grams of significance.
Your local health department
is backed up by the State Board
of Health, which employs spe-
cialized health personnel to
serve as consultants.
The health department, how-
ever, is just one health resource
in your community. Others are
private physicians and dentists,
hospitals, nursing homes, men-
tal health centers, and vocation-
al rehabilitation and voluntary
health agencies. The welfare
department provides funds for
some health services, as do
schools.
One big task facing local
health departments and the
State Board of Health is plan-
ning the most efficient and ef-
fective use of all resources. New
problems emerging with rapid
changes all around us require
concentrated attention: automo-
bile accidents, suicides and
homicides, air pollution, chronic
illnesses and others. The ideas,
reactions and expressions of the
public are needed.
You can help your health de-
partment. Go by for a visit one
day soon. Talk over local prob-
lems with the health director or
a member of the staff. The wel-
come mat is always out for con-
cerned, alert citizens.
10
THE HEALTH BULLETIN
October 1968
Set Jail Sanitation Standards
State Board of Health
Holds Quarterly Meet
The North Carolina State Inspection will be carried out
Board of Health met September by sanitarians of local or district
19 at Canton and adopted rules health departments at least once
and regulations which for the a year. Additional sanitation
first time set sanitation stand- inspections will occur when
ards for local confinement faci- inspectors from Public Welfare
lities throughout the State. spot hazards or deficiencies.
The board also took action to Sanitation inspectors will not
make population density a fac- award a numerical grade to con-
tor in protecting watersheds finement facilities, as they do
from overcrowded septic facili- for restaurants, meat markets
ties, and to protect both restau- and other food handling estab-
rant operators and the public lishments.
from contaminated shellfish. Instead, they will award
The new regulations for con- demerit points, the type and
finement facilities will go into total of which will determine if
effect next January 1. They call the confinement facility is clas-
for inspection and scoring of sified as approved, provisional
such items as cleanliness, light- or disapproved,
ing, ventilation, water supply. The commissioner of Public
lavoratory facilities, bedding. Welfare has authority to order
diet, and methods of preparing, a disapproved facility closed,
handling, storing, protecting J. M. Jarrett, director of the
and serving food. sanitary engineering division
The Board acted under a law at the Board of Health, said the
enacted by the 1967 General new inspection program proba-
Assembly. The statute gives en- bly will not involve any addi-
forcement authority to the State tional personnel.
Department of Public Welfare, The revision of watershed
but directs the State Board of regulations adds a requirement
Health to adopt rules and regu- that on watersheds where soil
lations governing sanitation. conditions warrant it, residen-
October 1968 THE HEALTH BULLETIN 11
tial lots for homes with individ-
ual septic tank facilities shall
be at least 40,000 square feet in
size.
A change in sanitation regu-
lations for restaurants makes it
mandatory for operators to keep
shellfish in the containers in
which they are shipped. Ship-
pers label containers with an
identification mark, Jarrett ex-
plained. In the event of an out-
break of illness due to contami-
nated foods, the source can be
more easily traced, he said.
The storing requirement for
shellfish already is a part of
regulations pertaining to mar-
kets and grocery stores.
In other action, the Board of
Health approved the creation of
a new Southwest Jacksonville
Sanitation District and expan-
sions of the Kannapolis and
Haw River districts. Residents
of the affected areas had peti-
tioned for the action.
The Board also approved a
general revision of regulations
governing control of communi-
cable diseases to bring them up
to date.
i
New Appointments at State Board of Health
Dr. J. N. MacCormack, consul-
tant, Communicable Disease
Control.
Benjamin S. Shepard Jr., coor-
dinator of emergency ynedical
services.
David C. Corkey, hiostatistician,
Public Health Statistics.
Dr. Ruth Burroughs, pediatric
consultant, Personal Health
Division.
Dr. Verna Y. Barefoot, public
health physician, Personal
Health Division.
Etra Page Wood, health educa-
tor, community health affairs,
Raleigh regional office.
Elizabeth G. Moore, considtant
in social work, Maternal and
Child Health.
Dr. Buford J. Suffridge, field
dentist, Cataivba, Lincoln and
Alexander Counties.
Dr. James Thomas Jumper,
field dentist, Pitt County.
Dr. Phillip Guest Hathcote,
field dentist, Martin and Ber-
tie Counties.
Dr. Jerry W. Duncan, field
dentist, Randolph County.
C. T. Clayton, sanitary engi-
neering technician, Western
Regional Office, Asheville.
Donald R. Butler, sanitary engi-
neering technician, Raleigh.
Charlie T. Vann, sanitary engi-
neering technician, Asheboro
Regional office.
