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THIRTEENTH BIENNIAL REPORT OF THE NORTH CAROLINA STATE BOARD OF HEALTH 1909-1910 iilil I lillllll llillllll iliijlljlsllijijj !: THE LIBRARY OF THE UNIVERSITY OF NORTH CAROLINA (mm THE COLLECTION OF NORTH CAROLINIANA C6U.06 N87 1909-10 c.2 DANiEL & WARREN THIRTEENTH BIENNIAL REPORT OF THE NORTH CAROLINA STATE BOARD OF HEALTH 1909-MO RALEIGH Edwards & Broughton Printing Co., State Printers 1911 Members G. G. Thomas, M.D., Pies., Wilmington. Thomas E. Axdersox, M.D., Statesville. J. Howell Way, M.D., Waynesville. W. 0. Spexcer, M.D., Winston-Salem. Edw. C. Register, M.D., Charlotte. David T. Tayloe, M.D., Washington. *J. A. Burroughs, M.D., Asheville. J. L. Ludlow, C.E., Winston-Salem. Richard H. Lewis, M.D., Raleigh. •Deceased. Succeeded by J. E. Asheraft M.D.. Monroe. County Superintendents of Health Alamance Dr. G. Alexander Dr. 0. Alleghany Dr. B. Anson Dr. J. Ashe Dr. J. Beaufort Dr. P. Bertie Dr. J. Bladen Dr. L. Brunswick Dr. J. Buncombe Dr. D. Burke Dr. I. Cabarrus Dr. J. Caldwell Dr. C. Camden Dr. C. Carteret Dr. W Caswell Dr. S. Catawba Dr. H. Chatham Dr. L. Cherokee Dr. J. ( lmwan Dr. H. Clay Dr. J. Cleveland Dr. T. Columbus Dr. H. Craven Dr. J. Cuml>erland Dr. W, Currituck Dr. H. Dare Dr. . . Davidson Dr. E. Davie Dr. M Duplin Dr. T. Durham Dr. X. Edgecombe Dr. S. Forsyth Dr. J. Franklin Dr. J. Gaston Dr. X. Gates Dr. G. Graham Dr. M. Granville Dr. S. Greene Dr. W Guilford Dr. A. Halifax Dr. I. Harnett Dr. L. Haywood Dr. J. Henderson Dr. J. Hertford Dr. J. Hyde Dr. K W. Long Graham. L. Hollar Taylorsville. 0. Choat Sparta. M. Covington Wadesboro. C. Testerman Jefferson. A. Nicholson Washington. L. Pritchard Windsor. B. Evans Clarkton. A. Dosher Southport. E. Sevier Asheville. W. Phifer Morganton. W. Wallace Concord. L. Wilson Lenoir. G. Ferebee Gregory. E. Headen Morehead City. A. Malloy Yanceyville. E. Rowe Newton. E. Farthing Pittsboro. F. Abernethy Murphy. M. S. Cason Edenton. M. Sullivan Hayesville. E. McBrayer Shelby. B. Maxwell Whiteville. F. Rhem Xew Bern. S. Jordan Fayetteville. M. Shaw Shawboro. J. Buchanan Lexington. . D. Kimbrough Moeksville. O. Coppedge Kenansville. M. Johnson Durham. P. Bass Tarboro. K. Pepper Winston. E. Malone Louisburg. L. Glenn Gastonia. D. Williams Gatesville. T. Maxwell Robbinsville. D. Booth Oxford. . B. Murphy Snow Hill. T. Fortune Greensboro. E. Green Weldon. F. Arnold Lillington. R. McCracken Waynesville. G. Waldrop Hendersonville. H. Mitchell Ahoskie. E. Windlev Lake Landing. Iredell Dr. M. E. Adams Statesville. Jackson Dr. A. S. Nichols Sylva. Johnston Dr. A. H. Rose Smithfield. Jones Dr. A. F. Hammond Pollocksville. Lee Dr. J. P. Monroe Sanford. Lenoir Dr. N. A. Whitaker Kinston. Lincoln Dr. J. W. Saine Lincolnton. McDowell Dr. Guy S. Kirby Marion. Macon Dr. S. H. Lyle Franklin. Madison Dr. W. J. Weaver Marshall. Martin Dr. W. E. Warren Williamston. Mecklenburg Dr. C. S. McLaughlin Charlotte. Mitchell Dr. V. E. Butt Bakersville. Montgomery Dr. C. Daligny Troy. Moore Dr. Gilbert McLeod Carthage. Nash Dr. J. P. Battle Nashville. New Hanover Dr. W. D. McMillan Wilmington. Northampton Dr. H. W. Lewis Jackson. Onslow Dr. Cyrus Thompson Jacksonville. Orange Dr. C. 0. Jones Hillsboro. Pamlico Dr. D. A. Dees Bayboro. Pasquotank Dr. H. T. Aydlett Elizabeth City. Pender Dr. E. H. Bradford Burgaw. Perquimans Dr. T. S. McMullen Hertford. Person Dr. W. T. Long Eoxboro. Pitt Dr. W. M. Fountain Greenville. Polk Dr. Earl Grady Tryon. Eandolph Dr. J. V. Hunter Asheboro. Eichmond Dr. W. P. Webb Eockingham. Eobeson Dr. W. A. McPhail Lumberton. Eockingham Dr. Samuel Ellington Wentworth. Eowan Dr. M. L. Smoot Salisbury. Eutherford Dr. E. B. Harris Eutherfordton. Sampson Dr. A. M. Cooper Clinton. Scotland Dr. Peter McLean Laurinburg. Stanly Dr. J. F. Laton Albemarle. Stokes Dr. J. W. Xeal Walnut Cove. Surry Dr. J. E. Woltz Dobson. Swain Dr. A. M. Bennett Bryson City. Transylvania Dr. Goode Cheatham Brevard. Tyrrell Dr. J. L. Spruill Columbia. Union Dr. H. D. Stuart Monroe. Vance Dr. E. F. Fenner Henderson. Wake Dr. J. J. L. McCullers McCullers. Warren Dr. M. P. Perry Macon. Washington Dr. W. H. Ward Plymouth. Watauga Dr. H. McD. Little Boone. Wayne Dr. T. M. Bizzell Goldsboro. Wilkes Dr. E. M. Hutchens North Wilkesboro. Wilson Dr. W. S. Anderson Wilson. Yadkin Dr. T. E. Harding Yadkinville. Yancev Dr. W. B. Eobertson Burnsville. Letter of Transmittal JSTorth Carolina State Board of Health, Office of the Secretary, Raleigh, X. C, August 3, 1911. His Excellency, W. W. Kitchen, Governor of Xorth Carolina. Sir:—Under the authority of Section 4137 of The Revisal of 1905, I have the honor to submit the Biennial Report of the State Board of Health for the years 1909 and 1910. In making this report I desire to express the sincere appreciation of the State Board of Health for your deep interest in the fundamental question