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If ®fie Htfcrarp of tfje Wlnibmitp of ^ortfj Carolina Cnboteeb lip Cije BiaUtfic anb I^frilantijropit Societies! 6Hu06 N86h v. 61-62 19U6-U7 Med, lib. J This book must not be taken from the Library building. f j This Bulletin, will be sent free to any citizen of the State upon request I Entered as second-class matter at Postoffice at Raleigh, N. C, under Act of July 16, 1804. Published monthly at the office of the Secretary of the Board, Raleigh, N. C. Vol. 61 JANUARY, 1946 No. 1 The Public Health Nurse Helps Keep North Carolina Strong A MEMBERS OF THE NORTH CAROLINA STATE BOARD OF HEALTH S. D. CRAIG, M.D., President Winston-Salem J. N. JOHNSON, D.D.S., Vice-President Goldsboro G. G. DIXON, M.D Ayden H. LEE LARGE, M.D Rocky Mount W. T. RAINEY, M.D Fayetteville HUBERT B. HAYWOOD, M.D Raleigh J. LaBRUCE WARD, M.D Asheville J. O. NOLAN, M.D Kannapolis JASPER C. JACKSON, Ph.G '. Lumberton 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. J. ROY HEGE, M.D., District 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. C. P. STEVICK, M.D., Director Division of Epidemiology and Vital Statistics J. M. JARRETT, B.S., Director Division of Sanitary Engineering. T. F. VESTAL, M.D., Director Division of Tuberculosis C. B. DAVIS, M.D., Director Division of Industrial Hygiene. WILLIAM P. JACOCKS, M.D., Executive Secretary, Nutrition Service of the State Board of Health MR. CAPUS WAYNICK, Director, Venereal Disease Education Institute. E. H. ELLINWOOD, M.D., Director, School-Health Coordinating Service WILLIAM L. FLEMING, M.D., Director, Reynolds Research Laboratory, Chapel Hill. JOHN J. WRIGHT, M.D., Director, Field Epidemiological 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 an 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 Chickenpcx 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 :itizen of the State on request to the State Board of Health, Raleigh, North Carolina. Prenatal Care. Baby's Daily Time Cards: Under 5 months; Prenatal Letters (series of nine 5 to 6 months; 7, 8, and 9 months; 10, 11, monthly letters.) and 12 months; 1 year to 19 months; 19 The Expectant Mother. months to 2 years. Breast Feeding. Diet List: 9 to 12 months; 12 to 15 months; Infant Care. The Prevention of 15 to 24 months; 2 to 3 years; 3 to 6 Infantile Diarrhea. years. Table of Heights and Weights. Instruction for North Carolina Midwives. CONTENTS Page Postwar Expansion of Public Health Nursing 3 "Snowball's" Club Feet 7 Progress of Industrial Nursing In North Carolina 8 What Do You Do? 9 "Me - - and You" 10 Opportunities In Public Health Nursing 11 Amanda Bunch—Midwife 13 Exhibits 14 Maternity Poster 14 The Premature Infant 15 LIBRARY UNIV. OF NORTH CAROLINA ? PUBLI5ME1D BY TML nORTn CAgQunA 5TATE- EPA^D •Mi.ALTH | Vol. 61 JANUARY, 1946 No. 1 CARL V. REYNOLDS, M.D., State Health Officer JOHN H. HAMILTON, M.D., Acting Editor Postwar Expansion of Public Health Nursing* By Maky J. Dunn, Senior Nurse (R), U. S. Public Health Service Washington, D. C. FOR the first time in years we are liberated from the forces of aggression and the fear and dread of some new outrage against the decencies of mankind: we can now build con-structively for a "Better Nation"—a "Better World"—for peace loving people. In so build-ing during the period of reconversion, it is assumed that health programs will expand greatly and rapidly. Dr. Parran has pointed out recently that, "in many peacetime health activities we shall have to 'learn by doing', but we shall learn faster and do better if we can agree upon certain basic assumptions which will shape our thinking and action. It is reasonable to assume that: — 1. Reconversion to a peacetime economy will create health problems comparable in scope and extent with those of war: 2. State and local health authorities will have to take over a larger share of the costs of many essential programs; 3. The release of manpower and materials for construction offers opportunities for the establishment of essential health facilities at an earlier time than could be anticipated two short months ago; 4. The Federal Government will not as-sume sole responsibility for the planning of public health works; initial efforts must come from the States; 5. The training of health personnel, in sufficient numbers and of adequate qualifica-tions, will require joint action on the part of all official and non-official agencies concerned; 6. A health organization larger than any we have known before, both in size and in scope of operations will be needed to attain the objectives of national health." Many factors will contribute to the shaping up of expanded health programs; these factors in turn will have a direct relationship to the number and kind of public health nurses needed. Therefore, it is timely that we as public health nurses have in mind our professional advancement, as well as the maximum con-tribution we may make to the commonwealth. It is by maintaining these two interests in proper balance that real progress may be made. To-day nurses are the most numerous pro-fessional group in health departments; they hold over 50 percent of the classified technical positions. The number employed full-time by *Paper presented by Mary J. Dunn, Senior Nurse Officer (R), U. S. Public Health Service, Washington, D. C. at the annual convention of The North Caroline State Nurses Association and of the State League of Nursing Education, Winston-Salem, North Carolina, November 7, 1945. The Health Bulletin January, 1946 public health agencies, including Boards of Education, number somewhat over 20,000. This does not take into account about 3,500 vacancies for which funds are currently avail-able. According to estimates compiled by the Subcommittee on Local Health Units of the American Public Health Association, at least 12,900 additional public health nurses are needed for public health protection of the population of Continental United States. This number would represent a ratio of one public health nurse to every 5,000 people. With in-creased emphasis on bedside nursing service on an hourly basis, the present number would need to be increased by more than 50 percent, thus providing a ratio of one public health nurse to every 2,000 people. Thus, it is obvious that the present number of public health nurses is insufficient to meet current needs, and consequently is wholly inadequate to meet the demands of expanding programs. Therefore, in considering any plan for the preparation of public health nurses it is assumed: 1) that they will be needed in in-creasing numbers; 2) that their preparation must fit them for the new evolving pattern of public health nursing. For example, our pattern is bound to change with advances in medical science. Already there is a marked reducdon and change in the prevalence and clinical course of certain communicable diseases,—especially among the Virus diseases and Venereal diseases,—be-cause of scientific discovery and application. The catastrophies of our all too recent war have given a renewed stimulus to mental hygiene, Psychiatry, and a sound rehabilitation program. Our expanding life span has its consequent health problems including an up-ward swing of chronic and degenerative dis-eases, and the many implications in the area of Geriatrics. Certain economic changes and the growing interest in health and hospital insurance plans affect markedly the number and type of patient known to the public health nurse. Another factor influencing our func-tions, responsibilities, and relationships is the many new types of workers—both professional and auxiliary—that have come into the health field. This pertains particularly to such per-sonnel as the health educator, the nutritionist, Social worker, physical therapist, practical or vocational nurse, housekeeping aides,—to men-tion but a few. If we are to prepare nurses to assume the many new and varied responsibilities that will be theirs, we should give thought: (1) to the most economical and effective type of preparation; (2) to the selection of promising recruits for public health nursing; (3) to needs and opportunities for financial assistance for essential training. Obviously the largest number of nurses needed will be Staff nurses or general public health nursing practitioners. The 1944 Census of public health nurses revealed that only nine states had reached the minimum emergent ratio of one Staff nurse to every 5,000 people. How are these Staff nurses to be prepared most effectively and economically? Many, through basic nursing programs or curricula which are an integral part of our universities and colleges. Programs which we have in mind are those having as their objective the preparation of a Community nurse well-versed in the curative and preventive phases of nursing; one who possesses an attitude, an under-standing, and a mastery of skill in caring for the whole patient in his different environ-mental situations; one who may take her place equally well in the hospital ward or in a public health agency under supervision. In order to prepare this type of professional nurse the teaching of the health, preventive, and rehabilitative elements of nursing, must be started very early in the basic curriculum and related to every function and to every appropriate learning situation. Likewise the concept of total nursing care calls for close coordination of the hospital nursing service with other community nursing services, simple but effective methods of referral and com-munication between these nursing services, ' and full appreciation of use of these channels January, 1946 The Health Bulletix by the entire nursing service and instructional staff. Assistance is frequently sought from public health agencies whereby students may have opportunity to observe, assist with, or give nursing care in homes. As a further means of implementing this broader concept of nursing care, an affiliation of two to three months, is frequently arranged with a public health nursing agency. Such an affiliation is planned ordinarily as an educational experience during the student's last year of training as an integral part of the required basic nursing curriculum. This experience should not be confused with the supervised practice period of the Senior Cadet which we come to know through our wartime accelerated basic pro-grams. The supervised practice period of the Senior Cadet Nurse is experience beyond the re-quired program of combined theory and practice, varying from 24 to 30 months in length. It serves to satisfy certain existing re-quirements of most State Boards of Nurse Examiners for graduation and registration. The Senior Cadet period represents an addi-tional six to twelve months' experience and emphasizes the service the Senior Cadet may render to the receiving institution or agency. Any study of present systems of nursing education, and the evaluation of curricula should consider possible values accruing from the wartime accelerated basic curriculum, in-cluding a terminal supervised practice period of the Senior student. The question might well arise as to the existence and prevalence of such basic pro-grams as we have described. Many are attempt-ing to enrich their programs, but very few have actually attained this broader goal. The final determination as to whether this goal has been realized is made by joint eval-uation and accreditation by the National League of Nursing Education, whose major responsibility is approval of the basic content, and by the National Organization for Public Health Nursing, whose function is to evaluate the public health nursing content of such a program. To date, only one school of nursing, the Skidmore College Department of Nursing of New York, has been thus accredited. Sev-eral other schools are seeking this type of accreditation and it is anticipated that still others will apply within the near future. While it is expected that increasing em-phasis will be placed upon the development of basic nursing preparation at least for a long time to come, these comprehensive pro-grams, of necessity, will produce a limited number of nurses. Therefore, increasing em-phasis must be placed upon the improvement and expansion of existing postgraduate pro-grams, especially those designed to prepare public health nursing supervisors and instruc-tors and clinical experts in such fields as psychiatry, orthopedics, pediatrics, obstetrics, and tuberculosis. It was mentioned earlier that careful thought should be given to the selection of recruits for public health nursing. The return of peace finds this nation face to face with the press-ing needs of its civilian population. We are at a critical level of one public health nurse to every 8,000 persons. It seems a strategic time to recruit and to prepare for this grow-ing field of endeavor. Senior Cadet experience in public health nursing has served and might continue to serve as an excellent means of securing desirable candidates for public health nursing. From information recently received from schools of nursing, and from our Public Health Service District Offices, it was learned that between July 1, 1944 and April 1, 1945, 402 Senior Cadet Nurses were assigned to public health agencies in 32 states. Of these 402 Senior Cadets, 176 were assigned to official health agencies, and 240 to visiting nurse associations. The length of experience has ranged from three to six months. The Senior student, as well as any other recruit who is to serve in public health nursing, must be chosen carefully. She must possess a degree of maturity, have an awareness of learning — teaching situations, and be able to adjust well in different situations. Any plan to raise the level of the Nation's The Health Bulletin January, 1946 health will require many more well prepared nurses than we have ever had before. A con-tinuing program to interest and guide superior young women into the field of public health nursing is vital to such a plan. Implicit in such a recruiting program is the need for sound personnel policies and practice. Once having recruited and trained desirable per-sonnel, the degree of stabilization and opti-mum functioning within an organization are usually in direct relation to the personal policies and practice of such an organization. Acceptable personnel practice should provide for freedom of action, opportunity for contin-uing professional growth, and economic se-curity. A third factor, and a very important one, affecting preparation for public health nursing is that of financial assistance for essential training. It is realized that public health nurses of tomorrow must be even better prepared than they are at the present time. It is realized, also, that public health nursing training, like other types of professional preparation is costly. Over the years, particularly since the passage of the Social Security Act in 1936, funds for educational purposes have been in-creasingly available for the pursuance of public health nursing programs of study. Brief men-tion might be made of some currently avail-able Federal funds that may be used for this purpose. Under Public Law 346, Servicemen's re-adjustment Act of 1944, (commonly known as the "G.I. Bill of Rights") Federal aid for further study is available to nurses who are Veterans of World War II. Universities re-port that many nurses already released from military service are availing themselves of this opportunity for further professional prepara-tion. During the Federal fiscal year which ended June 30, 1945, there had been allocated from Federal Funds administered by the Public Health Service, greater amounts for public health nurse training than for any previous year. An analysis made sometime before the close of this same year revealed the following: Source and amount of funds No. Students Nurse Education (Bolton Act) $809,695 2,459 Grants-in-aid (Social Security) 157,959 284 Venereal Disease 10,069 21 Total $977,663 2,764 In addition to the foregoing 2,764 public health nurse trainees, many more were en-rolled in the different on-the-job or in-service courses financed through Bolton Act funds. Public health nursing service is effective in relation to the number and quality of available nurses. Much of the foregoing dis-cussion was intended to illustrate the grow-ing need for greater numbers of well-prepared public health nurses. In order to meet these needs every effort must be directed to the most effective and economical preparation of nurses who will assume the many new responsibilities of public health nurses in the near and remote future. The quality of service to be rendered will depend, also, upon the type of young woman attracted to the profession. Interest in the profession will be assured in terms of the durable satisfaction to be experienced and the acceptability of personnel policies and practice. There must be a salary scale com-mensurate with the responsibilities to be assumed and the professional preparation of the nurse, opportunities for advancement, tenure of service, and assurance of adequate retirement. The more significant changes in store for nursing—all nursing—are geared to adjust-ment of medical science and medical service. The difference between public health nursing and the other branches of nursing are be-coming increasingly difficult to distinguish as the imaginary line between preventive and curative medicine. Because of this blending of preventive and curative forces, it does not fol-low that there will be a reduction in the im-portance of prevention. Likewise, to insure the paramountcy of prevention, it may be neces-sary for sometime—-and perhaps always—to maintain, within the general body of health January, 1946 The Health Bulletin workers, a group having special interest in, and special preparation for, this phase of the total program. Finally, let there be no mistaking the fact that the influence of public health nurses on the total nursing strength will be in direct relation to the size and importance of that part of the total program for which we demon-strate special fitness. It will be determined also by the continuing contribution we make to the body of technical knowledge and tradition which, in the long run, constitutes the only justification for the existence of a distinct pro-fessional group. Public Health Nursing Day will not be observed in January this year; instead April 7-13 will be observed as Know Your Public Health Nurse Week. "Snowball's" Club Feet By Lucy Lopp, Field Supervisor Crippled Children's Department North Carolina State Board of Health JUST why they called him "Snowball" no one really knew. Perhaps he did resemble a snowball as he sat in the hospital crib eyeing his new surroundings with wonder and concern, or maybe it was the contrast of his shiny chocolate skin against the white of his night gown. "Snowball" became known to the Crippled Children's Department at one of the State orthopedic clinics when he was three years old. He had been born with deformed feet. Each foot was turned in, causing most of his weight to fall on the top surfaces; he walked with an awkward gait. A club foot is usually the result of a con-genitalmal- development. There is no known means of preventing this deformity but early treatment and supervision can prevent the condition from becoming a permanent handi-cap. In most incidences corrective treatment can be started immediately after birth. Usually, the deformity will have been fully corrected by the time the baby is ready to walk. Treatment consists of the application of splints or casts which are changed at regular two-week intervals. The foot is corrected slow-ly and gradually; treatment varies with each individual case. When the orthopedic sur-geon feels a complete correction has been maintained, special shoes are recommended. After the child receives shoes he is not dis-charged from the clinic, but is requested to return for periodic check-up examinations. Should the correction relapse, a second period of treatment will be required. Regular follow-up examinations may be necessary over a number of years. In the case of 'Snowball' the clinic surgeon advised a hospital admission for a series of plaster casts and manipulations. After two months of concentrated corrective treatment he was dismissed from the hospital in plaster casts and requested to return for monthly check-ups in the orthopedic clinic where he was first examined; each time a new cast was applied. Had this case been discovered earlier, the treatment would have been much less prolonged. After two years of continuous treatment "Snowball" was at last ready for shoes. Act-ually, he had to learn how to walk on his corrected feet. (In his very young mind he must have been planning a game of hide and seek with his brothers and sisters back home.) His shy, pleased smile, his hesitating steps, together with the newness of his shoes seemed to radiate a warm glow about the room. And, I kept remembering the spiritual—"All God's Chillun Got Shoes." The Health Bulletin January, 1946 Progress of Industrial Nursing In North Carolina* By Mrs. Louise P. East Consulting Public Health Nurse North Carolina State Board of Health AS Shakespeare said, ''Coming events cast their shadows before them". Believing that there was a promising future for this highly specialized group of nurses, a small group of interested industrial nurses met in 1937, and organized an Industrial Nurses' Section of the North Carolina State Nurses Association. At that time very little was known regarding the number of nurses in the State who were doing that type of work, and so far as was known, only 36 nurses were employed by North Carolina industries. Form 1937-1942 the number gra-dually increased, and when a survey was made in 1942 of medical and nursing services in North Carolina industries, the number had grown to' nearly 100. During the war the employment of nurses in essential war industries was recognized as an important and necessary safeguard to workers. The number increased from 1942 until V. J. Day, to 186. Since then the war industries such as shipbuilding and munitions plants have closed, or are diminishing. Nursing staffs have likewise diminished, and the num-ber of industrial nurses has gone back to a peace time level. As for the future, some industries are planning expansion for peace time production. They have indicated that they intend to em-ploy a nursing staff as soon as nurses are available. One large plant has employed a staff of nurses to visit ill absentees in the hope that absenteeism may be controlled. Five small industries have employed nurses within the past year, which indicates a recognition, on the part of industrialists, of the value of nurs-ing service. In the past, industrialists have had no assistance in securing nurses, but when Counseling and Placement service has been worked out in North Carolina, there will be a definite plan whereby a nurse may be guided to positions which are available. Both nurses and employers will benefit by this service. There is more guidance and inspiration for the industrial nurse of today. In the past feu-years the American Association of Industrial: Nurses has been organized. Many North Caro-lina nurses have joined this organization. There is an Industrial Nurses Section of the N.C.N.A.; also, there are four local Industrial Nurses organizations in the State. More litera-ture is being printed on the subject than ever before. Articles appear regularly in all nurses. periodicals, and a monthly magazine is printed exclusively for the benefit of industrial nurses. Educationally, there is more promise for the future. Formerly, nurses who were employed by industry learned through the trial anJ error method. Some have developed excel-lent programs which are entirely satisfactory. Young nurses who plan to work in industries will be able to have a course in industrial hygiene and thus be better equipped when they enter this field of nursing. Several col-leges and universities are offering courses of training in industrial nursing. A plan is being considered whereby courses may be offered over the entire United States in Public Health Schools, including our own Public Health School at Chapel Hill. The plan includes both short courses and longer terms of stud} which would entitle the student to a degree. Some of the newer trends which are deve- •Paper presented at the annual convention of The North Carolina State Nurses Association and of the State League of Nursing Education. Winston-Salem, North Carolina, November 7, 1945. January, 1946 The Health Bulletin loping are: a recognition of the need for positive health programs; better nutrition; medical control of diseases such as Tuber-culosis, Venereal diseases, and prevention of upper respiratory infections; digestive distur-bances; conservation of eyesight; improvement of plant sanitation; and adequate first aid. The importance of pre-employment exami-nations and follow-up work on defects, is being recognized by management. The em-ployee, who will become a cog in the organi-zational set-up, is expected to have certain physical capacities for work just as machinery must meet certain specifications. The day for first aid only, by the nurse, has passed. Her field of service has broadened. She recognizes the importance of referring employees to community health agencies, and local physi-cians, for services not provided by the indus-trial physician. The door of opportunity is open for those who wish to help raise health standards in the industrial population. What Do You Do? By Mary Ruffin Robertson Public Health Nurse Orange-Person-Chatham District Health Department " A RE you a graduate nurse?" "How Jl\. come you don't wear a white uni-form?" "Can you nurse in a hospital?" "Is you connected with the welfare department?" "Tell me, lady, just what do you do?" "What is your job?" These and many more just like them, are questions the Public Health Nurse hears quite often. For those of you who are not quite so familiar with the "woman in blue" I'd like to tell you just a bit about the Public Health Nurse. She is a graduate registered nurse who has had at least three years of basic hospital training with from one to three years of extra training in the field of Public Health. Public Health Nurses, or PHN's, do not wear white uniforms because they would not be practical in all the traveling they have to do. In this state, all PHN's wear navy blue uniforms with the white collars. Public Health Nurses are not connected with the welfare department in any way, but they do work closely with such organizations. As to the last two questions mentioned, teaching better health habits might be a good answer for some of our duties. Why not come with me a few days and see for yourself? Better still, why not share with me a few ex-cerpts from my diary? These are parts of a few days picked at random but maye they will give you an idea of what one nurse does. "2/19 . . . Stopped to ask a negro farmer where some of his neighbors lived. His white boss couldn't stand to stay out of the conversation and I was soon busy trying to get away from crops, weather, etc. . . . Inez is worried—her baby is nine months old and she is afraid she is 'caught' again . . . don't guess the county welfare department will be so happy about the whole thing since they are the family's whole support. "3/1 . . . Dora's baby is not gaining . . . we weighed it before and after nursing and decided it was getting enough milk. Urged she take it to her family doctor as soon as possible to find the trouble . . . Anna is expecting another baby and sent for the nurse to come by. She came to the pre-natal clinic before her other babies came and wants to come again . . . she can't remember whether this is the seventh or eighth! She wants some advice about plan-ned parenthood as soon as this baby is born. We will give this as soon as she asks for it. . . "4/10 . . . A young white boy came in yesterday with acute gonorrhea. Gave a fifteen year old as his contact. Visited her 10 The Health Bulletin January, 1946 and she came to clinic today and gave two more contacts—all under sixteen. Result: two cases of acute gonorrhea—high school students—wonder if we could prevent these by more sex education in our schools. . . . "5/14 . . . Jean is still in her body cast. Am so thankful her parents took her to crippled children's clinic when they did. She must stay in the cast for several months yet but the doctor says she will walk later. Showed her mother how to prevent pressure sores on her toes and heels . . . baby brother is gaining nicely. . . . "6/23 . . . Typhoid clinics have begun and I gave over three hundred vaccinations today . . . also gave some diphtheria toxoid and some whooping cough vaccine. . . . "7/25 . . . Quarantined baby for typhoid fever today. Have worked with sanitarian trying to find source of infection . . . have warned all possible cantacts . . . fluoroscopic clinic this afternoon . . . about thirty con-tacts and suspects to be fluoroscoped for tuberculosis . . . one active case admitted to sanatorium yesterday after a few weeks wait . . . showed family how to clean room and contents . . . unable to find family today, old record reads, 'turn right at Adkins barn' . . . am still wondering where Adkins barn is! '8/22 . . . Midwife classes arc always a problem but we must keep them under supervision . . . they teach us too! "9/20 . . .School is under way and so are our school clinics . . . Wish more of the children had attended pre-school clinic last spring. Made a visit to Clyde's home today to talk with his mother about the rupture we found on him at school exams last week. She promised to see her doctor soon . . ." Much more could be said about the duties of the PHN but perhaps from the few things listed here you now have an idea what a problem it is to answer "What Do You Do?" "Me - and You" By H. Lillian Bayley, R. N. Consulting Public Health Nurse North Carolina State Board of Health ARE you asking me! Do people ask you, as nurse, teacher, parent, minister or friend how to answer the everlasting questions about the stork, the pin-up girls, the priority sweethearts and the V-Mail brides? Perhaps you would like to read the story of how help with sex education has