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i'lm .'.-,?',;;?."-'" ^i-'f-.-vL H001 11228 F WA 1 N562b 1940 -42 of t{)e (Knit)et0itp of Bottb earolina ennotoen iiF ^^t SDialecttc anU PI)Uanti)topic fbotittit0 Division Of HEALTH AFFAIRS LIBRARY -*- TWENTY-NINTH BIENNIAL REPORT OF THE North Carolina State Board Health JULY 1, 1940-JUNE 30, 1942 EDWARDS a BROUGHTON COMPANY RALEIGH MEMBERS OF THE STATE BOARD OF HEALTH Elected hj the North Carolina Medical Society S. D. Craig, M.D. Term expires 1945 G. G. Dixox, M.D. Term expires 1943 W. T. Rainby, M.D. Term expires 1945 John LaBruce Ward, M.D. Term expires 1943 Appointed by the Governor HiBKKT B. Haywood, M.D. Term expires 1945 H. Lee Large, M.D. Term expires 1943 J. N. Johnson, D.D.S. Term expires 1945 H. G. Baity, Ph.D. Term expires 1943 C. C. Fordham, Jr., Ph.G. Term expires 1945 1397 LETTER OF TRANSMITTAL Raleigh, N. C, September 16, 1942. His Excellency, J. Melville Broughtox, Governor of North Carolina. My DEAR Sir: — Under Authority of Chapter 118, Article 1, Section 7050, Consolidated Statutes of N'orth Carolina, I have to submit to you for transmission to the General Assembly the Biennial Report of the State Board of Health for the period July 1, 1940, to June 30, 1942, Yours sincerely, Carl V. Reynolds, Secretary and State Health Officer. TABLE OF CONTENTS Page The Chronological Development of Public Health Work in North Caro-lina - - 9 Report of the Secretary-Treasurer and State Health Officer 51 Annual Report North Carolina State Board of Health to Conjoint Ses-sion State Medical Society—1941 66 Annual Report North Carolina State Board of Health to Conjoint Ses-sion State Medical Society—1942 95 Informational Service 122 Division of Preventive Medicine - - 123 Crippled Children's Department 131 Division of Sanitary Engineering 139 Division of Oral Hygiene -... - 147 State Laboratory of Hygiene 149 Division of Epidemiology - 157 Division of Vital Statistics 165 Division of County Health Work 169 Division of Industrial Hygiene 186 School Health Coordinating Service 190 THE CHRONOLOGICAL DEVELOPMENT OF PUBLIC HEALTH WORK IN NORTH CAROLINA In the seventies Dr. Thomas Fanning Wood, of Wilmington, caught the vision of the possibilities of public health work to North Carolina. How fully he grasped the far-reaching consequences of his idea, how clearly he saw the ever-growing hosts of lives saved as a result of his vision and inspiration, we shall never know. We do know that the vision never left him, and that under its sway he worked, through the Medical Journal which he edited and through the North Carolina State Medical Society until his influence reached the people of the State in their General Assembly of 1877, with the effect that on February 12, 1877, the North Carolina State Board of Health was born. Ours was the twelfth state board of health to be established. Without treating the development of the newly-established board with that thoroughness that could be termed history, we think it enough to set down here in chronological order the principal events in the life and growth of the North Carolina State Board of Health. 1877. Board created by the General Assembly. Consisted in the beginning of entire State Medical Society. Society acted through a committee. Annual appropriation, $100. 1878. First educational pamphlet issued. Subject, "Timely Aid for the Drowned and Suffocated." Annual appropriation, $100. 1879. The General Assembly reconstituted the Board of Health. Made it to consist of nine members: six appointed by the Governor, three elected by the State Medical Society. Term of office, five years. Dr. Thomas F. Wood elected first Secretary of the Board, May 21. Dr. S. S. Satch-well was first President of the Board. Other legislative provisions: (1) Chemical examination of water, and (2) organization of county boards of health, composed of all regular practicing physicians and, in addition, the mayor of the county town, the chairman of the board of county commissioners, and the county surveyor. Four educa-tional pamphlets issued. Subjects: "Disinfection, Drainage, Drinking Water, and Disinfectants"; "Sanitary Engineering"; "Methods of Performing Post-morten Examinations"; "Limitation and Preven-tion of Diphtheria." Annual appropriation, $200. 1880. Much of the activity this year was devoted to efforts to control diph-theria. Prompt reporting of cases was urged. Water supplies and sewage disposal provoked much discussion. A survey of school-houses was carried out through the County Superintendents of Health. Most of the public schoolhouses were of one-teacher size, of frame and log construction, and none of them in rural districts had any type of privy. 1881. General Assembly passed a law requiring regulation of vital statistics at annual tax listing; law ineffective. Annual appropriation, $200. 8 Twenty-Ninth Biennial Report 1882. Dr. Thomas F. Wood, State Health Officer, was President of the North Carolina Medical Society and the annual meeting was held in Concord. At this meeting the State Board of Health appointed a committee for each county of one physician to "canvass (the people) in the interest of prospective legislation" on public health matters. The subject of the annual essay presented by Dr. W. P. Beall of Greensboro was "Pre-ventive Medicine." The chief items of public health interest this year was the emphasis placed on the effectiveness of smallpox vaccination and the increasing realization of polluted water as a source of typhoid fever. 1883. Dr. J. W. Jones of Wake Forest was elected to membership on the State Board of Health by the State Medical Society at its annual meeting at Tarboro. Dr. Jones became at once an active "friend and promoter of sanitary work." Due to his efforts, a meeting of all county superin-tendents of health was called in Raleigh early in the next session of the Legislature. One of the chief purposes of the proposed meeting was to urge the enactment of vital statistics legislation, and to procure a small appropriation for printing. Several epidemics of smallpox with numerous deaths were reported —one of the most severe was in Clay and Graham counties. 1884. Dr. Wood, Secretary and Treasurer of the State Board of Health, made a pessimistic report this year. He said that "during the year little more had been done than to issue pamphlets on the subject of city sanitation." Dr. Wood pointed out that it was impossible to inaugu-rate public health work to say nothing of carrying it on without some money at least. The State Medical Society adopted a resolution at its conjoint session held in Raleigh requiring the President of the Medical Society to appoint a committee "to go before the Legislature and request an adequate appropriation to be used by the Board in behalf of the high and humane objects of the Board." 1885. General Assembly made county boards of health more efficient; allowed printing privileges not to exceed $250 annually. Annual appropriation, $2,000. 1886. The Health Bulletin made its appearance in April. Pamphlet on "Care Eyes and Ears," by Dr. Richard H. Lewis, printed and distributed. 1887. Fear of yellow fever which had made its appearance late in the year through the port of Key West, Florida, where a patient with the dis-ease had been smuggled in, was one of chief concern to the Board. Much interest and discussion in the Board membership and through-out the state this year centered about the necessity for providing some safe method of drinking water and sewage disposal. 1888. Yellow fever epidemic in Florida and refugees to Western North Caro-lina demonstrated value of a Board of Health to cope with situation. Annual appropriation, $2,000. 1889. The chief item of interest and importance to the cause of public health was a state-wide "sanitary convention" held in Raleigh February 6. It was largely attended by physicians and others from many cities and towns who were much concerned about the problems of a pure North Carolina Board of Health 9 water supply and sewage disposal. The Board published an exhaustive paper by Dr. H. T. Bahnson of Salem, President of the Board, en-titled: "The Public Water Supply of Towns and Cities in North Carolina." Providing refuge for hundreds of people who had fled from their homes farther south on account of yellow fever was a grave problem. 1890. A widespread epidemic of influenza or as it was commonly called at the time "grip" or "La Grippe," spread over the state in January. The epidemic appeared first in Russia about November 1, 1889. By Decem-ber 15, 1889, 200,000 cases were reported in New York alone. It struck North Carolina during the first week in January and in two weeks time it was reported to be raging in 68 counties. 1891. Influenza continued to be present in all sections of the state through-out the year. The conjoint session met in Asheville on May 27. The term of Dr. W. D. Hilliard of Asheville as a member of the Board expired this year. Dr. S. Westray Battle also of Asheville was elected to succeed Dr. Hilliard. Dr. Thomas F. Wood was reelected Secretary and Treasurer for a term of six years. 1892. Dr. Thomas F. Wood, the Secretary of the Board, died August 22. Dr. Richard H. Lewis elected Secretary to succeed Dr. Thomas F. Wood, September 7. Annual appropriation, $2,000. 1893. Legislative provisions: (1) Laws improving the reporting of contagious diseases, (2) the protection of school children from epidemics, (3) protecting the purity of public water supplies, and (4) regulation of common carriers. Legislature provided that the Governor appoint five of the nine members of the Board of Health, that the State Medical Society elect four, and that the term of office of the members of the State Board of Health be six years. The $250 printing limit was re-moved. Pamphlet on quarantine and disinfection was prepared and reprinted by many of the state papers. Annual appropriation, $2,000. 1894. A number of public health conferences were arranged and held in different towns of the state. Bulletin was increased from a mailing list of 800 to 1,200. Annual appropriation, $2,000. 1895. Dr. Albert Anderson and Dr. W. T. Pate were elected bacteriologists for the Board. Annual appropriations, $2,000. 1896. Board passed a resolution requiring chemical and bacteriological exami-nations of municipal water supplies. Dr. Venable, of Chapel Hill, undertook the chemical examination, and Drs. Anderson and Pate the bacteriological examination. Board also directed Mr. John C. Chase, the engineer member, to inspect all municipal water plants in the state. Annual appropriation, $2,000. 1897. General Assembly enacted law requiring county superintendents of health to be elected by county commissioners and reduced term of office to one year. Annual appropriation, $2,000. 1898. The address of the President of the North Carolina Medical Society this year by Dr. Francis Duffy of New Bern was devoted almost exclu-sively to the promotion of public health. It really marked an epoch as sounding an advanced note in the advancement of human progress. The State Health Officer, Dr. R. H. Lewis, devoted a great deal of 10 TWE.NTY-Nl>TU BlE.NXIAL REPORT time and energy to try to arouse the people of the state to the necessity for vaccination against smallpox. 1899. General Assembly improved the laws protecting public water supplies. Smallpox prevailed extensively in the state. Dr. Henry F. Long, and later, on Dr. Long's resignation, Dr. Joshua Tayloe, were employed to travel over the state, consulting with and advising the local sanitary authorities as to proper means for protecting the public. Annual ap-propriation, $2,000. 1900. State Board of Agriculture, on request of State Board of Health, agreed to examine samples of w'ater from public water supplies until Board of Health could provide its own examiner. Annual appropriation, $2,000. 1901. State Board of Embalmers, with representatives of State Board of Health, established. County health work placed in the hands of county sanitary committees composed of county commissioners and two physi-cians w^hich commissioners elected to serve with them. Term of office of county superintendent of health made two years. Annual appropria-tion, $2,000. 1902. This year will be long remembered for the widespread prevalence of smallpox in virulent form. It caused many deaths in different sections in the early months of the year. In one county at least fifty people died, including many well-to-do-men. Not having any system of vital statistics reports, it is impossible to even estimate the number of cases, except from physicians' voluntary reports and death notices in the newspapers. 1903. General Assembly enacted law permitting Board of Health to charge $5 for each analysis of a public water supply, this fee to be used in pay-ing Department of Agriculture for services of examiner. Dr. C. W. Stiles, U.S. P.H.S., before the State Medical Society at Hot Springs, called attention to prevalence of hookworm disease in the South. Dr. J. L. Nicholson and Dr. W. S. Rankin, working under State Board of Health during fall of 1903 and spring of 1904, showed great preva-lence of this disease in North Carolina. Annual appropriation, $2,000. 1904. A stenographer was employed. One hundred and twenty thousand pamphlets on tuberculosis were printed and distributed. There was a renewal and an extension of cooperative work between the Board of Health and the state press, a number of articles dealing with hygienic and sanitary subjects being furnished the papers and published in them. Annual appropriation, $2,000. 1905. General Assembly established State Laboratory of Hygiene; imposed w^ater tax of $64 on all public water companies; voted $600 annually for the support of laboratory. Small appropriation made it necessary for the Department of Agriculture to continue to assist State Board of Health. Annual appropriation, $2,000. 1906. The North Carolina Association for the Study and Prevention of Tuberculosis was organized. Annual appropriation, $2,000. 1907. Two thousand dollars appropriated for the State Laboratory of Hygiene. Pasteur treatment provided. State Sanatorium for treatment of tuberculosis founded; $15,000 appropriated for permanent improve- NoKTH Cakolixa Board of Health 11 ments and $5,000 for maintenance. A law requiring the separation of tuberculosis prisoners from other prisoners was enacted. Annual appropriation, $4,000. 1908. January 1, Dr. C. A. Shore became Director of State Laboratory of Hygiene. Annual appropriation, $4,000. 1909. General Assembly provided for (1) whole-time State Health Officer; (2) collection of vital statistics of towns having a population of 1,000 or over; (3) that all public water companies file plans and specifications of their plants with the State Board of Health, and that the State Board of Health pass necessary rules and regulations for the care of public watersheds and plants and furnish such rules and regulations and other advice to those having charge of public water supplies; (4) that counties provide free diphtheria antitoxin for county indigents, and (5) that the maintenance appropriation for the Sanatorium be increased from $5,000 to $7,500, and an additional $30,000 be granted for permanent improvements. Dr. Richard H. Lewis resigned as Secretary of the Board, and Dr. W. S. Rankin was elected as his successor, beginning his official work July 1. Annual appropriation, $10,500. 1910. General effort to interest the people and state organizations in public health work. Bulletin increased from 3,500 edition to 10,500 edition. Addresses on public health work delivered to Conference of County Superintendents of Schools, State Federation of Women's Clubs, State Press Association, and Sanitary Sunday observed in April. Dr. John A. Ferrell elected, February, Assistant Secretary for Hook-worm Eradication; began work under State Board of Health and Rockefeller Sanitary Commission. 1911. Legislature established county boards of health to take the place of the county sanitary committees; county board of health composed of chairman board of county commissioners; county superintendent of schools, mayor of county town, and two physicians selected by the three county officials to serve with them. Legislature also abolished quarantine for smallpox and improved the quarantine laws. One thousand dollars annually appropriated to contract with antitoxin manufacturers for state supply of high-grade diphtheria antitoxin, with result that price of antitoxin was cut to one-fourth former price, saving the citizens of the state over $30,000 annually. Bulletin increased from 11,500 copies to 20,000 copies each edition; closer co-operation with press of state developed; regular weekly press articles prepared and sent to papers; increase in numbers of popular pam-phlets for distribution. Hookworm this year largely educational through the school forces and investigative through county dispen-saries; thousands of children found infected and treated. Strong sentiment began to make itself felt for better health work by coun-ties, four counties employing whole-time county health officers. Guilford County—one of the four—began its work June 1 and was the first county in the United States to inaugurate full-time county health work. Maintenance appropriation for State Sanatorium increased to $12,500, with $20,000 voted for permanent improvements. Annual appropriation, $22,500. 12 Twenty-Ninth Biennial Report 1912. Bulletin increased to 40,000 edition; number of popular pamphlets dealing with different diseases increased; press work improved; edu-cational work of Board along all lines amplified. Secretary of Board of Health called attention of conjoint meeting of State Medical Society and State Board of Health to the relative importance of health prob-lems and the bearing of this subject upon the proper apportionment of health funds; instrumental in passing a resolution to the effect that pellagra was an interstate problem, not a state problem, and re-questing the Federal Government to deal with pellagra as a Federal problem; resolution responsible, to considerable extent, for successful effort on part of Hon. John M. Faison's securing Congressional appropriation of $45,000 for the study of pellagra by the Federal Government. Hookworm work extended and county funds appro-priated to supplement state and Rockefeller Foundation for this work. Annual appropriation, $22,500. 1913. General Assembly passed Model Vital Statistics Law with $10,000 appropriation for its enforcement. County superintendent of health changed to either county physician or county health officer, depend-ing on whether part-time or full-time service. Educational efforts of Board continued and enlarged. Hookworm work along same line as year before increased in amount. Dr. John A. Ferrell resigned as Assistant Secretary to accept position with the central office of the Rockefeller Sanitary Commission in Washington, D. C. Dr. C. L. Pridgen succeeded Dr. Ferrell. The movement for improved county health work had by this time resulted in ten counties electing whole-time county health officers. The State Sanatorium for Treatment of Tuberculosis turned over by Extra Session of 1913 to the management of State Board of Health. Annual appropriation, $40,500. 1914. Preceding work of the Board continued. Board of Health took over management of Sanatorium; started out under many difficulties on account of the institution owing many debts and the appropriation being limited. Hookworm work changed to community work directed to the installation of sanitary privies in all homes. Laboratory began to produce and distribute free anti-typhoid vaccine. Dr. C. L. Pridgen resigned as Director Hookworm Eradication, and Dr. W. P. Jacocks succeeded him. Annual appropriation, $40,500. 1915. General Assembly makes state vital statistics law conform to national model by requiring burial permits in rural communities; enacts legislation permitting county commissioners and towns and cities to appropriate money for support of tuberculosis citizens in State Sanatorium; provides $15,000 for purchase and building of antitoxin plant; appropriates $60,000 for payment of Sanatorium debts and new buildings and other improvements, and $25,000 annually for maintenance and $10,000 for extension anti-tuberculosis work. Edu-cational work greatly extended: Bulletin now 47.000; traveling public health exhibit shown at fairs and other assemblages; press work greatly developed through employment of Miss Kate Herring, a journalist, for her whole time; stock lectures with lantern slides supplied public speakers in different parts of the state; community soil pollution work under Dr. W. P. Jacocks stops in April, and NoETH Carolina Board of Health 13 Bureau of Rural Sanitation, with Dr. G. M. Cooper at its laead, suc-ceeds, beginning work May 1. Considerable amount of work done for improvement of prison conditions. The unit system of county health, work gets a good start; over 52,000 people given three complete vaccinations against typhoid fever, and medical inspection of schools put on in six counties. Annual appropriation, $50,500. 1916. North Carolina was admitted to the Registration Area for deaths. To the educational agencies of the Board was added a self-supporting moving picture health show. Many saw this show during the year and, seeing, believed in health work as never before. BuUettn reached 51,000 edition. Cooperation with University in developing a plan and putting on a home post-graduate course in medicine, giving first course to 169 doctors. Put into operation an optional system of hotel inspection, with grading and publishing scores. Continued Bureau of Rural Sanitation, giving three anti-typhoid injections to 48,000, making 100,000 immunized in summers of 1915 and 1916. Did com-plete medical inspection of six counties and with inspection a large amount of educational work as to sanitary and hygienic living. Secured effort by Federal Children's Bureau to develop unit of child hygiene work, the Bureau using two employees to work in Cumber-land and Swain counties for about eight months. Laboratory of Hygiene buys land and erects its own building. Annual appropria-tion, $55,500. 1917. The General Assembly passed the following important health legisla-tion: Chapter 263, entitled "An act to prevent and control the occur-rence of certain infectious diseases in North Carolina"; Chapter 244, entitled "An act to provide for the physical examination of the school children of the state at regular intervals"; Chapter 276, entitled "An act for the cooperative and effective development of rural sanitation"; Chapter 257, entitled "An act to prevent blindness in infancy, designat-ing certain powers and duties and otherwise providing for the enforcement of this act"; Chapter 66, entitled "An act to provide for the sanitary inspection and conduct of hotels and restaurants"; Chapter 286, entitled "An act to regulate the treatment, handling and work of prisoners." Following the enactment of this legislation, administrative ma-chinery, consisting of a Bureau of Epidemiology under the direction of Dr. A. McR. Crouch, a Bureau for the Medical Inspection of Schools under the direction of Dr. Geo. M. Cooper, and a Bureau for County Health work, under the direction of Dr. B. E. Washburn, was estab-lished. Dr. Washburn, an officer of the International Health Board, was loaned to the state without cost, and the International Health Board, in addition to furnishing Dr. Washburn, appropriated $15,000 annually for County Health Work in accordance with the provisions of Chapter 276. The United States Public Health Service in February, 1917, detailed Dr. K. E. Miller to study county health work in different sections of the country and to estaiblish for demonstration purposes, in Edgecombe County, department of health on an economic basia easily within the financial reach of the average county. 14 . Twenty-Ninth Biennial Report The State Laboratory of Hygiene moved into its own building, January 15, 1917. The state was admitted to the registration area of the Union for births in January, 1917, the Bureau of the Census having found after investigation that our birth registration was 96 per cent complete. The special campaign against typhoid fever begun so satisfac-torily in 1915 was continued. Free vaccination of the people, however, was interfered with by the difficulty in securing medical officers to do the work, the preparedness program of the Government having caused many physicians and nurses to enter the army and navy; nevertheless, a total of 30,000 citizens of the state were vaccinated as a direct result of the Board's activities, and many thousands of others were vaccinated by the physicians of the state as a result of the educational work of the Board directed to impressing the people with the value of vaccination as a means of prevention for typhoid fever. In December, 1917, life extension work, which consisted briefly of the free physical examination of interested citizens for the purpose of advising them as to their physical condition and needed hygienic reform and medical treatment, was begun on a county basis. The funds necessary for this work were appropriated partly by the state and partly by the counties in which the life extension work was carried out. Dr. Amzi J. Ellington, of Raleigh, who at the time was a resident physician in the New York City Hospital, was employed and placed in charge of the work. Life extension work was carried out in Vance, Alamance, Lenoir and Robeson counties, and resulted in the full physical examination of 4,000 citizens. This work was very favorably received, and the outlook for its continued development seemed excellent when, with the declaration of war and the call for physicians to enter the military service of the country, Dr. Ellington enlisted in the Medical Corps of the Army. For this reason, and for the further reason that It has been almost impossible to secure health officers during the past two years, the work was not resumed. The educational work of the State Board of Health consisted in the issuance of eight issues of the Monthly Health Bulletin, each monthly edition amounting to 45,000, and a daily newspaper health article. The Bureau continued its moving picture show exhibit. Arrange-ments were made for the preparation of newspaper plate, which was sent to and extensively used by 202 papers having a total circulation of 303,000. The annual appropriation for the State Board of Health was $60,772.16. The annual appropriation for the State Laboratory of Hygiene was $12,500, and this, in addition to $9,087.22 in fees per-mitted under the laws of the state to be paid to the Laboratory for special work, provided the Laboratory with a total annual budget of $21,587.22. 1918. Much of the work this year was influenced by the war and had to do with preparedness. The State Health Officer visited Washington, at the request of the Council of National Defense and as chairman of a committee of State Health Officers, on a number of occasions for NOKTH C-UIOLINA BOARD OF HEALTH 15 conferences with respect to preparedness measures, provisions for the control of venereal diseases, arrangements for coordinating the control of infectious diseases in the civilian population with their con-trol in cantonments, and to arrange, if possible, with the Public Health Service and the Surgeon-General of the Army for preserving the personnel of state health departments during the war. Considerable time was given to assisting Major John W. Long, Medical Aide to the Governor, in the work of organizing the Medical Advisory Boards and in interesting physicians in entering the medi-cal service of the Army and Navy, and, later in the year, in inducing the physicians of the state to become members of the Volunteer Medi-cal Service Corps. Partly as a result of these activities, the Surgeon-General of the Army assigned Major Joseph J. Kinyoun to assist the State Board of Health in the control of communicable diseases, the Board being under no financial obligation for Major Kinyoun's assistance; and as a result of the successful termination of the activities of various inter-ests looking to a more effective control of venereal diseases, the Kahn-Chamberlain bill passed Congress, and made available to the State of North Carolina, and without condition, $23,988.61 for venereal disease w^ork. The Laboratory during this year began the distribution of a high grade of diphtheria antitoxin. The Bureau of Medical Inspection of Schools, under the direction of Dr. G. M. Cooper, developed, and with a degree of success that we may say established, free dental clinics for the public schools of the state. The Bureau also developed to a successful extent an arrange-ment in the form of adeno^ and tonsil clubs for the practical and economic treatment of public school children suffering from these defects. The Bureau of Epidemiology employed two third-year medical students, equipped them with motorcycles, and put them into the field to investigate infringements of the quarantine law. Sufficient convictions were obtained to impress the people with the determina-tion of the state to enforce its health laws, and a fairly satisfactory compliance with the laws regarding the reporting of communicable diseases was brought about. The Bureau of Venereal Diseases, paid for by the Federal appro-priation, was established in September under the directorship of Dr. James A. Keiger. Mr. Warren H. Booker, for the last seven years the efficient director of the Bureau of Engineering and Education, left in September for Red Cross work in France, the work of his bureau being continued, with the exception of the engineering work, by Mr. Ronald B. Wilson, who had been employed earlier in the year to succeed Miss Herring in assisting Mr. Booker with the journalistic work, Miss Herring having been engaged by the War Department for educational work. Perhaps the most outstanding feature of the health work during the year 1918 was the epidemic of influenza. The epidemic began early in October and caused in October alone 6,056 deaths; in November 16 Twenty-Ninth Biennial Report 2,133 deaths, and in December 1,497 deaths, a total during the last three months of 9,686 deaths. The annual appropriation for the State Board of Health for 1918 was $73,210.38. The annual appropriation for the State Laboratory of Hygiene was $12,500. The Laboratory, during this year, collected $8,532.48 in fees for special work, so that the total income of the Laboratory for this year was $21,032.48. 