";Place" in Environmental Epidemiology

A Rectangular Coordinate Method

HARLEY T. WRIGHT, M.S.P.H., CARL J. MARIENFELD, M.D., M.P.H.,and STANLEY L. SILBERG, Ph.D., M.P.H.

T HE METHODOLOGY of epidemiologicinvestigation of acute communicable disease

is being applied increasingly to the study of en-vironmental health and chronic diseases. Theefficacy of this method in describing and clari-fying the host-agent-environment interactionsill the herd ecology of the human being andotlher species is no longer questioned. There is,however, one basic difference in methodology asapplied to communicable disease in comparisonto environmental health in the availability ofdata on time, place, and person. In the study ofcommunicable disease the factor of place, as de-fined by the occurrence of an epidemic, gives theinitial orientation, and the remaining investiga-tion determines the specific time and popula-tioIn involved.Such a well-defined geograplhic locus is not

generally available in environmental epidemi-ology except in those rare instances involvingthe simultaneous and acute intoxication of largenumbers within a population, as in the pollutionof the air over Donora, Pa., fish kills, or theepidemic of abnormal infants due to thalido-mide. The many possible environmental health

Mr. Wright is instructor, Dr. Marienfeld is profes-sor, and Dr. Silberg is assistant professor, com-munity health and medical practice, University ofMissouri Medical Center, Columbia. Dr. Marienfeldis also director, environmental health center, Colum-bia. This research was supported by Public HealthService grant No. ES00082.

effects are chronic, of low intensity, and oftenwidely scattered. Thus, identification of a suffi-cient number of individuals who demonstrate amininmal effect may involve a number of specieslocated in scattered geographic areas over a pro-tracted period of time. This identification,nevertheless, requires an exactitude in deter-mining place which must be at least equal to thatof time and person.

The ProblemsPlace. The establishment of a surveillance

system for congenital abnormalities in multiplespecies by the environmental health center of theUniversity of Missouri has reinforced our con-cern about the lack of specificity regarding placein environmental investigations.

Since 1964 we have been conducting a 12-yearretrospective study of the significant congenitalabnormalities occurring in Missouri. Birth cer-tificate reports of these abnormalities were used,and these records will be checked in the pros-pective study against hospital morbidity report-ing currently underway in Missouri (1). In ad-dition to the prospective study of human beings,a statewide surveillance program is being es-tablished through the University of MissouriExtension Division to obtain comparable dataon congenital abnormalities in domestic swinebred within the S'tate. The Missouri Depart-ment of Conservation is obtaining related dataon the State's wild rabbit population.The need for establishing a simultaneous

Vol. 83, No. 5, May 1968 427

multispecies prospective surveillance systembrought to the surface a number of the follow-ing problems.

Political boundaries. The first problem wasthat the political boundaries within which vitalstatistics reports are obtained may bear little orno relationship to geoecologic environment. Infact, such reporting using county or communityboundaries often masks clustering in adjoiningareas. The total county rates often reflect anaverage incidence of cases when, in fact, smalladjoining land parcels within several countiesmay be found to have either unusually high orlow rates. This is not surprising since these areasare a geographic and ecologic whole despite theartificial boundaries which man has devised.In man's zeal to count and measure he has

repeatedly attempted to force nature to accepthis own political boundaries and section lines.The increasing confusion and litigation overpolitical rights and prerogatives in the use ofthe water in rivers testifies to his lack of success.Only recently have we begun to admit that theair is no respecter of city or State limits, andthat New York and New Jersey, for example,are inseparably bound through their sharedproblems of air, water, soil, and space. Even lessattention has thus far been given to our ecologicdependence upon the rest of the earth beyondour national borders, but this dependence musteventually be recognized and supercede man-made boundaries and priorities.The marked internal geophysical dissimilari-

ties and the irregularities in the size and shapeof the political units being measured often pre-clude a sufficient characterization of the envi-ronment from which vital statistics are beinggenerated. Concern for the exact enumerationof the population base from which a study groupis drawn must now be matched by equal atten-tion to the specific environmental locus in whichthis population is found.Multiple species populations. The second

problem was created when species other thanhuman beings were included in the statewideepidemiologic investigation. While we can lo-cate the residence of the urban dweller by cityblock and house number, this is virtually impos-sible for the rural resident and his farm ani-mals. Having failed in our attempt to use therural postal delivery system for locating the

farm home, we have concluded that even ruralpostal delivery would not function unless a localresident assumed responsibility for mail deliv-ery. Ever-changing and often consolidatingrural routes bear no relationship to geographyother than that introduced by the presence ofroads. The mailing address is therefore largelyunusable in a geographic investigation.Matching populations. The next problem,

