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Entered as second-class matter at Postoffice at Raleigh, N. C, under Act of July 16, 189i.
Published monthly at the office of the Secretary of the Board, Raleigh, N. C.
Vol. 53 JANUARY, 1938 No. 1
NORTH CAROLINA HEALTH GOALS FOR 1938
1. Make motherhood and babyhood safe by extending the
provision of competent medical care to every baby and pros-pective
mother.
2. Extend organized public health service to the thirty-three
counties now w^ithout it. Increase the quality and quantity of
work in counties enjoying organized health work.
3. Inaugurate an effective statewide syphilis control pro-gram.
4. Promote an adequate and coordinated pre-school and
school health service.
5. Safeguard family and community health by competent
supervision of milk and water supplies, public eating places,
disposal of human wastes and general sanitation.
6. Immunize every baby against diphtheria between six
and twelve months of age.
7. Extend laboratory services by the erection and furnish-ing
of a new state laboratory building.
8. Prevent or remove the handicaps that tend to deny any
family the opportunity to honestly provide themselves with
"sufficient for the needs of their bodies and the demands of
health."
9. Work for the day when no citizen shall suffer and die
from a preventable disease or injury.
MEMBER OF THE NORTH CAROLINA STATE BOARD OF HEALTH
S. D. Craig, M.D., President Winston-Salem
J. N. Johnson, D.D.S., Vice-President Goldsboro
G. G. Dixon, M.D Ayden
H. Lee Large, M.D Rocky Mount
H. G. Baity, ScD Chapel Hill
W. T. Rainey, M.D Fayetteville
Hubert B. Haywood, M.D Raleigh
James P. Stowe, Ph.G Charlotte
J. LaBrucb Ward, M.D Asheville
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.
Warren H. Booker, C.E., Director Division of Sanitary Engineering
and Malaria Control.
Ernest A. Branch, D.D.S., Director Division of Oral Hygiene.
John H. Hamilton, M.D., Director Division of Laboratories.
J. C. Knox, M.D., Director Division of Epidemiology and Venereal
Disease Control.
R. T. Stimson, M.D., Director Division of Vital Statistics. •
R. E. Fox, M.D., Director Division of County Health Work.
H. F. Easom, M.D., Director Division Industrial Hygiene.
FREE HEALTH LITERATURE
The State Board of Health publishes monthly The Health Bulletin,
which will be sent free to any citizen requesting it. The Board also has
available for distribution without charge special literature on the fol-lowing
subjects. Ask for any in which you may be interested.
Adenoids and Tonsils German Measles Scarlet Fever
Cancer Health Education Smallpox
Constipation Hookworm Disease Teeth
Chickenpox Infantile Paralysis Tuberculosis
Diabetes Influenza Tuberculosis Placards
Diphtheria Malaria Typhoid Fever
Don't Spit Placards Measles Typhoid Placards
Eyes Pellagra Venereal Diseases
Flies Residential Sewage Vitamins
Fly Placards Disposal Plants Water Supplies
Sanitary Privies 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, N. C.
Prenatal Care Baby's Daily Time Cards : Under 5 months ;
Prenatal Letters (series of nine 5 to 6 months; 7, 8, and 9 months; 10,
monthly letters) 11, and 12 months; 1 year to 19 months;
The Expectant Mother 19 months to 2 years.
Breast Feeding Diet List: 9 to 12 months; 12 to 15
Infant Care. The Prevention of months ; 15 to 24 months ; 2 to 3
Infantile Diarrhea j'ears ; 3 to 6 years.
Table of Heights and Weights Instructions for North Carolina Midwives
CONTENTS
Organized Public Health Work in North Carolina Page 3
No More Hasty Marriages in New York Page 9
Physician Wanted at Hatfjeras, N. C Page 10
General Pershing Commands New Army Page 10
Radio Broadcasts on Health Subjects Page 10
The Nurse As Preacher and Teacher of the Gospel of Health Page 11
Exploiting the School Child Page 16
Don't Put, Oil Drops in Baby's Nose Page 16
(
I PUBLI5ALD BY TML noR.TM CAeOLIhA 5TATL E>OAIgD 3>^M£i\LTM |
Vol. 53 JANUARY, 1938 No. 1
Organized Public Health Work
In North Carolina
By Roy Norton, M.D.
Assistant Director, Division of Preventive Medicine
I. State Board of Health Organization and Services
A GREAT many inquiries come to ^the State Board of Health regard-ing
the public health organization and
activities in the State. In order that
the greatest good may be accom-plished,
the people must know what
services are available. In general, it
is planned that public health services
shall be rendered either directly by
the local health department or in-directly
by the State Board of Health
through and with the cooperation of
local health departments. Even for
good curative work to be done, the
doctor must be called immediately
after the disease starts or the injury
is inflicted. Since the work of the
State Board of Health and of local
health departments is chiefly preven-tion
and health education, a greater
degree of public understanding and
cooperation is required than would
be the case in strictly curative pro-cedures.
Public health workers, there-fore,
feel complimented and also con-sider
that more effective work can be
done when local citizens request
health education and preventive serv-ices
for their communities. Public
sympathy, understanding, and partic-ipation
are essential to the success
of any public health program. The
following organization chart and out-line
of activities are provided so that
more and more North Carolinians
may make the fullest possible use of
the services made available through
a trained staff of public health per-sonnel
and the latest in modern pre-ventive
and health education equip-ment.
The chart on page 4 shows the State
Board of Health organization and its
various relationships. The governor
appoints five of the Board members
and the State Medical Society elects
the other four. The term of Board
membership is four years. The State
Health Officer serves as secretary-treasurer
of the Board, but he has no
vote in determining Board policies.
His term is for four years. He selects
the state health department staff
workers, subject to Board approval.
Board members and the State Health
Officer are eligible for reelection or
reappointment.
The activities and services of the
State Board of Health are so numer-ous
and so varied that space will only
allow the briefest reference to them
in outline form.
A. Central Administration
1. Policies—Programs
2. Relations with other state de-partments
and extra-state
agencies.
3. Personnel—Budget—Accounts
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January, 1938 The Health Bulletin
4. Requisitions
5. Central File
6. Library—Printing
7. Publicity Service
B. Preventive Medicine
1. Maternal and child hygiene
a. Prenatal infant centers
b. Midwife supervision
c. Distribute toxoid for in-fants
and pre-school chil-dren
d. Location, diagnosis, treat-ment,
and follow-up of crip-pled
children
e. School examinations, in-cluding
Audiometer tests
f. Allocation of M. S. Chil-dren's
Bureau funds
2. Health Education
a. Health Bulletin — 43,000
monthly
b. Preparation, revision, dis-tribution
of pamphlets and
leaflets
c. Releases to newspapers and
periodicals
d. Speakers' Bureau, movies,
radio
e. Special personal correspond-ence
in reply to 5,000 in-quiries
annually
f. Posters, maps, charts for
schools, clubs, fairs
g. Postgraduate training in
pediatrics, obstetrics, pre-venception
C. County Health Work
1. Organization and development
of local health units (county,
city, district)
2. Administrative supervision of
local health departments
a. Policies
b. Budgets
c. Allocation of funds from
State and U.S.P.H.S. sources
d. Approval of qualifications
for personnel
3. Consultation service
a. Administration — evalua-tion
of. character and con-tent
of local service—pro-gram
planning
b. Sanitation
c. Nursing— Conjointly with
Div. Preventive Med.)
d. Record keeping, analysis,
and interpretation
4. Negro Health Education
D. Laboratories
1. Diagnostic service
2. Analyses of drinking waters
a. Public supplies periodically
b. Private supplies on request
of health officer or physician
3. Manufacture and distribution
of preventive vaccines and anti-toxins
E. Vital Statistics
Birth, stillbirth and death certifi-cates
1. Collection
2. Classification
3. Indexing
4. Certification
5. Tabulation
6. Compilation
7. Analysis
8. Interpretation
9. Publication
F. Epidemiology
1. Collection, analysis, publication
of morbidity reports
2. Studies and investigations of
epidemics
3. Consultation service with local
health units and with private
physicians
4. Malaria investigation and con-trol
5. Venereal disease control
a. Advisory service to local
health departments
b. Distribution of antisyphili-tic
drugs
G. Sanitary Engineering
1. Supervision of water supplies
of schools, mills, homes, muni-
The Health Bulletin January, 1938
cipalities, state institutions
2. Control of sewage disposal
—
schools, mills, homes, munici-palities,
state institutions
3. Milk sanitation
4. Sanitary supervision of food
supplies, eating and lodging
places, cafes, schools, shellfish,
hotels, bedding, camps.
5. Malaria control drainage
6. Prevention of stream^ pollution
H. Oral Hygiene
1. Didactic teaching of mouth
health
a. School classrooms
b. PTA and civic club lectures
2. Demonstrative teaching of
mouth health
a. Examinations
b. Prophylaxis
c. Corrective treatment of un-derprivileged
children under
age 13
I. Industrial Hygiene
1. Surveys of industrial sanitation
2. Conservation service to indus-try
and state departments
3. Investigation of environmental
hazards in industry
4. Examination and recommenda-tion
of plans for industrial ven-tilating
systems
5. Evaluation of methods for con-trol
of specific hazards
6. Clinical and X-ray examina-tions
of industrial workers
II. Local Public Health Work in
North Carolina
At the present time (January
1938) 67 of our 100 counties have
voted appropriations for public health
work on either a single county or dis-trict
basis (two or more counties co-operating).
There are also six city
departments.
The county boards of health (with
a few exceptions) are composed of
six members made up as follows: the
chairman of the county commission-ers,
the mayor of the county town
and the county superintendent of
schools, serving as ex-officio members,
who meet together on the first Mon-day
in January in odd years and
select two regularly registered physi-cians
and one regularly registered
dentist to serve with them. The
chairman of the commissioners serves
as chairman of the county board of
health. If there is no county town
mayor, the clerk of the superior court
serves. The county physician and/or
county health officer is selected by
the board on the second Monday in
January of odd years.
In a district the county board of
health is still the controlling body
within each respective county. A dis-trict
executive committee, consisting
of at least one member from each
county board of health may constitute
an advisory body to the district health
officer meeting with the state health
officer or his representative in mat-ters
pertaining to district-wide serv-ices.
Any rules and regulations must
be adopted by each county board of
health before becoming effective in
the respective county.
City health department policies are
shaped by the board or committee of
the city government designated to
perform that function according to
the type of government in that city.
Local health officers employ and
dismiss the remaining personnel of
the local health department staff.
Guilford County Health Depart-ment
began work in 1911 and was
among the first in the United States.
Local rural health department work
is, therefore, comparatively new and
far from standardized and stabilized.
As old health threats like typhoid and
smallpox are practically conquered,
as others like diphtheria and tuber-
January, 1938 The Health Bulletin
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8 The Health Bulletin January, 1938
culosis are partially controlled and
as new hazards spring up or become
recognized the activities must neces-sarily
change. An attempt is, there-fore,
made to adapt the services of-fered
to the local community needs.
A county health department in an
eastern county with many farm work-ers
and a large Negro population is
necessarily different from a depart-ment
in a mountain county, and em-phasis
in public health work in a
piedmont county would differ from
both.
Health Bulletins for May 1923,
January 1935, and June 1937 contain
general articles on health department
organization and activities. Below is
found in bare outline form a list of
some of the activities of local health
departments divided according to
that done by different members of
the local staff. Several county, dis-trict,
and city departments have large
staffs and in such communities the
territory may be divided among sev-eral
workers, while that done by each
individual (such as public health
nurse) remains generalized. The
tendency toward keeping a general-ized
service is not so uniform among
the sanitation personnel as it is
among the nursing staff. In general,
however, the services are similar
whether the population served by the
local health department is large or
small.
A. Health Officer
I. Administrative Duties
1. Health education
2. Program planning
3. Public relations and co-operation
with other de-partments
and agencies
a. Hospitalization of tuber-culous
and handicapped
b. Housing and other eco-nomic-
living problems
c. Safety—the prevention
of accidents
4. Surveys
5. Distribution of
a. Biologicals — vaccines
and sera
b. Arsenicals
c. Yeast
6. Health legislation
7. Hospitalization
8. Office Routine
a. Personnel
b. Budgets
c. Finances
d. Conferences
II. Professional Duties
1. Health Education
2. Immunization
a. Diphtheria
b. Smallpox
c. Typhoid fever
3. Epidemiological Investiga-tions
4. Isolation — quarantine —
release
5. Diagnostic service
a. Consultation
b. Laboratory
6. Clinics
a. Maternity and infancy
b. Venereal diseases
c. Tuberculosis
d. Crippled children
e. Eye
7. Special Services
a. Dietary diseases
b. Intestinal parasites
c. Malaria
d. Rabies
8. Physical Examinations
a. Pre-school children
b. School children
c. Teachers
d. Child industry
e. Food handlers
9. Medical Services of County
Physician
a. Institutions
b. Prisoners
c. Court cases
d. Post mortems
January, 1938 The Health Bulletin
B. Sanitary Officer
1. Health Education
2. Sanitary disposal of human
wastes
a. Privies
b. Septic tanks
c. Sewerage systems
S. Supervision of foods and food
establishments
a. Milk supplies
b. Cafes, hotels, markets, abat-toirs
-<;. Shellfish
4. Special services
a. Public buildings and insti-tutions
b. Camp and recreation
grounds
c. Swimming pools
d. Halaria control
' 5. Sanitary surveys and exhibits
6. Control of animal wastes and
other health nuisances
C. Public Health Nurse
1. Health education
2. Prenatal, natal and postnatal
care
3. Midwife supervision
4. Infant, pre-school and school
health
5. Adult health
6. Communicable diseases
a. Acute childhood infections
b. Venereal diseases
c. Tuberculosis
7. Non-communicable diseases
8. Nutrition
9. Orthopedic service
10. Vital statistics
11. Mental Hygiene
12. Reports and records
D. Public Health Dentist
1. Didactic Teaching
a. Children in class-rooms
b. Adults in PTA, clubs, com-munity
groups
2. Demonstrative Teaching
a. Examinations
b. Prophylaxis
c. Corrections for underprivi-leged
children under age 13
E. Office Clerk
1. Health Education
a. Interpreter of department
activities to office public
b. Distribution of health lit-erature
c. Preparation and display of
maps, charts, graphs
2. Vital Statistics (Secure re-ports
a. Births
b. Deaths
c. Communicable diseases
d. Statistical analysis
3. Stenographic work
a. Letters
b. Reports
c. Financial accounting
d. Requisitions
e. Notifications
4. Office Routine
a. Supplies
b. Complaints
NO MORE HASTY MAR-RIAGES
IN NEW YORK
New York State has passed a law
to prevent runaway marriages. The
new law provides that "a marriage
shall not be solemnized within seven-ty-
two hours from the date and hour
of issuance of the marriage license
therefor, unless authorized by an
order of a court of record." It was
enacted by the 1937 Legislature for
the purpose of curbing socalled "gin
marriages," which are usually con-summated
in haste and repented of
at great leisure.