of public health, for the strong recommendation for the in-crease in the State appropriation for this purpose contained in your last message to the Legislature, and for your cordial co-operation un-stintedly given at all times in assisting us in dealing with public health situations of peculiar interest. Very respectfully yours, "W. S. Rankin, Secretary and Treasurer. Legislation by General Assembly of 1909 Chapter 389. AN ACT TO PROVIDE DIPHTHERIA ANTITOXIN FOR INDIGENT PERSONS SICK OF DIPHTHERIA. The General Assembly of North Carolina do enact: Section 1. That the North Carolina Board of Health is hereby authorized and directed to arrange for a sufficient supply of diphtheria antitoxin for the treat-ment therewith, free of charge, of indigent persons sick of diphtheria, and for immunizing against infection such indigent persons as may be exposed to the dis-ease, and to extend the facilities for making the diagnosis of the disease. Sec. 2. That the said board of health shall keep on hand in the State Labora-tory of Hygiene a supply of reliable diphtheria antitoxin, and shall distribute, through the said laboratory, to the several counties of the State, whenever the boards of county commissioners thereof shall request it, and shall notify the Sec-retary of the State Board of Health that they will pay for the same upon presen-tation of a bill, and shall designate the person or persons with whom it shall be deposited. The antitoxin shall be furnished at the lowest figure obtainable for a reliable preparation. Sec. 3. That whenever a physician is called to a case of diphtheria in an indi-gent person or one in immediate need and unable to pay for antitoxin, he may obtain the same from one of the depositories or diphtheria stations by filling out and signing in duplicate the blank requisition form to be supplied with the anti-toxin by the said board of health, and presenting the same to the county superin-tendent of health or any member of the county sanitary committee, or to such person as the said county sanitary committee may appoint, who, after satisfying himself as to the indigency of the person or persons for whom the antitoxin is intended, shall approve and countersign in duplicate the requisition. The person dispensing the antitoxin shall retain one copy of the requisition and shall mail the duplicate promptly to the director of the laboratory of hygiene. He shall also return to the said director all packages of antitoxin in his possession as soon as they become out of date. Sec. 4. The provisions of this act shall apply to cities and towns upon the same conditions as it does to counties. Sec. 5. That for carrying out the provisions of this act the sum of five' hundred dollars annually is hereby appropriated. Sec. 6. That this act shall be in force from and after its ratification. Ratified this the 26th dav of Februarv, A. D. 1909. Chapter 722. AN ACT TO PROVIDE FOR THE REGISTRATION OF DEATHS IN MUNICI-PALITIES OF ONE THOUSAND POPULATION AND OVER IN THE STATE OF NORTH CAROLINA. The General Assembly of North Carolina do enact: Section 1. That all deaths that occur in cities or towns having a population of one thousand or over by the last preceding federal census shall be registered bv the clerks or other officials designated bv the board of aldermen or town com- 6 NORTH CAROLINA BOARD OF HEALTH. missioners thereof, who are hereby constituted local registrars of deaths, within three days after the occurrence of said deaths and before the bodies are removed, interred or otherwise disposed of: Provided, that in cities or towns now having satisfactory registration of deaths under their ordinances the health officer or other official now acting as local registrar shall continue as such, but shall con-form to the provisions of this act and to the regulations of the State Board of Health adopted thereunder. Sec. 2. That a certificate of death, of standard form, provided by the State Board of Health, shall be filed with the local registrar by the undertaker or other person in charge of the removal, interment or other disposal of the body of the deceased person, and a permit shall be issued by said local registrar for such removal, interment or other disposal of the body only after such certificate of the cause of death, signed by the attending physician, or, in case there shall be no attending physician, by the health officer, or, in case there is no health officer of the city or town, by the local registrar, who shall give the medical cause of death, as nearly as he can determine it, after full inquiry, in regard thereto, of the householder in whose family the death occurred: Provided, that under no circum-stances shall the local registrar sign the death certificate when there has been an attending physician or there is a municipal health officer. No sexton or superin-tendent of a cemetery in cities