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tCfie librarp of tiie ?Hnibets(ttp of ^ortf) Carolina anb l^ttantiiropu ftodetiesi 61U.06 N86h v,63-6i| 19U8-U9 Med. lib. This book must not «M be taken from the Library building. MEDICAL LIBRARY U. OF N. C . CHAPEL HILL. N. Q^ ^S^' V^' V). C. i This Bulletin, will be serA free to any citizgn cf the State upon request | Published monthly at the office of the Secretary of the Board, Raleigh, N. C. Entered as second-class matter at Postoffice at Raleigh, N. C. under Act o£ August 24, 1912 Vol. 63 JANUARY, 1948 No. 1 He is going to make it, one step at a time, because you give him his chance through your purchase of Easter Seals. MEMBERS OF THE NORTH CAROLINA STATE BOARD OF HEALTH S. D. CRAIG, M.D., President Winston-Salem G. G. DIXON, M.D., Vice-President 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 Ashevillc J. O. NOLAN, M.D Kannapolis JASPER C. JACKSON, Ph.G.... Lumberton PAUL E. JONES, D.D.S FarmviUc EXECUTIVE STAFF CARL V. REYNOLDS, M.D., Secretary and State Health Officer. G. M. COOPER, M.D., Assistant State Health Officer and Director Division of Health Education, Crippled Children's Work, and Maternal and Child Health Service. R. E. FOX, M.D., Director Local Health Administration. W. P. RICHARDSON, M.D., District Director Local Health Administration. ERNEST A. BRANCH, D.D.S. , Director of Oral Hygiene. JOHN H. HAMILTON, M.D., Director Division of Laboratories. J. M. JARRETT, B.S., Director of Sanitary Engineering. T. F. VESTAL, M.D., Director Division of Tuberculosis. OTTO J. SWISHER, Director Division of Industrial Hygiene. WILLIAM P. JACOCKS, M.D., Director Nutrition Division. MR. C.^PUS WAYNICK, Director Venereal Disease Education Institute. C. P. STEVICK, M.D., Director, School-Health Coordinating Service, Epidemiology and Vital Statistics. HAROLD J. MAGNUSON, .M.D., Director Reynolds Research Laboratory, Chapel Hill. JOHN J. WRIGHT, M.D., Director Field Epidemiology Study of Syphilis, Chapel Hill. FREE HEALTH LITERATURE The State Board of Health publishes monthly THE HEALTH BULLETIN, which will be sent free to any citizen requesting it. The Board also has available for dis-tribution without charge special literature on the following subjects. Ask for any in which you may be interested. Adenoids and Tonsils German Measles Sanitary Privies Appendicitis Health Education Scabies Cancer Hookworm Disease Scarlet Fever Constipation Infantile Paralysis Teeth Chickenpoi 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 Schedule. Prenatal Letters (series of nine First Four Months. monthly letters.) Five and Six Months. The Expectant Mother. Seven and Eight Months. Infant Care. Nine Months to One Year. The Prevention of Infantile Diarrhea. One to Two Years. Breast Feeding. Two to Six Years. Table of Heights and Weights. Instructions for North Carolina Midwives, CONTENTS Page The World Food Need 3 The North Carolina League for Crippled Children, Inc. 8 Notes and Comment 12 Causes of Death In 1947 Are Compared With Those In 1900 15 y LIBHAttX UWAV. v# »0«.TH CAROLINA ^ ,: Vol. 63 JANUARY, 1948 No. 1 CARL V. REYNOLDS, M.D., State Health 0£Bcer JOHN H. HAMILTON, M.D., Acting Editof The World Food Need By ' Hazel K. Stiebel'ing Talk to State Nutrition Committee Raleigh, North Carolina THIS is a year of food crisis through-out the world. We meet it here in the form of high food prices, prices more than twice as high as in 1935-39. Soon we shall find much less meat in the markets than we would like to buy. Nevertheless, we enjoy generous food supplies. Most other parts of the world are far less fortunate. Despite the extra-ordinary efforts of governments to alle-viate food shortages, hunger continues for many people. In Europe, hunger is retarding general economic recovery and indeed the return to peaceful con-ditions. And, at best, we probably face two or three more years of short food supplies. In this crop year, 1947-48, world per capita food consumption is expected to be 2 or 3 per cent below last year, and nearly 10 per cent below prewar, ac-cording to the October estimates of the International Emergency Food Council. In pondering the significance of a fig-ure 10 per cent below prewar we should remember that even in that earlier pe- ^ riod over half of the people on earth were getting fewer than 2250 calories per day. We also should keep in mind that the change from prewar levels has differed greatly from country to coun-try. Last year, for example, it was 30 per cent below prewar in Germany; here in the USA it was considerably above. Except for potatoes, world production of most food crops was higher in 1947- 48 than in the year before. But a short-age of feed crops in all of the heavy livestock producing areas has created a serious food situation. World produc-tion of coarse food and feed grains combined, is down by 10 per cent. As a result there is heavy pressure on the part of livestock producers everywhere to use grain for feed that should be used for food. The major reason for shortage of feed compared with the previous year is the extremely unfavorable weather of last year. Here we had a short corn crop. In Europe the heavy freezes of last winter and the record-breaking drought of the summer resulted in short potato and feed crops. Food reserves in surplus-producing areas are smaller than in 1946-47, and in some, notably here in the Western hemisphere, consumers have incomes and savings big enough to buy more food than ever before. Hence it has been more difficult than might have been expected to acquire the food need-ed for export to deficit countries. Be-sides, the world's population has grown by some 15 to 20 million. And so food The Health Bulletin January, 1948 tends to be short. And because it isn't evenly distributed, some groups will inevitably suffer greatly before the next harvest comes In. The problem is to alleviate this inevitable situation to the greatest possible degree. Shortages of food and fuel, fiscal and financial difficulties, and frustration and fear are closely interrelated in their devastating effect upon people and nations. In Europe, for example, short-ages of food have impaii-ed the pro-ductivity of workers in some key in-dustries— notably in the production of coal in the Ruhr. Until very recently, shortages of coal have prevented the full use of plant capacity for the manu-facture of nitrogen fertilizer. Lack of sufficient fertilizer has limited the pro-duction of indigenous food. Lack of coal has also stood in the way of steel production and all-out Indus-trial activity. The inadequacy of production has made it practically impossible for most of the European countries to export large enough quantities of goods to pay for the imports which they lu-gently needed. This situation has in turn been aggravated by the fact that the things they needed most were in short supply throughout the world—with the result that the prices they have had to pay for what they bought abroad have gone up much faster than the prices of those things they had to sell. In many coimtries inflation has con-tributed to the prevailing difficulties. Money was plentiful at the end of the war and few governments have been strong enough to take the necessary corrective measures. In the worst cases (as in Germany, for example) this has meant a widespread reversion to prim-itive methods of barter. More generally it has contributed to extensive black market dealings. Thus, the war brought not only phys-ical destruction, but a shattering dis-ruption of economic organization and dislocation of economic relations, re-covery from which will not be easy. In the long-run, the situation can be remedied only by the development of concrete programs for coordinated and orderly expansion of production. This obviously requires both national and international efforts properly integrat-ed. Agricultural rehabilitation and ex-pansion must go hand and hand with industrial expansion and financial sta-bilization. To this, attention must and will be given. The short-run and immediate task before nutrition committees in this coimtry is to help families here help themselves and others through wise use of our own food resources. There simply isn't food enough to eat as we would like and yet to meet even the minimal requirements for grain, fat, dried milk and other foods abroad. Of some things such as meat, there isn't enough even to satisfy ovu" own people. And if we continue to try to buy as much as we have had recently, prices will be pushed up until only the rich can afford all they want. Each household can make its contri-bution to the Nation's task of conser-vation, so as both to save food and to use it wisely, especially the scarce grain, fats, and meat. In choosing among these scarce articles, take an extra slice of bread rather than correspond-ing extra calories from meat, because 3 or 4 times as much grain goes into livestock production than into bread production of the same number of calories. Also join in the fight to stop feeding our precious food to rats and insects. We can choose to lessen the demand for bread, for fat, and for meat, espe-cially highly finished grain-fed meat. We can choose to select commercial or good grades of meat, instead of choice or prime, which require undue amounts of grain for their production. We can conserve and make full use of every ounce of drippings and bacon fat. We can eat a second potato or an addi-tional serving of some other vegetable instead of the second slice of bread. During my two week stay in September with a family in Britain, no bread was on the table at the two main meals of each day. Plain boiled potatoes or tur- y January, 1948 The Health Bulletin nips or carrots (no butter) were served Instead. At public eating places, bread was served only on request. If you ordered bread for dinner or supper it coimted as a course, and you forfeited soup or dessert. Some families In this country are living at bedrock levels, and shouldn't be asked to reduce their food consump-tion. But everyone can avoid waste, and some of us can get along better by eating less. Many of us can adjust, and include in our everyday fare more than the usual amounts of fresh fruits and vegetables, and more of other hard-to-transport foods, even if, in some cases, these are among the relatively expen-sive foods. I need not spell out for this audience the many ways in which nutrition-trained people can help the Nation's families make good use of the food we have. College-trained nutritionists are resourceful persons. They can do much to help popularize effective sharing and conservation. These are important measures, both for our friends abroad and for our own pocketbooks, to help combat inflation. Each of us must have a personal pro-gram as well as a part to play In put-ting a national program into effect. We must not buy more than we need—or eat more than we need—or throw any food away. When we buy foolishly, we are helping to keep prices high and fanning inflation. When we overeat, we are compelling overseas friends to vm-dereat. When we waste food, or nutri-ents— bread, fat, even the invisible minerals and vitamins—we are wasting lives. In passing, I also want to remind you of the Importance of keeping alive a sense of direct participation in the sharing of food and clothing. The parcels that you send to your overseas friends, or give through a church, through CARE (the Cooperative for American Remittances to Europe), the American Women's Voluntary Services or other organizations—these parcels count for much more than their mere Intrinsic value. Though what any one person can give may seem only a drop in the great sea of need, singly and collectively such gifts mean much. To the families that get them they are in-valuable. To everyone they are symbols of sympathy and understanding—mor-ale builders of the first order. I am sure that our answer to the world's need wovild come swiftly and generously could each of us but see for ourselves the contrast between our own way of living and that which exists in so many other places. Each of us who has been abroad is trying to explain— each from his own experience. Owe friends in other countries are trying to describe their need. But it takes imagination—imagination of a very high type—really to comprehend these oral and written reports. Those of us who haven't seen first-hand may need to hear the story over and over—from many persons, in many contexts. And while first emphasis is generally laid on the need for material things, home economists will not forget the many ways in which the stresses and strains of long-continued poverty may adverse-ly affect family and community life. What too little food means day in, day out, for years, is hard for us to comprehend. Of course it means differ-ent things to different groups in the population: the city, the farm; the young, the old; the rich, the poor; the housewife, the heavy worker; in countries, as Britain, where food con-trols safeguard distribution according to need, in countries where over and above the meager rationed amounts of a few items every man is left pretty much to shift for himself. There is wide variation among countries in the degree of the current food crisis, the ad-justments that can be made in food utilization, the opportunities for food conservation and food control. In most of the countries suffering from severe food shortage and poor food distribution, the plight of the aged is pitiful. I shall never forget the anxious expression and the wax-like appearance of the faces of the elderly people whom I saw in Berlin in the 6 The Health Bulletin January, 1948 summer of 1946—people who in August were sitting in damp, dark, cold rooms bundled up with sweaters and rugs — people who couldn't avail themselves of the sun's warmth between showers be-cause their knees and ankles were so swollen or stiff that they couldn't walk much, and who were too ill clothed even to sit on the curbstone in the chilly afternoon sunshine. Most of them had lost the savings on which their security was to rest, and they did not have the strength to trudge into the country or stand in long queues for food. Food shortages intensify all problems of human relations. I remember one family of 13 children and an aged grandmother. To avoid the constant bickering among hungry children, the mother decided finally to give each child his quota of bread as soon as the weekly rations were received. To each she gave a special place to keep it so each could eat when and as he chose. Only thus could the children put aside the suspicion that someone else was getting more than his share. Half-starved people are very self-centered. That calorie shortages were marked last year is indicated by the fact that average adult weights in the U. S. Zone of Germany were lower in all instances in July 1947 than in the same month of 1946. The average losses varied from 0.3 pounds among women in the age ranges 20-39 years, and 60 years and over, to 4.6 pounds among men 60 years and over. Particularly significant is the average loss of 1.3 pounds in men aged 20 to 39 and 1.9 pounds in men aged 40 to 59 years. These groups represent the main productive labor pool so es-sential to economic recovery in the U. S. Zone. The average weights of all age and sex groups of adults are well below the minimum weight considered necessary for satisfactory health. This "minimum" level is not what would be considered a normal weight or an av-erage weight of a well nourished Ger-man population. For example, men aged 20 to 39 years averaged 130.6 pounds in weight as compared to the minimum of 142 pounds considered satisfactory for health and the average of approximately 154 pounds for this age group in the United States. On short food supplies—only half to two-thirds of what we are now eating in this country—there isn't the energy to do really heavy work. Naturally the first adjustment people make to caloric shortage is to spare themselves from physical exertion as much as possible. When energy expenditures greatly ex-ceeds energy intake, weight loss begins. Strength begins to diminish. People's faces sadden; cheeks lose their curves; eyes sink deeper into their sockets. People become irritable and suspicious. They lose their good humor. They be-come intensely preoccupied with food — robbed of all thought except where the next meal is coming from. Absenteeism from work increases—men must take time, a day or two a week, to scour the countryside for off-the-ration extras to eke out their family's existence. Shortage of food is reducing essential industrial production. While in most of Europe the coal miners, for example, get extra rations, their families do not. So the miner shares his ration with his wife and children and then lacks the physical strength to maintain his output in the pits. To combat this, special incentives including food for other family members are now being given to miners in U. K. and U. S. zones of Germany to encourage them to increase coal output; coal, as has been said before, is one of the chief keys to economic recovery in Europe. The prewar food of Europe as a whole is said to have provided about 2850 calories per person per day. This is scarcely equal to British consump-tion of last year—an amount believed to be about the minimum for mainte-nance of good health of people, even when a very high degree of control can be exercised in the composition and distribution of the diet. The British diet of last year was Spartan-like and monotonous, even more so than during the war. Nevertheless, it still provided on a national scale considerably more milk, fruit, mature legumes, and veg- January, 1948 The Health Bulletin etables other than potatoes than the marginal quantities to which many European countries are now reduced, amounts that are associated with mark-ed Increase In tuberculosis and in in-fant mortality rates. Moreover, the British selectively direct their food — milk and vitamin-rich foods, in par-ticular— to their vulnerable groups whose needs are most lurgent. As a result the nutritional health of the British people has been maintained in a remarkable fashion. The food dis-cipline to which that nation has sub-jected Itself, and the application of the science of nutrition to its program of food production, import and distribu-tion has been one of the valuable con-tributions to our knowledge of good food management in time of emerg-ency. In the year ahead, food in Britain will continue to be at a low level. But In nutritional well-being, most coun-tries of Europe probably will fall below Britain. In France last year about 2700 calories were available for the nation as a whole—2300 in large urban centers, 2500 in the smaller cities and 3000 on farms. But this year diets will be con-siderably poorer imless imports can be greatly increased. In November bread rations were less than half of prewar levels and there was milk only for children under three years. While there are no frank deficiency diseases, chil-dren over 10 are undersized as com-pared with prewar, and city workers are underv/eight (10 to 12 per cent.) They tire easily, and lack the joy of living characteristic of the nation. Shortage of supplies in cities has forced up prices, and through price has curtailed consumption. Rationed food costs only about % as much per calorie than free market or black mar-ket goods. But in November, 1947, bread was 7.6 times August 1939 prices eggs, 22.3; meats, 11 to 16; milk, 13; mature dry legumes, 20 to 27; lard, 8; sugar, 13; potatoes, 11.8. A food budget prewar in quantity would take practically the entire wages of imskilled workers, and 75 to 80 per cent of those of the skilled. This means poorer food for workers, and to man-age they must seek supplementary jobs, and depend heavily on food parcels from peasant friends. The aged without rural connections suffer greatly. In rural areas, people are eating better than before the war. Transportation problems, lack of confidence in the franc, and lack of consumer goods for which to exchange farm produce means that the peasants now eat more, and sell less than formerly. In rural areas, especially in Brittany and Normandy, the better diets have resulted in de-clining tuberculosis rates during the war and since. And so, with misery, cold and hunger stalking much of the earth today, there is general agreement that we must help and help now—to reduce suffering, to aid in economic and phys-ical recovery, and to bring about peace. Steps have been taken to bring mate-rial aid to Greece and Turkey, and through the International Childrens Emergency Fund to children, adoles-cents, expectant and nursing mothers in countries that were victims of aggres-sion. Some interim aid has also been given Italy, France and Austria. A program of rehabilitation and economic recovery of 16 nations of Western Europe is now under consideration. It is recognized that the need is there and that it is large-scale. Questions as to just how much, and as to how it shall be handled are stiU to be deter-mined by the Congress. This increased need in most parts of the world for food and other essentials of living, smaller supplies, higher prices, and a consideration of hiiman values, must all enter into decisions relating to governmental action and household and personal adjustments — in this and other food-surplus coun-tries. Efforts are being devoted to in-crease the export from USA not only of grains, but of other foods as well, 8 The Health Bulletin January, 1948 even though some of the latter are fairly expensive. Joint international efforts are being made to assure max-imum food shipments from all export-ing countries, the channeling of ex-ports to the most critical areas, and the increase in production of food in other counrties. Farmers, industry and the citizens of this country are all being asked to conserve food, to use it selectively, and to prevent waste in every way possible. We are being asked voluntarily to re-duce our demand for grain for food, drink, and feed, to accept less "well-finished" meat, to continue the salvag-ing of fat, and to increase where pos-sible the consumption of hard-to-transport fresh vegetables, fruits, and other abundant foods. We are being asked to prevent waste and spoilage in every possible way. Both the immediate and the long-term problems of food supply are so tremendous and of such significance that they must be dealt with from many angles on a national and inter-national scale. But in a democratic country, a national program can suc-ceed fully only when each individual, each household, each industry and business understands the issues and cooperates generously. We have a great and important task before us. We must not, and with your help, we will not fail. The North CaroHna League For Crippled Children, Inc. Dates and Program For the 13th year, the North Carolina League for Crippled Children invites its friends to share in financing its work during the Annual Easter Seal Cam-paign, February 28th through Easter, March 28th. During the past year the generous contributions of the public made it possible to expand considerably the program of the League. Among the services rendered by the League during the past year were: 1. Medical Care: Specialized care to insure best possible physical correction included orthopaedic operations, otho-denture treatments, blood transfusions, clinical treatments, hospitalization, convalescent home care, and physi-cians' visits to homes. 2. Artificial Aids: Artificial limbs, ex-tension shoes, crutches, wheel chairs, glasses, hearing aids, and a plastic ear, were provided. 3. Transportation: To clinics, hos-pitals, and schools. 4. Education: a) Special training classes at the University of North Carolina for teachers interested in working with handicapped pupils. b) Summer Educational Center for handicapped children. c) A speech correction program in one city school. d) An orthopedic class in two city schools. e) Bedside teaching in hospitals and private homes. f) Boarding school for pupils who cannot get to and from public school. g) Speech therapy and remedial reading for children in two coun-ties. h) Educational publicity through conferences and bulletins to in-form the public of the needs of crippled children. 5. Research: The League staff made a nationwide study of laws pertaining to the education of handicapped chil-dren. Following this study, a bill was drafted and introduced to the 1947 General Assembly. The General Assem-bly approved the bill, so now the type of education needed by the handicap-ped children in North Carolina through January, 1948 The Health Bulletin 9 the public schools will be made avail-able to them, as soon as teachers can be trained in specialized methods need-ed for conducting such classes. 6. Other Services: Referral to proiaer agencies of requests for services not available from the League. Interpreta-tion to parents of children's condition and needs when the physician was un-able to talk with parents. Supplement-ed services of other agencies for needs not included in scope of their program. The present services of the League need to be expanded and many others need to be added. Both will be done as soon as funds are available. The League is a private social agency that cooperates with, but does not dup-licate the work of, other public and private charitable organizations. Aid the crippled whether the condition re-sulted from accident, disease, infection or bu'th. Its only requirement for aid — a valid need not otherwise provided for. Its main source of funds—volun-tary contributions during the Annual Easter Seal Campaings. The consistent growth of the League during the past years reflects both the fundamental need for such an agency, and the increase of public confidence in its program. Your contribution at this time will improve the lot of one or more crippled children. For what-ever your heart prompts you to give, the children say "thank you and Hap-py Easter." STATISTICS RE: HANDICAPPED PERSONS IN THE UNITED STATES "The Census Bureau reported that the U. S. had gained approximately 2,279,000 residents in 1946, the greatest one-year population spurt in its his-tory. Estimated total U. S. population: 142,673,000." (From TIME, October 20, 1947.) How Many Persons Are Physically Handicapped 28,000,000 handicapped persons in the U. S., including all ages and all types of handicaps. (Lewis Schwellenbach, Secretary of Labor, in letter to all governors in the U. S. dated February 26, 1947.) How Many Persons Need Rehabilita-tion Services 2,500,000 persons of working age have injuries which interfere with getting and holding suitable jobs. (Journal of American Medical Association, Septem-ber 23, 1946.) Approximately 97% of all handicap-ped persons can be rehabilitated to point of some gainful employment. (Dr. Frank Kruzen: Occupational The-rapy and Rehabilitation, Vol. 25, No. 4, August 1946.) Economic Value of Rehabilitation Services 1946—the total yearly income of re-habilitated group that received service by state rehabilitation agency increas-ed about from $11,000,000 before rehab ilitation to $56,000,000 after rehabilita-tion. MORE THAN 400% INCREASE! $300-$600—is average cost for main-taining a disabled person in idleness each year. $400—is the average cost of rehabili-tating him into a productive citizen. (Office of Vocational Rehabilitation, Federal Security Agency. "July 6—In-dependence Day for Disabled Civilians" —1947.) How Many Children Need Special Education 5,000,000 children (approximately) in the U. S. between the ages of 5 and 19 years are classified as exceptional children. Mentally gifted, as well as physically and mentally disabled chil-dren are defined as exceptional chil-dren. In North Carolina last year ap-proximately 900,000 children were en-rolled in the public schools. According to percentages given in the following column there are in North Carolina: 18,000 children (0.2%) who are blind and partially seeing 13,500 children (1.5%) who are deaf and hard of hearing 9,000 children (1%) who are crip-pled 13,500 children (1.5%) who have speech defects 10 The Health Bulletin January, 1948 18,000 children (2%) who are men-tally retarded 18,000 children (2%) who are men-tally gifted 1,800 children (0.2%) who are epi-leptic 23,500 children (2.5%) who are be-havior problems (Needs of Exceptionl ChUdren: Leaf-let No. 74, p. 4, by Elise Martens, U. S. OflBce of Education, Federal Security Agency.) How Many Children Have Cerebral Palsy 7 out of every 100,000 population are born with cerebral palsy. Of the 7, at least 4 are educable. (Dr. Winthrop M. Phelps: "The Doctors Talk It Over" —^page 4, August 5, 1947.) SUGGESTED MATERIAL FOR USE IN EDITORIALS Article X of the Crippled Children's Bill of Rights says: "Not only for its own sake, but for the benefit of society as a whole, every crippled child has the right to the best body which modern science can help it to secure; the best mind which mod-ern education can provide; the best training which modern vocational guid-ance can give; the best position in life which its physical condition, perfected as it best may be, will permit; and the best opportunity for spiritual develop-ment which its environment affords." This is the eventual aim of the League for Crippled Children. As yet, funds and workers have not been ade-quate to supply all the services which would be required to provide this ideal program, but it is hoped that all can be made possible in the near future. The dawn of this Easter Season lights a world in search of a formula for world peace. Men of goodwill every-where are planning for reconstruction and rehabilitation. You, the friends of crippled children, have a significant share in this planning. Thousands of yoimgsters, handicapped with little crippled bodies, lack of vision or hear-ing, are asking you for the opportunity of taking their rightful place in the life of America. These children are not asking for charity—all they want is an even chance with their non-handi-capped brothers and sisters. Each Easter Season you are invited to take part in furnishing the oppor-tunities needed for providing that even chance — medical treatment, educa-tional advantages, artificial appliances, crutches, wheelchairs, transportation to clinics, vocational guidance, psycholog-ical service, and recreation. In considering your contribution, imagine: the bright face of a crippled boy having his first experience at walk-ing; hospital and home classes for children eager to learn, but denied the privilege of going to school; special teachers and counselors helping chil-dren accept their disabilities and train-ing them to make the best use of their assets. The success or failure in life for a disabled child depends greatly upon the early assistance and understanding he is given to help