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WAs^ia-ia^^
MEDICAL LIBRARY
U. OF N. C
.
Cjlj^ CHAPEL HILL. N. C
I This Bulletin wJl be sent free to on^dtizerv of the State vipon request!
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. 64 JANUARY, 1949 No. 1
Paul Pressley McCain, M. D.
1884-1946
MEMBERS OF THE NORTH CAROLINA STATE BOARD OF HEALTH
S. D. GILA.IG, M.D., President Winston-Salem
G. G. DIXON, M.D., Vice-President : Ayden
H. LEE LARGE, M.D Rocky Mount
W. T. RAINEY, M.D., ,_„^_,„ ^. »...s Fayetteville
HUBERT B. HAYWOOD, M.D '.;.......; .;..... Raleigh
J. LaBRUCE WARD, M.D - AsheviUe
J. O. NOLAN, M.D , Kannapolis
JASPER C. JACKSON, Ph.G ; Lumberton
PAUL E. JONES, D.D.S Farmville
EXECUTIVE STAFF
J. W. R. NORTON, M.D., M.P.H., Secretary and State Health Officer
G. M. COOPER, M.D., Assistant State Health Officer and Director Division of Health Education,
Crippled Children's Work, and Maternal and Child Health Service
, Director, Division Local Health Administration
, District Director, Local Health Administration
ERNEST A. BRANCH, D.D.S. , Director, Division Oral Hygiene
JOHN H. HAMILTON, M.D., Director, Division of Laboratories
J. M. JARRETT, B.S., Director, Division of Sanitary Engineering
OTTO J. SWISHER, M.D., Director, Division of industrial Hygiene
BERTLYN BOSLEY, Ph.D., Director, Nutrition Bureau
FELIX A. GRISETTE, Director, Venereal Disease Education Institute
C. P. STEVICK, M.D., M.P.H., Director, Division of Epidemiology and Vital Statistics, and
Co-Director, School-Health Coordinating Service
WILLIAM A. S.MITH, M.D., Director, Bureau of Tuberculosis Control
IVAN M. PROCTER, M.D., Director, Bureau of Cancer Control
HAROLD' J. MAGNUSON, M.D., Director, Reynolds Research Laboratory, Chapel Hill
JOHN J. WRIGHT, M.D., Director, Field Epidemiology Study of Syphilis, Chapel Hill
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 distribution without charge special
literature on the following subjects. Ask for any in which you may be interested.
Adenoids and Tonsils German Measles Sanitary Privies
Appendicitis Health Education Scabies
Cancer Hookworm Disease Scarlet Fever
Constipation ' Infantile Paralysis Teeth
Chickenpox Influenza Tuberculosis
Diabetes Malaria Typhoid Fever
Diphtheria Measles Venereal Diseases
Don't Spit Placards Padiculosis Vitamins
Endemic Typhus Pellagra Typhoid Placards
Flies Residential Sewage Water Supplies
Fly Placards Disposal Plants Whooping Cough
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, North Carolina.
Prenatal Care Baby's Daily Schedule
Prenatal Letters (series of nine First Four Months
monthly letters) Five and Six Months
The Expectant Mother Seven and Eight Months
Infant Care Nine Months to One Year
The Prevention of Infantile Diarrhea One to Two Years
Breast Feeding Two to Six Years
Table of Heights and Weights Instructions for North Carolina .Midwives
CONTENTS Page
Tribute Paid to Late Dr. Paul P. McCain 3
Introduction of Justice Rutledge 3
Paul P. McCain 4
Acceptance of Portrait of Doctor Paul McCain 7
The Health Department and the Food of the People 8
Narrative Report J3
Blood Derivatives Important for Medicine, Research lo
The Kenfield Memorial Fund 16
Vol. 64 JANUARY, 1949 No. 1
J. W. R. NORTON, M.D., M.P.H., State Health Officer JOHN H. HAMILTON, M.D., Acting Editor
TRIBUTE PAID TO LATE DR. PAUL P. McCAIN
A portrait of the late Dr. Paul P. Mc-
Cain was unveiled in the lobby of the
main building of the Sanatorium at
dedication ceremonies on Tuesday, De-cember
7. The portrait, a gift of the
State Medical Society, was unveiled by
Sarah Johnson McCollum, only grand-daughter
of Dr. McCain, and daughter
of Mr. and Mrs. N. M. McCollum of
Leaksville, North Carolina.
,i)r. Paul F. Whitaker, chairman of
.,th£ McCain Memorial Committee of
the State Medical Society, presided over
the dedication ceremony and presented
Justice Wiley Rutledge of the United
States Supreme Court, who delivered
the dedication address.
-; Mrs. Paul McCain, wife of the late
Dr. McCain, was the guest of honor at
the ceremonies. Other members of the
family present were: John McCain of
Chapel Hill; Mrs. N. M. McCollum, of
Leaksville; Dr. Irene McCain McPar-land,
of Philadelphia; and Miss Jane
Todd McCain, student at Agnes Scott
College in Georgia, all children of Dr.
and Mrs. McCain; and Mr. Charles Mc-
Cain of Birmingham, Alabama, brother
of Dr. McCain.
The portrait was painted by Prank
Benson of the National Art Galleries
in New York City. A bronze plaque
beneath the portrait has the inscrip-tion,
"In loving memory of Paul Press-ly
McCain, A.B., M.D., P.A.C.P., LL.D.,
1884-1946; Guardian of Public Health,
Warrior against tuberculosis, beloved
physician and friend of man, follower
of the Great Physician."
INTRODUCTION OF JUSTICE RUTLEDGE
By Paul F. Whitaker, M. D., Chairman
McCain Memorial Committee
Medical Society of the State of N. C.
Kinston, North Carolina
Ladies and gentlemen, members of
the family and friends of Dr. McCain,
members of the Medical Society of the
State of North Carolina, members of
the Sanatorium Board, members of the
Woman's Auxiliary and distinguished
guests:—As Chairman of the McCain
Memorial Committee of our Medical
Society, appointed by President Robert-son,
I am privileged and honored to
have a small part in this occasion which
honors the memory of a beloved col-league
who lived so fully and so use-fully.
As most of us know the portrait
to be presented today was made pos-sible
by the membership of the North
Carolina profession, who loved, honored
and respected Paiil McCain.
I am sure that as your representative
on this occasion, you would want me to
The Health Bulletin January, 1949
express thanks to a number of people
who have had a part in the eventuation
and consummation of this memorial.
To Dr. Donald Koonce, and the other
members of his Committee who raised
funds, and to every member of our
Society who contributed, we are grate-ful.
To President Robertson and Secre-tary
McMillan our Committee expresses
appreciation for their cooperation and
support. To Dr. Stuart Willis, Super-intendent
of the Sanatorium, Mr.
Charles Cannon of the Sanatorium
Board, and to Mrs. McCain who met
and advised with us often, we are also
grateful. And finally to Dr. Coppridge
and Dr. Hubbard, the other members
of your Committee, who have so gen-erously
given their time, their efforts
and their thoughts, I express both per-sonal
and official thanks. I assure you
that this memorial has been a labor of
love for all concerned, and that we are
happy and grateful to have had this
experience.
It is neither my purpose nor my
assignment to eulogize the memory of
our departed colleague. We have with
us a distinguished visitor who is priv-ileged
to honor himself and us, by this
assignment. Suffice it for me to say
that all of us loved and honored Paul
McCain, and that we are gathered here
today to pay himible tribute to his
memory, and to his warm and generous
spirit. I know of no citizen who served
his State more usefully. I know of no
man who lived more beautifully than
he did. I know of no man who was more
devoted to truth, and I know of no
man who was more filled with human
kindness which is the essence of good-ness,
than was he. Certainly his mul-tiple
accomplishments and his immor-tal
spirit will be projected forever into
the future service of mankind.
It is now my privilege and honor to
present the distinguished guest and
speaker for this occasion. He was born
in the State of Kentucky. He graduated
at the University of Wisconsin. He spent
a part of his boyhood in the beautiful
Carolina coimtry around Asheville, He
travelled to the far West, and lived for
a time in New Mexico. He is a man who
overcame disease and physical handi-cap
to obtain his present high position.
Many accomplishments too numerous to
enumerate have marked his life. He was
a successful lawyer and an able teacher.
He served as Dean of the Law School
of Washington University, and was also
Dean of the University of Iowa. He was
appointed by the late, President Roose-velt,
to the United States Circuit Court
of Appeals, and at present he is a
member of the highest and greatest
tribunal in our blessed and mighty
Nation, and last, but not least, he was
a friend and former patient of Paul
McCain. At this very busy and exact-ing
period in this year of his life, he
has taken time from his manifold re-sponsibilities
to honor us with his pre-sence
here today, and to pay tribute to
the memory of one whom he, like us,
loved and respected so much. We are
grateful for his presence. I am honored
and privileged to present to you a
distinguished and useful leader and citi-zen,
Mr. Justice Wiley Rutledge of the
Supreme Court of the United States.
PAUL P. McCAIN
By Mr. Justice Wiley Rutledge
United States Supreme Court
Washington, D. C.
"Greater love hath no man than this,
that a man lay down his life for his
friend." John XV, 13. These words aptly
describe the life and the death of Paul
McCain. That is true in the sense of
their more literal and usual understand-ing.
His life was taken away suddenly
and too early when and because he
was about his business of saving the
lives of others. As truly as the man who
January, 1949 The Health Bulletin
loses his life in some crisis by a heroic
surrender to rescue another, he made
his own sacrifice.
But the words of our text have
another, a deeper and truer meaning.
It does not detract from the heorism,
the courage, or the spontaneous unsel-fishness
of him who leaps suddenly and
sacrificially to the aid of one endan-gered.
But the text applies as well, I
think, to one who gives his life, not
merely at its end, but his whole life
to the saving of others! This, too, Paul
McCain did. He fulfilled the text in
both of its meanings. Pew do.
In speaking of another who has saved
one's life, or had a large hand in doing
so, it is more appropriate to speak with
honest and sincere restraint than ful-somely.
For such words come too easily
and no words can repay the debt. In
common with most of you here and
thousands of others, I stand vmder this
debt and this duty.
It was thirty-two years last July since
I first came to this place and to Paul
McCain's ministry. Then it was just
well begun. I came fearfully, seriously
stricken in body, downcast in mind
and hope. Then in the early twenties,
I learned that it is hard for the young
especially, with all of life before them,
to face slow death, worse perhaps to
stand in dread of lingering illness and
pain.
I do not wish to make this tribute
merely a personal history. But I cannot
forbear to say two or three things out
of an experience which can only have
been one in common with thousands of
others, indeed with all who became his
patients during his long and devoted
career.
His ministry, for it was such, was
threefold, of the mind, the heart and
the soul. In those days there were some
three hvmdred patients. Each received
his personal attention and on a personal
basis. None was merely "a case." Even
then highly skilled in his professional
art, he inspired complete confidence. If
there was help for the stricken body in
the field of his specialization, he could
give it. But his aid was never given
coldly, with mere efficiency. Scrupulously
honest, he gave the patient the facts
painstakingly and most often fully. This
of itself inspired confidence.
Beyond his skill and integrity, he
knew that the patient's state of mind
was quite as important to his recovery
or well-being as his physical state. His
effort was always to alleviate fears
where this could be honestly done and,
in any case, to bring composure. With-out
apparent effort, though it cost him
much in time and energy, he created
in each person a sense of understanding
and courage. Where there was room for
hope, he gave it.
It was due largely to his influence
that "The San," as we then called it,
became a place of cheerfulness, not of
despondency, and of courage among
even the far-advanced. I remember with
what surprise I so shortly discovered
this, after being sentenced as I had
thought by one of his friends. Dr.
Pritchard of the Battle Creek Sani-tarium,
to a term of months if not
years or the remainder of my life in an
institution hardly less attractive than
a prison.
In this connection, I cannot forbear
to mention his wife, always to me Sadie,
her father (then the Superintendent)
and her mother. For they too aided him
constantly in his work of building hope
and courage in all sorts of ways. Often
they would accompany him on his daily
rounds of the wards, to which every
patient looked forward. They too
brought hope, encouragement, and per-sonalized
interest.
Finally, Paul McCain was deeply
religious, but in no narrow sense. All
felt and understood this. All were in-fluenced
by it. He was thus the ideal
physician, healer, comforter, inspirer,
friend. It would be hard to say in which
of these aspects of his art he excelled.
Paul McCain was a pioneer in the
field of public medicine. North Carolina
has been a forenmner among our states
in two great things. One has been public
education, the other public medicine.
Even in the days of "Reconstruction",
6 The Health Bulletin January, 1949
the vision of a great North Carolina
leader foresaw that amid all the con-sequences
of defeat and ensuing poverty
the true and lasting reconstruction must
come from the people of the state them-selves,
not from the outside. The state
caught his vision and followed it,
slowly at first but with increasing mo-mentum
as the years passed.
I paused to pay tribute in this con-nection,
not comprehensively but only
by way of illustration, to one phase of
the state's achievement flowing out of
this policy. I mean the creation of your
system of higher public education and
especially the tridy distinguished Uni-versity
of North Carolina.
Its pre-eminence is not so much in
grounds and buildings or physical assets,
for there are many other universities
which equal or excel it in these respects.
But the greatness of a university is
found in its spirit. The soul of an insti-tution
marks it with distinction or the
lack of it. I know of no state university
and of few if any private ones, which
have succeeded as have your own in
creating and maintaining the traditions
of free inquiry and free expression.