10 The Health Bulletin January, 1938
PHYSICIAN WANTED AT
HATTERAS, N. C.
State Board of Health
Raleigh, N. C.
Gentlemen
:
Due to the recent death of our
only practicing physician, Dr. H. W.
Kenfield, we are completely without
medical aid. Our community consists
of some nine hundred in population
with adjacent territories.
Hatteras is a fishing village where
an abundance of marketable fish is
taken from the ocean and sound and
shipped to northern markets. This
community surpasses any other vil-lage
in Dare County in incoming and
outgoing commerce. We also afford
the best deep sea fishing on the North
Carolina coast. The future of Hat-teras
is rapidly becoming brighter
and a young doctor with ambition
and a natural foresight would do
well to settle here. His compensa-tions
at present would be very ade-quate,
and his possibilities would be
much greater.
If you do not know of some capable
doctor that would be interested in
practicing here, kindly print the
above paragraphs of this letter in
your next issue of Health Bulletin
and ask them to get in touch with me.
Yours very truly,
(Signed) M. L. BURRUS.
GENERAL PERSHING
COMMANDS NEW ARMY
General John J. Pershing, Com-mander
of the A. E. F. during the
World War, has accepted the chair-manship
of the National Anti-
Syphilis Committee of the American
Social Hygiene Association. Fighting
venereal diseases is not new to the
General. He evoked world admira-tion
for his services twenty years
ago in a campaign to reduce the
venereal diseases in the army. All
strength to his right command!
RADIO BROADCASTS
ON HEALTH SUBJECTS
Radio Station WPTF, operating on
a frequency of 680 kilocycles in Ra-leigh,
has very kindly given 15 min-utes
each Friday afternoon, 5:00 to
5:15 for a program sponsored by the
State Board of Health. Copies of these
programs will be mailed free upon re-ceipt
of your request either to Station
WPTF or to the State Board of
Health. Constructive comments and
suggestions will be appreciated. A
list of those in charge of programs
during the first quarter of 1938 fol-lows
:
Friday, January 7—J. M. Jarrett,
C. E.
Friday, January 14—H. F. Easom,
M. D.
Friday, January 21—Mr. James T.
Barnes.
Friday, January 28—J. C. Knox,
M. D.
Friday, February 4—Warren H.
Booker, C. E.
Friday, February 11—J. H. Ham-ilton,
M. D.
Friday, February 18—D. S. Abell,
C, E.
Friday, February 25—R. T. Stimp-son,
M. D.
Friday, March 4—R. E. Fox, M, D.
Friday, March 11—M. F. Trice,
C. E.
Friday, March 18—E. A. Branch,
D. D. S.
Friday, March 25—Roy Norton,
M. D.
Note: About ten years ago the
manager of the Durham Life Insur-ance
Station WPTF in Raleigh, gave
the State Board of Health a weekly
assignment of fifteen minutes. The
duty of arranging for these talks and
assuming full responsibility was as-signed
to Dr. G. M. Cooper. In the
five hundred talks made to date cover-ing
every known health subject, only
two have been criticised.
January, 1938 The Health Bulletin 1]
The Nurse As Preacher and Teacher of
The Gospel of Health
Address to the Oifice Nurses' Section of the North Carolina
Nurses' Association
By Frederick R. Taylor, M. D., F. A. C. P.
High Point, N. C.
ipVER since Miss McCracken asked
me to read this paper before your
section, I have been puzzled. She
was unacquainted with me, how-ever,
so cannot be blamed for my
selection. Indeed, she admitted as
much in her letter, and passed on the
responsibility to your capable Presi-dent,
Miss Ruth Council. I have the
highest regard and respect for Miss
Council, but wonder if this may not
be the first time I have ever known
her to make a slip in judgment. For
alas! I must make a confession to
you. I am a mere internist, and,
lacking the more substantial income
that accrues to the successful surg-eon,
I have not felt able to employ
a graduate nurse in my office. It
would be folly, therefore, for me to
attempt to discuss any phase of the
technical side of the graduate office
nui'se's work, and I shall spare you
such a display of ignorance.
In casting about for a subject that
might seem profitable for this occa-sion,
I recalled that several years
ago, when it was my duty to give a
Chairman's Address before the Sec-tion
on Practice of Medicine of our
state medical society, I took for my
subject, "The Teaching Function of
the Medical Profession as a Whole."
It is obvious that every physician
should have a teaching function. He,
above all others, should educate his
patients and his community in health
matters. However, that function is
sometimes sadly neglected, while al-most
every community is flooded with
a mass of misinformation broadcasted
from the housetops by charlatans,
patent medicine manufacturers,
preachers of the sophisti-y that all
diseases are due to displacements of
the spine, etc. The physician should
naturally be the leader in health edu-cation
in his community, but the
nurse has an educational function to
perform that is scarcely less impor-tant.
The good nurse will, of course,
teach her patients much of value.
This is especially true of the public
health nurse, whose teaching of the
practice of hygienic living has a life-saving
effect almost impossible to
overestimate. However, she has no
monopoly on the health education of
her patients, for the private nurse,
the hospital nurse and the office
nurse also can teach much of value.
So today I would direct your atten-tion
to the nurse's work in the com-munity
as a whole, as teacher and
preacher of the gospel of health.
Even the best physicians are some-times
handicapped seriously in their
efforts at teaching, because some per-sons,
often the very ones who need
the teaching most, suspect them of
self-interest. The best doctors are al-ways
trying to destroy their own
work, i. e., to prevent the very ill-nesses
by which they live. Many per-sons
do not understand this attitude —it is too idealistic for them to be-lieve
that it is a practical reality, and
when the doctor preaches on health
they ask at once, "What does he get
out of it?" Here is what one veiy
high-grade doctor in a small village
12 The Health Bullethv January, 1938
in this state got out of it : he remarked
to me some years ago that when he
located in that village fifteen years
before there was another doctor
there, and both of them were as busy
as they could be. At the time of our
conversation, however, he was the
only physician in the community, yet
had very little to do, and was consid-ering
moving to a new location for
that reason. What had happened?
Were the people going elsewhere for
medical service? Not at all! He had
simply wiped out most of the acute
diseases in his neighborhood. Not as
a salaried health officer, but in sym-pathetic
cooperation with that official
and in the course of his private prac-tice,
they had immunized the people
against smallpox, typhoid fever and
diphtheria; and taught them how to
feed their babies properly, thus prac-tically
stamping out the summer diar-rheas
that had been so prevalent and
deadly before, so that those things
which were the greatest sources of
his income in the past had disap-peared.
Outbreaks of respiratory in-fections,
measles, an occasional acci-dent,
and the few labor cases that
such a sparsely settled community af-forded,
were about all that he had
left to attend to. If his community
had waked up to the need of fighting
the chronic degenerative diseases by
periodic health examinations, he might
have become busy once more, and his
activities might have prevented a
number of cases of chronic disease in
middle life, yet if he had preached
this phase of the gospel of health too
insistently, doubtless many would
have considered him to be actuated
solely by self-interest.
The trained nurse escapes this sus-
1 picion of self-interest in large meas-ure,
and that is her unique advantage
in teaching and preaching the gospel
»f health. Often her friends will look
her for advice in health matters.
and here, just as truly as in the of-fice
or sickroom, she can render in-valuable
service. .
What are some of the most impor-tant
things which a nurse can teach
her community? There are so many
that it is hard to select a limited
list. The need of immunization against
smallpox, typhoid fever and diph-theria;
the urging of all expectant
mothers to place themselves in the
care of a physician as soon as their
pregnancy is known to them; the im-portance
of proper infant feeding;
the value of periodic health exami-nations;
the significance of the regis-tration
of every birth in the com-munity;
the need of medical super-vision
of the infant and child; the
importance of a standard milk ordi-nance
in every town; the encourage-ment
of proper sanitary laws; the
need of full-time specially trained
county and city health officers; the
significance of conscientious observ-ance
and enforcement of quarantine
laws; the value of frequent visits to
the dentist; the dangers of self-diagnosis
and treatment; the deadly
fraud of the patent medicine evil; the
folly of seeking diagnosis and treat-ment
from uneducated practitioners
of sundry cults ; these are some of the
most vital things.
Let us consider three of these top-ics
briefly:
The value of diphtheria toxoid is
thoroughly estabished, yet the people
as a whole do not realize sufficiently
the need of giving it in early in-fancy.
To give it to the school child
is not enough when over 80 per cent
of the deaths from diphtheria occur
before the age of six! It should be
given first at the age of six to eight
months if we really want to control
the disease most effectively. Phy-sicians
may advocate this, yet some
overanxious mothers may fear that it
will harm their babies. A word of re-
January, 1938 The Health Bulletin 13
assurance from a trained nurse who
is also a friend, may save such a
baby's life! If everyone in the world
were adequately protected against
smallpox, typhoid fever and diph-theria,
these diseases would be wiped
off the face of the earth, and the
germs causing them would become
extinct biologic species, no more to
be redeveloped than the mastodon or
the saber-toothed tiger.
The wholesale killers of our peo-ple
today, however, are not the epi-demic
diseases, not even tuberculosis,
but heart and kidney diseases and
cancer. These cripple or kill many of
our most valuable persons in middle
life, just when they should be at the
height of their powers, and when
they kill them, they often cause chil-dren
to become orphans. They are so
insidious that they usually do ir-reparable
harm before their victims
feel sick. To even partially control
these diseases, we must detect them,
or the things that predispose to their
development, before subjective symp-toms
arise, but to do this, we must
arouse the people to the need of
treating their bodies as well as they
do their banks and automobiles, by
having them examined periodically to
detect and correct small troubles be-fore
they become great ones.
The patent medicine and cult evils
are peculiar things. That great prac-tical
philosopher and showman,
Phineas T. Barnum, once remarked
that the American people love to be
humbugged. Barnum's phenomenal
success bears witness to the truth of
this statement so far as our amuse-ments
are concerned, and, indeed, I
suppose most of us can find quite
sufficient witness within ourselves,
for does not Circus Day appeal to
young and old alike? Nobody, how-ever,
really wants to be humbugged
in matters of life and death, yet
there is hardly any phase of human
activity in which there is more de-ceit
and fraud, and worse, near-deceit
and near-fraud that cannqt be
handled by the law, than in the treat-ment
of disease by pushing the sale
of useless or dangerous or ridicu-lously
expensive proprietary medi-cines,
and by applying single-track
ideas to the diagnosis and treatment
of all diseases.
Who among us has not heard some-one
speak of "Wampole's Extract of
Cod Liver Oil"? Yet, so far as I
know, there has never been any such
preparation in existence.* A prepa-ration
has been marketed under the
name "Wampole's Perfected and
Tasteless Extract of Cod Liver," but
the word "Oil" does not appear on
the label for the simple reason that
it does not belong there. There seems
to be no evidence that the vitamin
and food values of cod liver oil are
present in Wampole's Extract, but
there is a good deal of evidence to the
contrary. The Connecticut Agricul-tural
Experiment Station fed a group
of rats on cod liver oil. They grew
and gained weight normally. The
same investigators fed another group
of rats on Wampole's Extract, and
they were quickly reduced to starva-tion!
Probably the chief, if not the
sole action of Wampole's Extract lies
in its alcohol content, according to
the Bureau of Investigation of the
American Medical Association.
Wampole's Extract, however, is
mild compared to some other proprie-tary
drugs. What about the indis-criminate
and unrestricted sale in our
drug stores of such preparations as
Hypnobromic Compound and Bro-midia?
Their names sound as if they
were essentially bromide mixtures,
but in reality, while they contain
some bromides, hydrated chloral is
their chief constituent. The American
Medical Association found the Hypno-bromic
Compound to contain 96
14 The Health Bulletin January, 1938
grains, and Bromidia 91 grains, re-spectively,
of chloral to each ounce!
Hydrated chloral is a dangerous habit-forming
drug that has been used in
the form of the so-called "knock-out
drops" by certain types of criminals
who drug their victims into insensi-bility
in order to rob them, and while
a useful drug under certain condi-tions,
its sale should be carefully re-stricted
to legitimate purposes. The
Hypnobromic Compound, however,
has been sold without restriction in
eight ounce bottles containing 768
grains of hydrated chloral, and there
is no law in our state to prevent the
repeated sale of these drugs to the
same individual over an indefinite
period of years. The trained nurse
may sometimes learn of cases of such
dangerous self-medication and sound
a note of warning that may prevent
the development of a very bad drug
addiction. Most physicians of ex-perience
have seen chloral addicts
who were abject objects of pity.
