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Entered as second-class matter at Postoffice at Raleigh, N. C, under Act of July 16, 1884
Published monthly at the office of the Secretary of the Board, Raleigh, N. C.
Vol. 60 JANUARY, 1945 No. 1
Mt. Mitchell in the Winter
Ayden
Mourn
MEMBERS OF THE NORTH CAROLINA STATE BOARD OF HEALTH
I). CRAIG, M.D., President Winston-Salem
N. JOHNSON, D.D.S., Vice-President Goldsboro
G. DIXON, M.D
LEE LARGE, M.D. Rock >'
T. RAINEV, M.D Fayetteville
HUBERT B. HAYWOOD, M.D. Raleigh
J. LaBRUCE WARD, M.D Asheville
J. O. NOLAN, M.I) Kannapolis
LARRY I. MOORF, Jr
Wilson
Executive Staff
i AKL V. REYNOLDS, M.D., Secretary and State Health Officer.
G. M. COOPER, M.D., Assistant State Health Officer and Director Division of Heahli Education.
Crippled Children's Work, and Maternal and Child Health Service.
W. P. RICHARDSON, M.D., Director District No. 1 Local Health Administration.
R. E. FOX, M.D., Director District No. 2 Local Health Administration.
VACANT, Director District No. 3 Local Health Administration.
ERNEST A. BRANCH, D.D.S., Director of Oral Hygiene.
IOHN H. HAMILTON, M.D., Director Division of Laboratories.
R. T. STIMPSON, M.D., Director Division of Vital Statistics.
C. P. STEVICK, M.D., Acting-Director Division of Epidemiology.
I. M. JARRETT, B.S., Director Division of Sanitary Engineering.
T. F. VESTAL, M.D., Director Division of Industrial Hygiene.
|OHN F. KENDRICK, M.D., Executive Secretary, Nutrition Service of the State Board of Health.
MR. CAPUS WAYN'ICK, Director, Venereal Disease Education Institute.
WILLIAM P. JACOCKS, M.D., Director, School-Health Coordinating Service.
D. F. MILAN, M.D., Research Professor of N. C. Cooperative Nutrition Study, Chapel Hill.
WILLIAM L. FLEMING, M.D., Director, Reynolds Research Laboratory, Chapel Hill.
IOHN 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
requesting it. The Board also has available for
literature on the following subjects. Ask for anv
will be sent free to any citizen
distribution without charge special
in which you may be interested:
Adenoids and Tonsils
Appendicitis
Cancer
Constipation
Chickenpox
Diabetes
Diphtheria
Don't Spit Placards
Endemic Typhus
Flies
Fly Placards
German Measles
Health Education
Hookworm Disease
infantile Paralysis
Influenza
Malaria
Measles
Padiculosis
Pellagra
Residential Sewage
Disposal Plants
Sanitary Privies
Scabies
Scarlet Fever
Teeth
Tuberculosis
Typhoid Fever
Venereal Diseases
Vitamins
Typhoid Placards
Water Supplies
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 Stale Board of Health, Raleigh, North Carolina.
Baby's Daily Time Cards: Under 5 months;
5 to 6 months; 7, 8, and 9 months; 10, 11,
and 12 months; 1 year to 19 months; 19
months to 2 years.
Prenatal Care.
Prenatal Letters (series of nine
monthly letters.)
The Expectant Mother.
Breast Feeding.
Infant Care. The Prevention of
Infantile Diarrhea.
Table of Heights and Weights.
Diet List: 9 to 12 months; 12 to 15 months:
15 to 24 months; 2 to 3 years; 3 to 6
years.
Instruction for North Carolina Midwives.
CONTENTS
Typhoid Fever in North Carolina
Things You Should Know About Bacteria
The Whooping Cough Problem
Page
12
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[ PU&LI-S/AfLD BY TML MQR.TM CARPUMA 5TATE, BQ^D s^MEALTM 1 (L;
Vol. 60 JANUARY, 1945 No. 1
CARL V. REYNOLDS, M.D., State Health Officer JOHN H. HAMILTON, M.D., Acting Editor
Typhoid Fever in North Carolina
By
J. W. Kellogg
State Laboratory of Hygiene
Raleigh, North Carolina
DURING the past 30 years the State Lab-oratory
of Hygiene has distributed more
than 20,000 liters of anti-typhoid vaccine or
sufficient to give two complete series of inoc-ulations
to every man, woman and child in
North Carolina.
During this period the death rate from
typhoid fever has been reduced from 35.8 in
1914 to 0.5 per 100,000 population in 1943.
The immunization each year of an average
of 200,000 people, over a period of 30 years
has produced an immune group of uncertain
proportions, which has had a great influence
on the morbidity and mortality rates.
It is a recognized fact that the presence of
such an immune group in an area will effect-ually
prevent the occurrence of any wide
spread epidemic. This is borne out by our
experience in North Carolina where typhoid
fever has become more and more a rural
disease, endemic in certain areas where the
percentage of immunes is relatively low.
Before we began to supply free typhoid
vaccine, the bacterin so'd for SI.50 for each
person. Consequently few were immunized.
Typhoid fever was prevalent in all parts of
the State. In 1910, the U. S. Army began to
protect the men in the armed forces by in-'
iections of vaccine, and promising results were
indicated.
The medical profession, in the interest of
preventive medicine, began to see the pos-sibilities
of general vaccination against typhoid.
In 1913 Dr. G. M. Coper (at the time a
practicing physician in Sampson County) made
a plea for free distribution of typho-bacterin.
During the latter part of that year we began
the manufacture of our first biologic product.
During 1914 we distributed sufficient to
immunize more than 40.000 persons, although
there was no campaign and no general pro-gram
of clinics. The response of the health
officers as well as the general practitioners to
the demands of the people was generous and
gratifying.
In 1915 the State Board of Health inau-gurated
a definite program which would make
it possible for any person in North Carolina
to protect himself against this preventable dis-ease.
Campaigns were conducted by the State
Board of Health, under direction of the Divi-sion
of Epidemiology. Publicity was given by
lectures at schools, mills, etc. Posters, press
articles and newspaper advertisements, as
well as public lectures, were used to bring
to the attention of the public the danger of
the disease and to awaken interest in the
campaign.
In counties having full-time health or-ganizations,
the State Board of Health depend-ed
on this personnel to carry out the recom-mended
immunization programs against ty-phoid
fever. In other counties programs were
instituted, wherebv the work was done by the
The Health Bulletin January, 1945
regular licensed physicians of the count)'.
Physicians gave the treatments in their offices
and at points in the rural sections convenient
to the country people. This policy was follow-ed
in order to demonstrate that it was in the
interest of the family physician as well as the
State Board of Health to prevent disease.
Physicians who participated were paid a small
amount for each dose administered. Assistance
was also given counties which supported
whole-time health officers, who carried out
the programs with their own personnel.
Complete records were kept of the number
who received the three injections. In 1915 and
1916 more than 100,000 persons were im-munized.
The figures shown in Table B. in-clude
only those receiving the treatment in
the counties where the work was done under
the supervision of the State Board of Health.
No figures are available for the counties hav-ing
full-time health officers, nor for those
1600
who went to their family physician for the
injections.
In 1917 and 1918 the program was inter-fered
with by the difficulty of securing the
necessary medical officers to do the work, the
preparedness program of the government hav-ing
caused many doctors and nurses to enter
the Army and Navy. In spite of this handicap,
30,000 received the typho-bacterin in 1917.
In 1919 twenty counties co-operated in the
plan to have third year medical students give
the injections, and 49,076 completed the three
doses. In 1920 twelve counties gave the treat-ments
to 29,435 individuals.
A reduction was noted in the typhoid rate
during these two years, due to the fact that
32 campaigns were conducted, in which 88,000
people received the three doses, in addition
to 25,000 immunized by health officers
through the Bureau of County Health. The
records show that during 1921 and 1922
1400
12O0
lOOO
8O0
600
400
200
1910 II '12 "13 '14 '15 M> 17 'I8'I9"20'2I 72'23'2V25 v
26
>
27'Z8'29
,30'3r32 '33'3V35 "36 '37 ^^^CAI^r^
January, 1945 The Health Bulletin
campaigns in 30 counties were responsible for
90,338 immunizations. In 1923 and 1924.
74.460 people were immunized in 25 counties.
The number of persons immunized each
year under this plan is shown in the follow-ing
table A.
Table A
Year
Total Number
County Campaigns
Number
Persons Treated
1915-16
1917
1919-20
i92i::
1923
1924
: i25
1926
1927
1928
1929
1930
1931
1932
1933
11
30
16
12
18
11
11
11
11
6
13
10
8
100.000
30,000
8 s.000
90,338
47.837
48,427
74.460
49,749
51,239
51,973
65,745
55,772
76,775
60,411
78,893
While the general use of typhoid vaccine
has played a major role in the control of ty-phoid
fever in this State, there are other
factors which have had their influence. In
l
c'08 the State Laboratory of Hygiene began
to make regular monthly chemical and bacteri-ological
examinations of samples from each
public water supply. In 1909 the Genera!
Assemhlv provided that all public water com-panies
file plans and specifications of their
plants with the State Board of Health, and
that the State Board of Health pass necessary
rules and regulations for the care of public
watersheds and plants, and furnish such rules
and regulations and other advice to those hav-ing
charge of public water supplies. In 1911
the Legislature established County Boards of
Health to take the place of the county sanitary
committees, and four counties employed
whole-time county health officers. In 1914 the
State Board of Health began the program to
install privies in all homes.
Table B. shows the total number of liters
of vaccine distributed and the decrease in
number of cases and deaths per year, and the
decrease in the death rate per 100,000 popula-tion.
To arrive at the number of persons im-munized
each year, multiply the number of
liters distributed by 400, as one liter is suffi-cient
to immunize approximately 400 persons,
provided none is wasted.
Table B
The Health Bulletin January, 1945
county health officers through clinics establish-ed
in rural districts. In 1920 the Division of
Engineering of the State Board of Health was
assigned the duty of enforcing the State-wide
privy act and during the first two years
28,000 unsanitary privies were replaced either
by sanitary privies or sewer connections. Con-tinuance
of this program and of that to safe-guard
the public water supplies of the State
and the installation of suitable purification
systems in many small communities where
they had formerly been lacking, have had
their share in the control of enteric diseases
in North Carolina. In 1924 plans were form-ulated
for the more adequate sanitary control
of milk supplies in the State, and a standard
form of milk sanitation ordinance was adopted.
In 1926 surveys were made of the shellfish
growing areas of the State and control meas-ures
were instigated for the sanitary produc-tion
and handling of shellfish. In addition,
better sanitation of summer camps, resorts
and roadside eating places as well as inspection
of all hotels, cafes and boarding houses have
had their significance in the decrease of ty-phoid
fever as well as all other communicable
diseases. Factors having a part in the decrease
3500
3QOO
of typhoid fever as well as other communicable
diseases include: State Sanitary Privy Law-
School Sanitation, State Institution Sanitation.
Hotel and Restaurant Sanitation, Summer and
Tourist Camp Sanitation, Roadside Sanitation,.
Public Water Supply Control, Public Sewage-disposal
control, Public School water supplj
and sewerage disposal control, stream pollu-tion
surveys, chemical and bacteriological ex-aminations
if water samples, Milk and Shell-fish
Sanitation.
From 1914 until 1933 the vaccine distrib-uted
was made with the Rawlings strain of B.
typhosus, which was the same as that used bj
the U. S. Army. Beginning in 1929 we en-deavored
to secure histories of cases previoush
vaccinated in order to evaluate the protection!
against typhoid fever by the use of our vaccine.
We found that a large percentage of cases
had never been vaccinated or not within three
years of the time they contracted the disease.
During the period 1929-1933 an attempt was
made to increase the immmunizing properties-of
the vaccine by using only the smooth vari-ety
of colonies for the purpose of making the
vaccine. However, an increasing number of
cases were reported to have had three doses
2000
lOOO
January, 1945 The Health Bulletin
of vaccine within two years of the date of
onset. This fact induced us to change to
Grinnell strain of typhoid for making our
vaccine. Late in 1933 we hegan to use the
latter strain and found that while there were
more complaints of severe reactions following
the injections we were rewarded by having
relatively no failure reported. We continued
the use of the Grinnell strain until 1942 when
we changed to the Panama strain which was
being used by the Army for their vaccine.
Judging from the reports received to date, we
Jare convinced that both the Grinnell and
Panama strains are superior to Rawlings in
antigenicity. The occasional occurrence of un-desirable
reactions following injection is of
little importance in relation to the results ob-tained
in prevention of typhoid fever. From
1913 until October 1917 we distributed only
the straight typhoid vaccine, but since that
time we have also distributed the triple vac-cine
which contains both the para A. and
para B. as well as the typhoid bacilli. The
straight typhoid vaccine contains approximate-ly
1000 million organisms per ml. (cc.) and
the triple contains the same number typhoid
and in addition approximately 250 million of
each para A. and para B. bacilli. This is the
same scheme as used by the U. S. Army, which
has practically eliminated typhoid fever among
I
the armed forces in the present war. Each lot'
of vaccine is tested for sterility and for anti-genic
properties before being released for dis-tribution.
