24. YOUR MEDICAL CARE

If you are a complete stranger in a community and need a doctor, you may be in one of 600 communities throughout the country where county medical societies have emergency-call systems to make certain that a fully qualified doctor is available whenever he is urgently needed. In some areas the same type of service is available for emergency dental care.

Emergency-service doctors may be volunteers who want extra work or, in some instances, all doctors in a community serve in rotation.

To learn if such a plan is available, check the classified telephone directory under "Physicians and Surgeons" or ask the telephone operator. The county medical society also can tell you if such service is available, and hospitals have such information. If the service is not available, these sources usually can help you, anyhow.

In extreme emergencies a telephone operator can help, and city, county, and state police and fire departments usually are equipped to handle many emergencies.

When you are established in a community, or have recently moved to one, and wish to find a family doctor, you probably can get information about local doctors from family, friends, work associates, and other contacts.

With the increased trend toward various health plans, you may receive medical care through doctors associated with your plan, if you participate in one. Or you may seek medical help at a clinic or group of doctors who practice in association.

If you are faced with the problem of selecting a family doctor by yourself, there are a number of decisions to be made.

First of all, medicine is becoming more and more special­ized. A count, in October, 1960, disclosed 51 medical spe­cialities and subspecialities. Not only may this condition make it confusing for the average family to determine if a doctor is a "family doctor" and not a specialist concerned with only one area of medicine, but it also indicates a hard and realistic fact: there are fewer and fewer "family doctors" as we once knew them.

In May, 1960, the U.S. Public Health Service in a report to the Senate revealed that the number of doctors in general practice had dropped from 112,000 in 1931 to 82,000 in 1959. During the same period the ratio of family physicians decreased from 90 for every hundred thousand people to 46.

To add to the problem is the disturbing news that the U.S. is not turning out enough doctors. Time observed in the June 30, 1960 issue that 7,000 doctors were being graduated from 80 medical schools that month, and warned:

"After internship, the vast majority will be licensed to prac­tice as physicians, swelling the nation's total to almost 250,000. The big round number looks impressive. But in fact, if the proportion of doctors in the community is to be kept from slipping dangerously during the population growth of the next 10 to 20 years, the output must be upped by more than 40 per cent—to 10,000 a year."

What all this may mean is that families will more fre­quently have difficulty in finding a "family doctor." Yet many families feel the need of a personal physician to watch the family's health and ride herd on specialists when they are brought in.

If a family can find a general practitioner who is associated with an accredited hospital, there may be no problem for that particular family.

Some authorities suggest that an M.D. specialist—the internist—should be selected as a family doctor. From the very nature of his specialty the internist undoubtedly is excep­tionally well equipped to serve in the capacity of personal physician.

Consumer Reports, in a 1960 study, comments on the problem of the dwindling number of family physicians and believes that: "... more and more consumers must turn to physicians who limit their practice to internal medicine (or, for young children, to those who limit their practice to pedi­atrics) to find an adequate family doctor. In CU's view, such a physician, so long as he has been certified by the American Board of Internal Medicine or is an attending or visiting doctor in an accredited hospital, is the best choice consumers can make for their family doctor under current conditions of medical practice and of social and scientific development."

However Consumer Reports acknowledges that not a great many internists are available.

David D. Rutstein, M.D., writing for Harper's Magazine, October, 1960, emphasizes another side of this particular problem: "Where internists act as personal physicians they are seriously overworked. Demands on them are so great that they are forced either to turn away patients or to spend most of their waking hours at work."

For many thousands an answer has been found in group practice.

Medical groups may range from two suburban doctors working in partnership, to the prepaid-insurance, consumer-sponsored groups such as the Kaiser Foundation Health Plan, largest of them all, operating its own hospitals and serving more than 600,000 subscribers on the West Coast and Hawaii. Another is the Health Insurance Plan of Greater New York. Likewise, the famed Mayo and Lahey Clinics work as medical groups, financed by patients' fees.

It is customary for doctors to work on a salary basis in these group plans. They work as a team. In a well-functioning group a patient selects his own personal physician, who usually is an internist.

This personal physician takes the responsibility for estab­lishing a good physician-patient relationship and assumes the over-all care of the patient, including diagnosis and treatment. If necessary, he calls in group specialists and correlates the treatment of his patient.

Proponents of the system say that patients get more and better care for their money in group medicine than they may get from a voluntary health insurance plan.

Almost 130 million persons now have medical protection to one degree or another in some form of health insurance. It is pointed out, however, that sometimes these plans offer only limited medical care.

