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TWENTY-SECOND BIENNIAL REPORT
OF THE
NORTH CAROLINA
STATE BOARD OF HEALTH
JULY 1, 1926 - JUNE 30, 1928
Members of the State Board of Health
Elected by the North Carolina Medical Society
Cyrus Thompson, M.D.
Term Expires 1931
D. A. Stanton, M.D.
Term Expires 1931
L. E. McDaniel, M.D.
Term Expires 1935
Thomas E. Anderson, M.D.
Term Expires 1935
Appointed by the Governor
John B. Wright, M.D.
Term Expires 1931
E. J. Tucker, D.D.S.
Term Expires 1931
James P. Stowe, Ph.G.
Term Expires 1933
Chas. C. Orr, M.D.
Term Expires 1935
A. J. Crowell, M.D.
Term Expires 1935
Letter of Transmittal
Raleigh, N. C, December 1, 1928.
His Excellency, A. W. McLean,
Governor of North Carolina.
My Dear Sir:—Under authority of chapter 118, Ai'ticle 1, section 7050,
Consolidated Statutes of North Carolina, I have the honor to submit the
Biennial Report of the State Board of Health for the period July 1, 1926,
to June 30, 1928.
Very respectfully yours,
Chas. O'H. Laughinghouse,
Secretary and Treasurer.
Public Health Work in North Carolina
In the seventies Dr. Thomas Fanning Wood, of Wilmington, caught the
vision of the possibilities of public health work to North Carolina. How
fully he grasped the far-reaching consequences of his idea, how clearly he
saw the ever-growing hosts of lives saved as a result of his vision and
inspiration, we shall never know. We do know that the vision never left
him, and that under its sway he worked, through the Medical Journal
which he edited and through the North Carolina State Medical Society,
until his influence reached the people of the State in their General As-sembly
of 1877, with the eff'ect that on February 12, 1877, the North Caro-lina
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. Consisted in the beginning of entire State Medical
Society. Society acted through a committee. Annual appropri-ation,
$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 fii-st Secretary of the Board, May 21.
Other legislative provisions: (1) Chemical examination of water,
and (2) organization of county boards of health, composed of all
regular practicing physicians and, in addition, the mayor of the
county town, the chairman of the board of county commissioners,
and the county surveyor. Four educational pamphlets issued.
Subjects: "Disinfection, Drainage, Drinking-water, and Disin-fectants;"
"Sanitary Engineering;" "Methods of Performing Post-mortem
Examinations;" "Limitation and Prevention of Diph-theria."
Annual appropriation, $200.
1881. General Assembly passed a law requiring registration 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. Annual
appropriation, $2,000.
1886. Bulletin made its appearance in April. Pamphlet on "Care Eyes and
Ears," by Dr. Richard H. Lewis, printed and distributed. Subse-quent
Legislature provided for extra edition of 10,000 copies for
general distribution. Annual appropriation, $2,000.
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.
8 North Carolina Board of Health
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 con-tagious
diseases, (2) the protection of school children from epi-demics,
(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 reduced
from five to two years. The $250 printing limit was removed.
Pamphlet on quarantine and disinfection was prepared and re-printed
by many of the State papers. Annual appropriation,
$2,000.
1894. A number of public health conferences were arranged and held in
difl!"erent towns of the State. Bulletin was increased from a mail-ing
list of 800 to 1,200. Annual appropriation, $2,000.
1895. Dr. Albert Anderson and Dr. W. T. Pate were elected bacteriologists
for the board. Annual 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 superintendents of
health to be elected by county commissioners, and reduced term
of ofi'ice to one year. Annual appropriation, $2,000.
1899. General Assembly improved the laws protecting public water sup-plies.
Smallpox prevailed extensively in the State. Dr. Henry F.
Long, and later, on Dr. Long's resignation. Dr. Joshua Tayloe
were employed to travel over the State, consulting with and
advising the local sanitary authorities as to proper means for
protecting the public. Annual 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 commissioners
and two physicians which commissioners elected to 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 dis-
Twenty-second Biennial Report 9
ease 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 thousand
pamphlets on tuberculosis were printed and distributed. There
was a renewal and an extension of cooperative work between the
Board of Health and the State press, a number of articles dealing
with hygienic and sanitary subjects being furnished the papers
and published in them. Annual appropriation, $2,000.
1905. General Assembly established State Laboratory of Hygiene; imposed
water tax of $64 on all public water companies; voted $600 an-nually
for support of Laboratory. Small appropriation made it
necessary for the Department of Agriculture to continue to assist
State Board of Health. Annual appropriation, $2,600.
1906. The North Carolina Association for the Study and Prevention of
Tuberculosis was organized. Annual appropriation, $2,600.
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 re-quiring
the separation of tuberculous prisoners from other pris-oners
was enacted. Annual appropriation, $4,000.
1908. January 1, Dr. C. A. Shore became Director of State Laboratory of
Hygiene. Annual appropriation, $4,000.
1909. General Assembly provided for (1) whole-time State Health Officer;
(2) collection of vital statistics of towns having a population of
1,000 or over; (3) that all public water companies file plans and
specifications of their plants with the State Board of Health, and
that the State Board of Health pass necessary rules and regula-tions
for the care of public watersheds and plants and furnish
such rules and regulations and other advice to those having charge
of public water supplies; (4) that counties provide free diphtheria
antitoxin for county indigents, and (5) that the maintenance
appropriation for the Sanatorium be increased from $5,000 to
$7,500, and an additional $30,000 be granted for permanent im-provements.
Dr. Richard H. Lewis resigned as Secretary of the
Board, and Dr. W. S. Rankin was elected as his successor, begin-ning
his official work July 1. Annual appropriation, $10,500.
1910. General effort to interest the people and State organizations in
public health work. Bulletin increased from 3,500 edition to
10,500 edition. Addresses on public health work delivered to Con-ference
of County Superintendents of Schools, State Federation
of Women's Clubs, State Press Association, and Sanitary Sunday
observed in April. Dr. John A. Ferrell elected, February, As-sistant
Secretary for Hookworm Eradication; began work under
State Board of Health and Rockefeller Sanitary Commission. First
effort in the eradication of hookworm disease was to interest
school teachers in the disease and through their assistance ex-amine
and treat the children, and thereby reach the community.
10 North Carolina Board of Health
Three bottled spring waters sold on the market examined, found
polluted, and public attention called to the pollution. Annual
appropriation, $10,500.
1911. Legislature established county boards of health to take the place
of the county sanitary committees; county board of health com-posed
of chairman board of county commissioners, county superin-tendent
of schools, mayor of county town, and two physicians
selected by the three county officials to serve with them. Legis-lature
also abolished quarantine for smallpox and improved the
quarantine laws. One thousand dollars annually appropriated to
contract with antitoxin manufacturers for State supply of high-grade
diphtheria antitoxin, with result that price of antitoxin was
cut to one-fourth former price, saving the citizens of the State
over $30,000 annually. Bulletin increased from 11,500 copies to
20,000 copies each edition; closer cooperation 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. Maintenance appro-priation
for State Sanatorium increased to $12,500, with $20,000
voted for permanent improvements. Annual appropriation,
$22,500.
1912. Bulletin increased to 40,000 edition; number of popular pamphlets
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 meeting of State
Medical Society and State Board of Health to the relative im-portance
of health problems and the bearing of this subject upon
the proper apportionment of health funds; instrumental in pass-ing
a resolution to the effect that pellagra was an interstate prob-lem,
not a State problem, and requesting the Federal Government
to deal with pellagra as a Federal problem; resolution responsible,
to considerable extent, for successful effort on part of Hon. John
M. Faison's securing Congressional appropriation of $45,000 for
the study of pellagra by the Federal Government. Hookworm
work extended and county funds appropriated to supplement State
and Rockefeller Foundation for this work. Annual appropriation,
$22,500.
1913. General Assembly passed Model Vital Statistics Law with $10,000
appropriation for its enforcement. County superintendents of
health changed to either county physician or county health officer.
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 countv health officers.
Twenty-second Biennial Report 11
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 appro-priation
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 vac-cine.
Dr. C. L. Pridgen resigned as Director Hookworm Eradi-cation,
and Dr. W. P. Jacocks succeeded him. Annual appro-priation,
$40,500.
1915. General Assembly makes State vital statistics law conform to
National model by requiring burial permits in rural communities;
enacts legislation permitting county commissioners and towns and
cities to appropriate money for support of tuberculous 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-tubercu-losis
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 journalist for whole time; stock lectures with lantern slides
supplied public speakers in different parts of the State; com-munity
soil pollution work under Dr. W. P. Jacocks stops in May,
and Bureau of County Health Work with Dr. G. M. Cooper at
its head, succeeds, beginning work in June. 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 one county. Annual
appropriation, $50,500.
1916. North Carolina was admitted to the Registration Area for deaths.
To the educational agencies of the Board was added a self-sup-porting
moving picture health show. Many saw this show during
the year, and, seeing, believed in health work as never before.
Bulletin had to be discontinued temporarily for lack of printing
funds, but before discontinuance 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 unit system
of county health work, giving three anti-typhoid injections to
48,000, making 100,000 immunized in summers of 1915 and 1916.
Did complete medical inspection of five counties and with inspec-tion
a large amount of educational work as to sanitary and
hygienic living. Secured effort by Federal Children's Bureau to
develop unit of child hygiene work, the Bureau using two em-ployees
to work in Cumberland and Swain counties for about eight
months. Laboratory of Hygiene buys land and erects its own
12 North Carolina Board of Health
building. Sanatorium making a decided impression on the State.
Annual appropriation, $55,500.
1917. The General Assembly passed the following important health legis-lation:
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 ex-amination
of the school children of the State at regular inter-vals;"
chapter 276, entitled "An act for the cooperative and ef-fective
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 sani-tary
inspection and conduct of hotels and restaurants;" chapter
286, entitled "An act to regulate the treatment, handling and work
of prisoners."
Following the enactment of this legislation, administrative ma-chinery,
consisting of a Bureau of Epidemiology under the direc-tion
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. Washburn, an officer of the Inter-national
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 rural sanitation in
accordance with the provisions of chapter 276.
The United States Public Health Service in February, 1917, de-tailed
Dr. K. E. Miller to study county health work in different
sections of the country and to establish for demonstration pur-poses,
in Edgecombe County, department of health on an economic
basis easily within the financial reach of the average county.
The State Laboratory of Hygiene moved into its own building
January 15, 1917.
The State was admitted to the registration area of the Union
for births in January, 1917, the Bureau of the Census having
found after investigation that our birth registration was 96
per cent complete.
