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®tie litirarp of ttt ®nibets(ttp of ^ortt Carolina CnboUieb bp i:i]e IBialtttit anb I^Uantiirapu ftocteties; 61U.06 M86h V.63-6U 19U8-U9 Med. lib. This book must not be taken from the Library building. 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
Object Description
Description
Title | Health bulletin |
Other Title | Bulletin of the North Carolina State Board of Health; Bulletin of the North Carolina Board of Health |
Creator | North Carolina. State Board of Health. |
Date | 1949 |
Subjects |
Children--Health and hygiene Diseases Hygiene Public Health--North Carolina--Periodicals Sanitation |
Place | North Carolina, United States |
Time Period | (1945-1989) Post War/Cold War period |
Description | Volume 64, Issues 1-12. Issues for Feb.-May 1917 and for Jan.-July 1918 not published.Addresses by Walter Clark. |
Publisher | Raleigh,North Carolina State Board of Health. |
Agency-Current | North Carolina Department of Health and Human Services |
Rights | State Document see http://digital.ncdcr.gov/u?/p249901coll22,63754 |
Physical Characteristics | 61 v. :ill. ;23 cm. |
Collection | Health Sciences Library, University of North Carolina at Chapel Hill |
Type | text |
Language | English |
Format | Bulletins |
Digital Characteristics-A | 13,016 KB; 230 p. |
Digital Collection |
Ensuring Democracy through Digital Access, a North Carolina LSTA-funded grant project North Carolina Digital State Documents Collection |
Digital Format | application/pdf |
Related Items | Imprint varies: published later at Raleigh, N.C. |
Title Replaces | Bulletin of the North Carolina Board of Health** |
Audience | All |
Pres File Name-M | pubs_edp_healthbulletin1949.pdf |
Pres Local File Path-M | \Preservation_content\StatePubs\pubs_edp\images_master\ |
Full Text | ®tie litirarp of ttt ®nibets(ttp of ^ortt Carolina CnboUieb bp i:i]e IBialtttit anb I^Uantiirapu ftocteties; 61U.06 M86h V.63-6U 19U8-U9 Med. lib. This book must not be taken from the Library building. 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 |