common to all epidemiologic studies, was theneed for matched control areas for comparisonwith those areas in which a clustering or a highrate, of incidence might be identified. The gen-eral custom has been to attempt to fit the en-vironment into the human context or mold, andin the past we have chosen census tracts, sub-economic or market areas, culturally similarzones, political boundaries, or even the numberof telephones to establish control groupings. Itwould seem in such a survey that it is essentialfirst to set the geographic base for such controlpurposes. The latitude and longitude are themost identifiable starting points, after whichmatching or stratification for population, soiltypes, socioeconomic factors, and other parame-ters may be established.Data analysis and display. Finally, in a con-

tinuing epidemiologic surveillance system thereis a need for a clear, rapid, and easily accessiblemethod for communication and display of thedata. The usual examination for clustering on asemiannual or annual basis through an inter-mittent or periodic review of data cards pre-vents the rapid recognition of a problem area.Thus, the problem itself may have changed ordisappeared by the time it is recognized and ateam of epidemiologists can be mobilized to in-vestigate the possible causes. The disadvantagesof retrospective study are well known and thesepersist, to a large degree, whether the eventsoccurred years or months before. The rapid rec-ognition of clustering of health effects is par-ticularly important to our project, since theshorter gestation periods of the animal speciesobserved allows anticipation of the humanbirths which will occur some months later inthose areas in which the environment has beenidentified as suspect.

Thus, the surveillance system for congenitalabnormalities in Missouri was designed usingtopographic maps, rectangular coordinate

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grids, and a digital computer which is pro-gramed to store the multispecies data and tofurnish printout computer maps showing thecoordinate locations of the birth anomaliesfound. We intend that this model system willbe applied to other health parameters of meas-urement, such as those involving longevity andchronic diseases, and that it may be used tostudy any biological species within the Stateand elsewhere.

Materials and Methods

To implement this system, a set of 600 topo-graphic maps of Missouri was acquired fromthe U.S. Coast and Geodetic Survey. The mapsare overlaid with a rectangular grid systemscaled in meters, making it possible to recorddegrees of latitude and longitude in plane rec-tangular coordinates. This system of plane rec-tangular coordinates was established in 1932 forall States (2,3).The maps we use are scaled at 1:24,000 (1

inch=2,000 feet), having quadrangle dimen-sions of 71/2 minutes in both latitude and longi-tude and those scaled at 1: 62,500 (1 inch= 1mile), having quadrangle dimensions of 15 min-utes in both latitude and longitude. Maps pro-duced to these scales permit the recording of thecoordinates of any point within the State to anaccuracy of approximately 100 meters.Data from birth certificates, received each

month from the State division of health, arescreened for significant anomalies recognizableat birth and coded with a modification of thecongenital malformation coding classificationof Ingalls and Klingberg (4).The birth anomalies are then sorted into two

groups, rural and urban, using the usual resi-dence of the mother during pregnancy as thedetermining criterion. A list of the rural casesis sent to the field nurse of the Missouri Crip-pled Children's Service in each district, whereup-to-date county road maps are used to deter-mine the exact location of the usual residenceof the mother of each child reported to havean anomaly. The road maps are then used to fixthe location on the topographic maps to deter-mine the coordinates. In urban cases currentstreet maps of all cities are used in a similarmanner to locate the usual residence of the

mother during pregnancy. The residence canusually be located within one city block of theactual address. Once the coordinates have beendetermined, they are recorded on punchcardstogether with other pertinent information suchas sex of child, age of mother and father, dateof birth, and type of anomaly for storage onmagnetic tape.Data are retrieved in graphic form as a scatter

diagram printed on an outline map by the com-puter. The map itself is also printed by thecomputer, using the necessary coordinates of theState and county borders.All or any segment of the State may be dis-

played by selecting any four points for use informing the perimeter of a selected area. Choos-ing the minimum and maximum values of anyfour p!oints from the topographic maps andusing these points as input for the computer, itis possible to display quickly all cases of birthanomalies that have been repiorted within thatarea. The area may be the entire State (fig. 1)or any small segment of it (fig. 2). As with anyplotting scheme, the larger the scale selected, thegreater the discrimination. The size and loca-tion of the area to be shown may be varied atwill. A number of adjacent areas may be ob-served in succession for evidence of clustering.

It is also possible to select for direct observa-tion a particular portion of the case data suchas sex, type of anomaly, season of birth, andplurality.All cases of anomalies within the State are

routinely processed monthly and cumulativelyas a part of the continuing surveillance system.The majority of reported birth malformationsare integrated into this system within 2 monthsof occurrence, and almost all are included within3 months. Thus, it is possible to monitor con-tinuously any area of the State to detect anysudden changes in the incidence of cases.The environment has many physical, chemi-

cal, and biological components, and the environ-mental health center is simultaneously collect-ing data on a number of parameters for usewhen indicated in determining the influence of agroup of factors on increased incidence of coni-genital malformations. The geographic locationand distribution of components of the environ-ment, mapped in rectangular coordinates, arerecorded on punchcards and become a part of

