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W<rW9tV-i,W fl ^EVENTS BIENNIAL REPORT p* THE NORTH CAROLINA irE BOARD OF HEALTH JHiY , ;SHo- j\!>W Wy 1958 C&e Librae? of t|>e Onfoewtftp of sftottb Carolina Cnbotoea b? <H$t ^Dialectic rat P&tlant&roptc feociettr* Division Of HEALTH AFFAIRS LIBRARY TWENTY-SEVENTH BIENNIAL REPORT OF THE North Carolina State Board of Health JULY 1, 1936—JUNE 30, 1938 MEMBERS OF THE STATE BOARD OF HEALTH Elected by the North Carolina Medical Society S. D. Craig, M.D. Term expires 1941 G. G. Dixon, M.D. Term expires 1939 W. T. Rainey, M.D. Term expires 1941 John LaBruce Ward, M.D. Term expires 1939 Appointed by the Governor Hubert B. Haywood, M.D. Term expires 1941 H. Lee Large, M.D. Term expires 1939 J. N. Johnson, D.D.S. Term expires 1941 H. G. Baity, Ph.D. Term expires 1939 James P. Stowe, Ph.G. Term expires 1941 1395 LETTER OF TRANSMITTAL Raleigh, N. C, September 21, 1938 His Excellency, Clyde R. Hoey, Governor of North Carolina My Dear Sir:—Under Authority of Chapter 118, Article 1, Section 7050, Consolidated Statutes of North 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, 1936 to June 30, 1938. Yours sincerely, Carl V. Reynolds, Secretary and State Health Officer. TABLE OF CONTENTS Page The Chronological Development of Public Health Work in North Carolina 7 Report of the Secretary-Treasurer and State Health Officer 42 Informational Service Report 50 Syphilis and Its Control in North Carolina 51 Division of Preventive Medicine 62 Department for Crippled Children 70 Division of Sanitary Engineering 76 Division of Oral Hygiene 88 State Laboratory of Hygiene 90 Division of Epidemiology 102 Division of Vital Statistics 107 Division of County Health Work Ill Division of Industrial Hygiene 125 Annual Report North Carolina State Board of Health to Conjoint Session State Medical Society, year 1936 135 Annual Report North Carolina State Board of Health to Conjoint Session State Medical Society, year 1937 148 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 Gen-eral 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 begin-ning 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. Satchwell was first President of the Board. Other legislative provisions: (1) Chemical examination of water, and (2) organization of county boards of health, com-posed 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 educational pamphlets issued. Subjects: "Disinfection, Drainage, Drinking Water, and Disinfectants;" "Sanitary Engineering;" "Methods of Performing Post-mortem Examinations;" "Limitation and Prevention of Diphtheria." Annual appropriation, $200. 1881. General Assembly passed a law requiring regulation of vital statistics at annual tax listing; law ineffective. Annual appro-priation, $200. 1885. General Assembly made county boards of health more efficient; allowed printing privileges not to exceed $250 annually. An-nual 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. 8 Twenty-Seventh Biennial Report 1888. Yellow fever epidemic in Florida and refugees to Western North Carolina demonstrated value of a Board of Health to cope with situation. Annual appropriation, $2,000. 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 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 from five to six years. The $250 printing limit was removed. 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 bacteriolo-gists for the board. Annual appropriation, $2,000. 1896. Board passed a resolution requiring chemical and bacteriological examinations 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 superintend-ents of health to be elected by county commissioners and reduced term of office to one year. Annual appropriation $2,000. 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, con-sulting with and advising the local sanitary authorities as tc proper means for protecting the public. Annual appropriation $2,000. 1900. State Board of Agriculture, on request of State Board of Health, agreed to examine samples of water 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 commis-sioners and two physicians which commissioners elected to North Carolina Board of Health 9 serve with them. Term of office of county superintendent of health made two years. Annual appropriation, $2,000. 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 paying 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 prevalence of this disease in North Carolina. Annual appropriation, $2,000. 1904. A stenographer was employed. One hundred and twenty thou-sand pamphlets on tuberculosis were printed and distributed. There was a renewal and an extension of co-operative 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 appropria-tion, $2,000. 1905. General Assembly established State Laboratory of Hygiene; imposed water tax of $64 on all public water companies; voted $600 annually for the support of laboratory. Small appropria-tion 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 improvements 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 popu-lation 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 coun-ties 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. 10 Twenty-Seventh Biennial Report 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 Fed-eration of Women's Clubs, State Press Association, and Sani-tary Sunday observed in April. Dr. John A. Ferrell elected, February, Assistant Secretary for Hookworm Eradication; be-gan work under State Board of Health and Rockefeller Sani-tary 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. Bulle-tin 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 pamphlets for distribution. Hookworm work this year largely educational through the school forces and investigative through county dispensaries; thousands of children found infected and treated. Strong sentiment began to make itself felt for better health work by counties, four counties employing whole-time county health officers. Guil-ford 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 per-manent improvements. Annual appropriation $22,500. 1912. Bulletin increased to 40,000 edition; number of popular pam-phlets dealing with different diseases increased; press work improved; educational work of Board along all lines amplified. Secretary of Board of Health called attention of conjoint meet-ing of State Medical Society and State Board of Health to the relative importance of health problems and the bearing of this subject upon the proper apportionment of health funds; instru-mental in passing a resolution to the effect that pellagra was an interstate problem, not a State problem, and requesting the Federal Government to deal with pellagra as a Federal prob-lem; resolution responsible, to considerable extent, for success-ful effort on part of Hon. John M. Faison's securing Congres-sional appropriation of $45,000 for the study of pellagra by the Federal Government. Hookworm work extended and county funds appropriated to supplement State and Rocke- North Carolina Board of Health 11 feller Foundation for this work. Annual appropriation, S22.500. 1913. General Assembly passed Model Vital Statistics Law with SI 0.000 appropriation for its enforcement. County superinten-dent of health changed to either county physician or county health officer, depending 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 communi-ties; enacts legislation permitting county commissioners and towns and cities to appropriate money for support of tuber-culosis 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. Educational 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 Bureau of Rural Sanitation, with Dr. G. M. Cooper at its head, succeeds, 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. 