who is more likely to make an
early and positive response to
November 1968
THE HEALTH BULLETIN
his treatment. And a well-
informed public is more likely
to provide necessary services in
the community. In order to
bring about this understanding,
the Tuberculosis and Respira-
tory Disease Association en-
gages in investigation and
analysis of the facts and inter-
prets to the individual and the
community the significance of
these facts for needed action.
Pioneer Rule
Public health nursing and
casefinding are among the dem-
onstration projects which
brought needed action to the
battle against TB. Acting in the
role of pioneer, the association
helped prove the value of these
projects to provide solutions
where services did not exist or
where other funds to support
them were not available.
Another area in which the
association is making a contri-
bution to the health of the com-
munity is in research. The as-
sociation is sponsoring research
projects at the Duke University
Medical Center, Bowman Gray
School of Medicine, and the
University of North Carolina
School of Medicine. A select
committee of experienced physi-
cians screens the applications
and makes the selection of the
projects to be financed. This is
in addition to the contribution
sent yearly to the National
Tuberculosis and Respiratory
Disease Research Fund.
Because of this continued sup-
port of research, new knowl-
edge is becoming available for
detection and treatment of
tuberculosis. But it is vital that
the association continue to work
toward helping patients accept
adequate treatment. Failure to
use this knowledge could result
in their becoming chronic suf-
ferers of TB who continue to
spread the disease.
While these programs are
changing only as time and prog-
ress demand, the new challeng-
es of other respiratory diseases
are gettng their share of the
attention. These challenges are
not entirely new to the associa-
tion. For years the association
has been involved in the attack
on respiratory diseases other
than tuberculosis. But now the
association is looking to innova-
tions in areas of patient educa-
tion, case detection, inhalation
therapy, physical therapy and
emphysema clubs.
Film Education
A dramatic innovation in the
field of other respiratory dis-
eases is a patient education pro-
gram developed through the co-
operation of the State TB-RD
Association and its medical sec-
tion and the North Carolina
Thoracic Society. Under the
technical direction of Dr.
Charles Edward Buckley III,
president of the Thoracic Socie-
THE HEALTH BULLETIN
November 1968
ty, the association has devel-
oped and produced a 14-minute
patient education film on em-
physema.
The concept has a two-fold
purpose: (A) to free the indi-
vidual physician from repetitive
orientation of each patient on
the basic knowledge that the
patient needs to know; and (B)
to provide a consistent and
accurate description of the dis-
ease along with basic methods
of controlling symptoms.
The film is designed specifi-
cally for the 8mm desk projec-
tor. The entire film presenta-
tion is contained in a cartridge
much like the cartridges that
radio stations have used for
years in recording programs.
When this cartridge is injected
into the desk projector, the
patient simply pushes a button
and the presentation can be
viewed on a built-in screen.
While a patient is watching a
graphic illustration of his dis-
ease and the methods of control-
ling symptoms, the doctor can
be freed to see additional pa-
tients. This innovation does not
in any way damage the person-
al patient-doctor relationship.
On the contrary, the relation-
ship should be improved be-
cause the patient who has
viewed a series of films on his
disease can better understand
the directions of his physician;!.
The next step is application
for additional funds from the
Regional Medical Program to
produce film clips in volume.
Long range plans include the
production of another general
film and more specific films on
subjects such as postural drain-
age, breathing exercises and
intermittent positive pressure
or "breathing machine" opera-
tion.
Emphysemas Anonymous
Through the leadership and
direction of local TB-RD associ-
ations, emphysema clubs are
springing up throughout the
State. The emphysema club
operates on the theory that
many "anonymous" groups
have used for years. Patients
suffering from emphysema
gather at a meeting place once
a month and discuss their prob-
lems and exchange helpful ideas
on how a particular problem
was solved for them. The meet-
ings give patients an outlet for
their frustrations and they offer
hope for chronically ill patients
whose physical difficulties are
accentuated by depression.
New and more imaginative
approaches are being developed
on the subject of cigarette
smoking. Slide presentations,
films and personal appearances
by some of the nation's most
outspoken critics of the ciga-
rette habit are being taken into
the schools of the State in an
all-out effort to discourage
November 1 968
THE HEALTH BULLETIN
youngsters from getting the
smoking habit.
