fill in@ li@i@lii((liiql6* 0 0 INE READER'S REQUEST NATIONAL UBRARY OF MEDIC Today's INSTRUCTIONS: 1. Use one slip for each item requested. 4. Number of requests accepted 2. Please print clearly. at one time is limited. 3. Keep last copy. 5. Allow 30 minutes for delivery Call Number FOR JOURNAL REQUESTS, complete this "dlon Journal Tide Year/PAotO vol,,me lsiu AV REQUESTS, omplete this FOR BOOK OR REPLY TO READER Atftor rrEm IS NOT AVAILABLE... NLM does not own Kom E El Not on sheff 0 KOMI$ on z 0 ftem is at bindery 0 odwr R"d on reverse. @GTON STER Roc... s, -jolIK V, C,,avice The @ices o Se JANUARY 1965 Health N'OL. 42, NO. I CONTEN'FS EDITORIAL-.IIedical .4iidit-The Qiiest for Qlialit) - ------------------------3 A technique for coiitiiiuin- excellence in the practice of medicine. Ser-t@ices and Facilities Available to The Prit,ate Practitioner for His Cancer Patient ------------------------------------------ -1 Services and resources to facilitate the effective detection, diagnosis, treatment, and rehabilitation of the cancer patient. NELSON A. ROCKEFELLER Governor Activities of The Neiv York State Health Deparlitietit in Chronic Respiratory Disease ------------------------------------------ 16 HOLLIS S. IN(;RAHA',-Nl. II.D. Objectives, proposed services and research studies. Commissio7ter of Health EDITOR James J. Quinlivati, AI.D. The Cover The illustration on the front ADMINISTRATIVE EDITOR cover shows New Yorl, State Irvin- Weinstein coverage by tumor clinics. Eighty- ei.-lit per cent of the upstate population lives %ithin 25 miles MANAGING EDITOR of one of tli@e clinics. The radius Lillian S. Harrell of each circle represents 25 miles. PHOTOGRAPHIC STAFF Monroe Dixson Adolph Scherer H. F. McGau@ban STAFF ARTISTS Cre(lits Gerard E. Mealv Pages 9 and 14-courtesy prints. Other photos Earl C. Strickland by staff photographer. Health News published monthly by the New York State Department of Health, Albany, New York 12208. Second class postage paid at Albany, New York. EDITORIAL Medical Audit --- The Quest for Quality THE edical audit bill passed in 1963 staked out i workaday colleagues revieiv one inotlier liaN,e some major research frontier for public and private i-nedicine practical limits. in Neiv York State. Medical audit also offers the opportunity to dramatize This pioneering legislation, backed by both the State.' situations. For example, the effect on the quality of care medical Society and the State Health Department, all- caused by a doctor shortage in a rural area may be spot- tliorizes research and studies "Nvliich have for their pur- li-hted by a medical audit ivliicli can spur more vi@orous pose the reduction of morbidity and mortality and the recruitment of new physicians. iiiipl-on@ement of medical care throu-,b the conduction of Nonmedical ,roups like insurance companies, union medical audits." t) health programs and consumer groups are increasingly For a year and more the State Medical Society, medi- asking pointed questions about the quality of care they cal schools and the Department have vvorled to-,,ether pay for. But the physician would prefer to consider to develop a mutually acceptable, meaningful method- these questions when they are posed in studies spon- olo-y for gauging the quality of medical care. The first sored by medical confreres-bis medical society, niedi- audit research project gets underway this year. cal schools and public health acencies. C) The project goals are positive, its approach voluntary. The dominant value of the medical audit is its poten- Tiventy-nine hospitals in the Rochester area have agreed tial as a powerful teacbing tool. Auditing makes pos- to take part in a study of perinatal care to be carried out sible the deliberative, thorouob, unhurried review of by the Empire State Medical. Scientific and Educational cases that the conscientious physicians would like to Foundation, research arm of the State Medical Society. make for themselves, if only time permitted. Medical Tile State Health Department is cooperating closely in audit takes the time to find out for bard-ivorkin@ physi- development of the project. cians the present quality of care provided and lioiv that Practicing obstetricians and pediatricians from out- care can be made even better. side the study area will revienv and evaluate hospital Tile Society, the Department and cooperatin- schools records of perinatal care provided. These reviewers, se- will advance the desire for professional improvement lected by medical school faculties and the State Medical by jointly developing training pro"rams in areas where Society, Nvill concern tbem;-zelvcs only with identifying studies suggest that care can be strengthened. problems and evaluating care. Patients and attending In the medical audit we have perhaps the greatest in- physicians Nvill be identified by code number only, and strument for refreshing and enriching the pliysician'i in keepin-, with the lanv, information obtained ivill re- skills outside the lialls cof formal medical education. In- 0 main confidential. deed, we mi@bt look upon the three stages of these C5 The practicin- physician can justly ask Nyliat profes- studies-review, evaluation and impro'vement-as a c' sional benefit he gains from this project and any subse- kind of postgraduate institution Nvhere the subject pur- quent studies of his performance. sued is continuing excellence in the practice of medicine. For one thing, the audit technique contains the in- gredient essential to rigorous judgment-objectivity. Granting the desirability and value of devices such as hospital tisstie committees, these internal audits where HEAI.Tit NEws, January 1965. 