1919. The General Assembly passed the following important health legisla-tion: Chapter 71, entitled "An act to prevent the spread of disease from insanitary privies"; Chapter 192, entitled "An act to provide for the physical examination and treatment of the school children of the state at regular intervals"; Chapter 206, entitled "An act for the prevention of venereal diseases"; Chapter 213, entitled "An act to require the provision of adequate sanitary equipment for public schools"; Chapter 214, entitled "An act to obtain reports of persons infected with venereal diseases"; Chapter 215, entitled "An act to amend Chapter 671, Public-Local Laws of 1913, relating to the injunc-tion and abatement of certain nuisances." The Bureau of Engineering and Inspection was organized in April. The engineering work of the Board had been suspended with the resignation of Mr. Warren H. Booker in September, 1918, Mr. Booker having gone to France to engage in tuberculosis work under the direction of the Red Cross. Between September, 1918, and April, 1919, the engineering problems coming before the Board had been referred and very kindly and effectively taken care of by Col. J. L. Ludlow of Winston-Salem, the engineer member of the Board. Mr. H. E. Miller, an engineer and a graduate of the University of Michi-gan, was placed in charge of the new bureau, and his brother. Dr. K. E. Miller, of the United States Public Health Service, was detailed by the Service to assist him in the organization of his work. Mr. H. E. Miller and Dr. K. E. Miller spent the spring and summer and a part of the fall in studying various types of privies, in preparing plans for the construction and maintenance of privies, and in pre-paring the necessary notices and literature to inform the people of the objects and requirements of the new privy law. On May 1 Dr. A. J. Warren, health officer of Rowan County, was appointed to and accepted the position of Assistant Secretary of the Board. About the first of the year. Miss Herring returned to the educa-tional work of the Board. After a few months she returned to the Fed-eral Service, and Mr. R. B. Wilson, who had left the Board work upon Miss Herring's return, was again offered a place with the Board. Mr. Wilson accepted and assumed his duties on July 1. On August 1 Dr. A. McR. Crouch, Director of the Bureau of Epi-demiology, resigned to accept a position with the city of Wilmington. Dr. F. M. Register, whole-time health officer of Northampton County, succeeded Dr. Crouch as director of the bureau. Dr. E. J. Wood resigned this year, effective at the end of his term, North Carolina Board of Health 17 and Governor Bickett appointed Dr. E. J. Tucker of Roxboro for six years term—first dentist to serve on the Board. In September Dr. J. R. Gordon, Director of the Bureau of Vital Statistics since 1914, resigned on account of impaired health, and on October 1st the Bureau of Epidemiology and the Bureau of Vital Statistics were combined and placed under the direction of Dr. Register. In September Mrs. Kate Brew Vaughan, Director of the Bureau of Infant Hygiene, resigned. The bureau was reorganized under an under-standing with the American Red Cross and was enlarged to include, in addition to infant hygiene, the problem of public health nursing, the name of the bureau being changed to that of "Bureau of Public Health Nursing and Infant Hygiene." Under the agreement with the Red Cross this bureau was to have an available appropriation of $12,000 a year, half of which was was to be furnished by the American Red Cross and half by the State Board of Health. The personnel of the bureau and its plan of work, under the agreement, was made contin-gent upon the approval of both participating agencies, the American Red Cross and the State Board of Health. In December Miss Rose M. Ehrenfeld took charge of the new bureau and began its organization and work. On October 1 Dr. Jas. A. Keiger, Director of the Bureau of Venereal Diseases, resigned and Dr. Millard Knowlton was appointed to suc-ceed him. The typhoid campaign carried on during the summer through pre-vious years was continued in the summer of 1919, using third-year medical students, furnished either with automobile or motorcycles for getting about. Campaigns were carried out in the following coun-ties: Bertie, Cabarrus, Chatham, Chowan, Columbus, Craven, Hert-ford, Iredell, Johnston, Lincoln, Onslow, Pasquotank, Perquimans, Randolph, Richmond, Rockingham, Stanly, Union, Warren, Wayne. A total of 49,076 were given complete vaccination. The educational work of the Board consisted of the publication of 48,000 monthly edition of the Bulletin, and the distribution of about 350,000 pieces of public health literature. The funds available during this fiscal year amounted to $198,- 549.14, of which $102,301.98 was from state appropriations and the remainder from outside sources. The appropriation for the State Laboratory of Hygiene for this year was $28,500; in addition to this, the Laboratory collected in fees for special work, for antitoxin, and in water taxes a total of $14,344.02, making a total of $42,844.02 available for work of Laboratory. 1920. During this year there was a Special Session of the General Assembly, lasting twenty days and held in the latter part of August. This Special Session passed an act amending the vital statistics law, making the fees for local registrars 50 cents instead of 25 cents for each certifi-cate properly filed with the State Board of Health. On January 1 Dr. B. E. Washburn, who had had general direction of the cooperative county health work and who had rendered most acceptable service, was recalled by the International Health Board and 2 IS Twenty-Ninth Biennial Report detailed to take charge of their interests in Jamaica. Dr. K. E. Miller, of the United States Public Health Service, who had been detailed in January, 1917, to organize a model county health department in Edgecombe County and then, in 1919, to assist his brother, Mr. H. E. Miller, in organizing the work of the new Bureau of Engineering and Inspection, to which was assigned the duty of enforcing the state-wide privy act, succeeded Dr. Washburn as director of the Bureau of County Health Work. In January a cooperative effort with the United States Public Health Service and the International Health Board to demonstrate the possibilities and advantages of the eradication of malaria from certain towns and cities in the eastern part of the state was begun. The terms of cooperation were that the International Health Board and the State Board of Health were to pay one-half of the expenses of the local work and the town or city in which the work was done the other half, the Public Health Service furnishing, as its part, expert supervising personnel. The towns and cities chosen for this work were Goldsboro, Farmville, and Greenville, the budget for each municipality being respectively: Goldsboro, $13,670.98; Farmville, $5,000, and Greenville, $9,000, a total investment in this work of $27,670.98. Mr. W. A. Fuchs, Associate Sanitary Engineer, was detailed by the Service to have supervision of the work. In February Dr. A. J. Warren, Assistant Secretary of the State Board of Health, resigned his position in order to accept the appoint-ment of city health officer of Charlotte, N. C. In the winter and spring of 1920 the North Carolina Landowners Association, under the progressive leadership of Mr. W. A. McGirt, of Wilmington, undertook a very extensive educational campaign against malaria, which v/as carried on through the public schools of thirty-eight counties in eastern North Carolina. A series of county and state prizes for the best essay on malaria by public school chil-dren were offered as an inducement to the school children to interest and inform themselves and, indirectly, their parents with regard to the importance of this disease. To make possible this work by the school children 75,000 malaria catechisms, prepared by Dr. H. R. Carter, of the United States Public Health Service, were distributed through the public schools of the eastern part of the state to the school children. Thousands of essays were written, and it is reason-able to believe that the campaign was one of the most successful public health educational attempts yet undertaken. In June it was found advisable to separate the Bureau of Epidemi-ology and the Bureau of Vital Statistics which had, on account of the scarcity of health officers, been placed under the directorship of a single bureau chief, Dr. F. M. Register. Dr. Register was appointed Director of the Bureau of Vital Statistics and Dr. J. S. Mitchiner was appointed Director of the Bureau of Epidemiology. In April the Interdepartmental Social Hygiene Board assigned to the State Board of Health several workers for making a study of vice conditions in North Carolina towns and cities and for taking such steps as were found expedient for decreasing prostitution. This group of workers was withdrawn in September on account of differences- North Carolina Board of Health 19 developing between them and Dr. Knowlton, chief of the Bureau of Venereal Diseases, with the understanding that another group of workers would be assigned to this work at a later date. In June arrangements were made with the United States Public Health Service and the American Social Hygiene Association for the development of an elaborate educational unit on sex hygiene and venereal diseases designed to reach rural meetings through the use of picture films and a portable truck. An outfit consisting of several lec-tures and a moving picture truck began work in Cumberland County in August, and from its very beginning met a most cordial reception and gave every promise of developing into one of the most useful agencies for dealing with the venereal disease problem. During the year anti-typhoid vaccination campaign was continued in Alamance. Bladen, Columbus, Duplin, Franklin, Gaston, Harnett, and Mecklenburg counties. Cooperative campaigns, in which the counties furnished the working personnel, were also carried on in Anson, Johnston and Rutherford counties. A total of 29,435 citizens have been vaccinated against the disease, and this does not include Columbus County, in which the work was just beginning when this report was completed. The educational work of the State Board of Health during this year consisted of a 48.000 monthly edition of the State Board of Health Bulletin and the distribution of approximately 350,000 pieces of pub-lic health literature. The funds available during this fiscal year amounted to $342,- 284.33, of which $176,152.61 was state appropriation and the remain-der from outside sources. The appropriation for the State Laboratory of Hygiene for this year was $25,000; in addition to this, the Laboratory collected in fees for special work, for antitoxin and in water taxes, a total of $13,- 698.89, making a total of $38,698.89 available for the work of the Laboratory. The above amount being insufficient, the Special Session of the Legislature authorized a loan of $15,000 to enable the work of the Laboratory to be carried on. making a total of $53,698.89 available for the work of the Laboratory during this year. 1921. The Legislature meeting early in January of this year was asked by the Board to amend the state law restricting the salary of the executive officer of the Board to $3,000 annually, so as to make the salary $5,000. Such an amendment was passed. A further request from the Board was that legislation be enacted removing the inspection tax of forty cents from privies coming under the supervision of the Board of Health. Such an amendent to the State-wide Privy Law was also enacted. A bill was introduced in this session of the General Assem-bly under the initiative of Hon. Emmet H. Bellamy requiring a physical examination of all applicants for marriage and making issuance of license contingent upon the physical qualifications of the applicant. The State Board of Health approved and supported Mr. Bellamy's bill, realizing, as did the author of the bill, that the proposed legislation was but a step in the right direction and was, therefore, rather loosely drawn and left many things to be desired. 20 Twenty-Ninth Biennial Report The bill finally passed in amended form as Chapter 129, Public Laws of 1921. The Governor appointed Mr. Chas. E. Waddell, an engineer, of Asheville, to succeed Col. J. L. Ludlow as the engineer member of the Board. Perhaps the most important change inaugurated in state health administration during this year was the adoption of a cost basis for standardizing and measuring the efficiency of public health work in those counties in which, the state participated financially. This new principle is fully described in the State Board of Health BuUetin for January, 1922, and a further discussion of cost basis for public health work is unnecessary here except, perhaps, to say that it is apparently at least one of the first attempts to introduce the cost system of indus-try into government. The Bureau of Venereal Diseases, in charge ol Dr. Millard Knowl-ton, established as a part of the war-time activities of the Board in cooperation with the Bureau of Venereal Diseases of the Federal Gov-ernment, was combined with and made a part of the work of the Bureau of Epidemiology, under the general direction of Dr. J. S. Mitchener. Funds available for the year included state appropriation, $275,000; miscellaneous receipts, $164,184.42; total, $439,184.42. 1922. In order to bring the records of this department into harmony with those of other state departments, in accordance with the Act of the General Assembly of 1921, changing the fiscal year of the state so as to begin on July 1st each year, this report ends with June 30, 1922. It, therefore, covers a period of nineteen months; one full fiscal year from December 1, 1920, to November 30, 1921; seven months from December 1, 1921, to June 30, 1922. Effective February 1, the Ameri-can Red Cross Society abrogated the agreement existing since 1919 by which it jointly financed, with the Board of Health, the Bureau of Public Health Nursing and Infant Hygiene. This bureau was reor-ganized April 1 as the Bureau of Maternity and Infancy, for its main-tenance the state receiving $27,259.66 annually from the United States Government in accordance with the Sheppard-Towner Act for the promotion of the welfare of mothers and infants, Dr. K. P. B. Bonner, of Morehead City, was secured as the director of the reor-ganized bureau, with Miss Rose M. Ehrenfeld as supervisor of nursing and Mrs. T. W. Bickett in charge of educational work. The funds available during this period, and their distribution were seven-twelfths of the amounts set out under the tabulation for 1921. The appropriation for the State Laboratory of Hygiene for the nine-teen months between December 1, 1920, and June 30, 1932, was $87,- 083.33; in addition to this, the Laboratory collected in fees for special work, for antitoxin and in water taxes, a total of $30,872.51, making a total of $117,955.84 available for the work of the Laboratory. 1923. The General Assembly of 1923 enacted some important and far-reaching legislation affecting public health work in North Carolina. The most important legislation enacted this year was the act providing for an North Cakolixa Boakd of Health 21 independent board of directors for the State Sanatorium for Tuber-culosis, removing the direction of that institution from the authority of the State Board of Health. Facilities were also provided at the State Sanatorium for the confinement, care, and treatment of tuberculosis convicts. Other legislation included the act to provide for the sanitary manufacture of bedding, the latter act to be enforced by the State Board of Health. The Bureau of Epidemiology was again combined with the Bureau of Vital Statistics. On March 1 Dr. G. M. Cooper was made Assistant Secretary of the State Board of Health, and Dr. J. S. Mitchiner was assigned to the Bureau of Medical Inspection of Schools, after the consolidation of the Epidemiology work, which he had directed, with the Bureau of Vital Statistics. Dr. K. E. Miller, of the United States Public Health Service, was recalled for duty elsewhere. In order to experiment with the plan of District Health Work, an effort was made to place responsibility for all State Board of Health activities under the direction of district directors attached to the staff of the State Board of Health. This effort was continued throughout the year, but proved to be ineffective and unsatisfactory. During the year Dr. F. R. Harris resigned from membership on the State Board of Health to become health officer of Vance County. The Board elected Dr. D. A. Stanton, of High Point, to fill the unex-pired term of Dr. Harris. In order to further carry on the important work of malaria control in a number of the counties of the coastal plain area of the state, which work was so effectively commenced in an educational capacity in 1920, the International Health Board was requested to participate in this work and to provide a director for that service. The Interna-tional Health Board agreed, accepted the invitation and assigned Dr. H. A. Taylor, of Alabama, to head this division. Pamlico County was selected as headquarters for Dr. Taylor. The cost of this work was borne by the State Board of Health and Pamlico County contributing 40 per cent, each, and the International Board the remaining 20 per cent. The International Health Board, of course, paid the salary of Dr. Taylor. In June Dr. J. S. Mitchener resigned as director of the Bureau of Medical Inspection of Schools and Dr. Roy C. Mitchell, who had been doing some special educational field work for the Board, temporarily succeeded Dr. Mitchener. Early in 1923 Dr. W. S. Rankin, the State Health Oflficer, was invited by the Committee of Municipal Health Department Practice of the American Public Health Association to become field director for the committee in making a study of municipal health practices in the United States. This was for the purpose of working out a basis or set of principles through which city health departments could be given classification or grading, and also for the purpose of assisting such departments in their organization work. The request was brought before a special meeting of the executive committee of the Board, and it directed the Secretary to take advantage of the opportunity offered. The Board granted to the Secretary one year's leave of absence, but 22 Twenty-Ninth Biennial Report requested him at the same time to continue in touch as executive officer of the Board with the work of the Board. On November 1 Dr. Ranltin assumed his duties and established official headquarters in New York City for the work of the com-mittee. The general organization of the executive staff of the Board was continued with the Assistant Secretary, Dr. G. M. Cooper, as official head of the staff. Local health work in the eastern half of the state was directed by Dr. H. A. Taylor, and that in the western part of the state by Dr. E. F. Long, who had been assistant to Dr. K. E. Miller as director of county health work. To assist Dr. Taylor in the east. Dr. George Collins, formerly health officer of Mecklenburg County, was employed, and to assist Dr. Long in the western half of the state Dr. C. N. Sisk, formerly health officer of Forsyth County, was employed. During the year a plan for the more adequate sanitary control of public milk supplies in the state was formulated. This work was undertaken under the direction of the Bureau of Engineering and Inspection, and Mr. Malcolm Lewis was employed to organize this work. Several changes in personnel took place this year. Dr. M. L. Iseley, who had been employed in county health department work, and Dr. Roy C. Mitchell resigned. Miss Rose Ehrenfeld also resigned. 1924. During this year Dr. Rankin continued his work with the American Public Health Association until November 1. During this period the work of the Board was directed by Dr. G. M. Cooper, serving as Acting Secretary. On November 1 Dr. Rankin returned, and during that month, under the direction of Dr. Maxey of the United States Public Health Service, a school for health officers was conducted under the auspices of the State Board of Health for one week in Raleigh. This meeting was well attended, and every modern method which might be utilized in the work of a modern public health de-partment was discussed throughout the week. Dr. M. L. Townsend was placed in charge of the Division of Health Education. Dr. K. P. B. Bonner resigned as director of the Bureau of Maternity and Infancy. 1925. Dr. Rankin resigned, effective June 1, to accept the position of director of the Hospital and Orphan Division of the Duke Foundation. At a meeting of the Board of Health on May 30 Dr. G. M. Cooper was unanimously made Acting Secretary for an indefinite period of time to succeed Dr. Rankin. During the year Dr. E. F. Long resigned as director of county health work and Dr. C. N. Sisk, who had been assistant to Dr. Long, was placed in charge of county health work, without an assistant. 1926. On June 21 Dr. Charles O'H. Laughinghouse, a member of the Board, was elected permanent Secretary and State Health Officer to fill the unexpired term of Dr. Rankin. Dr. Laughinghouse accepted and took office October 1. Dr. G. M. Cooper, who had for sixteen months admin-istered the work of the Board as Acting State Health Officer, con-tinued with the service and was assigned to the Bureau of Health Education, succeeding Dr. M. L. Townsend, who resigned. On August North Carolina Board of Health 23 6 Dr. Richard H. Lewis died. Dr. Lewis liad served as a member of the Board since 1885, and from 1892 to 1909 he served as Secretary of the Board. Since 1909 he liad been a member of the executive com-mittee. Dr. Lewis held his membersliip on the Board by appointment from the Governor. To fill the term of Dr. Lewis, expiring in 1931, Governor McLean appointed Dr. John B. Wright, of Raleigh. Among other reasons assigned for this appointment, the Governor stated that it had been the rule since the Board of Health was established to have at least one of the members of the Board a resident of Raleigh. When Dr. Laughinghouse resigned, in order to accept the election to the position of State Health Officer by his fellow members on the Board, the remaining members of the Board elected Dr. W. S. Rankin, of Charlotte, former Secretary of the Board, to succeed Dr. Laugh-inghouse. 1927. There were no changes in personnel or in staff organizations during the year 1927. The most important event occurring this year was the death of Dr. J. Howell Way on September 22. Dr. Way had been a member of the Board for many years and had been President of the Board for a long time. Governor McLean appointed Dr. C. C. Orr, of Asheville, to succeed Dr. Way. At the first meeting of the State Board of Health following the death of Dr. Way, Dr. A. J. Crowell, of Charlotte, was made President of the Board. In April of this year Dr. W. S. Rankin resigned as a member of the Board, and Dr. L. E. McDaniel, of Jackson, was elected by the other members of the Board to succeed Dr. Rankin. 1928. Dr. J. C. Johnson, who had been director of the Oral Hygiene Division, resigned as director of the oral hygiene work of the Board, effective December 31. During this year a corps of nurses employed in the Maternity and Infancy Division of the Board, one-half of whose expenses were paid by the Federal Government from Sheppard-Towner funds, held mid-wife classes in about thirty counties of the state. The nurses gave spe-cial instruction to midwives in groups, and the county authorities en-acted midwife rules and regulations for the control of their practice. The educational work of the Board was of a high order during this year. A thirty-two page Bulletin was issued monthly, and a moving picture machine with several films on modern health subjects was exhibited in many sections of the state. 1929. With aid secured from the International Health Board, the Life Exten-sion Division was added to the activities of the Board this year. Dr. Frederick R. Taylor, of High Point, w^as made director of this division. Dr. Taylor carried this work before the medical profession in all sec-tions of the state. On January 1 Dr. Ernest A. Branch accepted the appointment as director of the Division of Oral Hygiene to succeed Dr. J. C. Johnson, resigned. Dr. Branch immediately set in motion reorganization plans for the oral hygiene work to include more lectures and more educa-tional demonstration work. Dr. Branch made contacts with several of the colleges of the state and training schools for teachers. 24 Twenty-Ninth Biennial Report Expenditures for the Board work this year reached the highest peak in the history of the Board, totaling about $486,000. There were no significant changes, other than those mentioned above, in personnel during the year. 1930. This year marked many significant changes in the affairs of the State Board of Health. Early in the year Dr. C. N. Sisk, director of county health, work, resigned. Dr. D. A. Dees succeeded Dr. Sisk as director of county health work. Soon after the resignation of Dr. Sisk, Dr. F. M. Register, director of the Bureau of Vital Statistics, resigned, and the work of that bureau was assigned to Dr. G. M. Cooper, in connection with his work as director of health education. On August 26, Dr. Chas. O'H. Laughinghouse, State Health Officer, died. Soon after his death, in a meeting of the Board, Dr. H. A. Taylor was made Acting State Health Officer. On September 24, following the death of Dr. Laughinghouse, the Board elected Dr. W. P. Jacocks State Health Officer to succeed Dr. Laughinghouse. On November 20 Dr. Cyrus Thompson, for many years a member of the Board, died. On Decem-ber 16 the Board met and unanimously elected Dr. James M. Parrott, of Kinston, as a member to succeed Dr. Thompson. 1931. At the beginning of this year, Doctor Jacocks having declined to accept the position of State Health Officer, to which he had been elected by the Board on September 24, 1930, a bill was introduced in the Legis-lature abolishing the State Board of Health as then constituted. This bill was passed and became law during the session of 1931. With the enactment of the new law the terms of the members of the old Board were automatically terminated. Under this new law governing the state health work, legislative machinery providing for the establish-ment of a new organization to carry on the public health work of the state was enacted. The new law differs in many respects from the old law under which the Board had operated for so long. However, the most important provision of the old law was retained; that is, the non-political character of the Board and the retention of the perma-nency of the policies of the Board, although shortening the terms of office and making it impossible for the Board to become a self-per-petuating machine. The important provisions in the new law under which the Board of Health work is now operating are as follows: The Governor still retains the power to appoint five of the nine members of the Board, the maximum term of office being four years instead of six, as under the old law. The Medical Society of the State of North Carolina still retains the power to elect four of the nine members of the Board, the same conditions as to term of office to obtain here as in those ap-pointed by the Governor. It was recommended to the Governor, although not written into the law, and Governor Gardner accepted the suggestion, that he appoint one member from the State Dental Society and that he appoint a man recommended by that society. This is equivalent to allowing the State Dental Society to name one of the members, but still leaves the balance of power in the hands of the Governor. This seems to be a very satisfactory arrangement. Another important change is that the Board still elects the State NoBTH Carolina Board ok Health 25 Health Officer, but it can only become effective upon the approval of the Governor. The term of the State Health Officer, along with mem-bers of the Board of Health, was restricted to four years. Following the adjournment of the Legislature, the Governor ap-pointed the following named members: Drs. J. T. Burrus, High Point; H Lee Large, Rocky Mount; J. N. Johnson, Goldsboro, the dental member; Professor H. G. Baity, of the University of North Carolina, and Mr. J. A. Goode, a druggist in Asheville. The State Medical Society at its first meeting after the adjournment of the Legislature elected the following physicians to membership: Drs. James M. Parrott, Kin-ston; Carl V. Reynolds, Asheville; S. D. Craig, Winston-Salem; L. B. Evans, Windsor. It will be noted that Dr. Parrott was the only member of the out-going Board honored with election to membership on the new Board. On May 28 the new Board met and organized. On that day it unanimously elected Dr. James M. Parrott State Health Officer. Dr. Parrott took the offer under consideration for a period of two weeks. On June 11 the Board met again; Dr. Parrott accepted the election and agreed to assume office on July 1. Dr. Parrott resigned his member-ship on the Board before being elected to the position of State Health Officer, and under the provisions of the new law the executive com-mittee' of the State Medical Society selected Dr. G. G. Dixon, of Ayden, to serve in Dr. Parrott's place until the 1932 meeting of the State Medical Society. It will be noted that this is an important variation from the provisions of the old law. Under the old law the other members of the Board held the authority to name a successor, whether a member resigned or died. Under the new law the Governor names his vacancies in his list and the executive committee of the State Medical Society is permitted to name a successor to serve only until the first meeting of the State Medical Society following. In the meeting of June 11 the new Board found it necessary to eliminate some members of the staff and to make some consolidations, on account of reduced appropriations for the Board work. The serv-ices of Dr. D. A. Dees and Mr. R. B. Wilson were dispensed with, effective July 1. The Board reorganized the staff and made many con-solidations. The new reorganization follows: The Board reorganized the work into divisions, making many con-solidations and increasing the duties of the directors of each division. Following are the divisions organized: Administrative Officer, Dr. James M. Parrott; Director Division of Laboratories, Dr. C. A. Shore; Director Division of Preventive Medicine, Dr. G. M. Cooper; Director Division of Oral Hygiene, Dr. Ernest A. Branch. The divi-sion of County Health Work and Epidemiology was temporarily assigned to Dr. H. A. Taylor, but on August 3 Dr. Taylor resigned and Dr. John H. Hamilton, health officer of New Hanover County, was appointed director of this division. The position of director of Division of Sanitary Engineering was filled on July 14 by electing Mr. Warren H. Booker, who had formerly headed that work, to succeed Mr. H. E. Miller. The election of Dr. Parrott was received throughout medical and public health circles of the entire state with enthusiasm. Under his 26 TWK.NTY-NlNTH BlE.XNIAL REPORT able direction the work of the Board during the last half of this year moved with a precision which was gratifying to all the friends of public health work in the state. 