and towns having a population of one thousand or over shall permit interment, and no railway company or other common carrier shall transport a body of a deceased person whose death occurred in this State unless accompanied by the local registrar's permit. Sec. 3. That the local registrar shall number each certificate as received, record it in a local register of deaths, and promptly by the fifth day of the following calendar month send all of the original certificates to the secretary of the State Board of Health, at Raleigh, who is hereby constituted State Registrar of Vital Statistics. The said registrar, with the approval of the State Board of Health, shall maintain in his office a bureau of vital statistics, preserve, index and com-pile the original returns, and make copies thereof for legal or other purposes, as may be necessary, which copies, when officially certificated, shall be prima facie evidence of the facts therein set forth, in all the courts of the State, for all pur-poses of this act. The State registrar shall prepare and distribute all blanks and instructions necessary for the execution of this act, and shall see that the pro-visions of this act are faithfully enforced; and the solicitors of the several dis-tricts and the Attorney-General shall aid him, upon his request, and enforce the penalty of the law, in case of its violation. Each of the said local registrars shall be entitled to a fee of twenty-five cents for his service, under this section, to be paid by the city or town. Sec. 4. That any undertaker, sexton or superintendent of a cemetery, agent of a transportation company, local registrar or other person who violates the pro-visions of this act, and any attending physician who fails or neglects to certify to the cause of death when the certificate is presented to him for the purpose, and every local registrar who shall neglect to perform any of the duties required of him by section three of this act shall be guilty of a misdemeanor, and upon con-viction thereof shall be liable to a fine of not less than five nor more than fifty dollars or imprisonment for not less than ten nor more than thirty days, and shall also be liable to a penalty of twenty-five dollars in favor of any person who shall sue for the same. Sec. 5. The mayor of each city or town of one thousand or more inhabitants THIRTEENTH BIENNIAL REPORT. 7 shall be responsible for the enforcement of this act in his jurisdiction. Failure on his part to so enforce its provisions shall be a misdemeanor, and he shall be liable to a fine of not less than ten nor more than fifty dollars; and it shall be the duty of the solicitor of the judicial district in which the city or town is situate, upon complaint of the State registrar or of the secretary of the State Board of Health, to institute a criminal action for the enforcement of said fine. Sec. 6. That this act shall be in force from and after its ratification. Ratified this the 6th day of March, A. D. 1909. Chapter 793. AN ACT TO AMEND SECTIONS 3045, 3058, 3457, 4440, 4442, 4444, 4457, 44G0 AND 4508 OF THE REVISAL OF 1905, RELATING TO THE PUBLIC HEALTH. The General Assembly of North Carolina do enact: Section 1. That section three thousand and forty-five of The Revisal of one thousand nine hundred and five be amended by inserting after the word "method," in line twenty-eight, the words "scope and detail," and by adding at the end of said section three thousand and forty-five the following: "Full reports, in dupli-cate, of all such inspections shall be made promptly to the secretary of the State Board of Health and their accuracy certified by the affidavit of the inspector or such officer or person as the said secretary may direct." Sec. 2. That section three thousand and fifty-eight of said Revisal be amended by adding thereto, as subsections (a), (b) and (c), the following: "(a) The State Board of Health shall have the general care and oversight of all inland waters, and shall, from time to time, as it may deem advisable, cause examinations of said waters and their sources and surroundings to be made, for the purpose of ascertaining whether the same are adapted for use as water sup-plies for drinking and other domestic purposes or are in a condition likely to impair the interests of the public or of persons lawfully using the same, or to imperil the public health. For the purpose aforesaid it may employ such expert assistance as may be necessary. The said board shall make such rules and regu-lations as in its judgment may be necessary to prevent contamination and to secure such purification as may be required to safeguard the public health. Any individual, firm, corporation or municipality, or the person or persons responsible for the management of the water supply, failing to comply with said rules and regulations shall be guilty of a misdemeanor, and upon conviction