Seleg Greenberg revealed in Harper's, October, 1960, that "Insurance still pays less than one-third of our total medical bills and enrollment seems to be reaching a plateau that excludes about fifty million persons in the lower-income groups. More than half of those now insured have only hospital-surgical protection (often far from adequate). Less than five million subscribers are enrolled in plans that give comprehensive services."

Even as these words are being written, the complex prob­lems of medical aid for the aged, the trend to link Social Security and medical care, the growing demands of new social consciousness in an expanding population, and the intelligent voice of a medical-conscious public are writing history.

From the results of this history-in-the-making probably will come the answers to millions who are concerned about finding the "right" doctors for themselves; a way to pay the increasingly high cost of medical care; and as much medical security as possible.

For the doctors, too, will come answers about their profes­sion and the future of medicine.

The complexion of medicine is rapidly and drastically changing in America.

One very significant outcome of prepaid medicine and group practice, has been an increased attention to preventive medicine. This is especially true where a plan entitles the sub­scriber to an annual physical examination.

The routine physical examination is one of the greatest boons to good health that we have. It demonstrates time and time again the old axiom that "if we take care of the little things, the big things take care of themselves," meaning, in this instance, of course, that if we detect illnesses early the possibility of cure may be vastly greater than if we wait until a disease is well advanced before seeing a doctor. Cancer is a prime example of this.

In its first major excursion into the health welfare of em­ployees, the Kaiser organization discovered the values of pre­ventive medicine before World War II.

As a contractor on the mammoth Grand Coulee dam project in the state of Washington, the firm recognized a medical problem in the isolated area where thousands were employed on the project away from normal medical care.

With Kaiser aid, a prepaid medical plan was begun and doctors were brought to the project to work in a group-medi­cine capacity.

Not only did the plan work extremely well in giving the workers adequate medical care, but the doctors in the plan soon made a most interesting discovery.

Many of the workers who once had avoided doctors unless they were seriously ill—frequently because they were eco­nomically unable to pay for help during the depression—now discovered that their prepaid plan entitled them to care when­ever they needed it, at no additional cost. Consequently, they went to a doctor when they became ill, or had physical com­plaints they might have previously "suffered through" rather than incur expenses they couldn't afford.

One young doctor of the group said later: "What happened was almost amazing. We began to catch things early. The incidence of disease began to drop dramatically. It became obvious to most of us that it is far better physically, socially, and economically to keep people well rather than to wait until they are ill before treating them."

ANNUAL PHYSICAL EXAMINATION—Today the "an­nual physical" is becoming more and more routine. Every year more people see the wisdom of "seeing your doctor before you get sick."

Most health authorities are in agreement that a good physical examination should include, first of all, a complete medical history of the patient and pertinent medical informa­tion about his family. Usually your personal physician—or the group or clinic to which you go—takes such a history on your first visit.

The physical examination itself may vary from doctor to doctor or group to group. Sometimes the complete examina­tion is given at one time. Other doctors may prefer two or three visits to complete the checkup.

The following routine is frequently recommended for a complete annual checkup:

The medical history; blood pressure, pulse, temperature; examination of body for growths and swellings; ear, eye, nose, throat, and mouth examinations; heart and lungs (by stethoscope and tapping); examination of male organs; rectum check; examination of female organs and Pap smear (to check for cancer), breast examination; check of reflexes (hammer test); blood tests; urine analysis; chest X-ray; elec­trocardiogram; stool specimen.

Such an examination generally covers the general health of the patient and checks for heart and circulatory disorders; cancer and other abnormalities; nervous defects; infections; tuberculosis, diabetes, ulcers, anemia, and other diseases that may be present.

YOUR MEDICINE CHEST—The adequately supplied home medicine chest actually is composed of two segments. One consists of equipment and supplies usually pertinent to first-aid treatment. The other segment usually consists of a few household aids for treatment of illnesses.

Check lists for medicine chests are numerous. Most of them are carefully researched and authoritatively recommended. All of them are similar to the point of being almost identical.

A survey of the many lists and the suggestions of doctors and other sources of authoritative information will yield most of the following check points for your medicine cabinet:

FOR FIRST AID:

Absorbent cotton, adhesive bandages, adhesive tape, anti­septic cream (for scrapes, burns, cuts), burn ointment, cotton swabs, roll bandages, spirits of ammonia ampules, S-shaped airway (for artificial respiration), sterile gauze pads, Universal antidote (for poisoning—from your druggist.)