Vol. 83, No. 5, May 1968 429

the permanent data file for subsequent com-puter plotting. These factors include popula-tion, river basins, geology and soil types, poison-ous plants, mining areas, and other features ofthe ecology of Missouri.In addition to data on human anomalies,

surveillance will include simultaneous record-ing and retrieval of data on birth malforma-tions and stillbirths in domestic animals. Theenvironmental health center, in cooperation

with the university extension division, recentlyestablished a biannual reporting system for ab-normal births and stillbirths in swine in onecounty as a pilot project. The number of swinebirths in Missouri each year number between 3and 4 million in comparison to less than 100,000human births annually. The statistical advan-tage of working with such large numbers ofbirths is readily apparent. Since live births aswell as birth defects are being recorded, the

Figure 1. Computer generated map showing usual residence during pregnancy of mothers ofsome of the children with congenital malformations, Missouri, 1965

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Figure 2. Computer generated map showinglocation of farms from which congenitalmalformations in swine were reported,Nodaway County, Mo.

rates per thousand live births can also be selec-tively printed out on the computer map.Each county extension director uses county

agricultural records to supply the environ-mental health center with a mailing list of allswine producers in his county. The year is di-vided into two farrowing periods, and at theend of each a letter, brochure, and reportingform are mailed to each producer. The letter ex-plains the survey and contains information onreporting procedures. The brochure lists the rea-sons for the survey and contains pictures ofvisible anomalies that may occur in swine. Therep,orting form, to be completed by the pro-ducer, asks the total number of sows bred, thenumber that farrowed, the number of still-births, and the number and type of anomaliesobserved. The respondent's address and the dis-tance and direction from the nearest town isasked so that the farm can be incorporated intothe total coordinate system. This information

and a county map are used to locate the farmon the rectangular grid maps.All practicing veterinarians are also being

supplied with cards through the school of vet-erinary medicine for reporting cases of congeni-tal malformations and stillbirths in farm ani-mals and domestic pets. Since the total basepopulation in these cases is not known, suchreports cannot be used to calculate incidencerates. Each case reported is, however, consid-ered as an index case and is investigated by thefield epidemiologists. The precise location ofthe farm and pertinent information on localherds are obtained during the investigation.Types of animal abnormalities can then be com-pared with those occurring in human beings.This information from veterinarians will alsoaid in rapidly identifying otherwise hiddenepidemics in local areas in species other thanswine.

Since 1957 the Missouri Department of Con-servation, through its Game Research Section,has also been collecting data on the reproduc-tion of populations of the cottontail rabbit inselected areas of Missouri. Annual rates forfetal resorption have been determined for theselected areas as an indication of fertilitychanges and embryonic abnormalities. Al-though these baseline data are not available ona statewide basis, they are being used to supple-ment. the information available on human be-ings and domestic animals in those areas of theState for which they are available. It will bepossible to collect such data on this species fromother regions of the State when necessary tosupplement the analysis of human and domes-tic animal surveillance. All data are keypunchedand stored on magnetic tape and are availableat any time for retrieval and printout displayin whole or in part.

DiscussionThe distribution and fluctuations in disease

incidence have long been graphically repre-sented on standard international, national, andlocal geographic maps (5, 6). Topographicmaps with rectangular coordinates have beenused by the U.S. Armed Forces and other Gov-ernment agencies; in some States land survey-ors use the maps, and the x and y coordinatesare used as a part of the legal description of

Vol. 83, No. 5, May 1968 431

real property (3, 7). Such maps have not, how-ever, been widely used in the health field.Other systems in health investigations have

required that cases of illness be grouped by somecommon political or geographic characteristicsuch as county, State, or census tract (8, 9).Since diseases show no regard for politicalboundaries, this method does not always repre-sent the tr-ue epidemiologic or ecologic picture.If, indeed, environmental factors do affect thehealth of a total and multispecies populationwithin an area then it should be possible to studytha,t population in detail witlhout the restrictionof unrelated political boundaries. The need,therefore, is to be able to consider the populationof all species under study without regard forartificial boundaries. Differences sometimes oc-cur in small contiguous areas that are not re-flected in the overall rate of a larger subdivision.With this system cases of congenital anomaliesor other health effects can be geogrraphicallyrepresented, and at the same time environmentalvariables can be located and identified in anysegment of the State.There are, of course, somne disadvantages to

a plane coordinate system of this type. Since thesurface of the earth is curved, no part of it canbe represented on a plane without some distor-tions and discrepancies resulting. The larger thearea the grea,ter will be the discrepancy. Thus ithas become necessary to provide some of thelarger States with two or more sets of grids.This factor must be taken into considerationwhen locatinig a point within any State border.One major problem in translating from oc-