been given to parents and children in several coun-ties through library facilities and the Public Health Nurses. Several years ago the writer at a professional dinner sat next to Miss Marjorie Beal, Secretary and Director of the North Carolina Library Commission. During the conversation Miss Beal learned of the need for a traveling li-brary of technical books to be used by Public Health Nurses. Like rubbing Alladin's Lamp, within a few weeks with the help of Miss Mary S. Yates, Head of Traveling Libraries, the books were on their way to the nurses and have been circulating ever since. These books have been used by the nurses and some teachers in several counties: as a reference set for two formal extension courses on family living, by the Parent Teachers As-sociations of two large schools, and are no%v in use in a school whose teachers and Parent Teacher Association have read and approved the books for school use. There arc now more requests from nurses, teachers and health educators for the books than the supply af-fords. Because of the unfulfilled requests the Library Commission is adding two more sets of books on sex education, which are to be sent to local libraries upon the request of interested nurses or persons. The books will be January, 1946 The Health Bulletin 11 loft in the libraries for two months and may be taken out in the usual way by parents, young people and children with the assistance of the local librarian. Any group wishing to buy the set of books may do so for about $35.00. No book costs more than $2.50, and some pamphlets cost only 25tf. If each local county paper could reprint this article many more people would learn of and utilize the books. The following is a short description of most of the books: The New Baby by Bell, Evelyn S. and Foragh, Elizabeth; J. B. Lippincott & Company, East Washington Square, Philadelphia, Pa. A photographic book for children age three to five. The story is simply told and will assist parents to properly begin the sex edu-cation of their children. The Story of a Baby by Ets, Marie Hall; the Viking Press, 18 East 48th Street, New York. A good book for children from age four to eight. Drawings illustrate pre-natal growth and is of interest to children. Being Born by Strain, Frances B.; Appleton Century Company, 35 West 32nd Street, New York. Very well written for information on re-production, sex behavior and conduct for pre-adolescents and adolescents. The Wonder of Life by Levine, Milton I. and Seligman, Jean H.; Simon & Schuster, 1230 6th Avenue, New York. Simply written for pre-adolescents and ado-lescents. Love at the Threshold by Strain, Frances B., D. Appleton-Century Company, 35 West 32nd Street, New York. Especially for younger people who are look-ing forward to marriage. Petting, Wise or Otherwise by Clark, Edwin L.; Association Press, 347 Madison Avenue. New York. Relation of petting to sexual activities. Attaining Womanhood and Attaining Man-hood by Cowen, George M.; Harper Brothers, 49 East 33rd Street, New York. Two books written for boys and girls of age twelve to sixteen. Looking Toward Marriage by Johnson, Ran-dolph Pixley; Allyn and Bacon, 181 Peach-tree Street, Atlanta, Georgia. Especially interesting to high school age. Sex Adjustments of Young Men by Kirkendal!, Lester; Harper and Brothers, 49 East 33rd Street, New York. For young men and boys. Modern Marriage by Popenoe; MacMillan Company Questions Girls Ask by Welshimer, Helen; E. P. Dutton & Company, 300 4th Avenue, New York. Life's Intimate Relationships by Johnson, Tal-madge C; Abingdon & Cokesbury Press, Nashville or New York. An interesting book on the principles of better living. Opportunities In Public Health Nursing By Amy Louise Fisher, R. N. Supervising Public Health Nurse North Carolina State Board of Health A NUMBER of people have asked lately, "Now that the war is over, what is going to happen to all the Cadet Nurses the Government has been training? Will there be jobs for them all?" Yes, there is still a critical shortage of nurses in almost every field. There are more than 50 Public Health Nursing va-cancies in North Carolina. Another 75 jobs are now being filled by War Emergency Nurses, many of whom are expecting husbands 12 The Health Bulletin January, 1946 or sweethearts home and will be giving up their jobs when the men get back to the United States. A number of these War Emer-gency Nurses will want to stay in Public Health and will be given scholarships for the course in Public Health Nursing if they are eligible for this training. Even with the jobs all filled North Carolina has a ratio of only 1 public health nurse for 10,300 population. In order to meet the minimum requirements of 1 nurse per 5,000 population North Carolina will need approximately 350 more staff nurses and 55 consultants and supervisors. There are still 7 of the 100 counties that do not have health departments. If all of the people in North Carolina are to have the benefit of health protection in the form of services by an organized health department there will be room for many more nurses in public health nursing in this State. How may a nurse qualify as a public health nurse? Does the blue uniform she wears in-dicate that she is not a graduate nurse? No, indeed! The public health nurse is a graduate registered nurse. She must have a high school education; college work is desirable. She must have graduated from an accredited school of nursing and be eligible for matriculation in a college or university offering a course in Pub-lic Health Nursing approved by the National Organization for Public Health Nursing. This post-graduate course consists of a year of study. Scholarships are available through the State Board of Health. If you are a nurse and meet the requirements you will find an interesting and satisfying career in this field of nursing. If you are still in high school or college and considering nursing be sure that you select carefully and wisely the school of nursing so that when you have finished the three years of training you will be able to enter any field of nursing you may choose. Advice and help will be given you gladly by Miss Bessie Chapman, Secretary of the State Board of Nurse Examiners, or by Miss Vir-ginia Miles of the North Carolina Counseling and Placement Service. Their offices are located at 415 and 419 Commercial Building, Raleigh, North Carolina. The Counseling and Place-ment Service is a new project of the North Carolina State Nurses Association, which was begun January 1. You may wonder why it is so important for a girl who wants to become a public health nurse to select a good nursing school and then to have post-graduate work in public health nursing. She who enters this field needs the best possible preparation because she must be both nurse and health teacher. Like odier nurses she aids in treatment, but her chief concern is prevention. She promotes the physical health of her patient and in addition his mental, social and emotional well-being. She needs to know and bring together all community resources needed for helping solve the social and economic problems that are so closely allied with sickness. The public health nurse needs to like people and know how to get along with them because her work brings her in contact with all sorts and kind of people—in homes, in schools, in clinics and in-dustrial groups. She works closely with phy-sicians, hospitals, health and welfare agencies. The opportunities for service are varied enough to make life interesting and to demand the best a nurse has to give. Public health nurses are doing everything possible to see that babies get the right start in life—this includes seeing that the baby is wanted and planned for—that the mother gets good care before and after the baby comes, either by her family physician or in a clinic. The nurses participate in the program of preven-tion through immunization for whooping cough, diphtheria, smallpox and typhoid fever. They play an important part in all commu-nicable disease control including tuberculosis and venereal diseases. They offer health super-vision for infants, pre-school and school child-ren and work with adults. Many public health nurses find work with crippled children one of the most satisfying services they can offer. In short, public health nursing includes any-thing that will help promote the health and welfare of all the people in the State. Nursing is a proud profession, and Public Health Nursing is one of the most interesting and satisfying fields of nursing. January, 1946 The Health Bulletin 13 Amanda Bunch - Midwife By Ida H. Hall, P. H. N. Wake County Health Department Raleigh, North Carolina AUNT Amanda died last week after forty-one years service as midwife in one community. It seems a pity that the story of Aunt Amanda was not written while she was alive, she would have been so proud of it. She was proud to be a midwife and she had a record to be proud of, and of her starched white mop-cap and apron that she always put on a-fresh when-ever she went out except-ing for church. The records kept since 1934 show that she delivered more than a thousand babies during this time. In one month in 1937 she had thirty deliveries and helped a doctor on two more. She 'helped-out' the doctors and they helped her out, and when she had to call a doctor he never delayed. Every doctor seemed to feel the same respect and personal affection for her and during her illness this last year they voluntarily gave her their best attention. Three fully equipped bags were kept in order by her and a good supply of extras for emergencies were folded away in a trunk. Sometimes she cared for three deliveries in twenty-four hours often she had several slow cases on at the same time and would shuttle between them. She appreciated her importance through-out several townships and in ad-joining counties and she felt apologetic when she missed a call, not because she lost a fee, but felt as if she had let someone down. Some-times she would grumble when she saw a man wasting money while in debt to her and once in a while employed a collector. She said there were no hard feelings but folks shouldn't get too careless. At Prenatal Clinics she was welcomed by everybody and the Clinician treated her as an equal and had her feel and listen to interest-ing conditions. She often said that she was still learning. The doctor would often have a little chat with her on the side regarding their latest fishing luck. No home was too poor and dirty for her to do a good job, leaving the patients neady fixed up and in a good state of mind. Her automobiles were not much satisfaction to her as she never tried to drive and her grand-sons took them out, got drunk and wrecked them and then sent for her to bail them out of jail. She was mighty proud that her friends lent her the needed money so ^cheerfully. Aunt Amanda had something that few peo-ple have, an extra sense of understanding that did not require going into detail. She said little, listened and observed closely and spoke everybody's language. Her success was re-markable. Her skin was the color of a new penny. There was a little hump in her nose and she thought she was part Indian. Her seventy-four years were full of hard work, self sacri-fice and charity for all. Love and esteem were expressed by the immense crowd including many white people that attended her funeral and heaped her grave with flowers. 14 The Health Bulletin January, 1946 Exhibits By H. Lillian Bayley, R. N. Consulting Public Health Nurse North Carolina State Board of Health SURVEYS! Surveys! Surveys!! How about making exhibits to show the general pub-lic what has been happening in your county? Any interested group could secure the neces-sary information from their local county health department. Several attractive Lanham Act health de-partment buildings have had formal open-ings during the past three years, and at some of those health department functions exhibits of the content and results of the personnel's work was shown. The interest of the visitors in the exhibits was a surprise, even to the health department personnel. Realizing that there is a need for child health planning in the post-war world, the American Academy of Pediatrics is under-taking a national study of child health facil-ities services. The U. S. Public Health Service and Children's Bureau are cooperating as mem-bers of the executive committee. North Caro-lina has been chosen as the first state and the study is already underway, sponsored by the North Carolina Pediatric Society. The North Carolina State Board of Health is throwing its full cooperation behind the study. Lay and official agencies have been informed of this survey which to quote, "The survey will cover the extent and quality of such services as child health conferences, school health services, medical care programs, immuniza-tion services, child guidance services and pub-lic health nursing." It is hoped that by know-ing of the study, groups will become interest-ed in child health in their own community. How about making one or more of the following exhibits to show the health prob-lems in your county? Maternity Poster Show the number of new mo-thers in your county during 1944 or 1945 by using a poster with similar figures to that in the mar-gin for each new mother. This will cover about 3x5 square feet according to the number of mo-thers represented. Building board is best and cheapest for the poster board, and pink is a good color for the figures, which may be printed in sheets. In comparison, show the num-ber of mothers under medical care, mothers under private medical care, and health department sup-ervision should be counted. This will cover a smaller space than the total mothers. Blue is a good contrasting color for these figures. In the last space show figures in solid black to denote the mater-nal deaths during the year. a January, 1946 Infant Poster Show the number of new babies in your county during 1944 or 1945 by using a large poster board and pink figures like that in the margin for each live birth. In comparison, show in blue fig-ures the number of babies under medical care by private physicians k- or health departments. In solid black figures show the number of infant deaths under one year during 1944 or 1945. The Health Bulletin 15 Immunization Poster Show number of babies under one year carried to clinics or priv-ate physicians to be immunized against whooping cough during 1944 or 1945. These figures may be in yellow, and one figure should represent one immuniza-tion. In similar manner show by pink figures the number of babies vac-cinated for smallpox. By blue figures represent the babies im-munized for diphtheria. This poster should be shown in combination with the infant poster. For the pre-school age show \ f) figures like the one in the mar-y gin. Show yellow figures for whooping cough immunization, pink figures for smallpox vac-cinations, blue figures for diph-theria immunizations. Nursing Visits A poster showing number of Public Health Nursing Visits to prenatal cases, to infants, to pre-school children and instructive visits for immunization should be of real interest to the public. Samples of the colored figures in mimeo-graphed sheets of about twenty-four figures to a sheet may be procured by writing the Mailing Room of the North Carolina State Board of Health. Henry Flud Campbell, age 22 months, son of Mr. and Mrs. John H. Campbell, Reedville, Virginia. The Mother, the former Miss Theo-dosia Flud, is remembered pleasantly as a public health nurse in North Carolina. The Premature Infant By Mabel Patton, R. N. Consulting Public Health Nurse North Carolina State Board of Health HOW many premature babies were born born in North Carolina in 1944. Of this in your county last year, last month? number approximately 4,524 were premature. Vital Statistics show that 90,481 babies were Many of the babies who die under one month 16 The Health Bulletin January, 1946 of age are born prematurely. These infant deaths should be of concern to everyone in North Carolina. You should be interested in knowing not only how many stillbirths and maternal deaths occur in your county, but also the number of babies born prematurely. If your family was one of the homes to which a premature baby was born, did you report it to your County Health Department: Your Health Department is anxious to give special assistance to families in the care of premature infants. Three points must be kept :n mind constantly when caring for a pre-mature baby 1. To keep the baby warm 2. To protect him from infection 3. To feed him properly A simple premature bed is necessary in caring for the infant. A pasteboard box lined with screw top bottles (pint size) filled with warm water may be used temporarily in the home or for transporting the baby to the hospital. If any of you develop a premature bed that proves to be adequate and practical, please share your plans with the Division of Maternity and Infancy, State Board of Health, Raleigh. The Children's Bureau, Washington, D. C, is also interested in our problem and gave us the following helpful suggestions: Suggestions In Regard to the Care of the Premature Infant In the Home 1. Preparation before birth of the infant. The following equipment should be ready for the baby's birth: a. A warm blanket and heated bed (80°- 90 °F.) for reception of the infant. b. A rubber bulb (ear syringe) for aspira-tion of mucus. (Necessary stimultants will be prescribed by the doctor.) 2. Provision of space for care of the infant in the home: a small, separate room is pre-ferable; room temperature at 75°-80°F. day and night. 3. The following individual equipment is needed for care of the infant: a. Rectal thermometer. b. Feeding equipment—medicine dropper and glass, small nursing bottle. (Use aseptic technique in preparing the in-fant's feeding. Boil all utensils 10 min-utes in a covered container.) Covered pail for soiled diapers. Oil and cotton. 4. Special measures for protecting the infant from infection. a.' Nurse to wash hands with soap and run-ning water — (1) Before handling infant. (2) Before feeding infant. (3) After diapering infant. b. Person caring for the infant must wear a c. d. clean gown or apron. (No one with respiratory or other infections should care for the infant.) c. Keep all members of the family who have infections (respiratory or skin in-fections or diarrheal diseases) away from the baby and exclude all visitors and all children. d. Keep mosquito netting over the bassinet or incubator, if it is of the open type. e. See that the baby's room and furniture are clean. (1) Floors must be mopped with a damp mop. (2) Furniture must be wiped with a cloth. (3) No sweeping of floors or dry dust-ing of furniture should be allowed. 5. Care of the baby's skin. It is not considered desirable to bathe a premature baby with soap and water or with oil for the first 24 hours after birth. He need not be bathed for a week or 10 days or longer. Apply mineral oil gently to folds of skin in soiled areas when changing diapers. 6. Directions should be obtained from the physician caring for infant in regard to meth-od, type, and interval of feeding. Bottles must be held by an attendant; an infant fed in the incubator should be fed with his head and shoulders elevated. ARt mm j This Bulletin will be sent free to any citizen of the State upon, request I 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 Boa'rd, Raleigh, N. C. Vol. 61 FEBRUARY, 1946 No. 2 Walkways that Lead from the State Laboratory of Hygiene to the State Board of Health MEMBERS OF THE NORTH CAROLINA STATE BOARD OF HEALTH S. D. CRAIG, M.D., President Winston-Salem J. N. JOHNSON, D.D.S., Vice-President Goldsboro G. G. DIXON, M.D Ayden H. LEE LARGE, M.D Rocky Mount W. T. RAINEY, M.D Fayetteville HUBERT B. HAYWOOD, M.D Raleigh J. LaBRUCE WARD, M.D Asheville J. O. NOLAN, M.D Kannapolis JASPER C. JACKSON, Ph.G _ Lumberton 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. J. ROY HEGE, M.D., District 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. C. P. STEVICK, M.D., Director Division of Epidemiology and Vital Statistics J. M. JARRETT, B.S., Director Division of Sanitary Engineering. T. F. VESTAL, M.D., Director Division of Tuberculosis WILLIAM P. JACOCKS, M.D., Executive Secretary, Nutrition Service of the State Board of Health MR. CAPUS WAYNICK, Director, Venereal Disease Education Institute. E. H. ELLINWOOD, 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 Epidemiological 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 Privie* 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 Time Cards: Under 5 months; Prenatal Letters (series of nine 5 to 6 months; 7, 8, and 9 months; 10, 11, monthly letters.) and 12 months; 1 year to 19 months; 19 The Expectant Mother. months to 2 years. Breast Feeding. Diet List: 9 to 12 months; 12 to 15 months; Infant Care. The Prevention of 15 to 24 months; 2 to 3 years; 3 to 6 Infantile Diarrhea. years. * Table of Heights and Weights. Instruction for North Carolina Midwives. CONTENTS Page 1946 Public Health Objectives 3 Reconversion of the Family—A First Post-War Task 5 A Comprehensive Program for Nation-wide Action in the Field of Nursing 7 Accidents 9 Notes and Comment 12 Vol. 61 FEBRUARY, 1946 No. 2 CARL V. REYNOLDS, M.D., State Health Officer JOHN H. HAMILTON, M.D., Acting Editor 1946 Public Health Objectives By Carl V. Reynolds, M. D. Secretary and State Health Officer North Carolina State Board of Health -yrrrE have crossed the threshold of a \\ new year. We have heard many sentiments expressed about 1946, some of which have been repetitions of what we have been hearing all our lives. There are certain stock phrases that are taken from the trunk of remem-brance every Christmas, New Year's Day, Fourth of July—and so on—and then put back into the moth balls for future use. But, like Christmas tree bulbs, they sometimes burn out, and it would be fortunate if some of them could not be replaced. Sentiment has no place in the begin-ning of a new year. We might as well be realistic about the matter. Thread-bare phrases, like threadbare fabric, will not stand the test of rough usage. No new year should be treated like the newborn babe it is all too often pictured to be. It should hold the ac-cumulated experiences of the past, and these experiences should be translated into action that in no sense resembles child's play. As we enter 1946, there is probably no better admonition for us than that given by the poet Richard Home: "Be rigid, plowman; bear in mind Your labor is for future hours. Advance, spare not, nor look behind! Plow deep and straight with all your powers!" We must know the past to appreciate the present—and to prepare for the future. But we must not live in the past. To do so is to display evidences of senility. To look ahead is an evidence of youth, vision, and vigor. In no field is an appreciation of the value of future responsibilities more essential than in the field of Public Health, which is dedicated to human betterment. For the future, we must have definite objectives. The world will no longer be satisfied with vague gen-eralities. We have just waged a war for the preservation of the fundamental rights of mankind; but these fund-amentals, if they are to prove worthy of the price we paid for their preserv-ation, must be put to work for human betterment and must be a part of any peace formula we adopt, if that formula is to endure. We have laid the foundations of Public Health. These foundations are solid and, we believe, enduring, but unless we build a suitable superstruct-ure, our efforts will have been put forth in vain. We in North Carolina propose, among other things, to so enlarge our program for the eradication of syphilis that it will reach those suffering with neuro-syphilis, fifty per cent of whom, if neglected, become fit subjects for our mental institutions—wards, rather than citizens, of the State. If properly treat-ed, 85 per cent can be restored to useful citizenship. This expanded program will be launched when suitable space is secured. Moreover, we will make a survey of certain groups covering the entire pop-ulation of these groups, for the diagno-sis and treatment of early, latent, and late latent syphilis, with a view to cur-ing promptly those that are curable and treating those suffering with neuro-syphilis as their condition may indicate. The Health Bulletin February, 1946 The time for resolutions concerning this and associated problems has pass-ed. The time for action is here. We propose also to make considerable headway during the year 1946 in a state-wide survey, to locate the un-known cases of tuberculosis and to secure, as nearly as possible, a complete picture of the tuberculosis situation in North Carolina among the body politic, with a view to the adoption of remedial measures. We are prepared and equip-ped for such an extensive survey, which will begin as soon as shipments of the means for carrying it out arrive. The object, of course, is to make hospitaliza-tion available for all open, or infectious cases, in order that we may prevent carriers from giving the disease to others. At the same time, we propose to give the sick the opportunity of be-ing restored to health. In the matter of cancer control, we are ambitious to start, as early as pos-sible, clinics where we can have special-ists ready, at definitely located places, to examine all cases, regardless of race, creed, or economic status, to determine the presence of cancer, with the fervent hope that ways and means will be found to have these cases diagnosed and treated promptly, thus making a valuable contribution to prevent the patients from reaching the incurable stage. Research, of course, will con-tinue— but the disease in its early and curable stages should, at the same time, be diagnosed. We should not await the results of research, but move swiftly to effect those cures that can be made with the knowledge which we already possess. Hence, the necessity for ade-quate diagnostic clinic facilities—now. It is heartening to note that, as this is being prepared, the United States Senate already has passed what is known as Senate Bill 191, which would provide Federal aid to the States for expanded hospital facilities, public health centers and better medical care for all people. The measure now goes to the House of Representatives, and it is to be earnestly hoped that it soon will have passed both branches of Con-gress and be ready for President Tru-man's signature, to make it become law, in order that it may be put into effect speedily. Passage of this measure will advance medical care at least ten years and pro-vide all our people with services to which they are entitled but which they have never, up to this time, enjoyed. By the enactment into law of this measure, many more of our doctors will be able to practice medicine as it should be practiced, that is, in well equipped hospitals and with consul-tants conveniently and immediately available. My earnest hope is that the people, as individuals, will become less indiv-idualistic and have a part in public health advancement, being sufficiently interested to analyze the health needs of the communities and of the State as a whole, and then insist on the appropriation of funds sufficient to meet these needs. This is a matter in which our return-ing service men can render assistance as citizens of the Republic they fought to preserve. As members of the armed forces, they were provided with pro-tective measures and given the best medical care, even though, in many instances, it was necessary to curtail medical facilities available to the civil-ian population. This was as it should be—but it should not be forgotten that those who fought our battles abroad are also citizens at home. Not only should they continue to enjoy the de-gree of medical care that was provided for them while in uniform, but they should insist on its continuances now that they are back home—not only for themselves, but for their mothers, fa-thers and other family connections who were not called upon to fight, as they were. We protected our service men, in order that they might fight and die, if necessary, to save us. We should con-tinue that protection, in order that they may live the more abundant life they fought to insure. A merciful Providence, together with vigilance on the part of Public Health workers and those engaged in the priv-ate practice of preventive and curative medicine who remained to work on the home front, saved us from serious or widespread epidemics while the fate of civilization hung in the balance. Every citizen in this government of the people, for the people and by the people, is entitled not only to life, lib-erty and the pursuit of happiness, but also to good health, in order that he or she may be physically and mentally fit to enjoy these unalienable rights Febt^uary, 1946 The Health Bulletin and compete for their rightful place in the world. Abraham Lincoln declared this na-tion could not survive half slave and half free. Neither can it reach the highest peak of potential efficiency half sick and half well. Let each of us, therefore, determine that during 1946 we will make our con-tribution toward ushering in an era not only of lasting peace, but of good health, on a permanent basis. The hospital and medical care we need cannot be provided without the necessary funds. Therefore, it is in-cumbent upon those who provide the tax dollar to insist that a sufficient amount of revenue be appropriated to insure health as a basic right and not as a charity. # Reconversion Of The Family- A First Post -War Task ALL through history, even when society broke down, the family remained intact. A new society was built upon the remaining family units. The German High Command, in their study of history, recognized this fact and throughout the war did everything possible in the conquered countries to destroy family life and thus make the re-establishment of a strong society a much more difficult problem. How well they succeeded is being dis-covered in every country of Europe, including the blasted remains of their own land. The chaos of these postwar years will continue until family units can be re-established in every country and family loyalties reaffirmed. Even in this relatively untouched America of ours, the family has been put to a stern test during four long years of war. The drafting of fathers, the break up of families when both parents engaged in war work, the loos-ening of family ties when mothers gave up their home tasks and concentrated on being nurses' aides or air raid war-dens or war bond solicitors weakened the forces of the family in our Nation's affairs. Reconversion of the Family The first big postwar task is recon-version of the family and the re-estab-lishment of family ties. The returning veteran may find difficulty in settling down with his wife and children. The woman war worker may give up her high wages and go back to her husband and her children with a feeling of be-ing let down. Young people who have left school to make big wages in the •Reprinted by permission from BRIEFS, Maternity Center Association. 