Other Medicine Chest Items (check uses with doctor):

Antiseptics—your doctor may suggest a preference. Soap and water is frequently suggested as the only home treatment advisable for minor scratches and cuts.

Aspirin.

Eye drops—ask your doctor.

Eye dropper and eye cup.

Nose drops—ask your doctor.

Ear syringe.

Alkalizer or antacid—check with your doctor.

Fever thermometers, one oral, one rectal.

Bismuth preparation or anti-diarrhea mixture—check with your doctor.

Lotion or ointment for insect bites—check with your doctor.

Enema equipment.

Hot water bag or bottle.

Ice bag.

Blunt-tipped scissors.

Tongue depressors.

Tweezers.

Electric vaporizer or humidifier.

Check Prescriptions You Keep

Tablet preparations usually are good until they show signs of disintegration.

Solutions usually are usable as long as they remain clear, unchanged in color and free of residue.

Suspensions last a long time. Always shake well before using.

Vitamins and wonder drugs are better off in the refrigerator. Keep all these drugs in a dry, cool place and out of bright light.

Throw away any bottle with the label missing. Date labels when purchased, note what the medicine is for, and for whom.

Check with your druggist about stability of medicines about which you may be doubtful.

Keep the medicine cabinet out of reach of children.

FIRST AID—The techniques of first aid are extensively covered in a large number of publications, training courses, and other sources of information. The subject may be dealt with exhaustively and completely (the excellent first-aid text­book and manual prepared by the American National Red Cross runs to more than 230 pages) or first-aid "tips" may cover a short page to be stuck to the back of a medicine cabinet door.

Here, again, techniques are all so similar and widely agreed upon that it is difficult to differentiate one set of instructions from another.

The following first-aid suggestions are familiar to virtually everyone who has studied first-aid practices or who has taken one of the various first-aid courses.

ARTIFICIAL RESPIRATION—The most widely advocated method of artificial respiration at the present time is the "mouth to mouth" technique. If one of the S-shaped airways manufactured for this purpose is available, the task is easier.

But it is effective without the device. The procedure follows:

1.  Clean out the mouth and throat if necessary with a finger or cloth wrapped around the fingers.

2.  Approach the victim's head from the left. Take the lower jaw with both hands just in front of the ear lobes. Tilt the head back so that the chin points upward. Push the
victim's lower lip toward the chin with your thumbs.

3.  Take a deep breath. Open your mouth wide and place it tightly over the victim's. Pinch the victim's nostrils shut, or close the nostrils with your cheek. (Or you may close the victim's mouth and place your mouth over the victim's nose.) Blow into the victim's mouth or nose. The first breath determines if there is an obstruction to be cleaned out.

4.  When the chest rises, take your mouth away and let the victim exhale. Listen for the rush of air from his lungs that indicates the exchange of air. Repeat. For an adult blow vigorously and pace the breathing to about 12 breaths per minute. For a child take relatively shallow breaths and pace at about 20 per minute. It is also advisable to place the
mouth over both the mouth and nose of a child.

5.  If the method is not working, check to be certain that the head is tilted backwards. If it is obvious that there may be an obstruction, turn the victim on one side and strike sharply several times between the shoulder blades in an effort to dislodge foreign matter. Clean the mouth again. If you do not wish to come in contact with the person during respira­tion, hold a cloth over the mouth or nose and breathe through it.

WHEN A HEART STOPS—A technique now is being taught first-aiders to be used in starting a heart that has stopped beating. It is a development from Johns Hopkins Hospital and is called "closed-chest heart massage." It is for heart patients and in almost any emergency treatment of cardiac arrest. The system is being taught to firemen, rescue squads, ambulance attendants, and first-aid personnel across the country. The procedure is relatively simple.

1.  Check for a pulse— the throat on either side of the wind­ pipe is the best place to check. If there is no pulse, you must work fast.

2.  Lay the patient face up on a solid surface such as a floor. A bed or couch is too flexible.

3.  Tilt the head far back.

4.  Kneel so that you can use your weight to apply pressure. Place the heel of your right hand on the breastbone of the victim. Spread your fingers and raise them so that the weight
and pressure is only on the breastbone—not the ribs.

5.  Place your left hand on top of the right. Press down verti­cally—enough to depress the breastbone one to one-and-a-quarter inches. (With a child use only one hand and rela­
tively light pressure.

6.  Release the pressure immediately. Lift the hands slightly. Repeat the pressure and release at a pace of 60 to 80 times a minute.