1932. The year 1932 was uneventful in public health work. The term of none of the members of the Board expired this year, but all members con-tinued their service just as the Board was constituted at the close of 1931. The International Health Board awarded a scholarship to Dr. J. C. Knox for a year's special Public Health Work at Harvard and to Dr. R. T. Stimpson for a year's special work in the School of Hygiene at Johns Hopkins. Following the very favorable reception of Doctor Parrott's annual report at the conjoint session of the State Board of Health and the State Medical Society, which was presented at Winston-Salem in April, the work of the Board was carried on on all fronts with satis-factory results, although on account of reduced appropriations many activities carried on in previous years had to be curtailed or definitely eliminated. The death rate in North Carolina for 1932 was 9.6 per 1,000 population. This is the lowest death rate ever before recorded in North Carolina. The trend in typhoid fever death rates has been consistently downward from 1914 to 1930. This year there were three more deaths than in 1931, there occurring a total of 158 deaths from typhoid fever. The increase in population, however, offset the slight increase in number, and the rate recorded was slightly lower than 1931. The cases and deaths from diphtheria this year were also the low-est of any previous year, although progress in the elimination of these diseases has not been so satisfactory as it should have been. Deaths from pellagra continue to show a marked decline. This year is the third year of the so-called financial depression, and it is too early to record any opinion as to what effect unemploy-ment and decreased income and rather widespread suffering may have on the health of the people of the state. It is not too much to say, however, that the effect will be felt more severely by the children than by any other class of the population. The infant mortality this year was 66.4 per 1,000 live births. This is so far the best record the state has ever made. The maternal mortality remains high, and indications are that with decreased expenditures for maternal and infant hygiene the rates, particularly for infant deaths, will rise again, pushing the state back among those having an excessive infant death rate. Expenditures for this year for all purposes by the Board were $315,- 276, of which amount $262,438 represented appropriations. This amount was just a little more than half of the total expenditures made by the Board of Health for the fiscal year ending June 30, 1930. 1933. The events of outstanding importance to the Board of Health this year was the death of Dr. C. A. Shore, which occurred on February 10. For twenty-five years Doctor Shore had been director of the State Labora-tory of Hygiene. He had built the work of the laboratory during these NoKTH Carolina Board of Health 27 years up to a point where its prestige and usefulness was equal to that of any other public health laboratory in America. Doctor Shore served longer as a member of the executive staff than any other man who has ever been connected with the State Board of Health. He held the confidence and esteem of the medical profession as well as the general public to a marked degree. He was a man of extraordinary ability, and much of the success of the public health work in North Carolina may be attributed to his fine and wiiolesome service. Suitable tribute has been paid to Doctor Shore and recorded in other publications of the Board and of the State Medical Society. One event in this connection, however, should be recorded here, and that is that by legislative action all buildings of the State Laboratory of Hygiene are hereinafter to be known as the Clarence A. Shore Labora-tory, in memory of his distinctive service. A few weeks after the death of Doctor Shore, Dr. John H. Hamilton, director of County Health Work, of Vital Statistics, and of Epidemi-ology, was made director of the laboratory work. Doctor Hamilton, on assuming his duties as director of the Laboratory, resigned the duties of director of County Health Work and of Epidemiology, but retained, how^ever, with the assistance of Dr. R. T. Stimpson as statistician and field director, the Bureau of Vital Statistics. Dr. D. F. Milam, a consultant assigned to the State Board of Health by the International Health Board, was made acting director of the Bureau of Epidemiology in place of Doctor Hamilton. Doctor Milam had as his assistant Dr. J. C. Knox. Dr. M. V. Ziegler, consultant assigned to the Board by the United States Public Health Service, assumed the duties of acting director of County Health Work to succeed Doctor Hamilton. During this year Mr. W. D. Riley, assigned to the work as Venereal Disease Control Officer by the United States Public Health Service, organized his work and succeeded in making an important contribution to the work of the Venereal Disease Control in North Carolina. The following changes in personnel of the State Board of Health took place during this year: Dr. W. T. Rainey, of Fayetteville, was elected by the State Medical Society for a four-year term to succeed Dr. L. B. Evans, of Windsor, whose term expired this year. Dr. S. D. Craig w^as reelected for a term of four more years. The Governor reappointed Dr. J. N. Johnson, dental member of the Board, for another term, which will expire in 1937. The Governor appointed Dr. Hubert B. Haywood, of Raleigh, for a four-year term, to take the place of Dr. J. T. Burrus, of High Point. The Governor also appointed Mr. James P. Stowe, a druggist of Charlotte, for a four-year term, expiring in 1937. Mr. Stowe succeeded Mr. J. A. Goode, a druggist of Asheville. Dr. Carl V. Reynolds succeeded Dr. Burrus as President of the Board. On July 1 Drs. Knox and Stimpson returned to the Board work and resumed their places after satisfactorily concluding their year's schol-arship work at Harvard and Hopkins, respectively. The year was not marked by any widespread outbreak of epidemic disease, and notwithstanding a continuation of the financial depres-sion, the work of the State Board of Health held up fairly well. The 28 Twenty-Ninth Biennial Report appropriations being lower this year than before for many years, much of the personnel service had to be reduced. A material reduction in state aid to County Health Work caused considerable contraction of the activities of County Health Department Work, but for the most part the morale of State Board of Health employees as well as the county health employees has held up remarkably well. The Legislature, meeting for an extended session following its opening in January, made drastic reductions in appropriations to all state health work and reduced the salaries of all state health employ-ees. This was said to be necessary in order to balance the state budget and to maintain the state's credit. The total expenditures for the Board of Health this year, that is, for the fiscal year ending June 30, were $291,786. Of this amount $225,274 was appropriated by the Legislature. It will be noted that this sum was less than half of that appropriated and spent for the fiscal year ending June 30, 1930. 1934. The event of greatest importance to the State Board of Health and to the health work throughout the state in this year was the death of Dr. James M. Parrott and the election of Dr. Carl V. Reynolds as his successor. Dr. Parrott assumed the duties of State Health Ofllcer on July 1, 1931. He had thus served a little more than three years and four months at the time of his death. Dr. Parrott was the first State Health OflScer to serve under the new, or reorganized, Board of Health. He was stricken with an attack of angina pectoris early in December, 1933. The last eleven months of his life, therefore, were ones of recur-ring illness and courageous fortitude in remaining at the helm of the Board of Health work. On the occasion of the first illness, with the consent of the members of the State Board of Health, he designated Dr. G. M, Cooper as Acting State Health Officer to be the responsible head of the work in such periods as he was physically unable to attend to the duties of the oflSce. The following sketch concerning Dr. Par-rott and his work, written by the Editor, was published in the Health Bulletin: "The death of Dr. James M. Parrott, State Health Oflacer of North Carolina, occurred on Wednesday evening, November 7, 1934. Doctor Parrott had been health officer of North Carolina for a little more than three years. He was so active mentally and so near and dear to his co-workers here at the office that to me, even yet, it seems impos-sible and unbelievable to think that he is dead. Nearly thirty years ago I 'took' the State Board examination for license to practice medi-cine. He was a member of that board. From then on I looked on him as one of the big men in the medical profession. He held every office within the gift of his profession and loved it and served its interests with a passionate devotion. "He took over the direction of the work of the State Board of Health in one of the darkest hours in the history of the Board. He brought to the affairs of the Board a new kind of leadership, a fresh outlook, a new viewpoint, and a breadth of vision which served notice on the world that the Board had a resourceful and able execu-tive in charge. Although he came to the Board work without previous North Carolina Board of Health 29 experience in an administrative capacity of this type, and knowing little or nothing of the practical workings of a modern public health organization, his chief contribution, which will be duly recorded in the history of this period, to the cause of public health advancement was his stand for the professionalization of public health work. "Before he had been here sixty days, he realized that all depart-ment divisions as well as all county health offices should be manned by physicians technically trained and experienced in public health work. It became necessary for him to oppose the ambitions of some of his lifelong friends in the medical profession, which hurt him; but it may be said to his credit that he stood four-square for compe-tently trained men as public health officials. "On assuming office, he realized that he had some very unpleasant duties confronting him in reorganizing the work of the Board. He soon demonstrated that he had convictions and the courage to back them up. When he laid down his armor for the great adventure, he left an organization of his own building functioning at top speed. He proved to his fellow workers here that he was tolerant to every-thing but laziness and lying and inefficiency. Being a man of clean personal life, and governed in all his actions by a strict sense of honor, he naturally expected such qualities in his staff and other subordinates. "For the past year he struggled against the malady which finally ended his life, and at the same time he felt keenly his official respon-sibility. He knew all during that last year that, in justice to himself and his family, he should resign and be relieved of the extra tax on his failing strength. On the other hand, he felt that his work was not quite done. He saw many essential features of public health work sacrificed to a program of questionable economy. He did not question the good intentions of the Governor, the Budget Bureau, nor the Legislature, but he felt that the time had come to put an end to the further needless sacrifice of human life for the lack of intelligent preventive efforts. He had a conviction that the incoming General Assembly would see eye to eye with him. He was ready to submit a program of far-reaching importance to the people of the state. It could not be. His big brain is forever inactive. His profound knowl-edge of the public health needs of the people is left for his successor to acquire for himself. "No man could build for himself a better monument than Doctor Parrott did in the record of worth-while work well done. In his death the state loses an honest public servant, and I lose a warm and understanding friend whose confidence was more precious to me than the riches of Araby." Following Dr. Parrott's death, the State Board of Health assembled in Raleigh on November 10, 1934, and unanimously elected Dr. Carl V. Reynolds, who at that time was serving as President of the Board, to the position of State Health Officer and Secretary and Treasurer of the State Board of Health. Dr. Reynolds immediately accepted and assumed his duties at once. The following Editorial appeared in the Health Bulletin in January, 1935, concerning Dr. Reynolds and his 30 Twenty-Ninth Biennial Report work. It is herewith reproduced in order that this chronological record may be complete. "Doctor Carl Vernon Reynolds, of Asheville, on November 10, took the oath of office and immediately assumed his duties as Acting State Health Officer, succeeding Dr. James M. Parrott, who died November 7. Doctor Reynolds was unanimously elected to the position by his fellow members on the Board. "Doctor Reynolds is a native of Asheville. His father was a suc-cessful Asheville physician who died when Doctor Reynolds was only three years old. Doctor Reynolds obtained his literary education in the private schools of Asheville and Wofford College, Spartanburg, South Carolina. He received his medical education at the college of the City of New York, graduating in medicine there in 1895. After his graduation he took a postgraduate course in London, England. Doc-tor Reynolds located in Asheville for the practice of medicine, special-izing in pulmonary tuberculosis. His skill in combating that disease has been widely recognized by the medical profession. An example of their confidence was his election as president of the North Carolina Medical Society, in which place he served with distinction in 1920. "On beginning practice he at once became interested in health work. His first connection was with the city health department in 1896. Following that period, for more than twenty years he served as city health officer of Asheville, in which capacity he rendered his city and the whole state important and permanent service. Some of his contributions to public health may be cited, as follows: "He organized the first crusade against the common housefly ever undertaken anywhere. "He assisted in drafting the first milk ordinance for Asheville. "He secured progressive sanitary laws. "He put through the compulsory vaccination law requisite to school attendance. "He secured the adoption of a bread-wrapping ordinance and one requiring the tuberculin testing of cows. "He saw typhoid fever drop from an average of two hundred and seventy cases a year in the city of Asheville to about five while he was city health officer, and saw smallpox practically eliminated. "We enumerate these things so that the people of the state may know they have a well-trained health officer at the head of the State Health Department—one fully worthy of confidence and support." The general routine work of the State Board of Health during this year was satisfactory and successful in every way. Dr. D. F. Milam, who had been loaned to the State Board of Health by the International Health Board and who had been acting as State Epidemiologist, was transferred to other fields and on the first of July Dr. J. C. Knox, who had been Assistant in the Division of Epidemiology, became State Epidemiologist. Dr. M. V. Ziegler, of the United States Public Health Service, who who had also been loaned by that organization as a consultant in the Division of County Health work and who had been Acting Director of that Division, was transferred back to Washington about the first of September. Dr. R. E. Pox, who had completed a postgraduate course North Carolina Board of Health 31 in the Public Health School of Harvard University, was made Direc-tor of the Division of County Health Work. Dr. R. T. Stimpson, who had also successfully completed a post-graduate course in the School of Public Health of Johns Hopkins University, and who had been acting as Assistant in the Department of Vital Statistics, was made Director of that Division. On November 10, at the time Dr. Reynolds was elected State Health Officer, Dr. G. M. Cooper was elected Assistant State Health Officer. Dr. Reynolds, of course, had to resign from his place on the Board in order to accept the office of State Health Officer. To succeed him as President. Dr. S. D. Craig of Winston-Salem was elected to that position. Dr. J. N. Johnson of Goldsboro, dental member of the Board of Health, was elected to the place of Vice President of the Board. The law provides that in case of a vacancy occurring on the State Board of Health among the membership elected by the State Medical Society, that the Executive Committee of the Medical Society of the State of North Carolina shall have the authority to appoint a succes-sor to serve until the next ensuing meeting of the State Society. In this case, the vacancy coming so close to the annual meeting of the State Society and the Board of Health on the following May 1 and there being no regularly scheduled meeting of the Executive Com-mittee of the State Medical Society, it was decided to defer the election of a successor to Dr. Reynolds to the meeting of the Society the fol-lowing May 1. 1935. Dr. Carl V. Reynolds served as Acting State Health Officer, the Gov-ernor having deferred the approval of his election the previous No-vember 10, 1934, but at the annual meeting of the State Board of Health, which was held in Pinehurst May 7, 1935, Dr. Reynolds was unanimously elected State Health Officer. His election was for a full four-year term to begin on the first of July following. The Governor immediately approved the election of Dr. Reynolds to be State Health Officer for the full term as stated. At the meeting of the conjoint session at Pinehurst on Wednesday, May 8, Dr. Grady G. Dixon was reelected to succeed himself to mem-bership on the State Board of Health for a term of four years. Dr. J. LaBruce Ward of Asheville was elected for the four-year term to succeed Dr. Carl V. Reynolds, resigned. In this year an important development in public health work was the experimental course put on in the school year of 1934-1935 at the University of North Carolina, under the auspices of the Public Health Administration, of a course of instruction designed to prepare physi-cians for positions as health officers. The courses in this school met with such success, plans were perfected to enlarge the scope of this new school as a part of the Medical School at the University. A fuller description of the inauguration of this school will be found under the records for 1936. During this year following the enactment of the National Social Security law, plans were worked out for an expansion of the work of all the divisions of the State Board of Health, through financial aid coming through the Children's Bureau and the United States Public 32 Twenty-Ninth Biennial Report Health Service at Washiiigton. It was a year which noted much activity in public health work all throughout the state, and the per-fection of plans, state and local, for extending health department activities. A Division of Industrial Hygiene was tentatively established in September of this year. The organization of this division resulted from an amendment to the Compensation Laws of the state by the 1935 General Assembly. This legislation made disablement or death by occupational disease interpretable as an injury by accident and thus compensable. For the execution of this legislation a sum of $10,000 was appropriated by the Legislature. The Industrial Commission ap-preciating that a problem of preventive medicine was involved, en-gaged in a series of conferences with the State Board of Health and Officers of the United States Public Health Service. The discussions culminated in the $10,000 appropriated for the administration of the occupational disease legislation being placed at the disposal of the State Health Officer. With this money, an Industrial Hygiene program was inaugurated as an activity of the State Board of Health. This arrangement was made with the understanding that the work would be subsidized by the United States Public Health Service when Social Security funds should become available. To begin the work of this division and to prepare the program for enlargement to its full scope, Dr. H. F. Easom of the State Sanatorium for Tuberculosis Medical Staff was selected as the Director of the division. Mr. M. F, Trice, formerly of the Division of Sanitary Engineering of the State Board of Health, was made Engineer of this new division. 1936. What may be termed the outstanding event of importance for the first half of this calendar year covered in the period of this report may be said to be the definite establishment of the new public health depart-ment at the University of North Carolina and the selection of Dr. Milton J. Rosenau as its director. This new department, of course, is an integral part of the School of Medicine of the University of North Carolina. The March issue of the Health Bulletin published the fol-lowing descriptive news item of the inauguration of this department: "The most important development in public health circles in many years for this section of the South is the establishment at Chapel Hill of a department of public health in connection with the School of Medicine, and the selection of Dr. Milton J. Rosenau as its direc-tor. This development has been made possible by the coordination of the staffs of the faculties of the North Carolina State Board of Health and the schools of medicine and engineering of the University of North Carolina. "The new department, while an integral part of the University School of Medicine with Dr. C. S. Mangum, Dean, will be under the personal direction of Dr. Rosenau. Dr. Rosenau is generally regarded as America's foremost authority on public health. His books on preventive medicine are used everywhere as standard textbooks in all schools of public health. Until his retirement recently from that fac-ulty he had been head of the famous Harvard School of Public Health for many years. North Cakolina Bo.mid of Health 33 "For a long time the officials of the State Board of Health have worked hard to secure the establishment of such a school. The necessity for it has been apparent to all responsible health workers. The chief credit for success in launching the enterprise should go to Dr. Charles S. Mangum, Dean of the University Medical School, and to Dr. Carl V. Reynolds, State Health Officer. Both of these officials have worked hard and cooperated with each other in overcoming all difficulties in the way of the establishment of the new department. "In the opinion of Drs. Mangum and Reynolds the development was in part made possible by the success of the course put on in the school year of 1934 and 1935 at the University under the auspices of the School of Public Administration. The first course put on with the teaching aid of the Schools of Medicine and Engineering of the University and members of the staff of the State Board of Health comprised a course of instruction for physicians in public health administration and extended over a period of twelve weeks. The work was so excellently done that they received recognition from the United States Public Health Service which assigned several of Its applicants for postgraduate work to take the second course. "We hope and believe that this enterprise under Dr. Rosenau's direction will expand into one of the most important departments of public health education in the entire country. The need for special training for physicians who want to enter public health work is great. Efficient public health departments, National, State and local in modern conditions of living are an absolute necessity. There are large numbers of young physicians who with proper postgraduate training could make excellent health officers. "The success of the new department at Chapel Hill will go a long way toward establishing an efficient system of public health work on a sound basis throughout the entire southeastern section of the country." On February 1 of this year, funds from the Social Security Act became available to the State Board of Health through the Public Health Service and the Children's Bureau at "Washington. In addi-tion to adding a division of field training of public health nursing in. connection with the new department of public health at the State Uni-versity, a department of Public Health Dentistry was also established in connection with the Public Health School at Chapel Hill. This is said to be the first school of like character in the country. The County Health Department was enabled through the Social Security subsidy from Washington to aid all the whole time county health departments in an expansion of their work. The Division of Preventive Medicine employed Mrs. J. Henry Highsmith to begin work on February 20 as an Assistant in the field of health education. The work of this division, of course, took on enlarged activities. Plans were immediately set in motion to establish special county nurses in counties having no whole time health organization as special demonstration service for such counties. Plans were also launched to establish Maternity and Infancy Centers in many sections of the state as Demonstration Centers, look- 34 Twenty-Ninth Biennial Report ing toward an eventual lowering of the infant and maternal death rates in this state. A sum of $17,500 of Social Security money was appropriated by the United States Public Health Service for the Division of Industrial Hygiene. Dr. M. T. Plyler was employed as an Assistant Medical Director in that division and Mr. C. R. Matbeson as a Medical Technician. Both of these men had been employed on the staff of the North Carolina Tuberculosis Sanatorium. Up to the first of July more than 150 plants involving siliceous dust hazards had been surveyed. The entire asbestos textile industry in the state involving five plants had been studied, in cooperation with the United States Public Health Service, a granite cutting establishment investigation made, and a foundry study inaugurated. There were 525 asbestos textile workers and 46 granite cutters examined during the investigatory work. In addition, preemployment examinations have been made of approxi-mately 400 workers. All persons examined have X-ray films made of their chests. During this w^ork nearly 300 atmospheric dust samples were analyzed. During the period, the physician and the engineer attended a four weeks' special course on Industrial Hygiene given by the Public Health Service in Washington. The division has installed a complete oflice equipment, as well as portable equipment necessary for successful execution of this important w^ork. The new division is housed in the basement of the State Board of Health Building. On April 1 of this year, the State Board of Health established a service for crippled children. This followed the approval in late March of the North Carolina Plan for Cripppled Children, prepared by the State Board of Health and submitted to the United States Chil-dren's Bureau. This plan was a prerequisite of the Children's Bureau toward participation by the state in the distribution of Social Security appropriations for this purpose. Dr. G. M. Cooper of the Division of Preventive Medicine was designated as Medical Director of this serv-ice, and Mr. J. T. Barnes was employed by the State Board as State Supervisor in charge of administrative duties of this service. An advisory committee representative of the Medical, Health, Welfare, and lay interest of the state in the problem of the crippled child was formulated to advise in the execution of this program. Prior to June 30, public clinics were arranged in various centers of the state under the direction of the State Board of Health. Cooperation had been arranged with the North Carolina Orthopedic Hospital and was being carried out satisfactorily. Under the provision of the Children's Bureau regulations, an advisory committee was secured by the Director of the Division of Preventive Medicine for the purpose of advising from time to time on the general program of maternal and child health service work. This committee held its first meeting on March 27 at the State Board of Health in Raleigh. Representatives from the following organizations were present: State Medical Society, State Dental Society, State Public Health Officers Association, State Nurses Association, State Federation of Women's Clubs, State Parent-Teacher Association. State Welfare Department, Division of Pediatrics and Obstetrics of North Carolina Board of Heajlth 35 the State Medical Society. On or before June 30, the enlarged program of all the divisions of the State Board of Health was well underway. 1937. There was no event of outstanding importance occurring in the year 1937. Few changes in the staff or the sub-staff of the State Board of Health have occurred. Following the expansion of service throughout the year 1936 with the aid of Social Security funds coming through the United States Children's Bureau and the United States Public Health Service at Washington, a tremendous amount of work was done during the entire year 1937 in expanding the work of the health department throughout the state, an increased number of nurses were employed, additional county health departments were estab-lished and more intensive efforts were made along all lines than in any previous year. The new School of Public Health Administration at the University of North Carolina under the direction of Dr. Milton J. Rosenau, aided materially by Dr. Carl V. Reynolds, State Health Officer, and the faculty of the Medical School of the State University, made substantial and satisfactory progress. An increasing number of sanitary engineers, sanitary inspectors, and health officers from this state and other states in the southeastern regional territory were trained at Chapel Hill. An Advisory Committee of leaders in different organizations in North Carolina, including such organizations as the State Medical and Dental Societies, Public Health Association, Parent-Teacher organi-zations. Women's Clubs, and the State Nurses Association, together with some independent members of the medical profession in the field of pediatrics and obstetrics and orthopedic surgery, was organized and held its first satisfactory meeting during this year. Dr. T. C. Woi-th joined the staff of the Division of Preventive Medicine on September 21, 1936, and served until April 15, 1937, in the capacity of assistant to Dr. Cooper. Dr. Worth aided materially in assisting in the organization of Maternity and Infancy Centers in some forty counties of the state and contributed a great deal toward strengthening the department work. Upon Dr. Worth's departure on April 15 to continue his postgraduate education in Boston. Dr. Roy Norton, who had been with the Division of County Health Work for about a year, and who was formerly health officer of Rocky Mount, succeeded Dr. Worth. Miss Mabel Patton, a qualified nurse, joined the staff of the Division of Preventive Medicine as a consultant nurse representing the Children's Bureau. Dr. W. J. Hughes, a colored physician whose services for work in the health education field in the Department of County Health Work was made possible through contribution by the Rosenwald Fund and who joined the staff on January 1, 1936, was able to achieve substantial progress in his work with the colored population of the state. This was the first time a colored physician had been admitted to membership on the sub-staff of the State Board of Health, and the results of work in 1936 and 1937 have fully justified his employment. Dr. R. L. Robinson joined the sub-staff of the Division of Industrial Hygiene on April 1, 1937, to succeed Dr. M. T. Plyler of that Division. Mr. W. H. Richardson, an experienced newspaperman who at one time was Secretary to Gov- 36 Twenty-Ninth Biennial Report ernor Morrison for his four years in the Governor's office, joined the Administrative Staff in the department exclusively conducted by the State Health Officer. Mr. Richardson has been a valuable addition to the staff and he has succeeded remarkably well in interpreting technical problems to the lay readers in hundreds of articles in the daily and weekly press of the state. Dr. G. M. Leiby, who had been Assistant District Health Officer in the Haywood-Jackson-Swain Dis-trict with headquarters at Bryson City, joined the sub-staff of the Department of Epidemiology in the fall of 1936 and after some field experience was sent to the Hopkins School of Public Health for a year's special studies in syphilology. Dr. F. S. Fellows of the United States Public Health Service was loaned to the State Board of Health as a consultant in the Department of Epidemiology in the field of venereal disease control. Miss Margaret Thompson, who holds a mas-ter's degree in home economics and nutrition work from the Uni-versity of Iowa, joined the sub-staff of the Division of Preventive Medicine in October, 1937. On March 15, 1937, Miss Frances R. Pratt, a specially trained nurse under the auspices of the State Maternal Health League, joined the sub-staff of the Division of Preventive Medicine. Miss Pratt's work was financed by an individual contribu-tion from an outside agency. Her work has been to organize through the medical profession and the local health officers on a voluntary basis a system of contraceptive control work when based on medical needs. Her work has been very successful and it has been a welcome and needed addition to the staff work. On December 16, 1937, following Legislative Provision in the 1937 session of the Legislature, $160,000 in bonds were sold for the pur-pose of building a new plant for the State Laboratory on the grounds adjacent to the present State Board of Health building on Caswell Square, Raleigh. A PWA grant of about $130,000 additional was received and work on the buildings was expected to be completed within the year 1938. A farm of 280 acres on the Raleigh-Cary paved highway was purchased and provision made for farm buildings to care for the animals used in the production of vaccines and serums. On December 17, a conference of Public Health Officers was called at Raleigh for the purpose of discussing and making decisions concern-ing various field work, jointly affecting the state and local health departments. This conference was so successful that it was voted to make it an annual affair. During the year a central general filing system was established and put into effect under the direct supervision of the State Health Officer and the Administrative Division of the Board of Health. This is proving to be a very satisfactory and progressive step. Malaria was made a reportable disease and a malaria inspection and control unit was established in the Department of Epidemiology July 1, 1937. Effective also in 1937 was the new plan of the Division of Vital Statistics with reference to the notification of birth registration certificates to parents. Instead of waiting for a parent to write to the department to inquire if the birth has been reported and to send 50c for certificate, the plan was adopted of sending to each parent whose North Carolina Board of Helvlth 37 baby's birth was reported properly a small neat certificate of the baby's birth. This was through an arrangement with the Bureau of the Census of the United States Government. Franking privilegese are allowed in this work. It simply informs parents that their babies' births have been properly recorded and the idea is through this method to reach many of those parents whose babies' birth have never been reported and get them to send in the reports. There were no changes in the membership of the State Board of Health this year. All members whose term expired were reelected by the State Medical Society or re-appointed by the Governor, for addi-tional four-year terms. The total expenditures for the State Board of Health during the fiscal year ending June 30, 1937, were $881,484.01. Of this amount $287,747.04 was appropriated by the Legislature, $191,943.85 was by the United States Children's Bureau, $312,210.42 by the United States Public Health Service, and finally $89,582.70 from fees received by the Laboratory in water taxes, etc., and other miscellaneous items. 