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r ©he litjrarp of tte Wini\}tx9iitp of ^ortf) Carolina Cnbotoeb bp t&:i)e Bialectit anb l^ilanttroptc ftodeties; blU.06 N86h v« 65-66 1950-51 Med.lib» .- o ' v..^^.:.,^.,^^.. JiA This book must not be taken from the Library building. iiA¥-8 — m ^f? n r «) FifrtF^-i^ ^ifo'ISm I TKis Bulletin will be senifree to dny citizen of fKe Ski^e upon request t Published monthly at the ofSce of the Secretary of the Board, Raleigh, N. C Entered as second-class matter at PostofSce at Raleigh, N. C. under Act of Angnst 24, 1912 Vol. 66 JANUARY, 1951 No. 1 <5 ^ ft » i. GEORGE MARION COOPER, M.D. 1876-1950 MEMBERS OF THE NORTH CAROLINA STATE BOARD OF HEALTH G. G. Ddcon, M.D., President Ayden HxnBEET B. Haywood, M.D., Vice-President Raleigh H. Lee Large, M.D Rocky Mount John LaBruce Ward, M.D Ashevllle Jasper C. Jackson, Ph.G Lumberton Mrs. James B. Hunt Lucama, Rt. 1 John R. Bender, M.D Winston-Salem Ben J. Lawrence, M.D Raleigh A. C. CxjHRENT, D.D.S Gastonla EXECUTIVE STAFF J. W. R. Norton, M.D., Secretary and State Health OflBcer , Director Personal Health Division C. C. Applewhite, M.D., Director Local Health Division Ernest A. Branch, D.D.S., Director of Oral Hygiene Division John H. Hamilton, M.D., Director State Laboratory of Hygiene J. M. Jarrett, B.S., Director Sanitary Engineering Division C. P. Stevick, MJ)., M.PJI., Director Epidemiology Division FREE HEALTH LITERATURE The State Board of Health publishes monthly The Health Bulletin^ which will be sent free to any citizen requesting it. The Board also has available for distribu-tion without charge special literature on the following subjects. Ask for any in which you may be interested. Adenoids and Tonsils Hookworm Disease Typhoid Fever Appendicitis Infantile Paralysis Typhus Fever Cancer Influenza venereal Diseases Constipation Malaria Residential Sewage Diabetes Measles Disposal Plants Diphtheria Pellagra Sanitary Privies Don't Spit Placards Scarlet Fever Water Supplies Flies' Teeth Whooping cough Tuberculosis Epilepsy, Feeble-mhidedness, Mental Health and Habit Training Rehabilitation of Psychiatric Patients The National Mental Health Act. SPECUL LITERATURE ON MATERNITY AND INFANCY The following special literature on the subjects listed below will be sent free to any citizen of the State on request to the State Board of Health, Raleigh, N. C. Prenatal Care. First Four Months. Prenatal Letters (series of nine Five and Six Months. monthly letters). Seven and Eight Months. The Expectant Mother. Nine Months to One Year. Infant Care. One to Two Years. The Prevention of Infantile Two to Six Years. Diarrhea. Instructions for North Carolina Breast Feeding. Midwives. Table of Heights and Weights. Your Child From One to Six Baby's Daily Schedule. Your Child From Six to Twelve Guiding the Adolescent CONTENTS Page Tributes to Dr. George Marion Cooper 3 mwrn [£l||PU6LI5A\ED BYTAE N<>RTM CAROLINA STATE B^'ARD-zAEALTAlB Vol. 66 JANUARY, 1951 No. 1 J. W. R. NORTON, M.D., M.P.H., State Health Officer JOHN H. HAMILTON, M.D., Editor George Marion Cooper, M.D.—1876-1950 The Health Bulletin sorrowfully marks the passing of Dr. George Marion Cooper, for nineteen years its editor and for thirty-five years a distinguished member of the staff of the North Carolina State Board of Health. We dedicate the pages of this issue to a partial expression of appreciation of the man and the good service which he rendered in promoting the health of all the people of North Carolina. The Health Bulletin JantLary, 1951 STATE OF NORTH CAROLINA GOVERNORS OFFICE RALEIGH W Kerr Scott GOVERNOR In the death of Dr. George Marion Cooper, Assistant State Health Officer, North Carolina has lost a faithful public official and humanity a devoted friend. He was interested in and gave his efforts to the solution of more public health prob-lems than any other man of his generation. Although he was qualified for leadership in any phase of public health work, he was willing to serve in the ranks. However, he was looked to for advice and guidance by every State Health Officer and every other Health Official with whom he worked. Dr. Cooper was able to place himself alongside those he served; to interpret their problems and minister to their needs in a sympathetic aind effective mcinner. He was able to serve his State over a period of many years without assuming any attitude of proprietorship. On the contrary, he remained a faithful servant of the people. He occupied a place in North Carolina history which was unique. In his relationship to Church and State, Dr. Cooper gave his best. Governor Jamuary 3, 1951 January, 1951 The Health Bulletin RESOLUTION OF RESPECT TO THE LATE DOCTOR GEORGE MARION COOPER The following Joint Resolution, in^ troduced in the Senate by Senator Paul Jones, was placed upon its immediate passage by unanimous consent on Jan-uary 17, 1951, then sent by special mes-senger to the House which took similar action. The Resolution was passed and ratified on the same day. WHEREAS, the death of Dr. George Marion Cooper, Assistant State Health Officer, which occurred on Monday, December 18, 1950, removed from our midst one of the greatest Public Health officials and humanitarians North Caro-lina has ever known; and WHEREAS, his efforts in behalf of the underprivileged, especially among mothers and babies, not only were signally outstanding, but bore wide-spread and beneficial results in every part of oiu- State; Now, therefore, be it resolved by the Senate, the House of Representatives concurring: Section 1. That official recognition be given the life and services of this distinguished and useful native of Sampson Coimty, who, for thirty-five years was associated with the State Board of Health. Sec. 2. That a copy of this resolution be given the Secretary and State Health Officer, and copies to Doctor Cooper's thl-ee surviving children. Sec. 3 That today's adjournment be in honor of Doctor Cooper. Sec. 4. That this resolution shall be in full force and effect from and after its ratification. Jan. 17, 1951 TRIBUTES TO DR. G. M. COOPER When advised of the death of Dr. G. M. Cooper, Assistant State Health Officer, Dr. J. W. R. Norton, Secretary and State Health Officer, made the following statement: "North Carolina has lost its greatest Public Health Official of all time. He served longer, engaged in more activi-ties and did more to make North Caro-lina Public Health conscious and to minister to its Public Health needs than any man in the history of the State. He pioneered more Public Health services than any other man I know, not only in North Carolina but in the nation. Both personally and professionally he had few peers, if any, and no superiors any-where. His was constantly an up-hill fight against ignorance, misinformation, indifference and short-sighted selfish interests. The two greatest groups of his beneficiaries were imder-privileged mothers and children, in whose behalf he not only worked unceasingly and for whose relief he was instriunental in securing millions of dollars in public funds, which he administered where they would do the most good among the greatest nimiber of people. During his service with the State Board of Health, the maternal death rate was reduced to one-fourth and the infant death rate to one-half of those rates prevailing in North Carolina when his service began. This progress was due to the work of many devoted physicians and assisting personnel; Dr. Cooper was the patient plarmer, the daimtless and resoiirceful leader, the tireless worker. "I feel in the passing of Dr. Cooper an over-whelming sense of personal loss. In generations to come, the de-scendants of those he has helped will rise up and call him blessed. His S3mi-pathies were broad and he worked tire-lessly in behalf of those he sought to 6 The Health Bulletin January, 1951 serve, and without hope of personal aggrandizement. He was not only a pillar of strength in the P'^oiic Health structure, but ever mindful of his family and personal friends and just as zealous in the work of the Presbyterian Church, of which he was a life-long member and a ruling elder at the time of his death. He was my personal friend and the personal friend of all who worked with him in any capacity. Our best expres-sion of faith in and love for him will be through closing ranks and marching on toward the goals toward which he strove so long and so well." Dr. Clyde A. Erwin, State Superinten-dent of Public Instruction, paid this tribute to the late Dr. Cooper: "I feel a deep personal loss in the death of Dr. Cooper. He has been a dear friend of mine for many years. In addi-tion I consider his loss to the State ir-reparable. No one in my opinion has given of himself more vmselfishly nor more effectively in the service of the people. His keen understanding of the problems of public health and his dedi-cation to the solution of these problems is a landmark along the road of hu-man progress." Statement by Dr. Ellen Winston, Commissioner of Public Welfare, on the death of Dr. George M. Cooper. "In the passing of Dr. George M. Cooper, the State Board of Public Wel-fare, has lost a staunch supporter and friend. His loss will be felt by welfare workers throughout the State who have known and loved him. He was ever mindful of the importance of the united efforts of health and welfare in his work in promoting North Carolina's health program. As an eminent citizen and de-voted leader in seeking social better-ment, Dr. Cooper made a lasting con-tribution to this State and to the nation." A GREAT PHYSICIAN When a North Carolinian who has been taking notice of public affairs for a quarter of a century reflects on the length, breadth and depth of the serv-ice of Dr. George Marion Cooper, as-sistant state health officer who died at Raleigh early Monday morning, he is constrained to conclude: Here was the public servant made perfect. It will have been printed elsewhere in the Daily News, but we think any esti-mate by an editorial commentator should include the tribute paid him by Dr. Roy Norton, state health officer: He served longer, engaged in more activities and did more to make North Carolina public health conscious and to minister to its public health needs than any man in the history of the state. He pioneered more public health services than any other man I know, not only in North Carolina but in the nation. Both personally and professionally he had few peers, if any, and no superiors anywhere. He was constantly an uphill fighter against ignorance, misinforma-tion, indifference and short-sighted selfish interest. The two greatest groups of his beneficiaries were underprivileged mothers and children, in whose behalf he worked unceasingly and for whose relief he was instrumental in securing millions of dollars in public funds, which he administered where they would do the most good for the greatest number of people ... In generations to come, the descendants of those he helped will rise up and call him blessed. Ordinarily we are inclined to discount estimates made by professional, busi-ness or governmental associates who know what they are expected to say, but Dr. Norton is as objective as would be any good reporter who has for years seen Dr. Cooper in action. If we were called upon to name his greatest characteristic, we'd make it courage. He was himself frail, with a deafness which kept him from being chosen as chief of the health service January, 1951 The Health Bulletin more than once; but this may have been at times of assistance to him in his work. Certainly he refused to listen to coimsel of the faint of heart; there was no contact between him and those who feared the political effect of any move-ment for bettering health conditions. But if he were resolute, none could question his willingness to work in har-ness. His fellow workers all down the years have sworn by him, and in his entire public lifetime, which was one a few years shorter than the lifetime of the DaUy News, there has never to cm' knowledge been offered a printed word of disparagement of Dr. Cooper by a responsible citizen. Even when there was objection by doctors of medicine to some his ad-vanced steps in caring for the health of school children the objectors soon sub-sided and without daring to question the good faith of a really great physl-ciaiL —Greensboro Daily News, Dec. 20, 1950 UNSELFISH SERVICE The death of Dr. George M. Cooper marks the end of a career of a man who served his fellow man, his State and his profession with imselfish de-votion for four decades. It would be difficult to overestimate the value of Dr. Cooper's services. As a young physician in Sampson County he saw the need for carrying advanced medical knowledge to all of the people. In his own practice he was the first physician in this State to use typhoid vaccine in North Carolina. He soon extended his practice to the entire State, joining the then young State Health Department in 1915 and serving as Assistant State Health officer from 1923 until his death yesterday. Dr. Cooper's primary work was in the fields of maternal and child health. No state has made more progress in those important fields in the last 30 years than has North Carolina. And for much of that progress the State is indebted to the tireless labor of this self-effacing man. Dr. Cooper's labors were by no means confined to maternal and child health. Those labors embraced the whole area of public health and he has left his mark in that entire field. North Carolinians are grateful to this pioneer in public health work, who al-ways placed the well being of the many above the good of the few. Raleigh News & Observer WAS A HEALTH PIONEER Dr. George M. Cooper, pioneer public health official and Assistant State Health officer in North Carolina since March 1, 1923, was in a very large mea-sure responsible for the fact that the North Carolina Health Department stood among the first in this Nation. Dr. Cooper was a native of Sampson County. He became interested in public health work and might well be credited with being first to realize the need for making possible hospital and medical facilities for the rank and file of the people of this State. Dr. Cooper was said to be the first physician in North Carolina to use ty-phoid fever vaccine. Dr. Roy Norton, State Health Officer, paid deserved tri-bute to Dr. Cooper, who was not only his assistant but assistant to his prede-cessors and often served as Acting Health Officer. Dr. Norton said of him that he was North Carolina's "greatest public health official of all time." Only because of his affiiction with total deafness and his self sacrificing 8 The Health Bulletin January, 1951 modesty kept George Cooper from be-ing not the assistant but the State Health Officer for the past 25 or more years. The Free Press is glad to add a tri-bute to his memory. He served long after the usual retirement age, being 74 when he died Monday in Raleigh. In the days when county health depart-ments were few and far between in North Carolina and the progressive coxmty of Lenoir became the second county in the State to provide full time service, Dr. Cooper rendered much help in getting things started. He was an honor to his profession, a Christian gentleman and his good work will be felt by generations yet unborn. —Kinston (N. C.) Daily Free Press DR. GEORGE M. COOPER Funeral services for Dr. George Marion Cooper, assistant State health officer since March, 1923, will be con-ducted Tuesday morning at 11 o'clock from the First Presbjrterian Church here. Dr. Cooper, 74, died at Rex Hospi-tal early yesterday morning after more than a week of critical illness with a heart ailment. Dr. J. A. Christian, pas-tor of the First Presbs^terian Church, and Dr. H. P. Powell of Edenton Street Methodist Chiu-ch will officiate at the rites. Afterward, the body will be taken to the Royall Funeral Home in Clinton, where it will lie in state from 12:45 to 1:45 p. m. Burial will follow in the Clinton Cemetery. The body will remain at Pennington-Smith Funeral Home here until just prior to the 11 a. m. rites. Pallbearers will be Drs. A. C. Bulla, John H. Hamilton, Roy Norton and Thomas Worth, all of Raleigh; Dr. Street Brewer of Clinton; and C. B. Taylor, Fred Harding and Jeff D. John-son, Jr., all of Raleigh. A public health pioneer at both the State and national levels, he had been with the State Health Department for 35 continuovis years. Earlier he had been a general practitioner in his native Sampson County, where he was the first Tar Heel physician to use tjTDhoid vaccine. Sur-vivors include three children. Dr. George M. Cooper, Jr., of Raleigh, John Phil Cooper of Winston-Salem, and Mrs. A. Sam Krebs of Cinciimati, Ohio; one brother, Thomas Cooper of Petersburg, Va.; a sister Mrs. Bard Fitzgerald of Gretna, Va.; and three grandchildren. —Raleigh News and Observer, Dec. 19, 1950 BIOGRAPHICAL SKETCH OF GEORGE MARION COOPER, M.D., LL.D. By William H. Richardson. State Board of Health, Raleigh, N. C. Born in Clinton, North Carolina, April 24, 1876. Educated in public and private schools of Sampson County. Taught school in public and high schools of Sampson County 1897 to 1901. Graduated in medicine at the Univer-sity College of Medicine in Virginia at the end of foiir years' attendance, 1905. licensed to practice medicine in North Carolina in Greensboro 1905. Located at once in Clinton, forming a partnership with Dr. Frank H. Holmes. This part-nership continued active for about eight years, both physicians doing general practice with a great deal of surgery, i obstetrics and gynecology. Soon after beginning practice. Dr. ; Cooper became interested in some ' January, 1951 The Health Bulletin 9 method of controlling the ravages of typhoid fever and the terribly high death rate from colitis and similar dis-eases among infants, and in helping to coimtermand the death warrant which in those days hiing over a patient as soon as a diagnosis of tuberculosis was made, by joining the movement for early diagnosis and rational treatment. Dr. Holmes died of tuberculosis eighteen months after the partnership was dis-continued. Then Dr. Cooper quit private practice to devote his full time to pre-ventive medicine and public health work. As part time Coimty Physician of Sampson County from 1909 to 1913, with the aid of the Mayor and Town Board, Dr. Cooper cleaned up the town of Clinton and used the first typhoid vaccine used by any physician in North Carolina as an experiment in mass con-trol and prevention of typhoid fever by vaccination of the civil population. For twenty-one months following this work in 1911 and 1912, there was not a case of typhoid fever in that town for the first time in its history. October 1, 1913 he became a full time health of&cer of Sampson County, being about the fifth such local health ofiBcer in North Carolina. During 1914, he con-ducted with the aid of the International Health Board two experiments in com-munity sanitation, one at Salemburg and the other at Ingold. Notable and lasting results were achieved in both, which afforded guidance for subsequent work elsewhere. 1 He was President of the Sampson County Medical Society in 1910, and President of the North Carolina Public Health Association in 1913 and 1914. He was appointed head of the Depart-ment of Rural Sanitation and a mem-ber of the executive staff of the North ; Carolina State Board of Health and moved to Raleigh and assumed these duties May 1, 1915. In 1917, he was made head of the school health work for the State Board with the title of State Medical Inspector of Schools. In that position he plarmed and put into operation in 1918 the J system of dental work for all State public school children and engaged and supervised the first dentists for school health work. That year he was made an honorary member of the State Den-tal Society, an honor continued to this day and valued highly. Under the sys-tem, since gradually expanded, more than three million school children have received free treatment, to make no mention of the most important aspect of the work, education. In 1919, he de-vised and put into effect the system of club operation for the removal of diseased tonsils and adenoids of school children, and supervised these clinics for most of the time until 1931. Opera-tions were performed on 23,211 children living in every school district in 86 of the State's 100 counties, with the lowest mortality record in the history of such work in the United States. The educa-tional effect of these two movements for better health for all children has been incalculable. On March 1, 1923, he was appointed Assistant State Health OfiBcer and Edi-tor of the Health Bulletin continuing as Editor until 1942. From September 1, 1923, to September 1, 1924, during the year's leave given Dr. W. S. Rankin, State Health OfiBcer, for work in New York, Dr. Cooper again became Acting State Health OfiBcer. Upon the return of Dr. Rankin September 1, 1924, he was continued as Assistant State Health OfiBcer, Director of Health Education, until the resignation of Dr. Rankin May 30, 1925, when he was again made Acting State Health OfiBcer and served in this capacity until the assumption of ofiBce by Dr. C. O'H. Laughinghouse October 1, 1926. During Dr. Laughing-house's term of ofBce until his death August 26, 1930, Dr. Cooper was Director of Health Education. Upon election of Dr. J. M. Parrott as State Health OfiBcer on July 1, 1931, he became Director of the Division of Preventive Medicine in the reorganized State Board of Health. This Division comprised School Health Work, Mater-nal and Child Health Services, Health Education, editorial work. etc. This work continued until the death of Dr. Parrott, November 7, 1934. He was Act- 10 The Health Bulletin January, 1951 ing State Health OfBcer during the in-terval between Dr. Parrott's death and the beginning of Dr. Carl V. Reynolds' administration as Health Officer. In 1934 Doctor Cooper was unani-mously elected President of the Raleigh Academy of Medicine. Upon assump-tion of duties as State Health Officer by Dr. C. V. Reynolds, November 10, 1934, following the death of Dr. Par-rott. Dr. Cooper was elected Assistant State Health Officer and reelected foiir time since, his present term to expire July 1, 1951. His other duties were the same as during the Parrott administra-tion, and in addition as Director of Maternal and Child Health Services for the United States Children's Bureau, he has had the responsibility of ad-ministering the Emergency Maternity and Infant Care work for service wives. During the war period, approximately 44,600 maternity and infant cases were aided to the extent of having their doctor and hospital bills paid. In 1941, Dr. Cooper was elected Presi-dent of the North Carolina Conference for Social Service. In 1942, Dr. Cooper was the recipient of one of the highest honors that can come to a citizen of North Carolina when the University of North Carolina conferred upon him the honorary de-gree of Doctor of Laws in recognition of his work in Health Education. In conferring the degree, President Frank P. Graham read the following citation: "GEORGE MARION COOPER, of Sampson County, nationally distin-guished as a public health officer, quiet and unassuming but relentlessly effec-tive, he has as state health officer serv-ed for a longer period and in more fields than any other person. He has been a leader in practical programs for the medical care of the poor and has work-ed courageously to lift North Carolina from the disgrace of its high birth mor-tality of children and mothers. His work, pioneering in America, both for the im-provement of the health of school child-ren through free dental and tonsil clinics, and for the improvement of the health of mothers and the birth of children, has become and will continue to be an example to this and other na-tions and a benefaction to this and succeeding generations." The honor which the Ladies of the State Auxiliary conferred upon him by naming the Bed in the Eastern North Carolina Tuberculosis Sanatorium at Wilson for him is highly prized and will be gratefully cherished by his children and many friends always. Dr. George M. Cooper, head of the Division of Preventive Medicine, North Carolina Health Department, honored with a 1949 Lasker Award of the Plan-ned Parenthood Federation of America for outstanding services in maternal and child health and for his efforts in making his State the first in the Union to include birth control in its public health services. On April 24, 1950, he celebrated his 74th birthday probably by putting in a hard day's work and on May 1, he ob-served the completion of thirty-five years' continuous work on the staff of the State Board of Health. The above is just a brief part of the record, and does not describe the in-tensity with which he had put himself, mentally and physically, into many years of efforts to improve the health of the citizens of North Carolina, and the many lives he has been instru-mental in saving, particularly mothers and babies. As the shadows lengthened rapidly toward the west for him, his one regret was that he had not been able to accomplish more for the plain people of North Carolina. January, 1951 The Health Bulletin 11 DR. GEORGE M. COOPER — AN APPRECIATION Earnest A. Branch, D.D.S., Director of Oral Hygiene Division North Carolina State Board of Health In the death of Dr. George M. Cooper on December 18, 1950, North Carolina dentistry lost one of its best friends. It was Dr. Cooper, a physician directing the Bureau of Medical Inspection of Schools of the North Carolina State Board of Health, who conceived and promoted the idea of including dentis-try in the State's Public Health Pro-gram. This was in 1918. Appearing on the program of the North Carolina Dental Society during their meeting in the old Oceanic Hotel at Wrightsville Beach, Dr. Cooper outlined a proposed plan of dental health education. This plan pro-vided for employing full time dentists on the staff of the State Board of Health and for sending these dentists into the schools of the State to teach Mouth Health and to make dental cor-rections for the underprivileged child-ren. From the beginning the objective was health education. The proposal came from an under-standing heart and mind. Dr. Cooper knew from personal experience the suf-fering caused from lack of dental at-tention in childhood. He knew from his experience as a physician and a public health worker the great need for dental health education and for dental serv-ice among our children. Dr. Cooper's presentation before the Dental Society struck a responsive chord, and it was Dr. J. Martin Fleming of Raleigh who made the motion that the North Carolina Dental Society go on record as heartily endorsing the plan and that the Society pledge Dr. Cooper their loyal support. This was done, and North Carolina became the first State to put dentistry in its Public Health Program. Dr. Cooper, assisted by members of the dental profession, went before the State Legislature and secured funds with which to begin operations. Several young dentists were employed, and, from that day to this, the program has been functioning. Because of the vision and work of this public health pioneer thousands and thousands of children have receiv-ed their first dental service, thousands and thousands and thousands of teeth have been saved. North Carolinians have become more and more Mouth Health conscious, and dentistry's health services are more widely recognized and appreciated. Dr. George M. Cooper was truly a great benefactor of the children and of the dental profession of North Carolina. January, 1951 GEORGE MARION COOPER, M.D., 1876-1950 By Waltfb J. Hughes, M.D. Bennett College, Greensboro, North Carolina John Milton in his sonnet "On His Blindness" said, "They also serve who only stand and wait." Milton was blind; Cooper had defective hearing. George Marion Cooper did not serve by stand-ing and waiting, but projected his per-sonality, with arduous activity, into all the significant social movements of his time. He brought to the field of public health and preventive medicine the force of his intellect, his creative ability, and great imagination. His achieve-ments were epical. He was an able public health statesman, a courageous and fearless spokesman in all things that mitigated against the health and 12 The Health Bulletin January, 1951 welfare of the people of this common-wealth. His administrative ability has been most constructive in the reduction of maternal and infant mortality, in school health services, and in the ad-vancement of preventive medicine in general. During his entire tenure as a health officer, he indicated to all the people the democratic way of living. He was impartial in the relationship with all of his subordinates and believed in equality of opportunity in order that all the people might share in being lifted up to a higher standard of usefulness and healthful living. His coimsel was sought by many and his advice was full of wisdom and as soothing as the bene-diction that follows after prayer. For all of these things the people of North Carolina, and the generations yet to come, owe him a lasting debt of grati-tude. TO THE EDITOR To the Editor:—Somehow I passed over in the news the death of Dr. G. M. Cooper, and am indebted for the in-formation to the brief eulogies by Nell Battle Lewis and C. A. Upchurch, Jr., in the News and Observer. I wish to add a personal tribute to him as not only an able and zealous crusader for public health, but especially as a warm-heart-ed, friendly human. I became acquaint-ed with him years ago through an oc-casional article I offered to the State Health Bulletin, of which he was so long the able editor. As a friend I pay tribute to two rare characteristics which I have seldom seen equaled in another. Few have such a capacity for warm, generous friend-ship; few such a cheerful and delightful a mastery of a personal handicap. His deafness he simply accepted and turned into a pleasing virtue. Cheerfully and gracefully and unobtrusively he seated you in front of him, turned the receiver of his hearing apparatus toward you, and talked delightfully without a trace of embarrassment or restraint. It was the zeal of one in love with life, love for his job, and love for his friends and co-laborers. It was the mark of a healthy mind and of a full-grown personality. Few have been so generous to recogn-ize and heartily to praise any worth or ability seen in another. Delightfully un-conscious of his own talents and achievements, he was always alert and eager to discover and praise any talent or virtue or accomplishment seen in another. Perhaps this is the highest at-tainment of a healthy mind and of im-alloyed greatness. Face to face, by phone, or through the mail, and with the heartiness of a father to a son, he passed on to the writer of an article he used in the Health Bulletin any favor-able reaction that came to him as editor. I loved and admired him as few other friends of a lifetime, and I fear I "shall not look upon his like