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| This Bulletin, will be sent free to any citizen of the State upon, request [
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. 59 JANUARY, 1944 No. 1
S^ttS****"**
« «
The John H. Sweeney Filtration Plant
Part of Wilmington's New Water Supply System
MEMBERS OF THE NORTH CAROLINA STATE BOARD OF HEALTH
S. D. CRAIG, M.D., President Winston-Salem
J. N. JOHNSON, D.D.S., Vice-President Goldsboro
G. G. DIXON, M.D Ayden
H. LEE LARGE, M.D Rocky Mount
W. T. RAINEY, M.D Fayetteville
HUBERT B. HAYWOOD, M.D Raleigh
J. LaBRUCE WARD, M.D Asheville
J. O. NOLAN, M.D Kannapolis
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.
J. C. KNOX, M.D., Director District No. 1 Local Health Administration.
R. E. FOX, M.D., Director District No. 2 Local Health Administration.
J. ROY HEGE, M.D., Director District No. 3 Local Health Administration.
ERNEST A. BRANCH, D.D.S., Director Division 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.
ROBERT F. YOUNG, M.D., Acting-Director Division of County Health Work.
J. M. JARRETT, B.S., Director Division of Sanitary Engineering.
T. F. VESTAL, M.D., Director Division of Industrial Hygiene.
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, II,
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.
fable of Heights and Weights. Instruction for North Carolina Midwives.
CONTENTS Page
62 Years (Time Taken to Develop Present Water Supply at Wilmington) 3
The Nation's Most Valuable Asset and Its Greatest Problem 5
Care of the Premature Infant 9
Suggested Feeding Schedule for Premature Babies 11
A Letter 12
Notes and Comment 14
How to Prevent Colds 15
Lib LV. W
RORTH CAKaLINA *
PU BLI 5AE.0 BY TAB PIPR.TA CAROUMA 5TATB BQAfgO °XABALTA
Vol. 59 JANUARY, 1944 No. 1
CARL V. REYNOLDS, M. D., Stat. H<;!t'i Officer JOHN H. HAMILTON, M.D., Acting Editor
62 Years
(Time Taken To Develop Present
Water Supply at Wilmington)
By James A. Westbrook, Dist. San. Engineer
North Carolina State Board of Health
Raleigh, North Carolina
ONLY 62 years ago, a North Carolina sea
coast town had its first public water
supply established. Yes, in 1881, the Clarendon
Water Works, a private concern, was organized
for the purpose of furnishing running water
to the people of Wilmington, North Ca-olina.
In fact, a pumping station was bui't on the
banks of the North East Cape Fear River near
the present plant in use today. Where did the
Clarendon Water Works get the water? Surely
not from the muddy, salty, dirty old North
East River. What treatment did these people
give the water? None at all, unheard of today,
but 62 years ago, the North East River was
not the muddy, salty, and dirty old river we
think of today. Few sewers were in existence
to dirty the stream, and no salt came up the
river with the tides to cause taste to the water.
For 25 years, Wilmington received water
from the Clarendon Pumping Station. During
this time, sanitary engineers were finding the
value of filtering water through sand to give
protection against filth-borne diseases. With
increasing filth getting into the North East
River, it became necessary in 1906 to add
filters to the water works. Three years later
the city of Wilmington bought the water
works, and in 1910 a new water treatment
plant was built.
What about the salt in the river? Well, with
a deeper channel in the river, along about 1923
salt began to come in with the tides and made
the supply of water very unpleasant. Then the
officials of Wilmington found it necessary to
jro to another source of supply. In the same
year a pipe line was laid to Toomer's Creek,
a short creek connecting into the Cape Fear
River at both ends. This creek was, of course,
up the river from the pumping station.
As the years went by, the salt in the river
increased, and, with the tides, went on up the
river into Toomer's Creek. In 1933, dams with
gates were constructed at both ends of Toom-er's
Creek, and dykes were built along the
creek. This gave protection against incoming
salt water for a few years.
In 1936, an additional filter was added to
take care of more water being sent through
the treatment plant.
. Starting in 1937, salt again entered into the
story and has rendered the water undrinkable
periodically to the present time. Now a new
pipe line is being extended up the river to
Hood's Creek, with the hope that salt will not
appear at that point.
To go back for 20 years, we find Wilming-ton
a quiet, peaceful seaport city of some
33,000 people. This population remained
almost the same until 1941. Almost overnight,
The Health Bulletin January, 1944
ment plant consisting of chemical treatment,
mixing of chemicals, sedimentation, filtration,
and chlorination.
This new plant, built with modern lines
throughout, has a war-time touch with a
minimum of critical materials. Upon entering
the plant, you will notice beautiful wooden
stairways, with wooden railings, painted with
soft blending colors in keeping with soft color-ed
walls. Simplicity, yet a neat appearance,
strikes the eye throughout the plant.
Of significance are features of latest design
in water treatment practice. One of them
strikes you as you enter the filter gallery
where the seven filters are operated. Here
tables for controlling each filter sparkle with
newness. As a valve is opened or closed,
lighted buttons begin to flash, showing what
Pipe Gallery
this small city of 33,000 grew to a buzzing
hive of shipbuilders, and military personnel.
Today, Wilmington and outlying areas have
something like 100,000 people.
What has become of the water treatment
facilities of which Wilmington boasted many
years ago? It has served its day, still producing
safe water, but, like all plants of this nature,
it was too small for the increased population.
The city found it necessary to enlarge on its
treatment facilities. A request was made of the
Federal Works Agency for assistance in con-structing
a complete new plant. After a great
deal of paper work, and obtaining of prior-ities
(a present day necessary evil), work was
started.
On December 9, 1943, the completed plant
of seven million gallons' capacity was officially
turned over to the city of Wilmington. The
plant is the conventional type of water treat-
Interior View of Filter Gallery,
Pipe Gallery and Pump Room
January, 1944 The Health Bulletin
Filter Gallery
Wilmington's Water Purification Plant
is taking place as a valve opens or closes.
Another most helpful "gadget" to the plant
chemist, and one which interests visitors, is
the simple table located in the laboratory.
Water from various points throughout the
process of treatment is brought to the table
by the simple snap of a switch. These samples
from five different places—namely, raw water,
treated water, settled water, filtered water, and
finished water—run through five glass jars.
At this point, a visual comparison can be made
of the water. Also, samples for daily tests may-be
collected here.
A great deal of credit for the improvements
made and the present water system at Wil-mington
is due Mr. A. C. Nichols, City Man-ager,
Mr. J. A. Loughlin, City Engineer, and
Mr. M'Kean Maffitt for their efforts. Wilming-ton
goes forward with another chapter written
in water supply and treatment, with a new
plant designed by Mr. W. C. Olsen, Consult-ing
Engineer, Raleigh, N. C, and built by-
Mr. A. H. Guion, General Contractor, Char-lotte,
N. C.
While this does not complete the story,
rru.ny more things to be told in the future,
this is the present ending of a development
started 62 years ago.
The Nation's Most Valuable Asset
And Its Greatest Problem*
By Harvey F.
Jackson,
THERE are approximately thirty-six million
children in our nation. These are the fu-ture
citizens of the United States. Among them
are our physicians, lawyers, engineers, states-men,
ministers and teachers of the future.
Among them also are our rank-and-file citizens
who form the backbone of any society.
During this war period, it is perhaps difficult
Garrison, M. D.
Mississippi
for us to look ahead to the time when these
children of today will have taken their places;
however, there is no more important time to
look ahead than today when too many minds
are pointed merely to the manifold problems
* President's Address, Southern Medical Association,
Thirty-Seventh Annual Meeting, Cincinnati, Ohio,
November 16-18, 1943. Reprinted by permission of
Southern Medical Journal.
6 The Health Bulletin January, 1944
of the day. The thirty-six million children of
America are our nation's most valuable assets,
and we must realize its greatest problem as
well. They are an asset in that they hold the
potential power and greatness of our nation;
they are a problem in that the care and train-ing
which they will receive within the period
of childhood will make them and our nation
with them superior or inferior.
As a pediatrician I am happy to announce
that for five decades or more pediatricians of
America have been a potent factor in the pro-motion
of child health and in the dissemina-tion
of knowledge pertaining to child hygiene.
They have contributed largely to the aggregate
of pediatric knowledge, they have stimulated
research, they have cooperated effectively in
the elevation of the standards of medical edu-cation
and of practice and they have encourag-ed
the organization of innumerable agencies
dedicated to the betterment of child welfare.
Unless the goddess Hygeia is our friend, life
is truly a curse to man, woman, and child. We
cannot enjoy the beauties of nature or man's
great works when we are tortured by pain.
Therefore, it is important that we guard our
baby's health as the most precious jewel of
his existence.
I believe from the moment a child is born
until it passes beyond parental control, that
its physical condition should be given the
closest attention. If we are cultivating a grove
of black walnut trees for profit or a cluster
of rose bushes for beauty, there is no phase
of their daily existence we miss.
As we cannot take care of a garden one
week and neglect it the next, expecting the
weeds to stay away, so with our children, we
must guard them constantly. We hope the
best for the coming generation. A hope im-plies
a desire and an expectation. A true and
genuine hope suggests a sincere responsibility.
That responsibility we willingly and cheerfully
accept.
The health of children is a responsibility
not only of parents, nurses, and physicians,
but of every person interested in achieving
ultimate victory for democracy.
To win the war on land and sea and in the
air will bring little reward if in the process
the stability and happiness of the future popu-lation
is jeopardized.
As doctors, perhaps we have been too closely
concerned with gross pathology, too little con-cerned
with positive health, which means
much more than freedom from obvious disease.
Other nations are making strenuous efforts to
produce a generation fit for war. Surely we
need no less a generation physically fit for the
pursuits of peace.
Every child is a history of the race beginning
again, entitled to a chance to become its best.
Of the thirty-six million children in our
nation, it is estimated that about seven million
are at least partly dependent on relief or
public aid in their homes. The latest figures
indicate that approximately 250,000 children
are in institutions for dependent children, and
it is estimated that at least 23,000 children
are in state schools for delinquent children.
There are approximately 365,000 in need of
medical attention, and many others are suffer-ing
from conditions which if neglected will
result in crippling. Last year in this nation
more than 110,000 babies died in their first
year of life or one out of every 21 Americans
born alive. Tragic as these figures may seem,
they represent a great advance since 1917,
when one baby out of every eleven died. Even
before 1917, indeed, since the early part of
this century, some of the best pediatric minds
in this country have attacked the problem of
how to help each child become a healthy, well
adjusted cooperative member of society. In
spite of all efforts the child remains the na-tion's
most valuable asset and its greatest prob-lem.
Children are the future. They do not simply
make it. They are the actual stuff of futurity.
To build children is to build the future.
The war has brought a new desire for
parenthood to many couples who had previous-ly
been indifferent to it. Though the average
age of mothers is now much lower than form-erly,
a sizable number of first babies are being
born to couples who have been married five to
ten vears.
January, 1944 The Health Bulletin
As one 30-year-old expectant mother recent-ly
expressed it: "We thought we'd wait till
we could own our own home . . . then a
car . . . But the war has changed our sense
of values. Material things don't seem so im-portant.
We want something real in our
lives—something that's all our own."
The task of increasing the armed forces of
the nation under the Selective Service Law of
1940 has offered an opportunity to evaluate
the physical condition of the young men of
our nation.
The study of the causes for rejection of
these men by the Army may reveal certain
trends and possibly indicate certain preventive
measures for the benefit of the children of
today.
The various causes for rejection for general
military service are listed.
Certain of these defects may be prevented,
certain ones are remediable, and many repre-sent
congenital defects or conditions for which
the future holds little hope of improvement
until medical science advances, the general
economic status improves, education is more
universal, or eugenics programs are more
forcefully carried out.
The world needs better men and women,
good as those of the present generation may
be. Let us begin with the young, the boys and
the girls, keeping them in health, sobriety, in-tegrity,
virtuous manhood and womanhood
of the noblest stamp.
We as a nation are rightly concerned today
with matters vital to our defense: with ships
and armies and airplanes, with new death-dealing
inventions, with production in defense
industries. These things are important, but
they deal with the present only. The kind of
a country we will have forty years from now
depends upon those who are just now starting
life. Whether we keep our place as the fore-most
nation of the world, or whether we re-cede
to an ignoble station; whether we are
victorious in battle or whether we are to be
overcome by some foreign foe, depends upon
the wisdom and the worth of those who come
after us. In fact, every issue which is beyond
the immediate present depends upon our sec-ond
line of defense, our American children.