3 ian And Services For The Physic His Cancer Patient by VINCENT H. HANDY, A,'I.D. Director, Bureait of Cancer Control Neiv York State Department of Health MUCH has been i%-ritten describing the advances made 4 Monthly Check Pays Dividends in cancer therapy during the last decade due to more A leaflet ivhich explains breast self-examination and is radical surgery, perfusion techniques, radioisotopes, intended primarily for adult women. supervoltage radiation, and neiver drugs. But too often one is inclined to forget that before the patient reaches Yes, Children Get Cancer Too A leaflet for the general public describing leukemia and the treatment staae, some selective process has taken c other malignancies of children. place to identify him. This is usually the result of a dif- ferential diagnosis by the patient's physician. Whatever Leukemia can be done to accelerate the process of identifying the A leaflet for the general public describin- leukemia both cancer patient is ivortb-,Ybile since treatment cannot start . in adults and children. until the patient is diagnosed. There are several ways in which the Bureau of Cancer Memo to Adults About Cigarette Smoking Control of the Neiv York State Department of Health A leaflet for adults describin- some of the evidence link- t) can assist the private practitioner in his ivork. in- ci-arette smoking and lun@ cancer. 0 0 C, Smoking-It's Up to You Public Education A leaflet for teenagers describin- soine'of the evidence C) linking cigarette smokin@ and lun@ cancer. The most important single characteristic of cancer is that during its early course, ivhen it is most curable, it Action Against Cancer is least apt to affect the general health or to cause symp- A booklet for special @roups which have a particular toms sufficiently severe to alarm the patient and impel zn him to seek medical care. During the early or most interest in cancer in Neiv York State. curable stage of cancer, the natural spurs of disability It Takes Two to Beat Oral Cancer and pain which lead to action are absent and must be A leaflet for adults ivbicb describes oral cancer and the replaced by incentives produced by education, publicity, use of oral cytology. and demonstration. The Bureau of Cancer Control, in cooperation ivith In addition, the folloivin- films on cancer are avail- the Office of Public Health Education, has produced the able for the general public from the State Health De- following education material ivhich can assist the physi- partment to assist physicians in group meetings. These cian not only in his daily patient contacts but also in films are more fully described in the Department's Film group cancer education meetings in which he might Catalogue. become involved: Challenge: Science Against Cancer The Truth About Cancer 'Points up -the meaning of new achievements in biology, .A basic cancer 14aflet. i e physics, chemistry and genetics. Its principal objective is 4 to help aligNs-ei, the i@-idesl)i-ea(l ]Fiat for iiifoi-iiiatioll i di@ease I)t-ol)lezii of concern liriiiiai-ily to adults. Planned about I)i,o-i-css in caticei- rescai@li. A film for all audiences, tc, elect requests fi,oiii I)iolo,), teachers for a filiii ivliicli 0 0 particularly Iii-ii school arid colle-e. (30 IllilILlICS) I)i,e@eiits caiicet- fi-oiii the student point of vieNv. Intended t.-ir I)iolo,@@, classroom use. It is not i-ecoiiiiiierided for 7'he Doctor Sl)eal,-s His @llitid n@ in @,(.@iiei-al school (14 minutes) Desi,iied to lease the i%,ay for the professional sl)ezikei- qualified to discuss the i-nedical tiicl scientific Isl)ects of '41it@ cancer i%rliicli ii-e iiot included in film. Tlieiiie centers (ICIICI'@ll purpose fi[iii on cancer. I)esi-iied to influence around a -eiiei-,-tl practitioner deepl%- concerned because the @ittitticle of the laN.1ii,@iii 1)), slioNviii, the lack of @ood so niaiiy of his patients come to Iiiiii i%lieii it is too late @Cli@e in fe@ti-iii- a cancer, cliecktil). Presented in aiiiiiiated, to be of help, Ilis subsequent obsei-\-@itioti and reminiscences cartoon St)-le. Stiitil)le for slio%@-iii,@- before an), lay audience. take the form of I)ictol-itl soliloquy %%-Iiicli ends on @t strong, 12 minutes) note of hope. (22 minutes') --I Qiiestioii Iii 7'irtic E7zemy X @-@@ks iii(I those cltiestiozis ibout cancer ivliicli Filiii open,, i%-itli ii)tir(lei@ iii),stei%. technique to 0I)t@iiii most coiiiiiioiiIN- addressed to doctor-speakei-s by lai audience interest. Stoi-@, tl)en -oc@ into subject of cancer audiences. ]3uilt around the theme that adults as Nvell as i%-ith "surprise I)titicli" to retain interest and cet across children, can let their iniao-iiiatioiis lead thein astray. the rnessi,e foi-cefti]]N-, For Iii,li sc-liool and adult -i-oul),c;. Deiiioii@ti-@itcs lioiv fear can be dispelled ivitli proper knoivl- C> z- (15 minutes) t-clze. (.22 minutes) From One Cell T'inie Is Life Desi,tied to stipl)l@@ instructors %@itli iii@itei-iil. Presents F-iiil)li@isizes the importance of seekiii- early medical ZD ZD the subject of caii(-ei- iii an eclucatic)iiil iii@iiiiiei- than i (lati-ei- si-iial of cancer 11)pears; a diSCLI.@- Some of the leciflets and boosters I)iiblished b), the A"eit: l'ork State Health Department iuhich deal ?tith c(iticer (arid 7i@hich cati assist tli.e physician. Copies of Dep(irtmeiit pziblic(itioi@s may be obtai7zed ivith- ozil charge from city, county or (7istrict he(ilth, offices and from the Office of Pitblic Health Edzicatio7i, .@'ei( )'ork State Health Depart- r@ieitt, 84 Holla7id 4Ve72ite, Illb(in),,. 1220(@. 5 IC] tile iiiil)oi-tatice of reco, tlii-ce iiiodes of tt,eatill(@lit@ (lati,,er signals. ilic@tlio(Is of tl,(,atllleTIt. tie si(@)II of $LI(-'II Z, dati@ei- tile 110])e of CLII-E. (19 IllilILItCS) 7't-(iitor 11"1'tliiii fol N@,oiiitti ill @@-oillell s CILIJ)@. 1))), illf"Rll@ Of aiiiiiiatioll@ tlli@-ili@IIIN "izltiolls. CIIIII-cli societies all(] social or!,@iiiiz@i- tell tile sto].N- of cailcel. Is@o@ li-ht @iiici (,iiteiLaiiiiiia iiialitle". tioiis. A li\c illociel is ii@e(I Lo exl)l@iii, tile stel)s NN-t-)iiieii call Ilitiltil)licltioii of Laiillstel' exjillitiatiorl. l,iiil)lia,-;ize, ti,at if breast tile cell Li@ON%tll. tile follo%%- ill I)o sl)i-ea(IiiiL of cancer I)\ @ill(I tile the stl4;1)ected cai-li(@i- I)%- i\,oiiieii tlieiiizel\-ez. 