Without these no university can avoid
in some part that tyranny over the
mind of man which Jefferson denounced
as alien to the free spirit of man him-self
and of democratic institutions. That
you have created such a place of learn-ing,
wisdom and creative freedom is
due not only to the founders of your
general policy in public education. It
flows also from the fact that you have
selected a succession of great leaders,
including the University's present presi-dent,
who have stressed the independ-ence
of the mind and the spirit, and
that you have followed their leadership.
Beginning much later, but still well
in the forefront of the states, you have
gone far in developing your system of
public medicine. The day when tubercu-losis
was wholly a private misfortune,
to be remedied if at all only by the
means available to the stricken person,
has gone for North Carolina. Would
that this could be said for all of our
states! That outmoded idea is in essence
but a policy of spreading the disease.
For unfortunately it is true still, as it
always has been in fact, that the great
majority of people contracting it have
not, and cannot get, the means which
will at once remove the certainty of
their infecting others and give them
the chance of recovery.
The same thing is true of all com-municable
diseases, more particularly of
those requiring extended periods for
rest or cure. One ill with such a disease
and without resources to protect him-self
and others is a menance to all with
whom he comes in contact. Throughout
your state and others rows of tomb-stones
in family lots, showing whole
families wiped out in short periods of
years, prove this. The thing is so ob-vious,
indeed, that it needs no proof.
Yet, even in North Carolina with its
early start, the real beginning in this
field did not come untU about the second
decade of this century. It arrived almost
half a century after your real beginning
in education. Perhaps this shows how
slow is the ripening of the fruit of
that tree. But it shows also that fruit
will be borne, once the tree is planted,
and that the two plantings and bear-ings
are not disconnected.
Since your beginning in public medi-cine,
you have made great strides for-ward.
The growth of this institution
and the foundation of others like it in
the intervening years, simply show what
can and will be done, once the necessity
for meeting this public menace is recog-nized
and the program to meet it gets
under way.
How much more humane, how much
more conservative in the true sense of
the word, is such a policy. For lives
which otherwise would be cut off, most
often early, with the loss of all they
might produce if salvaged, even in earn-ings
and taxes (to put the matter at
the lowest level), are saved, and restored
to productivity as well as to happiness.
Among all the trends of our day to-ward
mass devaluation and destruction
of human life, our people are still our
greatest asset. The conservation of hu-
January, 1949 The Health Bulletin f
man life has become our greatest neces-sity.
In all of your progress in this direc-tion
until his death, Paul McCain was
pioneer and leader. To this cause his
whole life was given, quietly, unostenta-tiously
and, if I knew him, without
thought of money or fame, only to serve
his people and mankind.
Thus he also was public servant. That
his work was not finished does not
mean it has ended. He has built foimda-tions
for a structure that will rise
higher and spread more widely by force
of the momentum he has created in
others which cannot recede or subside.
His work will last and will grow as long
as North Carolina and the nation live.
It is fitting for this building to be
dedicated by the State in his name
and to his memory.
The likeness presented today by his
professional associates cannot take his
place. But it will be a constant reminder
of him and his work, a continuing in-spiration
to others to carry on and to
expand that work in accordance with
the people's need and the public neces-sity.
I am grateful for having the privilege,
by participating today, of acknowledg-ing
my personal debt and of paying
tribute to this public servant.
ACCEPTANCE OF PORTRAIT OF
DOCTOR PAUL McCAIN
By Paul H. Ringer, M. D.
604 Medical Building
Asheville, N. C.
LADIES AND GENTLEMEN:
It is a matter of sadness and pleasure
for me to utter the few words that I
have to say—sadness, because this por-trait
brings before me with great poig-nancy
the memory of my dear old
friend; and pleasure, because I am able
once again to pay tribute to one I loved
so well.
This is an excellent portrait. The
artist is to be congratulated upon hav-ing
seized and shown so many of Paul
McCain's characteristics — his humility,
his shyness, his whimsiness, his trans-parent
honesty, his charm:
"And thus he bore without abuse
The grand old name of Gentleman.
Defamed by every charlatan
And soiled with all ignoble use."
It is fitting that this portrait should
hang in the lobby of this building so
recently dedicated to his memory, this
lobby through which he passed count-less
thowsands of times, going through
it to his work, coming out of it often
to go to receive new and always un-sought
honors which were thrust upon
him from all sides. North Carolina will
not long remember what we say here,
but North Carolina can never froget
what he did here. It is also fitting that
this portrait should hang in this lobby
so that former patients returning for a
visit, patients in the Sanatorium and
new arrivals, shall down the years be
able to look at the likeness of the one
who made this institution and who,
during his incumbency, hovered over his
charges whom he sought with all his
might to help in their fight for health.
Fearless, faithful and true, he shrank
from no duty which honor and right,
as he saw them, demanded but faced
every task with the strenuous energy of
a true man and the noble honesty of a
true gentleman. Loving, he was beloved,
his presence was a joy and an encour-agement;
absent, he is a never-failing
memory. And so, on behalf of myself
and my colleagues on the board of di-rectors
of the North Carolina Sanatoria
for Tuberculosis, I gratefully accept this
portrait of Paul Pressley McCain.
8 The Health Bulletin January, 1949
THE HEALTH DEPARTMENT AND THE
FOOD OF THE PEOPLE*
CHAIRMAN'S ADDRESS
Robert H. Riley, M. D.
Baltimore
It is difficult indeed adequately to
express how deeply I appreciate the
honor of presiding over this section.
For many years, bearing various names
and under the chairmanship of a long
list of distinguished physicians, the
annual meeting of this group have
afforded a valuable opportunity for
those engaged in the administration
of official health agencies and those
engaged in the practice of preventive
medicine to meet together for a dis-cussion
of the problems which confront
them both.
During the period of my connection
with this section, the fields of preven-tive
medicine and public health have
moved forward • so rapidly that only
those of us whose service covers a pe-riod
of more than one or two decades
can recognize how far we have come.
Every field of human knowledge, with
the possible exception of mathematics,
has made more scientific and techno-logic
progress in the last few decades
than during the whole of previous his-tory,
and public health and preventive
medicine have contributed more than
their full share in this development.
This new knowledge has resulted in
profound alterations in the way of life
of the human being, and the contribu-tion
of preventive medicine to these
changes has been most important of
all.
It is my purpose at this time, how-ever,
to discuss developments in only
•Reprinted with permission from tlie
Journal of the American Medical Associa-tion.
Director, State of Maryland Department of
Health.
Read before the Section on Preventive
Medicine and Public Health at the Ninety-
Seventh Annual Session of the American
Medical Association, Chicago, June 24, 1948.
one small sector of the whole field of
public health, that of human nutrition.
In that field I shall try to review the
changes which have already occurred
and to look forward to the problems
with which the future is pregnant, so
far as they can now be foreseen.
The changes in human food habits
during the last three decades have been
so rapid, so profound and so powerful
in their actual and potential effect on
the well-being of the race that they
should be far better understood than
is now the case. Some of us here can,
for example, remember when the food
supply of the nation was in large part
produced within a few miles of the
place of its consumption. Some have,
in fact, loaded a sack of corn on the
back of a horse or mule and ridden
with it to the grist mill and then
watched the grain poured into the
hopper and in a moment seen the
meal running smoothly back into the
sack from which the corn had just
been poured. I can't remember when
the fruits and vegetables on sale in
the larger cities were almost all pro-duced
on nearby farms. They were
brought to the markets of the city and
there sold to the consumer by the farm-ers
who had themselves grown and
harvested them. Tropical fruits were
a great luxury, available, except to the
very rich, only on very special occasions.
The supply of milk was from varied
soiu-ces and was wholly imregulated.
Many families in the cities kept one
or two cows for their own supply and
sold the surplus to their neighbors over
the back fence. These one-cow dealers,
as they were called, were a problem of
serious moment in the early campaigns
of milk sanitation. For the rest, the
public supply of milk was in great part
produced in small dairies located with-
January, 1949 The Health Bulletin 9
in the city itself, or in the nearby sub-xirbs,
and sold by the producer from
his own wagon as he made the daily
rounds of his customers. Meat was also
a local product, from animals killed in
slaughter houses within the community
and sold as soon as possible after
slaughter.
A few foods had of course always
come from distant sources; sugar, mo-lasses,
spices and condiments were ar-ticles
of ocean commerce for centuries.
The opening of the West moved the
center of the nation's grain supply and
of milling to west of the Mississippi.
The preservation of fruits and veg-etables
by heating and sealing has a
long history. The first experiments were
made in France during the Napoleonic
Wars, and actual industrial canning
began in the United States in 1819. It
was the perfection of this process that
really began the revolution in food
habits.
But with these exceptions, the mass
of the food of our fathers and grand-fathers
was produced close to the place
of its consumption and was subjected
to the simplest and most necessary
processing only.
We can, it is true, remember those
early days without nostalgic longing
for their retiirn. The vegetables pro-duced
on nearby farms were not always
of good quality and except for cabbage
and turnips were available only for a
brief season each year. The milk was
dirty, of poor keeping quality and not
infrequently dangerous. The meat was
tough and stringy, and even its relative
cheapness was not adequate consola-tion
for its poor quality. Fruits were
limited in amount and were, except
for apples, available only for a short
period each year. To those who lived in
those parts of the country where corn-bread
was a staple diet, it is only the
corn meal of the old days the dis-appearance
of which is to be regretted.
About the time when Benjamin Har-rison
became President of the United
States, the tremendous increase in the
population of the cities began to pro-duce
changes in the production and
distribution of the food supplies of the
nation. The invention of roller mills
had made possible the production of
flour of more agreeable appearance
than was possible under older methods,
and this flour rapidly drove from the
market the product of the smaller local
mills.
Similarly, the production of range
cattle in the far West resulted in the
establishment of great centers for the
slaughter of cattle and in the develop-ment
of methods for the shipment of
meat and meat products to distant con-sumers.
When "western beef," as it was
called, was first introduced in the mar-kets
of the eastern cities, it was re-garded
with considerable disfavor. Con-sumers
imagined that they could taste
the preservatives which they wrongly
believed had been used to make its
shipment possible. In the beginning only
its lower price commended it to the
public.
The crowding of the cities made it
impossible to continue to produce an
adequate amount of milk within or
near the city limits, and technologic
methods were devised for shipping milk
long distances. Successfully to manage
this business required the creation of
large corporations and the development
of depots for collecting milk in rural
areas and for distributing it in the
cities. The use of refrigerated cars for
the shipment of meat led quickly to the
shipment of citrus fruits and vegetables
in the same way. It was soon found
profitable to raise each fruit or veg-etable
in that part of the country where
climate and soil were most favorable
to its production, and although market
gardens near the cities have never quite
disappeared, the great bulk of fruit
and vegetable production was moved to
areas far distant from the places of
maximum consumption.
These changes were the inevitable
result of the advances in horticulture,
in food technology and in transporta-tion,
and without them the develop-ment
of our present civilization could
not have taken place. They brought,
however, certain dangers to the health
10 The Health Bulletin January, 1949
of the people, which made necessary
the development of systems of pro-tection
of equal complexity. The most
pressing were, of course, those connect-ed
with the production and distribution
of nulk. It was not difficult for the
large corporations which engaged in
the business of collecting and distribut-ing
mUk to produce a product far
cleaner and of better keeping quality
than that coming from the neighbor-hood
dairies of the past. However, the
mingling of milk coming from many
cows and its distribution by the larger
companies to thousands or even hun-dreds
of thousands of persons brought
dangers which had previously not
existed. The occasional infection of
these large supplies of milk and milk
products gave rise from time to time
to epidemics involving thousands of
cases of typhoid, scarlet fever and sep-tic
sore throat. The shipment of meat
and of certain other products led to
the use of preservatives, not all of which
were entirely innocuous. The great
commercial orchards and truck farms
began to use insecticides in large quan-tities,
and some of these were highly
toxic and at least potentially dangerous
to the health of those habitually using
products in the growth of which these
poisons had been employed.
The health departments of the na-tion
reacted promptly and, in general,
effectively to the challenge of these new
conditions. The almost complete control
of bovine tuberculosis, the inspection of
all establishments where milk and its
products were produced, distributed or
sold and the enactment of ordinances
requiring pasteiurization of public milk
supplies soon resulted in so safeguard-ing
most of the nation's supply of milk
that the dangers of wide distribution
were almost completely controlled. The
improved safety and quality resulted in
a large increase in the consumption of
mUk, and a most significant contribu-tion
was thus made to the public health.
It was indeed fortunate that the
federal government entered the field of
food control soon after the beginning
of this period of great change. Its first
activities were in connection with meat
inspection. Foreign countries threaten-ed
to interdict the shipment to them
of American meat products, because of
the fact that a large proportion of the
pork shipped abroad at that time was
foimd to be trichinous. It had not been
deemed necessary to inspect pork pro-ducts
in the United States, since it was
the habit in America to cook pork long
enough to insure the destruction of
trichinae. To meet this situation, the
federal government established a sys-tem
of inspection for meat slaughtered
in the larger abattoirs of the country
and destined for shipment overseas. It
was not long before this inspection was
extended to meat shipped interstate in
the United States.
In the very first years of the twen-tieth
century, Dr. Harvey W. Wiley,
then the Chief of the Bureau of Chem-istry
of the United States Department
of Agriculture, interested himself in the
question of the adulteration of foods
shipped in interstate commerce. Al-though
Dr. Wiley was a man of extra-ordinary
energy and courage, it was
only after many years of effort that
he succeeded in securing the passage
of the Federal Pood and Drug Act of
1906. The conditions which this act was
designed to correct were not for the
most part tremendously important by
modern standards, but it was an ex-ceedingly
fortunate thing that the act
itself was passed and that standards
of purity and freedom from deleterious
substances of our food supply were
established and enforced by the federal
government.