The newborn baby comes into the world
handicapped or helped by its hereditary back-ground
and its maternal environment during
pregnancy and labor. The hereditary influences
go back through each parent for many genera-tions.
To its ancestors the child must look for the
potential qualities with which it begins its
existence. From them come the color of its
eyes and hair, the shape of its head, its body
contours, the type of nervous system with
which it is endowed, and all the other qualities
by which an individual is characterized. Every
child derives from its parents the material from
which it is created.
If the man and woman who wish to have a
child have been created from sound heritage,
if they have been well nourished and protected
from the ravages of disease or environment, if
their emotional and mental development has
been sane, they bring the richest gifts to their
child.
In the children of a race lies its hope for
future greatness. Let them be well born and
well nurtured, given a chance for a normal
development during a childhood protected
from blighting influences, and they will grow
to manhood and womanhood ready for com-plete
participation in, and enhancement of, the
world in which they live. An attempt to make
this possible is our gift to children today.
There is nothing mysterious about children.
If a father is disorderly, his son is liable to
be so, too. If a mother is quick-tempered, she
is liable to have a daughter who has tantrums.
Parents usually see in their children a com-posite
of what they were when they were
young.
Today there are courses in parent-craft, and
there should be. The children of trained par-ents
are said to be more self-reliant, better able
to make their own decisions than those of the
untrained. They are said to have initiative and
enterprise and to be working nearer the limit
of their capacity, to be sounder in health, and
to be more tolerant and courteous and un-afraid.
8 The Health Bulletin January, 1944
Parents are learning that the first few years
of a child's life are the most important, and
a study of the spoiled child problem shows
that children do not outgrow early habits as
soon as parents think they will. Many of them
go through life with these attitudes and then
develop mental and nervous breakdowns when
they find they are not equipped to meet
bravely the vicissitudes and responsibilities of
adult existence.
When your child's health is disturbed,
growth slows down. When growth and health
are disturbed, development is retarded and
your better citizen has been interfered with.
But your child's prospect of becoming a
better citizen does not depend entirely on the
state of his physical health. Your boy and
your girl must learn to adjust themselves to
the social and economic conditions that sur-round
them. What would be the good of
bringing up a child in perfect health and
have him, because of lack of training in the
home, develop into a bank robber, a drunkard,
or a drug addict?
The ability of your child to adjust himself
to the world depends, to a large extent, on
the type of training he gets at home, and on
the habits that he is taught. Every step of the
adjustment made by the child requires train-ing.
Home, church, and school should combine
in building your child's personality from the
point shortly after birth until he has reached
maturity. This will require continued efforts
to meet the changing needs of the youngster.
Rearing a child properly is the most difficult
job any of us can face. But in the end, there
is just about the greatest satisfaction we can
know, that of having created a successful
citizen.
During these trying times of war, the re-sponsibility
of the medical profession is bur-dened
not only with the care of the armed
forces, but the civilian population must have
adequate medical attention. In no field is this
more important than in the care of the ex-pectant
mother. Upon her and her offspring
rest the duty and responsibility of reconstruc-tion
of a better world and a permanent peace.
So we must not be content with the progress
already made in maternal care, but must con-tinue
to improve that care till the deaths
from maternal causes will be lowered to the
irreducible minimum. Until that goal is
reached, none of us as physicians will cease
our efforts to improve the care of women in
child-birth.
"Human life in this country is not held in
high esteem if we are to judge by the reck-lessness
with which the lives of mothers are
wasted," says Dr. Thomas Parran, Surgeon
General United States Public Health Service.
The mortality figures are appalling, more
women dying between the ages of fifteen and
forty-five from diseases of pregnancy and
motherhood than from any other cause, ex-cept
tuberculosis. The tragedy is more dis-tressing
when it is known that many of these
deaths are preventable.
Maternity care is what needs emphasis, not
prenatal care, not delivery care, not postpartal
care. No one phase of care is more important
than the other two and all lose value if any
one phase is weak, or late, or missing.
Total maternity care: that is it; total care
keyed to fit into and enhance total living
provided for all expectant parents in all of
America.
At a White House Conference on Child
Care it was pointed out that if every woman
vould consult her physician just as soon as
she has reason to think a baby is coming, and
at regular intervals thereafter, 10,000 more
American mothers would live each year to
rear and cherish their children.
We have observed that today's adults enjoy
a more abundant life because of even the
partial and incomplete health care given yes-terday's
children. We are now attempting to
complete the cycle by smoothing the way for
tomorrow's children through intensification of
health efforts and providing better preventive
care for the parents and prospective parents
of today. More and more of tomorrow's chil-dren
will arrive with a welcome greeting from
their parents and with a community ever more
ready to use a larger portion of available re-sources
in proving our belief that children are
January, 1944 The Health Bulletin
our most valuable crop and that child life is
far more worthy of conservation than even
our soil, our forests and our soil resources.
In fact, conservation might well be our watch-word
in our consideration of tomorrow's chil-dren.
The child of today, the citizen of to-morrow,
is going to need all the fortitude,
courage, and adaptability of the first settlers
to work out a happy and successful existence.
What can we do to help him?
As physicians, our first thoughts are natur-ally
devoted to preserving for these children
healthy bodies and normal minds.
The child's health is like the foundation
of a new home. It is the basis upon which
the future structure must stand. Unless the
foundation is firmly laid, the completed build-ing
will be an unsatisfactory one. Its insecure
foundation will make it only half tenable and
the upkeep of such a structure will be far out
of proportion to that of maintaining a struc-ture
erected on enduring principles.
Just as important as preserving the health
of our children is teaching them to use their
bodies and minds to obtain both mental and
economic security. I believe that children
should be taught to work and to adapt them-selves
to any situation. The average American
child is adaptable and will learn to take care
of himself if the occasion arises. In recent
years, however, the trend has been to give
the child more and more pleasures and to
require less and less the assumption of any
duties. To give much and expect little is the
usual custom of the American parent. This
theory may be all right if the conditions the
child will face are those that will conform
to a familiar pattern. On the other hand, is it
fair now to make life for the child a bed of
roses when the path to be trod in the future
may be covered with thorns instead of rose
petals? We should teach him to work. The
more anyone is able to do for himself, the
better he will be fitted to face any situation
in which he may be placed. A gradual realiza-tion
that changes are taking place is much
better for a young mind than the sudden
discovery of the fact. Unquestionably, the
present younger generation is not so well fit-ted
to face the vicissitudes of life as were their
parents. It is not their fault, but the fault of
their parents, who want the best for their
children and who are putting protective walls
around them. Many parents pride themselves
on making things easy for their children, and
by the very giving and spoiling have wrecked
their chances of happiness.
If our nation is to go forward, if this
democracy is to survive and lead the world,
we must impress our people that we must
have the best, the strongest, and the most
intelligent boys and girls of any nation. We
must see to it that they are born of healthy
parents, that they are born in healthful sur-roundings,
that they are given the best of
medical and nursing care, that they are proper-ly
educated, and that they are taught to know
and respect God and their nation. No nation
can stand without these essentials.
Care Of The Premature Infant
By Merl J. Carson, M. D.
Pediatric Consultant
North Carolina State Board of Health
Raleigh, North Carolina
DURING the past eight years a great deal a steady decrease in infant mortality because
of emphasis has been laid on proper care of better prevention and treatment of diseases
of infants. Well baby clinics have been started during the first year of life. Why, then, has
throughout the State and educational programs the mortality due to prematurity been changed
have helped to give a clearer understanding so little? Many persons have shown that if
of the value of good child care. There has been these premature infants are given good care.
10 The Health Bulletin January, 1944
and attention, their mortality rate can be re-duced
markedly. Of course it is necessary to
spend a great deal of care and trouble, but
if a baby's life can be saved, any amount of
trouble is justified. Many people have little in-terest
in these infants because they feel that
they will probably be feebleminded when they
grow up. Scientific research has found that a
premature infant is no more likely to be
feebleminded than a full term baby.
Any infant who weighs less than 5 Vi pounds
at birth may be considered a premature infant.
It is important that the size of the infant be
taken as the measures of prematurity rather
than the length of time the mother is preg-nant
because of the wide variation in weights
of newborns whose mothers are supposed to
have been pregnant for the same length of
time. These infants are usually poorly develop-ed
and therefore have difficulty surviving.
Frequently they have not enough strength to
nurse the breast or a bottle and sometimes
cannot even swallow. Their resistance to in-fection
is very low. The mechanisms by which
correct body temperature is maintained are
usually poorly developed so that they become
chilled very easily.
There are three essentials in caring for
these infants: 1. Proper temperature and
humidity must be provided. 2. Proper nutrition
must be provided. 3. Infection must be avoid-ed.
1. In order to provide proper temperature
and humidity, it is usually necessary to either
obtain or make, an incubator, which can be
heated. These may be bought, but as they are
usually very expensive, they are usually only
seen in hospitals. Simple ones may easily be
constructed from wooden crates, or cardboard
boxes. These may be lined with cloth and a
small pillow may be used on the bottom as
a mattress. The lining can be divided into
several small pockets which may be used. to
hold flat bottles of hot water to furnish heat.
A pan of water kept on the stove in the room
will provide enough water in the air to keep
the humidity at a proper level. Flannel or
wool garments are best for dressing the infant.
They should be simply made so as to cover
his body loosely but completely, and should
be made so they can be put on or taken off
without bothering him too much.
When the infant is to be delivered at home,
the incubator should be prepared in advance.
It should be heated and blankets should be
warmed to wrap him in to prevent chilling
after birth.
2. Proper nutrition is essential if the baby
is to grow and develop normally. For this
reason food must be given. All newborn in-fants
normally lose a few ounces of weight
during the first few days of life, and then,
if they are adequately fed, slowly regain this.
Premature infants do the same thing, so one
must expect this weight loss and not be
alarmed and not try to feed the infant too
much.
Before giving anything by mouth, one
should wait until the infant has fully re-covered
from the shock of being born. It
may take from 12 to 36 hours in some cases
before the infant has begun to breathe regular-ly
and easily, without having blue spells,
choking or vomiting. It is only at this time
that one can begin giving anything by mouth.
First, find out how this can be done. Usually
if the infant is strong enough to nurse, he can
be fed on a small nipple and bottle. Most of
them are too weak to nurse the breast so that
breast milk should be pumped from the mo-ther's
breast and fed with the small nipple
and bottle. Many of them will be too weak
to nurse a nipple and will have to be fed
with a medicine dropper. To do this, cover
the tip of the dropper with a small piece of
rubber tubing which projects just beyond the
glass tip, and with this, small amounts of milk
may be put in the infant's mouth. Here again
it is necessary that the baby be able to swallow
the milk without choking or turning blue.
Occasionally they will be too poorly develop-ed
to even swallow milk put in their mouths,
and in these cases the feedings have to be
given through a tube which is passed through
the mouth into the stomach. This procedure
is very complicated and should only be done
by someone trained particularly in this work.
When preparing feedings, all utensils must
12 The Health Bulletin January, 1944
be carefully boiled and sterilized before using.
A very satisfactory schedule to begin on is
to give feedings every two or three hours. At
first these should consist of sterile boiled
water, given in small amounts of usually 5cc at
a time. The amount may be increased gradual-ly
and either breast milk or formula substituted
for the water. The following schedule copied
from "The Premature Infant," a publication
of the U. S. Children's Bureau, shows this
very well.
In addition to the milk and water, these
infants need more vitamins than the normal,
full term child. For that reason cod liver
oil is begun as soon as possible, usually at
about two or three weeks of age. The con-centrated
forms are best and it requires about
four times as much for the prematures as it
does for a normal, full term infant. Of the
concentrated Percomorph oils, 20 to 30 drops
each day is usually sufficient. Orange juice
should be started during the same period to
furnish vitamin C. They will need approx-imately
two ounces daily. One should begin
with a few drops and gradually increase the
amount given each day, until the infant is
able to take two ounces each day.
3. Any infection is extremely dangerous for
these infants. For that reason, everyone who
is sick must stay away from him. All of his
food must be handled very carefully in order
to avoid any contamination. All utensils used
in preparing this food must be sterilized.
Whenever possible one person alone should
be responsible for his care, and all other per-sons
should stay away from him. Everyone
should wear a mask over their noses and
mouths when caring for him, and a clean gown
or smock should be worn. These few simple
precautions will cut down tremendously on
the infections given to these babies and will
help more of them to live through this diffi-cult
first period.
The important thing to remember is that
the premature infant is worth fighting for,
and if given proper attention and care, he
will develop into just as fine a child as a
full term newborn infant.