him overcome his handicap. This is one of our great op-portunities— and responsibilities ! Amer-ica's children will bear the responsibil-ity of our Nation's tomorrow. Crippled children will have to share this respon-sibility, and should certainly be pre-pared to do their part. Please join again the partnership which provides oppor-tunity for those crippled by inheritance, birth, disease, infection, or injury. IT IS EXPENSIVE TO BE HANDICAPPED Only 63,000 handicapped children in North Carolina! A small group when you consider that there are approx-imately 1,000,000 school children in our state! That is, unless one of these handicapped children happens to be yours—then it means nothing that 6 children out of every 100 are physically disabled in some way. Your chUd is your world and the fact that he is one of the 6% instead of the 94% makes the 6% loom far larger than the 94% ever could. Why? Because you cannot help but wonder why your otherwise beautiful baby should have had to be aflaicted in some way—whether by January, 1948 The Health Bulletin 11 accident, birth, disease, infection, or inheritance, matters little—the impor-tant thing is that he cannot walk, or talk, or hear, or see, or (and sadder still) is incapable of thinking intellig-ently. Then, besides the fact that he is denied the use or partial use of one of his faculties, it is very expensive to have that extra care he needs provided for him. Medical care, especially for the crip-pled child, often runs into years—one operation must be performed and then there is a waiting period while the in-cision heals and the child becomes accustomed to the change in his arm, or leg, or body, and then there is an-other operation and another wait, again followed by others. This costs heavily for the physician who does the operating must be highly specialized or the results may not be those de-sired. Follow-up care during the time between operations is expensive, too, for it is necessary to have someone who understands the nattire of the surgeon's work to help in supervising the child's care between operations if best results are obtained. Sometimes well meaning relatives with more senti-ment than understanding, do things which retard the treatments. They "feel sorry" for the little child who with every step he takes must carry a brace which weighs pounds on his too thin leg, so they take it off, or loosen a bandage, and so cause his limb to heal in a different way from what the physician intended. This may make it necessary for an additional operation to be performed, so the child must suffer one more than would have been needed if the results the surgeon ex-pected had been secured with each operation. Education, too, for the exceptional child is more costly. If he cannot come to school and take the classes offered there as they are, then school must be brought to him. Perhaps he can get to school but arrangements must be made in the classroom to pro-vide special equipment, or teachers must be employed who have a particu-lar type of training in special tech-niques which make it possible for her to communicate with the child who does not hear or talk or who does not see to learn to understand the world which is around him. Then there is the fact that the everyday things which everyone must have are higher for the child who is partially disabled. Think of the necessity of purchasing two pair of shoes each time a change of shoes is needed. The child whose crippled foot is smaller than his nor-mal one must have two entirely dif-ferent sizes or be very uncomfortable. The child whose paralysis affects the hips and lower extremities often de-velops shoulders far out of proportion, and a suit of one size would not fit both the upper and lower portions of his body, and many other things could be mentioned which cost more for the crippled child because they must be different and cannot be bought from the stock on the counter. For other handicapped children, the aids toward helping offset their limita-tions also are costly. The hearing aid, glasses, artificial appliances, braces, and even irregular teeth call for the work of a specialist and a long series of treatments—all of which cost more than can be afforded by an average man on an average salary with an average family to support. Oftentimes, the handicapped child is provided with his needs at the expense of food for the other children. If this continues over a long period of time a total family becomes undernourished and subject to any disease which may be prevalent. IT IS TERRIBLY EXPENSIVE to be handicapped and to offset some of that abnormal cost such organizations as the North Carolina League for Crip-pled Children have been established and have functioned for several years. This has been possible because the "Good People" of North Carolina have graciously and generously supported its program of services to handicapped children. 12 The Health Bulletin January, 1948 SPECIAL EDUCATION This has long been of special interest to the North Carolina League for Crip-pled Children, Inc. For that reason the League is cooperating with the State Department of Public Instruction, and others, in introducing to the Legisla-ture a plan for providing these Ex-ceptional Children with the techniques and facilities needed for making edu-cation available to them. Some children are less fortunate than others, both physically and mentally, and need special consideration in order that they may secure the kind of an education which will be usable to them. It seems right that North Carolina should consider the specific needs of all the children in the state and pro-vide the facilities for meeting those needs. For the exceptional child to have equal opportimities with the non-handicapped child, extra provisions both in training techniques and class-room facilities must be made available. The 63,000 (or more) handicapped chil-dren in the state deserve an education, too—in fact it will be far more expen-sive to fail to educate them than the extra cost of the extra provisions need-ed now to give them the correct edu-cational opportunities. Notes And Comment By The Acting Editor JOSEPHUS DANIELS—Public Health lost a powerful friend when death end-ed the long and useful career of Josephus Daniels. Public health work-ers, particularly the old timers, appre-ciate the service which he had render-ed. Many eialogies have been written but none can better express the feel-ing which public health workers have for the memory of Josephus Daniels than Mr. William H. Richardson's, who for the past ten years has been a public health worker. Nearly forty years ago Mr. Richard-son worked as a cub-reporter for the News and Observer under the direct supervision and tutorage of Mr. Dan-iels. Since that time he has been re-garded as one of Mr. Daniel's boys. Each Saturday morning Mr. Richard-son gives a radio broadcast over Sta-tion WPTP of Raleigh. His broadcasts deal with public health problems and personalities. His broadcast of January 17, 1948 is as follows: Today's broadcast is not about Public Health, per se, but about a man who gave Public Health his whole-hearted support because it fitted into the pat-tern of his philosophy of life—Josephus Daniels, whose mortal remains will be laid to rest this afternoon in Oakwood Cemetery, in Raleigh, beside his be-loved wife, who walked at his side for more than a half century. Though friends will mourn today at his grave-side, the spirit of this great and good man has taken its place in the firma-ment of everlasting fame, there to shine for generations to come and to inspire men and women to nobler living. His exemplary habits did not con-stitute the cause of Josephus Daniels' greatness; they were the results of something basic that seemed to dom-inate his life from the beginning. He was as manly as a Hercules—as gentle as a woman. His thorough mastery of the English language made it un-necessary for him to resort to pro-fanity; his respect for the human body, as a temple dedicated to the spirit, excluded those things which harm the body. His life and personality con-stituted a living example of perfect health—that is, physical, mental and moral health. To him, the three were inseparable. He understood and was sympathetic January, 1948 The Health Bulletin 13 with the problems of the poor, the weak, and the underprivileged, whose cause he forever championed. As Dr. Carl V. Reynolds, State Health Officer, so aptly stated in his tribute, published in the News and Observer yesterday morning: "He talked with kings, but the language best understood by htm was that of the common man." Though 85 years old when stricken down by his last illness—the only really serious illness in his long life — he was young in spirit, and lived in the future, rather than in the past. He indulged in retrospection only to the extent that he viewed the past as a fitting foundation for the future something to be improved upon. He was not a destmctionist ; his respect for the traditions of his people was profound, yet when tradition conflicts with progress, he championed the lat-ter. When he put down his little stub of a pencil, with which he wrote all his editorials, and went to bed for the last time, he went not to dream of the past but to plan for the future—to plan, for example, the writing of the book he intended to give the world on his one hundredth birthday. Only recently, this great American made some observations, which were given on one of these broadcasts, but which wUl bear repeating. "What do you think a man 65 years old ought to do?" he was asked, arovmd Thanksgiving Day, last year, as the 85-year old editor and publisher sat at his desk in his News and Observer office, writing editorials with his stub of a pencil. "Why, he ought to keep on working, if he is able," he replied. "In fact, a man ought to work just as long as he is physically fit and mentally alert. (He was both). There may be exceptions," he went on, but I think that ought to be the rule. When a man gets 65, we'll say, he can do one of several things. If he is physically and mentally fit, he can keep on at what he is doing, imtil such a time as he feels he can no longer do jiistice to the job he is working at; or, if he has made adequate provision for it, he can go into voluntary retirement. If he belongs to no retirement system, he can look around for generous or well-to- do relatives who will take him in as a permanent charge. If there are no such benefactors handy, he can go on charity and let the taxpayers sus-tain him. But no person who is capable of self-support, whether he be 30 or 80, should be required to live at the ex-pense of others. Just so long as the body is strong and the mind Is active, every human being who wants to should be allowed to continue to make his contribution to a well-ordered economy, commensurate with his abil-ity." And then, with a twinkle in his eye, he smiled and said: "Why don't you write a piece or make a health broadcast about the value of old peo-ple?" The suggested broadcast was made, over this station. A copy of the script was mailed to Mr. Daniels, and the following Sunday it was printed, in part, in the News and Observer. Public Health had no stronger sup-porter in North Carolina than Josephus Daniels. He advocated larger legisla-tive appropriations for this important work, always maintaining that it was poor economy to undertake to save dollars and cents at the expense of human welfare. To repeat—that was a part of his philosophy of life: The protection of the weak, the sick, and underprivileged—and of little children. And again referring to the philos ophy of life that marked the activities of this great humanitarian, in whose memory flags are flying at half staff-none ever criticized that. There were those who differed with Josephus Dan-iels about his philosophy of govern-ment, but none who questioned hia sincere concern for the common man. Seeing the multitudes, he, like the Master of Galilee, "had compassion upon them and was moved by their infirmities." It was the privilege of your speaker, if you will pardon just this one per-sonal reference, to join the staff of the News and Observer forty years ago 14 The Health Bulletin January, 1948 next September, as a cub reporter. Mr. Daniels was then and until the time of his death���affectionately known as "the old man." It was an expression of the respect, confidence and affection which association with him engender-ed in the hearts of those who knew him at close range. To him, the young-est cub reporter was as much of an entity as the city editor, or the manag-ing editor: and from the humblest member of his staff his mind always was open to suggestions. There may be some listening in this morning who remember the buggy with the fringe around the top, in which Mr. Daniels used to ride each Simday morning to the Edenton Street Meth-odist Sunday School, where he taught a class of "A&M", boys. He referred to his class as the "Amen" class. "Miss Addie," his wife, was a Presbyterian — he went to his church and she went to hers, each as devoted a Christian as ever blessed North Carolina. No matter what might have been his views about economics and politics — and purely civic affairs—Josephus Daniels always defended religion, as a basic necessity in the life of any people. He would not—could not—tolerate any reflection or disparaging remark about the Bible or its teachings. The Book remained deposited in the ark of his heart, and any attempt to profane it drew from Mr. Daniels a sharp rebuke. Nor would he tolerate any obscene joke. He was clean of speech, and none dared to use unseemly langauge in his presence. One of the greatest fights Mr. Dan-iels ever made was not for enforced temperance, the reduction of railroad rates, or the continuance in power of the political party to which he be-longed— although he battled relent-lessly for all these. One of the greatest contributions he ever made to North Carolina was his militant defense of the hospital and medical care pro-gram, which was formulated several years previously and enacted into law by the 1947 General Assembly. He vis-ualized people in rural sections suffer-ing from the lack of adequate medical care and hospitalization, and, consis-tent with his philosophy of life, threw all the weight of his personal and edi-torial force behind the movement to correct this condition. He made a continuing war on vice — a fight that dated back to World War I, when he was asked by President Wilson to help devise ways and means designed not only to combat venereal diseases but to promote the general health of the armed forces. His news-paper was bold in its attacks on pros-titution as the chief source of infec-tion in the spread of venereal diseases and as basically immoral, and when such attacks drew the fire of critics, he failed to yield. No attempt has been made during this brief broadcast to eulogize Jose-phus Daniels; no attempt to enumerate his services to his people. He now be-longs to history, and it remains for historians to appraise his work. There may be, and doubtless, there will be memorials erected in his memory public buildings may be dedicated to him, and even statues of him may be erected in public places. Such would be fitting tributes. But the greatest of all testimonials will remain that in-scribed in the hearts of the people he loved and served. If he could have left a verbal mes-sage for those he was about to leave, it might well have been, in the words of William Cullen Bryant: So live, that when THY summons comes to join The innumerable caravan which moves To that mysterious realm where each shall take His chamber in the silent halls of death. Thou go not, like the quarry slave at night, Scourged to his dungeon, but sus-tained and soothed By an unfaltering trust, approach thy grave Like one who wraps the draperies of his couch January, 1948 The Health Bulletin 15 About him and lies down to pleas-ant dreams. In this manner, Josephus Daniels went to sleep. Amendment to Regulation No. 32 (Malaria Control) of the Regulations of the North Caro-lina State Board of Health Governing the Control of Communicable Diseases Regulation No. 32 of the Regulations of the North Carolina State Board of Health Governing the Control of Com-municable Diseases is hereby amended by adding at the end thereof the fol-lowing : 9. It shall be the duty of all local health officers to enforce the provi-sions of this regulation. Authorized representatives of the North Carolina State Board of Health and local health departments shall have authority at all times to enter, for the purpose of inspection, the premises upon which water has been impounded or upon which it is proposed to Impound water. Any person who shall hinder or pre-vent any authorized representative of the North Carolina State Board of Health or a local health department In the performance of his duty in con-nection with this regulation shall be guilty of a violation thereof. Adopted this 13th day of November, 1947. Carl V. Reynolds, M.D. Secretary and State Health OflBcer Causes of Death In 1947 Are Compared With Those In 1900 A contrast between the causes of death in the United States in 1900 with those in 1947 indicates the high status of medical care and public health prac-tice in the United States, according to an editorial which appears In the cur-rent issue of Hygeia, health magazine of the American Medical 'Association. The Hygeia editor writes: More impressive than any other de-monstration of the great progress made by medical science is a contrast be-tween the causes of death in the Unit-ed States in 1900 with those in 1947. In 1900 tuberculosis was still captain of the men of death, and more than 200 people out of each 100,000 popula-tion died from tuberculosis every year. Today tuberculosis is seventh in the list of the causes of death, and the rate has dropped to 37.2. Now heart disease is first. No doubt the increased control developed by the use of strep-tomycin and other methods of treat-ment wiU lower the rate for tuberculo-sis still further during the next 10 years. In 1900 pneumonia was second, with a rate of 180.5. In 1947 pneumonia com-bined with influenza was sixth, and the rate is now 46.1. The control of pneimionia has been brought about by new developments in its treatment, utilizing penicillin and the sulfonamide drugs, and also by the application of oxygen and new drugs for controll-ing the heart. Moreover, we have learn-ed much about the prevention of pneu-monia, treating it as an infectious dis-ease. In 1900 diarrhea and inflanmiation of the intestines were third. The rate was 133.2. It is now far down on the list—possibly 15th—and the rate has changed to 14. Such conditions are controlled by widespread application of the laws of sanitation and hygiene, the provision of pure food, pure water and particularly pure milk. The almost imiversal pasteiu"ization of milk in the United States has been a major factor in the control of diarrheal diseases. In 1900 heart disease was fourth In the list of causes of death with a rate 16 The Health Bulletin January, 1948 of 132.1 for each 100,000 population. Now heart disease has a rate of 306.6. This means that more people are liv-ing longer and that the heart event-ually succumbs to the advance of age and the degeneration of tissues asso-ciated with increased years. Nephritis or inflammation of the kid-neys was sixth in 1900 with a rate of 89. Now, as men live longer, nephritis has moved up to fifth place, but the rate is 58—far lower than it was In 1900. Great improvements have occur-red in the care of inflammations of the kidneys. Moreover, we have learned much about the prevention of such inflammations. Especially important has been the application of infections of the kidney of new drugs, such as the sulfonamides, penicillin, streptomycin and mandelic acid. The seventh classification in 1900 was unknown and ill defined diseases. The rate was 73.8. The classification has dropped out of the first 10 entirely and now is credited with a rate of 15. Eighth in the list in 1900 was hemor-rhage of the brain. Here again is an ex-ample of the effects of increasing age and the degenerations of the tissues that come with such prolongation of life. Today cerebral hemorrhage is third on the list of causes of death, and the rate is 90.5. With brain hemor-rhage we associate hardening of the arteries and the breakdown of tissue. Ninth in 1900 was accidents, with a rate of 65.4. In 1947 accidents moved up to fourth place with a rate of 71.2, and motor vehicle accidents accounted for 24.1 of this enormous figure. The motor car was just beginning to come on the scene in 1900; today we have a motor vehicle civilization. Society needs to develop new and better con-trols over this hazard than those that now prevail. Tenth in 1900 was cancer, with a rate of 65 deaths for every 100,000 popula-tion. Today cancer is second in the list of causes of death. The rate has moved up to 130, and cancer accounts for 180,000 deaths every year. Physi-cians are convinced that possibly one half and at least one third of these deaths could be prevented if people were aware of the fact that cancer diagnosed early is controllable by the use of surgery, X-ray or radium. While the figures cited are cause for great congratulation and indicate the high status of medical care and public health practice in the United States, they should not be taken as an author-ity to relax our battle against the dis-eases that threaten the life of man. Research and the application of re-search in medical practice will yield answers to problems that today seem incapable of solution. The enactment of the act for establishing a National Science Foundation, which will en-courage medical research along with research in the basic sciences, will give new weapons and new powers to the hundreds of thousands of scientists who are our soldiers in the battle against disease. i Albert Donaldson Liles, Jr., born Jime 2, 1947. Foiir months old, weighs 18 pounds. Son of Mr. and Mrs. A. D. Liles at 557 Newbern Avenue, Raleigh, N. C. Mrs. Liles was formerly Lillie Ruth Love, who was a member of the State Board of Health staff. MEDICAL LIBRARY U . OF N . C . CHAPEL HILL, F'^. C. i This Bulletin, will be sent free to ony dtizen cf tfve State upon requestj Published monthly at the office of the Secretary of the Board, Raleigh, N. C. Entered as second-class matter at Postoffice at Raleigh, X. C. under Act of August 24, 1912 Vol. 63 FEBRUARY, 1948 No. 2 MEMBERS OF THE NORTH CAROLINA STATE BOARD OF HEALTH S. D. CRAIG, M.D., President Winston-Salem G. G. DIXON, M.D., Vice-President Ayden H. LEE LARGE, M.D Rocky Mount W. T. RAINEY, M.D Fayetteville HUBERT B. HAYWOOD, M.D Raleigh J. LaBRUCE WARD, M.D Asheville J. O. NOLAN, M.D, Kannapolis JASPER C. JACKSON, Ph.G Lumberton PAUL E. JONES, D.D.S Farmville EXECUTIVE STAFF CARL V. REYNOLDS, M.D., Secretary and State Health Officer. G. M. COOPER, M.D., Assistant State Health Officer and Director Division of Health Education, Crippled Children's Work, and Maternal and Child Health Service. R. E. FOX, M.D., Director Local Health Administration. W. P. RICHARDSON, M.D., District Director Local Health Administration. ERNEST A. BRANCH, D.D.S. , Director of Oral Hygiene. JOHN H. HAMILTON, M.D., Director Division of Laboratories. J. M. JARRETT, B.S., Director of Sanitary Engineering. T. F. VESTAL, M.D., Director Division of Tuberculosis. OTTO J. SWISHER, Director Division of Industrial Hygiene. WILLIAM P. JACOCKS, M.D., Director Nutrition Division. MR. CAPUS WAYNICK, Director Venereal Disease Education Institute. C. P. STEVICK, M.D., Director, School-Health Coordinating Service, Epidemiology and Vital Statistics. HAROLD J. MAGNUSON, M.D., Director Reynolds Research Laboratory, Chapel Hill. JOHN J. WRIGHT, M.D., Director Field Epidemiology Study of Syphilis, Chapel Hill. FREE HEALTH LITERATURE The State Board of Health publishes monthly THE HEALTH BULLETIN, which will be sent free to any citizen requesting it. The Board also has available for dis-tribution without charge special literature on the following subjects. Ask for any in which you may be interested. Adenoids and Tonsils German Measles Sanitary 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 Schedule. Prenatal Letters (series of nine First Four Months. monthly letters.) Five and Six Months. The Expectant Mother. Seven and Eight Months. Infant Care. Nine Months to One Year. The Prevention of Infantile Diarrhea. One to Two Years. Breast Feeding. Two to Six Years. Table of Heights and Weights. Instructions for North Carolina Midwives. CONTENTS Page Public Health Nursing Week 3-16 iHIeaji' Vol. 63 FEBRUARY, 1948 No. 2 CARL V. REYNOLDS, M.D., State Health Officer JOHN H. HAMILTON, M.D., Acting Editor Public Health Nursing Week THE fourth annual National Public Health Nursing Week, sponsored by the National Organization for Pub-lic Health Nursing, will be celebrated the week of April 11 through the 17th. This week will give communities all over the country the opportunity to present to the people of the United States a concerted story of public health nursing—its past accomplish-ments, present needs and future goals. The following excerpts from Special Messages from Special People sent out by the National Organization for Pub-lic Health Nursing help to dramatize the theme "Help Your Public Health Nurse Help Your Community." From Ruth W. Hubbard, R.N., Pres-ident, National Organization for Public Health Nursing-: "Our first objective in 1948 is to con-tinue our efforts to make the work of the public health nurse known to every person in these United States so that no individual will be in need of the service of the public health nurse and be at the same time unaware of her existence. Our second objective is to recruit to this branch of nursing an increasing number of young women who will find challenge and satisfaction in the opportunities for service which it offers." From Thomas Parran, Surgeon Gen-eral, U. S. Public Health Service and member NOPHN Sponsoring Commit-tee for the "Week": "The Public Health Nurse typifies the traditional ideal of nursing. "Caring for the sick and furthering health in the home, her position has always been one of vital importance. Now, however, with shortages of hos-pital beds and the modern medical practice of sending patients home early from the hospital, the need for an in-creased supply of Public Health Nurses is greater than ever. "These nurses visit yoiong mothers who return home with babies only a few days old. They give essential care to patients with long-term illnesses, enabling them to go home earlier and thus releasing hospital beds for acutely ill patients. At home, with public health nursing care, these patients often show great improvement. "In addition to these expanded du-ties. Public Health Nurses carry out an increasing number of community-wide services to protect and improve the health of all. They explain the need for immunization. X-ray exam-ination, proper nutrition, child care, adequate sanitation, and other health measures. They assist the private phys-ician by helping his patients carry out his instructions for regaining health. "Public Health Nurses make more than 16 million visits to homes in a year, giving approximately 42 million hours of nursing service, much of which is devoted to bedside nursing. Their work is basic—involving the very fundamentals of nursing. The service of the Public Health Nurse in the home spells the difference between comfort The Health Bulletin February, 1948 and suffering and sometimes even be-tween life and death. "A special week has been set aside to pay tribute to the Public Health Nurse. This year let us honor her by making National Public Health Nurs-ing Week the symbol of our renewed efforts to swell the ranks of these nurses. Only 21,500 strong, they are in desperate need of additional recruits. Their responsibilities grow daily, and their forces must be strengthened ac-cordingly. Let us, therefore, make full use of National Public Health Nursing Week by pushing toward the ultimate goal of public health nursing services for all." From Mrs. Harry S. Truman, member of NOPHN Sponsoring Committee for the "Week": "My hope is that Public Health Nxirs-ing will continue to spread throughout the country and that eventually all communities may receive the benefit of this splendid service." From Kendall Emerson, M.D., Man-aging Director, National Tuberculosis Association: "The public health nurse has an especially important role in the tuber-culosis control program. Her assistance in case finding, in follow-up and in rehabilitation of patients cannot be too strongly stressed." laboratory in discovering the imder-lying causes of disease. Our Health Departments, our hospitals and the trained personnel of the medical, nurs-ing, dental, engineering and allied pro-fessions could not, however, have ac-complished such results without a final line in the chain—the public health nm'se. She renders the direct profes-sional services in the home; but she is also the messenger of health, the point of contact with the individual family, the ultimate channel through which the knowledge and the resources of the health sciences are actually brought to the men and women and children whom they are to serve. At one end of the chain are the Pasteurs, and the Listers, the Theobald Smiths and the Walter Reeds. At the other end are the 21,500 public health nurses who toil through the grimy tenement streets, or ride over the Appalachian Mountain passes, or bring succor to the residents of the rockbound islands off the Maine coast. The public health nui'se is the spearhead of our attack on preventable disease, the preacher in the home of the gospel of health." From Mrs. Franklin D. Roosevelt, member NOPHN Sponsoring Commit-tee for the "Week": "Public health nursing service is probably the greatest bulwark in the preservation of good health in our communities." From C. E. A. Winslow, Dr. P.H., Editor American Journal of Public Health, and member NOPHN Sponsor-ing Committee for the "Week": "Since the first public health nurse was employed in New York City sev-enty- one years ago, the average life span of a citizen of the United States has been increased by a quarter of a century. This triumph has been made possible by the advances made in the From Walter S. Gifford, Chairman of the Board, Community Service Society, N. Y., and member NOPHN Sponsor-ing Committee for the "Week": "Because health is so fundamental to the well-being of individuals and fam-ilies, to national security and world order, public health nursing through all that it does in bringing health to the people, is indeed a vital service of our times." February, 1948 The Health Bulletin RESOURCES CONTRIBUTING TO TOTAL FAMILY LIVING By Mrs. Edith