1938. During 1938, the extension and consolidation of health work in all departments of the State Board of Health was further accomplished. This year two outstanding events may be recorded. First, the Zachary Smith Reynolds Foundation decided to donate its income from a fund of about seven million dollars to the State Board of Health to aid in a long time program of syphilis control. The initial donation from this fund by the oflScials of the foundation to Dr. Reynolds was a check of $100,000. This philanthropy will bring to realization one of the finest dreams of Dr. Carl V. Reynolds, State Health Officer. It promises to enable the State Board of Health to accomplish in the near future some of the objectives that have sometimes seemed to be long years off. A long time before the Government began to realize its responsibility in the prevention of disease and the preservation of the health of its citizens as a means of bringing about better social and economic conditions and the promotion of human happiness, philanthropists such as Rockefeller led the way. This gift of the Reynolds Foundation, however, affords the practical means of enabling the State Board of Health to organize in collaboration with the various city and county health departments of the state an effective system through which the venereal diseases may be eventually con-trolled in this state. The other event in the same connection was the passage by the United States Congress early in 1938 of a bill known as the La- Follette-Bulwinkle Bill, sponsored and carried through the lower House of the United States Congress by Representative A. L. Bul-winkle of Gastonia who has long represented his district in the lower House of Congress. Through the provision of this bill the state was able to receive during the year about $80,000 additional funds for work in syphilis control. The proceeds of these funds enable the State Board of Health to attack the ravages of syphilis even in the prenatal stages by treating syphilitic mothers early enough in preg-nancy to prevent the birth of hopelessly syphilitic babies. It is proba-bly a fact that the benefaction of the Smith Reynolds Foundation is 38 Twenty-Ninth Biennial Report the largest single gift for this particular purpose that has ever been made by any public or private organization in this country. The cause is not only a worthy but a pressing one. It takes money to control and eliminate such diseases as yellow fever, typhoid and syphilis. The School of Public Health Administration of the State University at Chapel Hill has made such material progress that it became nec-essary on the first of September this year to employ an additional full-time professor in that department. Dr. Roy Norton, who for the preceding fifteen months had been an assistant in the Division of Preventive Medicine where he has done excellent work, was per-suaded to accept the professorship. The State Board of Health reluc-tantly agreed to Dr. Norton's transfer in view of the fact that the School of Public Health Administration is of such far-reaching impor-tance that it should have the services of the very best available talent in the medical profession of North Carolina. Dr. Norton is admirably equipped for this important work. There are now five full-time pro-fessors in this division of the University. Under the persistent work of Dr. Reynolds a stationary exhibit has been erected in the large halls of the central building of the State Board of Health, at Raleigh, an exhibit which is an education in itself. It demonstrates the work of all the departments. Some of the state's foremost artists were called into the work and the officials of the National Youth Administration provided a great deal of the actual work at little cost to the State Board of Health. It would pay any citizen of North Carolina who is interested in the state's progress to visit this exhibit sometime during the year. With the exception of the loss of Dr. Norton, there have been few staff changes of importance. Dr. R. L. Robinson who came with the Industrial Hygiene Division as a field worker in April, resigned and returned to his home to engage in private practice on the first of August. Mr. C. D. King, Jr., an Industrial Hygiene man, came with the Board in the Industrial Hygiene Division on June 15 as an assistant to Mr. M. F. Trice. Dr. G. M. Leiby returned at the completion of his course in Johns Hopkins University and assumed his duties as field director of the syphilis control program. Dr. Fellows still remains with the Board and continues to render valuable assistance. The officials and employees of the Department of Preventive Medi-cine were saddened this year on account of the death of two veteran nurses. Miss Katharine Livingston died on May 26 and Mrs. Margaret Sloan died on July 12. Both of these nurses had rendered valuable service in this Division for many years. There were no expiration of terms of service of the membership of the State Board of Health this year, therefore no changes in per-sonnel occurred. In March, 1938, the Board received a report from a committee previously appointed to study pneumonia. The committee headed by Dr. H. B. Haywood of Raleigh as chairman. Dr. W. T. Rainey and G. G. Dixon from the Board, with Doctors Fred Hanes, C. T. Smith as consultants, and Dr. C. V. Reynolds, ex-officio, made a full report. Arrangements were made through Dr. Hanes of the Duke Medical NoKTH Carolina Board of Health 39 faculty for a special course to train local technicians which was largely attended. An important piece of field work which met with widespread appre-ciation throughout the State this year was a series of 34 health Institutes for teachers and principals of schools in as many places representing the State. Eight thousand teachers and principals attended these Institutes which were of a practical character. The Institute were conducted under the joint auspices of the State Board of Health, State Department of Public Instruction and the Extension Service of the North Carolina State College. The officials who executed this piece of work were Dr. Roy Norton and Mrs. H. P. Guffy, nurse, of the State Board of Health, Miss Mary Thomas, nutrition specialist of the State College Extension Service, Mr. H. A. Perry and Mr. Charles E. Spencer of the State Department of Public Instruction. This work was under the general supervision of Doctors Reynolds and Cooper of the State Board of Health, and it was carried out under the health education division of the Board, and Dr. J. Henry High-smith of the State Department of Public Instruction. The total expenditures for the State Board of Health for the fiscal year ending June 30, 1938, were $1,041,895.98. Of this amount $353,- 953.55 was appropriated by the Legislature, $226,297.57 by the United States Children's Bureau, $337,914.39 by the United States Public Health Service, and $123,730.47 from fees received by the Laboratory in water taxes, etc., and other miscellaneous items. Dr. Roy Norton, who for nearly two years had been assistant di-rector in the Division of Preventive Medicine, resigned to accept the position of Professor of Public Health Administration in the School of Public Health in the University of North Carolina. Dr. Norton's resignation was effective September 1. A successor to Dr. Norton was not appointed during the remainder of the year. Beginning with July 1 of this year, the following counties set up whole time health department organizations: Alamance, Alleghany, Ashe, Davie, Polk and Union. On September 1, Catawba, and Septem-ber 16, Cleveland. On November 1, Currituck became a member of the district health department with Dare and other counties. 1939. In the Division of Sanitary Engineering, John D. Faulkner returned to the department to resume his work after taking a year of public health engineering training at the University of Michigan. Mr. James P. Stowe of Charlotte, for many years a member of the State Board of Health, died on February 12. The Governor later appointed Mr. C. C. Fordham, Jr., a Greensboro druggist who promptly qualified as a member of the Board. During the year there were no other changes in the personnel of the Board. All members whose term expired were either reelected by the State Medical Society or reap-pointed by the Governor. On August 7, Dr. John S. Anderson was appointed as a member of the staff as consultant in public health administration in the Division of County Health Work. Dr. Anderson had previously served as county health officer in Craven and Cabarrus counties. On December 31, Miss Josephine Daniel resigned as consultant in 40 Twenty-Ninth Biennial Report public health nursing in the Division of County Health Work and accepted an appointment as director of public health nursing with the Oklahoma State Department of Health. On December 15, Dr. George M. Leiby, venereal disease consultant, resigned his position with the Division of Epidemiology to accept the position of director of venereal disease control in the City of Wash-ington, D. C. On June 13, Dr. H. F. Easom resigned as director of the Division of Industrial Hygiene to return to the North Carolina Sanatorium as clinic physician. He was succeeded effective October 15, by Dr. T. P. Vestal, a native of Randolph County, formerly a member of the Sanatorium clinical staff. During the year, construction work was started on the new central Laboratory on Caswell Square adjoining the administrative building of the State Board of Health. Also, construction work was begun on the buildings on the State Laboratory farm between Raleigh and Cary. In the Division of Preventive Medicine, Mrs. J. Henry Highsmith resigned her position as health educator, effective October 1. Mrs. Highsmith's resignation was very reluctantly accepted. Off and on Mrs. Highsmith had been connected with the State Board of Health for many years. She has rendered invaluable service in the health education work of the Board. In the early months of the calendar year of 1939, plans were ma-tured after two or three years' efforts, attended by frequent con-ferences of all concerned, by the State Health Officer and the State Superintendent of Public Instruction, for the establishment of a service through which the facilities of the State Department of Edu-cation and the State Board of Health for the execution of a unified health service in the public schools of the State might be further integrated. Inauguration of this plan was made possible by a supple-mentary grant of $50,000 by the Rockefeller Foundation and the General Education Board to be spent over a five year period, com-mencing July 1, 1939. The official designation of this organization is the North Carolina School Health Coordinating Service. The or-ganization as a whole consists of an Advisory Committee and a full-time operating staff. The Advisory Committee consists of five mem-bers: namely. Dr. J. Henry Highsmith, Dr. G. M. Cooper, Dr. C. F. Strosnider, Dr. R. J. Slay, and Dr. Oliver K. Cornwell. The operating staff consists of the following seven members: Dr. Walter Wilkins, Coordinator; Miss French Boyd, nutritionist; Mr. Charles E. Spencer, physical education; Miss Olive Brown, physical education; Miss Mac- Veigh Hutchinson, nurse; Dr. Walter Hughes, Negro physician; Mrs. Irma N. Henry, Negro health educator. In addition to these regular staff members several nurses from the Division of Preventive Medicine have been assigned to work with the organization for varying periods of time. Dr. John F. Kendrick was lent to the state by the Rockefeller Foundation to serve temporarily as administrative adviser to this school health coordinating unit. Preliminary plans involving the selection of trained personnel and numerous other organization North Carolina Board' of Health 41 preparations were undertaken during the months of July and August, 1939, and initial field operations commenced in Stanly County in September. In addition to Stanly, cooperative work was undertaken in Person, Orange, Chatham and Wayne counties during the year. This was the first full fiscal year in which the sum of $100,000 donated by the Zachary Smith Reynolds Foundation to aid the Board of Health in its syphilis control work was available. This initial donation of $100,000 in cash to the State Health Officer to be used without strings attached, represents one of the largest gifts ever received by the Board of Health. It has enabled the State Board of Health to put into effect many necessary requirements in the State-wide work of control of the spread of syphilis. This money has been used for the specific purpose for which it was allotted. It has been used to employ additional men and women who are experts in their field and for the training of other nurses and physicians to become experts in the work necessary to deal with this enormous problem. This trust fund has enabled the Board to extend its activities in almost every direction and to keep up the official work in such a manner as to make sure a long time successful program which will be necessary to reduce the prevalence of syphilis in this State to a minimum. The total expenditures for the State Board of Health for the fiscal year ending June 30, 1939, were $1,215,056.80. Of this amount $364,- 506.25 was appropriated by the Legislature, $232,993.80 by the United States Children's Bureau, $311,859.00 general and $51,829.11 venereal disease by the United States Public Health Service, $130,290.49 by the Zachary Smith Reynolds Foundation, and $123,578.15 from fees received by the Laboratory in water taxes, etc., and other mis-cellaneous items. In this year no changes in the personnel of the State Board of Health occurred. Every member continues to serve to the full extent of his ability, giving unstintedly of his time and efforts to the con-structive work of the State Board of Health. 1940. The most important item in the field of public health in this State in 1940 was the completion and dedication of the central building known as the Clarence A. ShoJ'e Laboratory of Hygiene. As stated before in this chronology, this new plant costing about $311,000 was made possible by the selling of revenue bonds and the allocation of a PWA grant and in the acquisition of funds from various sources. The total outlay of $311,000 represents the cost of the central plant on Caswell Square, completed and equipped, and the cost of the buildings on the Laboratory farm located six miles west of Raleigh. The Shore Memo-rial Building was dedicated with appropriate ceremonies on February 21, 1940. There were addresses by Governor Clyde R. Hoey, Dr. S. D. Craig, President of the State Board of Health, Dr. Carl V. Reynolds, State Health Officer, Mr. J. W. Kellog, assistant director of the State Laboratory of Hygiene, Dr. George M. Cooper, Assistant State Health Officer, and Dr. John A. Ferrell, Associate Director of the Inter-national Health Division of the Rockefeller Foundation. Dr. John H. Hamilton, Director of the Laboratory, presided over the exercises. Greetings from neighboring and friendly organizations and institu- 42 Twenty-Ninth Biennial Report tioiis were brought by Dr. M. J. Rosenau, Division of Public Health of the University of North Carolina, Dr. W. C. Davison, Dean of the Medical School of Duke University, Dr. W. deB. MacNider, Dean of the Medical School of the University of North Carolina, Dr. E. S. King, Professor of Preventive Medicine of Wake Forest College, Dr. Hubert B. Haywood, President-elect of the Medical Society of North Caro-lina, Mr. E. C. Derby, Resident Engineering Inspector of the Public Works Administration, Dr. M. V. Zeigler, Senior Surgeon of the United States Public Health Service, Washington, and Dr. John M. Saunders, Regional Medical Consultant of the Children's Bureau, Washington. The entire issue of the April, 1940, number of the Health Bulletin was devoted to the description of the dedication of the Shore Memorial Building. The issue was increased from the normal sixteen pages to a thirty-two page volume. The central Laboratory building consists of four stories and is modern in every detail. The State Laboratory of Hygiene farm con-sists of approximately 280 acres of which 100 acres is under cultiva-tion, the balance in woodland. The farm has a frontage of fifteen hundred and fifty feet on the great United States national highway number one. Both the Seaboard and Southern railways also front it. The buildings on the farm consist of the farm laboratory building, horses and sheep barns and buildings for the production of smallpox vaccine and other biologic products, as well as the buildings for the housing of small animals needed in this work. On April 1, John D. Faulkner was transferred from the Division of Sanitary Engineering to the Division of Epidemiology to have charge of rodent control work. John Andrews who had effectively headed the milk sanitation pro-gram in the Division of Sanitary Engineering resigned to accept an important position with the United States Public Health Service in Washington. R. F. Hill, Jr., finished his year of specialized training in sanitary and public health engineering at the University of North Carolina and returned to his duties with the Sanitary Engineering Division. Effective work has been carried on with the aid of the WPA and United States Public Health Service in the malaria control drainage and community sanitation. Milk sanitation was advanced with a marked increase in the number of pasteurization plants. With the assistance of the aforementioned organizations and the PWA, the installation of new public water systems was brought up to a total of 52 installed during a four-year period ending June 30, 1940. Improvements, additions and extensions were made to a great many of the water and sewerage systems of the state. In the Division of Vital Statistics, there was closer cooperation with the local health departments in an effort to be of mutual assist-ance in registration. Social Security benefits requiring proof of num-ber and age of dependents and necessitating the presentation of the birth and death certificates has increased the number of verifications and copies of the certificates issued by the division. There were no material changes in the division during the first half of 1940. North Carolina Boaed of Helalth 43 On March 1, 1940, Miss Amy L. Fisher succeeded to the vacancy left by Miss Daniel as a consultant nurse in the Division of County Health Work. Miss Fisher had been supervising nurse in the Dur-ham Health Department. Gates County joined the district to be com-posed of Hertford and Gates, the work to become effective July 1, 1940. In the Division of Industrial Hygiene, there was issued a profusely illustrated one hundred page printed report presenting the results of a study of effects of exposure to dust in the mining and milling of pyrophyllite, the field work for which was done during the previous biennium. One of the outstanding achievements of this division was the design of seven industrial exhaust ventilation systems for the control of dust. Three of these had already been completed by June 30 and the installation of the others was already underway. With the closure of the public schools for the summer holidays, preparations were made for health courses to be given thirty white and thirty colored teachers at the University of North Carolina and the North Carolina College for Negroes at Chapel Hill and Durham respectively. These courses covered a six weeks period ending approx-imately July 20, 1940, and were made possible by a grant of $4,700 by the General Education Board. While it would be premature to attempt an appraisal of what was accomplished by this organization during its first year of existence, it may be stated that educational and health personnel alike cooperated generously, that certain pro-cedures were found to be satisfactory while practical considerations necessitated the modification of others, and that progress was made toward the maturation of a generally accepted school health program. On January 1, 1940, Dr. Ralph J. Sykes assumed the duties of venereal disease consultant in the Department of E)pidemiology. Dr, Sykes had previously served for several years as county health oflacer first in Surry and later in Halifax. Dr. Frank S. Fellows, Surgeon with the United States Public Health Service who has been assigned to North Carolina for several years, continued to render valuable service in the capacity of venereal disease consultant. The main accomplishment in the Division of Epidemiology was the great expansion of venereal disease control progi'am. This was largely as a result of financial aid from the Zachary Smith Reynolds Foundation and the United States Public Health Service. In June, 1936, there were 120 clinics in operation. They treated 13,304 patients. In June, 1940, as a result of the aforementioned financial aid, the number of clinics have been increased to 255 in which 27,814 patients received treatment in a single month. The system of mechanical tabulation set up in a central tabulating unit under the direction of this division reached its full stride in the early months of 1940. A complete progress record is kept on every patient receiving treatment. The central tabulating unit renders valuable assistance to other divi-sions of the State Board of Health. The Manual of Minimum Standards for conducting venereal disease clinics prepared by Drs. Fellows and Leiby still continues to be very 44 Twenty-Ninth Bienniax Report helpful to physicians and nurses and others concerned with the conduct of venereal disease clinics. Financial aid was given through this department to all organized counties in the state. Fifty-one clinics were supplied with combination darkfield and general purpose micro-scopes and sixteen of the larger clinics were given fluoroscopes. On January 1, Dr. Emmett S. Lupton was employed as assistant director in the Division of Preventive Medicine. Dr. Lupton had just completed his internship in pediatrics at the Duke Hospital. In the Division of Preventive Medicine, organized maternal and child health clinics were being operated in 55 counties. An increasing number of infants and expectant mothers among the poorer classes were in attendance on these monthly clinics. A total of approximately 250 physicians were cooperating on a part-time basis at the close of the fiscal year, June 30. The circulation of the Health Bulletin increased from about 52,000 ito 60,000 monthly copies during the year. In the Division of Oral Hygiene, there were no material changes except some expansion and expenditures of additional funds in the work of that division, necessitating the employment of an additional number of dentists. At the beginning of the calendar year 1940, the question of adoption by the State Board of Health of a so-called merit system as required by some sections of the Federal Government at Washington loomed as an important item for consideration during the year. Early in Jan-uary it was required by the Children's Bureau that standards to form the basis of a merit system should be submitted before the alloca-tion of Children's Bureau funds for the winter quarter would be forthcoming. By the middle of January, therefore. Doctors G. M. Cooper and Emmett S. Lupton, working in consultation with Dr. Carl V. Reynolds, State Health Officer, worked out and submitted a seventeen-page typewritten document setting up standards acceptable to the State Board of Health. These standards with a few minor modifi-cations were immediately accepted by the Children's Bureau. Later in the winter the Regional Medical Consultant of the United States Children's Bureau spent several days in Raleigh discussing with Dr. Reynolds and the representatives of the Children's Bureau in the State Board of Health plans for further development of the merit system, the next requirement being setting up of a merit system council with a supervisor and submission of classification plans for all State Board of Health workers. At this time the State Health Officer appointed the Director of the Division of County Health Work to be the responsible official to work out further plans. At a meeting of the State Board of Health on November 29, 1940, that body considered a new draft of what it termed "A Rule for a Merit System of Personnel Administra-tion in North Carolina." Much discussion on the subject was indulged in by various members of the Board at this meeting. A suggestion of Dr. H. G. Baity, a member of the Board, at this time deserves particu-lar emphasis. Dr. Baity made the suggestion that a general statement be placed somewhere in the compensation plan to the effect that the "duties outlined for each position classified were not to be con- North Carolina Board of Health 45 sidered as comprising all the duties that might be required of the position and that such other duties as might be required by the State Health Officer or the Division Director would be included." Late in the year 1940, the war clouds over the world were gathering with such an ominous outlook that the United States Army, Navy and Public Health authorities were busy laying the groundwork for a mighty army and navy to defend the country. One of the first con-siderations by the United States Public Health Service and the North Carolina State Board of Health in the fall of this year was an effort to detect the presence of syphilis in as large a section of the popula-tion as possible, especially those liable for military service. On Octo-ber 16, 1940, which was registration day under the Selective Service Draft, the North Carolina State Board of Health utilizing the services available in its 265 venereal disease clinics then established in the State offered to take blood samples from all registrants on a voluntary basis. Consequently, 132,671 blood specimens were taken and examined. This accomplishment was one of the most widespread efforts ever made in the State up to that time to locate by serological examination the presence and distribution of syphilis in North Carolina. The Federal Government proposed to set up what they call a "Firing Area" in Pender and Onslow counties. It became necessary for the State Board of Health to insist on the organization first of a whole time health department in each of these two counties, neither one having ever had such department before. This was arranged on a joint financial basis between the counties and the State and Federal Gov-ernment, and a district health department was set up. The total expenditures for the State Board of Health for the fiscal year ending June 30, 1940, were $1,380,174.90. Of this amount $370,- 057.67 was appropriated by the Legislature, $162,813.81 by the Zachary Smith Reynolds Foundation for syphilis control work, $229,872.28 by the United States Children's Bureau, $318,148.38 general and $175,557.72 venere
Object Description
Description
Title | Biennial report of the North Carolina State Board of Health |
Other Title | Report of the North Carolina State Board of Health. |
Creator | North Carolina. State Board of Health. |
Date | 1940; 1941; 1942 |
Subjects |
North Carolina. State Board of Health--Statistics--Periodicals Public health--North Carolina--Statistics--Periodicals Public Health--North Carolina |
Place | North Carolina, United States |
Time Period | (1929-1945) Depression and World War Two |
Description | Report covers two calendar years (13th-18th); (19th) covers Dec. 1, 1920-June 30, 1922; thence each covers July 1-June 30 years.; Printer: 13th (1909/10)-18th (1919/20) by Edwards & Broughton; 19th (1921/22)-20th (1923/24) by Bynum; 21st (1925/26)-<44th (1970/72)> unnamed. |
Publisher | Raleigh :The Board,1911- |
Agency-Current | North Carolina Department of Health and Human Services |