The special campaign against typhoid fever begun so satis-factorily
in 1915, was continued. Free vaccination of the people,
however, was interferred with by the difficulty in securing medical
officers to do the work, the preparedness program of the Govern-ment
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 as developed by the
Life Extension Institute of New York, which consisted briefly of
the free physical examination of interested citizens for the pur-pose
of advising them as to their physical condition and needed
Twenty-second Biennial Report 13
\ 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, who at the time
was a resident physician in the New York City Hospital and
who had during his residency in that institution studied the
methods of the Life Extension Institute under Dr. Eugene Lyman
Fisk, was employed and placed in charge of the work. Life ex-tension
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 Bulletins, each monthly edition amount-ing
to 45,000, and a daily newspaper health article. The Bureau
continued its moving picture show exhibit and, in addition, pre-pared
probably the best three-dimension educational exhibit in
the United States. In 1917 the following exhibits were given:
motion picture entertainments, 236; traveling public health ex-hibits,
32; special exhibits, 58; stereopticon entertainments, 3
—
to a total of 95,000 people. 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. A large
part of this newspaper material was prepared by the well-known
authority and publicist in matters of sanitary and hygienic edu-cation.
Dr. W. A. Brady of Elmira, New York.
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.
1918. Much of the work this year was influenced by the war and had to
do with preparedness. The State Health Officer visited Washing-ton,
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 preparedness
measures, provisions for the control of venereal diseases, arrange-ments
for coordinating the control of infectious diseases in the
civilian population with their control in cantonments, and to
arrange, if possible, with the Public Health Service and the
Surgeon-General of the Army for preserving the personnel of
State health departments during the war. The State Health
Officer also made a visit to the states of South Carolina, Georgia,
Alabama and Florida for the Council of National Defense in order,
14 North Carolina Board of Health
if possible, to interest the Governor, the State Board of Health,
and the State Council of Defense in venereal disease control.
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 enter-ing
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.
Pai'tly as a result of these activities, the Surgeon-General of
the Army assigned Major Joseph J. Kinyoun to assist the State
Board of Health in the control of communicable diseases, the
Board being under no financial obligation for Major Kinyoun's
assistance; and as a result of the successful termination of the
activities of various 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 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 de-veloped
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 quarantine law. Suf-ficient
convictions were obtained to impress the medical profession
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 ap-propriation,
was established in September under the directorship
of Dr. James A. Keiger of Charlotte, N. C.
Mr. Warren H. Booker, for the last seven years the efficient
director of the Bureau of Engineering and Education, left in
September for Red Cross work in France, the work of his bureau
being continued, with the exception of the engineering work, by
Mr. Ronald B. Wilson. As a result of Mr. Booker's leaving, cer-tain
funds became available, and a Bureau of Infant Hygiene,
under the directorship of Mrs. Kate Brew Vaughan, was organized
late in 1918.
Perhaps the most outstanding feature of the health work dur-ing
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.
Twenty-second Biennial Report 15
The annual appropriation for the State Laboratory of Hygiene
was $12,500. The Laboratory, during this year, collected $8,532.48
in fees for special work, so that the total income of the Laboratory
for this year was $21,032.48.
1919. The General Assembly passed the following important health legis-lation:
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;" chap-ter
215, entitled "An act for the repression of prostitution;" and
chapter 288, entitled "An act to amend chapter 671, Public-Local
Laws of 1913, relating to the injunction and abatement of certain
nuisances."
The Bureau of Engineering and Inspection was organized in
April. The engineering work of the Board had been suspended
with the resignation of Mr. Warren H. Booker in September, 1918,
Mr. Booker having gone to France to engage in tuberculosis work
under the direction of the Red Cross. Between September, 1918,
and April, 1919, the engineering problems coming before the
Board had been referred and very kindly and effectively taken
care of by Col. J. L. Ludlow of Winston-Salem. 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 detailed
by the Service to assist him in the organization of his work.
Mr. H. E. Miller and Dr. K. E. Miller spent the spring and sum-mer
and a part of the fall in studying various types of privies,
in preparing plans for the construction and maintenance of
privies, and in preparing the necessary notices and literature to
inform the people of the objects and requirements of the new
privy law.
On May 1st Dr. A. J. Warren, health officer of Rowan County,
was appointed to and accepted the position of Assistant Secretary
of the Board.
On July 1st Mr. R. B. Wilson accepted the position of Director
of Public Health Education.
On August 1st Dr. A. McR. Crouch, Director of the Bureau of
Epidemiology, i-esigned to accept a position with the city of Wil-mington.
Dr. F. M. Register, whole-time health officer of North-ampton
County, succeeded Dr. Crouch as director of the bureau.
In September Dr. J. R. Gordon, Director of the Bureau of Vital
Statistics since 1914, resigned on account of impaired health, and
on October 1st the Bureau of Epidemiology and the Bureau of
Vital Statistics were combined and placed under the direction of
Dr. Register.
In September Mrs. Kate Brew Vaughan, Director of the Bureau
of Infant Hygiene, resigned. The bureau was reorganized under
16 North Carolina Board of Health
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 ap-proval
of both participating agencies, the American Red Cross
and the State Board of Health. In December Miss Rose M. Ehren-feld
took charge of the new bureau and began its organization
and work.
On October 1st Dr. Jas. A. Keiger, Director of the Bureau of
Venereal Diseases, resigned and Dr. Millard Knowlton was ap-pointed
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 motor-cycle
for getting about. Campaigns were carried out in the fol-lowing
counties: Bertie, Cabarrus, Chatham, Chowan, Columbus,
Craven, Hertford, Iredell, Johnston, Lincoln, Onslow, Pasquotank,
Perquimans, Randolph, Richmond, Rockingham, Stanly, Union,
Warren, Wayne. A total of 49,076 were given complete vacci-nations.
The educational work of the Board consisted of the publication
of a 48,000 monthly edition of the Bulletin, and the distribution
of about 350,000 pieces of public health literature.
The funds available during this fiscal year amounted to $198,-
549.14, of which $102,301.98 was from State appropriations and
the remainder from outside sources.
The appropriation for the State Laboratory of Hygiene for this
year was $28,500; in addition to this, the Laboratory collected in
fees for special work, for antitoxin, and in water taxes a total
of $14,344.02, making a total of $42,844.02 available for work of
Laboratory.
1920. During this year there was a Special Session of the General As-sembly,
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 1st Dr. B. E. Washburn, who had had general
direction of the cooperative county health work and who had
rendered most acceptable service, was recalled by the Inter-national
Health Board and detailed to take charge of their inter-ests
in Jamaica. Dr. K. E. Miller, of the United States Public
Health Service, who had been detailed in January, 1917, to or-ganize
a model county health department in Edgecombe County
and then, in 1919, to assist his brother, Mr. H. E. Miller, in organ-izing
the work of the new Bureau of Engineering and Inspection,
Twenty-second Biennial Report 17
to which was assigned the duty of enforcing the State-wide privy
act, succeeded Dr. Washburn as Director of the Bureau of County
Health Work.
In January a cooperative effort with the United States Public
Health Service and the International Health Board to demonstrate
the possibilities and advantages of the eradication of malaria
from certain towns and cities in the eastern part of the State was
begun. The terms of cooperation were that the International
Health Board and the State Board of Health were to pay one-half
of the expenses of the local work and the town or city in which
the work was done the other half, the Public Health Service
furnishing, as its part, expert supervising personnel. The towns
and cities chosen for this work were Goldsboro, Farmville, and
Greenville, the budgets 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 v^^ork.
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.
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 pub-lic
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, v/ere 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
campaign was one of the most successful public health educational
attempts yet undertaken.
In June it was found advisable to separate the Bureau of Epi-demiology
and the Bureau of Vital Statistics which had, on ac-count
of the scarcity of health officers, been placed under the
directorship of a single bureau chief. Dr. F. M. Register. Dr.
Register was appointed Director of the Bureau of Vital Statistics
and Dr. J. S. 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 prosti-tution.
This group of workers was withdrawn in September, on
account of differences developing between them and Dr. Knowlton,
chief of the Bureau of Venereal Diseases, with the understanding
18 North Carolina Board of Health
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 consist-ing
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 the anti-typhoid vaccination campaign was con-tinued
in Alamance, Bladen, Columbus, Duplin, Franklin, Gaston,
Harnett and Mecklenburg counties. Cooperative campaigns, in
which the counties furnished the working personnel, were also
carried on in Anson, Johnston and Rutherford counties. A total
of 29,435 citizens have been vaccinated against the disease, and
this does not include Columbus County, in which the work was
just beginning when this report was completed.
The educational work of the State Board of Health during this
year consisted of a 48,000 monthly edition of the State Board of
Health Bulletin and the distribution of approximately 350,000
pieces of 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 available for the work
of the Laboratory. The above amount being insuff"icient, 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 ex-amination
of all applicants for marriage and making issuance of
license contingent upon the physical qualifications of the appli-cant.
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,
Twenty-second Biennial Report 19
therefore, rather loosely drawn and left many things to be de-sired.
The bill finally passed in amended form as chapter 129,
Public Laws of 1921.
The general health of the State for 1921, as indicated in the
vital statistical records for that year, published by the United
States Bureau of the Census, was good, and there was an im-provement
in reduced death rates for a number of diseases, as
well as a reduction in the general death rate over previous years.
Another general condition of State-wide importance with a vital
bearing on the work of the Board of Health which had to be
taken into account was a considerable amount of misunderstanding
between respective groups of the medical profession and the
Board of Health regarding matters of policy. Many physicians,
men in good standing professionally and men with high civic
ideals, seemed to feel that the Board of Health had no well-considered
and reasonable objectives in the field of public health
as it is related to that of private practice. This general condition
was responsible for the Board of Health seeking and availing
itself of opportunities to meet the profession, both in county, dis-trict
and State societies, and to discuss with the profession what
it conceived to be the proper relation between public health
activities and professional practice. This subject was presented
to and considered by the State Medical Society in its conjoint
meeting with the State Board of Health at Pinehurst in April,
1921. See transactions Medical Society of the State of North
Carolina, pages 472-506. As a result of these various conferences
between representative men engaged in public health work and
the profession, the general condition of misunderstanding and
some little friction had disappeared to a large extent by the latter
part of the year. Nevertheless, the results of contact between
those engaged in social medicine and private practice were such
as to encourage further conferences and efforts to bring about a
fuller recognition of mutual interests on the part of the public
and the profession, and the ultimate adoption of a program of
relations which would be to the mutual advantage of both parties.
Perhaps the most important change inaugurated in State health
administration during this year was the adoption of a cost basis
for standardizing and measuring the efficiency of public health
work in those counties in which the State participated financially.
This new principle is fully described in the State Board of Health
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 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 cooperation 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 direc-tion
of Dr. J. S. Mitchener.
20 North Carolina Board of Health
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 agree-ment
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 ac-cordance
with the Sheppard-Towner Act for the promotion of
the welfare of mothers and infants. Dr. K. P. B. Bonner of More-head
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 tabulation
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.
1922-23. In order to further develop local responsibility for the protection
and promotion of the public health, and to quicken local initiative,
a policy of decentralization was adopted by the Board. To carry
out this policy there were made several changes in the organi-zation
of the Board's executive staff. The Bureau of County
Health Work was discontinued. The Bureau of Epidemiology was
combined with the Bureau of Vital Statistics. Dr. G. M. Cooper,
director of the Bureau of Medical Inspection of Schools, was ap-pointed
Assistant Secretary, and Dr. J. S. Mitchener, director of
the Bureau of Epidemiology, was transferred to the Bureau of
Medical Inspection of Schools. Dr. K. E. Miller, who for four
years had been loaned to the Board by the United States Public
Health Service, and had directed the work of the Bureau of
County Health Work, was recalled for duty elsewhere. The State
was divided into four districts with Dr. E. F. Long, Dr. H. A.