The passage of the federal act was
followed, as is so often the case, by
parallel legislation on the part of the
states. Many of the state laws passed
at this time, however, placed the en-forcement
of the whole system of food
control in the hands of the department
of agriculture rather than that of
health. This fact, together with the
long failui-e of the older city depart-ments
of health to develop adequate
and effective systems of food inspec-tion,
gave food sanitation so low a
January, 1949 The Health Bulletin 11
position in the minds of the public
health profession that it has even now
not received the recognition it deserves.
The demonstration about this same
time of the tremendous importance of
the accessory food factors in the nutri-tion
of human beings and domestic
animals and the widespread popular-ization
of the facts have tended still
more to obscure the importance of con-tinuous,
complete and effective control
of all those foodstuffs which are pro-cessed
in anj' way before reaching the
ultimate consumer.
There is certainly no need in this
company to review the arguments for
an improvement in the diet of our peo-ple.
The new knowledge of the impor-tance
of vitamins and of certain min-eral
substances to health and physical
vigor is now known to all intelligent
persons in every civilized country. The
task remaining is to apply this knowl-edge
to those who have not yet been
reached by the flood of propaganda on
the subject which has been poured forth
in recent years. The success of the
British government in maintaining the
health of its whole people and in ac-tually
improving the physical status of
its children during the late war, in the
face of serious shortages of many foods,
is proof positive of the need for the
better utilization of the abundant food
supplies of this country and in par-ticular
of the enormous importance of
insuring to every expectant mother and
every growing child a diet which in
amount and content will make possible
the fullest and most healthful develop-ment.
This is the unfinished task in
nutrition.
There are still, however, unfinished
tasks in connection with the safety and
sanitary quality of our food supply.
The war waged by our growers of foods
of all sorts on their insect enemies is
never won, and it will probably con-tinue
as long as there are both human
beings and insects on this little planet.
Modern transportation is being utilized
as well by the insect as by the human
population of the earth, and new pests
are constantly appearing in areas where
they had not before been known. In
this war, new weapons are constantly
being developed and the old weapons
are used in steadily increasing amounts.
It was not very many years ago that
arsenic began to be used as a spray for
apples. The danger that the average
citizen would receive a toxic amount of
arsenic was not at first sufficiently
serious to give rise to much concern.
Since this early beginning, however, it
has proved necessary to use arsenic in
the commercial production of one after
another of our fruits and vegetables,
and the danger to the consumer is
thus constantly increasing. It seems
probable that Insecticides free from
toxicity to human beings will in time
replace the present dangerous sub-stances.
It will always be necessary,
however, for the health department to
protect the interests of the individual
consumer who has no means of know-ing
the danger to which he is subjected
and is always poorly represented when
any question of legislation is imder
consideration.
When the replacement of the original
Federal Food and Drugs Act by what
is now called the Federal Food, Drug
and Cosmetic Act was pending before
the Congress of the United States, the
interests of the public were presented
to the committee by the representative
of the Federal Food and Drug Adminis-tration,
whose motives were plainly
suspect of the committee, and by the
three physicians who were called "the
thi-ee professors," who appeared volim-tarily
as witnesses in behalf of the bill.
In opposition were several hundred
lawyers, lobbyists and technicians of
the various food-producing and process-ing
interests involved. Each one of these
paid lobbyists was fully aware of the
effect of the bill on the interests of his
own client and was prepared to expend
all the time, energy and money nec-essary
to protect those interests. No
administrative health of&cer appeared
at these hearings.
What has been said about insecticides
applies equally to a wide variety of
other chemical substances which have
12 The Health Bulletin January, 1949
been developed and which are now be-ing
used in the processing of food on a
commercial scale. Until Mellanby's de-monstration
of the fact that fioiar
treated with nitrogen trichloride, the
so-called "agene," produced hysteria in
dogs, few if any even of our best in-formed
health officers were aware of
the fact that a large proportion of all
flour now sold on the American market
is treated with this powerful chemical
agent. There is as yet, of course, no
evidence that the "agenizing" of flour
has produced any iU effects on our
human population, but Mellanby's ob-servations
have been confirmed and
extended in this country, and no one
as yet knows the effect on human be-ings
of the prolonged and regular use
of "agenized" flour, or whether or not
there will be remote and serious re-sults
from its occasional use by so large
a part of the population.
"Agene" is very much in the lime-light
at the moment, but it is by no
means the only substance used in this
country in the processing of flour.
Chlorine, nitrosyl Chloride, benzoyl
peroxide and the oxides of nitrogen are
all used for bleaching flour and for
additional aging effect. Potassium bro-mate
is used as a conditioner, to make
the flour easier to handle and to pro-duce
loaves of greater volume than is
possible without the addition of this
agent. Sodium bicarbonate, calcium
phosphate and sodium acid pyrophos-phate
are also added to certain flours
to produce one or another effect.
In the processing of evaporated milk,
disodium phosphate, sodiimi citrate and
calcium chloride are used as stabilizers.
In the making of cream cheeses, gum
karaya, gum tragacanth, carob bean
gum, gelatin and algin are used to pre-vent
the leakage of moisture from the
product. In the making of preserves,
jams and jellies, lactic, malic and tar-taric
acids are used to increase the
acidity of the product and sodium cit-rate
and potassium tartrate are used
as buffer salts to prevent its too rapid
jelling. This list of products now reg-ularly
in such use could be extended
to great length, and, in addition, a
large number of new products are now
being used experimentally. It should be
made clear that up to this time there
is no evidence that any of these sub-stances
is known unfavorably to affect
the health of consumers of the product.
The Food and Drug Administration has
actively interested itself in the subject
and has formulated stringent regula-tions
for controlling the use of all such
substances.
Surely it would seem that this situa-tion
should be a source of concern to
every state and local health officer in
this country and that the efforts of the
federal government to control it should
be aided and encouraged in every pos-sible
way. When it is proposed to use a
new substance of this kind, the repre-sentatives
of the food industry are at
once mobilized and every possible scrap
of evidence in favor of the use of the
product is assembled and presented to
the official agency. The millions of con-sumers
whose health is placed in pos-sible
danger have no knowledge of the
fact that their interests are in jeopardy
and no means by which these interests
can be represented. This important field
deserves far more attention at the hands
of all health officers than it has up to
now received.
The nation's food is more than ever,
therefore, the concern and responsibility
of our health officials. Its control has
passed far beyond the condemning of
spoiled meats, fruits and vegetables and
making perfunctory inspections of res-taurants.
These classic functions must,
of course, continue to be performed and
should be done as well as our existing
facilities make possible. There is, how-ever,
another and higher duty which
we must recognize and another respon-sibility
we must assume, and that is to
make sure that in the enormous busi-ness
of producing, processing and dis-tributing
the food supply of oiu- great
population, the interest of the consumer
and particularly the health of the con-sumer
must always come before the
convenience or the profit of those who
supply it.
January, 1949 The Health Bulletin 13
NARRATIVE REPORT
A. C. Bulla, M.D., Health Officer
City of Raleigh and Wake County
January 10, 1949
Growing up to be a human being is
not the hazardous and perplexing prob-lem
today as it has been in the past due
largely to the progress made in re-search,
health education, better mater-nity
and infancy care, and the applica-tion
of known proven preventive meas-ures
against sickness and suffering.
The infant, the child, the adolescent
is an ever changing individual within
himself, and, too, his environment is
forever changing. In considering the
growth and development of the human
being during his formative period, we
are first concerned about his heredity
and his birth which determine to a
large extent the kind of individual he
may be. We are concerned about his
environment which include all his sur-roundings,
his family, his home, his
teachers—every living thing, and every
given situation no matter how small,
simple, and insignificant. It takes all
these things plus intelligent guidance
with care and the application of all the
benefits that have come down to us in
the past to make it possible for an in-fant
born today to live out his full days
of expectancy and reach the average life
expectancy of 66 years with as little
sickness and suffering as possible.
Life is the adjustment of exterior and
interior relations. In other words, the
external battling against the internal.
This constant adjustment and re-ad-justment
is the process of living. A
child is more than a biological organ-ism;
he is also a social being growing
and adapting himself to specific en-vironments.
Yes, he is a part of hered-ity
and environment. Yes, he is made
up of hereditary tendencies and the en-vironment
in which he grows and de-velops.
He cannot escape these vital
influences and forces.
The road he must travel from infancy
to old age is not in all cases an easy
one, but it is straighter, easier, and more
certain than the roads traveled 20-10-5
years ago. He has the advantage of new
and useful tools which scientific re-search
has provided. These scientific
preventive and curative agents are to-day
the most useful agents for the
protection of life and the relief of sick-ness
and suffering that have ever been
given to man. They have not and will
not solve all of the medical and public
health problems that we are confront-ed
with today, but they have given new
hope to this and other generations.
The application of vaccines and sera
for the prevention of disease is a dy-namic
science. This has been true from
the day they were discovered down to
the present time. It is the duty of
physicians and health departments to
see that the public receives these pre-ventive
measures in that age group in
which they are most effective. The pub-lic
should always be mindful of the fact
that these preventive measures cannot
be effective unless it accepts them and
uses them to the greatest capacity,
which means that no infant or child
should be allowed to go unprotected
against those diseases for which there
are proven vaccines and sera to prevent
their occurrence.
We have seen the number of com-municable
diseases grow smaller and
smaller and the death rate from all
causes reduced from 11.2 in 1937 to 7.7
in 1948. The infant death rate per 1000
live births in 1937 was 83.9 and in 1948
it was 31.3—^a decrease of 52.6. This is
worthy of note: in 1937, 55 percent of
infant deaths occurred under one month
of age, and in 1948, 70 percent occurred
under one month of age. Notwithstand-ing
this fact and that measures are now
being instituted to try to reduce this
high percentage of infant deaths occur-ring
during the first month of life, as
stated above, the death rate in the first
year of life has been reduced from 83.9
14 The Health Bulletin January, 1949
in 1937 to 31.3 in 1948. This means that
this large reduction in the infant death
rate was from the end of the first
month of life to the end of the twelfth
month of life.
Prematurity is responsible for approx-imately
53 per cent of the deaths occur-ring
in the first month of life. A pro-gram
for the entire state under the
Division of Maternity and Infancy, di-rected
by Dr. G. M. Cooper, is being
worked out whereby premature infants
may receive prematiire care in the best
regulated hospitals of the state.
The maternal death rate per 1000
live births has been reduced from a
rate of 7.0 in 1937 to 1.5 in 1948—a de-crease
of 5.5.
We have seen the number of births
increase from 1977 in 1934 to 3517 in
1948. The number of white births has
increased from 1098 in 1934 to 2345 in
1948. The number of colored births has
increased from 879 in 1934 to 1172 in
1948.
The following figures show the com-parative
attendance of births by phy-sicians
for the years 1934 and 1948:
City of Raleigh Residents
Yr. Total Per White Per Color- Per
cent cent ed cent
1948 1457 95.5 1067 100.0 390 83.8
1934 515 75.4 389 100.0 126 42.9
Gain 20.1 40.9
The comparative figures for hospital
deliveries:
1948 1446 94.9 1063 99.6 383 82.2
1934 322 47.1 269 69.1 53 18.0
Gain 47.8 30.5 64.2
Wake Coimty Residents
1948 1507 89.0 1012 99.0 495 73.8
1934 929 72.0 668 95.8 261 44.4
Gain
January, 1949 The Health Bulletin 15
and sanitation, I think, are two of the
outstanding problems that still confront
every health department in this state.
Improvement in this direction is large-ly
influenced by knowledge of what is
right from what is wrong, together with
that powerful influence of education.
The personal habits of an individual
may be termed as a personal thing. His
environment may or may not be so
termed, but both are vital to health and
happiness.
BLOOD DERIVATIVES IMPORTANT FOR
MEDICINE, RESEARCH
Fractionation of blood is providing
important products with which physi-cians
can treat disease and investiga-tors
can obtain a better understanding
of the functions of the human body,
according to a Harvard physician.
Writing in the current (Nov. 20) issue
of The Journal of the American Medical
Association, Charles A. Janeway, M.D.,
from the Department of Pediatrics,
Harvard Medical School and the Chil-dren's
Medical Center, Boston, reports
that breaking up blood into specific
components also effects a great economy
in using blood donations.
Because a function of the blood is
concentrated in each fraction, dona-tions
which in the form of whole blood
could be used to treat only 20 patients
can be used as blood derivatives to treat
over 200 patients, he points out.
Another important consideration. Dr.
Janeway says, is that many of the blood
components undergo rapid deterioration
in whole blood. Separated and concen-trated,
each may be packaged in a state
best adapted to the preservation of its
functional activity, ready for clinical
use whenever and wherever it is need-ed.
During the Army-Navy-Red Cross
blood program of World War II, slightly
more than two million blood donations
were subjected to fractionation, yielding
products which were used in part by
the armed forces. Surplus products were
returned to the American people.
Certain derivatives—plasma, fraction
I, fibrin foam, fibrin film, gamma glo-bulin,
isohemagglutinins, and serum al-bimiin—
have been established as valu-able
agents in the treatment of disease,
Dr. Janeway explains.
Some of the products are important
for research. For example, one protein
which has been crystallized from a
fraction of htunan plasma—the fluid
portion of the blood before clotting has
occurred—accounts for the capacity of
the plasma to transport iron. Isolation
of this protein in pure form has made
it possible to study its reactions with
iron in the laboratory and to make
parallel observations in patients.
