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i This Bulletin will be sent free to orvy citizen of the State upon request j
Entered as second-class matter at Postoffice at Raleigh, N. C. under Act of August 24, 1912
Published monthly at the office of the Secretary of the Board, Raleigh, N. C.
Vol. 62 JANUARY, 1947 No. 1
MEMBERS OF THE NORTH CAROLESTA STATE BOARD OF HEALTH
S. D. CRAIG, 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 Jayetteville
HUBERT B. HAYWOOD, M.D Raleigh
J. LaBRUCE WARD, M.D _ Asheville
J. O. NOLAN, M.D Kannapoli*
JASPER C. JACKSON, Ph.G Lumberton
PAUL E. JONES, D.D.S Farmville
EXECUTIVE STAFF
CARL V. REYNOLDS, M.D., Secretary and State Health OflScer.
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.
R. E. FOX, M.D., Director Local Health Administration.
W. P. RICHARDSON, M.D., District Director Local Health Administration.
ERNEST A. BRANCH, D.D.S., Director of Oral Hygiene.
JOHN H. HAMILTON, M.D., Director Division of Laboratories.
J. ROY HEGE, M.D., Director Division of Epidemiology and Vital Statistics.
J. M. JARRETT, B.S., Director of Sanitary Engineering.
T. F. VESTAL, M.D., Director Division of Tuberculosis.
OTTO J. SWISHER, Director Division of Industrial Hygiene.
WILLIAM P. JACOCKS, M.D., Director Nutrition Division.
MR. CAPUS WAYNICK, Director Venereal Disease Education Institute.
C. P. STEVICK, M.D., Director, School-Health Coordinating Service.
HAROLD J. MAGNUSON, M.D., Director Reynolds Research Laboratory, Chapel Hill.
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 dis-tribution
without charge special literature on the following subjects. Ask for any in
which you may be interested.
Adenoids and Tonsils German Measles Sanitary Privicj
Appendicitis Health Education Scabies
Cancer Hookworm Disease Scarlet Fever
Constipation Infantile Paralysis Teeth
Chickenpox Influenza Tuberculosis
Diabetes Malaria Typhoid Fever
Diphtheria Measles Venereal Diseasei
Don't Spit Placards Padiculosis Vitamins
Endemic Typhus Pellagra Typhoid Placardi
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. Instruction for North Carolina Midwives.
CONTENTS Page
A Health Project 3
Medical Care Program Includes Medical School 7
Notes and Comment 14
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PU6U5MCD 5Y TML nOR.TM CAgOUhA 5TATL EAMgP •ME.ALTmI
Vol. 62 JANUARY, 1947 No. 1
CARL V. REYNOLDS, M.D., State Health Officer JOHN H. HAMILTON, M.D., Acting Editoi
A Health Project
By
Carl V. Reynolds, M.D.
North Carolina State Health Officer
The cooperation of the State Board
of Health recently was asked and gladly
given in the execution of a good health
movement that deserves to be publi-cized
throughout the State; and, to
that end, I sent a personal representa-tive
to bring me the facts, that I
might pass them along to the public.
We find here a conspicuous example
of how management and labor can
cooperate to mutual advantage and for
the public good.
Thomas J. Pearsall of Rocky Mount,
general manager of the M. C. Braswell
Farms, consisting of 22,000 acres in
Nash and Edgecombe counties, 5,500 of
which are under cultivation, wUl go
down in the public history of North
Carolina as a pioneer. He has set an
example in humanitarianism and sound
economy that should, and perhaps wUl,
be followed by others, in our effort to
supply what has been termed the
"Number One Need" of this State at
the present time—good health.
Living and working on the farms su-pervised
by Mr. Pearsall are 140 fami-lies,
consisting of 900 persons, seventy-five
per cent of whom are Negroes. So
familiar is the superintendent with
these people that he can address almost
every one of them by name and has
familiarized himself with their prob-lems.
When one of them is unable
to carry on, he knows the reason and
endeavors to do something about it.
He recently conceived the idea that
a mass health survey of the farm popu-lation
under his supervision should be
made by competent public health
authorities.
Not an Idle Dream
Nor did Mr. Pearsall stop after he
had made a mental blueprint of the
health needs of his farm population.
He contacted the county health ofiB-cers
of Nash and Edgecombe, namely
Dr. J. S. Chamblee and Dr. Robert P.
Yoimg, whose departments worked with
him in securing a mass health survey
that was carried out at Battleboro, on
December 16 and 17.
Early on the first day, everything was
in readiness. Hvmdreds had gathered
in the community house at Battleboro,
where the survey was to be made. Out-side
was a mobile vmit of the State
Board of Health's Division of Tubercu-losis
control, fully staffed and in oper-ation,
making x-ray chest pictures.
Inside, public health workers were
busy registering those who were to
undergo complete physical check-ups.
As fast as the blanks were filled out,
the farm workers proceeded to submit
themselves for examination.
The Health Bulletin January, 1947
They Are Going for Health
Bee-Hive Activity
In the rear of the biiilding, pubUc
health personnel was taking blood sam-ples
for blood tests, to be run at the
State Laboratory of Hygiene, in Ra-leigh,
of which Dr. John H. Hamilton
is the du'ector. In the main assembly
room, a public health dentist was ex-amining
teeth. Each person filled out
a blank stating whether he or she had
ever been treated for disease of the
lungs, heart, kidneys, eyes, ears, throat,
tonsils, or for rupture, deformed limbs,
or any venereal disease.
Also, there was a complete check-up
as to whether all children under six
had been vaccinated for diphtheria and
whooping cough. The names of those
who had not were listed, in order that
this protection might be administered.
Complete examinations were confined
to the personnel of the farms. How-ever,
the privilege of having chest
x-ray pictures made was extended to
any person living in the two counties.
Representing the State Board of
Health were Dr. Thomas F. Vestal,
director of the Division of Tubercu-losis
Control, and Dr. Earnest A.
Branch, director of the Division of
Oral Hygiene. By lunch time, hun-dreds
of x-rays had been taken, with
more to follow in the afternoon, the
total for the first day nimibering about
500.
Monday was confined to the exam-ination
of those living in Nash county,
while Tuesday was devoted to those
from Edgecombe, across the railroad.
Just Another Step
The mass examination of the 900
farm workers was by no means the
inauguration of Mr. Pearsall's program
to improve the condition and give
health protection to the tillers of 5,500
January, 1947 The Health Bulletin
acres producing cotton, tobacco, pea-nuts
and com as a major crop.
Home Economics at Work
This is evidenced by the fact that
for sometime he has been utilizing the
services of Miss Balmerlee Watson,
farm and home supervisor, who not
only conducts the services rendered at
the community house in Battleboro,
but also makes visits to individual
homes, studying the needs of the occu-pants.
To the rear of the community house
is a cannery, where during the past
season, under Miss Watson's super-vision,
the farm families put up out
of their share of what they produce,
18,000 cans of meats, fruits and vege-tables
for their personal use. Each
family has a milk cow of its own and
raises its own meat.
The farm and home supervisor has
the women to bring their sewing to the
center where she supervises it, as well
as teaching them to sew at home.
"Miss Watson has done excellent serv-ice
for these people," Mr. Pearsall said.
At the time he was standing in the
rear of the x-ray truck, lifting small
Negro children to the ground after
chest pictures had been taken.
He Tells "Why"
"Just why did you arrange for this
health survey?" Mr. Pearsall was asked.
"Because I think it ought to be done,"
he replied; "not only on these farms,
but on farms and in factories, schools
and all other establishments through-out
the State. It is not only the human-itarian
thing to do, but it is good,
soimd economy. We must not only
know what oui* health needs are, but
we must see to it that these needs are
met, if we expect to develop a strong,
healthy North Carolina.
Health Records Are Being Made
The Health Bulletin January, 1947
All-Aboard for the b i^hi Against Tuberculosis
Lined Up for Health
January, 1947 The Health Bulletin
Action to Follow
"What do you propose to do about
it?" Mr. Pearsall was asked. "That is,
when you have found what physical
deficiencies exist among your farm
population, do you propose to let it go
at that?"
"Certainly not!" he said. "What is
the use of knowing a thing and then
doing nothing about It? The defects
foxmd here today and tomorrow are
going to be remedied if possible, in one
way or another, and we intend to see
to it that they are. To this end, we
propose to utilize existing public health
facilities, to make an effort to have
these facilities still further expanded,
and, in some instances, to refer cases
to private practitioners of medicine and
dentistry, depending upon the patients'
ability to pay. But, in any event, we
are going to do something about it all.
That's why the siorvey is being made."
Medical Care Program Includes
Medical School
By
John H. Hamilton, M.D.
Raleigh, N. C.
The program for medical care which
has been placed before the General
Assembly is not a hastily concocted
scheme but a carefully considered plan
which has been evolved by many people
who have worked through the years.
It Is not the brain-chUd of one person
or of a small group. The Presidents
and past-Presidents of the Medical
Society of the State of North Carolina,
as well as the rank and file of the
medical profession, have helped to
study and prepare the program but
the doctors have no selfish interest nor
monopoly in it. Although many able
North Carolinians have contributed
thought and talent to it, the program
is not entirely the product of North
Carolina thought. Seven men, not
residents of the State, but who are
recognized throughout the nation as
authorities on the broad phases of
medicine and health problems, were
selected as a National Committee to
investigate, study and present recom-mendations.
Their report has been
carried almost in its entirety in The
Health Bulletin. Their recommenda-tions
may be summarized as follows:
1. Greatly expanded and improved
general hospital facilities;
2. Establishing a prepayment plan
for defraying the cost of hospital
care;
3. Expanding and improving public
health facilities;
4. A state constructed and operated
four-year medical school to be
located at Chapel Hill.
All seven agreed on the first three
recommendations. Only on the Pour-year
Medical School at Chapel Hill
was there a difference of opinion and
there the vote was five to two. When
the problem was submitted to Execu-tive
Committees, to Commissions and
to various groups, including farmers,
doctors, teachers and lawyers, the
majority vote has been for the entire
program.
When a person or a group opposes
a program the usual procedure is to
pick out one part for criticism while
praising the rest of it. If it be a wagon
or an automobile three of the wheels
are all right, but there is something
wrong with the fourth wheel. Perhaps
the opponents might admit that the
8 The Health Bulletin January, 1947
vehicle would not run as well on three fession. During the past sixteen years
wheels as it would on four but they many more physicians have died in the
just cannot approve that fourth wheel. State than have been graduated from
So it is with our Medical Care Program Duke and located in the State. In the
—It is the Four-Year Medical School freshman class of 1945-46, 15 of the 72
at Chapel Hill which is the rallying students in the class are listed as resi-point
of opposition—Just what are the dents of North Carolina. This class
objections? includes students from twenty-four
They say that North Carolina already states. At Bowman Gray Medical
has two Four-year medical schools. School—out of a freshman class of 51
We do have two four-year medical —21 are residents of the State and
schools located in the tate. They are sixteen states are represented,
good medical schools and we are proud Endowed Medical schools have a
of them. They are endowed institutions tendency to develop a desire to become
and secure no appropriation of tax national instead of local institutions,
money. They cost the tax-payers noth- Some of them frankly adpiit that they
ing. From the money standpoint it give preference to students from re-would
seem that our opinion about mote places. If two young men, iden-another
four-year school should be tical in academic attainments and
formulated without thought of our other qualifications, were to be on the
existing schools which cost us nothing, list of applicants for one vacancy in
If the opponents of the Chapel Hill the freshman class and one of these
school could assure us that the existing equally qualified men was a home-schools
would supply the state with town boy and the other lived 1500 miles
enough doctors to make up our defi- away, the 1500 miler would be the one
ciency, they could show us that we do admitted. All medical schools have
not need another school. What are more applicants than they can possibly
the facts? Duke Medical School was accept as students. That the state sup-established
in 1930. It has graduated ported schools give preference to stu-fifteen
classes. We are informed that dents from their own states and that
eighty-four of these graduates are students living in states which support
practicing in North Carolina. We know a medical school prefer their state
several of these yoimg physicians
—
medical school is shown in the foUow-they
are an honor to the medical pro- ing list:
Students
Number Who Are
Name of Medical School Freshmen Residents
Students of State
Medical College of Alabama 53 29
University of Arkansas School of Medicine 73 41
University of California Medical School 68 60
University of Colorado School of Medicine 65 33
*Emory University 60 23
University of Georgia School of Medicine 76 49
Loyola University School of Medicine, Illinois 88 34
Northwestern University Medical School 134 19
University of Chicago School of Medicine 65 2
University of Illinois College of Medicine 164 131
Indiana University School of Medicine 81 63
State University of Iowa College of Medicine 82 46
University of Kansas School of Medicine 74 38
University of Louisville School of Medicine 86 31
Louisiana State University School of Medicine 82 37
*Tulane University School of Medicine 125 18
Johns Hopkins University School of Medicine 70 7
January, 1947 The Health Bulletin 9
* Students
Number Who Are
Name o£ Medical School Freshmen Residents
Students of State
University of Maryland School of Medicine 82 23
University of Michigan Medical School 124 47
*Wayne University College of Medicine, Detroit 67 35
University of Minnesota Medical School 99 60
University of Mississippi School of Medicine 29 22
University of Missouri School of Medicine 40 22
*St. Louis University School of Medicine 104 16
Washington University School of Medicine, St. Louis 87 32
*Creighton University School of Medicine, Omaha, Neb. 61 10
University of Nebraska College of Medicine 85 27
University of North Carolina School of Medicine 47 28
*Duke University School of Medicine 72 15
*Bowman Gray School of Medicine 51 21
University of North Dakot aSchool of Medicine 29 16
University of Cincinnati College of Medicine 88 50
Western Reserve University School of Medicine, Ohio 84 42
Ohio State University College of Medicine 83 61
University of Oklahoma School or Medicine 72 48
University of Oregon Memical School 73 31
Medical College of the State of South Carolina 59 39
University of Teenessee College of Medicine 139 52
*Meharry Medical College 51 3
*Vanderbilt University School of Medicine 51 12
Southwestern Medical College, Dallas, Texas 66 37
Baylor University College of Medicine 82 44
University of Texas School of Medicine 98 65
University of Utah School of Medicine 48 30
University of Vermont College of Medicine 40 11
University of Virginia Medical Department 66 14
The Medical College of Virginia 80 31
West Virginia University School of Medicine 30 18
University of Wisconsin Medical School 65 51
Marquette University, Milwaukee 96 24
(Endowed institutions without state or municipal appropriations)
We have not included states such as quests an endowed school to give its
Massachusetts, New York, Pennsylva- students a course in preventive medi-nia
with old and well endowed medical cine, the answer may be a definite no.