again." —S. L. Morgan, Sr. Wake Forest GEORGE MARION COOPER, M.D. By The Editor In the passing of George Marion Cooper thousands upon thousands of people felt a deep sense of personal loss. It is impossible to write about him without emotion. For more than thirty-seven years he had been a wholetime public health physician. Even before he became health officer in his own Samp-son County he had, as a practitioner, seen the dire need of his patients and had been doing much in the field of preventive medicine. With this back- January, 1951 The Health Bulletin 13 ground Dr. Cooper felt the call to de-vote his life to public health just as genuinely as any minister of religion ever felt the call to preach the Gospel of Jesus Christ. To Dr. Cooper the de-sire to save human beings from disease and the prolongation of their lives was a compelling force. To this cause he dedicated his life. When the history of public health in North Carolina is written it will be es-sentially a biography of George Marion Cooper. Public health was in its infancy when he entered the specialty. During the long period of service with the State Board of Health he witnessed much growth and expansion. Early successes in the effort to reduce the prevalence of infectious diseases resulted in a grow-ing appreciation of public health, in-creases in appropriated fimds, addi-tional workers were recruited, more problems were attacked and new pro-grams developed. In fair weather and foul—his was a stablizing and whole-some force. In most successful endeav-ors he was a guiding and sustaining in-fluence. When mistakes were made and things went wrong it was frequently be-cause his advice was not sought or was ignored. Although North Carolina has contributed many illustrious names to the Honor Roll of PubUc Health, Dr. Cooper's long career in North Carolina caused many throughout the nation to consider him as "Mr. Public Health In North Carolina." There will probably be some disagree-ment in selecting Dr. Cooper's outstand-ing qualifications. To those who read history his ability to make long-range plans would probably be placed first. It would require much research work to list all of the programs which were started by him. Three of his early cam-paigns demonstrate the range of his planning. Take the tonsil-adenoid clinic for instance, the initial objective was, of course, Ito cure the trouble caused by dis-eased tonsils and adenoids, but the long-range effect was to educate the people as to the value of competent adequately trained medical specialists. Most of the older. Eye, Ear, Nose and Throat physi-cians in the State appreciate the firm foimdations of public confidence built by Dr. Cooper's early clinics. The Dental Program, started in 1918 while Dr. Cooper was directing the School Health work, resulted in Dr. Cooper's election as an honorary member of the State Dental Society, and laid the foundation for the formation of the Division of Oral Hygiene in 1931. The Orthopedic Clinics organized by him have smooth-ed the way for thousands of crippled children for years past and will offer hope for the crippled children of the future. It is no wonder that orthopedic surgeons were among the first to sug-gest a suitable memorial to Dr. Cooper. As Editor of the Health Bulletin for nineteen years, he established the for-mat which has become recognized as a symbol of North Carolina's Health Pro-gram. While other State Boards of Health have considered it advisable to streamline their publications or to make them into picture magazines, the Health Bulletin has remained, and with the help of a kind Providence will remain, a plain little publication with a simple message—told in plain straight-forward words and go to the 60,000 homes, offices and libraries of the State and Nation each month. There is much in Dr. Cooper's life and record to remind one of the Apostle Paul. Dr. Cooper's thorn in the flesh was deafness—it affected his life greatly —it deprived him of some honors that might have been bestowed upon him. He had a most remarkable memory, — probably part of this intellectual attain-ment was due to inherent ability. It would seem, however, to those who knew him intimately that a considerable de-gree of his most accurate memory was due to his defective hearing. He con-verted a defect into an asset. Dr. Cooper had courage, the courage to flght for that which he believed to be right—the courage to fight for those who could not defend themselves, the courage to fight those in high places who disregarded or were unmindful of the rights of all to a healthy existence. Dr. Cooper gave pub-lic health a sound doctrine—Like the Apostle Paul—he fought a good fight, finished his coxirse,, and he kept the 14 The Health Bulletin January, 1951 Faith. The torch lighted by Thomas Fanning Wood passed on to Richard H. Lewis, to W. S. Rankin and to George M. Cooper still burns. Those who now receive the torch may not hold it as high or as steadily but they are solemn-ly dedicated to hold it tight and to en-deavor to advance it without faltering. Some of Dr. Cooper's own editorials in the Health Bulletin give a clear pic-tiure of what he considered the Health Bulletin should be — NOTES AND COMMENT January, 1939—"With this issue the Health Bulletin enters it fifty-fourth year, the present number being Number 1 of Volume 54. It has thus completed fifty-three years of its monthly visits to the citizens of the State of North Caro-lina who are interested enough to write and ask that it be sent to them. This issue goes into seventy-six coun-ties with organized full-time health de-partment service, either on a county imit or a district basis, and in some in-stances with a city health department at the covmty-seat and a county health department fvmctioning for the county. The reader may compare the situation in this State now with reference to pub-lic health service with this month fifty-four years ago when Dr. Thomas Fan-ning Wood, the first State Health Offic-er, issued the first number. At that time the total appropriation for the State Board of Health work was $2,000 an-nualy. Dr. Wood, of course, worked on a part-time basis and a part-time clerk in his office wrote out the script in long-hand for the first publication. Today in these seventy-six counties, there are more than five hundred full-time work-ers, including health officers, nurses, clerical help, sanitary inspectors and engineers, etc. This is exclusive of the State Board of Health oragnization and also exclusive of the many full-time employees of city water departments such as chemists and engineers. It is the conviction of this writer that no money that the State and the localities have ever spent has resulted in more benefit to the citizens than that of the health workers. Many of these workers are un-known to the general public, their names seldom occur in the State papers, they are not given honorary degrees by the State's colleges, they are seldom ever any of them elected to office of any kind. Many of them receive daily com-plaints from citizens about trivial mat-ters. Most of them take such patiently and try to explain the purpose of their work and the protection that it affords the people. The Health Bulletin as a monthly reminder throughout all these more than fifty years has served to keep before the people of the State many of the practical requirements of public health practice. All of the con-tributors and the editors who have managed the affairs of the Health Bul-letin and who have tried to get it out month by month throughout the years have always had uppermost in their minds the hope that they would be pro-viding information that might enable people to know how to protect them-selves from preventable diseases and untimely deaths. About 46,000 numbers go out each month. As was pointed out some time ago, the little publication goes each month to people living at nearly 1,400 out of the 1,500 post offices in the State, it goes into every county and to some readers on almost every rural delivery route in the State. The Editor is frequently encouraged in many imexpected ways. For example, sometime ago on a particularly blue Monday morning a card requesting that some special Uterature be sent to two individuals of a certain county was re-ceived. The card was dated at the par-ticular town mentioned simply "Simday night." It was sent in from a R. F. D. route and started off by saying: "Dear Editor, I hasten to assure you that your Health Bulletin is profitably read by many families who never write to say so." Then went on to add the names whom they wished to receive the Health Bulletin in the future. It is pleasant to think that the idea expressed by the writer that the publi-cation may be profitably read by fami-lies who never write to say so is a fact. Anyhow, it is hoped that that is a fact. An effort is always made in every Issue to January, 1951 The Health Bulletin 15 try to publish at least one article carrying information which would be helpful to any reader. That idea has been the key effort running through every issue of the publication for many years. It is pleasant to know that there are readers comprising hundreds of young people who have set up housekeeping and who are now rearing families of their own whose parents received the Health Bul-letin through the years and during which time the young folks became in-terested in the material published. In the beginning of this new year, it seems to many people that there are more problems confronting the world than at any time since the close of the Dark Ages. The complexities of modern life and the strain of living today puts greater stress on the nervous system of the average individual than probably ever before in the history of the world. It Is more necessary today to take thought of the physical, mental and moral health of the individual and of the public than ever before. On the other hand, more protection against pestilential diseases is afforded the peo-ple of the world today than ever before. In the past, great plagues such as yellow fever, bubonic plague, smallpox and other epidemic diseases have decimated the population of the world. It varies in the opinion of some historians to the extent of as much as 50 per cent of the population of the world at one time. With the exception of influenza, toward the control of which little progress has been made, the great cities and thickly populated sections of the world are in little danger. All of this is due directly to the protection afforded by the scient-ists and active workers in the public health field. In the year that the Health Bulletin was first published, it was the common rule in North Carolina for every family to have typhoid fever among some of its members before the children of the family reached maturity, and it has been estimated that at least one out of four members of the average family died of the disease before all the other children reached matiu-ity. The aver-age family lost a large per cent of the children born as a result of the diar-rheal diseases of childhood before reaching the end of the first year of life. There is a long way to go in the field of prevention of disease before the State reaches the position it ought to occupy as one of the low mortality States, in the matter of infant deaths and deaths from such diseases as diph-theria. Diphtheria can and should be completely prevented, but in the face of that fact the State has had a higher death rate from diphtheria and a high-er case rate during the last two or three years than most of the other States. In the field of total infant deaths, it has had a little better record, but not much. The discouraging feature of the past year's work has been that infant deaths have not continued the downward trend started the year before, but apparently a larger number have occurred than occurred in 1937, although complete and accurate data are not yet available. It is with confidence that the faces of public health workers in this State are set toward the future, and it is hoped that the new year will result in greater progress in public health work than ever before in the history of the organization." NOTES AND COMMENT June, 1939—"On the front cover this month, we are publishing a picture of the old Dr. Thomas Fanning Wood residence, 201 Chestnut Street, Wilm-ington, North Carolina, where the State Board of Health oflBce was first set up and operated for many years, and where the first issue of the Health Bulletin was published. That issue was April, 1886, 53 years ago. This picture was in-tended for the April issue of the Health Bulletin as an anniversary number, but illness of the editor prevented its ap-pearing at that time. As stated once or twice before in these columns, the Health Bulletin was founded by Dr. Wood while Secretary of the State Board of Health and issued regularly month by month from the OflBce of the Board of Health which was 16 The Health Bulletin January, 1951 his private office in Wilmington. The publication continued regularly until his death in August, 1892. Not long ago, the editor had the privi-lege of visiting in the home where Dr. Wood's two daughters, Misses Jane and Margaret Wood still live. They showed the editor the very room from which the Bulletin was issued through the years, from April, 1886 until his death in August, 1892. They informed the edi-tor that Dr. Wood had associated with him a young physician at that time by the name of Dr. Robert Jewett who as-sisted him in doing some of the writing and the routine work of the office. They said that Dr. Jewett was still living in retirement at his home on Greenville Sound in New Hanover Coiinty. On May 6, the Associated Press announced from Wilmington that Dr. Jewett had died that morning at the age of 79. As stated above, the Health Bvilletin was founded by Dr. Wood and his ad-visers among the membership of the State Board of Health. With just a few alterations, the size and general ap-pearance of the publication is the same today as it was the first issue. It is slightly larger and about twenty years ago, the present management of the Health Bulletin made some improve-ments in the title page and In page 3, which has been carried as changed ever since. Dr. Wood was made Secretary and the first State Health Officer following the creation of the State Board of Health by the Legislatvure in 1877. Dr. Wood was at that time practicing medi-cine in Wilmington. He was coming to be a botanist of national reputation which he carried on as a hobby. He had also founded and conducted for several years up to that time the North Caro-lina Medical Journal, now known as Southern Medicine and Surgery and published in Charlotte. Sometime after Dr. Wood's death. Dr. Jewett obtained control of the North Carolina Medical Journal and owned and published it for some foiu" or five years, when it was sold to Dr. Dickson Register, a native of Duplin County who was practicing medicine in Charlotte and coming to be at that time a widely known physician. At Dr. Wood's death, however, Dr. R. H. Lewis of Raleigh succeeded him as Secretary and State Health Officer and immediately moved the office of the I State Board of Health from Wilmington. to Raleigh. The Bulletin has been issued monthly from Raleigh ever since. Dr. Wood and Dr. Lewis were both, of course, part time State Health Officers. The two of them combined served for more than thirty years in the office. The first announcement of the pub-lication of the Health Bulletin was made at the Conjoint Session of the North Carolina State Board of Health and the North Carolina State Medical Society at New Bern on May 20, 1886. Dr. J. W. Jones of Tarboro was presi-dent of the North Carolina State Board of Health and in his annual report t» the Conjoint Session made the official announcement of the founding of the Health Btilletin in the following langu-age quoted from the transactions of the North Carolina State Medical Society for that year. The record of the Health Bulletin for the following fifty years must accord to Dr. Jones a place as a major prophet. But with what sacri-fice in time and labor only a few men know! Dr. Jones: "Gentlemen of the Medical Society and the State Board of Health: Prom time to time and little by little, we have gotten the ports of the North Carolina Board of Health together. We occupy it. It is in motion .... "The North Carolina Board of Health, organized and equipped in all it depart-ments (a part time State Health Officer, a part time stenographer, and a total annual appropriation of $2,000!—Edi-tor), with a monthly Bulletin of Health, through which we may communicate, correspond, and instruct, unites in Con-joint Session with the North Carolina Medical Society, to exchange views and purpose plans that shall best advance our common work of making our people healthier, happier, wealthier and wiser. MEDICAL LIBRARY U. OF N, C . CHAPEL HILL. N. C. TIT^ I TKis Bulletin will be sent free to dni| citizen of fKe 5fai-e upon requesi I Published monthly at the office of the Secretary of the Board, Raleigh, N. C. Entered as second-class matter at Postoffice at Raleigh, N. C. under Act of August 24, 1912 Vol. 66 FEBRUARY, 1951 No. 2 ^gSgSi Lake at Airlie Azalea Gardens, Wilmington, North Carolina MEMBERS OF THE NORTH CAROLINA STATE BOARD OF HEALTH G. G. DncoN, M.D., President Ayden Hubert B. Haywood, M.D., Vice-President Raleigh H. Lee Large, M.D Rocky Mount John LaBruce Ward, M.D Asheville Jasper C. Jackson, Ph.G Lumberton Mrs. James B. Hunt Lucama, Rt. 1 John R. Bender, M.D Winston-Salem Ben J. Lawrence, M.D Raleigh A. C. Current, D.D.S Gastonia EXECUTIVE STAFF J. W. R. Norton, M.D., Secretary and State Health Officer John H. Hamilton, M.D., Assistant State Health Officer and Director State Labora-torj^ of Hygiene C. C. Applewhite, M.D., Director Local Health Division Ernest A. Branch, D.D.S. , Director of Oral Hygiene Division A. H. Elliot, M.D., Director Personal Health Division J. M. Jarrett, B.S., Director Sanitary Engineering Division C. P. Stevick, M.D.. M.P.H., Director Epidemiology Division FREE HEALTH LITERATURE The State Board of Health publishes monthly The Health Bulletin, which will be sent free to any citizen requesting it. The Board also has available for distribu-tion without charge special literature on the following subjects. Ask for any in which you may be interested. Adenoids and Tonsils Hookworm Disease Typhoid Fever Appendicitis Infantile Paralysis Typhus Fever Cancer Influenza Venereal Diseases Constipation Malaria Residential Sewage Diabetes Measles Disposal Plants Diphtheria Pellagra Sanitary Privies Don't Spit Placards Scarlet Fever Water Supplies Flies Teeth Whooping Cough Tuberculosis Epilepsy, Feeble-mindedness, Mental Health and Habit Training Rehabilitation of Psychiatric Patients The National Mental Health Act. SPECIAL LITERATURE ON MATERNITY AND INFANCY The following special literature on the subjects listed below will be sent free to any citizen of the State on request to the State Board of Health, Raleigh, N. C. Prenatal Care. First Four Months. Prenatal Letters (series of nine Five and Six Months. monthly letters). Seven and Eight Months. The Expectant Mother. Nine Months to One Year. Infant Care. One to Two Years. The Prevention of Infantile Two to Six Years. Diarrhea. Instructions for North Carolina Breast Feeding. Midwives. Table of Heights and Weights. Your Child From One to Six Baby's Daily Schedule. Your Child From Six to Twelve Guiding the Adolescent CONTENTS Page Aqua Pura ^ Today's Community Concept Of School Health 5 "These Little Ones" 8 Notes and Comment 11 milPUBLISAED BYTAE N^A CAROLINA STATE B^ARD-^AEALTAIB VoL 66 FEBRUARY, 1951 No. 2 J. W. R. NORTON, M.D., M.P.H., State Health Officer JOHN H. HAMILTON, M.D., Editor AQUA PURA By William H. Richardson Raleigh, North Carolina The progressive action by which the citizens of Raleigh recently voted funds for the erection of a sewage disposal plant and the improvement of the pub-lic water supply, has focused attention upon water in its various uses and its association with Public Health. Water is one of the most important, and sometimes neglected, substances used in helping to sustain life. When you woke up this morning, you brushed your teeth, washed your face and hands, and, perhaps, drank copiously of re-freshing cold water from your faucet. The purposes for which water is used are very numerous. First, we consume it as something necessary to our health-ful existence. We use it for generating electricity for power and light, for bear- 1 ing commerce, and for various other purposes. We not only use water to cleanse the body, but the Christian Church uses it, sympolically, to cleanse the soul. Water plays a prominent part [ in certain purification rites in other re- 1 ligions. No greater calamity can befall a city or community than a water shortage or famine. We are giving much attention now to the preservation, or reconstruc-tion, of our drinking water supplies, in «case of atomic attack. We are also de-vising ways and means of protecting the population against mass slaughter, through germ warfare upon our water supplies. There is pending in the pre-sent Legislature a bill designed to cor-rect stream pollution. So much by way of introduction. When you drink a glass of water, do you think about the processes through which it has passed on its way from the source, out yonder somewhere, to your stomach? Have you ever visited your local water shed, or inspected the processes through which the water is purified in order that you may be pro-tected against water-borne diseases. And have you ever considered the years of scientific training required of the waterworks operator, and the important responsibility you have placed upon him to make sure you are getting a safe water supply? Just what does happen between source arid stomach? The State Board of Health maintains a division called the Sanitary Engineer-ing Division, which is vitally interested in your water supply, and through which services are performed about which you may know little or nothing. For the answer to the question, "What happens to drinking water, from source to stomach?" let us consult one of those in the Division above referred to who is concerned with that form of public ser-vice which guarantees you a pure water supply and consequent protection again-st disease. Two Primary Sources There are two primary sources from which our public water supplies must The Health Bulletin February, 1951 be derived. These are surface sources, such as lakes and streams, and under-ground sources that are brought to the surface through man-made wells or natural springs. Most public supplies are, because of the large volume requir-ed to supply communities, taken from rivers and creeks, which often are im-pounded to form large storage lakes — in fact, all of the major ones come from surface sources. To the average individual, it may ap-pear quite difficult to pump water from a river or creek and so treat it that it will be safe and palatable for use by human beings. Frankly, it is not a simple task; however, developments in the science of water treatment, brought about by extensive study and research on the part of sanitary engineers, scien-tists and the medical profession, have resulted in the perfection of processes, equipment, and knowledge of chemistry and bacteriology which make it possible to satisfactorily purify surface water for hvunan consumption. It is emphasized that a word of cau-tion is proper at this point. Surface streams which are overly-polluted, by domestic sewage or industrial wastes, either cannot be satisfactorily treated or the cost of treatment is prohibitive. In view of this, it is liighly desirable that every water consumer, and polluter alike, put his shoulder to the important and necessary problem of properly maintaining streams used as sources of water supply in North Carolina, in such condition as to permit their present and future use for this purpose. In many instances, the authority for this article points out, surface streams constitute the only adequate sources of public water supplies. The supplies de-rived from underground sources are obtained either from springs or wells. Water from wells and springs ordinarily is clear and satisfactory, without treat-ment. Nevertheless, in some cases, un-derground water contains minerals dis-solved from the water strata which impart either hardness, iron or other materials that make it undesirable for domestic use. In such cases, it must be treated by certain processes well known to the waterworks profession. Harmful Substances Removed The fact that most public water sup-plies are obtained from surface soiu-ces makes it necessary that the water be treated for the removal of substances which cause turbidity, color, or unde-sirable odors and taste. Treatment also must be provided to remove the harmful bacteria, thus pro-viding for your use and well-being a clear, sparkling, safe water. In the course of water purification, the treatment processes usually begin with the storage of water in lakes or reservoirs. Following storage, the water is pumped to modernly-designed and efficiently-operated plants where lime and alum are added and thoroughly mixed with the water, in specially de-signed mixing and coagulating basins. A gelatinous floe is formed in these chambers, which enmeshes the mud, color bodies and many of the bacteria in the water, which, when permitted to settle in the sedimentation basins, leaves the water clear. It is then passed through sand filters to remove any re-maining floe and turbidity, following which chlorine is applied to kill all harmful bacteria which may have sur-vived the previously mentioned treat-ment processes. But, the foregoing does not tell the entire story of the preparation and care that goes into the work of provid-ing a safe and palatable water supply. Even after clarification and disinfec-tion, water, being a luiiversal solvent, must be treated to prevent corrosion of the distribution system, which, if per-mitted, results in "red water" that will stain the lavmdry and the porcelain fixtures of the bathroom and kitchen and will produce unpleasant odors and taste. The above information has been given in an effort to better acquaint the con-suming public with the preciseness to which water works operators must ad-here and to the innumerable scientific details which are involved in producing February, 1951 The Health Bulletin a water supply that is both safe and suitable for your use. The information presented in this discussion, which is designed to empha-size one of the many services Public Health renders, was obtained from Mr. Earle C. Hubbard, Principal Sanitary Engineer, in the Sanitary Engineering Division of the State Board of Health, whose duties involve supervising the de-sign and operation of public water and sewerage systems, and advising muni-cipal and institutional oflBcials and their engineers regarding the type of facili-ties and water works materials needed to provide safe and adequate supplies. Approved Plants Safe In conclusion, Mr. Hubbard stated that water from all approved public supplies in North Carolina may be con-sumed with a feeling cf uerfect safety, because of the long -icUxS and hard work of those public officials whose duty it is to see that water offered for public consumption is safe. So, turn on your spigot and have a drink to the health of those who look after your water sup-ply and do not forget to let them know that their efforts are appreciated. This article is designed to give in-formation on what your State Board of Health is doing to protect you and yovurs against those illnesses which are pre-ventable and the conditions which bring them about. If you should ask your family physician to name the water-borne diseases to which you would be subject without a safe and pure water supply, his answer would include many which now occur only in rare instances, because of the fact that we have made such advances in the science of sanita-tion. The responsibility involved in the protection of your drinking water is only one of many which fall upon the shoulders of the Sanitary Engineering Division. This Division not only super-vises public water supplies as to their sanitation, but also is concerned with environmental sanitation, the inspec-tion of public eating places, milk, bed-ding and shellfish. It also has sections which are concerned with insect and rodent control. Many of the services performed by this Division of the State Board of Health are so routine that they are taken for granted. While the personnel of this Division is non-medi-cal, in the generally accepted term, they work under the direction of the medi-cal mind, even as all other enlisted in the service of Public Health. TODAY'S COMMUNITY CONCEPT OF SCHOOL HEALTH* Davh) Van deb Slice, M.D.,** Coordinator of Health Services Oakland Public Schools Great strides have been made in school health in the relatively short period since 1894, when the first school health program in the United States was established in Boston. In those days public schools were "hotbeds" of con-tagion," and it was not uncommon for school doctors to find children with diphtheria, whooping cough or scarlet fever in the classroom. The position that health occupies in the schools to-day is the result of an evolutionary pro-cess which can be roughly divided into five stages: Stage I was characterized by an ef-fort to detect and exclude those pupils who, because of communicable disease, threatened the welfare of others. In Stage II there was added the re-sponsibility of finding pupils with physi- •Reprinted with permission from Cali-fornia's Health. ••Prior to his appointment by the Oak-land Public Schools in August, 1950, Doctor Van der Slice served for two and one-half years as School Health Consultant for the California State Department of Public Health. This article was prepared during that period. 6 The Health Bulletin February, 1951 cal defects, and of taking steps to secure corrections. Stage III was marked by a growing consciousness that health activities were carried out not only for corrections but for educational values as well. Stage IV was marked by an expansion of Stage III, and included such con-cepts as: (a) all teachers are health teachers, (b) personal health includes physical, mental and emotional health, (c) the health program concerns itself with community as well as personal health, (d) health education is a 24- hour-a-day program—365 days a year, and involves the cooperation of the home and community agencies as well as the schools. Stage V, the present one, is marked by a growing realization on the part of schools, health departments, profession-al groups and community organizations of their interdependence in carrying out the school health program. They re-cognize that each has a contribution to make and that no one of them can do the job alone. Each advanced stage has included the best of the practices and experiences gained from earlier stages. School health programs have steadily increased in breadth of services and complexity of organization. Forty years ago all health responsibility in the school was assumed by the doctor or the nurse, but this is not the case to-day. Today the job is shared with tea-chers, parents, dentists and dental hy-gienists, psychologists, psychiatric so-cial workers and psychiatrists, health educators, counselors, students and others. This has required the setting up of machinery within the school for co-ordinating efforts of various profession-al workers and groups involved in the school health program. This has usually taken the form of a school health com-mittee, a health coordinator, or both. The modern school health program. to be most effective, must also be in proper relationship to oth.