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SI>*r«PNTH BIENNIAL REPORT
'%,^ OF THE
DIVISION OF HEALTH AFFAIRS LlSrtAIlY
NORTH CAROLINA
STATE BOARD OF HEALTH
1915-1916
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SIXTEENTH BIENNIAL REPORT
OF THE
NORTH CAROLINA
STATE BOARD OF HEALTH
1915-1916
RALEIGH
Edwards & Broughton Printing Co.
State Printers
1917
TABLE OF CONTENTS
PAGE
Members of the State Board of Health 3
Letter of Transmittal 5
Preface 6
Health Work in the State of North Carolina for the Biennial Period 1915-
1916 7
Expenditure for Prevention of Disease Comparatively Considered 17
What the Board of Health is Doing with its Money 19
Present Organization of the North Carolina State Board of Health 23
Biennial Work of the Executive Staff 26
State Laboratory of Hygiene 28
Bureau of Engineering and Education 30
Bureau of Vital Statistics 35
State Sanatorium and Bureau of Tuberculosis 43
Bureau of Rural Sanitation 45
Soil Pollution Work 46
Bureau of Accounting 47
The Public Health Needs 48
State Control of Contagion 48
State Regulation of the Conditions of Sales of Trade-mark Remedies. 51
Relation of State to County Health Work 58
Minutes of Meetings of the State Board of Health 60
General Financial Report 67
Financial Report, Laboratory of Hygiene 68
Report of Audit 69
Fund Balance Sheet 71
Appropriations, Earnings, and Expenditures 72
Publications Showing Work of State Board of Health. 76
Members of the State Board of Health
Elected by the North Carolina Medical Society:
Thomas E. Anderson, M.D., Statesville.
Term expires 1917.
Charles O'H. Laughinghouse, M.D., Greenville.
Term expires 1917.
P. R. Harris, M.D., Henderson.
Term expires 1919.
Cyrus Thompson, M.D., Jacksonville.
Term expires 1919.
Appointed by the Governor:
J. L. Ludlow, C.E., Winston-Salem.
Term expires 1921.
J. Howell Way, M.D., Waynesville.
Term expires 1917.
W. 0. Spencer, M.D., Winston-Salem.
Term expires 1917.
Richard H. Lewis, M.D., LL.D., Raleigli.
Term expires 1919.
Edward J. Wood, M.D., Wilmington.
Term expires 1919.
^1^656^"^
Letter of Transmittal
Raleigh, N". C, January 1, 1917.
His Excellency, Locke Craig,
Governor of North Carolina.
My dear Sir :—Under autlnfrity of section 3, chapter 62, Public
Laws of 1911, as amended by the General Assembly of 1913, I have the
honor to submit the Biennial Eeport of the State Board of Health for
the years 1915 and 1916. Very respectfully yours,
W. S. EANKIIf,
Secretary and Treasurer.
PREFACE
It is our iuteutiou to smash precedent in the size and substance of
hionnial reports. The large size of the average biennial report appears
to rest on the hope of impressing those to whom it is addressed (not
the few who read it) with the size rather than with the contents of the
report. The size alone of most of these reports precludes their being
read by busy jieople; and it makes little difference whether the other
class does or does not read them. There is a story of a young reporter
who was directed by a large New York paper to report a certain lynch-ing
of unusual public interest. The young reporter wired his paper to
hold three columns for his story. The editor wired the reporter to con-fine
himself to one column. The young reporter, in the atmosphere of
the lynching, could see only the importance of the lynching, and wired
back to the paper that it was impossible to restrict his story to a single
column. The business manager telegraphed, ''Description whole crea-tion
covered in Grenesis one. Read it."
"With this idea of brevity, and with the hope of reaching busy people,
we have sought the avoidance (1) of matter that can be obtained easily
from other publications, and (2) of matter consisting largely of details
and statistics that is of little general interest and that can be more con-veniently
supplied to those interested in the form of supplementary
reports. For example, the State public health laws, the itemized state-ment
of the bookkeeper, and the vital statistics of the State have been
excluded from the report. Any or all of this matter may be obtained
in separate form by request of the State Board of Health.
The arrangement of this report is by fairly independent subdivisions,
so that it is possible for one to read and understand any part of the
report without reading the whole report.
Health Work in the State of North Carolina for the
Biennial Period 1915-1916
HISTORICAL
DEVELOPilEXT OF PUBLIC HEIAXTH
Prior to the seventeenth century our study and our knowledge of disease
was confined to the manifestations or symptoms of disease, and the treat-ment
of disease was purely empirical, and not rational. There was little
known about the causes of disease and how to prevent disease. The light
began to break in 1683, when Anthony van Leeuwenhoek, a lens polisher,
discovered germs in spittle. This discovery of van Leeuwenhoek was con-firmed
by others, but little progress was made in associating germs with
diseases for nearly a century afterwards. At this time, that is, along in the
eighteenth century, the relation of the germs discovered by van Leeuwenhoek
to disease began to be considered? One set of students took the position that
the germs found in putrefying matter or fermenting fluids or the diseased
bodies were not the cause of decomposition or fermentation or disease, but
the effect; the other set of students took the position that the germs were
the cause of decomposition, fermentation, and disease. Tlie debate on this
interesting question occupied the best scientific minds for a century, and
was not finally settled until Pasteur and Tyndall, in the nineteenth century,
between 1860 and 1880, performed certain conclusive experiments showing
that these lower forms of life were causes and not consequences of disease.
The essential features of this long-continued and interesting scientific debate
can be found In any well known text-book on bacteriology, and the evidence
in its details upon which the scientific world came to its verdict of germs as
the cause of disease will not be rehearsed here. Suffice to say, In passing,
that the actual and convincing results of prevention during the last thirty
or forty years have been accomplished by proceeding upon this scientific
principle of germs as the cause and not the consequence of disease; and the
proof of the pudding is in the eating.
Little headway in the association of specific germs with diseases was made
until well into the nineteenth century. In 1863 Devane proved that anthrax
In sheep was due to a specific germ. In 1873 Obermeier discovered the cause
of relapsing fever. In the early seventies septic infections or blood poison
and the suppuration of wounds was practically demonstrated to be due to
germs. Lord Lister's basic discovery in antiseptic surgery naturally fol-lowed,'
and the science of surgery as we know it today was born at about
this time, 1875. In 1879 the germ causing leprosy was discovered and. In
the same year, Neisser discovered the germ causing gonorrhea. In 1880 the
typhoid fever germ, the pneumonia germ, and the germ causing chicken
cholera were discovered; and In the same year Laveran discovered the germ
causing malaria. In 1882 Koch discovered the germ of tuberculosis, and
Loefiier and Shutz discovered the germ of glanders. In 1884 Koch discovered
the germ of Asiatic cholera and LoefHer the germ of diphtheria and Nicolaler
8 North Carolina Board of Health
the germ of lockjaw or tetanus. In 1892 the germ of influenza was discov-ered,
and in 1894 the germ of bubonic plague was discovered.
The important facts to note in this connection is that between the years
1875 and 1895 the specific causative germs of fifteen important diseases
were discovered. Out of these discoveries and based upon this knowledge
of certain diseases being due to seeds or germs, and of the way in which
tliese seed or germs are conveyed from the sick to the well, that is, the means
by which disease is spread, public liealth activities and public health organi-zations,
the definite and active participation of the Government in tlie con-trol
of disease came into existence. This fact explains the following table,
giving the dates of the establishment of the various State boards of health:
Name of State
Date
Established
District of Columbia
Louisiana
Massachusetts
California
Minnesota, Virginia.. !..
Michigan
Maryland.
.\labama-
Wisconsin
Illinois, Mississippi, Xew Jersey, North Carolina, Tennessee
Connecticut, Kentucky, Rhode Island, South Carolina
Delaware
Iowa, New York
Arkansas, Indiana. New Hampshire, West Virginia
Missouri .1
Kansas, Maine, Pennsylvania .
Ohio, Vermont '
Florida, North Dakota
Oklahoma
Nebraska, Washington
Colorado, Nevada
South Dakota.
Utah
Montana, Wyoming
Arizona, Georgia, Oregon, New Mexico
Idaho
Texas
1822
1855
1869
1870
1872
1873
1874
1875
1876
1877
1878
1879
1880
1881
188.3
1885
1886
1889
1890
1891
1893
1895
1898
1901
1903
1907
1909
Note that in the same period, from 1875 until 1895, twenty years, in which
more specific causes of diseases were discovered (15 specific disease germs)
than in any other like period of time, thirty-three "States organized, their
State boards of health, declared war on man's common enemy, and entered
the fight for better protection of health and life.
Once the Governments of the various States having launched a fight against
disease, the development of the State agencies for State health work has
Sixteenth Biennial Report 9-
gone along hand in hand with the accumulation of positive proof, in the
form of decreasing death rates, of the practicability of disease prevention.
The bulk of this important evidence can be seen in the following table:
GENERAL DEATH RATE OF THE UNITED STATES (REGISTRATION AREA), 1880-1914.
Year
10 North Carolina Board of Health
COMPARATIVE DEATH RATES BY STATES. 1900-1911.
Sixteenth Biennial Report 11
town, the chairman of the board of county commissioners, and the
county surveyor. Four educational pamphlets issued. Subjects:
"Disinfection, Drainage, Drinking-water, and Disinfectants"; "Sani-tary
Engineering"; "Methods of Performing Post-mortem Examina-tions";
"Limitation and Prevention of Diphtheria." Annual appro-priation,
$200.
1881. General Assembly passed a law requiring registration of vital statistics
at annual tax listing; law ineffective. Annual appropriation, $200.
1885. General Assembly made county boards of health more efficient; allowed
printing privileges not to exceed $250 annually. Annual appropria-tion,
$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 gen-eral
distribution. Annual appropriation, $2,000.
1888. Yellow fever epidemic in Florida and refugees to western North Caro-lina
demonstrated value of a Board of Health to cope with situation.
Annual appropriation, $2,000.
1892. Dr. Thomas P. Wood, the Secretary of the Board, died August 22. Dr.
Richard H. Lewis elected Secretary to succeed Dr. Tliomas F. Wood,
September 7. Annual appropriation, $2,000.
1893. Legislative provisions: (1) Laws improving the reporting of conta-gious
diseases, (2) the protection of school children from epidemics,
(3) protecting the purity of public water supplies, and (4) regula-tion
of common carriers. Legislature provided that Governor ap-point
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 quaran-tine
and disinfection was prepared and reprinted by many of the
State papers. Annual appropriation, $2,000.
1894. A number of public health conferences were arranged and held in dif-ferent
towns of the State. Bulletin was increased from a mailing
list of 800 to 1,200. Annual appropriation, $2,000.
1895. Dr. Albert Anderson and Dr. W. T. Pate were elected bacteriologists
for the Board. Annual appropriation, $2,000.
1896. Board passed a resolution requiring chemical and bacteriological ex-aminations
of municipal water supplies. Dr. Venable of Chapel Hill
undertook the chemical examination, and Drs. Anderson and Pate
the bacteriological examination. Board also directed Mr. John C.
Chase, the engineer member, to inspect all municipal water plants
in the State. Annual appropriation, $2,000.
1897. General Assembly enacted law requiring county superintendents of
health to be elected by county commissioners, and reduced term of
office to one year. Annual appropriation, $2,000.
1899. General Assembly improved the laws protecting public water supplies.
Smallpox prevailed extensively in the State. Dr. Henry F. Long,
and later, on Dr. Long's resignation. Dr. Joshua Tayloe were em-ployed
to travel over the State, consulting with and advising the
local sanitary authorities as to proper means for protecting the pub-lic.
Annual appropriation, $2,000.
12 North Carolina Board of Health
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 disease in the
South. Dr. J. L. Nicholson and Dr. W. S. Rankin, working under
State Board of Health during fall of 1903 and spring of 1904, showed
great prevalence of this disease in North Carolina. Annual appro-
. priation, $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 pub-lished
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 annually
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 Tu-berculosis
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 improve-ments
and $5,000 for maintenance. A law requiring the separation
of tuberculous prisoners from other prisoners was enacted. Annual
appropriation, $4,000.
1908. January 1, Dr. C. A. Shore became Director of State Laboratory of
Hygiene. Annual appropriation, $4,000.
1909. General Assembly provided for (1) whole-time State Health Officer;
(2) collection of vital statistics of towns having a population of
1,000 or over; (3) that all public water companies file plans and
specifications of their plants with the State Board of Health, and
that the State Board of Health pass necessary rules and regulations
for the care of public watersheds and plants and furnish such rules
and regulations and other advice to those having charge of public
water supplies; (5) that counties provide free diphtheria antitoxin
for county indigents; and (6) that the maintenance appropriation
Sixteenth Biennial Report 13
for the Sanatorium be increased from $5,000 to $7,500, and an addi-tional
$30,000 be granted for permanent improvements. Dr. Ricliard
H. Lewis resigned as Secretary of the Board, and Dr. W. S. Rankin
was elected as his successor, beginning his ofRcial work July 1. An-nual
appropriation, $10,500.