currences to rates is the lack of specific data onthe human population for each segment beingexamined. The population in Missouri has beenquite stable during the last 10 years except infour areas which are growing quite rapidly(10). If in fact the incidence of clustering doeschange within a particular area for a given time,it is necessary to determine the rates based uponthe population of the area. For human beings,we can only select segments based on countiesor census tracts for which population dataare currently available or construct an area-adjusted map as described by Levison and Had-don (11). However, the Census Bureau is cur-rently exploring the use of the topographic mapfor future census data. Such census coordinates

will supply the base population data necessaryfor the more accurate determination of ratesfor human beings in the future.This is not a problem with the data on swine

because the base population will be available.The number of live births for each farm report-ing is included with the malformation data; itwill therefore be possible to calculate rates perfarm or for a selected area directly from thisdata.By establishing a surveillance system for con-

genital malformations based on rectangular co-ordinates, we are constructing a model whichcan be applied to the relationship of most en-vironmental factors to any selected disease proc-ess. As multiple species are included in thissystem, a change in the incidence of cases willbe more quickly and readily identifiable thansuch a change in incidence in human beingsalone.

Since most domestic and wild animals havea shorter gestation period than human beings,any detrimental environmeental factor should in-duce a change more quickly in these species. Bycarefully monitoring the clustering of highrates of abnormalities in these species, a pro-spective watch for a similar change in humanbeings may be established. Any such change inthe abnormality rate of the species under sur-veillance will call for a careful epidemiologicinvestigation to determine the validity of thereporting and the possible factors responsiblefor change. Such an investigation will be greatlyenhanced by having readily and permanentlyavailable in computer map form many of theenvironmental constants and variables that con-tribute to the ecology of the specific area.The method described has a definite advan-

tage over pin maps or other manual plottingmethods as it is faster, more accurate, and moreflexible, and the storage capacity is virtuallyunlimited. Since the coordinates of current casereports and baseline data regarding many en-vironmental factors are stored on magnetictape, recall and comparison of any or all dataare possible with a minimum of cost and time.This system can be easily adapted to any me-dium sized digital computer having adequateoutput equipment, such as a printer, cathode-raytube, or digital plotter, and to any situation inwhich numbers may vary widely, in which vis-

Public Health Reports432

ual aids are important, and in which there is aneed to evaluate the interrelationships of manyvariables. This system will enable us to locatequickly an individual or a collection of indi-viduals, environmental components, and eventsthat may contribute to the overall occurrenceof the problem under investigation.SummaryA multispecies surveillance system for con-

gential abnormalities has been established bythe environmental health center of the Univer-sity of Missouri. This system is based on the useof topographic maps of Missouri, an x,y co-ordinate system, and a digital computer forrapid and periodic handling of data.The topographic maps are overlaid with a

rectangular coordinate grid which permits therecording of any geographic point in Missourito an accuracy of 100 meters.Data on congenital anomalies from birth cer-

tificates for human beings, from records pro-vided by swine producers to the extension divi-sion, and from records on wild animalsmaintained by the State department of conser-vation are included in this system.The x,y coordinates of the location of each

case are determined and recorded along withother parameters. This method permits the re-cording and selective retrieval of data wiithoutregard to manmade political or geographicboundaries. Thus, the factor of place is welldefined over a large area for an extended periodof time.

REFERENCES

(1) Silberg, S., et al.: Surveillance of congenitalanomalies in Missouri, 1953-64. Arch EnvironHealth (Chicago) 13: 641-644, November 1966.

(2) Wraight, A. J., and Roberts, E. B.: The Coast andGeodetic Survey-150 years of history. U.S.Government Printing Office, Washington, D.C.,1957.

(3) U.S. Coast and Geodetic Survey: Plane coordinatesystems. U.S. Government Printing Office,Washington, D.C., 1948.

(4) Ingalls, T. H., and Klingberg, M. A.: Implicationsof epidemic embryopathy for public health.Amer J Public Health 55: 200-208, February1965.

(5) Simmons, J. S., et al.: Global epidemiology. J. B.Lippincott Co., Philadelphia, 1954.

(6) Gentry, J. T., et al.: An epidemiological study ofcongenital malformations in New York State.Amer J Public Health 49: 4, April 1959.

(7) Anderson, C.: Use of plane rectangular coordi-nates in California. Surveying and Mapping 12:128-131, April-June 1952.

(8) Drosness, D. L., et al.: The application of com-puter graphics to patient origin techniques.Public Health Rep 80: 33-40, January 1965.

(9) Babbott, J. G., and Ingalls, T. H.: Field studies ofselected congenital malformations occurring inPennsylvania. Amer J Public Health 52: 12,December 1962.

(10) U.S. Bureau of the Census: United States censusof population: 1960. General population charac-teristics, Missouri. PC (1)-27B. U.S. Govern-ment Printing Office, Washington, D.C., 1961.

(11) Levison, M. E., and Haddon, W., Jr.: An area

adjusted map-an epidemiologic tool. PublicHealth Rep 80: 55-59, January 1965.