shall be fined or imprisoned, or both, at the discretion of the court. "(6) The said board shall from time to time consult with and advise the boards of directors of all State institutions, the authorities of cities and towns, corpora-tions or firms already having or intending to introduce systems of water supply, drainage or sewerage as to the most appropriate source of supply, the best prac-tical method of assuring the purity thereof or disposing of their drainage or sewage, having regard to the present and prospective needs and interests of other cities, towns, corporations or firms which may be affected thereby. All such boards of directors, authorities, corporations and firms are hereby required to give notice to said boards of their intentions in the premises, and to submit for its advice outlines of their proposed plans or schemes in relation to water supply and 8 NORTH CAROLINA BOARD OF HEALTH. disposal of sewage; and no contract shall be entered into by any State institu-tion, city or town for the introduction of a system of water supply or sewage disposal until said advice shall have been received, considered and approved by said board. Violation of the provisions of this subsection (5) shall be a misde-meanor, and upon conviction those responsible therefor by neglect of duty shall be fined not less than fifty dollars nor more than two hundred dollars, at the dis-cretion of the court. "(c) That for the purpose of carrying out the general provisions of the said section three thousand and fifty-eight, as set forth in subsections (a) and (6), every municipal or private corporation, company or individual supplying or au-thorized to supply water for drinking or other domestic purposes to the public shall file with the secretary of the State Board of Health, within ninety days after receipt of notice from said secretary, certified plans and surveys, in dupli-cate, pertaining to the source from which the water is derived, the possible sources of infection thereof, and the means in use for the purification thereof, in accord-ance with the directions to be furnished by the said secretary. Failure to file said plans and surveys, as required in this subsection (c), shall be a misde-meanor, and upon conviction those responsible therefor by neglect of duty imposed thereby shall be fined not less than fifty nor more than one hundred dollars, at the discretion of the court ; and every delay of one calendar month after the expi-ration of the said ninety days shall be a separate offense." Sec. 3. That section three thousand four hundred and fifty-seven of said Re-visal be amended by adding thereto as subsection (a) the following: "(a) That for any violation of this section or of the laws relating in any way to the public health it shall be the duty of the solicitors of the several judicial districts, upon complaint of the board of health, or of any of its officers, or of any individual injured or likely to be injured, to institute a criminal action against the person, firm, corporation or municipality charged with such violation in their respective districts, and prosecute the same." Sec. 4. That section four thousand four hundred and forty of said Revisal be amended by striking out all after the heading and substituting in lieu thereof the following: "The State Board of Health shall have a president, a secretary (who shall also be treasurer) and an executive committee, said executive committee to have such powers and duties as may be assigned it by the board of health. The president shall be elected from the members of the board and shall serve six years. The secretary-treasurer shall be elected from the registered physicians of the State and shall serve six years. The executive committee shall be composed of the president and the engineer member of the board, ex officio, and one other member of the board, to be elected from those composing it. The executive office of the board shall be in the city of Raleigh and the secretary shall reside there. The secretary shall be the executive officer of the board, and shall, under its direction, devote his entire time to public health work and shall be known as the State Health Officer. He shall receive for his services such yearly compensation as shall be fixed by the board, not to exceed three thousand dollars and his actual traveling and hotel expenses when engaged in the work of the board. The board may in its discretion elect as a special assistant to the State Health Officer, for the anti-tuberculosis work, the Secretary of the State Association for the Preven-tion of Tuberculosis, at an annual salary not to exceed six hundred dollars. The members of the board shall receive no pay, except that each member shall receive four dollars a day and necessary traveling and hotel expenses when on actual duty THIRTEENTH BIENNIAL REPORT. 