schools and which do not have medical The same request to a state school may
schools supported by tax funds since and has resulted in a School of Public
there is no element of competition with Health,
the state school. It would seem somewhat like bad
It is true that state supported medical manners to take up the time of a class
schools charge smaller tuitions for made up of 15 North Carolinians and
residents than they do for non-resi- 57 residents of other states by telling
dents. This is generally expected or them about North Carolina's hospital
required by the legislative body making system, North Carolina's health depart-the
appropriation. The responsiveness ment, North Carolina's health pro-of
the state school to public will is also gram. North Carolina's need for doctors
manifested in other ways. For in- in rural communities. North Carolina's
stance, if the State Health OflBcer re- economic conditions and North Caro-
10 The Health Bulletin January, 1947
Una's people, their problems, peiTDlexi-ties,
hopes and aspirations. Yet in-struction
of this sort would be right,
proper and helpful in a state supported
school having classes composed prin-cipally
of young North Carolinians. In
fact, if our State is to hold its young
doctors while our per capita income is
low, these young doctors must know
about the service which they can render
In building a better state. Most young-sters
who enter the medical profession
do so primarily for the pleasure which
they will derive from trying to heal
the sick and secondarily for the purpose
of earning a respectable living. If it
is money which the yovmgster desires,
a more profitable and less expensive
education should be sought than a
medical education. The state school
might be able to add to the medical
profession physicians who take pride
and pleasure In contributing to the
state's well-being as well as satisfaction
in the practice of scientific medicine.
It would seem that any discussion of
the relative merits of endowed schools
and state operated schools as related
to their financial stability and the
effect of politics upon them would be
foreign to the medical care program.
The issue has been raised by one who
states that medicine can best be taught
in an endowed school. It is true that
many innovations and improvements
in medical education have been brought
about by endowed schools. It is equally
true that many of our best medical
schools are operated by states. Any
innovation or improvement can be and
has been adopted by state schools. We
have pointed out that the state school
is generally more responsive to public
opinion. This may be due to politics
which is alleged to interfere with state
schools. There are many kinds of
politics and politics is omnipresent. We
have seen partisan politics, church
politics, school politics and even medi-cal
politics. It occurs in some form
wherever three persons assemble. It is
claimed that endowed schools have a
more stable financial foundation—yet
even their security is only relative. The
Baltimore fire of 1904 almost wrecked
Johns Hopkins. A prolonged period of
inflation would wreck any endowed
Institution. The honorable record of
the University of North Carolina in the
field of education should be sufBcient
assurance that a creditable medical
school can be conducted by it.
The fact that all medical schools
have a waiting list for students who
wish to study medicine makes it diflB-cult
for a student of a two year school
to gain admission to a school where
they can get their last two years of
training. The only chance which a stu-dent
attending the two-year school at
Chapel Hill has of gaining admission
to a four year school is to find a school
where a student has dropped out, either
because of deficient scholastic attain-ment,
because of financial difficulties,
because of ill health or because of a
change of pvirpose. There develops In
the second year man at Carolina an
anxiety which grows in intensity imtil
a place can be found where he can
finish his course. In the past practically
all of them have found places where
they could finish their work and secure
their degrees. Many have had extreme
difficulty in finding a four year school
which had a vacancy and have gained
admission only after much effort. In
all probability there will be even fewer
vacancies in the future. Waiting lists
make it possible for schools to select
students who are better prepared and
more determined. The G. I. Bill of
Rights provides financial aid. It
would, therefore, seem that most of
the vacancies which will occur in the
four year school will be due to the 111
health of students who have registered
in them.
The question has been raised about
establishing a four year medical school
in a village the size of Chapel Hill.
There seems ample evidence that good
medical schools can be and have been
conducted in small towns. The Uni-versity
of Michigan Medical School was
established at Ann Arbor in 1850. In
1880, thirty years later, Ann Arbor had
a population of 8,061. There were no
January, 1947 The Health Bulletin 11
good roads any where then. There was
no rapid transportation as we know it
now. There were no automobiles. Ann
Arbor in 1940 had a population of
29,182. The University of Iowa College
of Medicine was organized in 1869. It
is also recognized as a good school.
Iowa City in 1890 had a population of
7,016. In 1940—17,182 lived there. The
University of Kansas School of Medi-cine
was organized in 1880. The popu-lation
of Lawrence at that time was
8510 and in 1940 it was listed as 14,390.
The University of Virginia Department
of Medicine was organized in 1827.
Charlottesville in 1890 had a population
of 5,591—in 1940—19,400. If in 1890 a
man had stated that he was going to
» Rochester, the assumption would nat-urally
have been that he was going
to New York State. At that time
Rochester, Minnesota, had a population
of 5,321 and the Mayo name had not
the meaning that was later attached
to it. The Mayo's Rochester was found
by the census takers to have a popula-tion
of 26,312 people in 1940. It would
seem that good medical schools as well
as good medical centers can be devel-oped
in small towns.
Does anyone claim that there is a
city in North Carolina which is large
enough to furnish all by itself sufficient
clinical material to supply the teaching
needs of a medical school. We have
no walled cities in this state. Even if
we did, the state would be unwilling
to supply that city with a hospital and
a medical center which could be used
only for citizens of that city. What is
proposed is a teaching hospital and
medical school for all people of the
State.
There are those who say that it would
be impractical to have two medical
schools within twelve miles of each
other. It would seem that the person
who thought that one up did some
mighty hasty and wishful thinking.
There are numerous instances in which
top ranking medical schools are con-siderably
less than twelve miles apart.
If we keep in mind that it is the
people of the state for whom we are
making plans, it would seem desirable
to have the school and its hospital near
the center of the State. The geograph-ical
center of North Carolina is only a
few miles from Chapel Hill. There are
nvmierous advantages in having two
schools close together. An outstanding
authority could lecture to both student
bodies. A professor in one institution
might conduct courses in the other
school as was the case when a professor
in the School of Public Health at
Chapel Hill taught Preventive Medi-cine
at Duke Medical School. An In-teresting
exhibit, demonstration, or im-usual
patient at one school could be
seen by students of its neighbor. When
one institution has more patients than
it can accommodate, it might be pos-sible
to care for these at the nearby
hospital. This is not fanciful advan-tage.
A competent observer has stated
that there are now enough patients
turned away from Duke Medical School
to run another medical school. A
healthy rivalry could and should exist
without the development of antagonism.
A very clever and adroit opponent
of the four year school of medicine,
which was recommended by five of
the seven members of a National Com-mittee
and approved by the Medical
Care Commission and its Committees,
claims that his chief reason for oppos-ing
the four year medical school is:
"Another four-year medical school in
North Carolina will be constructed and
operated with funds that are needed
for our general hospitals and by our
mental hospitals."
The first argvunent offered to support
this objection seems to be quite beside
the point. It suggests the inconsistency
of Dr. W. T. Sanger, a member of the
National Committee engaged by the
North Carolina Medical Care Commis-sion.
Dr. Sanger was also a consultant
to the State of Mississippi. For North
Carolina, Dr. Sanger was one of the
five members of the Committee rec-ommending
a new four year medical
school as well as more hospital beds
for both general and mental patients.
For Mississippi, Dr. Sanger advised only
12 The Health Bulletin January, 1947
hospitals be constructed and that they
spend none of their money on a four
year medical school. The fact that
two states employed Dr. Sanger as a
consultant should establish him as
somewhat of an expert. That his is
not a one-track mind and that he does
not consider a medical school to be a
cure-all is established by his recom-mendations
that Mississippi have no
four year medical school and that
North Carolina have one. Conditions
in Mississippi are different from those
in North Carolina, so different recom-mendations
were made—a four year
medical school for North Carolina
—
none for Mississippi.
Then the opponent brings forth some
argument involving nvunbers of hospi-tal
beds—millions of dollars from fed-eral,
state and local som-ces. These
figures are pertinent and relevant but
too complicated to be presented here.
They were presented to the Advisory
Budget Commission. That they did
not convince this body is evidenced by
the fact that the Advisory Budget
Commission in their report and that
Governor Cherry in his message to the
General Assembly recommended the
establishment of a four year medical
school at Chapel Hill.
In the final paragraph the opponent
expresses what seems to be a precon-ceived
opinion, "The medical school
supplies no essential need for this
State." In telling why he is opposed to
a medical school owned and operated
by the State, he does not deny that we
need more doctors in the State. He
does not promise that the two endowed
schools will train the doctors we need.
He does not inform the young men and
women of North Carolina who wish to
study medicine that they will be given
preference when they apply to the
endowed schools for admission as stu-dents.
No one doubts that it will take money
and lots of money to operate a four
year medical school. No one claims
that every need of every state insti-tution
can be satisfied and still leave
enough money in the state treasury to
set up our Medical Care Program. No
one thinks that all teachers and state
employees can be paid as high salaries
as they wish. There is only so much
money available. We have many prob-lems
and many needs. If we had im-limited
fvmds, we could not solve all
of our problems in one sweep. If we
are to make the best use of what we
have, whether that be money, farms,
factories or human lives, we must plan
as best we can.
The Medical Care Commission has
presented a program which in their
opinion and in the opinion of a great
many people of the State goes a long
way in the right direction toward the
needs of the State. It seems to be
carefully related and Integrated to
other problems. All parts of the pro-gram
are interdependent. For instance,
if we are to 'build hospitals throughout
the state, we will need doctors, nvirses,
laboratory workers and state trained
personnel to staff them. If we do not
have properly trained people in these
buildings, they are not hospitals but
merely piles of brick which will serve
no useftol purpose.
Some one claims that the low per
capita income in North Carolina makes
it inadvisable for the state to spend
large sums of money for medical care.
The same person would have us solve
our economic problems first then he
says everyone would have enough
money to buy good health. If we could
solve our economic problem over-night,
that would be wonderfiU indeed. But
most thoughtful people realize that a
considerable part of our economic
problem is cavised by ill health. When
a person becomes sick, money is spent
to regain a semblance of health. If
the person happens to be a bread-winner,
his earning capacity may be
stopped for the duration of his illness.
In North Carolina as in other states
we lose income and capital because of
sickness. In other words, we pay for
health whether we have it or not. The
saying—"Save at the spigot and waste
at the bimg," has its application to our
Medical Care Program. If we are to
January, 1947 The Health Bulletin 13
Improve our economic condition, we
must stop wasting our human resources.
If you have ever been or ever seen a
small boy carrying water in a bucket
from a well to a water barrel on the
back porch, you can understand his
concern over the leaks in the barrel
and his efforts to stop those leaks.
Those of us who are engaged in im-oroving
the health of our people are
anxious to stop the waste of hiiman
life and hmnan well-being.
One weU meaning man has stated
that if we build hospitals in rural com-mxuiities
that doctors and nurses will
oish to them like flies after molasses.