654 Madison Ave., New York 21, New York. war plants may not want to return to their scholastic life and the usual peacetime disciplines of family living. Venereal disease is rife among young people of marriageable age. Restless-ness, lowered moral standards, lack of adequate housing, strikes, insecurity a-bout the future—all these tend to weaken family ties and the home there-fore loses much of its vital force which is so necessary to the stability of our society. A Challenge to United Efforts This gloomy situation should not be a cause for defeatism. The family is tough and resilient. It has great come-back powers. The situation is a chal-lenge to education, religion, medicine, public health and allied fields. We in obstetrics are in an unique position — for the coming of babies can be one of the strongest ties in knitting families together. We are operating at the very center and core of our Nation's vitality and strength. We need no reconversion policies, nor do we have thorny roads back to peacetime activities. Our task is to stay on the same course which was charted nearly thirty years ago. Even the war did not affect the chief goals of obstet-rics. Just after Pearl Harbor, the Ma-ternity Center Association was contin-ually asked the question, "What will your war work be?" Our answer was firm and sure for we knew exactly what should be done during those days of severe national crisis. We answered in the January 1942 issue of BRIEFS as follows: "We will sit at the bedsides of the women in labor as we continue to train more women in midwifery to send out to rural areas; we will teach The Health Bulletin February, 1946 the mothers and fathers who are having babies how to be good parents, how to make the most of their fam-ily living; we will continue to provide the best techniques, the best short cuts in maternity care for nurses and other workers throughout the United States. We will keep the home fires burning. "As we list for these enquirers the things we will do in this war, their . interest lags. We could be discouraged until we remember that thousands of strong, vigorous, confident boys who man our anti-aircraft guns in 1942, who fly the planes, who build the tanks, who launch the ships, are the babies we took care of in 1917." That was true of everyone who work-ed for better maternity care during those bitter years before and during World War II. The wartime job was well done despite the dislocations of medical, nursing and hospital care. Ma-ternal mortality was driven to the low-est point in history, while our national fortunes were at the lowest ebb. Many mothers were saved for their families so in need of their loving care and a firm hand on the tiller while Dad was away. Good maternity care protected the family. That is just as true today. There is no need to change bearings on our postwar course. If we carry our knowl-edge about obstetrics into the far cor-ners of the land and to every mother in the most remote nooks and crannies of big city and country crossroads alike, we should soon come to the time when there would be no NEEDLESS mater-nity deaths. But the putting into practice of this knowledge alone will not provide the best contribution which obstetrics can make to stronger family life in the United States. The progress we have made in the past three decades espe-cially has been based on the prevention and cure of pathological conditions. If we are to make the most of our oppor-tunities in strengthening family life by means of maternity care, we must do more than merely prevent disease. We must promote health, not only of body but of mind and spirit. Today's life-saving maternity care offers very little to the expectant par-ent in the way of education for family living or for positive teaching of any kind. A mother goes to her doctor early in pregnancy, often in response to our educational efforts. Frequently she goes in fear, expecting the doctor to examine her from head to toe—looking for path-ological conditions. This he does, and in addition, he asks many questions about her illness history since she was a child. She goes in trepidation because she fears the doctor will find some-thing wrong. His conversation with her may be chiefly concerned with ques-tions and advice about physical things such as spots before the eyes or blood pressure or bowel movements. She comes home dishevelled not only in coiffure and dress, but also in mind and spirit. The inner radiance which first came upon her when she knew that she was going to have a baby may have been dampened or dispelled by such an attitude. Here at one of the moments in life when a person is most teachable, the opportunity of teaching is let slip by. In obstetric care, we are not dealing with one isolated woman in an isolated moment of time, but with a human be-ing with family ties, hopes desires, fears, upon whose health and happiness the health and happiness of other peo-ple depends. We cannot glibly repeat the old adage that the coming of a baby will weld her home more closely together. It can do just the opposite if parents are untaught and unprepared for the physical and emotional expe-riences during pregnancy, at labor and afterward. That is why we in obstetrics hold the key to the strength or weakness of many families whose children are now being born under the tensions and un-certainties of a chaotic era in history. We have knowledge, which when ap-plied, can build great security, but we are not putting it to work in people's minds and hearts. We have the knowledge about how babies come, how they are conceived, how they grow within the mother's uterus and are born. We know about planning for the coming of babies. We know about the physical and psychol-ogical problems of marital adjustments —and we know some of the answers. We know how to fit the new baby phys-ically and psychologically into the fam-ily. We know that the joyful coming of a baby depends upon attitudes and habits created in the formative years — February, 1946 The Health Bulletin % long before a young person becomes an expectant parent. We know all this and more and we know it should be taught to young peo-ple BEFORE they are married. We know that it isn't taught. We sit back and bemoan this condition, but do very little about it. Prudery is still the great-est enemy of progress, of constructive, positive teaching in the field of obstet-rics, and will continue to block the dissemination of this essential infor-mation for sound family living until a concerted effort is launched to blast it forever from its entrenched position at the crossroads of public opinion. When the taboos are blasted and young people learn these facts and put them into practice in their own family living, the happy story portrayed in the pictures in this issue of BRIEFS will be the usual result. First, expec-tant parents plan together for the com-ing of the baby. They work out their family budget, with items for doctor, nurse and hospital and they select the best medical and hospital care within the power of their pocketbook. The wife goes to the doctor not in fear and trepidation but with confidence, know-ing that he is well trained and expe-rienced and together they work out her prescription for living. Then the months quickly pass and the mother is well instructed on how she should live, what she should do, what she should eat at different stages of pregnancy. Father, on the other hand, goes to class or reads a good book which fits him for the changes that are coming in his relationship to his wife. When the baby comes, father fits into his place without friction or jealousy and he can carry his share of the responsibilities in the care of the baby. Under such an attitude, we de-velope an understanding team of doc-tor and nurse, mother and father, and we help to build strongly and well another family unit which will con-tribute to the strength of our Nation in the years ahead. A Comprehensive Program for Nation-wide Action in the Field of Nursing * Introduction THE outline of a comprehensive pro-gram for nationwide action in nursing is the outgrowth of a war pro-gram of cooperative activity which nursing organizations have carried on since 1940. As the war has progressed, they have become increasingly aware that coordi-nated action in nursing will be quite as important during the post-war era as it has proved to be during the war pe-riod. Each national nursing organiza-tion set up its own Planning Commit-tee. All have recognized, however, that the nursing profession could make its leadership most effective by developing a comprehensive program. As a first step, the National Nursing Council for War Service appointed a Committee on Domestic and Postwar Planning in November 1943. In April 1944, this Committee became the National Nursing Planning Com- •Prepared and issued by the National Nursing Planning Committee of the National Nursing Council for War Service, Inc., 1790 Broadway, New York. mittee. The Committee is now compos-ed of the presidents, executive secre-taries, and planning committee chair-men of five national nursing organiza-tions; representatives from the Amer-ican Association of Industrial Nurses and the National Association for Prac-tical Nurse Education; directors of the nursing divisions of the American Red Cross and of certain federal agencies; and the chairman and executive secre-tary of the National Nursing Council for War Service. At its initial meetings, the Committee outlined ten objectives toward which nursing activities should be focused. It defined five areas in which programs for study and action should be develop-ed. These areas are: 1. Maintenance and Development of Nursing Services (in hospitals, sanatoria, and other institutions; in private practice; in public health and industry; and in other fields) 2. A program of Nursing Education (Professional—basic and advanced— and practical) The Health Bulletin February, 1946 3. Channels and Means for Distrib-ution of Nursing Services 4. Implementation of Standards (including legislation) to Protect the Best Interests of the Public and the Nurse 5. Information and Public Rela-tions Program To provide a basis for coordinated activity in these areas, individual plans and suggestions were made by all mem-bers of the Committee for incorpora-tion into one composite program. Before preparing the outline of this program, all the proposals presented were carefully studied. Many duplica-tions appeared. These duplications are significant because they indicate the extent to which the individual organ-izations are aware of problems in their own fields which are common to all fields of nursing. Also significant is the emphasis placed on the need for urg-ency in getting work under way. The individual plans, broadened sometimes to cover all fields of nursing instead of merely the ones in which particular organizations are interested, fitted easily into the four areas of study and action. The final composite pro-gram incorporates plans and sugges-tions made by all the organizations and interests represented in the National Nursing Planning Committee. The pro-gram relates to all nurses—professional and practical, Negro and white, men and women. The composite program takes into consideration the increase in the re-sponsibilities shouldered by professional nurses as a result of the war emergency and the effective use which has been made of practical nurses, other paid workers of various types, American Red Cross Volunteer Nurses' Aides, other volunteers, WACS and WAVES. It rec-ognizes the increased need for well-prepared nurses which will result from the expansion of hospital and health facilities proposed by the U. S. Public Health Service, the plans of the U. S. Children's Bureau for increased activ-ity in maternal and child health, the necessary enlargement of Veterans' Fa-cilities (particularly in psychiatry and tuberculosis), and the probably inclu-sion of home nursing in medical care insurance (voluntary and government-al). It points out the need for study to overcome the gaps and inadequacies in prewar nursing service and nursing education which war demands have highlighted. While the outline may not mention specifically every phase of the nursing problems on which one organization or another considered study and action necessary, these are, nevertheless, cov-ered by more general statements. For example, several plans emphasize the need for more specialists in nursing — in public health, in psychiatry, in tub-erculosis, in obstetrics, in teaching and supervision, and in other fields—and for the development of more and better programs for the preparation of such specialists. The importance of prepar-ing nurses to carry on the many special techniques and procedures that are a part of modern medical treatment was also stressed. Some projects are national in scope, as for example, accreditation, curric-ulum revision, and the study of selected aspects of nursing education. Others, like the counseling and placement bu-reaus, will be developed nationally, re-gionally, and locally. The nursing serv-ice bureaus and the community nurs-ing councils are primarily community projects, to be stimulated and guided by the national organizations. The outline does not go into detail; the statements and phrases under each section are often no more than sugges-tions of plans or ideas which can be developed according to the ability, imagination, financial resources, and enthusiasm for community welfare pre-sent in each responsible group. It is believed that the program is sufficiently flexible to permit development of in-dividual projects within each area, or within one or more areas, sometimes as units of a larger study, sometimes separately. Some part of each section may be started without delay. No in-dividual project needs to wait for the initiation of the program as a whole. A number of projects, in fact, are al-ready under way or have been active for several years; some are being ini-tiated; others are still to be undertaken. The composite program represents the expansion of existing projects consider-ed necessary for effective progress, to-gether with the introduction of new projects which must be undertaken if present and future needs in nursing are to be met satisfactorily. February, 1946 The Health Bulletin OBJECTIVES (Approved in principle September 16, 1944) The professional nursing organiza-tions have established the National Nursing Planning Committee as a co-ordinating body to plan and promote a five-year program for nationwide ac-tion in the field of nursing. Effective implementation of this pro-gram will enable the profession to pro-vide and maintain a high level of nursing service wherever it is needed. To achieve these objectives within the next five years, the following action will be taken: 1«. Determination of the needs of the nation for nursing care. 2. Determination of the number of nurses required to meet immediate needs for all types of nursing care. 3. Provision for meeting additional needs as social programs advance. 4. Education of nurses to give the best service which current scientific knowledge makes possible. 5. Promotion, development, and adoption of personnel policies and practices which will be satisfactory to employer and employee, and will ensure remuneration commensurate with the services rendered to society. 6. Promotion and support of plans to assure nursing care to all who need it, through an equitable distribution of the service cost. 7. Promotion, development, and es-tablishment of standards to guard the public and the nurse. 8. Development of public under-standing that the essential part which nursing plays in healing the sick and promoting positive health warrants use and support of a com-prehensive community nursing pro-gram. 9. Development of a progressive program of information to help nur-ses understand and accept their re-sponsibilities and opportunities. 10. Support of the program outlined without regard to race, creed, color, economic status, or geographic loca-tion. STATE AND LOCAL DEVELOPMENT OF THE COMPREHENSIVE PRO-GRAM IN NORTH CAROLINA Plans of the program were discussed at the annual convention of the North Carolina State Nurses* Association in Winston-Salem, November 5, 6, 7, 1945. The Board of Directors recommend-ed, and the recommendation was acted upon; that the outline of "A Compre-hensive Program for Nationwide Action in the Field of Nursing" be studied on a district basis by special committees of each district and lay representatives. That: The North Carolina Nursing Council for War Service be discontin-ued and that the work of the Council be delegated to the Post-War Planning Committee of the North Carolina State Nurses' Association, and that the mem-bership of this committee be expanded to include representatives from other professional organizations and lay groups. A complete outline of the pro-gram was printed in the September, 1945 issue of The American Journal of Nursing. Mrs. Louise P. East, Consult-ing Public Health Nurse, is Chairman of this Post-War Planning Committee of the North Carolina State Nurses' Association. Accidents THOSE of us who are interested in conserving human life are distress-ed at the heavy toll which accidents take in deaths and serious injury. In the few months since the end of the war automobile accidents have increas-ed some 40%. It is not known just what part unlimited gas and the increase in speed limit has played in this up-surge of highway accidents. Antiquated ve-hicles and their poor mechanical con-dition also enter into the picture. An-other factor which cannot be overlook-ed is the "devil-may-care" attitude of our people. With the coming of winter the weather will also contribute mark-edly to the hazards of highways and streets. We, in North Carolina, should heed the timely warning issued by the Connecticut State Department of Health, which reads as follows: Open Garage Doors Before Starting Engine With the coming of colder weather the annual warning against carbon monoxide is in order. 10 The Health Bulletin February, 1946 This gas is ordorless and colorless, so unless special warning is at hand the careless person is apt to think noth-ing of it. Carbon monoxide—CO to the chemist, is present in the exhaust gases from the family car. Although this gas is present at all times, usually garage doors are flung open and re-main so while the engine is being warmed up for a quick get-away. But when the mornings turn cold there is more tendency to close garage doors and so allow these exhaust gases to accumulate. This is especially dan-gerous in a small garage. Even a small car in a closed garage will generate enough carbon monoxide to render a person helpless. The action of carbon monoxide is insidious. It has a stronger affinity for hemoglobin than has oxygen, so the oxygen is quickly displaced leaving the hemoglobin without power to carry needed oxygen to the tissues. This change will have come about without being apparent to the person. At first a slight headache or muscular weakness may be noticeable, though the victim may not feel the effect of this until he starts to move or exercise, when he becomes helpless and falls. He soon be-comes unconscious and death may fol-low rapidly unless he is removed quick-ly to the open air for first-aid resuscita-ti TAKE IT EASYi svtaoef NATtONAl SA«TY COUNCJl IITAKE IT EASY" •toe?INCAN is on; tion measures which should include the use of an inhalator from the nearest available station. Play Safe To avoid this treacherous and deadly gas, observe the simple procedure of opening your garage doors before start-ing the engine, and keep them open until the car has been driven from the garage or the engine stopped. Further-more, be sure that your garage doors are equipped with substantial hardware to keep them open even in the face of a brisk wind. Cold weather warnings should also be heeded in the case of closed car windows. No car with engine going should be entirely closed no mat-ter how low the temperature outside. Carbon monoxide may be present in the exhaust gases which have seeped through the car because of some defect in the exhaust system. With proper ventilation in the car, the minute a-mount present would cause no ill effect, but with windows closed an accumulat-ed amount may be enough to jeopardize the health or even life of the occupants. Be sure and keep car window open while driving. Guarding Against Home Accidents Each year the lives of many thou-sands of men and women in our coun-try are needlessly sacrificed in home February, 1946 The Health Bulletin 11 accidents because ordinary, common-sense safety precautions are not ob-served. This tragic fact stands out in bold relief from an analysis of last year's death records. It is a curious fact that a consider-able majority of those who suffered fatal injuries in and about the home were not engaged, at the time the in-jury was sustained, in tasks necessary for the maintenance and operation of the household. This was the case in about two thirds of the fatalities among women and in four fifths of the fatal-ities among men. In many of these in-stances the person was merely walking from one room to another, or up or down stairs, relaxing on a chair or couch, or sleeping. A surprisingly large proportion of the total number of fatal injuries in this experience occurred between 10 p.m. and 6 a.m., when activity is at a min-imum in most homes. Injuries suffered during these hours accounted for about QUIT YOUR SKIDDING QUIT YOUR SKIDDING Follow other vehicles ai a safe dis-tance. It takes from 3 to I I times as long to stop when pavements are snowy or icy. Avoid making a quick stop in front of another vehicle. A rear-end collision may result. two fifths of all the deaths from home accidents among men and for one fourth of the deaths among women. Conflagration and asphyxiation by gas contributed materially to this night-time toll. Analysis of the death records reveals that conflagrations were often caused by defective or improperly used oil or coal stoves. Gas poisoning arose from a variety of circumstances: the inadvertent turning on of gas jets, leaking gas fixtures and appliances, and the use of gas heaters in poorly venti-lated rooms. But much more important numeri-cally than either conflagration or gas poisoning as a cause of fatal home accidents at night, are falls. In fact, falls accounted for around 40 percent of the fatal injuries suffered at night among both men and women. The large number of persons reported as falling on the floor or stairs while on the way to the bathroom at night indicates the need for night lights or lights easily reached from the bed, especially in homes where there are aged or sick 12 The Health Bulletin February, 1946 persons. A considerable number of deaths also were caused by falls on entrance steps or hallway stairs by members of the household returning home late at night. In this experience as a whole, including both night and day, falls are by far the outstanding cause of accidental death in and about the home. Contributing to this large toll are fatal falls on steps, many of which are too steep or too narrow, have insufficient headroom, or are without handrails or adequate illumination. That the smoking of cigarettes or pipes can be dangerous is evidenced by the considerable toll of life taken each year by accidents from this cause. One third of all the deaths from burns and conflagrations in the home among men were the result of careless smoking; even among women the proportion was as high as one sixth. In many instances the victim dozed off in bed or in an upholstered chair with a lighted cigar-ette in the hand or mouth. Another fairly common but danger-ous practice is dozing off while liquids are being heated on gas stoves. Last year, 11 people in this insurance expe-rience— 10 men and one woman—died from gas poisoning because, while they were taking a nap, the liquid on the gas stove boiled over and extinguished the flame. Striking examples of preventable deaths are those due to firearms. Play-ing with, lifting, cleaning or scuffling for guns are the causes of accidents of this kind. Even eating has its hazards. In this experience, eight persons died last year from accidentally swallowing bones or fruit pits, with resulting chok-ing or damage to the alimentary canal. Altogether, the American people each year pay a high price in lives for home accidents which are preventable. It is encouraging to note that our leading national health and safety organiza-tions are planning a combined attack on this problem. Notes and Comment PLASMA '-pHE American Red X Cross has delivered two truck loads of plasma to the State Laboratory of Hygiene for redistribu-tion to hospitals and physicians who are licensed to practice medicine in North Carolina. To the sentimentalist this plasma is a dramatic reminder that the war end-ed much sooner than was anticipated. This plasma was originally intended to aid in saving the lives of men in our armed forces who would be injured in combat. In a way each package rep-resents a man who would have been injured had the war continued. Each package also represents a patriotic American who donated blood to Amer-ican Red Cross blood banks. The pur-pose of the donor was to aid in saving human life. Each package sent into North Carolina by the Red Cross may save the life of some person in North Carolina. It would be idle to think that the 6476 packages represent the saving of 6476 lives. Some patients receiving the plasma will need more than one package; others who receive it will die in spite of it. Nevertheless, ©ne does not need a vivid imagination to realize that these huge piles of plasma are bulwarks against death. Those of us who have contributed to the Red Cross in the past have done so with the idea that this organization enabled us to minister into the victims of disaster, violence, pestilence, and famine. Individuals can do little to re-lieve distressed people in far away places by joining and investing in an organization such as the Red Cross, we can do much. Now this benevolent organization is in a measure declaring a dividend by returning to the people of North Carolina a sizeable portion of their contributions. Into every corner of the State will go plasma and its life-saving potentialities. In order that our people may have a greater under-standing of the terms under which this plasma is available we give the follow-ing statement from the American Red Cross: The American people gave through the American Red Cross large quant-ities of blood from which dried plasma was prepared for the armed forces. The supply of this material was predicted upon the needs of the Army and the Navy for a long and costly war. Be-cause of an earlier cessation of hostil- February, 1946 The Health Bulletin 13 ities than was reasonably to be expect-ed in both the European and Pacific Theaters, there is now on hand a quan-tity of dried plasma which is in excess of the needs of the Army and the Navy during the anticipated useful life of the plasma, namely, five years from the date of processing. According to army and navy estimates the available sur-plus amounts to approximately one and a quarter million packages at the pre-sent time. The transfer to the American Red Cross of dried plasma declared surplus by the Army and the Navy is provided for by Public Law 457 of the 78th Con-gress, approved October 3, 1944. The pertinent portion of this law, Section II (f), reads as follows: "No surplus property which was pro-cessed, produced, or donated by the American Red Cross for any govern-ment agency shall be disposed of except after notice of and consultation with the American Red Cross. All or any portion of such property may be donat-ed to the American Red Cross, upon its request, solely for charitable purposes." Under the foregoing provision of Congress a formal request was made to the Army and the Navy that all sur-plus plasma be transferred to the American Red Cross. This section was taken on the ground that the American Red Cross has a responsibility to the American people to assure that plasma and other derivatives of the blood vol-untarily contributed for the members of the armed forces be utilized to the best advantage and not be wasted or offered for sale or barter. In making this request it was proposed that any surplus should be returned to the American people, who had made these supplies of plasma possible, for use in veterans' hospitals and in civilian med-ical practice. This proposal was accept-ed by the Army and the Navy and, accordingly, they will transfer to the American Red Cross all available sur-plus stores of plasma and other blood derivatives. Each area office will provide ware-house storage space sufficient to handle the plasma to be made available to state departments of health within its jurisdiction. The storage temperature must not be allowed to go below 35 de-grees F. or above 120 degrees F. From these warehouses plasma will be furnished to any state department of health which, after consultation with the area medical director and repre-sentatives of the state medical society and state hospital association, has pre-pared a plan satisfactory to the Amer-ican Red Cross for the distribution of plasma within its state for use in civil-ian medical practice. The American Red Cross will esti-mate, on the basis of the population of the state, weighted by the number of physicians licensed to practice med-icine and surgery and by the number of general, pediatric, and maternity hospital beds and any other beds de-voted to the care of acute illness, the amount of plasma required by each state for a three months' supply. This will constitute the initial shipment to a state department of health, which will designate the depot or depots to which it desires shipment to be made. Requisitions for replacement supplies of plasma must be made in writing by the state department of health and sent to the area medical director for approval and transmittal to the area manager. The total amount held in storage by a state department of health at any time must not exceed an esti-mated six months' supply. No charge will be made by the Amer-ican Red Cross to the state department of health either for the product or for the cost of shipment. The plan of distribution within a state must include the following gen-eral principles and procedures: a. The state department of health is to: 1. Assume the responsibility for mak-ing an inventory of the plasma received so that it may be issued in time to in-sure its use before it becomes outdated. This is necessary because the surplus plasma is made up of lots bearing dif-ferent expiration dates. 