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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
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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