7.  Get the patient to a hospital and under a doctor's care as soon as possible.

8.  Continue massage until you get medical aid to take over.

9.  If you have someone to help you, have the other person begin mouth-to-mouth breathing to force oxygen into the victim's lungs. (This helps greatly to avoid brain damage
from lack of oxygen if the patient survives.)

10. Don't give up until rigor mortis sets in.

THE EMERGENCIES—Although it is possible for almost anyone to get complete training in first-aid techniques and, possibly, to become experts—most of us actually have little use for a complete knowledge of ft, and few of us ever have a chance to use more than the most simple techniques for a relatively few emergencies.

Nor is it always advisable for first-aid enthusiasts to attempt treatment unless they are certain of what they are doing. For instance, more and more, those who may arrive at the scene of car accidents are warned not to move the injured any more than necessary until qualified help arrives.

Undoubtedly, with a step-up in civilian defense activities, a large portion of the populace may eventually receive super­vised first-aid training. Such training usually takes weeks and even months of study and practice, but will be invaluable if ever needed in time of war.

In our contemporary world of communication and fast transportation, the problem of getting medical or other emer­gency aid has been greatly simplified. A call to most metro­politan fire or police departments will send trained first-aid persons, equipped with oxygen and other first-aid equipment, speeding to an emergency. Telephone and radio communica­tion can frequently bring help within moments. A call to a doctor will bring telephone instructions.

Nevertheless, there are areas in first aid that are almost fundamental for most of us to understand. Perhaps the first lesson in first aid is to learn and understand its definition as stated by the American National Red Cross: "First aid is defined as the immediate and temporary care given the victim of an accident or sudden illness until the services of a physi­cian can be obtained."

The following are the more common emergencies. If more detailed information and greater coverage is desired, it is sug­gested that the reader make use of the previously mentioned "First Aid Textbook" of the American National Red Cross. For those who may spend much time in the country or forest a "First Aid Guide" prepared by the Forest Service of the U. S. Department of Agriculture is available from the Super­intendent of Documents for 25«i.

WOUNDS—Minor scratches and abrasions are best cared for under direction of your physician, but if you prefer to take the responsibility, wash the wound with soap and running water, if possible. Clean out dirt or other foreign particles with a sterile gauze pad or cotton, and then cover the wound with an adhesive bandage or sterile gauze pad and bandage (not too tightly applied). If redness or swelling appears, the patient should see a doctor at once as these are indications of infections.

Bleeding that is not severe frequently may be controlled by merely lifting the injured part above the level of the heart. Apply a sterile pad or bandage. Direct pressure applied over a wound will control most external bleeding. When possible, use sterile gauze or bandages. Other cloth may be used in emergencies—the cleaner the better, of course. Occasionally, the bare hand may be needed to immediately control a major wound until cloth material can be brought into use. For quick control, in some cases, it may also be advisable to apply finger or heel-of-hand pressure to shallow supplying blood vessels under the skin. These are to be used for arm or leg bleeding. Arterial pressure points are along the inside of the biceps, and the front, inner sides of the groins. Never use arterial pressure to stop head, neck, or torso wounds. Don't attempt to use a tourniquet unless you've had expert training.

POISON BY MOUTH—Immediate treatment is essential.

If there is an antidote mentioned on the container in which the poison came, use it. Call a doctor immediately— or have someone call for you while you get on with first aid. Tell the doctor what the suspected poison may be. Follow his instructions.

If you don't know the poison, or you don't know the anti­dote, or can't get a doctor at once, do these things: , 1. Dilute the poison—four glasses of water for adults. Milk protects the digestive lining a little and slows the poison's effect. Give either or both.

2. Check to determine—if possible—the type of poison. // the victim's mouth is burned, it is safe to assume that the poison was a strong acid or an alkali. If it is kerosene, gaso­line, or solvents, you can usually recognize it by the odor on the victim's breath. In either case do not make the victim vomit

For strong alkalis (lye, ammonia) give lemon juice, or orange juice, or equal parts of vinegar and water to neutralize. For strong acids give Universal Antidote, or milk of magnesia, or one teaspoonful of baking soda in a glass of water, or chalk in water to neutralize. After neutralizing, give milk or raw eggs in milk. Get patient to hospital.

In all other cases of poisoning—or if the poison and anti­dote are not known—try to induce vomiting. Give 4 to 8 glasses of warm, soapy water, or a tablespoon of table salt or a teaspoonful of powdered mustard per glass. Tickling the back of the throat with a finger will usually induce vomiting.