In 1924 we began making blood (clot)
cultures in cases of suspected typhoid fever.
The physicians of the State took advantage
of this service, and during the following years
more and more early diagnoses were made.
Table "C" shows the number of positive
diagnoses as against the number of cases re-ported
for the same year. For the past six
years approximately three fourths of the cases
reported were based on laboratory diagnosis.
Table C
8 The Health Bulletin January, 1945
and sanitary conditions in general, for this
almost phenominal drop in typhoid fever rates
in North Carolina, it is our opinion that the
main factor has been the immunization of a
large percentage of our population, through
the use of prophylactic typhoid vaccine.
We might relate numerous instances where
those members of a family who had been
inoculated escaped, while those who had not
taken advantage of the prophylactic were
stricken with the disease, with equal exposure
to infection from a previous case of typhoid
carrier.
The problem of further reduction in the
incidence of typhoid seems to resolve itself
into three equally important procedures: first,
prompt laboratory diagnosis of cases by blood
rfclot) cultures, supplemented by cultures of
the urine and fecal discharges, in cases where
the blood culture is negative. Such a program
is important both from the diagnostic and
public health standpoints. It enables the physi-cian
to institute proper treatment of the sick,
and to prevent the spread of the disease among
the contacts by anti-typhoid vaccination and
the proper disinfection of the discharges of
the patient. Second, the examination of -feces
and urine specimens of suspected carriers,
and the proper supervision of known carriers,
especially as to the handling of food for any
persons other than themselves. The majority
of typhoid fever cases in North Carolina now
originate from other unrecognized cases or
from typhoid carriers. For this reason we ad-vise
the examination of specimens of feces
and urine from each convalescent case of
typhoid until at least two consecutive nega-tives
have been reported. Early laboratory di-agnosis
of cases is necessary to establish proper
preventative and control measures. Improved
cultural methods are used which simplify the
procedures. A "missed case'" of typhoid fever
is a significant factor in typhoid epidemiology.
Search for additional cases associated with
any reported case will aid in the control of
small epidemics. Third, the continued use of
the prophylactic antityphoid vaccine, both in
county clinics where it is made available free
of charge, or from your family physician.
We recommend that each person receive
three doses at weekly intervals, of 0.5 ml.
(7.5 minims), 1 ml. (15. minims) and 1 ml.
the first year. In cases where more than one
year has elapsed since the administration of
the phophylactic, the same course should be
followed. In succeeding years, one dose may
be taken each year, which is sufficient to
boost the immunity. These annual injections,
may be given subcutaneously, or if preferred,,
one tenth ml. may be given intracutaneously.
The latter method is less liable to produce
severe general reactions, and is the method
of choice for persons who develop such re-actions.
When the subcutaneous method is.
used, reactions are not liable to occur, if a.
rubber band is put around the arm above
the site of the injection for half an hour. This
merely slows down the absorption of the
vaccine, and is advantageous both in prevent-ing
general reactions and in the development
of higher immunity. The subcutaneous method
will probably be used in clinics where speed
in the administration of large numbers of in-jections
is important. Rut in the office of the
private physician, the intracutaneous method1
has its advantages. Either method is satisfactory
from the public health viewpoint in the pro-duction
of antibodies and immunity. Care-ful
study of our records shows that typhoid
immunity is a relative thing, increasing during
the first few months following a series of in-jections
until about the end of the first year,
followed by a slow but general decrease. The
majority of failures to protect occur either be-fore
sufficient immunity is produced or after
the expiration of two years following the im-munization.
For this reason, it would seem
better to take a single boosting injection each
year after the initial series, than to take a
complete series each third year. Re-vaccination
is advised for all contacts of a case of typhoid
fever, as soon as possible after diagnosis ha--
been made. Revaccination is also advisable
whenever one intends going on vacation where
the chance of infection may be increased, or
where the sources of food and drinks are less
carefully supervised or liable to infection.
January, 1945 The Health Bulletin
The use of the so-called "oral" typhoid
vaccine is not advised, because we have little
proof of the value of such vaccine in the pro-duction
of immunity.
Typhoid fever is now, more than ever, a
rural disease. This is due to the fact that
municipal water supplies are carefully super-vised
and the general sanitary conditions are
more favorable than in rural districts. During
the past year, typhoid fever occurred in -IS
receive the prophylactic, and thus prevent any
increase in the incidence of this preventable
disease.
The reduction in typhoid fever rates testifies
to the fact that safe-guards have been placed
around water supplies, milk and other foods,
as well as by general prophylaxis through im-munization
of a large portion of our popula-tion.
Typhoid has taken a tremendous toll in
of the 100 counties in North Carolina. During past years, and unless we continue the pro-the
present emergency, when all public health gram of sanitation and immunization, we ma>
activities are strained to the utmost, due to loss experience a reversion to higher rates, because
of personnel and other factors, we should be of our self complacency and lack of pre-more
careful to see that as man) as possible cautions.
Things You Should Know
About Bacteria
V. Personal Hygiene
By
Morris Ostrolenk, Bacteriologist
Division of Sanitary Engineering
North Carolina State Board of Health
Raleigh, North Carolina
(This is the last of a series of five articles dealing
handling of food.)
INTRODUCTION
TN the four articles which preceeded this one,
J- we weighed the factors of DISEASE PRO-DUCTION
against those of DISEASE PRE-VENTION.
The factors in favor of GERMS
are numerous and sundry. THE ODDS ARE
NOT IN OUR FAVOR. We are not, how-ever,
a people easily given over to defeat. In-stead,
we are a nation of people who have
been faced on many fronts, in our history,
with trials and tribulations, when defeat
seemed inevitable, WHEN THE ODDS WERE
CLEARLY AGAINST US. We won then—WE
CAN and WILL win now. It is within our
power to do so. Our disease producing enemies
are many, cunning and deceitful, lurking
everywhere. But we know and understand our
defenses.
with bacteria and their relation to the proper
Because germs are
so very tiny—it takes
about 25,000 to cover
nch
—
an
Because germs
multiply about every
20 minutes under fa-vorable
conditions
—
Because germs
must have FOOD,
WATER and proper
HEAT to live and
grow
—
we are ever alert in
dealing with these
unseen enemies,
we will not provide
them with a suitable
place to reproduce
such as encrusted
cracks and crevices
and dirty table sur-faces.
we will deprive them
of one or more of
these necessary re-quirements
by clean
careful preparation of
perishable foods and
by proper refrigera-tion.
10 The Health Bulletin January, 1945
Because germs are
everywhere, on and
in our bodies, on our
clothes and in the air
AND WOULD RE-MAIN
THERE IF
WE DID NOT
TRANSFER THEM
Because germs are
so prevalent on and
in the bodies of rats
and flies
—
Because germs are
washed off and killed
in the washing and
sanitization process
—
we will not be guilty
of this transfer of
germs by any unnec-essary
fingering of
foods or the surfaces
with which foods
make contact, or by
coughing or sneezing
over foods,
we will not allow
these creatures the re-fuge
they seek in or
near where food is
prepared and served,
we will protect these
safe eating utensils by
proper storage anc
subsequent proper
handling.
It is because of our knowledge and under-standing
of these and many other defenses
that we CAN and WILL lick out DISEASE
PRODUCING enemy. In the light of this
newer knowledge of GERMS, of CATCHING
DISEASES, of INSECTS and RODENTS,
and PREVENTION METHODS, covered
briefly in the first four articles, one more
important phase remains to be discussed.
The DESIRE and WILL to do the job
CORRECTLY.
Actions. Speak Louder Than Words
Much of one's desire and will to do any
job correctly rests with a knowledge and un-derstanding
of the job that must be done.
On its face value alone, it would appear that
it is our job to simply prepare and serve
food to the consuming public. But that is
grossly incorrect. Just as incorrect as it would
be to say that a policeman's job it to simply
patrol his beat. If he did no more than just
that, we would not get the protection he
should afford us. We depend on him not
only to patrol his beat, but to observe and
act when he encounters infractions of the
law. He is a good and reliable policeman
when he does his job correctly. We PROTECT
our own HEALTH and the HEALTH of those
we serve, when WE DO OUR JOR COR-RECTLY.
BATHE FREQUENTLY
KEEP YOUR BODY CLEAN
Frequent baths, at least once each day, is
your protection against offensive body odors
and the accumulation of surface body wastes
j
which help so much in maintaining physical
fitness. The habit is easily acquired. In addition
to its many healthful benefits, body cleanli-ness
is conducive to clean habits and whole-some
methods of conduct.
Tuberculosis is the No. 1 Disease Killer of persons between 15 and 45—the vital productive
years of life, years of youth, young mothers and young fathers, the years on which this country's
security and survival depend.
January, 1945 The Health Bulletin 11
DRESS CORRECTLY
Doctors, dentists, nurses, motormen, police-men,
soldiers, chauffeurs and many in other
professions wear identifying uniforms. WHY
NOT US?
We, as FOOD HANDLERS, in either the
kitchen or dining room, are engaged in a
most respectable and responsible profession.
The amount of respect and responsibility we
command depends on us. HOW WE DRESS
HELPS MATERIALLY. Clean bodies and
proper uniforms have a stimulating effect.
They help TO DO THE JOB CORRECTLY
WASH YOUR HANDS FREQUENTLY
ESPECIALLY
AFTER EVERY VISIT TO THE TOILET
During the course of a day's work, we
invariably get some soil (AND GERMS; on
our fingers and hands. Soap and water will
wash off the soil and GERMS. TO DO ANY-THING
ELSE IS A CARELESS TRANSFER
OF GERMS. Dirty hands means a dim
body and all too soon a dirty uniform. Fre-quent
washing of the hands will prevent all
that— AND MORE — THE OBIECTIONAL
TRANSFER OF GERMv
12 The Health Bulletin January, 1945
HANDLE WITH CARE
Be thoughtful of your own HEALTH and
WELFARE as well as of those you serve by
PREVENTING ANY TRANSFER OF
GERMS.
1. Use an ice tong or scoop—BY THE
HANDLE—to obtain cracked ice.
2. Use a butter fork—BY THE HANDLE—
to get chips of butter.
3. Set the table with knives, forks and
spoons—BY THE HANDLE END.
4. Handle coffee cups — BY THE CUP
HANDLE.
5. Carry water glasses—BY THE BOTTOM
END.
6. Handle dishes—BY THE BOTTOM and
RIM END.
7. Use your side towel — AS A SIDE
TOWEL.
Patrons are more alert than we suspect.
The manner in which you set the table, serve
the food and remove soiled eating utensils
makes a profound impression on the customer.
Even the politeness with which you act has
its effect. A "Thank you" when you present
the check is not apt to raise a response from
the patron of "Don't thank me—thank God
I ate it," IF YOU HAVE DONE YOUR JOB
CORRECTLY.
The Whooping Cough Problem
PART II
By
C. P. Stevick, M. D.
Director, Division of Epidemiology
North Carolina State Board of Health
Raleigh, North Carolina
INTRODUCTION
IN discussing the large scale use of whooping
cough vaccine it is necessary to know some-thing
of certain facts about the organism it-self,
particularly in regard to its immunity-producing
characteristics, to review certain
aspects of mass whooping cough vaccination
as carried out in field studies, and to outline
certain basic principles of a plan for use of the
vaccine in this state so as to eliminate as
much as possible of the mortality and morbid-ity
caused by this disease at present.
Summary of the Immunology of
Haemophilus Pertussis
The etiological agent of whooping cough
Haemophilus pertussis, is a short gram-nega-tive
ovoid rod occurring singly or in pairs.
The organisms grow readily only on special
media containing blood. The organisms when
freshly isolated from a patient with the dis-ease
produce round, glistening hemispherical,
and translucent colonics of about 0.5 mm. in
diameter. Colonics of organisms derived from
other sources are usually larger, with a rough-
January, 1945 The Health Bulletin 13
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ffonth Mon/b M>n/M Jfonffo M?n/fc Montis M>ff/J>s Ma/fc M/j/Ag Jfo/?///5 Montis M>af//s
ened surface, and may have indented edges.
Organisms in the former, or "smooth" colonies,
are encapsulated while those in the latter, or
"rough" colonies, have no demonstrable cap-sule.
This dissociation of the pertussis organism
into two or more morphological forms has
been found to hold the solution to the many
difficulties that appeared during the first
attempts at preparing an effective vaccine.
In 1931 Leslie and Gardner found that not
only were there two or more types of colonies
but that when the organisms were separated
on the basis of their serological reactions,
four distinct phases were identified. Phase I
organisms, which produce "smooth" type
colonies, were later found to be the most
virulent of the types and the only one capable
of bringing about effective immunity when
used as a vaccine.