Bkocker, Supervising Nurse Orange-Person-Chatham District Health Department Chapel Hill, North Carolina I SHOULD like for you to think with me about the health of the families in our communities. The constitution of the World Health Organization which was signed by fifty-one members at the International Health Conference in New York in 1946, defines "health as a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity." This definition is so broad and so all in-clusive that it helps us to set for our goal—optimum health for each world citizen. If we accept this challenging defini-tion then we can explore and use the resoui'ces with which we have to work and will support all the projects for research, for we need more scientific information and better methods of pro-cedure. Some one has said, "Certainty is illusive and repose is not the destiny of man." Optimum health for everyone means that every human being of whatever race, religious or political belief, econ-omic and social status has the funda-mental right to the enjoyment of the highest attainable standard of health. Since most of us are public health workers, we will probably think first of the protective functions of the local health departments and in 1947 sixty-six per cent of our population is under the supervision of an organized health department. Forty million are without. We can be proud that health depart-ments had theii" origin in communities and that they were organized to fill a real need, even if the needs were to abate epidemics and to give medical *This article was presented at the State Public Health Meeting in Charlotte, November 3, 1947. care, of a sort, to those who through age, poverty or misdemeanor had be-come the wards of the community. We here are in the army of the Preven-tioners. Dr. Parran says that "Preven-tion and treatment are two sides of the same coin." It takes both. I do not need to remind this audience of the six functions of the local health departments nor do I need to review for you the duties of the personnel. We know so well that public health workers are not dispensers of health but teachers of healthful living. Many health departments are becoming out-standing adult education centers where classes are held for expectant parents, baby sitters, food handlers, those in-terested in studying infant care and child guidance, nutrition and other subjects. We are aware of the tourniquet of safety that the sanitation department throws around our homes, schools and communities. Their progress includes practical preventive measures against diseases that are milk-borne, carried by polluted water, insects and unsafe disposal of wastes and sewage; so that we can have safe water, a safe milk supply, meats, foods, graded cafes, restaurants, and markets. Along with the environmental sani-tation program the Health Department staff has gone out strongly for immun-ization procedures. No longer do epi-demics of smallpox, diphtheria and typhoid fever wipe out whole families in our community. The pest houses are gone. In many areas, tuberculosis and venereal disease have been and still are, great problems. These two dis-eases upset the equilibrium of the fam-ily probably more than any others and it has been the work of the health de-partment staff to help these people to 6 The Health Bulletin February, 1948 adjust to these disturbances in the family unit. Help with health programs in the schools is an important part of health department work. It is said that ninety-five per cent of the babies born in the United States are in good physical con-dition at birth but by the age of four years, each of them average three phys-ical defects not counting carious teeth. The program of physical defect de-tection and correction is extremely im-portant to a child's progress and happi-ness in his school life. All of us will agree that health development of a child is of basic importance to his ability to live harmoniously in a chang-ing total environment. To many it may seem that our pub-lic health services (to the family) in the field of prevention are not very dramatic or too helpful. But the es-sence of prevention is to see that "nothing untoward happens" to any one in the community. It may not be "news" that the Hodunk family escap-ed typhoid fever, but each of us is glad that life expectancy has been in-creased to about sixty-five years (sixty-nine for women) and that tuberculosis has gone down from near the top to seventh place on the list of the ten leading causes for death. The resources of the local health de-partment touch a child before he is born if his parents attended the Plan-ned Parenthood clinic or if his mother needed clinic or public health nursing service or if his progenitors attended classes for expectant parents. His birth certificate will be recorded by the Vital Statistics Department of the Health Department. He may be taken to the Health Depatrment while he is an in-fant for protectives and health super-vision at the Well-Baby Conferences. During his school life he will probably be inspected and examined and edu-cated on health matters by members of the Health Department staff. If he attends U.N.C. he will have his chest X-rayed by Health Department equip-ment and he might go to the Health Department for a premarital blood test. Then the story begins again. If we interpret health as the preser-vation of a state of equilibrium in which the individual or family can best realize their potentialities for a full and satisfactory life then we must utilize resources other than the local health department. Every well-organ-ized health agency augments and sup-plements its program with that of other agencies working for good health in the community. Such groups as the tuberculosis so-ciety, service clubs, medical societies, League for Crippled Children, child guidance clinics, dairy councils, wel-fare agencies, church organizations, cancer societies. Red Cross Chapters, and others give financial assistance and direct service and conduct educational programs. Many of these agencies are local chapters of state organizations which, in turn, are part of a national set up. It is the belief of many people that the government has a responsibility for the health of its people which can be fulfilled only by the provision of adequate health and social measures. The government cannot dispense health any more than a member of the local health department. Every person will have to actively cooperate with the agency and work for his own health. Parents are still responsible for the health of their children and themselves in our country. A man's home is still his castle, even though it isn't always a safe one. Many of us have been to typhoid clinics and seen parents bring their children for immunization but back off themselves. Citizen participa-tion is particularly important in public health. However, when families are not able to provide medical care for them-selves then the government, if it fol-lows the traditional democratic pattern, is the servant—not the master—of the people, and must make available med-ical care. National good health is no accident. It is dependent upon a high level of education, a sufficiently high income among all groups of the population, February, 1948 The Health Bulletin good and safe sanitation, proper nu-trition and prompt and adequate pre-ventive and remedial medical care. We say that the family unit is the founda-tion of our civilization, then we must work for optimum health for each member of the family so we may have a happy community. Health is as com-municable as disease in families and communities. A STUDENT NURSE LOOKS AT PUBLIC HEALTH By Lelon Lambe, Student Nuese Highsmith Hospital School of Nursing Favetteville, North Carolina MY two weeks at the City-County Health Center gave me an oppor-tunity to observe and to assist in var-ious public health nursing activities. I learned that many phases of work go to make a good public health program. It was interesting to learn that each nurse is assigned to a district and in this district she is more or less re-sponsible for carrying on all phases of public health nursing. Sanitarians are also assigned a district, and are responsible for the protection of the community's health, through sanitation activities. The nurse visits selected families in her district and tries to motivate them to a higher standard of living. Cases are selected in order of their impor-tance, and include: communicable dis-eases, maternity and infancy cases, pre-school and school children. A great deal of the work is handled in clinics which function specifically for each service. At the time that I was at the Health Center, preschool clinics were the chief ones being held. I learned, though, that many other clinics such as immunization, tuberculin testing. X-ray, and midwife classes are con-ducted at planned intervals. Following is a list of the types of clinics and a brief summary of each service which I observed or with which I assisted during the two weeks at the Health Center: A. Maternity and Infancy 1. A weekly Maternity Clinic offers prenatal service and post-partum ex-amination; also contraceptive advice to mothers who need it. There is an av-erage attendance of 40 patients per clinic. In this clinic expectant mothers are interviewed, examined, and records are filled out accordingly. They are given a blood test for syphilis; their hemoglobin is checked and a urinalysis is done. A local obstetrician examines all expectant mothers on their first visit, and at their last scheduled visit before the baby arrives; and when they return for their six weeks post-partem examination. Advice and literature on maternal and infant care are given. Those who are interested are then re-ferred to a nurse who instructs them regarding how they may plan for the next baby. Patients needing medical or surgical care are referred to their fam-ily physician, or to the welfare agency which assists them in securing the needed care. 2. Over thirty per cent of the babies delivered in Cumberland County are delivered by trained midwives. These midwives are taught and supervised by the public health nurses. They are al-lowed to accept only normal cases, are well informed as to abnormal symp-toms, and call a doctor when they feel that they are not qualified to handle the case. All expectant mothers are re-quired to have pre-natal care by a private physician or at a clinic before the midwife is allowed to accept the case. Following delivery the midwife reports the case to the Health Center and the nurse visits the mother and baby for the purpose of checking the 8 The Health Bulletin February, 1948 condition of both for abnormal con-ditions. B. The Well-Baby Clinic Mothers bring their babies and pre-school children to this clinic in order that they may maintain good health. Each patient is carefully questioned by the nurse as to her child's condition and is advised regarding diet and habits. A local pediatrician examines each child and makes necessary recommen-dations for health maintenance. Im-munization against whooping cough, diphtheria, and smallpox are given at this clinic. Babies needing medical and surgical care are referred to their priv-ate physicians. Literature on child guidance and care is given to each patient. C. Pre- School Clinics Pre-school clinics are conducted each spring in order that children of pre-school age be better qualified physical-ly for the beginning of school. Children attending these clinics are from two to six years of age, most of them being those who will begin school the follow-ing fall. They are weighed, measured, and ex-amined by the attending physician who looks for any abnormal conditions and refers them to their private physician for any necessary medical or surgical care. Those children who have not already received the required vaccines for school entrance (diphtheria, whoop-ing cough and smallpox) may receive them at this time. Advice and litera-ture on child care are given the par-ents. The nurse keeps a record on each child examined, and those who have defects are visited during the summer months to assist, if needed, in obtaining corrections. D. Tuberculosis Control Persons who have been in contact with tuberculosis may have their chests fluoroscoped at a weekly diag-nostic tuberculosis clinic conducted by the Health OflEicer. This may also be done for routine personal health pro-tection. If tuberculosis is found they are referred to a sanatorium for treat-ment. The nurse visits these patients in the home in order that she may teach them precaution technique and general care. Arrested cases, and all contacts, are routinely visited by the nurse. Dur-ing the past year all of the high school students of the county were offered the tuberculin test and positive reactors were X-rayed. E. Venereal Disease Control Venereal diseases are found through routine examination for health cards, premarital and prenatal serological tests, examination of contacts of known cases and cases who voluntarily re-port. A nurse interviews each case. The contacts are then visited and ask-ed to report to the Venereal Disease Clinic for examination. Syphilis cases are referred, in the early stages, to the U. S. Public Health Service Rapid Treatment Centers for therapy. Gonor-rhea cases and contacts are given peni-cillin and negative cultvires are obtain-ed before the case is released. A few cases receive treatment for syphilis at this clinic, but the majority are for diagnosis and follow-up examinations. P. Orthopedic Clinic A clinic for handicapped children and adults is held at this center month-ly, serving five counties. This clinic is conducted by an orthopedic specialist and a pediatrician who examine the patients and make recommendations for treatment. Adults who are handi-capped and need assistance in training for a vocation for which they are physically suited, or need other assist-ance are counseled by a representative of the N. C. State Rehabilitation Pro-gram. G. Daily Clinic Services A clinic nurse is on duty daily for the purpose of giving service and ad-vice to all who come to the Health Center. She is responsible for registra-tion, for assisting in examining food handlers, domestic servajits, taxicab drivers, and for giving immunization against typhoid fever, whooping cough, diphtheria and smallpox. Indigent February, 1948 The Health Bulletin county cases are also given simple treatments in this clinic. Other major activities and functions of the Health Center which I had an opportunity to observe are: A. Sanitation Program Three sanitarians serve in this de-partment for the purpose of protecting community health through inspection of dairies, food handling establish-ments, public buildings, and for giving advice on installation of private water supplies and excreta disposal systems. I went out on one inspection tour. B. Laboratory Service Specimens for diagnosis of syphilis, gonorrhea, tuberculosis, malaria, and intestinal parasites are examined in the local laboratory. Milk is examined to determine its safety, quality, and butterfat content. Many specimens are sent to the State laboratory. Specimens of rural water supply are also sent to the State laboratory. (The city watel supply is examined in the water plant laboratory.) C. Health Education A trained health educator works in cooperation with members of the staff, the schools, and other agencies to fur-ther interest in public health among groups in the community. This is done through movies, radio, newspapers, dis-tribution of literature, and planning with groups on health programs. D. Vital Statistics Births, deaths, and communicable diseases are reported and are on file at the Health Center. From the stand-point of public health these facts are very necessary in evaluating the work and planning the program. I thoroughly enjoyed my two weeks at the Health Center, and would like to have remained longer. This short period, however, served to give me in-sight into the close relation between hospital nursing and public health service. It also made me aware of the unequaled opportimities for service which the public health nurse enjoys. MENTAL HYGIENE IN PUBLIC HEALTH NURSING By Mary F. Porter, R.N., Clinical Assistant Mental Hygiene Clinic, Charlotte, N. C. IT is good to talk of Mental Hygiene to public health nurses who daily experience the puzzlingly inadequate inter-personal relations between mem-bers of the same household and be-tween the family and the community; between the families of school children and their teachers; between the indus-trial worker and his employer, and pos-sibly between the public health niu-se and the family. No group of people is more advantageously placed than you to recognize the need of and to apply in your daily contacts the principles of Mental Hygiene. *Given at the Public Health Nurses Section of the N. C. Public Health Association, Charlotte, N. C, Novem-ber 4, 1947. One of your national associates, Ruth Gilbert, who was trained as a public health nurse, then added to that the special education of a psychiatric so-cial worker, wrote an excellently bal-anced book published in 1940 by the Commonwealth Fund and called The Public Health Nurse and Her Patient. Dr. Frank Walker, commenting on Ruth Gilbert's emphasis on the con-tribution Mental Hygiene may add to the contacts made by public health nurses, writes: "This contribution seems in the last analysis to be the engender-ing of a state of mind which enables the nurse with confidence to analyze and imderstand her own reaction to-ward nursing service; to appreciate, understand, and frequently do some-thing about the reaction of persons 10 The Health Bulletin February, 1948 physically or mentally ill; to recognize shoal waters and hidden rocks in fam-ily situations which may wreck the lives of growing children; and to carry her part of the team play which is necessary if there are to be effective relationships with Public Health nurs-ing and between it and allied agencies." In those few lines is boiled down the very heart of the attitude I should like to bring you today. First, "the en-gendering of a state of mind which enables the nurse with confidence to analyze and understand her own re-action toward nursing service." For example: Do you know why you chose the field of Public Health nursing out of all the specialties open to you in the nursing field? Why do you find your-self completely at ease in the Jones' home and dread going to the Brown's? The interaction of personalities always depends on at least two people and you or I are one of those two. You have doubtless long ago realized that when you are able to take yourself com-pletely off your own mind your pa-tients respond better. You get better results; and that when you are harried, troubled over some baffling previous situation, anxious or unhappy, or annoyed, your patients seem recalci-trant and uncooperative. Interaction and Unity of Mind and Body. There is a psychologic, a human fact that every nurse and every social worker, everyone whose occupation centers about people and who is en-deavoring to get results with and from people needs to remember constantly; i.e., that mind and body are incapable of separation; that they are not sep-arate entities, but interact one upon the other so continually that it is often impossible to know which initiates the response. And what a tremendous po-tential influence toward better mental health in the family, school, in industry and in whatever field the public health nurse touches if she herself is groimd-ed in the recognition of this essential oneness of the individual: if she has a reasoned conviction that what af-fects the mind affects the body; what affects the body, reacts on the mind; also that she is assisting a person who is ill, not a case of a disabling fracture or measles or pneumonia; but a certain man, woman or child in a certain set-ting of family, community, economic and social situation who is ill with a disabling fracture or measles or pneu-monia; and a lot of individual folks with certain problems in common but with as many approaches to the com-mon problem as there are people of varied experience in her group. Practically every nurse today in her undergraduate classwork learns of the effect of rage and fear and of their more chronic expressions of cherished dislikes, annoyances; and of worry, anxiety, and dread upon the physical health and the intellectual and voli-tional functioning. The Irrationality of Human Beings. Miss Mary Connor states: "Public health nurses are inevitably confronted with the Mental Hygiene need at every turn." Do you realize the meaning of the fact that 58% of all hospital pa-tients are diagnosed as nervous or mental cases? And that they represent the people too ill to be adequately help-ed by you and me outside of hospital grounds? Do you recognize that it is exclusive of most of the mfldly malad-justed fathers and mothers, teachers, nurses, social workers, ministers, busi-nessmen and women, yes, lawyers, doc-tors, industrial workers, and others whose maladjustments to life are caus-ing one divorce in 4 (nearly one in 3 now) marriages? And what of the re-sultant effect on the children? That it takes no cognizance of the numberless maladjusted in so-called minor ways, ourselves and our neighbors, who through our resolved conflicts are at war with ourselves or our environment or both? Mental Hygiene As Essential Part of the Nurses' Equipment and Technique. The need of our patients for Mental Health is only an exaggeration of our own. For no psychiatric social worker, no public health nurse, can grasp the February, 1948 The Health Bulletin 11 psychologic need of her patient until she has attained a fair amount of in-sight into her own adjustments and maladjustments and an objectivity about them. Only when we grasp con-sciously the raltionship between our own tendencies under stress to revert to the rebellion of the thwarted child, or to the security or parental protec-tion and care, can we properly evaluate the rebellious adolescent or adult pa-tient, and the others who accept illness as a haven. The alert public health nurse soon recognizes from baffling experience that some of her patients just don't recover when they should, despite the doctor's assurance of good physical condition and her own best efforts; and in spite, possibly, of needed financial assistance. Then, it is certainly time, if she has not done so before, to eval-uate the whole situation, psychologic as well as physical. Why does Mrs. Brown's indigestion continue, although the doc-tor who examined her found no ade-quate cause? Why does Johnnie refuse to try to walk when his broken leg is healed? Why does John Brown insist that he has T.B. and remain invalided despite all findings to the contrary? Why does Jane have convulsions at school when the specialists can find no cause? Why does Dot have these at-tacks of excessive vomiting which in-terfere with school, and all medical examination reveals no cause? Why won't Billy eat normally despite his mother's urgent insistence? Why does the Jones' baby stubbornly resist habit training and remain at three a diaper problem? Why can't Bill at nine learn to read when the intelligence tests give him an unusually high I.Q. and the specialists find no vision defect? Why is Mr. Blank always irritable regardless of conditions? Why does not Mr. S. regain his strength now that he has otherwise entirely recovered from pneiimonia? Why can't Johnny learn in school despite his proven intelli-gence? He Is eleven and has not yet earned any promotions in two years. Hysteria may be diagnosed. But it must serve some purpose, else it would not persist. Oversuggestability? Yes, but why always toward illness and not to-ward health? The public health nurse has had lectures in psychiatric nurs-ing, but she has not specialized. She does not always realize that the emo-tional environment is often much more determining than the physical; that the tense home of marital discord, the drunken father, the humiliation of some deforming physical defect; the depressing weight of poverty or the hurt of wounded pride in having to accept relief never before needed; the lack of becoming clothes making one conspicuous before her schoolmates; the pervasive insecurity of the child who is unloved; the humiliating sense of shame about one's home condition as contrasted with those of desired ac-quaintances or longed-for friends; the loneliness of insolation; the poison of fear, worry, jealousy, hate . . . that conditions such as these may not only explain prolonged illness without ade-quate physical cause but so interfere with body chemistry and general re-sistance as to be medically accepted causative factors in furnishing the groundwork for many systemic illnesses and infections which would otherwise have been resisted. What can the public health nurse do about it? You are not psychiatric nurses, but recognizing the inescapable fact of the oneness in functioning of the mind-body you cannot escape the respons-ibility for alertness in recognizing the effect of the harmful environment, emotional as well as physical or eco-nomical, on the recovery of your pa-tient. In scores of situations your own understanding can set the patient's fears at rest; your very bearing, your kindly thoughtfulness, the helpful in-terjection of a bit of himior to break the tension of the moment, your ob-vious desire to help—these are inval-uable aids added to your proven ability to nurse or to show others how to nurse the patient for his physical ill-ness. The attitude and diagnosis of the 12 The Health Bulletin February, 1948 doctor, with your own ability which comes through increased knowledge of people sick and well, will help you to know when to disregard symptoms and get the patient's attention turned to healthier channels. For the patient who tends to cling despite your friend-ly reassurances to invalidism, psychia-tric help may be needed. Whenever symptoms continue to manifest them-selves when the physical cause is clear-ed and your own methods have failed it is wise to turn to the most available mental hygiene authority for help, the psychiatrist, private or in the clinic. For the patient who remains "blue" who sees only the dark side, who can-not seem to get hold after an illness, a psychiatrist's help in or out of the clinic may be badly needed. For the tantrum child, the child who steals and cheats ,the destructive child, the child who is not learning in school, the chronically unhappy child, the child who wants to play alone, who day-dreams to the extent of failing to meet the realities of every day; for the child who persists in prolonged mastur-bation; for the child who fails to talk at a reasonably normal age; for the prolonged eneuretic; for the stubborn feeding problem; for all of these priv-ate psychiatrists and the psychiatric clinic exist. You public health nurses have the opportunity to recognize the problem as being well or badly handled by the family and to recommend to them a psychiatrist or a psychiatric clinic; and early help may prevent later tragedy. As public health nurses you may often see the too-good child — who not only never gives any trouble but never is part of the crowd; the child who clings with all his might to his mother, who cries when away from her and who continues this over an abnormally long period; the child fear-ful of the dark and of strangers; and he usually needs wise help more acute-ly than the so-called bad child whose mischief disrupts the peace. Stubborn-ly resistant habit cases; defiant prob-lem children; the run-away child; the child who just can't learn in school; in these extremes mental hygiene help from psychiatrist or clinic is certainly indicated, while in mild expressions of maladjustment, wise handling, preven-tive mental hygiene by understanding parents, nurse or teachers may be all that is needed. But as public health nurse you see again and again the making of prob-lem children from neglect, physical, psychologic or both; from lack of love, from over-protection by parents; from overlove as the recognized compensat-ory need of parents; from school and social maladjustment. You are often in position to explain the dangers and to give acceptable preventive advice, and frequently you are the best and often the only ones to advise the parents of the urgent need of psychiatric help from specialists. Surely no profession has more need of the assistance of a Mental Hygiene approach than the one whose members come closest of any outsider to the homes where futui-e neurotics and psy-chotics are being moulded through ig-norance or neglect; and from which so many can be saved by early recognition and referral to trained psychiatric help. A PUBLIC HEALTH NURSE'S EXPERIENCE AT THE N. C. SANATORIUM By Frances Stanton, Senior Public Health Nurse District Health Department, Elizabeth City, N. C. EARLY in 1946, public health leaders in North Carolina decided that, be-cause of the increased emphasis being placed on tuberculosis control, it seem-ed advisable to give the public health nurses some special preparation in that field. In cooperation with the late Dr. P. P. McCain and Miss Eula E. Rackley, February, 1948 The Health Bulletin 13 Superintendent of Nurses at the State Sanatorium, a plan for refresher courses was worked out. The Sanatorium offer-ed to take pubhc health nurses for one month. Later this course was shortened to two weeks. The program of study was planned to include classes, obser-vation, and practical experience on the wards. Letters were sent to local health officers in April, 1946, telling of the course which was to begin in June. It was suggested that only one nurse from a given department be released at a time but eventually that every public health nurse would be given the opportunity to take the course. In June, 1947, my turn came to go. For many reasons I welcomed the op-portunity. One was the fact that tuber-culosis is our number one problem, and I felt that members of the Sanatorium staff could answer some of the perplex-ing questions connected with our con-trol program. Then, too, the nui'ses from our department who had already visited the Sanatorium gave such glow-ing reports of their stay, such as the hospitable spirit which pervaded the place, the good food, the relaxing effect of the afternoon rest hour, etc., that I was eager to go. When I arrived I found that all they had said was true. I was welcomed by Mrs. Hatos, Nursing Instructor, and shown to an apartment in the Nurses Home which two other nurses shared with me. There were six nurses in our group, representing health departments from the mountains to the coast. We had Sunday night supper together and got acquainted with each other, had a good night's rest, and began classes on Monday