Call your doctor or hospital for advice and help.

If the victim is unconscious, do not attempt to administer fluids. Treat for shock. Send for doctor. Start artificial respi­ration if necessary.

SHOCK—Shock symptoms are: pale, cold, clammy skin; rapid and possibly weak pulse; shallow breathing, irregular or rapid; the victim appears to be apprehensive, restless, frightened; eyes may be vacant and lackluster; there may be nausea.

Call a doctor. Keep the patient lying down with head lower than feet unless there is a head or chest injury, in which case raise the patient's head and shoulders on pillows or other supports. Keep warm, but not overheated. If the patient is conscious and is thirsty, give plain water, neither hot nor cold, a few sips at a time. Do not give alcoholic drinks.

FAINTING—Place the patient on his back, head lower than feet. Loosen clothing. Apply cold cloths to face and forehead. Allow him to inhale spirits of ammonia if they are available. Do not attempt to give anything by mouth to any unconscious person. If faint lasts more than a few moments, treat as shock and call a doctor.

BITES—Animal bites should be immediately washed with running water and soap to cleanse the wound of the animal saliva. Apply sterile dressing and get the patient to a doctor at once. If the animal escapes, the police or health depart­ment should be notified. (Rabies may be suspected.)

Snake bites from nonpoisonous snakes may be treated as ordinary wounds.

Snake bites from poisonous snakes should be quickly and positively treated:

1.  The victim must stop muscular activity. He should lie down. This slows blood circulation and spread of the venom.

2.  Tie a constricting band (shoestring, necktie, belt) several inches above the bite if it is on an extremity. It should be tight enough to retard blood flow in surface blood vessels, but not tight enough to shut off deep-lying vessels. There should be some oozing from the wound.

3.  Sterilize a knife blade in a match flame. Make shallow incisions in X-marks about one-eighth inch deep and one- quarter inch long over each puncture wound.

4.  Apply suction to the opened wound with a suction cup—if you have one with you—or your mouth. The venom is not a stomach poison, but the mouth should be rinsed. Continue
suction for an hour or more. Loosen the constricting band every 15 minutes for a couple of moments.

5.  Get medical care. Take the snake—if you've killed it—so the doctor can identify it and the type of poison.

Note: There are four types of poisonous snakes in the United States. Three are more commonly known, and are pit vipers: rattlesnakes, copperheads, and cottonmouth moc­casins. The fourth snake is the small coral snake found in the Southeast. Pit vipers have a pit on each side of the head between the eyes and the nostrils. Their heads are roughly diamond shaped tapering down to necks thinner than the head or body. The coral snake is not a pit viper and looks not unlike a harmless garden snake. Pit vipers strike with fangs. Coral snakes chew rather than bite.

NOSEBLEED—The patient should sit quietly, head thrown back, clothing loosened at the neck. Apply wet, cold dressing over the nose. If unsuccessful, press nostrils together for five minutes. This may cause the blood to clot. If this fails, pack the bleeding nostril with a plug of sterile gauze, leaving one end outside the nostril for easy removal.

BURNS, SCALDS—Mild burns and scalds may be made less painful by running cold tap water over the burn. Be sure to wash hands thoroughly before touching the burn. When blistering is not present, Vaseline, mineral oil or similar product may be smoothed over the burn with a covering of several sterile dressings. If the skin is blistered, cover with sterile dressings and do not apply ointment, oil, or antiseptic, and do not break or drain blisters. If large areas are covered, be certain to call a doctor.

Major burns and scalds call for a doctor's immediate atten­tion and usually hospitalization. Shock is a serious hazard in these cases. Keep the victim lying down to lessen the shock. Cut clothing away from the burned area, but don't pull it loose if it sticks to the burn. Scrub your hands carefully before treating. Cover the burn with sterile, dry dressings to exclude air, reduce pain, and protect the burn. If medical aid has not arrived within 20 minutes or so, dissolve a half-teaspoonful of baking soda and one teaspoonful of salt in a quart of water. Give the patient a half glass of the solution every 15 minutes until help arrives, or unless the fluids cause vomiting, in which case discontinue at once.

A broken bone is a doctor's job. While waiting for him, keep the patient warm and treat for shock if necessary. An ice bag applied to the painful area will help. If the broken bone protrudes through the skin and there is severe bleeding, try to stop the bleeding. Don't try to clean the wound.

