the Laboratory's existence — 1909 — 2,902 laboratory examinations were made. In 1912 this number had increased to 5,058. For the calendar year 1957, more than 500,000 examinations were made. The intervening years have generally shown an upward trend in the volume of work. Some years, as 1941, when syphilis serology was urgently needed and when additional workers were available, showed extra-ordinary activity. Our specimens come from physicians, local health departments, state insti-tutions, hospitals and public water supplies. Most people in the State are fairly familiar with the aid which the Laboratory renders to physicians in the diagnosis of disease and to health departments in the detection of car-riers, and also with the large volume of biological products distributed to those who are authorized by law to use them. Few people realize that the epidemiologist can use laboratory find-ings to detect an impending epidemic and take steps to prevent it just as well as he can use the Laboratory to solve the mysteries of an epidemic in full bloom—an outbreak of food poi-soning, for example. Our oldest activity, yet one as useful and even more widely used today, is the work we can do to help safeguard the quality of drinking water. A newer endeavor in this general field is to assist the stream pollution work in making our rivers and their tributaries a bit cleaner and more usable, A newer activity is in the field of viruses —their isolation and identification. The newest activity is the monitoring of water and foods for radioactivity. In addition to the examination of specimens and the biological products which we distribute, we have the re-sponsibility of approving local labora-tories for serological tests for syphilis — some 180 of them—and the certifi-cation of laboratories for the testing of milk which may be shipped from North Carolina to other states. There are 25 of these certified milk labora-tories. At present our staff consists of 74 people, 32 of whom have been with us for more than ten years. Two have been with us for more than 40 years; five for from thirty to forty years; three from twenty-five to thirty years; five from twenty to twenty-five years; eleven from fifteen to twenty years; and six from ten to fifteen years. In addition, one has retired after forty years and one after thirty-nine years March, 1958 The Health Bulletin 5 of service, and one died after twenty-nine years of service. All members of our staff are important; some may draw larger salaries than others, but each and every one make a contri-bution to the smooth operation of the Laboratory and the quality of work performed. The persons doing labora-tory work are well trained and pro-ficient in their particular field of activity. All hold Bachelor degrees — several have advanced degrees. We have a promotional system. Practically all of those in the higher classifications have been promoted from lower classi-fications in the Laboratory. A young-ster can come to the Laboratory im-mediately after graduating from col-lege and be given an opportunity for advanced training and promotion. In fact, a person can make a life career in the Laboratory of Hygiene with a reasonable degree of assurance that he can marry, have a home, rear children, house, feed clothe and edu-cate them adequately and have security in his old age. He will never be rich, if his sole income is from the State, but he can enjoy his work because he knows that he is making a worth-while contribution to the well-being of his fellow citizens. He can have pride in his accomplishments and hopes for the future. We have a staff of labora-tory workers of whom any laboratory director could be proud. We have endeavored to outline briefly the State Laboratory of Hygiene as an institution dedicated to render-ing service helpful in the detection, treatment and prevention of disease, as well as evaluations of unfavorable environmental conditions. An institution is more than bviild-ings, equipment and supplies. It is people, who motivate it, who give it intelligence, loyalty, devotion, responsi-bility, reputation and tradition. The State Laboratory of Hygiene is fortu-nate that its foxmder and director for more than 25 years was Dr. Clarence A. Shore. He and his associates set the ideals and traditions of service which those who followed them have endeavored to maintain. Mr. J. W. Kellogg, in the April 1940 Health Bulletin, gave a brief but meticulously docvmiented history of the Laboratory from 1908 to 1940. This, April, 1940, Health Biilletin is devoted entirely to the dedication of the present plant to Dr. Shore. As we look backward with pride in the past we also look forward with hope for the futvire. We have confi-dence that the service which our in-stitution has rendered during its first half century has established us so firmly as a worthwhile institution that during the second half century of our existence we shall render even greater service. The State Laboratory of Hygiene has a part in the future. NOTES AND COMMENT By the Editor Dr. Applewhite Retires After forty-four years in service to the public health Dr. C. C. Applewhite has certainly earned the privilege of retiring. For more than eight and one half years—July 1, 1949, to January 31, 1958 he served as Director of Local Health Work for the North Carolina State Board of Health. He came to our State with a long and honorable record of accomplishments in public health over an area extend-ing from the Atlantic ocean to the tier of states west of the Mississippi. He tackled our problems in North Carolina with energy, enthusiasm, knowledge, experience and natural ability, with which he had been richly endowed. His tour of duty in North Carolina was fruitful. The General Assembly of 1949 had just increased the appropriation for State aid to local health departments by $800,000. The equitable distribution of this new money among the local health depart-ments, some of which was for single districts and some for municipalities which maintained separate organi- 6 The Health Bulletin March, 1958 zations, helped set the stage for an expanding health program. After 1949 there was no increase in State funds and an actual decrease in Federal fluids; yet Dr. Applewhite was most helpful in persuading local appropri-ating boards to increase local funds. The result tells the story. In 1950 local funds were $2,693,246 of the $4,372,628 expended for local health work in the State, the State funds being $1,500,000 and other soiirces, mostly Federal, $529,383. Through the years local health funds increased, while State funds remained stationary and Federal funds decreased, until, in 1958, local money amounted to $5,334,965 of the $6,905,758 budget for local health work. In 1950 only some eight or ten of oiu: local health departments were ade-quately housed. Most of them were crowded into basements or attics. By 1958, 73 new health centers had been completed to house our local health departments, and eight more were under construction. Dr. Applewhite and Dr. John A. Ferrell of the Medical Care Commission teamed together to induce county commissioners to construct these worthwhile buildings. Better housing facilities have helped our local health work in many ways. They have made it possible to improve the quality and increase the quantity of service which could be rendered. Veteran health workers have been en-couraged to remain steadfast in the faith, and recruiting of capable, well-trained young men and yovmg women as public health workers should be less difficult. While encouraging and stimulating the procedures which have been con-sidered a fundamental part of a well regulated health program. Dr. Apple-white did much to make mental health a definite part of our public health activities. His position is that much can be done to prevent mental disease and that public health workers can make a worthwhile contribution In that field of endeavor. Dr. Applewhite's kindly, sympathetic and understanding attitude won him a host of friends in North Carolina. When it was learned that he was re-tiring, the local health workers were the first to decide that due recognition should be made of our love and af-fection for him. The staff of the State Board of Health and the North Caro-lina Public Health Association followed their lead. On January 31, his last working day, a special meeting of the North Carolina Academy of Public Health was called. A traveling bag was presented to Dr. Applewhite by Dr. John Fowler, dii'ector of the Durham Child Guidance Clinic, in behalf of the mental health workers. Dr. W. A. Browne, director of the Edgecombe County Health Department, speaking for the local health workers and the staff of the State Board of Health, presented him with a lounging chair with the hope that he would enjoy many restful and pleasant hours re-clining in it. Dr. J. W. R. Norton pre-sented him with a stack of letters written and signed by numerous well-wishers. These have been boimd in book form. Dr. Applewhite has said: "Frankly, this toiur of duty in North Carolina will always be considered by me as the happiest one in my entire public health career." When we review his biography we in this State may justly feel highly complimented. Born—Winona, Mississippi, 1887 Attended Millsaps College, 1903-1907 —A. B. degree Taught public school in Mississippi, 1907-1909 Attended Vanderbilt University, 1909- 1913—M. D. degree Attended Harvard School of Public Health, 1932-1933—M. P. H. degree Career: Rural sanitary surveys, USPHS, in Mississippi, Georgia, North Caro-lina, Alabama, Tennessee, Illinois and Texas, 1914-1917 Extra cantonment sanitation, USPHS, in Georgia and New Jersey, 1917- 1919 Rural health work in Georgia and Kentucky 1919-1922 Director of Local Heath Service, State Health Department, Jackson, Mississippi, 1922-1932 Rural health work. State Health Department, Columbia, S. C, 1933- 1935 March, 1958 The Health Bulletin Regional consultant, USPHS, New York, Chicago and New Orleans Districts, 1935-1941 District Director, USPHS, Kansas City, Mo., 1941-1945 District Director, USPHS, New Orleans, La., 1945-1949 Director, Local Health Division, N. C. State Board of Health, 1949- January 31, 1958 Received Reynolds Award for out-standing achievement in public health field in North Carolina for 1953 Diplomate, American Board of Pre-ventive Medicine and Public Health Fellow, American Medical Association Member Wake County Medical Society Member, Medical Society of the State of North Carolina Member, American Public Health Association Member, American College of Pre-ventive Medicine Member North Carolina Academy of Preventive Medicine President, North Carolina Academy of Public Health Dr. Applewhite has left North Caro-lina to return to Mississippi, the State of his birth and early manhood. Al-though we are saddened by his de-parture from the ranks of public health workers in North Carolina, we are pleased that we have known him and have had the privilege of working with him in promoting the well-being of the people of North Caro-lina. We of the staff of the State Board of Health join with other health workers throughout the State in wish-ing for him many happy years in the land of the living. Our affection for him goes wherever he goes. We will remember him as an honorable Christian gentleman. COMPULSORY POLIOMYETITIS VACCINATION For nearly two years we have had suggestions from various and sundry sources that there should be a law, rule or regulation requiring that all children be vaccinated against polio-myelitis. The frequency with which these suggestions are made is in-creasing. There have been newspaper editorials. The problem has been dis-cussed by boards of health, both local and State. The evidence is accumu-lative that poliomyelitis vaccine is effective in preventing paralysis due to this disease. Just how long the protection induced by the vaccine will last is yet to be determined. Another year of experience with the vaccine will be possible before the General Assembly of 1958 meets. In the mean-time it is not necessary that any of us make a decision as to whether or not we favor compulsory vaccination against poliomyelitis. Physical Therapy Duke University, Durham, North Carolina, has inaugurated a program of graduate credit for specified courses in the physical therapy program. This augments the certi,ficate course in physical therapy offered for the past fifteen years by Duke Uni-versity Medical Center and approved by the Council on Medical Education and Hospitals of the American Medical Association. The new program in physical therapy is conducted imder the joint auspices of the Graduate School of Arts and Sciences and the Duke University Medical Center. The program has two phases: (1) The fundamental courses in physical therapy are studied in the first fifteen months. During this period fifteen hours of graduate credit, which meet one-half of the graduate residence requirement, may be accimiu-lated. The Certificate in Physical Therapy is awarded up>on completion of this work. The graduate is then eligible to become a member of the American Physical Therapy Associa-tion, to take state and national licen-sing and registration examinations and to work as a qualified physical therapist. (2) Later specialization in anatomy or in physiology can provide the additional fifteen hours of gradu-ate credit necessary for the Master of Arts degree. This second phase, in-cluding preparation of a thesis, may be formally scheduled in one semester. 8 The Health Bulletin March, 1958 Radio Program The State Board of Health's weekly radio program, over Station WWNC in Asheville, heard every Saturday, has been changed from 9:15-9:30 A.M. to 1:45-2 P.M. The subject of this pro-gram is "Your Health And You," and it is designed to reach listeners in the western part of the State, The Board also gives a program known as "Your Public Health Reporter" over Station WPTP, in Raleigh, each Satiu-day, beginning at 1:30 P.M. The scripts are prepared and delivered by William H. Richardson, publicity officer for the Board. AUTOMATION CONTRIBUTING TO OBESITY PROBLEM Automation may have its advantages but it is causing a major problem in the field of medicine. More and more people are tending to become overweight as a result of our new sedentary life which provides more leisure time with less heavy physical work, according to Dr. Robert H. Barnes, of Seattle. Writing in the Journal of the Ameri-can Medical Association, the University of Washington School of Medicine doctor said, "Reduction and perma-nent weight control require healthy changes in living habits." In addition to physical examinations and general health evaluation, a phy-sician today must also concern himself with the patient's personal living habits if he is to recommend an ef-fective reducing program. "Usual eating habits and average daily physical activity are two of the most important points to be explored," said Dr. Barnes. He added, "There is no single approach to the treatment of obesity, only lifetime control." A special history should be the first step in determining a program to bring long-term results. This history will give an index of past and present weight, maximum weight, and esti-mated ideal weight. The second step is to modify the way of eating, which must be designed to be followed during the patient's life-time. This approach is more satis-factory on the long-range basis than the conventional rigid diet. Dr. Barnes said. Lowering the caloric intake is neces-sary for anyone to reduce. Despite the fact that dieting alone has been a iSLilure, it is still the principal support in reducing, he said. In setting up a diet, the patient's working facilities, meal hours, family food patterns, and income level must all be considered. Additional steps in the program should include the use of medication (dispensed under a physican's super-vision), exercise, and posture control. He noted, "Moderate exercise, month in and month out, can be the differ-ence between following a starvation regimen and being able to follow a more normal diet according to one's appetite. "Here again modern civilization makes it difficult for the overweight patient to do regular exercising such as walking. The habit of riding every-where, even three blocks to the store, has depressed the physical activity of many to a very low state." There should also be developed a close relationship between doctor and patient, for, according to Dr. Barnes, "The patient should realize that he is under the care of a physician not only to lose weight but also to have treated the associated medical dis-orders common to obesity which com-mercial reducing salons are admittedly incapable of recognizing and treating." FACIAL PAIN CALLED "MOST AGONIZING" The reasons for facial pain being "perhaps the most agonizing of all afflictions" were given by a Georgia doctor. There is a reasonabe physical reason for severe suffering from facial pain. The "cephalic end of man has been blessed with the highest degree" of nervous development, which allows for the most acute awareness of any sensory stimulation. Also the head and face command more attention than other parts of the body, Dr. George W. Smith, Augusta, Ga., said in the Journal of the American Medical Association. March, 1958 The Health Bulletin 9 Man is very much aware of his face and head and its vulnerability to injury or hui't. Accordingly, he is quickly and greatly concerned about any painful sensation. Awareness of others scrutinizing his exposed face magnifies any sensation he might be experiencing, although there may be no objective change to the observer, Dr. Smith said. The way people bear pain depends on their own personalities, emotions and neurotic tendency, he said. This dif-ference among people makes evalu-ation, diagnosis, and treatment of facial pain a complicated and difficult problem for the doctor. The precise diagnosis and locali-zation of the origin of facial pain is difficult because there are so many nerves and they so overlap that it is hard to distinguish just what path the pain is following. Relief depends on the cause. If it results from something other than nerve damage, such as infection in the mouth or a tumor, it can be relieved by eradicating the cause. When the nerves themselves are damaged or dis-eased, the treatment is more compli-cated, often involving surgery. Dr. Smith is in the division of neurological surgery, the Medical Col-lege of Georgia. Hospitals One out of eight Americans will be hospitalized during the coming year. For the first time, many of us will know what a hospital really is—how it restores and protects oiur health. There was a time, according to an article in the spring issue of Blue Print for Health, a publication of the Blue Cross Commission of the Ameri-can Hospital Association, when the name "hospital" had an entirely dif-ferent meaning. "The Hospital Throughout the Ages" is the first of an eight-part series written by Arnold A. Rivin, formerly of the American Hospital Association. Riven shows how the modern hospital was "a long time coming" by tracing its origin back to the fifth century B. C. in Ceylon. Even as late as the eight-eenth century "hospitals" were used primarily to house human derelicts. The idea of a voluntary hospital solely for the curable sick emerged in the British Isles in the early 1700's. The Pennsylvania Hospital in Phila-delphia is generally accepted as the oldest true American hospital. It was founded in 1751 with the active aid of Benjamin Franklin. In the 1800's the quahty of patient care and hospital maintenance were so poor that most hospitals actually contributed to the spread of disease. With the development of ether, radical improvements in sanitation and hygiene, the use of new techniques and specialized equipment, hospitals emerged gradually into the form we know today. By the 1900's, more and more people who had formerly been treated at home went to the hospital for treat-ment. As the number of hospital ad-missions increased, it soon became apparent that a plan was necessary which would make hospitalization available to every family burdened with illness, regardless of its finan-cial status. Within the past twenty-five years, this need has been answered by steadily increasing nation-wide en-rollment in prepayment plans for hos-pital care. Thus today your hospital has become a community center for treatment of the sick. Mr. Rivin closes his article with the optimistic thought that what-ever ailment one out of eight of us has during the coming year, we now stand an excellent chance of being released from the hospital soon—in better health. Industrial Health Conference New problems and progress in the control of occupational health hazards and the provision of preventive medi-cal services by industry will be dis-cussed at the Thirteenth National Industrial Health Conference, to be held at Convention Hall in Atlantic City, New Jersey, April 19-25, 1958. Over 3,000 occupational health special-ists, businessmen and labor leaders will hear papers on problems of grow-ing significance to industry, workers, and the community. A total of 134 10 The Health Bulletin March, 1958 papers will be presented on such subjects as radiation, mental health in industry, air pollution, noise, medi-cal care and in -plant health services, industrial dentistry and industrial nursing. Radiation. — Comprehensive sessions on radiation will cover such specia-lized facets of the problem as stand-ardization in nuclear energy; radiation protection laws and codes—a scramble for action; radiation dosages to medi-cal personnel; environmental radio-activity in the nuclear test airplane test area; radiation safety monitoring of reactor demolition; the licensee in-spection program of the Atomic Energy Commission; facts and fallacies about radiation exposure; diagnostic radi-ation in industry, uses and abuses; microwave radiation hazards; and the Pennsylvania radiation protection pro-gram with its outlawing of shoe-fitting fluoroscopes. Mental Health in Industry.