I
12
THE HEALTH BULLETIN
October 1968
Patient- Expenses
Under Medicare
Going Up
Hospital and nursing home
patients under medicare face a
ten per cent increase in the
expenses they must bear start-
ing next January 1.
Robert A. Flynn, social se-
curity district manager in Ra-
leigh, said the new schedule of
expenses means that patients
who now pay the first $40 of
hospital care costs will have to
pay $44.
The increase also applies to
patient expenses for hospital
stays of more than 60 days, and
for stays of more than 20 days
in extended care facilities.
A patient now pays $10 a day
from the 61st through 90th days
of hospitalization. This expense
will go up to $11 a day.
A patient now pays $5 a day
for the 20th to 100th days of a
stay in a post-hospital extended
care facility. This amount will
go up to $5.50 a day.
For each day of the reserve
account a person can draw from
if he ever needs more than 90
days of hospital care, the
patient cost is now $20. This
amount will increase to $22.
Flynn explained that the in-
creases result from a require-
ment of the medicare law that
an annual review be made of
the deductible amount. The first
review was directed for 1968.
If the annual review shows
that hospital costs have changed
significantly, the hospital de-
ductible amount for medicare
must be adjusted for the year
following the review. To avoid
small changes, the increases
must be made in $4 steps, the
law directs.
Flynn said a comparison of
hospital costs in 1966 with those
in 1967, using the formula in
the law, worked out to an
increase of $45.36. Rounded to
the nearest multiple of $4 pro-
duces a deductible amount of
$44 for 1969.
Flynn pointed out that the
changes apply only to the hos-
pital insurance part of medi-
care. They do not affect the
financing of voluntary supple-
mentary medical insurance pro-
grams which cover doctor bills
and a wide variety of other
medical services.
October 1968
THE HEALTH BULLETIN
13
How It Was in the
Old North State
"And I understand the national
and state governments are at our
service if a hog has cholera. Is
not the health of the average citi-
zen of the town and county of as
much value as a bull vearling?
Why not get a health officer who
is an expert on sanitation. Give
him authority and let him be
such a man as will enforce his
every person in
regulations. If
Edgecombe was taxed ten cents —
hang the expense, make it a quar-
ter — such a person, with an assist-
ant, could be procured."
— Bulletin of the North Carolina
State Board of Health, May 1916.
New Health Directors
In North Carolina
Alton Brown
Davie-Wilkes-Yadkin District
Michael Dechman
Jackson - Macon - Swain Dis-
trict
Carl Tuttle
Alleghany - Ashe - Watauga
District
Dr. J. T. Barnes
Randolph County
Herbert Hawley
Roiuan County
Dr. Joseph C. Knox
Neiv Hanover County
Dr. Barbara Wood
Madison County
Your Driver's
License Could
Save Your Life
Ever look at the back of your
North Carolina driver's license?
What you see there could
save your life one day.
Or it could cost you your life.
North Carolina is the only
state in the nation that provides
a medical information question-
naire on its driver's license. But
the forward-looking innovation
is ignored by most people.
The blank calls for informa-
tion on the driver's blood type
(group and RH), date of teta-
nus immunization, whether tox-
oid or anti-toxin, medications,
allergies, and other subjects.
If the blank is filled in, vital
information is immediately
available in the event of need
to policemen, ambulance attend-
ants, hospital emergency room
workers, and doctors.
A campaign is now being con-
ducted by several State agencies
14
THE HEALTH BULLETIN
October 1968
and private institutions to edu-
cate Tar Heel motorists to see
their family doctor and fill in
the medical information ques-
tionnaire.
Sponsors of the educational
campaign are The N. C. Depart-
ment of Motor Vehicles, the
Trauma Committee and the
auxiliary of the Medical Society
of the State, the N. C. Hospital
Association, the N. C. Commit-
tee on Patient Care of North
Carolina Blue Cross and Blue
Shield, Inc.
NEW PLANNING OFFICER
FOR HEALTH AGENCY
FAMILY HEALTH WEEK
President Johnson has pro-
claimed the week of Novem-
ber 17-23 as National Family
Health Week.
The proclamation sets aside
the week "as a means of focus-
ing national attention during
the year upon the accomplish-
ments of the American health
care system and the central
role played by the family physi-
cian in the maintenance of su-
perior medical care for Ameri-
cans of all ages and from all
walks of life."
Senator Ernest Gruening of
Alaska and Representative Tim
Lee Carter of Kentucky intro-
duced the joint House-Senate
resolution calling on the Presi-
dent to make the proclamation.
Both Gruening and Carter are
physicians.