In the preparation of the vaccine on a large
scale it has been difficult, until a few years
ago, to prevent the dissociation of the organ-ism
in the culturing process. Frequently not
all of the organisms grown would be of Phase
I and the vaccine would consequently vary in
its ability to produce immunity. This difficulty
has been largely overcome. In the North Caro-lina
State Laboratory of Hygiene for each lot
of vaccine to be prepared six cultures are
selected which have been recently isolated
from whooping cough patients and which
show certain biological characteristics accord-ing
to five laboratory tests. Flasks of solid
media are inoculated and incubated. The
colonies are then washed from the media
with salt solution, washed again and suspend-ed
in salt solution containing merthiolate in
a concentration of 1:10,000. Sterility and
safety tests are carried out and the concentra-tion
of the vaccine adjusted so that each cc.
contains 10 billion organisms. At present,
agglutination with a specific anti-serum and
the agglutinin response of rabbits to injections
of the vaccine are used as potency tests. A
mouse protection test that can be standardized
more accurately may be available in the near
future as an additional potency test.
Recent work has shown that pertussis vac-cine
when precipitated by alum can produce a
satisfactory immunity in somewhat smaller
doses than with the plain vaccine. This fact
is probably due to the relative slowness with
which the alum precipitated material is ab-sorbed.
There is also reason to believe that
the action of the protein or other antigenic
material in the organism is enhanced by the
use of alum. The combination of pertussis
vaccine with alum precipitated diphtheria
toxoid was a logical consequence, therefore,
14 The Health Bulletin January, 1945
and has been shown in the first studies to be
practical and effective. Since diphtheria toxoid
is not administered to children until after the
sixth to ninth month, the pertussis and diph-theria
mixture cannot he used to immunize
the age group between one and six months
during which time approximately 40 per
cent of all whooping cough deaths in this
state occur.
The immune bodies produced by the in-jection
of plain or alum precipitated Phase I
pertussis organisms are of two general types,
namely, antibacterial and antitoxic. Toxin de-rived
from cultures of the organism has been
used in the preparation of a toxoid, as has
been done with diphtheria toxin. It is gener-ally
accepted at present, however, that the
antibacterial protection afforded by the in-jection
of the killed organisms is more effi-cient,
either alone or in combination with the
toxoid, than is that produced by the toxoid
alone.
The antibacterial antibodies in immunized
children have been demonstrated by comple-ment-
fixation, by agglutination, by the mouse
protection test, and by other means. Protective
antibodies demonstrated by the mouse pro-tection
test have been found to appear ap-proximately
twenty days after immunization
and to reach their maximum concentration
between one and two months after the in-jections.
These antibodies were still present
in some children fifteen and a half months
to four years later. Complement-fixing anti-bodies
were demonstrated to attain a max-imum
concentration within one month but to
disappear within three to lour months after
vaccination. Agglutinins in most of the chil-dren
studied reached a high point shortlv
after vaccination. Neither the agglutination
nor the complement-fixation tests have in all
instances provided an accurate index of im-munity,
since they have been found signifi-cantly
positive only occasionally following
attacks of the disease when the protective
power of the sera of the same group of in-dividuals
was found to be high by other
means.
Pertussis toxin and the killed bacteria have
been studied to determine their usefulness as
skin test antigens. Since pertussis vaccine con-tains
very little pertussis toxin, practically no
antitoxin is produced in an individual im-munized
with the vaccine. Only the sera of
persons who have recovered from the disease
or who received pertussis toxoid showed anti-toxic
activity as demonstrated by skin testing
with purified toxin in these studies. The anti-gen
containing no toxin but merely the bac-terial
agglutinogen in the purified state was
used in a skin test to determine the degree
of immunity resulting either from a case of
the disease or from the injection of the vac-cine.
This latter test needs to be evaluated to
determine whether or not it is suitable for
wide-scale use to determine the success of
pertussis immunization just as the Schick test
is used to confirm immunity following the
injection of diphtheria toxoid.
Another important observation that has
been made in studies on the appearance of
immunity as shown by serological tests is the
fact that "booster" doses of the vaccine stim-ulate
rapidly an increase in existing immunity
produced by vaccination. The use of "booster" .
doses has been recommended as a practical
procedure for stimulating immunity in older
children who were vaccinated early in life.
Review of Certain Aspects of Field
Immunization Studies
The problem of the protection from death
from whooping cough of the children in the
age group one to six months has not been
satisfactorily considered in field studies com-pleted
to date. Only two reports available deal
specifically with the problem. Sauer, who did
much of the original work on preparation of
the vaccine with Phase I organisms, made a
study of the immunity response to injections
of the vaccine in a group of infants under
three months of age. These infants withstood
the injections of 10 billion organisms in a
single dose as well as or better than children
in older age groups. The vaccine was not
standard in all cases in this study but a defi-nite
lowering of the attack rate of the disease
resulted.
January, 1945 The Health Bulletin 15
No deaths from whooping cough were ob-served
in the series. The degree of immunity
produced, however, was considerably lower
than in a group of older children vaccinated
at the same time.
A more recent study carried out in Louis-iana
by Trcuting and others showed definitely
favorable results in the age group one to six
months as far as protection from mortality
is concerned, although protection from the
disease itself was not as efficient as in the
older groups.
As far as the success of immunization pro-grams
of older children is concerned much
favorable evidence has been compiled. There
is no need for reviewing this material here
since wide acceptance by the medical profes-sion
of the value of the procedure has taken
place: however, certain details of two or three
studies are of interest in planning a control
program for this state.
In a study by Kendrick, using the alum
precipitated diphtheria toxoid and pertussis
vaccine combined, whooping cough appeared
in unvaccinated children approximately ten
times more frequently than in vaccinated
children. The disease when it did appear in
the vaccinated group was usually mild.
The success of vaccination in protecting
family contacts of whooping cough cases is
shown by data analyzed by a committee of
the American Public Health Association. In a
group of 4,212 children between the ages of
eight months and five years whooping cough
was reduced by 60 per cent in the vaccinated
group of family contacts.
The dosages used in the field studies have
varied but a committee of the American
Academy of Pediatrics has recommended the
use of 7cc. of the plain vaccine containing
10 billion organisms per cc, or of lcc. given
in divided doses over a period of four to
eight weeks of the alum precipitated vaccine
containing 40 billion organisms- per cc.
Studies are now being carried out relative
to the use of a two-dose schedule of the
combined alum precipitated diphtheria toxoid
and pertussis vaccine for the production of
immunity during the period from six months
to school age, with the possibility of giving
an additional dose on entering school. If a
skin test can be developed it would provide a
means of determining which children needed
this additional injection.
Certain Considerations Pertaining To
Pertussis Immunization In This State
As given previously, the mortality records
for the ten-year period, 1931-1940, show that
of the 2,198 whooping cough deaths that
occurred, approximately 900, or over 40 per
cent, occurred in the age group below six
months.' Figure I shows the age distribution
in months of deaths of children under one
year for the period 1941-1943.
This large group of infants deserves special
consideration in planning a program that
will be as effective in reducing whooping
cough mortality as the diphtheria control pro-gram
has been in reducing diphtheria mortal-ity.
The children in the age group over six
months in which 60 per cent of our deaths
occur can easily be protected by the vaccine.
The children below six months, however, do
not develop an equivalent immunity with the
same dosage of vaccine, and the immunity
that does develop is of shorter duration.
In spite of the relative inefficiency of the
vaccine in this group immunization by use
of the vaccine still remains the only specific
preventive that can be administered before
exposure occurs. After exposure hyper-immune
serum, when available, can be used for passive
immunization and even treatment, with con-siderable
success. Fortunately, a pardal solu-tion
of this problem can be seen in the follow-ing
fact: although protection by vaccination
from actually contracting the disease cannot be
as effective in the younger group as the older
group, protection from death is fairly effective.
This was brought out in the studies previously
mentioned. Saucr reported no deaths in his
series. Treuting reported a definite reduction
in mortality.
Therefore, vaccination at as early an age
as possible, even under three months, would
appear to be a valuable procedure in this
state during the next few years for providing
protection against death from whooping cough
16 The Health Bulletin January, 1945
for young infants, the protection from morbid-ity
being merely a secondary consideration.
Since "booster" doses have been shown to be
effective in increasing immunity previously
produced by vaccination, these young infants
should be reimmunized when they reach the
age group over six months. The development
of the alum precipitated diphtheria toxoid and
pertussis vaccine mixture would provide an
ideal means of administering the booster dose
of whooping cough vaccine at the same time
the diphtheria immunization is carried out;
that is, at approximately nine months.
Since deaths from tetanus are only one-sixth
those from whooping cough it would
be preferable to use the diphtheria-whooping
cough mixture, if it becomes available, in place
of the diphtheria and tetanus toxoids now in
common use. There is no reason to believe,
however, that a triple mixture of diphtheria
and tetanus toxoids, and whooping cough
vaccine would not be practical.
Should the skin test prove to be satisfactory
it would be suitable for use at the same time
the Schick test is given; that is, six months
after the diphtheria-pertussis immunization
and again at the preschool age. If immunity
was found to be low for either diphtheria or
pertussis as shown by the test, a "booster"
dose of the "D.-P." mixture could be adminis-tered.
In order to bring the urgency of the need
for pertussis immunization before the pul lie,
a state-wide whooping cough immunization
law requiring immunization of all children
before the age of one year should be seriously
considered. The passage of the diphtheria im-munization
law in 1939 was followed by an
immediate improvement in the rate of decline
of that disease.
As was shown in a previous article the
majority of cases of whooping cough appear
between one and nine years. This is the age
group in which the most effective resu'ts
can be obtained in reducing attacks of the
disease as well as deaths. By mea^s of a
state-wide immunization program the in-cidence
of the disease in this group can be
so greatly reduced that exposure of infants
under six months will be rare. Exposure of
children of this age takes place chiefly from
tamily contacts so that by the elimination of
whooping cough in the siblings a protecdve
wall of immune individuals can be built
around each infant. When this point is reach-ed
immunization of children under six months
can be safely delayed until the sixth to twelfth
month when the vaccination would result in a
highly effective protection from illness as well
as death from the disease.
There is every reason to believe that in
North Carolina whooping cough deaths can
be reduced practically to zero as is already the
case in areas of other states.
SUMMARY
1. Whooping cough is at present a serious
communicable disease problem in North Caro-lina.
2. Approximately 40 per cent of the deaths
occur under six months of age in this state
so that any control program should include
this group.
3. An immunizing agent is available for
the age group over six months for the highly
effective prevention of mortality and morbid-ity,
and for the age group under six months
for the fairly effective prevention of mortality.
4. Children should, for the present be im-munized
against whooping cough as early
as possible, preferably under two or three
months, should receive a booster dose of the
vaccine at six to twelve months, at the same
age diphtheria immunization is carried out,
either from or in combination with diphtheria
toxoid if the alum precipitated diphtheria
toxoid-pertussis vaccine mixture is available.
5. By the widespread vaccination of all age
groups for the next few years, possibly as re-quired
by a state law, a reduction in the in-cidence
of the disease can be brought about
so that exposure of the age group under six
months will be sufficiently infrequent to per-mit
the delay of immunization in this group
until the more efficient immunizing age of
six to twelve months is reached.
6. North Carolina can eliminate whooping
cough as a leading cause of death among
the communicable diseases.
| 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 July 16, 1884
Published monthly at the office of the Secretary of the Board, Raleigh, N. C.
Vol. 60 FEBRUARY, 1945 No. 2
BUTTER AND
FORTIFIED MARGARINE
(with added Vitamin A)
GREEN AND YELLOW
VEGETABLES . .
.
some raw —
some cooked,
frozen or canned
,5
ORANGES, TOMATOES,
GRAPEFRUIT...
/ve]©S MS J>\or raw cabbage or salad greens
BREAD, FLOUR,
AND CEREALS .
.
Natural whole -grain
or enriched
or restored.
MEAT, POULTRY,
FISH, OR EGGS.
or dried beans, peas,
^nuts, or peanut butter
POTATOES AND OTHER
VEGETABLES AND FRUITS
raw, dried, cooked,
frozen or canned //ar,
Si
©
MILK AND
MILK PRODUCTS,
fluid, evaporated,
dried milk, or cheese
G*2
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 Moum
W. T. RAINEY, M.D Fayetteville
HUBERT B. HAYWOOD, M.D Raleigh
J. LaBRUCE WARD, M.D Ashcville
J. O. NOLAN, M.D Kannapolis
LARRY I. MOORE, Jr.
.' Wilson
Executive Staff
CARL V. REYNOLDS, M.D., Secretary and State Health Officer.
G. M. COOPER, M.D., Assistant State Health Officer and Director Division of Health Education,
Crippled Children's Work, and Maternal and Child Health Service.
R. E. FOX, M.D.. Director Local Health Administration.
W. P. RICHARDSON, M.D., District Director Local Health Administration.
ERNEST A. BRANCH, D.D.S., Director of Oral Hygiene.
JOHN H. HAMILTON, M.D., Director Division of Laboratories.