Taylor, Dr. M. L. Ilsley, and Miss Rose M. Ehrenfeld as district
directors. This plan of organization became effective in the early
spring of 1923 and was continued through the calendar year.
Six vacancies in the membership of the Board occurred during
the year, four by expiration of term, and two by resignation.
The terms of Dr. J. Howell Way of Waynesville, and Dr. A. J.
Crowell of Charlotte, appointed by the Governor, expired, and
Twenty-second Biennial Report 21
they were respectively appointed to succeed themselves. The
terms of Dr. Charles O'H. Laughinghouse of Greenville, and Dr.
Thomas E. Anderson of Statesville, elected by the State Medical
Society, expired, and they w^ere respectively reelected. Mr.
Charles E. Waddell of Asheville, appointed by the Governor in
1921, resigned and as his successor the Governor appointed Mr.
James P. Stowe of Charlotte. Dr. F. R. Harris resigned to be-come
health officer of Vance County, and to fill the unexpired
term the Board elected Dr. D. A. Stanton of High Point. Dr. J.
Howell Way was reelected president of the Board.
The General Assembly of 1923 made provision for the constantly
growing work of the Board, approving the budget as submitted
and appropriating for the Board the sum of $425,000. Legislation
enacted included an act to provide for the sanitary manufacture
of bedding, to create an independent board of directors for the
State Sanatorium, and to provide sanatorium facilities for tuber-culosis
convicts.
The important new development during the year was the begin-ning
of malaria control work in certain counties of the coastal
plain area of the State. Through the courtesy of the International
Health Board a member of its field staff, Dr. H. A. Taylor, was
loaned to the Board for the purpose of making preliminary sur-veys,
and areas in Lenoir and Pamlico Counties were selected for
investigation. The results showed Pamlico County to be suitable
for the initial demonstration, and a unit for the investigation
and control of malaria was organized with Dr. Taylor as the
director, the budget being contributed forty per cent by the county,
forty per cent by the State, and twenty per cent by the Inter-national
Health Board. The progress of the work, and the results
achieved, proved so satisfactory that in January, 1923, an addi-tional
unit was organized in Beaufort Co"unty, and in May, Craven
and Bladen Counties were added to the list. Detailed resumes
of this work is given elsewhere in this report, but it should be
stated here that the success of the intensive malaria control
measures has been even greater than was anticipated. While
specializing on malaria control measures, the county units have
at the same time carried on a general program of public health
work. The International Health Board has continued its cooper-ative
aid in giving twenty per cent of the unit budget, and has
continued the loan of Dr. Taylor, who has directed the work.
In June the resignation of Dr. J. S. Mitchener as director of
the Bureau of Medical Inspection of Schools was accepted, and
Dr. Roy C. Mitchell, who had been engaged in special educational
field work, was appointed to the vacancy.
1923-24. The Committee on Municipal Health Department Practice of the
American Public Health Association requested the Secretary of
the Board to become field director for the Committee in making
a study of municipal health practices in the United States for
the purpose of working out with and for the Committee a basis
or set of principles on and through which city health departments
could be given classification or grading, and further for giving
22 North Carolina Board of Health
such additional time as might be needed in assisting such de-partments
in improving their organization and provision for work.
The request was brought before a special meeting of the Execu-tive
Committee of the Board, and it directed the Secretary to
take advantage of the opportunity offered to become acquainted
intimately and broadly with health administration in the cities of
the country, and at the same time continue to exercise general
supervision of, and executive control over, the work of the Board.
In January the Secretary established official headquarters in New
York City for the work of the Committee, and the general organ-ization
of the executive staff of the Board was continued with
the Assistant Secretary, Dr. G. M. Cooper, as administrative or
director. During the period of his absence the Secretary has kept
in close touch with the work of the Board through frequent reports
and a number of visits to the office for conferences with members
of the staff.
For the more efficient administration of the field activities of
the Board the four districts into which the State has been divided
the previous were consolidated into two, with Dr. E. F. Long and
Dr. H. A. Taylor as Deputy State Health Officers, as directors,
assisted respectively by Dr. C. N. Sisk, formerly health officer of
Forsyth County, and Dr. George Collins, formerly health officer
of Mecklenburg County.
At the annual meeting for the Board in April further steps
were taken towards making effective the policy of decentralization
adopted the previous year. This' policy looks, in a broad way, to
the diminishing of State personnel and the use of funds so made
available for stimulating and paying county personnel, either whole
or part time, to do work which formerly had been in all prob-ability
incorporated and carried on by full-time personnel em-ployed
by the Board. It was directed by the Board that all ma-chinery
and resources of the Bureau of Maternity and Infancy
and of the Bureau of Medical Inspection of schools be converted
into county machinery and resources, either full-time or part-time,
the transformation to be brought about gradually to become
effective not later than January 1, 1925.
During the year a plan for the more adequate sanitary control
of public milk supplies in the State was formulated. The de-velopment
of this important new undertaking was assigned to the
Bureau of Engineering and Inspection. Mr. Malcolm Lewis, a
graduate of Massachusetts Institute of Technology, and with
about seven years of experience in public health work, was secured
for this particular unit of work. As developed at the present
time this service has been largely an advisory one, the various
municipalities having at their command the aid of the Board in
improving local milk supply conditions.
The malaria control campaign in the coastal plain area was
enlarged by the addition of organized units in Columbus, Bruns-wick
and Hyde counties, making a total of seven counties in the
State specializing on this plan of health work. The cooperative
aid of the International Health Board was continued.
Twenty-second Biennial Report 23
During the year Dr. Roy C. Mitchell, director of the Bureau
of Medical Inspection of Schools, resigned. The work of the
Bureau was continued under the supervision of the Assistant
Secretary. Dr. M. L. Ilsley and Miss Rose M. Ehrenfeld, both
district directors, resigned, and effective with the end of the fiscal
year Dr. K. P. B. Bonner, director of the Bureau of Maternity
and Infancy, resigned.
The appropriation by the General Assembly was $275,000 and
$300,000 respectively for the two years of the biennium. For the
Laboratory of Hygiene the appropriation was $75,000 annually.
1924-25. During this year the work of the Board was directed by Dr.
G. M. Cooper, serving as Acting Secretary. Dr. Rankin continued
his work with the American Public Health Association. In June,
1925, Dr. Rankin resigned to accept the position of director of
the hospital and orphanage divisions of the Duke Foundation.
The system of district direction of county health work was
dropped, district health officers resigning not being replaced. Dr.
E. F. Long and Dr. C. N. Sisk were placed in charge of county
health work, and upon the resignation of Dr. Long the responsi-bility
for this work was left upon Dr. Sisk. Dr. K. P. B. Bonner
resigned as Director of the Bureau of Maternity and Infancy, and
Dr. H. A. Taylor was appointed to succeed him, with Dr. George
Collins as assistant. On December 1 a division of Health Edu-cation
was organized with Dr. M. L. Townsend in charge.
1925-26. Dr. Chas. O'H. Laughinghouse of Greenville, was elected Secre-tary
to fill the unexpired term of Dr. W. S. Rankin, resigned, to
take office October 1, 1926. Dr. M. L. Townsend resigned as
Director of the Bureau of Health Education and Dr. G. M. Cooper
succeeded him.
24 North Carolina Board of Health
ORGANIZATION OF BOARD
The work of the State Board of Health is administered by the State
Health Officer and an executive staff, the members of which have definitely
assigned duties.
The Board consists of nine members, five appointed by the Governor and
four elected by the State Medical Society. The terms are six years, and
interlock. Not more than two of the Governor's appointees nor more than
two elected by the Medical Society expire in any one year. The Board has
certain legislation authority, having the power conferred upon it to adopt
rules and regulations having the force and effect of law.
The work of the Board is now divided into the following bureaux or
divisions:
Administration: Headed by the State Health Officer with general super-vision
of the entire program of work.
Laboratory: For diagnostic examination of various specimens, and of
samples from public water supplies, and for manufacture and distribution
of various vaccines and sera.
Sanitary Engineering and Inspection: Enforce sanitary laws; supervise
public water supplies and sewerage systems; investigate problems of stream
pollution; supervise municipal milk sanitation; supervise shellfish sani-tation.
Maternity and Infancy: Supervise maternal and infant hygiene nursing
service; conduct prenatal educational service; midwife control.
Medical Inspection of Schools: Through staff of nurses gives medical
inspection of schools in one-third of the counties each year; conducts an-nually
tonsil-adenoid corrective clinics; conducts dental clinics.
Epidemiology: Enforces laws regarding communicable diseases; makes
epidemiological investigations; conducts campaigns for immunization
against typhoid fever, diphtheria, smallpox; makes malaria and mosquito
surveys.
Vital Statistics: Gathers through local registrars reports of births and
deaths; tabulates and indexes certificates; keeps permanent file of all
certificates.
Health Education: Prepares educational literature, special pamphlets,
edits monthly Health Bulletin, and conducts unit in visual education.
Life Extension: Promotes periodic health examination for prevention of
degenerative diseases; conducts special demonstration clinics for medical
profession.
County Health Work: Supervises and assists county health departments
to which State contributes financiallv.
Twenty-second Biennial Report 25
HEALTH—THE STATE'S GREATEST ASSET
North Carolina rejoices today in the lowest death rate since the pioneer
days of its first settlement. For the past year of 1927 a new low record
was achieved, 11.3 per thousand of the population. This was under the
rate for the United States' registration area which now includes approxi-mately
85 per cent of the population of the country. Again, it is demon-strated
that North Carolina is not only a healthful State in which to live,
but that it is in fact one of the most healthful of all the States in the
Union.
This has not always been true. Not so many years ago the State was
hampered and its material progress checked by the prevalence of hook-worm
disease and malaria. Smallpox was an ever-present menace, scar-ring
and killing. The "Great White Plague" of tuberculosis each year
claimed its thousands of victims. Typhoid fever was a constant summer
scourge, killing and maiming. One out of every five of the babies born
in the State died before reaching a first birthday.
This condition was due to a number of causes. On account of its geo-graphical
location, the State was especially susceptible to semi-tropical
diseases, hookworm and malaria. Because of its predominant rural popu-lation,
typhoid fever and other fecal-borne diseases, particularly the diar-rheal
diseases of infants, largely alfected the public health. Unprotected
public water supplies and general insanitary conditions throughout the
State contributed to the high death rate.
Today the picture is entirely changed. North Carolinians are a well and
happy people, vigorous and able whether at work or play. Co-incident
with the tremendous development during the years of the present century
in agriculture and industries has been an improvement in general health
conditions even more remarkable.