Gene Barrett of Cary has
taken up duties as planning
officer for the State Board of
Health. He is the first man to
hold the newly created position.
Barrett will coordinate the
work of various divisions and
sections on related programs to
prevent duplication of efforts,
and he will work to develop
ways of making health pro-
grams more effective through-
out the State.
Barrett is a native of Cleve-
land County. He is a graduate
of Thomasville high school and
North Carolina State Universi-
ty. He earned a degree of mas-
ter of science in public health
from the University of North
Carolina at Chapel Hill.
He has held previous posi-
tions as statistical analyst, com-
munity services consultant, and
administrative officer with the
Board of Health and the Depart-
ment of Mental Health.
October 1968
THE HEALTH BULLETIN
15
THE HEALTH BULLETIN
P. o. Box 2091 , - r n
Raieigh, N. C. 2760;^ L If
i\i,ui..i LU
DEC 4 *9^
DIVISION OF
^cMTu &FFMRS UWflEi
LIBRARIAN
DIVISION 0? n£,UT„ ^.p.„,i,
f-.C. Wt;/. H03P. u. H.
CHAPEL Ulll. N.C.
If you do NOT wish to con-
tinue receiving The Health Bul-
letin, please check here I — i
and return this page to
the address above.
Printed by The Graphic Press, Inc., Raleigh, N. C
North Carolina Oysters, Clams, Crabs
... As Safe As They Are Good
The North Carohna Shellfish
Sanitation Control program has
received a near-perfect rating
from the U. S. Public Health
Service.
The program is administered
by the State Board of Health
and the Division of Commercial
and Sports Fisheries of the De-
partment of Conservation and
Development to safeguard con-
sumers from oysters, clams and
crabs that might be contaminat-
ed.
The program earned a 97.2
per cent rating for 1968. It was
the fifth consecutive year in
which a higher rating was
achieved than in the preceding
year. The 1963 rating was 85.9
per cent.
The Board of Health main-
tains a permanent laboratory at
Morehead City and a mobile lab
for determining pollution.
Last year health workers
analyzed nearly 5,000 water
samples for bacteriological con-
tent and 18 samples of shellfish
meat for sanitary quality.
Operators of shellfish harvest
boats and processing plants co-
operate in the program. Some
2,400 shellfish harvesters are
licensed in North Carolina.
The Public Health Service
evaluation also cited Tar Heel
shellfish processing plants for
their "exceptionally high qual-
ity of sanitation."
16
THE HEALTH BULLETIN
October 1968
FiR/A\nT?Fi Rfinnnf^'i?
JIILs/aALLiUuU lijlHJLbLiLsLJ
The Official Publication
'orth Carolina Stofe Board of Health
Vol.83 /(^'ll
November 1968
ROMAN GABRIEL: SYMBOL OF
GOOD HEALTH AND PHYSICAL FITNESS
JAN 31
CflVED
. DIVISION OF *_
Inside
A Report on Hong Kong
Flu
An Ancient Enemy and
New Challenges
Tuberculosis Control in
North Carolina
12
THE HEALTH BULLETIN
First Published — April 1886
The official publication of the North Caro-
lina State Board of Health, 106 Cooper
Memorial Health Building, 225 North Mc-
Dowell Street, Raleigh, N. C. Published
monthly. Second Class Postage paid at
Raleigh, N. C. Sent free upon request.
Editorial Board
John C. Lumsden, B.C.H.E., Raletgh
Jacob Koomen, Jr.. M.D., M.P.H., Raleigh
John Andrews, B.S., Raleigh
Glenn A. Flinchum. B.S.. Raleigh
H. W. Stevens. M.D.. M.P.H., Asheville
Editor: H. B. Rogers
Vol. 83
November 1 968
No. 11
Cover: Roman Gabriel, quarter-
back for the Los Angeles Rams
football team and former All-
America at North Carolina State
University, calls signals for the
1968 Christmas Seal campaign in
the State.