R. T. STIMPSON, M.D., Director Division of Vital Statistics.
C. P. STEVICK, M.D., Acting-Director Division of Epidemiology.
J. M. JARRETT, B.S., Director Division of Sanitary Engineering.
T. P. VESTAL, M.D., Director Division of Tuberculosis.
C. B. DAVIS. M.D., Director Division of Industrial Hygiene.
JOHN F. KENDRICK, M.D., Executive Secretary, Nutrition Service of the State Board of Health.
MR. CAPUS WAYNICK, Director, Venereal Disease Education Institute.
WILLIAM P. JACOCKS, M.D., Director, School-Health Coordinating Service.
D. F. MILAM, M.D., Director Cooperative Nutrition Survey, Chapel Hill.
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
distribution without charge special literature on the following subjects. Ask for any
in which you may be interested:
Adenoids and Tonsils German Measles Sanitary Privies
Appendicitis Health Education Scabies
Cancer Hookworm Disease Scarlet Fever
Constipation Infantile Paralysis Teeth
Chickenpox Influenza Tuberculosis
Diabetes Malaria Typhoid Fever
Diphtheria Measles Venereal Diseases
Don't Spit Placards Padiculosis Vitamins
Endemic Typhus Pellagra Typhoid Placards
Flies Residential Sewage Water Supplies
Fly Placards Disposal Plants Whooping Cough
SPECIAL LITERATURE ON MATERNITY AND INFANCY
The following special literature on the subjects listed below will be sent free to any
citizen of the State on request to the State Board of Health, Raleigh, North Carolina.
Prenatal Care. Baby's Daily 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
Nutrition—An Allied Responsibility 3
State Nutrition Committee Holds Two-Day Conference 4
Reports of Standing Sub-Committees 6
Reports Of Working Committees 11
Enrichment In Practical Nutrition 15
I L£JJ 1 PUBL15A£D BY TME. P1PRTM CAROU^A 5TATE. E>cyyigDs^MEALTa] |L°_
Vol. 60 FEBRUARY, 1945 No. 2
CARL V. REYNOLDS, M.D., State Health Officer JOHN H. HAMILTON, M.D., Acting Editor
Nutrition - An Allied Responsibility
By Cael V. Reynolds, M.D.
Chairman of the North Carolina State Nutrition Committee
THE question, "Am I my brother's keeper : "
no longer can be evaded by any member
of a well-ordered society. The day of moral
isolationism has gone, whether we like it or
not. The difference between man and the
lower animals is that man's reactions are more
than defensive; he must assume a protective
attitude toward his fellow beings, especially
the less fortunate.
In order to better acquaint readers of the
Health Bulletin with the organization and
functioning of a group which has as its pur-pose
the protection of the population as a
whole, this entire issue is devoted to a con-sideration
of some of the activities and purposes
of the North Carolina State Nutrition Com-mittee,
through a study and interpretation of
reports and recommendations made at a meet-ing
in Raleigh on November 29th and 30th.
This group, representative of the State De-partment
of Agriculture, Agricultural Exten-sion
Service, Education, Health, and Welfare,
the Federal Farm Security Administration, and
many voluntary organizations, such as the
State Medical Society, the State Dental Society,
Parent-Teacher Organizations, the American
Red Cross, Home Economics Women in Busi-ness,
Women's Clubs, and others, has as its
ultimate objective the promotion of better nu-trition
for all groups. Its program is broad in
scope, dealing not only with the selection,
preparation and consumption of the right
kinds of food for the promotion of health,
but also with the production, proper handling,
and the preservation of such foods, all of
which must be taken into consideration in any
program of the character sponsored b\ the
State Nutrition Committee.
We know that adequate nutrition involves
problems of a very diverse nature, and it is
because of this that the Committee is made
up of so many representative groups, each of
•which is in a position to make valuable con-tributions
to the general program.
Adequate nutrition involves labor, farm ma-chinery,
food production quotas, food distrib-ution,
rationing, proper storage, nutrition edu-cation,
and also the study, diagnosis, preven-tion
and treatment of specific dietary deficien-cies.
The problem requires workers who are
trained in the fields of agriculture, education,
welfare, home economics, conservation, med-icine,
public health, industry, hotel, restaurant,
cafe and grocery management, perhaps others.
It is obvious, therefore, that only a cooperative
program, in which all official and voluntary-agencies
actively participate, can be expected to
result in maximum improvement in the nutri-tional
status of all our people. For this reason
the cooperation of everyone is earnestiy solicit-ed,
and it is hoped that no committee represen-tative,
whether he belong to an official or a
voluntary organization, will have any hesita-tion
in helping to promote the work of the
Committee, some of the recent accomplish-ments
and future objectives of which are set
forth in this issue of the Health Bulletin.
Readers of this issue of The Bulletin will
note that committee reports were made on
two separate days. The reports made on Nov-
The Health Bulletin Fefrr-uary, 1945
ember 29 were by chairmen of standing sub-committees
of the North Carolina State Nutri-tion
Committee. These were designed to re-view
past and current activities of the Com-mittee.
Whereas, those rendered on November
30 were by working committees appointed the
previous day to map out plans for future
action.
State Nutrition Committee Holds
Two-Day Conference
THE North Carolina State Nutrition Com-mittee
convened in the auditorium of
the State Laboratory of Hygiene, Raleigh,
November 29, for a two-day meeting.
The opening session was called to order at
10.30 A.M., by Dr. Carl V. Reynolds, Chair-man,
who presided. He extended to the mem-bers,
from all parts of the State, a cordial
welcome, and reminded them that this com-mittee,
representing approximately 30 agencies,
devoted to human betterment, is a clearing;
house for service, with no one agency or in-dividual
clamoring for honors.
Dr. Reynolds presented Dr. John F. Ken-drick,
who addressed the Committee briefly.
He outlined the duties of the State Nutrition
Committee, giving the background of its or-ganization
and tracing the progress of its work
up to the present time.
Chairmen of sub-committees then reported.
Brief discussions followed each report.
John W. Goodman, of the North Carolina
Agricultural Extension Service, gave the re-port
on Food Production, followed by a re-port
of the sub-committee on Food Conserva-tion,
by Mrs. Mary L. McAllister, also of the
Agricultural Extension Service.
In the absence of Miss Catherine Dennis,
Dr. Bertlyn Bosley of the State Board of
Health, reported for the sub-committee on
Nutrition Education. Dr. D. F. Milam, of the
State Board of Health, gave the report of the
sub-committee on Nutrition Research.
The report of the sub-committee on school
lunches was given by Mrs. Louine Moore, of
the State Department of Public Instruction,
after which Miss Phyllis Yates, of the North
Carolina Experiment Station, reported for the
sub-committee on publicity, in the absence of
Mr. F. H. Jeter, Committee Chairman.
The State Nutrition Committee requested
that summaries of the various sub-committee
reports be sent to all committee members for
study and guidance.
Mr. Ralph Scott, Chairman of the Alamance
County Nutrition Committee, was recognized.
He told of the activities being carried on by
that committee including contacts with key
persons and organizations designed to carry
the gospel of nutrition into the homes and
schools, and also the places of employment,
of the people.
Mrs. Stella R. Cusick, Executive Secretary of
the State Nutrition Committee, gave a report
of her activities since beginning work with the
State Committee. She urged the necessity for
the adoption of a program that would insure
.in active organization in every county of the
State.
At the conclusion of Mrs. Cusick's report,
Chairman Reynolds recognized Miss Gladys
Knight, of the War Food Administration, and
Miss Beatrice Fehr, representing the American
Red Cross.
Mr. Hillman Moody, of the War Food Ad-ministration,
informed the Committee that for
the present school year the allocation of WFA
funds to North Carolina for reimbursement
to schools for lunches is $1,888,640.00; that
to December 1, or through November, schools
approved numbered 835. He advocated asking
the State Legislature for additional funds for
administrative purposes.
Dr. ). Henry Highsmith, of tin. State De-partment
of Public Instruction, explained that
one reason more schools were not availing
February, 1945 The Health Bulletin
themselves of funds for school lunches was
that the program this year was late in getting
started. Mrs. Louine Moore added that many
schools are not spending the money available.
Chatham was cited as a model count}- in
the matter of furnishing school lunches. These,
it was pointed out, are available in that county
at five cents each.
Chairman Reynolds declared that he con-sidered
the matter of adequate school lunches
one of our greatest problems at this time;
that, with nearly $2,000,000.00 available, there
was no excuse for so little food going into the
bodies of malnourished children in attendance
upon the public schools. No red tape should
be allowed to stand in the way, he declared.
Dr. C. Horace Hamilton, of State College,
suggested that information be sought regarding
Selective Service rejectees, with a view to se-curing
a breakdown of the figures as to the
various causes, also as to the number of rejec-tions
in various regions of the State. Dr.
Hamilton felt that some of these rejections
were made on account of conditions arising
from nutritional deficiencies.
Chairman Reynolds said that by all means
he thought the published report concerning
rejectees should be challenged, in order that
it be clarified.
Prior to adjournment for lunch, Dr. John
F. Kendrick announced the various commit-tees,
which were to go into session during the
afternoon, assigning a meeting place to each.
At 6:30 the Committee met at the Raleigh
Woman's Club for a dinner meeting, when
the presiding officer, or toastmaster, was Dean
I. O. Schaub, of State College, and the guest
speaker Dr. E. }. Lease, of Clemson College,
South Carolina. Dr. Lease spoke on the En-richment
program.
November 30
The committee held its second general ses-sion
November 30, beginning at 10 A.M., Dr.
Clyde A. Erwin, State Superintendent of Pub-lic
Instruction, presiding. The main, order of
business was the submission of reports by the
working committees appointed the previous
day. These were followed by open discussions.
Reporting for Committee No. 1, Miss Anna
Cassatt, of the State Department of Public
Welfare, recommended that the State Nutri-tion
Committee act as a steering, fact-finding
and follow-up committee, its general objective
being to disseminate information and to stim-ulate
good nutrition habits and practices.
Chairman Erwin, speaking in his official
capacity, gave his unqualified endorsement to
the school lunch program.
Emphasizing the value of school lunches,
Dr. Erwin pointed out that approximately
360,000 North Carolina children are trans-ported
to and from school every day in buses.
Many of these, he said, have to ride for long
distances. Some eat hasty breakfasts, in order
to be off to school on time, while some return
home to scanty evening meals. "It is obvious,"
he concluded, "that these children need warm,
nourishing food at lunch time, as some are
none too well fed at home."
The report for Committee No. 2 was given
by Miss Gertrude Drinker, of the Farm Se-curity
Administration. It contained recommen-dations
on how the State and Local Nutrition
Committees can assist industry in a nutrition
program. It recommended that channels now
established be used to get the proper informa-tion
to those engaged in industry, and through
them, to the homes they represent.
For Committee No. 3, the report was made
by Mrs. Mary W. Thrasher, of the State
Board of Health. It dealt with nutrition educa-tion,
and it also stressed the importance of
adequate school lunches, drawing from Chair-man
Erwin additional comments of endorse-ment.
Dr. W. J. Dann, of the Duke School of
Medicine, reported for Committee No. 4, the
report dealing with how the State Nutrition
Committee can help promote effective re-search.
The crux of the matter, Dr. Dann de-clared,
is how to get better food eaten by
more of our people.
It was recommended that a research com-mittee
be appointed to which the State Nutri-tion
Committee, may refer inquiries, with a
view to having these promptly and properly
answered.
The Health Bulletin February, 1945
Mrs. Louine Moore, reporting for Committee
No. 5 on the establishment of school lunches
and their effectiveness in regard to food values,
attractiveness, participation "by all children, in-spired
the introduction of the following resolu-tion
by Dr. G. Howard Satterfield, of State
College:
"that the State Nutrition Committee re-quest
the appropriation committee of the
State Legislature to provide adequate
funds for conducting the work of the
said committee."
This resolution was unanimously passed.
Chairman Erwin and others voiced opposi-tion
to the sale by adjacent stores of carbonated
drinks, candy, etc., which, when purchased by
school children, prevent them from eating
regular nutritious lunches. Dr. Erwin, speak-ing
as State Superintendent of Public Instruc-tion,
declared that principals have the right to
forbid children to leave school grounds to
make these outside purchases; that no legisla-tion
is necessary to enforce this.
Mr. R. L. McMillan, State Director of
Civilian Defense, warmly commended the
State Nutrition Committee for die spirit of
cooperation it has shown. He declared there
was little concern about what particular agency
does this or that, the main objective being
what the committee as a whole is seeking to
accomplish rather than the acquition of in-dividual
or group kudos.
A feature of the concluding session of the
State Nutrition Committee was a talk by Dr.
Margaret Edwards, in which she reviewed the
various reports that had been submitted, mak-ing
pertinent observations and recommenda-tions.
Altogether, the two-day meeting of the
Committee was the most comprehensive yet
held. Reports and discussions showed that
much work has been accomplished and that
an efficient organization has been established.