Today it is true that no great number of our people are anaemic and
weak from the effects of hookworm disease. That affliction is becoming
rare in the State. Chills and fever and the sallow complexion of those
chronically malarious now is so uncommon as to evoke comment, for ma-laria
has been practically eradicated except from certain coastal sections
as yet undrained or only partially developed agriculturally. Smallpox now
kills less in a year than that comparatively new hazard to life, the auto-mobile,
kills in a week. The annual death toll from tuberculosis has been
cut more than half. Through sanitation and vaccination typhoid fever has
been removed as a major factor affecting the public health. Simultaneously
the infant death rate, following increased knowledge of sanitary living
and the protection of public water and milk supplies, has been reduced
more than one-half so that now instead of one out of each five of the
babies born in the State dying during the first twelve months of life the
ratio is one out of each thirteen.
The vital statistics records for the State as compared with those of the
Nation shows that North Carolina has made a markedly greater degree of
improvement in the health of its people since 1900 than has its neighboring
states, or the country as a whole. In 1900 the death rate for the entire
registration area of the United States was 17.6 per thousand of the popu-lation.
At that time North Carolina had no accurate records, but from
26 North Carolina Board of Health
the most accurate data obtainable it is estimated that the death rate for
the State was approximately 22.0 per thousand of the population. This
extremely high death rate has been steadily pulled downward until last
year it was 11.3 per thousand of the population as compared with 11.4
for the country as a whole. While the death rate for the Nation was
falling 35 per cent, that of North Carolina dropped practically fifty
per cent.
This remarkable reduction in the death rate is the more noteworthy
when considered in connection with the high birth rate. Last year there
were 83,334 births in the State, a rate of 28.8 per thousand of the popu-lation.
For the eighth consecutive year the State has maintained the
highest birth rate in the United States. This means an addition annually
to the population of a large group which is most susceptible to a number
of fatal diseases.
Tuberculosis, which holds a place throughout the world as one of the
major causes of death, in 1927 claimed more than three thousand less vic-tims
in this State than in 1910, just seventeen years previous. The total
number of deaths from this cause last year was 2,769, giving the State a
rate of 96.8 per hundred thousand of the population. This rate is con-siderably
under that for the country as a whole and is lower than any
other Southern State. This enviable record was made despite the fact
that nearly five hundred deaths from tuberculosis were of non-residents
of the State, patients at government or private sanatoria maintained in
North Carolina because of its excellent climatic advantages.
Sustaining the vital statistics records are the findings of the United
States government in connection with medical examinations made of men
called for military duty under the Selective Service Act. Figures are now
available on the basis of more than two and one-half million men examined,
of which number fifty thousand men were from North Carolina. This study
gives a cross-section of the physical condition of the male population at
an age when physical defects that may shorten life are beginning to ap-pear,
and may be taken as a good picture of the general physical condition
of the people.
These statistics show that North Carolina averaged fewer rejections
because of physical unfitness than the country as a whole, and on indi-vidual
points ranked well above the average. As compared with the entire
country there were in this State fewer defects per thousand, fewer defec-tive
men per thousand, fewer mechanical defects, less hernia, less under-weight,
fewer defects of the eyes, ears, throat, less organic heart disease,
and less defective and deficient teeth.
This State is today perhaps the best sanitated State in the Union, con-sidering
its predominant rural population. For ten years it has had State
laws requiring the sanitary disposal of human excreta. In this North
Carolina was a pioneer, being the only State with such beneficial laws
until in 1927 the legislature of Alabama gave that state legislation based
upon that of North Carolina. Practically the entire urban population is
now served with protected public water supplies and with water sewerage.
The semi-urban and village and a large portion of the rural population is
protected by a system of sanitary privies which are required to be con-structed
and maintained sanitarily in accordance with plans and specifi-cations
approved by the State Board of Health.
Twenty-second Biennial Report . 27
Three factors have been primarily responsible for the changed health
condition of our people, a change that in twenty-five years has brought
the State from near the bottom to a point close to the top. First of all
the State has been tremendously fortunate in having an alert and intelli-gent
medical leadership, and with this has been a heartily cooperative
profession. Such men as Wood, Lewis, Way, Rankin, have achieved na-tional
and international reputations for their leadership in preventive
medicine, and their labors for their fellowmen have been of inestimable
value. Second, the newspapers of the State, day by day, week by week,
have carried on an educational program for sanitation and hygienic living.
Third, the General Assembly has consistently enacted needed legislation
for the protection of the public health and biennially has provided adequate
appropriations for the maintenance and development of public health
measures.
A natural sequence of the combination of these three factors has been
the increasing realization of our people that health, like charity, begins
at home. In Guilford County on June 1, 1911, was established the first
county health department to be organized in the United States. Today
North Carolina has 39 county health departments and six city health de-partments,
serving more than one-half of the State's population. In this
phase of development North Carolina has been exceeded only by the State
of Ohio.
For the protection and promotion of the public health the annual appro-priation
by the General Assembly is $441,400.00, exclusive of appro-priations
made for maintenance and permanent improvements at the State
Sanatorium for the treatment of tuberculosis. This puts North Carolina
in sixth place in the group of forty-eight States of the Union, the ranking
states being Pennsylvania, New York, Illinois, Ohio, Massachusetts, North
Carolina. The appropriations made by the counties and cities approximate
$600,000.00 annually.
This investment of money for the purpose of protecting and promoting
the public health is probably the best paying one in direct dividends that
is made by the State. The fact that the death rate in the past twenty-five
years has been cut in half means a saving not only in lives, but in dollars
and cents—a sum one hundred times greater than the amount which has
been invested to achieve this result.
In ajddition to the local county and city health departments, the State
is served by a health department under the direction of a State Health
Officer who devotes his time and energy to this one job. Divisions of this
department, each under the direction of a trained expert, consist of a
hygienic laboratory, vital statistics, epidemiology, county health work,
medical inspection of schools, sanitary engineering and inspection, ma-ternity
and infancy, health education, and life extension.
The work of the State Board of Health may be briefly summarized by
divisions as follows:
(1) The State Laboratory of Hygiene annually makes 60,000 exam-inations
to assist the physicians of the State in the diagnosis and treat-ment
of their patients; periodically examines samples from all public water
supplies; distributes 750,000 doses of typhoid vaccine for the prevention
of typhoid fever; distributes 35,000 doses of pertussis vaccine for the pre-vention
and treatment of whooping cough; manufactures and distributes
28 North Carolina Board of Health
225,000 doses of smallpox vaccine for the prevention of smallpox; dis-tributes
210,000 doses of toxin-antitoxin for the prevention of diphtheria
and 1,500,000 units of antitoxin for the treatment of diphtheria; makes
and distributes 1,800 Pasteur anti-rabic treatments, for the prevention of
hydrophobia caused by the bites of mad dogs; distributes 5,000 packages
of tetanus antitoxin for the prevention of this dread disease; distributes
125,000 ampoules of neo-arsphenamine for the treatment of syphilis;
altogether, in water analysis, diagnostic examinations, and in sera and
vaccines supplied, the laboratory performs a public service that at ordinary
commercial rates would exceed $1,250,000.00 annually.
(2) The division of vital statistics is charged with the vital bookkeeping
of the State, an accounting in terms of life and death of the State's popu-lation.
Its objective is to secure a permanent record of the more important
facts concerning the birth and death of every citizen of the State, and
from such records to prepare card indices and tabular classifications in
such manner as to make readily available on inquiry the following
information:
(a) The total number of births occurring annually in the State; (b) the
birth rate of the State, that is, the number of births per thousand of the
population; (c) the birth rates by races, white and colored; (d) the number
of illegitimate births; (e) the number of still-births attended by midwives;
(f) the number of white births attended by physicians; (g) the number
of white births attended by midwives; (h) the number of colored births
attended by physicians; (i) the number of colored births attended by mid-wives;
(j) all of the foregoing data as to births with respect to each
county and city. These facts permit of comparisons of one part of the
State with another, of the birth rate of the two races, and of the birth
rate of this State with that of the other states and other countries. Such
information is necessary in forming conclusions as to vital conditions in
North Carolina and in the enactment of suitable legislation for dealing
with these conditions. Last year there were 83,334 live births in the State,
certificates for which were handled and classified.
(a) The number of deaths occurring in the State annually; (b) the death
rate, that is, the number of deaths per thousand of the population; (c) the
number of deaths, by races, and the death rates by races; (d) the number
of deaths among infants and young children as compared with the births,
and the total deaths as compared with the total births, with net gain in
population; (e) the total number of deaths by months and year from each
of the 209 causes appearing in the International List of Causes of Death;
(f) the number of deaths according to age and occupation; (g) the number
of deaths according to age and the causes of death; (h) the number of
"seasonal" deaths according to months; (i) all of the foregoing data
classified according to county, town and city. This information is abso-lutely
necessary to understand vital conditions in the State; to know where
intensive health work is needed, against what causes of death health
measures should be directed, and whether the work of local health depart-ments
is associated with a decrease or no decrease in death rates. Last
year 32,764 deaths occurred in the State, certificates for which were
handled and classified.
(3) Through its division of Epidemiology, the Board endeavors to con-trol
the spread of contagious and infectious diseases. It supervises the
Twenty-second Biennial Report 29
quarantine of approximately 50,000 such cases each year, supplying to
each home where any of the contagious or infectious diseases occur, direc-tions
for the care of the sick and other precautions necessary to prevent
the spread of the disease; makes epidemiological investigations to ascer-tain
the source of infection in such diseases as typhoid fever, diphtheria,
etc., when such diseases appear in local epidemics; conducts with the
assistance of local physicians mass vaccination campaigns for the pre-vention
of typhoid and diphtheria, covering about 20 counties each year
and securing about 40,000 typhoid vaccinations and 10,000 diphtheria vac-cinations;
supervises a malaria control program in a number of eastern
counties, and supervises a number of impounded water projects.
(4) The 39 county health departments through the division of County
Health Work are given supervision and advice, together with financial
assistance. Assistance is supplied in planning and developing general and
special units of local work, demonstrations, educational exhibits, clinics,
laboratories, and the like, and assists in the organization of new county
departments.
(5) In the division of Medical Inspection of Schools, a field staff of eight
nurses, eight dentists and one supervising dentist is maintained. An
average of 90,000 school children are being examined by the nurses in
those counties not having local health departments. The examinations are
for the purpose of discovering the more common defects of childhood such
as those of vision, hearing, throat, nose, teeth, skin or orthopoedic de-formities.
Personal notes are sent to parents advising of such defects as
may be found and urging that the child be given the indicated medical care
in order that correction may be made.
As a follow-up of this work, the Board conducts during the summer
months clinics for operative treatment of children of school age suffering
with diseased tonsils and adenoids. A special hospital unit sufficient to
care for twenty-five patients is transported by truck. A hospital unit is
maintained consisting of a physician to carefully examine the children
and administer anaesthesia, eleven experienced nurses, and an orderly.
The operating surgeon is a specialist secured on the recommendation of
the local county board of health. About 2,000 children are now being
treated each year in these summer clinics.
An average of 36,000 school children are receiving dental treatment.
This includes not only the cleaning of teeth, silver nitrate treatments or
temporary fillings for decayed first teeth, but an average of 30,000 per-manent
fillings each year, thereby saving that many permanent teeth, the
greater portion of which would otherwise be lost. The school dentists
doing this work are provided with portable outfits and conduct the dental
clinics in the school buildings.
