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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