Some of our ideas are founded on
the desire for a wish-fulfillment. How
fine it would be if only there were
medicines to cure everything! This
is a very natural wish, and the de-sire
for its fulfillment may explain
in part, at least, the idea that so
many people seem to have, that there
must be some preparation to cure
anything, if we could only find it.
The glamorous advertisements of the
patent medicines, were they all true,
would seem to indicate that medicines
have been found to cure all ills, and
they appeal to the gullibility of per-fectly
normal, but uninformed in-dividuals.
Why so many are willing to put
themselves in the care of those who
preach that displacements of the
spine are the cause of all diseases,
is a little more difficult to explain.
There are some diseases that the best
medical treatment cannot cure, yet
occasionally they may clear up spon-taneously
without treatment or in
spite of it! If such a thing happens
while a patient, grasping at a straw,
is in the care of an uneducated cult-ist,
he is misled into thinking that
the treatment cured him, and he tells
his friends, who, unless they do a lit-tle
sensible independent thinking, are
likely to flock to that same dispenser
of hokum, greatly to their discomfi-ture
and his profit. Let me cite just
one case illustrating such hokum.
Several years ago a frail little woman
who worked in a hosiery mill came to
consult me. Examination revealed
an early pulmojiary tuberculosis.
She was referred to Dr. J. L. Spruill,
Superintendent of the Guilford Coun-ty
Sanatorium for Tuberculosis, who
confirmed my diagnosis and admitted
her to the sanatorium for treatment.
After a few months she was dis-charged
as "an arrested case" and re-turned
to work. I lost track of her
for a few years, but one day she
came to my office again and asked if
I thought it would be a good thing
for her to consult a certain noted
orthopedic surgeon in Charlotte about
her spine. I told her I thought it
would be an excellent thing to do if
she had anything wrong with her
spine. Of course I conjured up vis-ions
of a tuberculous spine in the
light of her previous history. She
asked me to examine her, however,
and I found nothing other than a pos-tural
sacroiliac strain, and asked her
why she thought she had any serious
spinal trouble. Then she rather
sheepishly confessed that she had
been prevailed upon by an acquaint-ance
to consult a chiropractor who
had told her she had a displacement
of her spine. This seemed natural,
assuming that he subscribed to the
dogma that all diseases are due to
displacements of the spine. I in-quired
further and learned that she
January, 1938 The Health Bulletin 15
had taken one hundred "adjustments"
from him at two dollars per adjust-ment,
making a total of two hundred
dollars she had spent on this method
of treatment. This had put a severe
economic burden on her, and iiiight
even have lessened the available
amount of food on her table which
she, as an arrested tuberculosis pa-tient
of very slight build, needed so
sorely. I then asked why she finally
quit the chiropractor, and her reply
was most illuminating. She said that
he had made an X-ray picture of her
and then showed her the film and re-mai'ked
that he couldn't understand
"how those gallstones got over on the
wrong side," indicating some very
characteristic shadows on the left
side of her abdomen. She looked at
them and said, "Well, I'm no doctor,
but I am a woman, and I do know
buttons when I see them. Those are
buttons on my clothing!" With which
parting shot she left his office in dis-gust.
She asked my advice, and I sug-gested
that she get measured for a
special supporting corset, which she
did, and when she got one that gave
proper support she seemed to be re-lieved
of her trouble. All this by way
of leading up to the point that the
trained nurse can and should em-phasize,
wherever she has the oppor-tunity,
the necessity of consulting
only well trained physicians for the
diagnosis and treatment of disease.
I have tried to touch on some of
the ways in which a nurse can teach
her community. Indispensable, how-ever,
in any teaching work, is the
principle that we must do and be, as
well as say. Actions speak louder
than words. The nurse herself must
have health examinations, be vacci-nated,
go to the dentist often, etc.,
else all her teaching will be futile.
Her life will be an influence and an
example that will teach as much as
her words, or, if it does not corre-spond
with her words, will destroy
much of the good which she would do.
What we are often speaks so loudly
that people cannot hear what we say.
The supreme attribute and requisite
in teaching and preaching, as in all
other activities of life, is character.
If the nurse's character is like the
house founded on the rock, her friends
will know it and will trust her, and
her influence will be increased a hun-dred
fold.
In no profession have noble char-acters
been more the rule than in that
of the trained nurse. What more sub-lime
human character was ever de-veloped
than that great woman who
inspired Longfellow to write his cele-brated
poem: Santa Philomena, or
popularly known as "A Lady With
a Lamp."
That inspired Lady of the Lamp,
Florence Nightingale, whose name
will be revered throughout the world
so long as humanity exists, is but
the archetype of many great heroic
devoted members of your profession.
Study the lives of these great women,
follow in their footsteps, and you will
find a satisfaction in your profession
which none can t^ke away, because
it is based on the consciousness of
rendering high service to humanity;
you will find great joy amid sorrow
and suff'ering, and at the end of the
trail of life, yours will be that Peace
which passeth all understanding that
comes to those who hear the words,
"Inasmuch as ye have done it unto
one of the least of these my brethren,
ye have done it unto Me."
*Thirty years ago a product by
that name was sold by druggists and
prescribed by many physicians under
the mistaken idea that it contained
much cod liver oil. Good old Dr.
Harvey Wiley and his first "Pure
Food and Drug Law" took the name
"Oil" off the label of that particular
"Proprietary."—Editor.
16 The Health Bulletin January, 1938
EXPLOITING THE SCHOOL
CHILD
Attention is called to a recent
editorial in the Shelby Daily Star
with reference to the sale of certain
products by school children. We
quote two paragraphs from this edi-torial
as follows:
"Shrewd out-of-town business firms
have invaded the State-run public
schools with tempting selling schemes
to further the sale of their products.
And the sad part of it is that teach-ers
who are in responsible positions
will unthoughtedly allow the children
to be exploited in any such manner.
"We admit that an individual child
has a right to sell any legitimate pro-duct
his parent might allow on his
own responsibility, but when an or-ganized
body of school students take
to the streets as peddlers upon the
approval and encouragement of the
teachers, they are neglecting the pur-pose
for which the schools are oper-ating.
Such outside duties are a ser-ious
detraction from school work and
should not be permitted."
Superintendent Erwin has approv-ed
the stand taken by the editor of
the Shelby Daily Star, and at this
time wishes to caution all teachers
and principals about lending their
approval and support to money-mak-ing
schemes which takes the time of
the children away from their school
work. "Matters of this kind," Sup-erintendent
Erwin states, "May be
controlled by the person in charge
of the school. Chapter 220, Public
Laws of 1933, adequately covers this
question." —NORTH CAROLINA
PUBLIC SCHOOL BULLETIN.
We heartily concur in the above,
and trust its enforcement will make
it harder for certain patent medicine
interests to exploit the teachers and
children, than has been the case in
the past.—Editor HEALTH BULLE-TIN.
DON'T USE OIL DROPS IN
BABY'S NOSE
The Maryland State Board of
Health recently issued the following
caution in regard to the danger that
may result from using oil drops in the
baby's nose, which caution we pass
on to North Carolina mothers:
"It is a dangerous custom and haa
been found to have very serious after
effects. In some instances, the in-discriminate
use of such drops has
brought on a certain form of pneu-monia
that is particularly fatal tO'
young children. Oil nose drops should
never be used for young children, un-less
that method of treatment is spec-ifically
ordered by the child's physi-cian.
"In a small baby the nasal passag-es
are very short and it is quite easy
for oily fluids put into the nose of
such an infant to get down into the
lungs. Oil is not absorbed in the
nose and it therefore gradually seeps
downward. In the lungs the oil sets
up an irritation and produces a cer-tain
variety of pneumonia. The di-sease
develops slowly and the harm is
often done before the trouble is dis-covered.
This kind of pneumonia does
not yield to the usual form of treat-ment.
Reports from different parts of
the country show that it has been re-sponsible
for many deaths. In almost
every case careful inquiry has shown
that oil drops had been used."
NAME AND ADDRESS
PLEASE
Once again, this time in our first
issue for the New Year we want to
request our readers, especially when
ordering literature to be sent, that
the correct name and post office be
plainly given. We have a large num-ber
of such requests now on hand
to consign to the waste basket be-cause
of lack of name or address.
Inte®
Published bn TAf./4°RmCAR?U7m STATE, D<?ARD s^AL^JJin
This BuTletirvwil) be 5er\l free to arwj otizen of the State upon requeati
Entered as second-class matter at Postoffice at Raleigh, N. C, under Act of July 16, 189^.
Published monthly at the office of the Secretary of the Board, Raleigh, N. C.
Vol. 53 FEBRUARY, 1938 No. 2
Z. SMITH REYNOLDS FOUNDATION MAKES LARGE GIFT TO STATE
BOARD OF HEALTH FOR SYPHILIS CONTROL WORK
The above picture shows Dr. Carl V. Reynolds, State Health Officer,
receiving check for $100,000 from the Z. Smith Reynolds Foundation to aid
in the prevention and cure of syphilis. Facing the reader from left to right
is Dr. S. D. Craig, President of the State Board of Health; Dr. Carl V. Rey-nolds,
Secretary and State Health Officer; Mr. Richard J. Reynolds, President
of the Reynolds Foundation and Mr. Stratton Coyner, Secretary of the
Z. Smith Reynolds Foundation, Inc.—Photograph courtesy Winston-Salem
Journal and Sentinel.
MEMBER OF THE NORTH CAROLINA STATE BOARD OF HEALTH
S. D. Craig, M.D., President Winston-Salem
J. N. Johnson, D.D.S., Vice-President . Goldsboro
G. G. Dixon, M.D Ayden
H. Lee Large, M.D Rocky Mount
H. G. Baity, ScD Chapel Hill
W. T. Rainey, M.D : Fayetteville
Hubert B. Haywood, M.D RaleiRh
James P. Stowe, Ph.G Charlotte
J. LaBruce Ward, M.D AsheviUe
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.
Warren H. Booker, C.E., Director Division of Sanitary Engineering
and Malaria Control.
Ernest A. Branch, D.D.S., Director Division of Oral Hygiene.
John H. Hamilton, M.D., Director Division of Laboratories.
J. C. Knox, M.D., Director Division of Epidemiology and Venereal
Disease Control
R. T. Stimson, M.D., Director Division of Vital Statistics.
R. E. Fox, M.D., Director Division of County Health Work.
H. F. Easom, M.D., Director Division Industrial Hygiene.
FREE HEALTH LITERATURE
The State Board of Health publishes monthly The Health Bulletin,
which will be sent free to any citizen requesting it. The Board also has
available for distribution without charge special literature on the fol-lowing
subjects. Ask for any in which you may be interested.
Adenoids and Tonsils German Measles Scarlet Fever
Cancer Health Education Smallpox
Constipation Hookworm Disease Teeth
Chickenpox Infantile Paralysis Tuberculosis
Diabetes Influenza Tuberculosis Placards
Diphtheria Malaria Typhoid Fever
Don't Spit Placards Measles Typhoid Placards
Eyes Pellagra Venereal Diseases
Flies Residential Sewage Vitamins
Fly Placards Disposal Plants Water Supplies
Sanitary Privies 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, N. C.
Prenatal Care Babj^'s Daily Time Cards : Under 5 months ;
Prenatal Letters (series of nine 5 to 6 months; 7, 8, and 9 months: 10,
monthly letters) 11. and 12 months; 1 year to 19 months;
The Expectant Mother 19 months to 2 years.
Breast Feeding Diet List : 9 to 12 months ; 12 to 15
Infant Care. The Prevention of months: 15 to 24 months; 2 to 3
Infantile Diarrhea years : 3 to 6 years.
Table of Heights and Weights Instructions for North Carolina Midwives
CONTENTS
Evidence of Progress Page 3
Typhus Fever Spreading in North Carolina Page 4
Duke Hospital Page 5
Noises and the Sick Page 8
Zachary Smith Reynolds Foundation Donates Income to State Board of
Health to Aid in Control of Syphilis Page 11
Marihuana Page 14
Negligence of Parents Cause Many Baby Deaths Page 15
I PUBLI5ME.D BY TML riOR.TA CAgQLIhA STATE, EiOA^D s^ML^LTM |
Vol. 53 FEBRUARY, 1938 No. 2
Evidence of Progress
EDITORIAL
TN this issue of the HEALTH BUL-LETIN,
we present to our readers
who reside outside the State, some of
whom live in every state in the Un-ion
and in every civilized country in
the world from Ongole, India, to
Labrador, two comparatively new
views of the North Carolina scene in
the beginning of the year 1938.
First, situated in the suburbs of
Durham, N. C, in the midst of a five
thousand acre tract of rolling forest
land is Duke University with its four
million dollar hospital and medical
school. This institution, the gift of
the tobacco and power King of his
day, the late James B. Duke, an old
time monopolist, perhaps, but who re-membered
his native state by leaving
many of his millions in perpetuity
for the poor and ailing, is in truth
developing into a medical center of
nation-wide importance. During the
twelve years of its existence it has
given nearly eight million dollars to-ward
medical and hospital care for
the sick poor in this section. In the
coming years investigations to be
made in the Duke Medical School and
its system of hospitals will undoubt-edly
prove of great benefit to the
cause of preventive medicine. We
therefore take pleasure in calling at-tention
to the article in this issue en-titled
"Duke Hospital," by A. A. Wil-kinson.