Transmission of jaundice through in-fected
pooled blood or pooled blood pro-ducts
is a serious problem. Dr. Janeway
indicates that this problem may be
overcome by the sterilization of blood
and blood plasma on a large scale.
Although mass processing with ultra-violet
in'adiation has not yet proved
successful, there is enough evidence of
its effectiveness to justify optimism, he
says.
Methods introduced for the separa-tion
of half the plasma protein, serum
albumin, from the remaining proteins
can be used to obtain all the major
components of plasma. Such methods
have also been applied to the piu'iflca-tion
of virus vaccines, toxoids, animal
serums, and tissue extracts.
The value of plasma as an emergency
blood substitute in the treatment of
shock due to blood loss is well estab-lished.
Sixty-five per cent of the protein of
fraction I is fibringen, a substance
which is used in attaching skin grafts
and in removing kidney stones. Fraction
I also contains other proteins, including
antihemophilic globulin, so-called be-cause
it will rectify the coagulation de-fect
in hemophilia, an inherited condi-tion.
16 The Health Bulletin January, 1949
Fibrin is a whitish protein which
forms the essential part of a blood clot.
It is vised in two forms: a foam to pre-vent
bleeding in surgery and an elastic
film substitute for the outer covering
of the brain in neurosurgery.
Gamma globulin—fraction II—is of
value in the prevention and modifica-tion
of disease. Its use in the prevention
of measles has become a standard pub-lic
health practice, according to Dr.
Janeway. It is valuable in preventing
infectious jaundice, and is being in-vestigated
for use against scarlet fever
and German measles. Gamma globulin
obtained from the blood of patients
convalescing from mumps and whoop-ing
cough is used against these diseases.
Isohemagglutinins are substances
which cause the blood cells of other
members of the same species to collect
into clumps. Certain isohemagglutinins
obtained as part of the fractionation
procedure are used in testing for blood
grouping and for Rh sensitization.
Serum albumin was originally devel-oped
as a blood substitute for emerg-ency
treatment of shock in the wound-ed.
It is extremely effective in condi-tions
which may develop from severe
infections, bxirns, peritonitis, or abdom-inal
operations. It has a place in the
treatment of kidney disease and cirrho-sis
of the liver. Its use for patients who
have had brain injuries or operations
is under study.
Red cells contain the most important
blood protein, hemoglobin, which is re-sponsible
for the vital function of oxy-gen
transport. Red cell suspensions,
especially prepared concentrated pro-ducts,
are useful in the treatment of
anemia of all types, except those due
to acute blood loss or severe infection.
They supply hemoglobin, and a relative-ly
large dose can be given safely with-out
overloading the circulation.
THE KENFIELD MEMORIAL FUND
American Hearing Society
817 14th Street, N. W.
Washington 5, D. C.
A sum of money was subscribed in
1937 in memory of Miss Coralie N. Ken-field
of San Francisco, California, a
teacher who was known throughout the
United States for her high ideals and
advanced methods in teaching lip read-ing.
This money was placed in the Ken-field
Memorial Fund. The interest pro-vides
a scholarship known as the Cora-lie
Noyes Kenfield Scholarship for
Teachers' Training Courses for Teach-ers
of Hard of Hearing Adults. (The
scholarship offered in 1949 is $100.00).
The American Hearing Society is the
trustee of the Kenfield Memorial Fund.
Applications will be considered from
any prospective hard of hearing teacher
of lip reading to hard of hearing adults
who lives in the United States and who
can meet the following requirements:
A. Personal characteristics necessary
for successful teaching.
B. Ability to read lips as certified up-on
examination by an approved in-structor
in lip reading.
C. A bachelor's degree, or
Two years of college work plus
twelve semester hours of work In
adult education, psychology of the
handicapped, voice production and
control, sight conservation, social
service, or
Two years of successful experience
in teaching in public or private
schools, plus twelve semester hours
of work in adult education, psy-chology
of the handicapped, voice
production and control, social ser-vice,
or kindred subjects.
Applications must be filed between
March 1, 1949 and May 1, 1949, with:
Miss Rose V. Feilbach,
Teachers Committee,
American Hearing Society.
U. N. C
MEDICAL Lia
MEDICAL LIBRARY
u. OF N. c. iOMay
i This Bulletin will be sent free to ony citizen of the State xjporv requesfl
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. 64 FEBRUARY, 1949 No. 2
MEMBERS OF THE NORTH CAROLINA STATE BOARD OF HEALTH
S. D. GRAIG, M.D., President Winston-Salcm
G. G. DIXON, M.D., Vice-President Ayden
H. LEE LARGE, M.D Rocky Mount
W. T. RAINEY, M.D., Fayetteville
HUBERT B. HAYWOOD, M.D Raleigh
J. LaBRUCE WARD, M.D . Asheville
J. O. NOLAN. M.D Kannapolis
JASPER C. JACKSON, Ph.G Xumbcrton
PAUL E. JONES, D.D.S Farmville
EXECUTIVE STAFF
J. W. R. NORTON, M.D., M.P.H., Secretary and State Health Officer
G. M. COOPER, M.D., Assistant State Health Officer and Director Division of Health Education,
Crippled Children's Work, and Maternal and Child Health Service
, Director, Division Local Health Administration
, District Director, Local Health Administration
ERNEST A. BRANCH, D.D.S., Director, Division Oral Hygiene
JOHN H. HAMILTON, M.D., Director, Division of Laboratories
J. M. JARRETT, B.S., Director, Division of Sanitary Engineering
OTTO J. SWISHES, M.D., Director, Division of Industrial Hygiene
BERTL'i'N BOSLEY, Ph.D., Director, Nutrition Bureau
FELIX A. GRISETTE, Director, Venereal Disease Education Institute
C. P. STEVICK, M.D., M.P.H., Director, Division of Epidemiology and Vital Statistics, wd
Co-Director, School-Health Coordinating Service
WILLIAM A. SMITH, M.D., Director, Bureau of Tuberculosis Control
IVAN M. PROCTER, M.D., Director, Bureau of Cancer Control
HAROLD J. MAGNUSON, M.D., Director, Reynolds Research Laboratory, Chapel Hill
JOHN J. WRIGHT, M.D., Director, Field Epidemiology Study of Syphilis, Chapel Hill
FREE HEALTH LITERATURE
The State Board of Health publishes monthly THE HEALTH BULLETIN, which will be seiii free
to any citizen requesting it. The Board also has available for distribution without charge special
literature on the following subjects. Ask for any in which you may be interested.
Adenoids and Tonsils German Measles Sanitary Privies
Appendicitis Health Education Scabies
Cancer Hookworm Disease Scarlet Fever
Constipation Infantile Paralysis Teeth
Chickenpox Influenza Tuberculosis
Diabetes Malaria Typhoid Fever
Diphtheria Measles Venereal Diseases
Don't Spit Placards Padiculosis Vitamins
Eiidemic Typhus Pellagra Typhoid Placards
Flies Residential Sewage Water Supplies
Fly Placards Disposal Plants Whooping Cough
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, North Carolina.
Prenatal Care Baby's Daily Schedule
Prenatal Letters (series of nine First Four Months
monthly letters) Five and Six Months
The Expectant Mother Seven and Eight Months
Infant Care Nine Months to One Year
The Prevention of Infantile Diarrhea One to Two Years
Breast Feeding Two to Six Years
Table of Heights and Weights Instructions for North Carolina Midwive*
CONTENTS Page
The North Carolina League for Crippled Children 3
Vital Statistics 10
Notes and Comment 12
Accidents Rank First As Destroyer of Working Years 13
Our Front Cover 16
]jiI@sJMb@IB)M
LSJ I PUBU5MED BY TML nOfg.TM CAgOuriA STATL BCAgC
Vol. 64 FEBRUARY, 1949 No. 2
J. W. R. NORTON, M.D., M.P.H., State Health Officer JOHN H. HAMILTON. M.D., Acting Editoi
THE NORTH CAROLINA LEAGUE FOR CRIPPLED
CHILDREN
Dates and Progrram headings: (1) Inheritance, (2) Congeni-m
-.v. -.^^-u ^v, -NT 4.V, r-i ^^nv,„ tal conditions,, (2) Birth injuries, (4)
For the 14th year, the North Carolina ^ ^ ., . , = -, t-.-o^„=.^ „»,^ tR\ Tr,f^ . . , ^T.Mj • -4. n Accidents, (5) Disease, and (6) Iniec-
League for Crippled Children invites all ^. ^^ ., ^ „„,-^!^i„^ <,v,ii^^or, ^f
X,- • X i. J • 4-1, If ^^ ^f 4.v.„ tion. Among the crippled children of
those interested in the welfare of the _ ... ., „ ,. „ „ ^^^ w,„cf r^r..^ /i» J 4. I, • .fiv, v,^^^ +u„ North Carolina, over 85 ^^ must now de-handicapped
to share m financing the -kj^^-u <-, ^„i5„„ To„n^,= f^,.
1 * iv, T „ ,^ rrn.^ Av.>.„oi -t^ocffl-,. pend on the North Carolma League for
work of the League. The Annual Easter ^ . ^ r • t,- v, ««. _ , „ . -m u „^v,^„„+„^ u^ certain types of services which are ex-
Seal Campaign will be conducted be- ^ , , -c-, -^ ^ j *.-u • „„
4. 4.1, ^4. „ ^f Tv/Tov^v, i-T+v. ov,^ tremely valuable aids toward their re-iTrirnth
habilitation. Many children with other
The services of the North Carolina
handicapping conditions also look to
League for Crippled Children are plan- ^he. league for services they need but
ned so that they supplement but do not ^^'^^ ^'^ ^°t yet available else where,
duplicate those of any other Social Dui'ing the past year (1948) alone, the
Agency, thus broadening the scope of county chapters of the North Carolina
services available for handicapped child- League for Crippled Children provided
ren. services for 5,129 handicapped children
There are more than 250 causes of of the state at a cost of $45,361.78. Brief-crippling
conditions but most of these ly, the direct services rendered to indi-fall
under one of the following major vidual children include the following:
SERVICES CHILDREN COST
Transportation to Hospitals, Clinics, Schools 2,676 $ 7,953.76
Hospitalization 389 6,852.07
Appliances provided 411 6,816.53
Medical Treatments 208 6,963.24
Clothing 12 156.96
Supplementary food and Vitamin Tablets 34 397.60
Camping 44 1,772.16
Dental Care 22 218.85
X-rays 80 288.00
Convalescent Care 124 1,540.00
Special Shoes 28 240.00
Hearing Aids 6 1,050.00
Hospital Bed (Purchased) 4 90.00
Wheel Chair (Purchased) 6 120.00
Psychological and Audiometric testing 108 600.00
Special classes and individual instruction 973 10,258.61
School supplies 4 44.00
TOTAL SERVICES 5,129 $45,361.78
The Health Bulletin February, 1949
The above listed services were pro-vided
by the 50% of the funds which
remained in the county where the funds
were contributed. But direct services to
individual crippled children is only a
portion of the League's activities. De-monstration
projects, prevention, legis-lative,
promotional, education and re-search
programs make up the major
portion of the work done by the State
Office of the League.
During the past six years, the demon-stration
projects have been in the area
of education for handicapped children
and have included special training for
crippled children, hard of hearing child-ren,
speech defected children, and cere-bral
palsied children. Training classes
for teachers to prepare them for teach-ing
handicapped children have also been
included in the League's program. Last
year, more than 200 teachers had one or
more classes in the area of special edu-cation.
The Leagrue's Work is Varied
Work among crippled children is not
a field within itself, it is a segment of
many fields, Any crippled (or other
handicapped) child needs all of the
same things a non-handicapped child
plus the additional medical treatments
required to correct his handicap—or to
minimize it to the lowest degree possible —and specialized education opportuni-ties
designed to prepare him to use to
a maximum degree all his existing facili-ties
and thus be able to earn his own
livelihood and have the privilege of be-ing
a useful and contributing citizen.
For that reason, it is hard to give a
concise report of the work of the North
Carolina League for Crippled Children
as its program of activities must be as
broad, and as varied as the total needs
of life itself.
The League takes a broad interpreta-tion
of the word "CRIPPLED CHILD"
for it feels that any child with a physi-cal
limitation which prevents him from
getting an education thi'ough the nor-mal
channels provided for non-handi-capped
children, is a potentially handi-capped
adult. So, no matter how he
came by his crippling condition, (or
other defect")—He deserves any help
which the League may be able to pro-vide.
So, this report will show a wide variety
of services having been rendered to the
handicapped children of North Caro-lina.
Some were given to correct a de-formity,
others to prevent one from de-veloping,
while still others provided a
beginning stimulus toward a develop-ment
of the facilities which the child
has remaining and upon which he must
depend for life to produce for him a
livelihood, and whatever measure of
happiness he can attain from his sur-roundings.
Planning a New School, Church, Library,
or Other Public Buildings?
Before completing plans for a new
school building—and other public build-ings—
the North Carolina League for
Crippled Children would like to beg the
local school boards to give some consi-deration
to the handicapped children
in their communities. Perhaps you feel
that your community is singularly fortu-nate
in that all the children living there
are normal children, but are you sure
of that fact? Have you made any speci-fic
effort to see if there are children
who, although not hospitalized, are un-able
to cope with the routine for nor-mal
school life?