'oO ties Of CLII-ill the di@ the ease tlii,otiL-)Ii , us(, of I)t-i- of the I)aticiits could I)t@ qi\,ed 1)), siii-@,erN.. It is and i-aciiiiiii. l@ot- all t\-I)eq of iticlieti(-es sti(:Ii i@ Iii-,Ii scll,)ol ie(.,oiiiiii(,ii(le(i that a (locloi- I)e oil li@iiid qt all slitiN@ilIL-S to i@-oiiieii s (,,Itibs, PI'A"@. iiieii's Aiicl (iti(-@tioiis and (,i\,e i I)i-eliiiiiiiai,N- talk. 1 6 otliel.c. (14 minutes) 7'/ie 11"Ieb of Life litsill-a7ice Sti-e,sse.@ kiioi%-ti facts concerning, cancer-. tll(, ']'Iiis colorful filiii tells lion\- @tti isolated (ILiii,er eat-1), sNiiil)tonis, (lia,,iio@i@ Eiii(i iiietliocls of ti@eatnieiit. @Lllt- the liN-es of tlii-ee ,eiiei-atioiis (@f a -i\eii faniil@. c al)le for Leiieral audiences. 21-) IllitILItec;) It ])Oitl[S out ill telliti- f@isliioii a tlioi-oti,-,Ii pli,,z;ical tlxaiiiiiiatioii I)i- a conil)eteiit I)]iN-siciiAfi (,all iiieiii in the coii- )'ozi Are the Sivitchtizait Einphasizes the importance of seckitio earIN, coiiil)eteilt ti-C)l of cancer-. (15 illiTilit(,S) ineclical qd@@ice in the treatiiiejit of caticei- aiid tile (laiiLei@ 7,11(@ )Vai-iiiii- Sliadoiv ill delt@-, (juackery, prol)rietai-%- iiieclicine and anN- c,tl)ei 'riii., fit,,, is a dramatization of one of the first complete urirecc)L,iiizecl treatments. Also eiiil)liasizei,; the hol)e of ctitc-. Of ILIIIL' cancer. One sequence in aiiiiiiaticiii @hoivs The State [Iealth Deparitizeitt's Filitt Library has ritctity lay aizd I)rojessiotial films available oil c(t7teei-. Iriquii-ies should be addressed to the Filrii Librar), Siipei-visoi-, Neiv Yoi-k State He(iltli Depariiiieiit, 84 Hollaii(I Aveiiiie, Albariy, N. Y. @7220(l 6 Physician imparts i7ilot-ii2ation o7i ilie '7zcideiice of breast cancer and the importance of earl)- detection as part of a public education progrant. lio;@- luiiL, caii(-el- starts and hoiv it spreads. Special emphasis cancer. The clear and powerful use of statistics and I is given to the importance of semiannual cbest X-ray its direct sitiiplicit%-, complete honesty and freedom from examinations for men over 45, with the purpose of discover- an)- false note of optimism on the one hand, or li),steria in- an). si,-iis of possible lun, cancer earl), enou,h for its on the otliei-, add to its dramatic interest. (28 minutes) n ZD ZD complete cure. Suitable for shonvin- before an)- adult iD 7'i77ie and Tzvo Wonzeii audience interested in the prevention of lun,, cancer, includ- C, This film tlert4-; ivomeii to the urgency of early detection in@ ph@-ziciazis, nurses, i-nedical students and student iiurses. r, of titei-ine cancer and explains the uterine cancer cell (17 minutes) examination (the pap smear). It concludes with an appeal Horizons of Hope for then) to @o to their family physician once a year for n Cancer research is the theme of this motion picture. examination even thou,h they have no symptoms. ZD Skillfull)- combinin, live action and extremely clever 'I'lic picture is recommended for slioivin, to all women. C) C) cartoon animation, a clear, concise report is entertainingly (1.8 minutes) c presented of the pro-ress researchers and medical scientists 0 lilir?t for a Caticer Killer are makin- in the prevention and cure of cancer. It i@ not Z) This im ortaiit motion picture details scieiice's deter- a "ivarnin@" film but rather one of encouraenient and p iiiiiied search for a cancer cure and the resultiii, dis- hope for the future. (18 minutes) con,ei-ies Nvliich, althou,ii not provi(lin-, the miraculous ZD 0 146 Thousand Could Live cure, iien,ertheless do inipede the spread of the disease. It Dramatizes cancer's seven danger signals and stresses explores ivoi-k noi%- bein, done in the laboratory, hospital Z) the fact that cancer can be cured if diagnosed and treated and in the field in an attempt to develop a chemical xvhicli in time. Five of the si-tials are represented by cured cancer %s-ill destroy cancer cells ivitliout harming healthy tissue. patients, a sixth by a ivoman who lost her son to cancer, It also slioivs current ivork at the Brooklyn Botanical and the se%@ctitli by a man Nvlio noticed a dan-er si-nal in Gai-dezi aimed at findin@ a mold which may produce a himself but upon I)eiri@ 'examined found lie did not have cancer-killin@ chemical. (27 minutes) 7 Ph)-sicig,is egiste, for Ca,,ce, S),,i,l,osiu,,' to help ke,p i,ilor,,:,d of ,,e,v l,itli Lije Sior), film tl,e importance ,f nledic-I (29 exanii,)atio,@s la ))relenting and cancer. It ciiiplia@ZE'S detection ,f Cancer of the rect@ni and color. Professional E(li,catioit it is a @itisfactol% cl,"@ati.n@il I,,cce,@t,,ti.@ quite suitable foi- ally aucl@le,,cc an,] is I)e,llap@ inte)ijc(l to .1lay tl,e fears Ilost,,radiiate i,iedical educr@tioll j, ill,,)oitijit for the of la@, persons i,ho rn-)- see it. (15 nii@lutes) 1)ri%,ate l,ractitioncr since lie is the one 1)crsoit ill)oll Nvlio@e shoulders rests the ,reatest if' yc- The Cellaird the C),ioiechtiolo,,ist eard to the cancer patient. Frequently, life @itid deitli Aiii,i,ati,,n shot, li(,N, cells b,,I,a,e ,,,d """ (lei)end iiicii his efforts to rcco,,rii7.e I)r(,,c@inceiotis le- a. abnormal cell is a clue to cancer. k c) i.t@chnolo@,i@t in -i ' s, to 'diz@gnose cancer ei,rl) , to reii(Icr on a patholo,@3, laboratory pli,,@ at, important role in coi,cer treatment, ancl to secure competent consultation. (lotection as she screer@s slicl@es of cells nd i,ith the scientific learn. Throu@b lie, students it, Physicians are advised i,lieri special cancer courses are put oil in tl,eir areas. I'Iiyciciiiis interested in or- medical technology see all important sell re,,,irdilig career. amazing cancer Lucliing (li),s for their cotitit), medical (22 iriiiutcs) society uctially plan them il@rotili their local health Is officer since funds for paying honoraria to speakers for This film effecti-,,el)@ coi,lr@515 scenes s@.";Dg the iil thesespecial prc.,@rain- call be irr@inged from the Bureau effects of ,Ith a discussion by four teena@,crs %,he of Cancer Control. think the possibility of ]off, cancer is reniote. It Eho,,s that The following films are a@ailille from the Neiv York by the time icople I)e,-In to i,-orry about lung cancer the State Health Department film library and may ]fell) smokiti@@ habit is often so st,on@ly "t,e,iched that ab,t,@- physicians in carrying oil[ cancer education l,efoic pro. lion is difficult. (19 minutes) fe5sional groups. After Nlastectoriiy; Breist C@iricer--'I'Iic Problem of The MillioiL Cli,b Early Diagnosis; Cancer Detection; Cancer of the Cell- This is an exccql"t film de@cril@i@,, the Ec,@. da.