12 Twenty-Seventh Biennial Report 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. Bulletin reached 51,000 edition. Co-operation 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 inspec-tion, 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 complete medical inspection of six counties and with inspection a large amount of educational work as to sanitary and hygienic living. Secured effort by Federal Chil-dren's Bureau to develop unit of child hygiene work, the Bureau using two employees to work in Cumberland and Swain counties for about eight months. Laboratory of Hygiene buys land and erects its own building. Annual appropriation, $55,500. 1917. The General Assembly passed the following important health legislation: Chapter 263, entitled "An act to prevent and control the occurrence 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 co-operative and effective development of rural sanitation"; Chapter 257, entitled "An act to prevent blindness in infancy, designating 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 machinery, 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 established. Dr. Wash-burn, 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 dif-ferent sections of the country and to establish for demonstra-tion purposes, in Edgecombe County, department of health on an economic basis easily within the financial reach of the average county. North Carolina Board of Health 13 The State Laboratory of Hygiene moved into its own build-ing, 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 satis-factorily 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 news-paper health article. The Bureau continued its moving picture show exhibit. Arrangements 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 permitted 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. 14 Twenty-Seventh Biennial Report 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 conferences with respect to prepared-ness measures, provisions for the control of venereal diseases, arrangements for co-ordinating the control of infectious dis-eases in the civilian population with their control in canton-ments, 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 medical service of the Army and Navy, and, later in the year, in inducing the physicians of the State to become members of the Volunteer Medical 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 Kin-youn's assistance; and as a result of the successful termination of the activities of various interests 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 work. 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 arrangement in the form of adenoid 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 quaran-tine law. Sufficient convictions were obtained to impress the people with the determination 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 appropriation, was established in September under the direc-torship 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 North Carolina Board of Health 15 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 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, col-lected $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 legislation: 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 in-junction 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 tuber-culosis 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 Michigan, was placed in charge of the new bureau, and his brother, Dr. K. E. Miller, of the United States Public Health Service, was de-tailed 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 mainte-nance of privies, and in preparing the necessary notices and literature to inform the people of the objects and requirements of the new privy law. 16 Twenty-Seventh Biennial Report On May 1 Dr. A. J. Warren, health officer of Rowan County, was appointed to and accepted the position of Assistant Sec-retary of the Board. About the first of the year, Miss Herring returned to the educational work of the Board. After a few months she returned to the Federal 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 Epidemiology, 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, and Governor Bickett appointed Dr. E. J.. Tucker of Roxboro for six years term—first dentist to serve on 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 reor-ganized under an understanding 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 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 contingent 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 succeed him. The typhoid campaign carried on during the summer through previous 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 counties: Bertie, Cabarrus, Chatham, Chowan, Columbus, Craven, Hertford, Iredell, John-ston, Lincoln, Onslow, Pasquotank, Perquimans, Randolph, North Carolina Board of Health 17 Richmond, Rockingham, Stanly, Union, Warren, Wayne. A total of 49,076 were given complete vaccination. The educational work of the Board consisted of the publi-cation 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 appropria-tions 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 certificate properly filed with the State Board of Health. On January 1 Dr. B. E. Washburn, who had had general direction of the co-operative county health work and who had rendered most acceptable service, was recalled by the Inter-national Health Board and 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 Edge-combe 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 co-operative 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 co-operation 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. A. W. 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 appointment of city health officer of Charlotte, N. C. 18 Twenty-Seventh Biennial Report In the winter and spring of 1920 the North Carolina Land-owners' Association, under the progressive leadership of Mr. W. A. McGirt, of Wilmington, undertook a very extensive educational campaign against malaria, which was 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 children 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 reasonable to believe that the cam-paign was one of the most successful public health educational attempts yet undertaken. In June it was found advisable to separate the Bureau of Epidemiology and the Bureau of Vital Statistics which had, on account of the scarcity of health officers, been placed under the dictatorship of a single bureau chief, Dr. F. M. Register. Dr. Register was appointed Director of the Bureau of Vital Statistics and Dr. J. S. Mitchener 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 with-drawn in September on account of differences 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 lectures 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. Co-operative cam-paigns, 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 North Carolina Board of Health 19 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 public health literature. The funds available during this fiscal year amounted to $342,284.33, of which $176,152.61 was State appropriation and the remainder 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 avail-able 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 amend-ment to the State-wide Privy Law was also enacted. A bill was introduced in this session of the General Assembly under the initiative of Hon. Emmet H. Bellamy requiring a physical examination of all applicants for marriage and making issu-ance 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. 