The United States OflBce of Education,
in statistics released in 1937 (would pro-bably
be higher now), quoted North
Carolina as having 62,687 handicapped
children in need of special consideration
in order to enable them to secure the
type and amount of education needed to
develop their capabilities so that they
may contribute their share to human
progress. With that many handicapped
children in North Carolina it is reason-able
to believe that some of those child-ren
will be living in every coimty of the
state.
There are several types of handicap-ped
children whose needs it would be
worthwhile to consider before starting
to build a new school.
(1) FOR CRIPPLED CHILDREN—
For this group it would be helpful to
February, 1949 The Health Bulletin
have ground floor entrances, in larger
schools an unloading covered terrace or
platform with guard rails on a level
with the building entrance, ramps, or
elevators if classes are to be held on
more than one floor, non-slip floors,
hand-rails to assist with walking; little
(if any) fixed equipment, and that
should be adjusted to meet the needs
of the individual child (for instance,
leg rests for the child who must
wear braces) ; full length mirrors will
help children improve their walking,
and therapeutic departments if there is
a potentially large number of children
with orthopedic handicaps. These thera-peutic
departments should include treat-ment
tables and other equipment needed
for physical therapy including a warm
water pool. The pool also could be used
for teaching swimming to the non-handicapped
children during the hours
when not needed for treatments. A room
where arts and crafts may be taught is
especially helpful for crippled children.
Besides teaching them the skills learned
there, the added help of improved co-ordination
is a valuable aid toward help-ing
the child overcome his handicaps.
(2) FOR HARD OF HEARING
CHILDREN—The floors of rooms to be
used for this group should be hard-wood,
air-spaced below to increase the
child's awareness of vibration. This is
an important avenue in developing the
facUity of communication among child-ren,
who have seriously defective hear-ing.
Special wiring is needed so that
mechanical devices and equipment for
transmitting sound can be used to help
retain all residual hearing a given child
has. The ceiling should be acoustically
treated.
(3) FOR THE PARTIALLY SIGHT-ED
CHILDREN—The important item
for this group is to secure maximum
lighting, uniform and without glare or
shadows with automatic light switches
which turn on lights as soon as needed
and turn them off when not needed. The
switches can be arranged to tiirn on
one light when a corner gets dark, or
the row of hghts nearest the wall when
a side of the room gets darker than the
area nearest the windows. Soft blues
and greens are \isually used for the
walls, with "sea-moss" green being con-sidered
by many specialists as being
easiest on the eyes. Dark green black-boards
that are hung so they tip fur-ther
from the wall at the top than at
the bottom will prevent glare.
(4) Children with Lowered Vitality
and Cardiac Involvements, and many
of the children in the other groups
already mentioned, will need rest rooms
equiped with cots. Lockers for each child
to store his individual blankets assigned
to him add to the effectiveness of the
rest period. Open air classrooms and
sheltered sun bathing porches would
be especially helpful.
Besides these specific things which
will help the already handicapped child-ren
to secure educations, otherwise de-nied
them, there is one more need for
every careful consideration—the need
to Plan for Preventing, wherever pos-sible,
the development of a physical lim-itation.
A few items which would be
helpful along this line would be; to de-corate
carefully with a view to sight
saving; to give much attention to sun-light
and air, and at the same time
eliminate drafts and glare; to build all
cabinets in the wall and grUl all radia-tors
so as to avoid the possibility of
accidents; a special corrective gymna-sium
equipped with well designed and
carefully selected apparatus for exer-cise
and training tn remedial posture
classes; and numerous handrails for the
pupil who needs to steady himself occa-sionally.
Automatic light switches would
probably save more on electricity in a
short time than the extra cost of in-stalling
the switches and the saving of
glasses in a few years later would be far
greater than the cost of installation and
operation of a uniform lighting system.
Do You Feel As I Do About Crippled
ChUdren?
Do you feel the way I do about crip-pled
Children? Of course you believe
that every Crippled Child has a right
to every service he needs at the time
it will do him the most good . - . that
6 The Health Bulletin February, 1949
he has a right to Hve as near a nor-mal
life as his limitations will allow.
Most Crippled Children need m-^ny
expensive services to help them develop
into normal adults and some of their
needs are:
Medical Care—the best available and
at the earliest possible time so as to
correct deformities when possible and
improve as much as possible those which
cannot be entirely corrected.
Education—special classes or facilities
may be needed—but at least the type
of training which will help him use his
abilities in the best way possible and
thus become the best citizen his limited
condition permits.
Guidance—to help him better xmder-stand
his problems and enable him to
develop into a strong character capable
of accepting his limitations, the curio-sity
of other children, or the pity of
adults without embarrassment or hurt.
Spiritual Training-—it is just as im-portant
that crippled children be trained
to miderstand and live by the accepted
moral and ethical standards of his com-munity
as for any other chUd.
Of course you think that these "rights
of Crippled Children" are no different
than those of every child and you are
correct. All children have the same
basic needs for bringing happiness and
for growing into useful citizenship but
for Crippled Children some of these
needs are greater and more costly.
To provide as many of these needs
for as many Crippled Children as funds
allowed has been the program of the
League for Crippled Children for years
—to make it possible for all Crippled
Children to have every service needed
at the time it would be most helpful
is the aim of the League.
Every week, more requests are made
for assistance than it is possible to give
—Won't you help us reach those who
are still waiting? They are growing
older each day they wait and their
chances for best improvement are less-ened!
You wouldn't want any child to
have to drag a brace or live in a wheel
chair if it could be prevented would
you?
The League assists any Crippled
Child regardless of cause of crippling —whether congenital, birth injury, di-sease,
infection, or accident as far as
its funds permit. With more money we
could help more children—won't you
help us help them?
"Today's ChUdren"
"Today's children with their hopes
and fears, their problems and tears
shall be the builders of a brighter
world TOMORROW."
What about Crippled Children in that
March of Progress? Will they have a
share in the building of that better
world or do they have to sit on the
sidelines and watch? Must a bright
mind be ignored because a leg does
not function—must skilful hands lie idle
because the limbs will not carry the
hands to the place where they could be
useful?
Records from the past show that a
crippled arm, lame leg, a hearing de-ficit
is often the spark which fires an
individual to great accomplishment.
—
Demosthenes overcame his stuttering
to speak wisely to all generations;—
A
Blind Milton produced "Paradise Lost"; —A deaf Beethoven gave the world the
'Eighth Symphony";—Half paralyzed,
Louis Pasteur produced serums which
have blessed the world;—Francis Park-man,
in such pain that he could work
for only five minutes, who could see only
to scrawl huge words, gave the world
12 magnificient volumes of history;
Ceasar, an epileptic built a great em-pire;—
Charles Steinmetz, the wizard of
General Electric, was a hunchback;
Thomas A. Edison, appreciated perhaps
by more people than any other Ameri-can,
was deaf in one ear;—Charles Dick-ens
and Sir Walter Scott were lame.
What about the Cripple Children of
oui- generation? When the records are
written, will they show that we left
them to shift for themselves, or that
we encouraged them to accomplish all
they could in spite of their limitations.
A few of them will grow up with cour-age
within themselves to overcome de-spite
their defects, but in the main a
philosophical attitude toward one's
February, 1949 The Health Bulletin
handicap does not develop by accident
—One of the aims and ideals of the
North Carolina League for Crippled
Children is that of social ad.iustment,
to help those children accept the reality
of their limitations and, after taking
stock of the thrna;s they cannot do, to
live comfortably in tb° world which is
within their ability. Who knows from
where the next most startling contri-bution
to the welfare of the world may
come? Perhaps, a crippled child in
North Carolina, or many of them may
be listed in the roll call of the famous.
Fame does not require physical beauty
as a requisite—it is too evanescent. Only
those achieve the heights of everlasting
honor who by their labors have bene-fitted
mankind.
The work of the North Carolina
League for Crippled Children is financed
almost entirely from the proceeds from
their annual Easter Seal Campaign.
* « * *
HUMAN INTEREST ITEMS
Gene Attended the League's Education
Center
Gene was 12 that summer, but he did
not talk at all—depended on signs to
get him what he might want or need.
He was a ward of Juvenile Court at the
time the school opened and tentative
plans of the court were to have him
admitted to the school for Feeble Mind-ed
at Kinston. Gene's home was pathe-tic
and his family uncooperative with
the social agency which had been active-ly
trying to help him for several years.
There had been times when the family
sent Gene out to beg for them. He was
taught to act "deaf and speechless" as
they felt his helpless appearance would
add to the "take" that day.
All children enrolled in the summer
educational project of the League for
Crippled Children were given mental
tests as well as speech and hearing
tests. Gene' mental test showed that he
was not feeble minded.
All children also were given physical
examinatiorls, and there Gene's pecu-liar
pKJsture was discovered to be the
resvilt of an injury to shoulders and
neck. He was referred to an Orthopedic
Surgeon. Gene progressed so well dur-ing
his 4 weeks of specialized training
that a change of plan was made for
him. Instead of being sent to the school
for feeble minded he was placed in the
home of a kindly couple.
He was provided with needed dental
treatments, and orthopedic care. After
that his improvement in school was re-markable.
His speech gradually became
audible and his vocabulary increased
rapidly, — and one more handicapped
youngster has joined the ranks of those
who will grow into self-supporting
adults.
It's June 17th
"Wake up, Ted, it's June 17th." "Is
it REALLY June 17th?" You wouldn't
tease me about anything as important
as that, would you?" "No, Ted, we
wouldn't tease you. It actually is June
17th. Hurry now and get dressed. Break-fast
is ready and when you've finished
eating we are going to start."
Ted did hurry to get dressed, but he
refused to take time to eat for he said,
"We'd better get going now 'cause it is
172 miles to Chapel Hill, and I have
to be treated at 1:30 you know."
Of course they knew the distance and
the time for his appointment and that
there was time for him to eat his break-fast
before starting but he was so anxi-ous
they finally gave up and came along.
When it came time for lunch he in-sisted
that they not stop for fear it
would cause him to be late and he
wouldn't get to stay at the Educational
Center being opened for children with
physical handicaps. Ted had been born
with a cleft palate, and even though the
cleft in his mouth had been corrected
by surgery, he still talks with a strong
nasal tone and had a decided speech
defect.
Ted had attended the Center two
years before when he was twelve, and
had been a good student then, but his
determination to improve his speech at
14 was much stronger than it had been 2
years before.
8 The Health Bulletin February, 1949
Because of his haste to' arrive on time
and his refusal to take time to eat
either of his meals that day, he ar-rived
almost an hour early, and even
though severely fatigued from the long
drive without food, Ted entered the
Center wearing a smile of the type not
too often seen. The other children who
had been scheduled to arrive during the
morning had been given their lunch
and the dining room was closed so it
was not possible to secure food just then
for Ted but one of the workers learned
that he had not eaten all day sent to
a near-by drug store for a mUkshake
for him.
Soon after that, Ted was called for
his examination. First he saw the
physician who found him to be very
healthy even though fatigue was de-cidedly
evident. Then, his hearing was
tested and found to be normal. Next he
saw the speech correctionist who gave
Jhis speech test and prescribed the line
of speech therapy which his teacher
was to follow. His last test was the
psychometric test and when the exami-ners
met to discuss Ted (as they did all
cases) his I.Q. was rated much below
the level set for admission to the center.
Fortunately, the director of the cen-ter
had seen Ted at work two years be-fore
and knew he did have at least
average intelligence and even tho the
story about his anxiety to reach Chapel
Hill and his refusal to take time to eat
had not been given her, she felt some-thing
was wrong, so insisted that the
I.Q. score not be considered for the
present, and that he be kept, at least
temporarily. After a few days had pass-ed,
he was given a second mental test
and his rating, well above average, quite
justified the decision to have Ted stay,
as did his work during the four weeks
duration of the Educational Center,
Besides his speech classes, Ted went
swimming, played baseball and other
games with his pals who had also come
to the Center in order to try to improve
their speech. On the last 2 days of the
Center's program his parents attended
the Parents' Institute so that they could
help Ted continue at home some of the
work he had started in his speech
classes and thus help him continue to
improve his way of speaking.
Ted has made a nice adjustment so
far as accepting his handicap is con-cerned.
He has been known to have been
teased by boys of his own age and he
takes it casually. He even explains that
he is imfortunate enough to have been
handicapped all his life, while they
have been fortunate so far, but he re-minds
them they could have an illness
or an accident which could leave them
with a more severe handicap than his
is.
When Ted's parents came for him,
they brought his younger brother (now
10) and while the two boys "swapped"
experiences, the younger boy expressed
a desire to come to the Center next
year, for he believed Ted had had more
fun during the month just passed than
he had. Ted explained that it would not
be possible for the brother to be admit-ted
to the Center since he had no handi-cap
to be corrected. The brother then
turned to a staff member (who had
been standing close enough that she
had overheard the conversation) and
said, "If I'd walk up to Miss Honeycutt
and stutter real bad whUe I asked her
to let me come with Ted to the Center
next year, do you think she would let
me in?"
Speech—
O
Among the equipment of one of the
therapists directing a speech correction
class next fall was a game called
"Speech—O". The game is something
like lotto, only the word on the card
which is turned up must be pronounced
and the player is scored on the basis of
how well he says the word.
Since the game was entertaining, and
the children thoroughly enjoyed playing
it, the results from the time spent with
"Speech—O" were especially good.
One day, about a month before Christ-mas,
one little lad confided to his teach-er
that he had written Santa asking
that a "Speech—O" game be included
among his Christmas gifts. He asked
if the teacher could also send Santa
a note telling him that the little boy
needed a "Speech—O" game. She assur-
February, 1949 The Health Bulletin
ed him that she would get in touch with
Santa and Santa did bring the "Speech
—O" game.