morning. The classes under Dr. Hiatt and Mrs. Hatos were interesting and helpful. They brought us up-to-date on the newer knowledge of the aspects, and treatment of tuberculosis. We were giv-en opportunities to observe the differ-ent types of treatment given the pa-tients. Last but not least we assisted with nursing care of the patients on the wards. This experience had a peculiar meaning for me as a public health nui'se. I feel now that when I advise a patient to request sanatorium care, that my appeal will be stronger and perhaps have more effect because back of my words there has been experience. In other words, I am certain of what I am talking about when I describe sanatorium routine to the prospective patient. One of my ward duties was to deliver mail to the bedsides. I deter-mined then to remind the folks at home to write to their patients often, and to write cheerful news. Nothing helps the morale of the patients more than to hear from home. The two weeks came to a close quick-ly. I came back to my work feeling truly refreshed. I still remember pleas-antly the spirit of friendliness which hovers over the Sanatorium community of doctors, nurses, workers and patients. The knowledge gained in classes still inspires me to try to do a better job in the control of tuberculosis. And when I grow tired, as public health nurses sometimes do, I close my eyes and re-call the restful atmosphere on the Sanatorivun hUl among the whispering pines and the rustling oak trees. When all public health nurses have visited the Sanatorium, I hope they start around again. I want to go back. HISTORY OF THE BEDSIDE NURSING PROGRAM IN WINSTON-SALEM AND FORSYTH COUNTY By Marjorie Spaulding, Executive Secretary Community Nursing Service, Inc. IN 1930, a survey was made in Wm-ston- Salem which pointed out the need locally for bedside nursing. In March 1946, on the basis of this survey, Dorothy Rusby from the National Or-ganization for Public Health Nursing 14 The Health Bulletin February, 1948 spoke to the Health and Family and Child Welfare divisions of the Com-munity Coimcil at theii* request. Fol-lowing her visit she sent a report of a "Proposed Plan for Providing Bedside Care in Forsyth County." The Health Division of the Com-munity Council set up a Bedside Nurs-ing Committee who investigated local need and recommended action. This group contacted the Medical Society, Health Department, U. S. Public Health Service, three hospitals, and the heads of social agencies. A budget and an organizational plan for a combination agency (Service set up in the Health Department) was completed. A special committee presented the need to the Commimity Chest, who in turn contacted the Kate Bitting Rey-nolds Estate in June, 1947. These trustees approved a grant to institute and operate the nursing pro-gram during its first year with a reason-able assurance of future support. On the Community Council's recom-mendation, the Community Nursing Service was admitted as a member agency to the Community Chest in July, 1947. The Community Council or-ganized the board of the Community Nursing Service July 29, 1947. The board consisted of 24 representative citizens and the Health OfBcer. A nurse loaned by the United States Public Health Service became Executive Sec-retary of the Board and Assistant Nursing Supervisor in the City-Coimty Health Department. The Community Nursing Service be-gan hiring personnel August 1, 1947 and have added four nurses and one clerk to the Public Health Nursing staff. These public health nurses were placed in the City-County Health De-partment. All public health nurses (em-ployed by the City-County Health De-partment and the Community Nursing Service) include bedside care in their generalized public health nursing pro-grams. A proportionate amount of the total nursing time is spent in this new service. The City-County Board of Health, Medical Society, Board of Alderman and County Commissioners approved the program. The Community Nursing Service has been incorporated as a non-profit organization. On November 12, 1947, the new serv-ice became available to people in Win-ston- Salem and Forsyth County. All bedside care is given under the med-ical supervision of the patient's private physician. This service is on a grad-uated fee basis (from $1.50 an hour to free) individually decided. So far, one out of every four visits has been a full fee visit. To date (January 28, 1948) 350 visits have been made to 166 patients. WELL BABY CLINIC By Agnes Campbell, Senior Public Health Nurse Iredell County Health Department, Statesville, N. C. LAST October the Junior Service League of Statesville approached the Iredell County Health Department for suggestions for a project which their organization could sponsor. We gave them two alternatives—a well baby clinic or a dental clinic. The young women felt that the im-portance of a child's first year of life warranted the best it is possible for him to have by insuring him with the right start through a well and happy childhood. Thus, plans got vmder way to begin the clinic. Mrs. David Pressly, a most capable person, was appointed chairman of the project. The first meeting with the Junior Service Committee and the Health Department formulated plans for procedure of the clinics and for publicity discussions. The publicity was begun with a radio program, followed up with poster dis-play in downtown store windows, com- February, 1948 The Health Bulletin 15 mittee meetings in different sections of town. Discussions in the committee meet ings outlined time and place of clinic, procedure and the class work for in-formation to mothers before clinics. The results of this publicity were so very successful that not only States-ville, but all of the county were talk-ing the well baby clinic. Proof of this success, too, was the unexpectedly large attendance at the clinic—so many re-sponded in fact that there was no time for the thirty minute class periods. To take care of this situation, the fourth Thursday in each month was desig-nated as class period day. In the first white baby clinic there were twenty-five babies and fifty-four for the second clinic. The first Negro clinic brought in ninety-seven babies and eighty-nine in the second. Limited time and personnel make it necessary to include a great deal in each class discussion. There classes in-clude information for both expectant mothers and mothers with babies. Miss Anita Jones in her institute on Mater-nal and Infant Care held in Chapel Hill last September gave us many ideas for conducting this clinic and choosing the material for the class discussions. The Junior Service League is to be highly commended for their fine co-operation in this project. They send at least four volunteers to each clinic; one who registers the babies, one who controls trafQc, one who helps with the dressing and undressing of the babies, and one who helps the nurse weigh and measure the babies. Six local doctors have volunteered their service meaning that each comes twice a year to a clinic. This project shows that public health nursing truly lies in the hands of the lay public and that its ultimate success lies in a better informed public. 16 The Health Bulletin February, 1948 IDELL BUCHAN MEMORIAL LOAN FUND By Louise P. East, Chairman of Loan Fund Committee AT the annual meeting of the North Carohna Public Health Associa-tion which convened in Charlotte, Nov-ember, 1947, the members of the Public Health Nurses' Section voted unan-imously to raise and perpetuate a loan fund in honor of Miss Idell Buchan who died June 7, 1947, after 28 years of service as a public health nurse. Miss Buchan was known and respect-ed throughout the length and breadth of North Carolina, and she was beloved by a host of friends of all ages and walks of life. The loan fimd committee plans to raise the sum of $500.00 which will be administered from Chapel Hill for the benefit of public health nurse students from North Carolina who attend the School of Public Health at the Uni-versity of North Carolina. No funds will be personally solicited for this memorial fund, but to friends of Miss Buchan who knew of her un-tiring efforts in promoting good health for the citizens of the State and her interest in better education and prep-aration of young nurses, we offer the privilege of contributing to this fund if they care to do so. Contributions should be sent to Miss Margaret Blee, School of Public Health, University of North Carolina, Chapel Hill, North Carolina. A TRIBUTE TO MISS LAURA NIBLOCK, A PUBLIC HEALTH NURSE By Miss Amy Louise Fisher, R.N. Supervising Public Health Nurse State Board of Health, Raleigh, N. C. AFTER several months of illness. Miss Laura Niblock was released from suffering and passed to her re-ward on December 29, 1947. She leaves behind two sisters—one a missionary in Siam and the other a nurse in States-ville. She will be missed by her co-workers in public health. She was a graduate of Long's Sanatorium School of Nursing in Statesville and took the course in Public Health Nursing at George Peabody College, Nashville, Tennessee. After working in Tennessee and Virginia, she returned to North Carolina and was employed as a Pub-lic Health Nurse from September, 1936 until she resigned because of illness in August of 1947. A letter from Dr. Alfred Mordecai, the last health officer with whom Miss Niblock worked in the Davie-Stokes- Yadkin District Health Department, pays a flitting tribute to her memory: "Miss Niblock served under me for nearly two years, and I came to know her well. She was a woman of fine character, well informed, resourceful, dependable, and efficient. She was a willing worker and a cheerful worker — even under trying circumstances. She came up in the days when people re-spected authority and earned all they made, and she never changed. She was able to carry on by her own initiative to a great extent and exercised good judgment at all times. She always faced life and its trials bravely with-out a whimper, and I became very fond of her. She accepted her hopeless affliction without fear or quavering and faced death with the same gameness that she had faced all the trials of life." MEDICAL LI BRARY U . OF N . C . CHAPEL HILL. N. C. ^ TI wlmm I This Bulletin will be sgrvt free to ony citizen cjf the State upon request Published monthly at the office of the Secretary of the Board, Raleigh, N. C. Entered as second-class matter at Postoffice at Raleigh, N. C. under Act of August 24, 1912 Vol. 6i MARCH, 1948 No. 3 MEMBERS OF THE NORTH CAROLINA STATE BOARD OF HEALTH S. D. CRAIG, M.D.. President Winston-Salem G. G. DIXON. M.D., Vice-President -••; Ayden H. LEE LARGE, M.D ^°^J^y ^o*^' W. T. RAINEY, M.D FayetteviUe HUBERT B. HAYWOOD, M.D u -n J. LaBRUCE WARD, M.D AshevUle J. O. NOLAN, M.D Kannapolu JASPER C. JACKSON, Ph.G Lumbcrton PAUL E. JONES, D.D.S FarmviUe EXECUTIVE STAFF CARL V. REYNOLDS, M.D., Secretary and Sute Health OflScer. G. M. COOPER, M.D., Assistant State Health OflBcer and Director Division of Health Education, Crippled Children'* Work, and Maternal and Child Health Service. R. E. FOX, M.D., Director Local Health Adminiitration. W. P. RICHARDSON, M.D., District Director Local Health Administration. ERNEST A. BRANCH, D.D.S. , Director of Oral Hygiene. JOHN H. HAMILTON, M.D., Director Division of Laboratories. J. M. JARRETT, B.S., Director of Sanitary Engineering. OTTO J. SWISHER, Director Division of Industrial Hygiene. WILLIAM P. JACOCKS, M.D., Director Nutrition Division. MR. CAPUS WAYNICK, Director Venereal Disease Education Institute. C. P. STEVICK, M.D., Director, School-Health Coordinating Service, Epidemiology and Vital Statistics. HAROLD J. MAGNUSON, M.D., Director Reynolds Research Laboratory, Chapel Hill. JOHN J. WRIGHT, M.D., Director Field Epidemiology Study of Syphilis, Chapel Hill. FREE HEALTH LITERATURE The State Board of Health publishes monthly THE HEALTH BULLETIN, which will be sent free to any citizen requesting it. The Board also has available for dis-tribution without charge special literature on the following subjects. Ask for any in which you may be interested. Adenoids and Tonsils German Measles Sanitary Privies Appendicitis Health Education Scabies Cancer Hookworm Disease Scarlet Fever Constipation Infantile Paralysis Teeth Chickenpox Influenia Tuberculosis Diabetes Malaria Typhoid Fever Diphtheria Measles Venereal Diseases Don't Spit Placards Padiculosis Viumiiu Endemic Typhus Pellagra Typhoid PUcarda Flies Residential Sewage Water Supplies Fly Placards Disposal Plants Whooping Coufh 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. Prenaul Care. Baby's Daily Schedule. Prenatal Letters (series of nine First Four Months. monthly letters.) Five and Six Months. The Expectant Mother. Sc^fen and Eight Months. Infant Care. Nine Months to One Year. The Prevention of Infantile Diarrhea. One to Two Years. Breast Feeding. Two to Six Years. Table of Heights and Weights. Instructions for North Carolina Midwives. CONTENTS Page Doctor Reynolds Resigns 3 Cancer Division 3 The Public and the Medical Profession 5 Stork's Busiest Year Was 1947 8 New Public Health Nursing Course at N.C.C. In Durham 10 Inleali' l£J|| PU&U5AE:D by TML nc>R.TM CAeOUhA 5TATL eAaJgDv^MLALTM i|l2J Vol. 63 MARCH, 1948 No. 3 CARL V. REYNOLDS, M.D., Stale Health Officer JOHN H. HAMILTON, M.D., Acting Editor DOCTOR REYNOLDS RESIGNS February 19, 1948 Dr. S. D. Craig, President N. C. State Board of Health Winston-Salem, N. C. Dear Doctor Craig: For sometime divergent forces have been preying upon me;—from within, the abiding desire for "service before self," and from without, the desire of the family for my retirement. The persuasiveness of the family w^on; and, in consequence, I am asking that the Board accept my resignation as of June 30, 1948, or as soon there-after as a successor can be appointed to fill my unexpired term. All my professional life, I have had an unquenchable desire to render a service to the underprivileged masses. The past thirteen years, serving as your Secretary and State Health Offi-cer, have given me this opportunity. I have, under your intelligent direction, and with the support of well-qualified, loyal, enthusiastic directors and their personnel, given my best toward an unfinished job. I shall ever cherish my reappoint-ments as a satisfaction of services ren-dered. I have always been fond of my work, and the advances made are due to tlie united effort and enthusiastic interest in bettering the moral, mental and physical standards of life, and to lowering poverty, sickness and death, in order that we may have a happier and more abundant life. To severe my connection from the State Board of Health, is a real sacri-fice. With regards and best wishes, I am Most sincerely, r/e Carl V. Reynolds, M.D. President Craig read Doctor Rey-nolds' letter of resignation as Secretary and State Health Officer, effective June 30, 1948 or as soon thereafter as a successor could be appointed. President Craig stated that this letter showed Doctor Reynolds' big heart, big mind, and love for humanity. Because of Doctor Reynolds' resignation. Doctor Dixon moved that the Board express to Doctor Reynolds its sincere appre-ciation for the work that he has done with, and for the Board of Health, and for North Carolina as a whole, during the past thirteen years as State Health Officer, and that it is with sincere regret that they accept his resignation. Motion seconded by Doctor Haywood, and unanimously carried. CANCER DSViSION NORTH Carolina's intensive fight against cancer was launched offi-cially March 1, when the Cancer Con-trol Division of the State Board of Health began operation, with Dr. Ivan M. Procter, of Raleigh, as its director and Mildred Schram, Ph.D., of Phila-delphia, as his associate. They have The Health Bulletin March, 1948 been assigned oflBces in the Health Building, on Caswell Square. For some-time consultations between Dr. Carl V. Reynolds, State Health Officer, Dr. Procter, and others directly interested In getting the program started had been under way, with a view to work-ing out arrangements which could be put into effect immediately with the creation of the Cancer Control Division. Dr. Procter is a specialist in obstet-rics and diseases of women, and prac-ticed in that field of medicine for more than 25 years, in Raleigh. For the past five or six years, he has made an ex-tensive study of cancer, including its cause, diagnosis, management, preven-tion, and methods of control. Dr. Schram, formerly of Saint Louis, Missouri, served from June, 1932, until January of this year, as executive offi-cer of the Donner Cancer Foundation of Philadelphia, formerly the Inter-national Institute of Cancer Research, which, until its program was interrupt-ed by the war, sponsored projects in various parts of the world. During her activities in Philadelphia, Dr. Schram planned and organized a series of can-cer prevention clinics, first in five teaching hospitals in Philadelphia, the number having grown to eleven, to in-clude a group of non-teaching hospitals. She was a delegate to the Interna-tional Cancer Congress in Madrid, in 1933, a guest of the Research Institute, Royal Cancer Hospital, London, and one of eleven American women cited for service in cancer control by the American Cancer Society. The associate director arrived in Ra-leigh the first of the week, and express-ed herself as being highly pleased with the North Carolina program, which, she believes can be made an effective weapon in combatting cancer, by bringing it out into the open, where it can be attacked at its source. In pursuit of his intensive study of cancer. Dr. Procter has made personal visits to clinics in Georgia, Virginia, Pennsylvania and New York. Prior to the war, he engaged in post-graduate study in London, Berlin, Prague, and Vienna. Dr. Procter is a member of the Can-cer Committee of the North Carolina State Medical Society, also a member of the Executive Committee of the North Carolina Division of the Amer-ican Cancer Society, having formerly served as its chairman. He has pub-lished numerous articles on cancer of the breast and uterus. Authority for Program The authority for the cancer pro-gram is a legislative act of 1945, in-troduced in the North Carolina General Assembly as House Bill 786, in coop-eration with the Cancer Committee of the North Carolina State Medical So-ciety, as an advisory agency, and with the active participation of the North Carolina Division of the American Cancer Society, the program to be ad-ministered by the State Board of Health, through its newly-created Div-ision of Cancer Control. Funds with which the cancer pro-gram will be carried on are from three sources: State legislative appropriation, through the State Board of Health; United States Public Service, from Con-gressional appropriation, and the North Carolina Division of the American Cancer Society. Procter Outlines Objectives Upon assuming his duties. Dr. Procter outlined the policy to be followed in North Carolina's intensive war on cancer. "The primary object," he said, "will be to render the greatest amount of cancer control service to the greatest number of citizens of the State, in the shortest time practical." He continued: "This service will be permanent, sub-ject to future appropriations from the Legislature. "The program is to be conducted locally through the Board of Health, in cooperation with the physicians comprising the Medical Society of the county in which a clinic is located. March, 1948 The Health Bulletin The local physicians will render the professional service." Clinics: Type, Number Describing the clinical services to be available when the program gets under way, Dr. Procter said: "There will be two types of clinics. Detection clinics will be operated in both the larger and smaller communities of the State. These will be the medium of (1) screen-ing the largest number of applicants, in order to find cancer in its earliest stages and while almost completely curable, (2) to educate the public in prevention, through early diagnosis and cure, and (3) to establish annual ex-aminations among applicants. "North Carolina," Dr. Procter dis-closed, "is to have a new type of de-tection clinic. Limited examinations will serve three times as many people. The present standard detection clinic operating in the United States con-sists of a complete and detailed history, physical examination, laboratory and X-ray test. This is a health mainte-nance type of detection. "In North Carolina it will be the desire and policy of the Board to de-vote its funds and efforts to cancer detection and control, leaving the gen-eral health maintenance to the patient and practicing physician. The physical examination will be limited to those parts of the body where cancer most commonly occurs and is detectable and curable. "Disposition of those examinees who have positive findings will be referred to their personal physician. Examinees without a personal physician will be asked to select one from a list pre-pared by the local county medical society. "Cancer diagnostic and management clinics will be established in cities where the services of pathologists and other specialists are available. Suspect-ed cancers located in detection centers will be referred to cancer diagnostic clinics for final diagnosis and recom-mendation as to management. The pa-tient will be returned to his or her personal physician for treatment. "Clinics, where practical, will be con-ducted in hospitals approved by the American College of Surgeons, but all cancer clinics must be approved by the American College of Surgeons." "There will," Dr. Procter said, "be seven diagnostic cancer clinics and 10 detection clinics." Dr. Procter foresees a minimum of 50,000 examined annually after the pro-gram is in complete operation. THE GOVERNOR ISSUES A STATEMENT* THE PUBLIC AND THE MEDICAL PROFESSION WITH the possible exception of the Christian ministry, there is not, I think, a higher calling among men than that of the medical doctor. The clergyman is supposed to diagnose and prescribe for ailments of the soul, and the one who cannot do just that should take stock of himself. The medical doctor diagnoses and prescribes for bodily ills. Together, the minister and the doctor exercise a definite custodial care over humanity from the cradle to the grave, each helping to bring the individual into a more abundant life — here and hereafter. No attempt will be made to become technical in this brief discussion of what should be the layman's attitude toward the doctor. Certainly there will be an absence of medical terms, for the very obvious reason that I am in no way familiar with such terms. But is the medical profession tech-nical in its dealings with the layman as was once the case? To all appear-ances, the profession is emerging from the maze of technicalities which for-merly resulted in an aloofness on the part of the uninformed layman. Time was when the doctor, having arrived at The Health Bulletin March, 1948 the patient's bedside by horse and buggy, would put on a grave expres-sion as he applied the stethoscope, in-serted the fever thermometer under the tongue, looked at the whites of the eyes, and felt the pulse. "Umph-humph," he would say, with a far-off look in his eyes. Then he would take pencil and pad, write a prescription in Latin, give certain directions which must be followed, and depart, to return later in the day, tom.orrov,', or perhaps in a few days, as the condition of the patient might require. This gave the sick person and mem-bers of his household a sort of fear of the doctor, as if he knew more than he was willing to tell about the pa-tient's condition, or perhaps, his near-ness to death. Time was when a doctor would no more have addressed a group of lay-men, in their own language, than a preacher would have delivered a ser-mon at a football game. But now both the doctor and the preacher are be-coming more practical. There has been, for some years now, a growing tendency on the part of the doctor to meet the layman on terms of the latter 's understanding; to throw aside secrecy and formality, and to substitute plain American talk for La-tin prescriptions. That is as it should be. In the promotion of this growing spirit of understanding between doctor and layman, public health, no doubt, has played an important role. Workmg with both in the field of preventive medicine, this alreay existing and well estabhshed governmental agency—both the State Health Department and The United States Public Health Service-may be considered a "liaison officer" between the doctor and the average citizen. The obligation resting on pub-lic health is not only to afford mass protection, but to educate the public to the importance of good medical care —through the private practitioner where the patient is able to pay, and at public expense if the patient is indigent. Mass protection against certain com-municable diseases is, of course, a ben-efit that is extended to all, without charge, because no population that is half sick and half well can be 100 per cent efficient. Moreover, communicable diseases can be transmitted from pau-per to prince, and vice versa. There-fore it is the business of government, now;, so recognized by all, to set up and maintain conditions conducive to the good health of all—by means of im-munization, sanitation, and other meas-ures carried on at public expense. Dis-ease knows no barriers. It does not re-spect territorial lines. Especially is this true in this day of rapid transportation, when the remotest parts of the earth are within a comparatively few hours' flying time from any part of the United States. Communicable diseases hereto-fore unknown in this country exist in these remote sections, and can be im-ported from them. Therefore, it is nec-essary that our people not only become immunized against all preventable dis-eases, but also remain on guard against those ailments about which, at present, we know little, but which could easily be transmitted to us from distant parts of the world. Hence, the importance of mass pro-tection. Aside from those communicable dis-eases against which means of immun-ization have been discovered, however, thousands of persons die every year in North Carolina and other states as the result of the chronic or degenera-tive diseases of middle and late life, against which the chief protection is early diagnosis. While it is recognized that doctors consider it unethical to advertise—cer-tainly as individuals—it would appear to be perfectly proper for the medical profession to establish and maintain relations with the lay public, in order to let the people know just what it has to offer in the way of early diagnosis and other preventive measures. In 1942, the House of Delegates of the American Medical Association vot-ed its approval of the extension service of local health departments through- March, 1948 The Health Bulletin out the United States. In September, 1945, the official Journal of the Asso-ciation declared editorially: "Until the most remote American family has ac-cess to accepted modern public health services, the nation's health will not be properly served. Expansion of public health activity, long advocated and pioneered by the medical profession, is a more sound and logical step toward improving the nation's health than many grandiose plans for medical care." Public health, in its role of "liaison officer" between the laity and the med-ical profession, can and should serve a still larger purpose than it has ever served before. The medical profession, on the other hand, should seek still wider contacts with the public, through public health personnel. Public health is the child of organized medicine. No North Carolina doctor who has studied the history of his profession in this state is ignorant of the vision which was caught and held, more than seven-ty years ago, by Dr. Thomas Fanning Wood of Wilmington. That vision was translated into legislation which cre-ated, in 1877, the State Board of Health, which for a while was the State Medical Society. Later, the form of organization was changed, and the duties of the Board of Health were delegated to a board composed of mem-bers of the medical and allied profes-sions, elected by the State Medical Society and appointed by the governor. Here are some interesting facts, from which might be gathered many sug-gestions as to how the public and the medical profession may work together more closely in the promotion of the general health of the people: In 1921, the ten leading causes of death in North Carolina were, in this order: heart diseases, tuberculosis, apo-plexy, nephritis, pneumonia and in-fluenza, diarrhea and enteritis, pre-maturity, non-vehicular accidents, preg-nancy, and senility. In 1946, the ten leading causes of death in our state were listed in this order: diseases of the heart, apoplexy, nephritis, cancer, pneumonia and in-fluenza, prematurity, non-vehicular ac-cidents, tuberculosis, motor vehicle ac-cidents, and diabetes. Compare the two lists and note the changes. Tuberculosis, for example, dropped from second to eighth place. Cancer, not in the first list, was fourth in the second. Why the decline in tuberculosis? Be-cause we did something about it—and we are going to do more. Two things are important in our fight against the Great White Plague. We must separate the infectious from the non-infectious patients, and we must use every means at our command to detect cases in their early stages, in order that the disease may be arrested and cured. In the mass surveys being made under the super-vision of the State Board of Health, approximately a quarter of a million chest pictures had been made through December, 1947. The number of lives that will be saved as a result, no one can say. Those patients found to be infected are referred to their family physicians. There is a group of diseases, how-ever, against which we have not made the progress that we have against tuberculosis. We have prolonged life by immunizing against preventable communicable diseases, many of which occur among small children. But many of the dangers that still confront our citizens of middle and late life remain to be reckoned with. We have referred to these generally; let us be more spe-cific. Of the 15,48
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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 | 1948 |
Subjects |
Children--Health and hygiene Diseases Hygiene Public Health--North Carolina--Periodicals Sanitation |
Place | North Carolina, United States |
Time Period | (1945-1989) Post War/Cold War period |
Description | Volume 63, Issues 1-12. Issues for Feb.-May 1917 and for Jan.-July 1918 not published.Addresses by Walter Clark. |
Publisher | Raleigh,North Carolina State Board of Health. |