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 par-ticipated financially. This new principle is fully described in the State Board of Health Bulletin 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 20 Twenty-Seventh Biennial Report at least one of the first attempts to introduce the cost system of industry into government. The Bureau of Venereal Diseases, in charge of Dr. Millard Knowlton, established as a part of the war-time activities of the Board in co-operation with the Bureau of Venereal Diseases of the Federal Government, 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 American 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 reorganized April 1 as the Bureau of Maternity and Infancy, for its maintenance the State receiving $27,259.66 annually from the United States Government in accordance with the Sheppard-Towner Act for the promotion of the wel-fare of mothers and infants. Dr. K. P. B. Bonner, of Morehead City, was secured as the director of the reorganized 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 tabula-tion for 1921. The appropriation for the State Laboratory of Hygiene for the nineteen months between December 1, 1920, and June 30, 1922, 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 independent board of directors for the State Sanatorium for Tuberculosis, 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 tuber-culosis convicts. Other legislation included the act to provide for the sanitary manufacture of bedding, the latter act to be North Carolina Board of Health 21 enforced by the State Board of Health. The Bureau of Epi-demiology 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. Mitchener 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 unexpired 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 International 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 Health 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 Officer, was invited by the Committee of Municipal Health Depart-ment 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 22 Twenty-Seventh Biennial Report of absence, but 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. Rankin assumed his duties and estab-lished official headquarters in New York City for the work of the committee. 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 M. Ehrenfeld also resigned. 1924. During this year Dr. Rankin continued his work with the American Public Health Association until November 1. Dur-ing 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 department 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 ^une 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 North Carolina Board of Health 23 Officer to fill the unexpired term of Dr. Rankin. Dr. Laughing-house accepted and took office October 1. Dr. G. M. Cooper, who had for sixteen months administered the work of the Board as Acting State Health Officer, continued with the service and was assigned to the Bureau of Health Education, succeeding Dr. M. L. Townsend, who resigned. On August 6 Dr. Richard H. Lewis died. Dr. Lewis had served as a member of the Board since 1885, and from 1892 to 1909 he served as Secretary of the Board. Since 1909 he had been a member of the executive committee. Dr. Lewis held his membership 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 estab-lished 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. Laughinghouse. 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 Char-lotte, 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 midwife classes in about thirty counties of the State.' The nurses gave special instruction to midwives in groups, and the county authorities enacted 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. 24 Twenty-Seventh Biennial Report 1929. With aid secured from the International Health Board, the Life Extension Division was added to the activities of the Board this year. Dr. Frederick R. Taylor, of High Point, was made director of this division. Dr. Taylor carried this work before the medical profession in all sections of the State. On January 1 Dr. Ernest A. Branch accepted the appoint-ment 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 educational demonstration work. Dr. Branch made contacts with several of the colleges of the State and training schools for teachers. Expenditures for the Board work this year reached the highest peak in the history of the Board, totalling about $486,000. There were no significant changes, other than those mentioned above, in personnel during this 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. Laugh-inghouse. On November 20 Dr. Cyrus Thompson, for many years a member of the Board, died. On December 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 Legislature 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 establishment 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 permanency of the policies of the Board, although shortening the terms of office North Carolina Board of Health 25 and making it impossible for the Board to become a self-perpetuating 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, and no member to serve more than two terms, making the total tenure of office of any member not to exceed eight years. 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 appointed 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 Health Officer, but it can only become effective upon the approval of the Governor. The term of the State Health Officer, along with members of the Board of Health, was restricted to four years, with the privilege of being re-elected one time. Following the adjournment of the Legislature, the Governor appointed the following named members: Drs. J. T. Burrus, High Point; H. Lee Large, Rocky Mount; J. N. Johnson, Golds-boro, the dental member; Professor H. G. Baity, of the University of North Carolina, and Mr. J. A. Goode. a druggist of 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, Kinston; 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 outgoing 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 membership on the Board before being elected to the position of State Health Officer, and under the provisions of the new law the executive committee 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 26 Twenty-Seventh Biennial Report 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 per-mitted to name a successor to serve only until the first meeting of the State Medical Society follows. 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 services of Dr. D. A. Dees and Mr. R. B. Wilson were dispensed with, effective July 1. The Board reorganized the staff and made many consolidations. The new reorganization follows: The Board reorganized the work into divisions, making many consolidations 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 Pre-ventive Medicine, Dr. G. M. Cooper; Director Division of Oral Hygiene, Dr. Ernest A. Branch. The division 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 ap-pointed 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 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 continued their service just as the Board was con-stituted 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 satisfactory results, although on account of reduced appropriations many activities carried on in previous years had to be curtailed or definitely eliminated. North Carolina Board of Health 27 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 teen 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 popu-lation, 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 lowest 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 depres-sion, and it is too early to record any opinion as to what effect unemployment 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 appro-priations. 