^r community programs of public health and child welfare. The idea that tl:i school health program should be an isolated endeavor, operating apart from the rest of the community is being strongly challenged. There is a growing acceptance of the fact that, in general, the school child's health reflects the foundation of his health laid during the preschool years, the health of his family and the ade-quacy of health facilities in the com-munity in which he lives. Parents have the primary responsi-bility for the health of their children. How well the family meets its respon-sibility in relation to providing food, , rest, recreation, and medical and dental services, plus a healthful environment, is a highly important factor in relation to the child's health status. The job of the school health worker is to help motivate the parent to carry out re-sponsibilities of the home and to stim-ulate citizens to provide necessary com-munity facilities. Today's community concept recognizes the advantages of integrating school health services with community health services, of promoting the health of parents, especially mothers during the prenatal period, and of providing con-tinued health supervision during in-fancy, childhood and adulthood. Not only do community health pro-gram activities affect the school child, but the family health status Ls fre-quently influenced through the school health program. For example, a nurse-parent conference or a medical exami-nation at school may reveal a family health problem of greater significance and urgency than the child's health problem alone. Clearly, solution of a family health problem also benefits the child. On every hand there is evidence of the ever-increasing interest and activity in school health work, not only by schools and health departments, but also by parent groups, medical and dental societies and other community agencies. Two years ago the National Congress of Parents and Teachers asked the House of Delegates of the American Medical Association to request state medical societies to appoint committees or arrange for representation in con-ferences in the .several states between medical societies, dental societies, health departments, educational agencies and February, 1951 The Health Bulletin the National Congress of Parents and Teachers, looking toward the improve-ment of health services and health edu-cation for school children. The Amer-ican Medical Association demonstrated its interest by calling two conferences, one in 1947 and the second in 1949, to define the role of the practicing physi-cian in the school health program. FYom these conferences came recom-mendations that every local medical society should appoint a school health committee to study ways in which the physician's time may be used more ef-fectively in the schools. Several local medical societies in California have al-ready appointed school health commit-tees which are cooperating with the schools in the development of the school health program. Another promising development in recent years has been the increase in cooperation between schools and health departments in relation to the school health program. Most states now have formal plans for cooperation between state health departments and state de-partments of education with respect to school health programs. In California the closely related work of the State Departments of Education and Public Health in their responsibilities for the health of the school-age child is co-ordinated through the California State Joint Committee on School Health. On the local level, an increasing num-ber of county and city joint school health councils are being formed in California. Some have been initiated by the schools, others by the local health department. While council representa-tion varies, it usually includes school administrators and teachers, members of the school health staff, health de-partment representatives, parents, re-presentatives of medical and dental societies, voluntary health agencies and other community organizations with a particular interest in child health. The school health council facilitates joint program planning and the formu-lation of policies to guide the school health program. Fullest use of com-munity resources is possible only when there is joint planning and active par-ticipation of many different community groups. Joint planning, with a sharing of re-sponsibilities for different aspects of the program, has become a more and more common practice, particularly in rural areas where neither schools nor health departments have sufficient staff or re-sources to carry out an adequate pro-gram alone. A division of responsibilities and a sharing of personnel between schools and health departments makes possible the fullest utilization of exist-ing facilities and permits the best use of professional skill and time. Almost universally, both schools and health departments are under-staffed and can-not afford to use the time of their per-sonnel for any but the most essential and most productive activities. They caimot afford the luxury of duplicating services. However, there are many communities in which this fine working relationship and this spirit of cooperation, which is so conducive to developing the best type of school health program, do not pre-vail. Although school health policies of a general nature have been formu-lated and approved by many national health and education organizations for at least 10 years, and are now well established, they affect school health practices in all foo few local areas. Joint planning of school health pro-grams would give an opportunity to re-view and discuss these policies in terms of how well they are fitted to local situations and to apply those which are workable. Joint planning opens the way to a critical analysis of the total school health program with a view of deter-mining what the needs are and then deciding how best they can be met re-gardless of what the traditional pat-tern has been. Some of the patterns in use today were established at the turn of the century and do not take into consideration the newer knowledge con-cerning the growth and development and the behavior of children, nor do they recognize improved school health methods and practices, which have de-monstrated their worth. There have been many recent ad- 8 The Health Bulletin February, 1951 varices in school health, such as: (1) the increased participation of the class-room teacher, (2) improved school health records (which more fully utilize the contribution of the teacher, nurse and physician), (3) improved screening devices to select pupils with probable vision defects and hearing losses, (4) greater participation by practicing physicians, (5) fewer but more thorough medical examinations giving priority to referred cases and new entrants, (6) the establishment of otological, cardiac and other diagnostic facilities which provide a more accurate diagnosis of pupil health problems, and (7) estab-lishment of more adequate special edu-cation facilities for children with handi-capping defects. Despite these examples of progress, many of the answers pertaining to the school health program are still un-known. There is a great need for experi-mentation. For example, there are great gaps in our knowledge concerning a proper secondary school health pro-gram. There is a need for trying new methods in an attempt to find out what works and what doesn't work under to-day's conditions. Continual program evaluation is needed in order for us to modify our activities and to make them more successful, retaining things that prove to be effective and dropping those which prove ineffective. #/THESE LITTLE ONES" By William H. Richardson Raleigh, North Carolina The challenge given by the Master, "Isasmuch as ye have done it unto one of the least of these, my brethren, ye have done it unto me," has come down through two thousand years of history as an inspiration to those who would help the weak, especially, little children. North Carolina's Public Health Pro-gram has been characterized by many helpful and worthwhile undertakings; but none of these, perhaps, has been more synonymous with the spirit of the Great Physician than the program de-signed to find, treat and rehabilitate children who, otherwise, might consti-tute a burden on society and go through life with a feeling of futility and a sense of their deformity. The Crippled Children's Section of the State Board of Health is a monu-ment to the untiring efforts of the late Dr. George M. Cooper, under whose direction this program was organized, in April 1, 1936, following the availabili-ty of Federal Social Security funds. Dr. Cooper, in his administration of the program, spent many sleepless hours, taxing his wits as to how the work might be continued. There were times when he was almost, but not quite, dis-couraged. Even though it was necessary, often, to scrape the bottom of the bar-rel for money with which to carry on the program, Dr. Cooper usually found a way. Let us consider, now, the way in which this program for these little ones is conducted. First, the child in need of treatment is located, usually by the Local Public Health nurse, or the family physician. Conditions For Acceptance The list of conditions which are ac-cepted by the Crippled Children's Sec-tion of the State Board of Health may be outlined as follows: Congenital ab- ; normalities, including harelip, cleft palate, dislocation of hip, club feet, missing or extra bones. Birth injuries, also, are included, as well as tubercu-losis of the joint, rickets, poliomyelitis, arthritis, osteomyelitis — which means infection of the bone—, curvature of the spine and burns. If the child is found to be in need of hospitalization, after passing through one of the clinics, and if the parents say Febriuiry, 1951 The Health Bulletin they are unable to pay for the services needed, application is made to the local welfare board, which investigates the case in question. If the child's parents are found to be actually unable to pay, the case is certified and the child is placed in a hospital. If the parents are able to pay all or part of the expenses incurred, an effort is made to work out a satisfactory plan for treatment. It might be well, just here, to consider the number of clinics conducted by local health departments, in cooperation with the State Board of Health and the Department of Vocational Rehabilita-tion. There are, at the present time, twenty-eight clinics, so well distributed that each child is within sixty miles of one of these. Taking part in the pro-gram, besides the local Public Health staffs, are thirty-one physicians. These include orthopedic surgeons, plastic surgeons and pediatricians. A report recently prepared by the Crippled Children's Unit shows that 11,998 exam-inations were done in 1949. There were, at the last count, twenty thousand children on the State register. In requesting a State appropriation of one hundred thousand dollars a year, it was pointed out to the legislative ap-propriations committee that there are no existing State funds to finance sur-gical care of indigent children, with cleft palates, congenital defects, deform-ities from burns, and orthopedic condi-tions in hospitals other than the State Orthopedic Hospital. This hospital, lo-cated at Gastonia, does not have facili-ties for all these conditions and does not have the capacity for all of the in-digent children needing care for prob-lems which it is equipped to handle. There have been over three thousand, five hundred cases of polio in our State during the past four years. This, of course, has increased the necessity for orthopedic treatment. Funds Once Exhausted Funds from all sources were exhaust-ed in 1949 and the work was stopped during the last quarter, except for emergencies. The State Board of Health asked a one hundred thousand dollar annual appropriation by the State in matching Federal funds for the next biennium. It is pointed out that this may mean an additional three hundred thousand dol-lars, annually, from Federal funds. Hence, this would be a sound invest-ment, aside from the humanitarian aspects of the program. No State match-ing funds, conceivably, may mean no State Board of Health Program for Crippled Children. Now that we have considered the mechanics of the program and have pointed out the desirability for adequate funds, let us consider some of the actual work which is done for these little ones, to set their feet in paths of usefulness and to hold before them, as they grow up, incentive enjoyed by their physical-ly fit companions and school mates. Authorization for hospitalization en-titles the child not only to treatment, including both orthopedics and plastic surgery, but to braces, crutches, casts, orthopedic shoes, and other corrective devices. Plastic surgery corrects de-formities from burns, harelips and the like. When the child leaves the hospital, it is subject to a follow-up program, during which systematic visits are made to the home, to see that the orthopedic recommendations are being carried out. From Birth to 21 Most of the clinics are held in local health departments and all persons from birth to twenty-one years of age are eligible. Incidentally, it may be pointed out that 1,253 children who needed treatment in 1949 did not receive it, because of inadequate funds. Of the polio victims, many still are in need of surgery. There is more hu-man interest, both concealed and vis-ible, in the rehabilitation of children than in almost any other humanitarian problem confronting the American peo-ple. When a child is born into this world, it comes not of its own accord, but "of the will of the flesh." It must accept conditions under which it is born, without recourse, and with no remedial measures at its command. Such children often are doomed to lives of hopelessness and their spirits com-pelled to live in bodies that are distorted 10 The Health Bulletin February, 1951 and deformed, which could be made normal, in a vast majority of instances, through modern orthopedic and plastic surgery. The matter of Crippled Children con-stitutes not only a Public Health prob-lem, but a stern public responsibility. We spend many thousands of dollars every year on methods designed to im-prove our crops and our farm animals. All this is necessary, of course, but of how much more value is a baby boy or girl than a baby cow or pig ! Within the memory of those now living in the present generation, bovine tuberculosis has been conquered in cows; through vaccination, hog cholera has been at-tacked, with success. As a result, we have better cows, which mean more money for their owners; we have better hogs, which means more money for meat; we have better peanuts to feed the hogs, because the Government guarantees the price of peanuts. Science Works Wonders We now see fewer deformed children, than in the past, it seems, but that is due to advances in plastic and ortho-pedic surgery; to Federal funds and, in some instances, to contributions from private philanthropic agencies, such as the National Foundation for Infantile Paralysis, and the North Carolina Lea-gue for Crippled Children. If you live in a county where an orthopedic clinic is held, it would pay you to visit the clinic and see just what is being done for the unfortunate child-ren of the State. The program for crippled children has been underway now long enough for some definite results to be evident. Many children who, but for this treat-ment, would never have been able to use their hands and feet, have been trained to become men and women with useful trades, following their physical rehabilitation. Some are shoe makers. some are operators of various machines, while others have learned to be radio repairmen and even watch repairmen. Pictures have been taken of children when treatment began, when their de-formities were very pronounced. Later, pictures of the same children reveal that orthopedic and plastic surgery could and did restore these children almost to a normal appearance. If one should think of a crippled children's clinic as a scene of gloom and despair, this would be an entirely er-roneous conception. When those in need of orthopedic and plastic repair work are taken to a clinic, every effort is made on the part of those in charge to dispel any fear or misgivings on the part of the child. If they are hospital-ized, the surroundings during treatment are made as bright and cheerful as those in any home, insofar as is hu-manly possible. Plenty of Incentive It is no wonder that the State Board of Health is making every effort to se-cure a yearly investment by the State of one hundred thousand dollars, in order to meet the requirement that Federal funds be matched. It is not always easy to secure appropriations, with so many demands being made on the public treasury, but experience in-variably has shown that money invested in building up wrecked lives has paid good dividends. Once the crippled child-ren's work is given adequate funds and the results demonstrated, there is little likelihood that these will be denied in the future. Already, a remarkable re-cord has been made by the Crippled Children's unit and those agencies which cooperate with it. Progress has been difficult, at times, and the way ahead has been uncertain, but surely success must crown the efforts of those who are trying so earnestly to re-build the lives of these little ones. February, 1951 The Health Bulletin 11 NOTES & COMMENT By The Editor DR. ELLIOT—On February 1st Dr. A. H. Elliot joins the staff of the North Carolina State Board of Health as the Director of the Division of Personal Health. Since 1931 Dr. Elliot has been Health Officer for the Consolidated Board of Health for the City of Wil-mington and New Hanover County. He is known throughout the State as a good health officer. His program in New Hanover County was well balanced and included most of the activities which are generally recognized as good public health procedures. Practically all of the activities considered to be a part of the responsibilities of the Division of Personal Health are component parts of Dr. Elliot's program as a County Health Officer. He will, therefore, be familiar with the broad phases of the work which he will confront in his new capacity. In succeeding the late Dr. George M. Cooper as the Director of the Division of Personal Health, has a difficult assignment. However, those of us who know Dr. Elliot have every con-fidence that he will do a creditable job. • * * * TUBERCULOSIS STATISTICS—We are including in this issue of the Bul-letin the vital statistics of tuberculosis which ordinarily would have appeared in the November issue. We hope that our tardiness in publication of this in-formation will not detract from the in-terest which this important information should command. * • * • REPORT ON STUDY OF REGIONAL BLOOD GROUP DISTRIBUTIONS The blood type of 141,774 men and women who voluntarily contributed blood to the American Red Cross from January 1948 through March 1949 is the subject of a report in the Journal of the American Medical Association. The information was gathered from 15 representative cities and their out-lying areas. The regions included : Yakima, Wash.; Rochester, N. Y.: De-troit; Massachusetts (^42.3 degrees lati-tude north); Omaha; Columbus, O.; Washington; St. Louis, Stockton, Calif.; Wichita, Kan.; San Jose, Calif.; Spring-field, Mo.; Charlotte, N. C; Los Angeles and Atlanta. The total percentage of persons fall-ing into each blood type from all 15 regions was as follows: O blood group, 45.55 per cent; A, 40.77 per cent; B, 9.96 per cent; and AB, 3.72 per cent. The O type blood can be used in all transfusions regardless of blood type of the recipient. "In the event of an emergency re-quiring large quantities of blood," the report said in part, "the southern areas now appear to be comparatively favor-able sources of O and the northern areas of B." The results showed, to some extent, that for each degree of latitude pro-ceeding from north to south the O group percentage increased, on the average, .32 per cent. Prom north to south the B group percentage decreased .17 per degree of latitude. No east-west trends were discovered. The report brought out that from re-gion to region the greater the O, A or B percentage, the smaller on the average was the percentage for the remaining groups within the trio, but AB group "tended to be stable." In conclusion the report said that "population changes could be respon-sible for marked changes (in regional location of blood types) within the span of a very few years." Associates of the American Red Cross who made the study were: George W. Hervey, Sc.D.; Dr. Louis K. Diamond and Virginia Watson, M.S., of Washing-ton, D. C. * * • * AMERICAN HEARING SOCIETY 817 14th St., N. W. Washington 5, D. C. Kenfield Memorial Scholarship In 1937 a sum of money was sub-scribed in memory of Miss Coralie N. 12 The Health Bulletin February, 1951 Kenfield of San Francisco, California, a teacher well known throughout the United States for her high ideals and advanced methods in teaching lipread-ing. This money, placed in the Kenfield Memorial Fund, is administered by the American Hearing Society and provides an annual scholarship. The amount of the Kenfield Memorial Scholarship for 1951 is one hundred dollars ($100.00). Applications for the scholarship will be considered from any resident of the United States who desires to teach lip-reading (speechreading) with or with-out other types of hearing and speech therapy, and who can meet the follow-ing requirements: A. Personal Well adjusted individual with a pleasing personality, legible lips, a good speech pattern and no unpleasant mannerisms. B. Education College graduate with a major in education, psychology, and/ or speech. If the applicant is hard of hearing, 30 clock hours of private instruction under an approved teacher of lipreading or 60 clock hours of instruction in public school classes under an approved teacher of lipread-ing are required. The winner of the scholarship may take the Teacher Training Course from any normal training teacher or school or university in the United States offer-ing a covurse acceptable to the Teachers' Committee of the American Hearing Society. The scholarship must be used within one year from the date the award is made. Applicants must be prospective tea-chers of lipreading to the hard of hear-ing. Those already teaching lipreading cannot be considered. Applications must be filed between March 1 and May 1, 1951 with: Miss Rose V. Feilbach Chairman, Teachers' Committee 1157 North Columbus Street Arlington, Virginia PLANS ANNOUl^ICEB FOR RAISING FUNDS FOR MEDICAL SCHOOLS Announcement was made of the formation of the American Medical Education Foundation, a not-for-profit corporation vmder Illinois laws, to raise funds from the medical profession to aid medical schools. The fund, initiated by a contribution of a half-million dollars voted by the Board of Trustees of the American Medical Association in December, has been widely acclaimed as one of the most constructive programs ever imder-taken by the A.M.A. "The medical schools of the United States stand in need of additional financial support if they are to con-tinue to provide the American people with physicians second to none in the quality of their education and training," said Dr. Elmer L. Henderson of Louis-ville, president of the A.M.A. "Since the tremendous advances in the health of the American people in the last 50 years have been due in large measure to the great improvements in medical education during the same peri-od, it is clear that insuring adequate financial support of our medical schools is vital to the present and futvu-e health of the nation." In annoimcing the formation of the foundation, the Jovu*nal of the A.M.A. urged the doctors of the nation to con-tribute promptly and generously. "It is plarmed that the foundation will coordinate its activities closely with other major efforts to raise funds for medical education from voluntary sources which it is hoped will be an-nounced shortly," said the Journal. "Because of rising costs, inflation, fewer large individual benefactions and reduced income from endowments, the medical schools need, without further delay, assistance of the type this fund can give. "It is the desire of the foundation that the first annual disbursement of funds to the medical schools be made this spring. It is clear that if the foun-dation's contribution is to be an effec-tive one, a substantial fund must be February, 1951 The Health Bulletin 13 raised by the medical profession within the next few months." The Journal further pointed out that almost every physician now practicing received his medical education for less than what it cost his medical school. It added that many physicians have discharged this debt to society in full or in part by public and charitable activi-ties and by donations to the schools with which they have been associated, but continued: "The medical profession has tradi-tionally accepted a large measure of re-sponsibility for the training of the con-tinuing flow of young physicians, on which it must depend for recruits and replacements in its efforts to serve humanity. "It is to be expected, therefore, that all physicians regardless of the other contributions they have made to so-ciety, will want to share in the responsi-bility of making the foundation a suc-cess. "The American Medical Association has indicated its belief that the pos-sibilities of securing adequate support for medical education from voluntary sources are far from exhausted." • « • * REPORT AIR TRANSPORTATION OF MOST PATIENTS POSSIBLE A study of the effects of air travel on 14,000 patients moved by the Military Air Transport Service between January and October 1949 shows that almost all patients suitable for transportation by other methods can be transported suc-cessfully by air. Colonel Benjamin A. Strickland, Jr., of the U. S. Air Force Medical Corps, and Dr. James A. Rafferty, Randolph Field, Texas, said in the Journal of the American Medical Association that air transportation of patients proved "so successful" that it has been adopted as the "sole method" of moving patients for the armed forces. This report is valuable to civilians as well as military personnel. "Today," the doctors explained, "much of the available expert specialized medi-cal care is concentrated in medical centers. In many instances patients re-quiring (specialized) care must be transported to such a center. "In general," they continued, "the routes, altitudes, weather conditions and types of aircraft utilized were identical with conditions of commercial airline operations." A total of 16,020 case reports were made on the 14,000 patients studied. It was necessary to make more than one report on some patients if the flight was a particularly long one or if the nursing personnel changed during the course of the flight. One third of the number were litter or stretcher cases. Only seven percent (1,135) of the case reports recorded symptoms of any kind during flight. Most of the symptoms-due to motion, effects of altitude or the disease itself—occurred at cruising alti-tude but they were of a "minor nature." No ill aftereffects were reported. Ninty- seven percent of the time simple treatment relieved the symp-toms. Most frequently the patient was merely asked to lie down. Only 1.1 per cent received medication and that con-sisted of such simple remedies as as-pirin, motion sickness preventives and similar medications. According to the report, extremely few patients were rejected for air evacuation. For example, among a ran-dom sample of 2,796 patients, only five were considered unsuitable for move-ment by air. The doctors added, how-ever: "In the selection of a patient for pos-sible transportation by air, certain im-portant factors must be considered. The effects of air travel on certain diseases and injuries must be viewed critically and each case considered individually. The effects of ascent to altitude, both a reduction in barometric pressure and the corresponding decrease in partial pressure of oxygen in the inspired air, may have profound effect on certain pathological conditions." * * « • A.M.A. SPONSORS TELEVISION DRAMA OF FAMILY DOCTOR A thirty-minute dramatized television show about a typical family doctor will be telecast on WABC-TV, New York, 14 The Health Bulletin February, 1951 at 8:30 (E.S.T.) Monday evening, Jan-uary 22, under the sponsorship of the American Medical Association, Dr. W. W. Bauer, director of the A.M.A. Bureau of Health Education, announced. Walter Hampden will star as "Doctor Webb of Horseshoe Bend." The story takes Dr. Webb, a fictitious but typical family doctor, and the young assistant who will take over his practice, through a typical and eventful doctor's day. Film kinescopes will be made of the program for subsequent use on other television stations. These kinescopes. Dr. Bauer said, will be available to local medical societies on application to the Bureau of Health Education about seven days after the New York telecast. "Dr. Webb of Horseshoe Bend," a Marshall-Hester Production, New York, is directed by Martin Magner. * * K * URGES TRADING AREA PRINCIPLE IN SELECTING WAR SERVICE DOCTORS The trading area principle should be used to determine in what communities physicians can be spared for military service dxiring a major war, says the Journal of the American Medical Asso-ciation. The Journal cites a bulletin of the Bureau of Medical Economic Research of the A.M.A. presenting for the first time the size and population of the 757 medical service areas in the United States. "Few of these boundaries coincide with the boundaries of states, counties and other political areas," the publica-tion says. "From the findings of the bureau one can determine the actual medical service areas served by physi-cians. Further study will reveal what medical coverage actually is available for the population of each area." * « * • URGE MORE EXPENDITURES FOR PREVENTION OF BLINDNESS In 1949 more than $125,000,000 in tax and private funds was spent for care and services to the blind. Money avail-able for research in the blinding eye diseases for the same year was less than $1,000,000. Less than $500,000 was spent for organized prevention services. This striking contrast between the funds used for aid to the blind and those used for the purpose of prevention and research is brought out by Drs. Walter B. Lancaster, Boston, and Franklin M. Foote, New York, in the Journal of the American Medical Asso-ciation. Dr. Lancaster is an ophthalmologist, a specialist in diseases of the eye. Dr. Foote is associated with the National Society for Prevention of Blindness, New York. "We should not reduce activities for those already blind," the doctors point-ed out, "but by increasing what we are doing now to enable persons to keep their sight we can gradually reduce the number of unnecessarily blind." The report estimated that about 22,- 000 people each year have their vision reduced to one tenth of normal vision. Blindness is a major public health problem, the doctors said, not merely because of its incidence but also because the bUnd man or woman lives on for many years often partly or wholly de-pendent on others. Based on information covering 3,905 children in schools and classes for the blind and 46,537 adults receiving aid to the blind, it is estimated that blindness in all ages is due to infectious diseases in 22.5 per cent of the cases, to injury in 9.3 per cent, poisonings in 0.6 per cent, tumors in 0.9 per cent, general diseases in 5.5 per cent, prenatal origin in 12.2 per cent and causes unknown to science in 29.9 per cent. The remainder are of undetermined or unspecified origin. Of the blindness resulting from in-juries, about half are of occupational origin. The others are due to accidents at play or in the home. From 1936 to 1948 a 25 per cent de-crease in blindness among children in schools for the blind as a result of eye injuries was noted. This encouraging drop was attributed by the doctors as partly due to "wise legislation which has been adopted in 10 states to regulate the use of air rifles by children and in 29 states to control the sale of fire-works." February, 1951 The Health Bulletin 15 Deaths From Tuberculosis By County, Type, and Color: North Carolina, 1949 PLACE OP DEATH COUNTY TOTAL RESPIRATORY OTHER 16 The Health Bulletin February, 1951 Deaths From Tuberculosis By County, Type, and Color: North Carolina, 1949 MEDICAL LIBRARY U. OF N. C . CHAPEL HILL, N. C. Ii]I(MiIifc iSm P \ TKs BuUetin will be sehi free to dnu citizen of tKe Sktfg upon requcsi I Published monthly at the office of the Secretary of the Board, Raleigh, N C Entered as second-class matter at Postoffice at Raleigh, N. C. under Act of Augus* 24, 1912 MARCH, 1951 No. 3 ^^.