Agency-Current | North Carolina Department of Health and Human Services |
Rights | State Document see http://digital.ncdcr.gov/u?/p249901coll22,63754 |
Physical Characteristics | 61 v. :ill. ;23 cm. |
Collection | Health Sciences Library, University of North Carolina at Chapel Hill |
Type | text |
Language | English |
Format | Bulletins |
Digital Characteristics-A | 13,575 KB; 230 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_healthbulletin1948.pdf |
Pres Local File Path-M | \Preservation_content\StatePubs\pubs_edp\images_master\ |
Full Text | tCfie librarp of tiie ?Hnibets(ttp of ^ortf) Carolina anb l^ttantiiropu ftodetiesi 61U.06 N86h v,63-6i| 19U8-U9 Med. lib. This book must not «M be taken from the Library building. MEDICAL LIBRARY U. OF N. C . CHAPEL HILL. N. Q^ ^S^' V^' V). C. i This Bulletin, will be serA free to any citizgn cf the State upon request | Published monthly at the office of the Secretary of the Board, Raleigh, N. C. Entered as second-class matter at Postoffice at Raleigh, N. C. under Act o£ August 24, 1912 Vol. 63 JANUARY, 1948 No. 1 He is going to make it, one step at a time, because you give him his chance through your purchase of Easter Seals. MEMBERS OF THE NORTH CAROLINA STATE BOARD OF HEALTH S. D. CRAIG, M.D., President Winston-Salem G. G. DIXON, M.D., Vice-President 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 Ashevillc J. O. NOLAN, M.D Kannapolis JASPER C. JACKSON, Ph.G.... Lumberton PAUL E. JONES, D.D.S FarmviUc EXECUTIVE STAFF CARL V. REYNOLDS, M.D., Secretary and State Health Officer. G. M. COOPER, M.D., Assistant State Health Officer and Director Division of Health Education, Crippled Children's Work, and Maternal and Child Health Service. R. E. FOX, M.D., Director Local Health Administration. W. P. RICHARDSON, M.D., District Director Local Health Administration. ERNEST A. BRANCH, D.D.S. , Director of Oral Hygiene. JOHN H. HAMILTON, M.D., Director Division of Laboratories. J. M. JARRETT, B.S., Director of Sanitary Engineering. T. F. VESTAL, M.D., Director Division of Tuberculosis. OTTO J. SWISHER, Director Division of Industrial Hygiene. WILLIAM P. JACOCKS, M.D., Director Nutrition Division. MR. C.^PUS WAYNICK, Director Venereal Disease Education Institute. C. P. STEVICK, M.D., Director, School-Health Coordinating Service, Epidemiology and Vital Statistics. HAROLD J. MAGNUSON, .M.D., Director Reynolds Research Laboratory, Chapel Hill. JOHN J. WRIGHT, M.D., Director Field Epidemiology Study of Syphilis, Chapel Hill. FREE HEALTH LITERATURE The State Board of Health publishes monthly THE HEALTH BULLETIN, which will be sent free to any citizen requesting it. The Board also has available for dis-tribution without charge special literature on the following subjects. Ask for any in which you may be interested. Adenoids and Tonsils German Measles Sanitary Privies Appendicitis Health Education Scabies Cancer Hookworm Disease Scarlet Fever Constipation Infantile Paralysis Teeth Chickenpoi 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 Schedule. Prenatal Letters (series of nine First Four Months. monthly letters.) Five and Six Months. The Expectant Mother. Seven and Eight Months. Infant Care. Nine Months to One Year. The Prevention of Infantile Diarrhea. One to Two Years. Breast Feeding. Two to Six Years. Table of Heights and Weights. Instructions for North Carolina Midwives, CONTENTS Page The World Food Need 3 The North Carolina League for Crippled Children, Inc. 8 Notes and Comment 12 Causes of Death In 1947 Are Compared With Those In 1900 15 y LIBHAttX UWAV. v# »0«.TH CAROLINA ^ ,: Vol. 63 JANUARY, 1948 No. 1 CARL V. REYNOLDS, M.D., State Health 0£Bcer JOHN H. HAMILTON, M.D., Acting Editof The World Food Need By ' Hazel K. Stiebel'ing Talk to State Nutrition Committee Raleigh, North Carolina THIS is a year of food crisis through-out the world. We meet it here in the form of high food prices, prices more than twice as high as in 1935-39. Soon we shall find much less meat in the markets than we would like to buy. Nevertheless, we enjoy generous food supplies. Most other parts of the world are far less fortunate. Despite the extra-ordinary efforts of governments to alle-viate food shortages, hunger continues for many people. In Europe, hunger is retarding general economic recovery and indeed the return to peaceful con-ditions. And, at best, we probably face two or three more years of short food supplies. In this crop year, 1947-48, world per capita food consumption is expected to be 2 or 3 per cent below last year, and nearly 10 per cent below prewar, ac-cording to the October estimates of the International Emergency Food Council. In pondering the significance of a fig-ure 10 per cent below prewar we should remember that even in that earlier pe- ^ riod over half of the people on earth were getting fewer than 2250 calories per day. We also should keep in mind that the change from prewar levels has differed greatly from country to coun-try. Last year, for example, it was 30 per cent below prewar in Germany; here in the USA it was considerably above. Except for potatoes, world production of most food crops was higher in 1947- 48 than in the year before. But a short-age of feed crops in all of the heavy livestock producing areas has created a serious food situation. World produc-tion of coarse food and feed grains combined, is down by 10 per cent. As a result there is heavy pressure on the part of livestock producers everywhere to use grain for feed that should be used for food. The major reason for shortage of feed compared with the previous year is the extremely unfavorable weather of last year. Here we had a short corn crop. In Europe the heavy freezes of last winter and the record-breaking drought of the summer resulted in short potato and feed crops. Food reserves in surplus-producing areas are smaller than in 1946-47, and in some, notably here in the Western hemisphere, consumers have incomes and savings big enough to buy more food than ever before. Hence it has been more difficult than might have been expected to acquire the food need-ed for export to deficit countries. Be-sides, the world's population has grown by some 15 to 20 million. And so food The Health Bulletin January, 1948 tends to be short. And because it isn't evenly distributed, some groups will inevitably suffer greatly before the next harvest comes In. The problem is to alleviate this inevitable situation to the greatest possible degree. Shortages of food and fuel, fiscal and financial difficulties, and frustration and fear are closely interrelated in their devastating effect upon people and nations. In Europe, for example, short-ages of food have impaii-ed the pro-ductivity of workers in some key in-dustries— notably in the production of coal in the Ruhr. Until very recently, shortages of coal have prevented the full use of plant capacity for the manu-facture of nitrogen fertilizer. Lack of sufficient fertilizer has limited the pro-duction of indigenous food. Lack of coal has also stood in the way of steel production and all-out Indus-trial activity. The inadequacy of production has made it practically impossible for most of the European countries to export large enough quantities of goods to pay for the imports which they lu-gently needed. This situation has in turn been aggravated by the fact that the things they needed most were in short supply throughout the world—with the result that the prices they have had to pay for what they bought abroad have gone up much faster than the prices of those things they had to sell. In many coimtries inflation has con-tributed to the prevailing difficulties. Money was plentiful at the end of the war and few governments have been strong enough to take the necessary corrective measures. In the worst cases (as in Germany, for example) this has meant a widespread reversion to prim-itive methods of barter. More generally it has contributed to extensive black market dealings. Thus, the war brought not only phys-ical destruction, but a shattering dis-ruption of economic organization and dislocation of economic relations, re-covery from which will not be easy. In the long-run, the situation can be remedied only by the development of concrete programs for coordinated and orderly expansion of production. This obviously requires both national and international efforts properly integrat-ed. Agricultural rehabilitation and ex-pansion must go hand and hand with industrial expansion and financial sta-bilization. To this, attention must and will be given. The short-run and immediate task before nutrition committees in this coimtry is to help families here help themselves and others through wise use of our own food resources. There simply isn't food enough to eat as we would like and yet to meet even the minimal requirements for grain, fat, dried milk and other foods abroad. Of some things such as meat, there isn't enough even to satisfy ovu" own people. And if we continue to try to buy as much as we have had recently, prices will be pushed up until only the rich can afford all they want. Each household can make its contri-bution to the Nation's task of conser-vation, so as both to save food and to use it wisely, especially the scarce grain, fats, and meat. In choosing among these scarce articles, take an extra slice of bread rather than correspond-ing extra calories from meat, because 3 or 4 times as much grain goes into livestock production than into bread production of the same number of calories. Also join in the fight to stop feeding our precious food to rats and insects. We can choose to lessen the demand for bread, for fat, and for meat, espe-cially highly finished grain-fed meat. We can choose to select commercial or good grades of meat, instead of choice or prime, which require undue amounts of grain for their production. We can conserve and make full use of every ounce of drippings and bacon fat. We can eat a second potato or an addi-tional serving of some other vegetable instead of the second slice of bread. During my two week stay in September with a family in Britain, no bread was on the table at the two main meals of each day. Plain boiled potatoes or tur- y January, 1948 The Health Bulletin nips or carrots (no butter) were served Instead. At public eating places, bread was served only on request. If you ordered bread for dinner or supper it coimted as a course, and you forfeited soup or dessert. Some families In this country are living at bedrock levels, and shouldn't be asked to reduce their food consump-tion. But everyone can avoid waste, and some of us can get along better by eating less. Many of us can adjust, and include in our everyday fare more than the usual amounts of fresh fruits and vegetables, and more of other hard-to-transport foods, even if, in some cases, these are among the relatively expen-sive foods. I need not spell out for this audience the many ways in which nutrition-trained people can help the Nation's families make good use of the food we have. College-trained nutritionists are resourceful persons. They can do much to help popularize effective sharing and conservation. These are important measures, both for our friends abroad and for our own pocketbooks, to help combat inflation. Each of us must have a personal pro-gram as well as a part to play In put-ting a national program into effect. We must not buy more than we need—or eat more than we need—or throw any food away. When we buy foolishly, we are helping to keep prices high and fanning inflation. When we overeat, we are compelling overseas friends to vm-dereat. When we waste food, or nutri-ents— bread, fat, even the invisible minerals and vitamins—we are wasting lives. In passing, I also want to remind you of the Importance of keeping alive a sense of direct participation in the sharing of food and clothing. The parcels that you send to your overseas friends, or give through a church, through CARE (the Cooperative for American Remittances to Europe), the American Women's Voluntary Services or other organizations—these parcels count for much more than their mere Intrinsic value. Though what any one person can give may seem only a drop in the great sea of need, singly and collectively such gifts mean much. To the families that get them they are in-valuable. To everyone they are symbols of sympathy and understanding—mor-ale builders of the first order. I am sure that our answer to the world's need wovild come swiftly and generously could each of us but see for ourselves the contrast between our own way of living and that which exists in so many other places. Each of us who has been abroad is trying to explain— each from his own experience. Owe friends in other countries are trying to describe their need. But it takes imagination—imagination of a very high type—really to comprehend these oral and written reports. Those of us who haven't seen first-hand may need to hear the story over and over—from many persons, in many contexts. And while first emphasis is generally laid on the need for material things, home economists will not forget the many ways in which the stresses and strains of long-continued poverty may adverse-ly affect family and community life. What too little food means day in, day out, for years, is hard for us to comprehend. Of course it means differ-ent things to different groups in the population: the city, the farm; the young, the old; the rich, the poor; the housewife, the heavy worker; in countries, as Britain, where food con-trols safeguard distribution according to need, in countries where over and above the meager rationed amounts of a few items every man is left pretty much to shift for himself. There is wide variation among countries in the degree of the current food crisis, the ad-justments that can be made in food utilization, the opportunities for food conservation and food control. In most of the countries suffering from severe food shortage and poor food distribution, the plight of the aged is pitiful. I shall never forget the anxious expression and the wax-like appearance of the faces of the elderly people whom I saw in Berlin in the 6 The Health Bulletin January, 1948 summer of 1946—people who in August were sitting in damp, dark, cold rooms bundled up with sweaters and rugs — people who couldn't avail themselves of the sun's warmth between showers be-cause their knees and ankles were so swollen or stiff that they couldn't walk much, and who were too ill clothed even to sit on the curbstone in the chilly afternoon sunshine. Most of them had lost the savings on which their security was to rest, and they did not have the strength to trudge into the country or stand in long queues for food. Food shortages intensify all problems of human relations. I remember one family of 13 children and an aged grandmother. To avoid the constant bickering among hungry children, the mother decided finally to give each child his quota of bread as soon as the weekly rations were received. To each she gave a special place to keep it so each could eat when and as he chose. Only thus could the children put aside the suspicion that someone else was getting more than his share. Half-starved people are very self-centered. That calorie shortages were marked last year is indicated by the fact that average adult weights in the U. S. Zone of Germany were lower in all instances in July 1947 than in the same month of 1946. The average losses varied from 0.3 pounds among women in the age ranges 20-39 years, and 60 years and over, to 4.6 pounds among men 60 years and over. Particularly significant is the average loss of 1.3 pounds in men aged 20 to 39 and 1.9 pounds in men aged 40 to 59 years. These groups represent the main productive labor pool so es-sential to economic recovery in the U. S. Zone. The average weights of all age and sex groups of adults are well below the minimum weight considered necessary for satisfactory health. This "minimum" level is not what would be considered a normal weight or an av-erage weight of a well nourished Ger-man population. For example, men aged 20 to 39 years averaged 130.6 pounds in weight as compared to the minimum of 142 pounds considered satisfactory for health and the average of approximately 154 pounds for this age group in the United States. On short food supplies—only half to two-thirds of what we are now eating in this country—there isn't the energy to do really heavy work. Naturally the first adjustment people make to caloric shortage is to spare themselves from physical exertion as much as possible. When energy expenditures greatly ex-ceeds energy intake, weight loss begins. Strength begins to diminish. People's faces sadden; cheeks lose their curves; eyes sink deeper into their sockets. People become irritable and suspicious. They lose their good humor. They be-come intensely preoccupied with food — robbed of all thought except where the next meal is coming from. Absenteeism from work increases—men must take time, a day or two a week, to scour the countryside for off-the-ration extras to eke out their family's existence. Shortage of food is reducing essential industrial production. While in most of Europe the coal miners, for example, get extra rations, their families do not. So the miner shares his ration with his wife and children and then lacks the physical strength to maintain his output in the pits. To combat this, special incentives including food for other family members are now being given to miners in U. K. and U. S. zones of Germany to encourage them to increase coal output; coal, as has been said before, is one of the chief keys to economic recovery in Europe. The prewar food of Europe as a whole is said to have provided about 2850 calories per person per day. This is scarcely equal to British consump-tion of last year—an amount believed to be about the minimum for mainte-nance of good health of people, even when a very high degree of control can be exercised in the composition and distribution of the diet. The British diet of last year was Spartan-like and monotonous, even more so than during the war. Nevertheless, it still provided on a national scale considerably more milk, fruit, mature legumes, and veg- January, 1948 The Health Bulletin etables other than potatoes than the marginal quantities to which many European countries are now reduced, amounts that are associated with mark-ed Increase In tuberculosis and in in-fant mortality rates. Moreover, the British selectively direct their food — milk and vitamin-rich foods, in par-ticular— to their vulnerable groups whose needs are most lurgent. As a result the nutritional health of the British people has been maintained in a remarkable fashion. The food dis-cipline to which that nation has sub-jected Itself, and the application of the science of nutrition to its program of food production, import and distribu-tion has been one of the valuable con-tributions to our knowledge of good food management in time of emerg-ency. In the year ahead, food in Britain will continue to be at a low level. But In nutritional well-being, most coun-tries of Europe probably will fall below Britain. In France last year about 2700 calories were available for the nation as a whole—2300 in large urban centers, 2500 in the smaller cities and 3000 on farms. But this year diets will be con-siderably poorer imless imports can be greatly increased. In November bread rations were less than half of prewar levels and there was milk only for children under three years. While there are no frank deficiency diseases, chil-dren over 10 are undersized as com-pared with prewar, and city workers are underv/eight (10 to 12 per cent.) They tire easily, and lack the joy of living characteristic of the nation. Shortage of supplies in cities has forced up prices, and through price has curtailed consumption. Rationed food costs only about % as much per calorie than free market or black mar-ket goods. But in November, 1947, bread was 7.6 times August 1939 prices eggs, 22.3; meats, 11 to 16; milk, 13; mature dry legumes, 20 to 27; lard, 8; sugar, 13; potatoes, 11.8. A food budget prewar in quantity would take practically the entire wages of imskilled workers, and 75 to 80 per cent of those of the skilled. This means poorer food for workers, and to man-age they must seek supplementary jobs, and depend heavily on food parcels from peasant friends. The aged without rural connections suffer greatly. In rural areas, people are eating better than before the war. Transportation problems, lack of confidence in the franc, and lack of consumer goods for which to exchange farm produce means that the peasants now eat more, and sell less than formerly. In rural areas, especially in Brittany and Normandy, the better diets have resulted in de-clining tuberculosis rates during the war and since. And so, with misery, cold and hunger stalking much of the earth today, there is general agreement that we must help and help now—to reduce suffering, to aid in economic and phys-ical recovery, and to bring about peace. Steps have been taken to bring mate-rial aid to Greece and Turkey, and through the International Childrens Emergency Fund to children, adoles-cents, expectant and nursing mothers in countries that were victims of aggres-sion. Some interim aid has also been given Italy, France and Austria. A program of rehabilitation and economic recovery of 16 nations of Western Europe is now under consideration. It is recognized that the need is there and that it is large-scale. Questions as to just how much, and as to how it shall be handled are stiU to be deter-mined by the Congress. This increased need in most parts of the world for food and other essentials of living, smaller supplies, higher prices, and a consideration of hiiman values, must all enter into decisions relating to governmental action and household and personal adjustments — in this and other food-surplus coun-tries. Efforts are being devoted to in-crease the export from USA not only of grains, but of other foods as well, 8 The Health Bulletin January, 1948 even though some of the latter are fairly expensive. Joint international efforts are being made to assure max-imum food shipments from all export-ing countries, the channeling of ex-ports to the most critical areas, and the increase in production of food in other counrties. Farmers, industry and the citizens of this country are all being asked to conserve food, to use it selectively, and to prevent waste in every way possible. We are being asked voluntarily to re-duce our demand for grain for food, drink, and feed, to accept less "well-finished" meat, to continue the salvag-ing of fat, and to increase where pos-sible the consumption of hard-to-transport fresh vegetables, fruits, and other abundant foods. We are being asked to prevent waste and spoilage in every possible way. Both the immediate and the long-term problems of food supply are so tremendous and of such significance that they must be dealt with from many angles on a national and inter-national scale. But in a democratic country, a national program can suc-ceed fully only when each individual, each household, each industry and business understands the issues and cooperates generously. We have a great and important task before us. We must not, and with your help, we will not fail. The North CaroHna League For Crippled Children, Inc. Dates and Program For the 13th year, the North Carolina League for Crippled Children invites its friends to share in financing its work during the Annual Easter Seal Cam-paign, February 28th through Easter, March 28th. During the past year the generous contributions of the public made it possible to expand considerably the program of the League. Among the services rendered by the League during the past year were: 1. Medical Care: Specialized care to insure best possible physical correction included orthopaedic operations, otho-denture treatments, blood transfusions, clinical treatments, hospitalization, convalescent home care, and physi-cians' visits to homes. 2. Artificial Aids: Artificial limbs, ex-tension shoes, crutches, wheel chairs, glasses, hearing aids, and a plastic ear, were provided. 3. Transportation: To clinics, hos-pitals, and schools. 4. Education: a) Special training classes at the University of North Carolina for teachers interested in working with handicapped pupils. b) Summer Educational Center for handicapped children. c) A speech correction program in one city school. d) An orthopedic class in two city schools. e) Bedside teaching in hospitals and private homes. f) Boarding school for pupils who cannot get to and from public school. g) Speech therapy and remedial reading for children in two coun-ties. h) Educational publicity through conferences and bulletins to in-form the public of the needs of crippled children. 5. Research: The League staff made a nationwide study of laws pertaining to the education of handicapped chil-dren. Following this study, a bill was drafted and introduced to the 1947 General Assembly. The General Assem-bly approved the bill, so now the type of education needed by the handicap-ped children in North Carolina through January, 1948 The Health Bulletin 9 the public schools will be made avail-able to them, as soon as teachers can be trained in specialized methods need-ed for conducting such classes. 6. Other Services: Referral to proiaer agencies of requests for services not available from the League. Interpreta-tion to parents of children's condition and needs when the physician was un-able to talk with parents. Supplement-ed services of other agencies for needs not included in scope of their program. The present services of the League need to be expanded and many others need to be added. Both will be done as soon as funds are available. The League is a private social agency that cooperates with, but does not dup-licate the work of, other public and private charitable organizations. Aid the crippled whether the condition re-sulted from accident, disease, infection or bu'th. Its only requirement for aid — a valid need not otherwise provided for. Its main source of funds—volun-tary contributions during the Annual Easter Seal Campaings. The consistent growth of the League during the past years reflects both the fundamental need for such an agency, and the increase of public confidence in its program. Your contribution at this time will improve the lot of one or more crippled children. For what-ever your heart prompts you to give, the children say "thank you and Hap-py Easter." STATISTICS RE: HANDICAPPED PERSONS IN THE UNITED STATES "The Census Bureau reported that the U. S. had gained approximately 2,279,000 residents in 1946, the greatest one-year population spurt in its his-tory. Estimated total U. S. population: 142,673,000." (From TIME, October 20, 1947.) How Many Persons Are Physically Handicapped 28,000,000 handicapped persons in the U. S., including all ages and all types of handicaps. (Lewis Schwellenbach, Secretary of Labor, in letter to all governors in the U. S. dated February 26, 1947.) How Many Persons Need Rehabilita-tion Services 2,500,000 persons of working age have injuries which interfere with getting and holding suitable jobs. (Journal of American Medical Association, Septem-ber 23, 1946.) Approximately 97% of all handicap-ped persons can be rehabilitated to point of some gainful employment. (Dr. Frank Kruzen: Occupational The-rapy and Rehabilitation, Vol. 25, No. 4, August 1946.) Economic Value of Rehabilitation Services 1946—the total yearly income of re-habilitated group that received service by state rehabilitation agency increas-ed about from $11,000,000 before rehab ilitation to $56,000,000 after rehabilita-tion. MORE THAN 400% INCREASE! $300-$600—is average cost for main-taining a disabled person in idleness each year. $400—is the average cost of rehabili-tating him into a productive citizen. (Office of Vocational Rehabilitation, Federal Security Agency. "July 6—In-dependence Day for Disabled Civilians" —1947.) How Many Children Need Special Education 5,000,000 children (approximately) in the U. S. between the ages of 5 and 19 years are classified as exceptional children. Mentally gifted, as well as physically and mentally disabled chil-dren are defined as exceptional chil-dren. In North Carolina last year ap-proximately 900,000 children were en-rolled in the public schools. According to percentages given in the following column there are in North Carolina: 18,000 children (0.2%) who are blind and partially seeing 13,500 children (1.5%) who are deaf and hard of hearing 9,000 children (1%) who are crip-pled 13,500 children (1.5%) who have speech defects 10 The Health Bulletin January, 1948 18,000 children (2%) who are men-tally retarded 18,000 children (2%) who are men-tally gifted 1,800 children (0.2%) who are epi-leptic 23,500 children (2.5%) who are be-havior problems (Needs of Exceptionl ChUdren: Leaf-let No. 74, p. 4, by Elise Martens, U. S. OflBce of Education, Federal Security Agency.) How Many Children Have Cerebral Palsy 7 out of every 100,000 population are born with cerebral palsy. Of the 7, at least 4 are educable. (Dr. Winthrop M. Phelps: "The Doctors Talk It Over" —^page 4, August 5, 1947.) SUGGESTED MATERIAL FOR USE IN EDITORIALS Article X of the Crippled Children's Bill of Rights says: "Not only for its own sake, but for the benefit of society as a whole, every crippled child has the right to the best body which modern science can help it to secure; the best mind which mod-ern education can provide; the best training which modern vocational guid-ance can give; the best position in life which its physical condition, perfected as it best may be, will permit; and the best opportunity for spiritual develop-ment which its environment affords." This is the eventual aim of the League for Crippled Children. As yet, funds and workers have not been ade-quate to supply all the services which would be required to provide this ideal program, but it is hoped that all can be made possible in the near future. The dawn of this Easter Season lights a world in search of a formula for world peace. Men of goodwill every-where are planning for reconstruction and rehabilitation. You, the friends of crippled children, have a significant share in this planning. Thousands of yoimgsters, handicapped with little crippled bodies, lack of vision or hear-ing, are asking you for the opportunity of taking their rightful place in the life of America. These children are not asking for charity—all they want is an even chance with their non-handi-capped brothers and sisters. Each Easter Season you are invited to take part in furnishing the oppor-tunities needed for providing that even chance — medical treatment, educa-tional advantages, artificial appliances, crutches, wheelchairs, transportation to clinics, vocational guidance, psycholog-ical service, and recreation. In