Second, one morning in late De-cember
every important newspaper
in America carried the astounding
story that the Zachary Smith Rey-nolds
Foundation of Winston-Salem,
N. C, had donated to the State Board
of Health the income from a fund of
seven million dollars, to be used in a
carefully planned and scientific ef-fort
for the control and eventual erad-ication
of syphilis and other so-called
venereal diseases. The signi-ficance
of this gift and its far-reach-ing
importance may be illustrated by
quoting the opinion of the advertis-ing
manager of one of the country's
greatest railroad systems, himself
rated as one of the keenest and most
competent advertising men in the
business. This man had just returned
from conferences in Chicago and New
York with some of his fellows when
the editor of the HEALTH BULLE-TIN
ran into him. Said the Ad man:
"Look here, the big news in our cir-cles
is the Reynolds Foundation gift
to the State Board of Health to fight
syphilis. It is worth fifty times as
much to the state as any possible
kind of official or professional adver-tising.'
Said the Editor: "In what
way do you think the Reynolds dona-tion
rates so high in news and adver-tising
value?" The Ad man shot
right back: "1, It landed the name
of North Carolina in a most favorable
light on the front page and in half
the editorial columns of every daily
paper in the land; 2. It took the
word syphilis out of the back alley
The Health Bulletin February, 1938
and indicated to the world that here
was one state which proposed to deal
with the problem intelligently; 3.
And of far greater significance it
proclaimed to the four quarters of
the world that in the State of North
Carolina a great industrial group had
implicit confidence in at least one
vital division of the State Govern-ment,
to the extent that both might
cooperate in a great humanitarian
enterprise. In this day of 'Rights'
and 'Lefts', 'Communists' and 'Dic-tators'
that means something."
Somehow to the writer of these
lines it is satisfying to know that
the cash for these great enterprises
was garnered from all the world by
the genius of North Carolinians, and
is being expended for the benefit of
their own under-privileged people
who gave them their first opportun-ity.
TYPHUS FEVER SPREADING
IN NORTH CAROLINA
The rapidity with which typhus
fever is spreading in North Caro-lina
shows that it has gained a foot-hold
in some counties, and while its
presence is not yet alarming, that
something should be done to check it.
Especially is this true since the
means of its transmission is now
known. Last year there were thirty
cases of this disease and three deaths
reported to the State Board of Health
but for the eleven months of this
year ending November 30, there have
been 63 cases and seven deaths. In
Sampson County there have been
fifteen cases and two deaths report-ed;
in New Hanover six cases; Lenoir
six; Craven, five; Stanley, five;
Wayne, four; Mecklenburg, four;
Wake, two; Robeson, two; Moore,
two; and Anson, Gaston, Cleveland,
Buncombe, Chatham, Orange, Scot-land,
Vance, Wilkes, Beaufort and
Northampton have had one each.
Typhus fever as it is found in
North Carolina and other Southern
States is a more benign type than the
epidemic form of typhus which we
associate with war days, army camps
and the "cootie" or body louse. It is
known as the endemic type and is
carried from man to man or from
rat to man by the rat-flea. To control
this form of typhus means that rats,
the host of the flea that transmits
the infection to man must be gotten
rid of. It is believed that this dis-ease
found its way into the United
States from Mexico, as this form of
typhus resembles in many respects
the old Mexican form known as "Tab-ardillo."
Typhus fever is usually marked by
a sudden onset of fever, with head-ache
and dizziness. There is always
a rash which is a most characteris-tic
symptom. It appears about the
fifth day and lasts from two to ten
days. The death rate from this dis-ease
is usually not so high, about 5
per cent, or one death in twenty
cases. However, the fatality varies
with age, being less among patients
under forty-five years of age,
A rat-eradication campaign is the
remedy for checking the spread of
typhus in North Carolina. Rats carry
not only typhus but many other dis-eases.
They spread filth and poison.
They destroy produce and property.
A campaign for their riddance would
save the state money, property and
lives.
While the midwife problem is not
what it used to be in North Carolina,
it is still an important health ques-tion
when viewed in its relation to the
state's high death rate of mothers
and babies. It is estimated that ap-proximately
4,000 midwives practice
in the state, serving between a third
and a fourth of all mothers, but more
than twice as many colored as white
mothers.
February, 1938 The Health Bulletin
Duke Hospital
By A. A. Wilkinson
TOURING the present decade hos-pitalization
has made its most
signfiicant advances in North Caro-lina,
some of which can be attributed
not only to the direct aid of the Duke
Endowment but to the stimulus that
trust has had upon scores of com-munities
in planning and providing
for their own hospitals. Duke Hos-pital
in Durham has had a record of
development since its opening in
1930 that parallels the growth of hos-pitalization
in the state. With a
capacity of 456 bed patients it is the
largest general hospital of a broad
southern area. During the first six
and a half years of its operation it
received 78,500 different patients
from nearly all of the state's coun-ties
and more than a score of states.
To survey the accomplishments of
this young institution that is per-forming
so large and important a
task, much must be taken into con-sideration:
its organization, equip-ment,
methods, operation of public
dispensary clinics, contributions to
research and operative technique, its
teaching clinics, symposia for physi-cians,
its part in bearing the state's
charity load and the almost countless
other departments and activities
that are essentials in the performance
of its work.
A striking feature of the Duke Hos-pital's
first seven years has been its
immediate rise to importance as a
sectional hospital. This is shown in
the fact that the distance the average
patient travels to Duke Hospital is
71 miles. All of the hospital's pa-tients
have received an aggregate of
508,500 days of care (up until Janu-ary
1 of this year—hence the present
total is' much more) , and through the
past October more than 25,000 opera-tions
had been performed in five busy
operating rooms. In a measure the
growth in number of operations indi-cates
the expansion of the hospital's
work. By years operations have been
as follows: 623 in 1930; 1,807 in
1931; 2,397 in 1932; 2,884 in 1933;
3,566 in 1934; 4,246 in 1935; 5,170 in
1936; and 4,717 during the first ten
months of this year.
When the hospital began its serv-ice,
only 100 of its 456 beds were
opened, and it was expected that this
would accommodate all patients ad-mitted
for some time, yet in the fall
of the same year additional wards
were opened, and today no beds long
remain unoccupied. There were 91
patients for the daily average during
the first year, and this year the aver-age
will approximate 330.
By number the vast majority of
the hospital's patients are received
through the public dispensary clinics.
Hospital visitors frequently are sur-prised
upon seeing the lobbies and
waiting rooms so crowded with pa-tients
of all ages who have come for
medical care. These ambulatory pa-tients
numbered 500 monthly in 1930,
and by 1934 they had grown to 3,000
monthly. During this year the
monthly average has been 3,950 pa-tients.
This growth has necessitated
many additional examination and
treatment rooms.
Clinics conducted by the hospital
include general medicine, general
surgery, obstetrics and gynecology,
children's diseases; ear, nose, and
throat; dentistry, tumors, bnne and
joint diseases, urinary and kidney
diseases, eye, syphilis, asthma and
hay fever, diabetes, infant feeding,
pneumonia, pneumothorax, and en-docrine.
The Health Bulletin February, 1938
During 1936 91.4% of the patients
in Duke Hospital were not able to
pay the full cost of their medical
care; 75 of the 94 counties in the
state represented by this group, how-ever,
assisted them in amounts vary-ing
from $2 to $9,013.45. The money
contributed by the counties was 4.8%
of the cost of their care, and the pa-tients
themselves paid 53.1%. In
some counties the proportion contrib-uted
by the patients was even less.
Of the total $191,244.72 for the cost
of charity work, 92.7% was for the
care of patients from this state, 3.7%
for patients from South Carolina, and
2.5% for those from Virginia. For
the other 20 states represented in
Duke Hospital's patients for the year,
the patients paid 65.9% of their cost
of medical care.
It may be of interest to indicate
the percentages of the various operat-ing
costs of the hospital. Nursing
and care of patients required 50.8%,
food 32.1%, heat, water, and main-tenance
9.5%, and 7.6% for adminis-tration
of the preceding divisions.
During the year the hospital costs
totalled $509,797.80, or $4.51 per day
for each patient.
The hospital medical staff com-prises
more than 100 persons, includ-ing
internes, resident-staff, and teach-ing
staff; while secretaries, techni-cians,
nurses, and minor administra-tive
officials number 250. There are
more than 200 orderlies, maids, cooks,
and other employes.
The four major divisions of the
hospital are: (1) surgery, which in-cludes
the sub-divisions of surgery,
orthopedic surgery, urological surg-ery
and nose, throat, and eye surgery,
nerve and brain surgery, and thoracic
surgery; (2) general medicine and
its divisions: allergy, cardiology, der-matology,
neurology, psychiatry, and
gastro-intestinal diseases; (3) ob-stetrics
and gynecology; and (4)
pediatrics. There are also several
subsidiary departments ; pathology,
including gross and micropathology.
The pathological department, in ad-dition
to serving Duke Hospital does
pathology for some 50 hospitals which
are not financially able to maintain a
pathologist. Likewise the toxicologi-cal
laboratories serve a wide area.
An interesting array of physiothe-rapy
equipment is operated for treat-ment
of patients by massage, heat,
electricity, light, and water. There
is a pharmacy that supplies all the
drugs used in the hospital. Other in-teresting
features include the amphi-theater,
equipped with screen and
lights for pictures, that is used for
lectures and demonstrations, but not
for actual operations; the division of
medical illustration with its expert
photographer and artist, and several
printing presses.
During the past four years the
hospital has sponsored annual sym-posia
for the benefit of physicians in
the state and the border counties of
Virginia and South Carolina, and the
average attendance has been some
500. During this period the sym-posia
have brought to the hospital
widely-known authorities in the fields
of gynecology, pediatrics, obstetrics,
psychiatry, surgery, and specialists
in the fields of gastro-intestinal di-seases,
and diseases of the circulation,
heart, and kidney.
Throughout the year the hospital,
in addition, brings special lectures
to conduct teaching clinics in many
phases of medical and surgical prac-tice.
These are heard by visiting phy-sicians
as well as by members of the
hospital's staff and students.
During the seven years of its opera-tion
the hospital has been used in
connection with the medical school's
preparation of 199 graduates, and in
further training many of the 155
graduates who have already com-
February, 1938 The Health Bulletin
pleted their periods of interneship.
The first use of special ultra-violet
lamps in the hospital's operating
rooms for the purpose of sterilizing
the air of bacteria has offered a solu-tion
to the long baffling problem of
contaminated air in hospital operat-ing
rooms. Such rooms, often in al-most
constant use day and night,
present the contaminated air problem
with resultant post-operative infec-tions
and perhaps deaths in patients.
After hundreds of operations in the
Duke rooms with the sterilizing lamps
suspended above the tables, post-operative
temperatures have shown a
marked decline, and convalescence
has been accelerated. The tubes'
radiations effectively kill bacteria at
a considerable distance from their
source in 60 seconds to five minutes.
Not since surgeons abandoned the
use of Lord Lister's carbolic spray in
operating rooms has the problem of
air sterilization been considered to
any extent. Close tabulation of the
Duke Hospital records indicate the
efficacy of the lamps, and the work
is being checked in other large hos-pitals
in this country.
In addition to the pioneering work
in hospital operating room steriliza-tion,
Duke Hospital research has pro-duced
various improved surgical
methods in the sphere of hospital
care.
Of more significance than merely
its service to the staff and students
is the maintenance in the hospital of
a library of more than 32,500 vol-umes
that is used for reference
sources by physicians throughout the
state.
Other departments that carry on a
busy and highly interesting work are
the roentgenology and the brace and
instrument shop. The X-ray division
is one of the most completely equip-ped
in the country and is finding in-creasing
demands for its service.
In the realm of pure research many
interesting and potentially valuable
projects are under way, including the
studies of pellagra and anemias. A
hundred persons in the hospital are
engaged entirely in research work.
Inspection of Out-of-State
Sources of Milk Supply
Tightened
With surveillance of out-of-state
sources of supply more rigid than ever
before, milk from insanitary dairy
farms should be a rarity in New York
State.
For years, milk and cream shipped
into this State for fluid consumption
have been subject to the same stand-ards
as those for domestic supplies
and local health officers have been
responsible for seeing that foreign
milk and cream met the prescribed
requirements. Now, for the first
time, out-of-state supplies are given
rigid inspection at their very source
by the State Department of Health.
Since July 1, a corps of fourteen milk
sanitarians, who will inspect some
18,000 farms and about 169 dairj'
plants shipping milk into the State,
have been added to the Department's
Bureau of Milk Sanitation. General
sanitary conditions on farms, as well
as stables and equipment used in
milk production, will be carefully
examined. Two of the sanitarians,
who are also veterinarians, will make
physical examinations of herds as a
check on the results obtained by the
local veterinarian. About 23,000 dairy
farms have been insi>ected to date.
This strict supervision of out-of-state
milk supplies is required by
Chapter 404, Laws of 1937, which pro-vides
for licensing by permit of milk
shipped into this State. Permits are
predicated on inspection of the sources
of such milk to insure conformity
with New York standards and sani-tary
requirements. The law became
effective July 1.—New York State
HEALTH NEWS.
If the above regulations are good
for the people of New York, they
should be equally as desirable for the
people of North Carolina.—Editor.
The Health Bulletin February, 1938
Noises and the Sick
By John M. Gibson, Director,
Division of Public Health Education
Alabama State Department of Health
pvURING his recent tour of Europe,
former Governor Alfred E. Smith
of New York wrote of his impres-sions
of the Old World for an Ameri-can
newspaper syndicate. During his
visit to Italy he wrote of that coun-try
as follows
:
"There appeared to be a quiet not
known in the United States, parti-cularly
in New York City, where the
mayor was obliged to inaugurate an
anti-noise campaign. I discovered
that chauffeurs are not permitted to
sound their automobile horns, except
at curves on mountain roads. On
regular highways and on city streets
you never hear a sound. Even trol-ley
cars are noiseless. The police
directing traffic have no whistles to
blow. They wear black clothes with
white gloves and regulate traffic by
the motion of their hands. The white
gloves against the black background
are easy to see and take the place of
stop-and-go signals."