A Letter
By Miss Irene Lassiter, R. N.
Public Health Nurse in Harnett County
Lillington, North Carolina
Nell Russell
Sec. Lt.
Armed Forces
Somewhere in England
D,EAR Nell,
Last Sunday I picked up the Philadelphia
Inquirer and after reading the news section I
looked through the "Everybody's Weekly."
You can't imagine my delight in seeing your
picture taken somewhere in England.
It was so like you, Nell, to be right on the
front line of whatever is new in nursing, even
though it be on the fighting front! I felt
mighty proud that I knew you—as proud as
I was the night I bought you your first Belle-vue
cap. I thought then that the teaching pro-fession's
loss was the nursing profession's
gain. Now I'm sure of it! This war changed
your plans I know; I was awfully disappoint-ed
that you didn't get into Public Health,
but war has a way of changing all our plans.
Maybe when you come back you will find
the Public Health field larger than when you
left. I also believe that you will find the
people more interested in their health.
Remember our old discussion on how the
people should be taught health in general?
Well, this war has put that over for us in a
big way. Good articles on health, diet and
disease are being published in almost every
magazine and believe it or not, Mr. John Doe
Public is reading every line! Maybe the short-age
of doctors and nurses has made the public
more health minded—or maybe the Federal
January, 1944 The Health Bulletin 13
Government has forced the issue with all their
pamphlets on diet and health. (You can get
good pamphlets on almost every subject in
the land for just the asking and the new
Infant Care books that you get from the
Health Department have pictures in them!)
I can't put my finger on the "why" but I can
say the articles are plum good and educational.
Another thing that this war has done for us
is to bring the people out to Red Cross First
Aid classes and the Red Cross Home Nursing
class. I'm 'specially interested in the Home
Nursing classes and feel that every Public
Health Nurse should urge her mothers to
take this course. These classes have really
proven their value to me. They have also
made me do some studying, for it has been
so long since I've been in a hospital that I've
forgotten and gotten behind on the latest
technique. I had a regular "line" for my com-municable
disease cases but no more. Now
when I visit a communicable case, I ask the
mother first "Have you had the Red Cross
Home Nursing Classes?", and if she says
"yes"—believe me I watch my step for these
mothers are up to date!
I've heard some criticism that the public
would get mixed up on some of the medical
jaw breakers. So what? Maybe the public
won't remember that today medicine thinks
that rheumatic fever, my pet enemy, is caused
by the hemolytic streptococcus. They will re-member
the signs and symptoms of rheumatic
fever. No more will Mary's sore throat be just
a sore throat or joint pains "growing pains."
Every mother will think of early symptoms,
diagnosis and the stress laid on the care of
the rheumatic child. When I think of the
death toll of rheumatic fever cases yearly, I
wonder if one wouldn't be safer in Italy
dodging bullets. Of couse I've a phobia on
rheumatic fever—after fighting it for twelve
years, who wouldn't—but I truly feel that to
get the public interested in early symptoms
of any disease is a feather in our caps.
Tell the to-be fathers not to worry over
their wives, Nell. That's another good point
for this war. The Government is taking care
of the boys' wives, that is up to sergeants.
Guess the Government feels that the C.O.'s are
capable of managing their own affairs. But
Nell, it's a dream come true; women being
taught the value of anti-partum care, being
told to go see their doctor at least five times
before delivery, and then to go back six
weeks after delivery for a check-up on them-selves
and their babies. Can't you just see
what this is going to mean to our future
mothers? A mother once under good medical
care for herself and baby is going to demand
the same treatment next time. There's another
phase to it too—"I do what my neighbors
do," so mothers in the country over are going
te demand and receive good delivery service.
Isn't it wonderful? When you nurses come
back from over seas, it won't be like pulling
eye teeth to get a maternity clinic started.
Just dare not have one!
Well, Nell, I guess I've rambled enough,
but seeing your picture in the paper today
makes me think back on the days when we
were going to change nursing! You are doing
your part and I felt so smug and secure here
in my little house that I began to wonder if
I was doing mine. Then I thought of some
of the things that we are trying to do over
here, not big things like facing fire—I realize
that—but someone has to keep the home
front safe. After all, won't our boys be better
fighters if they know their families are being
cared for? I think so. Each Public Health
nurse has a big job on her hands for it is up
to us to see that the boys come home to happy,
healthy families. You tell the boys that what
North Carolina is doing, all the states are do-ing
and that the Public Health nurse is taking
her place like a true soldier.
Do write when you have a chance.
Irene.
14 The Health Bulletin January, 1944
Notes & Comment
By The Acting Editor
AN OLD FRIEND JT is always a
J- pleasure to meet
an old friend. It is especially pleasant to meet
a friend after several years have passed since
our last meeting. If the old friend has render-ed
valuable assistance to us during the years
of our youth, there is something deeper than
pleasure when we meet again. In turning the
pages of one of our favorite health publications,
the Monthly Bulletin of the Indiana State
Board of Health, we experienced the thrill of
seeing a poem which has contributed a great
deal to the modern public health program.
During the days when health workers valiantly
struggled for a few dollars to add to their
budget, the poem, "Fence or Ambulance" was
used in a multitude of ways. It was printed
in practically every health publication in the
United States. It was quoted and misquoted
by health officers throughout the land. It is
recited in practically every schoolroom. It was
plagiarized and adapted until few people
knew the poem in its original form. It in-spired
thousands upon thousands of posters
when poster contests were conducted in every
school. From the crudest of cartoons to genuine
attempts at artistic expression, the cliff, the
fence and the ambulance were before the eyes
of all poster contest judges.
A considerable amount of research work on
the part of Dr. Thurman B. Rice, editor of
the Indiana Bulletin, with the assistance of
Miss Hazel Felleman, editor of Queries and
Answers, New York Times, has established
the fact that the poem was written by one
Joseph Malins and that the author was pre-sumably
an Englishman. It is probable that
the poem was written a few years prior to
1878. We feel that the usefulness of our friend
has not passed with the years and that a
great many of our readers will enjoy seeing
an authentic reproduction.
FENCE OR AMBULANCE
'Twas a dangerous cliff, as they freely con-fessed,
Though to walk near its crest was so
pleasant;
But over its terrible edge there had slipped
A duke, and full many a peasant;
So the people said something would have to
be done
But their projects did not at all tally.
Some said, "Put a fence around the edge of
the cliff,"
Some, "An ambulance down in the valley."
But the cry for the ambulance carried the day,
For it spread through the neighboring city;
A fence may be useful or not, it is true,
But each heart became brimful of pity
For those who slipped over that dangerous
cliff,
And the dwellers in highway and alley
Gave pounds or gave pence, not to put up a
fence
But an ambulance down in the valley.
"For the cliff is all right if you're careful,"
they said,
"And if folks even slip and are dropping,
It isn't the slipping that hurts them so much
As the shock down below when they're
stopping;"
So day after day as those mishaps occurred,
Quick forth would these rescuers sally.
To pick up the victims who fell off the cliff
With the ambulance down in the alley.
Then an old sage remarked, "It's a marvel
to me
That people give far more attention
To repairing results than to stopping the cause,
When they'd much better aim at prevention,
"Let us stop at its source all this mischief,"
cried he,
"Come, neighbors and friends, let us rally;
If the cliff we will fence we might almost
dispense
With the ambulance down in the valley."
"Oh, he's fanatic," the others rejoined
"Dispense with the ambulance? Never!
January, 1944 The Health Bulletin 15
He'd dispense with all charities, too, if he
could,
No, No! We'll support them forever!
Aren't we picking folk up just as fast as they
fall?
And shall this man dictate to us? Shall he?
Why should people of sense stop to put up a
fence
While their ambulance works in the valley 3 "
But a sensible few, who are practical too,
Will not bear with such nonsense much
longer;
They believe that prevention is better than
cure,
And their party will soon be the stronger,
Encourage them, then, with your purse, voice
and pen,
And (while other philanthropists dally)
They will scorn all pretense and put a stout
fence
On the cliff that hangs over the valley.
Better guide well the young than reclaim them
when old,
For the voice of true wisdom is calling;
To rescue the fallen is good, but 'tis best
To prevent other people from falling;
Better close up the source of temptation and
crime
Than deliver from dungeon or galley;
Better put a strong fence 'round the top of
the cliff
Than an ambulance down in the valley.
TYPHOID FEVER Altogether too
IN CHILDREN many people are
of the opinion
that typhoid fever does not occur in children.
Dr. Angus McBryde and Frank Ledesman-Dias
of the Department of Pediatrics, Duke Hos-pital
and Duke Medical School, presented a
paper before the Section of Pediatrics of the
Medical Society of the State of North Carolina
at its last meeting in Raleigh, in which they
reported 46 proven cases of typhoid fever in
patients under 14 years of age. This paper
was published in the November, 1943 issue
of the North Carolina Medical Journal. Of the
46 patients, 25 were white and 14 were ne-groes.
Thirty of the 46 patients were six years
of age or less; ten were under 2 years of age;
the youngest was six months old. Prolonged
fever was the most frequent symptom. Abdo-minal
distention with tenderness were the
most common physical findings. Only six of
these 46 patients had ever had any typhoid
vaccine and 3 of these had been given vaccine
after exposure, but too late to afford any pro-tection.
This paper should be especially help-ful
to physicians, but parents should realize
that children do have typhoid fever and that
these children should be protected by typhoid
vaccine.
How To Prevent Colds
IN 1908 my father built a sleeping porch on
our house. We would all sleep out there in
the winter, if it got cold enough, he said, and
we wouldn't have any more colds. So we slept
out on the sleeping porch. All I can remember
about it now is that we had fun out there but
I was tired all the time and was glad to get
to school where I could sleep.
Then we started taking cold baths. My
father rigged up a rubber shower contraption
so that everybody could get up and have an
*
ice-water shower first thing in the morning.
That was so that we wouldn't have any more
colds. Cold showers went on for quite a while
and were very jolly. Everybody slapped and
snorted and shrieked in his turn and then
waited to hear the next victim. We caught
father using some warm water one morning,
so the whole system broke down. I don't
remember having any colds in those days but
that was forty years ago.
* An editorial in The Journal Lancet.
16 The Health Bulletin January, 1944
When I got older and left home, I didn't
do anything about colds except carry a hand-kerchief.
Those were busy, exciting days in
which I don't remember about colds. Other-wise
occupied.
Now, in the year 1943, my wife says we
should do something so the children won't
have colds. She turns to me because I am a
doctor and she doesn't know any better. Well,
let's see, there have been quite a few fads
about colds. Sunlamps, codliver oil, vaccines,
and now we sleep with the windows closed. I
think maybe the best thing would be to build
a sleeping porch where the kids can take up
the family pillow fights where they left off in
1910. I don't remember any colds then—or
much of anything else.
Colds May Lead to Serious Diseases**
In addition to the great number of man-hours
lost through the common cold itself, this
infection is important because of its relation-ship
to other respiratory diseases. By weaken-ing
the tissues of our nose and throat, it allows
infection to spread into our sinuses causing
sinusitis, into our ears with resulting inflam-mation
of the middle ear and mastoiditis, or
into our lungs to cause bronchitis and pneu-monia.
A cold may permit invasion of our
tissues by the common streptococcus germ
with resulting septic sore throat, scarlet fever
or possibly rheumatic fever. Although symp-toms
from a cold are usually mild and death
rarely if ever occurs from the cold itself, the
large number of individuals affected and the
seriousness of the complicating diseases make
us consider the common cold among the most
important communicable diseases in this part
of the world.
How Colds Are Spread
What makes colds so prevalent that millions
of people are affected year after year? The
causative agent of the common cold is one of
the most contagious germs we know of and
infection can be spread by breathing in the
air of a room which has been contaminated
by the coughing, sneezing or even talking by
a person infected with the cold germ. In a
room, bus or crowded auditorium, a sneeze
or cough may so fill the air with respiratory
germs of all sorts that everyone in close
proximity to the offender will be infected. A
person may also be infected by handling con-taminated
articles used by an infected person,
by kissing an individual with symptoms of a
cold, or by other means of direct contact.
There are a number of predisposing factors
which make us more susceptible to respiratory
diseases and these include exposure to extreme
cold or dampness with resultant chilling of
our body, excesses of alcohol, poor nutrition
and chronic diseases of various types. Recovery
from the common cold results in an immunity
which is only temporary and of short duration
so that we may have more than one cold
during a season and year after year.