2. Agree to affix to each individual package prior to distribution a special label, to be provided by the American Red Cross, bearing substantially the following statement: "This plasma, having been declared surplus to the needs of the armed forces, is made available by the American Red Cross without charge for civilian use." Space will be provided on the label for the department of health to add its name as the distributing agency. 3. Make the plasma available to all physicians licensed to practice medicine 14 The Health Bulletin February, 1946 and surgery and to all acceptable hos-pitals for administering to any patient without charge to physician, hospital, or patient either for the product or for the cost of shipment. 4. Encourage by all available means proper use of the plasma and maintain a record of its distribution. 5. Issue and disseminate information relative to the use of blood and blood derivatives to the medical profession and the public. 6. Conduct, in consultation with the area office, the distribution of plasma and direct the attendant publicity in such a way as to provide for participa-tion of the Red Cross chapter in the local program in accordance with the provisions set forth in Section VI be-low. 7. Submit periodic reports to the area medical director on the status of the program. These reports should include a monthly record of the amount of plasma distributed, the amount of the reserve supply, and copies of publicity, directives, and other material pertinent to the program. b. The national organization of the American Red Cross is to: 1. Issue publicity through its own channels concerning the distribution and use of the plasma and also make available releases for distribution through the regular state department of health channels. 2. Prepare for the use of state med-ical societies and the state departments of health technical information con-cerning the use of blood and blood de-rivatives for the purpose of assisting them in obtaining proper use of the plasma. 3. Prepare information on the devel-opment and operation of blood and blood derivatives programs throughout the country for the purpose of assist-ing the various state departments of health in these programs. It is desired and expected that the distribution and use of the surplus plasma in the manner described will, in addition to serving its primary pur-pose: a. Assist in making possible an accu-rate determination of the needs for blood and blood derivatives throughout the country. b. Strengthen and stimulate the de-velopment of already established state and local civilian blood and blood de-rivatives programs. c. Demonstrate the value of such programs and thus stimulate active in-terest in them on the part of the public, the medical profession, departments of health, and Red Cross chapters in those parts of the country where these pro-grams do not now exist. Arrangements have been made to provide plasma for former servicemen and women in veterans' hospitals. There will be shipped to the Veterans Administration the quantity of plasma which it has estimated as being suffi-cient to meet its needs during the five-year life of the dried plasma. This plan for the distribution of the surplus plasma has been concurred in by the Association of State and Terri-torial Health Officers, the American Medical Association, and the American Hospital Association. To the Physicians and Hospitals of North Carolina The American Red Cross has sent us a supply of plasma to be distributed equitably among the physicians and the hospitals of the State. This plasma was allotted on the basis of one unit to each physician licensed to practice medicine in North Carolina and to hospitals—one unit for each four general, maternity and pediatric hos-pital beds. This plasma is distributed with the understanding that it be made available to all, without charge, regardless of financial status. Each package of plasma is complete with solvent for the dry plasma, double flow needle, tubing, and intravenous needle. An attached sling is also pro-vided, thus everything needed for ad-ministration is provided except mate-rials for cleansing the arm of the pa-tient. Plasma should be stored in a dry place where the temperature range is between 35 degrees F. and 120 degrees F. The expiration date is based on the estimated life of the rubber used in making the outfit. Presumably this sup-ply of plasma will be supplemented within approximately ninety days with another allotment. February, 1946 The Health Bulletin 15 Institutions and physicians will be expected to fill out a short form report-ing use before securing an additional supply. Physicians can secure their package merely by writing or telegraph-ing a request to the State Laboratory of Hygiene, Raleigh, N. C. Hospitals in requesting their supply should furnish us with the following information: 1. Number of general, maternity and pediatric beds in the institution. 2. Number units of plasma used dur-ing the previous three months' period. 3. Number units requested for im-mediate shipment. The request should be on stationery of the institution and should bear the signature of a responsible officer of the institution. Yours truly, John H. Hamilton, M.D., Director State Laboratory of Hygiene * * * DR. GUDAKUNST During the re-cent epidemic of poliomyelitis the figure of Dr. D. W. Gudakunst was familiar in many of the stricken sections of our State. He work-ed hard to perfect the organization which was set up to aid the victims of this disease. We are, therefore, dis-tressed to receive the following death notice: Dr. Donald Welsh Gudakunst, Med-ical Director of The National Founda-tion for Infantile Paralysis, who died of a heart attack in his room at the Blackstone Hotel, Chicago, at 12:35 p.m. yesterday, (Sunday, January 20), had a long record in medicine and public health and was one of the country's leading authorities on polio-myelitis. He joined the National Foundation January 1, 1940, and was in charge of the organization's rapidly expanding program of research in infantile paral-ysis and care and treatment of patients. Prior to joining the National Founda-tion, Dr. Gudakunst spent several years in public health work, chiefly in Mich-igan. He was Deputy Health Commis-sioner of Detroit from 1924 to 1937 and Michigan State Health Commissioner, 1938 and 1939. From 1937 to 1942, he was non-resident Professor of Preven-tive Medicine and Public Health, Uni-versity of Michigan. Dr. Gudakunst was born at Paulding, Ohio, August 18, 1894, the son of Wil-liam Edward and Fannie May Welsh Gudakunst. He attended Latin High School, Somerville, Mass., and the Uni-versity of Michigan, graduating as Bachelor of Science in 1917 and as Doctor of Medicine in 1919. His interne-ship was spent at the University of Michigan Hospital. He is survived by his wife, Bernice Drahner Gudakunst, and a daughter, Mrs. Howard A. Vernon of Chicago. He lived on North Street, Westport, Conn. Dr. Gudakunst was a fellow of the American Public Health Association, the New York Academy of Medicine and the American Medical Association and a member of Alpha Kappa Kappa and Delta Omega fraternities. He was a frequent contributor to medical jour-nals. At the time of his death, Dr. Guda-kunst was talking in his hotel room with Commander Robert S. Schwab, formerly director of a research project at the Massachusetts General Hospital financed by the National Foundation. "*•**-. Paul Beavers, age 7 months, son of Mr. and Mrs. George M. Beavers, Jr., Apex, North Carolina. Paul is a good example of medical heritage and super-vision. 16 The Health Bulletin February, 1946 PROTECT CHILD LIFE! Caution your child about the changing traf-fic situation. There are more cars, traveling faster than during wartime. Many children were too young to remember traffic as it was before the war, or they have forgotten how to protect themselves. Knowledge now may avert tragedy later. Teach children to cross at intersections in city traffic. Be sure your child understands to walk with the green light. Caution children against crossing in middle of block or darting out from between parked cars. Be sure they know to look for turning traffic before cross-ing! Walk facing traffic is a cardinal rule for highway hiking. Teach children to walk facing traffic, preferably on the shoulder of the road allowing enough room for oncoming cars to pass at a safe distance. For night walking, wear something white or carry a flashlight. ''Playing in the street" is a leading cause of child traffic fatalities. Teach children to play in well-protected play areas. Even "blind" streets are dangerous because children may not be alert to cars which come into these streets. Children should learn very young to stay out of streets. fiftl PublisKedby THE-N R3H.CfiKliriA STArLB°ARDs^E^LTHL 1 This Bulletin, will be sent free to any 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. 61 MARCH, 1946 No. 3 One of Six Thousand Four Hundred Seventy-Six Packages of Plasma Allocated to North Carolina by the American Red Cross. MEMBERS OF THE NORTH CAROLINA STATE BOARD OF HEALTH S. D. CRAIG, M.D., President Winston-Salem I. N. JOHNSON, D.D.S., Vice-President Goldsboro (i. G. DIXON, M.D Ayden H. LEE LARGE, M.D Rocky Mount W. T. RAINEY, M.D Fayetteville HUBERT B. HAYWOOD, M.D Raleigh I. LaBRUCE WARD, M.D Asheville I. O. NOLAN, M.D Kannapolis JASPER C. JACKSON, Ph.G. Lumberton 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. J. ROY HEGE, M. D., District 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. C. P. STEVICK, M.D., Director Division of Epidemiology and Vital Statistics. J. M. JARRETT, B.S., Director Division 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., Executive Secretary, Nutrition Service of the State Board of Health. MR. CAPUS WAYNICK, Director, Venereal Disease Education Institute. E. H. ELLINWOOD, M.D., Director, School-Health Coordinating Service. HAROLD J. MAGNUSON, M.D., Director, Reynolds Research Laboratory, Chaflel Hill. JOHN J. WRIGHT, M.D., Director, Field Epidemiological Study of Syphilis, Chapel Hill. FREE HEALTH LITERATURE Infeair PUBU5MLD BY TMC MQRTM CAIgOUriA 5TATL e£A£0 •ME.ALTM Vol. 61 MARCH, 1946 No. 3 CARL V. REYNOLDS, M.D., State Health Officer JOHN H. HAMILTON, M.D., Acting Editor Life and Death in North Carolina in 1945 By W. H. Richardson North Carolina State Board of Health Raleigh, North Carolina NORTH Carolina's general death rate of 7.6 per one thousand in-habitants in 1945 was the lowest in the State's history. This is disclosed in the provisional report for the year issued by the State Board of Health's Division of Vital Statistics, which gives a concise picture of life and death in North Carolina during the closing year of World War II. North Carolina's general death rate maintained a sustained downward trend in mortality throughout the duration of the conflict recently ended. The last year of American participation in World War I was marked by a rate of 17.6 persons per one thousand popula-tion, this having been due to the influ-enza scourge which swept through the world in 1918, playing no favorites. No such epidemic occurred during World War II, throughout which we made substantial gains not only in the matter of lowering our general death rate, but also in our fight against certain specific diseases. It is interesting to compare the gen-eral death rates in our State for the four years in which we were engaged in World War II. The rates for 1942 and 1943 were identical, being 8.1 per thousand. The 1944 rate was 7.9 and the rate last year 7.6. These are all below the national rate, which was 10.9 in 1943. Later figures are not available at this time, but it is hardly to be sup-posed that the national rate has shown any such decline as that which has been noted in North Carolina. In numerical terms, there were 28,950 deaths in North Carolina in 1945, as compared with 29,560 in 1944. The birth rate, on the other hand, rose and fell during the war years, as might have been expected. The number of births recorded and rates were as follows: 1942, 90,056—24.6; 1943, 95,251 —25.7; 1944, 92,412—24.7; 1945, 88,597— 23.4. These figures are easily under-standable, when taking into considera-tion the shift in the male population during the fighting years. Early war-time marriages resulted in an all-time high in the number of births, in 1943. Then, men were moved overseas in ever-increasing numbers. It would not be unreasonable to assume that, with so many husbands back in America, there will be another upsurge in births in due time; but, in the handling of vital statistics, the State Board of Health's duty is to record and not to prophesy. One of the most gratifying things about the 1945 provisional report of the Division of Vital Statistics is the de-cline reported in the number of infant deaths, that is, deaths among babies under a year old. The total for 1945 was 3,842, as compared with 4,130 the preceding year, and the rate declined from 44.7 per one thousand live births reported to 43.3. Both figures are en-tirely too high and are above the national rate, but the reduction does denote progress, as do the figures on maternal deaths, of which there were 228 in 1945, with a rate of 2.5 per one The Health Bulletin March, 1946 thousand live births, compared with 274 in 1944, when the rate was 2.9. Numerically, these figures might seem insignificant, but in terms of percentage the difference is appreciable. That section of the 1945 report giving the number of deaths from preventable accidents does not constitute such a rosy picture. There were 1,299 such deaths in 1945, as compared with 1,440 the preceding year—a reduction, it is true; but the 1945 figures reveal a dis-tinct uptrend in deaths resulting from primary automobile accidents now that the war is over. According to figures reported by the State Board of Health, including fatalities occurring on mili-tary reservations and deaths not classed as resulting from traffic accidents, there were 695 such deaths in North Carolina last year, as compared with 634 in 1944. Such deaths are on the increase, ac-cording to reports from all sources. During 1945, there were only 64 deaths from air transportation accidents in North Carolina, as compared with 258 the preceding year. This is easily un-derstood when we take into considera-tion that North Carolina had a liberal quota of trainees for aerial warfare. Deaths from other accidents classed as preventable, last year, included 20 from automobile and railroad collisions, 68 from other railroad accidents, 145 from drowning, 209 from conflagration and accidental burns, and 98 from acci-dental traumatism by firearms. During the year, 241 persons in North Carolina committed suicide and 285 were homicide victims, making a total of 526 who killed themselves and were slain by their fellowmen. In addition to the 1,299 deaths from accidents termed preventable, there were 1,123 deaths in North Carolina during 1944 from diseases known to be preventable or curable. In the latter class were 288 deaths attributed to late syphilis, which might have been cured if early treatment had been adminis-tered, also 12 from typhoid fever, 16 from tetanus (lockjaw), 72 from pel-lagra (prevented and cured by eating the right kinds of food), 21 from malaria, 95 from diphtheria, 92 from whooping cough, and one from rabies. According to the provisional report for 1945, the death rate from all forms of tuberculosis in North Carolina dur-ing 1945 was 37.4 per 100,000 inhabi-tants, which was nearly one point higher than the 1944 rate. The number of tuberculosis deaths for each of the past two years was 1,417 and 1,368, respectively. After all, while we have made good progress, we have not as yet whipped all the infectious diseases over which we hold the whip hand—and we will not do so until we let go with all that science has to offer. The death toll from cancer in North Carolina in 1945 was 2,421, and the number of persons out of every 100,000 inhabitants dying of some form of this disease was 64. Deaths in 1944 totaled 2,298, with a rate of 61.4 per 100,000 inhabitants. There is food for thought in these figures and a mighty incentive for those who are seeking, with all the means at their command, to wage an all-out war on this ancient and, so far, unconquered enemy of the race. The 1945 death charged against the pneumonias stood at 1,540, as compared with 1,555 the preceding year, denoting practically no change. But these totals were both below those registered before the discovery of, first, anti-pneumonia sera, and, later, sulfa drugs and peni-cillin. Thus, we have a general picture of life and death in North Carolina in 1945, with the realization that there is still much to be done. The millenium has by no means arrived. March, 1946 The Health Bulletin Venereal Disease Control in North Carolina By W. D. Hazelhurst. M.D. Surgeon, U. S. P. H. S. V. D. Consultant North Carolina State Board of Health Raleigh, North Carolina THE primary objective of the vene-real disease control program in North Carolina is to reduce the attack rate of syphilis and gonorrhea. To this end, the treatment of infectious cases of these diseases is an essential method of attack. In the years before penicillin, effect-ive treatment of both syphilis and gon-orrhea was difficult to accomplish. Syphilis was treated with weekly in-jections of alternating courses of arsenicals and bismuth. A large per-centage of patients who began treat-ment of this type lapsed before minimal adequate treatment had been received. Much time and effort was spent 'in follow up of delinquent patients and generally with disappointing results. For example, of a group' of 1,884 pa-tients admitted to clinics in North Carolina between January 1 and July 1, 1943, 87% had received less than 40 injections by July 1, 1944, and only 6% had been discharged from the clinics as "cured." Gonorrhea, also was difficult to manage, especially in the female. Treat-ment with sulfathiazole was easily ad-ministered, but had the disadvantage of being orally administered. In irre-sponsible patients, one could not be sure whether the pills had actually been swallowed as directed or at all. Fur-thermore, it was extremely difficult to tell when a cure had been effected (especially in women), since facilities for culturing the gonococcus were not generally available. Some of the obstacles that have con-fronted the program have been re-moved by the advent of penicillin and intensive methods of treatment. Rapid Treatment Centers designed to administer intensive treatment for venereal diseases were established in Charlotte and in Durham in the fall of 1943. During the early months of their operation, syphilis was treated with various treatment schedules em-ploying arsenoxide (mapharsen) and bismuth. This treatment was effective, but proved too toxic to justify its con-tinuance. Fortunately, penicillin be-came available during the summer of 1944. Schedules of treatment for syphi-lis have been developed using penicillin plus relatively small amounts of arsen-oxide and bismuth which are safe and are proving effective. Penicillin alone has been tried, but too many relapses occurred, hence the addition of other drugs to supplement its effect. For gonorrhea, however, penicillin has been amazingly effective. The first treatment scheme that was used was the injection of 30,000 units of peni-cillin every three hours for five doses for a total dose of 150,000 units. Later this was modified when it was found that equally good results were achieved by giving the same total dose in three injections at two hour intervals. In the summer of 1945, penicillin in beeswax and peanut oil became avail-able. This preparation, by delaying absorption, makes it possible to give the entire dose of penicillin for gonorrhea in one injection. With this method of treatment, gonorrhea has been returned to the local clinics by the rapid treat-ment centers. These revolutionary developments in treatment methods have solved some of our problems. However, new prob-lems have arisen and much remains to be accomplished before venereal diseases are controlled. In the case of both syphilis and gon-orrhea, the problem of reinfection has arisen. To illustrate, John Doe learns that he has syphilis and goes to a rapid treatment center. His wife, Mary, was exposed to John before John was treated. Other exposures occur when John gets home just before Mary's The Health Bulletin March, 1946 syphilis shows up. She goes to a rapid treatment center and returns home just before John's second infection shows up, and she is again exposed. Conceiv-ably, this could go on indefinitely. Every attempt is being made to reduce possibilities for reinfection through in-tensive patient education and through contact investigation. Another problem has arisen with syphilis. No treatment scheme for syph-ilis gives 100^ cures. Intensive therapy has proved about 85% effective, which is as good as any method to date. However, the relapses that do occur following intensive therapy are mostly of an infectious type. Furthermore, the first lesions that recur usually appear trivial and may go unnoticed by the patient. The public health significance of this is readily appreciated. Fortun-ately, it is possible to predict such a recurrence by observing a quantitated blood test monthly for a year following intensive treatment. After the first year, the period of greatest danger is past. Observations are then made every three months for the second year and once yearly thereafter to assure the patient that all goes well. Our biggest problem, however, re-mains the uncovering of newly acquired infections. In general, the earlier a case is treated, the fewer people will be exposed to it and the better the chance of cure for the individual. Education of the public regarding the facts about venereal diseases and what is available for their treatment should go a long way toward control. Contact investi-gation must be continued, intensified, and speeded up as an adjunct. Finally, it should be pointed out that without the cooperation and assistance of the practitioners of medicine, the venereal disease control movement could never have succeeded to its present extent. An even closer cooperation and more active participation, particularly in the process of investigating contacts, is needed for ultimate success. Local Health Units SOME five years ago the American Public Health Association created a Committee to study the problems of local health administration. This Com-mittee was headed by Dr. Haven Emer-son. A little more than six months ago the Committee's report was published by the Commonwealth Fund, 41 East 57th Street, New York 22, New York. The price is $1.25. The first edition of one thousand copies was exhausted within a month. More than one-half of the second printing of two thousand has already been distributed. Reader interest has been widespread. Copies have been bought in every state and a number of foreign countries. The first section is devoted to prin-ciples upon which the report is based. The second is given over to definitions and sources of data. The third section discusses local health services existing and proposed in the United States. The fourth section includes the present and suggested personnel and costs for local health services for each state and the District of Columbia. In the Foreword Dr. Emerson states: "This report, by a committee of state and local public administrators, is ad-dressed to the home-town folk of con-tinental United States, and more par-ticularly to their elected officers of local government of village, town, city, or country. It's purpose is to suggest a way to cover a free society with full time health services at the community level. "It may come as a shock to many that only two-thirds of the people of our country are today under the um-brella of full time local health protec-tion, while approximately forty million are excluded by horse-and-buggy poli-tical boundary lines, or by the economic stringencies of the areas in which they happen to live. Yet such is our present situation. Further, the provision of health services, whether full or part time, is now essayed by 18,000 or more counties, cities, towns, villages, or dis-tricts. These local health jurisdictions are inherited from the past. They came into being, like many good and bad things in a young and growing country, without benefit of policy. We know now that we can afford nothing less than coverage of every population and area unit of our nation with competent local health service. How can we achieve it? Do we continue in an outworn tradition. March, 1946 The Health Bulletin or shall we boldly redesign our appar-atus? The authors of this report pro-pose the latter course. "They begin by presenting a picture of contemporary local health services as they are—the broad features of their adequacies and inadequacies, the num-ber and kinds of persons who do the work, and the cost of this indispensable function of local government. The or-ganization of local health services of each state is considered in detail and the existing personnel and the costs are analyzed. Detailed data are shown in tabular form, making comparative stu-dy simple. Comparisons are revealing: for example, it is by no means always true that the richest states spend the largest amount per capita for local health service or have the largest pro-portion of their population served by full time local health officers. Other cherished beliefs are upset by examina-tion of state summaries in relation to national figures distributed over the total population. This section of the report stands wholly on factual ground. This is how we are. "The Committee then moves into the realm of attainable possibilities. It suggests a new design in the adminis-trative apparatus for delivering local health services. Employing the same set of guides for each state — complete coverage with basic min-imum full time service; units of jurisdiction of populations large enough (50,000 or more) to support and justify staffs of full time, pro-fessionally trained persons; a cost of approximately $1.00 per capita — it shows that all the objectives can be realized and that only about 1200 units of local jurisdiction would be required to do the job. The authors repeat that this is a way to cover the entire pop-ulation with full time basic minimum local health service. The particular pro-posal for any given state or city-county or multi-county unit, however, must be considered by the people and their local government, and by the respective state health officer or board of health, as expressing a principle of adminis-tration not a finality for action. An-other arrangement of counties and populations may be preferable. The principle of local cooperation, however, and the pooling of community resources for health in the interest of economy and efficiency are important, and re-semble those that have brought about consolidated or union school districts and road districts serving large areas with engineering adequacy. "While in most of the states existing permissive or mandatory legislation authorizes the development advised by the Committee, in thirteen of them there are no such laws; but it is equal-ly true that such cooperative planning and operation of local health services are nowhere forbidden. "It is expected that among those who can be relied upon to encourage and actively support the plan here offered will be found the state medical, dental, and nursing organizations, the official and voluntary health agencies, and such bodies of influence and public opinion as state universities together with farmer and labor groups concern-ed with better quality of living in the smallest as in the largest communities. "This report has been made possible by a grant of the Commonwealth Fund which has also undertaken its publica-tion. The staff of the Fund has contrib-uted generously to its final editing. The Committee on Local Health Un-its of the American Public Health As-sociation assumes full responsibility for the report, including all statements of fact and opinion." There is much in the report which is good thought provoking material. Some of the recommendations will stimulate controversies. Since the prob-lem discussed is important, we will de-vote considerable space in this issue of the Bulletin to quotations from the report. "Whether local units of health juris-diction are created by local initiative or authority and by cooperative or leg-ally specified procedures, or are devel-oped under mandatory for permissive legislation by the leadership and per-sonnel of the state department of health is not a matter of primary im-portance or of sharp distinction. What is essential is that no population unit or area of the United State
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 | 1946 |