They cannot rush in from other parts
of North Carolina—for no community
to the State has more doctors than
are needed where they are. We cannot
expect them to come from other states
unless we give them a substantial
money subsidy because they would have
no particular interest in us except for
the money they could get out of vis.
There may be some who might be
employed for a price but those com-munities
which have offered a cash
subsidy have not been deluged with
applicants. In fact some who have
offered as much as $2,000 per year as
a subsidy have found no takers. It is
generally admitted that we need at
least 1000 additional doctors. If we
could get them at the rate of $2,000
each, the armual outlay would be
$2,000,000 which is considerably more
than the estimated cost of operating
a four year medical school.
Sizeable majorities of all groups who
have studied our problem, whether
from a purely economic point of view
or from the hmnanitarian standpoint
have agreed that if we are ever to have
as many doctors as we need, we must
train North Carolina's young people in
a medical school owned and operated
by the people of North Carolina.
We have tried to bring out the idea
that to train personnel; that is, doctors,
nurses, laboratory workers and other
technically qualified people, we need
a new training school.
The program has wide-spread popu-lar
approval—in fact one of it^ chief
hazards is over-confidence. Many people
who favor it feel that the entire medi-cal
program wiU be approved in the
General Assembly by a large majority
and that they need do nothing to make
assurance doubly sure. There are oppo-nents
to the program. These opponents
may not be nvunerous but they are
clever and are experienced in the art
of making themselves seem to be nu-merous.
They are articulate. They
know how to talk, when to talk and to
whom. They also know the right words
to use. They know the usefulness of
tactics. They subscribe to the idea of
divide and conquer. If the supporters
of the Medical Care Program will re-main
on the alert and wiU lift up their
voices where they will be heard, they
can do much to make this Medical
Care Program a reality. It is the North
Carolina General Assembly which
makes the final decision. We have a
capable legislative body who will en-deavor
to carry out the will of the
people. If all those who favor the
program will speak to their representa-tive
and senator, their voice should be
louder than that of those who master
the art of seeming to be numerous.
During the war whenever we wished to
impress the people of the urgency for
action, we would call upon our musi-cians
for a time. One of the favorites
was "The Time is Now." For the Medi-cal
Care Program it is all too apparent
that now is the time for the decision.
14 The Health Bulletin January, 1947
Notes and Comment
DR. J. N. JOHNSON—It is with sad-ness
that we note the death of Dr. J. N.
Johnson. Dr. Johnson was one of the
pioneers in the development of our
public health program. In the early
days he lifted up his voice for what we
now call Oral Hygiene work. In 1931
he became a member of the State Board
of Health and served faithf\illy and
conscientiously for more than fifteen
years. Although he had a serious dis-ease
of the heart which made him
realize fully the nearness of death, he
attended many board meetings which
were devoted to problems not directly
related to his profession but which his
high and broad sense of duty made him
feel that he should attend to expedite
the work of the board.
The other members of the State
Board of Health appreciated his serv-ices
so highly that they presented Dr.
Johnson with a Scroll in recognition
of his faithful service. The front cover
of the October, 1946 Health Bulletin
reproduced a photograph made at the
time the Scroll was given to him.
All persons who are interested in
public health should be grateful to
him. All who knew Dr. J. N. Johnson
will have an endiiring affection for him.
* * *
MISS BLANCHE HENDERSON—Death
has claimed one of the veteran workers
of the State Board of Health. During
some twenty years as bookkeeper in
the Bureau of Vital Statistics, Miss
Henderson probably rendered service to
more people than any other person In
the State. It was her duty to handle
every birth and every death certificate
that was filed with the Bureau of Vital
Statistics and to certify the number
sent in by each local register. During
a twenty year period it is probable that
every family in the State has received
some service from Miss Henderson. She
was so modest that many who worked
in the same building with her did not
know her or what she did. There can
be little doubt that she received the
commendation—"Well Done Thou Good
and Faithful Servant."
« * *
FIREWORKS —The following news
story really needs no interpretation or
comment. It tells its own story. To
those who are interested in public
health the remedy should be apparent.
751 INJURED BY FIREWORKS
DURING YEAR-END HOLIDAYS
Durham, Jan. 22.—^Fireworks caused
serious injury to 751 persons in North
Carolina during the 30-day period from
Dec. 10 to Jan. 10 this year, according
to a survey by the Hospital Care Asso-ciation,
Inc., of Dvu"ham.
The association revealed today that
reports from 261 physicians were re-ceived
and the 751 patients requiring
medical treatment received their in-jiiries
directly or indirectly from fire-crackers,
Roman candles or other fire-works
during the past Christmas-New
Year's season.
Loss of eyesight, hands and fingers
were reported for almost a hundred
fireworks victims. Ruptured ear drimis
and severe skin burns made up a large
portion of the other casualties.
The Hospital Care Association, a non-profit
Blue Cross organization, reported
that undoubtedly there were many ad-ditional
cases of fireworks injuries
which were not serious enough to re-quire
the attention of a physician.
Physicians' Comment
Comments of physicians answering
the survey poll included such state-ments
as the following:
Apex—"One boy with part of finger
blown off and ear drum damaged."
Fayetteville —"Amputation of three
fingers. Severe lacerations of entire
hand." "Loss of eye." "Mangled hand."
Forest City—Hand blown off."
Greensboro—"Explosion of TNT bomb
January, 1947 The Health Bulletin 15
purchased from a Wilmington concern
—mutilated hand."
Greenville—"Right eye ball burst."
Henderson—"He lost one eye."
Kinston—"Mangling and burning of
left hand."
Murfreesboro—"Loss of three fingers
and portion of hand."
Raleigh—"Loss of right hand, partial
loss of left hand, loss of vision, severe
face wound."
Sanford—"Loss of eye."
Wilmington—"Lost one eye."
Legislative Measures
Executive Vice President E. M. Hem-don
of the association said results of
the survey would be turned over to
State medical and hospital oflBcials and
members of the Legislature, which Is
currently considering measures for out-lawing
the manufacture, sale and use
of fireworks throughout the State.
Statements by a large number of phy-sicians
expressed a desire to see a
State-wide ban enacted.
Of the 751 patients reported treated
by physicians, 74 were admitted to
hospitals. A total of 121 patients were
reported as "seriously injured."
Among the seriously injured were 37
classified as "eye Injuries" including
nine cases involving the loss of an eye,
six cases resulting in the loss of vision
of one eye, two cases resulting in ques-tionable
vision of one eye, two cases
with corneal scar of one eye and four
cases of burns of the eye.
Among 50 reported arm injuries were
two cases of the loss of a hand, seven
cases of partial loss of hand, six cases
of loss of one finger, seven cases of
loss of two fingers, five cases of loss of
three fingers and one case of five fin-gers
lost.
Other serious Injuries and the num-ber
reported were: Severe skin burns,
eight; ruptured ear drums, four; chest
injuries, one; face Injuries, three; leg
Injuries, two; fractured foot, one; and
abdomen injury, one.
m
PAGE HORTON, age eight months,
weight 19 pounds, daughter of Mr. and
Mrs. Otis R. Horton, Raleigh, N. C. Mrs.
Horton was formerly a secretary in the
Division of Nutrition of the North Caro-lina
State Board of Healtli.
Margaret Ann, age four; Tommie, age
two and one-half; Helen, age ten
months; children of Mr. and Mrs. Guy
T. Perry, Piney Creek, North Carolina.
The advice of a sanitarian, a public
health nurse and The Health Bulletin
are given credit for helping in the
home and on the dairy farm operated
by Mr. Perry.
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Publi5l\edbv TftL JS^Km CftKlINA STATL B^ARD ^TimLTB
j This Bulletin will be sent free to ony citizen of the State upon 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. 62 FEBRUARY, 1947 No. 2
I
New Dam and Raw Water Reservoir
Completed During 1946
City of Asheboro, North Carolina
Piatt & Davis, Engineers
MEMBERS OF THE NORTH CAROLINA STATE BOARD OF HEALTH
EXECUTIVE STAFF
S. D. CRAIG, 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 Jayetteville
HUBERT B. HAYWOOD, M.D Raleigh
J. LaBRUCE WARD, M.D Asheville
I. O. NOLAN, M.D Kannapolis
JASPER C. JACKSON, Ph.G Lumberton
PAUL E. JONES, D.D.S Farraville
CARL V. REYNOLDS, M.D., 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.
R. E. FOX, M.D., Director Local Health Administration.
W. P. RICHARDSON, M.D., District Director Local Health Administration.
ERNEST A. BRANCH, D.D.S., Director of Oral Hygiene.
JOHN H. HAMILTON, M.D., Director Division of Laboratories.
J. ROY HEGE, M.D., Director Division of Epidemiology and Vital Statistics.
J. M. JARRETT, B.S., Director of Sanitary Engineering.
T. F. VESTAL, M.D., Director Division of Tuberculosis.
OTTO J. SWISHER, Director Division of Industrial Hygiene.
WILLIAM P. JACOCKS, M.D., Director Nutrition Division.
MR. CAPUS WAYNICK, Director Venereal Disease Education Institute.
C. P. STEVICK, M.D., Director, School-Health Coordinating Service.
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 dis-tribution
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. Instruction for North Carolina Midwives.
CONTENTS Page
Public Water Supplies in North Carolina, 1921-1946 3
Announcing State and Federal Fellowships in Health
Education For 1947 5
Dental Defects—Commonest of All Ailments 5
Public Water Supplies in North Carolina (Tables) 6
Cold Weather Increases Carbon Monoxide Hazard 24
Vol. 62 FEBRUARY, 1947 No. 2
CARL V. REYNOLDS, M.D., State Health Officer JOHN H. HAMILTON, M.D., Acting Editor
Public Water Supplies in
North Carolina, 1921 - 1946
By
J. M. Jarrett, Director
and
E. C. Hubbard, Prin. San. Engr.
Division of Sanitary Engineering
It is appropriate at this time—when
SO much emphasis is being placed on
the various phases of public health,
including medical care—to give some
thought to those health safeguards
which we have come to accept as "mat-ter-
of-fact." One of these much over-looked
factors is public water supplies
and their protection.
Too often, too many of us give too
little thought to what constitutes a safe
public water supply. If we get a free
flow of clear water when we open a
spigot at any hour of the day or night,
we are satisfied. Our interest is aroused,
however, when this fails to occur. Back
of this job of providing an adequate
and safe supply of water to cities,
towns, and industries is an enormous
outlay of public and private funds and
scientific and engineering service. We
should like to discuss here very briefly
the development of the State laws, the
activities of the State Board of Health
regarding public water supplies, and
the extent and adequacy of the various
public supplies, with the hope that this
discussion will not only be of interest
but will help to focus your attention
on the work of those interested in pro-viding
for you a safe public water
supply.
There have been state laws regulating
the sanitary protection of watersheds
of public water supplies since 1899, and
since 1905 there has been a State
statute requiring the monthly submis-sion
of water samples from public
water supplies to the State Laboratory
of Hygiene. State Board of Health ap-proval
of plans for public water supply
systems has been a statutory require-ment
since 1911.
From 1911 to 1918, there was an en-gineer
attached to the department who,
together with the engineer member of
the Board, reviewed and approved
plans. During this period, fleld inspec-tions
and investigations were not com-monly
made, and during a portion of
the years 1918 and 1919 there was no
engineer employer. The statute creat-ing
the Bureau of Sanitary Engineering
and Inspection was enacted by the
Legislatiure In 1919. The bureau was
established, however, primarily for the
purpose of providing machinery for
enforcing the State privy law enacted
at that time, and it was not until 1921
that the bureau was placed on a gen-eral
appropriation basis, permitting the
development of activities along the
The Health Bulletin February, 1947
usual lines of sanitary engineering
practice in the field of water supply as
commonly carried out by State Boards
of Health. In view of this, very little
accomplishment toward the control
and supervision of public water sup-plies,
as we know these functions today,
had been made prior to 1921; hence,
the past quarter century has been the
period during which the important
problem of public water supplies has
received proper recognition.
During the past quarter century, 204
public water supplies have been added
to the list of 132 which we had in 1921.
Not only new supplies were developed,
but many of the older supplies were
enlarged and improved. As our State
developed, the demand from cities and
towns and new industries increased.
This municipal growth and industrial
expansion also created problems of
sewage and waste disposal, and conse-quently
the need for better protection
of public water supplies taken from
surface streams. Therefore, beginning
about 25 years ago. North Carolina
municipalities entered upon one of the
most progressive periods of develop-ment
and construction. Many water
purification plants were constructed
throughout the State to better treat the
water being supplied the citizens.