Rights | State Document see http://digital.ncdcr.gov/u?/p249901coll22,63754 |
Physical Characteristics | v. ;24 cm. |
Collection | Health Sciences Library, University of North Carolina at Chapel Hill |
Type | text |
Language | English |
Format | Reports |
Digital Characteristics-A | 12,046 KB; 210 p. |
Series | Biennial report of the North Carolina State Board of Health |
Digital Collection |
Ensuring Democracy through Digital Access, a North Carolina LSTA-funded grant project North Carolina Digital State Documents Collection N.C. Public Health Collection |
Digital Format | application/pdf |
Related Items | Printer: 13th (1909/10)-18th (1919/20) by Edwards & Broughton; 19th (1921/22)-20th (1923/24) by Bynum; 21st (1925/26)-<44th (1970/72)> unnamed. |
Title Replaces | North Carolina. Board of Health../1 |
Audience | All |
Pres File Name-M | pubs_edp_biennialreportboardofhealth19401942.pdf |
Pres Local File Path-M | \Preservation_content\StatePubs\pubs_edp\images_master\ |
Full Text | i'lm .'.-,?',;;?."-'" ^i-'f-.-vL H001 11228 F WA 1 N562b 1940 -42 of t{)e (Knit)et0itp of Bottb earolina ennotoen iiF ^^t SDialecttc anU PI)Uanti)topic fbotittit0 Division Of HEALTH AFFAIRS LIBRARY -*- TWENTY-NINTH BIENNIAL REPORT OF THE North Carolina State Board Health JULY 1, 1940-JUNE 30, 1942 EDWARDS a BROUGHTON COMPANY RALEIGH MEMBERS OF THE STATE BOARD OF HEALTH Elected hj the North Carolina Medical Society S. D. Craig, M.D. Term expires 1945 G. G. Dixox, M.D. Term expires 1943 W. T. Rainby, M.D. Term expires 1945 John LaBruce Ward, M.D. Term expires 1943 Appointed by the Governor HiBKKT B. Haywood, M.D. Term expires 1945 H. Lee Large, M.D. Term expires 1943 J. N. Johnson, D.D.S. Term expires 1945 H. G. Baity, Ph.D. Term expires 1943 C. C. Fordham, Jr., Ph.G. Term expires 1945 1397 LETTER OF TRANSMITTAL Raleigh, N. C, September 16, 1942. His Excellency, J. Melville Broughtox, Governor of North Carolina. My DEAR Sir: — Under Authority of Chapter 118, Article 1, Section 7050, Consolidated Statutes of N'orth Carolina, I have to submit to you for transmission to the General Assembly the Biennial Report of the State Board of Health for the period July 1, 1940, to June 30, 1942, Yours sincerely, Carl V. Reynolds, Secretary and State Health Officer. TABLE OF CONTENTS Page The Chronological Development of Public Health Work in North Caro-lina - - 9 Report of the Secretary-Treasurer and State Health Officer 51 Annual Report North Carolina State Board of Health to Conjoint Ses-sion State Medical Society—1941 66 Annual Report North Carolina State Board of Health to Conjoint Ses-sion State Medical Society—1942 95 Informational Service 122 Division of Preventive Medicine - - 123 Crippled Children's Department 131 Division of Sanitary Engineering 139 Division of Oral Hygiene -... - 147 State Laboratory of Hygiene 149 Division of Epidemiology - 157 Division of Vital Statistics 165 Division of County Health Work 169 Division of Industrial Hygiene 186 School Health Coordinating Service 190 THE CHRONOLOGICAL DEVELOPMENT OF PUBLIC HEALTH WORK IN NORTH CAROLINA In the seventies Dr. Thomas Fanning Wood, of Wilmington, caught the vision of the possibilities of public health work to North Carolina. How fully he grasped the far-reaching consequences of his idea, how clearly he saw the ever-growing hosts of lives saved as a result of his vision and inspiration, we shall never know. We do know that the vision never left him, and that under its sway he worked, through the Medical Journal which he edited and through the North Carolina State Medical Society until his influence reached the people of the State in their General Assembly of 1877, with the effect that on February 12, 1877, the North Carolina State Board of Health was born. Ours was the twelfth state board of health to be established. Without treating the development of the newly-established board with that thoroughness that could be termed history, we think it enough to set down here in chronological order the principal events in the life and growth of the North Carolina State Board of Health. 1877. Board created by the General Assembly. Consisted in the beginning of entire State Medical Society. Society acted through a committee. Annual appropriation, $100. 1878. First educational pamphlet issued. Subject, "Timely Aid for the Drowned and Suffocated." Annual appropriation, $100. 1879. The General Assembly reconstituted the Board of Health. Made it to consist of nine members: six appointed by the Governor, three elected by the State Medical Society. Term of office, five years. Dr. Thomas F. Wood elected first Secretary of the Board, May 21. Dr. S. S. Satch-well was first President of the Board. Other legislative provisions: (1) Chemical examination of water, and (2) organization of county boards of health, composed of all regular practicing physicians and, in addition, the mayor of the county town, the chairman of the board of county commissioners, and the county surveyor. Four educa-tional pamphlets issued. Subjects: "Disinfection, Drainage, Drinking Water, and Disinfectants"; "Sanitary Engineering"; "Methods of Performing Post-morten Examinations"; "Limitation and Preven-tion of Diphtheria." Annual appropriation, $200. 1880. Much of the activity this year was devoted to efforts to control diph-theria. Prompt reporting of cases was urged. Water supplies and sewage disposal provoked much discussion. A survey of school-houses was carried out through the County Superintendents of Health. Most of the public schoolhouses were of one-teacher size, of frame and log construction, and none of them in rural districts had any type of privy. 1881. General Assembly passed a law requiring regulation of vital statistics at annual tax listing; law ineffective. Annual appropriation, $200. 8 Twenty-Ninth Biennial Report 1882. Dr. Thomas F. Wood, State Health Officer, was President of the North Carolina Medical Society and the annual meeting was held in Concord. At this meeting the State Board of Health appointed a committee for each county of one physician to "canvass (the people) in the interest of prospective legislation" on public health matters. The subject of the annual essay presented by Dr. W. P. Beall of Greensboro was "Pre-ventive Medicine." The chief items of public health interest this year was the emphasis placed on the effectiveness of smallpox vaccination and the increasing realization of polluted water as a source of typhoid fever. 1883. Dr. J. W. Jones of Wake Forest was elected to membership on the State Board of Health by the State Medical Society at its annual meeting at Tarboro. Dr. Jones became at once an active "friend and promoter of sanitary work." Due to his efforts, a meeting of all county superin-tendents of health was called in Raleigh early in the next session of the Legislature. One of the chief purposes of the proposed meeting was to urge the enactment of vital statistics legislation, and to procure a small appropriation for printing. Several epidemics of smallpox with numerous deaths were reported —one of the most severe was in Clay and Graham counties. 1884. Dr. Wood, Secretary and Treasurer of the State Board of Health, made a pessimistic report this year. He said that "during the year little more had been done than to issue pamphlets on the subject of city sanitation." Dr. Wood pointed out that it was impossible to inaugu-rate public health work to say nothing of carrying it on without some money at least. The State Medical Society adopted a resolution at its conjoint session held in Raleigh requiring the President of the Medical Society to appoint a committee "to go before the Legislature and request an adequate appropriation to be used by the Board in behalf of the high and humane objects of the Board." 1885. General Assembly made county boards of health more efficient; allowed printing privileges not to exceed $250 annually. Annual appropriation, $2,000. 1886. The Health Bulletin made its appearance in April. Pamphlet on "Care Eyes and Ears," by Dr. Richard H. Lewis, printed and distributed. 1887. Fear of yellow fever which had made its appearance late in the year through the port of Key West, Florida, where a patient with the dis-ease had been smuggled in, was one of chief concern to the Board. Much interest and discussion in the Board membership and through-out the state this year centered about the necessity for providing some safe method of drinking water and sewage disposal. 1888. Yellow fever epidemic in Florida and refugees to Western North Caro-lina demonstrated value of a Board of Health to cope with situation. Annual appropriation, $2,000. 1889. The chief item of interest and importance to the cause of public health was a state-wide "sanitary convention" held in Raleigh February 6. It was largely attended by physicians and others from many cities and towns who were much concerned about the problems of a pure North Carolina Board of Health 9 water supply and sewage disposal. The Board published an exhaustive paper by Dr. H. T. Bahnson of Salem, President of the Board, en-titled: "The Public Water Supply of Towns and Cities in North Carolina." Providing refuge for hundreds of people who had fled from their homes farther south on account of yellow fever was a grave problem. 1890. A widespread epidemic of influenza or as it was commonly called at the time "grip" or "La Grippe," spread over the state in January. The epidemic appeared first in Russia about November 1, 1889. By Decem-ber 15, 1889, 200,000 cases were reported in New York alone. It struck North Carolina during the first week in January and in two weeks time it was reported to be raging in 68 counties. 1891. Influenza continued to be present in all sections of the state through-out the year. The conjoint session met in Asheville on May 27. The term of Dr. W. D. Hilliard of Asheville as a member of the Board expired this year. Dr. S. Westray Battle also of Asheville was elected to succeed Dr. Hilliard. Dr. Thomas F. Wood was reelected Secretary and Treasurer for a term of six years. 1892. Dr. Thomas F. Wood, the Secretary of the Board, died August 22. Dr. Richard H. Lewis elected Secretary to succeed Dr. Thomas F. Wood, September 7. Annual appropriation, $2,000. 1893. Legislative provisions: (1) Laws improving the reporting of contagious diseases, (2) the protection of school children from epidemics, (3) protecting the purity of public water supplies, and (4) regulation of common carriers. Legislature provided that the Governor appoint five of the nine members of the Board of Health, that the State Medical Society elect four, and that the term of office of the members of the State Board of Health be six years. The $250 printing limit was re-moved. Pamphlet on quarantine and disinfection was prepared and reprinted by many of the state papers. Annual appropriation, $2,000. 1894. A number of public health conferences were arranged and held in different towns of the state. Bulletin was increased from a mailing list of 800 to 1,200. Annual appropriation, $2,000. 1895. Dr. Albert Anderson and Dr. W. T. Pate were elected bacteriologists for the Board. Annual appropriations, $2,000. 1896. Board passed a resolution requiring chemical and bacteriological exami-nations of municipal water supplies. Dr. Venable, of Chapel Hill, undertook the chemical examination, and Drs. Anderson and Pate the bacteriological examination. Board also directed Mr. John C. Chase, the engineer member, to inspect all municipal water plants in the state. Annual appropriation, $2,000. 1897. General Assembly enacted law requiring county superintendents of health to be elected by county commissioners and reduced term of office to one year. Annual appropriation, $2,000. 1898. The address of the President of the North Carolina Medical Society this year by Dr. Francis Duffy of New Bern was devoted almost exclu-sively to the promotion of public health. It really marked an epoch as sounding an advanced note in the advancement of human progress. The State Health Officer, Dr. R. H. Lewis, devoted a great deal of 10 TWE.NTY-Nl>TU BlE.NXIAL REPORT time and energy to try to arouse the people of the state to the necessity for vaccination against smallpox. 1899. General Assembly improved the laws protecting public water supplies. Smallpox prevailed extensively in the state. Dr. Henry F. Long, and later, on Dr. Long's resignation, Dr. Joshua Tayloe, were employed to travel over the state, consulting with and advising the local sanitary authorities as to proper means for protecting the public. Annual ap-propriation, $2,000. 1900. State Board of Agriculture, on request of State Board of Health, agreed to examine samples of w'ater from public water supplies until Board of Health could provide its own examiner. Annual appropriation, $2,000. 1901. State Board of Embalmers, with representatives of State Board of Health, established. County health work placed in the hands of county sanitary committees composed of county commissioners and two physi-cians w^hich commissioners elected to serve with them. Term of office of county superintendent of health made two years. Annual appropria-tion, $2,000. 1902. This year will be long remembered for the widespread prevalence of smallpox in virulent form. It caused many deaths in different sections in the early months of the year. In one county at least fifty people died, including many well-to-do-men. Not having any system of vital statistics reports, it is impossible to even estimate the number of cases, except from physicians' voluntary reports and death notices in the newspapers. 1903. General Assembly enacted law permitting Board of Health to charge $5 for each analysis of a public water supply, this fee to be used in pay-ing Department of Agriculture for services of examiner. Dr. C. W. Stiles, U.S. P.H.S., before the State Medical Society at Hot Springs, called attention to prevalence of hookworm disease in the South. Dr. J. L. Nicholson and Dr. W. S. Rankin, working under State Board of Health during fall of 1903 and spring of 1904, showed great preva-lence of this disease in North Carolina. Annual appropriation, $2,000. 1904. A stenographer was employed. One hundred and twenty thousand pamphlets on tuberculosis were printed and distributed. There was a renewal and an extension of cooperative work between the Board of Health and the state press, a number of articles dealing with hygienic and sanitary subjects being furnished the papers and published in them. Annual appropriation, $2,000. 1905. General Assembly established State Laboratory of Hygiene; imposed w^ater tax of $64 on all public water companies; voted $600 annually for the support of laboratory. Small appropriation made it necessary for the Department of Agriculture to continue to assist State Board of Health. Annual appropriation, $2,000. 1906. The North Carolina Association for the Study and Prevention of Tuberculosis was organized. Annual appropriation, $2,000. 1907. Two thousand dollars appropriated for the State Laboratory of Hygiene. Pasteur treatment provided. State Sanatorium for treatment of tuberculosis founded; $15,000 appropriated for permanent improve- NoKTH Cakolixa Board of Health 11 ments and $5,000 for maintenance. A law requiring the separation of tuberculosis prisoners from other prisoners was enacted. Annual appropriation, $4,000. 1908. January 1, Dr. C. A. Shore became Director of State Laboratory of Hygiene. Annual appropriation, $4,000. 1909. General Assembly provided for (1) whole-time State Health Officer; (2) collection of vital statistics of towns having a population of 1,000 or over; (3) that all public water companies file plans and specifications of their plants with the State Board of Health, and that the State Board of Health pass necessary rules and regulations for the care of public watersheds and plants and furnish such rules and regulations and other advice to those having charge of public water supplies; (4) that counties provide free diphtheria antitoxin for county indigents, and (5) that the maintenance appropriation for the Sanatorium be increased from $5,000 to $7,500, and an additional $30,000 be granted for permanent improvements. Dr. Richard H. Lewis resigned as Secretary of the Board, and Dr. W. S. Rankin was elected as his successor, beginning his official work July 1. Annual appropriation, $10,500. 1910. General effort to interest the people and state organizations in public health work. Bulletin increased from 3,500 edition to 10,500 edition. Addresses on public health work delivered to Conference of County Superintendents of Schools, State Federation of Women's Clubs, State Press Association, and Sanitary Sunday observed in April. Dr. John A. Ferrell elected, February, Assistant Secretary for Hook-worm Eradication; began work under State Board of Health and Rockefeller Sanitary Commission. 1911. Legislature established county boards of health to take the place of the county sanitary committees; county board of health composed of chairman board of county commissioners; county superintendent of schools, mayor of county town, and two physicians selected by the three county officials to serve with them. Legislature also abolished quarantine for smallpox and improved the quarantine laws. One thousand dollars annually appropriated to contract with antitoxin manufacturers for state supply of high-grade diphtheria antitoxin, with result that price of antitoxin was cut to one-fourth former price, saving the citizens of the state over $30,000 annually. Bulletin increased from 11,500 copies to 20,000 copies each edition; closer co-operation with press of state developed; regular weekly press articles prepared and sent to papers; increase in numbers of popular pam-phlets for distribution. Hookworm this year largely educational through the school forces and investigative through county dispen-saries; thousands of children found infected and treated. Strong sentiment began to make itself felt for better health work by coun-ties, four counties employing whole-time county health officers. Guilford County—one of the four—began its work June 1 and was the first county in the United States to inaugurate full-time county health work. Maintenance appropriation for State Sanatorium increased to $12,500, with $20,000 voted for permanent improvements. Annual appropriation, $22,500. 12 Twenty-Ninth Biennial Report 1912. Bulletin increased to 40,000 edition; number of popular pamphlets dealing with different diseases increased; press work improved; edu-cational work of Board along all lines amplified. Secretary of Board of Health called attention of conjoint meeting of State Medical Society and State Board of Health to the relative importance of health prob-lems and the bearing of this subject upon the proper apportionment of health funds; instrumental in passing a resolution to the effect that pellagra was an interstate problem, not a state problem, and re-questing the Federal Government to deal with pellagra as a Federal problem; resolution responsible, to considerable extent, for successful effort on part of Hon. John M. Faison's securing Congressional appropriation of $45,000 for the study of pellagra by the Federal Government. Hookworm work extended and county funds appro-priated to supplement state and Rockefeller Foundation for this work. Annual appropriation, $22,500. 1913. General Assembly passed Model Vital Statistics Law with $10,000 appropriation for its enforcement. County superintendent of health changed to either county physician or county health officer, depend-ing on whether part-time or full-time service. Educational efforts of Board continued and enlarged. Hookworm work along same line as year before increased in amount. Dr. John A. Ferrell resigned as Assistant Secretary to accept position with the central office of the Rockefeller Sanitary Commission in Washington, D. C. Dr. C. L. Pridgen succeeded Dr. Ferrell. The movement for improved county health work had by this time resulted in ten counties electing whole-time county health officers. The State Sanatorium for Treatment of Tuberculosis turned over by Extra Session of 1913 to the management of State Board of Health. Annual appropriation, $40,500. 1914. Preceding work of the Board continued. Board of Health took over management of Sanatorium; started out under many difficulties on account of the institution owing many debts and the appropriation being limited. Hookworm work changed to community work directed to the installation of sanitary privies in all homes. Laboratory began to produce and distribute free anti-typhoid vaccine. Dr. C. L. Pridgen resigned as Director Hookworm Eradication, and Dr. W. P. Jacocks succeeded him. Annual appropriation, $40,500. 1915. General Assembly makes state vital statistics law conform to national model by requiring burial permits in rural communities; enacts legislation permitting county commissioners and towns and cities to appropriate money for support of tuberculosis citizens in State Sanatorium; provides $15,000 for purchase and building of antitoxin plant; appropriates $60,000 for payment of Sanatorium debts and new buildings and other improvements, and $25,000 annually for maintenance and $10,000 for extension anti-tuberculosis work. Edu-cational work greatly extended: Bulletin now 47.000; traveling public health exhibit shown at fairs and other assemblages; press work greatly developed through employment of Miss Kate Herring, a journalist, for her whole time; stock lectures with lantern slides supplied public speakers in different parts of the state; community soil pollution work under Dr. W. P. Jacocks stops in April, and NoETH Carolina Board of Health 13 Bureau of Rural Sanitation, with Dr. G. M. Cooper at its laead, suc-ceeds, beginning work May 1. Considerable amount of work done for improvement of prison conditions. The unit system of county health, work gets a good start; over 52,000 people given three complete vaccinations against typhoid fever, and medical inspection of schools put on in six counties. Annual appropriation, $50,500. 1916. North Carolina was admitted to the Registration Area for deaths. To the educational agencies of the Board was added a self-supporting moving picture health show. Many saw this show during the year and, seeing, believed in health work as never before. BuUettn reached 51,000 edition. Cooperation with University in developing a plan and putting on a home post-graduate course in medicine, giving first course to 169 doctors. Put into operation an optional system of hotel inspection, with grading and publishing scores. Continued Bureau of Rural Sanitation, giving three anti-typhoid injections to 48,000, making 100,000 immunized in summers of 1915 and 1916. Did com-plete medical inspection of six counties and with inspection a large amount of educational work as to sanitary and hygienic living. Secured effort by Federal Children's Bureau to develop unit of child hygiene work, the Bureau using two employees to work in Cumber-land and Swain counties for about eight months. Laboratory of Hygiene buys land and erects its own building. Annual appropria-tion, $55,500. 1917. The General Assembly passed the following important health legisla-tion: Chapter 263, entitled "An act to prevent and control the occur-rence of certain infectious diseases in North Carolina"; Chapter 244, entitled "An act to provide for the physical examination of the school children of the state at regular intervals"; Chapter 276, entitled "An act for the cooperative and effective development of rural sanitation"; Chapter 257, entitled "An act to prevent blindness in infancy, designat-ing certain powers and duties and otherwise providing for the enforcement of this act"; Chapter 66, entitled "An act to provide for the sanitary inspection and conduct of hotels and restaurants"; Chapter 286, entitled "An act to regulate the treatment, handling and work of prisoners." Following the enactment of this legislation, administrative ma-chinery, consisting of a Bureau of Epidemiology under the direction of Dr. A. McR. Crouch, a Bureau for the Medical Inspection of Schools under the direction of Dr. Geo. M. Cooper, and a Bureau for County Health work, under the direction of Dr. B. E. Washburn, was estab-lished. Dr. Washburn, an officer of the International Health Board, was loaned to the state without cost, and the International Health Board, in addition to furnishing Dr. Washburn, appropriated $15,000 annually for County Health Work in accordance with the provisions of Chapter 276. The United States Public Health Service in February, 1917, detailed Dr. K. E. Miller to study county health work in different sections of the country and to estaiblish for demonstration purposes, in Edgecombe County, department of health on an economic basia easily within the financial reach of the average county. 14 . Twenty-Ninth Biennial Report The State Laboratory of Hygiene moved into its own building, January 15, 1917. The state was admitted to the registration area of the Union for births in January, 1917, the Bureau of the Census having found after investigation that our birth registration was 96 per cent complete. The special campaign against typhoid fever begun so satisfac-torily in 1915 was continued. Free vaccination of the people, however, was interfered with by the difficulty in securing medical officers to do the work, the preparedness program of the Government having caused many physicians and nurses to enter the army and navy; nevertheless, a total of 30,000 citizens of the state were vaccinated as a direct result of the Board's activities, and many thousands of others were vaccinated by the physicians of the state as a result of the educational work of the Board directed to impressing the people with the value of vaccination as a means of prevention for typhoid fever. In December, 1917, life extension work, which consisted briefly of the free physical examination of interested citizens for the purpose of advising them as to their physical condition and needed hygienic reform and medical treatment, was begun on a county basis. The funds necessary for this work were appropriated partly by the state and partly by the counties in which the life extension work was carried out. Dr. Amzi J. Ellington, of Raleigh, who at the time was a resident physician in the New York City Hospital, was employed and placed in charge of the work. Life extension work was carried out in Vance, Alamance, Lenoir and Robeson counties, and resulted in the full physical examination of 4,000 citizens. This work was very favorably received, and the outlook for its continued development seemed excellent when, with the declaration of war and the call for physicians to enter the military service of the country, Dr. Ellington enlisted in the Medical Corps of the Army. For this reason, and for the further reason that It has been almost impossible to secure health officers during the past two years, the work was not resumed. The educational work of the State Board of Health consisted in the issuance of eight issues of the Monthly Health Bulletin, each monthly edition amounting to 45,000, and a daily newspaper health article. The Bureau continued its moving picture show exhibit. Arrange-ments were made for the preparation of newspaper plate, which was sent to and extensively used by 202 papers having a total circulation of 303,000. The annual appropriation for the State Board of Health was $60,772.16. The annual appropriation for the State Laboratory of Hygiene was $12,500, and this, in addition to $9,087.22 in fees per-mitted under the laws of the state to be paid to the Laboratory for special work, provided the Laboratory with a total annual budget of $21,587.22. 1918. Much of the work this year was influenced by the war and had to do with preparedness. The State Health Officer visited Washington, at the request of the Council of National Defense and as chairman of a committee of State Health Officers, on a number of occasions for NOKTH C-UIOLINA BOARD OF HEALTH 15 conferences with respect to preparedness measures, provisions for the control of venereal diseases, arrangements for coordinating the control of infectious diseases in the civilian population with their con-trol in cantonments, and to arrange, if possible, with the Public Health Service and the Surgeon-General of the Army for preserving the personnel of state health departments during the war. Considerable time was given to assisting Major John W. Long, Medical Aide to the Governor, in the work of organizing the Medical Advisory Boards and in interesting physicians in entering the medi-cal service of the Army and Navy, and, later in the year, in inducing the physicians of the state to become members of the Volunteer Medi-cal Service Corps. Partly as a result of these activities, the Surgeon-General of the Army assigned Major Joseph J. Kinyoun to assist the State Board of Health in the control of communicable diseases, the Board being under no financial obligation for Major Kinyoun's assistance; and as a result of the successful termination of the activities of various inter-ests looking to a more effective control of venereal diseases, the Kahn-Chamberlain bill passed Congress, and made available to the State of North Carolina, and without condition, $23,988.61 for venereal disease w^ork. The Laboratory during this year began the distribution of a high grade of diphtheria antitoxin. The Bureau of Medical Inspection of Schools, under the direction of Dr. G. M. Cooper, developed, and with a degree of success that we may say established, free dental clinics for the public schools of the state. The Bureau also developed to a successful extent an arrange-ment in the form of adeno^ and tonsil clubs for the practical and economic treatment of public school children suffering from these defects. The Bureau of Epidemiology employed two third-year medical students, equipped them with motorcycles, and put them into the field to investigate infringements of the quarantine law. Sufficient convictions were obtained to impress the people with the determina-tion of the state to enforce its health laws, and a fairly satisfactory compliance with the laws regarding the reporting of communicable diseases was brought about. The Bureau of Venereal Diseases, paid for by the Federal appro-priation, was established in September under the directorship of Dr. James A. Keiger. Mr. Warren H. Booker, for the last seven years the efficient director of the Bureau of Engineering and Education, left in September for Red Cross work in France, the work of his bureau being continued, with the exception of the engineering work, by Mr. Ronald B. Wilson, who had been employed earlier in the year to succeed Miss Herring in assisting Mr. Booker with the journalistic work, Miss Herring having been engaged by the War Department for educational work. Perhaps the most outstanding feature of the health work during the year 1918 was the epidemic of influenza. The epidemic began early in October and caused in October alone 6,056 deaths; in November 16 Twenty-Ninth Biennial Report 2,133 deaths, and in December 1,497 deaths, a total during the last three months of 9,686 deaths. The annual appropriation for the State Board of Health for 1918 was $73,210.38. The annual appropriation for the State Laboratory of Hygiene was $12,500. The Laboratory, during this year, collected $8,532.48 in fees for special work, so that the total income of the Laboratory for this year was $21,032.48. 