It is not at all surprising that this
visitor, who had spent most of his
life in what is probably the world's
noisiest city, should have been greatly
impressed by this absence of noise
in a foreign country. Many others
have been similarly impressed.
From time to time newspapers pub-lish
letters from their readers pro-testing
against the incessant din that
disturbs would-be sleepers, makes
slumber all but impossible, and in-evitably
contributes heavily to the
staggering toll of physical and men-tal
wrecks who crowd our sanatoria,
our hospitals and our institutions for
mental cases. These letter-writers
ask why hard-working men and wo-men,
trying to get the rest they so
greatly need for the labors of the fol-lowing
day, must be kept awake for
hours in the dead of night or in the
early morning because of the thought-lessness
of automobile horn-tooters,
radio listeners who apparently can-not
enjoy a program unless it is loud
enough to be heard a block or two
away, truck drivers who dash here
and there with their muffler cut-outs
open, and innumerable others who
show little or no concern for the right
of the ordinary citizen to get a good
night's sleep.
"Last night I counted the number
of horns sounded during the five-minute
period between 11:55 and
12:00," wrote the author of such a
letter of protest published some time
ago in The New York Times, "and
the total was 36—an average of seven
blasts a minute at midnight. These
were not warning 'toots' to a stray-ing
pedestrian. They were 'blasts'
of impatient drivers—the favorite
sport of those behind a wheel to hur-ry
the car ahead. Why shou'd not
every policeman be authorized to or-der
a m isy driver to the curb for a
fifteen-minute period to think it over,
under penalty of receiving a ticket if
he moves before that time?"
Although the problem of noises at
night is perhaps greater in New York,
in spite of a noise-abatement drive be-gun
some time ago, it is one with
which the entire country, including
Alabama, has to deal. A reader of
The Birmingham Post wrote as fol-lows
in a recent issue of that paper:
"I would like to lay my hands on
certain motorists who persist in rid-ing
down Cotton Avenue honking
their horns for all they are worth at
night.
"I think, as a matter of common
February, 1938 The Health Bulletin
courtesy, motorists should refrain
from blowing their horns as much
as safety will allow when driving
through thickly populated residential
sections of the city.
"You can hear motorists a block
away bearing down on their horns as
they come plunging down Cotton
Avenue. It's a pain in the neck to
every resident on that avenue, and I
wish the chief of police or the city
fathers, or somebody, would take it
upon themselves to urge motorists to
be more considerate of sleeping resi-dents."
Several years ago it was made an
offense against His Majesty's govern-ment
for an automobile or truck
driver to blow his horn or make any
other unnecessary noise between the
hours of 11 P. M. and 6 A. M. in the
most populous sections of the city of
London. Offenders were informed in
no uncertain terms they might expect
prompt and adequate penalties for in-fractions
of the new regulations,
which it was planned to make effec-tive
later in all parts of the city and
throughout the British Isles. This
forward-looking step was greeted
with enthusiasm and has been emu-lated
by many other large cities.
The drive against needless noise
was taken up on this side of the At-lantic
by the American Automobile
Association. This organization an-nounced
that it would not confine its
campaign to an effort to curb night
noises alone, but would attempt to
reduce, as far as possible, the un-necessary
wear and tear on human
nerves and dispositions in the day-time
as well. After referring to the
success of the London campaign and
to a similar drive in Berlin, Mr.
Thomas P. Henry, of Detroit, presi-dent
of the A. A. A., had this to say,
as quoted in newspaper reports:
"Such a campaign in American
cities not only would bring an era of
quiet, particularly in residential sec-tions,
but would contribute to safer
motoring conditions.
"The horn was, and is, intended as
a warning signal, but not one out of
a hundred blasts today carries any
such significance. If we could cut
down the use of the horn, there would
be more respect for boulevard stops,
less speed in turning corners, less
hurrying in congested traffic, and a
decrease in the number of drivers
who weave their cars in and out of
lanes of traffic.
"Any program to reduce noises in
our streets also might include a drive
against open exhausts, back-firing of
engines, and other unnecessary
noises."
All sleep-wrecking noises, of
course, are not due to thoughtless
motorists and truck drivers. Those
who are kept awake by their neigh-bors'
radios probably feel that the
voices and music traveling the air
waves are more rest-disturbing than
the sounds emanating fi'om auto-mobile
or truck horn, exhaust or
brake.
"Unquestionably the worst public
nuisance in New York today is our
neighbors' radios," a long-suffering
night-noise victim protested in a let-ter
to the radio editor of The New
York Times last July. "During the
summer everybody's windows are
necessarily wide open and the broad-casts
that come blaring simultaneous-ly
out of so many different windows
turn whole neighborhoods into bed-lam."
This letter-writer continued:
"Either a great many radio owners
are hard of hearing or else they en-joy
noise for the sheer volume of
it. Entire districts are rendered un-fit
for civilized living and during the
evenings and Sundays, when people
want to rest from their work, they
are mercilessly exposed to this bed-
10 The Health Bulletin February, 1938
lam of noise, which is obviouslj'
damaging to public health.
"Now all this radio nuisance is un-necessary.
You can enjoy radio as
well turned down low as at full vol-ume."
The blame for blaring radios rests,
of course, upon the owners of re-ceiving
sets and not the broadcasting
stations. The latter have no control
over the noise-mania of those who lis-ten
to their programs, and they have
given frequent indications that they
are eager to do everything they can
to prevent the radio from being a
public nuisance. An example of this
eagerness was seen at the time of the
Joe Lewis-Jimmy Braddock cham-pionship
fight several weeks ago,
when the announcer reminded fight
fans listening in that the fight was
being held after many persons' bed-time
and asked that radio sets be
tuned down in order not to disturb
their rest.
Unnecessary noise, especially at
night, whether due to the causes that
have been mentioned or to others,
not only are a distinct nuisance, but
also constitute a serious problem in
public health. Those who cannot ob-tain
the rest and sleep they need are
most susceptible to the diseases that
play havoc with mind, body and
nerves. Those who are already sick
and are doing their best, by a strict
regimen of rest, to regain their
health find sleep-wrecking noises to
be severe handicaps in their fight
against illness.
Hospitals are permitted to estab-lish
"hospital zones" and to indicate
them by proper signs. Those making
unnecessary noise, whether at night
or in the daytime, within these zones
of quiet are subject to suitable penal-ties.
In view of the fact that only a
relatively small percentage of the
sick are hospital patients, is it not
proper to insist that those fighting
illness in their own homes are en-titled
to similar consideration, and to
a measure of protection against
thoughtless persons' hunger for noise
and yet more noise?
Many, indeed, have been the trib-utes
paid to sleep as a contributor to
human health and happiness. Cer-vantes
called it "meat for the hungry,
drink for the thirsty, heat for the
cold, and cold for the hot." To Sam-uel
Daniel it was a "Care-charmer."
The Psalmist rejoiced that God
"giveth His beloved sleep." To Sam-uel
Taylor Coleridge it was "a gentle
thing, beloved from pole to pole." To
Shakespeare it was "sore labor's bath,
balm of hurt minds, nature's second
course, chief nourisher in life's
feast." A less poetical but equally
correct tribute to sleep was written
by an anonymous author of an ar-ticle
published some time ago in
Clinical Medicine, in part as follows:
"Sleep is the most important thing
in the world, more important, even,
than food. We rest to sleep—but we
sleep to live. Men have gone sixty-three
days without food and a week
without water—but they cannot last
more than ten days without sleep.
Loss of sleep causes a form of star-vation,
for the food we eat is digested
and transmitted into new muscle,
brain, blood and nerve cells only while
we are asleep. Sleep recharges the
exhausted body-batteries and fills the
organic furnace with fresh fuel. Sleep
is a positive process—not a negative
one. It isn't merely a stopping of
bodily activity. It's the substitution
of a constructive process for a de-structive
one."
Macbeth, in anguish and remorse,
condemned himself as a murderer of
sleep. In our day the murderers of
sleep seldom suffer attacks of con-science.
In their easy-going, incon
siderate way, they make little or no
February, 1938 The Health Bulletin 11
effort to curb of eliminate the noises
that make sleep impossible for the
victims of their thoughtlessness.
Many, no doubt, do not realize how-much
damage they do, and need only
to be reminded of it. If those re-sponsible
for unnecessary night noises
could be induced to show the same
degi-ee of courtesy and consideration
for others that mark the lady and
gentleman in the ordinary affairs and
relationships of life, there would be
a vastly greater measure of health,
peace and happiness for all of us.
Zachary Smith Reynolds Foundation Do-nates
Income to State Board of Health
To Aid in Control of Syphilis
By W. H.
npHE North Carolina State Board
of Health has been designated to
handle the largest benefaction for
public health in the history of the
South and one. of the most significant
ever made anywhere—the income
from $7,000,000, with which war will
be waged on syphilis, that arch-enemy
of mankind.
The allotment was made by the
trustees of the Zachary Smith Rey-nolds
Foundation, Incorporated, and
the first check for $100,000 was re-ceived
by Dr. Carl V. Reynolds, State
Health Officer, upon his return to his
desk after the Christmas holidays.
"This magnificent philanthrophy
will bring to a realization one of the
fondest dreams of the State Board of
Health," Dr. Reynolds said. "It will
enable us to accomplish, in the com-paratively
near future, some of the
objectives that have seemed years off.
Long before government began to
realize its responsibility in the pre-vention
of disease and the preserva-tion
of the health of its citizens, as
a means of bringing about better so-cial
and economic conditions and the
promotion of human happiness,
philanthropists led the way; but this
gift to my mind, is the greatest of all,
in that it has been made available
Richardson
for war on 'the Great Exterminator',
a disease that has shown humanity
no mercy."
Dr. Reynolds, however, made it
plain that every cent of the money
—
both of the $100,000 already in hand
and any subsequent amounts—will be
used for the specific purpose for which
it was allotted, and that, while it
will be necessary to employ additional
men and women to do the work re-quired,
these will be experts and
chosen not because someone recom-mends
them, but because of their fit-ness
for the job they are to undertake.
In other words, as Dr. Reynolds put
it, "no gravy train has been set on
its way," adding: "This means hard
work, the performance of a task that
will require the execution of a very
definite program, over an extended
period." He went on to explain that
"this is a trust fund and will be ad-ministered
as such, with a view to
being able to give an account of our
stewardship, at any and all times."
There was a time when none dared
speak the word "syphilis" out loud.
Even so, there was a time when
"tuberculosis" was spoken in a soft
voice, behind the hand and directed
at the ear of only the one who was
supposed to hear. People were afraid
12 The Health Bulletin February, 1938
of tuberculosis—and as long as they
were afraid of it, they never con-quered
it. Now, it is a controllable
and a curable disease. Thousands of
persons throughout this and other
lands who have been delivered from
its curse, go about with smiling
faces, useful men and women, gain-fully
employed, keeping pace with
their fellows in the march of prog-ress.
Syphilis, as the medical profession
points out, has a known cause; it is
curable, and it can be exterminated.
The Scandinavian countries have
demonstrated this. In Sweden, for
example, it is practically nil. Yet,
in America it is a raging epidemic,
affecting about one-tenth of our
population, including one out of every
ten mothers who give birth to a child.
If measles, whooping cough, diph-theria
or any other disease within a
group of such infectious and contag-ious
maladies were as prevalent as
syphilis is today, the schools would
certainly be closed and, perhaps, the
movie houses and other places of pub-lic
gatherings and entertainment.
The fact that syphilis is curable
and can, with the proper treatment,
be exterminated, makes the Z. Smith
Reynolds Foundation benefaction to
North Carolina and its people, ad-ministered
through the State Board
of Health, all the more significant.
With the proceeds from this fund,
the Board of Health will fight
sjrphilis from the cradle to the grave
—and further. It will attack it in
its prenatal stage, by helping syphili-tic
mothers give birth to babies that
can have a chance in the world.
When we take into consideration the
fact as stated above that ten per cent
of all children are born of syphilitic
mothers, is it any wonder we stand
appalled and register a solemn vow
that this must not continue? This
question was asked by Dr. Reynolds:
"But what could we do without the
funds with which to prosecute the
work?" he added. Just so. Now the
funds have been provided.
Let us look for a moment at the
picture here in North Carolina, where
this trust fund committed to the
State Board of Health is to be ex-pended.
New cases of syphilis are
being reported at the rate of 33 a
day, or 12,000 a year, while a fair
estimate of the number existing in
North Carolina at the present time
is more than 300,000 including 20,000
children under 15 who inherited it
from their parents. As only 43 per
cent of the syphilitic children reach
the age of 10, it is assumed that, in
addition to the 20,000 just referred
to, 26,000 have gone to their graves.
The above figures were given, in a
more extended form, by Mrs. J.
Henry Highsmith, in her recent ar-ticle
advocating better marriage laws
as one of the safeguards against the
spread of venereal diseases. It will
interest the readers of The Bulletin
to know that at least fifty North
Carolina newspapers — perhaps a
larger number—reprinted Mrs. High-smith's
article in full, some of them
adding the weight of favorable edi-torial
comment.
The money available from the Z.
Smith Reynolds Foundation, Incor-porated,
to be used in connection with
other funds available to the North
Car- lina State Board of Health, will
enable the Board to carry on a cam-paign
that will be thorough. "We
propose," says Dr. Reynolds, "to lo-cate
those who have syphilis and to
see to it that they are treated to the
point where they will not only be
non-infectious but carry these treat-ments
to where the patients will be
completely cured. This is the only
safe course. We propose to keep be-
February, 1938 The Health Bulletin 13
hind delinquents, because temporary
relief is not sufficient. This only
means that in time to come there
will be a recurrence of the disease
and the patient will be subject to the
sequelae so well known to the medi-cal
profession, including heart and
other organic ailments that bring
men and women to their graves."
