Health bulletin

              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