These are only a few of the
programs that are being devel-
oped to diversify the program
of the North Carolina Tubercu-
losis and Respiratory Disease
Association. But we have not
forgotten our primary purpose,
and we don't intend to let up in
the struggle against tubercu-
losis, one of the most stubborn
diseases known to mankind. We
are still very much in the fight
against this ancient enemy and
we hope to continue to find new
ways of fighting until eradica-
tion has been accomplished. D
NUMBERS GAME
Sweden in 1749 was the first country in the world to conduct
census. The results were kept a state secret, because it was
considered dangerous to reveal to foreign powers the small size
of the population.
In 1947 Sweden established another "first" in population regis-
tration: the numbers system. Every Swede — man, woman, and
child †” has a nine-digit identification number, composed of his
or her birthdate, sex, etc. By means of these numbers the govern-
ment is assured of efficient and mistake-proof handling of voting,
tax collection, social security, marriage, divorce, death, military
service.
Only Israel and Holland have similar systems, while the rest of
the world muddles along with names, sometimes allowing dead
people to vote, women to lie about their age, awarding a pen-
sion to John Smithe instead of Smith.
To those who feel that society is becoming increasingly regi-
mented, with a resultant loss in individuality, the head of Sweden's
Bureau of Vital Statistics counters, "The numbers system is a tool
that helps us to implement democracy, whereas I don't see any-
thing at all democratic in the American way of doing things."
10
THE HEALTH BULLETIN
November 1968
How It Was In The
Old North State
COMPENSATION OF HEALTH OFFICERS
Resolved, bv the conjoint session of the State Board of Health and the
Medical Society of the State of North Carolina, in annual convention
assembled, that the following fees for County Health Officers are a
reasonable and equitable compensation for professional services rendered
the public:
For post-mortem examination $10.00
Examination for lunacy 5.00
For monthly inspection of county institutions, jail, convict camp, and
countv home, each 4.00
For visits to sick inmate of county institutions, per visit 1.50
Mileage from court house .50
Examination and treatment of more than one inmate on same visit „_ .50
For obstetrical work, per case 10.00
Surgical service regular fees, with discount of 33% for determining
nature of a disease for quarantine officer other than himself 2.50
For sanitary examination of public school building 2.50
For medical inspection of school children, each .40
Resolved, That county society be and is hereby requested to use
its best endeavors to establish the above mentioned basis of fees.
Resolved, That in the opinion of this Society the life and health of
our people are the greatest assets of our State.
Therefore, Be It Resolved, That every county in the State should
employ its health officer for all his time.
Resolved, That in case a fixed amount per annum be paid the health
officer in lieu of the above mentioned fees, we feel and believe that an
amount equal to that received by the Sheriff of the county should be
considered a minimum salary for his entire time.
L. B. McBRAYER,
WILLIAM McPHAUL,
L. N. GLENN,
COMMITTEE.
— Transactions of the Medical Society of the State of North Carolina
June 20. 22, 1911
November 1968 THE HEALTH BULLETIN 11
Tuberculosis Control
In North Carolina
By Dr. Roy V. Berry
Chief, Tuberculois Control Section
North Carolina State Board of Health
While the effects of tubercu-
losis on man, real or potential,
can never be thought of as other
than serious, notable advances
have been made during the last
two decades in controlling the
incidence and spread of this dis-
ease.
Principal^, this has been
achieved with the aid of highly-
effective and relatively inexpen-
sive antituberculous drugs. Pro-
vided they are properly taken,
these drugs mean that better
than 90 per cent of TB patients
can return to their families
within a matter of a very few
weeks or months. They can
resume a productive life with
the reassuring knowledge that
their prospects of remaining
non-infectious thereafter are
very good.