A conservative estimate of the cost value of the work done in the tonsil
and dental clinics each year is $500,000.00, an amount greater than the
total appropriation made for all of the work of the Board.
(6) The division of Sanitary Engineering and Inspection is charged with
manifold duties all of which intimately affect the public health.
Primarily this division supervises the construction and maintenance of
all public water supply and sewerage systems. There are 238 public water
supplies under supervision, representing an invested capital of $40,000,000
and an annual cost of operation of $3,750,000, serving 30 per cent of the
30 North Carolina Board of Health
State's population. The operation of these plants is on the best modern
scientific basis and in a manner capable of maintaining the full effective-ness
in purification for which the plants were designed. The water supply
plants of the State have been virtually built anew in the past ten years
and the supervision and advice of the State Board of Health has been of
inestimable value in safeguarding the municipalities against incompetent
engineering service and inadequate provision for growth. It is noteworthy
that all of this work has been handled by North Carolina engineers except
a few of the minor improvements.
This division is charged with the enforcement of the State sanitary privy
law, the work being carried on by a force of ten sanitary inspectors. In
addition to the sanitary privy work, supervising inspectors do hotel and
cafe inspection and handle special investigations and complaints. One
supervising inspector does jail and convict camp regulation, executing the
duties assigned by law to both the State Board of Health and the State
Department of Public Welfare.
The milk sanitation division is assisting in the protection of milk sup-plies
in 48 municipalities which have adopted the standard milk ordinance.
This now includes about 80 per cent of the public milk supply of the
State.
The shellfish sanitation division has made a complete sanitary survey
of the shellfish growing areas of the State, and supervision is maintained
throughout the shipping season. North Carolina shellfish now are accepted
in the markets of the country without question.
Special engineering service is now available to the counties in the mat-ter
of water supply and sewage disposal installation for consolidated
schools. Through this service about 200 school sewage disposal projects
are being handled each year, the total cost of the work involved in this
supervision being $350,000.00.
A special study of stream pollution is now being made, necessitated by
the growing sewage and waste pollution.
Engineering service, in a growing volume, is being supplied to State
institutions. This work includes investigations to determine the needs of
institutions in water supply and sewerage utilities for the advice of the
Budget Commission in recommending appropriations, field surveys, prep-aration
of plans, cost estimates and supervision of construction.
(7) The division of Maternity and Infancy is primarily charged with the
responsibility of reducing the infant and maternal death rate. It has the
supervision of the 6,500 midwives of the State, and through special classes
each year gives courses of instruction to 2,000 of these. Financial aid and
supervision is given to twenty counties which have local maternity and
infancy nurses. A correspondence course in prenatal care is maintained
with an average of 10,000 expectant mothers. Twenty thousand babies
are each year registered for whom special literature on infant care and
diet is sent. The field nurses personally see 30,000 mothers and advise
with them on the care of themselves and their babies. For the prevention
of blindness, 8,000 packages of silver nitrate are distributed.
(8) The division of Health Education consists of: (a) preparing copy
for the monthly Health Bulletin, a publication of 32 pages with a circu-lation
of 22,000, edited for the general public and containing timely articles
on sanitation and personal hygiene. The publication is sent only to those
Twenty-second Biennial Report 31
requesting it. This Bulletin has been rated by competent judges as the
best of its class in the United States; (b) preparing special pamphlets on
particular health subjects such as cancer, catarrh, care of babies, consti-pation,
colds, care of the eyes, care of the teeth, hookworm disease, malaria,
pellagra, tuberculosis, sanitary privies, venereal diseases, typhoid fever,
diphtheria, smallpox and the various contagious and infectious diseases.
Approximately 1,250,000 pieces of this special educational literature is dis-tributed
annually; (c) the preparation of special articles on health sub-jects
for the press of the State; (d) visual education through the means
of a mobile motion picture unit in charge of an experienced operator, with
showing primarily in the public schools of those counties having organized
health departments, this unit being designed especially as aid to the local
health officers. During the past year 13 counties were served, with 125
showings given to a total audience of 35,380.
(9) The division of Life Extension was organized in January, 1928. This
division was organized to meet a pressing public need, the action by the
Board following resolutions by the President and Councillors of the State
Medical Society urging the necessity of the work being undertaken. A
study of the vital records of the State disclosed that whereas the death
rate from the group of communicable diseases declined from 117.6 in 1917
to 35.4 in 1926, the death rate from degenerative diseases in the same ten-year
period rose from 318.9 to 374.9. The total deaths from the degen-erative
group in 1926 was 8,105, a fourth of all the deaths occurring in
the State. Included in this group are heart disease, Bright's disease, and
cancer, all of which particularly affect the citizenship in the age group of
40-60. The only way to combat the alarming increase in the deaths from
these degenerative causes is to get those citizens aft'ected under competent
medical care before the disease has reached an acute state. To detect these
in their incipient and curable stage, it is necessary that thorough physical
examinations be made periodically. The Life Extension division was or-ganized
and is functioning with two objectives: (1) to acquaint those
physicians residing in the rural sections of the State, and practicing with-out
the aid of hospitals and laboratories, with the technique of making
physical examinations of the apparently well; (2) to assist the medical
profession in impressing upon the citizenship of the State the fact that
through competent physical examinations these degenerative diseases may
be discovered in their incipiency and alleviated or cured.
Particularly affecting the coastal counties of the east have been two
important undertakings, the field studies in malaria control measures and
the survey of salt marsh mosquito infestation. While primarily both of
these problems are local, in that they are confined to a comparatively
limited area of the State, yet they materially affect the public health of
the State as a whole and are an important factor in the agricultural and
industrial development of the State.
In 1925 the State Board of Health was able to interest the Rockefeller
Foundation in malaria control measures to the extent that this Foundation
established at Edenton a station for the intensive and thorough study and
investigation of malaria control measures. The station is under the direc-tion
of Dr. Mark F. Boyd who is assisted by a staff' of trained assistants.
The study is still in progress and probably will not be concluded for several
years yet. From this North Carolina will secure accurate data upon which
32 North Carolina Board of Health
it may with confidence go forward towards the goal of complete eradication
of malaria from the State.
Second only to the malaria problem in the coastal section is that of the
salt marsh mosquito infestation. There are fourteen counties affected, con-taining
approximately 300,000 acres of salt marsh territory, this acreage
being distributed as follows: Brunswick 17,000, New Hanover 8,500, Pender
6,300, Onslow 13,000, Carteret 80,000, Camden 8,000, Pasquotank 2,000,
Perquimans 2,300, Chowan 9,800, Washington 14,600, Tyrrell 40,500, Hyde
25,500, Dare 53,000, Currituck 12,400.
For the purpose of making a survey of the salt marsh areas of the
South Atlantic and Gulf States, the Congress of the United States in 1926
appropriated the sum of $25,000 and the additional sum of $10,000 to con-tinue
the survey through the fiscal year ending June 30, 1928. Under the
auspices of the United States Public Health Service, with Dr. T. H. D.
Griffits in charge, the survey was undertaken. Included in the survey
was the investigation of various types of mosquito breeding areas in the
salt marshes along the coast from Virginia to Key West, and from Key
West to the Mexican border. This survey has already gathered incal-culably
useful data with reference to the egg-laying and larval habits of
solicitans mosquitoes; conditions which influence their breeding; distance
and direction of their flights; and the influence upon them of tides, vege-tation,
soils, salinity, natural enemies, climatological conditions and so on.
In addition to this, extensive studies of the habits of these pests have
been going on at Biloxi, Mississippi, Fort Pierce and Vero Beach, Florida,
and Wilmington, North Carolina. The survey at Wilmington covered
approximately all of the important breeding areas in New Hanover County,
and in adjacent territories in Brunswick and Pender Counties. Information
from this survey was of such valuable nature that it has put New Hanover
County in position largely to decrease the mosquito infestation there.
The necessary appropriation to continue this important work was left
out of the regular appropriation bill introduced into the recent session of
Congress. So necessary did its continuation appear that the State Health
Off"icer, the Governor and a number of interested citizens urged upon the
State's delegation in Congress that this appropriation item be restored.
Largely due to the earnest and persistent efforts of Hon. Charles L. Aber-nethy,
ably assisted by Hon. Lindsay Warren and other members of the
delegation, an appropriation of $10,000 was secured. As a result prac-tically
the entire remaining salt marsh area in North Carolina will be
included in the survey, and the work upon this is now in progress. From
it ways and means to control and prevent the breeding of solicitans
mosquitoes, it is hoped will be developed.
North Carolina moves forward, no longer a laggard handicapped by
disease and poverty. An intelligent leadership has envisioned the fact
that agricultural and industrial advancement depend upon a healthy citizen-ship,
and through the General Assembly has provided the necessary funds
for the protection and promotion of the public health. A medical leader-ship
alert to the opportunity presented has carried on, under the direction
of the State Board of Health, a continuously winning fight. Today North
Carolina is one of the wonder states of the Union—progressive, prosperous,
healthful.
Twenty-second Biennial Report 33
BUREAU OF VITAL STATISTICS
Report of Bureau of Vital Statistics for two years, July 1, 1926—June
30, 1928, inclusive.
Since August, 1927, the Bureau of Vital Statistics and Epidemiology
have been functioning as separate bureaus, with a director for each.
OBJECTIVES
The Bureau of Vital Statistics is more closely interlocked with other
departments of the State Board of Health than any other department.
The reason for all health work is based on vital statistics.
The Bureau of Vital Statistics turns out an immense amount of work
each year. One reason for this is because each month a definite amount
comes into the office which must be taken care of. Then too vital statistics
are becoming more useful as information accumulates from year to year.
When the Bureau of Vital Statistics of the North Carolina State Board
of Health was first created, there was no Bureau of Epidemiology, or
Maternity and Infancy, no World War, no Veterans Bureau, no Compensa-tion
Act, no School Age Law, no Welfare Department, few automobiles,
and a smaller population. All of the above departments are making daily
calls on the Bureau of Vital Statistics for information, or certified copies
of birth and death certificates.
The objective of the Bureau of Vital Statistics is to secure a permanent
record of the more important facts concerning the birth and death of
every citizen of the State of North Carolina, and from such records to
prepare card indices and tabular classifications in such manner as to make
readily available on inquiry the following information:
1. (a) The total number of births occurring annually in the State; (b)
the birth rate of the State, that is, the number of births per thousand of
the population; (c) the birth rates by races, white and colored; (d) the
number of illegitimate births; (e) the number of stillbirths attended by
midwives; (g) the number of white births attended by physicians; (h) the
number of white births attended by midwives; (i) the number of colored
births attended by physicians; (j) the number of colored births attended
by midwives; (k) all of the foregoing data as to births with respect to
each county and city. These facts permit of comparisons of one part of
the State with another, of the birth rate of the two races, and of the birth
rate of this State with that of the other states and other countries. Such
information is necessary in forming conclusions as to vital conditions in
North Carolina and in the enactment of suitable legislation for dealing
with these conditions.