—Since studies have shown that as much as one -third of sickness absenteeism in industry is due to mental health prob-lems, this is a problem of paramount concern to industrial physicians and management. A symposium will be held on this subject centering on early recognition of emotional problems by industrial physicians. Air Pollution.—The pollution session will cover numerous papers, including air pollution control in New Jersey, a progress report of the New Jersey Air Pollution Control Commission; the ap-plication of simplified techniques to air pollution measurement; air pollu-tion problems in petroleum refining; the effects of air pollution on human health; and pollen removal by air filters. Noise—Papers on noise will Include a report of a Public Health Service study on industrial noise and hearing loss in a controlled population; industrial audiometry; hearing loss related to non-steady noise exposure; reduction of air flow noise; acoustical treatment of walls and ceiling; and noise control methods used in foundry operation. Medical Care and In-Plant Health Services.—A symposium will be held on medical care of industrial workers. covering labor's health goals; the medical care plan of Endicott-Johnson Corporation; and community health association plans for operation in Detroit. A special session will also be held on health services for small plants, including a paper on the value of small plant health programs to management. Industrial Dentistry. — The sessions on industrial dentistry will include a symposium on dentistry as related to safety in industry, a panel discussion on the cost of an industrial dental program to management, and paper on the possibility of dental coverage in health insurance programs. Industrial Nursing. — The industrial nursing sessions will include dis-cussions on the effective use of com-munity resources; automation; and preparation for catastrophic and emergency situations in industrial plants. Other Sessions. — Nvunerous papers will be devoted to other aspects of occupational health, including the toxicity of various substances used in industry; engineering, chemical and analytical procedures as related to industrial health; rehabilitation and alcoholism. Special Conference addresses in-clude the C. O. Sappington Memorial Lecture, to be presented by C. W. Shilling, M. D., Deputy Director, Di-vision of Biology and Medicine, Atomic Energy Commission, on "Everybody's Business—The Problem of Fall Out and Radiation." The Donald E. Cum-mings Memorial Lecture will be given by Major General James P. Cooney, Deputy Siorgeon General of the Army, who will speak on "Interpersonal Relations." In an address commemo-rating the 20th aimiversary of a pro-fessional organization participating in the Conference, Mr. John J. Bloom-field, known as one of the founders of modern industrial hygiene in the United States, and now Regional Con-sultant in Industrial Hygiene at the Institute of Inter-American Affairs, will report on "What the American Conference of Government Industrial Hygienists has done for Industrial Hygiene." March, 1958 The Health Bulletin 11 The Industrial Health Conference is sponsored by the Industrial Medical Association, the American Industrial Hygiene Association, the American As-sociation of Industrial Dentists, the American Association of Industrial Nurses, and the American Conference of Governmental Industrial Hygienists. H. W. Lawrence, M. D., Medical Director, Procter & Gamble Co., Cin-cinnati, Ohio, and President-elect of the Industrial Medical Association, is General Chairman of the Conference. C. Scott McKinley, M. D., Medical Director, Bakelite Corporation, Bound Brook, New Jersey, and Mr. N. V. Hendricks, Esso Research & Engi-neering Company, Linden, New Jersey, are Deputy General Co-chairmen. Advance registration forms, as well as a copy of the program, may be ob-tained from Edward C. Holmblad, M. D., Managing Director, Industrial Medical Association, 28 East Jackson Boulevard, Chicago 4, Illinois. FINGERPRINTS CAN BE REMOVED BY SURGICAL TECHNIQUE Fingerprints, always considered to be permanent and unalterable, can be completely removed by the surgical technique of skin planing, a New Orleans doctor reported. Tu'o Detroit physicians also reported that they have proved an assumption of law enforcement officials that prints of the second or dermal layer of skin can be used for identification purposes as well as those of the top layer or epidermis. Their reports appeared in Archives of Dermatology, an American Medical Association publication. Dr. James W. Burks Jr.. of the Tulane University School of Medicine division of dermatology, said his pre-liminary report has important legal Implications because the possible re-moval of fingerprints makes positive identification by this means uncertain. He treated two men with arsenic-caused horny growths on the hands by planing the skin with a high speed electric wire brush. At the same time, he planed a finger of each man, re-moving the epidermis and the upper part of the dermal layer. Skin planing is often used to remove scars from acne or small pox. Weeks after the planing, the fingers were smooth, slightly pinker, and with-out visible ridges. A hand lens showed the normal arrangements of whorls to be replaced by minute, thin, criss-crossed and parallel lines similar to those on the back surface of the web between the thumb and index finger. Dr. Burks warned dermatologists that they must guard against treating criminals who seek to have their finger-prints removed. He added, however, that criminals who have this means of identification altered may still be re-cognized through "other equally satis-factory means." In fact, the "very absence" of ridge patterns on fingers could reflect an attempt to conceal identity. Dermatologists can help law enforcement officers in determining the medical reasons for a person's having planed fingers, he said. The Detroit physicians, Drs. Harold Plotnick and Hermann Pinkus, ran an experiment on the similarity of epider-mal and dermal fingerprints. Using recently amputated fingers, they first took prints of the epidermis. They then removed the epidemis and took prints of the dermis (also called the corium or "true skin"). The two prints were identical except that the ridges of the dermal prints appeared split or double, as well as finer that those of the epidermis. The dermal print is "just as effective for identification purposes." they said. Their study resulted from an actual case in Boston in which Dr. Pinkus was asked by the police to explain the difference between epidermal and dermal fingerprints. The police had found the body of a man and suspected that he had been murdered by his wife and dumped into the water. All the skin had come off the fingers, but prints were taken from the denuded dermal surfaces. It was up to the police to convince the jury of the identity of these prints with ordinary prints on file. "They built up a nice case with the information, but the wife confessed just before the trial opened, so all the 12 The Health Bulletin March, 1958 effort had been for nought," the doctors said. It did, however, lead to the study proving the vahdity of dermal prints as a means of identification. NUTRITION PLAYS NO ROLE IN ARTHRITIC PROCESS There is no special diet for the treat-ment of arthritis, according to the American Medical Association's Coun-cil on Foods and Nutrition. In a special report prepared for the council. Dr. William D. Robinson, Ann Arbor, Mich., said joint diseases are "essentially diseases of the supporting structiu-e of the body, the connective tissue." It is "extremely unlikely that the fimctioning of this tissue can be directly affected by dietary manipu-lation." However, patients with diseases of joints do need to pay attention to their diet, because of its effect on their general state of health. Dr. Robinson said. Many diets and specific vitamins and minerals have been suggested for the treatment of arthritis, but research has failed to show any relationship between nutrition and the cause of most rheumatic diseases. Gout is the only fairly common form of joint disease in which diet and the use of food by the body have been shown to affect the disease. Food allergy, high fat diets, and periods of fasting all precipitate gout attacks; therefore, patients need to watch their diets carefully. Occasionally special diets are needed by persons with arthritis, even though they will have no effect on the disease itself. For instance, overweight patients often need to lose weight to reduce the load on the affected weight-bearing joints. Diets high in calories, proteins, vitamins, and minerals are sometimes necessary for patients who have lost weight and muscle tissue, a situation frequently encountered in rheumatoid arthritis. Dr. Robinson noted that many forms of rheumatic disease are self-limiting. with a tendency to subside spon-taneously after a varying length of time. Confusion of such conditions as bursitis or psychogenic rheumatism with various types of arthritis un-doubtedly has been responsible for the claims of value for various diets and vitamins as treatments for arthritis. i Dietary treatment for the arthritic ! patient may be an important aspect of the total program of effective treat-ment, but such treatment "must be , adapted to the general condition of the individual patient as well as to the type of rheumatic disease present," Dr. Robinson concluded. He is in the department of internal medicine and the Rackham Arthritis Research Unit of the University of Michigan. His report appeared in the Journal of the A.M.A. TWO-MONTH-OLD BABIES NEED POLIO SHOTS Polio shots for infants as young as two months were recommended recently in a guest editorial in the Journal of the American Medical Association. At present shots are generally begun at six months of age. However, several groups of researchers have fovmd that many infants lose the immunity with which they are born before they reach six months. Dr. Lam-i D. Thrupp, chief of the poliomyelitis surveillance imit of the U. S. Public Health Service's Com-municable Disease Center, Atlanta, Ga., said the American Academy of Pedi-atrics has recommended beginning the shots at two months. The third shot should follow the first two by at least six or seven months. During 1956, attack rates of paralytic polio were highest in one-year-old children and the largest proportion of cases occurred in the under-five-year age group, Dr. Thrupp said. Preliminary data for 1957 indicate that a comparably high proportion of para-lytic cases is occurring in pre-school-age children. LIBRARIAN DIVISION OF HEALTH AFFAIRS LIBRA N.C. MEM, HOSP, U. N. C. CHAPEL HILL, N.C. I TKis Bulletin will be seni^jf^ to dniiciiizen of tKe 5kite upon request \ Entered as second-class mayi^ at Postoffice at Raleigh, N. C. under Act of August 24, 1912 Published monprfy at the office of the Secretary of the Board, Raleigh, N. C. Vol. 73 APRIL, 1958 No. 4 Rtct-.' ^,.,^^- m'i o 105^9 ASHE COUNTY HEALTH DEPARTMENT JEFFERSON, NORTH CAROLINA MEMBERS OF THE NORTH CAROLINA STATE BOARD OF HEALTH G. Grady Dixon, M. D., President Ayden John R. Bender, M. D., Vice-President Wlnston-Salem Charles R. Bugg, M. D. Raleigh Lenox D. Baker, M. D. Diirham H. C. Lutz, Ph.G. Hickory Mrs. J. E. Latta Hlllsboro, Rt. 1 John P. Henderson, Jr., M. D. Sneads Ferry Roger W. Morrison, M. D. Ashevllle Z. L. Edwards, D.D.S. Washington EXECUTIVE STAFF J. W. R. Norton, M.D., M.P.H., State Health Director John H. Hamilton, M.D., Assistant State Health Director, Director State Laboratory of Hygiene, and Editor Health Bulletin Robert D. Hlgglns, M.D., M.P.H., Director Local Health Division Ernest A. Branch, D.D.S., Director Oral Hygiene Division A. H. Elliot, M.D., Director Personal Health Division J. M. Jarrett, B.S., Director Sanitary Engineering Division Fred T. Foard, M.D., Director Epidemiology Division E. C. Hubbard, B.S., M.P.H., Director Division of Water Pollution Control List of free health literature will be supplied by local Health Departments or on written request. CONTENTS Page Nursing Homes and Homes for the Aged—The Heart of the Matter 2 Notes and Comment 9 Nursing Homes and Homes for the Aged — The Heart of the Matter* By L. E. Burney, M. D. Surgeon General, Public Health Service U. S. Department of Health, Education, and Welfare First let me express my sincere ap- pose, a wider vision of otir individual ! preciation to every individual who has and collective responsibilities for the i a part in this Conference. I am especi- patients in nursing homes, the resi-ally grateful to the Planning Commit- dents of homes for the aged. They are tee, the section chairmen, and all the ones who must reap the rewards of others who have worked hard these this Conference. They are the sole rea-past few months so that nothing shall son for our being here together this . be lacking to make this Conference a morning. I rewarding experience. Today, in a niursing home not far ' It is my earnest hope that after these from here there is a little old lady aged , four days of working together, each of 90 years, a former schoolteacher. She | us will return to our usual tasks with a is happy, active, comiortable, busy clearer understanding, a firmer pur- with her crossword puzzles, books, and •National Conference on Nursing Homes and Homes for the Aged, Washington,
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 | 1958 |
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 73, 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 | 9,539 KB; 170 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_healthbulletin1958.pdf |
Pres Local File Path-M | \Preservation_content\StatePubs\pubs_edp\images_master\ |
Full Text | Ci)e ILititatp of t|)e Dtt)t$ion of l^ealti) affait0 OniDetjSitp of il^otti) Carolina This Book Must Not Be Taken from the Division of Health Affairs Buildings. This JOURNAL may be kept out TWO DAYS, and is subject to a fine of FIVE CENTS a day thereafter. It is DUE on the DAY indicated below: J^ DIVlflorOF HEALTH AFFAIRS LIBRARY N.C. KEM. HOSP. U. N. C. CHAPEL HILL, N.C. (i®Mb'!SiI PuUisKed bvm/TETflcmM smamw^RimR I TKis Bulletin will be szrd^f^^o dnn cilfzen of tke Stafe upon request I Entered as second-class nmt^at Postoffice at Raleigh, N. C. under Act of August 24, 1912 Published moiuirty at the office of the Secretary of the Board, Raleigh, N. C. Vol. 73 ^ JANUARY, 1958 No. 1 JAN 31 ic^'- DlVlSiOM HEALTHAFfWRSlff^,^ PENDER COUNTY HEALTH CENTER BURGAW, NORTH CAROLINA MEMBERS OF THE NORTH CAROLINA STATE BOARD OF HEALTH G. Grady Dixon, M. D., President Ayden John R. Bender, M. D., Vice-President Winston-Salem Charles R. Bugg, M. D. Raleigh Lenox D. Baker, M. D. Durham H. C. Lutz, Ph.G. Hickory Mrs. J. E. Latta Hillsboro, Rt. 1 John P. Henderson, Jr., M. D. Sneads Ferry Roger W. Morrison, M. D. Asheville Z. L. Edwards, D.D.S. Washington EXECUTIVE STAFF J. W. R. Norton, M. D., M.P.H., State Health Director John H. Hamilton, M. D., Assistant State Health Director, Director State Laboratory of Hygiene, and Editor Health Bulletin C. C. Applewhite, M. D., Director Local Health Division Ernest A. Branch, D.D.S. , Director Oral Hygiene Division A. H. Elliott, M. D., Director Personal Health Division J. M. Jarrett, B. S., Director Sanitary Engineering Division Fred T. Foard, M. D., Director Epidemiology Division E. C. Hubbard, B.S., M.P.H., Director Division of Water Pollution Control List of free health literature will be supplied by local Health Departments or on written request. CONTENTS Page Your Health and You 2 Notes and Comment 5 YOUR HEALTH AND YOU BY WILLIAM H. RICHARDSON State Board of Health Raleigh, N. C. There are many people, perhaps, who pose to give you some more which, on | are not informed as to what their the face of it, is beneficial to the health department can do for them — average citizen. what it is doing and what it will do Public health affords protection not j upon request. The State Board of only to the public in general, to par- Health publishes an informative eight- ents, little children and infants, but page booklet titled: "How Your Health also to the unborn baby, as well as its Department Serves You." While the mother. i publication is in condensed form, it The health department is working does contain much pertinent informa- toward health for mothers and babies. tion which the general public should Public health nurses make home visits have. We have referred to portions of for health supervision and encourage this booklet in the past, and now pro- expectant mothers to seek medical care January, 1958 The Health Bulletin early in pregnancy. Public health nui-ses will visit the home to teach mothers infant care. To aid in saving the lives of premature babies, special services, including transporta-tion and hospitalization, are provided for them through the health depart-ment. Many health departments hold well-baby clinics to provide medical super-vision for infants, to give immunizations and to offer information to parents on the growth and development of the infant and pre-school child. Pre-school clinics are held in cooperation with the schools and Parent-Teacher Associa-tions, to give booster immunizations and examine children for physical de-fects. The children are referred to their private physicians for medical care when indicated. Your local health department pro-vides public health nursing service for school children. Medical inspections are given to children referred by the teachers and public health nurses and to selected groups of other children. The children found to have physical defects are referred to their family physicians. Funds for correction of de-fects are available through the joint school and health departments' school health program for those families un-t able to pay for corrections. ' When necessary, the public health nurses make home