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 Laboratory of Hygiene. He had built the work of the laboratory during these 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 Caro-lina may be attributed to his fine and wholesome 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 build-ings of the State Laboratory of Hygiene are hereinafter to be 28 Twenty-Seventh Biennial Report known as The Clarence A. Shore Laboratory, 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 Epidemiology, 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, however, 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 was re-elected 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 ap-pointed 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 scholarship 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 depression, the work of the State Board of Health held up fairly well. The 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. North Carolina Board of Health 29 The Legislature, meeting for an extended session following its opening in January, made drastic reductions in appro-priations to all State health work and reduced the salaries of all State health employees. 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 appro-priated 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 Officer 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 Officer 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 recurring 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 office. The following sketch concerning Dr. Parrott and his work, written by the Editor, was published in the Health Bulletin: "The death of Dr. James M. Parrott, State Health Officer 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 impossible and unbelievable to think that he is dead. Nearly thirty years ago I 'took' the State Board examination for license to practice medicine. 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 executive in charge. Although he came to the Board work without previous experience in an adminis- 30 Twenty-Seventh Biennial Report trative 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 advance-ment was his stand for the professionalization of public health work. "Before he had been here sixty days, he realized that all department 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 competently 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 everything 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 responsibility. 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 inten-tions 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 knowledge 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 North Carolina Board of Health 31 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 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. Par-rott, 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 successful 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. Doctor Reynolds located in Asheville for the practice of medicine, specializing 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 Ashe-ville. "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 confi-dence and support." 32 Twenty-Seventh Biennial Report 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. Zeigler, of the United States Public Health Service, 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. Fox, who had completed a postgraduate course in the Public Health School of Harvard University, was made Director of the Division of County Health Work. Dr. R. T. Stimpson, who had also successfully completed a postgraduate 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. John-son 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 successor 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 Committee 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 following May 1. 1935. Dr. Carl V. Reynolds served as Acting State Health Officer, the Governor having deferred the approval of his election the previous November 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 ap-proved the election of Dr. Reynolds to be State Health Officer for the full term as stated. North Carolina Board of Health 33 At the meeting of the conjoint session at Pinehurst on Wednesday, May 8, Dr. Grady G. Dixon was re-elected to succeed himself to membership 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 physicians 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 Health Service at Washington. It was a year which noted much activity in public health work all throughout the State, and the perfection 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 appreciating that a problem of preventive medicine was involved, engaged in a series of conferences with the State Board of Health and Officers of the United States Public Health Service. The dis-cussions 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 sub-sidized 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 enlarge-ment to its full scope, Dr. H. F. Eason 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. 34 Twenty-Seventh Biennial Report 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 department 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 following 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 director. This development has been made possible by the co-ordination 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 Uni-versity 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 faculty he had been head of the famous Harvard School of Public Health for many years. "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 enter-prise should go to Dr. Charles S. Mangum, Dean of the Uni-versity 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 develop-ment 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 post-graduate work to take the second course. "We hope and believe that this enterprise under Dr. Rose-nau's direction will expand into one of the most importanl North Carolina Board of Health 35 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 depart-ments, National, State and local in modern conditions of living are an absolute necessity. There are large numbers of young physicians who with proper post-graduate 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 south-eastern 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 Wash-ington. In addition to adding a division of field training of public health nursing in connection with the new department of public health at the State University, 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 demon-stration Centers, looking 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. Matheson as a Medical Technician. Both of these men had been employed on the staff of the North Carolina Tuberculosis San-atorium. 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, pre-employment examinations have been made of approximately 400 workers. All persons examined have X-ray films made of their chests. During this work nearly 300 atmospheric dust samples were analyzed. 36 Twenty-Seventh Biennial Report 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 in-stalled a complete office equipment, as well as portable equip-ment necessary for successful execution of this important work. 