Health bulletin |
Previous | 20 of 70 | Next |
|
small (250x250 max)
medium (500x500 max)
Large
Extra Large
large ( > 500x500)
Full Resolution
|
This page
All
|
®f)e library of tfje ®ntoersitp of iJortft Carolina Cnbotoeb op C(je Bialettu anb IPJjUantfjropit ftorietita 611' .06 N86h v. 59-60 19UU4i5 Med. lib, This book must not be token from the Library building. I This Bulletinwill be sent free to any citizen gf the State upon request I 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 fits? '• A mm, [ 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 40 XffOOPfflt CO&Gfl 7)£j4TJ/<S Mfl)£X 0//£Y£AR 30 >Y££faA?Jfy*r</stt6a///? zo JO' Under / 2 J S 7 9 JO J/ 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
Object Description
Description
Title | Health bulletin |
Other Title | Bulletin of the North Carolina State Board of Health; Bulletin of the North Carolina Board of Health |
Creator | North Carolina. State Board of Health. |
Date | 1945 |
Subjects |
Children--Health and hygiene Diseases Hygiene Public Health--North Carolina--Periodicals Sanitation |
Place | North Carolina, United States |
Time Period |
(1929-1945) Depression and World War Two (1945-1989) Post War/Cold War period |
Description | Volume 60, Issues 1-12. Issues for Feb.-May 1917 and for Jan.-July 1918 not published. |
Publisher | Raleigh,North Carolina State Board of Health. |
Agency-Current | North Carolina Department of Health and Human Services |
Rights | State Document see http://digital.ncdcr.gov/u?/p249901coll22,63754 |
Physical Characteristics | 61 v. :ill. ;23 cm. |
Collection | Health Sciences Library, University of North Carolina at Chapel Hill |
Type | text |
Language | English |
Format | Bulletins |
Digital Characteristics-A | 13,645 KB; 214 p. |
Digital Collection |
Ensuring Democracy through Digital Access, a North Carolina LSTA-funded grant project North Carolina Digital State Documents Collection |
Digital Format | application/pdf |
Related Items | Imprint varies: published later at Raleigh, N.C. |
Title Replaces | Bulletin of the North Carolina Board of Health** |
Audience | All |
Pres File Name-M | pubs_edp_healthbulletin1945.pdf |
Pres Local File Path-M | \Preservation_content\StatePubs\pubs_edp\images_master\ |
Full Text |
®f)e library
of tfje
®ntoersitp of iJortft Carolina
Cnbotoeb op C(je Bialettu
anb
IPJjUantfjropit ftorietita
611' .06
N86h
v. 59-60
19UU4i5 Med. lib,
This book must not
be token from the
Library building.
I This Bulletinwill be sent free to any citizen gf the State upon request I
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
fits? '•
A mm,
[ 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
40
XffOOPfflt CO&Gfl 7)£j4TJ/ |