The construction of a plant or devel-opment
of a new supply did not answer
the need completely. These plants
needed well trained technical men to
operate them, and in this respect North
Carolina also came forward with a pro-gram
of developing and employing men
trained and capable of insuring safe
water supplies.
The State Board of Health has dur-ing
this period been a great motivating
influence in the expansion and im-provement
of our public water supplies;
but credit must also be given to the
progressive minded public officials who
provided ways and means of carrying
out this program. North Carolina was
also fortunate in that we had in the
State a number of consulting engineers
interested in public water supplies, and
to these men must go the credit for
building in the State a number of plants,
large and small, which were modern
in every respect and designed according
to the best engineering practice.
Many of these plants now need to
be enlarged and rebuilt, because of the
growth of the towns in which they are
located. The impact of the war was
also felt in the water plants and equip-ment
was worn out which could not be
repaired or replaced during the war.
Thus, we are entering now another
period of water supply development in
the State. New problems will have to
be faced in supplying you with an ade-quate
and safe public water supply; but
we can with confidence look to our
city officials and consulting engineers
to provide us with the best that can
be had.
A great number of towns are already
making plans for future development.
Through assistance of the Federal
Works Agency, post war projects total-ling
more than $9,000,000.00 are being
developed. Your interest and support
should be given your local officials who
are trying to provide a safer and more
adequate supply of water for you.
The cover photograph shows one of
the latest water supply developments
in the State—a new impounded raw
water supply and dam for the town
of Asheboro. This improvement will
provide Asheboro with adequate water
to meet its fast growing needs, brought
about by the expansion of the town and
its industries. Piatt and Davis of Dur-ham
were the engineers who designed
and developed this supply.
On the following pages are tables
listing all public water supplies of the
State, with information regarding the
type of treatment, source of supply,
and other pertinent data. There are
also two maps showing the location of
public water supplies as of 1921 and
1946. From these tables and maps, it
may be seen that in 1921 there were
132 public water supplies in North
Carolina serving 592,582 persons, which
represented 23.2% of the total state
February, 1947 The Health Bulletin
population; whereas, in 1946, there are
336 public supplies serving 1,272,436
persons representing 32.8% of the total
state population. This represents con-siderable
progress; however, there is
still much to be accomplished toward
providing a safe public water supply
for the urban population in North
Carolina.
Announcing State and Federal Fellow-ships
in Health Education For 1947
Fellowships for a year's graduate
study in health education, leading to a
Master's Degree in Public Health, are
being offered for the academic year
1947-1948 to qualified persons through
the U. S. Public Health Service and
others through the N. C. State Health
Department.
Men and women, between the ages of
22 and 40, who have a Bachelor's De-gree
from a recognized college or uni-versity
and who meet the particular
entrance requirements of the school of
public health of their choice, are eli-gible
for the fellowships. There are
eight recognized schools of public health
in the country, and the candidate may
attend the school of his choice.
The fellowships include all tuition
expenses, plus a monthly stipend of
$100. Any war veterans who qualify for
training may elect to receive their
financial assistance under the G.I. Bill
of Rights or from fellowship funds.
Application forms for both the Fed-eral
and State fellowships may be ob-tained
by writing the Director, Division
of Local Health Administration, N. C.
State Board of Health, Raleigh. Appli-cations
must be on file by March 15,
1947.
Dental Defects - Commonest of
All Ailments
At the present time almost everyone
recognizes the close relationship be-tween
dental health and physical well-being.
Persons with unclean mouths,
and broken down or badly infected
teeth can scarcely expect to maintain
healthy well-novu"ished bodies free
from systemic infections.
Experience has shown that most peo-ple,
including young children, are vic-tims
of dental decay. Since this decay
starts soon after teeth appear in the
mouth, it is important to begin dental
care early in life. The only known way
to find and correct dental defects as
they occur is by means of routine visits
to a dentist.
Parents have a definite responsibility
in establishing the dental examination
habit in children. Most parents realize
the importance of giving their children
a good start in life by providing ade-quate
dental care, but there still remain
too many children who never receive
dental care. It is difficult to predict
what effect this lack of care will have
on the health of such children as they
grow to adults, but it is fairly safe to
assume that early regular dental atten-tion
could help reduce the nvunber of
chronic diseases of the heart, eyes,
kidneys or joints.
Dental defects are not only a decided
health hazard, but dental disease which
goes untreated in childhood leads to
more extensive dental damage in later
life. This damage is permanent, be-cause,
unlike other body tissues, the
teeth cannot repair themselves once
decay sets in.
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THE PUBLIC WATER SUPf^
DECEME.
GROUND WATER SUPPLIES ""
tSOF NORTH CAROLINA
i 1921
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PUBLIC WATER SUPPLY MAP OF NORTH CAROLINA
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TOWNS OVER 500 WITHOUT PUBLIC WATER SUPPLIES
PREPARED BY THE STATE BOARD OF HEALTH
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24 The Health Bulletin February, 1947
Cold Weather Increases Carbon
Monoxide Hazard
Despite repeated warnings about the
dangers of carbon monoxide, all too
often we still hear of narrow escapes
—
yes, and even deaths—due to air con-taminated
with this insidious gas. Cold
weather increases the danger. You
have to take special care then not to
inhale confined air fouled by exhaust
gases from automobile engines and
faulty heating apparatus. This can
easily be done by attention to ventila-tion.
Protect Yourself
Automotive engineers say that it's a
good idea to warm up the engine of
your car for a few moments before
driving in cold weather. But before
stepping on the starter in the family
garage, there's an even more important
step for you to take: Open wide your
garage doors to the outside air. By
warming up the car you help protect
its metal mechanism. But your pro-tection
should come first; by opening
the garage for ventilation, you protect
your body mechanism by preventing
dangerous accumulation of carbon
monoxide gas when the motor starts.
Your Nose Doesn't Know
Don't think for a minute that your
senses of smell, taste, or sight will warn
you beforehand of this danger. Deadly
carbon monoxide can't be detected so
easily. When pure, it is a colorless,
odorless, and tasteless gas. It is highly
poisonous because it combines with the
coloring matter of blood faster than
can oxygen. Further, blood that is
filled with carbon monoxide cannot
take up oxygen. Just how deadly the
gas is can be judged from the fact
that exposure to an atmosphere con-taining
two-tenths of one per cent will
cause a man at rest—such as a person
waiting for the car to warm-up—to
collapse within an hour. Exposure to
as little as five-hundredths of one per
cent can cause a headache within a
few hours. Different people are affected
differently: a person at work will be
overcome much quicker than one at
rest.
Prompt Action Important
Symptoms of carbon monoxide poison-ing
come without warning, and collapse
of the person exposed to the gas may
prove fatal unless outside aid arrives
soon. A running car engine would
continue to generate carbon monoxide
—and continue to make the air more
poisonous. If you should ever find a
person overcome in a garage, throw the
windows and doors wide open and at
once remove the patient to fresh air.
Call a doctor and while awaiting his
arrival give artificial respiration con-tinuously
until the doctor arrives or
until natural breathing is restored.
Other Danger Points
The dangers of carbon monoxide
poisoning are not limited to home
garages. Unless commercial garages
maintain good ventilation, enough car-bon
monoxide gas may be expelled from
the exhaust of automobile engines to
make the air poisonous. Nor is the
danger confined to areas subject to
exhaust gases of auto engines. Trouble
is also possible from faulty gas hot
water heaters, improperly vented kit-chen
gas ranges or gas plates for heat-ing
water in the laundry, and from
stoves or furnaces.
Usually, deaths and illness from car-bon
monoxide can be prevented by con-stant
attention to the following:
1. Open garage doors before starting
Automobile engines.
2. Be sure hot water gas heaters arQ
vented to the outside air.
3. Make certain that all gas burning
appliances are burning properly.
4. Adjust furnace and stove drafts
to carry off gases.
1
i This Bulletin, will be sent free to ony citizerv of Ihe State upon request t
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. 62 MARCH, 1947 No. 3
A Modern Dishwasher in a North Carolina Restaurant
MEMBERS OF THE NORTH CAROLINA STATE BOARD OF HEALTH
EXECUTIVE STAFF
S. D. CRAIG, 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 Jayetteville
HUBERT B. HAYWOOD, M.D Raleigh
J. LaBRUCE WARD, M.D Asheville
J. O. NOLAN, M.D Kannapolis
JASPER C. JACKSON, Ph.G Lumberton
PAUL E. JONES, D.D.S Farmville
CARL V. REYNOLDS, M.D., 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.
R. E. FOX, M.D., Director Local Health Administration.
W. P. RICHARDSON, M.D., District Director Local Health Administration.
ERNEST A. BRANCH, D.D.S. , Director of Oral Hygiene.
JOHN H. HAMILTON, M.D., Director Division of Laboratories.
J. ROY HEGE, M.D., Director Division of Epidemiology and Vital Statistics.
J. M. JARRETT, B.S., Director of Sanitary Engineering.
T. F. VESTAL, M.D., Director Division of Tuberculosis.
OTTO J. SWISHER, Director Division of Industrial Hygiene.
WILLIAM P. JACOCKS, M.D., Director Nutrition Division.
MR. CAPUS WAYNICK, Director Venereal Disease Education Institute.
C. P. STEVICK, M.D., Director, School-Health Coordinating Service.
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 dis-tribution
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 'nfantile 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. Instruction for North Carolina Midwives.
CONTENTS Page
Foodhandlers Conference
Catawba-Lincoln District Health Department 3
Typhoid In January 15
The North Carolina League for Cripple Children 16
Vol. 62 MARCH, 1947 No. 3
CARL V. REYNOLDS, M.D., State Health Officer JOHN H. HAMILTON, M.D., Acting Editor
Foodhandlers Conference
Catawba-Lincoln District Health Department
By
Sara Walker, AB, MSPH
and
Thomas J. Sharpe, BS
Introduction:
As an official agency charged with
the responsibihty of protecting and pro-moting
the public health, the Catawba-
Lincoln District Health Department is
attempting to discharge its responsibili-ties
by developing a program planned
with the people and designed to meet
theii' needs. Cooperative planning to
be effective in problem solving must be
based on public understanding follow-ed
with individual and group participa-tion.
Increasing numbers of people
eating out together with the rapid
turnover of foodhandling personnel
during the war and post-war period is
making the problem of adequate pro-tection
for the public more acute and
complex. The Catawba-Lincoln Dis-trict
Health Department staff felt that
as a public health agency they had a
greater responsibility in alleviating the
problem than just the routine sanitary
inspection of public eating places. Ob-viously
the paramount need is for food-handlers
to understand and to be able
to apply the scientific knowledge avail-able
on the various means of trans-mission
of diseases in public eating
places. This need could be met only
through teamwork among the Health
Department, Management, and em-ployees.
Lack of participation on the
part of any one would affect the efforts
of the others. The health department
staff could provide the technical in-formation
and with the help of the
other two groups could better protect
the public's health through the con-tinuous
application of this knowledge.
Management could improve the ap-pearance
and services of food-handling
establishments by utilizing the assist-ance
and guidance offered by the health
department staff. The foodhandler
through this cooperative effort develops
a sense of personal responsibility as he
learns and understands the basic rules
of health and sanitaition necessary for
the safeguarding of his own health and
the health of those whom he serves.
Organization:
After a great deal of pre-planning
by the Health Director and the sani-tarians,
the manager of each food-handling
establishment in the three
areas of the district were contacted
personally by the local sanitarian and
invited to come to a meeting in his
area to discuss with other managers
and members of the health depart-
The Health Bulletin March, 1947
A Restaurant Kitchen
merit staff the possibilities of organizing
Poodhandlers' Conferences.
The excellent attendance at each of
the three meetings proved that man-agement
was interested in cooperating
with the health department in this
imdertaking. A brief overall summary
of the content of the planned instruc-tion
was given by the sanitarians who
were largely responsible for the organi-zation.
The cooperative interest on the
part of management now became very
active with the managers asking ques-tions
as, "When can the conferences
begin? Can a schedule be arranged
so that it will be possible for all em-ployees
to attend?" With these ques-tions
satisfactorily answered, the date
was set for the conferences to begin.
For convenience of managers and
employees, the schedule was so ar-ranged
that each of the weekly one
and one-half hour conference periods
would be given both in the morning
and afternoon of the same day for
three consecutive weeks.
The complete schedule was sent to
each manager by letter. During the
two weeks prior to the beginning of the
conferences, the local sanitarian called
on each manager to talk with him fur-ther
about the convenience of the
schedule.
The generous publicity given by the
newspapers through releases from the
health department, reports of meeting
and editorials, gave impetus to this
initial undertaking. The content of the
news articles was not designed to create
an alarmed public sentiment but rather
to focus attention on the coordination
of the efforts of the health department
and of the foodhandling establishments
as they undertook cooperatively to give
the public protection through improved
foodhandling methods.