@r tral Ne,vous System; Cancer of the Lung; Cancer of [lie I', c, t I, te t II f@, III C.i (I: C,, ti,cr j f II IC I I I 1):" :11)]I) I;] l@'Cillile IC I,] E,@ II",i@: I f li,,Ii I c I i(,Il II, 1 t I M f I legal ri (I '@c (:II lic@e I 'I I IC I IC] a Cc I I S TI]@! of of fill ... oil, 0)I ill l'!@il)lelll of t) of li@c lle"(i of t,@e cel @f the e.%celle,it i@ ])Ieciljl(,r of (:El,ix 1)). C@ I')]O@@) 'I'lic I'@-I L-I,-taic @@Ol@. C@izc., of C"I((, a] )(4,iti;:C(l I,)). Ill,- to l@f- ciie of C@LI]C@r. ,IC @(!@@t to the ftill-ti,iie tl,cii '01 C@i,icel .f tl!C to ill, ci,iit@,91 ill All),-,iiN. . i'ii@l!'Ci@@1), ,iid the Cylolc,,ic local full foi Cficilic@l,i,,i of tl,e Lo,,ci- of ill(- Title liciltli (officer @i f@oiii tli, C,,iltiol L'- l'i@itiiieiit for Sl)leiiic I:lc\tllc 4i,tistic,,l @,,It to Iii,@@ttli cfriccr Solit,,.ry f,i%er tal)lilatill@- c@iticcr for I,;z as A,Cll SI)eecli After I'Llil)OT@ (If 13011c; for the State is I i,liole. Siicli c,,i,](l I,c li'll)ftil to of ilte l'ic@iiclii: Ulrirc C,@iicer-'flie I)IOI)Ielll of tl,e ])rival" ))I@,ctitiolici ill (If the @N7e Sl)eak leltll)ilit@@tioll of cai@ccr for I)ic@ei)titi(,ii @t staff, Pillie@lit@; I-'Rily (:IilliCal Si@'tl@ 'If cotjiitv inccl;cil sociel)., (,I. I)kll)lic ),)e till". oi Al Oi a] ]-'Kfoliit'@ c Cin@,,I-tro@COI)Y @N'itli 'I'J)C Ni,,sitig Service -A Pat t of the PI]% i- I'lic I)t,])Iic iii,r@e, tl,c Cal ]'lie Cancer Detectiori (ii,ectio,i of the 1)@@ticiit's o@vii (,ill great)). cx- ill c,@cer dig,,o,is ,,d help), re at hospitcl rsing Service tend the effectiveness of the pliysician's treatment plan Public Health Nu in several Nvays: as skilled observer, trained nursing Cotility Available for Patieiit at Hoiiie practitioner, and discriminating case finder. She is ex- Clieniuii- Co. Health De t. Nui,siilo'Ser%,ice perienced in observing and reporting promptly and C) p ccurately any signs and symptoiris that may -liaN,c real Clieiian@o Ntirsin- Service a Co. significance in the progress of a patient ivlio has had Clintoii Co. Health Dept. Nursiiia Service cancer treatment. The public health nurse brings corn- 0 forl to the patient and family because of her trained Columbia Co. Health Dept. NLirsin-, Service ability to perform skillfully such nursing measures as Cortland Co. Health Dept. Ntirsina Service dressings, bathing, positioning, feeding and toiletitig C) Nvhcn the patient is unable to do these things for himself. DelaNvarc Co. Ntirsin@ Sei@vice Furthermore, she teaches a fai-nily member or friend Dtitcliess Co. Health Dept. Nursing Service techniques to provide for the patient's comfort bet%veeii her visits. Sometimes these techniques are related to the Eric Co. Health Dept. Nursin,- Service site of the cancer as, for example, %vhen the nurse Essex Co. Ntirsiii-, Service teaches colostomy irrigation, arm exercises following 0 radical mastectomy, or the preparation and administra. Franklin Co. Ntirsin@ Service tion of a nutritious and acceptable diet for the patient Ftilton Co. Ntirsina Service Nvitli oral cancer or advanced gastrointestinal cancer. 0 Genesee Co. Health Dept. Ntirsin@ Service The public health nurse can also be useful to the pbysi- cian in cancer case-findin-, and in patient folloiv-up. Greene Co. Nursin-, Service r, ormal and informal educational opportunities supple- Hamilton Co. Nui-sin@ Service ment and update her clinical knowledge of cancer and Jeff erson Co. Nursin@ Service she uses this information effectively in alerting the pub- C) lic to the significance of certain deviations from normal Lewis Co. Nursing Service health. She encourages the individual to secure a rnedi- Livingston Co. Nursing Service cal opinion promptly and to follow through on any Madison Co. Nursing Service recommendations. During the sometimes extended i)e- riod of diagnostic work-up for suspected cancer as Nvell Monroe Co. Health Dept. Nursing Service as following the period of treatment, the public health Montgomery Co. Nursing Service nurse can do much to keep the patient under the super- Nassau Co. Health Dept. Nursing Service vision of his physician because of her ability to inter- pret his medical objectives to the patient. This often Niagara Co. Health Dept. Nursing Service takes more time and repetition than the physician is able Oneida Co. Nursing Service to give, and the nurse utilizes every contact ivith the Utica City Health Dept. Nursiliff Z) patient and family to reinforce the established physician- Service patient relationship. Also, because of her knoivledge of Onondaga Co. Nursing Service community facilities, she can often assist the physician Syracuse City Health Dept. Ntirs- in more effectively utilizing other community agencies in regard to rehabilitation. ing Service The following is a list of ties offering public Ontario Co. Nursing Service health nursing services in Upsta'@t,,Npw York. The serv- Orange Co. Nursing Service is available to patients ' '&ial of the private ice ' by ref Orleans Co. Health Dept. Nursing Service physician. Oswego Co. Nursing Service Public Health Nursing Service County 4vailable for Pa@nt at Ho7ne Putnam Co. Nursing Service Rensselaer Co. Health De t. Nursing Service p Albany Co. Health