1919. The General Assembly passed the following important health legisla-tion: Chapter 71, entitled "An act to prevent the spread of disease from insanitary privies"; Chapter 192, entitled "An act to provide for the physical examination and treatment of the school children of the state at regular intervals"; Chapter 206, entitled "An act for the prevention of venereal diseases"; Chapter 213, entitled "An act to require the provision of adequate sanitary equipment for public schools"; Chapter 214, entitled "An act to obtain reports of persons infected with venereal diseases"; Chapter 215, entitled "An act to amend Chapter 671, Public-Local Laws of 1913, relating to the injunc-tion and abatement of certain nuisances." The Bureau of Engineering and Inspection was organized in April. The engineering work of the Board had been suspended with the resignation of Mr. Warren H. Booker in September, 1918, Mr. Booker having gone to France to engage in tuberculosis work under the direction of the Red Cross. Between September, 1918, and April, 1919, the engineering problems coming before the Board had been referred and very kindly and effectively taken care of by Col. J. L. Ludlow of Winston-Salem, the engineer member of the Board. Mr. H. E. Miller, an engineer and a graduate of the University of Michi-gan, was placed in charge of the new bureau, and his brother. Dr. K. E. Miller, of the United States Public Health Service, was detailed by the Service to assist him in the organization of his work. Mr. H. E. Miller and Dr. K. E. Miller spent the spring and summer and a part of the fall in studying various types of privies, in preparing plans for the construction and maintenance of privies, and in pre-paring the necessary notices and literature to inform the people of the objects and requirements of the new privy law. On May 1 Dr. A. J. Warren, health officer of Rowan County, was appointed to and accepted the position of Assistant Secretary of the Board. About the first of the year. Miss Herring returned to the educa-tional work of the Board. After a few months she returned to the Fed-eral Service, and Mr. R. B. Wilson, who had left the Board work upon Miss Herring's return, was again offered a place with the Board. Mr. Wilson accepted and assumed his duties on July 1. On August 1 Dr. A. McR. Crouch, Director of the Bureau of Epi-demiology, resigned to accept a position with the city of Wilmington. Dr. F. M. Register, whole-time health officer of Northampton County, succeeded Dr. Crouch as director of the bureau. Dr. E. J. Wood resigned this year, effective at the end of his term, North Carolina Board of Health 17 and Governor Bickett appointed Dr. E. J. Tucker of Roxboro for six years term—first dentist to serve on the Board. In September Dr. J. R. Gordon, Director of the Bureau of Vital Statistics since 1914, resigned on account of impaired health, and on October 1st the Bureau of Epidemiology and the Bureau of Vital Statistics were combined and placed under the direction of Dr. Register. In September Mrs. Kate Brew Vaughan, Director of the Bureau of Infant Hygiene, resigned. The bureau was reorganized under an under-standing with the American Red Cross and was enlarged to include, in addition to infant hygiene, the problem of public health nursing, the name of the bureau being changed to that of "Bureau of Public Health Nursing and Infant Hygiene." Under the agreement with the Red Cross this bureau was to have an available appropriation of $12,000 a year, half of which was was to be furnished by the American Red Cross and half by the State Board of Health. The personnel of the bureau and its plan of work, under the agreement, was made contin-gent upon the approval of both participating agencies, the American Red Cross and the State Board of Health. In December Miss Rose M. Ehrenfeld took charge of the new bureau and began its organization and work. On October 1 Dr. Jas. A. Keiger, Director of the Bureau of Venereal Diseases, resigned and Dr. Millard Knowlton was appointed to suc-ceed him. The typhoid campaign carried on during the summer through pre-vious years was continued in the summer of 1919, using third-year medical students, furnished either with automobile or motorcycles for getting about. Campaigns were carried out in the following coun-ties: Bertie, Cabarrus, Chatham, Chowan, Columbus, Craven, Hert-ford, Iredell, Johnston, Lincoln, Onslow, Pasquotank, Perquimans, Randolph, Richmond, Rockingham, Stanly, Union, Warren, Wayne. A total of 49,076 were given complete vaccination. The educational work of the Board consisted of the publication of 48,000 monthly edition of the Bulletin, and the distribution of about 350,000 pieces of public health literature. The funds available during this fiscal year amounted to $198,- 549.14, of which $102,301.98 was from state appropriations and the remainder from outside sources. The appropriation for the State Laboratory of Hygiene for this year was $28,500; in addition to this, the Laboratory collected in fees for special work, for antitoxin, and in water taxes a total of $14,344.02, making a total of $42,844.02 available for work of Laboratory. 1920. During this year there was a Special Session of the General Assembly, lasting twenty days and held in the latter part of August. This Special Session passed an act amending the vital statistics law, making the fees for local registrars 50 cents instead of 25 cents for each certifi-cate properly filed with the State Board of Health. On January 1 Dr. B. E. Washburn, who had had general direction of the cooperative county health work and who had rendered most acceptable service, was recalled by the International Health Board and 2 IS Twenty-Ninth Biennial Report detailed to take charge of their interests in Jamaica. Dr. K. E. Miller, of the United States Public Health Service, who had been detailed in January, 1917, to organize a model county health department in Edgecombe County and then, in 1919, to assist his brother, Mr. H. E. Miller, in organizing the work of the new Bureau of Engineering and Inspection, to which was assigned the duty of enforcing the state-wide privy act, succeeded Dr. Washburn as director of the Bureau of County Health Work. In January a cooperative effort with the United States Public Health Service and the International Health Board to demonstrate the possibilities and advantages of the eradication of malaria from certain towns and cities in the eastern part of the state was begun. The terms of cooperation were that the International Health Board and the State Board of Health were to pay one-half of the expenses of the local work and the town or city in which the work was done the other half, the Public Health Service furnishing, as its part, expert supervising personnel. The towns and cities chosen for this work were Goldsboro, Farmville, and Greenville, the budget for each municipality being respectively: Goldsboro, $13,670.98; Farmville, $5,000, and Greenville, $9,000, a total investment in this work of $27,670.98. Mr. W. A. Fuchs, Associate Sanitary Engineer, was detailed by the Service to have supervision of the work. In February Dr. A. J. Warren, Assistant Secretary of the State Board of Health, resigned his position in order to accept the appoint-ment of city health officer of Charlotte, N. C. In the winter and spring of 1920 the North Carolina Landowners Association, under the progressive leadership of Mr. W. A. McGirt, of Wilmington, undertook a very extensive educational campaign against malaria, which v/as carried on through the public schools of thirty-eight counties in eastern North Carolina. A series of county and state prizes for the best essay on malaria by public school chil-dren were offered as an inducement to the school children to interest and inform themselves and, indirectly, their parents with regard to the importance of this disease. To make possible this work by the school children 75,000 malaria catechisms, prepared by Dr. H. R. Carter, of the United States Public Health Service, were distributed through the public schools of the eastern part of the state to the school children. Thousands of essays were written, and it is reason-able to believe that the campaign was one of the most successful public health educational attempts yet undertaken. In June it was found advisable to separate the Bureau of Epidemi-ology and the Bureau of Vital Statistics which had, on account of the scarcity of health officers, been placed under the directorship of a single bureau chief, Dr. F. M. Register. Dr. Register was appointed Director of the Bureau of Vital Statistics and Dr. J. S. Mitchiner was appointed Director of the Bureau of Epidemiology. In April the Interdepartmental Social Hygiene Board assigned to the State Board of Health several workers for making a study of vice conditions in North Carolina towns and cities and for taking such steps as were found expedient for decreasing prostitution. This group of workers was withdrawn in September on account of differences- North Carolina Board of Health 19 developing between them and Dr. Knowlton, chief of the Bureau of Venereal Diseases, with the understanding that another group of workers would be assigned to this work at a later date. In June arrangements were made with the United States Public Health Service and the American Social Hygiene Association for the development of an elaborate educational unit on sex hygiene and venereal diseases designed to reach rural meetings through the use of picture films and a portable truck. An outfit consisting of several lec-tures and a moving picture truck began work in Cumberland County in August, and from its very beginning met a most cordial reception and gave every promise of developing into one of the most useful agencies for dealing with the venereal disease problem. During the year anti-typhoid vaccination campaign was continued in Alamance. Bladen, Columbus, Duplin, Franklin, Gaston, Harnett, and Mecklenburg counties. Cooperative campaigns, in which the counties furnished the working personnel, were also carried on in Anson, Johnston and Rutherford counties. A total of 29,435 citizens have been vaccinated against the disease, and this does not include Columbus County, in which the work was just beginning when this report was completed. The educational work of the State Board of Health during this year consisted of a 48.000 monthly edition of the State Board of Health Bulletin and the distribution of approximately 350,000 pieces of pub-lic health literature. The funds available during this fiscal year amounted to $342,- 284.33, of which $176,152.61 was state appropriation and the remain-der from outside sources. The appropriation for the State Laboratory of Hygiene for this year was $25,000; in addition to this, the Laboratory collected in fees for special work, for antitoxin and in water taxes, a total of $13,- 698.89, making a total of $38,698.89 available for the work of the Laboratory. The above amount being insufficient, the Special Session of the Legislature authorized a loan of $15,000 to enable the work of the Laboratory to be carried on. making a total of $53,698.89 available for the work of the Laboratory during this year. 1921. The Legislature meeting early in January of this year was asked by the Board to amend the state law restricting the salary of the executive officer of the Board to $3,000 annually, so as to make the salary $5,000. Such an amendment was passed. A further request from the Board was that legislation be enacted removing the inspection tax of forty cents from privies coming under the supervision of the Board of Health. Such an amendent to the State-wide Privy Law was also enacted. A bill was introduced in this session of the General Assem-bly under the initiative of Hon. Emmet H. Bellamy requiring a physical examination of all applicants for marriage and making issuance of license contingent upon the physical qualifications of the applicant. The State Board of Health approved and supported Mr. Bellamy's bill, realizing, as did the author of the bill, that the proposed legislation was but a step in the right direction and was, therefore, rather loosely drawn and left many things to be desired. 20 Twenty-Ninth Biennial Report The bill finally passed in amended form as Chapter 129, Public Laws of 1921. The Governor appointed Mr. Chas. E. Waddell, an engineer, of Asheville, to succeed Col. J. L. Ludlow as the engineer member of the Board. Perhaps the most important change inaugurated in state health administration during this year was the adoption of a cost basis for standardizing and measuring the efficiency of public health work in those counties in which, the state participated financially. This new principle is fully described in the State Board of Health BuUetin for January, 1922, and a further discussion of cost basis for public health work is unnecessary here except, perhaps, to say that it is apparently at least one of the first attempts to introduce the cost system of indus-try into government. The Bureau of Venereal Diseases, in charge ol Dr. Millard Knowl-ton, established as a part of the war-time activities of the Board in cooperation with the Bureau of Venereal Diseases of the Federal Gov-ernment, was combined with and made a part of the work of the Bureau of Epidemiology, under the general direction of Dr. J. S. Mitchener. Funds available for the year included state appropriation, $275,000; miscellaneous receipts, $164,184.42; total, $439,184.42. 1922. In order to bring the records of this department into harmony with those of other state departments, in accordance with the Act of the General Assembly of 1921, changing the fiscal year of the state so as to begin on July 1st each year, this report ends with June 30, 1922. It, therefore, covers a period of nineteen months; one full fiscal year from December 1, 1920, to November 30, 1921; seven months from December 1, 1921, to June 30, 1922. Effective February 1, the Ameri-can Red Cross Society abrogated the agreement existing since 1919 by which it jointly financed, with the Board of Health, the Bureau of Public Health Nursing and Infant Hygiene. This bureau was reor-ganized April 1 as the Bureau of Maternity and Infancy, for its main-tenance the state receiving $27,259.66 annually from the United States Government in accordance with the Sheppard-Towner Act for the promotion of the welfare of mothers and infants, Dr. K. P. B. Bonner, of Morehead City, was secured as the director of the reor-ganized bureau, with Miss Rose M. Ehrenfeld as supervisor of nursing and Mrs. T. W. Bickett in charge of educational work. The funds available during this period, and their distribution were seven-twelfths of the amounts set out under the tabulation for 1921. The appropriation for the State Laboratory of Hygiene for the nine-teen months between December 1, 1920, and June 30, 1932, was $87,- 083.33; in addition to this, the Laboratory collected in fees for special work, for antitoxin and in water taxes, a total of $30,872.51, making a total of $117,955.84 available for the work of the Laboratory. 1923. The General Assembly of 1923 enacted some important and far-reaching legislation affecting public health work in North Carolina. The most important legislation enacted this year was the act providing for an North Cakolixa Boakd of Health 21 independent board of directors for the State Sanatorium for Tuber-culosis, removing the direction of that institution from the authority of the State Board of Health. Facilities were also provided at the State Sanatorium for the confinement, care, and treatment of tuberculosis convicts. Other legislation included the act to provide for the sanitary manufacture of bedding, the latter act to be enforced by the State Board of Health. The Bureau of Epidemiology was again combined with the Bureau of Vital Statistics. On March 1 Dr. G. M. Cooper was made Assistant Secretary of the State Board of Health, and Dr. J. S. Mitchiner was assigned to the Bureau of Medical Inspection of Schools, after the consolidation of the Epidemiology work, which he had directed, with the Bureau of Vital Statistics. Dr. K. E. Miller, of the United States Public Health Service, was recalled for duty elsewhere. In order to experiment with the plan of District Health Work, an effort was made to place responsibility for all State Board of Health activities under the direction of district directors attached to the staff of the State Board of Health. This effort was continued throughout the year, but proved to be ineffective and unsatisfactory. During the year Dr. F. R. Harris resigned from membership on the State Board of Health to become health officer of Vance County. The Board elected Dr. D. A. Stanton, of High Point, to fill the unex-pired term of Dr. Harris. In order to further carry on the important work of malaria control in a number of the counties of the coastal plain area of the state, which work was so effectively commenced in an educational capacity in 1920, the International Health Board was requested to participate in this work and to provide a director for that service. The Interna-tional Health Board agreed, accepted the invitation and assigned Dr. H. A. Taylor, of Alabama, to head this division. Pamlico County was selected as headquarters for Dr. Taylor. The cost of this work was borne by the State Board of Health and Pamlico County contributing 40 per cent, each, and the International Board the remaining 20 per cent. The International Health Board, of course, paid the salary of Dr. Taylor. In June Dr. J. S. Mitchener resigned as director of the Bureau of Medical Inspection of Schools and Dr. Roy C. Mitchell, who had been doing some special educational field work for the Board, temporarily succeeded Dr. Mitchener. Early in 1923 Dr. W. S. Rankin, the State Health Oflficer, was invited by the Committee of Municipal Health Department Practice of the American Public Health Association to become field director for the committee in making a study of municipal health practices in the United States. This was for the purpose of working out a basis or set of principles through which city health departments could be given classification or grading, and also for the purpose of assisting such departments in their organization work. The request was brought before a special meeting of the executive committee of the Board, and it directed the Secretary to take advantage of the opportunity offered. The Board granted to the Secretary one year's leave of absence, but 22 Twenty-Ninth Biennial Report requested him at the same time to continue in touch as executive officer of the Board with the work of the Board. On November 1 Dr. Ranltin assumed his duties and established official headquarters in New York City for the work of the com-mittee. The general organization of the executive staff of the Board was continued with the Assistant Secretary, Dr. G. M. Cooper, as official head of the staff. Local health work in the eastern half of the state was directed by Dr. H. A. Taylor, and that in the western part of the state by Dr. E. F. Long, who had been assistant to Dr. K. E. Miller as director of county health work. To assist Dr. Taylor in the east. Dr. George Collins, formerly health officer of Mecklenburg County, was employed, and to assist Dr. Long in the western half of the state Dr. C. N. Sisk, formerly health officer of Forsyth County, was employed. During the year a plan for the more adequate sanitary control of public milk supplies in the state was formulated. This work was undertaken under the direction of the Bureau of Engineering and Inspection, and Mr. Malcolm Lewis was employed to organize this work. Several changes in personnel took place this year. Dr. M. L. Iseley, who had been employed in county health department work, and Dr. Roy C. Mitchell resigned. Miss Rose Ehrenfeld also resigned. 1924. During this year Dr. Rankin continued his work with the American Public Health Association until November 1. During this period the work of the Board was directed by Dr. G. M. Cooper, serving as Acting Secretary. On November 1 Dr. Rankin returned, and during that month, under the direction of Dr. Maxey of the United States Public Health Service, a school for health officers was conducted under the auspices of the State Board of Health for one week in Raleigh. This meeting was well attended, and every modern method which might be utilized in the work of a modern public health de-partment was discussed throughout the week. Dr. M. L. Townsend was placed in charge of the Division of Health Education. Dr. K. P. B. Bonner resigned as director of the Bureau of Maternity and Infancy. 1925. Dr. Rankin resigned, effective June 1, to accept the position of director of the Hospital and Orphan Division of the Duke Foundation. At a meeting of the Board of Health on May 30 Dr. G. M. Cooper was unanimously made Acting Secretary for an indefinite period of time to succeed Dr. Rankin. During the year Dr. E. F. Long resigned as director of county health work and Dr. C. N. Sisk, who had been assistant to Dr. Long, was placed in charge of county health work, without an assistant. 1926. On June 21 Dr. Charles O'H. Laughinghouse, a member of the Board, was elected permanent Secretary and State Health Officer to fill the unexpired term of Dr. Rankin. Dr. Laughinghouse accepted and took office October 1. Dr. G. M. Cooper, who had for sixteen months admin-istered the work of the Board as Acting State Health Officer, con-tinued with the service and was assigned to the Bureau of Health Education, succeeding Dr. M. L. Townsend, who resigned. On August North Carolina Board of Health 23 6 Dr. Richard H. Lewis died. Dr. Lewis liad served as a member of the Board since 1885, and from 1892 to 1909 he served as Secretary of the Board. Since 1909 he liad been a member of the executive com-mittee. Dr. Lewis held his membersliip on the Board by appointment from the Governor. To fill the term of Dr. Lewis, expiring in 1931, Governor McLean appointed Dr. John B. Wright, of Raleigh. Among other reasons assigned for this appointment, the Governor stated that it had been the rule since the Board of Health was established to have at least one of the members of the Board a resident of Raleigh. When Dr. Laughinghouse resigned, in order to accept the election to the position of State Health Officer by his fellow members on the Board, the remaining members of the Board elected Dr. W. S. Rankin, of Charlotte, former Secretary of the Board, to succeed Dr. Laugh-inghouse. 1927. There were no changes in personnel or in staff organizations during the year 1927. The most important event occurring this year was the death of Dr. J. Howell Way on September 22. Dr. Way had been a member of the Board for many years and had been President of the Board for a long time. Governor McLean appointed Dr. C. C. Orr, of Asheville, to succeed Dr. Way. At the first meeting of the State Board of Health following the death of Dr. Way, Dr. A. J. Crowell, of Charlotte, was made President of the Board. In April of this year Dr. W. S. Rankin resigned as a member of the Board, and Dr. L. E. McDaniel, of Jackson, was elected by the other members of the Board to succeed Dr. Rankin. 1928. Dr. J. C. Johnson, who had been director of the Oral Hygiene Division, resigned as director of the oral hygiene work of the Board, effective December 31. During this year a corps of nurses employed in the Maternity and Infancy Division of the Board, one-half of whose expenses were paid by the Federal Government from Sheppard-Towner funds, held mid-wife classes in about thirty counties of the state. The nurses gave spe-cial instruction to midwives in groups, and the county authorities en-acted midwife rules and regulations for the control of their practice. The educational work of the Board was of a high order during this year. A thirty-two page Bulletin was issued monthly, and a moving picture machine with several films on modern health subjects was exhibited in many sections of the state. 1929. With aid secured from the International Health Board, the Life Exten-sion Division was added to the activities of the Board this year. Dr. Frederick R. Taylor, of High Point, w^as made director of this division. Dr. Taylor carried this work before the medical profession in all sec-tions of the state. On January 1 Dr. Ernest A. Branch accepted the appointment as director of the Division of Oral Hygiene to succeed Dr. J. C. Johnson, resigned. Dr. Branch immediately set in motion reorganization plans for the oral hygiene work to include more lectures and more educa-tional demonstration work. Dr. Branch made contacts with several of the colleges of the state and training schools for teachers. 24 Twenty-Ninth Biennial Report Expenditures for the Board work this year reached the highest peak in the history of the Board, totaling about $486,000. There were no significant changes, other than those mentioned above, in personnel during the year. 1930. This year marked many significant changes in the affairs of the State Board of Health. Early in the year Dr. C. N. Sisk, director of county health, work, resigned. Dr. D. A. Dees succeeded Dr. Sisk as director of county health work. Soon after the resignation of Dr. Sisk, Dr. F. M. Register, director of the Bureau of Vital Statistics, resigned, and the work of that bureau was assigned to Dr. G. M. Cooper, in connection with his work as director of health education. On August 26, Dr. Chas. O'H. Laughinghouse, State Health Officer, died. Soon after his death, in a meeting of the Board, Dr. H. A. Taylor was made Acting State Health Officer. On September 24, following the death of Dr. Laughinghouse, the Board elected Dr. W. P. Jacocks State Health Officer to succeed Dr. Laughinghouse. On November 20 Dr. Cyrus Thompson, for many years a member of the Board, died. On Decem-ber 16 the Board met and unanimously elected Dr. James M. Parrott, of Kinston, as a member to succeed Dr. Thompson. 1931. At the beginning of this year, Doctor Jacocks having declined to accept the position of State Health Officer, to which he had been elected by the Board on September 24, 1930, a bill was introduced in the Legis-lature abolishing the State Board of Health as then constituted. This bill was passed and became law during the session of 1931. With the enactment of the new law the terms of the members of the old Board were automatically terminated. Under this new law governing the state health work, legislative machinery providing for the establish-ment of a new organization to carry on the public health work of the state was enacted. The new law differs in many respects from the old law under which the Board had operated for so long. However, the most important provision of the old law was retained; that is, the non-political character of the Board and the retention of the perma-nency of the policies of the Board, although shortening the terms of office and making it impossible for the Board to become a self-per-petuating machine. The important provisions in the new law under which the Board of Health work is now operating are as follows: The Governor still retains the power to appoint five of the nine members of the Board, the maximum term of office being four years instead of six, as under the old law. The Medical Society of the State of North Carolina still retains the power to elect four of the nine members of the Board, the same conditions as to term of office to obtain here as in those ap-pointed by the Governor. It was recommended to the Governor, although not written into the law, and Governor Gardner accepted the suggestion, that he appoint one member from the State Dental Society and that he appoint a man recommended by that society. This is equivalent to allowing the State Dental Society to name one of the members, but still leaves the balance of power in the hands of the Governor. This seems to be a very satisfactory arrangement. Another important change is that the Board still elects the State NoBTH Carolina Board ok Health 25 Health Officer, but it can only become effective upon the approval of the Governor. The term of the State Health Officer, along with mem-bers of the Board of Health, was restricted to four years. Following the adjournment of the Legislature, the Governor ap-pointed the following named members: Drs. J. T. Burrus, High Point; H Lee Large, Rocky Mount; J. N. Johnson, Goldsboro, the dental member; Professor H. G. Baity, of the University of North Carolina, and Mr. J. A. Goode, a druggist in Asheville. The State Medical Society at its first meeting after the adjournment of the Legislature elected the following physicians to membership: Drs. James M. Parrott, Kin-ston; Carl V. Reynolds, Asheville; S. D. Craig, Winston-Salem; L. B. Evans, Windsor. It will be noted that Dr. Parrott was the only member of the out-going Board honored with election to membership on the new Board. On May 28 the new Board met and organized. On that day it unanimously elected Dr. James M. Parrott State Health Officer. Dr. Parrott took the offer under consideration for a period of two weeks. On June 11 the Board met again; Dr. Parrott accepted the election and agreed to assume office on July 1. Dr. Parrott resigned his member-ship on the Board before being elected to the position of State Health Officer, and under the provisions of the new law the executive com-mittee' of the State Medical Society selected Dr. G. G. Dixon, of Ayden, to serve in Dr. Parrott's place until the 1932 meeting of the State Medical Society. It will be noted that this is an important variation from the provisions of the old law. Under the old law the other members of the Board held the authority to name a successor, whether a member resigned or died. Under the new law the Governor names his vacancies in his list and the executive committee of the State Medical Society is permitted to name a successor to serve only until the first meeting of the State Medical Society following. In the meeting of June 11 the new Board found it necessary to eliminate some members of the staff and to make some consolidations, on account of reduced appropriations for the Board work. The serv-ices of Dr. D. A. Dees and Mr. R. B. Wilson were dispensed with, effective July 1. The Board reorganized the staff and made many con-solidations. The new reorganization follows: The Board reorganized the work into divisions, making many con-solidations and increasing the duties of the directors of each division. Following are the divisions organized: Administrative Officer, Dr. James M. Parrott; Director Division of Laboratories, Dr. C. A. Shore; Director Division of Preventive Medicine, Dr. G. M. Cooper; Director Division of Oral Hygiene, Dr. Ernest A. Branch. The divi-sion of County Health Work and Epidemiology was temporarily assigned to Dr. H. A. Taylor, but on August 3 Dr. Taylor resigned and Dr. John H. Hamilton, health officer of New Hanover County, was appointed director of this division. The position of director of Division of Sanitary Engineering was filled on July 14 by electing Mr. Warren H. Booker, who had formerly headed that work, to succeed Mr. H. E. Miller. The election of Dr. Parrott was received throughout medical and public health circles of the entire state with enthusiasm. Under his 26 TWK.NTY-NlNTH BlE.XNIAL REPORT able direction the work of the Board during the last half of this year moved with a precision which was gratifying to all the friends of public health work in the state. 