Experiments on Prevention
Recent experiments in air sterilization by
means of ultra-violet light or chemical sprays
have shown that the air in a room may be
sterilized readily and the spread of contagious
respiratory diseases thus limited. Since these
methods are still in the experimental stage and
have been applied chiefly to hospitals or
schoolrooms, their general use must be reserved
for the future. In the home or auditorium, our
best method of keeping the air clean and free
of germs is by adding pure air from the out-side.
This also permits a loss of heat, this
method is restricted during cold weather be-cause
of the shortage of fuel.
Known Preventive Measures
What can we do to prevent colds or at
least to minimize their effects? We can keep
up our general health and maintain a high
resistance to infection by the medium of a
well-balanced diet with plenty of proteins,
minerals and vitamins, with sufficient rest,
cleanliness and adequate recreation. We can
avoid chilling and exposure during cold and
damp weather by dressing warmly and sens-ibly.
We can prevent infection by avoiding
those who have a cold or other respiratory
illness. If we ourselves are infected we can
often suppress or at least cover with a hand-kerchief
our cough or sneeze, especially in a
crowded bus or room. If we become ill with
a cold and fever, we can stay home.
" From Weekly Bulletin, Connecticut State Depart-ment
of Health.
\3>
3Rr
Publis^dby Tfit/^RmCAKlIflA STATL5°ARDs^fiE^LT^
rhis Bulletin, will be sent free to any citizen of "the State upon request I
Entered as second-class matter at Postoffice at Raleigh, N. C, under Act of July 16, 1884
Published monthly at the office of the Secretary of the Board, Raleigh, N. C.
Vol. 59 FEBRUARY, 1944 No. 2
Control Building, Sewage Treatment Plant
Rocky Mount. North Carolina
MEMBERS OF THE NORTH CAROLINA STATE BOARD OF HEALTH
S. D. CRAIG, M.D., President Winston-Salem
J. N. JOHNSON, D.D.S., Vice-President Goldsboro
G. G. DIXON, M.D Ayden
H. LEE LARGE, M.D. Rocky Mount
W. T. RAINEY, M.D. Fayetteville
HUBERT B. HAYWOOD, M.D Raleigh
J. LaBRUCE WARD, M.D Asheville
J. O. NOLAN, M.D. Kannapolis
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.
I. C. KNOX, M.D., Director District No. 1 Local Health Administration.
R. E. FOX, M.D., Director District No. 2 Local Health Administration.
J. ROY HEGE, M.D., Director District No. 3 Local Health Administration.
ERNEST A. BRANCH, D.D.S., Director Division 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.
ROBERT F. YOUNG, M.D., Acting-Director Division of County Health Work.
J. M. JARRETT, B.S., Director Division of Sanitary Engineering.
T. F. VESTAL. M.D., Director Division of Industrial Hygiene.
*On leave.
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
The North Carolina Academy of Public Health 3
Rocky Mount Looks to the Future 6
A Letter 9
The Medical Follow-up of Hearing Impairments 10
How Is Your Cold? 12
Universal Service 13
Notes and Comment 16
fiS?
lnl@M
PU BLI5AE.D 5Y TML. HOR.TM CAgOUHA 5TATE. BQAIgD yHEALTM |
Vol. 59 FEBRUARY, 1944 No. 2
CARL V. REYNOLDS, M.D., State Health Officer JOHN H. HAMILTON, M.D., Acting Editor
The North Carolina
Academy of Public Health
By Mrs. Anne B. Edwards, Sec-Treas.
THE success of any new undertaking is
measured not by the plans it adopts but
how well it executes those plans. The North
Carolina Academy of Public Health was fully
aware of this when, on December 14, 1942, it
held its first meeting in the auditorium of the
State Laboratory of Hygiene.
First, it was decided that such an organiza-tion
would be of potential value, as well as
the need for the purpose of coordinating all of
the interest of the various departments of the
State Board of Health: and second, that this
should be a democratic organization, made up
of the entire personnel of the State Board of
Health, with no "priority list."' That is to say,
the opinions of all were to be respected, and
the majority to control. The State Health Of-ficer
emphasized this when he declared that he
wanted every employee to feel free to express
himself or herself on any subject that might
arise, regardless of his opinion or that of any
director.
With this background, the organization—the
first of its kind in the United States—began
functioning, smoothly from the very first.
However, the fact that this was a pioneer or-ganization
added to its responsibility, in that
it was necessary for it to chart its course from
its beginning. This it has done. Without pre-cedent,
each program has borne the stamp of
originality—each has proved successful, in that
it brought out the lessons its builders had in
mind.
The first program of the year was in charge
of Dr. T. F. Vestal, Director of the Division
of Industrial Hygiene. Doctor Vestal told
about some of the activities conducted in his
department, especially examinations made for
men engaged in occupations involving dust
hazards in "vital" industries in North Carolina.
Mrs. Louise P. East, staff consultant nurse
of the Division, presented a clean-cut synopsis
of some of the work done among women
entering the industrial field. Mr. M. F. Trice.
Engineer, also gave a very informative address
on field work, particularly in the mining and
other extensive work in the manufacturing
areas of the State, and what the division is
doing to remedy the dust hazards. The final
feature of the program was a moving picture
prepared by the U. S. Public Health Service
which showed scenes depicting what is being
done in the mines and factories of this State.
Visitors recognized were: Dr. W. A. Mc-intosh
of New York, a representative of the
Rockefeller Foundation; Dr. D. F. Milam of
the same Foundation, now located at Chapel
Hill and Director of the State Board of
Health's nutrition program: Dr. W. P. Jacocks
of the Rockefeller Foundation, who recently
joined the staff of the North Carolina State
Board of Health and is in charge of the school
Health Coordination Service: Dr. John F.
Kendrick of the Rockefeller Foundation, and
now Director of the State Nutrition program.
From the North Carolina School of Public
The Health Bulletin February, 1944
Health were Dr. Harold W. Brown, dean of
the School of Public Health; Miss Ruth W.
Hay, Professor of Public Health Nursing; Miss
Margaret Blee, Assistant Professor of Maternity
and Infant Hygiene; Dr. John J. Wright, Re-search
Professor of Epidemiology, and Dr.
Wm. L. Fleming, Research Professor of Syph-ilology.
The second meeting of the North Carolina
Academy of Public Health was conducted by
the Division of Oral Hygiene. Dr. Ernest A.
Branch, the Director, told the Academy why
oral hygiene was necessary in a health pro-gram
and the relationship of the health of the
mouth to systemic diseases. He also told about
the activities of the trained dentists on his
staff in the classrooms and their procedure of
teaching and work. Too, he discussed dental
caries, or tooth decay explaining the theory
of same and how it is caused.
Doctor Branch paid tribute to Dr. G. M.
Cooper for the oral hygiene program—stating
that he was the first person in the United States
to put dentistry in a public health program.
Miss Carolyn Mercer, Educational Consult-ant,
discussed the assistance given classroom
teachers to follow up the interest in mouth
health created by the teaching of the school
dentists.
A very amusing and enjoyable comedy skit
was presented to the Academy on the evening
of February 22nd by a group of employees.
The skit was based on suggestions for im-provement
of any condition or situation exist-ing
at the Health Department received through
a question box. The committee in charge of the
program were: Miss Mary Batchelor, Chair-man,
Mrs. Ruth Y. Harrell, Narrator, Mrs.
Mary B. Cross, Miss Sarah Goggans, Miss
HenreEtta Owen, Miss Maggie Blackburn and
Miss Fannie Nicholson.
Dr. H. L. Quickel, a new member of the
staff of the Division of Industrial Hvgiene
was introduced to the Academy, as also were
a number of visitors present from the Harnett
County Health Department.
The meeting on the evening of March 15th
was under the auspices of the Division of
Laboratory of Hygiene. A moving picture
showing the farm and buildings of the Labor-atory
were shown, Dr. John H. Hamilton,
Director, acting as narrator and explaining the
various scenes. Then those present were invit-ed
to visit the various laboratories comprising
the State Laboratory of Hygiene for a "peep I
show" to observe some of the numerous activ-ities
of the Division.
At this meeting it was deemed wise to ap-point
a committee to secure the names of all
members of our "public health family" now
serving with the armed forces, and that the
committee send a NEWS LETTER to each
one once a month in order that they could
keep up with the activities of the health de-partment
during their absence. Dr. Robt. F.
Young was elected Chairman of the Com-mittee.
Governor J. Melville Broughton was guest
speaker at the meeting of the Academy in
April. He endorsed the purposes and aims of
the organization, and said that better under-standing
among workers in public agencies
always resulted in higher standards of work.
Governor Broughton also said that we have
here in North Carolina the finest State Health
Department in the Union, and he was glad to
see that we were meeting, discussing our
problems, and learning of each other's duties
with a view of maintaining that standard and
rendering the public the kind of service that
is built on human relations.
At the conclusion of Governor Broughton's
address, Mr. Warren H. Booker, Director of
the Division of Sanitary Engineering, directed
a program in which topical discussions were
given on Malaria Control, Milk Sanitation, the
N. C. Bedding Program, Hotel and Cafe Sani-tation,
Shellfish Sanitation, Meat Market Sani-tation,
Abattoir Sanitation and Water Works
and Sewerage. Also a film "Health and the
Cycle of Water" was shown.
Another highlight program of the Academy
was held when Dr. Carl V. Reynolds, Secretary
and State Health Officer, was the speaker.
Doctor Reynolds began with the Biblical refer-ence
of the span of life in the very earliest
days of human history. He drew many valuable
lessons in his address as it related to longevity;
February, 1944 The Health Bulletin
need for better medical care and information;
the problem of the mentally sick; school work;
nutrition; oral hygiene and other work of
public health in general. Doctor Reynolds also
gave a synopsis of his annual report to the
Conjoint Session of the State Medical Society,
in which he enumerated, in part, some of the
activities within the State Health Department,
and accomplishments of the divisions. He paid
tribute to our "happy and enthusiastic family"
from the Board of Directors to the general per-sonnel
for "the enviable advancement made."
Dr. W. K. Sharp, Jr., Director of the United
States Public Health Service, District No. 2,
was introduced to the Academy, and in his
remarks he paid tribute to Doctor Reynolds
on his reappointment as State Health Officer,
and commended him for his leadership and
the fine work the organization is doing.
At the conclusion of the meeting Dr. and
Mrs. Reynolds were host and hostess to the
Academy. A social hour of music, dancing
and refreshments was enjoyed by all.
The Employees' Group had charge of the
meeting in June at which time a picnic was
held on the grounds of Caswell Square. Out-door
games and dancing was participated in.
Meetings were dispensed with during the
months of July and August.
Dr. J. C. Knox, Director of the Division of
Epidemiology, had charge of the program for
the Academy on the evening of September 20,
1943, which consisted of the showing of edu-cational
films on syphilis and malaria control.
Dr. John A. Ferrell of the Rockefeller
Foundation was introduced. Doctor Ferrell is
a North Carolinian and a friend of the Health
Department. He did pioneer work with the
State Board of Health on hookworm eradica-tion,
etc.
Mr. Capus Wynick, Director of the Venereal
Disease Education Institute, presented the pro-gram
in October. In his introductory remarks
on the objectives and achievements of the In-stitute
he said that the Institute was set up
primarily to originate educational materials
for use in the national program for control
of the venereal diseases, and to evaluate both
materials and technical investigations. While
located in North Carolina and demonstrating
the materials and methods in this State, the
Institute is expected to make its production
and its conclusions available to other states.
Other states now are using many of the ma-terials
originated here.
Mr. C. S. Buchanan, a member of the staff,
filled the role of "Dr. V. D. I. Q." in a very
unique and entertaining manner and con-ducted
a quiz on the subject of venereal
diseases.
The last program of the year was presented
by Miss Ruth W. Hay, Professor of Public
Health Nursing from the School of Public
Health at Chapel Hill. Miss Hay spoke very
interestingly and informatively on the Depart-ment
of Public Health Nursing which was
added to the School about two years ago. She
reviewed the work and activities of the De-partment
from the beginning, discussing the
analysis of the total student group through
the beginning of the third year: the curriculum
and the effective field experience in preparation
for public health nursing. Miss Hay said that
the Department of Public Health Nursing at
the University of North Carolina is being
keenly observed by educators in long establish-ed
schools and national organizations.
Visitors present were: Mrs. E. G. Shreve,
Director of Public Health and Welfare of
Atlantic City, New Jersey, and Dr. Howard
M. Kline of the U. S. Census Bureau.
The following officers were elected for the
coming year:
Dr. Ernest A. Branch, President
Mr. James W. Kellogg, Vice-President
Mrs. Anne B. Edwards, Secretary-Treasury
The foregoing summation of the Academy's
activities during the first year of its existence
serves as an index to its aspirations for a
future of continued and expanding service.