9 in attending the meetings of the board or of the executive committee or in pursu-ing special investigations in the State; but when attending important sanitary meetings beyond the limits of the State, the number of delegates thereto being limited to one, in addition to the secretary, only actual traveling and hotel ex-penses shall be allowed. These sums shall be paid by the treasurer on authenti-cated requisition, approved and signed by the president." Sec. 5. That section four thousand four hundred and forty-two of said Eevisal be amended by adding thereto the following: "The executive committee shall meet at such time as the president of the board may deem necessary, and he shall call such meetings through the secretary." Sec. 6. That section four thousand four hundred and forty-four of said Revisal be amended by adding thereto the following: "Provided, that if the sanitary committee of any county shall fail to elect a county superintendent of health with-in two calendar months after the time set in section four thousand four hundred and forty-one of said Eevisal for such election, the State Board of Health shall appoint a registered physician of good standing, resident in the said county, who shall serve the remainder of the regular two-year term, and shall fix his compen-sation, to be paid by the said county, in proportion to the salaries paid by other counties for the same service, having in view the amount of taxes collected by the said county." Sec. 7. That section four thousand four hundred and fifty-seven of said Revisal be amended by striking out, in line two, the word "two" and inserting in lieu thereof the word "six." Sec. 8. That section four thousand four hundred and sixty of said Eevisal be amended by adding thereto as subsection (a) the following: "(a) Any householder in whose family there is to his knowledge a person sick of cholera or typhoid fever, who shall permit the bowel discharges of such sick person to be emptied without first having disinfected them according to in-structions to be obtained from the attending physician or the county superintend-ent of health, shall be guilty of a misdemeanor, and upon conviction shall be fined not less than two nor more than twenty-five dollars or imprisoned not less than ten nor more than thirty days. In cases where such undisinfected discharges are emptied on the watershed of any stream or pond furnishing the source of water supply for any public institution, city or town, the penalty shall be a fine of not less than twenty-five nor more than fifty dollars or imprisonment for not more than thirty days. And any physician attending a case of cholera or typhoid fever who refuses or neglects to give the proper instructions for such disinfection as soon as the diagnosis is made shall be deemed guilty of a misdemeanor, and upon conviction shall be fined not less than ten nor more than fifty dollars." Sec. 9. That section four thousand five hundred and eight of said Eevisal be amended by inserting after the word "mention," in line eight, the words "or of tuberculosis or typhoid fever." Sec. 10. That this act shall be in force from and after its ratification. Ratified this the 8th day of March, A. D. 1909. 10 NORTH CAROLINA BOARD OF HEALTH. CHANGES IN PERSONNEL OF BOARD. In amending section 4440 of The Eevisal of 1905 the General Assem-bly of 1909 greatly benefited the cause of public health. This amend-ment increased the appropriation for the Board from $2,000 to $6,000, thereby, making it possible to further amend this section by requiring the entire time of the executive officer of the Board to be devoted to the public health work of the State. In securing the favorable consideration of the General Assembly for this extension of the work of the Board, former Secretary Dr. Richard II. Lewis was chiefly instrumental. The act, by requiring the entire time of the Secretary, made it necessary for the father of the bill to culminate seventeen years of patriotic devotion to the State's greatest asset, the health of her people, in his own official self-sacrifice. Along the trail that this pioneer sanitarian blazed through discouragement, super-stition and incredulity, his followers will endeavor to propel, with the force of public opinion awakened to its civic obligations in the pre-vention of unnecessary death, the life saving legislation of the future. On March 30, 1909^ the State Board of Health met in a called meet-ing in the office of the Secretary, at Raleigh. Dr. Lewis then explained the amended law which required the executive officer to devote his entire time to the work of the Board. After stating that he could not afford to surrender his practice, he tendered his resignation as Secre-tary. The Board, after insisting in vain upon the withdrawal of the resignation, reluctantly accepted it. Dr. W. S. Rankin, of Wake For-est, was elected to succeed Dr. Lewis. The