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 61, 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 | 13,853 KB; 234 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_healthbulletin1946.pdf |
Pres Local File Path-M | \Preservation_content\StatePubs\pubs_edp\images_master\ |
Full Text | If ®fie Htfcrarp of tfje Wlnibmitp of ^ortfj Carolina Cnboteeb lip Cije BiaUtfic anb I^frilantijropit Societies! 6Hu06 N86h v. 61-62 19U6-U7 Med, lib. J This book must not be taken from the Library building. f j This Bulletin, will be sent free to any citizen of the State upon request I Entered as second-class matter at Postoffice at Raleigh, N. C, under Act of July 16, 1804. Published monthly at the office of the Secretary of the Board, Raleigh, N. C. Vol. 61 JANUARY, 1946 No. 1 The Public Health Nurse Helps Keep North Carolina Strong A MEMBERS OF THE NORTH CAROLINA STATE BOARD OF HEALTH S. D. CRAIG, M.D., President Winston-Salem J. N. JOHNSON, D.D.S., Vice-President Goldsboro G. G. DIXON, M.D Ayden H. LEE LARGE, M.D Rocky Mount W. T. RAINEY, M.D Fayetteville HUBERT B. HAYWOOD, M.D Raleigh J. LaBRUCE WARD, M.D Asheville J. O. NOLAN, M.D Kannapolis JASPER C. JACKSON, Ph.G '. Lumberton 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. J. ROY HEGE, M.D., District 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. C. P. STEVICK, M.D., Director Division of Epidemiology and Vital Statistics J. M. JARRETT, B.S., Director Division of Sanitary Engineering. T. F. VESTAL, M.D., Director Division of Tuberculosis C. B. DAVIS, M.D., Director Division of Industrial Hygiene. WILLIAM P. JACOCKS, M.D., Executive Secretary, Nutrition Service of the State Board of Health MR. CAPUS WAYNICK, Director, Venereal Disease Education Institute. E. H. ELLINWOOD, M.D., Director, School-Health Coordinating Service WILLIAM L. FLEMING, M.D., Director, Reynolds Research Laboratory, Chapel Hill. JOHN J. WRIGHT, M.D., Director, Field Epidemiological 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 an 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 Chickenpcx 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 :itizen of the State on request to the State Board of Health, Raleigh, North Carolina. Prenatal Care. Baby's Daily Time Cards: Under 5 months; Prenatal Letters (series of nine 5 to 6 months; 7, 8, and 9 months; 10, 11, monthly letters.) and 12 months; 1 year to 19 months; 19 The Expectant Mother. months to 2 years. Breast Feeding. Diet List: 9 to 12 months; 12 to 15 months; Infant Care. The Prevention of 15 to 24 months; 2 to 3 years; 3 to 6 Infantile Diarrhea. years. Table of Heights and Weights. Instruction for North Carolina Midwives. CONTENTS Page Postwar Expansion of Public Health Nursing 3 "Snowball's" Club Feet 7 Progress of Industrial Nursing In North Carolina 8 What Do You Do? 9 "Me - - and You" 10 Opportunities In Public Health Nursing 11 Amanda Bunch—Midwife 13 Exhibits 14 Maternity Poster 14 The Premature Infant 15 LIBRARY UNIV. OF NORTH CAROLINA ? PUBLI5ME1D BY TML nORTn CAgQunA 5TATE- EPA^D •Mi.ALTH | Vol. 61 JANUARY, 1946 No. 1 CARL V. REYNOLDS, M.D., State Health Officer JOHN H. HAMILTON, M.D., Acting Editor Postwar Expansion of Public Health Nursing* By Maky J. Dunn, Senior Nurse (R), U. S. Public Health Service Washington, D. C. FOR the first time in years we are liberated from the forces of aggression and the fear and dread of some new outrage against the decencies of mankind: we can now build con-structively for a "Better Nation"—a "Better World"—for peace loving people. In so build-ing during the period of reconversion, it is assumed that health programs will expand greatly and rapidly. Dr. Parran has pointed out recently that, "in many peacetime health activities we shall have to 'learn by doing', but we shall learn faster and do better if we can agree upon certain basic assumptions which will shape our thinking and action. It is reasonable to assume that: — 1. Reconversion to a peacetime economy will create health problems comparable in scope and extent with those of war: 2. State and local health authorities will have to take over a larger share of the costs of many essential programs; 3. The release of manpower and materials for construction offers opportunities for the establishment of essential health facilities at an earlier time than could be anticipated two short months ago; 4. The Federal Government will not as-sume sole responsibility for the planning of public health works; initial efforts must come from the States; 5. The training of health personnel, in sufficient numbers and of adequate qualifica-tions, will require joint action on the part of all official and non-official agencies concerned; 6. A health organization larger than any we have known before, both in size and in scope of operations will be needed to attain the objectives of national health." Many factors will contribute to the shaping up of expanded health programs; these factors in turn will have a direct relationship to the number and kind of public health nurses needed. Therefore, it is timely that we as public health nurses have in mind our professional advancement, as well as the maximum con-tribution we may make to the commonwealth. It is by maintaining these two interests in proper balance that real progress may be made. To-day nurses are the most numerous pro-fessional group in health departments; they hold over 50 percent of the classified technical positions. The number employed full-time by *Paper presented by Mary J. Dunn, Senior Nurse Officer (R), U. S. Public Health Service, Washington, D. C. at the annual convention of The North Caroline State Nurses Association and of the State League of Nursing Education, Winston-Salem, North Carolina, November 7, 1945. The Health Bulletin January, 1946 public health agencies, including Boards of Education, number somewhat over 20,000. This does not take into account about 3,500 vacancies for which funds are currently avail-able. According to estimates compiled by the Subcommittee on Local Health Units of the American Public Health Association, at least 12,900 additional public health nurses are needed for public health protection of the population of Continental United States. This number would represent a ratio of one public health nurse to every 5,000 people. With in-creased emphasis on bedside nursing service on an hourly basis, the present number would need to be increased by more than 50 percent, thus providing a ratio of one public health nurse to every 2,000 people. Thus, it is obvious that the present number of public health nurses is insufficient to meet current needs, and consequently is wholly inadequate to meet the demands of expanding programs. Therefore, in considering any plan for the preparation of public health nurses it is assumed: 1) that they will be needed in in-creasing numbers; 2) that their preparation must fit them for the new evolving pattern of public health nursing. For example, our pattern is bound to change with advances in medical science. Already there is a marked reducdon and change in the prevalence and clinical course of certain communicable diseases,—especially among the Virus diseases and Venereal diseases,—be-cause of scientific discovery and application. The catastrophies of our all too recent war have given a renewed stimulus to mental hygiene, Psychiatry, and a sound rehabilitation program. Our expanding life span has its consequent health problems including an up-ward swing of chronic and degenerative dis-eases, and the many implications in the area of Geriatrics. Certain economic changes and the growing interest in health and hospital insurance plans affect markedly the number and type of patient known to the public health nurse. Another factor influencing our func-tions, responsibilities, and relationships is the many new types of workers—both professional and auxiliary—that have come into the health field. This pertains particularly to such per-sonnel as the health educator, the nutritionist, Social worker, physical therapist, practical or vocational nurse, housekeeping aides,—to men-tion but a few. If we are to prepare nurses to assume the many new and varied responsibilities that will be theirs, we should give thought: (1) to the most economical and effective type of preparation; (2) to the selection of promising recruits for public health nursing; (3) to needs and opportunities for financial assistance for essential training. Obviously the largest number of nurses needed will be Staff nurses or general public health nursing practitioners. The 1944 Census of public health nurses revealed that only nine states had reached the minimum emergent ratio of one Staff nurse to every 5,000 people. How are these Staff nurses to be prepared most effectively and economically? Many, through basic nursing programs or curricula which are an integral part of our universities and colleges. Programs which we have in mind are those having as their objective the preparation of a Community nurse well-versed in the curative and preventive phases of nursing; one who possesses an attitude, an under-standing, and a mastery of skill in caring for the whole patient in his different environ-mental situations; one who may take her place equally well in the hospital ward or in a public health agency under supervision. In order to prepare this type of professional nurse the teaching of the health, preventive, and rehabilitative elements of nursing, must be started very early in the basic curriculum and related to every function and to every appropriate learning situation. Likewise the concept of total nursing care calls for close coordination of the hospital nursing service with other community nursing services, simple but effective methods of referral and com-munication between these nursing services, ' and full appreciation of use of these channels January, 1946 The Health Bulletix by the entire nursing service and instructional staff. Assistance is frequently sought from public health agencies whereby students may have opportunity to observe, assist with, or give nursing care in homes. As a further means of implementing this broader concept of nursing care, an affiliation of two to three months, is frequently arranged with a public health nursing agency. Such an affiliation is planned ordinarily as an educational experience during the student's last year of training as an integral part of the required basic nursing curriculum. This experience should not be confused with the supervised practice period of the Senior Cadet which we come to know through our wartime accelerated basic pro-grams. The supervised practice period of the Senior Cadet Nurse is experience beyond the re-quired program of combined theory and practice, varying from 24 to 30 months in length. It serves to satisfy certain existing re-quirements of most State Boards of Nurse Examiners for graduation and registration. The Senior Cadet period represents an addi-tional six to twelve months' experience and emphasizes the service the Senior Cadet may render to the receiving institution or agency. Any study of present systems of nursing education, and the evaluation of curricula should consider possible values accruing from the wartime accelerated basic curriculum, in-cluding a terminal supervised practice period of the Senior student. The question might well arise as to the existence and prevalence of such basic pro-grams as we have described. Many are attempt-ing to enrich their programs, but very few have actually attained this broader goal. The final determination as to whether this goal has been realized is made by joint eval-uation and accreditation by the National League of Nursing Education, whose major responsibility is approval of the basic content, and by the National Organization for Public Health Nursing, whose function is to evaluate the public health nursing content of such a program. To date, only one school of nursing, the Skidmore College Department of Nursing of New York, has been thus accredited. Sev-eral other schools are seeking this type of accreditation and it is anticipated that still others will apply within the near future. While it is expected that increasing em-phasis will be placed upon the development of basic nursing preparation at least for a long time to come, these comprehensive pro-grams, of necessity, will produce a limited number of nurses. Therefore, increasing em-phasis must be placed upon the improvement and expansion of existing postgraduate pro-grams, especially those designed to prepare public health nursing supervisors and instruc-tors and clinical experts in such fields as psychiatry, orthopedics, pediatrics, obstetrics, and tuberculosis. It was mentioned earlier that careful thought should be given to the selection of recruits for public health nursing. The return of peace finds this nation face to face with the press-ing needs of its civilian population. We are at a critical level of one public health nurse to every 8,000 persons. It seems a strategic time to recruit and to prepare for this grow-ing field of endeavor. Senior Cadet experience in public health nursing has served and might continue to serve as an excellent means of securing desirable candidates for public health nursing. From information recently received from schools of nursing, and from our Public Health Service District Offices, it was learned that between July 1, 1944 and April 1, 1945, 402 Senior Cadet Nurses were assigned to public health agencies in 32 states. Of these 402 Senior Cadets, 176 were assigned to official health agencies, and 240 to visiting nurse associations. The length of experience has ranged from three to six months. The Senior student, as well as any other recruit who is to serve in public health nursing, must be chosen carefully. She must possess a degree of maturity, have an awareness of learning — teaching situations, and be able to adjust well in different situations. Any plan to raise the level of the Nation's The Health Bulletin January, 1946 health will require many more well prepared nurses than we have ever had before. A con-tinuing program to interest and guide superior young women into the field of public health nursing is vital to such a plan. Implicit in such a recruiting program is the need for sound personnel policies and practice. Once having recruited and trained desirable per-sonnel, the degree of stabilization and opti-mum functioning within an organization are usually in direct relation to the personal policies and practice of such an organization. Acceptable personnel practice should provide for freedom of action, opportunity for contin-uing professional growth, and economic se-curity. A third factor, and a very important one, affecting preparation for public health nursing is that of financial assistance for essential training. It is realized that public health nurses of tomorrow must be even better prepared than they are at the present time. It is realized, also, that public health nursing training, like other types of professional preparation is costly. Over the years, particularly since the passage of the Social Security Act in 1936, funds for educational purposes have been in-creasingly available for the pursuance of public health nursing programs of study. Brief men-tion might be made of some currently avail-able Federal funds that may be used for this purpose. Under Public Law 346, Servicemen's re-adjustment Act of 1944, (commonly known as the "G.I. Bill of Rights") Federal aid for further study is available to nurses who are Veterans of World War II. Universities re-port that many nurses already released from military service are availing themselves of this opportunity for further professional prepara-tion. During the Federal fiscal year which ended June 30, 1945, there had been allocated from Federal Funds administered by the Public Health Service, greater amounts for public health nurse training than for any previous year. An analysis made sometime before the close of this same year revealed the following: Source and amount of funds No. Students Nurse Education (Bolton Act) $809,695 2,459 Grants-in-aid (Social Security) 157,959 284 Venereal Disease 10,069 21 Total $977,663 2,764 In addition to the foregoing 2,764 public health nurse trainees, many more were en-rolled in the different on-the-job or in-service courses financed through Bolton Act funds. Public health nursing service is effective in relation to the number and quality of available nurses. Much of the foregoing dis-cussion was intended to illustrate the grow-ing need for greater numbers of well-prepared public health nurses. In order to meet these needs every effort must be directed to the most effective and economical preparation of nurses who will assume the many new responsibilities of public health nurses in the near and remote future. The quality of service to be rendered will depend, also, upon the type of young woman attracted to the profession. Interest in the profession will be assured in terms of the durable satisfaction to be experienced and the acceptability of personnel policies and practice. There must be a salary scale com-mensurate with the responsibilities to be assumed and the professional preparation of the nurse, opportunities for advancement, tenure of service, and assurance of adequate retirement. The more significant changes in store for nursing—all nursing—are geared to adjust-ment of medical science and medical service. The difference between public health nursing and the other branches of nursing are be-coming increasingly difficult to distinguish as the imaginary line between preventive and curative medicine. Because of this blending of preventive and curative forces, it does not fol-low that there will be a reduction in the im-portance of prevention. Likewise, to insure the paramountcy of prevention, it may be neces-sary for sometime—-and perhaps always—to maintain, within the general body of health January, 1946 The Health Bulletin workers, a group having special interest in, and special preparation for, this phase of the total program. Finally, let there be no mistaking the fact that the influence of public health nurses on the total nursing strength will be in direct relation to the size and importance of that part of the total program for which we demon-strate special fitness. It will be determined also by the continuing contribution we make to the body of technical knowledge and tradition which, in the long run, constitutes the only justification for the existence of a distinct pro-fessional group. Public Health Nursing Day will not be observed in January this year; instead April 7-13 will be observed as Know Your Public Health Nurse Week. "Snowball's" Club Feet By Lucy Lopp, Field Supervisor Crippled Children's Department North Carolina State Board of Health JUST why they called him "Snowball" no one really knew. Perhaps he did resemble a snowball as he sat in the hospital crib eyeing his new surroundings with wonder and concern, or maybe it was the contrast of his shiny chocolate skin against the white of his night gown. "Snowball" became known to the Crippled Children's Department at one of the State orthopedic clinics when he was three years old. He had been born with deformed feet. Each foot was turned in, causing most of his weight to fall on the top surfaces; he walked with an awkward gait. A club foot is usually the result of a con-genitalmal- development. There is no known means of preventing this deformity but early treatment and supervision can prevent the condition from becoming a permanent handi-cap. In most incidences corrective treatment can be started immediately after birth. Usually, the deformity will have been fully corrected by the time the baby is ready to walk. Treatment consists of the application of splints or casts which are changed at regular two-week intervals. The foot is corrected slow-ly and gradually; treatment varies with each individual case. When the orthopedic sur-geon feels a complete correction has been maintained, special shoes are recommended. After the child receives shoes he is not dis-charged from the clinic, but is requested to return for periodic check-up examinations. Should the correction relapse, a second period of treatment will be required. Regular follow-up examinations may be necessary over a number of years. In the case of 'Snowball' the clinic surgeon advised a hospital admission for a series of plaster casts and manipulations. After two months of concentrated corrective treatment he was dismissed from the hospital in plaster casts and requested to return for monthly check-ups in the orthopedic clinic where he was first examined; each time a new cast was applied. Had this case been discovered earlier, the treatment would have been much less prolonged. After two years of continuous treatment "Snowball" was at last ready for shoes. Act-ually, he had to learn how to walk on his corrected feet. (In his very young mind he must have been planning a game of hide and seek with his brothers and sisters back home.) His shy, pleased smile, his hesitating steps, together with the newness of his shoes seemed to radiate a warm glow about the room. And, I kept remembering the spiritual—"All God's Chillun Got Shoes." The Health Bulletin January, 1946 Progress of Industrial Nursing In North Carolina* By Mrs. Louise P. East Consulting Public Health Nurse North Carolina State Board of Health AS Shakespeare said, ''Coming events cast their shadows before them". Believing that there was a promising future for this highly specialized group of nurses, a small group of interested industrial nurses met in 1937, and organized an Industrial Nurses' Section of the North Carolina State Nurses Association. At that time very little was known regarding the number of nurses in the State who were doing that type of work, and so far as was known, only 36 nurses were employed by North Carolina industries. Form 1937-1942 the number gra-dually increased, and when a survey was made in 1942 of medical and nursing services in North Carolina industries, the number had grown to' nearly 100. During the war the employment of nurses in essential war industries was recognized as an important and necessary safeguard to workers. The number increased from 1942 until V. J. Day, to 186. Since then the war industries such as shipbuilding and munitions plants have closed, or are diminishing. Nursing staffs have likewise diminished, and the num-ber of industrial nurses has gone back to a peace time level. As for the future, some industries are planning expansion for peace time production. They have indicated that they intend to em-ploy a nursing staff as soon as nurses are available. One large plant has employed a staff of nurses to visit ill absentees in the hope that absenteeism may be controlled. Five small industries have employed nurses within the past year, which indicates a recognition, on the part of industrialists, of the value of nurs-ing service. In the past, industrialists have had no assistance in securing nurses, but when Counseling and Placement service has been worked out in North Carolina, there will be a definite plan whereby a nurse may be guided to positions which are available. Both nurses and employers will benefit by this service. There is more guidance and inspiration for the industrial nurse of today. In the past feu-years the American Association of Industrial: Nurses has been organized. Many North Caro-lina nurses have joined this organization. There is an Industrial Nurses Section of the N.C.N.A.; also, there are four local Industrial Nurses organizations in the State. More litera-ture is being printed on the subject than ever before. Articles appear regularly in all nurses. periodicals, and a monthly magazine is printed exclusively for the benefit of industrial nurses. Educationally, there is more promise for the future. Formerly, nurses who were employed by industry learned through the trial anJ error method. Some have developed excel-lent programs which are entirely satisfactory. Young nurses who plan to work in industries will be able to have a course in industrial hygiene and thus be better equipped when they enter this field of nursing. Several col-leges and universities are offering courses of training in industrial nursing. A plan is being considered whereby courses may be offered over the entire United States in Public Health Schools, including our own Public Health School at Chapel Hill. The plan includes both short courses and longer terms of stud} which would entitle the student to a degree. Some of the newer trends which are deve- •Paper presented at the annual convention of The North Carolina State Nurses Association and of the State League of Nursing Education. Winston-Salem, North Carolina, November 7, 1945. January, 1946 The Health Bulletin loping are: a recognition of the need for positive health programs; better nutrition; medical control of diseases such as Tuber-culosis, Venereal diseases, and prevention of upper respiratory infections; digestive distur-bances; conservation of eyesight; improvement of plant sanitation; and adequate first aid. The importance of pre-employment exami-nations and follow-up work on defects, is being recognized by management. The em-ployee, who will become a cog in the organi-zational set-up, is expected to have certain physical capacities for work just as machinery must meet certain specifications. The day for first aid only, by the nurse, has passed. Her field of service has broadened. She recognizes the importance of referring employees to community health agencies, and local physi-cians, for services not provided by the indus-trial physician. The door of opportunity is open for those who wish to help raise health standards in the industrial population. What Do You Do? By Mary Ruffin Robertson Public Health Nurse Orange-Person-Chatham District Health Department " A RE you a graduate nurse?" "How Jl\. come you don't wear a white uni-form?" "Can you nurse in a hospital?" "Is you connected with the welfare department?" "Tell me, lady, just what do you do?" "What is your job?" These and many more just like them, are questions the Public Health Nurse hears quite often. For those of you who are not quite so familiar with the "woman in blue" I'd like to tell you just a bit about the Public Health Nurse. She is a graduate registered nurse who has had at least three years of basic hospital training with from one to three years of extra training in the field of Public Health. Public Health Nurses, or PHN's, do not wear white uniforms because they would not be practical in all the traveling they have to do. In this state, all PHN's wear navy blue uniforms with the white collars. Public Health Nurses are not connected with the welfare department in any way, but they do work closely with such organizations. As to the last two questions mentioned, teaching better health habits might be a good answer for some of our duties. Why not come with me a few days and see for yourself? Better still, why not share with me a few ex-cerpts from my diary? These are parts of a few days picked at random but maye they will give you an idea of what one nurse does. "2/19 . . . Stopped to ask a negro farmer where some of his neighbors lived. His white boss couldn't stand to stay out of the conversation and I was soon busy trying to get away from crops, weather, etc. . . . Inez is worried—her baby is nine months old and she is afraid she is 'caught' again . . . don't guess the county welfare department will be so happy about the whole thing since they are the family's whole support. "3/1 . . . Dora's baby is not gaining . . . we weighed it before and after nursing and decided it was getting enough milk. Urged she take it to her family doctor as soon as possible to find the trouble . . . Anna is expecting another baby and sent for the nurse to come by. She came to the pre-natal clinic before her other babies came and wants to come again . . . she can't remember whether this is the seventh or eighth! She wants some advice about plan-ned parenthood as soon as this baby is born. We will give this as soon as she asks for it. . . "4/10 . . . A young white boy came in yesterday with acute gonorrhea. Gave a fifteen year old as his contact. Visited her 10 The Health Bulletin January, 1946 and she came to clinic today and gave two more contacts—all under sixteen. Result: two cases of acute gonorrhea—high school students—wonder if we could prevent these by more sex education in our schools. . . . "5/14 . . . Jean is still in her body cast. Am so thankful her parents took her to crippled children's clinic when they did. She must stay in the cast for several months yet but the doctor says she will walk later. Showed her mother how to prevent pressure sores on her toes and heels . . . baby brother is gaining nicely. . . . "6/23 . . . Typhoid clinics have begun and I gave over three hundred vaccinations today . . . also gave some diphtheria toxoid and some whooping cough vaccine. . . . "7/25 . . . Quarantined baby for typhoid fever today. Have worked with sanitarian trying to find source of infection . . . have warned all possible cantacts . . . fluoroscopic clinic this afternoon . . . about thirty con-tacts and suspects to be fluoroscoped for tuberculosis . . . one active case admitted to sanatorium yesterday after a few weeks wait . . . showed family how to clean room and contents . . . unable to find family today, old record reads, 'turn right at Adkins barn' . . . am still wondering where Adkins barn is! '8/22 . . . Midwife classes arc always a problem but we must keep them under supervision . . . they teach us too! "9/20 . . .School is under way and so are our school clinics . . . Wish more of the children had attended pre-school clinic last spring. Made a visit to Clyde's home today to talk with his mother about the rupture we found on him at school exams last week. She promised to see her doctor soon . . ." Much more could be said about the duties of the PHN but perhaps from the few things listed here you now have an idea what a problem it is to answer "What Do You Do?" "Me - and You" By H. Lillian Bayley, R. N. Consulting Public Health Nurse North Carolina State Board of Health ARE you asking me! Do people ask you, as nurse, teacher, parent, minister or friend how to answer the everlasting questions about