DrownproofingParents can now teach children how to protect themselves from

drowning by following the directions on a new wallet card publishedby the Public Health Service.Drownproofing consists of a series of arm and leg movements per-

formed in the water by a person moving up and down instead of for-ward, as in swimming. If performed correctly, drownproofing allowsa person to survive for hours, even in rough water. Information on thecard was prepared by the Injury Control Program of the NationalCenter for Urban and Industrial Health in cooperation with theAmerican Red Cross.The card contains other safety information for use around the water.

The card, "Safety Tips In-Out-and-Around the Water," may be ob-tained free in quantities of up to 100 by writing to the Injury ControlProgram, National Center for Urban and Industrial Health, 222 EastCentral Parkway, Cincinnati, Ohio 45202.

Vol. 83, No. 5, May 1968 433

Teaching the Mentally Retarded. Apositive approach. Motion picture,16 imm., black and white, sound, 23minutes, 1967. Not cleared for te7e-vision. Order No. il-1453-X. Pro-duced by the Uiniversity of Texas forthe Southern Regional EducationalBoard.AUDIENCE: Restricted to agencies

and institutions serving the retardedand to professional persons withtraining in mental retardation. Thefilm may be shown to the public foreducational purposes if such showingis supervised by a professional per-son trained in behavior-shapingtechniques.SUMMARY: Illustrates the use of a

system of teaching based on rewardsor positive reinforcement. Followsthe progress made by four severelyretarded children during a 4-monthprogram in which self-care toilettraining, dressing, eating-and man-ners were emphasized. Illustratesthat even the seriously retarded canlearn rather complex skills. Althoughthe film deals with the retarded inan institutional setting, the princi-ples of teaching also apply to the lessseverely retarded who may reside inthe community.AVAILABLE: Free short term loan

from the National AMedical Audio-visual Center (Annex), Chamblee.Ga. 30005, Attention: Film Distribu-tion. Purchase from DuArt FilmLaboratories, Inc., 245 West 55thStreet, New York, N.Y. 10019. (Saleof this film is restricted to profes-sional persons or groups working inthe field of mental retardation.)Hands of Action. Motion pictuire,16 mm., color, sound, 40 minutes;not clcared for television, not intend-ed for public showing. Order No. M1-1455-X. Produced by the TraunmaCommittee, North Carolina Chapterof the American College of Sutrgeons,under a grant from the EmergencyHealth Services Branch, PublicHealth Service.AUDIENCE: Emergency vehicle op-

erators, ambulance attendants.SUMMARY: Depicts a physician in-

structing ambulance attendants ini

emergency care. The physician ex-plains, in layman's language and withgraphic examples, the recommendedprocedure for handling blocked air-ways, bleeding, open wounds, andbroken bones. He briefly describesthe nature of the respiratory and cir-culatory systems, the danger of in-fection from open wounds, and thetypes of broken bones which attend-ants might encounter. He uses realand simulated injuries to illustratecorrect procedures for emergencycare. The film is intended for use byan instructor in a training programfor emergency vehicle operators. Itis divided into four distinct parts.and the instructor may stop the filmfor discussion after each part. Noportion of the film may be cut oromitted from any complete showing.AVAILABLE: Free short term loan

from National Medical AudiovisualCenter (Annex), Chamblee, Ga.30005, Attention: Film Distribution.Purchase from DuArt Film Labora-tories, Inc., 245 West 55th Street,New York, N.Y. 10019.Mammography Diagnosis: Normal,non-malignant breast. Motion pic-t?re. Part I. TFR-1 1779A, 30minutes; Part II. TFR-1179 B, 30minutes. Mammography Diagnosis:Malignant breast disease. Part I.TFR 1307A, 35 minuites; Part II.TFR-1307B, 38 minutes . 16 mm.,black and white, sound televisionfilm recor(lings, 1966 and 1967. Re-lated film:Mammography Technique, K-1162.Produtced by the National MedicalAudiovisual Center for the NationalCenter for Chronic Disease Control.AUDIENCE: Restricted to persons

listed in the Directory of the Amer-ican College of Radiology. Radiolo-gists not listed in the directoryshould address requests for this filimito: Program Representative forMammography, Cancer Control Pro-gram, National Center for ChronicDisease Control, Bureau of DiseasePrevention and Environmental Coni-trol, Public Health Service, Washing-ton, D.C. 20201.

SUMIrMARY: "Normal, Non-Malig-nant Breiast" outlines the classifica-tion and describes the appearailce ofthe normal breast, variations of thenormal and non-malignant diseasesof the breast, with accompanying dif-ferential diagnoses. Shows more than1253 mammograms simultaneously to

illustrate each point; includes dis-cussions with examples of difficultiesencountered with mammography."Malignant Breast Disease" outlinesthe appearance of malignant dis-eases; shows more than 175 mam-mograms to illustrate each point.Includes an expanded section on in-dications for mammography and itspotential use in reduction of mortal-ity from breast cancer.