visits to urge par-ents to have physical defects corrected. Special programs of hookworm, nutri-tion, chest X-ray examination, and other health programs are offered to teachers, school children and parents by many local health departments. The physically handicapped chUd 1 may come to the health department's I monthly orthopedic clinic for physical- ' ly handicapped children. The physi-cians holding the clinic are specialists ' in orthopedic work. ' Keeping the public informed about i health is an important part of the public health program. Every member of the health department staff does health education work as he or she carries on public health duties. Many health departments employ trained public health educators who work full-time on developing health education programs in the communities. The health educator and other public health workers will help communities organize to work on health problems. The development of health councils, neighborhood groups, adult study groups, and community health projects are all a part of a well-rounded pub-lic health program. The health educator and other pub-lic health workers can assist schools in developing units of study on health, aid schools with special health projects, work on programs of in-service train-ing for teachers and provide materials and films for school groups. Assistance is given to clubs, volun-tary and official agencies and indi-viduals in planning for health projects and programs and by providing them with materials and information on health. An effort is made to coordinate the program planning of groups to enable maximum benefits in the com-munity health program. The health educator and other staff members use the radio, newspapers, films, pamphlets, posters, exhibits, bul-letin boards and other media to pro-vide the public with accurate, up-to-date health information. Keeping the official record of births and deaths is one of the basic jobs of many health departments. Birth rec-ords are important for entrance to school, for employment and on other occasions when date of birth must be established. Death certificates are necessary in the settlement of insur-ance and legal matters. Certain diseases are reported to the health department by private physi-cians. This information enables the health department to plan immediate action to prevent communicable dis-eases from spreading and chart the progress of disease control. The local health department keeps records on the services provided to in-dividuals, families and the community. Studies of populations, causes of death, diseases occurring in the com-munity and studies of rates of disease and death are made use of by health departments and are also helpful to \ The Health Bulletin January, 195S schools, organizations and other agencies in planning long-range pro-grams. The public health program, just like modern medical care, must have the services of accurate laboratories. The public health laboratory services for your community may be in your local health department, or your health de-partment may use the services of the State Board of Health. Regular tests are made of milk sup-plies to safeguard the milk you buy. Public and school water supplies are tested for purity. Private approved water supplies will be tested upon re-quest to your local health department. Your health officer and your physi-cian can use the public health labora-tory service as an aid in diagnosis. Services for certain examinations of blood, feces, urine, sputum and other specimens are provided by the public health laboratories. Cancer detection and diagostic clinics are jointly sponsored by your local and state health departments, local and state medical societies and the local and state divisions of the American Cancer Society. The clinics are open to North Carolina citizens thirty-five years of age or over and citizens under thirty-five years of age who have symptoms of cancer. Ask your family physician or your local health depart-ment for information on individual examinations or for the meeting dates of the clinic nearest youi- community. The State Board of Health mobile X-ray trailers are available to carry on a chest X-ray survey in counties. Certain of the local health departments are equipped to make survey films on mobile or portable imits. Requests for the service must be made by your local health department. Clinics are open to citizens desiring guidance in emotional and mental hy-giene problems. Your local health de-partment can give you information about the clinic services nearest to you. The State Board of Health maintains a free film service to provide films, film-strips and slides on health sub-jects for use by health departments, clubs, schools and other organizations. Films may be requested through your local health department or directly from the State Board of Health. Consultation services of trained nu-tritionists and dietitians are available to schools, institutions and community groups from the State Board of Health upon the request of your local health department. The Oral Hygiene Division of the State Board of Health provides dental inspections for children under twelve years of age. Dental care is given to children under twelve years of age whose parents cannot meet the cost. This service is made available periodi-cally upon assignment from the Oral Hygiene Division. The School-Health Coordinating Ser-vice, supported jointly by the North Carolina State Board of Health and the North Carolina Department of Public Instruction, provides services to school and health department person-nel through: consultative services, field visits, in-service education, production and use of certain materials and re-sources in areas of health services, health instruction, school environment and physical education. This service may be requested through the local health officer or the local superinten-dent of schools. Your health department gives pro-tection against disease. The private physician and health department work together to control contagious diseases in your community. Your health de-partment holds clinics to give immuni-zation against whooping cough, diph-theria, smallpox and typhoid fever and also other immunizations. When a serious contagious disease occurs in a family, the public health nurse, at the request of the health oflficer or a private physician, will visit in your home. The nurse will teach the family how to carry out the doctor's instruc-tions, including how to give good home nursing care, and will instruct the family in isolation precautions to pro-tect other members of the family from catching the disease. Your local health department main-tains a register of all known cases of tuberculosis and their contacts and January, 1958 The Health Bulletin holds chest X-ray clinics for studying these cases, and contacts and the pub-lic at large. Persons with tuberculosis are referred to their private physicians and, when necessary, arrangements are made for sanatorium care. Your health department makes diag-nosis of venereal disease cases and pro-vides adequate penicillin treatment where indicated. Each case of venereal disease is carefully interviewed for source of infection and for new con-tacts. When cases of certain communi-cable diseases occur, your health de-partment traces down the source of the diseases in order that additional cases may be prevented. Through education of foodhandlers and regular inspection by the sanitar-ian, safe methods of preparing, serving and handling food in restaurants, in meat markets, in abbattoirs, and in other food handling establishments are maintained. A grade sign, indicating the relative degree of sanitation, is posted in each food handling establish-ment. Every citizen should look for this sign when entering a food hand-ling establishment. Regular inspections are made of dairy farms and pasteuri-zation plants to assure production and processing of clean, safe milk. NOTES AND COMMENT BY THE EDITOR THE PREVENTION OF DISEASE The practice of preventive medicine is not an individual enterprise. Preven-tive medicine not only protects indi-vidual patients from acquiring disease but, of equal importance, sees to it that patients do not transmit their disease to the community at large. Complete health protection thus en-tails a dual responsibility which is more than one person or group can handle. At this time of year, in many areas, the local public health agency appears before its elected governing body to justify proposed budgetry requests. On the average, a health ofBcer asks for one to three dollars annually for each person residing in his assigned juris-diction. In most cases, due to the re-turn of federal and state tax monies through grants, only part of the funds requested comes from local taxes. This, of course, is not meant to imply a sav-ing of local tax monies; in fact, such subsidies tend to increase the overall cost as well as allow local politicians to dodge certain responsibilities. i There is no need to reiterate the ' many preventive health services a public health department can perform for the community and the medical professon. There is, however, a need for medical leadership in the support of adequate local tax appropriations to maintain necessary preventive health activities. It is a curious paradox that two branches of the medical profession show their worth so differently. A family physician is successful by his overt demonstration of skill and acu-men, while the success of a health de-partment depends on the disease or epidemic that never manifested itself. Because the medical profession can more clearly understand such health services, it is up to them to spearhead the financial backing needed for suc-cessful official health programs. Supporting a health department budget results in more than just en-vironmental protection; it is also, another means for professional guid-ance to the health department. When the medical society believes its local health department is satisfactorily participating in the over-all health program, it should not hesitate to show its appreciation. The greatest respect and tribute that can be paid to public health personnel by organized medicine is the recognition and back-ing of public health activities, properly performed. It should be obvious to tax money custodians that with medical society support only where applicable, inadequacies and incompetence wDl stand out as clearly as efficiency. Medi- The Health Bulletin January, 1958 cal society participation will promote health services that the community understands and accepts and at the same time will help to avoid duplica-tion and waste. As Dr. Gunnar Gundersen, Presi-dent- elect of the American Medical Association, pointed out in his recent address before the American Associa-tion of Public Health Physicians, "the success of public health programs de-pends, to a large degree, upon the practicing physicians and other medi-cal personnel and medical facilities in the community. A health department, unsupported by the medical profession, divorced from the community's hospi-tals and alienated from others in the community working toward similar goals, is a sorry thing indeed .... These responsibilities are civic obliga-tions. They must be met by all citizens and especially physicians who are doc-tors of medicine dedicated to rendering service to humanity." Editorial—The Journal of the Ameri-can Medical Association, January 4, 1958 ACTIVITY RECOMMENDED AS FATIGUE TREATMENT Rest is not "a universal panacea" for fatigue, even among aging persons, a New York physician said recently. In many cases, activity is a better remedy, especially when the fatigue results from "atrophy of disuse," Dr. Theodore G. Klumpp, president of Winthrop Laboratories, Inc., said. In the absence of specific disease as a cause of fatigue, it arises in older persons from the normal physiological processes of aging which reduce the body's endurance; from loss of incen-tive, motivation, and interest; from a decline of glandular activity, and from "atrophy of disuse." Fatigue is "a normal incident of normal living," but when its pattern changes radically or it interfers with ordinary activities, it becomes a serious problem and needs medical attention. Dr. Klumpp said in the Journal of the American Medical Association. His article is one of a series on aging. "For a long time, the approach to the problem of fatigue was thought to be simple. A brief history of the patient's mode of life was obtained with one objective in mind—to cut out some-thing. "It made little difference how little the individual was doing—if the patient was tired, something had to go ... if the patient did nothing more than sit in a rocking chair all day long, he was no doubt advised to stop rocking and go lie down," he said. Now physicians know better. Follow-ing the surgeons' practice of getting patients up soon after surgery, they now prescribe physical activity. The pattern of American life is especially designed to avoid physical activity and stress—to the point where physical exertion is virtually eliminat-ed, the author said. Young people are able to keep in relatively good physical condition through sports and play, but, as they grow older, they need to give up these things. With the help of "labor-saving devices, now including electric golfmobiles," they begin to suffer rapidly and too early in life from atrophy of disuse. This brings with it a loss of muscu-lar tone and functional reserve of all parts of the body, so that the slightest added stress causes undue fatigue. Maintaining an adequate physical re-serve against stress is the best preven-tive for such fatigue. Fortunately some degree of fitness can be regained through a program of graded exercise at any time, except where its loss is due to advanced organic disease. The exercise should be fun for the patient and should not be drudgery. Along with the exercise, the aging patient also needs an adequate amount of sleep at night and if neces-sary a short nap at midday. Undue fatigue occures more com-monly among overweight persons. In addition to the obvious diet, the doc-tor should prescribe some type of exercise, despite the aditional "hearsay to the contrary," Dr. Klumpp said. Its greatest value lies in its stimulating effect on endocrine gland activity and in overcoming the tendency "to sleep and snooze too much — a common January, 1958 The Health Bulletin counterpart of obesity." Dr. Klumpp also noted that much fatigue in aged persons occurs because they lose their incentive and interest in life. Then the doctor must help the patient find a "new and absorbing in-terest." RESIDENCY, INTERNSHIP TRAINING INCREASES More than 30 thousand physicians last year took graduate training either as an intern or as a resident. According to the annual report on internships and residencies, prepared by the American Medical Association's Council on Medical Education and Hospitals, the number of medical school graduates taking further training con-tinued to increase in 1956-57. There were 9,893 graduates serving internships in 1956-57, an increase of 290 over 1955-56, while 23,012 were serv-ing residencies, an increase of 1,587 over the preceding year. The training was offered by 1,372 approved hospitals. The percentage of available intern-ship and residency positions filled in 1956-57 remained the same as that of 1955-56. Respectively they were 83 and 81 per cent filled. The report in the Journal of the A.M.A. also showed: —During the past 10 years, there has been an increase of 6 per cent in the number of approved hospitals and an increase of 31 per cent in the number of internships offered. —The number of interns per hospital has increased from 11.3 ten years ago to 13.9 in 1956-57. —Federal hospitals offered 5.4 per cent of the available internships, while nonfederal governmental hospitals offered 32 per cent and nongovern-mental institutions the remainder. The federal hospitals had the highest rate of filled positions, with Army hospitals having no vancancies and Public Health Service hospitals having 99 per cent filled. County and state hospitals had occupancy rates of 91 and 89 per cent respectively. —There has been an increase in the average monthly cash stipend paid to interns. Hospitals affiliated with teach-ing institutions raised their stipends from an average of $87 in 1954 to $140 in 1956, while nonaffiliated hospitals raised their stipends from an average of $136 to $177. —The report listed those hospitals with the highest autopsy rates, point-ing out that the autopsy rate is regard-ed as "an index of the scientific inter-est of the medical staff in medical education and in the progress of medi-cine." Hospitals with low rates are being urged to increase the number of autopsies performed. —The National Intern Matching Pro-gram, which matches interns to the hospitals in which they wish to train, has matched more than 35,000 students in the last six years without an error. —There are 17 residency review and conference committees which function as joint liaison groups of the A.M.A. Council on Medical Education and Hospitals with various specialty boards and, in certain instances, the American College of Physicians, the American College of Surgeons, and the American Academy of General Practice. —Seven specialties accounting for more than three-fourths of all approv-ed residencies offered were surgery, internal medicine, pathology, obstetric-gynecology, radiology, psychiatry, and pediatrics. AMA ENDORSEMENT OF FLUORIDATION On December 5, 1957, the following recommendation proposed by the Reference Committee on Hygiene, Pub-lic Health and Industrial Health, was passed by the House of Delegates of the American Medical Association. "The Committee has carefully re-viewed the special report on fluorida-tion of public water supplies prepared jointly by the Council on Drugs and the Council on Foods and Nutrition and transmitted as supplemental Re-port G, to the Board of Trustees. The two Councils are to be commended on their extensive study of the question and the excellent bibliography and tables which have been appended. "After careful consideration of the report, printed material and testimony. 