1910. General effort to interest the people and State organizations in public
health work. Bulletin increased from 3,500 edition to 10,500 edition.
Addresses on public health work delivered to Conference of County
Superintendents of Schools, State Federation of Women's Clubs,
State Press Association, and Sanitary Sunday observed in April.
Dr. John A. Ferrell elected, February, Assistant Secretary for Hook-worm
Eradication; began work under State Board of Health and
Rockefeller Sanitary Commission. First effort in the eradication of
hookworm disease was to interest school teachers in the disease and
through their assistance examine and treat the children, and thereby
reach the community. Three bottled spring waters sold on the mar-ket,
examined, found polluted, and public attention called to the pol-lution.
Annual appropriation, $10,500.
1911. Legislature established county boards of health to take the place of
the county sanitary committees; county board of health composed of
chairman board of county commissioners, county superintendent of
schools, mayor of county town, and two physicians selected by .the
three county officials to serve with them. Legislature also abolished
quarantine for smallpox and improved the quarantine laws. One
thousand dollars annually appropriated to contract with antitoxin
manufacturers for State supply of high-grade diphtheria antitoxin,
with result that price of antitoxin was cut to one-fourth former
price, saving the citizens of the State over $30,000 annually. Bulle-tin
increased from 11,500 copies to 20,000 copies each edition; closer
cooperation with press of State developed; regular weekly press
articles prepared and sent to papers; increase in number of popular
pamphlets for distribution. Hookworm work this year largely edu-cational
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 offi-cers.
Maintenance appropriation 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 deal-ing
with different diseases increased; press work improved; educa-tional
work of Board along all lines amplified. Secretary of Board
of Health called attention of conjoint meeting of State Medical
Society and State Board of Health to the relative importance of
health problems and the bearing of this subject upon the proper
apportionment of health funds; instrumental in passing a resolu-tion
to the effect that pellagra was an interstate problem, not a
State problem, and requesting the Federal Government to deal with
pellagra as a Federal problem; resolution responsible, to consider-
14 N'oRTir Carolina Board of Health
able 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 ap-propriation
for its enforcement. County superintendents of health
changed to either county physician or county health officer. Educa-tional
efforts of Board continued and enlarged. Hookworm work
along same line as year before increased in amount. Dr. John A.
Ferrell resigned as Assistant Secretary to accept position with the
central office of the Rockefeller Sanitary Commission in Washington,
D. C. Dr. C. L. Pridgen succeeded Dr. Ferrell. The movement for
improved county health work had by this time resulted in ten
counties electing whole-time county health officers. The State Sana-torium
for Treatment of Tuberculosis turned over by Extra Session
of 1913 to the management of State Board of Health. Annual appro-priation,
$40,500.
1914. Preceding work of the Board continued. Board of Health took over
management of Sanatorium; started out under many difficulties on
account of the institution owing many debts and the appropriation
being limited. Hookworm work changed to community work
directed to the installation of sanitary privies in all homes. Labor-atory
began to produce and distribute free antityphoid vaccine. Dr.
C. L. Pridgen resigned as Director Hookworm Eradication, and Dr.
W. P. Jacocks succeeded him. Annual appropriation, $40,500.
1915. General Assembly makes State vital statistics law conform to National
model by requiring burial permits in rural communities; enacts
legislation permitting county commissioners and towns and cities to
appropriate money for support of tuberculous citizens in State San-atorium;
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 antituberculosis work. Edu-cational
work greatly extended: Bulletin now 47,000; traveling pub-lic
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 dif-ferent
parts of the State. Community 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 con-ditions.
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. An-nual
appropriation, $50,500.
Sixteenth Biennial Repobt 15
1916. North Carolina was admitted to the Registration Area. To the edu-cational
agencies of the Board was added a self-supporting moving
picture health show. Many saw this show during the year, and,
seeing, believed in health work as never before. Bulletin had to be
discontinued temporarily for lack of printing funds, but before dis-continuance
reached 51,000 edition. Cooperation with University in
developing a plan and putting on a home post-graduate course in
medicine, giving first course to 169 doctors. Put into operation an
optional system of hotel inspection, with grading and publishing
scores. Continued unit system of county health work, giving three
antityphoid injections to 48,000, making 100,000 immunized in sum-mers
of 1915 and 1916. Did complete medical inspection of five
counties and with inspection a large amount of educational work as
to sanitary and hygienic living. Secured effort by Federal Children's
Bureau to develop unit of child hygiene work, the Bureau using two
employees to work in Cumberland and Swain counties for about eight
months. Laboratory of Hygiene buys land and erects its own build-ing.
Sanatorium making a decided impression on the State. Annual
appropriation, $55,500.
In addition to the regular appropriation, as above given, the Laboratory of
Hygiene has received, in accordance with the original act, fees for examina-tion
of pathological specimens submitted by physicians; also a tax on all
water companies of $64 annually for the examination of monthly samples of
water, and, since 1907, a small amount for administering the Pasteur treat-ment
to persons bitten by rabid animals. Receipts from these sources be-gan
to come in in 1905. The annual receipts from these sources for the
various years have been as shown in the following table:
1905 S 3,425.27
1906 3,425.27
1907 4,887.97
1908 4,887.97
1909 0,196.54
1910 5,196.54
1911 6.271.39
1912 6.271..39
1913 6,118.94
1914 6,118.94
1915 _• 8.541.72
1916 8,541.72
16 ;N"orth Carolina Board of Health
REVENUE BASIS STATE BOARD OF HEALTH SINCE ESTABLISHMENT.
Year
EXPENDITURE FOR PREVENTION OF DISEASE COMPARATIVELY
CONSIDERED
The mind grasps weights, sizes, and expenses—in fact, almost everything
—
through associations or comparisons. Measurements imply comparisons;
therefore, to appreciate the amount expended by North Carolina for the pre-vention
of disease it may be well to make certain comparisons.
The following table, showing the per capita State expenditures for public
health work, was compiled by Dr. Charles V. Chapin, one of the best known
health officers of this country, for the American Medical Association after
making a careful survey, at considerable expense to the Association, of the
work of the State boards of health of the Union.
PER CAPITA EXPENDITURE.
Cents Cents
Florida 15.21 Colorado 2.19
Pennsylvania 12 .70 Virginia 2.09
Maryland 10.54 Maine 1 .95
Vermont 9.27 Ohio 1.80
Nevada 7.59 Illinois 1 .78
Montana 5 .45 Oregon 1 .78
Idaho , 5.22 Oklahoma . 1.61
Massachusetts 4.95 Wisconsin 1 .56
Louisiana 4.93 North Dakota 1.48
New Hampshire 4.81 Michigan 1.48
New Jersey 4.47 Iowa 1.46
Delaware 4.C4 South Dakota 1.43
California 3.96 Kentucky 1.27
Arizona 3.76 Wyoming 1.24
Minnesota 3.25 Georgia 1 .21
Rhode Island i. 3.14 Texas . 1.13
Utah 2.93 Alabama 1.11
Kansas 2.60 Washington 1.08
New York 2.87 Mississippi 1.20
North Carolina 2.60 West Virginia , 1.02
Indiana 2 ..32 Missoiu-i .86
South Carolina 2.27 Nebraska .85
Connecticut 2.24 Tennessee .73
Arkansas .53
Chapin's Report shows North Carolina twentieth in per capita expenditure
for public health work; the same report shows North Carolina twelfth in effi-ciency.
North Carolina expends $650,000 annually for the care of her insane and
delinquents, and $55,500 annually for prevention. Much of insanity and de-linquency
has a preventable basis. Where the State spends $1 for the pre-vention
of disease it spends $11.60 for the care of the insane and delinquent.
Sixteen per cent of the Insanity is due to syphilis. This means that there
are 500 insane people in our asylums as the result of syphilis alone. The
annual per capita cost of these 500 people is $170. Therefore, for the care
of the syphilitic insane alone the State is spending 500 x $170, a total of
$85,000 a year. Twenty per cent of insanity is traceable to alcohol. If this
percentage holds for North Carolina, we have 600 insane in our asylums as
18 North Carolina Board of Health
the result of alcohol, the annual per capita cost being $170, making our bill
for taking care of our alcoholic insane 600 x $170, a total of $102,000 a year.
The General Assembly of Massachusetts of 1915 appointed a committee to
investigate the cost to the State of taking care of the syphilitic insane in
the State institutions. This committee found that syphilis was costing the
State of Massachusetts through its syphilitic insane alone $450,000 a year.
On this finding the committee recommended to the General Assembly that
the sum of $10,000 be appropriated for the purpose of experimentation in
the hope of finding a way to make a cheaper remedy than salvarsan, the
specific remedy for syphilis and the cost of which is about $5 a dose.
The saying that an ounce of prevention is worth a pound of cure is hack-neyed,
but it lacks a lot of being worn out.
WHAT THE BOARD OF HEALTH IS DOING WITH ITS MONEY
The following was prepared for and is taken from the Democratic Hand-book
for the year 1916:
DIVIDENDS ox INVESTMENTS IN PUBLIC HEALTH
Item Xo. 1.—The State Laboratory of Hygiene examines annually 5,000
microscopic specimens, which would cost the people and the physicians of
this State, if examined in other laboratories, $7,500. This $7,500 is one
dividend that is paid on the State investment of $59,000 in the health of her
people.
Item Xo. 2.—The State Laboratory of Hygiene examined last year 3,289
samples of drinking-water. These analyses made by other State laboratories,
or by private laboratories, would have cost our State $16,445. This is a
second dividend paid on the State's investment of $59,000 in the health of
her people.
Itein Xo. 3.—The State Laboratory of Hygiene treated last year 175 citizens
of North Carolina who had been bitten by rabid animals. It would have cost
the 175 citizens of the State $10,000 to have secured the Pasteur treatment
outside of the State. This $10,000 is a third dividend paid on the State's in-vestment
of $59,000 in the health of her people.
Item Xo. -j.^Before the State Laboratory began to supply typhoid vaccine
free to the people, the vaccine, for each immunization, cost $1.50, and conse-quently
relatively few people were immunized. With free vaccine there will
probably be at least 100,000 to 125,000 vaccinations this year, on which will
be saved $1.50 each, or a total of not less than $150,000, which is a fourth
dividend on the State's investment of $59,000 in the public health.
Item Xo. ').—The General Assembly of 1911 gave the State Board of Health
the authority to contract with those manufacturers of diphtheria antitoxin
that hold a United States license for a State supply of antitoxin to be pur-chased
from the lowest bidder by the State Laboratory of Hygiene and dis-tributed
through antitoxin stations in the various counties to the people at
exactly the cost of the antitoxin at the State rate. We might say right here
that the quality of the antitoxin is guaranteed by the United States Govern-ment.
Antitoxin is sold in packages, which are graded according to the
units of potency per package, into packages of 1,000, 3,000, and 5,000 units.
The prices of these packages of antitoxin, before this arrangement was made,
were as follows:
1,000 units $2.00
3,000 units 5.00
5,000 units 7.50
Under the present arrangement the same antitoxin can be purchased in
North Carolina at the following prices:
1,000 units $0.50
3,000 units 1.35
5,000 units 1.95
20 l^ORTH Carolina Board of Health
Estimating the amount of saving on this vital necessity from the amount
of antitoxin distributed per 100,000 population by the States keeping such
records, and on the difference in cost of antitoxin, this law is saving the
State annually at least $30,000. This is a fifth dividend paid on the State's
investment of $59,000 in the State's health.
Item No. G.—In 1911 the State Board of Health was instrumental in securing
from the General Assembly a law making the quarantine of smallpox optional
with the counties, and giving the right to the State Board of Health of ad-vertising
that no quarantine be established except under exceptional circum-stances.
An inquiry sent to county physicians the year before this law was
passed showed that there was annually 7,500 cases of smallpox in North
Carolina, with a cost for quarantine of $66,000 a year. An inquiry sent to
county physicians one year after this law went into effect showed a decline
in the number of cases of smallpox from 7,500 to 3,300 and a decline in the
public cost of the disease from $66,000 to $2,600. It is reasonable to conclude
that through the enactment of this law the State Board of Health is saving
the State every year something like $50,000, and at the same time more
effectually controlling the disease. This $50,000 may therefore be considered
as a sixth dividend paid on the State's investment of $59,000 in the public
health.
Item No. 7.—The General Assembly of 1909 enacted a law requiring that all
plans and specifications for water-works and sewerage systems should be sub-mitted
to and approved by the State Board of Health before being accepted
by the municipalities for which the plans and specifications were designed.