AVAILABLE: Free short term loanfrom National Medical AudiovisualCenter (Annex), Chamblee, Ga.30005. Attention: Film Distribution.Bold New Approach. Motion picture,16 mm., black and white, sound, 28minuttes, 1967; cleared for television.Order No. AM-1367. Related film:A Community Mental Health Cen-ter: The new way. Order No. M-1527-X. Produced by the MentalHealth Filmn Board for the NationalInutitute of Mental Health.

AUDIENCE: Health-related organi-7ations and commiiunity leladers.

SUIAriARY: Introduced by Dr. Stan-ley F. Yolles, Director of the Na-tional Institute of Mental Health,who reviews the Community MentalHealth Centers Act, the legislationwhich resulted from President Ken-nedy's recomminendation for "a boldnew approach" to the treatment ofthe mentally ill. As a psychiatristdescribes to an architect the Variouscomponents and services of a com-imiunity mental health center, the twomen design a center model that isendorsed by civic leaders. At inter-vals, the scene shifts to actual men-tal health programs, illusitrating thefive essential services of a mentalhealth center: inpatient service, out-patient service, partial hospitaliza-tion, emergency service, and consul-tation and educational services.Other special services for children,alcoholics, and drug addicts areshown, as well as the means of co-ordinating rehabilitation and otherprograms necessary to provide com-prehensive mental health services toall individuals of a cominunity inneed of them.AVAILABLE: Free short term loan

from the National Medical Audio-visual Center (Annex), Chamblee,Ga. 30005, Attention: Film Distribu-tion. Purchase from: DuArt FilmLaboratories, Inc., 245 West 55thStreet, New York, N.Y. 10019.

Public Health Reports434

New D.C. Detoxification CenterA 25-bed detoxification center in

the District of Columbia for theemergency care of alcoholics openedDecember 1, 1967. By Christmas, itwas nearly full with persons whovoluntarily admitted themselves.

This facility of the District of Co-luimnbia Department of Public Healthprovides 24-hour nursing care andtreatmiient, along with referral to fol-lowup health and rehabilitationservices.The center was designed to serve

as a substitute for confinement, con-victioin, ancd punishment throughlpolice and court channels. It is ex-pected that in the near future mostof the persons admitted will bebrought there by the police.-D.C.Healtht Newvs and Notes, January1968.

Environmental Health TrainingThe Monroe County (N.Y.) De-

partment of Health and the Roch-ester Institute of Technology haveestablished a cooperative educationalprogram for training environmentalhealth sanitarians.The program is open to majors in

biology and chemistry. Students willspend alternating 13-week periods atthe institute and at the health de-partment during the last 3 years of a5-year curriculum. The final 13weeks will be devoted to a thoroughenvironmental survey of a selectedcormmunity.The students will complete the

program with a B.S. degree, fullyqualified as professional sanitarians.

Hostels for Mental RetardatesThe first three of a network of hos-

tels (residences) to be established inNew York State for mentally re-tarded adults who are capable ofworking and living in the communitywith little supervision will be lo-cated in New York City, NassauCounty, and Monroe County. The

tlhree hostels are to serve 100-120persons.These hostels will be homelike

comminunity residences, such as studioapartments, in which the mentallyretarded adults can live under thesupervision of houseparents. House-keeping facilities, homemaking serv-ices, common dining areas, and recre-ational activities will be provided.The residences will be built by the

State or by a local government andcommunity organizations with Stateassistance.

"Coffees" Draw Expectant MothersEclucational programs offered ex-

pectant mothers by the San MigmiaCounty (N. Mex.) Health Center,Las Vegas, met with better responsewhen billed as "coffee hours" ratherthan "parents' classes."A series of weekly "coffee hours"

that the center held in 1967 was wellattended, drawing from 16 to 46participants per session. The groupsipped coffee, saw films, and dis-cussed pertinent topics.The sessions were attended not

only by prenatal patients but also byuniversity home economics studentsand high school seniors (men in-cluded) from a nurse aide classunder the State vocational educa-tion department.

Mumps Vaccine Put to TestA recent live mumps vaccine was

used in a Georgia county in January1968 in an attempt to halt an epi-demic. Developed by Merck, Sharpand Dohme, the vaccine was licensedby the Public Health Service on Jan-uary 4, 1968, for mass manufacturingand distribution.

In White County, a iseige of mumpshad extended from the beginning ofthe school year until the Christmasvacation. It reached about 40 pereentof the pupils in one elementaryschool and threatened to spread tothree other schools.

County school officials appealed tothe State health department for aid,and the drug company made im-mediiately available enough vaccineto immunize about 220 susceptiblechildren. On January 17, Mrs.Dorothy N. Payne, the countypublic health nurse, vaccinated 194children.