present incumbent took charge of his duties July 1, 1909. Another change in the personnel of the Board was caused by the untimely death of Dr. James A. Burroughs, of Asheville, on December 28, 1909. Dr. James E. Ashcraft, of Monroe, Avas elected by the Board at Wrightsville on June 22, 1909, to fill the vacancy made by the death of Dr. Burroughs. Colonel J. L. Ludlow, of Winston-Salem, whose term of office expired in May, 1909, Avas reappointed by the Governor. POLICY AND DUTIES OF STATE BOARD OF HEALTH. In pursuance of the policy inaugurated by his predecessor, the present Secretary has recognized the functions of the Board of Health as execu-tive and advisory or educational. Of the two duties the last is of first importance. Even the enactment of law, and much more the execution of law, is dependent upon an approving public sentiment, and public sentiment is the direct offspring of education. The Earl of Derby was therefore correct in saying, "Sanitary instruction is even more im-portant than sanitary legislation." With the great amount of indifference to the enforcement of sanitary laws on the part of the people, public health education, carried on through all available agencies, press, special literature and platform, is the most urgent, important and gigantic task of the Board. Neverthe- THIRTEENTH BIENNIAL REPORT. 11 less, the will of the people as expressed through their representatives makes the executive duties of the Board mandatory, and for this reason they will be first considered. Executive Functions of Boards of Health. DIFFERENCE IN PRINCIPLE OF STATE AND LOCAL HEALTH LAWS. The executive function of the State Board of Health consists in see-ing to the enforcement of all State health laws, with the exception of the Food and Drug Act. Health laws are and always will be divisible into State and local laws—municipal and county health laws. State health laws should control all those conditions affecting the public health that are not limited to the jurisdiction of counties; that is, that are inter rather than mira-county concerns. Those conditions that affect the public health and that conform to this principle are sanitary control of watersheds, the law requiring the registration of deaths, the sanitary supervision of State institutions and the enforce-ment of quarantine. The reasons for this are perfectly clear. The only available water supply of a town may be taken from a river that flows through another county before reaching the one in which the town supplied is located. Under such conditions, the necessary, just and only protection of the purity of such water supply must be furnished by the State. The same thing holds true for the law requiring the registration of deaths. If each county had its own system of death registration, there would be no uniformity, and, for comparison (and this is the only value of sta-tistics), the records would be almost worthless. The sanitary super-vision of State institutions that care for the afflicted and criminal, not of one county but of the entire State, should be, as it is, under State control. A GRAVE DEFECT IN THE STATE HEALTH LAWS. Contagion is no respecter of county boundaries, and the law controll-ing the prevalence of contagious diseases should be enforceable through State officials. Right here is one of the most serious defects in the health laws of our State. At present quarantine, that is, the control of contagious diseases, is entirely within the jurisdiction of the county superintendent of health. An inefficient county superintendent of health, elected and retained in office by a responsible board of county commissioners, may neglect or refuse to quarantine or disinfect until an epidemic in his county spreads and involves other contiguous and even distant counties. In this way it is in the power of a board of county commissioners to permit their county to become a hotbed for the dis-semination of disease, a public nuisance, and an expensive neighbor to sister counties and even other States. Under such conditions the State at present is powerless. A large number of appeals from county super-intendents of health to the secretary of the State Board of Health ask-ing protection for their counties against contagion turned loose through ignorance, indifference, or deliberate political play of moral weakness to ignorant popular favor, are now on file in the office of the secretary. 