The improved outlook for the
newly diagnosed individual
with active tuberculosis presup-
poses that he will undergo ap-
propriate evaluation of his con-
dition at the beginning of
treatment and that he will
remain under competent medi-
cal supervision for the remain-
12
THE HEALTH BULLETIN
November 1968
der of his life. Caution in being
over optimistic is necessary,
however, since occasionally
treatment does fail in spite of
good management and a coop-
erative patient. Treatment fail-
ures are more numerous when
patients are uncooperative. At
times this may be caused or
made worse by poor manage-
ment on the part of the provid-
ers of services.
Instances where relapse or
reactivation of tuberculosis oc-
cur bear witness to the need for
physicians and other health
workers to have a good under-
standing of the various possible
effects of tuberculosis on man
and for them in turn to impart
much of this information to the
patient, particularly the all
important question of staying
on drug therapy for the re-
quired period of time.
Hospitalization Important
Uninterrupted drug therapy
is almost certain to be required
for at least two years and in
several instances for a longer
period of time, perhaps indefi-
nitely. It is important that the
initial phase of the treatment
program be carried out in the
hospital and that the hospital
have the necessary trained staff
and facilities for managing the
tuberculous patient. The ques-
tion of infectiousness is only a
part of this. Other reasons for
initial hospitalization have to
do with getting adequate bac-
teriological investigations com-
pleted, including drug sensitivi-
ty tests; making sure the patient
is able to tolerate the drugs
selected for his treatment with-
out untoward effects; demon-
strating initial clinical improve-
ment by chest X-ray or other
means; and, while these things
are going on, educating the pa-
tient to the vital need of under-
standing that his tuberculosis
will not be brought under con-
trol unless he continues drug
treatment after leaving the hos-
pital for the prescribed period
of time.
Some adjustments in the
patient's mode of life after he
leaves the hospital may also be
necessary if he is to remain
well. These do not ordinarily
prohibit him from engaging in
most types of work, and any
adjustments necessary usually
relate to the need to live a well
ordered and not overly stressful
life. This is not always suitable
and is one reason why periodic
clinical evaluations are impor-
tant on an indefinite basis for
the ex-tuberculous patient.
Many new active cases of
tuberculosis occur in individu-
als infected some years earlier
without the necessity of recent
exposure. Recognition of this
fact has rendered the approach
to more effective control of
tuberculosis a rational one. The
November 1968
THE HEALTH BULLETIN
13
knowledge that persons with
close contacts to active cases,
especially children, are highly
susceptible to infection or dis-
ease, or both, clearly points the
way to yet further improved
control. The main objective in
achieving effective tuberculosis
control is to reduce to a mini-
mum the opportunities for the
disease to spread from one per-
son to another. Thus, one of the
major new tasks becomes the
identification of the infected
(latent cases) and the preven-
tive treatment of those at high-
est risk of developing tubercu-
lous disease. This approach, to-
gether with prompt contact in-
vestigation which by and large
is well done, can become the
needed impetus toward reaching
the goal of ultimate eradication
of tuberculosis as a health haz-
ard to the residents of North
Carolina or any other State.
Control Program
Involved in a tuberculosis
control program are tuberculin
skin testing, screening and diag-
nostic; chest X-rays; adequate
records procedures, including a
register of cases; hospitals for
the initial treatment of cases;
and local chest clinics with
adequate staffs and facilities for
the diagnosis, post-hospital su-
pervision of treatment, and long
term periodic follow-up of cases.
Activities of a chest clinic also
include the medical and nurs-
ing supervision necessary for j
those persons identified for pre- |
ventive treatment, such as in- *
fected young children, recent
tuberculin convertors, and close
contacts to infectious cases.
In short, trained personnel,
money, equipment, hard work,
and a well conceived and exe-
cuted program are needed for
any community having any
degree of high tuberculosis
incidence within its confines if
the disease is ultimately to be
eliminated as a health hazard. ^
Concentration of effort in high
prevalence areas has priority
but it cannot finish the job.
Sustained efforts in all areas
are necessary. The tools for
further significant reduction of
tuberculosis are at hand. The
time to be applying them is
now.