This law has safeguarded the municipalities of our State against the work
of cheap engineers and contractors. For example, in one North Carolina town
before this law went into operation, a public water supply was constructed
without being approved by the State Board of Health and, on account of the
faulty location of the water supply, it was necessary to abandon it, so that
that town lost from $10,000 to $15,000 in its investment. Many such losses
have been saved the municipalities of the State by this law which requires
all plans and specifications for water supplies and sewerage systems to be
submitted to and approved by the State Board of Health before acceptance.
Item No. 8.—A continuous, well-organized, and extensive educational cam-paign
against insanitary and unhygienic conditions has been waged. This
campaign has embraced the following measures: («) The issuance of an
educational monthly Bulletin of 51,000 copies; (b) the furnishing of news-paper
articles, directed toward the improvement of sanitary and hygienic con-ditions,
to 350 daily and weekly newspapers; (c) the publication and distri-bution,
upon request, of health literature, placards, leaflets, etc.; (d) an ex-tensive
correspondence with the people of the State in regard to the preven-tion
of unnecessary disease; (e) the furnishing of illustrated or stereopticon
lanterns and appropriate slides for public lectures to teachers, doctors, Y. M.
C. A. workers, social workers, and others; and lastly, (/) the equipment and
operation of a motion picture outfit for teaching disease prevention.
Item No. 9.—^A careful supervision has been maintained over all public
water supplies of the State. This supervision has been carried on through a
knowledge of the watersheds and surroundings of wells, as shown by maps
in the office, through a knowledge of sanitary conditions on the watersheds, as
shown through quarterly reports to the office and as shown through monthly,
weekly, or even daily analyses of the public water supplies. No one can
Sixteenth Biennial Report 21
estimate the number of epidemics, the number of cases of sickness, and the
number of deaths that have been prevented through this supervision.
Item No. 10.—One hundred and forty-seven schools have been visited by
competent medical inspectors, 10,108 children examined, 3,250 children found
suffering from minor defects which sooner or later would develop into a
serious menace to health, and at this time over 800 of those aflaicted have been
treated and cured.
Item Xo. 11.—The State Board of Health, by its educational activities, has
fostered, strengthened, and directed an interest on the part of the counties
in local health work, so that today North Carolina has more whole-time
county health officers than any. State in the Union. Local rural health work,
through the eleven whole-time county health officers and through the develop-ment
of the unit system of county health work, now in active process of
development, is far ahead of such work in the other States of the Union with
only two or three exceptions. The proper development of county health work
is bringing sanitary instruction and sanitary government closer to the people,
and will result in the saving of thousands of lives that would be lost without
active and effective county sanitary administration.
Item Xo. 12.—Probably the most important, certainly the most fundamental,
health measure that any State may enact was passed by the General Assembly
of 1913. This measure is known as the Vital Statistics Law.
For each individual the Vital Statistics Law requires the State to keep
a complete and permanent record, in a fire-proof vault, of the two principal
events in the individual's life, his or her birth and death. The State believes
that none of its citizens are so humble that North Carolina should not take
official notice of their coming and going and preserve such records for all
time. By such records the children and grandchildren of the State will be
enabled to keep track of their ancestors and their relatives; will be enabled
to prove their age in the courts, and thereby their right to suffrage, their
right to marriage, their right to insurance, their right to work in various in-dustries,
their right to inheritances, etc.
For the State this law means that the number of deaths per thousand of
the population occurring in North Carolina, or in any county or township or
town or city of the State, shall be known; it means that the number of deaths
from various diseases per thousand of the population of the State, or any
part of the State, shall be recorded; that the number of births per thousand
of the population in the State, in the counties, in any part or subdivision of
the State, shall be known; that by comparing such figures with similar fig-ures
from the other States of the Union, the people of this State, the people
of other States and of the world, may know, not guess, what health condi-tions
in North Carolina are.
And best of all, the Vital Statistics Law has shown and caused to be pub-lished
on the authority of the United States Government the fact that this
State is one of the healthiest in the Union, as demonstrated by a death rate
of 13.3 per thousand of the population per year and a birth rate of 31.0 per
thousand of the population per year. Our high birth rate of 31.0 per thou-sand
of our population, coupled with our low death rate, gives North Caro-lina
an enviable health record.
LET THOSE WHO THINK NORTH CAROLINA IS SPENDING TOO
MUCH ON PUBLIC HEALTH SHOW WHERE THE STATE GETS A BIG-GER
RETURN ON OTHER INVESTMENTS.
22 North Carolina Board of Health
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PRESENT ORGANIZATION OF THE NORTH CAROLINA
STATE BOARD OF HEALTH
The North Carolina State Board of Health consists of the Board proper
and the executive staff.
The Board of Health, as indicated diagramaticallj' on page 22, consists of
nine members, five of whom are appointed by the Governor and four of whom
are elected by the North Carolina State Medical Society. The organization
of this body embodies two important administrative principles: (1) stability
of organization and permanency of policies; (2) partnership of State and
medical profession in the conservation of human life.
The stability of the organizaton of the Board of Health depends funda-mentally
upon the Board's freedom from political tinkering. The divorce-ment
of the State Board of Health from politics depends largely upon the way
by which the members of the Board are selected. Sudden and marked changes
in the personnel of the Board under the present plan of organization are
impossible: First, because the members of the Board of Health are appointed
for terms of six years and their terms of service expire, not in the same year,
but in different years. The appointment of new members of the Board is,
therefore, gradual and not sudden. Second, the Board of Health is selected
by two parties: one, the Governor, and the other, the State Medical Society.
It is far less likely that two parties naming a Board would be dominated by
political considerations than where one party names the Board. This division
of the appointive and elective power and this provision for the slow and
gradual exercise of that power by two parties guarantees the State Board of
Health against the sudden changes associated with a purely political organiza-tion.
The Board of Health is stable; its members come and go, but as an
organized' body it stays.
This stability or organization is the responsible factor for the permanency
of policies adopted by the Board. Political boards elected or appointed for
two years or four years are naturally inclined to adopt two- and four-year
policies, to attempt to make the best showing during the short term of their
official life. Their administrative thoughts and plans are largely defined by
the time limitations of their administration. This is not true of self-perpetu-ating
bodies such as the Board of Health, that, as legally constituted, has no
limit to its life.
The second administrative principle embodied in the organization of the
State Board of Health is a recognition by the State of the fundamental rela-tion
of the medical profession to the work of prevention. The State recog-nizes
(1) the debt of society to that profession by which nearly all of the
experimentation and discovery on which disease prevention is based, with the
exception of the work of Pasteur, was contributed; (2) the interest of organ-ized
medicine in the conservation of hiiman life and the peculiar ability of
organized medicine to advise the State as to the methods of prevention; and
(3) the necessity of securing first information in regard to the occurrence of
deaths and their causes and the appearances of epidemics from the medical
profession.
The executive staff of the State Board of Health may be divided into the
executive office and the various bureaus or special divisions.
24 iN'oRTH Carolina Board of Health
The Executive Office.—The executive officer of the State Board of Health
should be a technical man and should be selected for his fatness for a technical
position. It is, therefore, right that the Secretary of the State Board of
Health, or the executive officer, should be selected by a specially qualified
committee, that is, the State Board of Health, and not elected in a general
election, as would be the case if the office were a political one. The six-year
term of office foi* which the Secretary is elected is in accordance with the
idea of permanency of policies. The most important work of the Secretary
is (1) the formulation of the important State health policies for submission
to the Board for their action, and, when approved, for submission to the
General Assembly; (2) to act for the Board when it is not in session; and
(3) to supervise and correlate the work of the bureaus.
The Bureaus or Special Divisions of the Executive Staff.—The work of the
State Board of Health is large and varied and calls for executive heads of
special talent and with special training; therefore, in accordance with the
administrative practice of other States and of other departments of this State
Government, the larger and more important State Board of Health policies,
such as the equipment and direction of the Laboratory of Hygiene, the prob-lem
of treating a large number of consumptives and dealing with the whole
State problem of tuberculosis, and the problem of popular education along
health lines, and the problem of supervising and assisting counties in adopt-ing
economic and efficient measures of local sanitation, and the problem of
gathering, correcting, properly classifying and publishing the death certifi-cates
of 33,000 decedents every year and the birth certificates of 80,000 births
every year, are delegated to bureaus or special divisions in the executive
work, and these bureaus are held responsible for the performance of the
tasks intrusted to them. This division of the executive staff into special
units or bureaus has the additional advantage of giving individualism to the
work of each bureau and creating a laudible pride and a healthy rivalry
among the various bureaus engaged in the general work of the Board.
The Correlation of the ^York of the Board.—Tliis is best brought out by an
examination of the simple diagram shown on page 22. While considerable
individualism is given to each division of the executive staff, the coordination
of the work, the compactness of the work of the Board as a whole is brought
about through the relation of the bureaus to one another through the executive
office of the Board. Moreover, it is just as important that the work of the
bureaus should be properly correlated as it is important that each bureau
should be given as much individualism as is consistent with the principles
of efficient administration. Referring to the correlated activities of the
Board, the Secretary recently said before the conjoint session of the State
Board of Health and the State Medical Society: "The Sanatorium by itself
is capable of great accomplishments; but the Sanatorium supported and assist-ed
by the influence and activities of the other executive divisions of the State
Board of Health is capable of far greater accomplishments. On the other
band, the loss of the State Sanatorium to the State Board of Health would
cripple the entire organization. And again, the Bureau of Vital Statistics
could never have come into existence and could not now maintain itself with-out
the public educational activities of the Board. On the other hand, the
Bureau of Education would be seriously handicapped without those funda-mental
facts obtained through the Bureau of Vital Statistics, upon which
Sixteenth Biennial, Report 25
health work is based. And still again, the State Laboratory of Hygiene, with-out
the general influence of the other divisions of the work, could not have
made the wonderful progress it has made during the past years. On the
other hand, the other work of the Board would have been greatly impaired
without the splendid support of the Laboratory. The full benefits derivable
from typhoid vaccination depend upon the cooperation of three divisions: the
production of vaccine by the Laboratory, the creation of a demand for vaccine
or the popularization of typhoid vaccination by the Bureau of Education, and
the provision for free public vaccination by the Bureau of Rural Sanitation.
And so I might continue these illustrations^ but I have said enough to make
it clear that to the different divisions of the executive staff of the Board, the
old adage, 'United W'e stand; divided we fall,' applies with full force."
BIENNIAL WORK OF THE EXECUTIVE STAFF
EXECUTIVE OFFICE
Routine Work.—The routine work of the executive office is best shown in
the following table, which is a twelve-months estimate based upon eleven
monthly reports. The estimate was necessary because these monthly reports
were not begun until January 1, 1916, and we could not wait without a con-siderable
delay in the printing of .the biennial report for the December
monthly report.
Letters received 3,?
Letters written : Individual 3,828
Articles written : Newspaper 4 ; words 1,200
Bulletins 3 ; words 10,400
Official pamphlets 3 ; words 7,400
Other publications 6; words 25,800
Forms and placards prepared 2
Addresses delivered: Number delivered 38
Total audience 4,305
Inspections : State institutions 10
County institutions 2
Hotels 15
Epidemics: Conferences with local authorities 9
Supervision of 4
Number units health work adopted 7
Number days spent out of office on official business 115
Special Wo-Jc.—While certain parts of the special work are included in the
table on routine work, there is much of the special work of such nature that
it cannot be represented in the table showing the routine work of the office.
Under this heading may be mentioned the following special items:
1. During the beginning and ending of each biennial period, covering alto-gether
a period of about four months, much of the Secretary's time is occupied
with the consideration of needed health legislation. Such consideration often
demands a thorough examination of the literature with reference to any
particular problem concerning which legislation is contemplated, and seeing
those interested (members of the State Board of Health and members of the
General Assembly) in such legislation, drawing the necessary bills to be
introduced in the General Assembly, and, during the meeting of the Genera]
Assembly, explaining to committees and to individual members of the As-sembly
the importance of the proposed legislation. Any one who has had any
experience, directly or indirectly, in matters of legislation will understand
that this kind of work cannot be measured in the hours that are consumed
in actually doing the work.
2. It falls to the share of the executive office to assist in the work of new
bureaus, to assist a bureau in the inauguration of new work, and to give tem-porary
help to a bureau that is encountering some unexpected difficulty in its
work. In the summer of 1915, with the Bureau of Rural Sanitation beginning
its work the first of June, much of the time of the executive office was given
in assisting that bureau in getting started. During the same summer a con-siderable
amount of reorganization in the Bureau of Vital Statistics was
Sixteenth Biennial Report 27
needed, and a certain amount of the time of the executive office was required
in assisting that bureau.