1932. The year 1932 was uneventful in public health work. The term of none of the members of the Board expired this year, but all members con-tinued their service just as the Board was constituted at the close of 1931. The International Health Board awarded a scholarship to Dr. J. C. Knox for a year's special Public Health Work at Harvard and to Dr. R. T. Stimpson for a year's special work in the School of Hygiene at Johns Hopkins. Following the very favorable reception of Doctor Parrott's annual report at the conjoint session of the State Board of Health and the State Medical Society, which was presented at Winston-Salem in April, the work of the Board was carried on on all fronts with satis-factory results, although on account of reduced appropriations many activities carried on in previous years had to be curtailed or definitely eliminated. The death rate in North Carolina for 1932 was 9.6 per 1,000 population. This is the lowest death rate ever before recorded in North Carolina. The trend in typhoid fever death rates has been consistently downward from 1914 to 1930. This year there were three more deaths than in 1931, there occurring a total of 158 deaths from typhoid fever. The increase in population, however, offset the slight increase in number, and the rate recorded was slightly lower than 1931. The cases and deaths from diphtheria this year were also the low-est of any previous year, although progress in the elimination of these diseases has not been so satisfactory as it should have been. Deaths from pellagra continue to show a marked decline. This year is the third year of the so-called financial depression, and it is too early to record any opinion as to what effect unemploy-ment and decreased income and rather widespread suffering may have on the health of the people of the state. It is not too much to say, however, that the effect will be felt more severely by the children than by any other class of the population. The infant mortality this year was 66.4 per 1,000 live births. This is so far the best record the state has ever made. The maternal mortality remains high, and indications are that with decreased expenditures for maternal and infant hygiene the rates, particularly for infant deaths, will rise again, pushing the state back among those having an excessive infant death rate. Expenditures for this year for all purposes by the Board were $315,- 276, of which amount $262,438 represented appropriations. This amount was just a little more than half of the total expenditures made by the Board of Health for the fiscal year ending June 30, 1930. 1933. The events of outstanding importance to the Board of Health this year was the death of Dr. C. A. Shore, which occurred on February 10. For twenty-five years Doctor Shore had been director of the State Labora-tory of Hygiene. He had built the work of the laboratory during these NoKTH Carolina Board of Health 27 years up to a point where its prestige and usefulness was equal to that of any other public health laboratory in America. Doctor Shore served longer as a member of the executive staff than any other man who has ever been connected with the State Board of Health. He held the confidence and esteem of the medical profession as well as the general public to a marked degree. He was a man of extraordinary ability, and much of the success of the public health work in North Carolina may be attributed to his fine and wiiolesome service. Suitable tribute has been paid to Doctor Shore and recorded in other publications of the Board and of the State Medical Society. One event in this connection, however, should be recorded here, and that is that by legislative action all buildings of the State Laboratory of Hygiene are hereinafter to be known as the Clarence A. Shore Labora-tory, in memory of his distinctive service. A few weeks after the death of Doctor Shore, Dr. John H. Hamilton, director of County Health Work, of Vital Statistics, and of Epidemi-ology, was made director of the laboratory work. Doctor Hamilton, on assuming his duties as director of the Laboratory, resigned the duties of director of County Health Work and of Epidemiology, but retained, how^ever, with the assistance of Dr. R. T. Stimpson as statistician and field director, the Bureau of Vital Statistics. Dr. D. F. Milam, a consultant assigned to the State Board of Health by the International Health Board, was made acting director of the Bureau of Epidemiology in place of Doctor Hamilton. Doctor Milam had as his assistant Dr. J. C. Knox. Dr. M. V. Ziegler, consultant assigned to the Board by the United States Public Health Service, assumed the duties of acting director of County Health Work to succeed Doctor Hamilton. During this year Mr. W. D. Riley, assigned to the work as Venereal Disease Control Officer by the United States Public Health Service, organized his work and succeeded in making an important contribution to the work of the Venereal Disease Control in North Carolina. The following changes in personnel of the State Board of Health took place during this year: Dr. W. T. Rainey, of Fayetteville, was elected by the State Medical Society for a four-year term to succeed Dr. L. B. Evans, of Windsor, whose term expired this year. Dr. S. D. Craig w^as reelected for a term of four more years. The Governor reappointed Dr. J. N. Johnson, dental member of the Board, for another term, which will expire in 1937. The Governor appointed Dr. Hubert B. Haywood, of Raleigh, for a four-year term, to take the place of Dr. J. T. Burrus, of High Point. The Governor also appointed Mr. James P. Stowe, a druggist of Charlotte, for a four-year term, expiring in 1937. Mr. Stowe succeeded Mr. J. A. Goode, a druggist of Asheville. Dr. Carl V. Reynolds succeeded Dr. Burrus as President of the Board. On July 1 Drs. Knox and Stimpson returned to the Board work and resumed their places after satisfactorily concluding their year's schol-arship work at Harvard and Hopkins, respectively. The year was not marked by any widespread outbreak of epidemic disease, and notwithstanding a continuation of the financial depres-sion, the work of the State Board of Health held up fairly well. The 28 Twenty-Ninth Biennial Report appropriations being lower this year than before for many years, much of the personnel service had to be reduced. A material reduction in state aid to County Health Work caused considerable contraction of the activities of County Health Department Work, but for the most part the morale of State Board of Health employees as well as the county health employees has held up remarkably well. The Legislature, meeting for an extended session following its opening in January, made drastic reductions in appropriations to all state health work and reduced the salaries of all state health employ-ees. This was said to be necessary in order to balance the state budget and to maintain the state's credit. The total expenditures for the Board of Health this year, that is, for the fiscal year ending June 30, were $291,786. Of this amount $225,274 was appropriated by the Legislature. It will be noted that this sum was less than half of that appropriated and spent for the fiscal year ending June 30, 1930. 1934. The event of greatest importance to the State Board of Health and to the health work throughout the state in this year was the death of Dr. James M. Parrott and the election of Dr. Carl V. Reynolds as his successor. Dr. Parrott assumed the duties of State Health Ofllcer on July 1, 1931. He had thus served a little more than three years and four months at the time of his death. Dr. Parrott was the first State Health OflScer to serve under the new, or reorganized, Board of Health. He was stricken with an attack of angina pectoris early in December, 1933. The last eleven months of his life, therefore, were ones of recur-ring illness and courageous fortitude in remaining at the helm of the Board of Health work. On the occasion of the first illness, with the consent of the members of the State Board of Health, he designated Dr. G. M, Cooper as Acting State Health Officer to be the responsible head of the work in such periods as he was physically unable to attend to the duties of the oflSce. The following sketch concerning Dr. Par-rott and his work, written by the Editor, was published in the Health Bulletin: "The death of Dr. James M. Parrott, State Health Oflacer of North Carolina, occurred on Wednesday evening, November 7, 1934. Doctor Parrott had been health officer of North Carolina for a little more than three years. He was so active mentally and so near and dear to his co-workers here at the office that to me, even yet, it seems impos-sible and unbelievable to think that he is dead. Nearly thirty years ago I 'took' the State Board examination for license to practice medi-cine. He was a member of that board. From then on I looked on him as one of the big men in the medical profession. He held every office within the gift of his profession and loved it and served its interests with a passionate devotion. "He took over the direction of the work of the State Board of Health in one of the darkest hours in the history of the Board. He brought to the affairs of the Board a new kind of leadership, a fresh outlook, a new viewpoint, and a breadth of vision which served notice on the world that the Board had a resourceful and able execu-tive in charge. Although he came to the Board work without previous North Carolina Board of Health 29 experience in an administrative capacity of this type, and knowing little or nothing of the practical workings of a modern public health organization, his chief contribution, which will be duly recorded in the history of this period, to the cause of public health advancement was his stand for the professionalization of public health work. "Before he had been here sixty days, he realized that all depart-ment divisions as well as all county health offices should be manned by physicians technically trained and experienced in public health work. It became necessary for him to oppose the ambitions of some of his lifelong friends in the medical profession, which hurt him; but it may be said to his credit that he stood four-square for compe-tently trained men as public health officials. "On assuming office, he realized that he had some very unpleasant duties confronting him in reorganizing the work of the Board. He soon demonstrated that he had convictions and the courage to back them up. When he laid down his armor for the great adventure, he left an organization of his own building functioning at top speed. He proved to his fellow workers here that he was tolerant to every-thing but laziness and lying and inefficiency. Being a man of clean personal life, and governed in all his actions by a strict sense of honor, he naturally expected such qualities in his staff and other subordinates. "For the past year he struggled against the malady which finally ended his life, and at the same time he felt keenly his official respon-sibility. He knew all during that last year that, in justice to himself and his family, he should resign and be relieved of the extra tax on his failing strength. On the other hand, he felt that his work was not quite done. He saw many essential features of public health work sacrificed to a program of questionable economy. He did not question the good intentions of the Governor, the Budget Bureau, nor the Legislature, but he felt that the time had come to put an end to the further needless sacrifice of human life for the lack of intelligent preventive efforts. He had a conviction that the incoming General Assembly would see eye to eye with him. He was ready to submit a program of far-reaching importance to the people of the state. It could not be. His big brain is forever inactive. His profound knowl-edge of the public health needs of the people is left for his successor to acquire for himself. "No man could build for himself a better monument than Doctor Parrott did in the record of worth-while work well done. In his death the state loses an honest public servant, and I lose a warm and understanding friend whose confidence was more precious to me than the riches of Araby." Following Dr. Parrott's death, the State Board of Health assembled in Raleigh on November 10, 1934, and unanimously elected Dr. Carl V. Reynolds, who at that time was serving as President of the Board, to the position of State Health Officer and Secretary and Treasurer of the State Board of Health. Dr. Reynolds immediately accepted and assumed his duties at once. The following Editorial appeared in the Health Bulletin in January, 1935, concerning Dr. Reynolds and his 30 Twenty-Ninth Biennial Report work. It is herewith reproduced in order that this chronological record may be complete. "Doctor Carl Vernon Reynolds, of Asheville, on November 10, took the oath of office and immediately assumed his duties as Acting State Health Officer, succeeding Dr. James M. Parrott, who died November 7. Doctor Reynolds was unanimously elected to the position by his fellow members on the Board. "Doctor Reynolds is a native of Asheville. His father was a suc-cessful Asheville physician who died when Doctor Reynolds was only three years old. Doctor Reynolds obtained his literary education in the private schools of Asheville and Wofford College, Spartanburg, South Carolina. He received his medical education at the college of the City of New York, graduating in medicine there in 1895. After his graduation he took a postgraduate course in London, England. Doc-tor Reynolds located in Asheville for the practice of medicine, special-izing in pulmonary tuberculosis. His skill in combating that disease has been widely recognized by the medical profession. An example of their confidence was his election as president of the North Carolina Medical Society, in which place he served with distinction in 1920. "On beginning practice he at once became interested in health work. His first connection was with the city health department in 1896. Following that period, for more than twenty years he served as city health officer of Asheville, in which capacity he rendered his city and the whole state important and permanent service. Some of his contributions to public health may be cited, as follows: "He organized the first crusade against the common housefly ever undertaken anywhere. "He assisted in drafting the first milk ordinance for Asheville. "He secured progressive sanitary laws. "He put through the compulsory vaccination law requisite to school attendance. "He secured the adoption of a bread-wrapping ordinance and one requiring the tuberculin testing of cows. "He saw typhoid fever drop from an average of two hundred and seventy cases a year in the city of Asheville to about five while he was city health officer, and saw smallpox practically eliminated. "We enumerate these things so that the people of the state may know they have a well-trained health officer at the head of the State Health Department—one fully worthy of confidence and support." The general routine work of the State Board of Health during this year was satisfactory and successful in every way. Dr. D. F. Milam, who had been loaned to the State Board of Health by the International Health Board and who had been acting as State Epidemiologist, was transferred to other fields and on the first of July Dr. J. C. Knox, who had been Assistant in the Division of Epidemiology, became State Epidemiologist. Dr. M. V. Ziegler, of the United States Public Health Service, who who had also been loaned by that organization as a consultant in the Division of County Health work and who had been Acting Director of that Division, was transferred back to Washington about the first of September. Dr. R. E. Pox, who had completed a postgraduate course North Carolina Board of Health 31 in the Public Health School of Harvard University, was made Direc-tor of the Division of County Health Work. Dr. R. T. Stimpson, who had also successfully completed a post-graduate course in the School of Public Health of Johns Hopkins University, and who had been acting as Assistant in the Department of Vital Statistics, was made Director of that Division. On November 10, at the time Dr. Reynolds was elected State Health Officer, Dr. G. M. Cooper was elected Assistant State Health Officer. Dr. Reynolds, of course, had to resign from his place on the Board in order to accept the office of State Health Officer. To succeed him as President. Dr. S. D. Craig of Winston-Salem was elected to that position. Dr. J. N. Johnson of Goldsboro, dental member of the Board of Health, was elected to the place of Vice President of the Board. The law provides that in case of a vacancy occurring on the State Board of Health among the membership elected by the State Medical Society, that the Executive Committee of the Medical Society of the State of North Carolina shall have the authority to appoint a succes-sor to serve until the next ensuing meeting of the State Society. In this case, the vacancy coming so close to the annual meeting of the State Society and the Board of Health on the following May 1 and there being no regularly scheduled meeting of the Executive Com-mittee of the State Medical Society, it was decided to defer the election of a successor to Dr. Reynolds to the meeting of the Society the fol-lowing May 1. 1935. Dr. Carl V. Reynolds served as Acting State Health Officer, the Gov-ernor having deferred the approval of his election the previous No-vember 10, 1934, but at the annual meeting of the State Board of Health, which was held in Pinehurst May 7, 1935, Dr. Reynolds was unanimously elected State Health Officer. His election was for a full four-year term to begin on the first of July following. The Governor immediately approved the election of Dr. Reynolds to be State Health Officer for the full term as stated. At the meeting of the conjoint session at Pinehurst on Wednesday, May 8, Dr. Grady G. Dixon was reelected to succeed himself to mem-bership on the State Board of Health for a term of four years. Dr. J. LaBruce Ward of Asheville was elected for the four-year term to succeed Dr. Carl V. Reynolds, resigned. In this year an important development in public health work was the experimental course put on in the school year of 1934-1935 at the University of North Carolina, under the auspices of the Public Health Administration, of a course of instruction designed to prepare physi-cians for positions as health officers. The courses in this school met with such success, plans were perfected to enlarge the scope of this new school as a part of the Medical School at the University. A fuller description of the inauguration of this school will be found under the records for 1936. During this year following the enactment of the National Social Security law, plans were worked out for an expansion of the work of all the divisions of the State Board of Health, through financial aid coming through the Children's Bureau and the United States Public 32 Twenty-Ninth Biennial Report Health Service at Washiiigton. It was a year which noted much activity in public health work all throughout the state, and the per-fection of plans, state and local, for extending health department activities. A Division of Industrial Hygiene was tentatively established in September of this year. The organization of this division resulted from an amendment to the Compensation Laws of the state by the 1935 General Assembly. This legislation made disablement or death by occupational disease interpretable as an injury by accident and thus compensable. For the execution of this legislation a sum of $10,000 was appropriated by the Legislature. The Industrial Commission ap-preciating that a problem of preventive medicine was involved, en-gaged in a series of conferences with the State Board of Health and Officers of the United States Public Health Service. The discussions culminated in the $10,000 appropriated for the administration of the occupational disease legislation being placed at the disposal of the State Health Officer. With this money, an Industrial Hygiene program was inaugurated as an activity of the State Board of Health. This arrangement was made with the understanding that the work would be subsidized by the United States Public Health Service when Social Security funds should become available. To begin the work of this division and to prepare the program for enlargement to its full scope, Dr. H. F. Easom of the State Sanatorium for Tuberculosis Medical Staff was selected as the Director of the division. Mr. M. F, Trice, formerly of the Division of Sanitary Engineering of the State Board of Health, was made Engineer of this new division. 1936. What may be termed the outstanding event of importance for the first half of this calendar year covered in the period of this report may be said to be the definite establishment of the new public health depart-ment at the University of North Carolina and the selection of Dr. Milton J. Rosenau as its director. This new department, of course, is an integral part of the School of Medicine of the University of North Carolina. The March issue of the Health Bulletin published the fol-lowing descriptive news item of the inauguration of this department: "The most important development in public health circles in many years for this section of the South is the establishment at Chapel Hill of a department of public health in connection with the School of Medicine, and the selection of Dr. Milton J. Rosenau as its direc-tor. This development has been made possible by the coordination of the staffs of the faculties of the North Carolina State Board of Health and the schools of medicine and engineering of the University of North Carolina. "The new department, while an integral part of the University School of Medicine with Dr. C. S. Mangum, Dean, will be under the personal direction of Dr. Rosenau. Dr. Rosenau is generally regarded as America's foremost authority on public health. His books on preventive medicine are used everywhere as standard textbooks in all schools of public health. Until his retirement recently from that fac-ulty he had been head of the famous Harvard School of Public Health for many years. North Cakolina Bo.mid of Health 33 "For a long time the officials of the State Board of Health have worked hard to secure the establishment of such a school. The necessity for it has been apparent to all responsible health workers. The chief credit for success in launching the enterprise should go to Dr. Charles S. Mangum, Dean of the University Medical School, and to Dr. Carl V. Reynolds, State Health Officer. Both of these officials have worked hard and cooperated with each other in overcoming all difficulties in the way of the establishment of the new department. "In the opinion of Drs. Mangum and Reynolds the development was in part made possible by the success of the course put on in the school year of 1934 and 1935 at the University under the auspices of the School of Public Administration. The first course put on with the teaching aid of the Schools of Medicine and Engineering of the University and members of the staff of the State Board of Health comprised a course of instruction for physicians in public health administration and extended over a period of twelve weeks. The work was so excellently done that they received recognition from the United States Public Health Service which assigned several of Its applicants for postgraduate work to take the second course. "We hope and believe that this enterprise under Dr. Rosenau's direction will expand into one of the most important departments of public health education in the entire country. The need for special training for physicians who want to enter public health work is great. Efficient public health departments, National, State and local in modern conditions of living are an absolute necessity. There are large numbers of young physicians who with proper postgraduate training could make excellent health officers. "The success of the new department at Chapel Hill will go a long way toward establishing an efficient system of public health work on a sound basis throughout the entire southeastern section of the country." On February 1 of this year, funds from the Social Security Act became available to the State Board of Health through the Public Health Service and the Children's Bureau at "Washington. In addi-tion to adding a division of field training of public health nursing in. connection with the new department of public health at the State Uni-versity, a department of Public Health Dentistry was also established in connection with the Public Health School at Chapel Hill. This is said to be the first school of like character in the country. The County Health Department was enabled through the Social Security subsidy from Washington to aid all the whole time county health departments in an expansion of their work. The Division of Preventive Medicine employed Mrs. J. Henry Highsmith to begin work on February 20 as an Assistant in the field of health education. The work of this division, of course, took on enlarged activities. Plans were immediately set in motion to establish special county nurses in counties having no whole time health organization as special demonstration service for such counties. Plans were also launched to establish Maternity and Infancy Centers in many sections of the state as Demonstration Centers, look- 34 Twenty-Ninth Biennial Report ing toward an eventual lowering of the infant and maternal death rates in this state. A sum of $17,500 of Social Security money was appropriated by the United States Public Health Service for the Division of Industrial Hygiene. Dr. M. T. Plyler was employed as an Assistant Medical Director in that division and Mr. C. R. Matbeson as a Medical Technician. Both of these men had been employed on the staff of the North Carolina Tuberculosis Sanatorium. Up to the first of July more than 150 plants involving siliceous dust hazards had been surveyed. The entire asbestos textile industry in the state involving five plants had been studied, in cooperation with the United States Public Health Service, a granite cutting establishment investigation made, and a foundry study inaugurated. There were 525 asbestos textile workers and 46 granite cutters examined during the investigatory work. In addition, preemployment examinations have been made of approxi-mately 400 workers. All persons examined have X-ray films made of their chests. During this w^ork nearly 300 atmospheric dust samples were analyzed. During the period, the physician and the engineer attended a four weeks' special course on Industrial Hygiene given by the Public Health Service in Washington. The division has installed a complete oflice equipment, as well as portable equipment necessary for successful execution of this important w^ork. The new division is housed in the basement of the State Board of Health Building. On April 1 of this year, the State Board of Health established a service for crippled children. This followed the approval in late March of the North Carolina Plan for Cripppled Children, prepared by the State Board of Health and submitted to the United States Chil-dren's Bureau. This plan was a prerequisite of the Children's Bureau toward participation by the state in the distribution of Social Security appropriations for this purpose. Dr. G. M. Cooper of the Division of Preventive Medicine was designated as Medical Director of this serv-ice, and Mr. J. T. Barnes was employed by the State Board as State Supervisor in charge of administrative duties of this service. An advisory committee representative of the Medical, Health, Welfare, and lay interest of the state in the problem of the crippled child was formulated to advise in the execution of this program. Prior to June 30, public clinics were arranged in various centers of the state under the direction of the State Board of Health. Cooperation had been arranged with the North Carolina Orthopedic Hospital and was being carried out satisfactorily. Under the provision of the Children's Bureau regulations, an advisory committee was secured by the Director of the Division of Preventive Medicine for the purpose of advising from time to time on the general program of maternal and child health service work. This committee held its first meeting on March 27 at the State Board of Health in Raleigh. Representatives from the following organizations were present: State Medical Society, State Dental Society, State Public Health Officers Association, State Nurses Association, State Federation of Women's Clubs, State Parent-Teacher Association. State Welfare Department, Division of Pediatrics and Obstetrics of North Carolina Board of Heajlth 35 the State Medical Society. On or before June 30, the enlarged program of all the divisions of the State Board of Health was well underway. 