The programs were varied, ranging from
technical discussions to social intermingling,
from which the lesson might well be drawn
that, to succeed, any human undertaking must
be broad in its scope, as well as definite in
its purposes.
The form of service the Academy is designed
to render will find reflection outside the or-
The Health Bulletin February, 1944
ganization itself, for the members realize that They realize that, as artists engaged in helping
they are servants of the people of North Caro- to paim the pubUc hca]th picturCj ^ mJ lina: that to be good servants thev must .
, , . ,
. •
i tr i i
•
', permit no blemishes to occur which might be
strive toward self-development, in order that
they may render more intelligent, as well as
charScabIe to indifference, neglect or ig-morc
efficient service to humanity as a whole. norance.
Rocky Mount
Looks To The Future
By James A. Westbrook
District Sanitary Engineer
Division of Sanitary Engineering
State Board of Health
A/TA^ " f US '""k k^ °n °Ur boyhood tne future and save some of the many "Ole
-Lt -L days when we made our daily visit to Swimmin' Holes" we used to enjoy so much?
the ole swimmin' hole on hot summer days. Down east, the City of Rockv Mount, a
We recall the old rope swinging from the very progressive industrial and manufacturing
highest oak along the creek, and how we center on the Tar River, was confronted with
would swing way out over the water, scream-ing
and yelling, then let go and splash into
the cool water. Then, one day, a dignified
little man came and after much shouting he
quieted us and said: "You boys can't swim
here any more. This stream is polluted and
is dangerous to your health." I didn't know
what "polluted" meant, except that it had create a nuisance in the river. On downstream
a problem. Being an up and coming com-munity,
growing steadily, it outgrew its facili-ties
for the proper treatment of wastes and
sewage. New industries were being established,
some of them using tremendous quantities
of water in their operations and finally turn-ing
the water into the sewer to eventualh
something to do with germs. When I went
home I asked Poppa about it and he said
he had planned to tell me not to go in that
ole swimmin' hole again on account of it
just won't fit to swim in. It seems that the
town had recently put in a sewer line to the
creek and ruined our nice swimmin' hole.
Yes. "swimmin' holes." bathing beaches,
oyster growing areas along the coast, and sur-face
water supplies have been actually affect-ed
and many times ruined because of waste
disposal into the stream. New industries built
along streams to use the water have in many
instances created bad conditions by emptying
wastes into the stream with no treatment to
the wastes at all.
Let's take a look and see what is going on
right in our own North Carolina. What arc
we doing about it
: Can't we look a little into
on this same Tar River, only 45 miles awaj
by river, the Town of Tarboro uses the river
as its source of water supply. The officials at
Rocky Mount, confronted with the problem
of properly disposing of domestic sewage and
industrial wastes, began to wonder: "What
are we going to do about it
: We are 'muddy-ing'
the water in the Tar River by what we
are putting into the river."
Well, they did something, and something
which stands as a shining example to other
towns and cities which may be faced with
the same problem in the future. They secured
the services of an engineering firm, J. E.
Sirrine & Co., Greenville, South Carolina.
which made plans tor a modern sewage treat-ment
plant—a type known as a chemical pre-cipitation,
separate sludge digestion plant—the
idea being to empty treated sewage into the
February, 1944 The Health Bulletin
river so that the sewage would have about
the same appearance and same quality as the
water already in the river.
It's not so simple to handle sewage from a
city of 25,000 population having industrial
wastes. However, plans for the plant were
submitted and approved in March 1941. Work
was completed the latter part of 1941.
Let's take a look into the results of the
forethought given this problem by Rocky
Mount. Located on the northern outskirts of
the city on the Leggett's Highway is a series
of buildings, tanks, and structures, fenced in
to give the appearance of a well-operated
business establishment of some kind. Contrary
to practice of years gone by of having such a
plant located way back in the woods out of
sight, this plant is located on a large tract of
open land and has a most inviting appearance.
Briefly, the plant consists of processes as
follows:
1. Bar Screen, where large particles, bricks,
and the like are stopped from entering the
plant. This screen is cleaned mechanically by
a mechanism which continuously rakes col-lected
material from the bars of the screen.
The collections are deposited into buckets
and disposed of by means of a hammer mill
which breaks up the solid matter. After going
through the hammer mill, the pulverized mat-ter
is put back into the sewer to continue to
the plant.
2. Grit Chambers (two in number), where
sand and grit are removed by means of a
Hydro-Grit Washer and sand elevator.
3. Grease Flotation Units (three in num-ber),
where grease from kitchens and laundries
is removed. The principle of this operation
is based on the fact that grease rises to the
surface after the sewage is agitated and stirred
up. The floating grease is readily removed
from the surface.
4. Primary Settling Tanks (three in num-ber),
where settled solids are removed from
the bottom of the tanks to reduce the clogging
of filters in the trickling filter process. Solid
matter is pumped from the tanks to the solids
digestion tanks periodically. In the primary
tank from 50 to 85 percent of the settleable
solids are removed.
5. Trickling Filters (four in number). The
purpose of trickling filters is to introduce
oxygen into the sewage, thereby keeping the
sewage fresh and preventing a septic condition.
The sewage flows on the rock filters through
rotary distributors which rotate in a manner
similar to the ordinary garden variety of
water sprinkler. The sewage trickles through
the rocks in the filter to underdrains. The
sewage then flows to a secondary settling
tank.
6. Secondary Settling Tanks. The purpose
of this part of the process is to remove any
settling solids not removed in the primary
tank, so that solid matter or sludge will not
be deposited in the river into which the
sewage is eventually emptied.
7. Digestion Tanks (two in number). Solids
collected in the settling tanks are pumped to
digestion tanks, the purpose being to render
the solids inoffensive. The process changes the
quality of the sludge, the final products being
gases, liquids, mineral compounds, and non-digestible
organic matter.
8. Pumping. The processes briefly mentioned
do not take place in a one-two-three operation
without machinery. Pumps of various kinds,
sizes, and shapes are located throughout the
plant.
9. Chemical Feed. The plant is equipped
with chemical feed machines which may be
used if necessary in the treating of the sewage.
This may become necessary if trade wastes be-come
more concentrated than they now are.
In a brief manner I have attempted to show
you the magnitude of the modern sewage treat-ment
plant at Rocky Mount. Now, just for
curiosity, what does all this pumping, settling,
filtering and digestion mean to the City of
Rocky Mount and to that old Tar River :
First, the final solid material from the
digestion tank is removed to drying beds
where, just as you expect, drying takes place.
The dried sludge has a rich tarry odor, is
light grey in color, and makes a pretty good
fertilizer. No, I don't mean something as good
as you could buy from your local fertilizer
8 The Health Bulletin February, 1944
Trickling Filter, Gas Holder and Digestors
dealer, because this dried solid material is not
a balanced product. It is used, however, around
the plant on the grass, and it really makes the
grass take a new lease on life.
Second, the most important result is that
of taking care of Old Man River. Let's take
the yardstick which the people gauging quality
of sewage and river pollution use and see
what the results are. The chief test is the
B.O.D. test, which is a measure of the oxygen
characteristics of the liquid. Tests run in the
laboratory almost every day on sewage coming
into the plant and sewage leaving the plant
show an average of 95 percent B.O.D. removal
through the plant. How does that compare
with the river? Tests of river water and the
final sewage emptied into the river below,
run an almost equal race as to which is which.
In looks, the sewage appears to be as good
or better than the river water. So, we find
that the plant superintendent is getting re-sults
he knows to be good according to his
tests. The appearance of the sewage, in which
we are more interested, is all right, too.
It seems as though there was one more
feature of the sewage treatment facilities I
forgot to tell you about. Let's see. I remember
now. I don't see how I could have let that
slip by, because that one thing is the reason I
have written all the rest of this paper. If you
remember, I mentioned gas as being a product
of digestion of the solids. This gas is collected
in a gas holder and is' piped to the city gas
plant. Here the gas is washed and mixed with
commercial coal tar gas. Relieve it or not,
but about 10 percent of the gas used in the
homes in Rocky Mount for cooking, heating
water, anil other purposes is gas produced at
the sewage plant in the digesters. This gas has
a much higher heat value than that of com-mercial
gas. Consequently, this by-product of
the sewage plant helps pay a part of the ex-pense
of the plant.
I believe I am correct in saying this (stop
me if I'm wrong): the sewage plant at Rocky
Mount is the first and possibly the only plant
in this country to sell gas to the public on a
large-scale commercial basis.
Rocky Mount is proud of its plant, and they
should be, for it is doing a grand job of
keeping clean a portion of the Tar River which
was a real source of trouble in the past. The
days of the ole swimmin' hole are gone for
many of us, but we pride ourselves in the
thought that many of our towns anil cities
are looking ahead to better stream conditions.
What is your town doinsj about it:
February, 1944 The Health Bulletin
A Letter
WE are indebted to Mrs. M. C. Patterson,
903 Shepperd Street, Durham, North
Carolina, for a copy of a letter written by a
physician practicing in Smithfield in the earlv
part of the last century. According to Mrs.
Patterson this letter was written with ink on
a double sheet of paper and folded to form an
envelope. In her letter of transmittal to Dr.
Reynolds Mrs. Patterson states:
"I have tried to copy the old letter as
accurately as possible, spelling, punctuation,
etc., but could not even attempt the forming
of the O's. Am very glad to send this copy.
Think you will find it amusing too in part."
Smithfield
May 22, 1826
Mann Patterson
Orange County, Chapel Hill
Dear Uncle:
In for a penny in for a pound is an old say-ing
and now that I am in the habit of writing
to you I cannot abandon it though you write
me not in return—Today is the first time in
two weeks that I have been able to write, hav-ing
been taken tomorrow two weeks ago with
a pain in the substance of my lungs, connected
with the pectoral complaint you know I have
been from infancy afflicted with. I had my-self
bled six times in three days, two Blister
Plasters on my Breast and legs, beside other
medical treatment that my case required, has
reduced me extremely but has been success-ful—
it was brought on by great fatigue the
pressure of my business this spring has been
greater than I ever before experienced and my
anxiety to attend to it has induced me to
undertake more than my strength was com-petent
to,, the day I was taken I rode forty
miles into Wayne County to Tap a man who
has the Dropsy—the whole business of the
county has been on my shoulders for the last
six months, Dr. Henderson having in effect
quit us, tho he is still here. It has been not
uncommon for me to drive Fifty miles in the
day and night and not get out of the county
visiting my sick this spring,, indeed I never
have witnessed so sickly a spring in my lite
any where as it has been here, the measles
and Influenza and the numerous train of
diseases arrising from them has kept almost
the whole county prostrate,, but fortunately
for the people and for me it was subsiding
very fast at the time I was taken down,, have
not lost much by being down it is believed
—
I had a great wish that some medical gentle-man
would come in to my help, and I am
glad to be told that there has come one, who
intends to settle in town, I have not seen him,
as this is the first day I have been able to set
up,, I had no medical aid to myself, my stu-dent
was constantly at my bedside, I told him
what to do if I should lose my senses, but
thanks to a Kind Providence they were con-tinued
as good as when in health—I found
the same treatment to answer in my case that
had sustained me in other cases, and though
it cannot but detract from me I must say to
you that I could think of no physician neither
in Raleigh or elsewhere convenient to this
place who I could place confidence in,, it is
known to you perhaps that there is a fashion
in medicine as well as other things, which I
hold to be destructive of its fundamental
principals. I do not mean to let these fashion-able
gentlemen practice on me, if my course
was not successful, and evidently gaining
ground, and has already gained me more
reputation than any one Physician ever had
here before,, I should think I was speaking
vainly,,—I had other medical men to see
Chesley when he was sick and I concienciously
believe that he owes his life to my having
pursued my own course to the entire exclusion
of the opinion of others
—
I want you if you know who has the old
Family Bible in which all the births of my
Family are registered, to procure for me a
transcript from it and send it down, Sister
(Sarah) wrote me the other day to know her
10 The Health Bulletin February, 1944
age, which I was ignorant of, I am also ig-norant
of Chesley Manns,
I know not that I ever shall see you again
though it would be a great pleasure, had I
leisure to come up, I am concerned about my
brother Wesley, I am afraid he is misspending
his time, if he comes in your reach, do give
him a lesson, I disapprove of his attempting
to Teach,, mention me in kind feelings to your
family, You will ever have my warmest affec-tions
Jno. T. P. Yeargain
P. S. I am weak and not much in order for
writing neither in body nor in mind as you see.