Dept. Nursing Service Rockland Co. Health Dept. Nursing Service@' Allegany Co. Nursing Service St. Lawrence Co. Nursing Service Broome Co. Health Dept. Nursing Service ' - Cattaraugus Co. Health Dept. Nursing Service Saratoga Co. Nursing Service Schenectad City Health Dept. (Schenectady Cayuga Co. Health Dept. Nursing Service y City Limits) Chautauqua Co. Health Dept. Nursing Service Scho'haric Co. Health Dept. Nursing Service 10 Public health nurses can extend the eflectiveness of the physician's treatment plan and also be useful to the physician in cancer case- finding, patient follow-up, and in many othei- ways. Pi,tblic Health Nursing Service Cancer Detection Facilities Coiintiy Available for Patient at Home Cancer detection programs or case-finding programs Schuyler Co. Nursing Service have been accepted by the organized medical profession Seneca Co. Health Dept. Nursin, Service as an important procedure in cancer control. The public C, has become increasingly aware of the value of periodic Stt@,uben Co. Nursing Service health examinations and of special examinations for the Suffolk Co. Health Dept. Nursing Service detection of cancer in apparently well people. Since can- Sullivan Co. Nursing Service cer detection is closely tied in with the whole field of Tompkins Co. Health Dept. Nursing Service personal preventive medicine, and since there is a reco@- Ulster Co. Health Dept. Nursing Service nized need for periodic health examinations that are adequate, thorough and meaningful, cancer detection as Warren Co. Nursing Service a principIle cannot be abandoned or ignored. Washington Co. Nursing Service At the present time, cancer detection examinations Wayne Co. Nursing Service are carried out by many private practitioners in their Westchester Co. Health Dept. Nursing Service offices. The procedures include a careful history, inspec- Mt. Vernon Health Dept. Nurs- tion and examination of the accessible areas such as ing Service skin, oral cavity, breasts pelvis and rectum, together New Rochelle Health Dept. Nurs- with laboratory tests such as uterine cytology and stool ing Service ffuaiac. Sigmoidoscopy should be done on individuals Yonkers Health Dept. Nursin, over 40. The educational material previously mentioned c can be used by the physician for patients as an aid in Service interpreting the kind of health examination he is doing. Wyoming Co. Health Dept. Nursing Service C, I.-terine cytology should be done on all adult female pa- Yates Co. Nursin, Service tients receiving a cancer detection examination since it Pil)-sI'ci(lit pet-foi-iiis coitzl)lete I)eli@ic e.vaiiiiii(ttio7l, iiicllidill- speciiIii7ii aiid birizaiiiial, as 1)(irl o,f c(ii2cel- (letectioiz e.va77li7iatioti. IS one of the iiio.,t efTecLi\@c nietlic@cl@ of case-fiiicliii, t]iLit Pli)--@iciatis N@-lio do not (lo caiicei- (]election ex@iiiiiii@i- t) \@'e lease. C),tolo@), i-eN-cals al)noi-iiial cells in secretions tioii@ ]III)' @%-isli to i-efei- tlieli- I)atieiit to one of the cancer fi-oiii the I)od), Of tlle lItCl-Ll-,- and cei-\-ix lon- before si,flc-z (If@te(!tioii ciiiiics in ttieii- areas. A(Iiiii@cziozi 1)i-ocediii-es to and s)riiil)toiiis (le@-cloj). If the 1)@ittiolo,ist find-, sticli the clinics and fee@ N-ar),, I)Llt 110 I)atiellt i@ i-efti.-;ed Id- cell@l the I)atieiit is examined ftii-tlier and q I)iol),.3y is iiiis@ioti I)ecitise of iiial.)ilit), to I)a)-. 'file State Healtli done. 'I'litis. c),tolo,ical exaliailiatioii of N"I,illll and I)c@I)at-tiiieiit financial])- assists cancer detection centers siiieai-.s is an effectiN-e (le%-ice in screeiiiii, i@-Olliell in the medical school area,. \@'itliotiL syziil)toiiis foi- e\-Idence of Uterine iiialic,tiaiic-N,. 0 'I'lic follo\viii, Caiicei- f)etectioii (:ciitci-@ in ,laid sliotild I)c a I)art of the I)IiN-@ical ex@ituitiatioii of n e\-ei@), ivoiiiari o%-er 20. lio@I)itiil@ in Ul)state Ne@\- )'ork: Pll)'Siciaiis sliotil(I I)roiiiote @Licli sci-eeiiiiiu aiiioti,, SI)eci,ql Iii--li i-ik (yrotil).@. sticli t-; N@-oiiieii ill tl)C C) r, All)@iti@, Hosl)lt@il socioeconomic ]eN-els and those atteii(Iiii, clinics. --ticli Aleiiioi-iql I-lo@I)it@ll ,is I)i-eiiatal clitiics, I)Itiiiied I)ai-eiitliood cliiiic,;, or (@iii- J)lo),ee clinics. A total of 186 local lal)oi-,,iLoi-ies is tl)- I)iitcliess I)i@oN-e(l for cytolo@y examination-; Ul)state. For those I)OLI-likeel)sic St. flo@I)ital I)il),Sici,lfls @%-Iio do not lia@-c access to ill Oi-,il Cilicei@ I)etectioli all(] lal)oi-,itoi-)- in t)ieii- county, c)tolo,@' service is offel-e(l N-elitioli Centel- I I)y the DiN,isioii of laboratories tiid Reseai-cli of the state I-leiiltli I)el)az-tiiient in AII)ati)-. As of Octol)ei- 1, liLiffalo J. inleyei- il,leiiioi-izil l@961@ tlict-e @vet-c 11 coLifitic@ ill INIlicil 11)1)1,oNled lal)oi-@t- Ilolll,oe toi-y sci-@-icc i%-a-@ not ti%,ailal)]c. The COLII)ties are Alle- Itocliester 13a(leti St. Hetiltli Centel- ,itiy, Dt@tai@@ai-e, l'I'ssex., Nortlici-ii Franklin, Hamilton, A'(i s,5 (i ii Hel-kit)ICI', I'Lltil@1111, SCIltlylel'. Sclioliarie, Seneca, all(] I,"[ilioiit Nasstit Cancer Detection Centel, Stillivaii. ]'Iiysicians in these counties call i-eceiN,c cytol- o,,y kits front ilic Division of laboratories ind Re- Betlil)a@c Ili(I-Islatid Hosl)ital ZD AII)aiiy, irid lia@,e snicar-@ interpreted i@,itliotit NNoodl)tii-), \Xlal(letiiit- inic(lical Iteizeat-cli (,osL I)y the I)i%@isioli of I,,tl)oratoi-ie4z and lteseai-cli. Iotiii(latioii 12 i@Io,lar(I (I 11,4 o (;oo(i @iiiiizttl[Lill I I it I I , o I 1) o I- I ii o ot, ]Vital I'lll(l 1.@ cl-itic@117 to titilizc@ tlit, of tll(,il. local ttiiiioi- clitil(@ a- III all[ ol' ill ])]Zlllllillc tile ti-t@iitilictit Oile of i ttitiiot- c-Iiiilt, i-,itlict- s I,I(Itciltl a tiot lill)lte(l to tile 4col)e of till)- Olle @1'ecizilt.k -Aleii1ol@l@il Iti@tittit(, it l@,4 @ilillo-t foi- 1)(@l'@011. of lii@ I)ioft@@sioii@il (Iiiilificatioii@., to i-eco,,iilz(-, cl@IIICCI' ill C) flo@l)ltzll of S@ll-iiii@ic C\CI'N ()TIC, of it@ iiittiifest@itioiic;. 