^*>i .w ^ y/»yiiiSS' ^^•^i-.^y fMijvvfiffi^.ffi'^f.^ ^^^ IN AIRLIE GARDENS, WILMINGTON, NORTH CAROLINA ^DSMBERS OF THE NORTH CAROLINA STATE BOARD OF HEALTH G. G. Dexon, M.D., President Ayden Hubert B. Haywood, M.D., Vice-President Raleigh H. Lie Large, M.D Rocky Mount John LaBruce Ward, M.D Ashevllle Jasper C. Jackson, Ph.G Lvunberton Mrs. James B. Hunt Lucama, Rt. 1 John R. Bender, M.D Wlnston-Salem Ben J. Lawrence, M.D Raleigh A. C. Current, D.D.S Gastonla EXECUTIVE STAFF J. W. R. Norton, M.D„ Secretary and State Health Officer John H. Hamilton, M.D., Assistant State Health Officer and Director State Labora-tory of Hygiene C. C. AppLEAVHrrE, M.D., Director Local Health Division Ernest A. Branch, D.D.S., Director of Oral Hygiene Division A. H. Elliot, M.D., Director Personal Health Division J. M. JARRETT, B.S., Director Sanitary Engineering Division C. P. Stevick, M.D., M.P.H., Director Epidemiology Division FREE HEALTH LITERATLTIE The State Board of Health publishes monthly The Health Bulletin, which will be sent free to any citizen requesting it. The Board also has available for distribu-tion without charge special literature on the following subjects. Ask for any in which you may be interested. Adenoids and Tonsils Appendicitis Cancer Constipation Diabetes Diphtheria Don't Spit Placards Files Typhoid Fever Typhus Fever Venereal Diseases Residential Sewage Disposal Plants Sanitary Privies Water Supplies Whooping Cough Hookworm Disease Infantile Paralysis Influenza Malaria Measles Pellagra Scarlet Fever Teeth Tuberculosis Epilepsy, Feeble-mindedness, Mental Health and Habit Training Rehabilitation of Psychiatric Patients The National Mental Health Act. SPECIAL LITERATURE ON MATERNITY AND INFANCY The following special IKerature on the subjects listed below will be sent free to any citizen of the State on request to the State Board of Health, Raleigh. N. C. Prenatal Care. Prenatal Letters (series of nine monthly letters). The Expectant Mother. Infant Care. The Prevention of Infantile Diarrhea. Breast Feeding. Table of Heights and Weights. Baby's Daily Schedule. First Four Months. Five and Six Months. Seven and Eight Months. Nine Months to One Year. One to Two Years. Two to Six Years. Instructions for North Carolina Midwives. Your Child From One to Six Your Child From Six to Twelve Guiding the Adolescent CONTENTS Page The Right to Health as a Basis for Human Rights 3 Life and Death in 1950 8 Notes and Comment H PUBLI5AED BYTAE NORTA CAROLINA STATE 6*>AF\D>/AEALTA |B Vol. 66 MARCH, 1951 No. 3 J. W. R. NORTON, M.D., M.P.H., State Health Officer JOHN H. HAMILTON, M.D., Editor THE RIGHT TO HEALTH AS A BASIS FOR HUMAN RIGHTS William P. Richardson, M.D., Director Department of Field Training, School of Public Health University of North Carolina, Chapel Hill, N. C. Most of us accept without question the principle that the right to health is one of the fundamental human rights, as is enunciated in the Universal Decla-ration of Human Rights adopted by the United Nations, but we are not always clear as to all the factors involved in the implementation of this right. The present discussion will undertake to analyze these factors and to look briefly at our progress and needs with respect to them. The "Right to Health" is set forth in Article 25 of the Universal Declaration of Human rights, which reads as follows: "Everyone has the right to standard of living adequate for the health and well being of himself and of his famUy, including food, clothing, housing, and medical care, and necessary social services, and the right to security in the event of unemployment, sickness, disability, widowhood, old age, or other lack of livelihood in circum-stances beyond his control." Of primary significance, of course, in the interpretation of this statement is the definition of the word health. The World Health Organization gives us in its constitution what is probably the most comprehensive definition. It states : "Health is defined as a state of complete physical, mental, and social well-being, not merely the absence of disease or infirmity." If we paraphrase the declaration, then, using this definition we have: "Everyone has the right to standard of living adequate for a state of com-plete physical, mental, and social well-being for himself and his family, in-cluding food, clothing, housing, medi-cal care, and necessary social services." Stating the Declaration this way serves to emphasize a point which I feel should be basic to oiu- thinking, and that is that health in the broad sense is a function of all the factors which enter into what we usually refer to as standard of living, and not simply of health and medical services. These health and medical services are of vital importance to the attainment and pre-servation of health, but they are only one of the necessary factors. In this country we have been devoting a great deal of attention to public health serv-ices, hospitals, and medical care, and we are sometimes prone to overlook the fact that even though these things were entirely adequate, they would not assure the individual of a "state of complete physical, mental, and social well-being" in the absence of economic security, de-cent housing, proper diet, and education in health matters. I want to devote the major part of this discussion to an analysis of health and medical services, but I would like first to emphasize the importance of The Health Bulletin March 1951 these other factors so that as we think and talk about doctors, nurses, health departments and hospitals, we may place them in their proper perspective in relation to the total picture of factors essential to health. A few examples will serve to illustrate the point. Forty years ago hookworm was a major cause of ill health in North Carolina. Today, although it still exists, it is a very minor problem. This reduc-tion has been due in no part to medical treatment of individual cases, and to only a limited extent to the health and sanitation program. More important factors have been the decline in the number of children who go barefooted and the rising standard of living with its effect on practices of excreta dis-posal at the individual home. At the time of the first world war and through the early years of the great depression pellagra was widespread in North Carolina. Today it is a minor problem. The most significant contribu-tions to this decline have been made by factors other than medical and health services, among them improved imder-standing of nutritional needs, rising standard of living, and changes in our agricultural economy resulting in more food and feed crops, livestock, poultry, and dairying. Malaria in the South has been re-duced to a negligible problem as much by the urban trend and screens as by drainage, spraying and the like. In more underprivileged areas of the world the importance to total health of social and economic factors is even more striking. World Health Organization has set out to attack several of the specific diseases affecting wide areas of the world—malaria, typhus, cholera, and certain parasitic diseases. Although some of these efforts are meeting with grati-fying success—as in the case of malaria —already it is becoming obvious that these eradication efforts will be of only limited and temporary benefit unless the general standard of living can be raised, imless soil erosion can be check-ed, water resources developed, agricul-ture modernized, and standards of hous-ing and basic sanitation Improved. These examples will suffice to Illu-strate the importance to health of these economic and social factors. Now to consider the right to health with specific reference to the area of health and medical services. Within this area what are the elements essential to the im-plementation of the right to health? I would suggest five: 1. The protection afforded by an or-ganized preventive and public health program, bringing to the individual the benefits of scientific developments which can be most effectively applied for the protection and promotion of health through a commvmity approach. 2. An adequate number of hospital beds, health centers and laboratories, meeting acceptable standards, and con-veniently accessible to all the people. 3. An adequate number of the scienti-fic persoimel — physicians, dentists, nurses, public health workers, and auxil-iary personnel—required to render need-ed care. 4. A comprehensive program of health information and education by all groups and agencies concerned with health care, to the end that the individual may have an imderstanding of the factors concerned with his personal health, of how he can make the most intelligent and effective use of the facilities avail-able, and of his part in supporting these facilities. 5. A method of financing services and facilities which makes them available to the individual on a basis which he can afford, and which preserves his dignity and self-respect. Now let us look briefiy at each of these elements and see how adequately they are met in the United States and in North Carolina, and what are some of the special needs. First, preventive and public health programs. While such programs are a responsibility shared by the full-time local health department with other groups, it is generally recognized that the service of such a department is a basic necessity, and the extent and ade-quacy of full-time local coverage gives us a rough measure of achievement in this regard. Of 3100 countries in the United States only 1900 have full-time local health departments at the present March. 1951 The Health Bulletin time. Of course many of the 1200 coim-tles without such service are small, but many of them are not, and of the 1900 counties with the coverage, relatively few meet minimimi standards of ade-quacy as to numbers and qualifications of personnel. Moreover nearly a third at last reports had a vacancy in the position for health oflBcer. In North Carolina we are somewhat better off than the country as a whole. We have health departments covering the entire 100 counties. However, our ratio of public health nurses to popula-tion is only a little more than half of approved standards, 1 to 9,000 as against a standard of 1 to 5,000, and there are nine health officer vacancies, affecting 13 counties. Next let us look at the physical facili-ties of health care: hospitals and health centers. The United States has around a million and a half hospital beds of all kinds. Approximately 44% of these are general beds, the balance being for mental, tuberculosis and chronic pa-tients. Nearly a third of these are un-satisfactory by the standards established by the Public Health Service imder the Hospital Construction Act, so that it was estimated by the National Health As-sembly in 1948 that a total of 900,000 new and replacement beds were needed. Some progress, of course, has been made under the Hospital Construction Act, but making up a deficit of this magni-tude will be a matter of years, since both personnel and construction are in-volved. In North Carolina we have a total of 27,400 beds of all types, of which 13,500, or about half are general beds. These general beds comprise 74% of those we need according to P.H.S. standards. We will, when present construction is com-pleted, meet the required number of beds for tuberculosis, but we have only 54% of the needed beds for mental patients and only 3% of the needed beds for chronic patients. As to this deficit of mental beds the view has been expressed that the standard for mental patients is too high if adequate personnel and facilities are provided so that all pa-tients are cured or improved who are susceptible of cure or improvement. In other words, it will not take as many beds if our mental hospitals can provide real therapeutic services rather than the largely custodial care they have been providing. I am inclined to agree with this point of view, which would reduce our deficit of mental beds to around 28%. With respect to health centers, the standards as to the number needed are not very satisfactory. Certainly, how-ever, we can figure at least one per county. Both in the country as a whole and in North Carolina we have made but a beginning on these facilities. When projects already approved in North Carolina are completed we will have the health departments in 25 of our 100 counties housed in reasonably adequate health centers, the other 75 being housed in quarters inadequate in size or ap-pointments, or in imsatisfactory loca-tions. The National Health Assembly made the point that effective and economical health service will require a great deal better integration than exists at present of the facilities within a given com-mimity and the facilities within a region. This is one of the more difficult problems we face but it is of vital im-portance that we begin giving it very serious attention because without pro-per integration we will not get the serv-ice to which we are entitled for the in-vestment we are making. The third element in health and medi-cal services is personnel. In estimating personnel needs I have used 1960 as the date of reference since that is the date on which the National Health Assembly and several recent studies of nursing needs have based their estimate. The figiu-es quoted represent the more con-servative of the available estimates. As to physicians, the present annual rate of graduation nationally is 1500 less than will be required to give us the number of physicians we will need by 1960. It is likely that the deficiency will not be quite so great as this figiu-e would indicate, since there are several new medical schools in prospect—in-cluding our own at the University—but it promises to be of significant propor-tions nevertheless. Of perhaps greater significance than the deficit in numbers The Health Bulletin March 1951 is the problem of maldistribution. While the urban areas generally have an ade-quate number of physicians, many smaller communities and rural areas have none. With respect to the dearth of physi-cians in these smaller communities it should be pointed out that this is often the fault of the communities them-selves. They move heaven and earth to get a physician to locate there, and then go to a not-too-distant larger center for their medical care except when they need a doctor at night or in bad weather. And then they wonder why he doesn't stay. There are several categories of physi-cians in which the shortage is acute: Psychiatrists Negro Physicians Physicians in government services Public health physicians As to dentists most of us have enough personal difficulty getting dental ap-pointments to realize that there is a serious shortage, although standards as to the number of dentists who will be needed once the great backlog of dental needs in the population has been dis-posed of are not as well established as is the case with physicians. The Na-tional Health Assembly estimated a shortage by 1960 of 8,000. The shortage of dentists is most acute in the same areas as physicians, rural communities, public health, government services, and as respect negro dentists. In both physi-cians and dentists North Carolina ranks in the lower group of states. In the field of nursing personnel the shortage is serious at all levels from trained practical nurses to top flight educators and administrators. Best esti-mates place the shortage by 1960 at 100,- 000 to 125,000 unless the number of nurses graduated can be greatly step-ped up. Coupled with shortage of num-bers are grave deficiencies in educa-tional program and facilities. A recently completed two-year survey of nursing problems in North Carolina highlights the inadequacies of many of our schools of nursing, and points out that it will be necessary to double the number of our nursing graduates in order to pro-vide for our nursing needs by 1960. The shortage of personnel in the var-ious related and auxiliary fields is of somewhat the same magnitude as physi-cians, dentists and nurses. In consider-ing oiur personnel needs it is necessary, of com'se, to distinguish between needs as determined by standards', and effec-tive demand. The estimates I have given are based on standards, and whether or not the effective demand will be that great will depend on many factors, but perhaps largely on the prosperity level. We have referred before to the short-age of public health personnel. Based on minimum standards of the number of personnel needed for full coverage of the United States with local health service we will need the following num-bers, in addition to people now em-ployed: 1.500 more physicians 19,000 more nurses 4,000 more sanitation workers Smaller numbers of dentists, health educators, laboratory workers, etc. The outlook as regards personnel is further clouded by the plight of our professional schools. Costs have advanc-ed so drasticly and income has lagged so seriously that many medical, dental, and nursing schools are in a critical situation, and their continued progress, and even existence, may depend on some form of Federal aid or support. The fourth element in health care is health instruction and information. This does not lend itself to the kind of ex-plicit definition and measurement we have used on facilities and personnel, but it is of such importance to the ful-fillment of the "right to health" that it requires some emphasis. Health edu-cation— to use a rather inadequate term —is a responsibility of all the groups and agencies concerned in any way with health programs and health care: our schools and educational institutions, public health agencies, the various health professions, and voluntary health organizations. It needs to be directed toward the goal of giving the individual in.sight in at least three areas: 1. The personal practices which make for healthful living—all those factors in our habits and way of life which are March, 1951 The Health Bulletin conducive to emotional and physical health. 2. The immunizations and health supervision each individual should have, the kinds of ill health which may threaten him, and symptoms which should warn him to seek medical atten-tion. 3. The elements involved in the pro-vision of complete health care to the community, how he can use these most effectively, and the coop>eration he must give if they are to function economically, and to the greatest satisfaction of the individual and the community. You can see that the provision of this kind of information and understanding is a major and continuing task in which many groups and agencies have a heavy responsibility. If it is not provided no degree of adequacy in available services will suffice to give us that "state of com-plete physical, mental and social well-being" which we call health. The fifth and final element in the right to health is a method or combina-tion of methods which makes it possible for each individual to secure adequate health and medical services at a cost which he can afford, and under a sys-tem which preserves his dignity and self-respect. Let us consider briefly some of the facts of this problem of financing medi-cal costs. There are two facts which Immediately stand out: 1. The greatly increased expensiveness of medical and hospital care in recent years. 2. The irregular and unpredictable in-cidence of medical costs. There is no question about the ex-pensiveness of medical and hospital care today. The new techniques of examination and treatment and the new therapeutic agents, which have multiplied the effectiveness of medical diagnosis and treatment, cost a lot of money. These costs can be tempered in a measure by more economical admini-stration, better coordination among the various individuals, groups, and facili-ties providing care, by expansion of group practice and by less demand on the part of patients for luxury care and facilities, but even with all possible economy the costs of good care are still high. The distribution of the medical care dollar among the various items of ex-penditure is interesting, and perhaps not quite what most of us would expect. Around 25 cents goes for physicians' services, 21 cents for hospitalization, 14 cents for dental care, 21 cents for drugs, and 19 cents for nursing and all other care. The population can be divided into tliree groups so far as their ability to pay the costs of medical care is con-cerned : 1. The indigent and medically indi-gent who can pay for none or only a small part of their care. 2. The great middle income group who could pay their medical costs if they were spread out uniformly, but whose financial competence is jeopardized by prolonged and major illness. 3. The relatively small percent able to meet any eventuality. $2000 a year would appear to be the minimum income on which a family could be expected to pay for even normal routine medical costs without assistance. In 1946 twenty eight percent of in-dividuals and families had an income of less than this figiore. Government clear-ly has the major responsibility for financing medical care for this group through some plan which assures them of adequate care, and which does not pauperize them or offend their self re-spect. This is a responsibility which is being met very unevenly and inade-quately in the country as a whole. And it is worth noting that the compulsory health insurance plans which have been proposed would not take care of this group. It is around the needs of the second group, who can meet their medical costs if they can be spread out through some kind of prepayment or insurance plan, that the greater part of current discus-sion has centered. There is general agreement that the principle of contri-butory health insurance should be the basic plan of financing medical care for a large majority of the American people, but there is wide divergence as to whether this can be accomplished by 8 The Health Bulletin March 1951 voluntary prepayment plans, or whether it will require a compulsory national plan. The National Health Assembly of 1948 expressed the conclusion that "voluntary prepayment group health plans, embodying group practice and providing comprehensive service, — are the best available means at this time of bringing about improved distribution of medical care." There are, of course serious problems which have to be solved if voluntary plans are to meet the country's needs. There is first of all the difficulty of en-rolling and collecting from individuals who do not belong to a group which can be enrolled en masse, and for which payment can be made by payroll de-duction. The most difficult group to reach, and one which particularly needs the protection is the rural group. It is vitally essential that some economical way be found of promoting and handling prepayment insurance among rural peo-ple. Another problem is that of over-use and abuse which can impose so heavy a burden on the program that rates will have to be set too high for many of the people who need the protection most. This is a problem which involves under-standing and acceptance of responsibili-ty for avoiding unnecessary hospitaliza-tion and care by both patients and physicians. We can summarize briefly, then, what we have been saying: 1. Health and medical services are only one factor entering into the im-plementation of the "right to health." Economic and social factors such as housing, good wages, steady employ-ment, and recreation are likewise es-sential. 2. The essential health and medical services include an adequate public health program, adequate hospital and health center facilities, an adequate number of properly trained professional personnel, a comprehensive program of health education, and a satisfactory method of financing the costs of medi-cal care. 3. There is a shortage of all categories of health personnel. This is especially marked with respect to nurses, to rural areas, and to negro physicians and den-tists. 4. The problem of more adequate sup-port for professional schools training health personnel is an urgent one, with Federal assistance probably the ultimate answer. 5. Contributory health insurance is generally agreed to be the basic method by which the majority of the American people may best finance the costs of medical care. Voluntary prepayment plans, Blue Cross and Blue Shield, offer the most efficient means of providing this insurance. Two problems of these plans challenge the best efforts of the health professions and the public: the prevention of over-use and abuse, and the development of effective and eco-nomical methods of enrolling our rural population. 6. Although we have made magnificent technical progress in health and medical care, there remain serious problems to be solved before we approach attain-ment of the objective set forth by the National Health Assembly that "ade-quate medical care for the prevention and relief of sickness, and the promo-tion of a high level of physical, mental, and social health should be available to all without regard to race, color, creed, residence, or economic status." LIFE AND DEATH IN 1950 William H. Richardson Raleigh, N. C. How many of you, especially if you are among those in middle or late life, know definitely that your hearts are sound? How many of you are certain that your blood pressure is not abnorm-ally high; and how many know that you have neither cancer, nor any of its danger signals. You can receive none of March, 1951 The Health Bulletin 9 this information except from a quali-fied physician, and even then, only after a thorough physical examination. There was a very definite motive be-hind the asking of the above questions. Out of a total of 31,257 deaths from all causes in North Carolina, last year, 16,- 625 were attributed to diseases of the heart, apoplexy, and cancer. This total is revealed in the provisional vital sta-tistics report for 1950, compiled by the State Board of Health. The total num-ber of deaths from the same causes in 1949 was only 15,525. When more than one-half of all deaths occurring in the State, in a single year, result from just three diseases, we have much food for thought. There was a substantial increase in deaths from all three of these causes, namely, diseases of the heart, apoplexy and cancer, in 1950. As a matter of fact, for some years, there has been a very pronounced up-ward trend in these figures. However, there appears one oasis in the desert of degenerative diseases, among which the above are classed. The bright spot re-ferred to is the sustained downward trend in deaths from nephritis. From this cause, there were 1,416 in 1950, com-pared with 2,141 in 1949. This compari-son reflects a decrease of 725 deaths from nephritis, or Bright's disease, in a single period of twelve months. The decline has been evident now for several years, and it is sincerely hoped that it will continue. In comparison, 910 more people died of heart disease in North Carolina in 1950 than in 1949; 107 more died of apoplexy and 83 more of cancer. Top Bracket Killers If we add to these three causes of deaths in North Carolina last year, the totals of nephritis and all accidents, we have a total of 20,381. As has previously been stated, deaths from all causes, in 1950, numbered 31,257. Incidentally, this reflects a decrease in all deaths of 159. The decrease in the total number of births was much greater, being 2,781. That is to say, there were only 106,686 live babies born in North Carolina last year, as compared with 109,467 the pre-vious year. During the period under comparison, death claimed 3,691 babies under a year old. This was a substantial decrease under the 4,155 infant deaths in 1949. Last year, 2,688 babies in North Carolina were born dead. This figure was slightly under that of the preceding year. Now that we have considered the top bracket killers in North Carolina, it might be well to acquaint you with some figures relative to those diseases which formerly took a heavy toll of life each year, but have been brought well under control. For many years, the sceptre was held by tuberculosis which remained the king of killers, for decade after de-cade. In years gone by, when one was told that he or she had tuberculosis, or consumption, funeral preparations were begvm. In fact, the patients sometimes were not told imtil their conditioH be-came evident to themselves. Tubercu-losis, at one time, wa
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 | 1951 |