3. During the past two years the executice office has secured valuable co-operation
from two divisions of the Federal Government in the health work in
this State. During the summer of 1915 the United States Public Health
Service used a force of from three to five health officers in sanitary work
in Orange County over a period of about six months. The piece of work
done was very thorough, and a great deal of sanitary improvement must have
resulted. During the year 1916 the Federal Children's Bureau, under Miss
Julia C. Lathrop, and represented in our State by Dr. Frances Sage Bradley
and her assistant^ Miss Williamson, has done some valuable health work in
Cumberland County. The object of the w^ork of the Federal Children's Bureau
in North Carolina has been to ascertain as near as possible the exact sanitary
and hygienic conditions bearing on child life in rural North Carolina, and,
on the result of their findings, to work out some economic and efficient plan
by which the county, or the county and State, may cooperate in reducing
infant mortality and improving the health of children generally. The execu-tive
office has also been instrumental in securing the promise of the United
States Public Health Service to detail one of their officers to work in Edge-combe
County for from one, two, three, or four years, the county bearing the
actual expense of the work, not to exceed, annually, $1,500, with the object
of developing a standard plan of county health administration.
4. The executive office, in cooperation with Dr. Joseph Hyde "Pratt, State
Geologist and chairman of the State Highway Commission, has given a great
deal of study and work to the preparation and publishing of plans and specifi-cations
for sanitary convict camps, proper rules and regulations governing
the care of such camps, and report forms to be made out by convict camp
supervisors showing the physical condition of prisoners at regular intervals.
This office and the chairman of the State Highway Commission became inter-ested
in this matter because of their opinion that the sanitary and hygienic
care of prisoners in North Carolina is one of the most urgently needed re-forms
for our State. Investigation of the sanitary conditions in convict camps,
based upon the score-card adopted by the State Highw^ay Commission and this
office, shows the average camp in this State to score between 50 and 60 out of
a possible 100. While this particular piece of work of the executive office
has apparently had little influence in bringing about needed prison reform in
North Carolina, a high Federal official, who has made a special study of prison
conditions in the United States, has pronounced the rules and regulations
for the sanitary and hygienic care of prisoners and the architectural designs
and specifications for the construction of prison camps as adopted, in many
respects, the best general plan in this country.
5. During the past year the executive office has prepared sanitary rules and
regulations governing the management of hotels, and a hotel score-card and
a form of certificate to be given hotels by the State Board of Health showing
their sanitary rating, and has put into execution a system of optional hotel
inspection and grading. The optional feature of this plan, leaving it to the
choice of the hotel manager as to whether or not he will have his hotel in-spected
and graded, is so generally acceded to by hotel managers that the plan
is practically of as general application to the hotels of this State as if the in-spection
and rating were compulsory. While we have only begun this work.
28 North Carolina Board of Health
and in the beginning have scored the hotels v.ery lightly, we believe that in
the inauguration of this policy of hotel inspection and published rating we
will bring about, eventually, important sanitary improvements. A hotel is
not a local institution, but a State institution, for the reason that the local
people do not use the hotel, but the people from all parts of the State and
from other States, and, therefore, as a State institution, capable, under cer-tain
conditions, of scattering disease not in a locality, but throughout the
State, should come under the responsibility of the State Government rather
than under the local government. This reasoning would not apply to board-ing-
houses or to restaurants, where, as a rule, the people of the community,
and not the people of the State, get their meals.
6. In cooperation with the State University, the executive office planned and
inaugurated a novel plan of home post-graduate medical study for the doctors
of this State. The post-graduate course among physicians has two values/:
for the physician, it refreshes his scientific interest in his profession and
makes his work more attractive, more efficient, and, therefore, more satisfac-tory;
for the public, an improved profession means a decreasing death rate,
better health. The fundamental principle of the plan of work adopted con-sists
in bringing the teacher to the class instead of sending the class to the
teacher. To illustrate: For 80 North Carolina doctors to go to Baltimore,
Philadelphia, New York, or somewhere else, to take a six-weeks post-graduate
course, say, in diseases of children, the total cost to the 80 doctors would be
$32,000, or $400 apiece. This $400 per capita would include the loss of $225,
the average six weeks income (that is, at the rate of $150 a month), $100
tuition for the right kind of a course, and $75 for railroad, hotel, and inci-dental
expenses. To leave these 80 doctors in their practice and to bring the
teachers of diseases of children to them can be done at a total expense of from
$2,000 to $2,500, an assessment for each member of the class of about $30
instead of $400. These classes are organized as follows: From 8 to 20
doctors around the towns of A, B, C, D, E, and F, all of which are conveniently
connected by railway and in the same section of the State, organize them-selves
into six sections of a class. The teacher brought from Boston or
Chicago, a specialist in diseases of children, meets the section of the class in
A, say, Monday at 11 o'clock, lectures to them from 11 to 12, and from 12 to 2
holds a clinic, that is, takes the sick children brought in by the members of
the section, goes over their trouble with the section and prescribes for them.
The total period of the class meeting is three hours. On Tuesday, the teacher
holds the same kind of meeting with the section of the class in town B, and so
on Wednesday, Thursday, Friday, and Saturday he meets the sections in towns
C, D, E, and F, respectively. Both the University and the executive office
of the Board of Health are intensely interested in this practical scheme for
interesting and advancing our medical profession and thereby improving the
public health, and we believe that this piece of work will in the end prove
to be one of the most important pieces of work, not only for the State but
also for other States, that we have undertaken.
state laboratory of hygiene
Routine Work.—The routine work of the State Laboratory of Hygiene is
shown in the following tables, which I take from the annual report of the
Sixteenth Biennial. Report 29
Secretary to the conjoint meeting of the State Board of Health and the State
Medical Society:
General Examinations.
30 North Carolina Board of Health
Special Woi-k.—The Director of the Laboratory during the last year has
given a great deal of careful attention to the purchase of land and the con-struction
of a laboratory building and biological plant as provided for by a
special act of the General Assembly of 1915. The new laboratory building
is in a most desirable location with reference to freight facilities and street
car lines, and in its construction and architectural arrangement is all that
.could be desired.
bureau of engineering and education
Routine Work.—The following tabular estimate for the last twelve months,
based upon eleven monthly reports, shows the work of this bureau for the past
year:
Number newspapers and magazines received and reviewed 7,583
Letters and postals received 7,822
Letters written: Individual 3,884
Multigraph (forms, 14) 2,194
Total number 6,078
Articles written: Newspaper (308) 93,045
Bulletin 43,636
Official pamphlet (1) 1,500
Other publication ( 1 ) 4,000
Stock lectures : Given 171
Audience 21,978
Motion picture entertainments given 210
Total audience at above entertainments 50,482
Continuous motion picture entertainments at fairs 5
Total audience at above entertainments approximately 28,000
Plans and specifications modified:
Water-works 3
Sewer systems 6
Plans and specifications disapproved:
Water-works 2
Sewer systems 3
Plans and specifications approved:
Water-works 6
Sewer systems 13
Watershed inspectors' reports examined 153
Traveling Public Health exhibits given (at fairs) 17
Special exhibits given (30 at fairs) 60
Approximate number seeing exhibits at 30 fairs 14,824
Monthly Health Bulletins mailed 309,000
Pamphlets distributed ]
Leaflets distributed :- 284,715
Placards distributed )
Reports of water analyses examined and copied 1,208
Number days spent out of office on official business 40
Special Work.—While certain parts of the special work hereinafter con-sidered
are included in the tabulation of routine work, the tabulation does not
and cannot express the significance of the educational work of this bureau.
Public Health Education.—Let us recall, in this connection, certain essen-tials.
The object of public health work is to change habits and customs that
interfere with the highest physical and mental development of the individual
and the State. The method of public health work under present conditions
is primarily educational. It is necessary not only to give the school children
of today the principles of hygiene and sanitation that are to influence them
as citizens of tomorrow, but it is necessary, by educational means, to reach the
j
Sixteenth Biennial Report 31
adult population who yesterday went through the schools without being
taught those principles of human conservation which should influence them
as neighbors and voters. The means for public health education may be di-
* vided into the means of public health education for the future citizens and the
means of public health education for the present citizen.
For the future, the principal means of public health education should be
the public school system. It should be impossible for a child to pass through
the public schools of today without being taught the essential principles of
disease prevention—self-preservation, the first law of nature. The public
schools are doing a great deal more in educating the children towards higher
hygienic and sanitary ideals, but they are still falling far short of meeting
their vital responsibility in this matter.
For the present, the means of public health education have to do with the
adult population, with the voters who make the general and local laws under
which man has to live. To reach this adult population, we must first interest
them in public hygiene, and, second, inform them as to what it is and how it
is to be obtained.
To gain the interest of the general public, the following agencies are used
by the North Carolina State Board of Health: A portable motion picture
outfit suitable for work in rural districts, a series of illustrated stock lectures,
traveling exhibits, and an extensive press service.
The Motion Picture Outfit.—The following extract from a newspaper article
written by a reporter who had just seen the motion picture health entertain-ment
will give some idea of its use:
"Fairview . . . last night was accorded the distinction of seeing in its
own midst the first moving picture show ever given in the country in this
State. ...
"One hundred and forty-four people living a distance of 10 or 12 miles from
Raleigh sat enthralled under the perfect picture, the drama of a sanitary
regeneration. Warren H. Booker, assistant secretary to the Board, drove the
department's automobile, which carries an extra engine to run the lights, and
put on the show. To vary even a good thing, he interspersed his pictures
on health with a Charlie Chaplin movie, and thus gave to the people who
live afar a treat which Arthur Brisbane confesses himself never to have
enjoyed. . . .
"The pictures ran from 8:30 to 10:45. In the changing of reels the operator
would insert a National anthem, a familiar hymn, or Tipperary, and on the
big canvas the people could read the words and sing with all their hearts.
They were long on 'Old Black Joe,' up on 'America,' unctuous on the hymns,
but rather tenderfooted on Tipperary. Thus Booker was teaching religion,
music, poetry, patriotism, and health—five in one, so to speak—and he held
that crowd hours beyond its accustomed retiring time.
"They wouldn't leave when it was over. Babies of two years rubbed their
fat little arms over the sleepy little eyes, but wouldn't lie down. Now and
then one fell by the wayside, was dropped on a cloak, and the show went on.
Between reels short speeches were made and songs sung, and in that one
night that single community enjoyed itself more than it has been able to do
in a month of the usual round of neighborhood pleasures.
"Mr. Booker put on a picture entitled 'Hope,' a tuberculosis story that
started in the resentment of a little town against the suggestioij that there
was enough tuberculosis in it to justify a sanatorium for treatment of tubercu-lar
patients.
"The town was horrified in a short while to know that the prettiest girl in
the place had it. The canvas showed her declining health, her treatment in
the hospital, her recovery and her return to her father and her lover. Then, it
became interesting.
32 North Carolina Board of Health
"Then came the story of typhoid fever, a case that came as the result of too
intimate association of pigs and people, bad dairy conditions, and the imme-morial
open well, 'Good enough for daddy, and good enough for his daddy, and
good enough for me.' This case, treated successfully, was shown on the screen
with the conversion of the fossil and the community clean-up campaign as the '
one sure preventive."
One of the best known physicians in the State said recently in regard to
the moving picture health show:
"The picture show campaign brought the people out, and from a standpoint
of teaching health it did a great deal of good. It is really the only way to
teach rural preventive medicine."
The motion picture health films reach, among others, a large class of people
who do not go to school and who read very little, and to this group of people
the principles of disease prevention are presented in a form they cannot fail
to comprehend. The motion picture health outfit has been in use by the State
Board of Health since March, 1916. At 210 entertainments, 50,482 people saw
the health films and heard the lectures. During the five weeks when the outfit
was engaged at the fairs, approximately 30,000 other people were reached.
The Illustrated Stock Lectures.—The illustrated stock lectures consist of
lectures already written out on such subjects as tuberculosis, typhoid fever,
patent medicines, care and feeding of babies, alcohol, prevention of blindness,
eyes, ears, nose, and throat, and health and sanitation. Each of these lectures
is illustrated by a set of lantern slides containing from 40 to 70 slides neatly
packed in a case which may be shipped by parcel post. These outfits are
furnished free of charge on application to Y. M. C. A. workers, teachers,
preachers, and others who are interested in public health and wish to give
illustrated lectures on some phase of hygiene, sanitation, or public health
work. Where borrowers are not already provided with a stereopticon lantern
in which to use the lantern slides, small portable lanterns, securely packed In
padded shipping cases, are loaned free of charge. During the last two years
approximately 402 of these lectures have been given and approximately 32,392
people have been reached in fhls way.
Traveling ExhiMt.—The traveling exhibit is a presentation of the more Im-portant
public health problems through charts and models, usually accom-panied
by a demonstrator. During the last two years 28 exhibits have been
given in 24 places, and approximately 150,000 people have seen the exhibits.
Besides the large traveling exhibit, a number of smaller exhibits have been
prepared for use by schools and for small community fairs.