1)1.01)el- tl.("Itlll(,Ilt ill a (,i@-eii c@i@e clcl)eiid., oil factors: the t)-I)e of ttiiiioi-. tile extent of tli(, (lise@i@e, the t,e aiicl ejiei-,il i,!iN @ic-al @N IONN II (;oo(I S@lilizil-itziil llosl)itzil C) C) coii(litioii of tile 1),itleiit@ etc. As i teiiii, the @it@-il:eo'1. 1),Atliolo,ist tcliie@-c @iii etil@ii-aecl @iii(I Z) - flosl)it@il o@-ez--@ill of c@iticei- iiot to ofie NN-110 Iii@ iti@-ezti-,ttiozi iii a limited field. Tlic, cliiiie Hi,])I@iiicl Ho@I)ital v Iloclicstet- I'tocliester Geiiei-al I-lo@I)ital all ac)(,i-e,-atioii of I)Itysici,,iii-@. a collection of c7 I'@oclic@LCI' St. -iNlii@y's Ho-@I)ital aii(I a joiiiiii, of skills. Sti-oii, i\lenioi-ial liosl)ital Ttiiiiol- cliiiics i%-ere firsL e@-tal)llslied I)y the Alliel'icaii . I I@ (issclit Colle-@e of Sui--eoii;-; iii 1930 I)ecause it Nvas i-ecc)ziiize(i n n ll(,nil)@,te@id iAleadoN@,I)i-ook Ilosl)ital that the dia,,iio-@is iiid iniiia,enierit of caiicei- l@)atieiit,; 0 C) - Allileoli NiSS@lLi Hosl)itat (leii)aiici the effort of a i,otil) of se@'eral specialists rather ZD tliaii qii indiN-idLlll I)Iivsiciaii. Basically. the ttiiiic)i- clitiic Oiiel'(I(t staff slioLild coiisist oiaii iiitei-iiist, sui-,eoii, I)atlic@lo@i@t. 'D r_ - , 1--tic@l St. l,"Ilztl)ctli Ilosl)iLal laid radiologist. i%-itli otliei- @I)ecialists Oil a Coll@Liltiii, Ttinior ciiiiies offer dia-nostic, tlierapetitic, and 011011(1(lg(i coli@tiltaiit sei-@'ice@. Oil]), I)atients iN@itli syii-il)toill-@ 01' S)'I@ZICLISC iAlClIlOl'iil Hosl)ital Sic@ll@ @Ll@I)iCiOtlc-; Of caiicer are accepted at a ttinic)r cliiiic. Olit(ill'o The I)i,i@-ate I)Iiysiciiii caii I)erforin a -i-eat sei-%-ice to ZD ClifLoii SI)i-iii,zz ('Iiftoti SI)i-iii,@@ Ho@I)ital IliS COIIII]Itlllity I)y 11@ill' tll(l SLII)I)oriiii, t)ie sei-N-icez-z of Iii@ local tLilliol@ Crime. I)Lefei-ril is ti-@Liall), tlii-c)ti@ili the Oi-aiige faillil). -,ill(] 11)1)Oilltiiieiits ii-c ll,,Llall)@ 311@ICIC ill St. 1,Llk-C@S 11 ,i(li-atice. Fc(@ sclie(]Lil es ])tit liei-e t,,ain iio 1),ttiejit Otsego is i-efti-@d qdziiis@ioii I)CCaticT of iii@II)Ilit)@ to I)aN-. 'I'lle Cool)erstoN@-ii Bassett Hospital State licaltli I)el)at-tjiiexit financially SLII)I)Ol'tS a zililiil)ei- Orieoiit@i 1, ox tlleiiioi-iil Tiosl)iLil of theme clliiics. I'Liiiioi- cliiiicz-z ol)ei-atiiicf ]'II Ne@N- York qi-e: Reii,ssel(tet- I'l-0), Saiiiii-itaii Hospital ,,I lbaii.), l@)ockl(171(1 All),,iii)@ AII)aii), Hospital AII)aiiy Memorial flosl)itil Nyack Nyack Hospital AII)aiiy St. Peter's Hospital Siiffci-ii Good Simai,itaii 14osl)it@il 13rool?le Scheiiecta(ly- Jolilisoii City NN'ilson -inlemoi-ial Hospitii Seliciiectady l,"Ilis I-Iosl)itil C(t)-iiga Ulstel- Aul)tit-ii Atil)tirn i@'lemorial Hospital Kiligstoli Ulstei- Couiity Ttiiiior Clitiic 13 7'his cigarette smoking Machine at Ros- well Park Memorial Institute, the State Health Departme t's cancer research lacility in Bu§alo, is used to help deter- iiiiiie the correlation between cigarette sinoking and lung cai cer. 14 I-'ails lio@I)itill @ei-% ices @itid resources ,,-e \,Liital)](, to tile tT -tzlt(I I)l iN to fiicilitite. the effectiN,(! (](@tectioll. (ii,'-- ifid i,elizil)ilititioii of tli(- ('@lilct'l- 1)@t- iiizitei,iils il)oLiL ciricci- i-c at Iiis I'kocllt,lle 110@i)it@ll foi@ ]ii.@ I)zitieiits ai)(I foi- the I)til)lic it ILii-,,e, i.-; 140@I)ital \\(,II @i@ for Iiiiii@elf @itid IliS COlleIZ17L]CS ill Ol-(]('I- to (Xtell(I (@liiiicil izifoi-iiiitioii Itl(l CXI)Cl'iCllce. Stzi- ti@ticzil (1@itzi (-@iii I)e, ol)taitie(I eitliei- fi-oiii tile loc@il lieziltli 01 f]Olll tile IiLll'e@Ill of ('@iticei- Control. Sticli @N711it(, N\-Ilite I-lo@l)ltzll lll@Itt@Z'IZII i@ ol)tqiiied fi-oiii tli(, (,,ii)cei- I)li)-sici@iii ]iLis I)I@iye(i iii ititeoi--,Il in )'otik(,i,@ St. Jolili's n of the Ali zi\\,ai-eii@< of tli(@ I)iCtLli,e locall and ill tile ITI)St@ite \N.I,ll liL,Ili @liLiil)ezi the focus of tli(, I)Iiy.,iciaii's ittezitioii in 1(lf(@i(@ii(-(, to the iiioi-e coalition -it(,s of citricei,. iiiost No (le@ct-il)tioii of tti(I facilities an,ailzil)le t(@, ii--e I-oli])ST all(] o\,ej--,ill incidence trends. I)atic,@itz, \\,ottlcl I)e COIIII)Iete \%-it]IOL[t IllelltiOllill@ I'lie I)li.N@ici@iii call exieti(i iii(I eiii),iilce, liis in the )'oi,k State Healtli Del)aj-Liiiezit's caricel, 1'e- tlit, ]ionic, 1)@ itsiii- the sei,\-ice-@ of qualified all(] @@-ille(I searcli lio@I)it@il in 13tiffalo-ltos\@-ell Pii-k Nlenic)i-ial Ill- I)iii)lic- licaltli iitti--c;e@ foi- I)cdsi(le care, teacliiii-. stit(ite. I'Iiis liosl)ital lias one of the 111OSt OLItStaiidiiiL, NI'@loii of Iii-@ 1)cttieiits. aiicl foi, Issistqrlce ill litilizili,@ cancei. i-e@cai-cli I)i-o,t-ani., in the coLintr'),, all(] 1)i-ovide@ Otilel' ('011111IL1111t)- a,,,eiicies tiid resources. Ciiiiic faciii- LI liosl)it@il ser%-ices foi- patients in connection ivitli it,; re- tiez are tl@o aN-,iiiable in iiiiii), areas for (]election ifid searcli I)i-o,rai-n. l@'acli I)Iiysician in the State tiltiiiiate]N- in dia-iiosis ai)d treatment. CD C) I)eflefitS fl-0111 SLICII I)rodLICtiN7e i-e,-;earcli. Nlariotis asl)ect@ 'I'lic I)IiN,si(-i@iii lias nearly resources on N%,Iiicli lie cqii of I'tos@@rell Park ialciiioi-ial Institute's i)i-o,raiii I)a\-e cill. 'f'lie), are all @eai-ed to issisL liiiii --since lie is tile I)eeri (lescril)e(I in IIe(ilth Aeit@s, issues of January 196.'. ken-@toiie in the I)i-opei- iiiana,eiiietiL of the caiicei- 1),i- April 1-963. A i)i-il 1 961. NoN,eml)er 1.9,-)g all(] June 195 tieiit. Book Revietv... PRINCIPLES OF PUBLIC HEALTIF AD@)11'\IS'I'RA'I'ION, I)N Jolili J. Haiiloii, @I.D., i)I.P.H. (total]) edition). St. Loitis: C. V. Alosb)t Coinp(iiii. 1904. S]1.50, pl). 5,38. TIIIS tien@- edition of i i%,ell-accel)te(I text is oi-@@illize(i .