considering your contribution, imagine: the bright face of a crippled boy having his first experience at walk-ing; hospital and home classes for children eager to learn, but denied the privilege of going to school; special teachers and counselors helping chil-dren accept their disabilities and train-ing them to make the best use of their assets. The success or failure in life for a disabled child depends greatly upon the early assistance and understanding he is given to help him overcome his handicap. This is one of our great op-portunities— and responsibilities ! Amer-ica's children will bear the responsibil-ity of our Nation's tomorrow. Crippled children will have to share this respon-sibility, and should certainly be pre-pared to do their part. Please join again the partnership which provides oppor-tunity for those crippled by inheritance, birth, disease, infection, or injury. IT IS EXPENSIVE TO BE HANDICAPPED Only 63,000 handicapped children in North Carolina! A small group when you consider that there are approx-imately 1,000,000 school children in our state! That is, unless one of these handicapped children happens to be yours—then it means nothing that 6 children out of every 100 are physically disabled in some way. Your chUd is your world and the fact that he is one of the 6% instead of the 94% makes the 6% loom far larger than the 94% ever could. Why? Because you cannot help but wonder why your otherwise beautiful baby should have had to be aflaicted in some way—whether by January, 1948 The Health Bulletin 11 accident, birth, disease, infection, or inheritance, matters little—the impor-tant thing is that he cannot walk, or talk, or hear, or see, or (and sadder still) is incapable of thinking intellig-ently. Then, besides the fact that he is denied the use or partial use of one of his faculties, it is very expensive to have that extra care he needs provided for him. Medical care, especially for the crip-pled child, often runs into years—one operation must be performed and then there is a waiting period while the in-cision heals and the child becomes accustomed to the change in his arm, or leg, or body, and then there is an-other operation and another wait, again followed by others. This costs heavily for the physician who does the operating must be highly specialized or the results may not be those de-sired. Follow-up care during the time between operations is expensive, too, for it is necessary to have someone who understands the nattire of the surgeon's work to help in supervising the child's care between operations if best results are obtained. Sometimes well meaning relatives with more senti-ment than understanding, do things which retard the treatments. They "feel sorry" for the little child who with every step he takes must carry a brace which weighs pounds on his too thin leg, so they take it off, or loosen a bandage, and so cause his limb to heal in a different way from what the physician intended. This may make it necessary for an additional operation to be performed, so the child must suffer one more than would have been needed if the results the surgeon ex-pected had been secured with each operation. Education, too, for the exceptional child is more costly. If he cannot come to school and take the classes offered there as they are, then school must be brought to him. Perhaps he can get to school but arrangements must be made in the classroom to pro-vide special equipment, or teachers must be employed who have a particu-lar type of training in special tech-niques which make it possible for her to communicate with the child who does not hear or talk or who does not see to learn to understand the world which is around him. Then there is the fact that the everyday things which everyone must have are higher for the child who is partially disabled. Think of the necessity of purchasing two pair of shoes each time a change of shoes is needed. The child whose crippled foot is smaller than his nor-mal one must have two entirely dif-ferent sizes or be very uncomfortable. The child whose paralysis affects the hips and lower extremities often de-velops shoulders far out of proportion, and a suit of one size would not fit both the upper and lower portions of his body, and many other things could be mentioned which cost more for the crippled child because they must be different and cannot be bought from the stock on the counter. For other handicapped children, the aids toward helping offset their limita-tions also are costly. The hearing aid, glasses, artificial appliances, braces, and even irregular teeth call for the work of a specialist and a long series of treatments—all of which cost more than can be afforded by an average man on an average salary with an average family to support. Oftentimes, the handicapped child is provided with his needs at the expense of food for the other children. If this continues over a long period of time a total family becomes undernourished and subject to any disease which may be prevalent. IT IS TERRIBLY EXPENSIVE to be handicapped and to offset some of that abnormal cost such organizations as the North Carolina League for Crip-pled Children have been established and have functioned for several years. This has been possible because the "Good People" of North Carolina have graciously and generously supported its program of services to handicapped children. 12 The Health Bulletin January, 1948 SPECIAL EDUCATION This has long been of special interest to the North Carolina League for Crip-pled Children, Inc. For that reason the League is cooperating with the State Department of Public Instruction, and others, in introducing to the Legisla-ture a plan for providing these Ex-ceptional Children with the techniques and facilities needed for making edu-cation available to them. Some children are less fortunate than others, both physically and mentally, and need special consideration in order that they may secure the kind of an education which will be usable to them. It seems right that North Carolina should consider the specific needs of all the children in the state and pro-vide the facilities for meeting those needs. For the exceptional child to have equal opportimities with the non-handicapped child, extra provisions both in training techniques and class-room facilities must be made available. The 63,000 (or more) handicapped chil-dren in the state deserve an education, too—in fact it will be far more expen-sive to fail to educate them than the extra cost of the extra provisions need-ed now to give them the correct edu-cational opportunities. Notes And Comment By The Acting Editor JOSEPHUS DANIELS—Public Health lost a powerful friend when death end-ed the long and useful career of Josephus Daniels. Public health work-ers, particularly the old timers, appre-ciate the service which he had render-ed. Many eialogies have been written but none can better express the feel-ing which public health workers have for the memory of Josephus Daniels than Mr. William H. Richardson's, who for the past ten years has been a public health worker. Nearly forty years ago Mr. Richard-son worked as a cub-reporter for the News and Observer under the direct supervision and tutorage of Mr. Dan-iels. Since that time he has been re-garded as one of Mr. Daniel's boys. Each Saturday morning Mr. Richard-son gives a radio broadcast over Sta-tion WPTP of Raleigh. His broadcasts deal with public health problems and personalities. His broadcast of January 17, 1948 is as follows: Today's broadcast is not about Public Health, per se, but about a man who gave Public Health his whole-hearted support because it fitted into the pat-tern of his philosophy of life—Josephus Daniels, whose mortal remains will be laid to rest this afternoon in Oakwood Cemetery, in Raleigh, beside his be-loved wife, who walked at his side for more than a half century. Though friends will mourn today at his grave-side, the spirit of this great and good man has taken its place in the firma-ment of everlasting fame, there to shine for generations to come and to inspire men and women to nobler living. His exemplary habits did not con-stitute the cause of Josephus Daniels' greatness; they were the results of something basic that seemed to dom-inate his life from the beginning. He was as manly as a Hercules—as gentle as a woman. His thorough mastery of the English language made it un-necessary for him to resort to pro-fanity; his respect for the human body, as a temple dedicated to the spirit, excluded those things which harm the body. His life and personality con-stituted a living example of perfect health—that is, physical, mental and moral health. To him, the three were inseparable. He understood and was sympathetic January, 1948 The Health Bulletin 13 with the problems of the poor, the weak, and the underprivileged, whose cause he forever championed. As Dr. Carl V. Reynolds, State Health Officer, so aptly stated in his tribute, published in the News and Observer yesterday morning: "He talked with kings, but the language best understood by htm was that of the common man." Though 85 years old when stricken down by his last illness—the only really serious illness in his long life — he was young in spirit, and lived in the future, rather than in the past. He indulged in retrospection only to the extent that he viewed the past as a fitting foundation for the future something to be improved upon. He was not a destmctionist ; his respect for the traditions of his people was profound, yet when tradition conflicts with progress, he championed the lat-ter. When he put down his little stub of a pencil, with which he wrote all his editorials, and went to bed for the last time, he went not to dream of the past but to plan for the future—to plan, for example, the writing of the book he intended to give the world on his one hundredth birthday. Only recently, this great American made some observations, which were given on one of these broadcasts, but which wUl bear repeating. "What do you think a man 65 years old ought to do?" he was asked, arovmd Thanksgiving Day, last year, as the 85-year old editor and publisher sat at his desk in his News and Observer office, writing editorials with his stub of a pencil. "Why, he ought to keep on working, if he is able," he replied. "In fact, a man ought to work just as long as he is physically fit and mentally alert. (He was both). There may be exceptions," he went on, but I think that ought to be the rule. When a man gets 65, we'll say, he can do one of several things. If he is physically and mentally fit, he can keep on at what he is doing, imtil such a time as he feels he can no longer do jiistice to the job he is working at; or, if he has made adequate provision for it, he can go into voluntary retirement. If he belongs to no retirement system, he can look around for generous or well-to- do relatives who will take him in as a permanent charge. If there are no such benefactors handy, he can go on charity and let the taxpayers sus-tain him. But no person who is capable of self-support, whether he be 30 or 80, should be required to live at the ex-pense of others. Just so long as the body is strong and the mind Is active, every human being who wants to should be allowed to continue to make his contribution to a well-ordered economy, commensurate with his abil-ity." And then, with a twinkle in his eye, he smiled and said: "Why don't you write a piece or make a health broadcast about the value of old peo-ple?" The suggested broadcast was made, over this station. A copy of the script was mailed to Mr. Daniels, and the following Sunday it was printed, in part, in the News and Observer. Public Health had no stronger sup-porter in North Carolina than Josephus Daniels. He advocated larger legisla-tive appropriations for this important work, always maintaining that it was poor economy to undertake to save dollars and cents at the expense of human welfare. To repeat—that was a part of his philosophy of life: The protection of the weak, the sick, and underprivileged—and of little children. And again referring to the philos ophy of life that marked the activities of this great humanitarian, in whose memory flags are flying at half staff-none ever criticized that. There were those who differed with Josephus Dan-iels about his philosophy of govern-ment, but none who questioned hia sincere concern for the common man. Seeing the multitudes, he, like the Master of Galilee, "had compassion upon them and was moved by their infirmities." It was the privilege of your speaker, if you will pardon just this one per-sonal reference, to join the staff of the News and Observer forty years ago 14 The Health Bulletin January, 1948 next September, as a cub reporter. Mr. Daniels was then and until the time of his death���affectionately known as "the old man." It was an expression of the respect, confidence and affection which association with him engender-ed in the hearts of those who knew him at close range. To him, the young-est cub reporter was as much of an entity as the city editor, or the manag-ing editor: and from the humblest member of his staff his mind always was open to suggestions. There may be some listening in this morning who remember the buggy with the fringe around the top, in which Mr. Daniels used to ride each Simday morning to the Edenton Street Meth-odist Sunday School, where he taught a class of "A&M", boys. He referred to his class as the "Amen" class. "Miss Addie," his wife, was a Presbyterian — he went to his church and she went to hers, each as devoted a Christian as ever blessed North Carolina. No matter what might have been his views about economics and politics — and purely civic affairs—Josephus Daniels always defended religion, as a basic necessity in the life of any people. He would not—could not—tolerate any reflection or disparaging remark about the Bible or its teachings. The Book remained deposited in the ark of his heart, and any attempt to profane it drew from Mr. Daniels a sharp rebuke. Nor would he tolerate any obscene joke. He was clean of speech, and none dared to use unseemly langauge in his presence. One of the greatest fights Mr. Dan-iels ever made was not for enforced temperance, the reduction of railroad rates, or the continuance in power of the political party to which he be-longed— although he battled relent-lessly for all these. One of the greatest contributions he ever made to North Carolina was his militant defense of the hospital and medical care pro-gram, which was formulated several years previously and enacted into law by the 1947 General Assembly. He vis-ualized people in rural sections suffer-ing from the lack of adequate medical care and hospitalization, and, consis-tent with his philosophy of life, threw all the weight of his personal and edi-torial force behind the movement to correct this condition. He made a continuing war on vice — a fight that dated back to World War I, when he was asked by President Wilson to help devise ways and means designed not only to combat venereal diseases but to promote the general health of the armed forces. His news-paper was bold in its attacks on pros-titution as the chief source of infec-tion in the spread of venereal diseases and as basically immoral, and when such attacks drew the fire of critics, he failed to yield. No attempt has been made during this brief broadcast to eulogize Jose-phus Daniels; no attempt to enumerate his services to his people. He now be-longs to history, and it remains for historians to appraise his work. There may be, and doubtless, there will be memorials erected in his memory public buildings may be dedicated to him, and even statues of him may be erected in public places. Such would be fitting tributes. But the greatest of all testimonials will remain that in-scribed in the hearts of the people he loved and served. If he could have left a verbal mes-sage for those he was about to leave, it might well have been, in the words of William Cullen Bryant: So live, that when THY summons comes to join The innumerable caravan which moves To that mysterious realm where each shall take His chamber in the silent halls of death. Thou go not, like the quarry slave at night, Scourged to his dungeon, but sus-tained and soothed By an unfaltering trust, approach thy grave Like one who wraps the draperies of his couch January, 1948 The Health Bulletin 15 About him and lies down to pleas-ant dreams. In this manner, Josephus Daniels went to sleep. Amendment to Regulation No. 32 (Malaria Control) of the Regulations of the North Caro-lina State Board of Health Governing the Control of Communicable Diseases Regulation No. 32 of the Regulations of the North Carolina State Board of Health Governing the Control of Com-municable Diseases is hereby amended by adding at the end thereof the fol-lowing : 9. It shall be the duty of all local health officers to enforce the provi-sions of this regulation. Authorized representatives of the North Carolina State Board of Health and local health departments shall have authority at all times to enter, for the purpose of inspection, the premises upon which water has been impounded or upon which it is proposed to Impound water. Any person who shall hinder or pre-vent any authorized representative of the North Carolina State Board of Health or a local health department In the performance of his duty in con-nection with this regulation shall be guilty of a violation thereof. Adopted this 13th day of November, 1947. Carl V. Reynolds, M.D. Secretary and State Health OflBcer Causes of Death In 1947 Are Compared With Those In 1900 A contrast between the causes of death in the United States in 1900 with those in 1947 indicates the high status of medical care and public health prac-tice in the United States, according to an editorial which appears In the cur-rent issue of Hygeia, health magazine of the American Medical 'Association. The Hygeia editor writes: More impressive than any other de-monstration of the great progress made by medical science is a contrast be-tween the causes of death in the Unit-ed States in 1900 with those in 1947. In 1900 tuberculosis was still captain of the men of death, and more than 200 people out of each 100,000 popula-tion died from tuberculosis every year. Today tuberculosis is seventh in the list of the causes of death, and the rate has dropped to 37.2. Now heart disease is first. No doubt the increased control developed by the use of strep-tomycin and other methods of treat-ment wiU lower the rate for tuberculo-sis still further during the next 10 years. In 1900 pneumonia was second, with a rate of 180.5. In 1947 pneumonia com-bined with influenza was sixth, and the rate is now 46.1. The control of pneimionia has been brought about by new developments in its treatment, utilizing penicillin and the sulfonamide drugs, and also by the application of oxygen and new drugs for controll-ing the heart. Moreover, we have learn-ed much about the prevention of pneu-monia, treating it as an infectious dis-ease. In 1900 diarrhea and inflanmiation of the intestines were third. The rate was 133.2. It is now far down on the list—possibly 15th—and the rate has changed to 14. Such conditions are controlled by widespread application of the laws of sanitation and hygiene, the provision of pure food, pure water and particularly pure milk. The almost imiversal pasteiu"ization of milk in the United States has been a major factor in the control of diarrheal diseases. In 1900 heart disease was fourth In the list of causes of death with a rate 16 The Health Bulletin January, 1948 of 132.1 for each 100,000 population. Now heart disease has a rate of 306.6. This means that more people are liv-ing longer and that the heart event-ually succumbs to the advance of age and the degeneration of tissues asso-ciated with increased years. Nephritis or inflammation of the kid-neys was sixth in 1900 with a rate of 89. Now, as men live longer, nephritis has moved up to fifth place, but the rate is 58—far lower than it was In 1900. Great improvements have occur-red in the care of inflammations of the kidneys. Moreover, we have learned much about the prevention of such inflammations. Especially important has been the application of infections of the kidney of new drugs, such as the sulfonamides, penicillin, streptomycin and mandelic acid. The seventh classification in 1900 was unknown and ill defined diseases. The rate was 73.8. The classification has dropped out of the first 10 entirely and now is credited with a rate of 15. Eighth in the list in 1900 was hemor-rhage of the brain. Here again is an ex-ample of the effects of increasing age and the degenerations of the tissues that come with such prolongation of life. Today cerebral hemorrhage is third on the list of causes of death, and the rate is 90.5. With brain hemor-rhage we associate hardening of the arteries and the breakdown of tissue. Ninth in 1900 was accidents, with a rate of 65.4. In 1947 accidents moved up to fourth place with a rate of 71.2, and motor vehicle accidents accounted for 24.1 of this enormous figure. The motor car was just beginning to come on the scene in 1900; today we have a motor vehicle civilization. Society needs to develop new and better con-trols over this hazard than those that now prevail. Tenth in 1900 was cancer, with a rate of 65 deaths for every 100,000 popula-tion. Today cancer is second in the list of causes of death. The rate has moved up to 130, and cancer accounts for 180,000 deaths every year. Physi-cians are convinced that possibly one half and at least one third of these deaths could be prevented if people were aware of the fact that cancer diagnosed early is controllable by the use of surgery, X-ray or radium. While the figures cited are cause for great congratulation and indicate the high status of medical care and public health practice in the United States, they should not be taken as an author-ity to relax our battle against the dis-eases that threaten the life of man. Research and the application of re-search in medical practice will yield answers to problems that today seem incapable of solution. The enactment of the act for establishing a National Science Foundation, which will en-courage medical research along with research in the basic sciences, will give new weapons and new powers to the hundreds of thousands of scientists who are our soldiers in the battle against disease. i Albert Donaldson Liles, Jr., born Jime 2, 1947. Foiir months old, weighs 18 pounds. Son of Mr. and Mrs. A. D. Liles at 557 Newbern Avenue, Raleigh, N. C. Mrs. Liles was formerly Lillie Ruth Love, who was a member of the State Board of Health staff. MEDICAL LIBRARY U . OF N . C . CHAPEL HILL, F'^. C. i This Bulletin, will be sent free to ony dtizen cf tfve State upon requestj Published monthly at the office of the Secretary of the Board, Raleigh, N. C. Entered as second-class matter at Postoffice at Raleigh, X. C. under Act of August 24, 1912 Vol. 63 FEBRUARY, 1948 No. 2 MEMBERS OF THE NORTH CAROLINA STATE BOARD OF HEALTH S. D. CRAIG, M.D., President Winston-Salem G. G. DIXON, M.D., Vice-President Ayden H. LEE LARGE, M.D Rocky Mount W. T. RAINEY, M.D Fayetteville HUBERT B. HAYWOOD, M.D Raleigh J. LaBRUCE WARD, M.D Asheville J. O. NOLAN, M.D, Kannapolis JASPER C. JACKSON, Ph.G Lumberton PAUL E. JONES, D.D.S Farmville EXECUTIVE STAFF CARL V. REYNOLDS, M.D., Secretary and State Health Officer. G. M. COOPER, M.D., Assistant State Health Officer and Director Division of Health Education, Crippled Children's Work, and Maternal and Child Health Service. R. E. FOX, M.D., Director Local Health Administration. W. P. RICHARDSON, M.D., District Director Local Health Administration. ERNEST A. BRANCH, D.D.S. , Director of Oral Hygiene. JOHN H. HAMILTON, M.D., Director Division of Laboratories. J. M. JARRETT, B.S., Director of Sanitary Engineering. T. F. VESTAL, M.D., Director Division of Tuberculosis. OTTO J. SWISHER, Director Division of Industrial Hygiene. WILLIAM P. JACOCKS, M.D., Director Nutrition Division. MR. CAPUS WAYNICK, Director Venereal Disease Education Institute. C. P. STEVICK, M.D., Director, School-Health Coordinating Service, Epidemiology and Vital Statistics. HAROLD J. MAGNUSON, M.D., Director Reynolds Research Laboratory, Chapel Hill. JOHN J. WRIGHT, M.D., Director Field Epidemiology Study of Syphilis, Chapel Hill. FREE HEALTH LITERATURE The State Board of Health publishes monthly THE HEALTH BULLETIN, which will be sent free to any citizen requesting it. The Board also has available for dis-tribution without charge special literature on the following subjects. Ask for any in which you may be interested. Adenoids and Tonsils German Measles Sanitary 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 Schedule. Prenatal Letters (series of nine First Four Months. monthly letters.) Five and Six Months. The Expectant Mother. Seven and Eight Months. Infant Care. Nine Months to One Year. The Prevention of Infantile Diarrhea. One to Two Years. Breast Feeding. Two to Six Years. Table of Heights and Weights. Instructions for North Carolina Midwives. CONTENTS Page Public Health Nursing Week 3-16 iHIeaji' Vol. 63 FEBRUARY, 1948 No. 2 CARL V. REYNOLDS, M.D., State Health Officer JOHN H. HAMILTON, M.D., Acting Editor Public Health Nursing Week THE fourth annual National Public Health Nursing Week, sponsored by the National Organization for Pub-lic Health Nursing, will be celebrated the week of April 11 through the 17th. This week will give communities all over the country the opportunity to present to the people of the United States a concerted story of public health nursing—its past accomplish-ments, present needs and future goals. The following excerpts from Special Messages from Special People sent out by the National Organization for Pub-lic Health Nursing help to dramatize the theme "Help Your Public Health Nurse Help Your Community." From Ruth W. Hubbard, R.N., Pres-ident, National Organization for Public Health Nursing-: "Our first objective in 1948 is to con-tinue our efforts to make the work of the public health nurse known to every person in these United States so that no individual will be in need of the service of the public health nurse and be at the same time unaware of her existence. Our second objective is to recruit to this branch of nursing an increasing number of young women who will find challenge and satisfaction in the opportunities for service which it offers." From Thomas Parran, Surgeon Gen-eral, U. S. Public Health Service and member NOPHN Sponsoring Commit-tee for the "Week": "The Public Health Nurse typifies the traditional ideal of nursing. "Caring for the sick and furthering health in the home, her position has always been one of vital importance. Now, however, with shortages of hos-pital beds and the modern medical practice of sending patients home early from the hospital, the need for an in-creased supply of Public Health Nurses is greater than ever. "These nurses visit yoiong mothers who return home with babies only a few days old. They give essential care to patients with long-term illnesses, enabling them to go home earlier and thus releasing hospital beds for acutely ill patients. At home, with public health nursing care, these patients often show great improvement. "In addition to these expanded du-ties. Public Health Nurses carry out an increasing number of community-wide services to protect and improve the health of all. They explain the need for immunization. X-ray exam-ination, proper nutrition, child care, adequate sanitation, and other health measures. They assist the private phys-ician by helping his patients carry out his instructions for regaining health. "Public Health Nurses make more than 16 million visits to homes in a year, giving approximately 42 million hours of nursing service, much of which is devoted to bedside nursing. Their work is basic—involving the very fundamentals of nursing. The service of the Public Health Nurse in the home spells the difference between comfort The Health Bulletin February, 1948 and suffering and sometimes even be-tween life and death. "A special week has been set aside to pay tribute to the Public Health Nurse. This year let us honor her by making National Public Health Nurs-ing Week the symbol of our renewed efforts to swell the ranks of these nurses. Only 21,500 strong, they are in desperate need of additional recruits. Their responsibilities grow daily, and their forces must be strengthened ac-cordingly. Let us, therefore, make full use of National Public Health Nursing Week by pushing toward the ultimate goal of public health nursing services for all." From Mrs. Harry S. Truman, member of NOPHN Sponsoring Committee for the "Week": "My hope is that Public Health Nxirs-ing will continue to spread throughout the country and that eventually all communities may receive the benefit of this splendid service." From Kendall Emerson, M.D., Man-aging Director, National Tuberculosis Association: "The public health nurse has an especially important role in the tuber-culosis control program. Her assistance in case finding, in follow-up and in rehabilitation of patients cannot be too strongly stressed." laboratory in discovering the imder-lying causes of disease. Our Health Departments, our hospitals and the trained personnel of the medical, nurs-ing, dental, engineering and allied pro-fessions could not, however, have ac-complished such results without a final line in the chain—the public health nm'se. She renders the direct profes-sional services in the home; but she is also the messenger of health, the point of contact with the individual family, the ultimate channel through which the knowledge and the resources of the health sciences are actually brought to the men and women and children whom they are to serve. At one end of the chain are the Pasteurs, and the Listers, the Theobald Smiths and the Walter Reeds. At the other end are the 21,500 public health nurses who toil through the grimy tenement streets, or ride over the Appalachian Mountain passes, or bring succor to the residents of the rockbound islands off the Maine coast. The public health nui'se is the spearhead of our attack on preventable disease, the preacher in the home of the gospel of health." From Mrs. Franklin D. Roosevelt, member NOPHN Sponsoring Commit-tee for the "Week": "Public health nursing service is probably the greatest bulwark in the preservation of good health in our communities." From C. E. A. Winslow, Dr. P.H., Editor American Journal of Public Health, and member NOPHN Sponsor-ing Committee for the "Week": "Since the first public health nurse was employed in New York City sev-enty- one years ago, the average life span of a citizen of the United States has been increased by a quarter of a century. This triumph has been made possible by the advances made in