the stork, the pin-up girls, the priority sweethearts and the V-Mail brides? Perhaps you would like to read the story of how help with sex education has been given to parents and children in several coun-ties through library facilities and the Public Health Nurses. Several years ago the writer at a professional dinner sat next to Miss Marjorie Beal, Secretary and Director of the North Carolina Library Commission. During the conversation Miss Beal learned of the need for a traveling li-brary of technical books to be used by Public Health Nurses. Like rubbing Alladin's Lamp, within a few weeks with the help of Miss Mary S. Yates, Head of Traveling Libraries, the books were on their way to the nurses and have been circulating ever since. These books have been used by the nurses and some teachers in several counties: as a reference set for two formal extension courses on family living, by the Parent Teachers As-sociations of two large schools, and are no%v in use in a school whose teachers and Parent Teacher Association have read and approved the books for school use. There arc now more requests from nurses, teachers and health educators for the books than the supply af-fords. Because of the unfulfilled requests the Library Commission is adding two more sets of books on sex education, which are to be sent to local libraries upon the request of interested nurses or persons. The books will be January, 1946 The Health Bulletin 11 loft in the libraries for two months and may be taken out in the usual way by parents, young people and children with the assistance of the local librarian. Any group wishing to buy the set of books may do so for about $35.00. No book costs more than $2.50, and some pamphlets cost only 25tf. If each local county paper could reprint this article many more people would learn of and utilize the books. The following is a short description of most of the books: The New Baby by Bell, Evelyn S. and Foragh, Elizabeth; J. B. Lippincott & Company, East Washington Square, Philadelphia, Pa. A photographic book for children age three to five. The story is simply told and will assist parents to properly begin the sex edu-cation of their children. The Story of a Baby by Ets, Marie Hall; the Viking Press, 18 East 48th Street, New York. A good book for children from age four to eight. Drawings illustrate pre-natal growth and is of interest to children. Being Born by Strain, Frances B.; Appleton Century Company, 35 West 32nd Street, New York. Very well written for information on re-production, sex behavior and conduct for pre-adolescents and adolescents. The Wonder of Life by Levine, Milton I. and Seligman, Jean H.; Simon & Schuster, 1230 6th Avenue, New York. Simply written for pre-adolescents and ado-lescents. Love at the Threshold by Strain, Frances B., D. Appleton-Century Company, 35 West 32nd Street, New York. Especially for younger people who are look-ing forward to marriage. Petting, Wise or Otherwise by Clark, Edwin L.; Association Press, 347 Madison Avenue. New York. Relation of petting to sexual activities. Attaining Womanhood and Attaining Man-hood by Cowen, George M.; Harper Brothers, 49 East 33rd Street, New York. Two books written for boys and girls of age twelve to sixteen. Looking Toward Marriage by Johnson, Ran-dolph Pixley; Allyn and Bacon, 181 Peach-tree Street, Atlanta, Georgia. Especially interesting to high school age. Sex Adjustments of Young Men by Kirkendal!, Lester; Harper and Brothers, 49 East 33rd Street, New York. For young men and boys. Modern Marriage by Popenoe; MacMillan Company Questions Girls Ask by Welshimer, Helen; E. P. Dutton & Company, 300 4th Avenue, New York. Life's Intimate Relationships by Johnson, Tal-madge C; Abingdon & Cokesbury Press, Nashville or New York. An interesting book on the principles of better living. Opportunities In Public Health Nursing By Amy Louise Fisher, R. N. Supervising Public Health Nurse North Carolina State Board of Health A NUMBER of people have asked lately, "Now that the war is over, what is going to happen to all the Cadet Nurses the Government has been training? Will there be jobs for them all?" Yes, there is still a critical shortage of nurses in almost every field. There are more than 50 Public Health Nursing va-cancies in North Carolina. Another 75 jobs are now being filled by War Emergency Nurses, many of whom are expecting husbands 12 The Health Bulletin January, 1946 or sweethearts home and will be giving up their jobs when the men get back to the United States. A number of these War Emer-gency Nurses will want to stay in Public Health and will be given scholarships for the course in Public Health Nursing if they are eligible for this training. Even with the jobs all filled North Carolina has a ratio of only 1 public health nurse for 10,300 population. In order to meet the minimum requirements of 1 nurse per 5,000 population North Carolina will need approximately 350 more staff nurses and 55 consultants and supervisors. There are still 7 of the 100 counties that do not have health departments. If all of the people in North Carolina are to have the benefit of health protection in the form of services by an organized health department there will be room for many more nurses in public health nursing in this State. How may a nurse qualify as a public health nurse? Does the blue uniform she wears in-dicate that she is not a graduate nurse? No, indeed! The public health nurse is a graduate registered nurse. She must have a high school education; college work is desirable. She must have graduated from an accredited school of nursing and be eligible for matriculation in a college or university offering a course in Pub-lic Health Nursing approved by the National Organization for Public Health Nursing. This post-graduate course consists of a year of study. Scholarships are available through the State Board of Health. If you are a nurse and meet the requirements you will find an interesting and satisfying career in this field of nursing. If you are still in high school or college and considering nursing be sure that you select carefully and wisely the school of nursing so that when you have finished the three years of training you will be able to enter any field of nursing you may choose. Advice and help will be given you gladly by Miss Bessie Chapman, Secretary of the State Board of Nurse Examiners, or by Miss Vir-ginia Miles of the North Carolina Counseling and Placement Service. Their offices are located at 415 and 419 Commercial Building, Raleigh, North Carolina. The Counseling and Place-ment Service is a new project of the North Carolina State Nurses Association, which was begun January 1. You may wonder why it is so important for a girl who wants to become a public health nurse to select a good nursing school and then to have post-graduate work in public health nursing. She who enters this field needs the best possible preparation because she must be both nurse and health teacher. Like odier nurses she aids in treatment, but her chief concern is prevention. She promotes the physical health of her patient and in addition his mental, social and emotional well-being. She needs to know and bring together all community resources needed for helping solve the social and economic problems that are so closely allied with sickness. The public health nurse needs to like people and know how to get along with them because her work brings her in contact with all sorts and kind of people—in homes, in schools, in clinics and in-dustrial groups. She works closely with phy-sicians, hospitals, health and welfare agencies. The opportunities for service are varied enough to make life interesting and to demand the best a nurse has to give. Public health nurses are doing everything possible to see that babies get the right start in life—this includes seeing that the baby is wanted and planned for—that the mother gets good care before and after the baby comes, either by her family physician or in a clinic. The nurses participate in the program of preven-tion through immunization for whooping cough, diphtheria, smallpox and typhoid fever. They play an important part in all commu-nicable disease control including tuberculosis and venereal diseases. They offer health super-vision for infants, pre-school and school child-ren and work with adults. Many public health nurses find work with crippled children one of the most satisfying services they can offer. In short, public health nursing includes any-thing that will help promote the health and welfare of all the people in the State. Nursing is a proud profession, and Public Health Nursing is one of the most interesting and satisfying fields of nursing. January, 1946 The Health Bulletin 13 Amanda Bunch - Midwife By Ida H. Hall, P. H. N. Wake County Health Department Raleigh, North Carolina AUNT Amanda died last week after forty-one years service as midwife in one community. It seems a pity that the story of Aunt Amanda was not written while she was alive, she would have been so proud of it. She was proud to be a midwife and she had a record to be proud of, and of her starched white mop-cap and apron that she always put on a-fresh when-ever she went out except-ing for church. The records kept since 1934 show that she delivered more than a thousand babies during this time. In one month in 1937 she had thirty deliveries and helped a doctor on two more. She 'helped-out' the doctors and they helped her out, and when she had to call a doctor he never delayed. Every doctor seemed to feel the same respect and personal affection for her and during her illness this last year they voluntarily gave her their best attention. Three fully equipped bags were kept in order by her and a good supply of extras for emergencies were folded away in a trunk. Sometimes she cared for three deliveries in twenty-four hours often she had several slow cases on at the same time and would shuttle between them. She appreciated her importance through-out several townships and in ad-joining counties and she felt apologetic when she missed a call, not because she lost a fee, but felt as if she had let someone down. Some-times she would grumble when she saw a man wasting money while in debt to her and once in a while employed a collector. She said there were no hard feelings but folks shouldn't get too careless. At Prenatal Clinics she was welcomed by everybody and the Clinician treated her as an equal and had her feel and listen to interest-ing conditions. She often said that she was still learning. The doctor would often have a little chat with her on the side regarding their latest fishing luck. No home was too poor and dirty for her to do a good job, leaving the patients neady fixed up and in a good state of mind. Her automobiles were not much satisfaction to her as she never tried to drive and her grand-sons took them out, got drunk and wrecked them and then sent for her to bail them out of jail. She was mighty proud that her friends lent her the needed money so ^cheerfully. Aunt Amanda had something that few peo-ple have, an extra sense of understanding that did not require going into detail. She said little, listened and observed closely and spoke everybody's language. Her success was re-markable. Her skin was the color of a new penny. There was a little hump in her nose and she thought she was part Indian. Her seventy-four years were full of hard work, self sacri-fice and charity for all. Love and esteem were expressed by the immense crowd including many white people that attended her funeral and heaped her grave with flowers. 14 The Health Bulletin January, 1946 Exhibits By H. Lillian Bayley, R. N. Consulting Public Health Nurse North Carolina State Board of Health SURVEYS! Surveys! Surveys!! How about making exhibits to show the general pub-lic what has been happening in your county? Any interested group could secure the neces-sary information from their local county health department. Several attractive Lanham Act health de-partment buildings have had formal open-ings during the past three years, and at some of those health department functions exhibits of the content and results of the personnel's work was shown. The interest of the visitors in the exhibits was a surprise, even to the health department personnel. Realizing that there is a need for child health planning in the post-war world, the American Academy of Pediatrics is under-taking a national study of child health facil-ities services. The U. S. Public Health Service and Children's Bureau are cooperating as mem-bers of the executive committee. North Caro-lina has been chosen as the first state and the study is already underway, sponsored by the North Carolina Pediatric Society. The North Carolina State Board of Health is throwing its full cooperation behind the study. Lay and official agencies have been informed of this survey which to quote, "The survey will cover the extent and quality of such services as child health conferences, school health services, medical care programs, immuniza-tion services, child guidance services and pub-lic health nursing." It is hoped that by know-ing of the study, groups will become interest-ed in child health in their own community. How about making one or more of the following exhibits to show the health prob-lems in your county? Maternity Poster Show the number of new mo-thers in your county during 1944 or 1945 by using a poster with similar figures to that in the mar-gin for each new mother. This will cover about 3x5 square feet according to the number of mo-thers represented. Building board is best and cheapest for the poster board, and pink is a good color for the figures, which may be printed in sheets. In comparison, show the num-ber of mothers under medical care, mothers under private medical care, and health department sup-ervision should be counted. This will cover a smaller space than the total mothers. Blue is a good contrasting color for these figures. In the last space show figures in solid black to denote the mater-nal deaths during the year. a January, 1946 Infant Poster Show the number of new babies in your county during 1944 or 1945 by using a large poster board and pink figures like that in the margin for each live birth. In comparison, show in blue fig-ures the number of babies under medical care by private physicians k- or health departments. In solid black figures show the number of infant deaths under one year during 1944 or 1945. The Health Bulletin 15 Immunization Poster Show number of babies under one year carried to clinics or priv-ate physicians to be immunized against whooping cough during 1944 or 1945. These figures may be in yellow, and one figure should represent one immuniza-tion. In similar manner show by pink figures the number of babies vac-cinated for smallpox. By blue figures represent the babies im-munized for diphtheria. This poster should be shown in combination with the infant poster. For the pre-school age show \ f) figures like the one in the mar-y gin. Show yellow figures for whooping cough immunization, pink figures for smallpox vac-cinations, blue figures for diph-theria immunizations. Nursing Visits A poster showing number of Public Health Nursing Visits to prenatal cases, to infants, to pre-school children and instructive visits for immunization should be of real interest to the public. Samples of the colored figures in mimeo-graphed sheets of about twenty-four figures to a sheet may be procured by writing the Mailing Room of the North Carolina State Board of Health. Henry Flud Campbell, age 22 months, son of Mr. and Mrs. John H. Campbell, Reedville, Virginia. The Mother, the former Miss Theo-dosia Flud, is remembered pleasantly as a public health nurse in North Carolina. The Premature Infant By Mabel Patton, R. N. Consulting Public Health Nurse North Carolina State Board of Health HOW many premature babies were born born in North Carolina in 1944. Of this in your county last year, last month? number approximately 4,524 were premature. Vital Statistics show that 90,481 babies were Many of the babies who die under one month 16 The Health Bulletin January, 1946 of age are born prematurely. These infant deaths should be of concern to everyone in North Carolina. You should be interested in knowing not only how many stillbirths and maternal deaths occur in your county, but also the number of babies born prematurely. If your family was one of the homes to which a premature baby was born, did you report it to your County Health Department: Your Health Department is anxious to give special assistance to families in the care of premature infants. Three points must be kept :n mind constantly when caring for a pre-mature baby 1. To keep the baby warm 2. To protect him from infection 3. To feed him properly A simple premature bed is necessary in caring for the infant. A pasteboard box lined with screw top bottles (pint size) filled with warm water may be used temporarily in the home or for transporting the baby to the hospital. If any of you develop a premature bed that proves to be adequate and practical, please share your plans with the Division of Maternity and Infancy, State Board of Health, Raleigh. The Children's Bureau, Washington, D. C, is also interested in our problem and gave us the following helpful suggestions: Suggestions In Regard to the Care of the Premature Infant In the Home 1. Preparation before birth of the infant. The following equipment should be ready for the baby's birth: a. A warm blanket and heated bed (80°- 90 °F.) for reception of the infant. b. A rubber bulb (ear syringe) for aspira-tion of mucus. (Necessary stimultants will be prescribed by the doctor.) 2. Provision of space for care of the infant in the home: a small, separate room is pre-ferable; room temperature at 75°-80°F. day and night. 3. The following individual equipment is needed for care of the infant: a. Rectal thermometer. b. Feeding equipment—medicine dropper and glass, small nursing bottle. (Use aseptic technique in preparing the in-fant's feeding. Boil all utensils 10 min-utes in a covered container.) Covered pail for soiled diapers. Oil and cotton. 4. Special measures for protecting the infant from infection. a.' Nurse to wash hands with soap and run-ning water — (1) Before handling infant. (2) Before feeding infant. (3) After diapering infant. b. Person caring for the infant must wear a c. d. clean gown or apron. (No one with respiratory or other infections should care for the infant.) c. Keep all members of the family who have infections (respiratory or skin in-fections or diarrheal diseases) away from the baby and exclude all visitors and all children. d. Keep mosquito netting over the bassinet or incubator, if it is of the open type. e. See that the baby's room and furniture are clean. (1) Floors must be mopped with a damp mop. (2) Furniture must be wiped with a cloth. (3) No sweeping of floors or dry dust-ing of furniture should be allowed. 5. Care of the baby's skin. It is not considered desirable to bathe a premature baby with soap and water or with oil for the first 24 hours after birth. He need not be bathed for a week or 10 days or longer. Apply mineral oil gently to folds of skin in soiled areas when changing diapers. 6. Directions should be obtained from the physician caring for infant in regard to meth-od, type, and interval of feeding. Bottles must be held by an attendant; an infant fed in the incubator should be fed with his head and shoulders elevated. ARt mm j This Bulletin will be sent free to any citizen of the State upon, request I 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 Boa'rd, Raleigh, N. C. Vol. 61 FEBRUARY, 1946 No. 2 Walkways that Lead from the State Laboratory of Hygiene to the State Board of Health MEMBERS OF THE NORTH CAROLINA STATE BOARD OF HEALTH S. D. CRAIG, M.D., President Winston-Salem J. N. JOHNSON, D.D.S., Vice-President Goldsboro G. G. DIXON, M.D Ayden H. LEE LARGE, M.D Rocky Mount W. T. RAINEY, M.D Fayetteville HUBERT B. HAYWOOD, M.D Raleigh J. LaBRUCE WARD, M.D Asheville J. O. NOLAN, M.D Kannapolis JASPER C. JACKSON, Ph.G _ Lumberton 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. J. ROY HEGE, M.D., District 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. C. P. STEVICK, M.D., Director Division of Epidemiology and Vital Statistics J. M. JARRETT, B.S., Director Division of Sanitary Engineering. T. F. VESTAL, M.D., Director Division of Tuberculosis WILLIAM P. JACOCKS, M.D., Executive Secretary, Nutrition Service of the State Board of Health MR. CAPUS WAYNICK, Director, Venereal Disease Education Institute. E. H. ELLINWOOD, 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 Epidemiological 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 Privie* 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 Time Cards: Under 5 months; Prenatal Letters (series of nine 5 to 6 months; 7, 8, and 9 months; 10, 11, monthly letters.) and 12 months; 1 year to 19 months; 19 The Expectant Mother. months to 2 years. Breast Feeding. Diet List: 9 to 12 months; 12 to 15 months; Infant Care. The Prevention of 15 to 24 months; 2 to 3 years; 3 to 6 Infantile Diarrhea. years. * Table of Heights and Weights. Instruction for North Carolina Midwives. CONTENTS Page 1946 Public Health Objectives 3 Reconversion of the Family—A First Post-War Task 5 A Comprehensive Program for Nation-wide Action in the Field of Nursing 7 Accidents 9 Notes and Comment 12 Vol. 61 FEBRUARY, 1946 No. 2 CARL V. REYNOLDS, M.D., State Health Officer JOHN H. HAMILTON, M.D., Acting Editor 1946 Public Health Objectives By Carl V. Reynolds, M. D. Secretary and State Health Officer North Carolina State Board of Health -yrrrE have crossed the threshold of a \\ new year. We have heard many sentiments expressed about 1946, some of which have been repetitions of what we have been hearing all our lives. There are certain stock phrases that are taken from the trunk of remem-brance every Christmas, New Year's Day, Fourth of July—and so on—and then put back into the moth balls for future use. But, like Christmas tree bulbs, they sometimes burn out, and it would be fortunate if some of them could not be replaced. Sentiment has no place in the begin-ning of a new year. We might as well be realistic about the matter. Thread-bare phrases, like threadbare fabric, will not stand the test of rough usage. No new year should be treated like the newborn babe it is all too often pictured to be. It should hold the ac-cumulated experiences of the past, and these experiences should be translated into action that in no sense resembles child's play. As we enter 1946, there is probably no better admonition for us than that given by the poet Richard Home: "Be rigid, plowman; bear in mind Your labor is for future hours. Advance, spare not, nor look behind! Plow deep and straight with all your powers!" We must know the past to appreciate the present—and to prepare for the future. But we must not live in the past. To do so is to display evidences of senility. To look ahead is an evidence of youth, vision, and vigor. In no field is an appreciation of the value of future responsibilities more essential than in the field of Public Health, which is dedicated to human betterment. For the future, we must have definite objectives. The world will no longer be satisfied with vague gen-eralities. We have just waged a war for the preservation of the fundamental rights of mankind; but these fund-amentals, if they are to prove worthy of the price we paid for their preserv-ation, must be put to work for human betterment and must be a part of any peace formula we adopt, if that formula is to endure. We have laid the foundations of Public Health. These foundations are solid and, we believe, enduring, but unless we build a suitable superstruct-ure, our efforts will have been put forth in vain. We in North Carolina propose, among other things, to so enlarge our program for the eradication of syphilis that it will reach those suffering with neuro-syphilis, fifty per cent of whom, if neglected, become fit subjects for our mental institutions—wards, rather than citizens, of the State. If properly treat-ed, 85 per cent can be restored to useful citizenship. This expanded program will be launched when suitable space is secured. Moreover, we will make a survey of certain groups covering the entire pop-ulation of these groups, for the diagno-sis and treatment of early, latent, and late latent syphilis, with a view to cur-ing promptly those that are curable and treating those suffering with neuro-syphilis as their condition may indicate. The Health Bulletin February, 1946 The time for resolutions concerning this and associated problems has pass-ed. The time for action is here. We propose also to make considerable headway during the year 1946 in a state-wide survey, to locate the un-known cases of tuberculosis and to secure, as nearly as possible, a complete picture of the tuberculosis situation in North Carolina among the body politic, with a view to the adoption of remedial measures. We are prepared and equip-ped for such an extensive survey, which will begin as soon as shipments of the means for carrying it out arrive. The object, of course, is to make hospitaliza-tion available for all open, or infectious cases, in order that we may prevent carriers from giving the disease to others. At the same time, we propose to give the sick the opportunity of be-ing restored to health. In the matter of cancer control, we are ambitious to start, as early as pos-sible, clinics where we can have special-ists ready, at definitely located places, to examine all cases, regardless of race, creed, or economic status, to determine the presence of cancer, with the fervent hope that ways and means will be found to have these cases diagnosed and treated promptly, thus making a valuable contribution to prevent the patients from reaching the incurable stage. Research, of course, will con-tinue— but the disease in its early and curable stages should, at the same time, be diagnosed. We should not await the results of research, but move swiftly to effect those cures that can be made with the knowledge which we already possess. Hence, the necessity for ade-quate diagnostic clinic facilities—now. It is heartening to note that, as this is being prepared, the United States Senate already has passed what is known as Senate Bill 191, which would provide Federal aid to the States for expanded hospital facilities, public health centers and better medical care for all people. The measure now goes to the House of Representatives, and it is to be earnestly hoped that it soon will have passed both branches of Con-gress and be ready for President Tru-man's signature, to make it become law, in order that it may be put into effect speedily. Passage of this measure will advance medical care at least ten years and pro-vide all our people with services to which they are entitled but which they have never, up to this time, enjoyed. By the enactment into law of this measure, many more of our doctors will be able to practice medicine as it should be practiced, that is, in well equipped hospitals and with consul-tants conveniently and immediately available. My earnest hope is that the people, as individuals, will become less indiv-idualistic and have a part in public health advancement, being sufficiently interested to analyze the health needs of the communities and of the State as a whole, and then insist on the appropriation of funds sufficient to meet these needs. This is a matter in which our return-ing service men can render assistance as citizens of the Republic they fought to preserve. As members of the armed forces, they were provided with pro-tective measures and given the best medical care, even though, in many instances, it was necessary to curtail medical facilities available to the civil-ian population. This was as it should be—but it should not be forgotten that those who fought our battles abroad are also citizens at home. Not only should they continue to enjoy the de-gree of medical care that was provided for them while in uniform, but they should insist on its continuances now that they are back home—not only for themselves, but for their mothers, fa-thers and other family connections who were not called upon to fight, as they were. We protected our service men, in order that they might fight and die, if necessary, to save us. We should con-tinue that protection, in order that they may live the more abundant life they fought to insure. A merciful Providence, together with vigilance on the part of Public Health workers and those engaged in the priv-ate practice of preventive and curative medicine who remained to work on the home front, saved us from serious or widespread epidemics while the fate of civilization hung in the balance. Every citizen in this government of the people, for the people and by the people, is entitled not only to life, lib-erty and the pursuit of happiness, but also to good health, in order that he or she may be physically and mentally fit to enjoy these unalienable rights Febt^uary, 1946 The Health Bulletin and compete for their rightful place in the world. Abraham Lincoln declared this na-tion could not survive half slave and half free. Neither can it reach the highest peak of potential efficiency half sick and half well. Let each of us, therefore, determine that during 1946 we will make our con-tribution toward ushering in an era not only of lasting peace, but of good health, on a permanent basis. The hospital and medical care we need cannot be provided without the necessary funds. Therefore, it is in-cumbent upon those who provide the tax dollar to insist that a sufficient amount of revenue be appropriated to insure health as a basic right and not as a charity. # Reconversion Of The Family- A First Post -War Task ALL through history, even when society broke down, the family remained intact. A new society was built upon the remaining family units. The German High Command, in their study of history, recognized this fact and throughout the war did everything possible in the conquered countries to destroy family life and thus make the re-establishment of a strong society a much more difficult problem. How well they succeeded is being dis-covered in every country of Europe, including the blasted remains of their own land. The chaos of these postwar years will continue until family units can be re-established in every country and family loyalties reaffirmed. Even in this relatively untouched America of ours, the family has been put to a stern test during four long years of war. The drafting of fathers, the break up of families when both parents engaged in war work, the loos-ening of family ties when mothers gave up their home tasks and concentrated on being nurses' aides or air raid war-dens or war bond solicitors weakened the forces of the family in our Nation's affairs. Reconversion of the Family The first big postwar task is recon-version of the family and the re-estab-lishment of family ties. The returning veteran may find difficulty in settling down with his wife and children. The woman war worker may give up her high wages and go back to her husband and her children with a feeling of be-ing let down. Young people who have left school to make big wages in the •Reprinted by permission from BRIEFS, Maternity Center Association. 