March, 1947 The Health Bulletin
Lesson No. 1: Bacteriology and
Communicable Disease
I. Introduction:
The health department appreciates
the fact that each and everyone of you
are cooperating by attending the first
lesson in this series. Your presence
proves to us that you are interested in
learning more about your job so that
you will be a more efficient foodhandler.
Yoiir job is important. About sixty-five
million people eat out every day
in the United States. The people whom
you serve expect to get good whole-some
food when they come into your
respective places of business—they don't
expect to get disease germs that will
make them sick. So you as foodhan-dlers
have a definite responsibility in
doing your part to keep down the spread
of communicable diseases.
II. Sound film—"Swat the Fly":
At this time, we would like to show
you a moving picture, "Swat the Fly,"
which explains the life history of the
common house fly. Note that the fly
breeds rapidly, contaminates food with
disease producing germs, and can be
controlled by (1; eliminating breeding
places—rubbish, garbage, manure heaps,
etc.; (2) screening doors and windows;
and (3) using fly sprays, traps and
swats.
The film does not explain how the
fly eats. The fly doesn't have teeth
like you and I with which to chew solid
food; therefore, when it eats sugar or
other solid food, it regiu'gitates or
vomits a liquid from its digestive system
to dissolve the solids. Only part of this
liquid is drawn back into the body,
much of it being left to contaminate
the food. There are millions of germs
on the hairy body of a fly and in it.
These germs are collected from all types
of filth such as manure, sewage, spittle,
garbage and other germ laden filth,
some of which the fiy leaves on the
food it touches. (Film ''Swat the Fly"
is shown).
III. Illustrated lecture on Bacteria and
Communicable Disease:
A. Introduction
The United States Public Health
Service lists sixty-two communicable
and reportable diseases, 25 or 40% of
which may be transmitted thi'ough
foodhandling establishments. A larger
percentage of these diseases are knovm
as killers, exacting a high death toll
from our population. None of you food-handlers
would willingly serve disease
germs to your customers in food that
would cause sickness, yet it is being
done somewhere every day within the
United States, either because the food-handlers
do not know how to do the
job right or because they are careless
and indifferent and do not understand
the importance attached to their jobs.
It should be the chief aim of each of
you, as well as every other foodhandler,
to not only serve food which is free
from the germs of these diseases, but
to serve this food in dishes and glasses
that are free from harmful contamina-tion.
B. Bacteriology
1. First, what are some of the causes
of communicable diseases. They don't
just happen. There are savages in some
parts of the world today, who think
that diseases are caused by evil spirits.
They think that these spirits live in the
rocks, trees, and rivers, and that their
only purpose in living is to invade man
and cause him pain, sickness, and some-times
death. They play peculiar music
and wear funny faces trying to d^ive
these evil spirits away so the members
of their tribes will not become sick. It
hasn't been too long ago when some
people in this country believed in
witchcraft, thinking that a witch could
make people sick by some sort of "spell."
We in civilized countries today know
that communicable diseases are not
caused by evil spirits, but are caused by
germs.
2. In order to better understand how
to prevent the spread of communicable
diseases, it is necessary to understand
6 The Health Bulletin March, 1947
the natiire of the germs which cause
the diseases.
a. Bacteria or germs are so small
that they can be seen only through a
microscope, which magnifies them about
1,000 times. It would take 25,400 aver-age
size bacteria laid side by side to
equal one inch. Because they are so
small sometimes we fail to realize their
existence. We may think they are not
here because we cannot see them, but
they are here just the same. They are
on our hands, under our fingernails, in
our hair, deep inside our bodies—they
are everywhere. Each of us has more
bacteria on and in our bodies than there
are people in the whole world.
b. Keep in mind that these little
germs are alive. They must have food,
moisture and a favorable temperature
in order to live.
1. The most favorable temperature
for growth is 98.6' F. or body tempera-ture.
They cannot survive if the tem-perature
is too hot. For this reason
one method of sterilizing dishes is to
immerse them in hot water of at least
170° F. for two minutes. This will kill
most disease producing germs that
might be present.
2. Bacteria cannot reproduce if the
temperature is too low; however, re-frigeration
or freezing does not kill
bacteria. Since refrigeration retards
the growth of bacteria, be sure to re-frigerate
all perishable foods at 50" F.
or below.
,c. Bacteria are able to reproduce
extremely rapidly under favorable con-ditions
of temperature, food, and mois-ture.
Within 20 minutes one bacterium
may divide and become two, thus
within 40 minutes the two may become
four. If this process goes on for a
period of six hours, one original bacte-rium
may become 250,000.
d. Bacteria are classified into three
groups according to shape:
1. Cocci—spherical like a ball: (a)
single cells, (b) Diplococci — Twos —
pneumonia can be caused by this germ,
(c) Streptococci — Chains — one type
causes septic sore throat and another
causes scarlet fever, (d) Staphylococci — irregular cluster — one type causes
food poisoning.
2. Bacilli—rod shaped like a cigar or
cigarette—one type causes tuberculosis.
3. Spirilla—shaped like a cork screw
—one type causes trench mouth and
another type causes syphilis.
One specific germ causes one specific
disease. The germ that causes typhoid
fever will not cause scarlet fever or
any other disease.
e. Fortunately not all bacteria are
harmful. (1) The types that cause sick-ness
and sometimes death are our
eternal enemies. (2) Another group as
far as we know are not much good to
us nor much harm to us, and this group
is here by the billions. (3) There is still
another group without which we could-n't
get along very well. These little
germs are working for us all the time.
We couldn't have cheese, buttermilk,
tan leather, make alcohol, and even
produce some medicine unless these
little bacteria were working for us. In
fact, if it were not for certain kinds
of this group, the earth would soon
become covered with garbage and
refuse.
C. Communicable Diseases—So much
for bacteria, now let's discuss com-municable
diseases.
1. By communicable diseases we
mean those diseases that can be and
are transmitted from one person to
another. How does this take place?
In order for any disease to be trans-mitted
we must have a source, a chan-nel
of infection, and a susceptible per-son.
a. Source—by the source we mean
the place from which the germs come,
and this is either a carrier or an in-fected
person who may harbor and
discharge bacteria which if consumed
by another person might produce this
particular disease. An infected person
has germs in his system which produce
symptoms of disease, while a carrier
harbors disease producing germs with-out
symptoms. For example, a person
may have had typhoid fever ten years
i
March, 1947 The Health Bulletin
ago. At that time he was sick; today
he may seem to be perfectly well, yet
be carrying germs and eliminating
them through his intestinal discharges,
thus spreading the disease to other
people.
b. Channel of infection—by channel
of infection we mean the method by
which these germs get from one indi-vidual
to another. They can't walk
around as we do, so they have to hitch
hike a ride, and in many cases they
hitch hike this ride through food and
eating utensils. Remember that at
least 25 diseases can be spread through
our foodhandling establishments.
c. Susceptible person — by this we
mean an individual that may get the
disease if the germs enter his system.
You foodhandlers cannot do much
about the source. The health depart-ment
tries to control this in certain
diseases by quarantine and isolation.
Neither can you do much about the
susceptible person, but here again the
health department tries to control cer-tain
diseases by immunization, vacci-nation
and fluoroscopic clinics.
Let's keep in mind that all three
things are necessary for disease trans-mission,
so you can do your part by
blocking the channel of infection—that
is keeping the disease germs from
traveling from one customer to another,
This channel can be cut in various
ways, and you foodhandlers can render
a great service to yourself, to your
community, and to your country if you
will learn and observe the rules of
sanitary foodhandling in your respect-ive
places of business.
2. Kinds of disease—we usually think
of the diseases that can be transmitted
through food establishments as being
of four kinds:
a. Intestinal born diseases—(Ex. ty-phoid,
dysentery). The germs that cause
these diseases are given off through the
intestinal discharges of a case or car-rier.
For example, a foodhandler may
have dysentery, use a toilet, fail to wash
his hands thoroughly, handle food or
food equipment and pass his germs on
to someone else. Always wash your
hands thoroughly before going to work,
after each visit to the toilet and often
during the foodhandling operation.
Clean hands are perhaps the most im-portant,
yet simplest, expedient to pre-vent
food contamination.
b. Respiratory diseases—(Ex. colds,
trench mouth, influenza). The germs
are given off through the mouth and
nose of a case or carrier. For example,
a person may have a common cold; he
coughs or sneezes into the air, then
some individual breathes the germs
into his lungs or gets them into his
mouth and soon he may have a cold
too. Food is often contaminated by bac-teria,
which get on food by coughing
and sneezing. Prevent the contamina-tion
of food in this way by covering
your coughs and sneezes with a hand-kerchief.
c. Diseases carried by insects and
animals (Ex. dysentery, food poison-ing).
The staphylococus bacteria which
causes one kind of food poisoning come
from boils, infected cuts and hang
nails. If these germs get into food and
are allowed to grow for a few hours,
they produce a poison that makes
people plenty sick. A gauze bandage is
not sufficient to keep these germs out
of food. Remember that we said these
germs are very small. They can pass
through a gauze bandage, without
much trouble, so if you have an infec-tion
on your hands or body, where
there is danger of these germs getting
into food, don't handle food because
you may spread food poisoning.
You have a definite responsibility in
doing your part to keep down the
spread of contagious diseases. There
are many sanitary practices and pre-cautions
that you need to observe to
break the channel of infection. These
will be discussed next week when the
second lesson of the series will be in
session.
IV. Demonstration:
Since some of you may never have
had the opportunity to see or study
8 The Health Bulletin March, 1947
bacteria, we want to back up our state-ments
by proving to you that germs do
exist and that they are everywhere.
Here we have some sterile petri dishes
containing sterile agar, a food on which
bacteria are grown. We want to con-taminate
these petri dishes with a hair
from someone's head, a finger drawn
lightly on the surface of the agar, a
good hefty cough, a coin, and some
dust from the floor. The petri dishes
will be returned to the classes next
week so you can see the results then.
V. Filmstrip—USPHS "Our Health in
Your Hands" No. 1 (Germs Take Pot
Luck)
This filmstrip "Germs Take Pot
Luck" will give you more information
on germs and communicable diseases.
VI. Sound Film—"Defense Against In-vasion"
During the showing of this Walt
Disney production in color you will see
how the body builds up immunity to
disease and how vaccination protects
you.
VII. Questionnaire:
• We have a very simple true and false
test that we want to give you. Don't
get excited, because this is not to test
you anymore than it is us; we want to
know if we made the points clear. In
addition to the questionnaire on the
clip board, you will find some literature
on proper foodhandling. Be sure to
read all the literature, because it con-tains
some good information. As we
read the true-false statements, write
your answer in the blank space.
VIII. We want to say again that we
appreciate your attendance and your
attentiveness throughout this first les-son,
and we want to urge each and
everyone of you to attend the second
lesson which will be conducted at this
same time next week.
Lesson No. 2: Good Housekeeping
Policies and Personal Hygiene
I. Sound film on rats "Keep Them
Out."
The first thing on our program today
is a sound film on the rat. We believe
that all of you will realize when you
have seen this film that rats as well
as files can and do carry disease pro-ducing
germs. It will also be noticed
that:
a. rats are very prolific.
b. rats destroy enormous amounts of
property, as well as carry many dis-eases
that are transmitted to man.
c. rats can be controlled by:
1. Ratproofing—build them out.
2. Destroying their nesting and hid-ing
places.
3. Keeping food supplies away from
them—protect garbage.
4. Catching and killing.
II. Illustrated Lecture—Good House-keeping
and Personal Hygiene
a. Introduction
:
You have already learned that cer-tain
diseases are caused by bacteria or
germs and that you as foodhandlers
have a definite responsibility in helping
to keep down the spread of communi-cable
diseases by blocking or cutting the
channel of infection.
b. There are numerous things that
you can do to block this channel:
1. Garbage and refuse disposal.
a. Every municipality should pro-vide
a satisfactory method of garbage
collection and disposal for its citizens.
After garbage is collected by means of
a sanitary type truck, it should be dis-posed
of by burning or incineration,
or by a sanitary land fill, and not
dumped on a hillside or in a gully to
encourage rat harborage and fiy breed-ing.
b. Although the city may collect and
dispose of garbage in a sanitary man-ner,
this is only half the story. Garbage
thrown carelessly about food establish-ment
premises, and left exposed en-courages
the presence of vermin such
as files, rats and roaches. It furnishes
them with breeding places and provides
them with a food supply. Flies, rats
and roaches are dangerous and expen-sive
pests. Therefore, each of you should
do your best to eliminate them. The
attack can be made on three fronts:
1. Eliminate their breeding places.
2. Cut off their food supply.
March, 1947 The Health Bulletin
3. Poison and trap.
c. Garbage protected in a clean can
with a tight fitting hd faciUtates col-lection
and helps to eliminate danger-ous
vermin. Remember, that it is just
as important to keep your garbage con-tainers
sanitary as it is other equip-ment
used in the foodhandling indus-try.