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 66, 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 | 13,931 KB; 242 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_healthbulletin1954.pdf |
Pres Local File Path-M | \Preservation_content\StatePubs\pubs_edp\images_master\ |
Full Text | r ©he litjrarp of tte Wini\}tx9iitp of ^ortf) Carolina Cnbotoeb bp t&:i)e Bialectit anb l^ilanttroptc ftodeties; blU.06 N86h v« 65-66 1950-51 Med.lib» .- o ' v..^^.:.,^.,^^.. JiA This book must not be taken from the Library building. iiA¥-8 — m ^f? n r «) FifrtF^-i^ ^ifo'ISm I TKis Bulletin will be senifree to dny citizen of fKe Ski^e upon request t Published monthly at the ofSce of the Secretary of the Board, Raleigh, N. C Entered as second-class matter at PostofSce at Raleigh, N. C. under Act of Angnst 24, 1912 Vol. 66 JANUARY, 1951 No. 1 <5 ^ ft » i. GEORGE MARION COOPER, M.D. 1876-1950 MEMBERS OF THE NORTH CAROLINA STATE BOARD OF HEALTH G. G. Ddcon, M.D., President Ayden HxnBEET B. Haywood, M.D., Vice-President Raleigh H. Lee Large, M.D Rocky Mount John LaBruce Ward, M.D Ashevllle Jasper C. Jackson, Ph.G Lumberton Mrs. James B. Hunt Lucama, Rt. 1 John R. Bender, M.D Winston-Salem Ben J. Lawrence, M.D Raleigh A. C. CxjHRENT, D.D.S Gastonla EXECUTIVE STAFF J. W. R. Norton, M.D., Secretary and State Health OflBcer , Director Personal Health Division C. C. Applewhite, M.D., Director Local Health Division Ernest A. Branch, D.D.S., Director of Oral Hygiene Division John H. Hamilton, M.D., Director State Laboratory of Hygiene J. M. Jarrett, B.S., Director Sanitary Engineering Division C. P. Stevick, MJ)., M.PJI., Director Epidemiology Division FREE HEALTH LITERATURE The State Board of Health publishes monthly The Health Bulletin^ which will be sent free to any citizen requesting it. The Board also has available for distribu-tion without charge special literature on the following subjects. Ask for any in which you may be interested. Adenoids and Tonsils Hookworm Disease Typhoid Fever Appendicitis Infantile Paralysis Typhus Fever Cancer Influenza venereal Diseases Constipation Malaria Residential Sewage Diabetes Measles Disposal Plants Diphtheria Pellagra Sanitary Privies Don't Spit Placards Scarlet Fever Water Supplies Flies' Teeth Whooping cough Tuberculosis Epilepsy, Feeble-mhidedness, Mental Health and Habit Training Rehabilitation of Psychiatric Patients The National Mental Health Act. SPECUL LITERATURE ON MATERNITY AND INFANCY The following special literature on the subjects listed below will be sent free to any citizen of the State on request to the State Board of Health, Raleigh, N. C. Prenatal Care. First Four Months. Prenatal Letters (series of nine Five and Six Months. monthly letters). Seven and Eight Months. The Expectant Mother. Nine Months to One Year. Infant Care. One to Two Years. The Prevention of Infantile Two to Six Years. Diarrhea. Instructions for North Carolina Breast Feeding. Midwives. Table of Heights and Weights. Your Child From One to Six Baby's Daily Schedule. Your Child From Six to Twelve Guiding the Adolescent CONTENTS Page Tributes to Dr. George Marion Cooper 3 mwrn [£l||PU6LI5A\ED BYTAE N<>RTM CAROLINA STATE B^'ARD-zAEALTAlB Vol. 66 JANUARY, 1951 No. 1 J. W. R. NORTON, M.D., M.P.H., State Health Officer JOHN H. HAMILTON, M.D., Editor George Marion Cooper, M.D.—1876-1950 The Health Bulletin sorrowfully marks the passing of Dr. George Marion Cooper, for nineteen years its editor and for thirty-five years a distinguished member of the staff of the North Carolina State Board of Health. We dedicate the pages of this issue to a partial expression of appreciation of the man and the good service which he rendered in promoting the health of all the people of North Carolina. The Health Bulletin JantLary, 1951 STATE OF NORTH CAROLINA GOVERNORS OFFICE RALEIGH W Kerr Scott GOVERNOR In the death of Dr. George Marion Cooper, Assistant State Health Officer, North Carolina has lost a faithful public official and humanity a devoted friend. He was interested in and gave his efforts to the solution of more public health prob-lems than any other man of his generation. Although he was qualified for leadership in any phase of public health work, he was willing to serve in the ranks. However, he was looked to for advice and guidance by every State Health Officer and every other Health Official with whom he worked. Dr. Cooper was able to place himself alongside those he served; to interpret their problems and minister to their needs in a sympathetic aind effective mcinner. He was able to serve his State over a period of many years without assuming any attitude of proprietorship. On the contrary, he remained a faithful servant of the people. He occupied a place in North Carolina history which was unique. In his relationship to Church and State, Dr. Cooper gave his best. Governor Jamuary 3, 1951 January, 1951 The Health Bulletin RESOLUTION OF RESPECT TO THE LATE DOCTOR GEORGE MARION COOPER The following Joint Resolution, in^ troduced in the Senate by Senator Paul Jones, was placed upon its immediate passage by unanimous consent on Jan-uary 17, 1951, then sent by special mes-senger to the House which took similar action. The Resolution was passed and ratified on the same day. WHEREAS, the death of Dr. George Marion Cooper, Assistant State Health Officer, which occurred on Monday, December 18, 1950, removed from our midst one of the greatest Public Health officials and humanitarians North Caro-lina has ever known; and WHEREAS, his efforts in behalf of the underprivileged, especially among mothers and babies, not only were signally outstanding, but bore wide-spread and beneficial results in every part of oiu- State; Now, therefore, be it resolved by the Senate, the House of Representatives concurring: Section 1. That official recognition be given the life and services of this distinguished and useful native of Sampson Coimty, who, for thirty-five years was associated with the State Board of Health. Sec. 2. That a copy of this resolution be given the Secretary and State Health Officer, and copies to Doctor Cooper's thl-ee surviving children. Sec. 3 That today's adjournment be in honor of Doctor Cooper. Sec. 4. That this resolution shall be in full force and effect from and after its ratification. Jan. 17, 1951 TRIBUTES TO DR. G. M. COOPER When advised of the death of Dr. G. M. Cooper, Assistant State Health Officer, Dr. J. W. R. Norton, Secretary and State Health Officer, made the following statement: "North Carolina has lost its greatest Public Health Official of all time. He served longer, engaged in more activi-ties and did more to make North Caro-lina Public Health conscious and to minister to its Public Health needs than any man in the history of the State. He pioneered more Public Health services than any other man I know, not only in North Carolina but in the nation. Both personally and professionally he had few peers, if any, and no superiors any-where. His was constantly an up-hill fight against ignorance, misinformation, indifference and short-sighted selfish interests. The two greatest groups of his beneficiaries were imder-privileged mothers and children, in whose behalf he not only worked unceasingly and for whose relief he was instriunental in securing millions of dollars in public funds, which he administered where they would do the most good among the greatest nimiber of people. During his service with the State Board of Health, the maternal death rate was reduced to one-fourth and the infant death rate to one-half of those rates prevailing in North Carolina when his service began. This progress was due to the work of many devoted physicians and assisting personnel; Dr. Cooper was the patient plarmer, the daimtless and resoiirceful leader, the tireless worker. "I feel in the passing of Dr. Cooper an over-whelming sense of personal loss. In generations to come, the de-scendants of those he has helped will rise up and call him blessed. His S3mi-pathies were broad and he worked tire-lessly in behalf of those he sought to 6 The Health Bulletin January, 1951 serve, and without hope of personal aggrandizement. He was not only a pillar of strength in the P'^oiic Health structure, but ever mindful of his family and personal friends and just as zealous in the work of the Presbyterian Church, of which he was a life-long member and a ruling elder at the time of his death. He was my personal friend and the personal friend of all who worked with him in any capacity. Our best expres-sion of faith in and love for him will be through closing ranks and marching on toward the goals toward which he strove so long and so well." Dr. Clyde A. Erwin, State Superinten-dent of Public Instruction, paid this tribute to the late Dr. Cooper: "I feel a deep personal loss in the death of Dr. Cooper. He has been a dear friend of mine for many years. In addi-tion I consider his loss to the State ir-reparable. No one in my opinion has given of himself more vmselfishly nor more effectively in the service of the people. His keen understanding of the problems of public health and his dedi-cation to the solution of these problems is a landmark along the road of hu-man progress." Statement by Dr. Ellen Winston, Commissioner of Public Welfare, on the death of Dr. George M. Cooper. "In the passing of Dr. George M. Cooper, the State Board of Public Wel-fare, has lost a staunch supporter and friend. His loss will be felt by welfare workers throughout the State who have known and loved him. He was ever mindful of the importance of the united efforts of health and welfare in his work in promoting North Carolina's health program. As an eminent citizen and de-voted leader in seeking social better-ment, Dr. Cooper made a lasting con-tribution to this State and to the nation." A GREAT PHYSICIAN When a North Carolinian who has been taking notice of public affairs for a quarter of a century reflects on the length, breadth and depth of the serv-ice of Dr. George Marion Cooper, as-sistant state health officer who died at Raleigh early Monday morning, he is constrained to conclude: Here was the public servant made perfect. It will have been printed elsewhere in the Daily News, but we think any esti-mate by an editorial commentator should include the tribute paid him by Dr. Roy Norton, state health officer: He served longer, engaged in more activities and did more to make North Carolina public health conscious and to minister to its public health needs than any man in the history of the state. He pioneered more public health services than any other man I know, not only in North Carolina but in the nation. Both personally and professionally he had few peers, if any, and no superiors anywhere. He was constantly an uphill fighter against ignorance, misinforma-tion, indifference and short-sighted selfish interest. The two greatest groups of his beneficiaries were underprivileged mothers and children, in whose behalf he worked unceasingly and for whose relief he was instrumental in securing millions of dollars in public funds, which he administered where they would do the most good for the greatest number of people ... In generations to come, the descendants of those he helped will rise up and call him blessed. Ordinarily we are inclined to discount estimates made by professional, busi-ness or governmental associates who know what they are expected to say, but Dr. Norton is as objective as would be any good reporter who has for years seen Dr. Cooper in action. If we were called upon to name his greatest characteristic, we'd make it courage. He was himself frail, with a deafness which kept him from being chosen as chief of the health service January, 1951 The Health Bulletin more than once; but this may have been at times of assistance to him in his work. Certainly he refused to listen to coimsel of the faint of heart; there was no contact between him and those who feared the political effect of any move-ment for bettering health conditions. But if he were resolute, none could question his willingness to work in har-ness. His fellow workers all down the years have sworn by him, and in his entire public lifetime, which was one a few years shorter than the lifetime of the DaUy News, there has never to cm' knowledge been offered a printed word of disparagement of Dr. Cooper by a responsible citizen. Even when there was objection by doctors of medicine to some his ad-vanced steps in caring for the health of school children the objectors soon sub-sided and without daring to question the good faith of a really great physl-ciaiL —Greensboro Daily News, Dec. 20, 1950 UNSELFISH SERVICE The death of Dr. George M. Cooper marks the end of a career of a man who served his fellow man, his State and his profession with imselfish de-votion for four decades. It would be difficult to overestimate the value of Dr. Cooper's services. As a young physician in Sampson County he saw the need for carrying advanced medical knowledge to all of the people. In his own practice he was the first physician in this State to use typhoid vaccine in North Carolina. He soon extended his practice to the entire State, joining the then young State Health Department in 1915 and serving as Assistant State Health officer from 1923 until his death yesterday. Dr. Cooper's primary work was in the fields of maternal and child health. No state has made more progress in those important fields in the last 30 years than has North Carolina. And for much of that progress the State is indebted to the tireless labor of this self-effacing man. Dr. Cooper's labors were by no means confined to maternal and child health. Those labors embraced the whole area of public health and he has left his mark in that entire field. North Carolinians are grateful to this pioneer in public health work, who al-ways placed the well being of the many above the good of the few. Raleigh News & Observer WAS A HEALTH PIONEER Dr. George M. Cooper, pioneer public health official and Assistant State Health officer in North Carolina since March 1, 1923, was in a very large mea-sure responsible for the fact that the North Carolina Health Department stood among the first in this Nation. Dr. Cooper was a native of Sampson County. He became interested in public health work and might well be credited with being first to realize the need for making possible hospital and medical facilities for the rank and file of the people of this State. Dr. Cooper was said to be the first physician in North Carolina to use ty-phoid fever vaccine. Dr. Roy Norton, State Health Officer, paid deserved tri-bute to Dr. Cooper, who was not only his assistant but assistant to his prede-cessors and often served as Acting Health Officer. Dr. Norton said of him that he was North Carolina's "greatest public health official of all time." Only because of his affiiction with total deafness and his self sacrificing 8 The Health Bulletin January, 1951 modesty kept George Cooper from be-ing not the assistant but the State Health Officer for the past 25 or more years. The Free Press is glad to add a tri-bute to his memory. He served long after the usual retirement age, being 74 when he died Monday in Raleigh. In the days when county health depart-ments were few and far between in North Carolina and the progressive coxmty of Lenoir became the second county in the State to provide full time service, Dr. Cooper rendered much help in getting things started. He was an honor to his profession, a Christian gentleman and his good work will be felt by generations yet unborn. —Kinston (N. C.) Daily Free Press DR. GEORGE M. COOPER Funeral services for Dr. George Marion Cooper, assistant State health officer since March, 1923, will be con-ducted Tuesday morning at 11 o'clock from the First Presbjrterian Church here. Dr. Cooper, 74, died at Rex Hospi-tal early yesterday morning after more than a week of critical illness with a heart ailment. Dr. J. A. Christian, pas-tor of the First Presbs^terian Church, and Dr. H. P. Powell of Edenton Street Methodist Chiu-ch will officiate at the rites. Afterward, the body will be taken to the Royall Funeral Home in Clinton, where it will lie in state from 12:45 to 1:45 p. m. Burial will follow in the Clinton Cemetery. The body will remain at Pennington-Smith Funeral Home here until just prior to the 11 a. m. rites. Pallbearers will be Drs. A. C. Bulla, John H. Hamilton, Roy Norton and Thomas Worth, all of Raleigh; Dr. Street Brewer of Clinton; and C. B. Taylor, Fred Harding and Jeff D. John-son, Jr., all of Raleigh. A public health pioneer at both the State and national levels, he had been with the State Health Department for 35 continuovis years. Earlier he had been a general practitioner in his native Sampson County, where he was the first Tar Heel physician to use tjTDhoid vaccine. Sur-vivors include three children. Dr. George M. Cooper, Jr., of Raleigh, John Phil Cooper of Winston-Salem, and Mrs. A. Sam Krebs of Cinciimati, Ohio; one brother, Thomas Cooper of Petersburg, Va.; a sister Mrs. Bard Fitzgerald of Gretna, Va.; and three grandchildren. —Raleigh News and Observer, Dec. 19, 1950 BIOGRAPHICAL SKETCH OF GEORGE MARION COOPER, M.D., LL.D. By William H. Richardson. State Board of Health, Raleigh, N. C. Born in Clinton, North Carolina, April 24, 1876. Educated in public and private schools of Sampson County. Taught school in public and high schools of Sampson County 1897 to 1901. Graduated in medicine at the Univer-sity College of Medicine in Virginia at the end of foiir years' attendance, 1905. licensed to practice medicine in North Carolina in Greensboro 1905. Located at once in Clinton, forming a partnership with Dr. Frank H. Holmes. This part-nership continued active for about eight years, both physicians doing general practice with a great deal of surgery, i obstetrics and gynecology. Soon after beginning practice. Dr. ; Cooper became interested in some ' January, 1951 The Health Bulletin 9 method of controlling the ravages of typhoid fever and the terribly high death rate from colitis and similar dis-eases among infants, and in helping to coimtermand the death warrant which in those days hiing over a patient as soon as a diagnosis of tuberculosis was made, by joining the movement for early diagnosis and rational treatment. Dr. Holmes died of tuberculosis eighteen months after the partnership was dis-continued. Then Dr. Cooper quit private practice to devote his full time to pre-ventive medicine and public health work. As part time Coimty Physician of Sampson County from 1909 to 1913, with the aid of the Mayor and Town Board, Dr. Cooper cleaned up the town of Clinton and used the first typhoid vaccine used by any physician in North Carolina as an experiment in mass con-trol and prevention of typhoid fever by vaccination of the civil population. For twenty-one months following this work in 1911 and 1912, there was not a case of typhoid fever in that town for the first time in its history. October 1, 1913 he became a full time health of&cer of Sampson County, being about the fifth such local health ofiBcer in North Carolina. During 1914, he con-ducted with the aid of the International Health Board two experiments in com-munity sanitation, one at Salemburg and the other at Ingold. Notable and lasting results were achieved in both, which afforded guidance for subsequent work elsewhere. 1 He was President of the Sampson County Medical Society in 1910, and President of the North Carolina Public Health Association in 1913 and 1914. He was appointed head of the Depart-ment of Rural Sanitation and a mem-ber of the executive staff of the North ; Carolina State Board of Health and moved to Raleigh and assumed these duties May 1, 1915. In 1917, he was made head of the school health work for the State Board with the title of State Medical Inspector of Schools. In that position he plarmed and put into operation in 1918 the J system of dental work for all State public school children and engaged and supervised the first dentists for school health work. That year he was made an honorary member of the State Den-tal Society, an honor continued to this day and valued highly. Under the sys-tem, since gradually expanded, more than three million school children have received free treatment, to make no mention of the most important aspect of the work, education. In 1919, he de-vised and put into effect the system of club operation for the removal of diseased tonsils and adenoids of school children, and supervised these clinics for most of the time until 1931. Opera-tions were performed on 23,211 children living in every school district in 86 of the State's 100 counties, with the lowest mortality record in the history of such work in the United States. The educa-tional effect of these two movements for better health for all children has been incalculable. On March 1, 1923, he was appointed Assistant State Health OfiBcer and Edi-tor of the Health Bulletin continuing as Editor until 1942. From September 1, 1923, to September 1, 1924, during the year's leave given Dr. W. S. Rankin, State Health OfiBcer, for work in New York, Dr. Cooper again became Acting State Health OfiBcer. Upon the return of Dr. Rankin September 1, 1924, he was continued as Assistant State Health OfiBcer, Director of Health Education, until the resignation of Dr. Rankin May 30, 1925, when he was again made Acting State Health OfiBcer and served in this capacity until the assumption of ofiBce by Dr. C. O'H. Laughinghouse October 1, 1926. During Dr. Laughing-house's term of ofBce until his death August 26, 1930, Dr. Cooper was Director of Health Education. Upon election of Dr. J. M. Parrott as State Health OfiBcer on July 1, 1931, he became Director of the Division of Preventive Medicine in the reorganized State Board of Health. This Division comprised School Health Work, Mater-nal and Child Health Services, Health Education, editorial work. etc. This work continued until the death of Dr. Parrott, November 7, 1934. He was Act- 10 The Health Bulletin January, 1951 ing State Health OfBcer during the in-terval between Dr. Parrott's death and the beginning of Dr. Carl V. Reynolds' administration as Health Officer. In 1934 Doctor Cooper was unani-mously elected President of the Raleigh Academy of Medicine. Upon assump-tion of duties as State Health Officer by Dr. C. V. Reynolds, November 10, 1934, following the death of Dr. Par-rott. Dr. Cooper was elected Assistant State Health Officer and reelected foiir time since, his present term to expire July 1, 1951. His other duties were the same as during the Parrott administra-tion, and in addition as Director of Maternal and Child Health Services for the United States Children's Bureau, he has had the responsibility of ad-ministering the Emergency Maternity and Infant Care work for service wives. During the war period, approximately 44,600 maternity and infant cases were aided to the extent of having their doctor and hospital bills paid. In 1941, Dr. Cooper was elected Presi-dent of the North Carolina Conference for Social Service. In 1942, Dr. Cooper was the recipient of one of the highest honors that can come to a citizen of North Carolina when the University of North Carolina conferred upon him the honorary de-gree of Doctor of Laws in recognition of his work in Health Education. In conferring the degree, President Frank P. Graham read the following citation: "GEORGE MARION COOPER, of Sampson County, nationally distin-guished as a public health officer, quiet and unassuming but relentlessly effec-tive, he has as state health officer serv-ed for a longer period and in more fields than any other person. He has been a leader in practical programs for the medical care of the poor and has work-ed courageously to lift North Carolina from the disgrace of its high birth mor-tality of children and mothers. His work, pioneering in America, both for the im-provement of the health of school child-ren through free dental and tonsil clinics, and for the improvement of the health of mothers and the birth of children, has become and will continue to be an example to this and other na-tions and a benefaction to this and succeeding generations." The honor which the Ladies of the State Auxiliary conferred upon him by naming the Bed in the Eastern North Carolina Tuberculosis Sanatorium at Wilson for him is highly prized and will be gratefully cherished by his children and many friends always. Dr. George M. Cooper, head of the Division of Preventive Medicine, North Carolina Health Department, honored with a 1949 Lasker Award of the Plan-ned Parenthood Federation of America for outstanding services in maternal and child health and for his efforts in making his State the first in the Union to include birth control in its public health services. On April 24, 1950, he celebrated his 74th birthday probably by putting in a hard day's work and on May 1, he ob-served the completion of thirty-five years' continuous work on the staff of the State Board of Health. The above is just a brief part of the record, and does not describe the in-tensity with which he had put himself, mentally and physically, into many years of efforts to improve the health of the citizens of North Carolina, and the many lives he has been instru-mental in saving, particularly mothers and babies. As the shadows lengthened rapidly toward the west for him, his one regret was that he had not been able to accomplish more for the plain people of North Carolina. January, 1951 The Health Bulletin 11 DR. GEORGE M. COOPER — AN APPRECIATION Earnest A. Branch, D.D.S., Director of Oral Hygiene Division North Carolina State Board of Health In the death of Dr. George M. Cooper on December 18, 1950, North Carolina dentistry lost one of its best friends. It was Dr. Cooper, a physician directing the Bureau of Medical Inspection of Schools of the North Carolina State Board of Health, who conceived and promoted the idea of including dentis-try in the State's Public Health Pro-gram. This was in 1918. Appearing on the program of the North Carolina Dental Society during their meeting in the old Oceanic Hotel at Wrightsville Beach, Dr. Cooper outlined a proposed plan of dental health education. This plan pro-vided for employing full time dentists on the staff of the State Board of Health and for sending these dentists into the schools of the State to teach Mouth Health and to make dental cor-rections for the underprivileged child-ren. From the beginning the objective was health education. The proposal came from an under-standing heart and mind. Dr. Cooper knew from personal experience the suf-fering caused from lack of dental at-tention in childhood. He knew from his experience as a physician and a public health worker the great need for dental health education and for dental serv-ice among our children. Dr. Cooper's presentation before the Dental Society struck a responsive chord, and it was Dr. J. Martin Fleming of Raleigh who made the motion that the North Carolina Dental Society go on record as heartily endorsing the plan and that the Society pledge Dr. Cooper their loyal support. This was done, and North Carolina became the first State to put dentistry in its Public Health Program. Dr. Cooper, assisted by members of the dental profession, went before the State Legislature and secured funds with which to begin operations. Several young dentists were employed, and, from that day to this, the program has been functioning. Because of the vision and work of this public health pioneer thousands and thousands of children have receiv-ed their first dental service, thousands and thousands and thousands of teeth have been saved. North Carolinians have become more and more Mouth Health conscious, and dentistry's health services are more widely recognized and appreciated. Dr. George M. Cooper was truly a great benefactor of the children and of the dental profession of North Carolina. January, 1951 GEORGE MARION COOPER, M.D., 1876-1950 By Waltfb J. Hughes, M.D. Bennett College, Greensboro, North Carolina John Milton in his sonnet "On His Blindness" said, "They also serve who only stand and wait." Milton was blind; Cooper had defective hearing. George Marion Cooper did not serve by stand-ing and waiting, but projected his per-sonality, with arduous activity, into all the significant social movements of his time. He brought to the field of public health and preventive medicine the force of his intellect, his creative ability, and great imagination. His achieve-ments were epical. He was an able public health statesman, a courageous and fearless spokesman in all things that mitigated against the health and 12 The Health Bulletin January, 1951 welfare of the people of this common-wealth. His administrative ability has been most constructive in the reduction of maternal and infant mortality, in school health services, and in the ad-vancement of preventive medicine in general. During his entire tenure as a health officer, he indicated to all the people the democratic way of living. He was impartial in the relationship with all of his subordinates and believed in equality of opportunity in order that all the people might share in being lifted up to a higher standard of usefulness and healthful living. His coimsel was sought by many and his advice was full of wisdom and as soothing as the bene-diction that follows after prayer. For all of these things the people of North Carolina, and the generations yet to come, owe him a lasting debt of grati-tude. TO THE EDITOR To the Editor:—Somehow I passed over in the news the death of Dr. G. M. Cooper, and am indebted for the in-formation to the brief eulogies by Nell Battle Lewis and C. A. Upchurch, Jr., in the News and Observer. I wish to add a personal tribute to him as not only an able and zealous crusader for public health, but especially as a warm-heart-ed, friendly human. I became acquaint-ed with him years ago through an oc-casional article I offered to the State Health Bulletin, of which he was so long the able editor. As a friend I pay tribute to two rare characteristics which I have seldom seen equaled in another. Few have such a capacity for warm, generous friend-ship; few such a cheerful and delightful a mastery of a personal handicap. His deafness he simply accepted and turned into a pleasing virtue. Cheerfully and gracefully and unobtrusively he seated you in front of him, turned the receiver of his hearing apparatus toward you, and talked delightfully without a trace of embarrassment or restraint. It was the zeal of one in love with life, love for his job, and love for his friends and co-laborers. It was the mark of a healthy mind and of a full-grown personality. Few have been so generous to recogn-ize and heartily to praise any worth or ability seen in another. Delightfully un-conscious of his own talents and achievements, he was always alert and eager to discover and praise any talent or virtue or accomplishment seen in another. Perhaps this is the highest at-tainment of a healthy mind and of im-alloyed greatness. Face to face, by phone, or through the mail, and with the heartiness of a father to a son, he passed on to the writer of an article he used in the Health Bulletin any