the From Walter S. Gifford, Chairman of the Board, Community Service Society, N. Y., and member NOPHN Sponsor-ing Committee for the "Week": "Because health is so fundamental to the well-being of individuals and fam-ilies, to national security and world order, public health nursing through all that it does in bringing health to the people, is indeed a vital service of our times." February, 1948 The Health Bulletin RESOURCES CONTRIBUTING TO TOTAL FAMILY LIVING By Mrs. Edith Bkocker, Supervising Nurse Orange-Person-Chatham District Health Department Chapel Hill, North Carolina I SHOULD like for you to think with me about the health of the families in our communities. The constitution of the World Health Organization which was signed by fifty-one members at the International Health Conference in New York in 1946, defines "health as a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity." This definition is so broad and so all in-clusive that it helps us to set for our goal—optimum health for each world citizen. If we accept this challenging defini-tion then we can explore and use the resoui'ces with which we have to work and will support all the projects for research, for we need more scientific information and better methods of pro-cedure. Some one has said, "Certainty is illusive and repose is not the destiny of man." Optimum health for everyone means that every human being of whatever race, religious or political belief, econ-omic and social status has the funda-mental right to the enjoyment of the highest attainable standard of health. Since most of us are public health workers, we will probably think first of the protective functions of the local health departments and in 1947 sixty-six per cent of our population is under the supervision of an organized health department. Forty million are without. We can be proud that health depart-ments had theii" origin in communities and that they were organized to fill a real need, even if the needs were to abate epidemics and to give medical *This article was presented at the State Public Health Meeting in Charlotte, November 3, 1947. care, of a sort, to those who through age, poverty or misdemeanor had be-come the wards of the community. We here are in the army of the Preven-tioners. Dr. Parran says that "Preven-tion and treatment are two sides of the same coin." It takes both. I do not need to remind this audience of the six functions of the local health departments nor do I need to review for you the duties of the personnel. We know so well that public health workers are not dispensers of health but teachers of healthful living. Many health departments are becoming out-standing adult education centers where classes are held for expectant parents, baby sitters, food handlers, those in-terested in studying infant care and child guidance, nutrition and other subjects. We are aware of the tourniquet of safety that the sanitation department throws around our homes, schools and communities. Their progress includes practical preventive measures against diseases that are milk-borne, carried by polluted water, insects and unsafe disposal of wastes and sewage; so that we can have safe water, a safe milk supply, meats, foods, graded cafes, restaurants, and markets. Along with the environmental sani-tation program the Health Department staff has gone out strongly for immun-ization procedures. No longer do epi-demics of smallpox, diphtheria and typhoid fever wipe out whole families in our community. The pest houses are gone. In many areas, tuberculosis and venereal disease have been and still are, great problems. These two dis-eases upset the equilibrium of the fam-ily probably more than any others and it has been the work of the health de-partment staff to help these people to 6 The Health Bulletin February, 1948 adjust to these disturbances in the family unit. Help with health programs in the schools is an important part of health department work. It is said that ninety-five per cent of the babies born in the United States are in good physical con-dition at birth but by the age of four years, each of them average three phys-ical defects not counting carious teeth. The program of physical defect de-tection and correction is extremely im-portant to a child's progress and happi-ness in his school life. All of us will agree that health development of a child is of basic importance to his ability to live harmoniously in a chang-ing total environment. To many it may seem that our pub-lic health services (to the family) in the field of prevention are not very dramatic or too helpful. But the es-sence of prevention is to see that "nothing untoward happens" to any one in the community. It may not be "news" that the Hodunk family escap-ed typhoid fever, but each of us is glad that life expectancy has been in-creased to about sixty-five years (sixty-nine for women) and that tuberculosis has gone down from near the top to seventh place on the list of the ten leading causes for death. The resources of the local health de-partment touch a child before he is born if his parents attended the Plan-ned Parenthood clinic or if his mother needed clinic or public health nursing service or if his progenitors attended classes for expectant parents. His birth certificate will be recorded by the Vital Statistics Department of the Health Department. He may be taken to the Health Depatrment while he is an in-fant for protectives and health super-vision at the Well-Baby Conferences. During his school life he will probably be inspected and examined and edu-cated on health matters by members of the Health Department staff. If he attends U.N.C. he will have his chest X-rayed by Health Department equip-ment and he might go to the Health Department for a premarital blood test. Then the story begins again. If we interpret health as the preser-vation of a state of equilibrium in which the individual or family can best realize their potentialities for a full and satisfactory life then we must utilize resources other than the local health department. Every well-organ-ized health agency augments and sup-plements its program with that of other agencies working for good health in the community. Such groups as the tuberculosis so-ciety, service clubs, medical societies, League for Crippled Children, child guidance clinics, dairy councils, wel-fare agencies, church organizations, cancer societies. Red Cross Chapters, and others give financial assistance and direct service and conduct educational programs. Many of these agencies are local chapters of state organizations which, in turn, are part of a national set up. It is the belief of many people that the government has a responsibility for the health of its people which can be fulfilled only by the provision of adequate health and social measures. The government cannot dispense health any more than a member of the local health department. Every person will have to actively cooperate with the agency and work for his own health. Parents are still responsible for the health of their children and themselves in our country. A man's home is still his castle, even though it isn't always a safe one. Many of us have been to typhoid clinics and seen parents bring their children for immunization but back off themselves. Citizen participa-tion is particularly important in public health. However, when families are not able to provide medical care for them-selves then the government, if it fol-lows the traditional democratic pattern, is the servant—not the master—of the people, and must make available med-ical care. National good health is no accident. It is dependent upon a high level of education, a sufficiently high income among all groups of the population, February, 1948 The Health Bulletin good and safe sanitation, proper nu-trition and prompt and adequate pre-ventive and remedial medical care. We say that the family unit is the founda-tion of our civilization, then we must work for optimum health for each member of the family so we may have a happy community. Health is as com-municable as disease in families and communities. A STUDENT NURSE LOOKS AT PUBLIC HEALTH By Lelon Lambe, Student Nuese Highsmith Hospital School of Nursing Favetteville, North Carolina MY two weeks at the City-County Health Center gave me an oppor-tunity to observe and to assist in var-ious public health nursing activities. I learned that many phases of work go to make a good public health program. It was interesting to learn that each nurse is assigned to a district and in this district she is more or less re-sponsible for carrying on all phases of public health nursing. Sanitarians are also assigned a district, and are responsible for the protection of the community's health, through sanitation activities. The nurse visits selected families in her district and tries to motivate them to a higher standard of living. Cases are selected in order of their impor-tance, and include: communicable dis-eases, maternity and infancy cases, pre-school and school children. A great deal of the work is handled in clinics which function specifically for each service. At the time that I was at the Health Center, preschool clinics were the chief ones being held. I learned, though, that many other clinics such as immunization, tuberculin testing. X-ray, and midwife classes are con-ducted at planned intervals. Following is a list of the types of clinics and a brief summary of each service which I observed or with which I assisted during the two weeks at the Health Center: A. Maternity and Infancy 1. A weekly Maternity Clinic offers prenatal service and post-partum ex-amination; also contraceptive advice to mothers who need it. There is an av-erage attendance of 40 patients per clinic. In this clinic expectant mothers are interviewed, examined, and records are filled out accordingly. They are given a blood test for syphilis; their hemoglobin is checked and a urinalysis is done. A local obstetrician examines all expectant mothers on their first visit, and at their last scheduled visit before the baby arrives; and when they return for their six weeks post-partem examination. Advice and literature on maternal and infant care are given. Those who are interested are then re-ferred to a nurse who instructs them regarding how they may plan for the next baby. Patients needing medical or surgical care are referred to their fam-ily physician, or to the welfare agency which assists them in securing the needed care. 2. Over thirty per cent of the babies delivered in Cumberland County are delivered by trained midwives. These midwives are taught and supervised by the public health nurses. They are al-lowed to accept only normal cases, are well informed as to abnormal symp-toms, and call a doctor when they feel that they are not qualified to handle the case. All expectant mothers are re-quired to have pre-natal care by a private physician or at a clinic before the midwife is allowed to accept the case. Following delivery the midwife reports the case to the Health Center and the nurse visits the mother and baby for the purpose of checking the 8 The Health Bulletin February, 1948 condition of both for abnormal con-ditions. B. The Well-Baby Clinic Mothers bring their babies and pre-school children to this clinic in order that they may maintain good health. Each patient is carefully questioned by the nurse as to her child's condition and is advised regarding diet and habits. A local pediatrician examines each child and makes necessary recommen-dations for health maintenance. Im-munization against whooping cough, diphtheria, and smallpox are given at this clinic. Babies needing medical and surgical care are referred to their priv-ate physicians. Literature on child guidance and care is given to each patient. C. Pre- School Clinics Pre-school clinics are conducted each spring in order that children of pre-school age be better qualified physical-ly for the beginning of school. Children attending these clinics are from two to six years of age, most of them being those who will begin school the follow-ing fall. They are weighed, measured, and ex-amined by the attending physician who looks for any abnormal conditions and refers them to their private physician for any necessary medical or surgical care. Those children who have not already received the required vaccines for school entrance (diphtheria, whoop-ing cough and smallpox) may receive them at this time. Advice and litera-ture on child care are given the par-ents. The nurse keeps a record on each child examined, and those who have defects are visited during the summer months to assist, if needed, in obtaining corrections. D. Tuberculosis Control Persons who have been in contact with tuberculosis may have their chests fluoroscoped at a weekly diag-nostic tuberculosis clinic conducted by the Health OflEicer. This may also be done for routine personal health pro-tection. If tuberculosis is found they are referred to a sanatorium for treat-ment. The nurse visits these patients in the home in order that she may teach them precaution technique and general care. Arrested cases, and all contacts, are routinely visited by the nurse. Dur-ing the past year all of the high school students of the county were offered the tuberculin test and positive reactors were X-rayed. E. Venereal Disease Control Venereal diseases are found through routine examination for health cards, premarital and prenatal serological tests, examination of contacts of known cases and cases who voluntarily re-port. A nurse interviews each case. The contacts are then visited and ask-ed to report to the Venereal Disease Clinic for examination. Syphilis cases are referred, in the early stages, to the U. S. Public Health Service Rapid Treatment Centers for therapy. Gonor-rhea cases and contacts are given peni-cillin and negative cultvires are obtain-ed before the case is released. A few cases receive treatment for syphilis at this clinic, but the majority are for diagnosis and follow-up examinations. P. Orthopedic Clinic A clinic for handicapped children and adults is held at this center month-ly, serving five counties. This clinic is conducted by an orthopedic specialist and a pediatrician who examine the patients and make recommendations for treatment. Adults who are handi-capped and need assistance in training for a vocation for which they are physically suited, or need other assist-ance are counseled by a representative of the N. C. State Rehabilitation Pro-gram. G. Daily Clinic Services A clinic nurse is on duty daily for the purpose of giving service and ad-vice to all who come to the Health Center. She is responsible for registra-tion, for assisting in examining food handlers, domestic servajits, taxicab drivers, and for giving immunization against typhoid fever, whooping cough, diphtheria and smallpox. Indigent February, 1948 The Health Bulletin county cases are also given simple treatments in this clinic. Other major activities and functions of the Health Center which I had an opportunity to observe are: A. Sanitation Program Three sanitarians serve in this de-partment for the purpose of protecting community health through inspection of dairies, food handling establish-ments, public buildings, and for giving advice on installation of private water supplies and excreta disposal systems. I went out on one inspection tour. B. Laboratory Service Specimens for diagnosis of syphilis, gonorrhea, tuberculosis, malaria, and intestinal parasites are examined in the local laboratory. Milk is examined to determine its safety, quality, and butterfat content. Many specimens are sent to the State laboratory. Specimens of rural water supply are also sent to the State laboratory. (The city watel supply is examined in the water plant laboratory.) C. Health Education A trained health educator works in cooperation with members of the staff, the schools, and other agencies to fur-ther interest in public health among groups in the community. This is done through movies, radio, newspapers, dis-tribution of literature, and planning with groups on health programs. D. Vital Statistics Births, deaths, and communicable diseases are reported and are on file at the Health Center. From the stand-point of public health these facts are very necessary in evaluating the work and planning the program. I thoroughly enjoyed my two weeks at the Health Center, and would like to have remained longer. This short period, however, served to give me in-sight into the close relation between hospital nursing and public health service. It also made me aware of the unequaled opportimities for service which the public health nurse enjoys. MENTAL HYGIENE IN PUBLIC HEALTH NURSING By Mary F. Porter, R.N., Clinical Assistant Mental Hygiene Clinic, Charlotte, N. C. IT is good to talk of Mental Hygiene to public health nurses who daily experience the puzzlingly inadequate inter-personal relations between mem-bers of the same household and be-tween the family and the community; between the families of school children and their teachers; between the indus-trial worker and his employer, and pos-sibly between the public health niu-se and the family. No group of people is more advantageously placed than you to recognize the need of and to apply in your daily contacts the principles of Mental Hygiene. *Given at the Public Health Nurses Section of the N. C. Public Health Association, Charlotte, N. C, Novem-ber 4, 1947. One of your national associates, Ruth Gilbert, who was trained as a public health nurse, then added to that the special education of a psychiatric so-cial worker, wrote an excellently bal-anced book published in 1940 by the Commonwealth Fund and called The Public Health Nurse and Her Patient. Dr. Frank Walker, commenting on Ruth Gilbert's emphasis on the con-tribution Mental Hygiene may add to the contacts made by public health nurses, writes: "This contribution seems in the last analysis to be the engender-ing of a state of mind which enables the nurse with confidence to analyze and imderstand her own reaction to-ward nursing service; to appreciate, understand, and frequently do some-thing about the reaction of persons 10 The Health Bulletin February, 1948 physically or mentally ill; to recognize shoal waters and hidden rocks in fam-ily situations which may wreck the lives of growing children; and to carry her part of the team play which is necessary if there are to be effective relationships with Public Health nurs-ing and between it and allied agencies." In those few lines is boiled down the very heart of the attitude I should like to bring you today. First, "the en-gendering of a state of mind which enables the nurse with confidence to analyze and understand her own re-action toward nursing service." For example: Do you know why you chose the field of Public Health nursing out of all the specialties open to you in the nursing field? Why do you find your-self completely at ease in the Jones' home and dread going to the Brown's? The interaction of personalities always depends on at least two people and you or I are one of those two. You have doubtless long ago realized that when you are able to take yourself com-pletely off your own mind your pa-tients respond better. You get better results; and that when you are harried, troubled over some baffling previous situation, anxious or unhappy, or annoyed, your patients seem recalci-trant and uncooperative. Interaction and Unity of Mind and Body. There is a psychologic, a human fact that every nurse and every social worker, everyone whose occupation centers about people and who is en-deavoring to get results with and from people needs to remember constantly; i.e., that mind and body are incapable of separation; that they are not sep-arate entities, but interact one upon the other so continually that it is often impossible to know which initiates the response. And what a tremendous po-tential influence toward better mental health in the family, school, in industry and in whatever field the public health nurse touches if she herself is groimd-ed in the recognition of this essential oneness of the individual: if she has a reasoned conviction that what af-fects the mind affects the body; what affects the body, reacts on the mind; also that she is assisting a person who is ill, not a case of a disabling fracture or measles or pneumonia; but a certain man, woman or child in a certain set-ting of family, community, economic and social situation who is ill with a disabling fracture or measles or pneu-monia; and a lot of individual folks with certain problems in common but with as many approaches to the com-mon problem as there are people of varied experience in her group. Practically every nurse today in her undergraduate classwork learns of the effect of rage and fear and of their more chronic expressions of cherished dislikes, annoyances; and of worry, anxiety, and dread upon the physical health and the intellectual and voli-tional functioning. The Irrationality of Human Beings. Miss Mary Connor states: "Public health nurses are inevitably confronted with the Mental Hygiene need at every turn." Do you realize the meaning of the fact that 58% of all hospital pa-tients are diagnosed as nervous or mental cases? And that they represent the people too ill to be adequately help-ed by you and me outside of hospital grounds? Do you recognize that it is exclusive of most of the mfldly malad-justed fathers and mothers, teachers, nurses, social workers, ministers, busi-nessmen and women, yes, lawyers, doc-tors, industrial workers, and others whose maladjustments to life are caus-ing one divorce in 4 (nearly one in 3 now) marriages? And what of the re-sultant effect on the children? That it takes no cognizance of the numberless maladjusted in so-called minor ways, ourselves and our neighbors, who through our resolved conflicts are at war with ourselves or our environment or both? Mental Hygiene As Essential Part of the Nurses' Equipment and Technique. The need of our patients for Mental Health is only an exaggeration of our own. For no psychiatric social worker, no public health nurse, can grasp the February, 1948 The Health Bulletin 11 psychologic need of her patient until she has attained a fair amount of in-sight into her own adjustments and maladjustments and an objectivity about them. Only when we grasp con-sciously the raltionship between our own tendencies under stress to revert to the rebellion of the thwarted child, or to the security or parental protec-tion and care, can we properly evaluate the rebellious adolescent or adult pa-tient, and the others who accept illness as a haven. The alert public health nurse soon recognizes from baffling experience that some of her patients just don't recover when they should, despite the doctor's assurance of good physical condition and her own best efforts; and in spite, possibly, of needed financial assistance. Then, it is certainly time, if she has not done so before, to eval-uate the whole situation, psychologic as well as physical. Why does Mrs. Brown's indigestion continue, although the doc-tor who examined her found no ade-quate cause? Why does Johnnie refuse to try to walk when his broken leg is healed? Why does John Brown insist that he has T.B. and remain invalided despite all findings to the contrary? Why does Jane have convulsions at school when the specialists can find no cause? Why does Dot have these at-tacks of excessive vomiting which in-terfere with school, and all medical examination reveals no cause? Why won't Billy eat normally despite his mother's urgent insistence? Why does the Jones' baby stubbornly resist habit training and remain at three a diaper problem? Why can't Bill at nine learn to read when the intelligence tests give him an unusually high I.Q. and the specialists find no vision defect? Why is Mr. Blank always irritable regardless of conditions? Why does not Mr. S. regain his strength now that he has otherwise entirely recovered from pneiimonia? Why can't Johnny learn in school despite his proven intelli-gence? He Is eleven and has not yet earned any promotions in two years. Hysteria may be diagnosed. But it must serve some purpose, else it would not persist. Oversuggestability? Yes, but why always toward illness and not to-ward health? The public health nurse has had lectures in psychiatric nurs-ing, but she has not specialized. She does not always realize that the emo-tional environment is often much more determining than the physical; that the tense home of marital discord, the drunken father, the humiliation of some deforming physical defect; the depressing weight of poverty or the hurt of wounded pride in having to accept relief never before needed; the lack of becoming clothes making one conspicuous before her schoolmates; the pervasive insecurity of the child who is unloved; the humiliating sense of shame about one's home condition as contrasted with those of desired ac-quaintances or longed-for friends; the loneliness of insolation; the poison of fear, worry, jealousy, hate . . . that conditions such as these may not only explain prolonged illness without ade-quate physical cause but so interfere with body chemistry and general re-sistance as to be medically accepted causative factors in furnishing the groundwork for many systemic illnesses and infections which would otherwise have been resisted. What can the public health nurse do about it? You are not psychiatric nurses, but recognizing the inescapable fact of the oneness in functioning of the mind-body you cannot escape the respons-ibility for alertness in recognizing the effect of the harmful environment, emotional as well as physical or eco-nomical, on the recovery of your pa-tient. In scores of situations your own understanding can set the patient's fears at rest; your very bearing, your kindly thoughtfulness, the helpful in-terjection of a bit of himior to break the tension of the moment, your ob-vious desire to help—these are inval-uable aids added to your proven ability to nurse or to show others how to nurse the patient for his physical ill-ness. The attitude and diagnosis of the 12 The Health Bulletin February, 1948 doctor, with your own ability which comes through increased knowledge of people sick and well, will help you to know when to disregard symptoms and get the patient's attention turned to healthier channels. For the patient who tends to cling despite your friend-ly reassurances to invalidism, psychia-tric help may be needed. Whenever symptoms continue to manifest them-selves when the physical cause is clear-ed and your own methods have failed it is wise to turn to the most available mental hygiene authority for help, the psychiatrist, private or in the clinic. For the patient who remains "blue" who sees only the dark side, who can-not seem to get hold after an illness, a psychiatrist's help in or out of the clinic may be badly needed. For the tantrum child, the child who steals and cheats ,the destructive child, the child who is not learning in school, the chronically unhappy child, the child who wants to play alone, who day-dreams to the extent of failing to meet the realities of every day; for the child who persists in prolonged mastur-bation; for the child who fails to talk at a reasonably normal age; for the prolonged eneuretic; for the stubborn feeding problem; for all of these priv-ate psychiatrists and the psychiatric clinic exist. You public health nurses have the opportunity to recognize the problem as being well or badly handled by the family and to recommend to them a psychiatrist or a psychiatric clinic; and early help may prevent later tragedy. As public health nurses you may often see the too-good child — who not only never gives any trouble but never is part of the crowd; the child who clings with all his might to his mother, who cries when away from her and who continues this over an abnormally long period; the child fear-ful of the dark and of strangers; and he usually needs wise help more acute-ly than the so-called bad child whose mischief disrupts the peace. Stubborn-ly resistant habit cases; defiant prob-lem children; the run-away child; the child who just can't learn in school; in these extremes mental hygiene help from psychiatrist or clinic is certainly indicated, while in mild expressions of maladjustment, wise handling, preven-tive mental hygiene by understanding parents, nurse or teachers may be all that is needed. But as public health nurse you see again and again the making of prob-lem children from neglect, physical, psychologic or both; from lack of love, from over-protection by parents; from overlove as the recognized compensat-ory need of parents; from school and social maladjustment. You are often in position to explain the dangers and to give acceptable preventive advice, and frequently you are the best and often the only ones to advise the parents of the urgent need of psychiatric help from specialists. Surely no profession has more need of the assistance of a Mental Hygiene approach than the one whose members come closest of any outsider to the homes where futui-e neurotics and psy-chotics are being moulded through ig-norance or neglect; and from which so many can be saved by early recognition and referral to trained psychiatric help. A PUBLIC HEALTH NURSE'S EXPERIENCE AT THE N. C. SANATORIUM By Frances Stanton, Senior Public Health Nurse District Health Department, Elizabeth City, N. C. EARLY in 1946, public health leaders in North Carolina decided that, be-cause of the increased emphasis being placed on tuberculosis control, it seem-ed advisable to give the public health nurses some special preparation in that field. In cooperation with the late Dr. P. P. McCain and Miss Eula E. Rackley, February, 1948 The Health Bulletin 13 Superintendent of Nurses at the State Sanatorium, a plan for refresher courses was worked out. The Sanatorium offer-ed to take pubhc health nurses for one month. Later this course was shortened to two weeks. The program of study was planned to include classes, obser-vation, and practical experience on the wards. Letters were sent to local health officers in April, 1946, telling of the course which was to begin in June. It was suggested that only one nurse from a given department be released at a time but eventually that every public health nurse would be given the opportunity to take the course. In June, 1947, my turn came to go. For many reasons I welcomed the op-portunity. One was the fact that tuber-culosis is our number one problem, and I felt that members of the Sanatorium staff could answer some of the perplex-ing questions connected with our con-trol program. Then, too, the nui'ses from our department who had already visited the Sanatorium gave such glow-ing reports of their stay, such as the hospitable spirit which pervaded the place, the good food, the relaxing effect