Press Service.—The press service consists in sending out to the newspapers
of the State a dally article of from 200 to 300 words—about one third of a
column. The material sent out may be divided Into three kinds: (1) that
which has news value but no value in teaching sanitation and hygiene; (2)
that which has both news. value and value In teaching sanitation and hygiene;
and (3) that which has no news value but which teaches sanitation and
hygiene. The newspapers are more than generous in the use they make of
this material; but we think we are correct in saying that the amount of the
material used is in the order of the above classification. This is, however, not
the fault of the newspapers so much as it is the demand of the people. The
public is more Interested in reading of the spectacular than of the every-day
Sixteenth Biennial Report 33
occurrences; more interested in a murder than in a death from typhoid fever
or tuberculosis; more interested in news tlian in doctrine.
The attitude of the State press towards this phase of the work of the State
Board of Healtli especially and toward the work of the Coard generally is
most cordial, and the State Board of Health cannot express its appreciation
for this most valuable support and cooperation on the part of the newspapers
in too strong terms. A large per cent of what success we have attained may
be credited to the State press.
To inform the general public after we get them interested, after we create
a desire, through the above mentioned agencies, to know the principles of self-preservation,
our best educational agencies are the Bulletin and special pam-phlets
and leaflets.
The Bulletin of the State Board of Health for the last two years has gone
to 51,000 North Carolina homes. It reaches a great many teachers, preachers,
lawyers, business and professional men; but about 75 per cent of the homes
reached are the homes of the average intelligent, progressive citizenship of the
State, and in many of these homes the health Bulletin is the only publication
received dealing to any extent with the subject of hygiene and public health.
The State Board of Health Bulletin is regarded among the public health
officers of the country as one of the best, and by not a few as the best State
health Bulletin in the Union. A comparison of the North Carolina State
Board of Health Bulletin with the official organs of the other State Boards
of Health will convince any one that the foregoing rather sweeping statement
is not too strong. In fact, in a recent National survey of the educational
activities of the various State Boards of Health, our Bulletin received a per-fect
score. Only two other bulletins, those of New York and Virginia, were
scored perfect.
The Biilletin costs the State about one-half cent a copy, and, therefore, it
costs the State only about 6 cents a year, three 2 cent postage stamps, to give
this publication, the only publication that the people receive to tell them how
to live, to its people. In going to 50,000 homes, the Bulletin reaches a total
population of 300,000 people, about one-eighth of the total population of the
State and about one-sixth of the white population of the State.
Unfortunately, we had to suspend, for the first time in twenty years, the pub-lication
of the Bulletin during the past year. The amount of printing allowed
the State Board of Health has remained the same since 1911, six years, while
the public demand for bulletins and leaflets and information regarding disease
prevention has increased somewhere between 500 and 1,000 per cent. The
General Assembly of 1915 was asked for a sufficient appropriation to have per-mitted
the publication of the Bulletin, but refused to grant it, and so restricted
the printing fund of the State Board of Health as to make it necessary to
suspend publication of this important, not to say vital, publication. If money
was ever saved at the spigot and lost at the bung it was in this restriction
on the printing of the State Board of Health. The Bulletin, as we have said,
costs only one-half cent a copy, 6 cents, to the average family for a whole
year. The lowest average economic value placed on human life if $1,700 per
capita. Saving 6 cents, three postage stamps, and losing the lives is the
economic wisdom of being penny wise and pound foolish. The Bulletin ought
to be sent to not less than 100,000 homes, and it is exceedingly doubtful
34 N'oRTH Carolina Board of Health
whether the State can get a greater revenue from any other money spent than
money expended in this way.
The Bulletin differs from newspaper public health work in that it deals
exclusively with health topics, and deals with these subjects in a compre-hensive
and systematic way in which they cannot be presented through the
two or three hundred-word newspaper article. The newspaper work is, pri-marily,
to interest the public in self-preservation; secondarily, to inform them
as to the means of self-preservation. The Bulletin, on the other hand, is pri-marily
to inform the public in regard to the means of human conservation.
Special Pamphlets.—The State Board of Health keeps in stock a large
number of pamphlets on special subjects, including all of the important pre-ventable
diseases, for distribution on request. The following table shows the
subjects on which we have or have had special pamphlets and the number
of these pamphlets distributed during 1915:
Tuberculosis 65,000
Typhoid 65,000
Flies 59,000
Privy 61.000
Baby 60,000
Cancer 20,000
Malaria 20,000
Health Catechism 17,000
Health Laws 2,000
Weak Eyes 1,600
Adenoids 2,000
Measles v 3,000
Diphtheria 3,000
Disinfection 3,000
Scarlet Fever 3,000
Fly Placard 4,000
Typhoid Placard 4,000
Tuberculosis Placard 3,000
Don't Spit Placard 1,000
Residence Sewage Disposal 2,000
The restricted printing fund, which has handicapped our work so badly
during the past six or eight months, has made it impossible for us to keep up
our, stock of special pamphlets. Many of them are now out of stock. With
our depleted stock of literature and with continued requests for pamphlets
on various diseases, we have been placed in an embarrassing position, which
would have been even more embarrassing had it not been for the Metropolitan
Life Insurance Company and for Colgate & Co., who have supplied us with
a large amount of well gotten up material dealing with the important subjects
on which our stock of literature had been exhausted. We wish to make grate-ful
acknowledgment to the Metropolitan Life Insurance Company and to
Colgate & Co., for their help under the circumstances.
In conclusion, it is perfectly clear: first, that the State Board of Health,
to improve longevity and efficiency in this State, must have the cooperation
of the people; second, that to get the cooperation of the people, it must be
heard by the people; thircl^ that it can be heard by the people through two
means, (1) the living voice and (2) the mail route. Any one who will stop
to count the cost of reaching 2,300,000 people by lectures and the cost of reach-ing
them by attractively prepared literature will recognize the fact that the
Sixteenth Biennial Report 35
State Board of Health must be allowed sufficient printing privileges to furnish
the people of this State (a) the health literature that they are asking for,
and (b) health literature that will create a still greater desire on the part
of the people to learn how to take care of themselves, how to live longer and
be more efficient and happy.
BUREAf OF VITAL STATISTICS
Routine ^york.—The following tabular estimate for the year 1916, based
upon eleven monthly reports, shows the routine work of this bureau:
Letters received 14,652
Postals received 1^644
Undertakers' reports received 5,064
Supplemental reports received 2^686
Acceptance papers received 120
Deputy blanks received 48
Violation blanks received 336
Provisional certificates received- *12
Permits received (burial and transit) 324
Packages supplies sent out 5,088
Commissions sent out 132
Acceptance papers sent out 72
Postals sent out 1,572
Individual letters written, 21.912; circular-letters, 8,340; total 30,252
Days out of office on official business 108
Hotel inspections made *14
Certificates received: Births (exclusive stillborn) 76,704
Deaths (exclusive stillborn) 31,776
Stillborn 7.104
Total number certificates received 115,584
Death rate for year 13.4
Birth rate for year 32.2
Index cards made for birth certificates (1915) 24,781
Index cards made for death certificates (1915 and 1916) 24,284
Index cards furnished (decedents from tuberculosis) 1,524
Convictions secured *36
Fines imposed $115.92
Miscellaneous tables made up 24
The figures of this table indicate in but a vague way what it means (1) to
receive 115,584 death and birth certificates a year, about 20 per cent of which,
are incorrectly made out and have to be returned for corrections; (2) to care-fully
index these certificates so that on request of any citizen of North Carolina
the birth and death certificate of any person may be turned to within two or
three minutes, copied, and sent to the interested party; (3) to classify the
birth and death certificates according to counties and townships and cities,
and according to diseases, races, and ages, so that any information asked for
regarding vital conditions in North Carolina may be immediately available.
The amount of clerical work in a bureau of vital statistics is so large, and
necessarily has to be so accurate and systematic, that no one can appreciate
what it means without actually spending five or ten minutes in the bureau
observing the details of the work. The work of this bureau has been sub-jected
to very thorough tests by the United States Government. Its methods
*Total for eleven months.
36 North Carolina Board of Health
have been fully approved, and the completeness of the registration of births
and deaths in North Carolina has been found sufBciently accurate to admit
North Carolina, in June, 1916, as one of the Registration States of the Union.
This means that the Government approves our records and that the rest of
the world will recognize them as correct. Our vital statistics records, more-over,
prove North Carolina to have an enviable health record. There are
many sanitary and legal values of official records of births and deaths which
it will not be necessary to detail here.
Important Statistical Facts About North Carolina
The following table shows the State birth rate and death rate:
Birth rate (exclusive of stillbirths) for North Carolina, 1915:
Total rate 31.7
White (estimated) 31.1
Colored (estimated) 28.7
Death rate (exclusive of stillbirths) for North Carolina, 1915:
Total rate 13.2
White 11.5
Colored 16.9
The most interesting thing about this table is the difference between the
white and colored death rates and birth rates. Not only is the white death
rate 5.4 deaths less per thousand than the colored death rate, but the white
birth rate exceeds the colored birth rate by 2.4 births per thousand population.
The difference between the white birth rate and the white death rate shows
a gain of 19.6 per thousand white population a year, while the difference
between the colored birth rate and the colored death rate shows a gain of
only 11.8 per thousand colored population a year. These figures are very
significant, showing that the proportion between the two races is growing
greater in favor of the white race.
These facts are interesting at this time because it has been only within the
last two or three years that southern States have been collecting reliable
vital statistics, and with all that has been written on the race question, the
biggest southern problem, the facts bearing upon so fundamental a phase of
the subject as the proportionate increase and decrease of the races have been
unknown.
The following table is taken, from the last mortality statistics report of the
United States Bureau of the Census, and it shows the death rates of those
States whose collection of vital statistics is accurate enough to receive the
approval of the United States Government:
Sixteenth Biennial Report 37
Death Rates of the Registkation States—1914.
State Death Rate Per
l.Ono Population
California
Colorado
Connecticut '.
Indiana
Kansas
Kentucky
Maine
Maryland
Massachusetts--
Michigan
Minnesota
Missouri
Montana
New Hampshire
New Jersey
New York
North Carolina
-
Ohio
Pennsylvania
—
Rhode Island
Utah
Vermont
Virginia
Washington
Wisconsin
13.6
11.2
15.1
12.9
9.8
12.9
15.6
15.9
14.7
13.4
10.6
12.3
11.2
16.3
14.2
14.7
19.0
13.0
13.9
14.7
10.1
15.0
14.0
8.1
11.1
North Carolina's death rate for 1915 of 13.2 may be compared with the
death rates of the above States. The younger western States, like California,
Colorado, Kansas, Minnesota, Missouri, Montana, Utah, Washington, and Wis-consin,
have death rates somewhat lower than the death rate of North Caro-lina.
Tliis difference is due largely to differences in the average age of the
populations of the older eastern States and the younger western States. The
new western States have a relatively large middle-age population, resulting
from the large emigration which is contributory to their increasing population.
The number of people over 60 or even over 50 in the younger western States
is much less per thousand population than in the older eastern States; and,
again, the birth rate in the younger western States is much less than the
birth rate in the older eastern States. This means that the two extremes of
life, a large infant population and a large old-age population, both extremely
susceptible to morbid influences and contributory to high death rates, are
absent in the West and are present in the East. It is, therefore, unfair to
place too much importance upon the difference in the death rate of North
Carolina and the younger western States. By comparing the death rate of
38 North Carolina Board of Health
North Carolina with the older eastern States appearing in the above column,
the real significance of our low death rate may be appreciated.
The following table was compiled to show the influence of race distribution
on birth and death rates:
BIRTH AND DEATH RATES FOR 1915—By Gnoups of Counties.
Estimated
Population
11,927
7,745
19,074
15,335
3,909
4,884
4,964
23,551
13, 602
12,237
20,132
18,314
31,914
11,458
7,492
13,630
32,080
16,137
12,392
52,705
23,363
23,154
14,813
30,969
31,823
32,569
14,067
17,399
17,992
14,049
7,974
30,154
30,115
22,382
20,302
Counties
Under 10% Colored Popul.^tion.
Alexander
Alleghany
Ashe
Cherokee
Clay
Dare
Graham
Haj'W'ood ,
Jackson
Macon
Madison
Mitchell r
Surry
Swain
Transylvania
Watauga
Wilkes
Yadkin ,
Yancey
Average
Over 10% and Under 20% Colored Popul-vtion.
Buncombe
Burke
Caldwell
Carteret
Catawba
Cleveland
Davidson
Da^de
Henderson
Lincoln
McDowell
Polk
Randolph
Rutherford
Stanly
Stokes
Average
Birth Rates
40.7
28.6
37
35
49
35
35
37
33.4
45.4
22.7
39.7
36.9
36.7
38.0
.39.7
40.4
33.5
48.4
37.6
Death Rates
12
9
9
12.