@@COII(l 1)@il-t CON-ei-s go%rei@iiiiieiital, le-al, oi--,iiiizatiorial, to giN@e a ])road i,iei@. of I)ul)lic liealtli ,i(iiiiiiiisti-atioii. It I)et,@otitiel, 1)til)llc relations, arid fiscal considerations in contains liberal use of I)r@ictical examples iiid I)er,;oiial 1)Lll)lic licaltli. ']'lie tliird I)Eti-t deals i@-itli the I)reseiit I)at- experiences @iii(i is easily read. l@'ritteii in -t direct. t(@i-ii of 1)til)lic liealtli activities in the United States. iiiantici- trid it a N,ei-y I)i,acticil le@-el. 1'rol)(@i- ciiil)litsis is gi%!eii to i(ldic[iN,e diseises. chronic tells ]took is not foi- those i@-lio desire a deel) disctiz@ioii all(] accidents. Tli(@ text concludes ivitli a I)rief of administrative tlicoi-y oi@ I)til)lic lie@iltli I)i-actice. It look ifito tile future, -,IIOLII(l I)Q of N@AILIC to the student of I)ul)lic licaltli iii(i 'I'lic oi@,@iiiizatiozi of t)ie material and tli(, il)l)i-oicii 1)til)lic licaltli I)ractitioiici-s NN,Ito desire, all oNrei-@,ieiv of tile text enjoyable. I)III)Iic lictltli aclniiriisti@atioii. 'I'lie first part of the iie@v edition is (le@,oted to tlif@ h.v I?obe@t-I /'. irhfileii, ;11.[). 4ssoci(ite Co7iiiiiissioiier 1)liilosol)liy -ttid Iiistory. of I)Lil)lic heiltli iiid its relatioti- roitiriiiiiiit)- fle(ilili Seri@ices sliij) to the I)eli,-ivorial -sciences ancl ,3ocial 1)atliolo@y. Tlie@ A'.i,.s. nepartitieii.t of Health 'i 5 Ac ,tiA7it,@ies Oi- Tli(-,, NEA@T Yoj-k SLate (@a- c.-I-i Del)arLii-teii-t, III C-li@i,oiiic, Res-1)@i-i.,a-Lo-ry Disease I),tii-eatt 0 .i CIII-0111(@ I-ot-k Sl(,tl(, o,f Ite(flill Tlil-, litti-eati of Ciii-oiiic I)te@I)ii-atoi@), Disease of tile 1)1-01)lelll, it SI]OLI]D I)e 1)oiiited otit that fi-oll, 1950 to 1960 tile ttll)CL-CLI]O@is deatli rite iii t-l)z;tate -\ei@- fOl-Illall)' eStELI)Iislied iii tlic- )-oi-k State Heiltli De- I)ai-tiiieiit's DiN-i-,ioii of Clii-oiiic D@ea@e Sci-N-ices, AI)i-il )-oi-k (Iecliiied froiii 96 to 7, i%-Iiiie the cleatli rate fi-oiii 1. 196-1. Tile exteiit of the clli@oiiic 1)1.011(.Ilitis aiid eiiil)]iN-zzeiiia rose froiii 4 to 14. ActLiil 1)1.01)lelll I%-,Is olitlitle(l. is kiioi\-ii il)oiit the ei)i- I)i-e@-@ileiice data ai@e iiot i@-ailal)le ])tit it i.@ estimated tliit -it le@ist 10.000 I)ei-soii4-z ai@e dis@il)led fi-c)iii ciii-oiiic i-e@- (leiiiiolo,y iN-as clefiiie(l. aii(l, tile klioIN-11 exitiii, I sotirce, n 0 J)il-,Itol@y disease iii Ul)@tate Ne@%- Yoi-k. Ill a(lditioii. little foi, coiitrol iii t-1)@tate @@eN%- Yoi-k i\-ere listed. i@ A I)Ian i\-Iiicli otitliiie(I the I)ro,i-,ini ol)- I)otit the 1),i@ic ciLi@es of ol)@ti-LictiN-c qii-NvaN 0 (li@ei@e. tlie, i-e@tilts of ti,eatiiieilt of the so-called @@eai-l@- jecti@,@., I)i,ol)o@e(I sei-@-ice@ aiicl i-e@eai-cli @tLiclie;;. ci-4c oi- Ithe iiitLii-al Iii@toi-y of ttiese coii(litioiilz iie%%- Bui-e@ttt'zz iiiiiiie(liate I)i-e(lecessor evil tli(@ As t I,)Ill-eatt Of 'I'Lll)el.ctil lie first stel) iii iiiitiatiii, i 1)lati of @tttc]N aticl i-e- o,zl@ Case i\-Iiicli i,:,is e@t@il)- C, c @c,at,cli. i medical adN-1,@oi-y committee to the iien\- 13iii-eiiii li@lied ill 19-16. T,'oi- I,) Ncai-@ it i%-a@ ciiai,ed iii fiiicliii, LI LI lie@v cases of tLtl)eICLIIO'@i@ 1)), the X-i-,,i)- sci-eeniii,, teeli- N%-as zil)l)oiiited. The cotiiiiiittee coii-@i@t@ of -zen-eii iiieiii- icti\-it@@ I)ecaiiie less I)i-o ill tile fields of I)II).,ZioloN-. iii(itie. O%ei@ the ),car.- tlii- dtic (11,,I(Ic@iiiiolo,,@),, clinical @iiid idiiiiiii@ti-@iti\-e medicine. tiN-e and iiioi-e exl)eii@ix-e. I'liei-efoi-e, it i%-a@ else fin(iiii,, I))- exaiiiiiiiii- LI Zl@ foIl(@)N@@-. ']'lie of the lie\%- ll'ILII-C@l (-oiiL@icts of kiion@-ii ci@(-z; ati(I I)eol)ie ivitli s)-iiil)toiiis, lio\\-- -as coii c tiiitic(l and tlli-, ])el-iO(l 7're(ititieiii (]lie note N@-,ts taken of the mortality fi-otti C, liosj)itil-coiiiiected centers in t-1),;taLe -\e\\- I)t-oricliiti,, itici ciiil)li@--;eiiii iiid the ciiiei@,@ezice of the r )'oi-k study and ti,e@it 1),itieiits ivitti t(l\aiice(I I)i-oiicliiti@ clit@otiie respiratory q i iiiajoi- liealtli I)i-ol)leiii. and ciiil)liyseiiia. lIoN%eN-ei-, their facilities iii(I I)ei-@oiiiie-I file! Iiiiiited. l,'Iacli 1)t-o,i-aiii (]it-ectoi- CIL]e@tiC)Ile(I ill(]iCite(l Det)(?Ic)l)ttteitt of 7'iie Pro,yr(trit LI iiiot-(@ I)aticiits could be career foi- and iiic)i-e I)Li@ic clinical Conse(Itictitly, ill tile SLI11iinei- of 1962, the Directoi- cit-i-ied out if Sel'\'iCCS COLII(T I)e exl),tiide(l. of the 13LireiLi ivas as-@i,,iied full-time to de@,elop t I)i-o- I)atisioii of sticli facilities ivotild etizil)le iiiore 1),itieilt,; ,ul,alll 1)lari foi- clii.onic respiratory (lic-;ea-,e. The I)Iaii ivis x%,itli "early" or "moderately idvaiiee(l" I)roiiciiiti@ and by tile Corn- Cilil)llysellla to be studied in relation to the effect of coiiil)leted in June 1963 ai)(I i@,as al)l)ro\-ed inissioiiel- of Ilealtli, Soi-ne nioiitlis later it Nvis al)l)ro@,e(l 1)i-ol)ei- care and iiiil)ro%,ed treatment and rehabilitation by the DiN@ision -of the Btid,et, oil tile cause and natural Iiistoi-y of their cli@eises. Witliotit ciitei-iii- into a (iet@iiie(I account of the extent 'I'lici-efoi-c, t inajoi- i-eseii-cli center AN-ill lie 16 to carry out basic research and clinical studies on in- cal surveys with measurements of the levels of various patients and outpatients. The center will be associated pollutants should provide valuable information. with one of the medical centers in Upstate New York. It must be emphasized that such surveys will be solely for investigational purposes and will not be utilized as Epidemiological Studies a case-finding activity for chronic puhnonary disease. Of course, persons whose tests indicate the possible Two carefully planned investigations of prevalence of presence of disease will be referred to their physicians. obstructive airway disease are under way in New York In addition, the epidemiology program will gather in- State: one in the Buffalo area and one in New York formation regarding morbidity and mortality from all City. No others have been done in the Upstate area. available sources, such as death certificates