8 The Health Bulletin January, 1958 your Reference Committee is of the opinion that fluoridation of water sup-plies is a safe and practical method of reducing dental caries during child-hood; it agrees with the conclusion of the joint committee of the above-named Council and recommends the approval of the report." The closing paragraph of the Com-mittee's 27 page report, which was also adopted by the American Medical As-sociation House of Delegates is as fol-lows: "Fluoridation of public water sup-plies should be regarded as a prophy-lactic measure for reducing tooth decay at the community level and is appli-cable where the water supply contains less than the equivalent of 1 ppm (parts per million) of fluorine." DRUG ADDICTION PICTURE NOT BLEAK, SAYS A.M.A. REPORT Frightening images of American youth being preyed upon by unscrupu-lous dope peddlers aren't very true to life, according to an article in the Journal of the American Medical As-sociation. The article, first of three consecutive ones scheduled to appear in the Jour-nal, says that while drug addiction among younger persons is a problem, it isn't as alarming as most people think it is. The third article in the series states that recent studies have shown that "active proselyting by drug peddlers plays a very small role in spreading addiction." Addiction apparently spreads, adds the article, from person to person, with addicts giving drugs to the beginner as a friendly gesture. The articles constitute the report of the A.M.A.'s Council on Mental Health in conjunction with its committee on narcotic addiction. The report was first presented to the A.M.A.'s Board of Trustees in November 1956, and was adopted by the A.M.A.'s House of Delegates last June. Generally speaking, the council mem-bers feel that drug addiction should be viewed as an illness. They also feel there should be a movement toward treating addicts medically rather than punitively. The group points out that in Great Britain, where the approach to the problem is more medical than that of the U.S., addiction is considerably less in terms of percentages. In the U.S., the report continues, "there are probably not more than 60,000 addicts . . . ." And, while addic-tion in persons under 21 years of age has increased since World War II, the problem isn't as great as many people think it is. Only about 13 per cent of known addicts are younger than 21. Nor is the problem of adolescent addic-tion a new one. A similar alleged in-crease of drug addiction among young people followed World War I. The council feels that while opiate addiction is undesirable, it is not near-ly as evil as the public and law en-forcement ofiBcers think it is. For one thing, "opiate addiction does not cause the degree of damage to physical health that other intoxica-tions tolerated by our society can cause." Also, opiates don't incite addicts to commit violent crimes which they would not commit without the drugs. Opiates are quieting drugs that repress hostile urges and depress sexual drives. Among the recommendations made in the report is one that the A.M.A. continue to study the problem and "to support reasonable proposals designed to improve the treatment and preven-tion of drug addiction." Such measures might include, adds the report: (a) Development of institutional care programs in cities and states with significant problems . (b) Study of various means to obtain institutional care in states with small addiction loads. (c) Development of programs for intensive postinstitutional treatment of addicts. (d) Development of methods for commitment of addicts to institutions by civil action rather than through actions in the criminal courts. (e) Continued support and expansion of mental health programs. January, 1958 The Health Bulletin The council strongly recommended that the policy of voluntary admissions for addiction treatment be continued and extended. The report also says that "in view of all available evidence," the establish-ment of clinics to supply drugs to addicts would not be a wise move. This latter opinion should, the report adds, be subject to review from time to time as new scientific knowledge be-comes available. FAMILY DOCTOR MAY HELP PREVENT MENTAL ILLNESS "Mood-altering drugs" combined with good nutrition may help prevent men-tally ill patients from being commit-ted to mental hospitals, a Michigan psychiatrist said recently. Writing in the Journal of the Ameri-can Medical Association, Dr. John T. Ferguson, Traverse City, Mich., said general practitioners "may well take the lead in preventive psychiatry" through the use of drugs and good nutrition and the practice of the art of medicine. He reported on the use of various neuropharmacological agents among patients with chronic mental illness at Traverse City State Hospital. The study has been conducted for four years. In that time the new drugs, "to-gether with the art of medicine as practiced by family doctors," have brought about many changes in the patients and the hospital. The number of wards for disturbed patients has been reduced from four to one and the number of open wards has been increased from three to four. The housekeeping is excellent, the nursing care has improved, and shock, sedation, and seclusion have been practically eliminated. The patients have taken a new interest in life and the atmosphere of the wards has be-come a happy one, although the num-ber and type of personnel remains the same. At the start of the program, only tranquilizers were used, but it was found that they helped only the over-active patients. Then analeptics (drugs that increase activity) were given to the more repressed patients. Eventually combinations of these drugs were given. They produced what may be called a "deep-change" in the patients. Dr. Ferguson said. It is a change within the patient that enables him to re-spond to other treatment methods and to participate In a rehabilitative pro-gram. The combination of tranquilizers and analeptics was especially effective in confused, disoriented, and mildly over-active elderly patients, although the reasons for it are not understood, he said. The improvement does, however, give the hope that further research and newer drugs will soon make it possible for doctors to lessen, control, and "even prevent mental changes now associated with senility," Dr. Ferguson added. Early in the program a direct paral-lel was noted between the physical well-being of patients receiving drugs and their rate and degree of improve-ment. Therefore, all medical and surgi-cal problems of the patients were found and treated. In addition, special diets and extra feedings high in minerals and vitamins were begun. Patients who had reached a "plateau" in improvement on drugs alone improved further when they were given supplementary diets. This was especially marked among elderly pa-tients. As the patients became more man-ageable, the attitude of the staff also changed. This brought about better understanding and more considerate treatment, which in turn benefited the patients. In conclusion. Dr. Ferguson pointed out that the drugs by themselves or even when incorporated into a total hospital program will not empty the mental hospitals of the country. How-ever, "by combining them with nutri-tional therapy, family doctors may hope to prevent commitment of mental-ly ill patients encountered in their home and office practices." 10 The Health Bulletin January, 1958 HOME IS BEST PLACE TO TEACH CHILD HOW TO MAKE FRIENDS The best time and place for learning how to make and keep friends is in childhood and at home, according to an article in Today's Health. Elizabeth B. Hurlock, Ph.D., outlined in the American Medical Association's popular health magazine some tips for parents on how they can help their children learn to make friends. If good foundations for getting along with others are laid in the home, a child's chances for being popular are greatly increased, she said. Some of her suggestions to parents are: —Set a good example for social re-lationships in the family, since child-ren quickly imitate patterns of be-havior they observe around them. —Supervise a child's early play with his brothers and sisters and with the neighborhood children. Show him how to get along with others and explain why a particular behavior is good or bad. As he grows older, discuss as a family what makes certain children popular and others unpopular. This should be kept on an impersonal level. —Encourage him to bring his friends home and help him learn how to enter-tain. —Watch for the first signs of jeal-ousy toward a brother or sister and correct the cause before it becomes a habit. —Play games with a child, so he can learn how. Since most contacts with other children will be in play, he must be able to play as well as they do if he is to be included in the group. —Give him an opportunity to talk when the family is together and help him to talk about things that are in-teresting to others. —Call on him for help. Children who develop the habit of helping at home rarely sit back and expect others to do all the work, nor do they grumble be-cause they feel they are expected to do more than their share. —Expect him to consider the in-terests and desires of the family. Teach him to laugh at himself. And make sure the home is a cheerful place. Being cheerful will become a habit and this goes a long way toward making anyone popular. Dr. Hurlock is former secretary-treasurer of the American Psychologi-cal Association's division on childhood and adolescence. DIAPERS DON'T CAUSE DIAPER RASH In spite of its name, diaper rash is not usually caused by diapers, accord-ing to an editorial in the Journal of the American Medical Association. Diaper rash is a general term for several types of skin eruptions in the "diaper region," the editorial said. The commonest cause of a rash is the formation of ammonia by bacteria after urea is broken down. Other erup-tions may be prickly heat, thrush, chaf-ing, allergy, and various types of der-matitis. All of these rashes are aggravated by lack of cleanliness and softening of the skin, which may occur if it remains too long. The best preventive for diaper rash is changing the diaper as soon as possible after it becomes wet or soiled. This prevents softening of the skin and the formation of ammonia. Since plastic or rubber pants increase the likelihood of ammonia formation, their use should be limited to those "brief social occasions when prompt changing would be inconvenient," the editorial said. Studies have shown that commercial laundering of diapers in much more effective than home laundering in re-moving and stopping the growth of ammonia-forming bacteria and in re-moving irritating detergents, the edi-torial said. The usual commercial pro-cess includes three initial warm and hot rinses, two soapings, bleaching, and three rinses in hot water followed by two rinses in chemicals which stop the growth of ammonia-forming bacteria. Although commercial laundering is not essential to the prevention of diaper rash, the more a home launder-ing procedure is like that of com-mercial launderies, the better the pro-tection, the editorial said. January, 1958 The Health Bulletin 11 Ti'eatment of diaper rash varies ac-cording to the cause, but in any case, the diaper region should be kept dry and warm. Preventive measures must be con-tinued as long as diapers are worn, the editorial concluded. PHYSICIAN GIVES MEDICAL ADVICE ON FLYING Physicians can do a lot toward eas-ing the fear and discomfort some people associate with flying, an Air Force doctor said recently. Writing in a recent issue of the Journal of the American Medical As-sociation, Lt. Col. Frederick S. Spiegel (MC), U. S. Air Force, Washington, D. C, listed some of the things a doc-tor needs to know if he is to advise his patients about traveling by air. He pointed out that more and more people are flying each year. Last year over 25 million passengers traveled on U.S. domestic air lines. Many people have had no experience with flying and go to their doctor for advice. Among the things the doctor should know about airline regulations is that permission must be granted by the public health ofiBcials before any per-son with a contagious or communicable disease may be transported across state lines, the colonel pointed out. Diabetics requiring insulin may travel only if their insulin and syringe are kept in their hand baggage in the passenger cabin, he said. Physicians generally agree that a woman with an imcomplicated preg-nancy is not "sick" and can travel safely. However, if she wishes to fly in the very late stages of pregnancy, she must present a certificate from her physician stating that she will not deliver "for at least 72 hours," Colonel Spiegel said. Infants less than six weeks old are not generally transported by com-mercial carriers unless there are ex-tenuating circumstances. Then a pedia-trician's certificate is requested, stating that the infant is healthy and physi-cally fit to fly. Patients recovering from recent coro-nary thrombotic attacks or those suf-fering from coronary insufficiency need careful examination before being ad-vised to fly. Anemic patients and those with certain types of respiratory diffi-culty also need careful checking, the author said. "Children are only fair air travelers," the colonel said. Those under five years of age experience airsickness and ear trouble five to 10 times more frequent-ly than adults. The increased susceptibility to aii'- sickness may be related to insecurity and apprehension, while the ear dis-comfort is associated with the difficulty of teaching children to swallow while descending in an airplane. Airsickness in adults is no longer a major problem, but when it does occur, it is five times more frequent among women than among male passengers. As with children, this is probably due to anxiety and apprehension. Fear of airsickness hastens its development. There are several effective remedies for those who develop airsickness. The same drugs also prevent it if taken be-fore flight. The value of reassurance by the doctor in such cases cannot be over-emphasized, Colonel Spiegel con-cluded. ELDERLY PERSONS NEED TO REDUCE FOOD INTAKE Most aging persons do not need to alter their normal eating habits, ex-cept to decrease the amount they eat, a New York physician said recently. Basically the nutritional require-ments for the aged are the same as for younger adults. How^ever, older per-sons need fewer calories to maintain their normal weight, Dr. Herbert Pol-lack said in the Journal of the Ameri-can Medical Association. The article is one of a series prepared under the auspices of the A.M.A.'s committee on aging. Dr. Pollack, associate professor of clinical medicine. New York University Postgraduate School of Medicine, said the "obesity of the elderly is not due to gourmandizing," but to eating the same amount of food they did in their younger years when their bodies need-ed more food. 12 The Health Bulletin January, 1958 The body needs a decreasing amount of oxygen as it ages. When this is coupled with a decreased over-all physical activity, it means that the body needs fewer calories to maintain the same weight. Many religious rituals and certain food practices among groups of people indicate that they have long recognized the place of periodic fasting and limit-ed diets in the prevention of overeat-ing. Now scientific knowledge of nutri-tion and diet makes is possible to develop diets that are rich in the necessary nutrients but do not lead to overweight, Dr. Pollack pointed out. In some cases special diets must be devised for aging persons with chronic diseases which sometimes influence nu-tritional requirements. Dr. Pollack said. For instance, patients with Parkinson's disease (paralysis agitans) sometimes have trouble feeding themselves. They may need concentrated food in liquid mixtures as between-meal supplements. Limitation of physical activity be-cause of heart and circulatory diseases or arthritis means there must be a compensating decrease in caloric in-take. Dr. Pollack said. Otherwise weight gain is inevitable and this added weight causes a fui'ther load on the circulation and on weight-bearing joints. In setting up a diet, the doctor must also pay attention to the "mechanical state" of the food as well as to its nutritional content since many elderly people have difficulty chewing because of tooth or mouth disorders. Regardless of the type of patient re-ceiving the diet, the doctor must make certain that the diet "not only is nutritionally adequate on paper but is actually consumed by the patient," Dr. Pollack said. DRIVER TRAINING WOULD LOWER INSURANCE RATES Probably the best way to reduce automobile insurance rates is to teach teen-agers how to drive properly. This would increase the number of accidentless drivers which would help reduce insurance costs, a New York high school teacher has said. Writing in Today's Health, the American Medical Association's popu-lar health magazine, David Star, Floral Park, N. Y., said training would also help reduce the rising number of fatal accidents involving drivers under 25 years of age. Yearly 1,600,000 boys and girls reach legal driving age; 728,000 receive no training except what is picked up from friends and relatives. "If everyone of our 1,600,000 16-year-olds passed a driver training course, we could in a generation put more than 30,000,000 drivers on our highways who had been trained in safe and skillful practices," Star said. Since last February, Michigan has had a law that says no one under 18 can be licensed to drive unless he has passed an approved course of driver in-struction. The cost of instruction in the high schools is provided for from licensing fees and the course requires a minimum of 30 hours of classroom in-struction and six hours of driving. Among the subjects taught are the motor vehicle's effect on social and cultural life; the driver's physical re-quirements, mental attitudes and social responsibilities; characteristics of streets and highways; legal structures and codes; automotive mechanics and maintenance; automotive consumer education, and skills in driving. "We used to think anyone could just pick up driving, but we now realize that instruction and coaching are just as important in driving as they are in athletics, music, or bridge building," Star said. "When a youngster just picks up driving, he usually acquires bad atti-tudes from his parents or other drivers. Faulty attitudes are much more often at the bottom of young driver acci-dents than lack of skill." The more young drivers given knowl-edge and healthy driving attitudes at the beginning of their driving careers, the fewer unsafe drivers of all ages there will be in the years ahead, he concluded. DIVISION OF HEALTH AFFAIRS LIBRARY N.C. MEM. HOSP, U. N, C. CHAPEL HILL, N.C. RDtfCr.iViVtO 28 1958 I TKis BulJefm will be sent free to any ciiizen of ri\e 5kite upon reques-t J Entered as second-class matter at Postoffice at Raleigh, N. C. under Act of Angust 24, 1912 Published monthly at the office of the Secretary of the Board, Raleigh, N. C. Vol. 73 FEBRUARY, 1958 DR. J. MARTIN FLEMING 1867-1957 No. 2 MEMBERS OF THE NORTH CAROLINA STATE BOARD OF HEALTH G. Grady Dixon, M. D., President Ayden John R. Bender, M. D.. Vice-President Wlnston-Salem Charles R. Bugg. M. D. Raleigh Lenox D, Baker, M. D. Durham H. C. Lutz, Ph.G. Hickory Mrs. J. E. Latta Hillsboro, Rt. 1 John P. Henderson, Jr., M. D. -» Sneads Ferry Roger W. Morrison, M. D. Asheville Z. L. Edwards. D.D.S. Washington EXECUTIVE STAFF J. W. R. Norton, M. D., M.PJI., State Health Director John H. Hamilton, M. D., Assistant State Health Director, Director State Laboratory of Hygiene, and Editor Health Bulletin Robert D. Higgins, M. D., M.P.H., Director Local Health Division Ernest A. Branch, DJ).S., Director Oral Hygiene Division A. H. Elliott, M. D., Director Personal Health Division J. M. Jarrett, B. S., Director Sanitary Engineering Division Fred T. Foard, M. D., Director Epidemiology Division E. C. Hubbard, B.S., M.P.H., Director Division of Water Pollution Control List of free health literature wUl be supplied by local Health Departments or on written request. CONTENTS Page A Tribute to Dr. J. Martin Fleming 2 Recently approved Public Health Regulations 4 Notes and Comment 10 A TRIBUTE TO DR. J. MARTIN FLEMING BY ERNEST A. BRANCH, D. D. S. State Board of Health Raleigh, North Carolina The North Carolina State Board of that dentistry be included in the pro- Health and, indeed, the cause of public gram of the North Carolina State health in North Carolina have suffered Board of Health. This motion was a great loss in the death of Dr. J. carried, and North Carolina became Martin Fleming on December 18, 1957. the first State to have dentistry as an Dr. Fleming was a friend of public integral part of its public health pro-health, in general, and of public health gram. Prom that time on Dr. Fleming dentistry, in particular. It was he who gave generously of his time and ener- i made the motion in the meeting of gies to the enterprise, thus rendering , the North Carolina Dental Society in great service to his profession, to ; 1918 that the Society give its whole- public health, and to the people of ; hearted endorsement and approval to North Carolina. He favored and work-the suggestion of Dr. George M. Cooper ed for all legislation which promoted February, 1958 The Health Bulletin public health dentistry in the State. Dr. naming became the first dental member of the Wake County Board of Health in 1931 and served in that capacity until 1942. In 1942, when the younger dentists were called into armed service and a dentist could not be secured for position of school dentist