11.
9.
10.
9.
11.
11.4
8.0
12.2
7.0
14.9
8.0
11.4
11.4
8.6
10.4
33.5
Sixteenth Biennial Report 39
BIRTH AND DEATH RATES FOR 1915—Corehnued.
Estimated
Population
40 ISToRTH Carolina Board of Health
BIRTH AND DEATH RATES FOR \915—Co Jitinued.
Estini.atctl
Population
33,237
38,467
24,692
10,477
26,072
13,634
8,840
8,982
24,947
18,179
38,077
35,335
18,293
16,573
17,710
39,216
21,686
20,870
11,303
37,988
30,734
27,363
24,358
14,858
11,854
26,350
16,038
19,069
22,942
11,561
58,050
16,843
34,868
41,262
20,855
Counties
Over 40% and Under 50% Colored Population.
Beaufort --.
Cumhcrland
Franklin
Gates
Granville
Greene
Hyde
Jones
Lenoir
Bladen
Nash
New Hanover.
Pasquotank
Pender
Person
Pitt
Richmond
Vance..- __
Washington
Wayne
Wilson
Average.
OvER 50% AND LTnder 60% Colored Population.
Anson
Bertie.
Caswell.
Chowan
Craven
Hertford
Martin
Northampton.
Perquimans
Robeson
Scotland
Average.
Birth Rates
Over 60% and Under 70% Colored Population.
Edgecombe
Halifax
Warren
Average
Death Rates
35.4
Sixteenth Biennial Report 41
above, the white birth rate slightly exceeds the colored birth rate. The high
birth rates of the State are in the western mountain counties. Note, for
example: Alexander 40.7, Ashe 37.7, Avery 39.7, Caldwell 39.7, Cherokee 35.9,
Clay 49.6, Graham 35.6, Haywood 37.5, Maeon 45.4, McDowell 58.6, Mitchell
39.7, Polk 34.6, Stokes 37.3, Surry 36.9, Swain 36.7, Transylvania 38.0, Wa-tauga
39.7, Wilkes 40.4, and Yancey 48.4.
Tlie following table shows the birth rate and death rate by counties for the
year 1915:
TABLE SHOWING NUMBER OF BIRTHS AND DEATHS IN EACH COUNTY, TOGETHER
WITH THE RATIO PER THOUSAND POPULATION, FOR YEAR 1915.
Counties
42 North Carolina Board of Health
TABLE SHOWING NUMBER BIRTHS AND DEATHS IN EACH COUNTY, TOGETHER
WITH THE RATIO PER THOUSAND POPUL.4TION, FOR YEAR 1915—Continued.
Counties
SixTEEXTH Biennial Report 43
STATE SANATORIUM AND BUREAU OF TUBERCULOSIS
Routine Work.—The following tabular estimate for the last twelve months,
based upon eleven monthly reports, shows the work of the Sanatorium and
• the Bureau of Tuberculosis for the past year:
Letters and postals received 17,023
Letters written: Individual 14,364
Multigraph 51,828
Total number 66,192
Articles written (approx. No. words): Newspaper 69,564
Bulletin 1,692
Official pamphlets 8,616
Other publications 4,356
Total number 84,228
Forms and placards prepared 37
Blank books mailed for reporting cases 17,064
Number cases registered: White 2,412
Black 1,452
Total number 3,864
Literature sent to registered cases 3^204
Other literature sent out 9,972
Sputum cups distributed 65^784
Tuberculin sent physicians for Von Pirquet diagnostic tests 1^764
Blanks for reporting result of Von Pirquet diagnostic tests 1,764
Patients' histories written (approximate number words) 135,156
Envelopes addressed 52,224
Addresses delivered : Number 38
Total audience 4,356
Local activities: Local investigations 1
Conferences with local authorities 63
Days out of office on official business 84
Patients admitted: Incipient 96
Moderately advanced 156
Far advanced 72
Miscellaneous 9
Total number 333
Patients discharged : Arrested 33
Apparently arrested 48
Quiescent 66
Improved 96
Unimproved 24
Died 8
Total number 275
Outside patients examined 432
Sputum examinations 1,416
Urinalyses: Chemical 744
Miscellaneous 396
Blood examinations 144
Gastric analyses 6
Examination feces 6
Other examinations 3
Special Work.—The Sanatorium and the Bureau of Tuberculosis has been
operated during the last biennial period on the following revenue:
For permanent improvements $60,000.00*
For maintenance 50,000.00
For extension work 20,000.00
Fees from patients 67,020.37
*Out ct this amount 819,030 had to be paid cut on old debts of the institution contracted before
the Sanatorium was turned over to the State Board of Health.
44 North Carolina Board of Health
The patients or their friends, or the organizations sending the patients to
the Sanatorium, pay $1 per day to the Sanatorium, which covers all the ex-penses
of the patient while in the institution. The actual cost of treating the
patients for the last two years has been $1.50 per capita per diem. Of this
amount, the patient has paid 87 cents and the State 63 cents.
During the past two years 454 patients have been admitted. Of these, 102
were incipient cases, 216 were moderately advanced, and 136 far advanced.
During the last two years 263 patients who have stayed ninety days or
more in the institution have been discharged. Of these, 41 were arrested, 68
apparently arrested, 82 quiescent, 40 improved, 25 unimproved, and 7 died.
The following is an abstract from the biennial report of the Sanatorium and
Bureau of Tuberculosis during the last two years:
"Building Activities.—"We have constructed the left wing of our main build-ing,
which is to be the receiving building, administration building and in-firmary.
This left wing was intended to accommodate 48 patients. We are
now housing 64 patients in this building. We have built a power house, in-stalled
a 100 h.p. boiler, engine, and dynamo. Prom this power house we heat
all the buildings on the hill, furnish steam to run ice plant, heat for cooking,
and electricity for light and power. We have installed an ice plant and cold
storage. We have built a coal chute which delivers the coal in front of the
power house door, have built a house for engineer, and a two-room house for
fireman, a storage warehouse in which to store supplies, close by the railroad
where it is convenient to unload freight and express direct into the warehouse.
We have painted, screened, underpinned, and otherwise repaired all the old
buildings on the hill, making extensive repairs to the dining-room and kitchen.
In matters of economy, we are running our power plant for about what it cost
us to pump our water with gasoline and buy our ice; so that we have our
electric lights and steam heat free.
''Extension Department.—In the Extension Department we have in two
years examined 643 cases for diagnosis, 411 during 1916. We have car-ried
on extensively a correspondence course with physicians throughout the
State, especially with regard to the early diagnosis of tuberculosis. This has
been productive of great good. We have endeavored to enforce the law
requiring the physicians to report their cases of tuberculosis to us, and
have sent such patients printed instructions in regard to the prevention
of the spread of the disease to others, and as to open-air treatment. We
have bought sputum cups in quarter-million lots and are shipping them
by parcels post to any one wanting them, at actual cost—50 cents per 100.
We have distributed 60,302 of these during the last year. We have sent out
12,093 copies of literature. We have had 3,557 cases reported. Of these,
2,545 are alive. The others have died. Of the 2,545, 1,776 are white, 769 are
colored. We have written letters, multigraph and personal, to the number
of 60,744. We have received 14.605 letters. We have written articles for the
press. Bulletin, and other magazines, amounting to 80,273 words. We have
prepared 37 forms, placards, etc., amounting to 19,241 copies. We have been
furnishing capillary tubes, of tuberculin for the Von Pirquet diagnostic test
to physicians, and have sent out 1,625 of these, the only charge being that
they should report the result of the test. We have delivered during the last
year 35 addresses, to a total audience of 3,995. We have had 58 conferences
with local authorities. We have done 2,350 laboratory examinations in the
last year and furnished physicians with histories of the first examination
of their patients amounting to 133,787 words. We made a complete detailed
sickness survey of the silk mill village at Wadesboro, perhaps more complete
than has ever been done in the United States, and among other things, ad-vised
the employment of a public health nurse, which has been done.
''Public Health Nursing—After a conference with the Secretary of the State
Board of Health, and at his suggestion, we took the matter of Public Health
Sixteenth Biennial Report 45
Nursing under the Bureau of Tuberculosis. We had all the public health
nurses in the State, about 35 in number, as our guests at the Sanatorium for
a few days, and the meeting did much to further the cause of public health
nursing. We have secured a Director of Public Health Nursing for North
Carolina, Miss S. H. Cabanis, who devotes all her time to this particular
thing. We are fortunate to secure the cooperation of the Metropolitan Life
Insurance Company, who is paying one-half of the salary and traveling ex-penses
of Miss Cabanis. This company is also cooperating in local nursing
activities, and has given to us five scholarships in public health nursing in
the University of Cincinnati.
''Red Cross Seals—We have conducted the Red Cross Seal Campaign for
two years, and are actively engaged in the third campaign at this writing.
The receipts last year amounted to $8,033.86. We confidently expect the re-ceipts
this year to go over $10,000. Seventy-five per cent of the receipts will
be used by the local committees in their own localities; 10 per cent will be
sent to the National Association for the Study and Prevention of Tubercu-losis,
who furnish the seals and advertising matter, and 15 per cent will go
to the State Red Cross Seal Commission. All of it will be used in the fight
against tuberculosis in North Carolina. In connection with the Red Cross
Seal Campaign we have each year sent out printed matter and letters to every
minister in the State, requesting him to address his congregation on the sub-ject
of the prevention of tuberculosis on Tuberculosis Sunday."
BUREAU OF RURAL SANITATION
Routine Work.—The following tabular estimate for the last twelve months,
based upon eleven monthly reports, shows the work of the Bureau of Rural
Sanitation for the last twelve months:
Letters received 3,092
Letters written : Individual 1,416
Multigraph 7,258
Total number 8,674
Articles written, 14; approximate number words 9,330
Forms and placards prepared 23
Pieces of literature sent out 92,341
Lectures or addresses delivered : Total number 309
Illustrated 102
Total attendance 48,891
Average attendance 158
Inspections : Hotels 3
Schools (medical) 173
Children examined 12,550
Children found defective 5,664
Children card indexed 5,524
Typhoid dispensaries: Total number held 647
Estimated attendance 61,561
Number people taking complete treatment.... 48,051
Number days spent out of office on official business 102
Number units health work adopted 12
Total money received from counties $ 4,581
Special Work.—(1) In the nineteen months of its existence the Bureau of
Rural Sanitation has given three complete vaccinations to 100,000 people, dis-tributed
among 21 counties, vaccinating an average of 4,761 persons in each
county, which is from 16 to 20 per cent of the population of the counties.
(2) This bureau has inspected 206 schools, examined 15,751 children, found
7,390 physically defective, and has been instrumental in having 10 per cent
treated. Along with this inspection of schools, 241 public health lectures
46 North Carolina Board of Health
were given in the schoolhouses, 125 of which were illustrated, to a total audi-ence
of 40,000 people. This school work has been confined to 6 counties and
5 towns.
.SOIL POLIX'TIOX WORK
This work has only recently started in North Carolina, and the following
is a report of the first three months of the work from the Medical Director,
Dr. B. E. Washburn:
Preliminary Report of the Wilson County Public Health Campaign, from
September 1 to December 1. 1916
The Wilson County Public Health Campaign is being conducted under the
direction of the State Board of Health and has for ita object the control of
diseases spread through pollution of the soil. The method of work is to visit
each and every home in the county and demonstrate to the people the ways
in which this class of diseases is spread and to interest them in providing
sanitary privies as a preventive measure. Also, an important part of the
campaign is to examine and give treatments for hookworm disease and
vaccinations to prevent typhoid fever. From September 1 to November 15
the staff consisted of three field workers; on the latter date the work was
enlarged, and the staff now consists of a medical director, an office assistant,
a microscopist, and six field workers. The central office is in the town of
Wilson, and it is here that the clerical and microscopical work is done.
The active campaign began on September 11, 1916, and at present field
work is being conducted in 5 of the 10 townships of the county, namely. Old
Fields, Spring Hill, Cross Roads, Black Creek, and Stantonsburg. The cam-paign
has jtist become well organized, and, since many patients are still
under treatment and the building of sanitary privies is still under way in all
of the above townships, it is impossible before the completion of the work in
any given township to record all of the results which have been accomplished
in the district. The following table, however, shows the work that had been
accomplised up to December 1:
Number of homes visited 965
Number of homes cooperating 772 or 80.3%
-.Ntxmber of people examined for hookworms 3,801
Number found infected 598 or 19.4%
Number treated 333
Number ctired to date 50
Number refused to take treatment 7
Number immunized against typhoid fever 119
Number of homes having completed sanitary
privies 119 or 12.1%
Number of schools provided with sanitary privies. 4
The educational work, in addition to the home visits, was conducted
through the medium of public lectures and school demonstrations; 25 lec-tures,
illustrated with magic-lantern slides or moving pictures, have been
given, and lectures and microscopic demonstrations have been made at 7
schools. The aggregate attendance at these 32 meetings is estimated to have
been at least 2,500.