and hospital Surveys of rural or semi-rural population groups and discharge diagnoses. in order to determine the size of of selected industrial groups should prove fruitful. These surveys will employ the standard questionnaire. the problem. a spirographic tracing and a chest X-ray. These studies will be planned to control for a,e and The Natural History of Disease for smoking before assessing the effect of other varia- Long-term longitudinal studies are needed to learn bles such as air pollution. Coordination of epidemiologi- more about the prevalence of these conditions, particu- Facing the camera during a press conference called by Dr. Hollis S. Ingraham, New York State Health Commissioner, to announce the estab- lishment of the Bureau of Chronic Respiratory Disease in the State Health Department are, from left to right: Dr. I. Jay Brightman, Assistant Com- missioner for the Division of Chronic Disease Services; Dr. Ingrahatti: Alexander Rihm, Jr., Director of the Bureau of Air Pollution Control Services; and Dr. Henry Shultz, Director of the new Bureau. 17 ESTIMATED NUMBER OF DAYS PER YEAR OF RESTRICTED ACTIVITY AND BED DISABILITY ASSOCIATED WITH ACUTE CONDITIONS, NEW YORK STATE, 1962 DAYS PER 100 PERSONS PER YEAR ESTIMATED 0 100 200 300 400 500 600 DAYS PER YEAR (in millions) Infectious 27.7 and Parasitic 12.3 Respiratory 59.1 23.2 Digestive 6.1 2.8 Injuries 31.1 Restricted Activity 5.1 All other Bed disability acute 22.2 conditions 7.5 BASED ON DATA FOR NORTHEAST REGION OF UNITED STATES FROM NATIONAL HEALTH SURVEY, JULY 1960-JUNE 1961 Respiratory diseases are responsible for more bed disability and restricted activity in New York State than any other acute condition. larly which persons may develop disease over the years Confirmatory Tests and how rapidly or slowly disease progresses. An oppor- These persons will undergo certain confirmatory tests. tunity for such a study presents itself as part of the They will then be examined at intervals and objective State Employees Health Services being developed by evidence of changes in the disease process will be ob- the New York State Department of Civil Service. This tained. Since bronchitis and emphysema are usuallv Department plans an elaborate health service for State employees, including comprehensive preemployment slowly progressive, the study will have to be continue(] for a period of ten or more years. In this way. evidence and periodic physical examinations. health counseling, will be collected that might shed light on which patients etc. All treatment problems will be referred to the indi- will progress to severe disability and which will remain vidual's private physician. It is estimated that 10,000 stationary or regress. In addition, the results of treat- to 12,000 persons will be involved in the Albany area. ment and preventive measures such as cessation of Each person participating in this study will be ad- smoking can be evaluated. It must be emphasized that ministered a standard questionnaire on respiratory this study will probably include only those individuals symptoms, a chest X-ray film, and certain tests of pul- with mild or moderate ventilatory impairment. To act monary function. Previous studies indicate the preva- as controls, a similar group of employees who present lence of obstructive airway disease varies from 2.5 no signs or symptoms of chronic respiratory disease will per cent to 30 per cent, depending on many factors, be followed in the same manner by the same tests. The such as a-,e, sex, smoking habits and the like. In a cross control group will he matched for age, sex, smokin- section of the population, it is likely that the low habits and the like. This procedure will provide furtliet- prevalence rates would apply. Consequently, it is esti- epidemiological information regarding the incidence of mated that between 200 and 300 people will be found these conditions and might aid in the identification of to have evidence of chronic respiratory disease. those who develop these conditions. 18 4 A spirometer, used to test lung in clion, is demonstrated in the exhibit area o.i a medical conference. Projessioiial Education as staff meetings of hospitals., meetings of county medi- cal societies. formal courses in diagnosis and manae- A need for education and training of health personnel n in the chronic respiratory disease field is widelv con- ment of chronic respiratory diseases, and two-way radio conferences. ce(led. For years emphysema was "the forgotten dis- ease" and little emphasis was placed on the management of this and similar conditions. The avera,e practitioner Summary t) is apt to refer all chronic pulmonary patients, including In view of the mounting problem of chronic respira- those with tuberculosis, to appropriate specialists since tory disease, the New York State Department of Health he feels he can do little for such patients and is not equipped to carry out the necessary physiological studies has established a Bureau of Chronic Respiratory Dis- required for accurate evaluation. ease which will be concerned with the three broad fields of research: basic pathophysiological research, epidem- The State Health Department, in cooperation with the iological studies, and a long-term longitudinal study of Medical Societies, the American Thoracic Society, the the natural history of obstructive airway disease. In American College of Chest Physicians, and the New cooperation with other a-encies, educational efforts York State Tuberculosis and Respiratory Disease Asso- will be directed to practicing physicians and other pro- ciation and its local affiliates, will sponsor educational fessional groups. It is anticipated that in all the activi- efforts directed not only to physicians but also to the ties of the Bureau there will be a close workin, relation- paramedical -roups. Numerous media can be used. such ship with the State and local tuberculosis associations. 19