2. Store all food so it is protected
from contamination.
a. Pies, doughnuts and other foods
should not be placed on open counter
where they are exposed to all types of
contamination. The customer can con-taminate
them by coughing, sneezing,
and fingering over them. There is no
reason for a customer to ever contam-inate
food if you foodhandlers would
do youi- part.
b. Open sugar bowls encourage the
presence of files. The fly is not satis-fied
by simply walking across your food,
but it eats some of it, and contaminates
much more than it eats. Then, too,
your customer may taste his coffee,
realizing he hasn't sweetened it and
after contaminating his spoon by put-ting
it into his mouth, he dips it into
the open sugar bowl and passes his
germs on to someone else. Use the
closed sugar bowl which prohibits the
customers spoon being dipped into it
and which protects the sugar from dust
and insects.
c. All other foods must be stored so
as to be protected from all sources of
contamination. Be sure to cover left
over foods immediately after serving
time is over, and refrigerate perishable
foods.
d. Store dried beans, sugar, meal and
flour so they are protected from dirt,
rats and mice—preferably in metal or
glass containers with tight lids. All
items of storage should be on shelves
or racks at least 12" above the floor.
3. Handling of food — while having
lunch in a restaurant, I saw a waitress
open the refrigerator and pick up but-ter
with her fingers. I thought she
was new at the business, and that the
manager would soon have that insani-tary
practice corrected, but I saw six
other waitresses do the same thing. This
manager was more interested in the
cash register than he was seeing to it
that his customers got "safe service."
A good rule to follow is: Don't handle
any food with your fingers unless it
is absolutely necessary. Sometimes it
is necessary to handle certain foods
such as lettuce and tomatoes, but before
handling them, wash your hands thor-oughly
with plenty of warm water and
soap. A nation is eating out of your
hands and dishes—make sure they are
clean.
4. Construction and cleanliness of
equipment.
a. All equipment should be construct-ted
so it will be easy to clean and free
from any cracks, chips and broken
places.
b. Meat blocks, sandwich boards and
food preparation tables with cracks
in the surfaces offer excellent places
for bacteria to grow. Food particles
become lodged in the cracks and all
conditions for growth are favorable,
namely, food, moisture and a warm
temperature.
c. Meat grinders, slicers, and all
other equipment used in the prepara-tion
of food should be thoroughly
cleaned each day. Each item should
be taken apart and every part cleaned
thoroughly. Do this at the end of each
day's operation, because if it is put
aside until the following day someone
may forget to clean it, as was the case
of one food establishment that waited
about ten days to clean a meat grinder.
Upon inspection the sanitarian found
magots working inside it—someone had
forgotten to take it apart and clean it.
d. Clean cooking utensils both inside
and outside thoroughly each day, and
do not use chipped enamel in the prep-aration
of food.
5. Dish washing — we now come to
one of the most important jobs in the
foodhandling business.
a. Mechanical dishwashing. If dish-washing
is done with a dishwashing
machine, be sure to:
10 The Health Bulletin March, 1947
1. Scrape dishes well.
2. Pre-rinse.
3. Arrange properly in dish rack and
place into machine.
4. Turn on 130-140" F. wash water,
containing effective detergent, for one
minute.
5. Turn off the wash and turn on
the 170'-180' F. rinse water for one-half
minute.
6. Place racks of dishes on drain
board and allow to dry.
7. When the dishes are done, take
out, empty, and clean the scrap trays.
Clean washer arms, jets, spray nozzles
and the inside of the machine thor-oughly.
A good detergent should be
added frequently during operation. To
maintain water at the desired tem-perature
a booster burner should be
placed under the vat, and a thermom-eter
should be a part of the dishwash-ing
machine.
b. Handwashing of dishes—an ade-quate
three compartment sink and
plenty of hot water is necessary for
washing dishes by hand.
1. Scrape the dishes well and stack
plates with plates, cups with cups, etc.
Don't try to wash them all scrambled
together. If the dishes are arranged
in a systematic order it will reduce
breakage as well as facilitate the oper-ation.
2. Wash the dishes thoroughly with
a brush in vat No. 1 which contains
water at a temperature of about 120' F.
Too many dishwashers make the mis-take
of trying to wash dishes in water
that is not hot enough. The tempera-ture
must be above the melting point
of fats, if a good job of dishwashing
is accomplished. In addition to the
hot water a good dishwashing com-pound
should be used—not a soap pow-der.
Soap leaves a greasy film that will
not readily rinse off.
3. When the dishes have been thor-oughly
washed, place them in a long
handle immersion basket in the second
vat, where they will be thoroughly
rinsed in warm water.
4. Then move the basket of dishes
to vat No. 3 where the sterilization
process takes place. There are two
methods of sterilizing dishes—(1) hot
water and (2) chemicals.
a. Hot water—if hot water steriliza-tion
is used, the temperature should
be at least 170° F. and the dishes
allowed to remain in the hot water for
at least two minutes. To maintain
water at this temperature, it is neces-sary
to have a booster heater under the
vat. A thermometer is also essential
to make sure the heater is keeping the
temperature at or above 170° F.
b. Chemical sterilization — of the
chemicals used for sterilization, chlorine
is the most common. Allow the dishes
to remain at least two minutes in a
100 PPM chlorine solution. ,
5. Remove the dishes from the steri- \
lizing vat, place on drain board and
allow to dry.
6. Store the dishes so as to be pro-tected
from contamination. Store
dishes in tight cabinets, and glasses
and cups "bottoms up" in wire storage
racks. Silver should be so arranged that
only the handle is grasped when it is
removed for service.
7. Handle clean dishes and utensils
carefully. i
a. Keep fingers out of clean bowls,
cups and glasses, fingers may transfer
germs.
b. Keep fingers off the eating sur-face
of any utensil. Touch only the bot-toms
and edges of dishes and plates
with the fingers.
c. The bowls of spoons, the tines of
forks, and the blades of knives are for
food, take them by the handle.
6. Personal hygiene—personal clean-liness
is fundamental. Each and every
one of you should obey the rules of
good health.
A neat, clean waiter or waitress is
an asset to the food handling business.
A neat and courteous waitress whets
the appetite, but a dirty, slouchy, dis-com'teous
waitress can ruin an appe-tite
very quickly. A waitress should
be neat, clean and should have a pleas-ant
manner.
March, 1947 The Health Bulletin 11
III. Film Strips—"Our Health in Your
Hands"—More information on personal
hygiene and dish washing will now be
presented by the use of two USPHS
film strips, No. 2 and 3, "Service With
a Smile" and "In Hot Water."
IV. "The Danger Point" — This color
film will explain exactly how diseases
can be spread in foodhandling estab-lishments
by improperly sanitized dishes
and glasses.
"V. Demonstration — At this time we
want to explain how we take the bac-teria
count on glasses and other eating
utensils. In this bottle is a sterile swab
in sterile water; the swab when rubbed
over the surface to be examined may
pick up any germs which might be
there. The germs are taken to the
laboratory, plated out, incubated at
body temperature for 48 hours and
then counted. If each utensil contains
over 100 germs sanitation is unsatisfac-tory.
Here are the petri dishes that you
contaminated last week, and we believe
that after you see them you can better
understand why it is necessary to wear
a hair net or cap to keep hair out of
food, wash your hands often, cover
your coughs and sneezes with a hand-kerchief,
and sweep floors by dustless
methods.
VI. Questionnaire: In addition to the
true and false test on this clip board,
you will find some more literature on
food sanitation.
The last lesson in this course of in-struction
will be conducted at this same
time next week, and we hope to see
each of you here at that time. Each
foodhandler who completes the entire
course will receive a "Certificate of
Merit."
Lesson No. 3: Nutrition, Food Poisoning
and Prevention of Food
Contamination
I. Sound Film—"Something You Didn't
Eat." This film shows us the impor-tance
of eating a va-iety of foods for
good health. Our bodies are made of
many materials which must be replen-ished
from the food we eat. We must
have foods that give energy, foods
that supply materials for growth and
upkeep, and foods to keep our bodies
in good running order.
II. Lecture of Food Poisoning and Pre-vention
of Food Contamination.
A. Food Poisoning—probably each of
us at sometime in our life has experi-enced
a gastro-intestinal upset in which
stomach cramps, vomiting and diar-rhea,
lasting for several hours, occur-red.
Usually the recovery is within
several days, but sometimes the attack
is fatal. Illness of this kind may be
the result of food poisoning. Poor poi-soning
occurs in three different ways.
1. Food infection—that is food that
contains certain bacteria which when
eaten grow and multiply in the human
body, causing disease. Ex. Typhoid
Fever.
2. Chemical poison—Food that con-tain
poisonous chemicals. Store all
poisons away from food supplies, so
they will not be mistaken for food
ingredients. Sometime ago 236 people
became seriously ill shortly after eating
in a restaurant on the West Coast.
Upon investigation it was found that a
foodhandler had mistaken sodium fluor-ide
roach powder for powdered milk
and used it in preparing scrambled
eggs. Two-hundred-thirty-six people
became sick and forty-seven died as a
result of careless handling of poison!
Use only colored insect powders that
can be distinguished from flour, baking
powder and other food ingredients.
3. Food intoxication—Foods that con-tain
bacteria which grow and multiply
in the food and produce toxins (poi-sons)
which cause illness when eaten.
Ex. Botulism.
In the foodhandling business we are
very much concerned with the type
food poisoning that is caused by sta-phyloccus
bacteria. Boils and sores
containing pus are alive with bacteria
which multiply like wildfire in such
foods as salad dressing, cream and
meringue, eclaire, cream puffs, etc. If
you have an infection on any part of
your body, don't handle food.
12 The Health Bulletin March, 1947
Only a few years ago about 250 sol-diers
and sailors became ill shortly
after eating breakfast in a large dining
hall. Public health officials were con-tacted
and asked to try to find the
cause. After an official spent almost
two days combing the place thoroughly
the origin of the outbreak of food
poisoning was traced to the milk pump,
which had not been cleaned properly.
Some of the material from the pump
was forwarded to the laboratory where
it was found to be thriving with
"staphs." The manager was asked who
was responsible for cleaning the pump,
and it was learned that even the man-ager
didn't know how to take the
pump apart, although it had been in
use for two or three months.
If someone had done a simple thing,
that is learn to clean the milk pump
and keep it clean one soldier who died,
might be living today. He died for the
simple reason that he got the first mtlk
from the pump that morning and he
had two glasses, because his buddy
didin't want his and gave it to him.
You may say "That won't happen to
me or in my place of business; things
like that always happen in some other
town or some other state." Let's hope
it won't happen to you, but there are
similar experiences practically every
day somewhere in the United States.
It won't happen to you, or in your
town if all sanitary precautions are
taken and regulations are followed
carefully.
B. Prevention of Food Contamination.
The introduction of the harmful bac-teria
which cause food poisoning and
those which cause epidemics occiir in
practically the same manner. Some
of the ways in which contamination
of food may be prevented are:
1. Properly washed vegetables.
2. Examination of foodhandlers to
make sure they are not carriers of dis-ease.
3. Proper washing of the hands
after visiting the toilet is absoutely
essential.
4. Protection of foods from rats,
flies, and roaches.
5. Workers free of sores, boils, and
similar infections.
6. Food protected from contamina-tion
by customer.
7. Precautions taken in the dispen-sing
of waiter or w^aitresses.
8. Proper use of side towel.
9. Clean preparation tables.
10. Proper installation and care of
refrigerator.
11. Protection against contamination
of food by sewage.
12. Protection against contamination
of drinking water.
13. Use of inspected meats.
14. Adequate cooking of foods.
15. Use of pasteurized milk.
16. Proper storage and dispensing of
milk and other bottled drinks.
17. Proper handling of pies and
other pasteries with cream filling.
18. Proper handling of commercially
prepared sandwiches.
19. Proper handling and use of
cracked ice.
20. Use of certified oysters.
People have died because they ate
and drank heartily, trusting in those
who prepared and served the food. And
people will continue to sicken and die
because they eat out, unless you pro-tect
them. The food you prepare for
your customers must first of all be
clean, wholesome, free from spoilage
and safe for human consumption. If
you have any doubt, don't take a
chance. Remember, lives are at stake.
IV. Film Strips, USPHS Series No. 4
"Safe Food for Good Health". This
film stresses the importance of buying
only safe foods, refrigerating perish-able
foods properly, preparing and
cooking foods thoroughly, and serving
them carefully.