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 Crippled Children, prepared by the State Board of Health and submitted to the United States Children'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 pur-pose. Dr. G. M. Cooper of the Division of Preventive Medicine was designated as Medical Director of this service, and Mr. J. T. Barnes was employed by the State Board as State Super-visor in charge of administrative duties of this service. An ad-visory committee representative of the Medical, Health, Wel-fare, and lay interest of the State in the problem of the crip-pled 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 meet-ing on March 27 at the State Board of Health in Raleigh. Representatives from the following organizations were pres-ent: State Medical Society, State Dental Society, State Public Health Officers Association, State Nurses Association, State Federation of Women's Clubs, State Parent-Teacher Associa-tion, State Welfare Department, Division of Pediatrics and Obstetrics of 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 ex-pansion of service throughout the year 1936 with the aid of Social Security funds coming through the United States Chil-dren'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 North Carolina Board of Health 37 were established 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 Doctor 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, Par-ent- Teacher organizations, Women's Clubs, and the State Nurses Association, together with some independent members of the medical profession in the field of pediatrics and obstet-rics and orthopedic surgery, was organized and held its first satisfactory meeting during this year. Dr. T. C. Worth 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 Rosen-wald Fund and who joined the staff on January 1, 1936, was able to achieve substantial progress in his work with the col-ored 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 Governor 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- 38 Twenty-Seventh Biennial Report Jackson-Swain District 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 master's degree in home economics and nutrition work from the University of Iowa, joined the sub-staff of the Divi-sion 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 contribution from an out-side agency. Her work has been to organize through the medi-cal 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 purpose 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 pur-chased 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 concerning 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 estab-lished 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 inspec-tion 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 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. Frank- North Carolina Board of Health 39 ing privileges are allowed in this work. It simply informs par-ents 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 re-elected by the State Medical Society or re-appointed by the Governor, for additional 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. 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 re-corded. First, the Zachary Smith Reynolds Foundation decided to donate its income from a fund of about seven million dol-lars to the State Board of Health to aid in a long time program of syphilis control. The initial donation from this fund by the officials 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 Govern-ment 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 lead the way. This gift of the Reynolds Foun-dation, 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 controlled 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 LaFollette-Bulwinkle Bill, sponsored and carried through the lower House of the United States Congress by Represen-tative A. L. Bulwinkle of Gastonia who has long represented his district in the lower House of Congress. Through the pro-vision of this bill the State was able to receive during the year about $80,000 additional funds for work in syphilis con-trol. 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- 40 Twenty-Seventh Biennial Report nancy to prevent the birth of hopelessly syphilitic babies. It is probably a fact that the benefaction of the Smith Reynolds Foundation is 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 necessary 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 persuaded to accept the profes-sorship. The State Board of Health reluctantly 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 avail-able talent in the medical profession of North Carolina. Dr. Norton is admirably equipped for this important work. There are now five full-time professors 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 John 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 Medicine 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. North Carolina Board of Health 41 There were no expiration of terms of service of the mem-bership of the State Board of Health this year, therefore no changes in personnel occurred. In March, 1938, the Board received a report from a com-mittee previously appointed to study pneumonia. The com-mittee 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 faculty for a special course to train local technicians which was largely attended. An important piece of field work which met with wide-spread appreciation 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 thou-sand teachers and principals attended these Institutes which were of a practical character. The Institutes 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, nutri-tion specialist of the State College Extension Service, Mr. H. A. Perry and Mr. Charles E. Spencer of the State Depart-ment 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 edu-cation division of the Board, and Dr. J. Henry Highsmith 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. A detailed account of the organization work of each one of the divisions covering the activities of this biennium will be found in the pages to follow. REPORT OF THE SECRETARY-TREASURER AND STATE HEALTH OFFICER July 1, 1936—June 30, 1938 By Carl V. Reynolds, M.D. Excerpts of the activities as recorded in Minutes: At the quarterly meeting of the Board, September 24, 1936, the "Notification of Birth Registration" which was passed on at the last Board meeting was discussed. Motion was passed "that under Dr. R. T. Stimpson's, Special Agent, signature, the Board be identified by the words "North Carolina State Board of Health." The Secretary discussed requirements of sanitary rules and regu-lations as pertain to circuses, carnivals, and fairs. Also, according to request of Mr. R. G. Deyton, Assistant Director of the Budget, a motion was passed to transmit a letter to Mr. Deyton confirming specific rules and regulations concerning sanitation of the State Fair. The Board adopted a resolution to approve the textbook, "Alcohol and the Habit Forming Drugs" by Grant L. Donnelly, relating to the effects of alcohol and narcotics on the human system. This is a text-book to be used in the public schools. A motion was passed at this meeting that shellfish dealers be required to meet requirements of the Division of Sanitary Engineer-ing. Also that oysters of Grade A be washed before shucked. Other discussions were made regarding activities of the maternity and infancy program centers as a demonstrative piece of work; a course in public health dentistry; plan and set-up of mouth health teaching in the schools of North Carolina, as well as activities of the various divisions of the State Board of Health. On January 26, 