Social Workers in Health OfficesNine public health social workers

hiave been assigned to the regionaloffices of the New York State Depart-ment of Health. One of the isocialworker's responsibilities is answer-ing questions for the State's newhealth information and referralservice.The department established the

service in January 1968. It providesany State resident with free and con-fidential answers to any question onhealth or health-related problems.

Hospitals, nursing homes, andmedical care have been the majorsubjects of telephone inquiries, ac-cording to Elizabeth W. Heinmiller,director of the health department'soffice of public health slocial work.

Legislators Try to Stop SmokingForty New York State senators

and assemblymen enrolled early in1968 in a 6-week course to break thesmoking habit. Sessions were heldeach Tuesday in the State capitol.The withdrawal course was given

under the supervision of Dr. DonaldT. Frederickson, district health offi-cer for central Harlem (Borough ofManhattan), and the smoking con-trol program director for the NewYork City health department.

Diabetes Screening in PennsylvaniaThe Pennsylvania Department of

Health's continuing diabetes screen-ing survey is expected to reach ap-proximately 170,000 residents during1968. In 1967, a total of 152,182 per-sons participated in 217 screeningIprograms sponsored by the depart-ment in 49 counties.The main objective of the screen-

ing is to discover residents withundiagnosed or potential diabetesand to refer these persons to familyphysicians for definitive diagnosis.The program is not intended to testresidents with known cases ofdiabetes.

Vol. 83, No. 5, May 1968 435

synopses

WADDELL, SAMUEL J. (Columbia University College of Physicians andSurgeons): The Parkinson's Disease Information and Research Center.Public Health Reports, Vol. 83, May 1968, pp. 391-395.

In 1964 the Parkinson's DiseaseInformation and Research Centerat Columbia University was estab-lished by the National Institute ofNeurological Diseases and Blindness,Public Health Service. It is the firstneurological information center in aplanned national network of spe-cialized neurological informationcenters to be supported by contractfunds.

This center is concerned withbasic sciences covering neurological

research, including anatomy, path-ology, physiology, pharmacology,chemistry, and clinical extrapyra-midal disorders.Any person working in the bio-

medical sciences or the paramedicalprofessions can use the services ofthe center. These services include(a) searches and bibliographies ondemand, (b) publication of aweekly alerting list, which gives ci-tations of recent documents onParkinson's disease and Parkinson-

related research, (c) verification ofreferences accompanying m a n u -

scripts or galley proofs, (d) de-velopment of interest profiles onscientists affiliated with the centeror writing on Parkinsonism, (e) pro-duction of a thesaurus on Parkin-son's disease, which now contains5,000 entries, (f) translation of doc-uments, (g) reproduction of docu-ments on request, and (h) mainte-nance of a directory file of scientistsworking on Parkinson-related re-search. The information center iscomposed of the bibliographic unit,the thesaurus and indexing unit, thesystems unit, and the clerical unit.

PELL, SIDNEY (E. I. du Pont de Nemours & Co.): Epidemiologic studiesin a large company based on health and personnel records. Public HealthReports, Vol. 83, May 1968, pp. 399-403.

Information for epidemiologicstudies in a large, widely dispersedpopulation of employees can be ob-tained economically, since most ofthe required information is gener-ated routinely and is readily avail-able through computer retrieval

systems. The large numbers of ob-servations available increase thereliability of the data and reduce thelength of time required to obtainanswers to epidemiologic questions.The size and dispersion of the

population, however, results in a

proportionate loss in the degree ofsurveillance over the sources of cer-tain types of information. One wayof coping with this problem is to con-fine the study to a probaibility sampleor a segment of a company's employ-ees. If the investigator uses theentire population, he will have tomodify his objectives in accordancewith the limitations thus imposed onthe data.

O'SHEA, ROBERT M. (State University of New York, Buffalo), andGRAY, SHIRLENE B.: Dental patients' attitudes and behavior concern-ing prevention. National survey. Public Health Reports, Vol. 83, May1968, pp. 405-410.A national survey of the attitudes,

beliefs, and behavior of 1,520 adultsconcerning dental health was con-ducted in October 1965 by the Na-tional Opinion Research Center.Responses to the questionnaire

were related to age, sex, race, in-come, educational level, and com-munity size. Half the persgons in thesurvey sample had not visited a den-tist within a year, 26 percent hadnot visited a dentist in 3 years, and1 percent had never been to a dentist.