Numerous conferences already
have been held at this writing, in-cluding
one between Dr. Reynolds,
Dr. R. A. Vonderlehr, Assistant Sur-geon
General of the United States in
charge of venereal control work, and
Health Board staff members. Others
were scheduled to follow, during
which all phases of the campaign
were to be taken up and given con-sideration.
This benefaction from the Board
of Trustees of the Zachary Smith
Reynolds Foundation, Incorporated, is
the largest single gift for the par-ticular
purpose to which it has been
dedicated that has ever been made,
and its effect will be far-reaching, in
stimulating further allotments from
other sources, including, perhaps,
governmental sources. The cause is
not only a worthy but a pressing one.
It took money to exterminate yellow
fever, typhoid and other maladies
which formerly claimed their victims
by the hundreds of thousands every
year. It will take money to bring
sjrphilis under control; but the public
should never lose sight of the fact
that, along with that, along with that
of the clinic, lies the work of educa-tion.
Syphilis must be dragged from
its den, out into the open, and ex-posed
to the public gaze. It must be
treated as a public enemy—for it is
such—Public Enemy Number One, in
the realm of disease. Cancer is pain-ful
and deadly—alas, deadly to the
point where it has never been brought
under control. But cancer, with all
its consequent suffering and its tre-mendous
annual toll cannot be classed
with syphilis in the scope of its havoc,
because it is not controllable, and
syphilis is.
Educational matter about venereal
diseases can be obtained from the
North Carolina State Board of
Health. This should be studied, with
a view to getting people interested in
avoiding it. In this age of sophistica-tion,
there is no reason why youth
should not be warned of the dangers
of syphilis. It knows about it, any-way.
It knows what causes it, but it
is the duty of the elders, and those
who have made a study of the situa-tion,
to sound a note of warning that
must catch the ear of youth.
Syphilis should be fought, through
education, in the home. It should be
fought in the school, the Sunday-school,
the church, the Army and
Navy, the Y. M. C. A. and kindred
organizations—it should be fought to
the bitter end by every agency that
has the power to raise its voice or
finger against it!
The North Carolina State Board
of Health is preparing to do its part,
in its way—in a great big way—but
YOU must cooperate, Mr. and Mrs.
Citizen. What will you do? If you
have any suggestions, send them in
to the Editor of The Bulletin, Care
of the State Board of Health.
Health centers are no longer an ex-periment
in North Carolina. Last
year there were operating in the dif-ferent
counties 120 health centers for
mothers and babies. These centers
were served by local physicians and
public health nurses. Needy indigent
mothers who had been visited by the
nurses came and brought their babies.
They were examined and the mother
was told what to do to safeguard her
health and that of her baby.
14 The Health Bulletin Fehi-uary, 1938
Marihuana
By Mrs. J. Henry Highsmith
A/TARIHUANA
term for an
is a new world
old world drug
whose ancient history is black with
crime and insanity. It was intro-duced
only a few years ago into the
border country of the United States
by Mexican laborers. Today it is
known to have spread to every stata
in the Union, and the number of
marihuana addicts is now estimated
to be more than 100.000, the majority
of whom are of high school and col-lege
age.
Marihuana, or marijuana, is the
Mexican name for the dried flowers
and leaves of the commercial hemp
plant, cannabis sativa. In Asia the
plant is known as cannabis indica, or
Indian hemp, and the narcotic derived
from it is called hashish. The Eng-lish
word "assassin" is derived from
the Arabic "hashishin," or "hemp
eaters," an oriental religious and
military society noted for its violence
and crimes committed under the in-fluence
of hashish. Orientals long
ago learned that hashish produced
the proper mental and emotional
state for committing crimes of the
most heinous nature.
Marihuana circulates in the United
States usually in the form of cigar-ettes
under a variety of local names,
such as reefers, greefas, mutahs,
muggles, miggles, love weed, giggle
weed, joy-smoke and the like. It is
peddled out especially to high school
boys and girls by vagabond dope ped-dlers.
It is made alluring to youth
by a whispered secret that it is a
cigarette with a new thrill, a "real
kick," with no harmful aftereffects.
Its introduction into the United
States was preceded by a whispering
campaign which represented it as
able to perform miracles, to produce
great physical and mental strength.
and to sharpen one's wits and social
gifts.
In this country the effects of the
drug are obtained almost entirely by
smoking the dried leaves and flowers
of the plant. It has been found be-ing
sold not only in high school and
college communities, but across re-freshment
counters, in second rate
dance halls, low amusement places,
barbecue stands and some filling sta-tions.
Marihuana dens have been
found in some of the larger cities,
and many of these were visited by
high school boys and girls in search
of a new sensation.
The effect of the marihuana drug
differs with the individual. No one
can predict what the reaction in any
case will be. On the immature brain
of the young, it acts as an almost
overpowering stimulant. Its contin-ued
use undoubtedly results in gen-eral
instability, mental weakness and
finally in insanity. "Floating" is
the term given to marihuana intoxi-cation.
In this condition the per-son's
ego becomes greatly magnified,
and nothing appears impossible. All
sense of time, place, conscience or
consequence is lost. Marihuana vic-tims
suffer hallucinations which of-ten
take the form of a persecution
complex, with violent murders, maybe
of father, mother or best friend, as
the result.
A. J. Anslinger, U. S. Commis-sioner
of Narcotics, says: "Mari-huana
is contributing to an alarming
wave of sex crimes. How many mur-ders,
suicides, robberies, criminal as-saults,
holdups, burglaries and mani-acal
insanity are caused each year by
marihuana can only be conjectui'ed.
The sweeping march of its addiction
has been so insidious that it thrives
in numerous communities and is only
February, 1938 The Health Bulletin 15
found out by the commitment of a
heinous crime."
That marihuana, or cannabis sat-iva,
is a weed that grows wild
throughout the country; that it is a
habit-forming drug making dope ad-dicts
of thousands of men and women,
and that the youth of the country
has been chosen by the peddlers of
this poison as their most fertile field,
make it a problem of serious concern
to every man and woman.
To bring the traffic in this drug
under control, says Mr. Anslinger,
means a job of unceasing watchful-ness
on the part of the police, pa-rents,
school officials, public health
officials and all welfare workers. It
means education through the schools,
the home and the press. It means
also cooperation on the part of all
good citizens in securing the strict
enforcement of State and Federal
Narcotic Laws.
Fortunately, North Carolina has a
State law for the control of mari-huana,
but not until last summer
when Congressman R. L. Doughton
introduced and secured the passage
of a law by Congress did we have a
Federal Law. One without the other
was ineffective, while both, it is be-lieved,
will be able to curb the traffic
in the marihuana drug.
NEGLIGENCE OF PARENTS
CAUSE MANY BABY DEATHS
That more than 2,000 babies under
one year of age are killed acciden-tally
every year in this country shows
great negligence and ignorance on
the part of parents. In a recent
study of accidents to infants record-ed
in the statistical bulletin of the
Metropolitan Life Insurance Com-pany,
it was found that more babies
die from accidents than from mea-sles,
scarlet fever, and diphtheria com-bined.
Among colored infants the
fatal accident rate was found to be
about double that of white infants.
Among the accidents listed as caus-ing
infant deaths over a two-year
period — 1933-1935, suffocation was
given as causing the greatest number,
or 38.7 percent of the total accident
deaths. Smothering by bed clothing
headed the list of accidents. This was
followed by smothering by adults
sleeping in the same bed with in-fants,
and smothering by means of
the child's face being buried in a pil-low
or by sleeping on the face was
next. The winter months when heavy
bed clothing is used and when pa-rents
yield to the temptation to take
the baby into their bed afford the
greatest number of accidents.
Foreign bodies, such as food parti-cles,
safety pins, tacks and marbles,
lodged principally in the air passages
caused about 9 percent of the acci-dents.
Burns such as result from
scalding from hot water, coffee, tea, or
from upsetting pans, accounted for
another 9 per cent; while falls, chief-ly
out of cribs, beds, or high chairs,
down the stairs, or out of windows,
were listed third.
Other important causes were auto-mobile
accidents, drowning, poisoning
by food, and conflagration. All of
which is to say that parents, nurse
maids and cooks are all too careless
in regard to the care and safety of
babies. Thus a baby's first year of
life is made one of peril and great
danger.
Schick Tests for Children
In the fall of 1936, the State Board
of Health supervised the administra-tion
of toxoid to 375 children in Al-leghany
County. The job was effi-ciently
done with a fresh product.
One year later, in the fall of 1937,
the Schick test was given to the 375.
Nineteen of them reacted positive.
This should be an important item for
health officers to note.
16 The Health Bulletin February, 193S
A SECTION OF DUKE HOSPITAL, DURHAM, N. C.
(See article in this issue by A. A, Wilkinson)
IfcJMb&il
Published bq TPCE^N°KmCI^^SUIVK STATE.DPARDs^AEAJjn
This DuTIetirv will be 5er\l free to arwi atizen of 1he 5tcrte upor\ Tequestf
Entered as aecond-clasa matter at Postoffice at Raleigh, N. C, under Act of July 16, 189i.
Published monthly at the office of the Secretary of the Board, Raleigh, N. C.
Vol. 53 MARCH, 1938 No. 3
THREE HUNDRED FEET UNDERGROUND IN NORTH CAROLINA
Siliceous dusts, to which the workers in many trades are exposed, con-stitute
the most extensive occupational disease hazards in the state. Silica,
uncombined as quartz or chemically united with other elements as silicates,
when inhaled converts healthy lung tissue into scar tissue, the accumulation
of which will result ultimately in the disablement of the worker. Such health
risks are not confined to the numerous mines of North Carolina but exist in
all of the many industries that mill or fabricate mineral substances or employ
them in manufacturing processes. The scene above is a picturization of one
way in which a dust hazard is created. Into an ore deposit a pneumatically
operated Jack Hammer drill is cutting a hole which subsequently will be
loaded with d^Tiamite in preparation for blasting down the mineral. The
dust cloud issuing from the drill hole is so dense as to partially obscure one
of the workmen. Note the air filter worn by the woi'ker whose face is visible.
One phase of the work of the Division of Industrial Hygiene, which functions
in cooperation with the N. C. Industrial Commission, administrator of the
Workmen's Compensation Act, is to evaluate the extent of such risks and pro-mote
the introduction of safeguards. The use of water liner drills reduces
the dust hazard. In the mine pictured above wet methods recently have
been introduced. In one locality active mining operations are in progress
more than 2,000 feet -nnderground.
MEMBERS OF THE NORTH CAROLINA STATE BOARD OF HEALTH
S. D. Craig, M.D., President Winston-Salem
J. N. Johnson, D.D.S., Vice-President Goldsboro
G. G. Dixon, M.D Ayden
H. Lee Large. M.D Rocky Mount
H. G. Baity, ScD Chapel Hill
W. T. Rainey, M.D Fayetteville
Hubert B. Haywood, M.D Raleigh
James P. Stowe, Ph.G Charlotte
J. LaBruce Ward, M.D AsheviUe
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.
Warren H. Booker, C.E., Director Division of Sanitary Engineering
and Malaria Control.
Ernest A. Branch, D.D.S., Director Division of Oral Hygiene.
John H. Hamilton, M.D., Director Division of Laboratories.
J. C. Knox, M.D., Director Division of Epidemiology and Venereal
Disease Control
R. T. Stimpson, M.D., Director Division of Vital Statistics.
R. E. Fox, M.D., Director Division of County Health Work.
H. F. Easom, M.D.. Director Division Industrial Hygiene.
FREE HEALTH LITERATURE
The State Board of Health publishes monthly The Health Bulletin,
which will be sent free to any citizen requesting it. The Board also has
available for distribution without charge special literature on the fol-lowing
subjects. Ask for any in which you may be interested.
Adenoids and Tonsils German Measles Scarlet Fever
Cancer Health Education Smallpox
Constipation Hookworm Disease Teeth
Chickenpox Infantile Paralysis Tuberculosis
Diabetes Influenza Tuberculosis Placards
Diphtheria Malaria Typhoid Fever
Don't Spit Placards Measles Typhoid Placards
Eyes Pellagra Venereal Diseases
Flies Residential Sewage Vitamins
Fly Placards Disposal Plants Water Supplies
Sanitary Privies 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, N. C.
Prenatal Care
Prenatal Letters (series of nine
monthly letters)
The Expectant Mother
Breast Feeding-
Infant Care. The Prevention of
Infantile Diarrhea
Table of Heights and Weights
Baby's Daily Time Cards : Under 5 months ;
5 to 6 months ; 7, 8, and 9 months ; 10,
11, and 12 months; 1 year to 19 months;
19 months to 2 years.
Diet List : 9 to 12 months ; 12 to 15
months ; 15 to 24 months ; 2 to 3
years ; 3 to 6 years.
Instructions for North Carolina Midwives
CONTENTS
Doing Something About Pneumonia Page 3
Nervous People Page 4
Telltales of Fingerprints Vase 4
Hope for Hard of Hearing Children ^^Ke 5
Treatment Versus Prevention Page i
First Aiders Valuable Help at Clemmons Page 9
Book Review Page 10
Not Safe to Wait If It's Appendicitis i^a^e 10
First Aid for the Home S^^^ ,,
Don't Drink Water Just Because It Looks Good Page 13
Don't Let Filthy Habits Make You an Ally of Death Page 15
Public Health Exhibits _ _ Page 16
Vol. 53 MARCH, 1938 No. 3
Doing Something About Pneumonia
EDITORIAL
npHE North Carolina State Board
of Health, with the aid of the
State Medical Society and the Medi-cal
School and Faculty of Duke Uni-versity,
has set up a commission for
pneumonia control and study in this
state. Recently, the Duke Medical
School conducted a laboratory course
of instruction in pneumonia typing.