If you have to transport the patient to medical aid, immo­bilize the fracture with splints so that more damage will not be done. Use anything for splints that will keep the broken bones from moving. Newspapers or magazines may be used for arms; boards or broomsticks for legs. Make the splints long enough to reach beyond the joint both below and above the break. Pad splints with cotton or clean rags and tie in place snugly (not too tightly) with bandages, strips of cloth­ing, neckties, or anything available.

If a limb has to be straightened before splints can be ap­plied, support the limb on either side with your hands while someone else gently eases it into a position as natural as feasible.

Leave the bone-setting to the doctor. Splinting is just to immobilize the break until the doctor can attend to it.

If a break appears to be in the back, neck, pelvis, or skull, do not try to move the patient. Loosen clothing around the neck and waist. Cover the victim and send for a doctor or an ambulance. Don't move him for examination.. Don't let him try to move. Don't lift his head to give him a drjnk.

If the patient can move his fingers but not his toes or feet, or if there is a tingling or numbness in his legs, or pain when he tries to move back or neck, his back may be broken.

If he cannot move his fingers readily, or if he has a tingling or numbness around his shoulders, he may have a broken neck.

Get a doctor.

OLD FOLK-MEDICINE "FIRST AID"—Back in the last century, numerous "first-aid" treatments were used in all types of medical emergencies. Some of them were nothing more than common sense. Some were a far cry from any­thing resembling common sense.

Even in some primitive areas today, results may be ob­tained from what we may consider to be quite odd treat­ments.

Alexander Lake in Hunter's Choice describes an African folk medicine treatment for a burn.

A small child was severely burned. A native immediately cut his own arm and dripped blood over the burns. He then bandaged the burn to keep flies away and told the mother to feed the child milk. As soon as the blood-bath treatment was completed, the child stopped screaming, according to the report, and in three weeks the burn was healed without leav­ing scars.

African natives also use onion juice for burns and scalds.

Among first-aid treatments suggested around 1870 were some of the following techniques:

Bleeding: apply cold water or ice until a clot has formed. (Cold water still is used in modern treatment, of course.) A mixture of flour and salt, in equal parts, could be bound to the wound with a cloth.

Snake bite called for a large variety of treatments including ash bark tea, alum water, whiskey (applied internally), inci­sion of the bite and application of salt and gunpowder, crushed garlic juice, or salt and tobacco, and sweet oil.

Burns and cuts called for horseradish leaves in vinegar, or salve of pokeberry leaves boiled in flour, sweet oil, honey, and eggs.

If infection set in, Jimson-leaf salve was popular and if it reached the "mortifying flesh" stage, a compound of tar, feathers and brimstone on hickory coals was popular.

Burns have received considerable attention in the past. One remedy was said to have been discovered when a yarnisher of metals, in Paris, badly burned his hand and in agony thrust the hand into a pot of varnish at his side. To his amazement the pain stopped at once, goes the story, and the wound healed rapidly.

Colonists of southern Russia once used the white of eggs for burns, cuts, bruises and scratches. Another folk remedy for burns called for two pounds of pitch Burgundy, one pound of bees' wax, and one pound of hog's lard. "Mix all together and simmer over a slow fire until the whole are mixed well together, and then stir it until cold. Apply on muslin to the parts affected."

To relieve pains from wounds, one 1879 remedy was ex­plicit: "Take a pan or shovel with burning coals, and sprinkle upon them common brown sugar, and hold the wounded part in the smoke. In a few moments the pain will be allayed and recovery proceed rapidly."

From the same era, for someone struck by lightning: "Strip the body and throw buckets full of cold water over it for ten to fifteen minutes; let continued frictions and infla­tions of the lungs also be practiced; let gentle shock of elec­tricity be made to pass through the chest, when a skillful person can be procured to administer them; and apply blisters to the chest."

Fainting, according to one folk medicine source, could be handled by immediately placing the patient in a recumbent position, head lower than shoulders, clothing loosened. "Moisten the nostrils with ammonia," reads the direction. "Throw cold water into the face, and strike palms of the hands and rub them rapidly. Dip a plate in hot water and place it over the stomach and breastbone."

Anyone who watches "Westerns" probably is familiar with the old first-aid treatment of wounds by "cauterizing" with gun powder.

All in all, however, many of the old first-aid treatments were quite effective, especially when based upon common sense, and proved through experience.

Many of them saved lives then, and probably would today.