Plastic Ear
To be "different" in school brings
many unhappy experiences to a child.
One of the County Chapters of the
League for Crippled Children learned
that a little boy attending one of the
city schools had been born with only
one ear. The child's embarrassment
was acute.
The Committee asked if it could help.
It could, and did. The result was a
plastic ear. No longer was this little
boy thought "queer" by his school mates.
His social adjustment had improved im-mensely,
and the $75.00 the Committee
invested can only be measured in terms
of happiness.
Statistics
Approximately 146,000,000 persons live
in the U. S. (Source: U. S. Census Bu-reau,
July, 1948.)
23,000,000 of these or one out of six
has some type of handicap. About 97%
of all handicapped persons can be re-habilitated
sufficiently for them to ob-tain
gainful employment. (Source:
Baruch Committee on Physical Medi-cine.)
Accidents during 1947 required 1/10
of all available hospital beds! Many of
the injured will remain permanently
handicapped. 100,00 persons were killed
and 80,000 were injured in the United
States. There were 500 accidents daily
and these resulted in one death every
16 minutes during the year. (Source:
National Safety Council.)
Children needing Special Education.
On the basis of estimated population of
the total number of Children in the
United States:
2% are blind or partially sighted.
1.5% are deaf or hard of hearing.
1% are crippled.
1.5% have speech defects.
2% are mentally retarded.
0.2% are epileptic.
2.5% are behavior problems.
(Source: United States OfBce of Edu-cation—
Leaflet No. 4)
Number of Children with Cerebral
Palsy. To every 100,000 population:
7 children are born each year with
Cerebral Palsy, or
1 for every 215 births.
Of these 1 out of the 7 dies in infancy
or soon after.
2 out of the 7 are loneducable.
2 out of the 7 are mentally gifted.
2 out of the 7 are average mentally.
'Source: Dr. Winthrop M. Phelps
—
"The Doctors Talk it Over."
According to the State Health Depart-ment
109,372 babies were born in North
Carolina last year. Of these, 508 children
(one out of every 215 births) sustained
brain injuries, and will be paralyzed to
some extent. Many of this 508 will be
severely paralyzed, and the majority will
require much medical treatment, specia-lized
care and training. 70 percent of
all cerebral palsied children are capable
of becoming self-supporting citizens, if
given adequate training and opportuni-ties.
One child out of every 800 is born
with a cleft palate, making North Caro-lina's
total for last year 124. Of every
1,100 births one baby has club feet,
which means North Carolina had 10
babies born last year with that defor-mity.
Statistics on osteomyelitis, polio, rheu-matic
fever, and the other 251 causes
of crippling, show that North Carolina's
handicapped constituency is increasing,
as well as that of the rest of the nation.
No one expects to become crippled,
and no one expects to be born crippled,
or to become crippled as the result of
disease, accident, or infection. Few fami-lies
are financially able to adequately
meet the needs of a handicapped mem-ber,
and to date no social agency, either
public or private, has been able to pro-vide
all the needs of the handicapped
groups.
The objective of the North Carolina
League for Crippled Children, Inc., is
to help those who became crippled last
year, and the years before, and those
who will become crippled in the years
to come. The League does not have
funds to meet all the needs of all the
10 The Health Bulletin February, 1949
handicapped groups in the state, but
by supplementing the services of other
agencies, and by spending continuously
what funds it does have, it has been
able to provide some of the services
needed for a small number.
VITAL STATISTICS
William H. Richaedson
State Board of Health
Raleigh, N. C.
Frequently, Bulletin articles have been
devoted to a discussion of vital statistics
—that is, the number of people who
are born and who die during certain
specified periods of time. Vital statistics
might properly be referred to as the
bookkeeping of life and death.
The State Board of Health also keeps
another important set of records, deal-ing
with the number of persons suffer-ing
from 35 diseases, practically all of
which are capable to being transmitted
from person to person, under certain
circumstances. Some of these diseases
are more contagious than others. Many
of them are controllable, through the
application of modern scientific dis-coveries.
It is perfectly logical to say
that when diseases are controlled or
prevented, the death rates from such
diseases are, or should be, reduced.
A morbidity report reveals the number
of people who become ill. A majority of
those who go down with almost any
disease get well, with certain exceptions.
Others die. Those who become ill are
included in morbidity reports. Those
who die are included in vital statistics
reports. We propose at this time to dis-cuss
morbidity in North Carolina.
The sixteenth bulletin of North Caro-lina
morbidity statistics, covering the
calendar year 1947, contains the same
tabulations of the thirty-five reportable
diseases as are contained in the previous
bulletins.
There are three diseases which have
shown some increase during the past
few years: granuloma inguinale. Rocky
Mountain spotted fever, and tularemia.
Granuloma inguinale, which was not
made reportable until 1945, has shown a
slight increase in reported incidence
each year since that date. Rocky Moun-tain
spotted fever has made a small
increase each year except one since 1941.
The rate at that time was 0.6 cases per
100,000 population and is now 2.4. The
tularemia rate in 1944 was 0.3 and has
increased to 2.0 in 1947.
In addition to the above, chancroid has
shown increases for the past two years,
reaching 14.3 cases per 100,000 popula-tion
in 1947, as compared to 11.8 in
1945. The highest chancroid rate in the
past ten years was 18.4 in 1943. Tuber-culosis
has shown an increase in re-ported
cases for the past three years,
probably largely due to improved case
findings. The 1947 morbidity rate of 96.6
together with the mortality rate for the
same year of 28.4, presents the most
favorable ratio of cases per death in
North Carolina for many years. There
has been an increase in the percentage
of reported minimal active tuberculosis
cases from 14.7 in 1945 to 16 in 1947.
Undulant fever increased from 9 cases
in 1946 to 21 cases in 1947.
In 1947, poliomyelitis cases reached
the third largest number ever reported.
The majority of the cases were confined
to three south central counties in the
state and occurred relatively late in the
season.
Gonorrhea and syphilis remain the
largest single cause of morbidity among
the reportable communicable diseases;
however, encouraging declines occurred
in 1947. The gonorrhea morbidity rate
has been steadily rising in this state,
as reporting and case finding have im-proved.
Ten years ago the reported gon-orrhea
morbidity rate was 82 cases per
February, 1949 The Health Bulletin 11
100,000 population. This rate increased
steadily to 421 in 1946. This past year
shows the first sizeable decline that has
taken place during this period with a
rate of 381. Syphilis morbidity reports
rose steadily for many years until 1939
when a peak of 877 cases per 100,00 pop-ulation
was reported. Following that
year, syphilis morbidity declined an-nually
until 1946, when the rate again
rose to 242. In 1947, the rate declined
to 235. Whether or not this decline re-presents
a renewal of the downward
trend in syphilis morbidity, interrupted
by demobilization, remains to be seen.
Diphtheria morbidity rose slightly
over the record low established in 1946;
however, pertussis morbidity was the
lowest recorded since 1936. Typhoid fever
cases reached a record low of 47 cases,
having declined without interruption
since 1935.
An interesting decline has taken place
in scarlet fever morbidity during the
past two years. Prior to 1945, the rate
fluctuated between 60 and 80 cases per
100,000 population over a period of at
least ten years without any tendency to
decline. In 1946 the rate dropped to 40,
the lowest recorded. In 1947 the rate
dropped still fui'ther to 31.
The hazard of war-born malaria and
amebic dysentery appears to be steadily
diminishing. While reports of malaria
in veterans are being received, the over-all
recorded malaria hiorbidity rate de-clined
from 9.6 cases per 100,000 last
year to 3.7 in 1947. The rate for amebic
dysentery remained unchanged at 0.5
cases per 100,000 population.
Murine typhus fever declined to 1.4
cases per 100,000 population, making the
fourth consecutive year of decline. This
is the lowest rate recorded for this
disease since 1934. Meningococcus men-ingitis
declined to the lowest point since
1942, having decreased each year since
1943. The rate that year was 13.2 the
highest recorded in many years, and
may have been a result of large popula-tion
movement during the war. The
1947 rate is 2.6.
Now, for an over all picture of mor-bidity
statistics in North Carolina dur-ing
the calendar year of 1947. The 35 re-portable
diseases caused 38,016 individ-ual
illnesses. During the year there
were 14,169 cases of gonorrhea reported
to the State Board of Health; 8,724
cases of syphilis; 3,484 cases of pulmo-nary
tuberculosis; 4,978 cases of measles,
and 2,983 cases of whooping cough. In
spite of the fact that diphtheria can be
prevented, and despite the fact that
immunization of babies between 6
months and a year old is cumpulsory,
there were 751 cases of diphtheria re-ported
during the calendar year. Fortu-nately,
however, there were only 33
diphtheria deaths.
The above 38,016 cases of illness repre-sent
only 35 diseases. Ailments which
cause the greatest number of deaths,
however, are not in the reportable class.
For example, 2,777 people died of cancer
in North Carolina last year; 7,487 were
victims of heart diseases; 3,379 died of
apolplexy; 2,614 died of Bright's disease,
and 1,307 of pneumonia. These figures,
remember, represent death from some
of the diseases which are not reportable.
There were thousands afflicted with these
known reportable diseases who did not
die last year. We must keep in mind
that the degenerative diseases referred
to above are not preventable. At the
same time, however, they are not con-taigous,
but, combined, they kill more
people every year than do all the con-taigous
and reportable diseases.
Now, back to the reportable diseases,
for oui- conclusion. You have been given
the number of cases, last year, of gonor-rhea,
syphilis, pulmonary tuberculosis,
diphtheria, and whooping cough. Let us,
then, make a comparison of the number
of cases and the number of deaths in
each instance. As previously stated,
there were 33 diphtheria deaths among
the 751 children who were down with
that disease last year. During 1947, there
were reported to the State Board of
Health 256 syphilis deaths among the
8,724 cases reported. While 3,484 cases
of pulmonary tuberculosis were reported,
there were 983 deaths. We shall not un-dertake
to compare current tuberculo-sis
deaths with currently-reported cases,
because it is certain that many of those
who died last year contracted the disease
12 The Health Bulletin February, 1949
before 1947. Some of them probably had
had tuberculosis for years and were not
diagnosed until it was too late to effect
a cure. This should serve as an incen-tive
to all to make sure they have not
the disease—not even in its incipiency
—by having their chests X-rayed. This
service is now available, without cost.
^
Case-finding machinery already has
been set up in many counties and, it
is safe to say, many lives have been
saved because of early diagnosis and
treatment. Medical science now knows
how to take care of tuberculosis in all
but the most advanced stages. Let us
conclude then, by urging everyone to
have a chest X-ray made, at the earliest
possible moment. The fight against the
white plague now is on in earnest. Only
the people who have the opportunity to
avail themselves of benefits of the pre-sent
case-finding program are to blame
if they wait too long. There are more
avenues to suicide than guns, knives,
and poison drugs. They work quickly
it is true. Neglect is a slower but none
the less effective means of self-destruc-tion.
NOTES AND COMMENT
Public Health Nurse Chosen as
Representative
Miss Lida Grey Bissette, Registered
Nurse in Public Health of the Wilson
City and County Health Department,
and a recent graduate of the Woodard
Herring Hospital, has been chosen by
that hospital to represent it in the
contest to receive the Linda Richard
Award, which will be one feature of a
"Diamond Jubilee Program of the
American Nurses' Association".
The American Nurses' Association will
present the Award to one outstanding
nurse in each state who graduates from
an accredited school of nursing and be-comes
registered during the period
August 1, 1948, through July 1, 1949.
The Award will be granted on the basis
of achievement, scholarship, aptitude
for nursing, devotion to duty, leader-ship,
appearance and personality. So
long as she is registered, a professional
nurse, it makes no difference in which
field the contestant is employed. She
may be engaged in private duty or hos-pital
staff work, in public health, indus-trial,
school, army or navy nursing, or
of any other branch of the profession.
The Award will be furnished by the
American Nurses' Association and will
consist of a bronze medal bearing the
likeness of Linda Richard and carry
the inscription on the*observs "Diamond
Jubilee of American Nursing 1948-1949";
and in the center of the reverse " (name
of nurse) Award of Achievement"; at
the top of the primeter "American Nur-ses'
Association", and at the bottom
"North Carolina State Nurses' Associa-tion".
The Award will be presented to the
North Carolina winner at the forty-seventh
annual convention of the North
Carolina Nurses' Association, which will
be held in High Point the week of Octo-ber
23, 1949.
February. 1949 The Health Bulletin 13
ACCIDENTS RANK FIRST AS DESTROYER OF
WORKING YEARS
CHICAGO—A complete cure for heart
diseases or cancer would have added
fewer working years to the life expec-tancies
of the American people in 1945
than would have been added by pre-vention
of all fatal accidents, accord-ing
to the Bui'eau of Medical Economic
Research of the American Medical
Association.
Writing in The Journal of the Ameri-can
Medical Association, Frank G. Dick-inson,
Ph.D., director of the bureau, and
Everett L. Welker, Ph.D., associate in
mathematics, say that fatal accidents
now cut more years from the working
lifetimes of the people of the United
States than do deaths from any one
natural cause.
The total numbers of deaths, which
show heart diseases and cancer to be
number one and number two "killers,"
are not alone an accurate measurement
of the number of working years—those
between the ages of 20 and 65—which
are lost by death, they say, because
mere numbers conceal wide differences
in the average ages at death from diffe-rent
causes.
Neither can the loss to the produc-tive
and military strength of the nation
from any one cause of death be accur-ately
determined by this one measure
in the present period of declining mor-tality,
long life, and a rapidly aging
population, they point out.