This was offered free of charge to
the technicians of the State, those
working in the offices of private phy-sicians,
those connected with public
or private hospitals, and those in the
various city and county departments
of health. The course lasted a week,
from January 24 to 29, and was at-tended
by more than 60 technicians.
The purpose of the commission is
to study ways and means of prevent-ing
fatalities in attacks of pneumonia
by the use of a serum treat-ment
which is said to be effective in
certain types of the disease. As all
physicians know, there are several
types of pneumonia, thirty-two to be
exact. So far, the serum has been
found to be effective in several of the
more common types, including one of
the types of lobar pneumonia which
comprise about 50% of all cases.
Sera may be used in only about 60%
of combined types of cases. It is
within these types that most deaths
occur. Physicians, of course, under-stand
that a certain percent of all
pneumonia cases are caused by or-ganisms
other than pneumococci and
therefore plan their course of treat-ment
accordingly.
The serum at present is expensive,
but a few of the counties have al-ready
made provision for a supply of
the serum in all cases of indigent per-sons
needing it. The Commissioners
of Raleigh and Wake County recently
made an initial appropriation of a
thousand dollars at the request of
two of the practicing physicians of
Raleigh to be used for people unable
to pay for it. Dr. Hubert B. Hay-wood,
a member of the State Board
of Health is chairman of the Pneu-monia
Commission. The Commission
has already held one or two meet-ings,
and as a result of one of the
conferences, the Duke Hospital au-thorities
arranged the school for
technicians.
This movement to study and make
available all of the most modern
facilities for the treatment of this
terrible disease which causes so many
deaths in the prime of life is one of
the most significant efforts which the
State Board of Health has sponsored
in a long time. It is understood at
present that the results from the
proper serum when used immediately
and in sufficient quantity is very
satisfactory. Just two things are
required for the serum treatment to
extend full protection to the people.
These two things are, first, people
must send for a competent physician
just as soon as a patient is stricken.
It will not do to wait three or four
days until the patient is in an extreme
condition before sending for the doc-tor.
It will not do to waste valuable
The Health Bulletin March, 1938
time messing with various "drops"
and "salves" in the hope that the
patient has only a bad cold and will
soon be better. The physician must
be sent for immediately. The second
thing, is that when the physician is
called, that he respond promptly, that
he immediately procure the necessary
specimen of the patient's sputum, and
have the disease typed at once. Then
following that must be immediate ad-ministration
of the serum, which
must be a fresh and potent product.
People living in the country dis-tricts
considerable distance from the
cities or towns, or even the nearest
physician, must bear these things in
mind and lose no time in procuring a
competent physician once pneumonia
is even suspected.
This is only one instance of the
important work that the State Board
of Health is carrying on over a wide
front at this time which will even-tually
be of a great deal of benefit
to all the people of the State.
"NERVOUS PEOPLE'
I know a family in which the adults
are all exceedingly nervous and high
strung. Recently I saw in the sec-ond
generation of the family the per-fect
illustration of the reason for the
nervousness of the older members of
the family. I was invited to the
home for the evening. The little
grandchild, four years old, was there
on a visit. The aunt remarked that
little Jane wasn't taking her nap now
in the afternoon, "because she is on
a vacation now." Other company
called during the evening and the
child was petted and given attention.
At ten o'clock the little four year old
was still up, having had no nap, and
she was so completely exhausted and
nervous that she was almost quiver-ing.
Of course she cried when finally
carried to bed. Instead of making
the most of a bad situation, soothing
the child and quieting her as best she
could, the grandmother got a switch
and whipped the child for crying. If
the grandchild was treated that way
it is a safe bet that the children were
treated in a comparable manner. Yet
people sometimes remark "I wonder
what makes all the Jones family so
nervous and high-strung."
—
Contrib-uted.
Telltales of Fingerprints
According to the fingerprint rec-ords
of the Federal Bureau of Inves-tigation
at Washington, more than
250,000 arrests were made for state
and local offenses, crimes and viola-tions
in the first six months of 1937,
and 20 per cent of these were of
youths under voting age. Of these
arrests, 41,043 were for drunkenness,
with 627 for 19 year-olds; 10,599
were for driving while intoxicated,
with 498 under 21 years, and 4,807
were for violating liquor laws, 84 of
which were under 18 years. Another
I'eport showed that in New York State
drunken drivers had increased ten
times as fast as the use of auto-mobiles
on the highways and streets.
While the number of cars increased
only 5 per cent, the drunken dri\Tng
rate went up 56 per cent in a single
year. Connecticut's accidents by alco-holic
operators jumped 288 per cent
in one year, Cleveland's coroner re-ported
that 45 per cent of all of the
city's fatal accidents in which motor-ists
or pedestrians were involved
showed alcohol as a factor.
J. Edgar Hoover says: "Over 700,-
000 mothers in the United States
mourn the fact that their boys and
girls, all under voting age, either are
or have been in jail, in reformatories,
in prisons, or have met death in the
electric chair or by the hangman's
rope."
March, 1938 The Health Bulletin
Hope for Hard of Hearing Children
By Margaret
'T^HE sick babies, the crippled chil-dren,
those who can't see, have all
been getting their share of attention
from the State Board of Health and
other state supported agencies, and
now the State Board is going to give
the hard of hearing children their
chance for a happy and useful life,
too. The Board has purchased an
audiometer for measuring the hear-ing
of children and with it they plan
to make an extensive survey of the
hearing of school children in North
Carolina.
It has been found, through the
work of this nature that has been
carried on in a great many cities of
this country, that an average of five
percent of all school children have a
hearing loss of nine percent or more
in one or both ears. Sometimes the
loss is not very serious when found,
but if the cause of it is not corrected,
that slight hearing loss can grow
great enough to be a tremendous
handicap when the child grows up.
The late Dr. F. W. Bock of Roches-ter,
N. Y., was one of the first men
in this country to interest himself
in the deafened child to the extent
of doing something about it. In 1916
be started a piece of work for them
in Rochester which could be a model
and an inspiration to every city in
the United States. At that time he
started a systematic search for chil-dren
who did not have normal hear-ing,
which now covers the entire city
school system of Rochester. He
examined those found with impaired
hearing, always with the parent's
consent, to find, if possible, the cause
of the deafness. Hardened wax,
beans, popcorn, buttons, almost any
small object in the ear (Dr. Bock said
M. Thompson
once, "we find everything in the chil-dren's
ears except flivvers"), infected
tonsils or teeth, chronic colds, run-ning
ears, abscesses, all these are
among the more common causes of
deafness. Still with the parents' con-sent.
Dr. Bock and his staff gave
whatever attention might be needed.
They have found in Rochester, from
many years of experience, that a
large majority of cases of deafness
in children can be cleared up entirely
or in large part by simple medical or
surgical means.
Testing is now done with the audio-meter,
a machine like a phonograph,
except that the sound travels to head-sets
instead of coming out of a sound
box. For many years routine health
inspections in schools have included
"Watch and Whisper" tests for chil-dren's
hearing, but they are neither
uniform nor accurate and are not fine
enough to find hearing impairments
until they may have progressed too
far to be corrected.
The saving in dollars and cents of
this procedure has been clearly dem-onstrated,
too, not only in Rochester,
where the pioneer work has been
done but in the many other cities of
the country where this work is car-ried
on. To do it well means an ini-tial
expenditure of about $500 for
the audiometer, plus provision of
means for giving the necessary at-tention
to those children who cannot
afford the services of a private physi-cian
or speciaMst but that is soon paid
for in the cutting down of the num-ber
of children who because of deaf-ness
have had to repeat grades in
school. It costs any school system a
definite amount of money to put a
child through a term of school and
The Health Bulletin March, 1938
if that child has to repeat a grade
due to some remediable physical de-fect,
that repetition unnecessarily
costs the school system for an extra
year of schooling for that child. In
Rochester 221 deafened children re-peated
grades 441 times, costing the
city $22,460. Some cities that have
made surveys have found that deaf-ened
children repeat grades about
twice as often as those with normal
hearing. What the cost to the state
may be in future years for those hard
of hearing children who grow into
deafened adults unable to earn a liv-ing
because of their handicap and
who are therefore dependent on pub-lic
supported charity for a living, is
problematical.
That is cost in terms that everyone
can understand. The human cost is
even greater. We are sociable beings,
and deafness, more than any other
one affliction, cuts us off from our
fellow beings, makes us lonesome, and
we all know that loneliness can be
one of the worst of afflictions. It is
generally agreed that to be blind is a
greater handicap but it is also known
by those who have observed both hard
of hearing people and blind people,
that the former suffer much more
from depression, self-pity, and other
destroyers of happiness, than do the
blind. Speaking as one who has been
through that unhappiness, and from
which few emerge, I can say without
exaggeration that any investment in
time and money that will prevent even
one child from experiencing that un-happiness,
cannot be too gi'eat.
Finding the deafened child is only
the first step. He needs immediate
and thorough examination by a phy-sician
or a specialist, a private one
if financially possible, and whatever
measures may be needed to correct
the cause of his deafness. For those
whose loss of hearing has progressed
to the extent of its being a handicap
in everyday life, or for whom no
medical or surgical help can repair
the damage done, or prevent it from
becoming worse, lip reading instruc-tion
should be given in the public
schools.
Many problems gi'ow out of the
deafness of the little child. Neither
he nor his parents or teachers may
realize that he is deafened but be-cause
he can't hear well, he may miss
a great part of what is said in school,
may get twisted that which he does
partly hear, may appear stupid, or
be a "problem child." A first grade
teacher said to me recently of a lit- I
tie boy in her room whom she knows
to be hard of hearing, "I don't think \
he is stupid," and my reply was, "Of
course, he probably isn't stupid, but
he just can't hear, and I know from
experience that when I can't hear I
act stupid, and feel stupid and I
probably look stupid, too." Because
they can't join in play and feel them-selves
one of the group, they may re-tire
into a book or day dreams, or
solitary play, or try to compensate
for lack of social satisfaction by be-coming
bullies or show-offs, or in-dulging
in other behavior that makes
them undesirable members of society.
They suffer from social starvation
and another name for that is loneli-ness.
For the past several years I have
kept informed as to the work being
done and from the trend of the past
few years, even during the depres-sion,
I feel safe in predicting that it
is only a matter of time until a com-plete
plan of hearing conservation
will be a part of the health program
of every public school system in the
country, and will be as much a mat-ter
of course as sanitary drinking
fountains are today.
March, 1938 The Health Bulletin
TREATMENT VERSUS
PREVENTION
By Mrs. J. Henry Highsmith
Recently there was dedicated in
Jersey City a county tuberculosis
hospital of skyscraper proportions.
It is twenty-five stories high, ap-proximately
300 feet, and was
built at a cost of $3,000,000, secured
from the WPA, When it is furn-ished
and equipped at a cost of $750,-
000 more, it will have a capacity for
between 500 and 600 tuberculosis
patients, and it will be the finest
county - owned tuberculosis hospital
in the country. Into it will go every
modern facility that is available to
any hospital. There will be in addi-tion
to the most up-to-date clinical,
diagnostic and treatment facilities
such features as an auditorium for
lectures and entertainment of the
patients, a swimming pool, a Roman
Catholic chapel with stained glass
windows, bronze and marble trimmed
halls, a modern dental department
and an ear, nose and throat division.
In the erection of this institution,
according to the dedication issue of
the Jersey Journal, the mayor of the
city "has advanced a step nearer his
ambition to give the residents of Jer-sey
City and Hudson County one of
the finest and most complete medical
centers in the new world."
We quote again from one of the
dedicatory speeches recorded in the
Jersey Journal: "This magnificent
new hospital unit, one of the finest
and best equipped of its kind in the
country, is surely a splendid addition
to Jersey City's great Medical Center
of which we are all so proud. No more
humane work could be done, or is
being done, than caring for the thous-ands
who fall victim to what is com-monly
called the "white plague," and
this new buildng, with its staff of
doctors and nurses, is destined to
bring still further renown to the al-ready
famous names of Jersey City
and Hudson County, for the work
achieved here in the tuberculosis
field."
Could it be that in this modern,
grand way that the mayor of Jersey
City has chosen to meet the tuber-culosis
needs of his people, every fea-ture
of which is fine, that one of the
most modern and effective measures
has been disregarded? What about
preventing tuberculosis and saving
the 600 young lives from falling vic-tims
to the Great White Plague, mak-ing
their treatment unnecessary?
Nothing was said in any of the
speeches or reports carried in the 36
page dedication issue of the Jersey
Journal concerning any program of
prevention, such as better housing,
more and better food, better living
conditions, shorter work hours, ade-quate
pay, safe and sanitary condi-tions
in which to work as well as to
live, more recreational facilities and
a better all round chance to avoid the
misfortune of becoming an invalid
with tuberculosis. Hudson County
may be carrying on an adequate pre-ventive
program of this kind. If so,
well and good. The point we wish to
make is that adequate hospitalization
is only one of the essentials in a well-balanced
tuberculosis control pro-gram.
Treatment of the victims of the
Great White Plague is humane, but
more humane, more compassionate,
more* rational, and more economical is
it to prevent boys and girls, men and
women, from becoming White Plague
victims.
There may be a place and a need
now in Jersey City's health program
for a great skyscraper tuberculosis
hospital, but let us hope that it will
not be ever thus, and that its policy
will be to serve more as part of the
fence on top of the cliff rather than
as the ambulance down in the valley.