1937, the Board met in regular quarterly session. Again, the "Notification of Birth Registration" blanks were discussed and the Secretary informed the Board that we could not invalidate the franking privilege, hence it was necessary to insert the wording "The State Board of Health, Raleigh, North Carolina." Consequently, motion was adopted to accept the above in lieu of the rule made at the September 24, 1936 meeting. At this meeting the Board adopted a regulation that local health officers may "degrade" any cafe or hotel when inspection shows that same should be "degraded," and when future inspection showed that the Grade of said cafe or hotel should be "re-instated," not higher than the Grade removed, that the Health Officer should be authorized so to do. The Secretary discussed the feasibility of withdrawing funds from county health departments that persisted in not complying with county contracts, rules and regulations of the State Board of Health. The general consensus was that this was a very good idea, and that not only the health officer should be notified but that the Chairman of the North Carolina Board of Health 43 County Board of Commissioners also should be advised of the with-drawal of funds when such action was necessary. A report of the work being done by Dr. G. M. Leiby, who has been connected with the Board of Health since October 1, 1936, was dis-cussed. Doctor Leiby is doing full-time work in the venereal disease program, giving illustrated lectures in clubs, schools, and public meetings. Dr. J. C. Knox, Director of the Division of Epidemiology, who is also Chairman of the Committee on Venereal Disease Control, gave a full report of the meeting held in Raleigh on December 14, 1936. He made also a report on the visit of Dr. W. F. Snow of the American Social Hygiene Association to this State. Motion was passed to send a copy of the "Suggestions for Changes and Inclusions in Rules and Regulations for Venereal Disease" to all members of the Board in order that they might study the changes very carefully and take them up at the next Board meeting. Due to the fact that it is almost impossible to secure capable school dentists for only eight months of the year, the following resolution was adopted: "BE IT FURTHER RESOLVED, That no County Health Depart-ment shall receive a maximum of State or Federal Aid unless said County provides funds for a Mouth Health Program to be approved by the Division of Oral Hygiene. "BE IT FURTHER RESOLVED, That inasmuch as the State Board of Health is helping to defray the expense of the Mouth Health Pro-grams, a part of the Program in a County will be done during the summer, or when schools are closed, this time not to exceed four weeks of dental service in a twenty weeks' program, and that the Health Officer of the County will be requested and expected to coop-erate with this in view. It is understood that the same applies in all counties and, in such counties as do not have full-time health officers, that the County Superintendent of Schools will assist in carrying out our program." At this meeting, and in • compliance with Sections 7088(a) and 7089(a) of Public Health Laws, and since Hertford County has a whole-time county health officer, it was deemed wise that Hertford County should be consolidated for purposes of registration of births and deaths, and the whole-time health officer of Hertford County be made registrar of said county. This motion adopted. At this quarterly meeting a resolution was enacted that the Secre-tary of the Board confer with the Governor relative to preliminary organization, with power to act, regarding plans and outlines such as provided by State and Provincial Health Officers, and also The Disaster Committee on Sanitary Engineering Section of American Public Health Association. The annual meeting of the Board was held at Winston-Salem, N. C, May 5, 1937. At this time Dr. Carl V. Reynolds, Secretary and State Health Officer, submitted his annual report to the Board, also a paper on a special subject: "Syphilis and Its Control in North Caro-lina." The plan and methods of control set forth in the paper were unanimously approved by the members of the Society at the Conjoint Session. 44 Twenty-Seventh Biennial Report At this meeting a regulation was passed that "Board Policies for Allocation of Funds to Counties for Health Work" be referred to the Executive Committee, with power to act. The Secretary presented to the Board the advisability of securing the services of an "Informational Representative." The plan was approved and orders given that the services of such a publicity agent be secured. A motion was passed unanimously to adopt Rules and Regulations recommended by Doctor W. F. Snow of the American Social Hygiene Association, for the program on control of syphilis in North Carolina. The Secretary presented "Regulations Governing the Impounding and Maintenance of Impounded Waters in North Carolina" with par-ticular reference to malaria control, together with a letter from the Attorney General dated February 20, 1937, re: Public Health; control of preventable diseases; report relating to the authority of the Board to pass such regulations. At the May 5, 1937, Board meeting, malaria fever was made a reportable disease. A Committee was appointed to study pneumonia. The Board was informed that Dr. M. T. Plyler, Assistant to Doctor Easom in the Industrial Hygiene Division, was resigning with-out prejudice, and that Dr. R. L. Robinson would be appointed to take his place. There was a called Executive Committee meeting of the Board held June 2, 1937. An amendment was presented to request the allocation of a grant instead of a loan and grant to aid in financing the construc-tion of a new Central Laboratory Building and a Laboratory Farm for the State Laboratory of Hygiene. Also the possibility of securing a farm to be known as the "State Laboratory Farm" was discussed. The amendment to the Application to the U. S. Federal Emergency Admin-istration of Public Works was passed unanimously to finance the construction of a new plant for the State Laboratory of Hygiene. The Executive Committee also met with the Highway Commission in regard to a farm location. A motion was unanimously carried that the Chair-man and two members of the Commission be requested to investigate the proposal, with power to act. A regular quarterly meeting of the Board was held October 21, 1937. The Secretary informed the Board that a farm had been bought on the Cary Highway of about 270 acres for the amount of $8,500, this to be designated as the "State Laboratory of Hygiene Farm." He also discussed the bond issue of $160,000 but stated that the resolutions were not quite ready for approval. A delegation of the N. C. State Burial Association were present at this meeting and presented their plea for representation on the State Board of Embalmers in lieu of the nomination coming from the N. C. Funeral Directors Association. The Board decided that it was time to have a policy, not only for this group, but for any other that may come up from time to time. Hence, a motion was adopted that the Board, as a matter of policy, get away from accepting the recom-mendations of one man for appointment to the Embalming Board, or any Board. And, in lieu of one nomination, that the Secretary ask all North Carolina Board of Health 45 interested organizations to furnish the State Board of Health with a list of approved candidates, not to exceed five in number, which would be suitable to select a nominee from. A motion was enacted that the Secretary communicate with the