State Resources
Resources available from the
State of North Carolina are de-
signed to relieve and assist local
health departments achieve sat-
isfactory standards of tubercu-
losis control in their respective
areas. There are five major
resources at the State level:
1. In-patient and out-patient
facilities at the four sanitoria
comprising the North Caro-
lina State Sanatorium Sys-
tem. These hospitals are
located at Chapel Hill
(Gravely), McCain, Wilson
and Black Mountain. Any
14
THE HEALTH BULLETIN
November 1968
person in North Carolina
known or suspected to have
tuberculosis can be admitted
to one or other of these hos-
pitals for investigation and
treatment without regard to
financial ability to pay. Clini-
cian services for county chest
clinics are provided by staff
members. The System also
provides tuberculin (PPD-S)
and anti-tuberculous drugs
on a cost basis to local health
departments.
2. Consultative services from
the Tuberculosis Control Sec-
tion, Division of Epidemiolo-
gy, North Carolina State
Board of Health, in the areas
of:
a) Epidemiology and Pro-
gram Development and
Evaluation.
b) Public Health Nursing in
relation to Tuberculosis.
c) Records Procedures and
Tuberculosis Care Regis-
ters (available from Pub-
lic Health Records Unit,
Community Health Divi-
sion).
3. Financial assistance for the
expansion and improvement
of local control programs
through the United States
Public Health Service Spe-
cial Tuberculosis Control
Project Grant Award to the
North Carolina State Board
of Health. The level of sup-
port under this project, cur-
rently $650,000 per annum,
has reached its anticipated
maximum. There are now
forty counties receiving con-
tinuous support under this
project.
4. Mobile chest X-ray clinic
services. This program, avail-
able to local health depart-
ments and certain State
agencies from the Tubercu-
losis Control Section, North
Carolina State Board of
Health, now consists of the
operation of a single newly
equipped, fully mobile and
self-contained combined 14 x
17 and 70 mm clinic unit for
limited intensive casefinding
surveys in known or suspect-
ed high prevalence areas
anywhere within the State.
As circumstances permit, it
is also available for assist-
ance in reducing any back-
log of definitive chest X-ray
work in respect of contacts,
suspects and known inactive
tuberculous patients in
health departments unable
to complete this work from
their own or other local
resources.
5. Supply, as funds permit, of
certain tuberculin skin test-
ing materials from the Tu-
berculosis Control Section,
North Carolina State Board
of Health, to local health
departments at approximate-
ly fifty percent of cost. D
November 1968
THE HEALTH BULLETIN
15
THE HEALTH BULLETIN
P. O. Box 2091
Raleigh, N. C. 27602
MEDICAL LIBRARY
U. OF N. C.
CHAPEL HILL. N. <:
BX. 1020 i\
ECEIVEB
JAN Hi 1969
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DIVISION OF
HEALTH AFFAIRS LIBRARY
Printed by The Graphic Press, Inc., Raleigh, N. C
Physicians Seek Better Services
For Handicapped Children
Around 100 pediatricians,
psychiatrists, orthopedics spe-
ciahsts and family doctors from
throughout North Carolina at-
tended a fall seminar in Raleigh
to explore ways of improving
medical services to handicapped
children in the State.
Dr. Robert B. Kugel, a mem-
ber of the President's commit-
tee on mental retardation and
professor of pediatrics at the
University of Nebraska, dis-
cussed frontiers in the manage-
ment of handicapped children.
Other topics covered were
newer psychological approaches
to evaluation of handicapped
children, the physician's ap-
proach to counseling parents of
handicapped children, needed
resources in North Carolina,
and continuing education for
physicians.
The seminar was sponsored
by the maternal and child
health and crippled children
sections of the State Board of
Health, and the departments of
pediatrics of the Bowman Gray,
Duke University and University
of North Carolina Schools of
Medicine. D
16
THE HEALTH BULLETIN
November 1968
/A\nT?Fi Rfinnnf^'i?