Special mention should be made of the sanitary work done by the citizens
of the villages of Stantonsbtirg and Lucama. On December 1, 65 of the 80
homes in Stantonsburg had been provided with sanitary privies and at Lu-cama
41 of the 58 homes were so provided. Prior to the campaign none of the
homes in either village had sanitary privies.
Special Work—Assistance was given to three Better Babies Contests, all of
which created mtich interest in the communities in which they were held.
Sixteenth Biennial Report 47
bureau of accounting.
The following table shows the actual work, exclusive of the double-entry
bookkeeping, of the Bureau of Accounting for eleven months:
Number of letters received 672
Number of letters written 1,200
Number of bills sent .- 1,692
Number of receipts issued 610
Number of checks issued 3,444
Amount collected on Laboratory accounts $9,550.80
Amount due Laboratory January 1, 1916 4,430.00
Amount due Laboratory November 30, 1916 2,795.00
THE PUBLIC HEALTH NEEDS
RECOMMENDATIONS OF THE NORTH CAROLINA STATE BOARD OF HEACTH TO THE
GENERAX ASSEMBLY OF 1917
At this time the three most important needs of the State in public health
legislation, and to the serious consideration of which we respectfully invite
the attention of the General Assembly are:
1. A State law for the control of the occurrence and spread of contagious
or epidemic diseases that will be uniform and efBcient throughout the State.
2. A State law regulating the conditions of sales of trade-mark remedies
and alleged remedies of secret composition.
3. Adequate provision to encourage the development of county health work
in the direction of economy and efficiency.
STATE CONTROL OF CONTAGION
The control of the occurrence and spread of epidemic and contagious dis-eases
is a State and not a county or local responsibility. To this fundamental
principle of sanitary government the United States Public Health Service, the
American Public Health Association, the International Health Board, the
American Medical Association, and every progressive State board of health
or department in the Union will subscribe. Even slight consideration of the
nature of the problem will convince any one of the soundness of this concep-tion
of it. The State should recognize its responsibility for the control of
contagious and epidemic diseases for the following reasons:
Reason 1.—The local governments, counties and small municipalities, are
helpless to protect themselves from the introduction of epidemic or contagious
infection. To illustrate: We will assume that in the seven counties—Harnett,
Johnston, Nash, Franklin, Granville, Durham, and Chatham—which touch the
90-mile boundary of Wake, there exists well conceived rules and regulations for
the control of epidemics, and that back of these rules and regulations there is
an intelligent and interested health officer who is not afraid of doing his duty.
We will assume that Wake County is very lax in the control of epidemic dis-eases.
Under these conditions an epidemic of scarlet fever, diphtheria, whoop-ing
cough, measles, infantile paralysis, or other contagious disease, starting in
Wake, would spread into the seven neighboring counties, which, without State
intervention, would be practically helplesa to prevent the introduction of the
infection among their people. We will reverse the situation: We will suppose
that Wake, so far as her internal machinery is concerned, is adequately pro-tected,
but that one or all seven of her neighbors are careless; then Wake is
helpless to prevent the introduction of infection from one or all of the seven
neighbors. The routes of infection recognize no county boundaries, and if one
county or one community is to be protected from infection from neighboring
or even distant counties and communities, the State alone can give it the pro-tection
that it needs.
Reason 2.—If an epidemic or contagious disease has been introduced into a
county, local measures and agencies of control are weak as compared with
State measures and State agencies of control.
Sixteenth Biennial Report 49
(a) Measures: In the absence of State rules and regulations for the con-trol
of a local outbreak of an epidemic or contagious disease, the local board
of health (composed of the chairman of the board of county commissioners,
the county superintendent of schools, the mayor of the county town, and two
local physicians selected by the three county officials), acting with or without
the advice of the county physician, pass, or do not pass, rules and regulations
for the control of infectious and contagious diseases. Now, as a matter of
fact, in 75 per cent of the counties of the State there are no rules and regula-tions
for the control of epidemic and contagious diseases. The rules and regu-lations
governing the control of contagious and infectious diseases are in
their nature technical. These rules are subject to important revisions at any
time for adjustment to scientific discoveries and new methods of control, and
such rules and regulations should be thoroughly considered, in the light of
our present knowledge and the epidemiological practice in other States, by
experts who can give practicallj^ their entire time to this subject. This being
true, the county board of health (composed of laymen with many other inter-ests
and assisted by a county physician giving but a small part of his time to
this service) is not qualified to enact such local ordinances.
(6) Agencies: The local agent for the enforcement of rules and regulations
governing contagion is the county physician. If he prosecutes his fellow physi-cians
for not reporting cases, personal motives are attributed to him, and his
loss in his professional standing under misguided public opinion does not
compensate him for the small salary he receives as quarantine officer. He,
therefore, does not enforce the law. Every one is familiar with the indiffer-ence
of the public tow^ards quarantine measures; every one knows that where
quarantine rules and regulations exist—and even the existence of rules is ex-ceptional—
they are violated freely; furthermore, an examination of the court
records of this State, in our opinion, will show less than ten or twelve prose-cutions
a year for infringements of the quarantine laws.
Reason 3.—All of the above defects incident to county control of epidemics
and contagions are removed completely or partially by the State's assuming
this respnsibility. The State can warn and protect counties against other
counties. The State Board of Health, with the assistance of a technical staff,
is many times more able to pass proper rules and regulations governing local
quarantine than the local lay boards of health. The force of a State law, with
a State agency for its enforcement back of it, would have far greater respect
than a local ordinance and would be enforced and recognized, whereas the
local ordinance is neither enforced nor even regarded by the majority of the
people.
METHOD OF CONTROL
A proper system of State control of contagious and epidemic diseases would
include the following:
1. Accurate and prompt reporting.
2. A proper system of recording at the central office, showing the geographi-cal
distribution of contagious disease throughout the State at all times, and
also showing the number of cases of such disease as compared with the ex-pected
incidence of every contagious disease.
3. Preliminary notices to threatened counties and localities and the inaugu-ration
of anticipatory measures when the geographical chart shows the spread
of the contagion toward certain counties and localities.
4
50 North Carolina Board of Health
4. The adoption by the State Board of Health, with the assistance of an
expert epidemiologist, of an effective and conservative and economic system
of technical rules for the control of contagion that will have the approval of
public opinion.
5. A State officer, that is, a State epidemiologist, with sufficient means to
see that the State rules and regulations are enforced in all counties.
Beporting.—The physicians and the nurses of the State would be required
to report promptly, within twenty-four hours, all cases of contagious or in-fectious
diseases which they have diagnosed or have good reasons to suspect.
The same requirement would apply to parents and householders where there
was a case of a contagious disease with no physician in attendance. The
physicians of the State would be supplied with a proper form of postal card
upon which to make the report. This report would be made to a county
quarantine officer selected by the county board of health, but under the con-trol
and direction, so far as his quarantine duties are concerned, of the State
Board of Health. This county official would send in to the State official every
day the reports of all contagious and infectious diseases received by him.
Becording.—The reports received in the State office would be recoi'ded in
the following way: A very large wall map would be kept, and the contagious
diseases reported indicated on the map by special colored tacks and spots.
Every colored tack in the map would indicate the location of an existing case
of one of these diseases. Every colored spot would indicate where a case of
the disease had occurred during the year, but had, at some previous time,
been released from quarantine. The color of the tacks and spots would be
the same for the same disease; that is to say, if yellow represented scarlet
fever, a yellow tack in the map would indicate the location of an existing case
of scarlet fever, and a yellow spot would indicate wliere a case of scarlet fever
had existed, and so on with red tacks and red spots representing measles, blue
tacks and blue spots representing diphtheria, green tacks and green spots
typhoid fever, purple tacks and purple spots whooping-cough, etc. This sys-tem
of keeping the geographical distribution of disease is most important.
It enables the State Government to know where a certain epidemic started
and in which direction or directions it is traveling, and thereby enables it to
notify and put on guard those counties and communities towards which the
disease is making its way.
In addition to the geographic record of epidemic distribution, another rec-ord,
the chronological record, would be kept in the central office. A chronologi-cal
disease chart consists of 365 vertical spaces, properly numbered and sub-divided
according to the twelve months of the year. Across the vertical
space are drawn a number of lines converting the chart into squares.
On this checkered background the number of cases and the number
of deaths of any given disease, based upon the average occurrence of such
disease through the country, is platted in solid lines. The cases of disease
then reported, that is, the actual occurrence of the disease, is recorded on the
chart by drawing a vertical line in one of the horizontal spaces and in that
vertical space corresponding with the month and day of the month on which
the disease occurred. This chart will show on any day in the year just
what contagious disease is occurring in North Carolina in fewer cases than
the expectancy, and the reverse. The central officer, then, and the local offi-cers
in the various counties, through the chronological chart, serving as a
Sixteenth Biennial Report 51
disease barometer, are kept constantly posted, not only as to where greater
action is needed for the suppression of contagious diseases, but also as to
what disease is demanding greater effort.
Anticipatory Measures.—During the present year scarlet fever has been
coming down the Southern Railway from the western part of the State. Could
we have had a State system of reporting and recording, we could have known
when and where this epidemic began; we could have prepared communities
and counties towards which the disease was making its way; and, by antici-pation,
could have prevented many cases. In other words, we .could have
burned a fire zone around the spreading epidemic. These anticipatory meas-ures
would include notification of the medical profession, putting them on
their guard for early cases, notification of schools, work through newspapers,
etc.
Proper Rules and Regulations.—The State, with an expert staffl of health
officers, is as much better prepared to pass the necessary technical rules and
regulations for the control of contagious and epidemic diseases as the State,
with its Laboratory of Hygiene, is better prepared to do this technical highly
scientific work than the counties are prepared to do it.
Rigid Enforcement of Quarantine Laics.—Quarantine regulations in North
Carolina at present are so little regarded generally that their principal effect
is to create a disrespect for law in general, and quarantine laws in particular,
rather than to inhibit the spread of contagion. We do not include in this
statement those communities with well organized health departments and
whole-time health officers, but, on the other hand, we do include the larger
part of the State and about three-fourths of the State's population.
In conclusion, the control of epidemics and contagions is a State responsi-bility
and not a local responsibility. The State should do its duty.
STATE REGULATIO^^ OF THE CONDITIONS OF SATES OF TRADE-ilARK REMEDIES
There is a large and dangerous class of remedies the claims of which are
not vouched for by any scientific or official organization and that represent
neither discovery nor invention, that is, that cannot secure patent rights from
the United States Government. These remedies are the trade-mark or secret
remedies, a group of remedies usually and erroneously referred to as "patent
medicines." Trade-mark or secret remedies are nothing more than an ordi-nary
prescription, the ingredients of which are withheld from the public, com-pounded
and sold, through extensive and usually misleading advertising, in
enormous quantities.
It is estimated that the drug bill of the United States amounts to $500,-
000,000 a year. The population of the United States from 1880 to 1910 in-creased
83.3 per cent, and the sales of manufactured remedies 740.5 per cent.
The population less than doubled: the sale of manufactured remedies in-creased
more than eightfold. There are from 40,000 to 50,000 brands of pro-prietary
remedies on the market in this country. Recently in North Carolina,
according to the claims of the manufacturer, over $200,000 worth of one secret
remedy has been sold. The sales of secret remedies in North Carolina prob-ably
amount to over $1,000,000 a year. *
It can be shown that, as a class, the manufacturers of secret remedies are
probably the most unscrupulous of all commercial classes, and it can be fur-ther
shown by a report of so high and so unbiased an authority as the British
52 • North Carolina Board of Health
House of Commons that the secret remedy business is permeated with fraud,
and dangerous alike to our physical and economic well-being. The harmful
effects of secret remedies may be classified as follows:
EFFECTS OF SECRET REMEDIES
Effect No. 1.—The secret remedy business, through its extensive advertis-ing,
influences a large number of people to rely on drugs when they should be
influenced to rely upon the adoption and cultivation of proper habits of living.
Example: from 20 to 30 per cent of the adult population of this country is
constipated and suffers from time to time with what they call "torpid liver,"
"liver out of fix," "a general no-account feeling." What these people need is
to drink plenty of water, including a glass of warm water before breakfast,
to take a diet containing a good amount of vegetable matter and fr,uit, and to
cultivate regular habits of going to stool, regular habits of exercise, and, if
necessary, special exercises of bending motions, forward and sideways, twist-ing
motions such as compress the abdominal contents and develop the abdom-inal
muscles. The effect of taking purgatives for this condition and neglect-ing
these right habits of living causes the bowels to become more and more
dependent on artificial stimulation, so that when the purgative remedy has
been taken for some time the patient, although relieved temporarily, is perma-nently
in worse shape than when he began the treatment. Secret remedies,
in inculcating habits of disobedience to nature and reliance upon artificial
agents, are particularly harmful.