I
MEMBERS OF THE NORTH CAROLINA STATE BOARD OF HEALTH
James S. Raper, M.D., President Asheville
Lenox D. Baker, M.D., Vice President Durham
Ben W. Dawsey, D.V.M. Gastonia
Ernest A. Randleman. Jr., B.S.Ph. Mount Airy
Paul F. Maness, M.D. Burlington
A. P. Cline, Sr., D.D.S. Canton
Joseph S. Hiatt, Jr., M.D. Southern Pines
J. M. Lackey Rt. 2, Hiddenite
Howard Paul Steiger, M.D. Charlotte
EXECUTIVE STAFF
Jacob Koomen, M.D., M.P.H. State Health Director
\V. Burns Jones, M.D., M.P.H. Assistant State Health Director
J. M. Jarrett, B.S. Director, Sanitary Engineering Division
Martin P. Hines, D.V.M., M.P.H. Director, Epidemiology Division
Ronald H. Levine, M.D., M.P.H. Director, Community Health Division
E. A. Pearson, Jr., D.D.S., M.P.H. Director, Dental Health Division
Lynn G. Maddry, Ph.D., M.S.P.H. Director, Laboratory Division
Ben Eaton, Jr., A.B., LL.B. Director, Administrative Services Division
Theodore D. Scurletis, M.D. Director, Personal Health Division
THE HEALTH BULLETIN
November 1 968
The New Influenza and the Old
A REPORT ON HONG KONG FLU
By. Dr. J. N. MacCormack
Consultant, Communicable Disease Control
North Carolina State Board of Health
Some old timers still call it
"the grippe." Most people call
it simply "the flu."
Regardless of what you call
it, influenza has been with us
for centuries. An epidemic in
1557 was described as follows:
It began with a roughness of
the jaws, small cough, then a
strong fever, with a pain of the
head, back and legs; some felt
as though they were over the
breast and had a weight at the
stomach; all which continued
to the third day at the farthest;
there the fever went off with a
sweat or bleeding at the nose.
In some few, it turned to pleun-
sy, or fatal peri pneumony.
This classic description of the
disease tells us that a flu epi-
demic 400 years ago was very
much like an epidemic today. A
lot of people got sick — but few
died.
Usually 15 to 40 per cent of
the population is affected dur-
ing an epidemic of influenza.
Most deaths result from lung
complications. These occur
mainly in the elderly and among
those with chronic respiratory
or heart diseases.
After a person is exposed to
the disease, it takes one to three
days for symptoms to appear.
Therefore, an epidemic of the
flu can develop rapidly.
During an epidemic the high-
est attack rates are among the
young. The rate of infection de-
creases with increasing age.
This phenomenon points up the
November 1968
THE HEALTH BULLETIN
fact that as a person grows old-
er, he builds up a battery of
antibodies against influenza vi-
ruses.
Significant Milestone
Medical men first realized
that influenza is caused by a
virus in the 1930s. It was a sig-
nificant milestone.
The first influenza virus iso-
lated from man was designated
Type A. Epidemics in the Unit-
ed States caused by this virus
occurred at two-year intervals
in the 1930s and at three-year
intervals during the 1940s.
The Type B influenza virus
was first identified in 1940. It
has accounted for less extensive
and generally less severe flu
epidemics at four to six-year
intervals since that time.
A significant variation of the
A virus was first noted in 1947.
This is known as the Al or A-
prime virus.
Yet another variation of the
Type A virus appeared in 1957
when the Al virus underwent a
change and became the A2 vi-
rus. We called it the "Asian" flu
virus.
Epidemics caused by variants
of the Type A virus occur in
the same two-to-three year in-
tervals as those caused by the
original Type A organism.
A Type C virus isolated in
1950 has proved to be of little
importance.
The last A2 epidemic in the
United States occurred last win-
ter (1967-68), and there was
widespread involvement in most
of the eastern states. Type B
influenza caused an epidemic in
1965-66 in the eastern United
States and in 1966-67 in the
West. Based on these facts,
along with a knowledge of the
intervals at which influenza
outbreaks occur, the United
States Public Health Service
Influenza Advisory Committee
recommended last June that flu
vaccine be administered this
year only to high risk groups —
the elderly and those with
chronic diseases.
Virus Changes
Influenza vaccines, unlike
many other vaccines, must be
continually re-evaluated and
re-formulated from year to year
because of frequent changes in
the characteristics of influenza
viruses.
The bivalent vaccine — vac-
cine containing two types of
influenza virus — recommended
for use by the United States
Public Health Service commit-
tee this year was prepared from
two strains of Type A2 influen-
za virus isolated in 1962 and
1964 and one strain of Type B
virus isolated in 1966.
A polyvalent vaccine is also
available. It contains all four
common types of influenza vi-
rus (A, Al, A2, and B).
The bivalent vaccine is rec-
THE HEALTH BULLETIN
November 1968
ommended over the polyvalent
type because it contains a high-
er proportion of the more recent
strains.
Last July and August an in-
fluenza epidemic struck the
Hong Kong area. Numerous
cases of a clinically mild type
of influenza were noted during
this period. Mortality from com-
plications was reportedly low.