William H. Richardson
Secretary.
Reports of Standing Sub-Committees
Following are the Reports of the Standing Sub-committees of the
North Carolina State Nutrition Rendered November 29, 1944
FOOD PRODUCTION
By John W. Goodman, Chairman
Since it is recognized that a good diet must
include adequate milk, poultry, eggs, meat,
fresh fruit and vegetables, the sub-committee
on Food Production makes the following
recommendations:
1. That continued emphasis be put on the
production of these foods by all groups and
agencies making up the State Nutrition Com-mittee.
2. That interest in year round gardens be
increased, giving special attention to the pro-duction
of green and yellow vegetables. Where
space is limited careful consideration should
be given to the growing of vegetables which
insure the greatest return in terms of food
values, for instance corn requires a great deal
of space, whereas vegetables like green leafy
vegetables and yellow vegetables supply abun-dant
food value for the space used in produc-ing
sufficient quantities for use as fresh, can-ned
and stored vegetables should be provided.
3. That more emphasis be given to the
production of an adequate supply of milk by
stressing more adequate feed, including perma-nent
pastures and better care of the familv
cow. We should also stress among urban fam-ilies
the use of an adequate supply of milk.
4. Sufficient quantities of poultry, eggs and
odier meats should be available, home pro-duced
as far as practical.
5. Information on the production of these
foods is available in bulletin form in the
offices of both county and home agents.
County Agents, Home Agents, Vocational
Agriculture teachers and others are technically
February, 1945 The Health Bulletin
trained and can give advice about the produc-tion
of these foods. Their help should be used
by all groups.
This sub-committee and the State Nutrition
Committee as a whole desires to emphasize
at this time the marked superiority of fresh
home grown vegetables and fruits over those
obtained in the markets. The home grown pro-duct
comes to the table without loss of natural
nutrients, whereas even the best market pro-ducts
suffer some loss through aging, drying
or the process of handling. Home production,
therefore, should become a permanent practice
and not one to be discarded at the termination
of the war.
FOOD CONSERVATION
By Mary L. McAllister, Chairman
Food Conservation was considered in its
broad sense as it relates to the retention of
nutritive value, every day use of food, harvest-ing,
buying, storing and all methods of pre-servation.
»
After a general discussion of the problems
presented by committee members it was agreed
that work should be done in educating the
public regarding waste of food in buying
habits, storage of foods in the home refriger-ator
or other storage spaces, leaving foods un-harvested
or improper methods of harvesting,
waste of foods at mealtime, waste of nutritive
values and waste of foods due to improper
preservation methods.
Each member of the committee was asked
to direct various phases of the committee pro-gram.
Miss Brewer was asked to plan the program
for college students.
Miss Mobley and Miss Allen were asked to
prepare materials on waste of foods due to
improper storage in the refrigerator—giving
recommendations for proper storage.
Mr. Harris will direct the work on proper
storage of products from the fall garden or
orchards.
Miss Jenkins is to make plans for the
school's part in teaching conservation of foods.
Miss Yarborough will work on the mate-rials
for the Farm Security or low income
group of people.
Dr. Jones and Mrs. McAllister will under-take
work on food preservation methods.
Mrs. James and the Negro Specialist will
direct the program with Negroes.
NUTRITION EDUCATION
Bv Catherine T. Dennis, Chairman
Each representative gave a brief resume of
the nutrition services offered by his agency.
Weaknesses in the nutrition education pro-gram
were discussed and a few of those most
apparent are listed:
1. We are not reaching and convincing the
greatest possible number of people.
2. We are not using effective methods with
all groups.
3. We are not adequately interpreting the
program to the public.
4. Lay leaders need better nutrition train-ing.
5. There is insufficient coordination of pro-grams
so that all people can be served.
6. We need to reach the masses with simple,
practical materials and information.
7. Nutrition education committees on the
local level need to assume greater respons-ibility.
This indicates a need of assistance from
those at the state level.
8. Necessary assistance is not beinj; provid-ed
Industrial groups. Representatives of In-dustry
should be active members on both
state and local committees.
Recommendations for meeting these needs
were
1. That" a plan for nutrition education be
made, contemplated to reach all groups both
white and Negro.
2. That nutrition education methods be im-proved.
This involves a study of present meth-ods
used and plans for more effective tech-niques.
3. That institutions feeding a number of
people should have trained dietitians or nutri-tionists
on their staffs.
4. That Industrial plants, especially those
employing 250 or more workers, employ nutri-tionists
to carry on an educational program
among the workers and their families.
5. That more nutrition be be included in
s The Health Bulletin February, 1945
the basic training of teachers, health officers,
dentists, nurses and social workers with prac-tical
applications in actual situations.
NUTRITION RESEARCH AND ITS PUBLIC
HEALTH APPLICATION
By D. F. Milam, M.D., Chairman
The Committee on "Research and Its Public
Health Application" makes the following re-port
on nutrition research activities in the state
and the bearing of this work on a practical
program of nutrition improvement.
The science of nutrition is the foundation
on which the superstructure of application of
the principles of dietetics is based, and this
science is not a closed book. It is rather a
rapidly developing affair. The gaps in our
knowledge of nutrition are many and great
and knowledge of the affects of various nutri-ents
or lack of them on our bodies is one of
the least complete parts of our information.
In projecting its activities along the lines of
improved nutrition, the State Nutrition Com-mittee
should keep its program within the
bounds considered valid by the best of nutri-tion
science at the present time. There are
interests, whose influence might sway a pro-gram
beyond that of well grounded scientific
facts and it is therefore quite necessary to
keep abreast of the results of nutrition
research. Keeping up with developments in this
field is quite a chore in itself. This State
Nutrition Committee in particular is interested
in and concerned with nutrition research that
comes out of agencies in the state of North
Carolina. A brief summary of some of this
recent work is reported here.
The Cooperative Nutrition Study, housed
at Duke University, and supported otherwise
by the State Board of Health and the Rocke-feller
Foundation, has carried forward field
surveys of nutrition status of populations for
the past five years. Three counties, Chatham,
Wayne and Alamance, have been the scenes
of studies now completed, and in Orange, a
fourth and possibly the last survey of this
particular type, is now underway. The results
of these surveys have been very informing
and frequently surprising. In general, nutri-tion
status has been improved since the com-mencement
of these surveys in 1940, and in
the boom years of wartime, nutrition in sur-veyed
rural areas has been, if not satisfactor)-,
at least such as to exclude overt signs attri-butable
to malnutrition in all except the un-usual
family, and to make untrue the state-ments
that nearly everybody or at least a
large percentage of the populations is mal-nourished.
That's a matter of definition. While
the dietaries of most families can stand great
improvement, it appears that rural people in
general are now getting diets sufficiently ade-quate
to prevent the appearance of any de-finite
signs of malnutrition. Where diets are
grossly inadequate the responsible factor is
nearly always the economic one. This applies
to people at home, and not to hospital popula-tions,
or other ill persons, nearly all of whom
need most careful dietetic management and
dietary supplements.
At Duke University Dr. Perlzweig and his
collaborators of the Department of Biochemis-try
have recently discovered and improved a
technique for assaying the status of an in-dividual's
nutrition with regard - to nicotinic
acid (or niacin), which is a technique long
needed here. This newer method will probably
be used in field studies within die coming
year. Dr. Perlzweig has also made improve-ments
in the method for assaying nutrition
status with respect to riboflavin and thiamin.
These improved techniques will also be put
to use in the field as soon as practicable.
Drs. Dann and Darby, also at Duke, have
greatly clarified our concepts on "the appraisal
of human nutrition" in a long review soon
to be published in Physiological Reviews. In
this article is a clear statement of the pitfalls
in the way of diagnosis of nutritional defici-ency,
short of, and I quote, "actual manifest
deficiency disease". Individuals in a state of
"potential deficiency disease" where some new
stress, e. g. illness, could quickly produce
actual deficiency disease, and those in a state
of "latent deficiency disease" where vague and
non-specific symptoms occur, but might have
other origin—these conditions and many like
them are best handled with improved dietaries
to lift their nutritional status along the line.
February, 1945 The Health Bulletin
and not simply in a few vitamin nutrients as
indicated by the indefinite but non-specific
signs and symptoms.
Drs. Ruffin and Cayer at Duke recently
completed a study of the effect of added
vitamins to diets of 200 normal individuals
getting what is considered a usual normal diet.
Individuals getting sugar pills over a period
of one month made as much improvement in
pep and energy as those getting vitamin sup-plements.
In that study grave doubt was cast
on the wisdom of the procedure of having
everyone take extra vitamins for superabundant
health. That procedure had best be limited
to those who are ill or in a depleted state.
Dr. Ruffin has also shown recendy that hos-pital
patients are usually less completely satur-ated
with B complex vitamins than are un-hospitalized
individuals, and that in patients
he actually diagonosed as having deficiency
disease, this decrease may be quite marked.
There are many other nutrition research
activities under way at Duke University Me-dical
school where a quite large group of in-vestigators
in nutrition are at work on basic
physiological and chemical problems.
It is impossible, in the time for this report,
to present information on all the nutrition
research projects underway at State College,
Woman's College, Bowman Gray, and else-where.
At State College much work is con-stantly
being carried forward on the better
processing and preservation of foods, and, of
course, on better production. Also in State
College Experiment Station under Dr. Baver
special studies have been and are being carried
out on the riboflavin and thiamin determina-tion
and content in meats and eggs, and the
vitamin A content of sweet potatoes and butter.
The research of the Southern Cooperative
Cooking Project has been set forth in two
progress reports and is still under way. Dr.
Satterfield has accumulated much valuable
data on the vitamin C content of North Caro-lina
foods. At Woman's College, under the
supervision of Miss Margaret Edwards obser-vational
projects on the nutrition habits of
various groups are constantly being carried
out. Recent studies there include 1) the relation
of past and present diets to the physical con-dition
of a group of aged people in a home
for the aged 2) a study of the adequacy of
diets selected by industrial workers on day
and night shifts and 3) several studies of the
effects of nutrition teaching on eating habits.
That's the report on research. Now about
public health
In the application of research items to prac-tical
nutrition, there is usually quite a lag.
In some items there is urgent need to decrease
this interval between discovery of fact and its
application to human problems. We have every
reason now to adhere to the principle that
group feeding or nutritional advice for normal
individuals should be limited to improved
diets with the omission of any suggestion for
vitamin additions. This does, of course, not
include the program of enriched bread. En-richment
of any other food should be looked
at with great skepticism (excepting only vita-min
D milk for special groups).
There is one lesson to be read from these
research items, and that is that for the im
provement of human nutrition, better dietaries,
and not any drug-store purchases, is the
answer. If this program for better dietaries
had all the attention and extension that it
deserves it could well take the full time of
all the employees of government and as many
more as could be paid for. Since this is an
impossible goal, the next best thing is to have
all governmental employees (particularly those
whose duties touch health or food science
—
to have these people use every human contact
in their field duties to say a word for the
program of improved human nutrition. To
do that it is necessary that they be informed
and up to date on this subject themselves.
And that is a problem in education both
"inservice" and out of service. I am verj
happy to be able to pass this problem on tr.
our Nutrition Education Committee.
SCHOOL LUNCHES
By Louine M. Moore, Chairman
The subject most discussed at this meeting:
was sanitation. It was felt that there was a
definite need for a sanitary code for lunch
10 The Health Bulletin February, 1945
rooms. It was decided that sanitary regulations
should be met by all schools serving lunches.
Since school lunch rooms vary so—one teacher
schools to the larger consolidated schools—it
was agreed that two codes of sanitation should
be drawn up. Mr. Melvin of the State Health
Department was asked to prepare such codes
to be presented to the Committee. These codes
have not been completed as yet.
The Committee also felt that there was very
definite need of plans for lunch rooms. Two
types of plans were suggested; a plan for
building of a new lunch room and a plan
for converting class rooms into lunch rooms,
these plans to show the proper equipment, its
placing and dimensions. Mr. Credle was asked
to work on this. He is. now working on plans
for building new lunch rooms.
The Committee further decided that there
was a great need for training workers in
proper sanitary practices. Mr. Melvin offered
the services of the Health Deparuuent in doing
this. The County Sanitarians have visited the
lunch rooms since the fall terms began. More
three-compartment sinks and refrigerators have
been put in lunch rooms or purchased for
installation than in any single year in the
past.
It was pointed out that it was the respon-sibility
of the Health Department to recom-mend
the closing of lunch rooms when the
operation endangers the health of the child.
Before a lunch room is closed, however, the
city or county superintendent will be notified
as to existing conditions and he will be given
sufficient time to make the necessary changes.
All sanitarians are to be notified of this
procedure.
Finally the Committee went on record as
discouraging the sale of candy, soft drinks
and knicknacks, because they tend to destroy
the appetite and interfere with the child's
selection of a good nutritious lunch.
PUBLICITY
By F. H. Jeter, Chairman
The report of the Publicity Sub-Committee
of the State Nutrition Committee may be
divided into three parts: Newspaper publicity,
radio publicity and publicity by the distribution
of literature.