654 Madison Ave., New York 21, New York. war plants may not want to return to their scholastic life and the usual peacetime disciplines of family living. Venereal disease is rife among young people of marriageable age. Restless-ness, lowered moral standards, lack of adequate housing, strikes, insecurity a-bout the future—all these tend to weaken family ties and the home there-fore loses much of its vital force which is so necessary to the stability of our society. A Challenge to United Efforts This gloomy situation should not be a cause for defeatism. The family is tough and resilient. It has great come-back powers. The situation is a chal-lenge to education, religion, medicine, public health and allied fields. We in obstetrics are in an unique position — for the coming of babies can be one of the strongest ties in knitting families together. We are operating at the very center and core of our Nation's vitality and strength. We need no reconversion policies, nor do we have thorny roads back to peacetime activities. Our task is to stay on the same course which was charted nearly thirty years ago. Even the war did not affect the chief goals of obstet-rics. Just after Pearl Harbor, the Ma-ternity Center Association was contin-ually asked the question, "What will your war work be?" Our answer was firm and sure for we knew exactly what should be done during those days of severe national crisis. We answered in the January 1942 issue of BRIEFS as follows: "We will sit at the bedsides of the women in labor as we continue to train more women in midwifery to send out to rural areas; we will teach The Health Bulletin February, 1946 the mothers and fathers who are having babies how to be good parents, how to make the most of their fam-ily living; we will continue to provide the best techniques, the best short cuts in maternity care for nurses and other workers throughout the United States. We will keep the home fires burning. "As we list for these enquirers the things we will do in this war, their . interest lags. We could be discouraged until we remember that thousands of strong, vigorous, confident boys who man our anti-aircraft guns in 1942, who fly the planes, who build the tanks, who launch the ships, are the babies we took care of in 1917." That was true of everyone who work-ed for better maternity care during those bitter years before and during World War II. The wartime job was well done despite the dislocations of medical, nursing and hospital care. Ma-ternal mortality was driven to the low-est point in history, while our national fortunes were at the lowest ebb. Many mothers were saved for their families so in need of their loving care and a firm hand on the tiller while Dad was away. Good maternity care protected the family. That is just as true today. There is no need to change bearings on our postwar course. If we carry our knowl-edge about obstetrics into the far cor-ners of the land and to every mother in the most remote nooks and crannies of big city and country crossroads alike, we should soon come to the time when there would be no NEEDLESS mater-nity deaths. But the putting into practice of this knowledge alone will not provide the best contribution which obstetrics can make to stronger family life in the United States. The progress we have made in the past three decades espe-cially has been based on the prevention and cure of pathological conditions. If we are to make the most of our oppor-tunities in strengthening family life by means of maternity care, we must do more than merely prevent disease. We must promote health, not only of body but of mind and spirit. Today's life-saving maternity care offers very little to the expectant par-ent in the way of education for family living or for positive teaching of any kind. A mother goes to her doctor early in pregnancy, often in response to our educational efforts. Frequently she goes in fear, expecting the doctor to examine her from head to toe—looking for path-ological conditions. This he does, and in addition, he asks many questions about her illness history since she was a child. She goes in trepidation because she fears the doctor will find some-thing wrong. His conversation with her may be chiefly concerned with ques-tions and advice about physical things such as spots before the eyes or blood pressure or bowel movements. She comes home dishevelled not only in coiffure and dress, but also in mind and spirit. The inner radiance which first came upon her when she knew that she was going to have a baby may have been dampened or dispelled by such an attitude. Here at one of the moments in life when a person is most teachable, the opportunity of teaching is let slip by. In obstetric care, we are not dealing with one isolated woman in an isolated moment of time, but with a human be-ing with family ties, hopes desires, fears, upon whose health and happiness the health and happiness of other peo-ple depends. We cannot glibly repeat the old adage that the coming of a baby will weld her home more closely together. It can do just the opposite if parents are untaught and unprepared for the physical and emotional expe-riences during pregnancy, at labor and afterward. That is why we in obstetrics hold the key to the strength or weakness of many families whose children are now being born under the tensions and un-certainties of a chaotic era in history. We have knowledge, which when ap-plied, can build great security, but we are not putting it to work in people's minds and hearts. We have the knowledge about how babies come, how they are conceived, how they grow within the mother's uterus and are born. We know about planning for the coming of babies. We know about the physical and psychol-ogical problems of marital adjustments —and we know some of the answers. We know how to fit the new baby phys-ically and psychologically into the fam-ily. We know that the joyful coming of a baby depends upon attitudes and habits created in the formative years — February, 1946 The Health Bulletin % long before a young person becomes an expectant parent. We know all this and more and we know it should be taught to young peo-ple BEFORE they are married. We know that it isn't taught. We sit back and bemoan this condition, but do very little about it. Prudery is still the great-est enemy of progress, of constructive, positive teaching in the field of obstet-rics, and will continue to block the dissemination of this essential infor-mation for sound family living until a concerted effort is launched to blast it forever from its entrenched position at the crossroads of public opinion. When the taboos are blasted and young people learn these facts and put them into practice in their own family living, the happy story portrayed in the pictures in this issue of BRIEFS will be the usual result. First, expec-tant parents plan together for the com-ing of the baby. They work out their family budget, with items for doctor, nurse and hospital and they select the best medical and hospital care within the power of their pocketbook. The wife goes to the doctor not in fear and trepidation but with confidence, know-ing that he is well trained and expe-rienced and together they work out her prescription for living. Then the months quickly pass and the mother is well instructed on how she should live, what she should do, what she should eat at different stages of pregnancy. Father, on the other hand, goes to class or reads a good book which fits him for the changes that are coming in his relationship to his wife. When the baby comes, father fits into his place without friction or jealousy and he can carry his share of the responsibilities in the care of the baby. Under such an attitude, we de-velope an understanding team of doc-tor and nurse, mother and father, and we help to build strongly and well another family unit which will con-tribute to the strength of our Nation in the years ahead. A Comprehensive Program for Nation-wide Action in the Field of Nursing * Introduction THE outline of a comprehensive pro-gram for nationwide action in nursing is the outgrowth of a war pro-gram of cooperative activity which nursing organizations have carried on since 1940. As the war has progressed, they have become increasingly aware that coordi-nated action in nursing will be quite as important during the post-war era as it has proved to be during the war pe-riod. Each national nursing organiza-tion set up its own Planning Commit-tee. All have recognized, however, that the nursing profession could make its leadership most effective by developing a comprehensive program. As a first step, the National Nursing Council for War Service appointed a Committee on Domestic and Postwar Planning in November 1943. In April 1944, this Committee became the National Nursing Planning Com- •Prepared and issued by the National Nursing Planning Committee of the National Nursing Council for War Service, Inc., 1790 Broadway, New York. mittee. The Committee is now compos-ed of the presidents, executive secre-taries, and planning committee chair-men of five national nursing organiza-tions; representatives from the Amer-ican Association of Industrial Nurses and the National Association for Prac-tical Nurse Education; directors of the nursing divisions of the American Red Cross and of certain federal agencies; and the chairman and executive secre-tary of the National Nursing Council for War Service. At its initial meetings, the Committee outlined ten objectives toward which nursing activities should be focused. It defined five areas in which programs for study and action should be develop-ed. These areas are: 1. Maintenance and Development of Nursing Services (in hospitals, sanatoria, and other institutions; in private practice; in public health and industry; and in other fields) 2. A program of Nursing Education (Professional—basic and advanced— and practical) The Health Bulletin February, 1946 3. Channels and Means for Distrib-ution of Nursing Services 4. Implementation of Standards (including legislation) to Protect the Best Interests of the Public and the Nurse 5. Information and Public Rela-tions Program To provide a basis for coordinated activity in these areas, individual plans and suggestions were made by all mem-bers of the Committee for incorpora-tion into one composite program. Before preparing the outline of this program, all the proposals presented were carefully studied. Many duplica-tions appeared. These duplications are significant because they indicate the extent to which the individual organ-izations are aware of problems in their own fields which are common to all fields of nursing. Also significant is the emphasis placed on the need for urg-ency in getting work under way. The individual plans, broadened sometimes to cover all fields of nursing instead of merely the ones in which particular organizations are interested, fitted easily into the four areas of study and action. The final composite pro-gram incorporates plans and sugges-tions made by all the organizations and interests represented in the National Nursing Planning Committee. The pro-gram relates to all nurses—professional and practical, Negro and white, men and women. The composite program takes into consideration the increase in the re-sponsibilities shouldered by professional nurses as a result of the war emergency and the effective use which has been made of practical nurses, other paid workers of various types, American Red Cross Volunteer Nurses' Aides, other volunteers, WACS and WAVES. It rec-ognizes the increased need for well-prepared nurses which will result from the expansion of hospital and health facilities proposed by the U. S. Public Health Service, the plans of the U. S. Children's Bureau for increased activ-ity in maternal and child health, the necessary enlargement of Veterans' Fa-cilities (particularly in psychiatry and tuberculosis), and the probably inclu-sion of home nursing in medical care insurance (voluntary and government-al). It points out the need for study to overcome the gaps and inadequacies in prewar nursing service and nursing education which war demands have highlighted. While the outline may not mention specifically every phase of the nursing problems on which one organization or another considered study and action necessary, these are, nevertheless, cov-ered by more general statements. For example, several plans emphasize the need for more specialists in nursing — in public health, in psychiatry, in tub-erculosis, in obstetrics, in teaching and supervision, and in other fields—and for the development of more and better programs for the preparation of such specialists. The importance of prepar-ing nurses to carry on the many special techniques and procedures that are a part of modern medical treatment was also stressed. Some projects are national in scope, as for example, accreditation, curric-ulum revision, and the study of selected aspects of nursing education. Others, like the counseling and placement bu-reaus, will be developed nationally, re-gionally, and locally. The nursing serv-ice bureaus and the community nurs-ing councils are primarily community projects, to be stimulated and guided by the national organizations. The outline does not go into detail; the statements and phrases under each section are often no more than sugges-tions of plans or ideas which can be developed according to the ability, imagination, financial resources, and enthusiasm for community welfare pre-sent in each responsible group. It is believed that the program is sufficiently flexible to permit development of in-dividual projects within each area, or within one or more areas, sometimes as units of a larger study, sometimes separately. Some part of each section may be started without delay. No in-dividual project needs to wait for the initiation of the program as a whole. A number of projects, in fact, are al-ready under way or have been active for several years; some are being ini-tiated; others are still to be undertaken. The composite program represents the expansion of existing projects consider-ed necessary for effective progress, to-gether with the introduction of new projects which must be undertaken if present and future needs in nursing are to be met satisfactorily. February, 1946 The Health Bulletin OBJECTIVES (Approved in principle September 16, 1944) The professional nursing organiza-tions have established the National Nursing Planning Committee as a co-ordinating body to plan and promote a five-year program for nationwide ac-tion in the field of nursing. Effective implementation of this pro-gram will enable the profession to pro-vide and maintain a high level of nursing service wherever it is needed. To achieve these objectives within the next five years, the following action will be taken: 1«. Determination of the needs of the nation for nursing care. 2. Determination of the number of nurses required to meet immediate needs for all types of nursing care. 3. Provision for meeting additional needs as social programs advance. 4. Education of nurses to give the best service which current scientific knowledge makes possible. 5. Promotion, development, and adoption of personnel policies and practices which will be satisfactory to employer and employee, and will ensure remuneration commensurate with the services rendered to society. 6. Promotion and support of plans to assure nursing care to all who need it, through an equitable distribution of the service cost. 7. Promotion, development, and es-tablishment of standards to guard the public and the nurse. 8. Development of public under-standing that the essential part which nursing plays in healing the sick and promoting positive health warrants use and support of a com-prehensive community nursing pro-gram. 9. Development of a progressive program of information to help nur-ses understand and accept their re-sponsibilities and opportunities. 10. Support of the program outlined without regard to race, creed, color, economic status, or geographic loca-tion. STATE AND LOCAL DEVELOPMENT OF THE COMPREHENSIVE PRO-GRAM IN NORTH CAROLINA Plans of the program were discussed at the annual convention of the North Carolina State Nurses* Association in Winston-Salem, November 5, 6, 7, 1945. The Board of Directors recommend-ed, and the recommendation was acted upon; that the outline of "A Compre-hensive Program for Nationwide Action in the Field of Nursing" be studied on a district basis by special committees of each district and lay representatives. That: The North Carolina Nursing Council for War Service be discontin-ued and that the work of the Council be delegated to the Post-War Planning Committee of the North Carolina State Nurses' Association, and that the mem-bership of this committee be expanded to include representatives from other professional organizations and lay groups. A complete outline of the pro-gram was printed in the September, 1945 issue of The American Journal of Nursing. Mrs. Louise P. East, Consult-ing Public Health Nurse, is Chairman of this Post-War Planning Committee of the North Carolina State Nurses' Association. Accidents THOSE of us who are interested in conserving human life are distress-ed at the heavy toll which accidents take in deaths and serious injury. In the few months since the end of the war automobile accidents have increas-ed some 40%. It is not known just what part unlimited gas and the increase in speed limit has played in this up-surge of highway accidents. Antiquated ve-hicles and their poor mechanical con-dition also enter into the picture. An-other factor which cannot be overlook-ed is the "devil-may-care" attitude of our people. With the coming of winter the weather will also contribute mark-edly to the hazards of highways and streets. We, in North Carolina, should heed the timely warning issued by the Connecticut State Department of Health, which reads as follows: Open Garage Doors Before Starting Engine With the coming of colder weather the annual warning against carbon monoxide is in order. 10 The Health Bulletin February, 1946 This gas is ordorless and colorless, so unless special warning is at hand the careless person is apt to think noth-ing of it. Carbon monoxide—CO to the chemist, is present in the exhaust gases from the family car. Although this gas is present at all times, usually garage doors are flung open and re-main so while the engine is being warmed up for a quick get-away. But when the mornings turn cold there is more tendency to close garage doors and so allow these exhaust gases to accumulate. This is especially dan-gerous in a small garage. Even a small car in a closed garage will generate enough carbon monoxide to render a person helpless. The action of carbon monoxide is insidious. It has a stronger affinity for hemoglobin than has oxygen, so the oxygen is quickly displaced leaving the hemoglobin without power to carry needed oxygen to the tissues. This change will have come about without being apparent to the person. At first a slight headache or muscular weakness may be noticeable, though the victim may not feel the effect of this until he starts to move or exercise, when he becomes helpless and falls. He soon be-comes unconscious and death may fol-low rapidly unless he is removed quick-ly to the open air for first-aid resuscita-ti TAKE IT EASYi svtaoef NATtONAl SA«TY COUNCJl IITAKE IT EASY" •toe?INCAN is on; tion measures which should include the use of an inhalator from the nearest available station. Play Safe To avoid this treacherous and deadly gas, observe the simple procedure of opening your garage doors before start-ing the engine, and keep them open until the car has been driven from the garage or the engine stopped. Further-more, be sure that your garage doors are equipped with substantial hardware to keep them open even in the face of a brisk wind. Cold weather warnings should also be heeded in the case of closed car windows. No car with engine going should be entirely closed no mat-ter how low the temperature outside. Carbon monoxide may be present in the exhaust gases which have seeped through the car because of some defect in the exhaust system. With proper ventilation in the car, the minute a-mount present would cause no ill effect, but with windows closed an accumulat-ed amount may be enough to jeopardize the health or even life of the occupants. Be sure and keep car window open while driving. Guarding Against Home Accidents Each year the lives of many thou-sands of men and women in our coun-try are needlessly sacrificed in home February, 1946 The Health Bulletin 11 accidents because ordinary, common-sense safety precautions are not ob-served. This tragic fact stands out in bold relief from an analysis of last year's death records. It is a curious fact that a consider-able majority of those who suffered fatal injuries in and about the home were not engaged, at the time the in-jury was sustained, in tasks necessary for the maintenance and operation of the household. This was the case in about two thirds of the fatalities among women and in four fifths of the fatal-ities among men. In many of these in-stances the person was merely walking from one room to another, or up or down stairs, relaxing on a chair or couch, or sleeping. A surprisingly large proportion of the total number of fatal injuries in this experience occurred between 10 p.m. and 6 a.m., when activity is at a min-imum in most homes. Injuries suffered during these hours accounted for about QUIT YOUR SKIDDING QUIT YOUR SKIDDING Follow other vehicles ai a safe dis-tance. It takes from 3 to I I times as long to stop when pavements are snowy or icy. Avoid making a quick stop in front of another vehicle. A rear-end collision may result. two fifths of all the deaths from home accidents among men and for one fourth of the deaths among women. Conflagration and asphyxiation by gas contributed materially to this night-time toll. Analysis of the death records reveals that conflagrations were often caused by defective or improperly used oil or coal stoves. Gas poisoning arose from a variety of circumstances: the inadvertent turning on of gas jets, leaking gas fixtures and appliances, and the use of gas heaters in poorly venti-lated rooms. But much more important numeri-cally than either conflagration or gas poisoning as a cause of fatal home accidents at night, are falls. In fact, falls accounted for around 40 percent of the fatal injuries suffered at night among both men and women. The large number of persons reported as falling on the floor or stairs while on the way to the bathroom at night indicates the need for night lights or lights easily reached from the bed, especially in homes where there are aged or sick 12 The Health Bulletin February, 1946 persons. A considerable number of deaths also were caused by falls on entrance steps or hallway stairs by members of the household returning home late at night. In this experience as a whole, including both night and day, falls are by far the outstanding cause of accidental death in and about the home. Contributing to this large toll are fatal falls on steps, many of which are too steep or too narrow, have insufficient headroom, or are without handrails or adequate illumination. That the smoking of cigarettes or pipes can be dangerous is evidenced by the considerable toll of life taken each year by accidents from this cause. One third of all the deaths from burns and conflagrations in the home among men were the result of careless smoking; even among women the proportion was as high as one sixth. In many instances the victim dozed off in bed or in an upholstered chair with a lighted cigar-ette in the hand or mouth. Another fairly common but danger-ous practice is dozing off while liquids are being heated on gas stoves. Last year, 11 people in this insurance expe-rience— 10 men and one woman—died from gas poisoning because, while they were taking a nap, the liquid on the gas stove boiled over and extinguished the flame. Striking examples of preventable deaths are those due to firearms. Play-ing with, lifting, cleaning or scuffling for guns are the causes of accidents of this kind. Even eating has its hazards. In this experience, eight persons died last year from accidentally swallowing bones or fruit pits, with resulting chok-ing or damage to the alimentary canal. Altogether, the American people each year pay a high price in lives for home accidents which are preventable. It is encouraging to note that our leading national health and safety organiza-tions are planning a combined attack on this problem. Notes and Comment PLASMA '-pHE American Red X Cross has delivered two truck loads of plasma to the State Laboratory of Hygiene for redistribu-tion to hospitals and physicians who are licensed to practice medicine in North Carolina. To the sentimentalist this plasma is a dramatic reminder that the war end-ed much sooner than was anticipated. This plasma was originally intended to aid in saving the lives of men in our armed forces who would be injured in combat. In a way each package rep-resents a man who would have been injured had the war continued. Each package also represents a patriotic American who donated blood to Amer-ican Red Cross blood banks. The pur-pose of the donor was to aid in saving human life. Each package sent into North Carolina by the Red Cross may save the life of some person in North Carolina. It would be idle to think that the 6476 packages represent the saving of 6476 lives. Some patients receiving the plasma will need more than one package; others who receive it will die in spite of it. Nevertheless, ©ne does not need a vivid imagination to realize that these huge piles of plasma are bulwarks against death. Those of us who have contributed to the Red Cross in the past have done so with the idea that this organization enabled us to minister into the victims of disaster, violence, pestilence, and famine. Individuals can do little to re-lieve distressed people in far away places by joining and investing in an organization such as the Red Cross, we can do much. Now this benevolent organization is in a measure declaring a dividend by returning to the people of North Carolina a sizeable portion of their contributions. Into every corner of the State will go plasma and its life-saving potentialities. In order that our people may have a greater under-standing of the terms under which this plasma is available we give the follow-ing statement from the American Red Cross: The American people gave through the American Red Cross large quant-ities of blood from which dried plasma was prepared for the armed forces. The supply of this material was predicted upon the needs of the Army and the Navy for a long and costly war. Be-cause of an earlier cessation of hostil- February, 1946 The Health Bulletin 13 ities than was reasonably to be expect-ed in both the European and Pacific Theaters, there is now on hand a quan-tity of dried plasma which is in excess of the needs of the Army and the Navy during the anticipated useful life of the plasma, namely, five years from the date of processing. According to army and navy estimates the available sur-plus amounts to approximately one and a quarter million packages at the pre-sent time. The transfer to the American Red Cross of dried plasma declared surplus by the Army and the Navy is provided for by Public Law 457 of the 78th Con-gress, approved October 3, 1944. The pertinent portion of this law, Section II (f), reads as follows: "No surplus property which was pro-cessed, produced, or donated by the American Red Cross for any govern-ment agency shall be disposed of except after notice of and consultation with the American Red Cross. All or any portion of such property may be donat-ed to the American Red Cross, upon its request, solely for charitable purposes." Under the foregoing provision of Congress a formal request was made to the Army and the Navy that all sur-plus plasma be transferred to the American Red Cross. This section was taken on the ground that the American Red Cross has a responsibility to the American people to assure that plasma and other derivatives of the blood vol-untarily contributed for the members of the armed forces be utilized to the best advantage and not be wasted or offered for sale or barter. In making this request it was proposed that any surplus should be returned to the American people, who had made these supplies of plasma possible, for use in veterans' hospitals and in civilian med-ical practice. This proposal was accept-ed by the Army and the Navy and, accordingly, they will transfer to the American Red Cross all available sur-plus stores of plasma and other blood derivatives. Each area office will provide ware-house storage space sufficient to handle the plasma to be made available to state departments of health within its jurisdiction. The storage temperature must not be allowed to go below 35 de-grees F. or above 120 degrees F. From these warehouses plasma will be furnished to any state department of health which, after consultation with the area medical director and repre-sentatives of the state medical society and state hospital association, has pre-pared a plan satisfactory to the Amer-ican Red Cross for the distribution of plasma within its state for use in civil-ian medical practice. The American Red Cross will esti-mate, on the basis of the population of the state, weighted by the number of physicians licensed to practice med-icine and surgery and by the number of general, pediatric, and maternity hospital beds and any other beds de-voted to the care of acute illness, the amount of plasma required by each state for a three months' supply. This will constitute the initial shipment to a state department of health, which will designate the depot or depots to which it desires shipment to be made. Requisitions for replacement supplies of plasma must be made in writing by the state department of health and sent to the area medical director for approval and transmittal to the area manager. The total amount held in storage by a state department of health at any time must not exceed an esti-mated six months' supply. No charge will be made by the Amer-ican Red Cross to the state department of health either for the product or for the cost of shipment. The plan of distribution within a state must include the following gen-eral principles and procedures: a. The state department of health is to: 1. Assume the responsibility for mak-ing an inventory of the plasma received so that it may be issued in time to in-sure its use before it becomes outdated. This is necessary because the surplus plasma is made up of lots bearing dif-ferent expiration dates. 