2. (a) The number of deaths occurring in the State of North Carolina
annually; (b) the death rate, that is, the number of deaths per thousand
of the population; (c) the number of deaths, by races, and the death rates
by races in North Carolina; (d) the number of deaths among infants and
young children as compared with the births, and the total deaths as com-pared
with the total births, with net gain in population; (e) the total
number of deaths by months and year from each of the 209 causes ap-pearing
in the International List of Causes of Death; (f) the number of
deaths according to age and to occupation; (g) the number of deaths
according to age and the causes of death; (h) the number of "seasonal"
deaths according to months; (i) all of the foregoing data classified ac-
34 North Carolina Board of Health
cording to county, town and city. This information is absolutely necessary
to understand vital conditions in the State; to know where health work is
needed, against what causes of death health measures should be directed,
and whether the work of health departments is associated with a decrease
or no decrease in death rates.
3. Under one and two, information necessary for the public welfare and
available under the operation of the vital statistics law has been briefly
indicated. But the vital statistics law not only supplies information to
legislatures, state and county commissioners, and other administrative
bodies, which is necessary for framing conservation measures for human
life, but it also records facts which may at any time become of great value
to the individual. In matters of tracing ancestry, birth records are in-valuable;
also in matters of proving age where the fact of age is in ques-tion,
as for voting, as for the right to marry, as for the right to enter
certain industries, as to entering school, as to liability for military
service, etc.
METHODS
The Bureau of Vital Statistics secures the birth and death certificates
for the births and deaths occurring in North Carolina through approxi-mately
fourteen hundred and fifty local registrars, appointed by the chair-man
of the boards of county commissioners for the various townships and
by the mayors for the various incorporated towns and cities of the State.
The duties and powers of the local registrars are defined in Consolidated
Statutes, section 7113. The county pays the local registrars fifty cents for
each birth and death certificate furnished by them to the off'ice of the
State Registrar at Raleigh. The vital statistics law makes it the duty of
the doctors and midwives in attendance on a birth to file a birth certificate
with the local registrar of the district in which the birth occurs and makes
the undertaker, or person acting as undertaker, responsible for the filing
of the death certificate. The birth and death certificates filed with the
local registrars of the State are sent to the Bureau of Vital Statistics on
the fifth of the month succeeding the month in which the birth or death
occurred. The certificates received in the office of the Bureau of Vital
Statistics are examined carefully, and if incorrect or incomplete (as a
large per cent of them are) effort is made to secure the information
necessary to complete them. Every parent of a legitimate child whose
birth is reported is sent a card advising them of the date of birth and
whether or not name appears on the certificate. This gives the parent an
opportunity to send in to the office the name of the child, in case it does
not appear on the certificate, or to make such change in name or date of
birth necessary to make certificate an accurate record of birth. The cer-tificates
are then classified and tabulated according to county, townships,
and registration districts, according to races, according to age at death,
according to cause of death, according to death rates and birth rates, etc.,
in order to make readily available upon request the information mentioned
under the heading of Objectives.
ROUTINE WORK
The routine work in the registration of births and deaths is indicated
in the following table. This covers period from July 1, 1926, through
June 30, 1928, inclusive.
Twenty-second Biennial Report 35
BIENNIAL REPORT
July, 1926—June, 1928
Letters and postals received *27,504
Casket dealers reports received 7,072
Supplementals received 3,346
Name cards received 11,240
Violation blanks received 51
Acceptance papers received - - 64
Report cards received from local registrars 24,154
Letters written 16,076
Form letters sent 49,224
Postal cards sent 137,257
Packages of supplies sent 11,301
Bulletins (transferred to another department) 108,304
Indexing:
Cards made 254,296
Cards proofread 261,401
Cards assorted 242,262
Cards filed 221,054
Credit certificates sent local registrars 1,759
Certified copies made 5,754
Tables made 654
Cards punched and proofread 71,585
Cards furnished Dr. McCain giving information as to deaths
from tuberculosis monthly 5,033
Epidemiology reports from death certificates 4,405
Transcripts made and proofread 240,157
Tabulation of births -..- 165,793
Number certificates made in triplicate 5,800
Lines miscellaneous typing 5,290
Certificates Received:
Births 164,609
Deaths 68,333
Stillbirths 15,576
Total 248,518
Names checked on undertakers reports with death
certificates .„.- 8,379
Local registrars visited 315
Doctors visited .. - 105
Undertakers and coffin dealers 105
Register of Deeds 20
Midwives 70
RESULTS OBTAINED
Of course there is always a large per cent of routine work that is im-possible
to put in a report of this kind, and without going into unnecessary
detail, it may be said that the objective of this Bureau, as aforestated, has
been reached, and that all of the information with its vital bearing upon
the public health needs of the State and with the public health accomplish-ments
of the State is readily and completely available.
*This total does not include letters and postals received for Bureau of Epidemiology from
July 1, 1926, to August, 1927.
36 North Carolina Board of Health
BUREAU OF EPIDEMIOLOGY
The Division of Epidemiology and Venereal Diseases, formally connected
with the Bureau of Vital Statistics, was organized into a separate Bureau
with a full-time Medical Director, July 1, 1927.
OBJECTIVES
To prevent and control the occurrence of infections and contagions with
special reference to whooping cough, measles, diphtheria, scarlet fever,
infantile paralysis, cerebro-spinal meningitis, chicken pox, septic sore
throat, german measles, smallpox, typhoid fever, trachoma, malarial fevers,
and venereal diseases.
METHODS FOR OBJECTIVES
For convenience of description, the methods employed by the Bureau in
accomplishing its objectives may be divided into two main divisions or
units, each having a dual responsibility in the enforcement of rules and
regulations pertaining to the control of communicable diseases.
Section I.—The County Unit
A quarantine officer for each county and city having a separate health
department in the State has been secured. He is the Bureau's representa-tive
in the field, is required to execute oath of office, and is, therefore,
designated as assistant collaborating epidemiologist, receiving compen-sation
from their respective counties in accordance with the following
provision:
The said certification and the sum paid the quarantine officer by the
county authority shall be in accordance with a system of fees determined
by the North Carolina State Board of Health for each item of work in-volved
in the duties of the quarantine officer: Provided, however, that
the total annual payment for any county shall not be in excess of the sum
stated for such county classified according to population as follows:
Per Month
Counties with a population less than 10,000 $15.00
Counties with a population of from 10,000 to 15,000 17.50
Counties with a population ctf from 15,000 to 25,000 -— -- 25.00
Counties with a population of from 25,000 to 40,000 35.00
Counties with a population of from 40,000 to 50,000____. 45.00
Counties with a population over 50,000 50.00
Duties of the Quarantine Officer
The duties of the quarantine officer, acting as assistant collaborating
epidemiologist are similar to a certain extent to those designated by the
Board to the Bureau of Epidemiology and may be briefly outlined as
follows
:
(a) To secure reports from parents, teachers, and physicians of all cases
of communicable diseases.
(b) To keep an accurate record in his office of all reports.
(c) To transmit all reports daily to the Bureau of Epidemiology.
(d) To supply the parent, guardian, or householder, when the disease is
reported, with rules and regulations governing that person, with a
placard to be posted on the house, and with a pamphlet descriptive
of the disease, its dangers, cause, mode of infection, and methods of
control.
Twenty-second Biennial Report 37
(e) To inform the teachers in the community where the disease exists
that the disease is present, and to supply them with rules and regu-lations
governing the school while the disease is present, and with
pamphlets descriptive of the disease, its dangers, cause, mode of in-fection,
and methods of control, to be distributed through the children
to the parents represented in the school.
(f) To make the presence and locations of diseases known to the public
by publishing notices in the county paper when the disease appears
and how to prevent it.
(g) To furnish householders forms to report diseases in their community
which have not previously been reported.
(h) To investigate all cases of suspected contagions which have not been
reported, to determine the nature of the disease,
(i) To enforce the laws, rules and regulations governing the control of
communicable diseases,
(j) To make monthly reports to the Bureau of Epidemiology of all the
work, educational, administrative, or otherwise, done during the
month.
Section II.—Bureau of Epidemiology or State Unit
In order for the reader to more easily comprehend the duties performed
by this Bureau, consideration is given to the work under the following
heads: (a) General Office Routine, (b) Special Immunization Campaigns
for the Prevention of Typhoid Fever, (c) Special Immunization Campaigns
for the Prevention of Diphtheria, (d) Investigations to determine the Pre-valence
of Mosquitoes and to Institute Measures for the Control of Malarial
Fevers.
Office Routine
The daily reports of the communicable diseases are recorded by the
Bureau of Epidemiology by the counties in which they occur. These are
permanent records of the Bureau, and they show the number, location, age
distribution, increase or decrease in the number of cases of each disease
from month to month and from year to year.
Spot maps are kept, showing the daily occurrence of cases and monthly
occurrence of deaths of smallpox, diphtheria, scarlet fever, and typhoid
fever, and according to the sections of the State in which they occur, by
counties, and townships, and whether the cases are urban or rural.
Charts have been prepared showing the number of cases and deaths for
the above four diseases for the years 1918 to 1927, inclusive.
Weekly telegraphic and monthly written reports of all cases of infectious
and contagious diseases reported are made to the Surgeon-General, United
States Public Health Service, Washington, D. C.
All report cards, blank forms, educational posters, placards and liter-ature
on the reportable diseases, and all rules and regulations governing
the control of the diseases are prepared and distributed to all assistant
collaborating epidemiologists by the Bureau.
During this biennial, 15,697 circular letters have been mailed by the
department on subjects pertaining to the reporting and control of com-municable
diseases.
Weekly bulletins are issued by the Bureau showing the prevalence of
typhoid fever, diphtheria, smallpox, scarlet fever, measles and whooping
cough by counties. These bulletins are mailed to all assistant collaborating
epidemiologists, members of the State Board of Health, and others inter-ested
in the occurrence of these diseases in the State. The morbidity
38 North Carolina Board of Health
statistics of all reportable diseases are checked against the mortality
statistics in order to establish the efficiency of reporting.
Special Immunization Campaigns for the Prevention of Typhoid Fever
During the biennial, special immunization campaigns for the prevention
of typhoid fever and diphtheria have been conducted in 37 counties.
The campaigns are conducted in the following manner: The Bureau of
Epidemiology circularizes the county and furnishes advertising materials
to the county for the mailing list made up from the tax books. (The
Bureau makes up mailing list from the records of births in the county,
filed with the Bureau of Vital Statistics.)
Physicians who participate in these campaigns are paid 8i/^ cents a
single dose. Physicians make reports to the Bureau on forms supplied
for the purpose. These are checked and certifications sent to the County
Commissioners for payment.