Only one in three adults went to thedentist for checkups or prophylaxis;the other two went because of symp-toms or because of an identifiedneed.The Isurvey data on beliefs in the

efficacy of dental visits and oftoothbrushing showed almost uni-versal acceptance by the respond-ents. Variation was between the"'much" and "some" responses ratherthan the "little good," "none," and"don't know" responses. These atti-

tudes seem to have relatively littleeffect on actual behavior (going tothe dentist within the year and goingfor preventive treatment).Only about one-fifth of the persons

with elementary school educationshad been to the dentist during theyear. Two-thirds of the college grad-uates, however, and three-fourths ofpersons with postgraduate and pro-fessional training had done so. Only16 percent of persons earning $2,000or less per year had visited the den-tist, but 76 percent of those withincomes of $15,000 or more hadvisited the dentist.

Public Health Reports436

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CANNEFAX, GEORGE R. (National Communicable Disease Center, Pub.lic Health Service), HANSON, ALBERT W., and SKAGGS, ROMULUS,Jr.: An investigation of sorbing substances in the FTA-ABS test forsyphilis. A preliminary study. Public Health Reports, Vol. 83, May 1968,pp. 411-416.

In an investigation of sorbingsubstances in the fluorescent trep-onemal antibody-absorption (FTA-ABS) test, uninoculated mediumwas found to have sorbing efficiencysimilar to media in which 22 spiro-

chetal species or strains had beencultivated. Pancreatic digests ofcasein and yeast extracts werefound to be medium components re-sponsible for the sorbing effect. Sor-bing effect was found in both frac-

tions where deproteinized yeastextract was fractionated into 80 per-cent ethanol soluble and insolublefractions. The ethanol soluble frac-tion was found to have sorbing effi-ciency equivalent to FTA-ABS sor-bent in comparative testing of 30syphilis serums and 23 reactive non-syphilis serums. Peptides or peptidepresent in yeast extracts and hydro-lytic decomposition products ofcasein are suspected to representthe sorbing substances or substance.

KAUFMANN, ARNOLD F. (National Communicable Disease Center),and FEELEY, JAMES C.: Culture survey of Salmonella at a broiler-rais-ing plant. Public Health Reports, Vol. 83, May 1968, pp. 417-422.

Salmonella culture surveys of avertically integrated broiler opera-tion were conducted at intervals overa 2-year period. Salmonellae wereisolated from 18.2 percent of 1,400fecal samples and from 29.3 percentof 324 samples of feed and feed in-

gredients. A self-perpetuating cycleof infection was suggested by theisolation of the same serotypes fromthe live birds, their feed, and thepoultry meal incorporated in thefeed.The poultry meal, which was ren-

dered offal from the company's ownprocessing plant, served as the majorsource of feed contamination. Sal-monellae were isolated from 94 per-cent of 48 poultry meal samplesexamined. Another major source wasthe fishmeal added to the feed. Iso-lations were made from 44 percentof the 34 fishmeal samples. Thehatcheries appeared to be unimpor-tant in the perpetuation of infectionin the operation.

KATZ, SELIG H. (New York State Department of Health), and HARRO,DALE E.: Screening for PKU in New York State. Public Health Reports,Vol. 83, May 1968, pp. 423-426.Since January 1965 New York

State law has required all newborninfants to be tested for phenylketo-nuria. Regulations prescribe theGuthrie inhibition assay procedureas the only test currently fulfillingthe legal requirement.

Results of all tests are reported induplicate to the submitting hospital

as less than 4 mg. (negative), 4 mg.or greater (positive), or inadequate.Infants whose initial Guthrie testsshow levels of 20 mg. or greaterare referred for immediate clinicalevaluation; those with levels be-tween 4 mg. and 20 mg. are retested.

Since the inception of the manda-tory testing program, 77 infants

have been diagnosed as havingphenylketonuria, yielding an appar-ent incidence of approximately onein 13,000 live births. All newborninfants in New York are now beingtested as required.The total cost of the program is

$227,000 per year. It costs approxi-mately $10,000 to detect a case ofPKU in an infant. The cost of eachdetermination performed is roughly66 cents.

WRIGHT, HARLEY T. (University of Missouri Medical Center),MARIENFELD, CARL J., and SILBERG, STANLEY L.: "Place" in en-vironmental epidemiology. A rectangular coordinate method. PublicHealth Reports, Vol. 83, May 1968, pp. 427-433.

A multispecies surveillance systemfor congenital abnormalities hasbteen established by the environ-mental health center of the Univer-sity of Missouri. This system is basedon the use of topographic maps ofMissouri, an $,y coordinate system,and a digital computer for rapid andperiodic handling of data.

The topographic maps are overlaidwith a rectangular coordinate gridwhich permits the recording of anygeographic point in Missouri to anaccuracy of 100 meters.Data on congenital anomalies from

birth certificates for human beings,from records provided by swine pro-ducers to the extension division, and

from records on wild animals main-tained by the State department ofconservation are included in thissystem.The x,y coordinates of the location

of each case are determined and re-corded along with other parameters.This method permits the recordingand selective retrieval of data with-out regard to manmade political orgeographic boundaries. Thus, the fac-tor of place i's well defined over alarge area for an extended period oftime.

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