favor-able reaction that came to him as editor. I loved and admired him as few other friends of a lifetime, and I fear I "shall not look upon his like again." —S. L. Morgan, Sr. Wake Forest GEORGE MARION COOPER, M.D. By The Editor In the passing of George Marion Cooper thousands upon thousands of people felt a deep sense of personal loss. It is impossible to write about him without emotion. For more than thirty-seven years he had been a wholetime public health physician. Even before he became health officer in his own Samp-son County he had, as a practitioner, seen the dire need of his patients and had been doing much in the field of preventive medicine. With this back- January, 1951 The Health Bulletin 13 ground Dr. Cooper felt the call to de-vote his life to public health just as genuinely as any minister of religion ever felt the call to preach the Gospel of Jesus Christ. To Dr. Cooper the de-sire to save human beings from disease and the prolongation of their lives was a compelling force. To this cause he dedicated his life. When the history of public health in North Carolina is written it will be es-sentially a biography of George Marion Cooper. Public health was in its infancy when he entered the specialty. During the long period of service with the State Board of Health he witnessed much growth and expansion. Early successes in the effort to reduce the prevalence of infectious diseases resulted in a grow-ing appreciation of public health, in-creases in appropriated fimds, addi-tional workers were recruited, more problems were attacked and new pro-grams developed. In fair weather and foul—his was a stablizing and whole-some force. In most successful endeav-ors he was a guiding and sustaining in-fluence. When mistakes were made and things went wrong it was frequently be-cause his advice was not sought or was ignored. Although North Carolina has contributed many illustrious names to the Honor Roll of PubUc Health, Dr. Cooper's long career in North Carolina caused many throughout the nation to consider him as "Mr. Public Health In North Carolina." There will probably be some disagree-ment in selecting Dr. Cooper's outstand-ing qualifications. To those who read history his ability to make long-range plans would probably be placed first. It would require much research work to list all of the programs which were started by him. Three of his early cam-paigns demonstrate the range of his planning. Take the tonsil-adenoid clinic for instance, the initial objective was, of course, Ito cure the trouble caused by dis-eased tonsils and adenoids, but the long-range effect was to educate the people as to the value of competent adequately trained medical specialists. Most of the older. Eye, Ear, Nose and Throat physi-cians in the State appreciate the firm foimdations of public confidence built by Dr. Cooper's early clinics. The Dental Program, started in 1918 while Dr. Cooper was directing the School Health work, resulted in Dr. Cooper's election as an honorary member of the State Dental Society, and laid the foundation for the formation of the Division of Oral Hygiene in 1931. The Orthopedic Clinics organized by him have smooth-ed the way for thousands of crippled children for years past and will offer hope for the crippled children of the future. It is no wonder that orthopedic surgeons were among the first to sug-gest a suitable memorial to Dr. Cooper. As Editor of the Health Bulletin for nineteen years, he established the for-mat which has become recognized as a symbol of North Carolina's Health Pro-gram. While other State Boards of Health have considered it advisable to streamline their publications or to make them into picture magazines, the Health Bulletin has remained, and with the help of a kind Providence will remain, a plain little publication with a simple message—told in plain straight-forward words and go to the 60,000 homes, offices and libraries of the State and Nation each month. There is much in Dr. Cooper's life and record to remind one of the Apostle Paul. Dr. Cooper's thorn in the flesh was deafness—it affected his life greatly —it deprived him of some honors that might have been bestowed upon him. He had a most remarkable memory, — probably part of this intellectual attain-ment was due to inherent ability. It would seem, however, to those who knew him intimately that a considerable de-gree of his most accurate memory was due to his defective hearing. He con-verted a defect into an asset. Dr. Cooper had courage, the courage to flght for that which he believed to be right—the courage to fight for those who could not defend themselves, the courage to fight those in high places who disregarded or were unmindful of the rights of all to a healthy existence. Dr. Cooper gave pub-lic health a sound doctrine—Like the Apostle Paul—he fought a good fight, finished his coxirse,, and he kept the 14 The Health Bulletin January, 1951 Faith. The torch lighted by Thomas Fanning Wood passed on to Richard H. Lewis, to W. S. Rankin and to George M. Cooper still burns. Those who now receive the torch may not hold it as high or as steadily but they are solemn-ly dedicated to hold it tight and to en-deavor to advance it without faltering. Some of Dr. Cooper's own editorials in the Health Bulletin give a clear pic-tiure of what he considered the Health Bulletin should be — NOTES AND COMMENT January, 1939—"With this issue the Health Bulletin enters it fifty-fourth year, the present number being Number 1 of Volume 54. It has thus completed fifty-three years of its monthly visits to the citizens of the State of North Caro-lina who are interested enough to write and ask that it be sent to them. This issue goes into seventy-six coun-ties with organized full-time health de-partment service, either on a county imit or a district basis, and in some in-stances with a city health department at the covmty-seat and a county health department fvmctioning for the county. The reader may compare the situation in this State now with reference to pub-lic health service with this month fifty-four years ago when Dr. Thomas Fan-ning Wood, the first State Health Offic-er, issued the first number. At that time the total appropriation for the State Board of Health work was $2,000 an-nualy. Dr. Wood, of course, worked on a part-time basis and a part-time clerk in his office wrote out the script in long-hand for the first publication. Today in these seventy-six counties, there are more than five hundred full-time work-ers, including health officers, nurses, clerical help, sanitary inspectors and engineers, etc. This is exclusive of the State Board of Health oragnization and also exclusive of the many full-time employees of city water departments such as chemists and engineers. It is the conviction of this writer that no money that the State and the localities have ever spent has resulted in more benefit to the citizens than that of the health workers. Many of these workers are un-known to the general public, their names seldom occur in the State papers, they are not given honorary degrees by the State's colleges, they are seldom ever any of them elected to office of any kind. Many of them receive daily com-plaints from citizens about trivial mat-ters. Most of them take such patiently and try to explain the purpose of their work and the protection that it affords the people. The Health Bulletin as a monthly reminder throughout all these more than fifty years has served to keep before the people of the State many of the practical requirements of public health practice. All of the con-tributors and the editors who have managed the affairs of the Health Bul-letin and who have tried to get it out month by month throughout the years have always had uppermost in their minds the hope that they would be pro-viding information that might enable people to know how to protect them-selves from preventable diseases and untimely deaths. About 46,000 numbers go out each month. As was pointed out some time ago, the little publication goes each month to people living at nearly 1,400 out of the 1,500 post offices in the State, it goes into every county and to some readers on almost every rural delivery route in the State. The Editor is frequently encouraged in many imexpected ways. For example, sometime ago on a particularly blue Monday morning a card requesting that some special Uterature be sent to two individuals of a certain county was re-ceived. The card was dated at the par-ticular town mentioned simply "Simday night." It was sent in from a R. F. D. route and started off by saying: "Dear Editor, I hasten to assure you that your Health Bulletin is profitably read by many families who never write to say so." Then went on to add the names whom they wished to receive the Health Bulletin in the future. It is pleasant to think that the idea expressed by the writer that the publi-cation may be profitably read by fami-lies who never write to say so is a fact. Anyhow, it is hoped that that is a fact. An effort is always made in every Issue to January, 1951 The Health Bulletin 15 try to publish at least one article carrying information which would be helpful to any reader. That idea has been the key effort running through every issue of the publication for many years. It is pleasant to know that there are readers comprising hundreds of young people who have set up housekeeping and who are now rearing families of their own whose parents received the Health Bul-letin through the years and during which time the young folks became in-terested in the material published. In the beginning of this new year, it seems to many people that there are more problems confronting the world than at any time since the close of the Dark Ages. The complexities of modern life and the strain of living today puts greater stress on the nervous system of the average individual than probably ever before in the history of the world. It Is more necessary today to take thought of the physical, mental and moral health of the individual and of the public than ever before. On the other hand, more protection against pestilential diseases is afforded the peo-ple of the world today than ever before. In the past, great plagues such as yellow fever, bubonic plague, smallpox and other epidemic diseases have decimated the population of the world. It varies in the opinion of some historians to the extent of as much as 50 per cent of the population of the world at one time. With the exception of influenza, toward the control of which little progress has been made, the great cities and thickly populated sections of the world are in little danger. All of this is due directly to the protection afforded by the scient-ists and active workers in the public health field. In the year that the Health Bulletin was first published, it was the common rule in North Carolina for every family to have typhoid fever among some of its members before the children of the family reached maturity, and it has been estimated that at least one out of four members of the average family died of the disease before all the other children reached matiu-ity. The aver-age family lost a large per cent of the children born as a result of the diar-rheal diseases of childhood before reaching the end of the first year of life. There is a long way to go in the field of prevention of disease before the State reaches the position it ought to occupy as one of the low mortality States, in the matter of infant deaths and deaths from such diseases as diph-theria. Diphtheria can and should be completely prevented, but in the face of that fact the State has had a higher death rate from diphtheria and a high-er case rate during the last two or three years than most of the other States. In the field of total infant deaths, it has had a little better record, but not much. The discouraging feature of the past year's work has been that infant deaths have not continued the downward trend started the year before, but apparently a larger number have occurred than occurred in 1937, although complete and accurate data are not yet available. It is with confidence that the faces of public health workers in this State are set toward the future, and it is hoped that the new year will result in greater progress in public health work than ever before in the history of the organization." NOTES AND COMMENT June, 1939—"On the front cover this month, we are publishing a picture of the old Dr. Thomas Fanning Wood residence, 201 Chestnut Street, Wilm-ington, North Carolina, where the State Board of Health oflBce was first set up and operated for many years, and where the first issue of the Health Bulletin was published. That issue was April, 1886, 53 years ago. This picture was in-tended for the April issue of the Health Bulletin as an anniversary number, but illness of the editor prevented its ap-pearing at that time. As stated once or twice before in these columns, the Health Bulletin was founded by Dr. Wood while Secretary of the State Board of Health and issued regularly month by month from the OflBce of the Board of Health which was 16 The Health Bulletin January, 1951 his private office in Wilmington. The publication continued regularly until his death in August, 1892. Not long ago, the editor had the privi-lege of visiting in the home where Dr. Wood's two daughters, Misses Jane and Margaret Wood still live. They showed the editor the very room from which the Bulletin was issued through the years, from April, 1886 until his death in August, 1892. They informed the edi-tor that Dr. Wood had associated with him a young physician at that time by the name of Dr. Robert Jewett who as-sisted him in doing some of the writing and the routine work of the office. They said that Dr. Jewett was still living in retirement at his home on Greenville Sound in New Hanover Coiinty. On May 6, the Associated Press announced from Wilmington that Dr. Jewett had died that morning at the age of 79. As stated above, the Health Bvilletin was founded by Dr. Wood and his ad-visers among the membership of the State Board of Health. With just a few alterations, the size and general ap-pearance of the publication is the same today as it was the first issue. It is slightly larger and about twenty years ago, the present management of the Health Bulletin made some improve-ments in the title page and In page 3, which has been carried as changed ever since. Dr. Wood was made Secretary and the first State Health Officer following the creation of the State Board of Health by the Legislatvure in 1877. Dr. Wood was at that time practicing medi-cine in Wilmington. He was coming to be a botanist of national reputation which he carried on as a hobby. He had also founded and conducted for several years up to that time the North Caro-lina Medical Journal, now known as Southern Medicine and Surgery and published in Charlotte. Sometime after Dr. Wood's death. Dr. Jewett obtained control of the North Carolina Medical Journal and owned and published it for some foiu" or five years, when it was sold to Dr. Dickson Register, a native of Duplin County who was practicing medicine in Charlotte and coming to be at that time a widely known physician. At Dr. Wood's death, however, Dr. R. H. Lewis of Raleigh succeeded him as Secretary and State Health Officer and immediately moved the office of the I State Board of Health from Wilmington. to Raleigh. The Bulletin has been issued monthly from Raleigh ever since. Dr. Wood and Dr. Lewis were both, of course, part time State Health Officers. The two of them combined served for more than thirty years in the office. The first announcement of the pub-lication of the Health Bulletin was made at the Conjoint Session of the North Carolina State Board of Health and the North Carolina State Medical Society at New Bern on May 20, 1886. Dr. J. W. Jones of Tarboro was presi-dent of the North Carolina State Board of Health and in his annual report t» the Conjoint Session made the official announcement of the founding of the Health Btilletin in the following langu-age quoted from the transactions of the North Carolina State Medical Society for that year. The record of the Health Bulletin for the following fifty years must accord to Dr. Jones a place as a major prophet. But with what sacri-fice in time and labor only a few men know! Dr. Jones: "Gentlemen of the Medical Society and the State Board of Health: Prom time to time and little by little, we have gotten the ports of the North Carolina Board of Health together. We occupy it. It is in motion .... "The North Carolina Board of Health, organized and equipped in all it depart-ments (a part time State Health Officer, a part time stenographer, and a total annual appropriation of $2,000!—Edi-tor), with a monthly Bulletin of Health, through which we may communicate, correspond, and instruct, unites in Con-joint Session with the North Carolina Medical Society, to exchange views and purpose plans that shall best advance our common work of making our people healthier, happier, wealthier and wiser. MEDICAL LIBRARY U. OF N, C . CHAPEL HILL. N. C. TIT^ I TKis Bulletin will be sent free to dni| citizen of fKe 5fai-e upon requesi I Published monthly at the office of the Secretary of the Board, Raleigh, N. C. Entered as second-class matter at Postoffice at Raleigh, N. C. under Act of August 24, 1912 Vol. 66 FEBRUARY, 1951 No. 2 ^gSgSi Lake at Airlie Azalea Gardens, Wilmington, North Carolina MEMBERS OF THE NORTH CAROLINA STATE BOARD OF HEALTH G. G. DncoN, M.D., President Ayden Hubert B. Haywood, M.D., Vice-President Raleigh H. Lee Large, M.D Rocky Mount John LaBruce Ward, M.D Asheville Jasper C. Jackson, Ph.G Lumberton Mrs. James B. Hunt Lucama, Rt. 1 John R. Bender, M.D Winston-Salem Ben J. Lawrence, M.D Raleigh A. C. Current, D.D.S Gastonia EXECUTIVE STAFF J. W. R. Norton, M.D., Secretary and State Health Officer John H. Hamilton, M.D., Assistant State Health Officer and Director State Labora-torj^ of Hygiene C. C. Applewhite, M.D., Director Local Health Division Ernest A. Branch, D.D.S. , Director of Oral Hygiene Division A. H. Elliot, M.D., Director Personal Health Division J. M. Jarrett, B.S., Director Sanitary Engineering Division C. P. Stevick, M.D.. M.P.H., Director Epidemiology Division FREE HEALTH LITERATURE The State Board of Health publishes monthly The Health Bulletin, which will be sent free to any citizen requesting it. The Board also has available for distribu-tion without charge special literature on the following subjects. Ask for any in which you may be interested. Adenoids and Tonsils Hookworm Disease Typhoid Fever Appendicitis Infantile Paralysis Typhus Fever Cancer Influenza Venereal Diseases Constipation Malaria Residential Sewage Diabetes Measles Disposal Plants Diphtheria Pellagra Sanitary Privies Don't Spit Placards Scarlet Fever Water Supplies Flies Teeth Whooping Cough Tuberculosis Epilepsy, Feeble-mindedness, Mental Health and Habit Training Rehabilitation of Psychiatric Patients The National Mental Health Act. SPECIAL LITERATURE ON MATERNITY AND INFANCY The following special literature on the subjects listed below will be sent free to any citizen of the State on request to the State Board of Health, Raleigh, N. C. Prenatal Care. First Four Months. Prenatal Letters (series of nine Five and Six Months. monthly letters). Seven and Eight Months. The Expectant Mother. Nine Months to One Year. Infant Care. One to Two Years. The Prevention of Infantile Two to Six Years. Diarrhea. Instructions for North Carolina Breast Feeding. Midwives. Table of Heights and Weights. Your Child From One to Six Baby's Daily Schedule. Your Child From Six to Twelve Guiding the Adolescent CONTENTS Page Aqua Pura ^ Today's Community Concept Of School Health 5 "These Little Ones" 8 Notes and Comment 11 milPUBLISAED BYTAE N^A CAROLINA STATE B^ARD-^AEALTAIB VoL 66 FEBRUARY, 1951 No. 2 J. W. R. NORTON, M.D., M.P.H., State Health Officer JOHN H. HAMILTON, M.D., Editor AQUA PURA By William H. Richardson Raleigh, North Carolina The progressive action by which the citizens of Raleigh recently voted funds for the erection of a sewage disposal plant and the improvement of the pub-lic water supply, has focused attention upon water in its various uses and its association with Public Health. Water is one of the most important, and sometimes neglected, substances used in helping to sustain life. When you woke up this morning, you brushed your teeth, washed your face and hands, and, perhaps, drank copiously of re-freshing cold water from your faucet. The purposes for which water is used are very numerous. First, we consume it as something necessary to our health-ful existence. We use it for generating electricity for power and light, for bear- 1 ing commerce, and for various other purposes. We not only use water to cleanse the body, but the Christian Church uses it, sympolically, to cleanse the soul. Water plays a prominent part [ in certain purification rites in other re- 1 ligions. No greater calamity can befall a city or community than a water shortage or famine. We are giving much attention now to the preservation, or reconstruc-tion, of our drinking water supplies, in «case of atomic attack. We are also de-vising ways and means of protecting the population against mass slaughter, through germ warfare upon our water supplies. There is pending in the pre-sent Legislature a bill designed to cor-rect stream pollution. So much by way of introduction. When you drink a glass of water, do you think about the processes through which it has passed on its way from the source, out yonder somewhere, to your stomach? Have you ever visited your local water shed, or inspected the processes through which the water is purified in order that you may be pro-tected against water-borne diseases. And have you ever considered the years of scientific training required of the waterworks operator, and the important responsibility you have placed upon him to make sure you are getting a safe water supply? Just what does happen between source arid stomach? The State Board of Health maintains a division called the Sanitary Engineer-ing Division, which is vitally interested in your water supply, and through which services are performed about which you may know little or nothing. For the answer to the question, "What happens to drinking water, from source to stomach?" let us consult one of those in the Division above referred to who is concerned with that form of public ser-vice which guarantees you a pure water supply and consequent protection again-st disease. Two Primary Sources There are two primary sources from which our public water supplies must The Health Bulletin February, 1951 be derived. These are surface sources, such as lakes and streams, and under-ground sources that are brought to the surface through man-made wells or natural springs. Most public supplies are, because of the large volume requir-ed to supply communities, taken from rivers and creeks, which often are im-pounded to form large storage lakes — in fact, all of the major ones come from surface sources. To the average individual, it may ap-pear quite difficult to pump water from a river or creek and so treat it that it will be safe and palatable for use by human beings. Frankly, it is not a simple task; however, developments in the science of water treatment, brought about by extensive study and research on the part of sanitary engineers, scien-tists and the medical profession, have resulted in the perfection of processes, equipment, and knowledge of chemistry and bacteriology which make it possible to satisfactorily purify surface water for hvunan consumption. It is emphasized that a word of cau-tion is proper at this point. Surface streams which are overly-polluted, by domestic sewage or industrial wastes, either cannot be satisfactorily treated or the cost of treatment is prohibitive. In view of this, it is liighly desirable that every water consumer, and polluter alike, put his shoulder to the important and necessary problem of properly maintaining streams used as sources of water supply in North Carolina, in such condition as to permit their present and future use for this purpose. In many instances, the authority for this article points out, surface streams constitute the only adequate sources of public water supplies. The supplies de-rived from underground sources are obtained either from springs or wells. Water from wells and springs ordinarily is clear and satisfactory, without treat-ment. Nevertheless, in some cases, un-derground water contains minerals dis-solved from the water strata which impart either hardness, iron or other materials that make it undesirable for domestic use. In such cases, it must be treated by certain processes well known to the waterworks profession. Harmful Substances Removed The fact that most public water sup-plies are obtained from surface soiu-ces makes it necessary that the water be treated for the removal of substances which cause turbidity, color, or unde-sirable odors and taste. Treatment also must be provided to remove the harmful bacteria, thus pro-viding for your use and well-being a clear, sparkling, safe water. In the course of water purification, the treatment processes usually begin with the storage of water in lakes or reservoirs. Following storage, the water is pumped to modernly-designed and efficiently-operated plants where lime and alum are added and thoroughly mixed with the water, in specially de-signed mixing and coagulating basins. A gelatinous floe is formed in these chambers, which enmeshes the mud, color bodies and many of the bacteria in the water, which, when permitted to settle in the sedimentation basins, leaves the water clear. It is then passed through sand filters to remove any re-maining floe and turbidity, following which chlorine is applied to kill all harmful bacteria which may have sur-vived the previously mentioned treat-ment processes. But, the foregoing does not tell the entire story of the preparation and care that goes into the work of provid-ing a safe and palatable water supply. Even after clarification and disinfec-tion, water, being a luiiversal solvent, must be treated to prevent corrosion of the distribution system, which, if per-mitted, results in "red water" that will stain the lavmdry and the porcelain fixtures of the bathroom and kitchen and will produce unpleasant odors and taste. The above information has been given in an effort to better acquaint the con-suming public with the preciseness to which water works operators must ad-here and to the innumerable scientific details which are involved in producing February, 1951 The Health Bulletin a water supply that is both safe and suitable for your use. The information presented in this discussion, which is designed to empha-size one of the many services Public Health renders, was obtained from Mr. Earle C. Hubbard, Principal Sanitary Engineer, in the Sanitary Engineering Division of the State Board of Health, whose duties involve supervising the de-sign and operation of public water and sewerage systems, and advising muni-cipal and institutional oflBcials and their engineers regarding the type of facili-ties and water works materials needed to provide safe and adequate supplies. Approved Plants Safe In conclusion, Mr. Hubbard stated that water from all approved public supplies in North Carolina may be con-sumed with a feeling cf uerfect safety, because of the long -icUxS and hard work of those public officials whose duty it is to see that water offered for public consumption is safe. So, turn on your spigot and have a drink to the health of those who look after your water sup-ply and do not forget to let them know that their efforts are appreciated. This article is designed to give in-formation on what your State Board of Health is doing to protect you and yovurs against those illnesses which are pre-ventable and the conditions which bring them about. If you should ask your family physician to name the water-borne diseases to which you would be subject without a safe and pure water supply, his answer would include many which now occur only in rare instances, because of the fact that we have made such advances in the science of sanita-tion. The responsibility involved in the protection of your drinking water is only one of many which fall upon the shoulders of the Sanitary Engineering Division. This Division not only super-vises public water supplies as to their sanitation, but also is concerned with environmental sanitation, the inspec-tion of public eating places, milk, bed-ding and shellfish. It also has sections which are concerned with insect and rodent control. Many of the services performed by this Division of the State Board of Health are so routine that they are taken for granted. While the personnel of this Division is non-medi-cal, in the generally accepted term, they work under the direction of the medi-cal mind, even as all other enlisted in the service of Public Health. TODAY'S COMMUNITY CONCEPT OF SCHOOL HEALTH* Davh) Van deb Slice, M.D.,** Coordinator of Health Services Oakland Public Schools Great strides have been made in school health in the relatively short period since 1894, when the first school health program in the United States was established in Boston. In those days public schools were "hotbeds" of con-tagion," and it was not uncommon for school doctors to find children with diphtheria, whooping cough or scarlet fever in the classroom. The position that health occupies in the schools to-day is the result of an evolutionary pro-cess which can be roughly divided into five stages: Stage I was characterized by an ef-fort to detect and exclude those pupils who, because of communicable disease, threatened the welfare of others. In Stage II there was added the re-sponsibility of finding pupils with physi- •Reprinted with permission from Cali-fornia's Health. ••Prior to his appointment by the Oak-land Public Schools in August, 1950, Doctor Van der Slice served for two and one-half years as School Health Consultant for the California State Department of Public Health. This article was prepared during that period. 6 The Health Bulletin February, 1951 cal defects, and of taking steps to secure corrections. Stage III was marked by a growing consciousness that health activities were carried out not only for corrections but for educational values as well. Stage IV was marked by an expansion of Stage III, and included such con-cepts as: (a) all teachers are health teachers, (b) personal health includes physical, mental and emotional health, (c) the health program concerns itself with community as well as personal health, (d) health education is a 24- hour-a-day program—365 days a year, and involves the cooperation of the home and community agencies as well as the schools. Stage V, the present one, is marked by a growing realization on the part of schools, health departments, profession-al groups and community organizations of their interdependence in carrying out the school health program. They re-cognize that each has a contribution to make and that no one of them can do the job alone. Each advanced stage has included the best of the practices and experiences gained from earlier stages. School health programs have steadily increased in breadth of services and complexity of organization. Forty years ago all health responsibility in the school was assumed by the doctor or the nurse, but this is not the case to-day. Today the job is shared with tea-chers, parents, dentists and dental hy-gienists, psychologists, psychiatric so-cial workers and psychiatrists, health educators, counselors, students and others. This has required the setting up of machinery within the school for co-ordinating efforts of various profession-al workers and groups involved in the school health program. This has usually taken the form of a school health com-mittee, a health coordinator, or both. The modern school health program. to be most effective, must also be in proper relationship to oth.