12 NORTH CAROLINA BOARD OF HEALTH. \ To these appeals we were, under our present quarantine law, debarred from extending the necessary assistance. A bill will be introduced in the present General Assembly to give the State authority to enforce the quarantine laws, making it possible thereby to protect the majority of intelligent, health-loving counties from a few county health governments remarkable for lax quarantine enforcement. PRESENT STATE HEALTH LAWS. The present enforceable State health laws are : The law requiring the registration of deaths in towns or cities with a population of 1,000 or over, according to the last decennial census; the law relating to the inspection of State institutions ; the law requiring the distribution of diphtheria antitoxin to the indigent sick of diphtheria ; the law requir-ing the appointment of a county superintendent of health when this duty is not performed by the county sanitary committee; the law per-taining to the sanitary control of public water supplies and the law governing the work of the State Laboratory of Hygiene. THE VITAL STATISTICS LAW. To the health officer vital statistics are what the chart and compass are to the mariner. Without them he knows not whence he came nor whither he goes. By vital statistics he is warned against danger. A timely warning, an opportune application of the ounce of prevention, and many lives are saved. For example, the vital statistics of a certain town show that that town has twice the average death rate of other towns in which the same climatic conditions prevail. This fact, but for these statistics, would escape notice, for people die slowly, and neighbors, without some comparative record, would regard their deaths as natural. An inves-tigation follows the disclosure of these statistics, and the cause of this increased death rate is discovered ; the cause is then removed and proper precautions are taken to prevent its continued morbid effect and the loss of many lives is prevented. By vital statistics the health officer's course—progression or retro-gression— is both indicated and measured. Some measure of supposed sanitary value is put into operation. Its value will be measured almost wholly by the statistical returns. If it is without effect, the cost of operating it will be saved; if it is life-saving, others may know and take advantage of it. By vital statistics justice often finds her way clear and travels quickly, whereas, without them, she creeps along with difficulty or loses altogether the indistinct trail of the murderer, abortionist, or suicide. Without them the child labor law is often administered by an ignorant or cruel parent. ~No birth registration, no efficient child labor laws. Our vital statistics law, chapter 722, Laws of 1909, pronounced by Chief Statistician Wilbur, of the United States Bureau of the Census, to be the only practical vital statistics law in the South, has been in operation since September, 1909. This authority and government ex-pert on the enforcement of vital statistics laws made an inspection of THIRTEENTH BIENNIAL REPORT. 13 the results of the enforcement of our vital statistics law through a per-sonal visit and examination of the certificates filed in the office at Raleigh, in the early part of April, 1910. It is encouraging to those of us concerned in its execution to know that he was well pleased with its enforcement. The approval of the execution of this law encour-ages us to hope that North Carolina will at an early date he accepted by the Federal Government as a registration State. At present our vital statistics law applies only to cities and towns with a population of 1,000 or over, according to the last decennial census. This gives us a registration area containing about 450,000 people, or about one-fifth of our State's population. THE LAW GOVERNING SANITARY INSPECTION OF STATE INSTITUTIONS. This law has been faithfully executed. In every instance the inspec-tion was made without previous notification, and the conditions found may therefore be regarded as a fair index to the everyday conditions obtaining in our State institutions. The official report of these inspec-tions will be found on pages 85-92 of this report. THE LAW REQUIRING THE DISTRIBUTION OF DIPHTHERIA ANTITOXIN. In accordance with this act, passed by the Legislature of 1909, 67 counties and 8 cities have availed themselves of the opportunity of obtaining antitoxin at a very reduced rate for their poor. The State Laboratory of Hgyiene acts as a distributing depot, and ships the antitoxin, on demand, to any point in the State. By the contract with the manufacturers, the special rate can be obtained only for indigent cases when paid for by the county or municipality. The benefits of the act do not apply to that largest class of the population, the independent poor, those who do not want to be classed with the indigent, yet can ill afford to pay the high prices charged for diphtheria antitoxin. It is therefore recommended that the General Assembly be requested to fur-nish diphtheria antitoxin to its citizens free of charge or at least ar-range to furnish it to all its citizens at actual cost. It is possible that the latter arrangement could be made without a change in the law, and it is recommended that a new contract be sought with this in view. It may be