List of counties in which special campaigns for the prevention of typhoid
and diphtheria together with the population immunized:
No. Taking No. Taking
Three Doses Three Doses
County Typhoid Vaccine Toxin-Antito.vin
1. Alamance (1926) 5,868 1,047
2. Alexander (1927) 4,140 1,266
3. Burke (1928) 6,274 1,812
4. Caldwell (1927) 8,323 1,913
5. Camden (1927) 1,358 1
6. Caswell (1928) 3,446 1,933
7. Catawba (1926) 9,030 2,101
8. Chatham (1926) 2,444 89
9. Dare (1926) 902 478
10. Davie (1927) 3,934 1,314
11. Durham (1928) No Report*
12. Gates (1927) 2,006 444
13. Greene (1927) 8,705 2,642
14. Harnett (1927) 10,008 1,780
15. Hertford (1928) 3,549 715
16. Iredell (1928) 10,911 1,848
17. Lee (1928) 8,878 1,510
18. Lincoln (1926) 5,415 1,073
19. Madison (1927) No Report
20. Martin (1926) 4,540 1,513
21. Martin (1928) 4,282 1,654
22. Montgomery (1926) 181 44
23. Moore (1926) 5,186 723
24. Moore (1927) 244
25. Perquimans (1927) 3,208 295
26. Person (1926) 6,966 1,502
27. Randolph (1926) 5,984 1,940
28. Rockingham (1926) 3,233 422
29. 'Robeson (1928) No Report*
30. Scotland (1928) 3,921 1,016
31. Stanly (1927) No Report
32. Stokes (1928) 3,225 839
33. Surry (1928) No Report*
34. Warren (1927) 7,055 1,262
35. Washington (1927) 2,258 823
36. Wayne (1928) No Report*
37. Yadkin (1928) 7,487 2,160
Total 152,961 36,159
*Whole-time counties.
Twenty-second Biennial Report 39
Total (11 counties—1926) 49,749 10,932
Total (11 counties—1927) 51,239 11,740
Total (9 counties—1928) ..51,973 13,487
Grand Total 152,961 36,159
Compiled Monthly Report of Part-Time County Quarantine Officers
July 1, 1926, to June 30, 1928
Cases reported by householder.... — 7,992
Cases reported by health officers and nurses 10,290
Cases reported by physicians 35,090
Cases reported by teachers .— 3,329
Total number of cases reported 56,701
Homes placarded 41,736
Articles published 411
Teachers' certificates 5,838
Indictments 82
Total number cases reported by whole-time quarantine off. 112,050
Grand total cases reported by all 100 counties in State 168,751
Summary of Office Work
Circular letters 15,697
Oaths of Office 23
Telegrams sent 128
Letters written—Individual — ._ 4,070
Multigraphed 4,759
Total all letters 24,526
VENEREAL DISEASE DIVISION
Although since 1924 the distribution of medicinal remedies for the treat-ment
of venereal diseases have been sent out by the State Laboratory of
Hygiene, and since the Federal appropriation was discontinued, the Bureau
has been unable to maintain public clinics for the treatment of indigent
cases, nor has any extensive educational work been conducted. However,
the Bureau receives a large number of letters requesting bulletins, pamph-lets
and advice. These are carefully answered and whatever information
requested sent.
The purposes of this dissemination of information are as follows:
(a) To stimulate the provision of facilities for proper treatment by estab-lishing
clinics for persons infected with venereal disease who are
unable to pay for treatment from private physicians.
(b) Information concerning patients dangerous to the public health is
referred to local health officers for investigation and action.
(c) Instruction and advise is given to persons infected with venereal dis-ease
concerning the necessity for proper treatment and continuing
treatment until cured.
(d) Tabulations are made from the data collected in an effort to gain
knowledge of the prevalence of infection and the best methods of
prevention.
In gathering information concerning cases of venereal diseases dangerous
to the public health, the Bureau has had recourse to the usual procedure
of requiring physicians to report their cases and requiring druggists to
report the sale of venereal disease remedies. These reports by physicians
and druggists are required by Chapters 206 and 214, respectively. Public
Laws of 1919.
The system of reporting provided by law and the regulations adopted by
the State Board of Health is designed especially to furnish usable infor-
40 North Carolina Board of Health
mation concerning dangerous cases. For this reason physicians are re-quired
to report names and addresses only when in their judgment the
patients should be under the supervision of the health officer in order to
protect the public health. When patients are considered trustworthy,
physicians may report their cases by number without disclosure of identity.
Reports that reach the office are so handled that information concerning
cases that should be invesitgated is referred to the local health officer.
Every effort is made to encourage reporting by physicians through
courteous treatment rather than by harsh measures. In carrying out this
policy a number of form letters have been drafted for use in the routine
handling of venereal disease case reports.
There has been reported to this office the following number of cases of
venereal diseases by part-time quarantine officers:
Gonorrhea 3,852
Syphilis 6,002
Chancroid 290
Balanitis 1
Total -._.. 10,145
Total number cases reported by whole-time quarantine off. 7,775
Grand total cases reported by all 100 counties in State 17,920
DIVISION FOR THE INVESTIGATION AND CONTROL
OF MALARIAL FEVERS
The work of the State Board of Health on Mosquito and Malaria Control
through the division for this purpose, as a result of insistent demand, has
increased four-fold in application during the last biennium. In addition to
the work in the malarial zone of the State, which had previously absorbed
the efforts of the division, three other variations were gone into, namely:
1. The study of impounded water and its effect upon the prevalence of
mosquitoes and the incidence of malaria; 2. The investigation of situations
which produce pestiferous mosquitoes; 3. The surveying of salt marsh areas
conjointly with the U. S. Public Health Service.
Of these issues, circumstances presented the questions surrounding the
impounding of water as the paramount mosquito and malaria problem of
the period. The damming of streams for developing hydro-electric power
was in a stage of expansion. The effect upon health conditions had previ-ously
led to long, bitter, and depressing ligitation and the issues by no
means had been satisfactorily cleared. Adequate study of the situation
necessitated application before and after building these projects, there-fore,
a major portion of the division's time was given to it. Space in the
report is allotted accordingly. The other issues, though probably having
been more or less constant, were meeting with a continually decreasing de-gree
of tolerance for they were proving more and more to be an obstacle
in the courses which progress and development were taking.
The original undertaking of the division in the malarial zone being
already well-organized and in operation in the hands of county health
units, is adequately covered in previous reports and therefore, not gone
into here further than the aid offered in maintaining it and taking up the
periodic problems which arose. Detail of the report is given in the order
of the subjects named.
Twenty-second Biennial Report 41
Studies on Impounded Waters
Since the year 1904, attention has been focused upon the impounding of
water for commercial purposes to an unprecedented degree. The elec-trical
developments which have made practical the broadspread utilization
of water power even to remote locations have created for the country
assets which can be estimated only in hundreds of millions of dollars.
North Carolina has had a large share in this harnessing and utilizing of
a wasting natural resource. It now holds fourth place among the states
in developed waterpower and second in developed horsepower as compared
to population. In this State alone, fortunes have been spent in hydro-electric
developments and upon the completion of developments projected
or now under construction, the expenditures will have mounted fifty million
more and the developed horsepower will be practically sixty per cent of
that available in the State. While there is a limit to this resource to
which the economic situation sooner or later will push development, it is
far in the future and in the meantime there are due many changes in
application, utilization, and demand which put the vista almost beyond
conjecture. However, not only the tremendous asset of power from water
impounding has presented itself, for as the ever-present thorn there is also
a derogatory side which has claimed no small share of attention, which
continues to loom as a tremendous liability and persists in engendering
grave concern.
The early impounders apparently were unaware of any health hazards
contingent upon their projects. Available pond sites were dammed and
filled, capacity for power being the interest. No concern was felt about
the condition of the basins. Whole forests were flooded or partly inundated
without a guess of evil days to come. Powerhouse wheels then spun busily
on while malaria mosquitoes availed themselves of these newly-prepared
and excellent breeding grounds. Thus, in connection with impounding for
hydro-electric development, the malaria problem grew, and in the form of
a lawsuit—Chattanooga & Tennessee River Power Company vs. Lawson
—
in the Tennessee courts, 1915, announced itself as a momentous issue.
To the present, lawsuits tried and pending in the South have involved
millions of dollars in addition to fees and costs. One power company at
one time had six hundred suits pending against it, each for .$3,000.00, a
total of $1,800,000.00. Together with the costs of war, North Carolina has
been the battleground for sums commensurate with her position in the
power field. The liability in health hazards and the uneasiness injected
into the progress of a key industry cannot be estimated. There are sec-tions
of the State for which progress awaits only until health conditions
are brought up to standard. Also, there are instances in which industries
have been turned away from the State because of the unavailability of
suitable power.
Another view of the situation is presented in our courts. Juries are
called upon to settle claims for malaria damage. Malaria has existed
before the present era of impounding, oftimes in the community in which
the impounding is done. Defendants are not responsible for this. Plain-tives
contend that impounders have created or intensified these conditions.
Conclusive facts often have been wanting. The dilemma of a jury left to
settle the issue upon evidence which is largely a matter of greatly-diff'ering
opinion is obvious. Neither the jeopardizing of health through impre-
42 North Carolina Board of Health
cautions or lack of foresight nor the persecution of those in a position to
make available our natural resources can be condoned. The availability
of more definite information regarding the mosquito and malaria condition
in a locality both before and after impounding would greatly facilitate the
clearing up of difficulties.
More preferable, however, than the settling of controversies would be
the elimination of their causes. This bespeaks the need of knowledge
which will go further toward the elimination of health detriments in the
maintenance of power ponds. Much has been done already. No more
ponds are found rising in uncleared forests. Old ponds have been cleared,
and the practice of keeping all of them clean and of discouraging mosquito
breeding is general. However, amidst a condition of uncertainty there has
arisen a desire for more knowledge in handling mosquito and malaria con-ditions,
better and surer methods of control, and some level of conduct
and understanding which will reduce health hazards to a minimum, com-mand
the approval of fair-minded people, and better put the hydro-electric
industry upon the road of progress with the good-will of all concerned.
In these problems and controversies the State has a responsibility, an
obligation, a stake for loss or gain.
It is true that a state best promotes its interests by fostering industries
and even truer is this in the safe-guarding of the health of its people.
Solving the problems outlined is progress in promoting such interests.
Purpose of Studies
Industries naturally follow in the wake of power development and can
thrive only in proportion as the power interests prosper. Power growth
has come more and more to center around water developments and like-wise
has the malaria problem centered. The work and development of the
U. S. Public Health Service gave hydro-electric projects their living
chance. This was excellent headway, but there is yet much to be done in
carrying on that work. While the present knowledge is generally appli-cable
and makes possible the contingent interests, each project has an
individual equation upon which much of its prosperity may depend and
which to know is highly desirable. As with railroads and other organi-zations
in whose welfare malaria has been discovered to play a part, im-pounders
may desire to gain the asset accruing to the improving of health
conditions and the gaining of good-will among those whom they may
benefit, but this is not incumbent upon them. However, all are concerned
in knowing that conditions, if not improved, remain at least unchanged.
This is another call for facts resultant of which there has arisen an urgent
need for the study of mosquito and malaria conditions in connection with
North Carolina industries. Power officials are deeply concerned with it,
and in addition to maintaining their own forces for control work on ponds
already in use, they are much interested in work carried on by the State.