1937. There was no event of outstanding importance occurring in the year 1937. Few changes in the staff or the sub-staff of the State Board of Health have occurred. Following the expansion of service throughout the year 1936 with the aid of Social Security funds coming through the United States Children's Bureau and the United States Public Health Service at Washington, a tremendous amount of work was done during the entire year 1937 in expanding the work of the health department throughout the state, an increased number of nurses were employed, additional county health departments were estab-lished and more intensive efforts were made along all lines than in any previous year. The new School of Public Health Administration at the University of North Carolina under the direction of Dr. Milton J. Rosenau, aided materially by Dr. Carl V. Reynolds, State Health Officer, and the faculty of the Medical School of the State University, made substantial and satisfactory progress. An increasing number of sanitary engineers, sanitary inspectors, and health officers from this state and other states in the southeastern regional territory were trained at Chapel Hill. An Advisory Committee of leaders in different organizations in North Carolina, including such organizations as the State Medical and Dental Societies, Public Health Association, Parent-Teacher organi-zations. Women's Clubs, and the State Nurses Association, together with some independent members of the medical profession in the field of pediatrics and obstetrics and orthopedic surgery, was organized and held its first satisfactory meeting during this year. Dr. T. C. Woi-th joined the staff of the Division of Preventive Medicine on September 21, 1936, and served until April 15, 1937, in the capacity of assistant to Dr. Cooper. Dr. Worth aided materially in assisting in the organization of Maternity and Infancy Centers in some forty counties of the state and contributed a great deal toward strengthening the department work. Upon Dr. Worth's departure on April 15 to continue his postgraduate education in Boston. Dr. Roy Norton, who had been with the Division of County Health Work for about a year, and who was formerly health officer of Rocky Mount, succeeded Dr. Worth. Miss Mabel Patton, a qualified nurse, joined the staff of the Division of Preventive Medicine as a consultant nurse representing the Children's Bureau. Dr. W. J. Hughes, a colored physician whose services for work in the health education field in the Department of County Health Work was made possible through contribution by the Rosenwald Fund and who joined the staff on January 1, 1936, was able to achieve substantial progress in his work with the colored population of the state. This was the first time a colored physician had been admitted to membership on the sub-staff of the State Board of Health, and the results of work in 1936 and 1937 have fully justified his employment. Dr. R. L. Robinson joined the sub-staff of the Division of Industrial Hygiene on April 1, 1937, to succeed Dr. M. T. Plyler of that Division. Mr. W. H. Richardson, an experienced newspaperman who at one time was Secretary to Gov- 36 Twenty-Ninth Biennial Report ernor Morrison for his four years in the Governor's office, joined the Administrative Staff in the department exclusively conducted by the State Health Officer. Mr. Richardson has been a valuable addition to the staff and he has succeeded remarkably well in interpreting technical problems to the lay readers in hundreds of articles in the daily and weekly press of the state. Dr. G. M. Leiby, who had been Assistant District Health Officer in the Haywood-Jackson-Swain Dis-trict with headquarters at Bryson City, joined the sub-staff of the Department of Epidemiology in the fall of 1936 and after some field experience was sent to the Hopkins School of Public Health for a year's special studies in syphilology. Dr. F. S. Fellows of the United States Public Health Service was loaned to the State Board of Health as a consultant in the Department of Epidemiology in the field of venereal disease control. Miss Margaret Thompson, who holds a mas-ter's degree in home economics and nutrition work from the Uni-versity of Iowa, joined the sub-staff of the Division of Preventive Medicine in October, 1937. On March 15, 1937, Miss Frances R. Pratt, a specially trained nurse under the auspices of the State Maternal Health League, joined the sub-staff of the Division of Preventive Medicine. Miss Pratt's work was financed by an individual contribu-tion from an outside agency. Her work has been to organize through the medical profession and the local health officers on a voluntary basis a system of contraceptive control work when based on medical needs. Her work has been very successful and it has been a welcome and needed addition to the staff work. On December 16, 1937, following Legislative Provision in the 1937 session of the Legislature, $160,000 in bonds were sold for the pur-pose of building a new plant for the State Laboratory on the grounds adjacent to the present State Board of Health building on Caswell Square, Raleigh. A PWA grant of about $130,000 additional was received and work on the buildings was expected to be completed within the year 1938. A farm of 280 acres on the Raleigh-Cary paved highway was purchased and provision made for farm buildings to care for the animals used in the production of vaccines and serums. On December 17, a conference of Public Health Officers was called at Raleigh for the purpose of discussing and making decisions concern-ing various field work, jointly affecting the state and local health departments. This conference was so successful that it was voted to make it an annual affair. During the year a central general filing system was established and put into effect under the direct supervision of the State Health Officer and the Administrative Division of the Board of Health. This is proving to be a very satisfactory and progressive step. Malaria was made a reportable disease and a malaria inspection and control unit was established in the Department of Epidemiology July 1, 1937. Effective also in 1937 was the new plan of the Division of Vital Statistics with reference to the notification of birth registration certificates to parents. Instead of waiting for a parent to write to the department to inquire if the birth has been reported and to send 50c for certificate, the plan was adopted of sending to each parent whose North Carolina Board of Helvlth 37 baby's birth was reported properly a small neat certificate of the baby's birth. This was through an arrangement with the Bureau of the Census of the United States Government. Franking privilegese are allowed in this work. It simply informs parents that their babies' births have been properly recorded and the idea is through this method to reach many of those parents whose babies' birth have never been reported and get them to send in the reports. There were no changes in the membership of the State Board of Health this year. All members whose term expired were reelected by the State Medical Society or re-appointed by the Governor, for addi-tional four-year terms. The total expenditures for the State Board of Health during the fiscal year ending June 30, 1937, were $881,484.01. Of this amount $287,747.04 was appropriated by the Legislature, $191,943.85 was by the United States Children's Bureau, $312,210.42 by the United States Public Health Service, and finally $89,582.70 from fees received by the Laboratory in water taxes, etc., and other miscellaneous items. 1938. During 1938, the extension and consolidation of health work in all departments of the State Board of Health was further accomplished. This year two outstanding events may be recorded. First, the Zachary Smith Reynolds Foundation decided to donate its income from a fund of about seven million dollars to the State Board of Health to aid in a long time program of syphilis control. The initial donation from this fund by the oflScials of the foundation to Dr. Reynolds was a check of $100,000. This philanthropy will bring to realization one of the finest dreams of Dr. Carl V. Reynolds, State Health Officer. It promises to enable the State Board of Health to accomplish in the near future some of the objectives that have sometimes seemed to be long years off. A long time before the Government began to realize its responsibility in the prevention of disease and the preservation of the health of its citizens as a means of bringing about better social and economic conditions and the promotion of human happiness, philanthropists such as Rockefeller led the way. This gift of the Reynolds Foundation, however, affords the practical means of enabling the State Board of Health to organize in collaboration with the various city and county health departments of the state an effective system through which the venereal diseases may be eventually con-trolled in this state. The other event in the same connection was the passage by the United States Congress early in 1938 of a bill known as the La- Follette-Bulwinkle Bill, sponsored and carried through the lower House of the United States Congress by Representative A. L. Bul-winkle of Gastonia who has long represented his district in the lower House of Congress. Through the provision of this bill the state was able to receive during the year about $80,000 additional funds for work in syphilis control. The proceeds of these funds enable the State Board of Health to attack the ravages of syphilis even in the prenatal stages by treating syphilitic mothers early enough in preg-nancy to prevent the birth of hopelessly syphilitic babies. It is proba-bly a fact that the benefaction of the Smith Reynolds Foundation is 38 Twenty-Ninth Biennial Report the largest single gift for this particular purpose that has ever been made by any public or private organization in this country. The cause is not only a worthy but a pressing one. It takes money to control and eliminate such diseases as yellow fever, typhoid and syphilis. The School of Public Health Administration of the State University at Chapel Hill has made such material progress that it became nec-essary on the first of September this year to employ an additional full-time professor in that department. Dr. Roy Norton, who for the preceding fifteen months had been an assistant in the Division of Preventive Medicine where he has done excellent work, was per-suaded to accept the professorship. The State Board of Health reluc-tantly agreed to Dr. Norton's transfer in view of the fact that the School of Public Health Administration is of such far-reaching impor-tance that it should have the services of the very best available talent in the medical profession of North Carolina. Dr. Norton is admirably equipped for this important work. There are now five full-time pro-fessors in this division of the University. Under the persistent work of Dr. Reynolds a stationary exhibit has been erected in the large halls of the central building of the State Board of Health, at Raleigh, an exhibit which is an education in itself. It demonstrates the work of all the departments. Some of the state's foremost artists were called into the work and the officials of the National Youth Administration provided a great deal of the actual work at little cost to the State Board of Health. It would pay any citizen of North Carolina who is interested in the state's progress to visit this exhibit sometime during the year. With the exception of the loss of Dr. Norton, there have been few staff changes of importance. Dr. R. L. Robinson who came with the Industrial Hygiene Division as a field worker in April, resigned and returned to his home to engage in private practice on the first of August. Mr. C. D. King, Jr., an Industrial Hygiene man, came with the Board in the Industrial Hygiene Division on June 15 as an assistant to Mr. M. F. Trice. Dr. G. M. Leiby returned at the completion of his course in Johns Hopkins University and assumed his duties as field director of the syphilis control program. Dr. Fellows still remains with the Board and continues to render valuable assistance. The officials and employees of the Department of Preventive Medi-cine were saddened this year on account of the death of two veteran nurses. Miss Katharine Livingston died on May 26 and Mrs. Margaret Sloan died on July 12. Both of these nurses had rendered valuable service in this Division for many years. There were no expiration of terms of service of the membership of the State Board of Health this year, therefore no changes in per-sonnel occurred. In March, 1938, the Board received a report from a committee previously appointed to study pneumonia. The committee headed by Dr. H. B. Haywood of Raleigh as chairman. Dr. W. T. Rainey and G. G. Dixon from the Board, with Doctors Fred Hanes, C. T. Smith as consultants, and Dr. C. V. Reynolds, ex-officio, made a full report. Arrangements were made through Dr. Hanes of the Duke Medical NoKTH Carolina Board of Health 39 faculty for a special course to train local technicians which was largely attended. An important piece of field work which met with widespread appre-ciation throughout the State this year was a series of 34 health Institutes for teachers and principals of schools in as many places representing the State. Eight thousand teachers and principals attended these Institutes which were of a practical character. The Institute were conducted under the joint auspices of the State Board of Health, State Department of Public Instruction and the Extension Service of the North Carolina State College. The officials who executed this piece of work were Dr. Roy Norton and Mrs. H. P. Guffy, nurse, of the State Board of Health, Miss Mary Thomas, nutrition specialist of the State College Extension Service, Mr. H. A. Perry and Mr. Charles E. Spencer of the State Department of Public Instruction. This work was under the general supervision of Doctors Reynolds and Cooper of the State Board of Health, and it was carried out under the health education division of the Board, and Dr. J. Henry High-smith of the State Department of Public Instruction. The total expenditures for the State Board of Health for the fiscal year ending June 30, 1938, were $1,041,895.98. Of this amount $353,- 953.55 was appropriated by the Legislature, $226,297.57 by the United States Children's Bureau, $337,914.39 by the United States Public Health Service, and $123,730.47 from fees received by the Laboratory in water taxes, etc., and other miscellaneous items. Dr. Roy Norton, who for nearly two years had been assistant di-rector in the Division of Preventive Medicine, resigned to accept the position of Professor of Public Health Administration in the School of Public Health in the University of North Carolina. Dr. Norton's resignation was effective September 1. A successor to Dr. Norton was not appointed during the remainder of the year. Beginning with July 1 of this year, the following counties set up whole time health department organizations: Alamance, Alleghany, Ashe, Davie, Polk and Union. On September 1, Catawba, and Septem-ber 16, Cleveland. On November 1, Currituck became a member of the district health department with Dare and other counties. 1939. In the Division of Sanitary Engineering, John D. Faulkner returned to the department to resume his work after taking a year of public health engineering training at the University of Michigan. Mr. James P. Stowe of Charlotte, for many years a member of the State Board of Health, died on February 12. The Governor later appointed Mr. C. C. Fordham, Jr., a Greensboro druggist who promptly qualified as a member of the Board. During the year there were no other changes in the personnel of the Board. All members whose term expired were either reelected by the State Medical Society or reap-pointed by the Governor. On August 7, Dr. John S. Anderson was appointed as a member of the staff as consultant in public health administration in the Division of County Health Work. Dr. Anderson had previously served as county health officer in Craven and Cabarrus counties. On December 31, Miss Josephine Daniel resigned as consultant in 40 Twenty-Ninth Biennial Report public health nursing in the Division of County Health Work and accepted an appointment as director of public health nursing with the Oklahoma State Department of Health. On December 15, Dr. George M. Leiby, venereal disease consultant, resigned his position with the Division of Epidemiology to accept the position of director of venereal disease control in the City of Wash-ington, D. C. On June 13, Dr. H. F. Easom resigned as director of the Division of Industrial Hygiene to return to the North Carolina Sanatorium as clinic physician. He was succeeded effective October 15, by Dr. T. P. Vestal, a native of Randolph County, formerly a member of the Sanatorium clinical staff. During the year, construction work was started on the new central Laboratory on Caswell Square adjoining the administrative building of the State Board of Health. Also, construction work was begun on the buildings on the State Laboratory farm between Raleigh and Cary. In the Division of Preventive Medicine, Mrs. J. Henry Highsmith resigned her position as health educator, effective October 1. Mrs. Highsmith's resignation was very reluctantly accepted. Off and on Mrs. Highsmith had been connected with the State Board of Health for many years. She has rendered invaluable service in the health education work of the Board. In the early months of the calendar year of 1939, plans were ma-tured after two or three years' efforts, attended by frequent con-ferences of all concerned, by the State Health Officer and the State Superintendent of Public Instruction, for the establishment of a service through which the facilities of the State Department of Edu-cation and the State Board of Health for the execution of a unified health service in the public schools of the State might be further integrated. Inauguration of this plan was made possible by a supple-mentary grant of $50,000 by the Rockefeller Foundation and the General Education Board to be spent over a five year period, com-mencing July 1, 1939. The official designation of this organization is the North Carolina School Health Coordinating Service. The or-ganization as a whole consists of an Advisory Committee and a full-time operating staff. The Advisory Committee consists of five mem-bers: namely. Dr. J. Henry Highsmith, Dr. G. M. Cooper, Dr. C. F. Strosnider, Dr. R. J. Slay, and Dr. Oliver K. Cornwell. The operating staff consists of the following seven members: Dr. Walter Wilkins, Coordinator; Miss French Boyd, nutritionist; Mr. Charles E. Spencer, physical education; Miss Olive Brown, physical education; Miss Mac- Veigh Hutchinson, nurse; Dr. Walter Hughes, Negro physician; Mrs. Irma N. Henry, Negro health educator. In addition to these regular staff members several nurses from the Division of Preventive Medicine have been assigned to work with the organization for varying periods of time. Dr. John F. Kendrick was lent to the state by the Rockefeller Foundation to serve temporarily as administrative adviser to this school health coordinating unit. Preliminary plans involving the selection of trained personnel and numerous other organization North Carolina Board' of Health 41 preparations were undertaken during the months of July and August, 1939, and initial field operations commenced in Stanly County in September. In addition to Stanly, cooperative work was undertaken in Person, Orange, Chatham and Wayne counties during the year. This was the first full fiscal year in which the sum of $100,000 donated by the Zachary Smith Reynolds Foundation to aid the Board of Health in its syphilis control work was available. This initial donation of $100,000 in cash to the State Health Officer to be used without strings attached, represents one of the largest gifts ever received by the Board of Health. It has enabled the State Board of Health to put into effect many necessary requirements in the State-wide work of control of the spread of syphilis. This money has been used for the specific purpose for which it was allotted. It has been used to employ additional men and women who are experts in their field and for the training of other nurses and physicians to become experts in the work necessary to deal with this enormous problem. This trust fund has enabled the Board to extend its activities in almost every direction and to keep up the official work in such a manner as to make sure a long time successful program which will be necessary to reduce the prevalence of syphilis in this State to a minimum. The total expenditures for the State Board of Health for the fiscal year ending June 30, 1939, were $1,215,056.80. Of this amount $364,- 506.25 was appropriated by the Legislature, $232,993.80 by the United States Children's Bureau, $311,859.00 general and $51,829.11 venereal disease by the United States Public Health Service, $130,290.49 by the Zachary Smith Reynolds Foundation, and $123,578.15 from fees received by the Laboratory in water taxes, etc., and other mis-cellaneous items. In this year no changes in the personnel of the State Board of Health occurred. Every member continues to serve to the full extent of his ability, giving unstintedly of his time and efforts to the con-structive work of the State Board of Health. 1940. The most important item in the field of public health in this State in 1940 was the completion and dedication of the central building known as the Clarence A. ShoJ'e Laboratory of Hygiene. As stated before in this chronology, this new plant costing about $311,000 was made possible by the selling of revenue bonds and the allocation of a PWA grant and in the acquisition of funds from various sources. The total outlay of $311,000 represents the cost of the central plant on Caswell Square, completed and equipped, and the cost of the buildings on the Laboratory farm located six miles west of Raleigh. The Shore Memo-rial Building was dedicated with appropriate ceremonies on February 21, 1940. There were addresses by Governor Clyde R. Hoey, Dr. S. D. Craig, President of the State Board of Health, Dr. Carl V. Reynolds, State Health Officer, Mr. J. W. Kellog, assistant director of the State Laboratory of Hygiene, Dr. George M. Cooper, Assistant State Health Officer, and Dr. John A. Ferrell, Associate Director of the Inter-national Health Division of the Rockefeller Foundation. Dr. John H. Hamilton, Director of the Laboratory, presided over the exercises. Greetings from neighboring and friendly organizations and institu- 42 Twenty-Ninth Biennial Report tioiis were brought by Dr. M. J. Rosenau, Division of Public Health of the University of North Carolina, Dr. W. C. Davison, Dean of the Medical School of Duke University, Dr. W. deB. MacNider, Dean of the Medical School of the University of North Carolina, Dr. E. S. King, Professor of Preventive Medicine of Wake Forest College, Dr. Hubert B. Haywood, President-elect of the Medical Society of North Caro-lina, Mr. E. C. Derby, Resident Engineering Inspector of the Public Works Administration, Dr. M. V. Zeigler, Senior Surgeon of the United States Public Health Service, Washington, and Dr. John M. Saunders, Regional Medical Consultant of the Children's Bureau, Washington. The entire issue of the April, 1940, number of the Health Bulletin was devoted to the description of the dedication of the Shore Memorial Building. The issue was increased from the normal sixteen pages to a thirty-two page volume. The central Laboratory building consists of four stories and is modern in every detail. The State Laboratory of Hygiene farm con-sists of approximately 280 acres of which 100 acres is under cultiva-tion, the balance in woodland. The farm has a frontage of fifteen hundred and fifty feet on the great United States national highway number one. Both the Seaboard and Southern railways also front it. The buildings on the farm consist of the farm laboratory building, horses and sheep barns and buildings for the production of smallpox vaccine and other biologic products, as well as the buildings for the housing of small animals needed in this work. On April 1, John D. Faulkner was transferred from the Division of Sanitary Engineering to the Division of Epidemiology to have charge of rodent control work. John Andrews who had effectively headed the milk sanitation pro-gram in the Division of Sanitary Engineering resigned to accept an important position with the United States Public Health Service in Washington. R. F. Hill, Jr., finished his year of specialized training in sanitary and public health engineering at the University of North Carolina and returned to his duties with the Sanitary Engineering Division. Effective work has been carried on with the aid of the WPA and United States Public Health Service in the malaria control drainage and community sanitation. Milk sanitation was advanced with a marked increase in the number of pasteurization plants. With the assistance of the aforementioned organizations and the PWA, the installation of new public water systems was brought up to a total of 52 installed during a four-year period ending June 30, 1940. Improvements, additions and extensions were made to a great many of the water and sewerage systems of the state. In the Division of Vital Statistics, there was closer cooperation with the local health departments in an effort to be of mutual assist-ance in registration. Social Security benefits requiring proof of num-ber and age of dependents and necessitating the presentation of the birth and death certificates has increased the number of verifications and copies of the certificates issued by the division. There were no material changes in the division during the first half of 1940. North Carolina Boaed of Helalth 43 On March 1, 1940, Miss Amy L. Fisher succeeded to the vacancy left by Miss Daniel as a consultant nurse in the Division of County Health Work. Miss Fisher had been supervising nurse in the Dur-ham Health Department. Gates County joined the district to be com-posed of Hertford and Gates, the work to become effective July 1, 1940. In the Division of Industrial Hygiene, there was issued a profusely illustrated one hundred page printed report presenting the results of a study of effects of exposure to dust in the mining and milling of pyrophyllite, the field work for which was done during the previous biennium. One of the outstanding achievements of this division was the design of seven industrial exhaust ventilation systems for the control of dust. Three of these had already been completed by June 30 and the installation of the others was already underway. With the closure of the public schools for the summer holidays, preparations were made for health courses to be given thirty white and thirty colored teachers at the University of North Carolina and the North Carolina College for Negroes at Chapel Hill and Durham respectively. These courses covered a six weeks period ending approx-imately July 20, 1940, and were made possible by a grant of $4,700 by the General Education Board. While it would be premature to attempt an appraisal of what was accomplished by this organization during its first year of existence, it may be stated that educational and health personnel alike cooperated generously, that certain pro-cedures were found to be satisfactory while practical considerations necessitated the modification of others, and that progress was made toward the maturation of a generally accepted school health program. On January 1, 1940, Dr. Ralph J. Sykes assumed the duties of venereal disease consultant in the Department of E)pidemiology. Dr, Sykes had previously served for several years as county health oflacer first in Surry and later in Halifax. Dr. Frank S. Fellows, Surgeon with the United States Public Health Service who has been assigned to North Carolina for several years, continued to render valuable service in the capacity of venereal disease consultant. The main accomplishment in the Division of Epidemiology was the great expansion of venereal disease control progi'am. This was largely as a result of financial aid from the Zachary Smith Reynolds Foundation and the United States Public Health Service. In June, 1936, there were 120 clinics in operation. They treated 13,304 patients. In June, 1940, as a result of the aforementioned financial aid, the number of clinics have been increased to 255 in which 27,814 patients received treatment in a single month. The system of mechanical tabulation set up in a central tabulating unit under the direction of this division reached its full stride in the early months of 1940. A complete progress record is kept on every patient receiving treatment. The central tabulating unit renders valuable assistance to other divi-sions of the State Board of Health. The Manual of Minimum Standards for conducting venereal disease clinics prepared by Drs. Fellows and Leiby still continues to be very 44 Twenty-Ninth Bienniax Report helpful to physicians and nurses and others concerned with the conduct of venereal disease clinics. Financial aid was given through this department to all organized counties in the state. Fifty-one clinics were supplied with combination darkfield and general purpose micro-scopes and sixteen of the larger clinics were given fluoroscopes. On January 1, Dr. Emmett S. Lupton was employed as assistant director in the Division of Preventive Medicine. Dr. Lupton had just completed his internship in pediatrics at the Duke Hospital. In the Division of Preventive Medicine, organized maternal and child health clinics were being operated in 55 counties. An increasing number of infants and expectant mothers among the poorer classes were in attendance on these monthly clinics. A total of approximately 250 physicians were cooperating on a part-time basis at the close of the fiscal year, June 30. The circulation of the Health Bulletin increased from about 52,000 ito 60,000 monthly copies during the year. In the Division of Oral Hygiene, there were no material changes except some expansion and expenditures of additional funds in the work of that division, necessitating the employment of an additional number of dentists. At the beginning of the calendar year 1940, the question of adoption by the State Board of Health of a so-called merit system as required by some sections of the Federal Government at Washington loomed as an important item for consideration during the year. Early in Jan-uary it was required by the Children's Bureau that standards to form the basis of a merit system should be submitted before the alloca-tion of Children's Bureau funds for the winter quarter would be forthcoming. By the middle of January, therefore. Doctors G. M. Cooper and Emmett S. Lupton, working in consultation with Dr. Carl V. Reynolds, State Health Officer, worked out and submitted a seventeen-page typewritten document setting up standards acceptable to the State Board of Health. These standards with a few minor modifi-cations were immediately accepted by the Children's Bureau. Later in the winter the Regional Medical Consultant of the United States Children's Bureau spent several days in Raleigh discussing with Dr. Reynolds and the representatives of the Children's Bureau in the State Board of Health plans for further development of the merit system, the next requirement being setting up of a merit system council with a supervisor and submission of classification plans for all State Board of Health workers. At this time the State Health Officer appointed the Director of the Division of County Health Work to be the responsible official to work out further plans. At a meeting of the State Board of Health on November 29, 1940, that body considered a new draft of what it termed "A Rule for a Merit System of Personnel Administra-tion in North Carolina." Much discussion on the subject was indulged in by various members of the Board at this meeting. A suggestion of Dr. H. G. Baity, a member of the Board, at this time deserves particu-lar emphasis. Dr. Baity made the suggestion that a general statement be placed somewhere in the compensation plan to the effect that the "duties outlined for each position classified were not to be con- North Carolina Board of Health 45 sidered as comprising all the duties that might be required of the position and that such other duties as might be required by the State Health Officer or the Division Director would be included." Late in the year 1940, the war clouds over the world were gathering with such an ominous outlook that the United States Army, Navy and Public Health authorities were busy laying the groundwork for a mighty army and navy to defend the country. One of the first con-siderations by the United States Public Health Service and the North Carolina State Board of Health in the fall of this year was an effort to detect the presence of syphilis in as large a section of the popula-tion as possible, especially those liable for military service. On Octo-ber 16, 1940, which was registration day under the Selective Service Draft, the North Carolina State Board of Health utilizing the services available in its 265 venereal disease clinics then established in the State offered to take blood samples from all registrants on a voluntary basis. Consequently, 132,671 blood specimens were taken and examined. This accomplishment was one of the most widespread efforts ever made in the State up to that time to locate by serological examination the presence and distribution of syphilis in North Carolina. The Federal Government proposed to set up what they call a "Firing Area" in Pender and Onslow counties. It became necessary for the State Board of Health to insist on the organization first of a whole time health department in each of these two counties, neither one having ever had such department before. This was arranged on a joint financial basis between the counties and the State and Federal Gov-ernment, and a district health department was set up. The total expenditures for the State Board of Health for the fiscal year ending June 30, 1940, were $1,380,174.90. Of this amount $370,- 057.67 was appropriated by the Legislature, $162,813.81 by the Zachary Smith Reynolds Foundation for syphilis control work, $229,872.28 by the United States Children's Bureau, $318,148.38 general and $175,557.72 venere |