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®f)e itfcrarp Of tfjt Wlnfamitp of ^ortfj Carolina Cnbotoeb bp Cfje Biakctit anb ^fjilanttropit ftoriete* 61U . 06 W86h v. 59-60 19hk-h< Med. lib. This book must not be taken from the Library building. 3fvT PutlisKedbij TfiL^°RmC4F°LIflA STATL^ARDs^.fflEftL'm | 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
Object Description
Description
Title | Health bulletin |
Other Title | Bulletin of the North Carolina State Board of Health; Bulletin of the North Carolina Board of Health |
Creator | North Carolina. State Board of Health. |
Date | 1944 |
Subjects |
Children--Health and hygiene Diseases Hygiene Public Health--North Carolina--Periodicals Sanitation |
Place | North Carolina, United States |
Time Period | (1929-1945) Depression and World War Two |
Description | Volume 59, Issues 1-12. Issues for Feb.-May 1917 and for Jan.-July 1918 not published. |
Publisher | Raleigh,North Carolina State Board of Health. |
Agency-Current | North Carolina Department of Health and Human Services |
Rights | State Document see http://digital.ncdcr.gov/u?/p249901coll22,63754 |
Physical Characteristics | 61 v. :ill. ;23 cm. |
Collection | Health Sciences Library, University of North Carolina at Chapel Hill |
Type | text |
Language | English |
Format | Bulletins |
Digital Characteristics-A | 15,435 KB; 238 p. |
Digital Collection |
Ensuring Democracy through Digital Access, a North Carolina LSTA-funded grant project North Carolina Digital State Documents Collection |
Digital Format | application/pdf |
Related Items | Imprint varies: published later at Raleigh, N.C. |
Title Replaces | Bulletin of the North Carolina Board of Health** |
Audience | All |
Pres File Name-M | pubs_edp_healthbulletin1944.pdf |
Pres Local File Path-M | \Preservation_content\StatePubs\pubs_edp\images_master\ |
Full Text | ®f)e itfcrarp Of tfjt Wlnfamitp of ^ortfj Carolina Cnbotoeb bp Cfje Biakctit anb ^fjilanttropit ftoriete* 61U . 06 W86h v. 59-60 19hk-h< Med. lib. This book must not be taken from the Library building. 3fvT PutlisKedbij TfiL^°RmC4F°LIflA STATL^ARDs^.fflEftL'm | 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 |