^r community programs of public health and child welfare. The idea that tl:i school health program should be an isolated endeavor, operating apart from the rest of the community is being strongly challenged. There is a growing acceptance of the fact that, in general, the school child's health reflects the foundation of his health laid during the preschool years, the health of his family and the ade-quacy of health facilities in the com-munity in which he lives. Parents have the primary responsi-bility for the health of their children. How well the family meets its respon-sibility in relation to providing food, , rest, recreation, and medical and dental services, plus a healthful environment, is a highly important factor in relation to the child's health status. The job of the school health worker is to help motivate the parent to carry out re-sponsibilities of the home and to stim-ulate citizens to provide necessary com-munity facilities. Today's community concept recognizes the advantages of integrating school health services with community health services, of promoting the health of parents, especially mothers during the prenatal period, and of providing con-tinued health supervision during in-fancy, childhood and adulthood. Not only do community health pro-gram activities affect the school child, but the family health status Ls fre-quently influenced through the school health program. For example, a nurse-parent conference or a medical exami-nation at school may reveal a family health problem of greater significance and urgency than the child's health problem alone. Clearly, solution of a family health problem also benefits the child. On every hand there is evidence of the ever-increasing interest and activity in school health work, not only by schools and health departments, but also by parent groups, medical and dental societies and other community agencies. Two years ago the National Congress of Parents and Teachers asked the House of Delegates of the American Medical Association to request state medical societies to appoint committees or arrange for representation in con-ferences in the .several states between medical societies, dental societies, health departments, educational agencies and February, 1951 The Health Bulletin the National Congress of Parents and Teachers, looking toward the improve-ment of health services and health edu-cation for school children. The Amer-ican Medical Association demonstrated its interest by calling two conferences, one in 1947 and the second in 1949, to define the role of the practicing physi-cian in the school health program. FYom these conferences came recom-mendations that every local medical society should appoint a school health committee to study ways in which the physician's time may be used more ef-fectively in the schools. Several local medical societies in California have al-ready appointed school health commit-tees which are cooperating with the schools in the development of the school health program. Another promising development in recent years has been the increase in cooperation between schools and health departments in relation to the school health program. Most states now have formal plans for cooperation between state health departments and state de-partments of education with respect to school health programs. In California the closely related work of the State Departments of Education and Public Health in their responsibilities for the health of the school-age child is co-ordinated through the California State Joint Committee on School Health. On the local level, an increasing num-ber of county and city joint school health councils are being formed in California. Some have been initiated by the schools, others by the local health department. While council representa-tion varies, it usually includes school administrators and teachers, members of the school health staff, health de-partment representatives, parents, re-presentatives of medical and dental societies, voluntary health agencies and other community organizations with a particular interest in child health. The school health council facilitates joint program planning and the formu-lation of policies to guide the school health program. Fullest use of com-munity resources is possible only when there is joint planning and active par-ticipation of many different community groups. Joint planning, with a sharing of re-sponsibilities for different aspects of the program, has become a more and more common practice, particularly in rural areas where neither schools nor health departments have sufficient staff or re-sources to carry out an adequate pro-gram alone. A division of responsibilities and a sharing of personnel between schools and health departments makes possible the fullest utilization of exist-ing facilities and permits the best use of professional skill and time. Almost universally, both schools and health departments are under-staffed and can-not afford to use the time of their per-sonnel for any but the most essential and most productive activities. They caimot afford the luxury of duplicating services. However, there are many communities in which this fine working relationship and this spirit of cooperation, which is so conducive to developing the best type of school health program, do not pre-vail. Although school health policies of a general nature have been formu-lated and approved by many national health and education organizations for at least 10 years, and are now well established, they affect school health practices in all foo few local areas. Joint planning of school health pro-grams would give an opportunity to re-view and discuss these policies in terms of how well they are fitted to local situations and to apply those which are workable. Joint planning opens the way to a critical analysis of the total school health program with a view of deter-mining what the needs are and then deciding how best they can be met re-gardless of what the traditional pat-tern has been. Some of the patterns in use today were established at the turn of the century and do not take into consideration the newer knowledge con-cerning the growth and development and the behavior of children, nor do they recognize improved school health methods and practices, which have de-monstrated their worth. There have been many recent ad- 8 The Health Bulletin February, 1951 varices in school health, such as: (1) the increased participation of the class-room teacher, (2) improved school health records (which more fully utilize the contribution of the teacher, nurse and physician), (3) improved screening devices to select pupils with probable vision defects and hearing losses, (4) greater participation by practicing physicians, (5) fewer but more thorough medical examinations giving priority to referred cases and new entrants, (6) the establishment of otological, cardiac and other diagnostic facilities which provide a more accurate diagnosis of pupil health problems, and (7) estab-lishment of more adequate special edu-cation facilities for children with handi-capping defects. Despite these examples of progress, many of the answers pertaining to the school health program are still un-known. There is a great need for experi-mentation. For example, there are great gaps in our knowledge concerning a proper secondary school health pro-gram. There is a need for trying new methods in an attempt to find out what works and what doesn't work under to-day's conditions. Continual program evaluation is needed in order for us to modify our activities and to make them more successful, retaining things that prove to be effective and dropping those which prove ineffective. #/THESE LITTLE ONES" By William H. Richardson Raleigh, North Carolina The challenge given by the Master, "Isasmuch as ye have done it unto one of the least of these, my brethren, ye have done it unto me," has come down through two thousand years of history as an inspiration to those who would help the weak, especially, little children. North Carolina's Public Health Pro-gram has been characterized by many helpful and worthwhile undertakings; but none of these, perhaps, has been more synonymous with the spirit of the Great Physician than the program de-signed to find, treat and rehabilitate children who, otherwise, might consti-tute a burden on society and go through life with a feeling of futility and a sense of their deformity. The Crippled Children's Section of the State Board of Health is a monu-ment to the untiring efforts of the late Dr. George M. Cooper, under whose direction this program was organized, in April 1, 1936, following the availabili-ty of Federal Social Security funds. Dr. Cooper, in his administration of the program, spent many sleepless hours, taxing his wits as to how the work might be continued. There were times when he was almost, but not quite, dis-couraged. Even though it was necessary, often, to scrape the bottom of the bar-rel for money with which to carry on the program, Dr. Cooper usually found a way. Let us consider, now, the way in which this program for these little ones is conducted. First, the child in need of treatment is located, usually by the Local Public Health nurse, or the family physician. Conditions For Acceptance The list of conditions which are ac-cepted by the Crippled Children's Sec-tion of the State Board of Health may be outlined as follows: Congenital ab- ; normalities, including harelip, cleft palate, dislocation of hip, club feet, missing or extra bones. Birth injuries, also, are included, as well as tubercu-losis of the joint, rickets, poliomyelitis, arthritis, osteomyelitis — which means infection of the bone—, curvature of the spine and burns. If the child is found to be in need of hospitalization, after passing through one of the clinics, and if the parents say Febriuiry, 1951 The Health Bulletin they are unable to pay for the services needed, application is made to the local welfare board, which investigates the case in question. If the child's parents are found to be actually unable to pay, the case is certified and the child is placed in a hospital. If the parents are able to pay all or part of the expenses incurred, an effort is made to work out a satisfactory plan for treatment. It might be well, just here, to consider the number of clinics conducted by local health departments, in cooperation with the State Board of Health and the Department of Vocational Rehabilita-tion. There are, at the present time, twenty-eight clinics, so well distributed that each child is within sixty miles of one of these. Taking part in the pro-gram, besides the local Public Health staffs, are thirty-one physicians. These include orthopedic surgeons, plastic surgeons and pediatricians. A report recently prepared by the Crippled Children's Unit shows that 11,998 exam-inations were done in 1949. There were, at the last count, twenty thousand children on the State register. In requesting a State appropriation of one hundred thousand dollars a year, it was pointed out to the legislative ap-propriations committee that there are no existing State funds to finance sur-gical care of indigent children, with cleft palates, congenital defects, deform-ities from burns, and orthopedic condi-tions in hospitals other than the State Orthopedic Hospital. This hospital, lo-cated at Gastonia, does not have facili-ties for all these conditions and does not have the capacity for all of the in-digent children needing care for prob-lems which it is equipped to handle. There have been over three thousand, five hundred cases of polio in our State during the past four years. This, of course, has increased the necessity for orthopedic treatment. Funds Once Exhausted Funds from all sources were exhaust-ed in 1949 and the work was stopped during the last quarter, except for emergencies. The State Board of Health asked a one hundred thousand dollar annual appropriation by the State in matching Federal funds for the next biennium. It is pointed out that this may mean an additional three hundred thousand dol-lars, annually, from Federal funds. Hence, this would be a sound invest-ment, aside from the humanitarian aspects of the program. No State match-ing funds, conceivably, may mean no State Board of Health Program for Crippled Children. Now that we have considered the mechanics of the program and have pointed out the desirability for adequate funds, let us consider some of the actual work which is done for these little ones, to set their feet in paths of usefulness and to hold before them, as they grow up, incentive enjoyed by their physical-ly fit companions and school mates. Authorization for hospitalization en-titles the child not only to treatment, including both orthopedics and plastic surgery, but to braces, crutches, casts, orthopedic shoes, and other corrective devices. Plastic surgery corrects de-formities from burns, harelips and the like. When the child leaves the hospital, it is subject to a follow-up program, during which systematic visits are made to the home, to see that the orthopedic recommendations are being carried out. From Birth to 21 Most of the clinics are held in local health departments and all persons from birth to twenty-one years of age are eligible. Incidentally, it may be pointed out that 1,253 children who needed treatment in 1949 did not receive it, because of inadequate funds. Of the polio victims, many still are in need of surgery. There is more hu-man interest, both concealed and vis-ible, in the rehabilitation of children than in almost any other humanitarian problem confronting the American peo-ple. When a child is born into this world, it comes not of its own accord, but "of the will of the flesh." It must accept conditions under which it is born, without recourse, and with no remedial measures at its command. Such children often are doomed to lives of hopelessness and their spirits com-pelled to live in bodies that are distorted 10 The Health Bulletin February, 1951 and deformed, which could be made normal, in a vast majority of instances, through modern orthopedic and plastic surgery. The matter of Crippled Children con-stitutes not only a Public Health prob-lem, but a stern public responsibility. We spend many thousands of dollars every year on methods designed to im-prove our crops and our farm animals. All this is necessary, of course, but of how much more value is a baby boy or girl than a baby cow or pig ! Within the memory of those now living in the present generation, bovine tuberculosis has been conquered in cows; through vaccination, hog cholera has been at-tacked, with success. As a result, we have better cows, which mean more money for their owners; we have better hogs, which means more money for meat; we have better peanuts to feed the hogs, because the Government guarantees the price of peanuts. Science Works Wonders We now see fewer deformed children, than in the past, it seems, but that is due to advances in plastic and ortho-pedic surgery; to Federal funds and, in some instances, to contributions from private philanthropic agencies, such as the National Foundation for Infantile Paralysis, and the North Carolina Lea-gue for Crippled Children. If you live in a county where an orthopedic clinic is held, it would pay you to visit the clinic and see just what is being done for the unfortunate child-ren of the State. The program for crippled children has been underway now long enough for some definite results to be evident. Many children who, but for this treat-ment, would never have been able to use their hands and feet, have been trained to become men and women with useful trades, following their physical rehabilitation. Some are shoe makers. some are operators of various machines, while others have learned to be radio repairmen and even watch repairmen. Pictures have been taken of children when treatment began, when their de-formities were very pronounced. Later, pictures of the same children reveal that orthopedic and plastic surgery could and did restore these children almost to a normal appearance. If one should think of a crippled children's clinic as a scene of gloom and despair, this would be an entirely er-roneous conception. When those in need of orthopedic and plastic repair work are taken to a clinic, every effort is made on the part of those in charge to dispel any fear or misgivings on the part of the child. If they are hospital-ized, the surroundings during treatment are made as bright and cheerful as those in any home, insofar as is hu-manly possible. Plenty of Incentive It is no wonder that the State Board of Health is making every effort to se-cure a yearly investment by the State of one hundred thousand dollars, in order to meet the requirement that Federal funds be matched. It is not always easy to secure appropriations, with so many demands being made on the public treasury, but experience in-variably has shown that money invested in building up wrecked lives has paid good dividends. Once the crippled child-ren's work is given adequate funds and the results demonstrated, there is little likelihood that these will be denied in the future. Already, a remarkable re-cord has been made by the Crippled Children's unit and those agencies which cooperate with it. Progress has been difficult, at times, and the way ahead has been uncertain, but surely success must crown the efforts of those who are trying so earnestly to re-build the lives of these little ones. February, 1951 The Health Bulletin 11 NOTES & COMMENT By The Editor DR. ELLIOT—On February 1st Dr. A. H. Elliot joins the staff of the North Carolina State Board of Health as the Director of the Division of Personal Health. Since 1931 Dr. Elliot has been Health Officer for the Consolidated Board of Health for the City of Wil-mington and New Hanover County. He is known throughout the State as a good health officer. His program in New Hanover County was well balanced and included most of the activities which are generally recognized as good public health procedures. Practically all of the activities considered to be a part of the responsibilities of the Division of Personal Health are component parts of Dr. Elliot's program as a County Health Officer. He will, therefore, be familiar with the broad phases of the work which he will confront in his new capacity. In succeeding the late Dr. George M. Cooper as the Director of the Division of Personal Health, has a difficult assignment. However, those of us who know Dr. Elliot have every con-fidence that he will do a creditable job. • * * * TUBERCULOSIS STATISTICS—We are including in this issue of the Bul-letin the vital statistics of tuberculosis which ordinarily would have appeared in the November issue. We hope that our tardiness in publication of this in-formation will not detract from the in-terest which this important information should command. * • * • REPORT ON STUDY OF REGIONAL BLOOD GROUP DISTRIBUTIONS The blood type of 141,774 men and women who voluntarily contributed blood to the American Red Cross from January 1948 through March 1949 is the subject of a report in the Journal of the American Medical Association. The information was gathered from 15 representative cities and their out-lying areas. The regions included : Yakima, Wash.; Rochester, N. Y.: De-troit; Massachusetts (^42.3 degrees lati-tude north); Omaha; Columbus, O.; Washington; St. Louis, Stockton, Calif.; Wichita, Kan.; San Jose, Calif.; Spring-field, Mo.; Charlotte, N. C; Los Angeles and Atlanta. The total percentage of persons fall-ing into each blood type from all 15 regions was as follows: O blood group, 45.55 per cent; A, 40.77 per cent; B, 9.96 per cent; and AB, 3.72 per cent. The O type blood can be used in all transfusions regardless of blood type of the recipient. "In the event of an emergency re-quiring large quantities of blood," the report said in part, "the southern areas now appear to be comparatively favor-able sources of O and the northern areas of B." The results showed, to some extent, that for each degree of latitude pro-ceeding from north to south the O group percentage increased, on the average, .32 per cent. Prom north to south the B group percentage decreased .17 per degree of latitude. No east-west trends were discovered. The report brought out that from re-gion to region the greater the O, A or B percentage, the smaller on the average was the percentage for the remaining groups within the trio, but AB group "tended to be stable." In conclusion the report said that "population changes could be respon-sible for marked changes (in regional location of blood types) within the span of a very few years." Associates of the American Red Cross who made the study were: George W. Hervey, Sc.D.; Dr. Louis K. Diamond and Virginia Watson, M.S., of Washing-ton, D. C. * * • * AMERICAN HEARING SOCIETY 817 14th St., N. W. Washington 5, D. C. Kenfield Memorial Scholarship In 1937 a sum of money was sub-scribed in memory of Miss Coralie N. 12 The Health Bulletin February, 1951 Kenfield of San Francisco, California, a teacher well known throughout the United States for her high ideals and advanced methods in teaching lipread-ing. This money, placed in the Kenfield Memorial Fund, is administered by the American Hearing Society and provides an annual scholarship. The amount of the Kenfield Memorial Scholarship for 1951 is one hundred dollars ($100.00). Applications for the scholarship will be considered from any resident of the United States who desires to teach lip-reading (speechreading) with or with-out other types of hearing and speech therapy, and who can meet the follow-ing requirements: A. Personal Well adjusted individual with a pleasing personality, legible lips, a good speech pattern and no unpleasant mannerisms. B. Education College graduate with a major in education, psychology, and/ or speech. If the applicant is hard of hearing, 30 clock hours of private instruction under an approved teacher of lipreading or 60 clock hours of instruction in public school classes under an approved teacher of lipread-ing are required. The winner of the scholarship may take the Teacher Training Course from any normal training teacher or school or university in the United States offer-ing a covurse acceptable to the Teachers' Committee of the American Hearing Society. The scholarship must be used within one year from the date the award is made. Applicants must be prospective tea-chers of lipreading to the hard of hear-ing. Those already teaching lipreading cannot be considered. Applications must be filed between March 1 and May 1, 1951 with: Miss Rose V. Feilbach Chairman, Teachers' Committee 1157 North Columbus Street Arlington, Virginia PLANS ANNOUl^ICEB FOR RAISING FUNDS FOR MEDICAL SCHOOLS Announcement was made of the formation of the American Medical Education Foundation, a not-for-profit corporation vmder Illinois laws, to raise funds from the medical profession to aid medical schools. The fund, initiated by a contribution of a half-million dollars voted by the Board of Trustees of the American Medical Association in December, has been widely acclaimed as one of the most constructive programs ever imder-taken by the A.M.A. "The medical schools of the United States stand in need of additional financial support if they are to con-tinue to provide the American people with physicians second to none in the quality of their education and training," said Dr. Elmer L. Henderson of Louis-ville, president of the A.M.A. "Since the tremendous advances in the health of the American people in the last 50 years have been due in large measure to the great improvements in medical education during the same peri-od, it is clear that insuring adequate financial support of our medical schools is vital to the present and futvu-e health of the nation." In annoimcing the formation of the foundation, the Jovu*nal of the A.M.A. urged the doctors of the nation to con-tribute promptly and generously. "It is plarmed that the foundation will coordinate its activities closely with other major efforts to raise funds for medical education from voluntary sources which it is hoped will be an-nounced shortly," said the Journal. "Because of rising costs, inflation, fewer large individual benefactions and reduced income from endowments, the medical schools need, without further delay, assistance of the type this fund can give. "It is the desire of the foundation that the first annual disbursement of funds to the medical schools be made this spring. It is clear that if the foun-dation's contribution is to be an effec-tive one, a substantial fund must be February, 1951 The Health Bulletin 13 raised by the medical profession within the next few months." The Journal further pointed out that almost every physician now practicing received his medical education for less than what it cost his medical school. It added that many physicians have discharged this debt to society in full or in part by public and charitable activi-ties and by donations to the schools with which they have been associated, but continued: "The medical profession has tradi-tionally accepted a large measure of re-sponsibility for the training of the con-tinuing flow of young physicians, on which it must depend for recruits and replacements in its efforts to serve humanity. "It is to be expected, therefore, that all physicians regardless of the other contributions they have made to so-ciety, will want to share in the responsi-bility of making the foundation a suc-cess. "The American Medical Association has indicated its belief that the pos-sibilities of securing adequate support for medical education from voluntary sources are far from exhausted." • « • * REPORT AIR TRANSPORTATION OF MOST PATIENTS POSSIBLE A study of the effects of air travel on 14,000 patients moved by the Military Air Transport Service between January and October 1949 shows that almost all patients suitable for transportation by other methods can be transported suc-cessfully by air. Colonel Benjamin A. Strickland, Jr., of the U. S. Air Force Medical Corps, and Dr. James A. Rafferty, Randolph Field, Texas, said in the Journal of the American Medical Association that air transportation of patients proved "so successful" that it has been adopted as the "sole method" of moving patients for the armed forces. This report is valuable to civilians as well as military personnel. "Today," the doctors explained, "much of the available expert specialized medi-cal care is concentrated in medical centers. In many instances patients re-quiring (specialized) care must be transported to such a center. "In general," they continued, "the routes, altitudes, weather conditions and types of aircraft utilized were identical with conditions of commercial airline operations." A total of 16,020 case reports were made on the 14,000 patients studied. It was necessary to make more than one report on some patients if the flight was a particularly long one or if the nursing personnel changed during the course of the flight. One third of the number were litter or stretcher cases. Only seven percent (1,135) of the case reports recorded symptoms of any kind during flight. Most of the symptoms-due to motion, effects of altitude or the disease itself—occurred at cruising alti-tude but they were of a "minor nature." No ill aftereffects were reported. Ninty- seven percent of the time simple treatment relieved the symp-toms. Most frequently the patient was merely asked to lie down. Only 1.1 per cent received medication and that con-sisted of such simple remedies as as-pirin, motion sickness preventives and similar medications. According to the report, extremely few patients were rejected for air evacuation. For example, among a ran-dom sample of 2,796 patients, only five were considered unsuitable for move-ment by air. The doctors added, how-ever: "In the selection of a patient for pos-sible transportation by air, certain im-portant factors must be considered. The effects of air travel on certain diseases and injuries must be viewed critically and each case considered individually. The effects of ascent to altitude, both a reduction in barometric pressure and the corresponding decrease in partial pressure of oxygen in the inspired air, may have profound effect on certain pathological conditions." * * « • A.M.A. SPONSORS TELEVISION DRAMA OF FAMILY DOCTOR A thirty-minute dramatized television show about a typical family doctor will be telecast on WABC-TV, New York, 14 The Health Bulletin February, 1951 at 8:30 (E.S.T.) Monday evening, Jan-uary 22, under the sponsorship of the American Medical Association, Dr. W. W. Bauer, director of the A.M.A. Bureau of Health Education, announced. Walter Hampden will star as "Doctor Webb of Horseshoe Bend." The story takes Dr. Webb, a fictitious but typical family doctor, and the young assistant who will take over his practice, through a typical and eventful doctor's day. Film kinescopes will be made of the program for subsequent use on other television stations. These kinescopes. Dr. Bauer said, will be available to local medical societies on application to the Bureau of Health Education about seven days after the New York telecast. "Dr. Webb of Horseshoe Bend," a Marshall-Hester Production, New York, is directed by Martin Magner. * * K * URGES TRADING AREA PRINCIPLE IN SELECTING WAR SERVICE DOCTORS The trading area principle should be used to determine in what communities physicians can be spared for military service dxiring a major war, says the Journal of the American Medical Asso-ciation. The Journal cites a bulletin of the Bureau of Medical Economic Research of the A.M.A. presenting for the first time the size and population of the 757 medical service areas in the United States. "Few of these boundaries coincide with the boundaries of states, counties and other political areas," the publica-tion says. "From the findings of the bureau one can determine the actual medical service areas served by physi-cians. Further study will reveal what medical coverage actually is available for the population of each area." * « * • URGE MORE EXPENDITURES FOR PREVENTION OF BLINDNESS In 1949 more than $125,000,000 in tax and private funds was spent for care and services to the blind. Money avail-able for research in the blinding eye diseases for the same year was less than $1,000,000. Less than $500,000 was spent for organized prevention services. This striking contrast between the funds used for aid to the blind and those used for the purpose of prevention and research is brought out by Drs. Walter B. Lancaster, Boston, and Franklin M. Foote, New York, in the Journal of the American Medical Asso-ciation. Dr. Lancaster is an ophthalmologist, a specialist in diseases of the eye. Dr. Foote is associated with the National Society for Prevention of Blindness, New York. "We should not reduce activities for those already blind," the doctors point-ed out, "but by increasing what we are doing now to enable persons to keep their sight we can gradually reduce the number of unnecessarily blind." The report estimated that about 22,- 000 people each year have their vision reduced to one tenth of normal vision. Blindness is a major public health problem, the doctors said, not merely because of its incidence but also because the bUnd man or woman lives on for many years often partly or wholly de-pendent on others. Based on information covering 3,905 children in schools and classes for the blind and 46,537 adults receiving aid to the blind, it is estimated that blindness in all ages is due to infectious diseases in 22.5 per cent of the cases, to injury in 9.3 per cent, poisonings in 0.6 per cent, tumors in 0.9 per cent, general diseases in 5.5 per cent, prenatal origin in 12.2 per cent and causes unknown to science in 29.9 per cent. The remainder are of undetermined or unspecified origin. Of the blindness resulting from in-juries, about half are of occupational origin. The others are due to accidents at play or in the home. From 1936 to 1948 a 25 per cent de-crease in blindness among children in schools for the blind as a result of eye injuries was noted. This encouraging drop was attributed by the doctors as partly due to "wise legislation which has been adopted in 10 states to regulate the use of air rifles by children and in 29 states to control the sale of fire-works." February, 1951 The Health Bulletin 15 Deaths From Tuberculosis By County, Type, and Color: North Carolina, 1949 PLACE OP DEATH COUNTY TOTAL RESPIRATORY OTHER 16 The Health Bulletin February, 1951 Deaths From Tuberculosis By County, Type, and Color: North Carolina, 1949 MEDICAL LIBRARY U. OF N. C . CHAPEL HILL, N. C. Ii]I(MiIifc iSm P \ TKs BuUetin will be sehi free to dnu citizen of tKe Sktfg upon requcsi I Published monthly at the office of the Secretary of the Board, Raleigh, N C Entered as second-class matter at Postoffice at Raleigh, N. C. under Act of Augus* 24, 1912 MARCH, 1951 No. 3 ^^.