This form of influenza subse-
quently spread rather rapidly
both east and west of Hong
Kong. Isolated outbreaks oc-
curred among American mili-
tary personnel returning from
these areas. Civilian outbreaks
were confirmed in several states,
including North Carolina. A
group of over 300 General Elec-
tric employees from North Caro-
lina took a two week trip to
Hawaii in September. A signifi-
cant number of this group suf-
fered a flu-like illness. The first
cases developed shortly before
leaving Hawaii for home.
Cases Confirmed
Soon afterward a contingent
of 155 Shriners from North Car-
olina flew to Las Vegas and
then on to Honolulu for a five-
day excursion. Three members
of this group were ill with flu
before leaving North Carolina
on October 13. By October 30
fifty-four more cases had
occurred. Blood tests on people
in this group confirmed Hong
Kong flu.
The Hong Kong virus was
classified by the World Influ-
enza Centre of the World
Health Organization in London
as a variant of Type A2 influ-
enza virus. The strain is so
markedly different from preced-
ing A2 viruses that some virolo-
gists have advocated that it be
classified as a new type of
influenza virus altogether: A3.
In any case, it is doubtful
that currently available biva-
lent or polyvalent influenza vac-
cines will confer significant pro-
tection against this new strain.
However, the June recommen-
dations of the United States
Public Health Service still will
stand since infections from older
strains of A2 and B virus still
can occur. If history repeats
itself, we are one year overdue
for a widespread epidemic of
influenza. Such pandemics have
occurred in the past at ten-year
intervals. The Al type of influ-
enza virus first appeared in
1947 and the A2 type made its
appearance in 1957.
Vaccine Race
Seven American drug compa-
nies were issued a seed strain of
the Hong Kong virus in mid-
September so that they might
begin the race against time to
produce a new vaccine that will
be effective against Hong Kong
flu. The companies working on
the vaccine: Lederle, Lilly,
Merck, National Drug, Parke-
November 1968
THE HEALTH BULLETIN
Davis, Pfizer, and Wyeth. Small
supplies of the vaccine had been
made available to North Caroli-
na physicians in the last week of
November; more was expected
later, but demand will no doubt
far exceed supply.
Since the initial supplies of
vaccine are in rather short sup-
ply, the United States Public
Health Service is recommend-
ing that those over 65 years of
age and those of all ages with
chronic debilitating diseases be
given the vaccine first. The pro-
tection afforded by this mono-
valent vaccine has, of course,
not been substantiated, but
judging from experience with
previous potent monovalent
vaccines, significant protection
should be afforded by one injec-
tion. It is important that immu-
nization be started as soon as
possible since about two weeks
are required between immuni-
zation and maximal antibody
response.
Besides immunization, stay-
ing out of situations in which
large groups of people are
crowded together seems to be
the only other important meas-
ure for avoiding influenza. If
symptoms of flu are noted, stay-
ing home will help prevent
spreading the disease to others.
Of course, maintenance of good
personal nutrition and adequate
rest can play a role in the pre-
vention of many infectious dis-
eases, and influenza should
probably be included in this
group.
Treatment of influenza is
largely symptomatic except in
the case of complications. O
New Appointments at State Board of Health
Pamela J. Bothe, physical thera-
pist, Community Health.
Ruth L. Piesinger, nutrition in-
tern, Community Health.
Wilton A. WiUiams, public
health investigator, Pesticide
Program.
Conrad C. Rich, x-ray techni-
cian, Occupational Health.
Sandra W. Pearce, electrocar-
diographic technician, Heart
Unit.
Elmo John Pascal, sanitarian,
Sanitation Section.
New Health Directors
Dr. Robert R. Albanese, Act-
ing Health Director, Tyrrell-
Washington District.
Dr. Roy G. Nation, Acting
Health Director, Wayne
County.
THE HEALTH BULLETIN
November 1968
An Ancient Enemy
and
New Challenges
By C. Scott Venable
Executive Director
N. C. Tuberculosis and Respiratory Disease Association
Since last April the North
Carolina Tuberculosis Associa-
tion has officially been operat-
ing under the name of "North
Carolina Tuberculosis and Re-
spiratory Disease Association."
That addition to the name
means all it implies.
While the primary goal of
the Association is still the eradi-
cation of tuberculosis, the new
name gives us another dimen-
sion. New challenges have
opened up, challenges that call
for creative approaches to dis-
eases such as emphysema,
chronic bronchitis, asthma and
a host of other diseases that
attack the respiratory system.
In keeping with our primary
goal, the association has pre-
pared to move ahead with the
battle against tuberculosis. Edu-
cation, demonstration of activi-
ties dealing with case detection
and rehabilitation, and research
will still play large parts in the
association's overall tubercu-
losis program. Basic among
these, of course, is education.
Experience has shown that a
well-informed TB patient is one