First of the newspaper articles to be dis-tributed
was a story containing Governor
Broughton's proclamation, declaring Septem-ber
Nutrition Month. This story was distri-buted
to about 40 state papers, in which it
was widely used. It was also accompanied by
a dummy of an advertisement sent to the
advertising manager of each paper, and by a
glossy print of the Basic Seven Chart for use
in the papers.
Following this, two stories were sent to all
the daily papers in the state. One explained
the function of the State Nutrition Committee,
and the other pointed out the contents and
importance of the Basic Seven Chart.
In addition, a leading article was prepared
by the members of the Nutrition Committee
and sent to all the papers. Reports show that
it was widely used, either in its original form
or after proper adaptation.
The second main division was radio publi-city.
To help with this, the State Board of
Health was very generous in donating the
time of four of its Saturday broadcasts given
by Mr. W. H. Richardson over WPTF to dis-cussions
of nutrition month. These broadcast-dealt
with the Governor's Proclamation, the
basic seven foods, and the results of an inade-quate
diet. Also, a series of eight broadcasts,
prepared by the nutrition specialists, was dis-tributed
to the nutrition chairmen in counties
in which radio stations are located.
The third type of publicity used in con-nection
with this program was distribution of
literature, such as pamphlets . . . 100,000
of which were sent out - - - exhibition ma-terial,
charts and posters. This material was
sent directly from the Washington office for
distribution in the field.
EXECUTIVE SECRETARY'S REPORT
By Stella R. Cusick, Chairman
My first duty was to attend a regional meet-ing
of the State Chairmen and Executive
Secretaries, which was held in Roanoke, Vir-ginia,
the first four days of March, 1944. Much
help was gained from the discussions and
instructions given there.
February, 1945 The Health Bulletin 11
Upon our return a meeting of the Planning
Committee was called to discuss the outcome
of the Roanoke meeting, plans for our own
committee and the work of the Executive
Secretary.
It was decided to study more closely the
membership of the State Nutrition Committee
with the view to revising the list and rework-ing
the sub-committees for more effective
work.
It appeared to the Planning Committee that
one of the first things to be undertaken by the
Executive Secretary should be in making
contacts in counties with members of the
county committees and in conducting meet-ings
of county committees. Such meetings have
been conducted in 33 counties and conferences,
have been held with chairmen and other com-mittee
members in 14 counties.
While our record showed that we had an
organization in some 95 of jhe counties not
all of these were actively at work and in
some of them meetings had not been held since
the Food Conservation Workshops of 1943.
One of their chief reasons for delaying action
was that they had not been told anything
specific to do. We have attempted to show
them our reasons for not telling them specific
things to do and we have offered our services
in helping them plan a program to meet the
needs of their own people.
The Planning Committee agreed that since
more frequent contacts were important and
badly needed that field supervisors in a number
of the agencies should be responsible for as-sisting
the County Committees as they make
their regular official visits. Two counties were
assigned to each of the field supervisors of
all agencies to cooperate. Discussions were held
with these groups to assist them with the plan
to follow. This we feel has been of a great
deal of help in counties where supervisors
have found the time and opportunity to work
with County Committees. We hope that this
helpful plan can be more effectively carried
out in die future with a larger number co-operating.
In addition to counties visited the State
Chairman has felt that it is important for the
Executive Secretary to make many contacts
both with individuals and groups. This has
been done. Some of the groups with whom \vt
have worked, or with whom we have made
effective contacts are:
The State Congress of Parents and Teachers:
The Nursing Consultants; The N. C. Council
of Home Demonstration Clubs; The N. C
Federation of Womens' Clubs; Civic Clubs:
N. C. Dietetic Association; N. C. Home Econo
mics Association; Schools; The Radio
Five meetings of the Planning Committee
have been attended. We have also had tin-opportunity
of meeting with many of the sub-committees
in the State Committee.
A 3 day meeting of the Executive Secretaries
was held in Atlanta in October, which was
helpful in taking stock of our progress to date
and for outlining new plans.
Several days have been spent with the in-plant
feeding specialists of the War Food
Administration studying their work with In-dustries.
Arrangement was made for Dr. E. J. Lease,
of the Nutrition Department, Clemson College,
to spend some time with us giving us infor-mation
on the Enrichment Program.
Growing out of this we are pleased to
announce that Dr. Lease will be the speaker
at our dinner tonight.
Reports Of Working Committees
Following are the Reports of Special Working Committees
Rendered on November 30. 1944
STATE AND COUNTY ORGANIZATION
By Anna Cassatt, Chairman
Committee Number 1 of the State Nutrition
Committee, after discussing the organization
and goals of State and Local Nutrition Com-mittees
made the following recommendations:
12 The Health Bulletin February, 1945
That the function of the State Nutrition
Committee should be to act as a steering, fact-finding,
and follow-up committee.
That the administrative heads urge their
personnel to participate in furthering the or-ganization
and work of the County Nutrition
Committees.
That the general objectives of the State and
Local Nutrition Committees shall be to dis-siminate
facts regarding nutrition to all citi-zens
of the State and to stimulate all citizens
to adopt good nutritional habits and practices.
That the goals for 1945 shall be:
1. The organization of a Nutrition Com-mittee
in each county with an active
chairman in each.
a. In counties where there ts already a
Nutrition Committee that this commit-tee
be reorganized where necessary to
get it actively functioning.
2. That a concertive effort shall be made
by all Nutrition Committees in getting
an equivalent of a Grade A lunch to be
made available in all consolidated and
city schools of the state and that at least
a supplementary lunch be provided for
children attending all of the other schools.
3. That the Nutrition Committee should
conduct an educational program to reach
into every home. It is recognized that
every child should have a good lunch
at school.
4. That we as a Nutrition Committee en-dorse
and actively support a program for
the enrichment of all refined cereal pro-ducts
and continue to promote the use
of whole grain products.
5. That Nutrition Committees shall co-operate
in getting well balanced lunches
served in Industrial plants and nutrition
education to the workers.
NUTRITION
By Gertrude Drinker, Chairman
1. That a proper approach be made to
management to discuss with them the
nutritional services available through the
War Food Administration.
2. That local nutrition committees include
industrialists who may study nutritional
needs of the community and plan a pro-gram
suitable to the needs of their workers.
3. That good radio programs on nutritional
needs of industrial workers be given.
4. That committees try to reach more plants
and to work with a greater number of
small plants.
5. That industries be encouraged to follow
recommendations of the Department of
Agriculture and the Extension Service
on gardening.
6. That full use be made of channels now
established in getting better nutrition
presented to workers in plants and through
them to the homes.
• 7. That greater efforts be made to coordinate
the nutrition activities of all official and
voluntary agencies through the respective
local nutrition committees.
8. That the word INDUSTRY be broadly
interpreted, and that all industries, both
large and small, be included in die promo-tion
of better nutrition.
9. That industrialists be urged to participate
actively in a nutrition education program
for the families of industrial workers.
10. That the State Nutrition Committee ap-point
a permanent chairman of its sub-committee
on Nutrition in Industry.
NUTRITION EDUCATION
By Bertlyn Bosley, Ph.D., Chairman
The Committee on Nutrition Education be-gan
its meeting with a summary of the con-tributions
of the various interested agencies
and organizations to the Nutrition Education
Program in the state.
The Committee set up the following aim
for education in nutrition: To get as many
people as possible to eat enough of the right
food at the right time.
In achieving this aim it was suggested that
we must consider existing food habits, econo-mic
status, the present knowledge of the people,
and the best techniques for developing good
attitudes toward the foods that people need
to eat.
From this statement of aims and considera-tions
in a Nutrition Education Program the
February, 1945 The Health Bulletin 13
Committee proceeded to di.scus.sion of methods
to be used in effecting a program.
I. Schools
The need for more adequate pre-service
and in-service training of all teachers in the
sciences of nutrition and how to present nutri-tion
to children was brought out. It was stated
that the State Nutrition Committee could use
its influence in getting colleges to require a
nutrition course for all pre-service teachers,
but no minimum reqirements or definite plans
for such courses were made. (It was likewise
stated that such a course should be required
of all pre-service social workers). Working
through the Department of Public Instruction
it was agreed that the committee could reach
in-service teachers with Nutrition Education
Workshops in every school administrative
unit in the state. The aim of these workshops
would be to give teachers factual information
and methods of interpreting this information
m the classroom. Two or Three hour sessions,
two or three times a week for two or three
months was suggested for the time to be given
to these workshops, and a suggestion was
also made that a workshop using a minimum
amount of time could reach more teachers.
As a step leading to these workshops a motion
was passed that the committee should pre-pare
a brief suggested program to be used,
and that this program be made available to
those people best qualified to help with the
workshops. The cooperation of the Department
of Public Instruction in organizing the work-shops
was assured. It was suggested that social
workers, public health nurses, and workers
with various services and agencies in the local
communities could also take advantage of the
training in these workshops. There was a
question as to whether these workers should
use the same training as that to be given
teachers, but need for training was definitely
recognized.
The importance of the school lunch as a
Nutrition Education device as well as a feed-ing
program was brought out, but the com-mittee
left a thorough discussion of this prob-lem
to the committee on the school lunch. It
sv;is agreed that the topic of school lunches
must be included in the workshop program.
II. Communities
The problem of educating adult groups in
the community seemed to be one (1) of or-ganizing
so as to reach the most people and
(2) deciding what information to give to
people and what techniques to use. The part
that the Red Cross, Vocational Home Econom-ics
teachers, social workers, nurses, the Exten-sion
Service, and community organizations,
such as Parent-Teacher Associations, and Li-braries,
can play in the program was discussed.
It was agreed that each community presents
.in individual problem of organization for
Nutrition Education. A motion was passed
that the committee prepare an outline of (1)
suggested schemes for organizing to reach
people in the community and (2) what and
how to teach the people.
HI. Industries
It was suggested that the State Nutrition
Committee use its influence in encouraging
industries employing 250 or more people to
employ nutritionists to work with their em-ployees
and their families.
IV. County Nutrition Committees
The need for educating the County Nutri-non
Committees was recognized.
In conclusion it was suggested that a steer-ing
committee be appointed to investigate the
tremendous task of setting up a comprehensive
12-year course of study in Nutrition for the
public schools of North Carolina.
COMMITTEE ON RESEARCH
By W. J. Dann, M.D., Chairman
(1) The discussion of this committee was
around the following points: first, how can the
State Nutrition Committee help promote re-search
aspects of nutrition? The discussion
suggested that it could, from its knowledge
of projects in all groups, point the direction in
which research should move and which agen-cies
can most fruitfully undertake each aspect
of this work. It could collect information on
what is going on and make it available to all.
It could inform the several research groups
as to what funds could be possibly available
for this purpose, that is, serve as a clearing
house for this information. The opportunities
14 The Health Bulletin February, 1945
for coordinated attack on the nutrition problem
by these means were emphasized. The follow-ing
resolution was passed: "That the State
Nutrition Committee (its executive committee)
is requested to serve as a receiver of questions
regarding nutrition and to transmit these to
those who can answer them." The function of
this sub-committee as part of the Nutrition
Committee to carry out these functions was
stressed, but its impermanence, being appoint-ed
for today only, was mentioned. The follow-ing
resolution was therefore submitted and
passed: "That this sub-committee or a perma-nent
research sub-committee of the State Nu-trition
Committee be appointed with member-ship
similar to that of today's group, that it be
made a permanent standing sub-committee to
carry out the functions of coordination in
nutrition research in this statei" One other
service of the committee was also mentioned,
namely that it could inform industrial groups
or others where certain types of nutrition in-formation
can be obtained or furnish the in-formation
itself. There was considerable dis-cussion
on cooking methods in institutions,
types of cookers most useful and the results
of various cooking processes on nutrients in
foods as well as taste.
(2) Application of nutrition research to
public health was discussed.. This involved
chiefly getting useful information across to
the individual in need of it, for example, the
grower. Improved varieties of sweet potatoes
and other tubers are available and can be
selected to fit the needs of growers provided
they are rapidly informed of the results of
latest researches. Results of better canning,
freezing and drying studies are also pertinent
in this regard. Much was made of the Federal
program of having a national chairman of
each food commodity, who will prepare a
digest of information past and present on his
commodity presenting the data on production,
preservation, etc. regarding it. Such handbooks
would be extremely useful and the meetings
of those interested in each commodity would
serve to disseminate useful information of all
kinds regarding it. Particular mention was
made of a turnip with high vitamin C con-tent,
a hugh sweet potato of high starch con-tent.
The need of local studies of each variety
was emphasized.
Relation of soil deficiency to human nutri-tion
was discussed by Dr. Baver and the de-ficiencies
of certain North Carolina socials
mentioned, particularly boron, manganese,
copper and zinc.