^*>i .w ^ y/»yiiiSS' ^^•^i-.^y fMijvvfiffi^.ffi'^f.^ ^^^ IN AIRLIE GARDENS, WILMINGTON, NORTH CAROLINA ^DSMBERS OF THE NORTH CAROLINA STATE BOARD OF HEALTH G. G. Dexon, M.D., President Ayden Hubert B. Haywood, M.D., Vice-President Raleigh H. Lie Large, M.D Rocky Mount John LaBruce Ward, M.D Ashevllle Jasper C. Jackson, Ph.G Lvunberton Mrs. James B. Hunt Lucama, Rt. 1 John R. Bender, M.D Wlnston-Salem Ben J. Lawrence, M.D Raleigh A. C. Current, D.D.S Gastonla EXECUTIVE STAFF J. W. R. Norton, M.D„ Secretary and State Health Officer John H. Hamilton, M.D., Assistant State Health Officer and Director State Labora-tory of Hygiene C. C. AppLEAVHrrE, M.D., Director Local Health Division Ernest A. Branch, D.D.S., Director of Oral Hygiene Division A. H. Elliot, M.D., Director Personal Health Division J. M. JARRETT, B.S., Director Sanitary Engineering Division C. P. Stevick, M.D., M.P.H., Director Epidemiology Division FREE HEALTH LITERATLTIE The State Board of Health publishes monthly The Health Bulletin, which will be sent free to any citizen requesting it. The Board also has available for distribu-tion without charge special literature on the following subjects. Ask for any in which you may be interested. Adenoids and Tonsils Appendicitis Cancer Constipation Diabetes Diphtheria Don't Spit Placards Files Typhoid Fever Typhus Fever Venereal Diseases Residential Sewage Disposal Plants Sanitary Privies Water Supplies Whooping Cough Hookworm Disease Infantile Paralysis Influenza Malaria Measles Pellagra Scarlet Fever Teeth Tuberculosis Epilepsy, Feeble-mindedness, Mental Health and Habit Training Rehabilitation of Psychiatric Patients The National Mental Health Act. SPECIAL LITERATURE ON MATERNITY AND INFANCY The following special IKerature on the subjects listed below will be sent free to any citizen of the State on request to the State Board of Health, Raleigh. N. C. Prenatal Care. Prenatal Letters (series of nine monthly letters). The Expectant Mother. Infant Care. The Prevention of Infantile Diarrhea. Breast Feeding. Table of Heights and Weights. Baby's Daily Schedule. First Four Months. Five and Six Months. Seven and Eight Months. Nine Months to One Year. One to Two Years. Two to Six Years. Instructions for North Carolina Midwives. Your Child From One to Six Your Child From Six to Twelve Guiding the Adolescent CONTENTS Page The Right to Health as a Basis for Human Rights 3 Life and Death in 1950 8 Notes and Comment H PUBLI5AED BYTAE NORTA CAROLINA STATE 6*>AF\D>/AEALTA |B Vol. 66 MARCH, 1951 No. 3 J. W. R. NORTON, M.D., M.P.H., State Health Officer JOHN H. HAMILTON, M.D., Editor THE RIGHT TO HEALTH AS A BASIS FOR HUMAN RIGHTS William P. Richardson, M.D., Director Department of Field Training, School of Public Health University of North Carolina, Chapel Hill, N. C. Most of us accept without question the principle that the right to health is one of the fundamental human rights, as is enunciated in the Universal Decla-ration of Human Rights adopted by the United Nations, but we are not always clear as to all the factors involved in the implementation of this right. The present discussion will undertake to analyze these factors and to look briefly at our progress and needs with respect to them. The "Right to Health" is set forth in Article 25 of the Universal Declaration of Human rights, which reads as follows: "Everyone has the right to standard of living adequate for the health and well being of himself and of his famUy, including food, clothing, housing, and medical care, and necessary social services, and the right to security in the event of unemployment, sickness, disability, widowhood, old age, or other lack of livelihood in circum-stances beyond his control." Of primary significance, of course, in the interpretation of this statement is the definition of the word health. The World Health Organization gives us in its constitution what is probably the most comprehensive definition. It states : "Health is defined as a state of complete physical, mental, and social well-being, not merely the absence of disease or infirmity." If we paraphrase the declaration, then, using this definition we have: "Everyone has the right to standard of living adequate for a state of com-plete physical, mental, and social well-being for himself and his family, in-cluding food, clothing, housing, medi-cal care, and necessary social services." Stating the Declaration this way serves to emphasize a point which I feel should be basic to oiu- thinking, and that is that health in the broad sense is a function of all the factors which enter into what we usually refer to as standard of living, and not simply of health and medical services. These health and medical services are of vital importance to the attainment and pre-servation of health, but they are only one of the necessary factors. In this country we have been devoting a great deal of attention to public health serv-ices, hospitals, and medical care, and we are sometimes prone to overlook the fact that even though these things were entirely adequate, they would not assure the individual of a "state of complete physical, mental, and social well-being" in the absence of economic security, de-cent housing, proper diet, and education in health matters. I want to devote the major part of this discussion to an analysis of health and medical services, but I would like first to emphasize the importance of The Health Bulletin March 1951 these other factors so that as we think and talk about doctors, nurses, health departments and hospitals, we may place them in their proper perspective in relation to the total picture of factors essential to health. A few examples will serve to illustrate the point. Forty years ago hookworm was a major cause of ill health in North Carolina. Today, although it still exists, it is a very minor problem. This reduc-tion has been due in no part to medical treatment of individual cases, and to only a limited extent to the health and sanitation program. More important factors have been the decline in the number of children who go barefooted and the rising standard of living with its effect on practices of excreta dis-posal at the individual home. At the time of the first world war and through the early years of the great depression pellagra was widespread in North Carolina. Today it is a minor problem. The most significant contribu-tions to this decline have been made by factors other than medical and health services, among them improved imder-standing of nutritional needs, rising standard of living, and changes in our agricultural economy resulting in more food and feed crops, livestock, poultry, and dairying. Malaria in the South has been re-duced to a negligible problem as much by the urban trend and screens as by drainage, spraying and the like. In more underprivileged areas of the world the importance to total health of social and economic factors is even more striking. World Health Organization has set out to attack several of the specific diseases affecting wide areas of the world—malaria, typhus, cholera, and certain parasitic diseases. Although some of these efforts are meeting with grati-fying success—as in the case of malaria —already it is becoming obvious that these eradication efforts will be of only limited and temporary benefit unless the general standard of living can be raised, imless soil erosion can be check-ed, water resources developed, agricul-ture modernized, and standards of hous-ing and basic sanitation Improved. These examples will suffice to Illu-strate the importance to health of these economic and social factors. Now to consider the right to health with specific reference to the area of health and medical services. Within this area what are the elements essential to the im-plementation of the right to health? I would suggest five: 1. The protection afforded by an or-ganized preventive and public health program, bringing to the individual the benefits of scientific developments which can be most effectively applied for the protection and promotion of health through a commvmity approach. 2. An adequate number of hospital beds, health centers and laboratories, meeting acceptable standards, and con-veniently accessible to all the people. 3. An adequate number of the scienti-fic persoimel — physicians, dentists, nurses, public health workers, and auxil-iary personnel—required to render need-ed care. 4. A comprehensive program of health information and education by all groups and agencies concerned with health care, to the end that the individual may have an imderstanding of the factors concerned with his personal health, of how he can make the most intelligent and effective use of the facilities avail-able, and of his part in supporting these facilities. 5. A method of financing services and facilities which makes them available to the individual on a basis which he can afford, and which preserves his dignity and self-respect. Now let us look briefiy at each of these elements and see how adequately they are met in the United States and in North Carolina, and what are some of the special needs. First, preventive and public health programs. While such programs are a responsibility shared by the full-time local health department with other groups, it is generally recognized that the service of such a department is a basic necessity, and the extent and ade-quacy of full-time local coverage gives us a rough measure of achievement in this regard. Of 3100 countries in the United States only 1900 have full-time local health departments at the present March. 1951 The Health Bulletin time. Of course many of the 1200 coim-tles without such service are small, but many of them are not, and of the 1900 counties with the coverage, relatively few meet minimimi standards of ade-quacy as to numbers and qualifications of personnel. Moreover nearly a third at last reports had a vacancy in the position for health oflBcer. In North Carolina we are somewhat better off than the country as a whole. We have health departments covering the entire 100 counties. However, our ratio of public health nurses to popula-tion is only a little more than half of approved standards, 1 to 9,000 as against a standard of 1 to 5,000, and there are nine health officer vacancies, affecting 13 counties. Next let us look at the physical facili-ties of health care: hospitals and health centers. The United States has around a million and a half hospital beds of all kinds. Approximately 44% of these are general beds, the balance being for mental, tuberculosis and chronic pa-tients. Nearly a third of these are un-satisfactory by the standards established by the Public Health Service imder the Hospital Construction Act, so that it was estimated by the National Health As-sembly in 1948 that a total of 900,000 new and replacement beds were needed. Some progress, of course, has been made under the Hospital Construction Act, but making up a deficit of this magni-tude will be a matter of years, since both personnel and construction are in-volved. In North Carolina we have a total of 27,400 beds of all types, of which 13,500, or about half are general beds. These general beds comprise 74% of those we need according to P.H.S. standards. We will, when present construction is com-pleted, meet the required number of beds for tuberculosis, but we have only 54% of the needed beds for mental patients and only 3% of the needed beds for chronic patients. As to this deficit of mental beds the view has been expressed that the standard for mental patients is too high if adequate personnel and facilities are provided so that all pa-tients are cured or improved who are susceptible of cure or improvement. In other words, it will not take as many beds if our mental hospitals can provide real therapeutic services rather than the largely custodial care they have been providing. I am inclined to agree with this point of view, which would reduce our deficit of mental beds to around 28%. With respect to health centers, the standards as to the number needed are not very satisfactory. Certainly, how-ever, we can figure at least one per county. Both in the country as a whole and in North Carolina we have made but a beginning on these facilities. When projects already approved in North Carolina are completed we will have the health departments in 25 of our 100 counties housed in reasonably adequate health centers, the other 75 being housed in quarters inadequate in size or ap-pointments, or in imsatisfactory loca-tions. The National Health Assembly made the point that effective and economical health service will require a great deal better integration than exists at present of the facilities within a given com-mimity and the facilities within a region. This is one of the more difficult problems we face but it is of vital im-portance that we begin giving it very serious attention because without pro-per integration we will not get the serv-ice to which we are entitled for the in-vestment we are making. The third element in health and medi-cal services is personnel. In estimating personnel needs I have used 1960 as the date of reference since that is the date on which the National Health Assembly and several recent studies of nursing needs have based their estimate. The figiu-es quoted represent the more con-servative of the available estimates. As to physicians, the present annual rate of graduation nationally is 1500 less than will be required to give us the number of physicians we will need by 1960. It is likely that the deficiency will not be quite so great as this figiu-e would indicate, since there are several new medical schools in prospect—in-cluding our own at the University—but it promises to be of significant propor-tions nevertheless. Of perhaps greater significance than the deficit in numbers The Health Bulletin March 1951 is the problem of maldistribution. While the urban areas generally have an ade-quate number of physicians, many smaller communities and rural areas have none. With respect to the dearth of physi-cians in these smaller communities it should be pointed out that this is often the fault of the communities them-selves. They move heaven and earth to get a physician to locate there, and then go to a not-too-distant larger center for their medical care except when they need a doctor at night or in bad weather. And then they wonder why he doesn't stay. There are several categories of physi-cians in which the shortage is acute: Psychiatrists Negro Physicians Physicians in government services Public health physicians As to dentists most of us have enough personal difficulty getting dental ap-pointments to realize that there is a serious shortage, although standards as to the number of dentists who will be needed once the great backlog of dental needs in the population has been dis-posed of are not as well established as is the case with physicians. The Na-tional Health Assembly estimated a shortage by 1960 of 8,000. The shortage of dentists is most acute in the same areas as physicians, rural communities, public health, government services, and as respect negro dentists. In both physi-cians and dentists North Carolina ranks in the lower group of states. In the field of nursing personnel the shortage is serious at all levels from trained practical nurses to top flight educators and administrators. Best esti-mates place the shortage by 1960 at 100,- 000 to 125,000 unless the number of nurses graduated can be greatly step-ped up. Coupled with shortage of num-bers are grave deficiencies in educa-tional program and facilities. A recently completed two-year survey of nursing problems in North Carolina highlights the inadequacies of many of our schools of nursing, and points out that it will be necessary to double the number of our nursing graduates in order to pro-vide for our nursing needs by 1960. The shortage of personnel in the var-ious related and auxiliary fields is of somewhat the same magnitude as physi-cians, dentists and nurses. In consider-ing oiur personnel needs it is necessary, of com'se, to distinguish between needs as determined by standards', and effec-tive demand. The estimates I have given are based on standards, and whether or not the effective demand will be that great will depend on many factors, but perhaps largely on the prosperity level. We have referred before to the short-age of public health personnel. Based on minimum standards of the number of personnel needed for full coverage of the United States with local health service we will need the following num-bers, in addition to people now em-ployed: 1.500 more physicians 19,000 more nurses 4,000 more sanitation workers Smaller numbers of dentists, health educators, laboratory workers, etc. The outlook as regards personnel is further clouded by the plight of our professional schools. Costs have advanc-ed so drasticly and income has lagged so seriously that many medical, dental, and nursing schools are in a critical situation, and their continued progress, and even existence, may depend on some form of Federal aid or support. The fourth element in health care is health instruction and information. This does not lend itself to the kind of ex-plicit definition and measurement we have used on facilities and personnel, but it is of such importance to the ful-fillment of the "right to health" that it requires some emphasis. Health edu-cation— to use a rather inadequate term —is a responsibility of all the groups and agencies concerned in any way with health programs and health care: our schools and educational institutions, public health agencies, the various health professions, and voluntary health organizations. It needs to be directed toward the goal of giving the individual in.sight in at least three areas: 1. The personal practices which make for healthful living—all those factors in our habits and way of life which are March, 1951 The Health Bulletin conducive to emotional and physical health. 2. The immunizations and health supervision each individual should have, the kinds of ill health which may threaten him, and symptoms which should warn him to seek medical atten-tion. 3. The elements involved in the pro-vision of complete health care to the community, how he can use these most effectively, and the coop>eration he must give if they are to function economically, and to the greatest satisfaction of the individual and the community. You can see that the provision of this kind of information and understanding is a major and continuing task in which many groups and agencies have a heavy responsibility. If it is not provided no degree of adequacy in available services will suffice to give us that "state of com-plete physical, mental and social well-being" which we call health. The fifth and final element in the right to health is a method or combina-tion of methods which makes it possible for each individual to secure adequate health and medical services at a cost which he can afford, and under a sys-tem which preserves his dignity and self-respect. Let us consider briefly some of the facts of this problem of financing medi-cal costs. There are two facts which Immediately stand out: 1. The greatly increased expensiveness of medical and hospital care in recent years. 2. The irregular and unpredictable in-cidence of medical costs. There is no question about the ex-pensiveness of medical and hospital care today. The new techniques of examination and treatment and the new therapeutic agents, which have multiplied the effectiveness of medical diagnosis and treatment, cost a lot of money. These costs can be tempered in a measure by more economical admini-stration, better coordination among the various individuals, groups, and facili-ties providing care, by expansion of group practice and by less demand on the part of patients for luxury care and facilities, but even with all possible economy the costs of good care are still high. The distribution of the medical care dollar among the various items of ex-penditure is interesting, and perhaps not quite what most of us would expect. Around 25 cents goes for physicians' services, 21 cents for hospitalization, 14 cents for dental care, 21 cents for drugs, and 19 cents for nursing and all other care. The population can be divided into tliree groups so far as their ability to pay the costs of medical care is con-cerned : 1. The indigent and medically indi-gent who can pay for none or only a small part of their care. 2. The great middle income group who could pay their medical costs if they were spread out uniformly, but whose financial competence is jeopardized by prolonged and major illness. 3. The relatively small percent able to meet any eventuality. $2000 a year would appear to be the minimum income on which a family could be expected to pay for even normal routine medical costs without assistance. In 1946 twenty eight percent of in-dividuals and families had an income of less than this figiore. Government clear-ly has the major responsibility for financing medical care for this group through some plan which assures them of adequate care, and which does not pauperize them or offend their self re-spect. This is a responsibility which is being met very unevenly and inade-quately in the country as a whole. And it is worth noting that the compulsory health insurance plans which have been proposed would not take care of this group. It is around the needs of the second group, who can meet their medical costs if they can be spread out through some kind of prepayment or insurance plan, that the greater part of current discus-sion has centered. There is general agreement that the principle of contri-butory health insurance should be the basic plan of financing medical care for a large majority of the American people, but there is wide divergence as to whether this can be accomplished by 8 The Health Bulletin March 1951 voluntary prepayment plans, or whether it will require a compulsory national plan. The National Health Assembly of 1948 expressed the conclusion that "voluntary prepayment group health plans, embodying group practice and providing comprehensive service, — are the best available means at this time of bringing about improved distribution of medical care." There are, of course serious problems which have to be solved if voluntary plans are to meet the country's needs. There is first of all the difficulty of en-rolling and collecting from individuals who do not belong to a group which can be enrolled en masse, and for which payment can be made by payroll de-duction. The most difficult group to reach, and one which particularly needs the protection is the rural group. It is vitally essential that some economical way be found of promoting and handling prepayment insurance among rural peo-ple. Another problem is that of over-use and abuse which can impose so heavy a burden on the program that rates will have to be set too high for many of the people who need the protection most. This is a problem which involves under-standing and acceptance of responsibili-ty for avoiding unnecessary hospitaliza-tion and care by both patients and physicians. We can summarize briefly, then, what we have been saying: 1. Health and medical services are only one factor entering into the im-plementation of the "right to health." Economic and social factors such as housing, good wages, steady employ-ment, and recreation are likewise es-sential. 2. The essential health and medical services include an adequate public health program, adequate hospital and health center facilities, an adequate number of properly trained professional personnel, a comprehensive program of health education, and a satisfactory method of financing the costs of medi-cal care. 3. There is a shortage of all categories of health personnel. This is especially marked with respect to nurses, to rural areas, and to negro physicians and den-tists. 4. The problem of more adequate sup-port for professional schools training health personnel is an urgent one, with Federal assistance probably the ultimate answer. 5. Contributory health insurance is generally agreed to be the basic method by which the majority of the American people may best finance the costs of medical care. Voluntary prepayment plans, Blue Cross and Blue Shield, offer the most efficient means of providing this insurance. Two problems of these plans challenge the best efforts of the health professions and the public: the prevention of over-use and abuse, and the development of effective and eco-nomical methods of enrolling our rural population. 6. Although we have made magnificent technical progress in health and medical care, there remain serious problems to be solved before we approach attain-ment of the objective set forth by the National Health Assembly that "ade-quate medical care for the prevention and relief of sickness, and the promo-tion of a high level of physical, mental, and social health should be available to all without regard to race, color, creed, residence, or economic status." LIFE AND DEATH IN 1950 William H. Richardson Raleigh, N. C. How many of you, especially if you are among those in middle or late life, know definitely that your hearts are sound? How many of you are certain that your blood pressure is not abnorm-ally high; and how many know that you have neither cancer, nor any of its danger signals. You can receive none of March, 1951 The Health Bulletin 9 this information except from a quali-fied physician, and even then, only after a thorough physical examination. There was a very definite motive be-hind the asking of the above questions. Out of a total of 31,257 deaths from all causes in North Carolina, last year, 16,- 625 were attributed to diseases of the heart, apoplexy, and cancer. This total is revealed in the provisional vital sta-tistics report for 1950, compiled by the State Board of Health. The total num-ber of deaths from the same causes in 1949 was only 15,525. When more than one-half of all deaths occurring in the State, in a single year, result from just three diseases, we have much food for thought. There was a substantial increase in deaths from all three of these causes, namely, diseases of the heart, apoplexy and cancer, in 1950. As a matter of fact, for some years, there has been a very pronounced up-ward trend in these figures. However, there appears one oasis in the desert of degenerative diseases, among which the above are classed. The bright spot re-ferred to is the sustained downward trend in deaths from nephritis. From this cause, there were 1,416 in 1950, com-pared with 2,141 in 1949. This compari-son reflects a decrease of 725 deaths from nephritis, or Bright's disease, in a single period of twelve months. The decline has been evident now for several years, and it is sincerely hoped that it will continue. In comparison, 910 more people died of heart disease in North Carolina in 1950 than in 1949; 107 more died of apoplexy and 83 more of cancer. Top Bracket Killers If we add to these three causes of deaths in North Carolina last year, the totals of nephritis and all accidents, we have a total of 20,381. As has previously been stated, deaths from all causes, in 1950, numbered 31,257. Incidentally, this reflects a decrease in all deaths of 159. The decrease in the total number of births was much greater, being 2,781. That is to say, there were only 106,686 live babies born in North Carolina last year, as compared with 109,467 the pre-vious year. During the period under comparison, death claimed 3,691 babies under a year old. This was a substantial decrease under the 4,155 infant deaths in 1949. Last year, 2,688 babies in North Carolina were born dead. This figure was slightly under that of the preceding year. Now that we have considered the top bracket killers in North Carolina, it might be well to acquaint you with some figures relative to those diseases which formerly took a heavy toll of life each year, but have been brought well under control. For many years, the sceptre was held by tuberculosis which remained the king of killers, for decade after de-cade. In years gone by, when one was told that he or she had tuberculosis, or consumption, funeral preparations were begvm. In fact, the patients sometimes were not told imtil their conditioH be-came evident to themselves. Tubercu-losis, at one time, wa |