North Carolina Funeral Directors and the North Carolina Burial Association, informing them of the new policy of the Board and request them to submit names of five candidates for the State Board of Health's approval. In addition, the Executive Committee was given authority to select one man for the next appointment. After much discussion regarding the short lunch hour allotted to school children; the alarming increase in degenerative diseases among the present generation, and the acknowledgment that these degenera-tive diseases come on, more or less, on account of irregularity in eating habits, that the school children need much longer time for lunch period. A motion was adopted that the Secretary take the mat-ter up with Superintendent Clyde A. Erwin and Dr. J. Henry High-smith, and report back to the Board. At this meeting the Board approved the Sanitary Rules Governing Barbers and Barber Shops and Barber Schools and Colleges in the State of North Carolina. The Secretary of the Barber Board was so advised. The State Board of Health assumes no responsibility for the enforcement of these rules and regulations. At the October 21, 1937 meeting, Board Policies as to allocations of funds to the various whole-time County Health Departments were presented. A motion was adopted to the effect that the changes in Board policies in appropriating funds for County Aid be made from a percentage basis to the dollar basis as outlined. Doctor Large wished to be recorded as opposing the change from percentage basis to dollar basis for County Aid. By special request, Franklin County was allocated $1,260 instead of the present maximum allotment of $1,152, but this appropriation was to be kept in effect only through this fiscal year. At this meeting the Board discussed mileage allowance for em-ployees in local health units and the following mileage allowance was enacted: "$50.00 per month travel allowance will be paid provided there is as much as 800 miles travel per month, average for the year. Travel less than 800 miles per month will be paid for at the rate of 6c per mile." At the October 21, 1937 meeting, permission was asked to allow the blind to have a stand within the Health Building for the sale of soft drinks, etc. Motion was unanimously passed that this would be an improper use of the Building and declined the request. Upon petition from the County Board of Commissioners, the whole-time health officer, and the County Board of Health, motion was made, and carried unanimously, that Edgecombe County be consolidated as to a vital statistics registration district, and that the whole-time health officer of Edgecombe County be made registrar for said county. At this meeting the following committee was appointed to study pneumonia:—Dr. Hubert B. Haywood, Chmn.; Dr. W. T. Rainey; Dr. 46 Twenty-Seventh Biennial Report G. G. Dixon. Consultants, Dr. Fred Hanes, Prof, of Medicine, Duke University, Durham; Dr. C. T. Smith, Park View Hospital, Rocky Mount, and Dr. Carl V. Reynolds, ex-omcio. A special called meeting of the Board of Health was held December 16, 1937, to consider and adopt proposals of the bonds for revenue for the construction of the State Laboratory of Hygiene which were offered for sale by the State Treasurer at 12:00 o'clock noon, Decem-ber 16, 1937. The firm of Lewis & Hall were the successful purchasers. Amount of bid was $160,017.00; rate of interest 4% %. The resolution was adopted unanimously. Also the Secretary read a resolution which was an opinion, dated June 7, 1937, from the Attorney General, A. A. F. Seawell, authorizing the State Board of Health to purchase the farm and pay additional funds for legal services, taxes, etc., and that said purchase could be paid from the proceeds derived from the sale of State Laboratory Revenue bonds. Motion was made to adopt the resolution, which was seconded, and unanimously carried. At this meeting upon recommendation of the American Dental Association Vincent's infection was made a reportable disease. Again, at the December 16, 1937 meeting, the Secretary took up the matter of travel allowance for employees in local health units. There being quite a deal of dissatisfaction among the local health departments, the Board was asked to reconsider the motion passed at the October 21, 1936 meeting. It was deemed best to rescind the motion passed at the October meeting and in lieu thereof a new motion was made as follows:— that the depreciation of cars be made $25.00 per month and with an earned travel on each mile travelled at the rate of three cents per mile, not to exceed the amount budgeted within a given year. This motion was seconded and carried. Also at this meeting a copy of "A Standard Plan for Malaria Con-trol in North Carolina" was given to each member of the Board who was asked to read and write in expressing approval or disapproval. The Secretary gave a brief but confidential statement to the Board of the gift from the Z. Smith Reynolds Foundation, Inc., Winston- Salem, N. C, through its trustees, of $100,000 to the State of North Carolina, for the cure and control of syphilis, to be spent during the current year in specified districts. It is also intended that this Fund be used over a long period, possibly fifteen years, in order to aid in eradicating syphilis in North Carolina. It was moved and seconded that Dr. G. G. Dixon be asked to prepare resolutions of appreciation and thanks to the Reynolds Foundation on behalf of the N. C. State Board of Health for this generous gift for syphilis control. Motion carried unanimously. The regular quarterly meeting of the State Board of Health was held Thursday, March 17, 1938. The Secretary discussed with the Board the cooperation between the State Department of Public Instruction, the Extension Division of State College, and the State Board of Health for collaborating in a plan for school health supervision with the public school teachers of the State; and, reported that school institutes North Carolina Board of Health 47 are being conducted, beginning March 10th. Teachers are requested to attend the meeting; round table discussions are conducted by repre-sentatives of the above named departments, and, that this course of lectures now being carried on as experiments, it was hoped, eventually would become a forward step in the study of the prevention of disease and the preservation of health among the school population. A delegation from the N. C. Funeral Directors and Embalmers Association were heard in regard to a member of their Association being approved for a period of five years to the N. C. Funeral Direc-tors and Embalmers Association. The committee presented their views to the Board, stating that there was no ill-feeling entering into the controversy with the N. C. State Burial Association, (which had been heard at a previous meeting of the Board) but that the State Funeral Directors & Embalmers were a member of, and recognized by the National Association—that the Burial Association was an Association which pertains to insurance, etc. It was moved and seconded that the Board consider this matter in executive session, therefore the delega-tion from the Funeral Directors & Embalmers retired. Motion was made, seconded, and carried to rescind the original action of the Board taken October 21, 1937, and in lieu thereof the following motion was made, seconded, and carried: That the N. C. Funeral Directors and Embalmers Association suggest to the N. C. State Board of Health, at their May meeting, ten names from their membership from which the Board may select two men to be appointed to the Board