with the Wake County Health Depart-ment, Dr. Fleming closed his office, took the job and served until his retirement in 1954. Dr. Fleming engaged in the private practice of dentistry in Raleigh from 1895 to 1942. He was one of the best known and best loved dentists in North Carolina. He exerted a great and good influence in the affairs of the North Carolina Dental Society, and this Society conferred on him many honors. He served as president of the Society in 1903-1904. Dr. Fleming made an outstanding contribution to dentist-ry as a member and president of the State Board of Dental Examiners from 1914 to 1926. In this capacity he had an opportunity to encourage and in-fluence many young dentists. For many years, when the molding and making of dentistry in North Carolina was in the process. Dr. Fleming was chairman of the Ethics Conunittee. To him membership on this committee, as well as on the Board of Dental Examiners, was a mandate to uphold the standards of the profession and also to protect the rights of the people of North Carolina to have the best in dental service. It can be truly said that. In carrying out this mandate, he brought honor to himself and to dentistry in North Carolina. Dr. Fleming believed in hewing to the line himself, and he expected the same of others. Those who knew him well realized that his seem-ing sternness was tempered with kind-liness and a rare sense of himaor. Perhaps Dr. Fleming's greatest ac-complishment was writing the HISTORY OF THE NORTH CARO-LINA DENTAL SOCIETY. This scholarly work was the result of years of painstaking research and of collect-ing, compiling and editing material. The "History" is an interesting and invaluable book which will be a lasting memorial to his untiring and imselfish service to the profession. Though born in Arkansas, whUe his North Carolina parents were living temporarily in that State, Dr. Fleming lived most of his life in North Carolina. He received his A. B. degree from the University of North Carolina in 1891 and his D.D.S. degree from the Uni-versity of Maryland in 1895. He was made a Fellow of the American College of Dentists in 1929. He held member-ship in the Raleigh and Fourth Dis-trict Dental Societies, the North Carolina Dental Society and the American Dental Association. Fimeral services were held for Dr. Fleming in the Edenton Street Metho-dist Church of Raleigh, of which he had been a faithful and devoted mem-ber, having served for many years on the Board of Stewards. It can truly be said that he was a public spirited citizen, a Christian gentleman and a true friend and counsellor. The Health Bulletin February, 1958 RECENTLY APPROVED PUBLIC HEALTH REGULATIONS The following regrulations affecting public health, approved by the State Board of Health February 7, 1958, are published in The Health Bulletin in accordance with legislation passed by the 1957 Session of the North Caro-lina General Assembly. —Editor, The Health Bulletin. NORTH CAROLINA STATE BOARD OF HEALTH Rules And Regulations Governing State Aid Mosquito Control Districts Or Other Local Governmental Units Engaged In Mosquito Control Under-takings. For the purpose of administering State funds received by the State Board of Health to aid mosquito con-trol districts or other local govern-mental units engaged in mosquito con-trol imdertakings, pursuant to the provisions of Chapter 832, Session Laws of 1957, the North Carolina State Board of Health adopts the following rules and regulations governing: State aid to mosquito control districts or other local governmental units en-gaged in mosquito control imdertakings. SECTION I. CREATION OP ZONES For the purpose of administering these rules and regulations, the State of North Carolina is divided into three zones as follows: A. Zone I shall be comprised of those counties in which the studies of the Salt Marsh Mosquito Study Commis-sion showed a salt marsh mosquito problem to exist, and shall include the following counties: Beaufort, Brunswick, Camden, Carteret, Chowan, Craven, Ciurituck, Dare, Hyde, Jones, New Hanover, Onslow, Pamlico, Pas-quotank, Pender. Perquimans, Tyrell, and Washington. B. Zone II shall be comprised of those counties not in Zone I where the highest probability of mosquito-borne disease outbreaks exists, and shall include the following coimties: Gates, Hertford, Bertie, Martin, Pitt, Lenoir, Duplin, Sampson, Bladen, Columbus, Robeson, Ciunberland, John-ston, Wayne, Greene, Wilson, Nash, Edgecombe, Halifax, and Northampton. C. Zone IH shall be comprised of those counties not included in Zone I, or Zone II. SECTION II. ALLOCATION OP STATE FUNDS OR FACILITIES-GENERAL Before aid is given in the form of cash, or other items of monetary value, the county, tov^n, or other government-al unit applying for such aid shall submit a project application to the North Carolina State Board of Health on a form provided for that purpose. Project applications shall hst the cash, materials and supplies, equip-ment, and other facilities that will be provided by the applicant during the fiscal year. In computing the monetary value of local fimds and facilities provided by the applicant, in order to de-termine the amoimt of State aid that can be given on a matching basis credit will be allowed for labor, materi-als, and general operating expenses, as well as rental on equipment that has been approved for use on the project by the representative of the State Health Director. The rental rates will be established by said representative of the State Health Director. No credit will be allowed for money spent to repay loans or to pay interest, pur-chase equipment or real estate, nor for overhead expenses such as cleri-cal help, office and storage space rental, etc. State funds shall not be spent by local governmental units to purchase equipment, make repasTnents on loans, pay interest on borrowed money, pur-chase real estate, pay clerical person-nel, rent storage or office space, nor for any purposes other than those directly connected with the application of mosquito control operations. February, 1958 The Health Bulletin Embodied in project applications shall be such assurances and agree-ments as may be required by the of-ficial of the North Carolina State Board of Health who is responsible for the administration of this activity. These shall include: (a) The assumption by the applicant of all responsibility for claims for damage resulting from the operation of the project. (b) An agreement to submit such plans as may be required to the North Carolina State Board of Health, and perform all work in conformity with the plans that are approved by the appropriate representative of the North Carolina State Board of Health. (c) An agreement to use funds pro-vided by the North Carolina State Board of Health and those shown on the project application as being pro-vided by the applicant exclusively for mosquito control, in accordance with these rules and regulations and the approved plan, (d) An agreement to perform all mosquito control under the direction of a competent supervisor whose quali-fications meet the approval of the North Carolina State Board of Health. (e) An agreement to submit reports at the end of each month showing work performed during the month, expenditures made, facilities utilized, and materials expended. (f) An agreement to submit a certi-fied financial statement to the North Carolina State Board of Health no later than ten days after the last day of December and June of each year. Such statement must include an item-ized account of expenditures during the preceding six months, of both local and State funds, as well as an itemized accoimt of other assets and facilities that have been utilized to carry out the mosquito control project. Such supporting documents as may be re-quired by the North Carolina State Board of Health shall be included. (g) An agreement to return to the North Carolina State Board of Health at the end of December and June of each year all State funds not matched by local expenditvtres for mosquito control purposes during the preceding six months. In Ueu thereof the State Health Director may allow the excess of State funds over local fimds expend-ed during the preceding six-months' period to be deducted from the State aid given the applicant during the next six-months' period. In Zone I, if the application for State aid is made by a county, the ap-pUcation must be signed by the local Health Director, and the project must be operated under his direction. If the application is made by a local governmental unit other than a county, a resolution must be adopted by the governing board of such governmental imit designating an official to sign necessary papers in connection with the mosquito control project. In such cases, operation of the project shall be under the direction of the designat-ed official, but approval of the project by the local Health Director shall be reqiiired. In Zones II and III, the project application shall be signed by the local Health Director, and the project shall be carried out under his direction. The provisions of these regulations requiring that the local Health Director sign, approve, or direct a project shall not apply to any application made by, or project conducted by a Mosquito Control District established under the provisions of Chapter 1247, 1957 Session Laws. SECTION III. ALLOCATION OF FUNDS A. Zone I. Seventy-five per cent of the State funds available for allocation to local mosquito control projects shall be set aside for aid to local govern-mental units within Zone I. If sufficient State funds are avail-able, the amounts provided by local appropriations for mosquito control projects in Zone I shaU be matched on a fifty-fifty basis for temporary control measures, and on a basis of twice the amount of local appropri-ations, or the monetary value of other facilities provided locally, for drainage, filling or dyking. If insufficient State 6 The Health Bulletin February, 1958 funds are available for matching on this basis, the State aid is to be allocated to local projects in any one county as follows: the first one thousand dollars ($1,000.00) of State aid is to be on a fifty-fifty basis; thereafter, the State aid is to be allo-cated on a pro rata basis to be de-termined by dividing the total remain-ing appropriations and monetary value of other facilities provided (above the one thousand dollars ($1,000.00) match-ed on a fifty-fifty basis) by all of the local governmental units in Zone I into the total remaining State aid available for projects in that Zone. In no case is the State aid to all projects within a county to exceed fifteen thousand dollars ($15,000.00) when there are insufficient funds to match on a fifty-fifty basis. Two or more governmental vmits in Zone I may jointly employ a supervisor to look after mosquito control activi-ties. The North Carolina State Board of Health may match fimds to pay the travel and salary of such super-visors on a fifty-fifty basis, if State funds are available. The qualifications of supervisors employed under this provision must be approved by the re-presentative of the State Health Director. B. Zone II. The local Health Director shall be the official in Zone II who is recognized by the North Carolina State Board of Health as authorized and empowered to sign and execute documents necessary in connection with applications for aid in the con-trol of mosquitoes, to carry out all agreements stipulated in the project applications, and perform other acts that are necessary in connection with the operation of the project. All State funds and other facilities provided for mosquito control projects in Zone II shall be disbursed through the local Health Director on a county basis. In Zone II, the first one thousand dollars ($1,000.00) of State funds allot-ted to local health departments for mosquito control project shall be allo-cated on a fifty-fifty basis with local fimds. Any additional funds are to be allotted on a basis of 30 per cent State fimds for 70 per cent local funds, with a maximiun allocation of two thousand doUars ($2,000.00) to any one coimty. C. Zone III. The local Health Director shall be the official in Zone III who is recognized by the State Board of Health as authorized and empowered to sign and execute documents neces-sary in connection with applications for aid in the control of mosquitoes, to carry out all agreements stipulated in the project applications, and perform other acts that are necessary in con-nection with the operation of the proj-ect. All State fimds and facilities provid-ed for mosquito control projects in Zone III shall be disbursed through the local Health Director on a county basis. In Zone III, State funds allotted to local health departments for mosquito control purposes shall be allocated on a fifty-fifty basis with local funds, with a maximum allocation of five hundred dollars ($500.00) to any one county. SECTION IV. AUTHORIZED CHANGES IN ALLOCATION RULES If at the end of a reasonable dead-line for submission of applications for State funds to aid in mosquito control in any zone the funds set aside for aid in that zone have not been applied for, and allocated to local government units in that zone, the State Health Director is authorized to utilize such funds for assistance to projects in other zones, and to change the allo-cation basis. If at the end of the second quarter of the fiscal year it is determined by the official of the North Carolina State Board of Health, who is respon-sible for the administration of this activity, that State funds allocated to any project will probably not be spent and matched by local expenditures, or other creditable assets by the end of the fiscal year, said funds may be re-allocated to other local projects on the basis of potential mosquito densities February, 1958 The Health BuixEmN and local participation. Other State funds that become avail-able for allocation to local projects from any source, after the end of the second quarter of the fiscal year, may be allocated to local projects in either of the three zones on the basis of potential mosquito densities and local participation. SECTION V. RKPEAL All rules and regulations heretofore adopted by the North Carolina State Board of Health in conflict with the provisions of these rules and regula-tions are hereby repealed. The regu-lations concerning State aid to local governmental imits for mosquito con-trol purposes, adopted by the North Carolina State Board of Health on July 18, 1957, are hereby repealed, and replaced by these rules and regulations. SECTION VI. EFFECTIVE DATE These rules and regulations shall be in full force and effect from and after February 15, 1958. The foregoing rules and regulations relating to the administering of State aid to assist local governmental units in carrying out mosquito control proj-ects were duly adopted at a meeting of the State Board of Health at Raleigh, North Carolina, on February 7, 1958. viously-used materials; the issuance of stamp exemption permits; and, the transfer of manufacturer's licenses and sanitizer's licenses. Rules And Regrulations Governing The Sanitizing Of Mattresses, Previously- Used Materials, Second-Hand Bedding, And Bedding Containing Previously- Used Materials; The Storage of Pre-viously- Used Materials; The Issuance of Stamp Exemption Permits; And, The Transfer Of Manufacturer's Licenses And Sanitizer's Licenses. For the purpose of carrying out the provisions of Article 16 of Chapter 1357 Session Laws of North Carolina, the North Carolina State Board of Health hereby adopts the following rules and regulations governing: the sanitizing of mattresses, previously-used materials, second-hand bedding, and bedding containing previously-used materials; the storage of pre- SECTION I. SANITIZING a. No person shall renovate any mattress without first sanitizing it in accordance with one of the processes authorized in subsection (e) below. b. Any sanitizing apparatus or pro-cess used to sanitize articles as required by Article 16 of Chapter 1357 of the 1957 Session Laws of North Carolina, or by these rules and regulations, must comply with the provisions of these rules and regulations. c. No person shall manufacture or sell in this State any bedding contain-ing previously-used materials without first sanitizing the previously-used materials in accordance with one of the processes authorized in subsection (e) below. d. No person shall sell any second-hand bedding or bedding containing any previously-used material imless it is sanitized, since last used, in ac-cordance with one of the processes authorized in subsection (e) below; provided, however, that this require-ment shall not apply to a mattress sold by the owner and previous user from his home directly to a purchaser for his own personal use, unless such mattress has been exposed to an in-fectious or contagious disease. e. Authorized sanitizing processes (1). Process Number 1 — Dry Heat In this process, the bedding must be heated at a temperature of 230° F. for a period of one hour. The chamber in which this process is performed must be Insulated suf-ficiently to insure maintenance of a imlform temperature of 230° F. Articles to be sanitized must be placed on racks, or other devices provided therein, in such a manner that a minimum space of 6" is left around each item being sanitized, and between such item and the walls, floor, ceiling and other items. Loose materials to be sanitized must be placed in tiers on slats, or on other arrangements that permit an even distribution of heat throughout the 8 The Health Bulletin February, 1958 material. A thermometer that has been checked for accuracy within 1° P. must be placed within the chamber at a point where it can be easily read at all times through a window provided for that purpose. (2) Process number 2 — Formaldehyde and Sulfur In tills process, the bedding must be exposed to formaldehyde and sulfiu-dioxide gas in a moist and warm atmosphere for at least 10 hours, using one pint of 37% formaUn and three pounds of sulfur to 1,000 cubic feet. Formaldehyde is generated from the formalin by adding potassium perman-ganate. Commercial fumigators which gener-ate an equivalent quantity of gas may be used. The chamber in which this process is performed shall be sealed in such a manner as to make it gas tight. The placing of bedding within the chamber shall conform with the re-quirements set out for process number 1 above. (3) Process number 3 — Washing In this process, the bedding is boiled for fifteen minutes, and washed with an approved soap or detergent. After drying, the bedding shall be clean to touch, sight, and smell. (4) Notwithstanding the provisions of subsections (e) (1) tlu'ough (e) (3) of this section, other methods of sani-tizing may be used after receiving the approval of the State Board of Health in writing, if it is demonstrated that they destroy pathogenic micro-organisms and arthropods, and remove dirt and filth. (5) Notwithstanding the provisions of subsections (e) (1) through (e) (4) of this section, second-hand bedding and previously-used materials that show evidence of contamination with feces, urine, pus, vomit, blood, mucus, or other filth, or are not reasonably clean, must be sanitized by process number 3 only. SECTION II. STORAGE OF PREVIOUSLY- USED MATERIALS When previously-used materials that have not been sanitized are stored in a bedding manufacturing establish-ment in the same room with new, or sanitized bedding or bedding materials, such previously-used materials must be segregated from the new, or sani-tized bedding or bedding materials, by partitions that are free of holes, cracks, or other openings. The top of the partitions must be at least one foot higher than the level of the vmsani-tized materials. SECTION III. STAMP EXEMPTION PERMITS (a) Any person who manufactures bedding in North Carolina or any person who manufactures bedding to be sold in North Carolina may, in lieu of purchasing