The Officiol Publication Of The Nort'
T
i
\o!.83jLi^
of Health
December 1968
ore for Dental Hi
N. C. State Fair
MAM 13 1969
DIVISION OF
miW AFFAIRS LIBRARY
Inside
Score for Healthy Teeth 3
N. C. Public Health
Association 4
The Arthritis Foundation 6
Numbers Game — Continued
8
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 Andrews, B.S., Raleigh
Glenn a. Flinchum. B.S., Raleigh
Jacob Koomen, Jr., m.D., M.P.H., Raleigh
John C. Lumsden, B.C. HE., Raleigh
H. W. Stevens, M.D , M.P.H., Asheville
Editor: H. B. Rogers
Vol. 83
December 1968
No. 12
NOTE: This abbreviated issue
of The Health Bulletin will be
followed by another small edi-
tion next month.
Cover: An intent young miniature
golfer scores at the State Board of
Health's exhibit at the N. C. State
Fair in October. He was one of
many hundreds of youngsters
who played.
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
W. 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
December 1968
Young
For Healthy Teet
STATE^BOARD
HEALTH-
Some 6,000 youngsters, from toddlers to teenagers, played minia-
ture golf at the North Carolina State Fair in October — and picked
up some pointers for healthy teeth at the same time. They were
guests at the State Board of Health's exhibit.
The exhibit was a four-hole miniature golf course laid out to
promote the four rules for having healthy teeth:
• Fluorides
• Nutrition
• Toothbrushing
• Core by a dentist
At the end of each hole was a sign board with a dental health
rule printed on it. Whenever a player scored on the hole, the sign
board lit up and a siren sounded, or bells rang, to let everybody
know.
The exhibit was located on the lower level of the Dorton Arena.
It was open from 10 a.m. Monday through 6 p.m. Saturday.
Volunteers from the administrative staff of the State Board of
Health acted as attendants.
The exhibit was designed and built by members of the staff of
the Dental Health Division. Dr. E. A. Pearson Jr. is division director.
k
December 1968
THE HEALTH BULLETIN
Co-recipient of the Watson S. Rankin
Award in recognition of outstanding con-
tributions to public health in North Caro-
lina over a period of many years was
Mrs. Maxine Matheson of Raleigh. The
other recipient was Thomas W. Bivens
of Charlotte.
Mrs. Mary Edith Duncan Ro-
gers of the Gaston County
Health Department received
the Carl V. Reynolds Award,
which goes to an individual
"for outstanding contributions
to public health in North
Carolina during the past year
and for meritorious service
above and beyond the call of
duty." The Reynolds Award,
oldest given by NCPHA, is
one of the organization's high-
est honors. Reading the cita-
tion for Mrs. Rogers is Dr.
W. Fred Mayes, dean of the
School of Public Health at the
University of North Carolina
at Chapel Hill.
state Senator Marshall Ranch of Gaston
County was co-recipient of the Dis-
tinguished Service Citation, given to non-
member individuals. He shared the aivard
u'ith Robert Conn, assistant city editor of
the Charlotte Observer.
Mrs. Lucille W. Jenkins of the Randolph
County Health Department shared the
Merit Citation Award for outstanding
work in her role as fulltime public health
worker. Co-recipient was Anne Parrish of
the State Board of Health.
For outstanding contributions to public
health, the Group Merit Award ivent to
the Air Pollution Control Section, Envi-
ronmental Health Division, Mecklenburg
County Health Department. W. L. Dentler,
director, accepted the bronze plaque.
THE HEALTH BULLETIN
December 1968
Ben Eaton of Raleigh
(left), outgoing NCPHA
vice president and out-
going President Dr. Mau-
rice Kamp of Charlotte
at convention awards
banquet.
NORTH CAROLINA PUBLIC HEALTH ASSOCIATION
Public health workers from throughout North Carolina got
together in Charlotte in October to attend professional meetings
and workshops and to grant recognition to their own for dis-
tinguished accomplishments.
The occasion was the 57th annual meeting of the North Carolina
Public Health Association, held at the White House Inn October
9-11. Meeting at the same time were the N. C. Academy of Pre-
ventive Medicine and Public Health and the N. C. Conference of
Health Directors.
Highlights of the meeting were the awards banquet and the
election of new officers to serve in 1969.
New president is Dr. E. A. Pearson Jr. of Raleigh, director of
the Dental Health Division of the State Board of Health. President-
elect is C. Scott Venable of Raleigh, executive director of the N. C.