J.T.PY.
The Medical
Follow-up of Hearing Impairments
By Horace Newhart, M. D.
Emeritus Professor of Otolaryngology, University of Minnesota
*
' I 'ODAY the school is recognized as the
-L most important unit in the conservation
of hearing. The adequate medical follow-up
of all pupils who have an existing or potential
handicapping hearing deficiency is a serious
problem in Preventive Medicine. In view of its
educational, economic and social implications,
this problem is a challenge to the physician,
educator and the legislator. Too few, unfor-tunately,
are aware that it exists. It deals with
our largest group of physically handicapped
school children. Its importance has been appre-ciated
only during recent years as the result
of increasing knowledge of the incidence,
causes and possibilities of preventing and treat-ing
ear diseases.
The successful medical follow-up is based
primarily upon the findings yielded by mass
screening tests of the hearing acuity of all
members of the school population by modern,
approved methods. The objective is to disclose
those pupils who have hearing deficiencies
which demand a thorough otological examina-tion,
to be followed, when indicated, by treat-ment
by a physician skilled in the care of ear
diseases. The tests should not be limited to
selected groups of obviously or suspected hear-ing
defective pupils, lest many be overlooked.
While gratifying progress has been made in
the incorporation of periodic hearing tests in
the state school health programs of several
commonwealths and independently in many
communities, the implied medical follow-up
has not been executed with equal effectiveness.
The reasons for this disappointing failure to
carry out the most important part of the
school hearing program is a lack of knowledge
of certain fundamental facts related to the
problem which should be made known to
every physician, school official, school and
public health nurse, member of parent-teacher
groups and social welfare worker.
Among these facts we mention the follow-ing:
1. The best results are achieved in the con-servation
of hearing by the earliest possible
discovery of existing or impending hearing im-pairments,
and the prompt application of cor-rective
measures. Delay invites irreparable-damage.
2. A child may have a significant hearing
deficiency so slight as to be overlooked by the
parent and teacher, but which frequently
causes retardation, speech defects, behavior
problems and emotional maladjustments.
3. It is now recognized by otologists that
neglected attacks of acute otitis media are
the most frequent cause of hearing impair-ment
among young children. The later effects
may become manifest in progressively handi-capping
hearing loss in adult life. Parents of
young children should be especially warned of
Reprinted from Journal of School Health
of the American School Health Association.
February, 1944 The Health Bulletin 11
this danger. Traditionally, earaches, with or
without discharge, are still regarded by the
uninformed as mere trifles not worthy of
medical care.
4. Contrary to our earlier accepted teaching,
it has recently been discovered that diminished
hearing acuity for tones of higher pitch, dis-closed
only by the pure tone audiometer, are
frequently found in younger school children,
and are an indication of impairment of the
function of the eustachian tube and middle
ear. Such losses have important clinical signif-icance,
and call for expert investigation and
treatment. It should be noted in this connection
that obstructing adenoids when removed sur-gically
before puberty occur in more than
fifty per cent of cases.
5. The classic methods for detecting hear-ing
defects as ordinarily applied in school work
are too crude and time-consuming to meet
the requirements of modern otologic practice.
6. Accurate, dependable hearing tests can-not
be made in the presence of interfering
noises which mask the test tones.
These fundamental facts must be widely
broadcast among all classes, from the general
physician and school administrator to the
pupil who is old enough to receive through
the school health education program practical
instruction in the preservation of his hearing.
This can be accomplished by a planned edu-cational
program under the leadership of in-terested
otologists and educators. The result
will be a public ear consciousness and an in-sistent
demand for a thorough otological fol-low-
up of all hearing defective pupils, which
should be repeated at intervals during school
life.
The medical follow-up of those pupils found
by screening tests to have significant hearing
deficiencies, preferably confirmed by a pure
tone audiometer test, is most effectively carried
out in schools in which there is in operation
a well organized and supervised state hearing
conservation program, administered jointly by
the State Board of Health and the State Board
of Education. These agencies must work in the
closest cooperation, with the approval and
backing of the State Medical Society.
The first step in the medical follow-up is
the referral of the hearing deficient pupil by
the principal or other school official to the
school otologist or to a designated qualified
physician for a preliminary otological examina-tion.
It is desirable that the parent be present,
to whom the procedure and findings are ex-plained.
It should be noted that referral often
should be made on other grounds, if the
screening tests do not disclose a significant
loss. Such referral may be based on a suggestive
personal or family ear history, poor scholastic-achievement,
speech defects, behavior prob-lems,
absence after infectious diseases, and
other conditions which suggest possible hear-ing
impairment requiring otological scrutiny.
Attention should be called to the fact that
many only partially controllable variables are
encountered in making audiometric tests, espe-cially
when large numbers are simultaneously
screened. These are due to haste in applying
the tests, the immaturity of the subject, wide-variations
in the hearing acuity of the same
subject between tests performed at different
times, variations in the calibration and output
of the instruments used, the training and ex-perience
of the operator, and his or her lack
of familiarity with the care and application of
the audiometer, and the previous experience
of the subject. The great variations in the pre-vailing
noise level in the places in which the
tests are made cause inaccuracy. These con-ditions
must be considered in evaluating audio-metric
tests. It is recommended that only
audiometers accepted by the Council on Phys-ical
Therapy of the American Medical Asso-ciation
be used, and that only nurses or
technicians properly trained in this field be
entrusted with the work.
Following the routine otological examina-tion
by the school physician or his representa-tive,
the findings are reported to the parents
with the recommendation that the child either
be given early corrective medical care by a
competent ear specialist or his case be deferred
for further observation. In the former instance,
the parents are advised to consult the family
physician to whom the school findings are re-ported.
He will refer the child for diagnosis
12 The Health Bulletin February, 1944
and needed treatment to the otologist of his
choice. The latter will report his findings and
results of treatment to the school authorities
for the pupil's school health record. This pro-gram,
with modifications, can be put in effec-tive
operation in any community, rural as well
as urban, through the cooperation of all local
agencies interested in the health and educa-tional
advancement of school children, our
citizens of tomorrow.
The advantages of a traveling school hear-ing
clinic to meet conditions in sparsely settled
areas has been demonstrated to be practical.
Some conservatives have suggested that it
would be wise and patriotic to postpone for
the duration any vigorous campaign to promote
increased activity for conserving the hearing.
The answer is that in the great emergency.
"America's strength is health." The recent re-port
of Col. Leonard G. Roundtree covering
Selective Service Medical and Army examina-tions
up to May 31, 1941, show that of 2,000,-
000 men examined, 1,000,000 were found de-fective.
Of these 40,000 had disqualifying ear
conditions. Defective hearing is impaired
health. Normal hearing is a valuable national
asset. Defective hearing among the civilian
population in war production and especially
those in combat units, is a serious liability,
often a calamity. We should, therefore, put
forth greater effort to safeguard the hearing,
not in spite of the war, but as a recognized
part of the expanding War Health Program,
thereby taking advantage of the growing in-terest
in health promotion on a nation-wide
scale.
How Is Your Cold?
T) EN Stebbins, assistant accountant in a large
-LJ office, had a cold. His first sneeze spatter-ed
droplets all over the requisition he was sign-ing,
but it dried quickly, and he routed it on
to his secretary. All that day he was busy wip-ing
his nose. The handkerchief, with its pollu-tion,
he stowed meticulously in his pocket. He
thumbed papers with moistened fingers, he
sprayed any number of people with his breath,
he shook hands with visitors and didn't even
wash them (the hands) when he went to
lunch. On the third day of his cold, Ben had
the sympathy of his boss, Mr. Smith, for he,
too, had caught a cold. And strangely, a num-ber
of people in the office were sniffling and
two were home on sick leave.
Gloom pervaded the Smith household. Baby
Sue was sick. Some "bug" from somewhere
had somehow gotten into the baby's tender
lungs, and now she was waging a grim battle
with bronchopneumonia. The doctor was tact-ful
and didn't even hint that poor Mr. Smith
was probably the donor of the germ.
Gertrude McBride, Ben's sweetheart, a wait-ress
at a restaurant, was sent home when she
came to work with a cold. A high-class out-fit
—they protect their customers and no one
handles food who has a cold. Joe Siegel almost
lost his job. He was a junior clerk and took
Ben's work when Ben finally had to stay
home with a bad sinus. Joe, being new, made
a clerical blunder that cost the concern $50.
The manager was unhappy about the ab-sentee
rate last month, sick leaves reached a
peak. "Dammit" was about all he could say,
for you can't blame anybody for these foolish
cold epidemics—and it took a 15 -cent cigar
to calm him down.
This disconnected story (a bit exaggerated
but possible) hangs together if you know the
key. Most colds are caused by a filterable
virus, which means germs so small they pass
through the finest filter. And how these germs
travel! On microscopic drops of spray, from
mouth to articles to the next mouth. If germs
left a red stain wherever they traveled, what
a gaudy tangle of red tape one would see in
a place where colds have broken loose!—H. E.
Kleinschmidt, M.D.—NTA Clip Sheet.
February, 1944 The Health Bulletin 13
Universal Service
By William H. Richardson
North Carolina State Board of Health
Raleigh, North Carolina
WE hear much these days about total
mobilization, universal service and other
subjects associated with our military progress,
designed to hasten victory on the field of battle,
in the air, on the sea and under the sea. We are
fighting an all-out war, and nothing short of
all of our best will suffice, if we are to survive.
We must conserve and utilize every material
resource—we must avoid waste—if we are to
achieve our objectives, at a minimum of loss
to ourselves.
We all know that there is much talk in
connection with any great undertaking—some
helpful, some downright harmful. Oratory is
not going to win this war; neither will zeal,
unless it is properly channeled.
What will it profit a man if he gain the
whole world and lose his own soul, or what
will a man give in exchange for his soul?
Without any attempt to preach a sermon, the
observation can be made that soul, in this
instance, means that which cannot be weighed
or measured. It embraces the verities of lift-.
as distinguished from the purely material
things. Hence, it is not amiss to ask this
question. What is a man profited if he gain
the whole world and lose his own health, or
what—if he considers the matter well—will a
man give in exchange for health :
An unhealthy man is not accepted for com-bat
duty. He must sit on the sidelines.
Nor can it be said that all the unhealthy
are in that condition through no fault of their
own. Thousands are unhealthy because of their
faults. Consider, as an example, that vast
army of syphilitics, for whose protection the
men at the front are fighting. Are these men
unhealthy through no fault of their own 2 Are
they straight-shooters when they make no
attempt to remedy the condition that has
placed them on the inactive list? It can hardly
be said that they are, for public health offers
them a cure, without cost.
No person who has become unhealthy be-cause
he has failed to avail himself of the
benefits that science has provided for his
restoration can be classed as blameless.
Mass protection is the business of public
health, and in providing this, it has done its
job well. In our own State of North Carolina,
within the past few years, public health has
expanded to the point where, out of a total
population of 3,571,623, only 200,698, or 5
per cent, live in counties that have not com-petent,
well-organized public health depart-ments.
During the fiscal year of 1934-1935 we had
52 counties participating in organized public
health programs. Social Security funds became
available in February, 1936, and since then
Melvin Martin Miles, son of Mr. and Mrs.
W. M. Miles, Cherrylane, N. C. At 6 months
he had been immunized against whooping
cough and diphtheria. His parents read the
Htalth Bulletin.
14 The Health Bulletin February, 19H
James Caldwell Fisher, live and one-half
months. Son of Mr. and Mrs. James K. Fisher,
Rockingham. N. C. Mr. Fisher is a member of
the staff of the Richmond County Health De-partment.
there has been rapid growth. By the fiscal
year 1940-1941 we had 81 counties and 5
cities participating in these federal funds. The
number of people being served had grown
from 1,822,961 to 3,132,192. Today we have
- :
' ounties with organized health departments,
serving 3,370,945, or 95 per cent, of the entire
population.
We hear much these days about minority
groups. Public Health places these on a parity
with majority groups, as the public health
program considers neither race nor numerical
status, but humanity as a whole.
The largest so-called minority group in
North Carolina is our negro population, which
numbers 981,298. Of this group, all but 49,-
2
r " enjoy the full benefits of organized public
health, anil the only reason these do not is
because the counties in which they live happen
to be the eleven counties without public health
departments. In these counties live 151,938
members of the white race without full public
health protection.
Of the 22,546 members of another minority
group, namely Indians, every one of these lives
in a county with a public health department.
North Carolina has the largest Indian popula-tion
of any state east of the Mississippi River,
and about the fifth largest of any state in the
entire Union.