These conclusions are not based upon
an alarming rise in the number of fatal
accidents, but upon man's conquest of
disease—medical progress against the
"younger" and some of the "older"
causes of death — the article empha-sizes.
The leading causes of death are
divided into "younger" and "older"
causes because the average age of per-sons
who die from heart disease, can-cer,
intracranial lesions of vascular ori-gin,
and nephritis is 22 years more than
that of persons who die from pneumonia
and influenza, accidents, and tuberculo-sis,
the article indicates.
Actually ,the high death rate of per-sons
65 years of age and over from the
"older" causes of death is an indication
of the progress that has been made in
extending the lifetimes of many per-sons
who formerly would have died in
young or middle age from these diseases,
the authors point out.
In the "younger" group of diseases,
pneumonia fatalities have been sharply
reduced by the "wonder" drugs, such as
sulfanilamide, sulfadiazine, and peni-cillin.
Dr. Dickinson and Dr. Welker's classi-fications
of the seven leading causes of
deaths were taken from the Manuel of
the International List of Causes of
Death, compiled by the United States
National Office of Vital Statistics, Wash-ington,
and published in 1946. They
were—diseases of the heart, including
rheumatic heart disease, which is mostly
a disease of children and young persons;
cancer and other malignant tumors; in-tracranial
lesions of vascular origin;
nephritis; pneumonia and influenza;
tuberculosis; and accidental deaths.
Using these classifications, Dr. Dickin-son
and Dr. Welker developed two new
measures for ranking the causes of
death. Both take into account the age
as well as the number of persons dying
from each cause.
One measure, working years lost, is
based on the concept of a working life-time
as the period between the 20th
and 65th birthdays. Everyone below age
65 has a certain number of "unrealized"
working years ahead of him which are
destroyed if he dies before the custo-mary
retirement age. When the unrea-lized
working lifetimes of all persons
dying from each of the causes are added
together, the various causes can be com-pared
in terms of the amounts of the
nation's productive capacity which they
destroy, the authors explain.
The other measure, life years lost, is
the same as the first except that it con-siders
the leisure as well as the work-
14 The Health Bulletin February, 1949
ing years destroyed by death and is
based upon the average hfe expectancy
of the American people at death rather
than upon the arbitrary designation of
the working years.'
Applying these two new measures to
the leading causes of death in 1930, 1935,
1940, and 1945, as listed by the National
Office of Vital Statistics, Dr. Dickinson
and Dr. Welker found that in 1945, a
year of nationwide gasoline rationing,
fatal accidents were first in terms of
working years lost, although heart di-sease
killed over four times and cancer
nearly twice as many persons. Accidents
held this same rank in 1940, were se-cond
in 1935, and third in 1930. Acci-dental
deaths accounted for 7 percent of
all deaths in each of the four years
studied. Young white men are the
chief victims of accidents, the article
says.
In 1945 the number of working years
lost from accidental deaths was 1,750,-
000, which may be compared to 1,680,-
000 from heart diseases. 1,110,000 from
pneumonia, and 1,040,000 from cancer
in the same year. Pneumonia deaths
which held first place in 1930 and 1935
as a cause of working years lost, dropped
to third place and tuberculosis, which
held second place in 1930, dropped to
fifth place.
The authors developed these two new
measures to evaluate the loss to society
resulting from the causes of death, and
point out that neither is designed to
gauge the importance of any one cause
to the individual. As a whole, the study
shows that the people of the nation are
living longer and dying during old age
when their working lifetimes are largely
over. In 1945 no leading cause of death
struck primarily at the young, mortality
from diseases which kill before middle
age had decreased rapidly, and the
majority of heart and cancer deaths
occurred after age 65.
The findings that fatal accidents are
a greater menace to the nation's eco-nomy
and security than is any one natu-ral
cause of death suggest that persons
who plan health improvement programs
do well to place more emphasis on a.oci-dent
prevention.
The public must also, as patients, co-operate
with physicians, and must con-tinue
to support medical research and
education if the accelerated rate of
medical progress is to be maintained, the
article points out.
As a guide to the use of the two new
measures. Dr. Dickinson and Dr. Welker
say that " if the retired, leisure years
are a major consideration, life years
lost are recommended as the better of
the two measures. If economic conside-rations
are paramount, use of the se-cond
measure, working years lost, is
advised."
The complete story of Dr. Dickinson
and Dr. Welker's study may be found
in their recent published monograph,
"What Is the Leading Cause of Death?"
The bureau plans to make a second
study using similar criteria to measure
the loss to society from disability re-sulting
from sickness and injury, both
fatal and non-fatal. The authors be-lieve
that the common cold will rank
high among the leading causes of dis-ability.
FUNDS MEAGER FOR RESEARCH
ON HEART CONDITIONS
An editorial in Hygeia states:
"Today in the United States heart
disease is the new captain of the men
of death; fifty years ago it was tuber-culosis.
Once the acute and chi'onic
infectious diseases were far greater as
a menace to mankind than diseases of
the heart, high blood pressure and hard-ening
of the arteries.
Today tuberculosis is seventh among
the causes of death. High blood pressure
and hardening of the arteries are re-sponsible
for 45 percent of all cases of
heart disease in adults.
The prolongation of life by the tech-nics
of modern medicine has resulted
from the manner in which the diseases
of childhood have been brought under
control. People today live far longer
than they did in 1900.
Rheumatic heart disease is the lead-ing
fatal disease among children be-tween
the ages of 5 and 19. Many of
February, 1949 The Health Bulletin 15
those who die of heart disease as they
grow older represent children who have
had rheumatic heart disease and who
then suffered, more or less, disability
for their remaining years.
Thus heart disease takes its toll in
sickness and disability as well as in
death. Thousands of men in the prime
of life whose economic value to society
is tremendous are stricken when they
are beginning to make theii' richest
contribution.
From the facts here recited, the out-look
may seem dismal. Perhaps the
apathy of most people toward heart
disease and the acceptance of the in-evitability
of deaths from diseases of
the heart are largely responsible for
our failure to meet the challenge.
The American people contribute mil-lions
of dollars to the control of tuber-culosis,
cancer, infantile paralysis, and
many other easUy dramatized diseases.
The funds for research on conditions
affecting the heart are pitifully meager.
Already scientific medicine has done
much in its advances against heart di-sease.
The development of surgery of
the heart in recent years has been
among the most striking of medicine's
great accomplishments, yet far more
remains to be done than has already
bfjen accomplished.
What has been achieved is merely the
proof of how much could be accom-plished
if the men and the facilities and
the funds so sorely needed could be
made available.
Every year during the past decade we
have increased oui- knowledge of the
coronary arteries. The development of
the radioactive isotopes and of technics
for catheterizing the heart and research
with the electrocardiogram have permit-ted
studies to be made that go far be-yond
anything that could be imagined
twenty years ago. Yet for these studies
the funds available are pitifully small.
Already the scientists who devote
themselves wholly to the basic medical
sciences, anatomy, physiology, bateri-ology,
pathology, biochemistry, and
pharmacology among others, are ready
and capable of extending their fun-damental
research into vmsolved prob-lems
of diseases of the heart.
Many of these scientists are the
teachers in our medical schools. If we
look forward as we should to the future,
they must be given opportunity to train
young men in the knowledge of their
sciences so as to make them available
for research in the future.
Today the attack on disease requires
teamwork. The medical personnel in-cludes
physicians, technicians, statis-ticians,
nurses and social and clerical
workers. The facilities include clinics,
hospital wards, research laboratories,
administrative offices, sanitaria, and
rest camps. Both personnel and facil-ities
are inadequate to meet the need.
A comprehensive program of research
on problems of diseases of the heart
means more facilities for the care and
study of patients, more laboratories for
research, more trained personnel. The
need is established. America can and
should meet that need."
AVERAGE AGE OF PHYSICIANS
AT DEATH RISES STEADILY
CHICAGO—The average age of phy-sicians
in the United States at death
has risen steadily during the past four
years, according to American Medical
Association statistics.
In 1948 the average age of physicians
at death was 67.4 years, says an edi-torial
in The Journal of the American
Medical Association. In 1947 it was
66.7 years; in 1946, 66.1 years; and in
1945, 65.3 years.
Heart disease is the number one
killer among physicians, The Journal
figures for 1948 show. Coronary throm-bosis,
angina pectoris, rheumatic heart,
and other heart conditions accounted
for 41 per cent of the 3,230 deaths of
physicians reported by The Journal
during the year.
Diseases of the nervous system were
second, causing 412 deaths, cancer and
other malignant tumors third, account-ing
for 348 deaths, and accidents fourth,
accounting for 173 deaths.
Falls caused more deaths than did
any other type of accident, and motor
16 The Health Bulletin February, 1949
vehicle accidents caused more than
twice as many deaths as did air trans-port
accidents.
Other major causes of death among
physicians were diseases of the respira-tory
system, accounting for 163 deaths,
and diseases of the digestive system,
accounting for 114.
Twenty-three physicians of the 3,-
230 total were killed in action during
World War II, and 33 died while in
military service.
EMOTIONAL STRESS
CAUSES MOST HEADACHES
CHICAGO — Most headaches are
caused by emotional stress, five New
York physicians indicate in The Journ-al
of the American Medical Association.
Three of the physicians—Arnold P.
Friedman, of the Headache Clinic Sec-tion,
Mental Hygiene Service, Veterans
Administration, and Charles Brenner
and Sidney Carter, from the Division
of Neuropsychiatry, Montefiore Hos-pital,
and the College of Physicians
and Siu-geons, Columbia University
—
conducted special headache clinics. They
foimd that headaches for which there
is no apparent physical cause and
headaches following head injuries were
by far the most common among pa-tients.
Treating 494 patients with headaches
of these kinds, the three physicians
found that 50 to 60 per cent responded
favorably to almost any medicine given
them, and nearly as well to placebos,
harmless but effective substitutes for
drugs.
Treatments used included psycho-therany,
pain-relieving drugs, sub-stances
to constrict and dilate the blood
vessels, vitamins and hormones.
Results of the study strongly suggest
that the effectiveness of the medica-tions
was caused primarily by the pa-tient's
psychologic reaction to the treat-ment
situation in general and to hav-ing
a "remedy" from the doctor, the
article says adding:
"Both types of headache probably
are responses of the body to distributing
psychologic stress."
Robert M. Marcussen, M. D., and
Harold G. Wolflf, M. D., from the New
York Hospital and the Departments of
Medicine and Psychiatry, Cornell Uni-versity
Medical College, made a study
of migraine headache.
The typical sufferer from migraine
headache, they found, is ambitious and
tends to be a perfectionist.
Describing the personality of persons
suffering from migraine, the physicians
say:
"They are tense driving persons who
have found that doing more than and
better than their fellows brings a good
deal of satisfaction. However, this end
is accomplished at a great cost in en-ergy.
They become resentful because
they cannot keep up with the load
which the world and themselves impose.
"The natural outcome is tension,
fatigue, and exhaustion; in this setting
headache makes its appearance. Rage,
resentment, and frustration are often
common denominators of the emotional
derangement preceding an attack of
migraine. However, dramatic events
need not precede headache—many fol-low
long periods of so-called routine
living with slowly accumulating ten-sion."
Although the doctor can make the
migraine patient aware of the cost of
such a way of life, the decision of what
to do about it is the patient's, the phy-sicians
emphasize.
OUR FRONT COVER — Graham D.
Canfield, son of Mr. and Mrs. Norman
S. Canfield, Morehead City, North Caro-lina,
born July 25, 1947 with no right
leg below the knee and no toes on left
foot. He was taken to the Orthopedic
Clinic at Greenville, North Carolina.
When about a year old he was hos-pitalized
under the supervision of Dr.
Hugh A. Thompson, Orthopedic Sur-geon,
Raleigh, North Carolina. An ar-tificial
leg, constructed by J. E. Hanger
of Raleigh, North Carolina, was fitted
on Graham when he was thirteen
months old. He started using it when
he was fourteen months old. The pic-ture
was taken one month later when
he was walking and running as well as
a normal child of his own age.
MEDICAL LIBRARY
U. OF N. C .
CHAPEL HILL. N. C.
1
i This Bulletin. wiJl be sgr\t free to ony citizen of the State upon request!
Published monthly at the office of the Secretary of the Board, Raleigh, N. C.
Eniered as secund-class mattct at Postoffice at Raleigh, N. C. under Act of Aueu't 24. 1912
Vol. 64 MARCH, 1949 No. 3
ARTHUR G. RAYMOND, JR.