and affixing the adhesive stamps provided for by Article 16 of Chapter 1357 of the 1957 Session Laws, annually secure from the State Board of Health a stamp ex-emption permit upon compliance with the provisions of said article and these rules and regulations. The holder of the stamp exemption permit shall not be required to purchase or affix ad-hesive stamps to bedding manufactured or sold in North Carolina. The cost of a stamp exemption permit is to be determined annually by the total num-ber of bedding items manufactured or sold in North Carolina by the applicant during the calendar year immediately preceding the issuance of the permit, at the rate of Eight Dollars ($8.00) for each five hundred pieces of bed-ding or fraction thereof. A maximmn charge of Four Hundred Dollars ($400.00) shall be made for pieces of bedding manufactured in North Caro-lina but not sold in North Carolina. (b) Applications for stamp exempt-ion permits must be submitted on forms supplied by the State Board of Health. No stamp exemption permit may be issued to any person imless he has done business in North Carolina throughout the preceding calendar year in compliance with the provisions of Article 16 of Chapter 1357 of the 1957 Session Laws, and unless he complies with these regulations, (c) Any person applying for a stamp exemption permit must include on the February, 1958 The Health Bulletin 9 application form furnished by the State Board of Health a statement in writing showing the number of bedding items that were, during the preceding calendar year: (1) manufactured in North Carolina and sold in North Carolina; (2) manufactured outside of North Carolina and sold in North Carolina; and (3) manufactured in North Carolina but not sold in North Carolina. Provided, however, that if the applicant's statement sets out the total nimiber of bedding items which such manufacturer produced during the preceding calendar year, it shall not be necessary for the applicant to set out what proportion of that total was manufactured inside or outside of North Carolina or sold inside or outside of North Carolina, in which case the cost of the stamp exemption permit will be determined as if the total production were manufactured in North Carolina and sold in North Carolina. The statement of the ap-plicant required by this subsection must contain a certification by a certi-fied public accountant that he has examined the records of the applicant and finds that the statement correctly reflects the information contained in the records of the applicant. (d) The State Board of Health may require additional proof of the number of bedding items sold during the pre-ceding calendar year when it has reason to believe that the proof sub-mitted by the manufactiirer (whether in-state or out-of-state) is incomplete, misleading, or incorrect. (e) The stamp exemption permits issued pursuant to these regulations shall be valid from the first day of March of any calendar year through the last day of February of the follow-ing calendar year. SECTION IV. TRANSFER OP MANUFACTURER'S LICENSES AND SANITIZER'S LICENSES (a) If any person to whom a manu-facturer's license or sanitizer's license has been issued shall sell his manu-facturing or sanitizing establishment, he may transfer the license with the business, if such transfer is accomp-lished in accordance with the provisions of these rules and regulations. (b) In order to make such transfer, and before the purchaser may use such license of the seller, the pur-chaser must submit to the State Board of Health the following: (1) the name and address of the seller; (2) the location of the establishment being purchased; (3) the name of the establishment being purchased; (4) the name and address of the pur-chaser; (5) the effective date of sale; and, (6) whether the name of the establishment being purchased is to be changed, and if so, the name imder which it is to be operated by the purchaser. SECTION V. VIOLATIONS If any person shall wilfully violate any rule or regulation adopted by the State Board of Health pursuant to Chapter 1357 of the 1957 Session Laws, or shall wilfully fail to perform any act required by, or shall wilfully do any act prohibited by such rules and regulations, he shall be guilty of a misdemeanor and upon conviction thereof shall be punished by a fine not to exceed Fifty Dollars ($50.00) or by imprisonment for a period not to exceed thirty days (30), as provided in Article 22 of Chapter 1357 of the 1957 Session Laws. SECTION VI CONFLICTING RULES AND REGULATIONS REPEALED All rules and regulations heretofore adopted by the State Board of Health which are in conflict with the pro-visions of these rules and regulations are hereby repealed. SECTION VII. SEVERABILITY If any provision of these rules and regulations, or the application there-of to any person or circumstance, is held invalid, the remainder of the rules and regulations, or the applica-tion of such provision to other persons or circumstances, shall not be affected thereby. SECTION VIII. EFFECTIVE DATE These rules and regulations shall be in full force and effect from and after 10 The Health Bulletin February, 1958 February 15, 1958. The foregoing rules and regulations governing the sanitizing of mattresses, previously-used materials, second-hand bedding, bedding containing previously-used materials; storage of previously-used materials; the issuance of stamp exemption permits; and, the transfer of manufacturer's licenses and santizer's licenses were adopted at a meeting of the State Board of Health on February 7, 1958, at Raleigh, North Carolina. NOTES AND COMMENT BY THE EDITOR STRANGULATION FROM SWALLOWING TOY BALLOON Two small children of North Caro-lina parentage have lost their lives recently in a rather bizarre type of accident—strangulation from swallow-ing a toy boUoon. It appears that in each case, the child was trying to blow up the balloon, inhaled it, and strang-led to death. In both cases the children were between 2 and 214 years of age. A newspaper clipping reveals that two other children—a 2% year old in New Jersey and a 7 year old in New York — died under similar circumstances re-cently. Tlie tragedy of such deaths is that they are useless deaths. There is also irony in the fact that toys given to children to make them happy can also produce death and serious injury; a toy balloon is only one example. Pa-rents and others who buy toys for small children should be conscious of the dangers inherent in toys and should use great care in selecting them. THE RECOGNITION OF CHICK-EMBRYO ORIGIN RABIES VACCINE IN DOGS FOR A PERIOD OF THREE YEARS WHEREAS, the duration of immrm-ity against rabies in dogs following the administration of chick-embryo rabies vaccine has been shown to be effective for a period of at least thirty-six months by research conducted by the United States Public Health Ser-vice, and WHEREAS, this research has been recognized by nvmierous national and international veterinary and public health organizations (World Health Organization, United States Public Health Service, American Veterinary Medical Association, United States Livestock Sanitary Association), and WHEREAS, the local health officers of North Carolina have been informed of this proposal and recormnend its approval, and WHEREAS, the North Carolina State Veterinary Medical Association on June 28, 1956 passed a resolution recom-mending that the North Carolina State Board of Health officially approve chick-embryo rabies vaccine for a period of three years when administer-ed by a licensed veterinarian, and WHEREAS, the Attorney General in an opinion dated 6 March 1956 has ruled that the State Board of Health under G. S. 106 - 365 is authorized to specify how often a dog must be vac-cinated against rabies with the single restriction that vaccination may not be required oftener that once in each calendar year, NOW, THEREFORE, the State Board of Health in its official meeting, Feb-ruary 14, 1957, does hereby establish the time or times when a dog shall be vaccinated against rabies. "1. When rabies vaccine of nervous tissue origin is administered, the dog must be revaccinated annually. 2. When rabies vaccine of chick-embryo origin is administered by a licensed veterinarian the dog must be revaccinated every three years, except that a dog under 6 months of age receiving chick-embryo vaccine shall be revaccinated after a period of one year and every three years thereafter. Provided, however, when a district or county board of health or the State Board of Health adopts a resolution stating that in order to control rabies and protect the public health, annual vaccination is necessary within the February, 1958 The Health Bulletin 11 area over which they have jurisdiction, then the dog must be vaccinated an-nually regardless of the type vaccine used." THE N. C. COMMISSION ON PATIENT CARE You might be interested in the fol-lowing information regarding the above Commission for the Health Bulletin: There has been recently organized in North Carolina a North Carolina Com-mission on Patient Care. The major purpose of this Commission is to stimulate, implement, assist in, and sponsor activities which will contribute to the care of the patient. Membership consists of representatives of the Medi-cal Society of the State of North Caro-lina, the North Carolina Hospital As-sociation, the North Carolina League for Nursing, and the North Carolina Licensed Practical Nurses Association. Mr. George Harris of the Duke Foun-dation is Chairman. It shall be the intention of the Com-mission to obtain a better understand-ing of the problems and programs of all represented groups; to serve as a source of information on trends within the programs of the participating organizations; to facilitate the develop-ment of a more unified public relations approach by the participating organi-zations; to explore the needs for and stimulate studies in areas of patient care in which the organizations par-ticipate; and to perform such fimctions and carry on such activities contribut-ing to major objectives as may be mutually satisfactory to the appointing organizations and to the Commission. A. M. A. PAMPHLET TELLS DRIVER FITNESS RULES Even though a person has a good safety record and thinks he's in ex-cellent health, there are certain cir-cumstances imder which he shouldn't drive. Some of the things that can make a driver dangerous are listed in a new American Medical Association pamph-let, "Are You Pit To Drive?" The pamphlet, to be distributed through physicians' offices, was pre-pared by the A.M.A. Committee on Medical Aspects of Automobile In-juries and Deaths, in cooperation with the Center for Safety Education, New York University. A doctor can help answer the ques-tion of driving fitness. The pamphlet urges drivers to ask their doctors when they are In doubt about their fitness. Some of the things that make a driver dangerous are: —Emotional upsets. Unless a person can keep his mind on the wheel and not on his worries, he should not take the wheel. —The driver's attitude. Some drivers feel the other fellow is always wrong. Some are aggressive and intolerant when they get into a car. They need to be mature. —Sleepiness. A sleepy driver is as much a hazard as a drinking one. Dozing is not restricted to night driv-ing. When making long trips, a person should rest every two hours, drinking coffee or cola to stay alert. He should not take any medicine that makes him drowsy. —Medicines. Antihistamines, cold tablets, sedatives, tranquilizers, and some other drugs may dull reflexes or impair coordination. Stimulants may make a person nervous. The doctor should be consulted about the side effects of any drugs. —Faulty vision. A driver needs regu-lar eye examinations; if he notices any change in his eyes between exami-nations, he should see his eye doctor immediately. To reduce eye strain, he should wear properly fitted sunglasses, but not after dark. To avoid tiring the eyes, excessive night driving should be avoided if possible. Hay fever or the common cold can bliu: the vision dangerously. —Certain nerve and heart disorders. Some may -cause convulsions and others may result in occasional loss of consciousness. The doctor is the best judge of whether a patient with these should drive. 12 The Health Bulletin February, 1958 —Diabetes. Insulin reactions may cause difficulties, but diabetic patients who follow their doctor's advice can be safe drivers. —Old age. After 65, reflexes and co-ordination tend to be a little slower, people tire more easUy, resistance to glare is lessened, and the ability to see at night is declining. Older drivers should schedule their trips at non-rush hours and should not spend long periods at the wheel. —And, of course, drinking. NEW THEORY ADVANCED ON SPEECH MECHANISM Recent French research has Indicat-ed that the brain—not the movement of air in the larynx—caxises the vocal cords to vibrate and produce soimd. This new and controversial theory of how man speaks was reported in Archives of Otolaryngology, an Ameri-can Medical Association publication, by Esti D. Freud, Ph.D. New York, a teacher of voice and speech patho-logy. The French researchers believe that vocalization results from the action of the brain on the nerves of the larynx which in tiu-n produce vibra-tions of the vocal cords. According to long-accepted theory, expiration of air from the trachea causes the thyroarytenoid muscle to vibrate and thus set up vibrations of the vocal cords. In a note preceding the article, Dr. Ernest M. Seydell, Wichita, Kan., a member of the Archives editorial board, pointed out that some of the article's contents were "very contro-versial," but they were published with the hope of stimulating research io "a phase of otolaryngology in which there is much to be proved." Dr. Freud said the French experi-ments have shown "beyond doubt" that vocal cords vibrate in the absence of an exhaled current of air, and that the vibrations seem to be governed by excitations deriving dir^tly from the recurrent laryngeal nerve. This means that the exhaled air current cannot be considered instru-mental in creating the vibrations of the vocal cords, hut only as a sound-carrying medium. The exact roles of air pressiure, air volume, and the breathing motions in vocalization are questions that still must be answered, she said. Dr. Freud also reported that French researchers have shown that singing and speaking, which produce different vibratory patterns in the vocal cords, originate in different centers of the brain, even though they are both ex-ecuted by the vocal cords. This helps explain why persons who stutter or who have lost their ability to speak can still sing without diffi-culty. Dr. Freud said. It also helps explain why a person with a tenor singing voice may speak with a very deep voice. Dr. Freud, a daughter-in-law of the late Sigmund Freud, is associated with New York Hospital, New York, and a Veterans Administration men-tal hygiene clinic in Newark, N. J. NEW HORMONE RELIEVES SCLERODERMA SYMPTOMS A new hormone that prevents pre-mature birth is also useful in the treatment of a rare skin disease, sclero-derma, two Florida physicians reported recently. The hormone is relaxin (Releasin), which is synthesized from an extract of the ovaries of pregnant sows. Work-ing with other hormones, relaxin in-fluences the contraction of tte uterus in pregnancy and labor. It also has an effect on the elasticity of the skin. This effect is important in the treatment of scleroderma, Drs. Gus G. Casten and Robert J. Boucek, Miami, said in the Journal of the American Medical Association. In scleroderma, the skin hardens, restricting movement. The blood supply is cut off, causing fingers, toes, and ankles to ulcerate. In addition to af-fecting the skin, the disease eventually attacks the internal organs. The Florida doctors gave relaxin to 23 patients. While it had no effect on the disease itself, it did cause "signifi-cant improvement." LIBRARIAN DIVISION OF HEALTH AFFAIRS LIBRARY N.C. MEM, HOSP. U. ^» C. CHAg£L^UlLL«^JL^C, I TKisBulletmynDb^^ntfre/fodlMj citizen of ri\e Sfai^e upon request I Entered as second-dlass matter at PostofEce at Raleigh, N. C. under Act of August 24, 1912 Published monthly at the office of the Secretary of the Board, Raleigh, N. C. Vol. 73 MARCH, 1958 No. 3 M^ vaSSVV-' CENTRAL BUILDING, STATE LABORATORY OF HYGIENE MEMBERS OF THE NORTH CAROLINA STATE BOARD OF HEIALTH G. Grady Dixon, M. D., President Ayden John R. Bender, M. D., Vice-President Wlnston-Salem Charles R. Bugg, M. D. Raleigh Lenox D. Baker, M. D. Diirham H. C. Lutz, Ph.G. Hickory Mrs. J. E. Latta Hlllsboro, Rt. 1 John P. Henderson, Jr., M. D. Sneads Ferry Roger W. Morrison, M. D. Afihevllle Z. L. Edwards, D.D.S. Washington EXECUTIVE STAFF J. W. R. Norton, M.D., M.P.H., State Health Director John H. Hamilton, M.D., Assistant State Health Director, Director State Laboratory of Hygiene, and Editor Health Bulletin Robert D. Higgins, M.D., M.P.H., Director Local Health Division Ernest A. Branch, D.D.S., Director Oral Hygiene Division A. H. EUiot, M.D., Director Personal Health Division J. M. Jarrett, B.S., Director Sanitary Engineering Division Fred T. Foard, M.D., Director Epidemiology Division E. C. Hubbard, B.S., M.P.H., Director Division of Water Pollution Control List of free health literature will be supplied by local Health Departments or on written request. CONTENTS Page Fiftieth Anniversary of the State Laboratory of Hygiene 2 Notes and Comment 5 FIFTIETH ANNIVERSARY OF THE STATE LABORATORY OF HYGIENE By JOHN H. HAMILTON, M. D., Director State Laboratory of Hygiene On February 28, 1958, the State supply, the fee to be used in paying Laboratory of Hygiene completed fifty the Department of Agriculture for years of existence and service as an this service which they had rendered institution. It could have been two since 1900. Still further back we find years older had the 1905 General As- that in 1896 the State Board of Health sembly which created it been a little passed a resolution requiring that more generous with their appropria- certain chemical and bacteriological tion. Only $500.00 and fees from water examinations be made at the Uni-analyses were made available that versity of North Carolina. Even in year. If one wishes to trace our history 1895 the Board had elected two further back, we would find that in physicians to serve as bacteriologists. 