These problems in the State were given cognizance and a program insti-tuted
with the following purposes in view: to further determine the effect,
on mosquito and malaria propagation from damming water-courses, to
determine the variation in species breeding because of changing from flow-ing
streams—the natural haunts in the South of Anopheles Punctipennis
—
to sluggish streams and ponds—the natural breeding places of Anopheles
Quadrimaculatus, the principal carriers of malaria; to ascertain and perma-
Twenty-second Biennial Report 43
nently record conditions surrounding impounded water projects before and
after impounding; to work toward the future elimination as far as possible
of the mosquito and malaria problem. A brief consideration of breeding
habits and the effect of surroundings and changes may give something of
the outlook of the undertaking.
Differential Breeding
The breeding habits of the different species of mosquitoes are an im-portant
consideration in the impounding of water, and is the factor that
threatened to bring to grief the first water-power projects in the South.
While the whole mosquito family is given with variable adaptability, each
species has a marked preference for waters of particular characteristics.
This is so pronounced that the type to be found in different situations can
be forecast with fair accuracy. Preference with most species is for natural
instead of artificial collections of water. However, when both are present
this may often mean a greater extent of breeding in the natural, than in
the artificial ones, rather than all breeding in one and none in the other.
In all cases quiet and protection are essential for propagation. Absence
of trash, weeds, grass, or other obstructions, or the presence of wave and
ripple action are strong deterrents to production.
Of the Anopheles, the Quadrimaculatus, or principal malaria carriers,
breed in ponds, lakes, pools, lagoons and estuaries, sluggish streams and
tubs and cans. Marine growth, floatage, and moderate stagnancy only add
to their comfort. Organic acids such as tannic, any kind of filth as excreta
or waste, or contaminations of a chemical nature tend to discourage them.
Appreciable quantities of any of these will stop their breeding altogether.
Anopheles Crucians tend to begin breeding where Quadrimaculatus leave
off. The inclusion of minerals such as found in brackish water, or swamp
and bog water containing tannic acid proves attractive to them. These
attributes with a nature akin to Quadrimaculatus for peaceful water, tend
to locate this group in lowlands and flat country. They therefoi'e may be
on the scene in malaria epidemics.
Punctipennis is the free-water active stream group of the Anopheles.
They are to be found harbored along running streams, springs, branches,
and not infrequently in springs. They are more adaptable to both temper-ature
and environment changes than the other species, upon necessity will
resort to various departures from their choice of waters, and therefore,
are the more widely distributed.
It is hilly country with pronounced fall that affords the best impounding
sites. Any kind of condition may exist on a small scale in such an area,
but in whole it is one of springs and briskly moving water-courses, and
therefore, the haunts of Punctipennis. Though this species can be infected
with malaria it has not been proved infective in nature and disease carry-ing
has not been generally charged to them. When such an area as they
inhabit is impounded and the flowing water replaced by relatively still
water, they may tend to lose interest and wane in their breeding while
Quadrimaculatus thus favored will begin intensified activities which, if not
controlled, soon will reach unhealthful proportions. Even though the
adaptability of the Punctipennis may continue them in unabated numbers,
it can be dependably relied upon that, left to their own volition, Quad-rimaculatus
will be added to the mosquito population evolving from such
44 North Carolina Board of Health
changes. Thus, from the nature of the insects, the hazard of malaria is
incurred upon impounding.
Other factors of prime importance in the control of mosquitoes in im-pounded
waters are sanctuary and natural enemies. To utilize a location
for breeding, mosquitoes must find in it more than favorable water con-ditions.
Sanctuary from agitating elements and enemies are essential. If
an otherwise favorable body of water is free of trash, floatage, and vegeta-tion,
and is open to wind and wave action, mosquito larvae do not thrive
in it.
The mosquito realm in all three stages is inflicted with numerous pre-dacious
enemies—fish, birds, insects, parasites, plants, reptiles, and even
their own cannabalism. It is possible to utilize these natural enemies in
the control of mosquitoes. One of them, a small surface minnow—Gam-busia
Affinis—has been used extensively in ponds. However, conditions
must be suitable to their abilities and habits or the purpose is defeated.
Any material such as growth or trash and floatage will offer mosquito
larvae sanctuary and bar access to the minnows.
In addition to these considerations there are other factors such as
geology, topography, and climate which exert direct influence on a mos-quito
situation and off'er extended avenues of study. In the work on im-pounded
water, these were gone into extensively, however, any compre-hensive
treatment of the subject is too extensive for space here.
Methods and Procedure
Studies of impounded water projects were carried on in the form of sur-veys.
A feature of the work was cooperation between the State Board of
Health and county health organizations in whose territory the work was
carried on. The general data collected was histories of past occurrences
of malaria, present malaria both by history and by taking blood tests, and
general premises conditions which pertain to mosquito favorability. These
constitute an index to the prevalence of malaria, past and present. Also
a general mosquito survey of the territory is made with a view of de-termining
the kind and prevalence of mosquitoes. This finds service in
correlation with existing malaria conditions as well as showing potenti-alities
and also as a basis for future comparison.
The territory of immediate interest for study is that within a one mile
range of the territory of impounding, this being considered the probable
extent of effect from a breeding area. When such an area has been laid
out, workers proceeded from house to house. The purpose was explained
and then through a series of questions, blanks arranged for the desired
information were filled out. In addition blood smears were taken as fol-lows:
The tip of a little finger was thoroughly cleaned with alcohol, and
while being gripped to cause congestion, was quickly punctured with a
needle. The first drop of blood was wiped away, the second drop was
picked up with an end edge of a clean slide, placed on the face of a second
slide near one end, allowed a moment to spread across their widths, and
with the first slide held at 45 degrees to the face of the second, was quickly
smeared along two-thirds of this surface. Such a smear dries very rapidly.
The serial number of the person being examined is then written with lead
pencil directly into the smear. Slides were then returned to container for
safe-keeping. Daily they were brought into the office, wrapped in tissue
paper, and filed to await examination.
Twenty-second Biennial Report 45
Completing the blood smear work was as follows: Wright's stain, secured
already prepared, was used for staining. The method given for preparation
and use was—"Stock solutions; dissolve two-tenths grain dry slain in
120 cc of acetone-free methyl alcohol, store in a light-proof bottle. For
staining, filter 20 cc stock solution, dilute with 5 cc acetone-free methyl
alcohol. With slide lying flat apply small amount of stain with medicine
dropper, let remain for one and one-half minutes, add distilled water, allow
to stand for three or four minutes; rinse with distilled water and permit
drying." Slides are then ready for examination.
Examinations were made on a movable stage microscope, oil immersion.
Detail of identification will not be gone into here. After twenty minutes
of careful scrutiny, unless findings were otherwise, smears were passed up
as negative. Results were then duly recorded.
Mosquito Conditions
In surveying for mosquito conditions in areas as large as those involved
in the present day impounding project, the application must be shaped in
a manner to best secure the desired results and still be within range of
practicability according to personnel available for it. The method in gen-eral
is to size up the territory carefully, spot a maximum number of pro-ducing
areas, choose from these the apparently more significant, in quantity
within range of practicable application, and then visit them by regular
schedule, seeking out the desired breeding and prevalence date and record-ing
in collective forms. The date thus compiled constitutes a permanent
record in cross-section of the areas under surveillance. Good maps are
very useful and time-saving in planning and getting the work under way.
In following the plan laid out, field notes are compiled carrying data of
apparent value. Such mosquitoes and larvae as are taken are labeled and
reserved to later be identified and results entered on the records started
in the field. Thus is gradually compiled a continuous portrayal of tran-spirations
through a season.
Field equipment is simple, consisting of insect-catching apparatus and
containers for storing until catches are identified. Identification is done
both microscopically while the insects are in the larvae stage and by
maturing and identifying adults.
Recording is a highly essential feature and demands careful attention,
for the permanent value of the work rests thereon.
Studies on impounded waters were made on three projects: The High
Rock Project of the Tallassee Power Company, Davidson, Davie and Rowan
counties; Lake Lure, Rutherford county, and the Norwood project of the
Carolina Power & Light Company, Stanly and Montgomery counties.
The data collected on these projects is within itself of quantity sufficient
to form a volume. Only collective results in outline are given here.
The High Rock Project
The High Rock Project, under construction at the time of this report, is
one of the twenty major hydro-electric power developments producing from
500 to 93,000 horsepower per unit, wholly or partly within North Carolina
and is one of the five in the State promoted by the Tallassee Power Com-pany.
To the 216,000 horsepower now being developed by the company
in the State, this project is planned to add 45,000, which, by contract
stipulating delivery of current by the first of 1928, is consigned wholesale
46 North Carolina Board of Health
o
to the Southern Power Company which will market it for industrial or
general use locally or broadspread as the demand may arise.
The project is located on a twenty-three mile section of the Yadkin
river, occupying an area from the dam and powerhouse site at High Rock
Mountain eighteen miles east of Salisbury; along the territory of the com-mon
border of Davidson and Rowan counties, upstream, northwest, touch-ing
Davie county on two sides by branching into the South Yadkin river
for eight miles.
Figures given for the lake and dam are as follows: dam, 59 feet high,
1,200 feet long; lake 19,000 acres or 20.7 square miles in area, 300-mile
shore line, to back water 23 miles.
The mosquito surveys on this project were carried on through two sea-sons—
1926 and 1927. The history and blood work was terminated in the
first year. Work of this type on a large project is volumnous and in many
respects subject to the difficulties that go with the organizing of temporary
forces of limited personnel for such work. Due cognizance is taken of this
and results evaluated accordingly.
Malaria in the High Rock Territory
History and blood indices disclose that for the period embraced by the
1926 survey in the High Rock territory, malaria as compared to districts
in which the disease becomes a major problem, was not a feature of public
health importance. The infections as shown by histories was 1.789<', by
blood smears, 3.50%.
It is well, however, for those interested in malaria and malaria control
to remember that the problem is a constantly shifting and fluctuating one
and that it is practically impossible to secure a picture of the disease at
rest, nor is it expected that the parasitic or history indices will remain
the same for long periods of time. Sectional differences, in view of the
disease and toleration for it, will have influence. Also, the experience
gained in one community may be entirely contradicted by that from another
of similar type.
Mosquitoes in the High Rock Territory
The outcome of the mosquito survey in the High Rock territory amply
meets any normal expectation that may have been held for it. Both Culex
and Anopheles existed in proportion as they were aff"orded sanctuary and
favorable conditions.
Culex were generally prevalent in limited quantities throughout the terri-tory,
with exaggeration in sections when afforded fitting encouragement
such as conditions of water contamination by rubbish, waste, or sewage.
This was given expression in the increase in prevalence during dry seasons.
Punctipennis existed in by far the greatest quantities, v/hich marks the
section as majorly Punctipennis grounds. This measures up to original
appearances, that at large the section topographically was fitted best to
the production of this type of mosquito.
Quadrimaculatus existed in limited quantities and were fairly well dis-tributed
under general conditions throughout the territory. They appear
prominently where efforts were confined to territory of the type most
suited to them. This again supports original indications, that while the
territory was by nature majorly of Punctipennis producing proclivities, it
also would be subject to local Quadrimaculatus production