It has long been realized in military circles
that the first principle of defense is attack. To
a military-minded civilian population there is
perhaps no better way of describing the advan-tages
of a local health department than by
saying that, in making health service available
within a community, the citizens of that com-munity
have provided themselves with leaders
[aye Carol Lee, daughter of Mr. and Mrs.
Elton Lee, Pikeville, N. C. At 5 months of age
Carol weighed 25 pounds. Prenatal and Infant
Care bulletins supplied by the State Board of
Health were helpful in giving this \oung lady
• k1 start in life.
February, 1944 The Health Bulletin 15
to plan and execute the attack upon diseases
and conditions dangerous to the public health.
They have provided themselves with protection
against an aggressive enemy. Those communi-ties
in which there is no full-time health service
have no such protection. No attack is possible
to them. They are without leadership fur
establishing attack.
Since there are many manifestations of
dangers to the public health, there must, con-sequently,
be many phases of attack, and each
type of personnel within the health department
—doctor, nurse, dentist, sanitary officer, and
clerk—has its particular part of the campaign
to plot and advance. Each carries its individual
responsibility; each individual responsibility is
a part of the whole. While each is responsible
for executing a certain phase of the attack, all
are united in the concerted drive.
The county which has a whole time health
department has an organization which stands
between its citizens and the ravages of com-municable
disease—which attacks such diseases
by means of immunization, epidemiological
investigation, isolation, quarantine, diagnostic
service (consultation and laboratory examina-tion)
by sanitation, and by the education of
the public to the dangers of such diseases and
the methods by which they are spread. In
diseases such as tuberculosis, diagnostic service
is of vital importance since early diagnosis is
the first step toward cure and likewise the
first step toward preventing its spread. In the
case of communicable diseases such as syphilis,
the health department goes even further in its
attack, establishing clinics for the treatment
of syphilis as a means of preventing its spread.
It has an organization which concerns itself
with the welfare of the expectant mothers and
the babies within its jurisdiction, offering med-ical
and nursing service in the clinic and in
the home. It exercises supervision over the
practicing midwives of the community, in-structing
them in proper care of normal cases
and pointing to them the danger signals of
conditions which they are incompetent to
handle.
It undertakes the examination of preschool
children in an effort to find and correct all
remediable defects prior to the child's entering
school. It plans a careful program of work
within the schools which includes the examina-tions
of school children—both medical and
dental examinations — and health education
activities.
It provides for the sanitary supervision of
cafes, hotels, and other food-handling establish-ments;
for the sanitary disposal of human
wastes, as a safeguard against the spread of
filth borne diseases; for the sanitation of milk
supplies, and for many other special services.
It provides for the physical examination of
food-handlers as a further means of safe-guarding
the public health.
And through the whole fabric of the public
health program runs the policy of backing up
all the safeguards, all the services, with a well
formulated plan for the education of the public
as to the necessity for such services. It is
necessary not only that the community have
such service, but that they be given a clear
understanding of its meaning to the individual
and its value to the community as a whole.
Through health education, an effort is made
to enlist every citizen in the campaign for the
public health.
1G The Health Bulletin February. 1944
Notes & Comment
By The Acting Editor
ACADEMY l"T may not be fair to eval- Iuate the accomplishments
of a child iust one year old, yet to those who
have watched it from its advent there can be
but little doubt that the North Carolina Acad-emy
of Public Health has already made sub-stantial
contributions to the States' health pro-gram.
For one thing, the health workers know
each other better than they did one year ago.
Then too, they are more familiar with the
activities of the various divisions and with the
part the divisions are trying to play in pro-moting
the health of our people. By having
this knowledge the individual worker has a
greater appreciation of his co-workers and can
be more helpful in passing beneficial informa-tion
to the people of the State. Many of the
nation's outstanding leaders in public health
have been introduced to members of the Acad-emy.
These are intangible benefits, but they
increase in value through the years. There have
been some definitely tangible accomplishments
of immediate value. Notable illustrations of
the latter are some administrative changes
rather apparent to the casual visitor and readily
recognizable to the workers themselves. Onlv
time can determine the real value of the
Academy.
The first year has been one of experimen-tation.
Divisions have vied with each other to
present programs of originality. Future experi-ence
may tend toward programs conforming to
a definite patten of a conservative or con-ventional
type. Perhaps variety will be the type
of program in the future. It will be the re-sponsibility
of the members to bring up the
young organization in the ways in which it
should go. If it serves the needs of its members,
it will continue to justify its existence and have
a permanent place in the minds and hearts of
the people who are trying to serve the cause of
public health.
To Dr. G. M. Cooper, the first president of
the North Carolina Academy of Public Health,
and Mrs. Annie B. Edwards, Secretary-Treas-urer,
we express our heartfelt gratitude for the
intelligence and effort which they have con-tributed.
To Dr. Ernest A. Branch, the new
President, we extend our best wishes.
# # *
PROGRESS In this issue of the Bulletin
Mr. Westbrook has given us
a glimpse of the modern sewage treatment
plant at Rocky Mount. In the January i^sue he
told us of the new water purification plant at
Wilmington. In these war time days most of
our communities cannot carry out construction
programs, however, they can plan for the fu-ture.
The progress which has been made in
Rocky Mount and Wilmington should stim-ulate
progressive minded municipalities
throughout the State.
The water purification plant at Wilmington
is noteworthy for several reasons. It represents
62 years of development and 62 years of effort
by the John Swecneys, father and son. Sixty-two
years ago water distribution plants were
a novelty in North Carolina. There is a vast
difference in the standards of public water
supplies then and now. The Wilmington plant
has had many difficulties to overcome. Their
new plant should give them water of a uni-formly
high quality.
The sewage plant at Rocky Mount should
point the way to a great many North Carolina
communities. We have been very careless about
polluting our streams. Rocky Mount is demon-strating
that sewage treatment can be accomp-lished
effectively and economically.
Both at Wilmington and at Rocky Mount we
have demonstrations that our municipally
operated utilities need not be ugly. It costs no
more to have architectual lines that are pleas-ing
to the eye than it does to have those
atrocities which we formerly constructed and
tried to justify only upon the grounds that
they were useful. Let us hope that we have
embarked upon a program of constructing
useful buildings on attractive lines.
j This Bulletinwill be sent free to any citizen of the State upon request
|
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. 59 MARCH, 1944 No. 3
A North Carolina Slaughter House In 1936
It Was Closed Shortly After This Picture Was Made
MEMBERS OF THE NORTH CAROLINA STATE BOARD OF HEALTH
S. D. CRAIG, M.D., President Winston-Salem
I. N. JOHNSON, D.D.S., Vice-President Goldsboro
G. G. DIXON, M.D Ayden
H. LEE LARGE, M.D. Rocky Mount
\V. T. RAINEY, M.D Fayetteville
HUBERT B. HAYWOOD, M.D Raleigh
I. 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.
|. C. KNOX, M.D., Director District No. 1 Local Health Administration.
R. E. FOX, M.D., Director District No. 2 Local Health Administration.
J. ROY HEGE, M.D., Director District No. 3 Local Health Administration.
ERNEST A. BRANCH, D.D.S., Director Division 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.
ROBERT F. YOUNG, M.D., Acting-Director Division of County Health Work
J. M. JARRETT, B.S., Director Division of Sanitary Engineering.
T. F. VESTAL, M.D., Director Division of Industrial Hygiene.
•On leave.
FREE HEALTH LITERATURE
The State Hoard of Health v 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 Disease*
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 ol 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
Winston-Salem 1943 3
The Division of Epidemiology 6
A Review of the Abattoir Situation in North Carolina 9
Life and Death in North Carolina in 1943 13
North Carolina Bureau of Vital Statistics Provisional Report for 1943 16
PUBLI5ME.D BY TML HQR.TA CAROUMA 5TATE. BQA^D ^MEALJhI
Vol. 59 MARCH, 1944 No. 3
CARL V. REYNOLDS, M. D., State Health Officer JOHN H. HAMILTON, M.D., Acting Editoi
Winston-Salem 1943
By R. L. Carlton, M.D.
City Health Officer
Winston-Salem, North Carolina
CIVILIAN health is important—more im-portant
just now than usual—so some
figures about births and deaths and those dis-eases
which threaten the population from day
to day become of importance, too.
Births. A larger number of babies were born
in Winston-Salem in 1943 than in any previous
year in the city's history. Certificates were filed
for 1,878 white and 798 colored babies, a
total of 2,676, an increase of 79 over the 1942
record which year had the largest number of
births up to that time. These figures indicate
a birth rate of 32.6 per 1,000 population—an
increase of .2 over the birth rate of 1942 and
an increase of 5.6 over that of 1941.
1,035 babies were born here of non-resident
parents during the year just closed. The records
show that 2,290 or 85% of all the babies born
here last year occurred in hospitals.
Stillbirths. 87 babies were born dead—51
white and 36 colored—an increase of 17 over
the year before. This means that 1 in every
31 babies was born dead last year, while in
1942, 1 in 37 was a stillbirth. The stillbirth
record is proceeding in the wrong direction
—
not alarmingly so—but nevertheless our record
in this respect was not as favorable in 1943 as
in the two-year period immediately preceding.
Deaths. 977 persons—576 white, 400 color-ed
and 1 Indian died in Winston-Salem last
year. This is an increase of 193 over the year
before. The increase is practically all in the
white race—there being 191 more white deaths
than in the year before and an increase of
only 1 colored and 1 Indian. These figures in-dicate
a general death rate of 11.9 which is
2.3 above the rate of 1942 and corresponds
quite closely to the general death rates for
several years just prior to 1942.
Death rates by color are of interest—the
white death rate for the year being 12.8 (and
that's up 4.3 from the year before) while the
colored death rate was 11.1 (down 1.6 from
the 1942 rate).
Non-resident Deaths. 291 non-residents died
here last year. This is an increase of 130 non-resident
deaths over the year before. Deduct-ing
the non-resident deaths from the total
there is left a true or resident death list of
686, making a resident death rate of 8.4 per
1,000. A creditable rate indeed, but represent-ing
an increase of .6 over the record low
rate of the year before.
Deaths by Age Groups. To know at what
ages most of the deaths occur is of interest as
well as of considerable importance. Important
from a public health standpoint, certainly, be-cause
vastly different programs of health pro-tection
and disease prevention are required for
the different age groups of the population.
Our statistics show that for several years
the largest number of deaths have occurred in
the groups of greatest age. Last year there
were 338, the largest number for any age
group in the 60 years and older class, while
next in numerical importance was the 40 to
The Health Bulletin March, 1944
59 year old class with 284. We lost 51 in the
15 to 24 year old group, and 136 in the 25 to
39 year old class—making nearly 200 deaths
of persons in young and what should have
been active manhood and womanhood—cut
off just where they should have been most
productive.
Then there are the babies who did not live
long enough to celebrate their first birthday
anniversary—127 of them last year—24 more
than in 1942. An item that ought to be of
interest is this—our infant mortality rate in
1940 was 80 per 1,000 live births and in 1941
it came down to 60 and in 1942 it dropped
still lower and reached 40 per 1,000 live
births—the lowest rate the city has had. Then
last year the baby death rate turned the wrong
way and went up to 47 per 1,000 live births,
an increase of 7. It would have been so much
nicer if the rate could have kept on coming
down. This rate, 47, is by no means one to
make health workers and mothers lose courage
and give up. The infant death rate in past
years has been far greater than the present rate.
The health officer remembers when the mor-tality
rate here was 200 per 1,000 births. Think
of all the hosts of little folks living now who
would be dead if death rates such as that
existed at present.
The infant death rate for the two races
should be of interest. While our white died
last year at the rate of 41 per 1,000 born, an
increase of 10 over the year before, the colored
babies passed out at the rate of 61 per 1,000
born which is a decrease of 30 from the rate
of 1942—and that calls for congratulations to
colored babies and their mothers.
These figures all indicate there is still much
to be done in the way of care and protection
of our little ones. Both white and colored death
rates are too high—the white rate proceeding
in the wrong direction and the colored rate
showing some improvement.
Causes of Deaths. Heart diseases last year as
for many years lately killed more than any
other cause—in fact several others combined—
214 persons lost their lives because of various
heart conditions, an increase of 73 over the
year before. One death in every 4/4 last year
was a heart case. Cerebral hemorrhages was
next to the top with 125 victims, an increase of
20. Cancer was in third place among the chief
causes—87 deaths being charged to cancer, an
increase of 12. 57 of the cancer victims were
white and 30 colored. It is hoped that we may
soon see the tide turn with respect to cancer
deaths.