Effect No. 2.—The second harm done by secret medicines and secret appli-ances
may be illustrated by the oxypathor of late renown. As will be remem-bered
by North Carolina people, the oxypathor was nothing more than a tube,
filled with sorne inert substances, and having wires attached to it through
which its promoters claimed electric currents passed from the tube to the body
of the patient. The people were charged $35 for the oxypathor. This little
toy never hurt anybody except by robbing them of $35, and possibly by^
Effect No. 3.—Many people in the incipient stages of tuberculosis, cancer,
Bright's disease, and other diseases, are influenced by the manufacturers and
venders of secret remedies to believe that by taking one of these remedies
their disease will be cured. They buy the remedy, spend from two to six or
probably twelve months in trying it out, and then, on finding they have gone
from bad to worse, they consult a physician and find out they have tuberculo
sis, cancer, or some other disease that has passed from an incipient and a
curable condition to a well developed and possibly incurable condition. Many
lives are lost through this effect of secret remedies.
Effect No. .'f.—The Select Committee of the British House of Commons says:
"There can be no doubt that many persons acquire the drink habit by taking
these wines and preparations [remedies containing from 14 to 30 per cent
alcohol] either knowing that they are alcoholic, since tliey can be purchased
and consumed without giving rise to the charge of drinking, or in ignorance
that they are highly intoxicating liquors."
As an illustration, according to the State Chemist of Michigan, Tanlac con-sists
of a mixture of alcohol of about 17 per cent—that is, about the strength
of Sherry wine or three times the strength of beer or one-third the strength
Sixteenth Biennial REroRT 53
of good whiskey—and purgatives. Now, why shouldn't any one taking Tanlac
feel better, with the stimulation of its whiskey and the relief from its purga-tives
which get rid of . the accumulated poisons of the bowels? But why
shouldn't the users of Tanlac know what they are taking? Of course, the
Prohibitionists would object to people taking all the liquor that the adver-tisements
of Tanlac indicate they are taking. The Tanlac allowance beats
the legislative allowance of two quarts monthly, all hollow. If (and we have
no reason to doubt) the State Chemist of Michigan is correct in his analysis
of Tanlac, this up-to-date secret remedy affords us a beautiful example of the
typical secret remedy. The manufacturer, knowing the craving of the masses
for artificial stimulants, and knowing the large number of people suffering
from constipation, have combined alcohol and purgatives in a way to meet the
popular demand; whereas there are very few intelligent people that would
knowingly take alcohol and purgatives for the relief of either worry or con-stipation.
Effect No. 5.-—Dr. Martin I. Wilbert, of the Division of Pharmacology of the
United States Public Health Service, associates the increasing death rate in
this country from degenerative diseases, such as chronic Bright's, high blood
pressure, apoplexy, diabetes, cirrhosis of the liver, etc., causing the death of
over 200,000 persons annually, with the increasing consumption of drugs, as
brought out in another section of this article. He raises the interesting ques-tion
as to whether there is any connection between the increase of more than
100 per cent in the deaths from this class of diseases and the increase of 740
per cent in the consumption of drugs that has taken place during the past
thirty years. Dr. Wilbert then goes on to say:
"When one considers the potential possibilities for harm inherent in
practically aU drugs and preparations it is astonishing that attention has not
earlier been directed to the need for careful, systematic study of the possible
untoward influences of the several drugs used.
"The frequent, excessive or long continued use of any one of a number of
inorganic compounds, particularly the soluble salts of mercury, lead, uranium,
and related metals, has been shown to be irritating to the kidneys and capable
of producing chronic lesions. The constant ingestion of many of the otherwise
innocuous inorganic salts when contaminated by traces of arsenic or lead
may, and undoubtedly will, produce toxic manifestations.
"Many organic compounds have also been found to produce marked changes
or secondary manifestations. The changes produced by alcohol and the nar-cotic
drugs have been fairly well recognized, and considerable data are also
available regarding the harmful effects of the coal-tar analgesics, the several
hypnotics, and a number of aldehydes and related products.
"All of the important or active medicaments must of necessity have harmful
influences when taken indiscriminately or for a continued length of time. It
has been very properly asserted that the activity of drugs may vary to an in-finite
number of degrees. It may be accepted as fact that whenever the
activity is sufficient to produce a decided therapeutic effect in disease it is
also sufficient to produce a deleterious effect when improperly used, either
as to time or quantity. In other words, useful drugs are of necessity poison-ous
substances which tend to derange normal processes of the human organ-ism,
and many of them must of necessity be extremely injurious to the
various organs of the body if used at all liberally for any appreciable length
of time.
"Quinine, for instance, the alkaloid of cinchona bark, is still used in rather
large quantities, and as such or in the form of bark was imported into the
United States, in 1913, to the total of 2,065,000,000 average doses, enough to
give every man, woman, and child from 25 to 30 doses each year. This
54 I^ORTH Carolina Board of Health
drug has long been known to produce a characteristic form of intoxication
accompanied by roaring in the ears, impairment of hearing, dizziness, head-ache,
and nausea. Gastro-intestinal disturbances are also observed at times,
and the ingestion of even small doses for a considerable period may be fol-lowed
by gastric catarrh and its sequelae. The administration of larger doses
has been followed by marked and at times persistent deafness, and even blind-ness.
"The habitual ingestion of coal-tar analgesics, which form para-aminophenol,
is followed by a train of sjmiptoms including destructive changes in the
blood, the production of methemoglobin, a degeneration of the heart muscle,
cardiac failure, cyanosis, abnormally low temperature, and collapse.
"The salicylates have many of the properties of coal-tar analgesics and are
used quite extensively as sedatives for the relief of headache and neuralgic
pains. They are known to have a deleterious influence on the digestive func-tion,
and in larger doses or when long continued are frequently accompanied
by symptoms of cinchonism similar to those produced by quinine. The salicy-lates
may also have a depressing influence on the central nervous system ac-companied
by convulsions, slowing of respiration, and collapse from circu-latory
depression.
"Pontius (J. Am. M. Assoc, v. 62, p. 797) reports seeing a nervous woman,
age 45, who on tlie advice of a friend had for the past year taken 5-grain tab-lets
(1 per dose) from 3 to 10 times daily for neuralgic pains. Her mental
condition when seen by the physician was similar to that of one addicted to
the morphine habit.
"The coal-tar hypnotics like sulphonal and trional may cause acute symp-toms
of poisoning accompanied by ataxia, nausea, gastric pain, irritation of
the kidneys, albuminuria, and nephritis.
"The mental state induced by the long continued use of sulphonal and its
congeners in full doses is said to be a badly distui'bed one, with derangement
and even dementia.
"The occurrence of acute intoxication in patients from the ingestion of
various drugs is frequently ascribed to idiosyncrasy. As yet comparatively
little is known regarding the principles underlying this occasional manifesta-tion
of undue activity, but it is probable that idiosyncrasy, so called, is in
reality due to the synergistic action of several compounds taken at the same
time or to the combined action of products formed in the human body with a
compound taken as medicine.
"In connection with some drugs, the use of which is long continued, the
body may develop a tolerance or diminished sensitiveness to their action. This
appears to be particularly true of narcotics and of many of the cathartic
drugs. These lead to the habitual consumption of drugs, and their use once
commenced is fraught with many difficulties. That the use of the so-called
laxative drugs is not an entirely negligible factor is well known.
"The amount of money expended annually for drugs and medicines in this
country is out of all proportion to the real need or requirements of the people,
and to this extent at least the unnecessary use of medicines may be considered
an economic waste.
"Enough has been said to demonstrate that medicines, if at all deserving
of the name, must of necessity be harmful when misapplied or when used for
any considerable length of time icithout a due appreciation of their possible
secondary influences and the chronic derangements that may folloio in their
ivake." [Emphasis ours.]
Explanation of Public Confidence in the Secret Remedy
Explanation Xo. 1, or the Psychology of Advertising.—No secret remedy can
find a sale or exist without advertising. Advertising a secret remedy is abso-lutely
essential to its existence. As the peeled saplings which Jacob placed
before the gravid sheep caused a mental impression on the animals sufficient
to mark their offspring, so the constant and conspicuous secret remedy adver-
Sixteenth Biennial Report 55
tisements ever before the eyes of the public finally grip the public mind so
as to color its thoughts and influence its actions.
Explanation Xo. 2, or Superstition and Cure.—We are all superstitious.
Superstition is not restricted to any class; we find it in both the ignorant and
intellectual, differing only in degree; it is our common heredity. From out
of our prehistoric past, out of the past of legend and myth, and still further
back from the childhood and infancy of the race, we have brought up with us
various forms of superstition. We don't want to see the new moon through
the trees; we don't like to sit down with thirteen at the table; we hang horse-shoes
over our doors; we carry buckeyes to keep off rheumatism and to cure
piles; and we take the gallstone of the deer, moisten it, and stick it on the
fresh bite of rabid animals to prevent hydrophobia. The very wisest men of
England at one time shared the belief with the masses that the touch of the
king was almost an infallible cure for scrofula. This faith in the mysterious,
this inherent trait of human nature, is responsible for much of the confidence
of the people in those secret remedies that claim some extraordinary origin.
Explanation No. S, or the Tendency of People to Confuse Coincidence with
Cause and Effect.-—Dr. Osier, in going through the wards with medical stu-dents,
would often point to a typhoid fever patient who had never received
a single drop or grain of medicine and who was getting well in the third or
fourth week of the disease, and would then remark: "What a great pity that
old Dr. X had not had a chance to give that patient his infallible remedy for
the cure of typfcoid fever. What a fine demonstration that patient would
have made of its wonderful effects." Scientific medical literature contains
numerous examples of instances like the following: The medical staff of a
certain hospital adopts a new treatment for pneumonia. The first twenty-five
cases of pneumonia admitted to the hospital make prompt and complete
recovery under the new treatment. The younger, less experienced, and more
enthusiastic staff of the hospital are anxious to rush into print with the won-derful
effects of the new treatment. The older heads say, "No; let's wait
until we get a few more cases." Out of the next ten cases admitted, eight
die; and no report of what appeared to be a new discovery ever occurs, for
the fatality under the new treatment is just what it has been for fifty years
under the old treatment—about 25 per cent. A person has pneumonia; a
friend drops in on the fifth day and advises the family to apply some Gowan's
Pneumonia Cure. The next day the crisis occurs. The patient passes within
a few hours from the edge of the grave back to a condition of safety. What
a wonderful remedy! But another patient living in another part of the town
and with the same identical symptoms did not have any Gowan's Pneumonia
Cure applied on the fifth day, and the crisis occurred on the sixth day just as
in the case that had an application of Gowan's Pneumonia Cure. The great
majority of diseases are cured by Mother Nature. The human body began its
fight with the causes of disease and death many years ago, long before either
secret or open remedies were discovered or concocted. The cells that make
the body are soldiers of long experience in dealing with germs and their
allies. In ninety-five recoveries out of a hundred Nature, the fighting cells of
the body, turns the trick. Before people are justified in recognizing a remedy
as a cure they must be careful to distinguish between occurrences that are
merely coincidents and occurrences that stand in the relation of cause and
effect.
56 North Carolina Board of Health
Explanation No. .'/, or Apparent Relief and Real Harm.—Assuming that the
State Chemist of Michigan is correct in stating that Tanlac consists of a com-bination
of alcohol and purgatives, this remedy, as we have elsewhere pointed
out, furnishes an excellent example of this explanation of public confidence in
secret remedies. Tanlac will, no doubt, make any one who takes it feel better,
especially if such a person is constipated—and about 25 per cent of the people
are constipated. The same effect can be obtained for less money by taking
the equivalent amount of whiskey as a stimulant and some of the simple
purgatives. The fact that this remedy stimulates and makes a torpid bowel
throw off the poisons of the body does not mean that the drug has done the
person any permanent good. Like all stimulants, the person taking sucli a
drug becomes more dependent upon tlie artificial agent and farther removed
from those natural agencies, the hygienic liabits of life, which constitute the
sure foundations of health.
The Public Remedy for the Secret Remedy
The secret remedy business needs exactly the same prescription that the
Legislature of 1907 wrote for the fertilizer business. That prescription con-sisted
of just two requirements: (1) that fertilizer manufacturers should
write the name and amounts of the active ingredients of their fertilizer on
the package or sack, and (2) that the manufacturers should pay a small tax
sufficient to enable the State to verify the statement of composition and to
inform farmers as to the effects of any given fertilizer upon plants.
The fertilizer people at tliat time doubtless argued that to make them dis-close
the formula of their fertilizer, the sale of which they had established
through large expenditures for advertising, was unfair in that it would per-mit
oth