MEDICAL SERVICES AND HELP YOU CAN CALL UPON—SOME WITHOUT COST—When you and your family are faced with some illnesses, there may be serious problems facing you. The costs of medical care may be stag­gering and far beyond the average family's income. The wage earner may be stricken ill. The mother may come down with a serious illness with no one to help take care of a large family. Problems of care, treatment and, sometimes, rehabilitation may be overwhelming.

No one person has all the answers to the many questions that arise from these circumstances, nor is there a panacea for these problem of immediate illness. However, there may be considerable help and services available to you.

Beyond the area of immediate illness, there are services that frequently are in the nature of preventive medicine, usu­ally set up in the interests of public health and safety. You may be entitled to some of these services, and frequently you are urged to take advantage of them.

In the first instance—in case of an illness that is of threat­ening proportions to you or your family's welfare—a few basic suggestions may be invaluable:

1.  Get all the facts about a disease condition. Don't accept what someone has "heard" or what you guess. What you may have heard about another's experience with the disease may not hold true in your case. When your doctor tells you facts—listen. Don't let yourself be afraid to hear the facts. Listen to them. Understand them. Most of all, accept them when you have confidence in your doctor.

2.  Don't make all your decisions on the basis of your first appraisal of the situation. Wait for developments and act when it is obviously necessary to act.

3.  Discuss your medical problems with your doctor—not with neighbors or with persons not qualified to discuss such problems. When you face decisions, don't be afraid to talk them over with your doctor. Don't hesitate to question him about costs, and to let him know any financial or other family problems the situation is forcing upon you.

4. If it looks as if you—or your family—may need help, ask your doctor where you might get help. In addition to your doctor, public health nurses, county medical societies, and other obvious sources of help and information, there are voluntary and official health agencies that can aid in many instances.

In relation to public health, quite frequently official agen­cies—sometimes with the co-operation of voluntary agencies —will engage in a health or medical program to handle prob­lems that call for community action.

Such efforts may be found in immunization projects, for instance. In many communities where smallpox has threatened to spread in epidemic proportions, the health departments of localities have stepped into the breach with free vaccination for residents.

Other immunization projects frequently are made available to a community without cost, or at a nominal cost. More recently, there have been many instances where vaccine against polio has been given without charge through one agency or organization, or through the co-operation of sev­eral. Some communities maintain free venereal disease clinics.

Probably millions of persons in the nation have had free chest X-rays as a result of the National Tuberculosis Asso­ciation's fight, along with official agencies, to conquer tuber­culosis. Schools frequently have free clinics for children. Health examinations of school children are quite common in many areas. Dental clinics for school children are common, along with eye, ear, nose and throat clinics.

In some places it may be possible to get a test for diabetes at no cost or for a nominal charge.

Nor should the various courses in first aid and home nurs­ing, usually conducted by the American Red Cross, civil de­fense, various youth organizations, and some other service organizations, be ignored. Much of the training may be ob­tained at little or no expense.

It would be almost impossible to give a detailed explanation of how to find these services. There are many, and they vary from one community to another. However, there are certain sources that almost everyone can check.

To learn what free immunization may be available, local newspaper stories often are a good source—especially when an epidemic threatens. Otherwise, a call to a local municipal health officer usually will bring the necessary information.

GOVERNMENTAL HEALTH SERVICES primarily are concerned with the "public health" and any health problem that can be most effectively handled by community action.

They are vitally concerned with sanitation, safety, and control of communicable diseases. Quite a number of chronic dis­eases, and complications resulting from them, also come un­der public-health attention. Lately, tax funds have become more and more available for research in these areas as efforts are made to meet the results of chronic and debilitating illnesses.

The Federal public-health organization is mainly repre­sented by the U. S. Department of Health, Education and Welfare, Washington 25, D. C. and its various departments and agencies.

All of the states have health departments, as do most towns, cities and counties. Occasionally, several counties may have one consolidated health department to serve the group.

All the public agencies work in co-operation, although re­sponsibilities of local agencies may vary somewhat in one or another community.

If you have a problem that appears to fall in the area of service given by any of these departments, a call to one of the health officers usually will bring you the information you want.

When free immunization, or free diagnostic services (such as chest X-rays) are available, the public usually is informed. Watch your newspapers and other news sources. If you have children, keep in touch with the health programs offered by your local schools.

PUBLIC WELFARE is a term used to identify a wide variety of health and welfare services that are tax-supported and provided by local, state, or federal government, or a com­bination of them. Some of this work is financed through matched funds.

For instance, the Federal Social Security Program encour­ages development of state public-welfare programs by match­ing state funds used for certain purposes with equal amounts from federal funds.