1903 the General Assembly enacted Before that, in 1893, laws had been a law authorizing the State Board of enacted for the purpose of protecting Health to charge $5.00 for each analy- the purity of public water supplies, sis of water from the public water The background for our beginning March, 1958 The Health Bulletin was undoubtedly the epochal 15-year period between 1876 and 1890 when such phenomenal progress was made in the development of bacteriology and our knowledge of infectious dis-eases. Then too, these outstanding ac-complishments in Europe were follow-ed by the establishment of public health laboratories in our United States, notably in New York City. Even though the 1905 General As-sembly gave us our name, it was the 1907 General Assembly which gave us our existence, for they appropriated $2,000 per year and established a schedule of fees which we are required to collect from public water supplies. This established a precedent which has persisted to this date that the Labora-tory must be partially self-supporting. There has been no change in the schedule of fees which public water supplies pay since the 1907 General Assembly; however, there has been some change in the definitions for public water supplies. The Laboratory has been at four different locations in the City of Raleigh; the first occupied March 1, 1908 consisted of three small rooms and a closet in the Agricultural Build-ing at the corner of Halifax and Eden-ton Streets. On January 1, 1909, the Laboratory was moved to more com-modious quarters on the third floor of the Holoman Building on Fayetteville Street. In January, 1917, the Labora-tory moved into its own building on Jefferson Street. This building was designed and constructed for labora-tory work. In February, 1940, the Laboratory was moved to its present plant. The Central Building is on Caswell Square, facing West Jones Street, where specimens are examined and biological products are prepared for distribution. The Laboratory Farm, 280 acres with seven buildings is located seven and one half miles west of the Capitol, on U. S. High-ways Numbers 1, 64 and 70A. Here are carried out the initial stages of the preparation of rabies vaccine and smallpox vaccine. Here too our larger animals are quartered, as well as our smaU animal colonies. , The Laboratory has participated actively in many of the battles which have been fought against communi-cable diseases in North Carolina. In 1907 many of the public water supplies were unsafe sources of drinking water. A considerable number of the munici-pal supplies were suitable only for fighting fires and flushing toilets. Most cities maintained wells at numer-ous locations within their boimdaries. Even the wells were frequently con-taminated. The Laboratory played an active part in the improvement of these public water suppliers to their present high standards, and they have practically ceased to be a source of infection. In 1916 typhoid fever was credited with causing 702 deaths. Since 1950 we have had only from 1 to 4 deaths each year from typhoid fever. In the fight against this disease the Labora-tory examined not only specimens of water but specimens from patients as an aid to the diagnosis of the disease or detection of carriers. In addition large voliunes of typhoid vaccine were manufactured and distributed. In 1916 there were 410 deaths from diphtheria in the State. Since 1952 there has been no year in which we have had more than nine deaths from this disease. Here the Laboratory assisted in the fight by examining specimens as an aid to the diagnosis of the disease, the detection of carriers, and the distribution of diphtheria antitoxin and immimizing antigens. In 1916 there were 13 deaths from smallpox in North Carolina. Since 1944 we have not had a single death from this disease. The Laboratory's only service in the fight against small-pox w-as the distribution of smallpox vaccine, but that service contributed to the immunization of millions. Shortly after the armouncement was made that there was hookworm infestation in North Carolina, the Laboratory confirmed the presence of hookworm disease in our State. By 1912 the Laboratory was not only making hookworm examinations at the rate of 22,000 per year; technicians were also trained in the Laboratory to make these examinations in the field. The salaries of these workers were The Health Bulletin March, 1958 paid by the Rockefeller Sanitary Com-mission. This hookworm campaign did much to reduce the prevalence of in-testinal parasites in the State and to establish public health as a worth-while procedure. The best known work of the State Laboratory of Hygiene is the exami-nation of dog heads for rabies. When-ever the name of the State Laboratory of Hygiene is mentioned at nearly any crossroads in North Carolina, people know that Is the place where dog heads are examined, although they may be unaware of any of oiu- other activities. In addition to aiding in the diagnosis of rabies in animals, the Laboratory as early as 1917 administered antirabic treatments to patients coming to Raleigh. By 1919 the Laboratory was distributing antirabic vaccine to phy-sicians who could administer it in their own offices. The largest nvunber of animal heads ever examined in a single year was in 1935 when some 2000 were received at the Laboratory. We are winning the fight against rabies, provided we do not relax our efforts. The largest activity ever undertaken by the Laboratory was in connection with the fight on syphilis. In 1918 we started making the Wassermann test. As with other procedures we have dis-carded the older tests and adopted newer ones whenever we were con-vinced that we were making improve-ment in our services. The largest number of blood tests we ever made in a single year was in 1941 when a total of 427,488 specimens were examined. Ninety-four thousand of these were from draft registrants being made ready for World War n. Here, too, we seem to be on the winning side, pro-viding the efforts which are now being made are sustained. During the first calendar year of the Laboratory's existence — 1909 — 2,902 laboratory examinations were made. In 1912 this number had increased to 5,058. For the calendar year 1957, more than 500,000 examinations were made. The intervening years have generally shown an upward trend in the volume of work. Some years, as 1941, when syphilis serology was urgently needed and when additional workers were available, showed extra-ordinary activity. Our specimens come from physicians, local health departments, state insti-tutions, hospitals and public water supplies. Most people in the State are fairly familiar with the aid which the Laboratory renders to physicians in the diagnosis of disease and to health departments in the detection of car-riers, and also with the large volume of biological products distributed to those who are authorized by law to use them. Few people realize that the epidemiologist can use laboratory find-ings to detect an impending epidemic and take steps to prevent it just as well as he can use the Laboratory to solve the mysteries of an epidemic in full bloom—an outbreak of food poi-soning, for example. Our oldest activity, yet one as useful and even more widely used today, is the work we can do to help safeguard the quality of drinking water. A newer endeavor in this general field is to assist the stream pollution work in making our rivers and their tributaries a bit cleaner and more usable, A newer activity is in the field of viruses —their isolation and identification. The newest activity is the monitoring of water and foods for radioactivity. In addition to the examination of specimens and the biological products which we distribute, we have the re-sponsibility of approving local labora-tories for serological tests for syphilis — some 180 of them—and the certifi-cation of laboratories for the testing of milk which may be shipped from North Carolina to other states. There are 25 of these certified milk labora-tories. At present our staff consists of 74 people, 32 of whom have been with us for more than ten years. Two have been with us for more than 40 years; five for from thirty to forty years; three from twenty-five to thirty years; five from twenty to twenty-five years; eleven from fifteen to twenty years; and six from ten to fifteen years. In addition, one has retired after forty years and one after thirty-nine years March, 1958 The Health Bulletin 5 of service, and one died after twenty-nine years of service. All members of our staff are important; some may draw larger salaries than others, but each and every one make a contri-bution to the smooth operation of the Laboratory and the quality of work performed. The persons doing labora-tory work are well trained and pro-ficient in their particular field of activity. All hold Bachelor degrees — several have advanced degrees. We have a promotional system. Practically all of those in the higher classifications have been promoted from lower classi-fications in the Laboratory. A young-ster can come to the Laboratory im-mediately after graduating from col-lege and be given an opportunity for advanced training and promotion. In fact, a person can make a life career in the Laboratory of Hygiene with a reasonable degree of assurance that he can marry, have a home, rear children, house, feed clothe and edu-cate them adequately and have security in his old age. He will never be rich, if his sole income is from the State, but he can enjoy his work because he knows that he is making a worth-while contribution to the well-being of his fellow citizens. He can have pride in his accomplishments and hopes for the future. We have a staff of labora-tory workers of whom any laboratory director could be proud. We have endeavored to outline briefly the State Laboratory of Hygiene as an institution dedicated to render-ing service helpful in the detection, treatment and prevention of disease, as well as evaluations of unfavorable environmental conditions. An institution is more than bviild-ings, equipment and supplies. It is people, who motivate it, who give it intelligence, loyalty, devotion, responsi-bility, reputation and tradition. The State Laboratory of Hygiene is fortu-nate that its foxmder and director for more than 25 years was Dr. Clarence A. Shore. He and his associates set the ideals and traditions of service which those who followed them have endeavored to maintain. Mr. J. W. Kellogg, in the April 1940 Health Bulletin, gave a brief but meticulously docvmiented history of the Laboratory from 1908 to 1940. This, April, 1940, Health Biilletin is devoted entirely to the dedication of the present plant to Dr. Shore. As we look backward with pride in the past we also look forward with hope for the futvire. We have confi-dence that the service which our in-stitution has rendered during its first half century has established us so firmly as a worthwhile institution that during the second half century of our existence we shall render even greater service. The State Laboratory of Hygiene has a part in the future. NOTES AND COMMENT By the Editor Dr. Applewhite Retires After forty-four years in service to the public health Dr. C. C. Applewhite has certainly earned the privilege of retiring. For more than eight and one half years—July 1, 1949, to January 31, 1958 he served as Director of Local Health Work for the North Carolina State Board of Health. He came to our State with a long and honorable record of accomplishments in public health over an area extend-ing from the Atlantic ocean to the tier of states west of the Mississippi. He tackled our problems in North Carolina with energy, enthusiasm, knowledge, experience and natural ability, with which he had been richly endowed. His tour of duty in North Carolina was fruitful. The General Assembly of 1949 had just increased the appropriation for State aid to local health departments by $800,000. The equitable distribution of this new money among the local health depart-ments, some of which was for single districts and some for municipalities which maintained separate organi- 6 The Health Bulletin March, 1958 zations, helped set the stage for an expanding health program. After 1949 there was no increase in State funds and an actual decrease in Federal fluids; yet Dr. Applewhite was most helpful in persuading local appropri-ating boards to increase local funds. The result tells the story. In 1950 local funds were $2,693,246 of the $4,372,628 expended for local health work in the State, the State funds being $1,500,000 and other soiirces, mostly Federal, $529,383. Through the years local health funds increased, while State funds remained stationary and Federal funds decreased, until, in 1958, local money amounted to $5,334,965 of the $6,905,758 budget for local health work. In 1950 only some eight or ten of oiu: local health departments were ade-quately housed. Most of them were crowded into basements or attics. By 1958, 73 new health centers had been completed to house our local health departments, and eight more were under construction. Dr. Applewhite and Dr. John A. Ferrell of the Medical Care Commission teamed together to induce county commissioners to construct these worthwhile buildings. Better housing facilities have helped our local health work in many ways. They have made it possible to improve the quality and increase the quantity of service which could be rendered. Veteran health workers have been en-couraged to remain steadfast in the faith, and recruiting of capable, well-trained young men and yovmg women as public health workers should be less difficult. While encouraging and stimulating the procedures which have been con-sidered a fundamental part of a well regulated health program. Dr. Apple-white did much to make mental health a definite part of our public health activities. His position is that much can be done to prevent mental disease and that public health workers can make a worthwhile contribution In that field of endeavor. Dr. Applewhite's kindly, sympathetic and understanding attitude won him a host of friends in North Carolina. When it was learned that he was re-tiring, the local health workers were the first to decide that due recognition should be made of our love and af-fection for him. The staff of the State Board of Health and the North Caro-lina Public Health Association followed their lead. On January 31, his last working day, a special meeting of the North Carolina Academy of Public Health was called. A traveling bag was presented to Dr. Applewhite by Dr. John Fowler, dii'ector of the Durham Child Guidance Clinic, in behalf of the mental health workers. Dr. W. A. Browne, director of the Edgecombe County Health Department, speaking for the local health workers and the staff of the State Board of Health, presented him with a lounging chair with the hope that he would enjoy many restful and pleasant hours re-clining in it. Dr. J. W. R. Norton pre-sented him with a stack of letters written and signed by numerous well-wishers. These have been boimd in book form. Dr. Applewhite has said: "Frankly, this toiur of duty in North Carolina will always be considered by me as the happiest one in my entire public health career." When we review his biography we in this State may justly feel highly complimented. Born—Winona, Mississippi, 1887 Attended Millsaps College, 1903-1907 —A. B. degree Taught public school in Mississippi, 1907-1909 Attended Vanderbilt University, 1909- 1913—M. D. degree Attended Harvard School of Public Health, 1932-1933—M. P. H. degree Career: Rural sanitary surveys, USPHS, in Mississippi, Georgia, North Caro-lina, Alabama, Tennessee, Illinois and Texas, 1914-1917 Extra cantonment sanitation, USPHS, in Georgia and New Jersey, 1917- 1919 Rural health work in Georgia and Kentucky 1919-1922 Director of Local Heath Service, State Health Department, Jackson, Mississippi, 1922-1932 Rural health work. State Health Department, Columbia, S. C, 1933- 1935 March, 1958 The Health Bulletin Regional consultant, USPHS, New York, Chicago and New Orleans Districts, 1935-1941 District Director, USPHS, Kansas City, Mo., 1941-1945 District Director, USPHS, New Orleans, La., 1945-1949 Director, Local Health Division, N. C. State Board of Health, 1949- January 31, 1958 Received Reynolds Award for out-standing achievement in public health field in North Carolina for 1953 Diplomate, American Board of Pre-ventive Medicine and Public Health Fellow, American Medical Association Member Wake County Medical Society Member, Medical Society of the State of North Carolina Member, American Public Health Association Member, American College of Pre-ventive Medicine Member North Carolina Academy of Preventive Medicine President, North Carolina Academy of Public Health Dr. Applewhite has left North Caro-lina to return to Mississippi, the State of his birth and early manhood. Al-though we are saddened by his de-parture from the ranks of public health workers in North Carolina, we are pleased that we have known him and have had the privilege of working with him in promoting the well-being of the people of North Caro-lina. We of the staff of the State Board of Health join with other health workers throughout the State in wish-ing for him many happy years in the land of the living. Our affection for him goes wherever he goes. We will remember him as an honorable Christian gentleman. COMPULSORY POLIOMYETITIS VACCINATION For nearly two years we have had suggestions from various and sundry sources that there should be a law, rule or regulation requiring that all children be vaccinated against polio-myelitis. The frequency with which these suggestions are made is in-creasing. There have been newspaper editorials. The problem has been dis-cussed by boards of health, both local and State. The evidence is accumu-lative that poliomyelitis vaccine is effective in preventing paralysis due to this disease. Just how long the protection induced by the vaccine will last is yet to be determined. Another year of experience with the vaccine will be possible before the General Assembly of 1958 meets. In the mean-time it is not necessary that any of us make a decision as to whether or not we favor compulsory vaccination against poliomyelitis. Physical Therapy Duke University, Durham, North Carolina, has inaugurated a program of graduate credit for specified courses in the physical therapy program. This augments the certi,ficate course in physical therapy offered for the past fifteen years by Duke Uni-versity Medical Center and approved by the Council on Medical Education and Hospitals of the American Medical Association. The new program in physical therapy is conducted imder the joint auspices of the Graduate School of Arts and Sciences and the Duke University Medical Center. The program has two phases: (1) The fundamental courses in physical therapy are studied in the first fifteen months. During this period fifteen hours of graduate credit, which meet one-half of the graduate residence requirement, may be accimiu-lated. The Certificate in Physical Therapy is awarded up>on completion of this work. The graduate is then eligible to become a member of the American Physical Therapy Associa-tion, to take state and national licen-sing and registration examinations and to work as a qualified physical therapist. (2) Later specialization in anatomy or in physiology can provide the additional fifteen hours of gradu-ate credit necessary for the Master of Arts degree. This second phase, in-cluding preparation of a thesis, may be formally scheduled in one semester. 