of the afternoon rest hour, etc., that I was eager to go. When I arrived I found that all they had said was true. I was welcomed by Mrs. Hatos, Nursing Instructor, and shown to an apartment in the Nurses Home which two other nurses shared with me. There were six nurses in our group, representing health departments from the mountains to the coast. We had Sunday night supper together and got acquainted with each other, had a good night's rest, and began classes on Monday morning. The classes under Dr. Hiatt and Mrs. Hatos were interesting and helpful. They brought us up-to-date on the newer knowledge of the aspects, and treatment of tuberculosis. We were giv-en opportunities to observe the differ-ent types of treatment given the pa-tients. Last but not least we assisted with nursing care of the patients on the wards. This experience had a peculiar meaning for me as a public health nui'se. I feel now that when I advise a patient to request sanatorium care, that my appeal will be stronger and perhaps have more effect because back of my words there has been experience. In other words, I am certain of what I am talking about when I describe sanatorium routine to the prospective patient. One of my ward duties was to deliver mail to the bedsides. I deter-mined then to remind the folks at home to write to their patients often, and to write cheerful news. Nothing helps the morale of the patients more than to hear from home. The two weeks came to a close quick-ly. I came back to my work feeling truly refreshed. I still remember pleas-antly the spirit of friendliness which hovers over the Sanatorium community of doctors, nurses, workers and patients. The knowledge gained in classes still inspires me to try to do a better job in the control of tuberculosis. And when I grow tired, as public health nurses sometimes do, I close my eyes and re-call the restful atmosphere on the Sanatorivun hUl among the whispering pines and the rustling oak trees. When all public health nurses have visited the Sanatorium, I hope they start around again. I want to go back. HISTORY OF THE BEDSIDE NURSING PROGRAM IN WINSTON-SALEM AND FORSYTH COUNTY By Marjorie Spaulding, Executive Secretary Community Nursing Service, Inc. IN 1930, a survey was made in Wm-ston- Salem which pointed out the need locally for bedside nursing. In March 1946, on the basis of this survey, Dorothy Rusby from the National Or-ganization for Public Health Nursing 14 The Health Bulletin February, 1948 spoke to the Health and Family and Child Welfare divisions of the Com-munity Coimcil at theii* request. Fol-lowing her visit she sent a report of a "Proposed Plan for Providing Bedside Care in Forsyth County." The Health Division of the Com-munity Council set up a Bedside Nurs-ing Committee who investigated local need and recommended action. This group contacted the Medical Society, Health Department, U. S. Public Health Service, three hospitals, and the heads of social agencies. A budget and an organizational plan for a combination agency (Service set up in the Health Department) was completed. A special committee presented the need to the Commimity Chest, who in turn contacted the Kate Bitting Rey-nolds Estate in June, 1947. These trustees approved a grant to institute and operate the nursing pro-gram during its first year with a reason-able assurance of future support. On the Community Council's recom-mendation, the Community Nursing Service was admitted as a member agency to the Community Chest in July, 1947. The Community Council or-ganized the board of the Community Nursing Service July 29, 1947. The board consisted of 24 representative citizens and the Health OfBcer. A nurse loaned by the United States Public Health Service became Executive Sec-retary of the Board and Assistant Nursing Supervisor in the City-Coimty Health Department. The Community Nursing Service be-gan hiring personnel August 1, 1947 and have added four nurses and one clerk to the Public Health Nursing staff. These public health nurses were placed in the City-County Health De-partment. All public health nurses (em-ployed by the City-County Health De-partment and the Community Nursing Service) include bedside care in their generalized public health nursing pro-grams. A proportionate amount of the total nursing time is spent in this new service. The City-County Board of Health, Medical Society, Board of Alderman and County Commissioners approved the program. The Community Nursing Service has been incorporated as a non-profit organization. On November 12, 1947, the new serv-ice became available to people in Win-ston- Salem and Forsyth County. All bedside care is given under the med-ical supervision of the patient's private physician. This service is on a grad-uated fee basis (from $1.50 an hour to free) individually decided. So far, one out of every four visits has been a full fee visit. To date (January 28, 1948) 350 visits have been made to 166 patients. WELL BABY CLINIC By Agnes Campbell, Senior Public Health Nurse Iredell County Health Department, Statesville, N. C. LAST October the Junior Service League of Statesville approached the Iredell County Health Department for suggestions for a project which their organization could sponsor. We gave them two alternatives—a well baby clinic or a dental clinic. The young women felt that the im-portance of a child's first year of life warranted the best it is possible for him to have by insuring him with the right start through a well and happy childhood. Thus, plans got vmder way to begin the clinic. Mrs. David Pressly, a most capable person, was appointed chairman of the project. The first meeting with the Junior Service Committee and the Health Department formulated plans for procedure of the clinics and for publicity discussions. The publicity was begun with a radio program, followed up with poster dis-play in downtown store windows, com- February, 1948 The Health Bulletin 15 mittee meetings in different sections of town. Discussions in the committee meet ings outlined time and place of clinic, procedure and the class work for in-formation to mothers before clinics. The results of this publicity were so very successful that not only States-ville, but all of the county were talk-ing the well baby clinic. Proof of this success, too, was the unexpectedly large attendance at the clinic—so many re-sponded in fact that there was no time for the thirty minute class periods. To take care of this situation, the fourth Thursday in each month was desig-nated as class period day. In the first white baby clinic there were twenty-five babies and fifty-four for the second clinic. The first Negro clinic brought in ninety-seven babies and eighty-nine in the second. Limited time and personnel make it necessary to include a great deal in each class discussion. There classes in-clude information for both expectant mothers and mothers with babies. Miss Anita Jones in her institute on Mater-nal and Infant Care held in Chapel Hill last September gave us many ideas for conducting this clinic and choosing the material for the class discussions. The Junior Service League is to be highly commended for their fine co-operation in this project. They send at least four volunteers to each clinic; one who registers the babies, one who controls trafQc, one who helps with the dressing and undressing of the babies, and one who helps the nurse weigh and measure the babies. Six local doctors have volunteered their service meaning that each comes twice a year to a clinic. This project shows that public health nursing truly lies in the hands of the lay public and that its ultimate success lies in a better informed public. 16 The Health Bulletin February, 1948 IDELL BUCHAN MEMORIAL LOAN FUND By Louise P. East, Chairman of Loan Fund Committee AT the annual meeting of the North Carohna Public Health Associa-tion which convened in Charlotte, Nov-ember, 1947, the members of the Public Health Nurses' Section voted unan-imously to raise and perpetuate a loan fund in honor of Miss Idell Buchan who died June 7, 1947, after 28 years of service as a public health nurse. Miss Buchan was known and respect-ed throughout the length and breadth of North Carolina, and she was beloved by a host of friends of all ages and walks of life. The loan fimd committee plans to raise the sum of $500.00 which will be administered from Chapel Hill for the benefit of public health nurse students from North Carolina who attend the School of Public Health at the Uni-versity of North Carolina. No funds will be personally solicited for this memorial fund, but to friends of Miss Buchan who knew of her un-tiring efforts in promoting good health for the citizens of the State and her interest in better education and prep-aration of young nurses, we offer the privilege of contributing to this fund if they care to do so. Contributions should be sent to Miss Margaret Blee, School of Public Health, University of North Carolina, Chapel Hill, North Carolina. A TRIBUTE TO MISS LAURA NIBLOCK, A PUBLIC HEALTH NURSE By Miss Amy Louise Fisher, R.N. Supervising Public Health Nurse State Board of Health, Raleigh, N. C. AFTER several months of illness. Miss Laura Niblock was released from suffering and passed to her re-ward on December 29, 1947. She leaves behind two sisters—one a missionary in Siam and the other a nurse in States-ville. She will be missed by her co-workers in public health. She was a graduate of Long's Sanatorium School of Nursing in Statesville and took the course in Public Health Nursing at George Peabody College, Nashville, Tennessee. After working in Tennessee and Virginia, she returned to North Carolina and was employed as a Pub-lic Health Nurse from September, 1936 until she resigned because of illness in August of 1947. A letter from Dr. Alfred Mordecai, the last health officer with whom Miss Niblock worked in the Davie-Stokes- Yadkin District Health Department, pays a flitting tribute to her memory: "Miss Niblock served under me for nearly two years, and I came to know her well. She was a woman of fine character, well informed, resourceful, dependable, and efficient. She was a willing worker and a cheerful worker — even under trying circumstances. She came up in the days when people re-spected authority and earned all they made, and she never changed. She was able to carry on by her own initiative to a great extent and exercised good judgment at all times. She always faced life and its trials bravely with-out a whimper, and I became very fond of her. She accepted her hopeless affliction without fear or quavering and faced death with the same gameness that she had faced all the trials of life." MEDICAL LI BRARY U . OF N . C . CHAPEL HILL. N. C. ^ TI wlmm I This Bulletin will be sgrvt free to ony citizen cjf the State upon request Published monthly at the office of the Secretary of the Board, Raleigh, N. C. Entered as second-class matter at Postoffice at Raleigh, N. C. under Act of August 24, 1912 Vol. 6i MARCH, 1948 No. 3 MEMBERS OF THE NORTH CAROLINA STATE BOARD OF HEALTH S. D. CRAIG, M.D.. President Winston-Salem G. G. DIXON. M.D., Vice-President -••; Ayden H. LEE LARGE, M.D ^°^J^y ^o*^' W. T. RAINEY, M.D FayetteviUe HUBERT B. HAYWOOD, M.D u -n J. LaBRUCE WARD, M.D AshevUle J. O. NOLAN, M.D Kannapolu JASPER C. JACKSON, Ph.G Lumbcrton PAUL E. JONES, D.D.S FarmviUe EXECUTIVE STAFF CARL V. REYNOLDS, M.D., Secretary and Sute Health OflScer. G. M. COOPER, M.D., Assistant State Health OflBcer and Director Division of Health Education, Crippled Children'* Work, and Maternal and Child Health Service. R. E. FOX, M.D., Director Local Health Adminiitration. W. P. RICHARDSON, M.D., District Director Local Health Administration. ERNEST A. BRANCH, D.D.S. , Director of Oral Hygiene. JOHN H. HAMILTON, M.D., Director Division of Laboratories. J. M. JARRETT, B.S., Director of Sanitary Engineering. OTTO J. SWISHER, Director Division of Industrial Hygiene. WILLIAM P. JACOCKS, M.D., Director Nutrition Division. MR. CAPUS WAYNICK, Director Venereal Disease Education Institute. C. P. STEVICK, M.D., Director, School-Health Coordinating Service, Epidemiology and Vital Statistics. HAROLD J. MAGNUSON, M.D., Director Reynolds Research Laboratory, Chapel Hill. JOHN J. WRIGHT, M.D., Director Field Epidemiology Study of Syphilis, Chapel Hill. FREE HEALTH LITERATURE The State Board of Health publishes monthly THE HEALTH BULLETIN, which will be sent free to any citizen requesting it. The Board also has available for dis-tribution without charge special literature on the following subjects. Ask for any in which you may be interested. Adenoids and Tonsils German Measles Sanitary Privies Appendicitis Health Education Scabies Cancer Hookworm Disease Scarlet Fever Constipation Infantile Paralysis Teeth Chickenpox Influenia Tuberculosis Diabetes Malaria Typhoid Fever Diphtheria Measles Venereal Diseases Don't Spit Placards Padiculosis Viumiiu Endemic Typhus Pellagra Typhoid PUcarda Flies Residential Sewage Water Supplies Fly Placards Disposal Plants Whooping Coufh 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. Prenaul Care. Baby's Daily Schedule. Prenatal Letters (series of nine First Four Months. monthly letters.) Five and Six Months. The Expectant Mother. Sc^fen and Eight Months. Infant Care. Nine Months to One Year. The Prevention of Infantile Diarrhea. One to Two Years. Breast Feeding. Two to Six Years. Table of Heights and Weights. Instructions for North Carolina Midwives. CONTENTS Page Doctor Reynolds Resigns 3 Cancer Division 3 The Public and the Medical Profession 5 Stork's Busiest Year Was 1947 8 New Public Health Nursing Course at N.C.C. In Durham 10 Inleali' l£J|| PU&U5AE:D by TML nc>R.TM CAeOUhA 5TATL eAaJgDv^MLALTM i|l2J Vol. 63 MARCH, 1948 No. 3 CARL V. REYNOLDS, M.D., Stale Health Officer JOHN H. HAMILTON, M.D., Acting Editor DOCTOR REYNOLDS RESIGNS February 19, 1948 Dr. S. D. Craig, President N. C. State Board of Health Winston-Salem, N. C. Dear Doctor Craig: For sometime divergent forces have been preying upon me;—from within, the abiding desire for "service before self," and from without, the desire of the family for my retirement. The persuasiveness of the family w^on; and, in consequence, I am asking that the Board accept my resignation as of June 30, 1948, or as soon there-after as a successor can be appointed to fill my unexpired term. All my professional life, I have had an unquenchable desire to render a service to the underprivileged masses. The past thirteen years, serving as your Secretary and State Health Offi-cer, have given me this opportunity. I have, under your intelligent direction, and with the support of well-qualified, loyal, enthusiastic directors and their personnel, given my best toward an unfinished job. I shall ever cherish my reappoint-ments as a satisfaction of services ren-dered. I have always been fond of my work, and the advances made are due to tlie united effort and enthusiastic interest in bettering the moral, mental and physical standards of life, and to lowering poverty, sickness and death, in order that we may have a happier and more abundant life. To severe my connection from the State Board of Health, is a real sacri-fice. With regards and best wishes, I am Most sincerely, r/e Carl V. Reynolds, M.D. President Craig read Doctor Rey-nolds' letter of resignation as Secretary and State Health Officer, effective June 30, 1948 or as soon thereafter as a successor could be appointed. President Craig stated that this letter showed Doctor Reynolds' big heart, big mind, and love for humanity. Because of Doctor Reynolds' resignation. Doctor Dixon moved that the Board express to Doctor Reynolds its sincere appre-ciation for the work that he has done with, and for the Board of Health, and for North Carolina as a whole, during the past thirteen years as State Health Officer, and that it is with sincere regret that they accept his resignation. Motion seconded by Doctor Haywood, and unanimously carried. CANCER DSViSION NORTH Carolina's intensive fight against cancer was launched offi-cially March 1, when the Cancer Con-trol Division of the State Board of Health began operation, with Dr. Ivan M. Procter, of Raleigh, as its director and Mildred Schram, Ph.D., of Phila-delphia, as his associate. They have The Health Bulletin March, 1948 been assigned oflBces in the Health Building, on Caswell Square. For some-time consultations between Dr. Carl V. Reynolds, State Health Officer, Dr. Procter, and others directly interested In getting the program started had been under way, with a view to work-ing out arrangements which could be put into effect immediately with the creation of the Cancer Control Division. Dr. Procter is a specialist in obstet-rics and diseases of women, and prac-ticed in that field of medicine for more than 25 years, in Raleigh. For the past five or six years, he has made an ex-tensive study of cancer, including its cause, diagnosis, management, preven-tion, and methods of control. Dr. Schram, formerly of Saint Louis, Missouri, served from June, 1932, until January of this year, as executive offi-cer of the Donner Cancer Foundation of Philadelphia, formerly the Inter-national Institute of Cancer Research, which, until its program was interrupt-ed by the war, sponsored projects in various parts of the world. During her activities in Philadelphia, Dr. Schram planned and organized a series of can-cer prevention clinics, first in five teaching hospitals in Philadelphia, the number having grown to eleven, to in-clude a group of non-teaching hospitals. She was a delegate to the Interna-tional Cancer Congress in Madrid, in 1933, a guest of the Research Institute, Royal Cancer Hospital, London, and one of eleven American women cited for service in cancer control by the American Cancer Society. The associate director arrived in Ra-leigh the first of the week, and express-ed herself as being highly pleased with the North Carolina program, which, she believes can be made an effective weapon in combatting cancer, by bringing it out into the open, where it can be attacked at its source. In pursuit of his intensive study of cancer. Dr. Procter has made personal visits to clinics in Georgia, Virginia, Pennsylvania and New York. Prior to the war, he engaged in post-graduate study in London, Berlin, Prague, and Vienna. Dr. Procter is a member of the Can-cer Committee of the North Carolina State Medical Society, also a member of the Executive Committee of the North Carolina Division of the Amer-ican Cancer Society, having formerly served as its chairman. He has pub-lished numerous articles on cancer of the breast and uterus. Authority for Program The authority for the cancer pro-gram is a legislative act of 1945, in-troduced in the North Carolina General Assembly as House Bill 786, in coop-eration with the Cancer Committee of the North Carolina State Medical So-ciety, as an advisory agency, and with the active participation of the North Carolina Division of the American Cancer Society, the program to be ad-ministered by the State Board of Health, through its newly-created Div-ision of Cancer Control. Funds with which the cancer pro-gram will be carried on are from three sources: State legislative appropriation, through the State Board of Health; United States Public Service, from Con-gressional appropriation, and the North Carolina Division of the American Cancer Society. Procter Outlines Objectives Upon assuming his duties. Dr. Procter outlined the policy to be followed in North Carolina's intensive war on cancer. "The primary object," he said, "will be to render the greatest amount of cancer control service to the greatest number of citizens of the State, in the shortest time practical." He continued: "This service will be permanent, sub-ject to future appropriations from the Legislature. "The program is to be conducted locally through the Board of Health, in cooperation with the physicians comprising the Medical Society of the county in which a clinic is located. March, 1948 The Health Bulletin The local physicians will render the professional service." Clinics: Type, Number Describing the clinical services to be available when the program gets under way, Dr. Procter said: "There will be two types of clinics. Detection clinics will be operated in both the larger and smaller communities of the State. These will be the medium of (1) screen-ing the largest number of applicants, in order to find cancer in its earliest stages and while almost completely curable, (2) to educate the public in prevention, through early diagnosis and cure, and (3) to establish annual ex-aminations among applicants. "North Carolina," Dr. Procter dis-closed, "is to have a new type of de-tection clinic. Limited examinations will serve three times as many people. The present standard detection clinic operating in the United States con-sists of a complete and detailed history, physical examination, laboratory and X-ray test. This is a health mainte-nance type of detection. "In North Carolina it will be the desire and policy of the Board to de-vote its funds and efforts to cancer detection and control, leaving the gen-eral health maintenance to the patient and practicing physician. The physical examination will be limited to those parts of the body where cancer most commonly occurs and is detectable and curable. "Disposition of those examinees who have positive findings will be referred to their personal physician. Examinees without a personal physician will be asked to select one from a list pre-pared by the local county medical society. "Cancer diagnostic and management clinics will be established in cities where the services of pathologists and other specialists are available. Suspect-ed cancers located in detection centers will be referred to cancer diagnostic clinics for final diagnosis and recom-mendation as to management. The pa-tient will be returned to his or her personal physician for treatment. "Clinics, where practical, will be con-ducted in hospitals approved by the American College of Surgeons, but all cancer clinics must be approved by the American College of Surgeons." "There will," Dr. Procter said, "be seven diagnostic cancer clinics and 10 detection clinics." Dr. Procter foresees a minimum of 50,000 examined annually after the pro-gram is in complete operation. THE GOVERNOR ISSUES A STATEMENT* THE PUBLIC AND THE MEDICAL PROFESSION WITH the possible exception of the Christian ministry, there is not, I think, a higher calling among men than that of the medical doctor. The clergyman is supposed to diagnose and prescribe for ailments of the soul, and the one who cannot do just that should take stock of himself. The medical doctor diagnoses and prescribes for bodily ills. Together, the minister and the doctor exercise a definite custodial care over humanity from the cradle to the grave, each helping to bring the individual into a more abundant life — here and hereafter. No attempt will be made to become technical in this brief discussion of what should be the layman's attitude toward the doctor. Certainly there will be an absence of medical terms, for the very obvious reason that I am in no way familiar with such terms. But is the medical profession tech-nical in its dealings with the layman as was once the case? To all appear-ances, the profession is emerging from the maze of technicalities which for-merly resulted in an aloofness on the part of the uninformed layman. Time was when the doctor, having arrived at The Health Bulletin March, 1948 the patient's bedside by horse and buggy, would put on a grave expres-sion as he applied the stethoscope, in-serted the fever thermometer under the tongue, looked at the whites of the eyes, and felt the pulse. "Umph-humph," he would say, with a far-off look in his eyes. Then he would take pencil and pad, write a prescription in Latin, give certain directions which must be followed, and depart, to return later in the day, tom.orrov,', or perhaps in a few days, as the condition of the patient might require. This gave the sick person and mem-bers of his household a sort of fear of the doctor, as if he knew more than he was willing to tell about the pa-tient's condition, or perhaps, his near-ness to death. Time was when a doctor would no more have addressed a group of lay-men, in their own language, than a preacher would have delivered a ser-mon at a football game. But now both the doctor and the preacher are be-coming more practical. There has been, for some years now, a growing tendency on the part of the doctor to meet the layman on terms of the latter 's understanding; to throw aside secrecy and formality, and to substitute plain American talk for La-tin prescriptions. That is as it should be. In the promotion of this growing spirit of understanding between doctor and layman, public health, no doubt, has played an important role. Workmg with both in the field of preventive medicine, this alreay existing and well estabhshed governmental agency—both the State Health Department and The United States Public Health Service-may be considered a "liaison officer" between the doctor and the average citizen. The obligation resting on pub-lic health is not only to afford mass protection, but to educate the public to the importance of good medical care —through the private practitioner where the patient is able to pay, and at public expense if the patient is indigent. Mass protection against certain com-municable diseases is, of course, a ben-efit that is extended to all, without charge, because no population that is half sick and half well can be 100 per cent efficient. Moreover, communicable diseases can be transmitted from pau-per to prince, and vice versa. There-fore it is the business of government, now;, so recognized by all, to set up and maintain conditions conducive to the good health of all—by means of im-munization, sanitation, and other meas-ures carried on at public expense. Dis-ease knows no barriers. It does not re-spect territorial lines. Especially is this true in this day of rapid transportation, when the remotest parts of the earth are within a comparatively few hours' flying time from any part of the United States. Communicable diseases hereto-fore unknown in this country exist in these remote sections, and can be im-ported from them. Therefore, it is nec-essary that our people not only become immunized against all preventable dis-eases, but also remain on guard against those ailments about which, at present, we know little, but which could easily be transmitted to us from distant parts of the world. Hence, the importance of mass pro-tection. Aside from those communicable dis-eases against which means of immun-ization have been discovered, however, thousands of persons die every year in North Carolina and other states as the result of the chronic or degenera-tive diseases of middle and late life, against which the chief protection is early diagnosis. While it is recognized that doctors consider it unethical to advertise—cer-tainly as individuals—it would appear to be perfectly proper for the medical profession to establish and maintain relations with the lay public, in order to let the people know just what it has to offer in the way of early diagnosis and other preventive measures. In 1942, the House of Delegates of the American Medical Association vot-ed its approval of the extension service of local health departments through- March, 1948 The Health Bulletin out the United States. In September, 1945, the official Journal of the Asso-ciation declared editorially: "Until the most remote American family has ac-cess to accepted modern public health services, the nation's health will not be properly served. Expansion of public health activity, long advocated and pioneered by the medical profession, is a more sound and logical step toward improving the nation's health than many grandiose plans for medical care." Public health, in its role of "liaison officer" between the laity and the med-ical profession, can and should serve a still larger purpose than it has ever served before. The medical profession, on the other hand, should seek still wider contacts with the public, through public health personnel. Public health is the child of organized medicine. No North Carolina doctor who has studied the history of his profession in this state is ignorant of the vision which was caught and held, more than seven-ty years ago, by Dr. Thomas Fanning Wood of Wilmington. That vision was translated into legislation which cre-ated, in 1877, the State Board of Health, which for a while was the State Medical Society. Later, the form of organization was changed, and the duties of the Board of Health were delegated to a board composed of mem-bers of the medical and allied profes-sions, elected by the State Medical Society and appointed by the governor. Here are some interesting facts, from which might be gathered many sug-gestions as to how the public and the medical profession may work together more closely in the promotion of the general health of the people: In 1921, the ten leading causes of death in North Carolina were, in this order: heart diseases, tuberculosis, apo-plexy, nephritis, pneumonia and in-fluenza, diarrhea and enteritis, pre-maturity, non-vehicular accidents, preg-nancy, and senility. In 1946, the ten leading causes of death in our state were listed in this order: diseases of the heart, apoplexy, nephritis, cancer, pneumonia and in-fluenza, prematurity, non-vehicular ac-cidents, tuberculosis, motor vehicle ac-cidents, and diabetes. Compare the two lists and note the changes. Tuberculosis, for example, dropped from second to eighth place. Cancer, not in the first list, was fourth in the second. Why the decline in tuberculosis? Be-cause we did something about it—and we are going to do more. Two things are important in our fight against the Great White Plague. We must separate the infectious from the non-infectious patients, and we must use every means at our command to detect cases in their early stages, in order that the disease may be arrested and cured. In the mass surveys being made under the super-vision of the State Board of Health, approximately a quarter of a million chest pictures had been made through December, 1947. The number of lives that will be saved as a result, no one can say. Those patients found to be infected are referred to their family physicians. There is a group of diseases, how-ever, against which we have not made the progress that we have against tuberculosis. We have prolonged life by immunizing against preventable communicable diseases, many of which occur among small children. But many of the dangers that still confront our citizens of middle and late life remain to be reckoned with. We have referred to these generally; let us be more spe-cific. Of the 15,48 |
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