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ariie librarp of tfje ©nibersJitp of ^orttj Carolina CnbotDeb bp tBi)t IBialtctic anil HfjUanrtjropit dorietiei 61ii.06 N86h V. 61-62 19l;6-U7 Med. lib. This book must not be taken from the Library building. ^ PublhKedbi^ TfiE^°RmCftFSUTiA SIATL h^P^KD s^iffi^UH 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 ]cmm hm 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. z< -I a < LU > > 5 ituj (OU. 3 °- I 1IS03- I "T ' IOil©I isii© \^ I '/^-'N I 1%^ lii© ii©>'" r 1-5 0 o 10(0 If -r c h 3 if©^' 'gM ©IM < Z _J o q: < m u lO b. o u J J< u 0) a Of a fli'o O-- o ir),o fl t CI ol^ ^ tl «l c) s CI c (OiClDlDifl^uJ ooooo o oooo <. OC OQ o 00 rj- _0 1/) <^I -J a I ,>0 (0 J) o (0 a ,n L " 5 = "E <d - e Q4 i cn- L « -</>0 O c o 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. <z -J O <u O CO UJ o. Q- D c/) uu I- < y Q. lO 3 111 «i (9 o <19 o 8 uj v! m — 1 THE PUBLIC WATER SUPf^ DECEME. GROUND WATER SUPPLIES "" tSOF NORTH CAROLINA i 1921 :t' _* pt^jtJte^ to ^m'»Jf I 1 ,.—1 \-*^'""J—^_/ '- \ /^•^^''<- M ._J.^Q v: No :\^H °-<^ ^^'o-^' LABORATORY COh^TROL or RLTRATION LEGEND RECAPITULATION T E 1 N E S S E E < JNCW<LLC -i-'. [ L.J AmPMTftaUNIUMv OiSTMlCTS —±j± — ZztSg'Si '*« KWTo too • -OBI.* MM* wo • TOWNS WITHOUT nWJCWkTeH SUP»UCI 1*^ TOWNS I POP iiiLT ovafB (u»n.iti I 1 •lIH F>l.t(«fD »uM«CI MJfr\.ltt J—] 3q- T y—[— cz" *• ! ...... L ",•_!' .A.". •"""~ ••*«-•._„ / ••«»4./ •«».T„i,. ~~ 1""" ' ' ^^^ ! I -1 I I / •""«*'-v./ " • " r T T s. _^ . _ ^ . / N.--' -, . - '^. m a m t y X- 1- ,.^.. _L . * .1 e ,.... • T-; -.y^^--\ '^ w", /^ • •«rrTrn»,ty ^ - ••-< ' V-. \ '-^ *Sii^ ( • \ PUBLIC WATER SUPPLY MAP OF NORTH CAROLINA SHOWING ALL TOWNS WITH PUBLIC WATER SUPPLIES AND ALL TOWNS OVER 500 WITHOUT PUBLIC WATER SUPPLIES PREPARED BY THE STATE BOARD OF HEALTH AvuAfn- 194? RALEIGH. N. C UJ w s (9 o h in rsl VO 13 o <e> u is «2 lA IN 0) 3 EE o U h. a> .9* "gL Q. 3 to 0) <0 m t CO «A 0) 3E E o U Ul <j "is 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
Object Description
Description
Title | Health bulletin |
Other Title | Bulletin of the North Carolina State Board of Health; Bulletin of the North Carolina Board of Health |
Creator | North Carolina. State Board of Health. |
Date | 1947 |
Subjects |
Children--Health and hygiene Diseases Hygiene Public Health--North Carolina--Periodicals Sanitation |
Place | North Carolina, United States |
Time Period | (1945-1989) Post War/Cold War period |
Description | Volume 62, Issues 1-12. Issues for Feb.-May 1917 and for Jan.-July 1918 not published. |
Publisher | Raleigh,North Carolina State Board of Health. |
Agency-Current | North Carolina Department of Health and Human Services |
Rights | State Document see http://digital.ncdcr.gov/u?/p249901coll22,63754 |
Physical Characteristics | 61 v. :ill. ;23 cm. |
Collection | Health Sciences Library, University of North Carolina at Chapel Hill |
Type | text |
Language | English |
Format | Bulletins |
Digital Characteristics-A | 14,328 KB; 238 p. |
Digital Collection |
Ensuring Democracy through Digital Access, a North Carolina LSTA-funded grant project North Carolina Digital State Documents Collection |
Digital Format | application/pdf |
Related Items | Imprint varies: published later at Raleigh, N.C. |
Title Replaces | Bulletin of the North Carolina Board of Health** |
Audience | All |
Pres File Name-M | pubs_edp_healthbulletin1947.pdf |
Pres Local File Path-M | \Preservation_content\StatePubs\pubs_edp\images_master\ |
Full Text |
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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
]cmm hm
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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