The school lunch program was discussed at
some length as a central item in any nutrition
improvement program and the chief item in
the public health aspects of nutrition. Food
preferences were mentioned as highly in-fluenced
by foods available in childhood, this
emphasizing the importance of well planned
school lunches. The Army life was believed
to exert a potentially great effect on future
food habits. Dr. Hamilton wanted some elfon
made to study statistically the effects of the
school lunch program.
Industrial feeding was also discussed brief1 y
as a second important public health item. The
banning of soft drinks and candies both in
schools and industrial plants was mentioned
as desirable, if attainable, with substitution
of milk as the recommended beverage. Miss
Mobley mentioned the great increase in elec-tric
bills at school cafeterias due to cooking
in improper utensils, for example dish pans.
It was repeatedly emphasized that teaching
right food habits to school children is an out-standing
opportunity and duty.
Dr. Lease discussed the South Carolina
program of enrichment of wheat and corn
products, emphasizing this as a possible pro-gram
from which great good results would
flow, while much of the discussion of this
committee has been on items not easily car-ried
out and therefore of more distant pos-sible
benefits. The desirability of the enrich-ment
program in this state was discussed with
considerable keenness and both views were
well represented. No agreement was reached
by the committee.
The following resolution was passed by the
committee: "The enrichment program when
it comes up before the legislature in this
state should be referred to the State Nutrition
Committee and its subcommittee on nutrition
February, 1945 The Health Bulletin 15
research as an advisory group." The discussion
emphasized the point that the enrichment pro-gram
will carry nutrition improvement only
a short way since deficiency diseases are not
uncomplicated but multiple and that an in-dividual
living on a yearly income under
$200.00 could not get an adequate diet even
with enrichment of his cereals. The enrich-ment
program is to be regarded as just a
help and not a cure-all. The question of de-sirability
of legislation in North Carolina for
enrichment was brought up as also the ques-tion
as to whether or not an enrichment pro-gram
might decrease the possibility of getting
a long extraction flour generally in use.
(3) A further resolution was passed as fol-lows:
"This sub-committee recommends to the
State Nutrition Committee that it explore all
agencies for possibility of increasing better
nutrition in schools, homes and industries."
SCHOOL LUNCHES
By J. S. Waters, Chairman
Much rime was spent in the discussion of
the question "How can the Nutrition Com-mittee
function as to participation in school
lunch program?"
It was recommended that a study be made
by the Nutrition Committee through the prin-cipal
and teachers of each school to determine
the following points:
1. The percentage of children eating in the
lunch room.
2. The percentage of children bringing
lunch from home.
3. The percentage of children having no
lunch.
4. Number of free lunches that should be
served.
5. The type meals or menus served in the
lunch room.
6. The price charged for lunch.
7. The facilities (space and equipment) for
preparing and serving lunch.
8. Are foods other than the school lunch
available at lunch time? At little recess?
9. Are students allowed to go to near-by
stores to make purchases?
When this study has been made the Com-mittee
should know the facts and can then
take the necessary steps to handle the particular
problem.
Enrichment In Practical Nutrition
Resume' of Address by Dr. E. J. Lease,
Clemson Agricultural College,
Delivered at the Raleigh Woman's Club on the evening of November 29.
THE word "Enriched" has been popular-ized
recently but enrichment has been
practiced for generations. Long ago poultry-men
found that by enriching their feeds with
limestone, cod liver oil, etc., they were able to
produce healthier chickens that were more re-sistant
to diseases. Chickens fed this "Enriched
feed" grew better and, therefore, poultrymen
recognized enrichment as practical. Today
poultry feeds are enriched with cystalline
riboflavin, vitamin D, calcium compounds,
manganese compounds, and many other ingre-dients.
Baby foods such as Pablum and Gerber's
have been enriched with vitamins and minerals
for many years. The enrichment of oleomar-garine
with vitamin A has been practiced a
long while in Europe and America. Iodized
salt is really salt that has been enriched by the
addition of small amounts of potassium iodide.
In the broadest sense of the term, the sprink-ling
of salt on meat at the table is an enrich-ment
process whereby the meat is enriched
with a mineral needed and craved for by the
body.
The South Carolina Nutrition Committee
was interested in enrichment from the begin-ning
of the program because it offered a means
of promptly making a contribution toward
improvement of the diet of the mass of the
people. In discussions of the food value of
16 The Health Bulletin February, 1945
cereals consumed in appreciable quantities by
the average American, comparisons should not
be made between whole wheat flour and en-riched
white flour. The comparison should be
between enriched and non-enriched white
flour, for it is the non-enriched white flour
that is to be condemned and improved a bit
by enrichment. Unfortunately white flour and
white bread are used in very much greater
quantities than the whole wheat products.
Nutrition leaders should continue as they
have for many years to advocate the use of
whole wheat bread. However, if the public
insists on white flour and white bread, we
should take such action as is necessary to
assure the public that these commonly con-sumed
foods have as high a nutritional quality
as can be made under practical conditions.
Elderly people often ask, "How did our
grandparents get along without enrichment?"
It is to be remembered that eighty years ago
the foods consumed were less refined and
therefore of higher vitamin and mineral po-tency.
The flour was an unbleached whole-ground
product with perhaps part of the big
pieces of bran screened out. Our grandparents
consumed rice which contained considerable
brown hulls and nutritionally valuable outer
coats known as polishings. Their grits were
made from whole-ground corn, while today
ours are made from the degerminated, starchy
endosperm portion of the corn kernel. Today
the average American uses 100 pounds more
sugar per year than did his grandparents
eighty years ago. These changes all contribute
to making the diet more dilute in essential
nutrients. Enrichment of refined foods tends
to correct this undesirable trend.
The reason we enacted enrichment legisla-tion
in South Carolina was to get the cheapest
brands of family flour and bulk grits enriched.
These staples are consumed by those most
needing the enrichment. The highly adver-tised
fancy package goods would probably be
enriched without the law, but not the less
expensive foods. Pearl grits are especially low
in vitamins and minerals, in fact lower than
white flour or rice. Grits can easily be en-riched
under practical conditions by a use of
a premix which does not lose its vitamin con-tent
when the grits are washed before cook-ing.
Several mills are now enriching grits, and
the industry favors enrichment.
The South Carolina Nutrition committee
met with the Agricultural committees of the
Senate and House of Representatives and dis-cussed
the proposed Bills. Cooperation was
sought from the industries concerned and
little opposition was encountered. Nevertheless
much work was involved in educating the in-terested
parties as to the reasons for the action
and how the law could best be administered.
The Committee feels that the nutritional im-provement
brought about was well worth the
effort.
'*=^»^=*'
Education has been the chief weapon used to gain all past victories against tuberculosis. Educa-tion
must continue to be the chief weapon. No drug has yet been found to cure tuberculosis in
spite of long sustained and extensive medical research.
I This Bulletin, wfll be sent free to any citizen of the State upon reque:
Entered as second-class matter at Postoffice at Raleigh, N. C, under Act of July 16, 1884
Published monthly at the office of the Secretary of the Board, Raleigh, N. C.
Vol. 60 MARCH, 1945 No. 3
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
C. 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
LARRY I. MOORE, Jr Wilson
Executive Staff
CARL V. REYNOLDS, M.D., Secretary and State Health Officer.
G. M. COOPER, M.D., Assistant State Health Officer and Director Division of Health Education,
Crippled Children's Work, and Maternal and Child Health Service.
R. E. FOX, M.D., Director Local Health Administration.
W. P. RICHARDSON, M.D., District Director Local Health Administration.
ERNEST A. BRANCH, D.D.S., Director of Oral Hygiene.
JOHN H. HAMILTON, M.D., Director Division of Laboratories.
R, T. STIMPSON, M.D., Director Division of Vital Statistics.
C. P. STEVICK, M.D., Acting-Director Division of Epidemiology.
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.
JOHN F. KENDRICK, M.D., Executive Secretary, Nutrition Service of the State Board of Health.
MR. CAPUS WAYNICK, Director, Venereal Disease Education Institute.
WILLIAM P. JACOCKS, M.D., Director, School-Health Coordinating Service.
D. F. MILAM, M.D., Director Cooperative Nutrition Survey, Chapel Hill.
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
distribution without charge special literature on the following subjects. Ask for any
in which you may be interested:
Adenoids and Tonsils German Measles Sanitary Privies
Appendicitis Health Education Scabies
Cancer Hookworm Disease Scarlet Fever
Constipation Infantile Paralysis Teeth
Chickenpox Influenza Tuberculosis
Diabetes Malaria Typhoid Fever
Diphtheria Measles 1 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
Changing Emphases In Public Health Nursing 3
Public Health Nursing Day 7
"Know Your Public Health Nurse—Who She Is—What She Does" 10
Nursing Activities In Sampson County Health Department School Program 15
Jiol@aj
PUBLI5AE.D BY TML. HQR.TA CAROUMA 5TATE. EPAlgD s^MLALTM
Vol. 60 MARCH, 1945 No. 3
CARL V. REYNOLDS. M.D., State Health Officer JOHN H. HAMILTON, M.D., Acting Editor
Changing Emphases
In Public Health Nursing*
By
Pearl McIver, Senior Nurse Officer (R), Chief,
Office of Public Health Nursing, U. S. Public Health Service
Washington, D. C.
MOST of us assume that health programs
will expand greatly during the postwar
period. These assumptions are based upon the
belief that:
1. Full employment and a high national in-come
level will be maintained through-out
the nation.
2. An increased number of our citizens
(both military and industrial) will have
developed an understanding and appre-ciation
of the value of adequate health
services.
3. Federal -State cooperative relationships
will be maintained and strengthened.
. There will be general agreement with re-gard
to the statement that prevention
and treatment are two phases of the
same problem.
5. Private and public enterprise will be
integrated but both shall continue to
function.
Public health nursing gains since World War
I have kept pace with the general expansion
in public health activities. As a matter of fact,
public health nurses now outnumber all other
workers in the health field and yet the mini-mum
ratio of nurses to population recommend-ed
by the Committee on Administrative Prac-tice
of the American Public Health Association
has been reached by only nine states. Health
departments today recognize that public health
nurses are needed to translate into practice
virtually every type of public health services.
As the scope of all health programs expands,
additional functions will be added to the re-sponsibilities
of the public health nurse. How
will these increased responsibilities be met and
where will the emphasis be placed in future
public health nursing developments?
Program Emphases:
Every community needs public health nurs-ing
service for three basic purposes. These are:
1. The prevention and control of disease.
2. The care of the sick in their homes.
3. Family health counselling or what has
been called health supervision or health
teaching.
In the future, health departments will be
concerned with any disease which is a major
cause of disability or death. Those diseases
which yield to known control procedures will
no doubt be given precedence but the degree
of communicability will not be the primary
determining factor, as has often been true in
the past. In some communities routine activ-ities
in an attempt to control measles and
chicken pox have consumed much valuable
time of the nurses which might have been
spent more profitably on rheumatic heart
disease; cancer or diabetes. The availability of
•Read before The North Carolina Public Health Asso-ciation,
October 31, 1944, Raleigh, North Carolina.
The Health Bulletin March, 1945
more accurate diagnostic procedures and facil-ities
will make the nursing follow-up of such
diseases as tuberculosis and syphilis more effec-tive.
Many of the nurses present have had the
discouraging experience of making routine
visits to "suspected" tuberculosis cases over a
period of months or years until the death
certificate finally confirmed their "suspicions."
Likewise, many nurses have worked diligently
to persuade a prenatal case who gave a history
of numerous still births to go to her doctor
for a blood test only to have her go to the
doctor and be told that "blood tests were not
for the likes of her," and she returned home
to give birth to another still born child. Better
medical facilities will make public health ,
nursing much more purposeful and effective.
The public health nurse of tomorrow will
analyze her case load carefully, and armed
with complete medical diagnosis and instruc-tions,
she will direct her efforts directly to-wards
the source of the problem.
Public health nursing originated as a bed-side
nursing service for the sick in their homes.
Some public health nurses have out-grown
their usefulness in this field. If we accept the
premise that prevention and treatment repre-sent
two phases of the same problem, then the
problem is only half solved when we limit our
service to prevention. Likewise, the early pub-lic
health nurses found that nursing care with-out
preventive measures would not solve the
whole problem either. The qualified public
health nurse is equipped and has a marvelous
opportunity to use both of these weapons—pre-vention
and treatment. In large cities, vol-untary
visiting nurse associations working co-operatively
with the official health agency have
met the nursing care needs. A number of
smaller cities have worked out satisfactory
amalgamations of services and are rendering
a complete service under the administration
of the official health agency. Very few, if
any, strictly rural health departments offer
such a program. From an economy standpoint,
it would seem that bedside nursing services
should be an integral part of the rural health
department program rather than to establish
separate organizations for that purpose. Within
the next year the Public Health Service ex-pects
to cooperate with four or five rural
health departments which have fairly adequate
preventive nursing services, in order to study
the administration of a complete nursing serv-ice
including bedside nursing care. Some of the
questions which will be answered by such
studies are:
1. How many additional nurses must be
added to a staff which already meets the
minimum requirement of one nurse to
5000 population if a bedside nursing
service is added?