MEMBERS OP THE NORTH CAROLINA STATE BOARD OF HEALTH
S. D. GRAIG, M.D., President Winston-Salem
G. G. DIXON, M.D., Vice-President Ayden
H. LEE LARGE, M.D Rocky Mount
W. T. RAINEY. M.D Fayetteville
HUBERT B. HAYWOOD, M.D Raleigh
J. LaBRUCE WARD, M.D Ashevillc
J. O. NOLAN, M.D Kannapolis
JASPER C. JACKSON, Ph.G Lumberton
PAUL E. JONES, D.D.S Farmville
EXECUTIVE STAFF
J. W. R. NORTON, M.D., M.P.H., Secretary and Slate Health Officer
G. M. COOPER, M.D., Assistant State Health Officer and Director Division of Health Education,
Crippled Children's Work, and Maternal and Child Health Service
, Director, Division Local Health Administration
, District Director, Local Health Administration
ERNEST A. BRANCH, D.D.S. , Director, Division Oral Hygiene
JOHN H. HAMILTON, M.D., Director, Division of Laboratories
J. M. JARRETT, B.S., Director, Division of Sanitary Engineering
OTTO J. SWISHER, M.D., Director, Division of Industrial Hygiene
BERTLYN BOSLEY, Ph.D., Director, Nutrition Bureau
FELIX A. GRISETTE, Director, Venereal Disease Education Institute
C. P. STEVICK, M.D., M.P.H., Director, Division of Epidemiology and Vital Statistics, and
Co-Director, School-Health Coordinating Service
WILLIAM A. SMITH, M.D., Director, Bureau of Tuberculosis Control
IVAN M. PROCTER, M.D., Director, Bureau of Cancer Control
HAROLD J. MAGNUSON, M.D., Director, Reynolds Research Laboratory, Chapel Hill
JOHN J. WRIGHT, M.D., Director, Field Epidemiology Study of Syphilis, Chapel Hill
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 distribution without charge special
literature on the following subjects. Ask for any in which you may be interested.
Adenoids and Tonsils German Measles Sanitary Privies
Appendicitis Health Education Scabies
Cancer Hookworm Disease Scarlet Fever
Constipation Infantile Paralysis Teeth
Chickenpox Influenza Tuberculosis
Diabetes Malaria Typhoid Fever
Diphtheria Measles Venereal Diseases
Don't Spit Placards Padiculosis Vitamins
Endemic Typhus Pellagra Typhoid Placards
Flies Residential Sewage Water Supplies
Fly Placards Disposal Plants Whooping Cough
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, North Carolina.
Prenatal Care Baby's Daily Schedule
Prenatal Letters (series of nine First Four Months
monthly letters) Five and Six Months
The Expectant Mother Seven and Eight Months
Infant Care Nine Months to One Year
The Prevention of Infantile Diarrhea One to Two Years
Breast Feeding Two to Six Years
Table of Heights and Weights Instructions for North Carolina Midwives
CONTENTS Page
School Hearing Conservation Activities in North Carolina 3
Window Operation For Deafness 5
Your Pond—A Public Health Responsibility 7
Notes and Comment 13
Vol. 64 MARCH, 1949 No. 3
J. W. R. NORTON, M.D., M.P.H., State Health Officer JOHN H. HAMILTON, M.D., Acting Editor
SCHOOL HEARING CONSERVATION ACTIVITIES
IN NORTH CAROLINA
By
C. P. Stevick, M. D., M. p. H., Co-Director
School-Health Coordinating Service
School health work in North Carolina
is the responsibility of schools and local
health departments. In the conduct of
this work the local agencies receive
assistance from the State Department
of Public Instruction and the State
Board of Health.
Much can be taught in our public
schools that will enable the student not
only to be healthier when he graduates
from high school, but also to know what
he needs to do to preserve his health
for the remainder of his own life, and
insure good health for his children.
Learning is frequently accomplished
most easily by doing, and our school
health program in North Carolina in-cludes—
where available—certain nurs-ing
and medical facilities that provide
for the finding of children with physical
and mental defects; and, at the same
time, give the children valuable educa-tional
experiences in health.
The school health service we wish to
discuss briefly here pertains to the con-servation
of the hearing of our school
children. This is a program that the
School-Health Coordinating Service, a
joint Division of the State Departments
of Health and Public Instuction, is help-ing
to develop throughout the State.
Hearing conservation in the public
schools can be divided into four closely
related activities:
I. Hearing testing of the school popu-lation
II. Medical care for the children with
hearing defects
III. Special education for those need-ing
it because of their handicap
IV. Vocational rehabilitation in select-ed
cases
The fii'st step in the actual carrying
out of the hearing work in the schools
is to find the children with hearing de-fects.
The human ear is capable of hear-ing
a wide range of sound, from very
low notes in the musical scale to ex-tremely
high notes. Due to the way in
which the nerve of the ear is con-structed,
it is possible for a person to
lose the ability to hear high notes or
low notes, but to hear all other notes
fairly well. In other words, the ear can
be damaged by disease so that certain
sounds can still be heard, but others
cannot. This fact is important in test-ing
the hearing of children. A child
may hear certain sovmds well, but have
difficulty understanding speech. A par-ent
or teacher may know that the child
hears thunder or music and, because
of this, fail to recognize that the child
does not hear speech well. It is also
possible for a child to hear speech well,
and yet have a loss of hearing in the
range of sound that is higher in pitch
than the human voice.
The Health Bulletin March, 1949
Certain apparatus has been diesigned
to test hearing accurately. This appa-ratus
is able to detect loss of the ability
to hear any part of the full range of
sound. It is obvious that tests of hear-ing
that are not carried out by means
of such apparatus are not complete or
very accurate. Because of the expense
of this apparatus and the time involved
in using it, this phase of school health
work in North Carolina has only re-cently
received wide-spread attention.
The following counties and cities now
have audiometers—as they are called,
for testing hearing in the schools. In
some cases, the purchase was made by
interested civic clubs, such as the Ex-change
or Kiwanis Clubs. In other in-stances,
the schools or health depart-ments
purchased the equipment. The
counties and cities are: Alamance, Bun-combe,
Burke, Catawba—Lincoln and
Alexander, Cleveland, Gaston, Halifax,
Moore, New Hanover, Pasquotank—Per-quimans
and Camden, Rowan, Vance
Wake, Wayne, Asheville, Charlotte,
Greensboro, High Point, and Rocky
Mount.
There may be one or two other coun-ties
or cities that should be included in
this list, but for which the School-
Health Coordinating Service does not
have complete information.
It can be seen from this list that only
part of the State is covered by the pro-per
equipment. It is hoped that addi-tional
fimds for school health work will
be available soon for assisting the coun-ties
in pvu-chasing audiometers and pro-viding
personnel to operate them.
In those counties having machines,
the nurses and teachers or technicians
working in cooperation with the nurses,
test the children in a carefully selected
room in the school where as much noise
is excluded as possible. Tests require
about two minutes per child and can be
given to children in all grades. The
ideal program provides for testing every
child every other year.
The test with one type of audiometer
("puretone") is carried out as follows:
The child holds the receiver of the
audiometer to his ear just as if he were
listening to the telephone. The person
giving the test then turns a switch on
the audiometer that reproduces a low
pitched musical note in the receiver. The
audiometer also has a volume control
which is adjusted so that the musical
note is exactly as loud as it should be
for the normal ear to hear. If the child
hears the sound, he raises his hand.
The switch on the machine is then
turned to the next note in the scale. A
total of eight separate tones are used
in testing each ear. The tones are select-ed
so as to cover the complete range of
hearing. If the child is unable to hear
any two of these tones, or musical notes,
he is then scheduled for a more com-plete
test at a later date. At the time
of the retest, the volume control is ad-justed
for each tone until it is found
exactly how loud the sound miost be
before the child can hear it. In this way,
the exact degree of hearing loss can be
determined and the type of sounds that
cannot be heard are also clearly evi-dent.
This type of test is performed with
one child at a time. There is another
type of tests that can be carried out
with 25 or 30 children at a time by
means of multiple ear pieces connected
to a phonograph. The phonograph test
is not as accurate as the test in which
the separate tones are used and is not
used as widely now as formerly.
In those counties where testing has
been started in the schools for the
first time, approximately 3 to 5 per cent
of the children have been found to
have defective hearing requiring refer-ral
to a physician. In the case of many
of these children, prompt medical care
restores the hearing to normal. This is
why the hearing program is officially
spoken of as a hearing conservation
program. If foimd early enough, a
large number of children with ear
trouble can permanently preserve their
normal hearing ability. As mentioned
above certain children who are able to
hear conversation easily may not be
able to hear high pitched sounds. Such
a child is just as badly in need of
medical care as those having an in-ability
to hear conversation because the
loss shows that some disease process is
March, 1949 The Health Bulletin
present and the damage done to the
upper tones only may become progres-sive
and later affect the speech range of
hearing. It is only by means of the
"puretone" audiometer tests that this
type of child can be located and referred
for medical care.
When a child is found with certain
degrees of deafness, his educational
care must be planned in addition to
his medical care. In mild cases, seating
near the teacher is all that is required.
In more serious cases, lip reading in-struction
is needed. For children with
a progressive hearing loss, it is impor-tant
that lip reading be taught before
all of the hearing is lost, since it is
much easier to learn to read someone's
lips if his voice can also be heard at the
same time. Speech correction is neces-sary
for some children who, because of
their inability to hear speech clearly,
do not speak clearly themselves. For
those children who are unable to pro-gress
satisfactorily in our public schools,
the State has excellent schools for the
deaf. The colored school for the deaf is
in Raleigh, and the white school is at
Morganton.
The State Vocational Rehabilitation
service of the State Department of
Public Instruction is able to provide
special medical care and vocational
training for many persons over 16
years of age, who are otherwise unable
to receive it. The objective of this pro-gram
is to assist worthy persons in
learning vocations in which their physi-cal
defects are not a handicap. Many
well paid jobs can be done as well or
better by handicapped persons as by
persons without defects of any kind.
From what we have outlined here, it
can be seen that the hearing program
requires the cooperation of schools,
health departments, civic clubs, and
many other agencies. We have made a
good beginning in North Carolina, and
when funds become available to buy
additional equipment and employ addi-tional
nurses, teachers and other person-nel
the program can move forward
rapidly as one of the many phases of
a well rounded school health program.
WINDOW OPERATION FOR DEAFNESS
By
James W. Ballew, M. D.
Raleigh, N. C.
Sound is vibrations in various wave
lengths. The normal himian being is
capable of intercepting and interpret-ing
a certain range of wave lengths in
the sound spectrum. When this sound
is transmitted to our brain, and there
interpreted by the conscious mind—we
hear. The segment of the sound spect-rum
audible to the human varies from
about the low of the bullfiddle or base
horn: to the highest pitches of the vio-lin—
a watch tick—or a cricket's chirp.
The normal conversational range of the
human voice is approximately the mid-dle
half of the sound segment.
The mechanism for changing the
vibrations of sound to the nerve im-pulses
that are carried to our brain
for interpretation or action is located
in a hard bony capsule located in the
base of the skull. This capsule also
houses the mechanism concerned with
our balance and equilibrium. The part
concerned with balance is called the
labrynth, and that part concerned with
hearing is called the cochlea. The coch-lea
is named for a spiral shaped shell-fish,
which it resembles. The labrynth
suits its name too. There are two flex-ible
openings to this bony capsule. One
of these is called the round window,
and the other is called the oval window.
The round window is covered by a thin
membrane, and the oval window is clos-ed
by the footplate of the Stapes. The
Stapes is one of the bones serving to
The Health Bulletin March, 1949
transmit the vibrations of sound from
the ear drum to the fluid of the lab-rynth.
The whole capsule is filled with
fluid in which floats the soft tissues of
the nerves and organs of hearing and
balance .
Normally the vibrations of soimd
entering at the oval window causes the
fluid within the capsule bathing the
sensitive endings of the nerve of hear-ing
to vibrate and move. It is theorized
that the thin membrane covered round
window serves as a valve to allow the
fluid to move freely and quickly. This
vibration of the fluid is picked up by
the nerve endings—changed to nerve
impulses and transmitted to various
parts of our central nervous system.
Normally, the footplate of the Stapes
moves freely in the ,oval window. But
in a certain group of people there is an
overgrowth of bone in this area. And
the edge of the oval window overgrow
the narrow space to the footplate and
fix the Stapes so that it can no longer
move freely. Vibrations are no longer
transmitted freely to the fluid of the
labrynth. Thus altho the nerve of
hearing itself may be in perfect condi-tion,
the individual no longer hears
well. This condition is known techni-cally
as Otosclerosis.
Otosclerosis can and does occur at
any age, but the larger per cent of
cases needing help to hear is the 25
to 45 year group. These people are in
the most active and productive period
of their lives. This fact, plus others in-spired
much work on some surgical
procedure that might help these people.
Many attempts were made, but failed.
The greatest cause for failure in even
well devised technics was infection
following operation. This is serious be-cause
infection in the labrynth usually
causes profound or total loss of hearing
in the affected ear. And it was almost
certain to be complicated by a meningi-tis.
The advent of the sulfa drugs and
the antibiotics, such as penicillin caused
new thinking and activity in the field.
In the late thirties, Dr. Julius Lempert
worked out the basic technic for the
operation known as the fenestration or
window operation.
In performing this operation, the
surgeon cuts thru the outer ear, and
opens the mastoid bone. He then locates
the part of the bony capsule (labrynth)
known as the horizontal semicircular
canal. This canal is concerned with our
balance mechanism, but as noted pre-viously,
the fluid in which the soft tis-sues
float communicates freely with
those bathing the organ of hearing. The
surgeon then makes a new opening
into the bony capsule on the anterior
end of the canal. Meanwhile, he has
carefully dissected free the skin cover-ing
the back of the external ear canal,
which leads from the outer ear to the
driun. He leaves this attached to the
ear drum. At the end of the operation,
he covers his new window with the upper
part of the ear drum and this skin.
This skin is the only thing that has
been successful in keeping the window
from closing. This skin is tissue paper
thin, and contains no oil or sweat gland,
and no hair follicles.
The operation is not as simple as it
may sound. It is tedious and difl&cult
to perform, and in vmskUlful hands may
lead to permanent injury to the patient.
The surgeon must be quite skilled In
ear surgery of other kinds before
attempting the fenestration operation.
Even skilled ear surgeons spend much
time practicing the operation on cada-vers
before attempting it on live pati-ents,
even