V. Film "Eating- Out. "Eating Out is a
silent picture which points out num-erous
violations of food sanitation in
the restaurant business, then shows the
correct procedures. It is somewhat a
review of the things that have been
presented in this series of classes.
March, 1947 The Health Bulletin 13
VI. Questionnaires — This question-naire
is similar to the ones you have
already completed. There is also more
literatui'e on the clip board for you to
take and read. The floor is open for
questions and discussions.
The health department wishes to
thank you again for your excellent
cooperation in making this food con-ference
a success. It is hoped that all
of you gained some helpful information
here, and that you will go back to your
respective places of business and put
it into practice.
At this time we would like to flash
the National Anthem on the screen.
Let us stand and join in singing.
Make up classes were arranged to
enable the foodhandlers, who had
missed one or more of the conference
sessions, to qualify for their certifi-cates.
A number of recently employed
foodhandlers attended all these classes
and obtained certificates since the sub-ject
matter presented and length of
periods were the same as arranged for
the first series.
Certificates were awarded to food-handlers
who attended all the three
lessons. Appropriate placards of rec-ognition
were given to establishments
having 100% of their personnel receiv-ing
certificates.
A short condensed course is now be-ing
planned for all foodhandlers who
have not had previous training. This
will enable new foodhandlers to get
some training immediately before or
after beginning work. All foodhandlers
applying for the required health certi-ciates
will be encouraged to attend
this course. It will consist of discussions
centering around the four filmstrips in
the United States Health Food Hand-ling
Series and will be a regular weekly
service of the health department.
The health department plans to make
the Foodhandlers Conference an ann-ual
event presenting the same basic
fundamentals with new materials. A
paramount objective in designing the
next conference will be to stimulate
more group discussion.
Any evaluation if the conference
must take into consideration both im-mediate
and long term benefits. The
number of establishments represented
and the number of foodhandlers at-tending
the conference indicates that
cooperative working relationships of
foodhandling establishments have been
strengthened. Some of the actual carry
over value of the information can be
measured in the future ratings of the
establishments as they are determined
by sanitary inspections.
The following editorial and state-ments
given volnutarily by foodhandl-ing
establishment managers give some
indication as to the value of the con-ference.
EDITORIAL
"The Record congratulates Sanitar-ians
T. J. Sharpe and Julian R.- Taylor
of the Catawba County Health Depart-ment,
on the excellent start they have
made in raising the sanitary standards
of eating places throughout the county.
We urge the general public to take
cognizance of what has been done, and
cooperate in every way possible to-ward
making the program more and
more effective.
One way we can help, is by giving
our business to the cafes and restau-rants
that display the certificates
which the Health Department is dis-tributing
to those eating places having
one hundrer per cent if their per-sonnel
trained in sanitary methods of
food preparation and service. This
certificates carries the heading "For
Your Health Protection," and if pro-perly
displayed should be easily seen
by the customer.
We commend the cafe and restaurant
operators who have been suflBciently
concerned over the health of their cus-tomers
to see that all of their employees
are properly trained in sanitary pract-ices.
Those who patronize only such
eating places as have a good rating
and whose employees are trained to
safeguard health, will not only demon-strate
their appreciation but will also
14 The Health Bulletin March, 1947
give added impetus to the Health De-partment's
program."
Volunteer remarks of restaurant
managers:
"I have observed a definite improve-ment
in the work of cafeteria personnel
since attending the course. I would like
to attend the school myself."
"Personally, the food classes were a
great help to me and to all my help. I
am proud to say that all my help at-tended
each lesson, and I didn't have
to force or pay them to go."
"The best thing the health depart-ment
has done for cafes."
The following tabulation gives a com-prehensive
picture of the enrollment,
attendance, and representation. Per-centages
have been computed to show
the scope of participation on the part
of management and employees. It
should be noted that only the establish-ments
who had 100% personnel repre-sentation
at all three classes received
the special award.
EQUIPMENT NECESSARY
Room. — The meeting room should be
at least 20 x 30 feet in size, conveniently
located, and should present a desirable
environment relative to lighting and
ventilation. If the meetings are to be
held during the day, it will be necess-ary
to darken the room.
Suggested meeting places:
1. Health Department Building.
2. City Hall.
3. Civic Clubs or Union Halls .
4. Community Buildings.
5. Court House.
6. Schools.
7. Churches.
8. Theaters.
Equipment needed:
1. Adequate seats.
2. Outlets for electrical equipment.
3. Two tables for movie projector,
slides and filmstrip projector.
5. Slide and filmstrip projector.
6. Screen.
7. Clipboard and pencil for each
person in attendance. (Clipboards
may be made inexpensively from
masonite).
8. Transparent 2x2 slides.
9. 16 mm. films and 35 mm. film-strips.
a. Swat the Ply
b. Defense Against Invasion
(color)
.
c. Keep Them Out.
d. The Danger Point, (color)
e. Something You Didn't Eat.
(color)
f. Eating Out. (silent)
g. USPHS filmstrip series "Our
Health in Yom' Hands."
10. Literature and questions for
foodhandlers.
a. Foodhandlers' Manual.
b. Take a Tip.
c. Safety Suggestions for Food-handlers.
d. Health Hints for Proprietors.
e. Pamphlets on various diseases.
f. Questionnaires.
11. Swabs to demonstrate rim count
procedure.
12. Petri dishes to demonstrate bac-terial
growth.
I
Department
March, 1947 The Health Bulletin 15
Typhoid In January
By Mrs. Louise P.- East, R.X., Consultant
District No. 5, Asheville, N. C.
A Mother lies ill in a Western North
Carolina hospital—diagnosis: Typhoid
Fever.
The case came to our attention Jan-uary
21, 1947, through the interest of
a Health Officer in an adjoining area.
As always, a case of Typhoid Fever
calls for investigation to determine
through what source the deadly germs
were transmitted to the patient. In
downstate sections of North Carolina
suspicious vectors would be shell fish,
water, milk and food eaten at unaccus-tome
places, within the incubation
period of the disease. In the high alti-tude
from whence this patient came,
in Madison County, some of these us-
\ially suspected sources were eliminated
because of the isolated area in which
the stricken woman lives.
Armed with Typhoid vaccine, steri-lized
bottles for water samples and
confidence that no mountain home was
too remote for a Public Health worker
to reach, I hopefully set out on the
quest of uncovering the source of the
Typhoid germs.
I wish that I had been supplied with
a kodak so that I could send a picture
to go along with the article showing
the fringe and network of ice which
transformed the rocky walls bordering
the highway between Asheville and
Marshall into a picture of exquisite
beauty. In such a setting Typhoid seems
definitely misplaced to those of us who
knew Typhoid intimately years ago.
In looking back over the experience
of the afternoon thus spent, the lines
of a poem by Robert Burns keeps com-ing
to mind about:—"The best laid
plans of mice and men".
Upon arrival at the office of the phy-sician
of the family involved, we con-tacted
Dr. Saams, who serves the county
in regard to matters which affect the
health of the public, since there is no
health department in Madison County.
The family physician was already on
the alert and had begun administering
Typhoid vaccine to members of the
family.
Water supply: Could any water sup-ply
be purer than that which falls
from rocky ledges so high that there
is no human habitation about it?
Milk supply: The family owns their
own cow, do their own milking. Ty-phoid
germs do not come from cows, nor
from milk unless the water supply is
contaminated or there is a Typhoid
carrier around!
Being eager to reach the home, I
began asking for directions. Both phy-sicians
advised against it. One said,
"Why I would not go up there this
afternoon for a thousand dollars".
Clouds hung low and dark, it was
bitter cold. The oth^.- physician said,
"When I get a call to that family, I
ask the man to meet me at the high-way
with a horse so that I can ride
the mile and a half up the cove to his
home".
About that time snow began falling,
not straight down, for the wind was
high and the flakes were blown straight
across the sky in such a winterish
fashion that all living creatures were
prompted to seek the shelter of home
and warmth.
As I was leaving the office I had a
feeling that Robert Burns must have
known what he was talking about in
that poem. We checked over the inform-ation
gained and plans made. Said the
family physician: "The husband of the
patient refused to take Typhoid Vac-cine
because, 'as he said, T had Typhoid
Fever a few years ago".
Gang way, Robert Burns!
Typhoid carrier? Milk? Water?
Tomorrow is another day.
On horseback or on foot, a Public
Health visitor may yet uncover the
source of the misplaced Typhoid germs.
16 The Health Bulletin March, 1947
The North CaroHna League for
Cripple Children
DATE AND PROGRAM
For the 12th year the North Carohna
League for Crippled Children invites
its friends to share in financing its
work during the Annual Easter Seal
Campaign, March 6th through Easter,
April 6th. During the past year the
generous contributions of the public
made it possible to expand consider-ably
the program of the League.
The League is a private social agency
that cooperates with, but does not dup-licate
the work of other public and
private charitable organizations. Aids
the crippled whether the condition re-sulted
from accident, birth, disease or
infection. Its only requirement for aid
—a valid need not otherwise provided
for. Its main source of funds—vol-untary
contributions during the An-nual
Easter Seal campaigns.
The consistent growth of the league
during the past years reflects both the
fundamental need for such an agency
and the increase of public confidence
in its program. Your contribution at
this time will improve the lot of one
or more crippled children. For what-ever
your heart prompts you to give,
the children say, "Thank you, and a
Happy Easter."
Among the services rendered by the
League during 1946 were:
1. Medical Care: Specialized care to
insure the best physical correction in-cluded
orthopedic operations, orthoden-tui'e
treatments, blood transfusions, in-sulin,
clinical treatments, hospitaliza-tion,
convalescent home care, and phys-icians'
visits to homes.
2. Artificial Aids: Artificial limbs, ex-tension
shoes, crutches, wheel chairs,
glasses, hearing aids, and plastic ears
were provided.
3. Transportation: Miles traveled to
clinics, hospitals, and schools, amount-ed
to more than three times the dis-tance
around the world.
4. Education:
a. Special training classes at the
University of North Carolina for teach-ers
interested in working with hand-icapped
pupils.
b. Scholarships for taking this spe-cialized
training were provided for 12
teachers and 2 school nurses, and tui-tion
was made available to 3 other
professional workers.
c. A summer educational center
for handicapped children.
d. A two day Special Education
Institute for school executives.
e. A speech correction program in
one city school.
f. Three teachers trained to work
with exceptional children are assisting
with the work of the Child Guidance
Clinic in one city.
g. Bedside teaching in 2 hospitals
in one city.
% Aao.,
MARY ETHEL JACOCKS, age 2,
daughter of Mr. and Mrs. Frank Ja-cocks
of Charlotte, N. C. Mr. Jacocks
is Director of Sanitation for the City
of Charlotte.
\ This Bulletin, will be sent free to any citizen of the State \xpor\ 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. 62 APRIL, 1947 No. 4
A Public Health Nurse On Duty
MEMBERS Of THE NORTH CAROLINA STATE BOARD OF HEALTH
S. D. CRAIG, 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 Asheville
I. O. NOLAN, M.D Kannapolis
JASPER C. JACKSON, Ph.G Lumberton
PAUL E. JONES, D.D.S Farmville
EXECUTIVE STAFF
CARL V. REYNOLDS, M.D., 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.
R. E. FOX, M.D., Director Local Health Administration.
W, P. RICHARDSON, M.D., District Director Local Health Administration.
ERNEST A. BRANCH, D.D.S. , Director of Oral Hygiene.
JOHN H. HAMILTON, M.D., Director Division of Laboratories.
J. M. JARRETT, B.S., Director of Sanitary Engineering.
T. F. VESTAL, M.D., Director Division of Tuberculosis.
OTTO J. SWISHER, Director Division of Industrial Hygiene.
WILLIAM P. JACOCKS, M.D., Director Nutrition Division.
MR. CAPUS WAYNICK, Director Venereal Disease Education Institute.
C. P. STEVICK, M.D., Director, School-Health Coordinating Service.
HAROLD J. MAGNUSON, M.D., Director Reynolds Research Laboratory, Chape! 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 dis-tribution
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. Instruction for North Carolina Midwives.
CONTENTS Page
Public Health Nursing Week __ __ 3
"Public Health Nursing Week" 4
Annual Report of Charlotte Public Health Nursing Service 1946 5
The Follow Up of the Tuberculous Veteran and His Family 8
Public Health Nursing in the City of Greensboro _- 12
Field Training Reflections 13
Cancer—A Proclamation __ 14
'M®m ^m
PUBU5ME:D by TML nOR.TM CAgQUMA 5TATL BOMgD •ME-ALTM | LiJ
Vol. 62 APRIL, 1947 No. 4
CARL V. REYNOLDS, M.D., State Health Officer JOHN H. HAMILTON, M.D., Acting Editor
Public Health Nursing Week
By Amy Louise Fisher, R.N.