8 The Health Bulletin March, 1958 Radio Program The State Board of Health's weekly radio program, over Station WWNC in Asheville, heard every Saturday, has been changed from 9:15-9:30 A.M. to 1:45-2 P.M. The subject of this pro-gram is "Your Health And You," and it is designed to reach listeners in the western part of the State, The Board also gives a program known as "Your Public Health Reporter" over Station WPTP, in Raleigh, each Satiu-day, beginning at 1:30 P.M. The scripts are prepared and delivered by William H. Richardson, publicity officer for the Board. AUTOMATION CONTRIBUTING TO OBESITY PROBLEM Automation may have its advantages but it is causing a major problem in the field of medicine. More and more people are tending to become overweight as a result of our new sedentary life which provides more leisure time with less heavy physical work, according to Dr. Robert H. Barnes, of Seattle. Writing in the Journal of the Ameri-can Medical Association, the University of Washington School of Medicine doctor said, "Reduction and perma-nent weight control require healthy changes in living habits." In addition to physical examinations and general health evaluation, a phy-sician today must also concern himself with the patient's personal living habits if he is to recommend an ef-fective reducing program. "Usual eating habits and average daily physical activity are two of the most important points to be explored," said Dr. Barnes. He added, "There is no single approach to the treatment of obesity, only lifetime control." A special history should be the first step in determining a program to bring long-term results. This history will give an index of past and present weight, maximum weight, and esti-mated ideal weight. The second step is to modify the way of eating, which must be designed to be followed during the patient's life-time. This approach is more satis-factory on the long-range basis than the conventional rigid diet. Dr. Barnes said. Lowering the caloric intake is neces-sary for anyone to reduce. Despite the fact that dieting alone has been a iSLilure, it is still the principal support in reducing, he said. In setting up a diet, the patient's working facilities, meal hours, family food patterns, and income level must all be considered. Additional steps in the program should include the use of medication (dispensed under a physican's super-vision), exercise, and posture control. He noted, "Moderate exercise, month in and month out, can be the differ-ence between following a starvation regimen and being able to follow a more normal diet according to one's appetite. "Here again modern civilization makes it difficult for the overweight patient to do regular exercising such as walking. The habit of riding every-where, even three blocks to the store, has depressed the physical activity of many to a very low state." There should also be developed a close relationship between doctor and patient, for, according to Dr. Barnes, "The patient should realize that he is under the care of a physician not only to lose weight but also to have treated the associated medical dis-orders common to obesity which com-mercial reducing salons are admittedly incapable of recognizing and treating." FACIAL PAIN CALLED "MOST AGONIZING" The reasons for facial pain being "perhaps the most agonizing of all afflictions" were given by a Georgia doctor. There is a reasonabe physical reason for severe suffering from facial pain. The "cephalic end of man has been blessed with the highest degree" of nervous development, which allows for the most acute awareness of any sensory stimulation. Also the head and face command more attention than other parts of the body, Dr. George W. Smith, Augusta, Ga., said in the Journal of the American Medical Association. March, 1958 The Health Bulletin 9 Man is very much aware of his face and head and its vulnerability to injury or hui't. Accordingly, he is quickly and greatly concerned about any painful sensation. Awareness of others scrutinizing his exposed face magnifies any sensation he might be experiencing, although there may be no objective change to the observer, Dr. Smith said. The way people bear pain depends on their own personalities, emotions and neurotic tendency, he said. This dif-ference among people makes evalu-ation, diagnosis, and treatment of facial pain a complicated and difficult problem for the doctor. The precise diagnosis and locali-zation of the origin of facial pain is difficult because there are so many nerves and they so overlap that it is hard to distinguish just what path the pain is following. Relief depends on the cause. If it results from something other than nerve damage, such as infection in the mouth or a tumor, it can be relieved by eradicating the cause. When the nerves themselves are damaged or dis-eased, the treatment is more compli-cated, often involving surgery. Dr. Smith is in the division of neurological surgery, the Medical Col-lege of Georgia. Hospitals One out of eight Americans will be hospitalized during the coming year. For the first time, many of us will know what a hospital really is—how it restores and protects oiur health. There was a time, according to an article in the spring issue of Blue Print for Health, a publication of the Blue Cross Commission of the Ameri-can Hospital Association, when the name "hospital" had an entirely dif-ferent meaning. "The Hospital Throughout the Ages" is the first of an eight-part series written by Arnold A. Rivin, formerly of the American Hospital Association. Riven shows how the modern hospital was "a long time coming" by tracing its origin back to the fifth century B. C. in Ceylon. Even as late as the eight-eenth century "hospitals" were used primarily to house human derelicts. The idea of a voluntary hospital solely for the curable sick emerged in the British Isles in the early 1700's. The Pennsylvania Hospital in Phila-delphia is generally accepted as the oldest true American hospital. It was founded in 1751 with the active aid of Benjamin Franklin. In the 1800's the quahty of patient care and hospital maintenance were so poor that most hospitals actually contributed to the spread of disease. With the development of ether, radical improvements in sanitation and hygiene, the use of new techniques and specialized equipment, hospitals emerged gradually into the form we know today. By the 1900's, more and more people who had formerly been treated at home went to the hospital for treat-ment. As the number of hospital ad-missions increased, it soon became apparent that a plan was necessary which would make hospitalization available to every family burdened with illness, regardless of its finan-cial status. Within the past twenty-five years, this need has been answered by steadily increasing nation-wide en-rollment in prepayment plans for hos-pital care. Thus today your hospital has become a community center for treatment of the sick. Mr. Rivin closes his article with the optimistic thought that what-ever ailment one out of eight of us has during the coming year, we now stand an excellent chance of being released from the hospital soon—in better health. Industrial Health Conference New problems and progress in the control of occupational health hazards and the provision of preventive medi-cal services by industry will be dis-cussed at the Thirteenth National Industrial Health Conference, to be held at Convention Hall in Atlantic City, New Jersey, April 19-25, 1958. Over 3,000 occupational health special-ists, businessmen and labor leaders will hear papers on problems of grow-ing significance to industry, workers, and the community. A total of 134 10 The Health Bulletin March, 1958 papers will be presented on such subjects as radiation, mental health in industry, air pollution, noise, medi-cal care and in -plant health services, industrial dentistry and industrial nursing. Radiation. — Comprehensive sessions on radiation will cover such specia-lized facets of the problem as stand-ardization in nuclear energy; radiation protection laws and codes—a scramble for action; radiation dosages to medi-cal personnel; environmental radio-activity in the nuclear test airplane test area; radiation safety monitoring of reactor demolition; the licensee in-spection program of the Atomic Energy Commission; facts and fallacies about radiation exposure; diagnostic radi-ation in industry, uses and abuses; microwave radiation hazards; and the Pennsylvania radiation protection pro-gram with its outlawing of shoe-fitting fluoroscopes. Mental Health in Industry.—Since studies have shown that as much as one -third of sickness absenteeism in industry is due to mental health prob-lems, this is a problem of paramount concern to industrial physicians and management. A symposium will be held on this subject centering on early recognition of emotional problems by industrial physicians. Air Pollution.—The pollution session will cover numerous papers, including air pollution control in New Jersey, a progress report of the New Jersey Air Pollution Control Commission; the ap-plication of simplified techniques to air pollution measurement; air pollu-tion problems in petroleum refining; the effects of air pollution on human health; and pollen removal by air filters. Noise—Papers on noise will Include a report of a Public Health Service study on industrial noise and hearing loss in a controlled population; industrial audiometry; hearing loss related to non-steady noise exposure; reduction of air flow noise; acoustical treatment of walls and ceiling; and noise control methods used in foundry operation. Medical Care and In-Plant Health Services.—A symposium will be held on medical care of industrial workers. covering labor's health goals; the medical care plan of Endicott-Johnson Corporation; and community health association plans for operation in Detroit. A special session will also be held on health services for small plants, including a paper on the value of small plant health programs to management. Industrial Dentistry. — The sessions on industrial dentistry will include a symposium on dentistry as related to safety in industry, a panel discussion on the cost of an industrial dental program to management, and paper on the possibility of dental coverage in health insurance programs. Industrial Nursing. — The industrial nursing sessions will include dis-cussions on the effective use of com-munity resources; automation; and preparation for catastrophic and emergency situations in industrial plants. Other Sessions. — Nvunerous papers will be devoted to other aspects of occupational health, including the toxicity of various substances used in industry; engineering, chemical and analytical procedures as related to industrial health; rehabilitation and alcoholism. Special Conference addresses in-clude the C. O. Sappington Memorial Lecture, to be presented by C. W. Shilling, M. D., Deputy Director, Di-vision of Biology and Medicine, Atomic Energy Commission, on "Everybody's Business—The Problem of Fall Out and Radiation." The Donald E. Cum-mings Memorial Lecture will be given by Major General James P. Cooney, Deputy Siorgeon General of the Army, who will speak on "Interpersonal Relations." In an address commemo-rating the 20th aimiversary of a pro-fessional organization participating in the Conference, Mr. John J. Bloom-field, known as one of the founders of modern industrial hygiene in the United States, and now Regional Con-sultant in Industrial Hygiene at the Institute of Inter-American Affairs, will report on "What the American Conference of Government Industrial Hygienists has done for Industrial Hygiene." March, 1958 The Health Bulletin 11 The Industrial Health Conference is sponsored by the Industrial Medical Association, the American Industrial Hygiene Association, the American As-sociation of Industrial Dentists, the American Association of Industrial Nurses, and the American Conference of Governmental Industrial Hygienists. H. W. Lawrence, M. D., Medical Director, Procter & Gamble Co., Cin-cinnati, Ohio, and President-elect of the Industrial Medical Association, is General Chairman of the Conference. C. Scott McKinley, M. D., Medical Director, Bakelite Corporation, Bound Brook, New Jersey, and Mr. N. V. Hendricks, Esso Research & Engi-neering Company, Linden, New Jersey, are Deputy General Co-chairmen. Advance registration forms, as well as a copy of the program, may be ob-tained from Edward C. Holmblad, M. D., Managing Director, Industrial Medical Association, 28 East Jackson Boulevard, Chicago 4, Illinois. FINGERPRINTS CAN BE REMOVED BY SURGICAL TECHNIQUE Fingerprints, always considered to be permanent and unalterable, can be completely removed by the surgical technique of skin planing, a New Orleans doctor reported. Tu'o Detroit physicians also reported that they have proved an assumption of law enforcement officials that prints of the second or dermal layer of skin can be used for identification purposes as well as those of the top layer or epidermis. Their reports appeared in Archives of Dermatology, an American Medical Association publication. Dr. James W. Burks Jr.. of the Tulane University School of Medicine division of dermatology, said his pre-liminary report has important legal Implications because the possible re-moval of fingerprints makes positive identification by this means uncertain. He treated two men with arsenic-caused horny growths on the hands by planing the skin with a high speed electric wire brush. At the same time, he planed a finger of each man, re-moving the epidermis and the upper part of the dermal layer. Skin planing is often used to remove scars from acne or small pox. Weeks after the planing, the fingers were smooth, slightly pinker, and with-out visible ridges. A hand lens showed the normal arrangements of whorls to be replaced by minute, thin, criss-crossed and parallel lines similar to those on the back surface of the web between the thumb and index finger. Dr. Burks warned dermatologists that they must guard against treating criminals who seek to have their finger-prints removed. He added, however, that criminals who have this means of identification altered may still be re-cognized through "other equally satis-factory means." In fact, the "very absence" of ridge patterns on fingers could reflect an attempt to conceal identity. Dermatologists can help law enforcement officers in determining the medical reasons for a person's having planed fingers, he said. The Detroit physicians, Drs. Harold Plotnick and Hermann Pinkus, ran an experiment on the similarity of epider-mal and dermal fingerprints. Using recently amputated fingers, they first took prints of the epidermis. They then removed the epidemis and took prints of the dermis (also called the corium or "true skin"). The two prints were identical except that the ridges of the dermal prints appeared split or double, as well as finer that those of the epidermis. The dermal print is "just as effective for identification purposes." they said. Their study resulted from an actual case in Boston in which Dr. Pinkus was asked by the police to explain the difference between epidermal and dermal fingerprints. The police had found the body of a man and suspected that he had been murdered by his wife and dumped into the water. All the skin had come off the fingers, but prints were taken from the denuded dermal surfaces. It was up to the police to convince the jury of the identity of these prints with ordinary prints on file. "They built up a nice case with the information, but the wife confessed just before the trial opened, so all the 12 The Health Bulletin March, 1958 effort had been for nought," the doctors said. It did, however, lead to the study proving the vahdity of dermal prints as a means of identification. NUTRITION PLAYS NO ROLE IN ARTHRITIC PROCESS There is no special diet for the treat-ment of arthritis, according to the American Medical Association's Coun-cil on Foods and Nutrition. In a special report prepared for the council. Dr. William D. Robinson, Ann Arbor, Mich., said joint diseases are "essentially diseases of the supporting structiu-e of the body, the connective tissue." It is "extremely unlikely that the fimctioning of this tissue can be directly affected by dietary manipu-lation." However, patients with diseases of joints do need to pay attention to their diet, because of its effect on their general state of health. Dr. Robinson said. Many diets and specific vitamins and minerals have been suggested for the treatment of arthritis, but research has failed to show any relationship between nutrition and the cause of most rheumatic diseases. Gout is the only fairly common form of joint disease in which diet and the use of food by the body have been shown to affect the disease. Food allergy, high fat diets, and periods of fasting all precipitate gout attacks; therefore, patients need to watch their diets carefully. Occasionally special diets are needed by persons with arthritis, even though they will have no effect on the disease itself. For instance, overweight patients often need to lose weight to reduce the load on the affected weight-bearing joints. Diets high in calories, proteins, vitamins, and minerals are sometimes necessary for patients who have lost weight and muscle tissue, a situation frequently encountered in rheumatoid arthritis. Dr. Robinson noted that many forms of rheumatic disease are self-limiting. with a tendency to subside spon-taneously after a varying length of time. Confusion of such conditions as bursitis or psychogenic rheumatism with various types of arthritis un-doubtedly has been responsible for the claims of value for various diets and vitamins as treatments for arthritis. i Dietary treatment for the arthritic ! patient may be an important aspect of the total program of effective treat-ment, but such treatment "must be , adapted to the general condition of the individual patient as well as to the type of rheumatic disease present," Dr. Robinson concluded. He is in the department of internal medicine and the Rackham Arthritis Research Unit of the University of Michigan. His report appeared in the Journal of the A.M.A. TWO-MONTH-OLD BABIES NEED POLIO SHOTS Polio shots for infants as young as two months were recommended recently in a guest editorial in the Journal of the American Medical Association. At present shots are generally begun at six months of age. However, several groups of researchers have fovmd that many infants lose the immunity with which they are born before they reach six months. Dr. Lam-i D. Thrupp, chief of the poliomyelitis surveillance imit of the U. S. Public Health Service's Com-municable Disease Center, Atlanta, Ga., said the American Academy of Pedi-atrics has recommended beginning the shots at two months. The third shot should follow the first two by at least six or seven months. During 1956, attack rates of paralytic polio were highest in one-year-old children and the largest proportion of cases occurred in the under-five-year age group, Dr. Thrupp said. Preliminary data for 1957 indicate that a comparably high proportion of para-lytic cases is occurring in pre-school-age children. LIBRARIAN DIVISION OF HEALTH AFFAIRS LIBRA N.C. MEM, HOSP, U. N. C. CHAPEL HILL, N.C. I TKis Bulletin will be seni^jf^ to dniiciiizen of tKe 5kite upon request \ Entered as second-class mayi^ at Postoffice at Raleigh, N. C. under Act of August 24, 1912 Published monprfy at the office of the Secretary of the Board, Raleigh, N. C. Vol. 73 APRIL, 1958 No. 4 Rtct-.' ^,.,^^- m'i o 105^9 ASHE COUNTY HEALTH DEPARTMENT JEFFERSON, NORTH CAROLINA MEMBERS OF THE NORTH CAROLINA STATE BOARD OF HEALTH G. Grady Dixon, M. D., President Ayden John R. Bender, M. D., Vice-President Wlnston-Salem Charles R. Bugg, M. D. Raleigh Lenox D. Baker, M. D. Diirham H. C. Lutz, Ph.G. Hickory Mrs. J. E. Latta Hlllsboro, Rt. 1 John P. Henderson, Jr., M. D. Sneads Ferry Roger W. Morrison, M. D. Ashevllle Z. L. Edwards, D.D.S. Washington EXECUTIVE STAFF J. W. R. Norton, M.D., M.P.H., State Health Director John H. Hamilton, M.D., Assistant State Health Director, Director State Laboratory of Hygiene, and Editor Health Bulletin Robert D. Hlgglns, M.D., M.P.H., Director Local Health Division Ernest A. Branch, D.D.S., Director Oral Hygiene Division A. H. Elliot, M.D., Director Personal Health Division J. M. Jarrett, B.S., Director Sanitary Engineering Division Fred T. Foard, M.D., Director Epidemiology Division E. C. Hubbard, B.S., M.P.H., Director Division of Water Pollution Control List of free health literature will be supplied by local Health Departments or on written request. CONTENTS Page Nursing Homes and Homes for the Aged—The Heart of the Matter 2 Notes and Comment 9 Nursing Homes and Homes for the Aged — The Heart of the Matter* By L. E. Burney, M. D. Surgeon General, Public Health Service U. S. Department of Health, Education, and Welfare First let me express my sincere ap- pose, a wider vision of otir individual ! preciation to every individual who has and collective responsibilities for the i a part in this Conference. I am especi- patients in nursing homes, the resi-ally grateful to the Planning Commit- dents of homes for the aged. They are tee, the section chairmen, and all the ones who must reap the rewards of others who have worked hard these this Conference. They are the sole rea-past few months so that nothing shall son for our being here together this . be lacking to make this Conference a morning. I rewarding experience. Today, in a niursing home not far ' It is my earnest hope that after these from here there is a little old lady aged , four days of working together, each of 90 years, a former schoolteacher. She | us will return to our usual tasks with a is happy, active, comiortable, busy clearer understanding, a firmer pur- with her crossword puzzles, books, and •National Conference on Nursing Homes and Homes for the Aged, Washington, |