The public-assistance section of the Social Security Act provides help to states in financing aid to the blind, the aged, and to dependent children. Other sections of the Social Se­curity Act may provide federal aid to states to help with health and welfare services, to rehabilitation of the handicapped, to permanently and totally disabled persons in need, and to children. You, or some of your family, may be entitled to this type of help.

Frequently, a chronically ill patient being cared for in a home may be entitled to old-age assistance. Some communi­ties have their own medical care program for such patients.

A home teacher program is provided for home-bound chronically ill or handicapped children in many communities.

These are children who cannot attend either regular or special classes. A visiting teacher visually conducts the work. In some communities electronic or closed television circuits are used. The service is not practical for acutely ill children, or those confined in short-time illnesses, but it can be most valuable to the youngster who can study but is house-bound.

For information about public health and public welfare you can call or write your state or local health department, or contact the following organizations:

American Public Welfare Association

1313 East 60th Street, Chicago 37, 111. American Public Health Association

1790 Broadway, New York 19, N. Y. Social Security Administration

U. S. Department of Health, Education and Welfare

Washington 25, D .C. The Children's Bureau

U. S. Department of Health, Education and Welfare

Washington 25, D. C.

VOLUNTARY HEALTH ORGANIZATIONS are tremend­ously important to the progress of medicine in the world and to the health of our people.

Through the funds people have contributed to them; through the research, treatment, rehabilitation and occasional legislation they have inspired; the people of the nation actu­ally have brought about many of their own medical and health successes through support of their own voluntary health organizations.

Although most of the voluntary health organizations have salaried, professional staffs, literally hundreds of thousands of citizens serve as volunteer workers in one capacity or an­other with the organizations. Some serve on local boards, others contribute time, labor, and skills in other ways. Mil­lions of citizens voluntarily finance the organizations and their work with contributions.

The following list includes most of the largest and most important agencies.

In almost all instances the organization's title embodies the name of the disease or disorders with which the agency is concerned.

Many of the organizations have local units in principal centers of population.

If you are confronted with one of the diseases or disorders specified by the organizations, it may be very helpful to get in touch with the local unit, if there is one, or—in some cases —with the national. In all cases, additional information can be obtained about the help that is available by writing to the appropriate national headquarters.

Remember—it is important to get the facts about diseases when you are immediately concerned with them. Besides your doctor, an excellent source of information may be found in the official agencies and the volunteer agencies listed below. In some cases you will find that you can obtain medi­cal, rehabilitation, and even financial aid. If you need help, find out what help is available. You have only to ask.

Allergy Foundation of America

801 Second Ave., New York 17, N. Y. American Red Cross

17th at D. Streets, N. W., Washington, D. C. Arthritis and Rheumatism Foundation

10 Columbus Circle, New York 19, N. Y. National Association for the Prevention of Blindness

1790 Broadway, New York 19, N. Y. American Cancer Society

521 W. 57th Street, New York 19, N. Y. United Cerebral Palsy Association

321 West 44th Street, New York 17, N. Y. National Society for Crippled Children and Adults

11 So. LaSalle Street, Chicago 3, 111. American Diabetes Association

1 East 45th Street, New York 17, N. Y. National Epilepsy League

208 No. Wells St., Chicago 6, 111. American Hearing Society

1800 H Street, N. W., Washington 6, D. C. American Heart Association

44 East 23rd Street, New York 10, N. Y.

The National Foundation (infantile paralysis, polio, birth de­fects, arthritis)

800 Second Ave., New York 17, N. Y. American Leprosy Missions

297 Park Ave. So., New York 10, N. Y. National Association for Mental Health

10 Columbus Circle, New York 19, N. Y. National Multiple Sclerosis Society

257 Fourth Ave., New York 10, N. Y. Muscular Dystrophy Associations of America

1790 Broadway, New York 19, N. Y. National Nephrosis Foundation

143 E. 35th Street, New York, N. Y. National Association for Retarded Children

386 Park Aye. So., New York 3, N. Y. American Social Hygiene Association (family life education)

1790 Broadway, New York 19, N. Y. National Tuberculosis Association

1790 Broadway, New York 19, N. Y.

Information about family planning may be available at the: Margaret Sanger Research Bureau

17 West 16th Street, New York 11, N. Y.

Information about the availability of visiting nurses in your community may be obtained from the organization so listed in your directories or from the local health department.

In medical emergencies due to accidents, heart attacks, convulsions and similar circumstances, your local police or fire departments may be of aid if you cannot obtain a doctor.

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