The Health Bulletin March, 1938
March, 1938 The Health Bulletin
First Aiders Valuable Help at Clemmons
Trained Students Ready to Assist Nurse in Duties
By Theodore Rondthaler, Principal
CTUDENT first aiders working in
cooperation with the regular school
nurse have now become such an estab-lished
feature of our daily routine at
Clemmons that it is hard to recall
how we formerly managed without
them. I believe that it was five years
ago when the county board of health
first off'ered a course in American Red
Cross first aid to any high school
pupil who wished to take it. This
class, which may be taken as typical
of all our subsequent work, met twice
a week for about eight weeks and
proved very popular, producing about
twenty of our own pupils trained in
accident prevention and first aid to
the injured, filled with enthusiasm,
furnished with certificates, and eager
for someone to aid.
Some one to aid was not far to
seek: We simply turned over to
these students, and have continued
to turn over to them, all school and
playground first aid work not handled
hy the county nurse on her regular
visits, and in this they found ample
out'et for their energies. Each "first
aider" serves for one week, is on duty
at all recesses, during one specified
period in the morning, and at any
other times when called in emergency.
A schedule of the first aider's where-abouts
during the day is prominently
posted, so as to make possible a quick
contact in case of urgent need. The
system has worked smoothly from the
start and has never needed material
change.
What had been the altogether in-formal,
and—shall I confess—fre-quently
inept help given by teachers,
principal, and sympathetic fellow
students, now became the form.al
trained, and matter of fact help of
our corps of first aiders. Several
vexing little problems vanished at the
same time, such as the securing of
economy in the use of bandages, iod-ine,
and other supplies. The time
worn question just where the key to
the nurse's closet might be found at
any given instant disappeared, along
with the uncertainly whether at some
crucial moment the adhesive tape
might not be altogether lacking, hav-ing
been used perhaps to aid in ail-ing
window pane or basbet ball.
It is a source of constant amaze-ment
to me how few major injuries
occur on school playgrounds, in view
of the innumerable petty injuries that
do occur. Checking back through our
files for two years during which our
student first aiders have been in serv-ice
I find we have had on Clemmons
School playground only two major in-juries,
one a broken arm, the other
a fall resulting in temporary uncon-sciousness.
But checking back only a
half year (four school months), I find
an astonishingly long list of petty
ailments our young first aiders have
treated : Scratches and infections,
176; cuts, 58; sprains, 33; burns
(brought from home), 37; headaches,
22; bumps, 5; others, including sore
throats, toothaches, splinters, run-arounds,
boils, and what not else, 75.
Total cases treated since September,
1937: 403. All these our first aiders
have handled cheerfully, speedily,
and with reasonable skill.
We are just preparing to give our
newest class of first aiders their ap-prenticeship,
which consists for each
10 The Health Bulletin March, 1938
of them of an eight weeks' course,
followed by one day's service under
the guidance of one of last year's
aiders. Thus the organization (pic-tured
elsewhere in this issue) feeds
itself, and if our hopes are realized,
will continue to do so as long as chil-dren
on school playgrounds fall down,
skin knees, bark knuckes, bump heads,
stub toes, and in general make abrupt
contact with Mother Earth.
NOT SAFE TO WAIT IF IT'S
APPENDICITIS
BOOK REVIEW
EMOTIONAL HYGIENE
The Art of Understanding
By Camilla M. Anderson, M. D.
J. B. Lippincott Company, Publishers,
Philadelphia. $2.00.
This book, written by a woman doc-tor
primarily for student nurses, is
intelligible and interesting to the gen-eral
reader, and it is recommended to
those who wish to know some sound
psychology, which will lead to a bet-ter
understanding of themselves and
their associates and co-workers. The
author illustrates each of her points
with a case history, in several cases
taken from her personal experience.
She begins with the embryo and
traces the emotional reactions of hu-man
beings through every age, with
special emphasis on the dangers of
never becoming adult in one's reac-tions.
"When intellect and body are
both normal two of the factors for
making living satisfactory are pres-ent.
A third factor, which is neces-sary,
is fullness of emotional develop-ment."
"Nothing can happen to the
body which does not leave some repre-sentation
in the psyche." One could
hardly read this book without gain-ing
a deeper self knowledge and that
fellow feeling that makes us won-drous
kind.
A recent study made of appendi-citis
in children by the Pediatrics and
Surgery Departments of the New
York Post-Graduate Medical School
and Hospital, and involving cases of
362 children over a period of nine
years, found that the death rate from
appendicitis in children is still high
when the operation is performed dur-ing
the acute stage, but when it is
performed during the formative or so-called
chronic stage, it is nil. The
death rate was found to range from
for operations performed in the
formative stage to .35 for those per-formed
after peritonitis had set in.
Among other salient facts found
were: 1. It is not safe to wait for
acute symptoms to develop before
operating; that peritonitis can spread
within eight hours after the first
symptoms of the present attack.
2. That the mortality in acute
cases of appendicitis runs from 5 to 7
per cent, and that to reduce this rate
there must be means for finding suf-ficient
evidence of pathology to justify
the removal of the appendix before
the onset of an acute attack.
3. That there has been little de-crease
in the general practice of giv-ing
children cathartics when they are
first taken ill, before consulting a
physician.
4. That more education is needed
that the public, and parents in par-ticular,
may know the danger of wait-ing
for definite symptoms to appear
before consenting to an operation, as
well as the danger of giving cathart-ics
for every pain in the stomach.
March, 1938 The Health Bulletin 11
First Aid for the Home
Selections for Medicine Chest Should Be Carefully Made and
Cautiously Used
By Roy Norton, M.D.
Assistant Director, Division of Preventive Medicine, State Board of Health
'"pHE following' list includes some pi-actically every accident, with the
exception of those coming under the
classification of "by an act of God,"
such as lightning, hurricane, tornado,
or blizzard, there has been some care-lessness,
negligence, lack of fore-thought,
or downright criminal reck-lessness.
A surprising number of
serious accidents could be prevented
by simple courtesy or good manners.
Analyze a few accidents and near-accidents
and test the truth of this
statement. Children should be taught
not to point the muzzle of even toy or
air guns at anyone.
The above list of materials is given
with the full realization that prob-ably
no two physicians will agree
completely on the importance of ar-ticles
to be included on any list. Its
very brevity and seeming inadequacy
are intended to emphasize the far
greater importance of prevention and
the prompt calling in of competent
medical supervision. First aid treat-ment
is temporary. Its prompt appli-cation
will prevent many infections.
The care of an infected injury is
medical and not first aid treatment.
Knowing principles is much more im-portant
than any type of prepared
equipment.
The giving of good elementary
courses in first aid and in home
hygiene and care of the sick to every
boy and girl in the seventh or eighth
grade in public school would be the
means of saving much suffering and
many deaths. I was called into a
home where a woman had received a
suggestions for the regular con-tents
of a home first aid and medi-cine
cabinet:
2 oz. Tincture Iodine, mild {ZV2%)
Rubber-stoppered bottles or am-pules.
Do not use tight unventi-lated
bandage after application. If
evaporation from bottle is possible,
concentration will take place.
2 oz. Aromatic Spirit of Ammonia
Pint Rubbing Alcohol—70% strength
1 lb. Epsom Salts—for external use
only
Sterile Tube 59f greaseless Tannic
Acid Jelly—(Ointment for burns)
2 oz. 49c Boric acid solution
Splinter forceps
Scissors (small, blunt pointed)
Tourniquet—never applied contin-uously
longer than twenty minutes
Two triangular bandages
Three each—1 inch and 2 inch roller
bandages
Dozen 1 inch sterilized compresses on
adhesive
3 ^/2 oz. packages of sterilized absorb-ent
cotton or cotton "picker" pack-age
Six 3 in. sterile gauze compresses
Light thin board splints (assorted
sizes) for fractures
Wooden applicators wound with cot-ton
Wooden tongue depressors
In any consideration of first aid it
should be remembered that preven-tion
is the primary aim. The exer-cise
of intelligent forethought is more
important than all the available first
aid medications and procedures. In
12 The Health Bulletin March, 1938
cut that severed a medium sized art-ery.
The frightened family were
throwing soot into the wound. Sim-ple
pressure toward the heart from
the cut stopped the bleeding that
might soon have proved fatal. All
of us know instances of drowning
persons being br'^ught out of the
water rather promptly and then fail-ing
to recover because no one around
at the time knew first aid. Everyone
should know pressure points to stop
arterial or venous bleeding and the
best methods of giving artificial res-piration.
Many simple arm, leg or
spin-^" fractures have been converted
into fatal injuries by improper hand-ling
in transportation to a doctor or
hospital. No knowledge of mathe-matics,
Latin, history or English can
make up for such fatal ignorance
—
especially if the person bleeding to
death, drowning, or getting a trans-portation
injury happens to be one's
mother, father, sister, brother, son or
daughter. The thin board splints,
triangular bandages and roller band-ages
can be used to prevent the fatal
conversion of a simple into a com-pound
fracture.
Tincture of iodine is no better than
some of the other antiseptics. Mer-thiolate,
mercurochrome, and others
are probably equally good. In simple
cuts and scratches the raw surfaces
and one half to an inch around should
be painted. Then after allowing to
dry, apply a thin sterile covering that
is not airtight. Iodine is a poison
and it, along with any other poison
temporarily in the house while being
prescribed by a physician, should have
pins stuck around the stopper to give
further warning when the container
is opened.
Passing the aromatic spirit of am-monia
bottle under the nose tends to
cause revival from a fainting attack
-and it may also be used in this way
or internally (half teaspoonful in a
half glass of water) as a preventive.
Sterile tannic acid jelly or other
fresh preparation of 5% tannic acid
constitutes the best first aid treat-ment
for burns. Oils and greases are
contraindicated. Baking soda is an
acceptable substitute. A large or deep
burn should always be treated by a
physician.
Note that no drug intended for
use as a laxative is included. Ep-som
salts (50% in boiled water solu-tion)
is useful in compresses to pre-vent
or control wound infection. Cas-tor
oil and epsom salts should never
be used internally except on advice
of a competent physician, after care-ful
examination. All cathartics and
laxative drugs are irritating, even-tually
constipating and highly dan-gerous.
None of them should be
taken internally except on advice of
a competent physician. An analysis
of appendicitis in Philadelphia dem-onstrated
the fact that a considerable
number of doctors fail to give proper
warning against the misuse of laxa-tives
and some even carelessly pre-scribe
them. It is criminal negligence
to prescribe or give a cathartic in an
attack of appendicitis, and remember
that the early pain of appendicitis
does not usually begin in the right
side. An outfit for giving enemas
should be available. Cai'e should be
used to avoid too frequent use or
holding the bag too high and thus
exerting dangerous pressure in the
lower intestine.
Some would include in the medi-cine
chest argyrol, witch hazel, some
form of liniment, or counter-irritant
plaster, bichloride of mercury tablets
and other medicaments. A fresh four
per cent solution of boric acid makes
a satisfactory eye-drop preparation.
The value of plasters and poultices
has probably been considei-ably exag-
March, 1938 The Health Bulletin la
gerated, just as the "freezing treat-ment"
of such ailments as appendi-citis
has been. Great care should be
exercised in the use of drugs con-taining
silver or mercury. Some
would include an antacid and a head-ache
remedy but the radio and news-paper
advertising of these along with
laxatives have been so misleading
and dangerous that about the only
way to avoid the dangers of their
promiscuous use is to limit the advis-ing
of them to physicians.
Certain drugs are useful—even
life-saving—at times. Only a compe-tent
physician knows when, how
much and how long such drugs
should be taken by each individual
needing them. Entirely too many
people take potent drugs of which
they know little or nothing. We
would not put just any kind of prep-aration
into a good watch or car or
even into a valuable cow or horse just
because someone, probably more ig-norant
than we, recommends it. We
take such unknown preparations our-selves
though, and give them to our
little children. Many people are
rapidly becoming overdrugged while
others fail to receive proper, prompt
and adequate treatment.
For this home medicine and first
aid cabinet only those things that are
safe for general use in the way sug-gested
have been included. Dr.
Charles Solomon, in his book, "Traf-fic
in Health," has appropriately
summarized four general rules re-garding
home remedies
:
"But home remedies should not be
habit-forming; they should not con-tain
dangerous drugs; they should not
be used or recommended in serious
diseases; and they should not be
proprietaries of secret composition."
I should like to add that they should
not be used promiscuously without re-gard
to their need, or without regard
to dosage or duration of their use.
Don't Drink Water Just Becavise It
Looks Good
By M. F. Trice
A strange fact of nature is that
fresh, clear, sparkling water may
contain millions of disease germs;
while turbid, colored water may not
contain any disease germs at all.
Usually the clear sparkling water is
most likely to contain fewer germs,
but freshness and an attractive ap-pearance
do not guarantee that it is
safe to drink. The purity of water
is dependent upon many factors, some
of which are: the kind of substance
over which the water has flowed, the
material through which it has seeped,
and the things that have been dipped
or which have fallen into it.
A stream may be crystal clear.
have a sand and gravel bed, clean
banks, and be so attractive as to in-vite
all who come along to pause and
drink deeply. Not far above, how-ever,
it may have flowed across a road,
through a pasture, a hog lot, or
seeped through a pile of rubbish.
Around the bend a decaying carcass
may be half submerged in it, or some
passing hunter may have defiled the
water. It is possible for any one, or
all, of such sources to contribute pol-lution
to a stream and yet leave no
visible evidence that the water is un-fit
to drink. It is always dangerous
to drink water directly from a
stream. Don't gamble on the water
14 The Health Bulletin