Pneumonias were 4th in the list of important
causes killing 79 persons, an increase of 17.
Deaths from pneumonias seemed to be on
the decline in 1942 when the record showed
10 fewer than in 1941, but unfortunately in
1943 the pneumonia death rate went up to
the tune of 17 more than in 1942.
Conditions of prematurity and congenital
malformations had 61 deaths charged to these
conditions, which is an increase of 12 over
the previous year.
Tuberculosis which in 1942 dropped to 8th
place went up to 6th position in 1943 with
54 deaths as compared to 30 the year before.
These figures indicate a tuberculosis death
rate of 65 per 100,000 population, A sharp
rise from the rate of 48 in 1942. The present
rate, however, reveals a favorable situation as
compared with 1941 of 85. By color the record
shows that last year the white tuberculosis
death rate was 35 per 100,000 and the colored
rate 103. Both white and colored rates are
increases over the 1942 rate—the white rate
26 points higher and the colored rate 6 points
higher than the year before.
Violence, or external causes, were charged
with 52 deaths a decrease of 1. In this group
are included 1 1 deaths due to accidental falls,
an increase of 4; 5 suicides, an increase of 3:
4 homicides, a decrease of 5; 7 accidental
burns, 3 less than the year before; automobile
accidents were charged with 17 deaths, a de-crease
of 1 from the 1942 record; 3 deaths
due to railway accidents, none in 1942. So,
we lost 52 persons because of violence last
year—and that's too many.
Vephritis occupied 8th place in the principal
causes of death, with 45 victims, a decrease
of 16.
March, 1944 The Health Bulletin
Complications of Pregnancy and Labor
caused 22 deaths, and that's 10 more than
in 1942. Of this total number 14 were babies
and 8 mothers which means that there was a
maternal death rate last year of 3 per 1,000
births as compared to 2.3 the year before.
Diabetes was 10th in the list of principal
.auses with 18 deaths—and that's exactly
'louble the number of diabetes deaths for the
vear before.
Communicable Diseases. The city had a good
record—there were no epidemics. Whooping
cough was reported in 787 persons, most of
these being reported the first half of the year,
and 2 children died because of this disease.
Scarlet fever was reported in 74 cases, an
increase of 15. There was no scarlet fever
death.
Diphtheria attacked 27 children and 3 died.
An increase over the year before when there
was only 16 cases and no death. We ought to
be ashamed of our diphtheria record—some of
us are. There is no excuse for a city to have
27 cases of diphtheria in any year. The disease
is one that is well understood. There is definite
knowledge of what causes it, of how it may
be cured and of how it may be prevented.
The preventive treatment is available to any
child regardless of circumstances. Further-more,
there is a law which makes the failure
to protect children against diphtheria a mis-demeanor
on the part of the parents—and yet
in spite of all this we have 27 children attack-ed
and 3 of them lost to this killer.
Measles was reported in 275 cases and no
death.
Typhoid fever occurred in only 5 persons
—
no death. In 1942 there were exactly 5 cases
and 1 died.
Endemic Typhus Fever occurred in 6 per-sons.
We may expect to continue to have
typhus cases with us until the city rids itself
of rats and fleas.
Another item which should interest many
Winston-Salem citizens is this—we lost 14
children because of ileo-colitis or summer
complaint—and that number is 8 more than
for the year 1942.
Tuberculosis was reported in 135 new case-
—19 more than for the year before. And this
number does not represent all the cases of
tuberculosis in our city because they were
simply not found. For 54 tuberculosis deaths
there should have been discovered 400 cases
of the disease. There is still much work to be
done before tuberculosis is eliminated. The
local tuberculosis program is a good one; the
disease is being slowly conquered—let's in-crease
the tempo of the fight against it.
Venereal diseases were reported and treated
in wholesale numbers throughout the year
—
nearly 2,400 new cases being admitted to the
clinic and more than 28,000 treatments ad-ministered.
These figures pertain to the city's health for
the year just closed. Some of the balances are
in the red, many of them are certainly on the
right side of the ledger. In spite of wars and
confusion and upset conditions and changed
programs and family disruptions and crowd-ed
hospitals with short medical personnel, the
city generally has come through the year in
good condition so far as it's health is con-cerned.
This is the 27th year the present health
officer has had something to do with the sum-ming
up of the city's annual health record.
There have been many years in which the
general health record was not so good as in
1943 and there has been one or two years
when the record was a little better. And that's
what happened in Winston-Salem in 1943.
The Health Bulletin March, 1944
The Division Of Epidemiology
By C. P. Stevick. M.D.
Acting Director. Division of Epidemiology
North Carolina State Board of Health
Raletfrh. Xorth Carolina
REGARDLESS n( the particular specialized
capacity in which .1 public health worker
may be serving, such as health educator, nurse,
medical officer, sanitary officer, engineer, or
•echnician, he must know the fundamentals of
d! of the different public health services in
irder to perform his job with the maximum
efficiency. In the same way, although the
various divisions of the State Board of Health
ire engaged in specialized work, each must
know and carry out certain fundamental public-health
duties common to all. This situation is
particularly true in regard to epidemiology.
While one of the divisions of the State Board
of Health is devoted primarily to epidem-iological
work, all of the other divisions are
also engaged frequently in epidemiological
study. In fact, this type of study forms the
foundation for most of our present dav activ-ities
in the field of public health.
Epidemiologists have frequently been de-scribed
by the term "Disease Detectives." How-ever,
while the work of the police department
detective is done when his case is solved, the
most important work of the epidemiologist is
done after the cause of the particular outbreak
or epidemic of disease is determined; that is. he
must use the facts discovered to set up a con-trol
program to prevent, in so far as possible,
recurrence of the outbreak. At times he must
even administer the control program himself.
Since all public health procedures are used
only where they will be the most good, the
"Disease Detective" applies his efforts only
where the results justify them. The most fertile
field for present day epidemiological service
has resolved itself to be that of the commun-icable
diseases.
The Division of Epidemiology of the North
Carolina State Board of Health is under the
direction of the state epidemiologist. The l>m
sion receives information from many sources
in order to be immediately aware of outbreak*
of certain preventable communicable diseases
It has available to it medical, laboratory, and
other technical assistance in order to carry our
investigations and prepare control progams
found necessary. During the past few years the
venereal disease problem has received increas
ing attention by the Division of Epidemiology,
along with many other divisions of the State
Board of Health, and there has come about
such a flood of data through the channels of
information, and so much has been required
of certain other technical services that the
work dealing with other epidemiological prob-lems
has appeared overshadowed at times.
However, the various services of the Division
have continued to produce valuable results in
all the other established programs. A summarj
of each of these services with a brief ex-planation
as to the part each plays in solving
disease control problems will illustrate the
operation of the Division as a unit.
REPORTING AND
TABULATING SERVICE:
This service constitutes the Division's chan-nel
of information. The incidence of commun-icable
diseases in the various parts of the
world is reported at weekly intervals to the
director's office by the bulletins and reports
of the U. S. Public Health Service. The com-municable
disease picture in the other states
of this country is presented also by reports
from the U. S. Public Health Service at weekly
intervals, and by direct reports from many of
the states themselves. The prevalence of disease
in oiir own state is reported daily to the di-rector's
office.
March, 1944 The Health Bulletin
The staff that receives these reports from
the various areas and records and tabulates
them is known as the Central Tabulating
Unit. It compiles the daily reports and pub-lishes
weekly and monthly summaries of all
the reportable diseases in North Carolina.
Valuable communicable disease information is
also received from various laboratories in the
-.tate. Information from all these sources shows
when new epidemiological work is needed and
evaluates the results of the current activities.
LABORATORY SERVICE:
The Division of Epidemiology employs two
full time Laboratory Technicians and in addi-tion
has the complete cooperation of the State
Laboratory of Hygiene. The laboratory study
of disease outbreaks is an important part of
the investigation necessary on such occasions.
When the causative agent is determined the
control measures necessary can be outlined.
ENTOMOLOGICAL SERVICE:
The Division employs a full time Entom-ologist
and is constantly studying the preval-ence
and location of certain disease-carrying
insects. At present mosquito-transmitted malar-ia
and other diseases constitute definite prob-lems
facing the Division. It is only by knowl-edge
of the breeding areas and numbers of
these insects that control programs can be
started.
ENGINEERING SERVICE:
The control of certain diseases with which
the Division is concerned necessitates the build-ing
of drainage systems, changes in and super-vision
of the construction of buildings. Spe-cially
trained engineering assistance is available
from the Division of Sanitary Engineering, in
addition to the full time engineer attached to
the Division of Epidemiology.
EDUCATIONAL SERVICE:
All public health programs are made up to
a considerable extent of methods of educating
the public. The State Board of Health has
been fortunate in having the assistance of
experienced educators who have been of great
value to the Division both for consultation
and for the administration of programs. The
distribution of literature of many kinds giving
information about certain communicable dis-eases
is being carried out constantly. A film
library is also maintained by the Division. Ar
present seventy-six films are available for dis-tribution.
Topics covered include malaria,
typhus fever, tuberculosis, venereal disease, and
many others.
MEDICAL SERVICE:
The services of the Director of the Division
are available constantly for investigating
epidemics or outbreaks of diseases, and con-sultation
in case of illness suspected of being
due to a communicable disease; for assisting
in the outlining of control programs for such
disease problems; and for the general super-vision
of the other services of the Division. In
addition, the assistance of one or more medical
officers with special knowledge in regard to
the venereal diseases is available.
THE EPIDEMIOLOGICAL PROGRAM:
All of these services are used to carry out
the fundamental program of the Division
which is the investigative or epidemiological
program. By use of the laboratory, entomol-ogical,
and medical services, the diagnosis of
a disease that suddenly appears and spreads
rapidly in some area, as reported by the tab-ulating
service, can be made; and with the
aid of the engineering, educational, and other
services necessary, the medical officer can aid
in working out a control program. In certain
instances the control program is administered
through the Division itself. At present five
major control programs are being administer-ed
in this way.
VENEREAL DISEASE
CONTROL PROGRAM:
An enlarged program has been administered
by the Division of Epidemiology for several
years for the control of venereal disease. Con-siderable
federal financial aid, as well as aid
from the Reynolds Foundation, has made pos-sible
one of the most intensive fights against
8 The Health Bulletin March, 1944
the venereal diseases in the United States. The
tabulating, educational, laboratory, and med-ical
services are all playing an important part
in this program.
THE GENERAL COMMUNICABLE
DISEASE CONTROL PROGRAM:
The rules and regulations governing the re-porting,
isolation, and quarantine of com-municable
diseases in North Carolina are pre-pared
by this Division for submission to the
State Board of Health. The administration or
the application of these regulations after adop-tion
by the State Board of Health is one of
the major parts of this program. All of the
services take part in this work.
THE MALARIA CONTROL PROGRAM:
Special measures have been taken in North
Carolina for many years for the control of
malaria. At present the many units of the
armed service stationed in North Carolina are
receiving protection from this disease through
the efforts of the War Areas Malaria Control
Program. Under the direction of an experi-enced
engineer, a large staff of field engineers,
entomologists, and laborers is carrying out
widespread drainage and larvicidal work in
the war areas of the State. This program is
financed in its entirety by the U. S. Public
Health Service. Other personnel are main-taining
a state-financed program in the other
parts of the state. This consists of the location
of breeding areas, the supervision of local
control programs, and surveys to determine
the prevalence of malaria. All of the services
of the Division are taking part in this pro-gram.
THE TYPHUS FEVER
CONTROL PROGRAM:
Endemic typhus fever has been steadily on
the increase in North Carolina in recent vears.
Since the disease is spread by rats, a control
program necessitates extensive rat proofing
and extermination. Under the direction of a
trained engineer of the Division of Sanitary
Engineering, an increasing number of local
programs have been originated throughout
the state and put under supervision. Again,
all the services of the Division take part in
this work.
ADMINISTRATION OF THE
PREMARITAL EXAMINATION LAW:
In April, 1939 the state legislature passed a
law requiring a premarital examination for
mental diseases, tuberculosis, and the venereal
diseases. The administration of this law has
been handled by the Division of Epidemiology.
Medical and education services have been in
charge of this program.
NEW SERVICES AND PROGRAMS:
At all times improvement in methods and
the training of personnel is being carried out
wherever possible. As the need for new serv-ices
arises the resources of the Division are
used to their fullest extent to provide them.
At present a reorganization of the typhoid
fever carrier register is being made. Improve-ments
in the system of reporting notifiable
diseases is planned. Revision of the rules and
regulations for communicable disease control
has been receiving attention for some time.
An expansion of the tabulating servic