2. Agree to affix to each individual package prior to distribution a special label, to be provided by the American Red Cross, bearing substantially the following statement: "This plasma, having been declared surplus to the needs of the armed forces, is made available by the American Red Cross without charge for civilian use." Space will be provided on the label for the department of health to add its name as the distributing agency. 3. Make the plasma available to all physicians licensed to practice medicine 14 The Health Bulletin February, 1946 and surgery and to all acceptable hos-pitals for administering to any patient without charge to physician, hospital, or patient either for the product or for the cost of shipment. 4. Encourage by all available means proper use of the plasma and maintain a record of its distribution. 5. Issue and disseminate information relative to the use of blood and blood derivatives to the medical profession and the public. 6. Conduct, in consultation with the area office, the distribution of plasma and direct the attendant publicity in such a way as to provide for participa-tion of the Red Cross chapter in the local program in accordance with the provisions set forth in Section VI be-low. 7. Submit periodic reports to the area medical director on the status of the program. These reports should include a monthly record of the amount of plasma distributed, the amount of the reserve supply, and copies of publicity, directives, and other material pertinent to the program. b. The national organization of the American Red Cross is to: 1. Issue publicity through its own channels concerning the distribution and use of the plasma and also make available releases for distribution through the regular state department of health channels. 2. Prepare for the use of state med-ical societies and the state departments of health technical information con-cerning the use of blood and blood de-rivatives for the purpose of assisting them in obtaining proper use of the plasma. 3. Prepare information on the devel-opment and operation of blood and blood derivatives programs throughout the country for the purpose of assist-ing the various state departments of health in these programs. It is desired and expected that the distribution and use of the surplus plasma in the manner described will, in addition to serving its primary pur-pose: a. Assist in making possible an accu-rate determination of the needs for blood and blood derivatives throughout the country. b. Strengthen and stimulate the de-velopment of already established state and local civilian blood and blood de-rivatives programs. c. Demonstrate the value of such programs and thus stimulate active in-terest in them on the part of the public, the medical profession, departments of health, and Red Cross chapters in those parts of the country where these pro-grams do not now exist. Arrangements have been made to provide plasma for former servicemen and women in veterans' hospitals. There will be shipped to the Veterans Administration the quantity of plasma which it has estimated as being suffi-cient to meet its needs during the five-year life of the dried plasma. This plan for the distribution of the surplus plasma has been concurred in by the Association of State and Terri-torial Health Officers, the American Medical Association, and the American Hospital Association. To the Physicians and Hospitals of North Carolina The American Red Cross has sent us a supply of plasma to be distributed equitably among the physicians and the hospitals of the State. This plasma was allotted on the basis of one unit to each physician licensed to practice medicine in North Carolina and to hospitals—one unit for each four general, maternity and pediatric hos-pital beds. This plasma is distributed with the understanding that it be made available to all, without charge, regardless of financial status. Each package of plasma is complete with solvent for the dry plasma, double flow needle, tubing, and intravenous needle. An attached sling is also pro-vided, thus everything needed for ad-ministration is provided except mate-rials for cleansing the arm of the pa-tient. Plasma should be stored in a dry place where the temperature range is between 35 degrees F. and 120 degrees F. The expiration date is based on the estimated life of the rubber used in making the outfit. Presumably this sup-ply of plasma will be supplemented within approximately ninety days with another allotment. February, 1946 The Health Bulletin 15 Institutions and physicians will be expected to fill out a short form report-ing use before securing an additional supply. Physicians can secure their package merely by writing or telegraph-ing a request to the State Laboratory of Hygiene, Raleigh, N. C. Hospitals in requesting their supply should furnish us with the following information: 1. Number of general, maternity and pediatric beds in the institution. 2. Number units of plasma used dur-ing the previous three months' period. 3. Number units requested for im-mediate shipment. The request should be on stationery of the institution and should bear the signature of a responsible officer of the institution. Yours truly, John H. Hamilton, M.D., Director State Laboratory of Hygiene * * * DR. GUDAKUNST During the re-cent epidemic of poliomyelitis the figure of Dr. D. W. Gudakunst was familiar in many of the stricken sections of our State. He work-ed hard to perfect the organization which was set up to aid the victims of this disease. We are, therefore, dis-tressed to receive the following death notice: Dr. Donald Welsh Gudakunst, Med-ical Director of The National Founda-tion for Infantile Paralysis, who died of a heart attack in his room at the Blackstone Hotel, Chicago, at 12:35 p.m. yesterday, (Sunday, January 20), had a long record in medicine and public health and was one of the country's leading authorities on polio-myelitis. He joined the National Foundation January 1, 1940, and was in charge of the organization's rapidly expanding program of research in infantile paral-ysis and care and treatment of patients. Prior to joining the National Founda-tion, Dr. Gudakunst spent several years in public health work, chiefly in Mich-igan. He was Deputy Health Commis-sioner of Detroit from 1924 to 1937 and Michigan State Health Commissioner, 1938 and 1939. From 1937 to 1942, he was non-resident Professor of Preven-tive Medicine and Public Health, Uni-versity of Michigan. Dr. Gudakunst was born at Paulding, Ohio, August 18, 1894, the son of Wil-liam Edward and Fannie May Welsh Gudakunst. He attended Latin High School, Somerville, Mass., and the Uni-versity of Michigan, graduating as Bachelor of Science in 1917 and as Doctor of Medicine in 1919. His interne-ship was spent at the University of Michigan Hospital. He is survived by his wife, Bernice Drahner Gudakunst, and a daughter, Mrs. Howard A. Vernon of Chicago. He lived on North Street, Westport, Conn. Dr. Gudakunst was a fellow of the American Public Health Association, the New York Academy of Medicine and the American Medical Association and a member of Alpha Kappa Kappa and Delta Omega fraternities. He was a frequent contributor to medical jour-nals. At the time of his death, Dr. Guda-kunst was talking in his hotel room with Commander Robert S. Schwab, formerly director of a research project at the Massachusetts General Hospital financed by the National Foundation. "*•**-. Paul Beavers, age 7 months, son of Mr. and Mrs. George M. Beavers, Jr., Apex, North Carolina. Paul is a good example of medical heritage and super-vision. 16 The Health Bulletin February, 1946 PROTECT CHILD LIFE! Caution your child about the changing traf-fic situation. There are more cars, traveling faster than during wartime. Many children were too young to remember traffic as it was before the war, or they have forgotten how to protect themselves. Knowledge now may avert tragedy later. Teach children to cross at intersections in city traffic. Be sure your child understands to walk with the green light. Caution children against crossing in middle of block or darting out from between parked cars. Be sure they know to look for turning traffic before cross-ing! Walk facing traffic is a cardinal rule for highway hiking. Teach children to walk facing traffic, preferably on the shoulder of the road allowing enough room for oncoming cars to pass at a safe distance. For night walking, wear something white or carry a flashlight. ''Playing in the street" is a leading cause of child traffic fatalities. Teach children to play in well-protected play areas. Even "blind" streets are dangerous because children may not be alert to cars which come into these streets. Children should learn very young to stay out of streets. fiftl PublisKedby THE-N R3H.CfiKliriA STArLB°ARDs^E^LTHL 1 This Bulletin, will be sent free to any 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. 61 MARCH, 1946 No. 3 One of Six Thousand Four Hundred Seventy-Six Packages of Plasma Allocated to North Carolina by the American Red Cross. MEMBERS OF THE NORTH CAROLINA STATE BOARD OF HEALTH S. D. CRAIG, M.D., President Winston-Salem I. N. JOHNSON, D.D.S., Vice-President Goldsboro (i. G. DIXON, M.D Ayden H. LEE LARGE, M.D Rocky Mount W. T. RAINEY, M.D Fayetteville HUBERT B. HAYWOOD, M.D Raleigh I. LaBRUCE WARD, M.D Asheville I. O. NOLAN, M.D Kannapolis JASPER C. JACKSON, Ph.G. Lumberton 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. J. ROY HEGE, M. D., District 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. C. P. STEVICK, M.D., Director Division of Epidemiology and Vital Statistics. J. M. JARRETT, B.S., Director Division 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., Executive Secretary, Nutrition Service of the State Board of Health. MR. CAPUS WAYNICK, Director, Venereal Disease Education Institute. E. H. ELLINWOOD, M.D., Director, School-Health Coordinating Service. HAROLD J. MAGNUSON, M.D., Director, Reynolds Research Laboratory, Chaflel Hill. JOHN J. WRIGHT, M.D., Director, Field Epidemiological Study of Syphilis, Chapel Hill. FREE HEALTH LITERATURE Infeair PUBU5MLD BY TMC MQRTM CAIgOUriA 5TATL e£A£0 •ME.ALTM Vol. 61 MARCH, 1946 No. 3 CARL V. REYNOLDS, M.D., State Health Officer JOHN H. HAMILTON, M.D., Acting Editor Life and Death in North Carolina in 1945 By W. H. Richardson North Carolina State Board of Health Raleigh, North Carolina NORTH Carolina's general death rate of 7.6 per one thousand in-habitants in 1945 was the lowest in the State's history. This is disclosed in the provisional report for the year issued by the State Board of Health's Division of Vital Statistics, which gives a concise picture of life and death in North Carolina during the closing year of World War II. North Carolina's general death rate maintained a sustained downward trend in mortality throughout the duration of the conflict recently ended. The last year of American participation in World War I was marked by a rate of 17.6 persons per one thousand popula-tion, this having been due to the influ-enza scourge which swept through the world in 1918, playing no favorites. No such epidemic occurred during World War II, throughout which we made substantial gains not only in the matter of lowering our general death rate, but also in our fight against certain specific diseases. It is interesting to compare the gen-eral death rates in our State for the four years in which we were engaged in World War II. The rates for 1942 and 1943 were identical, being 8.1 per thousand. The 1944 rate was 7.9 and the rate last year 7.6. These are all below the national rate, which was 10.9 in 1943. Later figures are not available at this time, but it is hardly to be sup-posed that the national rate has shown any such decline as that which has been noted in North Carolina. In numerical terms, there were 28,950 deaths in North Carolina in 1945, as compared with 29,560 in 1944. The birth rate, on the other hand, rose and fell during the war years, as might have been expected. The number of births recorded and rates were as follows: 1942, 90,056—24.6; 1943, 95,251 —25.7; 1944, 92,412—24.7; 1945, 88,597— 23.4. These figures are easily under-standable, when taking into considera-tion the shift in the male population during the fighting years. Early war-time marriages resulted in an all-time high in the number of births, in 1943. Then, men were moved overseas in ever-increasing numbers. It would not be unreasonable to assume that, with so many husbands back in America, there will be another upsurge in births in due time; but, in the handling of vital statistics, the State Board of Health's duty is to record and not to prophesy. One of the most gratifying things about the 1945 provisional report of the Division of Vital Statistics is the de-cline reported in the number of infant deaths, that is, deaths among babies under a year old. The total for 1945 was 3,842, as compared with 4,130 the preceding year, and the rate declined from 44.7 per one thousand live births reported to 43.3. Both figures are en-tirely too high and are above the national rate, but the reduction does denote progress, as do the figures on maternal deaths, of which there were 228 in 1945, with a rate of 2.5 per one The Health Bulletin March, 1946 thousand live births, compared with 274 in 1944, when the rate was 2.9. Numerically, these figures might seem insignificant, but in terms of percentage the difference is appreciable. That section of the 1945 report giving the number of deaths from preventable accidents does not constitute such a rosy picture. There were 1,299 such deaths in 1945, as compared with 1,440 the preceding year—a reduction, it is true; but the 1945 figures reveal a dis-tinct uptrend in deaths resulting from primary automobile accidents now that the war is over. According to figures reported by the State Board of Health, including fatalities occurring on mili-tary reservations and deaths not classed as resulting from traffic accidents, there were 695 such deaths in North Carolina last year, as compared with 634 in 1944. Such deaths are on the increase, ac-cording to reports from all sources. During 1945, there were only 64 deaths from air transportation accidents in North Carolina, as compared with 258 the preceding year. This is easily un-derstood when we take into considera-tion that North Carolina had a liberal quota of trainees for aerial warfare. Deaths from other accidents classed as preventable, last year, included 20 from automobile and railroad collisions, 68 from other railroad accidents, 145 from drowning, 209 from conflagration and accidental burns, and 98 from acci-dental traumatism by firearms. During the year, 241 persons in North Carolina committed suicide and 285 were homicide victims, making a total of 526 who killed themselves and were slain by their fellowmen. In addition to the 1,299 deaths from accidents termed preventable, there were 1,123 deaths in North Carolina during 1944 from diseases known to be preventable or curable. In the latter class were 288 deaths attributed to late syphilis, which might have been cured if early treatment had been adminis-tered, also 12 from typhoid fever, 16 from tetanus (lockjaw), 72 from pel-lagra (prevented and cured by eating the right kinds of food), 21 from malaria, 95 from diphtheria, 92 from whooping cough, and one from rabies. According to the provisional report for 1945, the death rate from all forms of tuberculosis in North Carolina dur-ing 1945 was 37.4 per 100,000 inhabi-tants, which was nearly one point higher than the 1944 rate. The number of tuberculosis deaths for each of the past two years was 1,417 and 1,368, respectively. After all, while we have made good progress, we have not as yet whipped all the infectious diseases over which we hold the whip hand—and we will not do so until we let go with all that science has to offer. The death toll from cancer in North Carolina in 1945 was 2,421, and the number of persons out of every 100,000 inhabitants dying of some form of this disease was 64. Deaths in 1944 totaled 2,298, with a rate of 61.4 per 100,000 inhabitants. There is food for thought in these figures and a mighty incentive for those who are seeking, with all the means at their command, to wage an all-out war on this ancient and, so far, unconquered enemy of the race. The 1945 death charged against the pneumonias stood at 1,540, as compared with 1,555 the preceding year, denoting practically no change. But these totals were both below those registered before the discovery of, first, anti-pneumonia sera, and, later, sulfa drugs and peni-cillin. Thus, we have a general picture of life and death in North Carolina in 1945, with the realization that there is still much to be done. The millenium has by no means arrived. March, 1946 The Health Bulletin Venereal Disease Control in North Carolina By W. D. Hazelhurst. M.D. Surgeon, U. S. P. H. S. V. D. Consultant North Carolina State Board of Health Raleigh, North Carolina THE primary objective of the vene-real disease control program in North Carolina is to reduce the attack rate of syphilis and gonorrhea. To this end, the treatment of infectious cases of these diseases is an essential method of attack. In the years before penicillin, effect-ive treatment of both syphilis and gon-orrhea was difficult to accomplish. Syphilis was treated with weekly in-jections of alternating courses of arsenicals and bismuth. A large per-centage of patients who began treat-ment of this type lapsed before minimal adequate treatment had been received. Much time and effort was spent 'in follow up of delinquent patients and generally with disappointing results. For example, of a group' of 1,884 pa-tients admitted to clinics in North Carolina between January 1 and July 1, 1943, 87% had received less than 40 injections by July 1, 1944, and only 6% had been discharged from the clinics as "cured." Gonorrhea, also was difficult to manage, especially in the female. Treat-ment with sulfathiazole was easily ad-ministered, but had the disadvantage of being orally administered. In irre-sponsible patients, one could not be sure whether the pills had actually been swallowed as directed or at all. Fur-thermore, it was extremely difficult to tell when a cure had been effected (especially in women), since facilities for culturing the gonococcus were not generally available. Some of the obstacles that have con-fronted the program have been re-moved by the advent of penicillin and intensive methods of treatment. Rapid Treatment Centers designed to administer intensive treatment for venereal diseases were established in Charlotte and in Durham in the fall of 1943. During the early months of their operation, syphilis was treated with various treatment schedules em-ploying arsenoxide (mapharsen) and bismuth. This treatment was effective, but proved too toxic to justify its con-tinuance. Fortunately, penicillin be-came available during the summer of 1944. Schedules of treatment for syphi-lis have been developed using penicillin plus relatively small amounts of arsen-oxide and bismuth which are safe and are proving effective. Penicillin alone has been tried, but too many relapses occurred, hence the addition of other drugs to supplement its effect. For gonorrhea, however, penicillin has been amazingly effective. The first treatment scheme that was used was the injection of 30,000 units of peni-cillin every three hours for five doses for a total dose of 150,000 units. Later this was modified when it was found that equally good results were achieved by giving the same total dose in three injections at two hour intervals. In the summer of 1945, penicillin in beeswax and peanut oil became avail-able. This preparation, by delaying absorption, makes it possible to give the entire dose of penicillin for gonorrhea in one injection. With this method of treatment, gonorrhea has been returned to the local clinics by the rapid treat-ment centers. These revolutionary developments in treatment methods have solved some of our problems. However, new prob-lems have arisen and much remains to be accomplished before venereal diseases are controlled. In the case of both syphilis and gon-orrhea, the problem of reinfection has arisen. To illustrate, John Doe learns that he has syphilis and goes to a rapid treatment center. His wife, Mary, was exposed to John before John was treated. Other exposures occur when John gets home just before Mary's The Health Bulletin March, 1946 syphilis shows up. She goes to a rapid treatment center and returns home just before John's second infection shows up, and she is again exposed. Conceiv-ably, this could go on indefinitely. Every attempt is being made to reduce possibilities for reinfection through in-tensive patient education and through contact investigation. Another problem has arisen with syphilis. No treatment scheme for syph-ilis gives 100^ cures. Intensive therapy has proved about 85% effective, which is as good as any method to date. However, the relapses that do occur following intensive therapy are mostly of an infectious type. Furthermore, the first lesions that recur usually appear trivial and may go unnoticed by the patient. The public health significance of this is readily appreciated. Fortun-ately, it is possible to predict such a recurrence by observing a quantitated blood test monthly for a year following intensive treatment. After the first year, the period of greatest danger is past. Observations are then made every three months for the second year and once yearly thereafter to assure the patient that all goes well. Our biggest problem, however, re-mains the uncovering of newly acquired infections. In general, the earlier a case is treated, the fewer people will be exposed to it and the better the chance of cure for the individual. Education of the public regarding the facts about venereal diseases and what is available for their treatment should go a long way toward control. Contact investi-gation must be continued, intensified, and speeded up as an adjunct. Finally, it should be pointed out that without the cooperation and assistance of the practitioners of medicine, the venereal disease control movement could never have succeeded to its present extent. An even closer cooperation and more active participation, particularly in the process of investigating contacts, is needed for ultimate success. Local Health Units SOME five years ago the American Public Health Association created a Committee to study the problems of local health administration. This Com-mittee was headed by Dr. Haven Emer-son. A little more than six months ago the Committee's report was published by the Commonwealth Fund, 41 East 57th Street, New York 22, New York. The price is $1.25. The first edition of one thousand copies was exhausted within a month. More than one-half of the second printing of two thousand has already been distributed. Reader interest has been widespread. Copies have been bought in every state and a number of foreign countries. The first section is devoted to prin-ciples upon which the report is based. The second is given over to definitions and sources of data. The third section discusses local health services existing and proposed in the United States. The fourth section includes the present and suggested personnel and costs for local health services for each state and the District of Columbia. In the Foreword Dr. Emerson states: "This report, by a committee of state and local public administrators, is ad-dressed to the home-town folk of con-tinental United States, and more par-ticularly to their elected officers of local government of village, town, city, or country. It's purpose is to suggest a way to cover a free society with full time health services at the community level. "It may come as a shock to many that only two-thirds of the people of our country are today under the um-brella of full time local health protec-tion, while approximately forty million are excluded by horse-and-buggy poli-tical boundary lines, or by the economic stringencies of the areas in which they happen to live. Yet such is our present situation. Further, the provision of health services, whether full or part time, is now essayed by 18,000 or more counties, cities, towns, villages, or dis-tricts. These local health jurisdictions are inherited from the past. They came into being, like many good and bad things in a young and growing country, without benefit of policy. We know now that we can afford nothing less than coverage of every population and area unit of our nation with competent local health service. How can we achieve it? Do we continue in an outworn tradition. March, 1946 The Health Bulletin or shall we boldly redesign our appar-atus? The authors of this report pro-pose the latter course. "They begin by presenting a picture of contemporary local health services as they are—the broad features of their adequacies and inadequacies, the num-ber and kinds of persons who do the work, and the cost of this indispensable function of local government. The or-ganization of local health services of each state is considered in detail and the existing personnel and the costs are analyzed. Detailed data are shown in tabular form, making comparative stu-dy simple. Comparisons are revealing: for example, it is by no means always true that the richest states spend the largest amount per capita for local health service or have the largest pro-portion of their population served by full time local health officers. Other cherished beliefs are upset by examina-tion of state summaries in relation to national figures distributed over the total population. This section of the report stands wholly on factual ground. This is how we are. "The Committee then moves into the realm of attainable possibilities. It suggests a new design in the adminis-trative apparatus for delivering local health services. Employing the same set of guides for each state — complete coverage with basic min-imum full time service; units of jurisdiction of populations large enough (50,000 or more) to support and justify staffs of full time, pro-fessionally trained persons; a cost of approximately $1.00 per capita — it shows that all the objectives can be realized and that only about 1200 units of local jurisdiction would be required to do the job. The authors repeat that this is a way to cover the entire pop-ulation with full time basic minimum local health service. The particular pro-posal for any given state or city-county or multi-county unit, however, must be considered by the people and their local government, and by the respective state health officer or board of health, as expressing a principle of adminis-tration not a finality for action. An-other arrangement of counties and populations may be preferable. The principle of local cooperation, however, and the pooling of community resources for health in the interest of economy and efficiency are important, and re-semble those that have brought about consolidated or union school districts and road districts serving large areas with engineering adequacy. "While in most of the states existing permissive or mandatory legislation authorizes the development advised by the Committee, in thirteen of them there are no such laws; but it is equal-ly true that such cooperative planning and operation of local health services are nowhere forbidden. "It is expected that among those who can be relied upon to encourage and actively support the plan here offered will be found the state medical, dental, and nursing organizations, the official and voluntary health agencies, and such bodies of influence and public opinion as state universities together with farmer and labor groups concern-ed with better quality of living in the smallest as in the largest communities. "This report has been made possible by a grant of the Commonwealth Fund which has also undertaken its publica-tion. The staff of the Fund has contrib-uted generously to its final editing. The Committee on Local Health Un-its of the American Public Health As-sociation assumes full responsibility for the report, including all statements of fact and opinion." There is much in the report which is good thought provoking material. Some of the recommendations will stimulate controversies. Since the prob-lem discussed is important, we will de-vote considerable space in this issue of the Bulletin to quotations from the report. "Whether local units of health juris-diction are created by local initiative or authority and by cooperative or leg-ally specified procedures, or are devel-oped under mandatory for permissive legislation by the leadership and per-sonnel of the state department of health is not a matter of primary im-portance or of sharp distinction. What is essential is that no population unit or area of the United State |