of Elbalmers Association, the term of one to expire in 1942 and the other in 1943. Also motion was made and seconded to endorse the nominees of the N. C. Funeral Directors & Embalmers Association. After discussion, the motion tied and the President of the Board was called upon to cast a deciding ballot which carried the motion. At this meeting a motion was made that the Secretary make an effort, in the 1939 General Assembly, to eliminate from the statutes the provision that the members of the State Board of Examiners and Embalmers be approved by the N. C. State Board of Health. The motion was seconded, and carried unanimously. Dr. John H. Hamilton, Director of the Division of Laboratories, appeared before the Board and presented plans and specifications for the laboratory and barn to be erected on the farm of the State Labora-tory of Hygiene. He went into detail as to the approximate cost of all the buildings, such as small laboratory; horse barn, water supply, etc. A resolution was adopted that the Board adopt plans and specifications as submitted by Doctor Hamilton. It was at the March 17, 1938, meeting of the Board that the Secretary presented the agreement or resolution of the "Administra-tive Program of Venereal Disease Control and Agreement of Partici-pation for the North Carolina State Board of Health Operating in Cooperation with Local Health Departments, Through the Utilization of Funds Made Available by the Z. Smith Reynolds Foundation, Incorporated," and the "Administrative Program of Venereal Disease Control and Agreement of Participation for the North Carolina State 48 Twenty-Seventh Biennial Report Board of Health in Cooperation with Local Health Departments." These resolutions had been previously studied by the Board members, and after a few changes in both sets of resolutions, a motion was adopted to approve them with the corrections. Each member of the Board was presented with a copy of "Rules and Regulations Governing the Sanitation of Abattoirs" and with a copy of "Rules and Regulations Governing the Sanitation of Meat Markets," with the request that they read them carefully and send in their approval or disapproval of same. The pneumonia control activities and the technicians trained to type pneumonia, were discussed at length, and at the suggestion of Doctor Haywood, Chairman of the Commission for the Study and Control of Pneumonia, a motion was made that a special bulletin concerning Pneumonia, and the list of technicians be printed. The motion was amended by stating that a copy of this bulletin be supplied to each physician in the State. The motion was adopted. The quarterly meeting of the Board of Health was held at Pine-hurst, N. C, May 4, 1938. An addition was made to the Minutes of the March 17, 1938, meeting, to be inserted following the "Motion made by Doctor Large that the Board adopt plan sand specifications as submitted by Doctor Hamilton" as follows: Motion made that the Executive Committee be authorized to let contract after bids had been canvassed. The motion was seconded, and carried unanimously. Motion was made that the "Rules and Regulations Governing the Sanitation of Abattoirs" and "Rules and Regulations Governing the Sanitation of Meat Markets" be approved, v/ith the request that Doctor Reynolds and Mr. Booker look into the feasibility of the rat-proofing of these establishments. The motion was adopted. At the May 4, 1938 meeting the Board passed a motion unanimously to approve a letter to the Trustees of the Z. Smith Reynolds Founda-tion, Incorporated, written December 16, 1937. Following is copy: "To the Trustees of the Z. Smith Reynolds Foundation, Inc.: In the course of human events, we must often stand by, in the face of a deep but helpless concern, and see suffering, even death, harrass and strike down our fellow beings. Happily, we have advanced a long way in the direction of both preventive and curative medicine. But we are told that "earth hath its price for what earth gives us," meaning, in this connection, that the remedy is not always within the financial reach of those who need it and to whom it should be supplied. Great philanthropies have blazed the way for research, resulting in the discovery of preventive and curative methods; these philan-thropies stand out as beacon lights along the road of human endeavor. From the Z. Smith Reynolds Foundation. Incorporated, there has just been made available for the war on syphilis in North Carolina the sum of $100,000, to be administered through the State Board of Health. It is with sincere appreciation that the Directors of this Board give voice to our gratitude for this significant benefaction, which we do at this, a called meeting, held on the 16th day of December, 1937. With this money, we will be able to realize one of our fondest dreams. We wish to go on record as expressing not only the thanks North Carolina Board ov Health 49 of the State Board of Health, but also the gratitude of all the people of North Carolina—those afflicted with this terrible disease and those who, although they are free from it, would rid our Commonwealth of this social insecurity which will remain as long as it is prevalent. We, the committee named to tender you this expression, heartily concur in the above as reflecting the sentiment of the Board. Signed: Dr. G. G. Dixon, Chairman Dr. S. D. Craig, President Dr. J. N. Johnson, Vice-President Dr. Carl V. Reynolds, Sec-Treas. and State Health Officer." There was a special called meeting of the Board June 29, 1938, for the purpose of considering the offer of the United States (Federal Government through the PWA) to aid by way of grant in financing the construction of buildings for the State Laboratory of Hygiene. After detailed information, motion was made, seconded and carried unanimously that the State Board of Health accept the offer of the United States to the N. C. State Board of Health to aid by way of grant in financing the construction of buildings for the State Labora-tory of Hygiene. Motion was made, seconded and carried unanimously to appoint the following members on the "Building Committee": Dr. Hubert B. Haywood, Chairman; Dr. S. D. Craig, and Dr. H. G. Baity. The Laboratory of Hygiene's problem was presented to the Board at the June 29, 1938 meeting as to the question of specimen containers as to whether or not the Board would continue to distribute them free, or charge actual cost. The laboratory operates on a budget and the demand is so great, and there is such a waste in containers, etc. for specimen, and with the increased volume of business and expendi-tures, the Laboratory needed an increase in receipts, or an increased budget. Motion was made, seconded, and carried unanimously, that beginning July 1, 1938, the State Laboratory of Hygiene charge cost for all specimen containers. The Secretary presented to the Board, at this meeting, a concise summary of the venereal disease control program in the State under the Z. Smith Reynolds Foundation Fund to date. Also a report as to the status of the Federal allotment to be used for venereal disease control. INFORMATIONAL SERVICE REPORT Through the office of the Informational Representative, who assumed his duties on May 1, 1937, routine news releases, feature articles and other information are given out for publication, each such article being sent to every newspaper in North Carolina, except in cases where the material was worked up at the special request of some individual newspaper or news-gatherer. Before any article is released for publication, it is carefully checked for accuracy and to elimin