Supervising Public Health Nurse
State Board of Health
The week of April 20-26 has been
designated as Public Health Nursing
Week for 1947. It will also mark the
70th anniversary of public health nurs-ing
in the United States. The whole
nation wUl pay tribute to the blue-clad
nurses who work so tirelessly in homes,
clinics and schools to help keep the
scovirge of sickness and epidemic out
of our homes and communities and
promote better health.
Miss Ruth Weaver Hubbard, Presi-dent
of the National Organization for
Public Health Nursing, has said, "Public
Health Nursing Week will give us the
opportunity to work together for na-tional
health. We are not nurses work-ing
alone. We are lay and professional
people working with other citizens to-ward
a jointly accepted goal. But just
as all must work to provide the quality
and quantity of public health nursing
service this nation needs, so all must
join to interpret that service broadly
imtil there remains no person ignorant
of its offerings to his neighbor and
himself.
Public health nursing is an integral
part of a national health program for
every individual in these United States.
The growing army of public health
nurses is still far too small for the
demands made upon it by the national
health program. There are still places
where the services of public health
nurses are not available in any form
to American families. The public health
nm'se of the future is yet to be re-cruited
from the young womanhood of
today and tomorrow."
North Carolina is fortunate in hav-ing
93 of the 100 counties organized for
public health work, other counties will
probably organize during this year. The
need for more public health nurses is
nationwide and is urgent. Sixty six
positions out of three hundred and sixty
(.360) budgeted positions for public
health nurses in North Carolina are
vacant. The State Board of Health
offers scholarships to help nurses qual-ify
for post graduate study in this
field.
Public health nursing offers a long-term
career in a socially useful activity
in which there are many personal
satisfactions. It offers many opportun-ities
for service and requires your best
efforts.
The following articles in this Public
Health Nursing issue of the Health
Bulletin will serve to focus attention on
the scope and type of public health
nursing service now being carried on in
North Carolina.
The Health Bulletin April, 1947
"Public Health Nursing Week"
By Thomas Parran, M.D.
Surgeon General, U. S. Public Health Service
"Public Health Nursing Week" is
America's appropriate tribute to a group
of workers dedicated to protecting and
improving the country's health. Since
the 1870's the public health nurse has
contributed continuously to the well-being
of our people and to the success
of this country's entii'e public health
program.
The work of the public health nurse
long has been recognized as the back-bone
of the local health program.
Today's emphasis on preventive medi-cine
places an even higher premium on
the nurse's services. She plays an im-portant
part in the control of epidemics,
the early detection of remedial defects,
the prevention of disease, and the adop-tion
of good health habits.
No local health program can meet its
goal without adequate public health
nursing services. These services are
available to everyone regardless of eco-nomic
status. But in addition to the
percentage of the population of a com-munity
benefiting directly from the
efforts of the public health nurse, life
for all in the locality is healthier, more
secure, and happier because of her
work. In these days of inadequate hos-pital
facilities, the public health nurse
plays a particularly vital role in keep-ing
the nation fit.
As scientific horizons continue to
broaden, we must bring medical tri-imiphs
from the research laboratory
into the homes, shops, factories, and
farms of the United States. The public
health nurse is indispensable in her role
as interpreter of scientific advances in
medicine. In her direct dealings with
the people of a community, she has
the opportunity to explain new drugs
and treatments and to encourage their
use. Working with specialists in such
fields as tuberculosis, orthopedics, pedi-actrics,
obstetrics, and psychiatry, she
has unlimited opportunity to strive
constantly for the better health of all
people.
Today, more than 20,000 public health
nurses are employed in national, Fed-eral,
State, and local agencies — in
health departments, boards of educa-tion,
visiting nurse associations, insur-ance
companies, and schools of nursing.
Many more are needed, however, if we
are to reach the ratio of one public
health nurse for each 2,000 of our popu-lation—
the ration recommended where-ever
bedside nursing is included in the
community health program. We need
more than three times the present
number to reach that goal. Some 1100
counties in the United States still are
entirely without public health nursing
services; few other areas are adequate-ly
staffed.
Public health nursing is a deeply re-warding
career. Activities are stimu-lating
and varied, all offering the op-portunity
to contribute to the nation's
health and security. At present there
are hundreds of openings for public
health nurse recruits.
I am confident that a public which
is aware of the benefits offered through
public health nursing will take advan-tage
of the services where they exist,
support them fully where they require
expansion, and cooperate in bringing
them to areas where they are now un-available.
During "Public Health Nurs-ing
Week" many persons will have the
opportunity to learn the value of public j
health nursing.
ApriL 1947 The Health Bulletin
Annual Report of Charlotte Public
Health Nursing Service 1946
By Ann C. Barentine, R.N.
Director, Public Health Nursing Department
The Health Department Nursing Serv-ice,
aware of the marvelous develop-ment
of scientific research which
characterizes this period of this world's
history, has endeavored throughout
1946 to meet this challenge of enlight-enment
by sounding out new means
and methods .adopting them quickly
and spontaneously where proven su-perior,
and discarding as soon as prac-ticable
the outmoded and stereotyped,
no matter how time-honored. This
resolute adoption of the best thought
available, and the earnest desire to
advance with the times have made the
preceding months a day by day march
of progress towards the ultimate
achievement of improved mental, physi-cal,
and moral health for the citizens
of the city of Charlotte.
This has meant experimentation, in-tensified
effort, and determined growth
as well as honest appraisal, self-analy-sis,
and a willingness on the part of
the entire staff to surrender personal
differences, and to lose all restricted
habits of thought relative to techniques
and procedures in a larger conception
of service, as evidenced by an enthus-iastic
and comprehensive welcome of
the new and promising.
The generalized program of the
Nursing Service has been carried out
by the nineteen nurses—thirteen white
and six colored—which comprise the
staff. Its activities, extended through-out
the nineteen districts it serves, in-clude:
bedside nursing, new-born care,
infant, pre-school, and adult health
supervision, school nursing, ante-par-tum,
post-partum, morbidity, and crip-pled
children, tuberculosis, communi-cable
and venereal disease control. In
addition to work in the various districts,
the nursing staff, through systematic
rotation, has continued to serve in the
Immunization, Maternity, Planned Par-enthood,
Orthopedic, Tuberculosis, Ve-nereal
Disease, Medical clinics and in
the Child Health Stations.
In the furtherance of advanced tech-nical
knowledge in Public Health Nurs-ing
and Special Education for handi-capped
children, six (6) scholarships
were made available through the North
Carolina State Board of Health, the
G.I. Bill of Rights, and the North
Carolina League for Crippled Children.
The Local Chapter of the American
Red Cross sponsored two six-day train-ing
courses through which eight (8)
members of the staff were instructed
in, and now teach, home nursing classes.
In-service training, designed to de-velop
latent resources in the staff with-out
interruption of performance in the
field, provided for enlargement of in-dividual
capacity through instituteSr
courses, and staff conferences. Of par-ticular
and far-reaching value were:
a two (2) day institute and a twelve
hour refresher course on Nutrition,
conducted by Miss Willidell Schawe,
Nutritionist, Metropolitan Life Insur-ance
Company, and Miss Eunice Out-law,
Nutritionist, with the North Caro-lina
School Health Coordinating Serv-ice;
an institute in Nursing Aspects of
Tuberculosis Control, conducted by Mrs.
Louise Lincoln Cady, Nursing Consult-ant,
National Tuberculosis Association,
and Dr. Hillis Seay, Superintendent of
the Mecklenburg County Tuberculosis
Sanatorium; and an institute on Social
and Health Concepts of Nursing in the
Basic Curriculum, conducted by Miss
Mary J. Dunn, Senior Nurse Officer,
United States Public Health Service.
The discussions at the institute were
the determining factor in the adoption.
6 The Health Bulletin April, 1947
by the Superintendent of the Hospital
and the Health Department OfBcials,
of the present advanced procedure
which affords the nearest approach to
perfect integration of social and health
aspects of nursing in the basic cur-riculum
of local hospital training school.
This marks a definite improvement in
this direction inasmuch as it is now
possible for all students in these schools
to obtain two (2) weeks' training and
observation in the Public Health De-partment,
whereas formerly this oppor-tunity
was available to only a limited
number.
Definite response on the part of the
public to group teaching by public
health nurses has been reflected by
visible improvement throughout the
year. This teaching in the form of
lectures, classes, and demonstrations,
covered a variety of subject matter, in-cluding:
Community Health and Social
Resoui'ces; Health talks to Parent
Teacher Associations; Radio talks on
Health Education and Activities of the
local Health Department; Vocational
Guidance to High School students; Red
Cross Home Nursing Classes; movies
and talks on Venereal Diseases and
Tuberculosis; Nutrition classes; Pre-natal
and Practical Nursing classes;
Personal Hygiene; Marriage counseling
and Planned Families.
During 1946 approximately one hun-dred
(100) student nurses, enrolled in
the training courses of the local hos-pitals,
were given the privilege of ac-quainting
themselves with the activi-ties,
aims, piirposes, and functions of
the Public Health Nursing Service.
Through the Student's Affiliate Pro-gram
maintained through joint par-ticipation
of the Nursing Service and
Mercy, Presbyterian, and Good Samar-itan
Hospitals, eleven (11) affiliates
from these hospitals were given two
full months' training in Public Health
Nursing.
Approved in 1945 by the University
of North Carolina of Public Health as
a Field Training Center, four (4)
associate nurses were accepted for
eleven weeks' training in the field. In
addition to guidance step by step in
learning actual public health work,
demonstrations in office and clinics,
and field work, especial attention was
given to the elimination of individual
defects or weaknesses in particular
phases of the work, and the broaden-ing
and strengthening of special
branches of the service in which the
associate anticipated a need when
assigned to her permanent position
after completion of her training.
Recognizing the importance of pre-natal
instruction, the Nursing Service
intensified its efforts to bring more
cases under its supervision. Only one
hundred and twenty-five babies, out
of the total four thousand seven him-dred
and twenty-nine born during
1946, were delivered in the home. Nine
hundred thirty-six of the total de-liveries
were given post-partum care
by public health nurses.
Through proper hospitalization, the
propagation of health knowledge, and
better medical and nursing care, the
maternal deaths decreased from eight
(8) in 1945 to three (3) in 1946.
Alarmed in 1945 to discover, from an
appraisal made by the American Pub-lic
Health Association, that Charlotte
had one of the highest infant mor-tality
death rates from diarrhea and
enteritis in the nation (of the cities
reporting) a concerted effort on the
part of the entire Health Department
to improve this situation was begun,
and continued throughout the year.
Dr. Bethel, in this connection, called
a meeting of all the pediatricians in
Charlotte, reviewed the deaths, dis-cussed
possible causes, and inaugurated
a procedure which has been faithfully
followed with the gratifying result that
not a single death from this cause has
been reported this year.
With the assistance and cooperation
of the School Health Coordinating
Service, principals, teachers, and school
authorities, the nurses have continued
their work in the School Health Pro-gram.
Individual and group confer-
April. 1947 The Health Bulletin
ences on health problems have proven
very beneficial. The nui'ses have as-sisted
the teachers with the screening
(health appraisal) of the students and
referred for medical care cases where
the need was indicated. In instances
where defects were observed, follow-up
visits by the nurses were continued
until corrections were effected when-ever
possible. All First Grade and
Seventh Grade and Selected students
were given a medical examination by
Dr. Maude Pressley.
The Sunshine Projects operated at
First Ward and Bethune Schools
jointly by the Charity League, the
Board of Education, and the Health
Department have shown no diminution
of interest or enthusiasm in their un-selfish
endeavor to correct defects and
deficiencies among school children, and
the far reaching result of their efforts
are of immeasurable worth to the
community, fortiuiate indeed to bear
the imprint of their vision in this
direction. Considering each extension
of service, a slight but cherished mark
of progress, the Nursing Service re-ports
the addition of another Child
Health Station, bringing the total num-ber
maintained to nine (9), located in
readily accessible localities throughout
the city.
Outstanding progress has been made
in the detection and control of Ve-nereal
Disease, as revealed by reports
from the Venereal Disease Clinic.
Although Tuberculosis is the ninth
leading cause of death in Charlotte,
the danger has been checked to the
extent that the death rate is steadily
declining. With further progress in
the total eradication of this disease
as its goal, the Nursing Service has
worked closely with Dr. Hillis Seay and
his staff at the Mecklenburg County
Sanatorium, and Miss Ruth Harris,
Executive Secretary of the Tuberculosis
Association, and her staff to locate
cases, bring them under treatment,
and have examinations made of con-tacts.
An educational program de-sig