2. Do all of the nurses need to be especially
prepared public health nurses or can
senior cadet nurses, veteran nurses with-out
public health preparation or even
licensed practical nurses be used if they
serve as "nurse assistants" to a qualified
public health nurse?
3. How much bedside nursing care should
be made available to all citizens through
tax funds?
4. Is there a point where additional nursing
care ceases to be of public health value
and becomes a mere convenience for a
limited group of the population?
5. Should the health department accept fees
for such service if the patients are able
to pay ?
If through a limited number of field de-monstrations
and studies, accurate answers to
the above questions can be secured, it is be-lieved
that appropriating bodies will not hes-itate
to support such a program. The Con-ference
of State and Territorial Health Officers
has endorsed the promotion of more bedside
nursing in official health departments. Verbal
support is not enough. The time has come
when this activity must become common
practice if generalized public health nursing
is to be what its definition implies. 2/
Health counselling or health supervision has
always been an important function of health
department nurses. The effectiveness of their
teaching has sometimes been questioned, prob-ably
because they have done too much "tell-
2/ A generalized public health nurse is nnc who
renders all types of public health nursing services
needed by the people in a certain geographic area.
March. 1945 The Health Bulletin
ing" and not enough "doing." The Chinese
say: "You hear a thing and soon forget it.
You see it and remember half. You do it your-self
and remember all." The public health
nurse has unlimited opportunity for health
teaching and if she integrates that teaching
with a service to the family which is recog-nized
and wanted, her teaching begins to show
results. The health educator, a valuable addi-tion
to our health team, will supplement the
health teaching of the public health nurse but
will never replace her type of teaching. To
me, the health educator becomes the "John
the Baptist" of the health department. She
prepares the way and stimulates the oppor-tunities
of the other members of the health
department for health instruction. The health
educator and the public health nurse can and
will be mutually helpful to each other.
Volume of Service Needed:
While the number of public health nurses
increased greatly from 1920 to 1940, there has
been no increase since 1940 even though war
time problems have increased the demand for
more service. The 1944 Census of Public
Health Nursing shows that only nine states
have reached the minimum war time standard
of one staff nurse per 5000 population. If the
public health nursing program is to meet
fully the needs for nursing care, as well as
the preventive and educational services, we
shall need three times as many public health
nurses as are now available. Fortunately the
cadet nurse program has been successful and
within a few years an adequate number of
nurses should be available. Some commentators
have suggested that nursing schools have ad-mitted
too many students and that there will
be an oversupply of nurses when the war is
over. However, we have never had enough
nursing service when the available supply is
compared with the needs for nursing care.
There has been an oversupply when the num-ber
available was compared with the ability
of individuals to purchase necessary nursing
care. Our emphasis in the future must be on
furnishing adequate nursing care on the basis
of patient need and not on individual ability
to pay for that care. Adequate public health
nursing care will require an appropriation of
from one to one and a half dollars per capita.
Our post war public health budgets must make
provision for nursing service on that basis.
Educational Emphases:
To prepare nurses who are equipped to
assume the many new responsibilities which
public health nurses will assume in the future,
to guide and supervise various types of auxil-iary
workers and to coordinate the public
health nursing service with the nursing serv-ice
rendered in hospitals and sanatoria will
require careful planning and adequate finan-cial
support. To be specific:
1. We must develop basic nursing educa-tion
programs which integrate the social and
health aspect with the care of the sick. All
nurses, not only public health nurses, must
have an understanding and appreciation of
disease prevention and health promotion. In
order to give all nursing students this appre-ciation,
schools of nursing recognize the value
of a closer tie-up with community health
agencies. The faculty in schools of nursing
and the community public health nurses have
much to give each other. As public health
nurses we have a responsibility to assist in
the preparation of our future nurses. We may
assist by arranging visits in the community
and by conducting discussion groups on health
projects for the younger student nurses within
schools of nursing. Actual field experience in
public health for student nurses has in the
past been a regular requirement of some
schools of nursing but such experience must
not take the place of a continuous emphasis
on the social and health aspects of nursing
which should begin when a student enters
the school of nursing.
2. Universities and colleges which offer pub-lic
health nursing programs of study must
develop their programs on a level adapted to
the needs of graduates from these modern
schools of nursing. Nothing destroys the in-terest
of a young nurse so much as to be re-quired
to take a postgraduate program of study-in
public health nursing which does little
but rehash the same material she was given
in her basic program. However, universities
The Health Bulletin March, 1945
must be flexible in arranging postgraduate
programs for the large group of graduate
nurses who did not graduate from modern
schools of nursing. Prerequisite courses and
special seminars must be arranged for that
group if they are to be admitted to the pro-grams
designed for the graduates of modern
schools.
3. We must develop programs in the clinical
specialties such as tuberculosis, venereal disease,
and cancer control; orthopedics; pediatrics
and obstetrics. These programs should be de-signed
primarily to meet the needs of public
health nursing consultants in these special
fields and for institutional supervisors and
administrators of special services. There is a
trend towards having one special nursing
consultant serve both the health agency and
the hospital or sanatorium. This sharing of
consultant services may point the way to a
better coordination of the nursing programs
in hospitals and public health agencies.
4. Finally we must expand those programs
designed to prepare supervisors of public
health nursing. The use of more "nurse assist-ants"
will require more and better super-visors.
Every public health nurse to whom an
assistant is assigned exercises certain super-visory
functions. Therefore, field conferences,
on a supervisory level, and didactic courses
in supervision must go hand in hand if real
leadership and supervision are to be available
to the student nurses and to younger nurses
in the field of public health.
Future Opportunities in Nursing
The nursing profession is passing through
a critical period in its history. Professional
nursing as it is known today is scarcely more
than fifty years old. It has made remarkable
progress in its educational and service develop-ments
particularly since 1900. It is expanding
now at a tremendously rapid pace. The ad-missions
to schools -of nursing have increased
sixty-six per cent during the past nine years.
Growing pains may be inevitable but we are
assured that the expansion is not out of pro-portion
to the real needs for nursing service.
For the first time in the history of nursing,'
this need for nursing service has been pub-licized
far and wide, by both federal and
private enterprise. Generous federal appropria-tions
have been made to promote the educa- '
tion of more nurses. Patterns of nursing educa-tion
have been modified but not changed
fundamentally. Some of the modifications may
prove to be better than the original pattern
and perhaps should be continued when the
war is over. I believe we can rely upon our
nursing education leaders to hold on to that
which was sound in past practices, to visualize
the changes through which our civilization is
passing and to develop an educational program
which will produce better nurses than we
have ever had before.
As service agencies, we have a responsibility
to lead the public to appreciate the need for
more nursing service and to develop a plan
for the utilization of the available nurse sup-ply.
Such a plan must take into consideration
the ability of the public to buy such service
and a salary scale which is commensurate
with the responsibilities and professional pre-paration
of a registered nurse. We can not
continue to interest intelligent young women
in the nursing profession unless tenure of
office, adequate financial compensation and re-tirement
benefits are assured. Such assurance
can be given only when every state and every
agency within the state operates under the
principles of an efficient merit system.
The opportunities in the whole field of
public health are truly unlimited. Nurses will
share in those opportunities if they but have
the vision to see and the courage to assume
the responsibility which is always the twin
of opportunity.
No one need die today with the disease. Tuberculosis is preventable and
curable. Diagnosis and treatment are proved procedures.
March, 1945 The Health Bulletin
Public Health Nursing Day
By
Amy Louise Fisher, Supervising Public Health Nurse
North Carolina State Board of Health
Raleigh, North Carolina
FRIDAY, January 26, was the first National
Public Health Nursing Day. The purpose
of the day was to help the people to "Know
Your Public Health Nurse—Who She Is, What
She Does."
In the words of Dr. Thomas S. Parran,
Surgeon General of the United States Public
Health Service, I quote, "Public health nurs-ing
is very largely a 20th century development.
During the past 30 years, the number of pub-lic
health nurses has increased from 3,000 to
more than 20,000 until today they outnumber
any professional group in the health field.
From the beginning, public health nurses have
been concerned with the total health situation
of the family, including sickness care and
health promotion."
In our own State as early as 1904, Wilming-ton
had a visiting nurse. Within the next few
years similar services were added in Asheville,
Charlotte, Durham, Greensboro and Winston-
Salem. The first Red Cross town and country-service
to be established in the United States
was in Old Fort, North Carolina in 1915.
From May, 1915, to April, 1935, American
Red Cross nurses were stationed in 52 North
Carolina counties and played thdir part in
helping to establish the Public Health Pro-gram.
There were 6 nurses appointed by the
State Board of Health in 1919 to carry out a
program of periodic inspection of school chil-dren.
These six and the two added later did
much to stimulate the organization of full-time
health units. The greatest expansion in
public health nursing in North Carolina has
occurred since 1932. In that year there were
only 66 Public Health Nurses in the State
serving on 43 local health department staffs.
By December, 1944, we had 315 public health
nurses serving in 91 counties and 6 cities
which have full-time organized, health de-partments
with 34 vacancies. In addition to
this number there are 5 senior nurses and 7
consultants on the staff of the State Board of
Health. Even with this growth we have not
reached the minimum war-time standard of
1 nurse per 5,000 population recommended
by the Committee on Administrative Practices
of the American Public Health Association.
Since this ratio is considered the minimum
number needed as essential to protect the
health of the people at home, qualified public
health nurses in North Carolina have been
given the classification 4B, essential for un-limited
duration.
Public Health Nurses are serving in City
and County Health Departments from the
coast to the mountains. Their work takes
them into schools, homes, clinics, classes and
industries. These nurses in their blue uniforms
are an everyday familiar sight as they travel
about on foot, motorboat, rowboat, horseback,
motor car and any other method possible to
reach the patients needing their services. The
duties of the public health nurse are to teach
health to individuals, to families and to com-munity
groups and to provide or demonstrate
nursing care for the sick- in their homes.
A day with a public health nurse in Wake
County on January 2 illustrates the variety of
these services, for her day's work included
visits to a new mother, to the home of a baby,
a home where a midwife had delivered the
mother, a sick school child, and another home
with a baby. After lunch she spent a short
time at a tuberculosis clinic; then visited a
pre-school child, a crippled child, a venereal
disease patient, and ended the day meeting
with three midwives for supervision of their
delivery equipment.
In carrying on the Maternal and Child
Health program alone the public health nurse
is much in demand. During the past two
years public health nurses made nearly 257,000
8 The Health Bulletin March, 1945
nursing visits for maternity and infant care.
On these visits to mothers and babies the
public health nurse attempts to give the mo-ther
the help she needs so the baby will have
a good chance to grow and develop normally.
For instance, with a brand new baby it means
weighing him, inspecting him carefully from
head to toe, just in case there may be some
condition such as a cleft palate, club foot, or
other defect that could be corrected early and
keep the child from being deformed. The
nurse may teach the mother how. to bathe the
baby and assist her with the feeding schedule.
Getting the baby under good medical care
of either a private physician or the health
department clinic is a very important part of
health supervision, for each child needs to be
watched carefully to see that he gets the
proper food, sleep, play, and protection
against disease.
Iri connection with communicable disease
control the public health nurse visits homes
to show mothers how to give sick children
good nursing care, isolate them to protect the
rest of die family, and quarantine contacts
to prevent the spread of the disease. 67,000
visits were made for this purpose during the
past two years.
However, this is only one part of the com-municable
disease control program. We are
primarily interested in preventing disease. We
encourage everyone to take advantage of the
protection available against diphtheria, small
pox, typhoid fever and whooping cough.
Many people have responded for nearly 200,-
000 smallpox vaccinations and 148,000 im-munizations
for diphtheria were reported dur-ing
the last two-year period. With the popula-tion
shifting about as it has during this emer-gency,
it is more important than ever to make
certain that these preventable diseases do not
sabotage our war effort.
The war has certainly stimulated the ma-ternity
program for the birth rate has in-creased,
which, of course, means more mothers
and babies to care for. Congress appropriated
funds for the Emergency Maternity and Infant
Care program for soldiers' wives, and Dr.
Martha Elliott, Medical Director of the Chil-dren's
Bureau in Washington, reported recent-ly
that about 1 of every 6 babies born in the
United States last year came under this pro-gram.
Since April 8, 1943, the infant and
maternity benefits have been provided in
North Carolina to 1,500 sick babies and to
nearly 22,000 mothers. We are averaging
about 900 completed cases a month. Approx-imately
95% of the soldiers' wives in North
Carolina are participating in this program.
Think what this means to our men overseas to
know that their wives and babies are getting
good care while they are away. They are
fighting for us, and we can't let them down
for we must keep America a safe place for
their families and for them to come back to.
That means we have a big job ahead in pub-lic
health in North Carolina.
Tuberculosis is another of our outstanding
health problems for this disease ranked first
among the 18 selected reportable diseases in
1943. Considerable tuberculosis control work
is bei