desirable ultimately for the State to manufacture its own anti-toxin, but meanwhile the same good can be accomplished at approxi-mately the same cost if the General Assembly sees fit to buy all the anti-toxin needed for its citizens. A bill will be introduced in the next legislature asking for a change in this law. THE LAW REQUIRING THE APPOINTMENT OF A COUNTY SUPERINTENDENT OF HEALTH. The proviso in Section 4444, Revisal of 1905, as amended by the General Assembly of 1909, authorizes the Secretary of the State Board of Health to appoint a county superintendent of health in counties where the sanitary committee have failed to elect that official. In only one instance has it been necessary for the secretary to comply with this proviso of the law during the last two years. 14 NORTH CAROLINA BOARD OF HEALTH. THE LAWS RELATING TO THE PUBLIC WATER SUPPLY. The laws governing the protection of public water supplies against pollution requires the filing in duplicate by the superintendent of the water company of certified plans and surveys of the watershed made in accordance with instructions furnished by the State Board of Health. These instructions are embodied in "Circular A," an exact copy of which is reproduced on page 98 of this report. The law protecting the public water supplies against pollution further requires that a quarterly inspection and report of the sanitary condi-tion of the watershed and all surface supplies be made in accordance with reasonable rules and regulations of the State Board of Health. In accordance with these rules and regulations the sanitary inspectors of the different surface supplies are furnished with instructions for making the inspection. These instructions are embodied in "Circular B," an exact copy of which is reproduced on page 101 of this report. In making the inspection of a watershed the inspector leaves at each home a copy of "Circular C," which instructs the householder and family in regard to their duties in the protection of the public water supply through the proper sanitary care of their premises. This circular is reproduced on page 108 of this report. Finally, the inspector after having made his inspection in accordance with "Circular A," and after having instructed the residents on the watershed in accordance with "Circular C," makes out his report in duplicate on "Form A," an exact copy of which is reproduced on page 110 of this report, and then mails these reports to the Secretary of the State Board of Health. In connection with the sanitary supervision of the public water sup-plies, I feel that as the State health officer I should violate both my sense of duty and my public trust if I failed to make grateful acknowl-edgment of the cordial, untiring and almost unlimited assistance ren-dered me in my efforts to protect the public water supplies by Colonel J. L. Ludlow, of the State Board of Health. His able service has been given so unstintedly to the public water supply interests that I feel that it is a considerable imposition on the part of the State to accept these services further without some material compensation. The sanitary patrol and inspection of watersheds for the purpose of preventing water-borne disease is reinforced in its purpose by the law requiring monthly analyses of the various public water supplies. It has never yet been necessary to apply to the courts to enforce the law requiring water companies to send samples of their water monthly for analysis, but the penalty for the enforcement of this law is so small that Ave hope the General Assembly of 1911 will see fit to increase it. Analyses to the number of 14,826 have been made in accordance with this law from January 1, 1909, to December 31, 1910. The law protecting public water supplies also applies to springs from which water is sold either at summer or health resorts or in bottles. This law requires that these springs shall pay a graduated tax or procure a license, through which revenue the State Laboratory of Hygiene shall be able to analyze the waters of these springs. The law further pro- THIRTEENTH BIENNIAL REPORT. 15 vides that if any bottled water be found polluted in three successive analyses, publication of that fact shall be made in the Monthly Bul-letin of the State Board of Health. Very little trouble has been experienced in the enforcement of this law. During the last two years three bottled waters have been found polluted, and notice thereof given to the public through the Bulletin. Here I wish to call attention to the wide and beneficent scope of this law. Those placing bottled waters on the market, knowing that sooner or later some of the water will find its way into the State Laboratory of Hygiene and there be analyzed, realize that if it is found polluted and published through the Monthly Bulletin of the State Board of Health, not only to the people of ISTorth Carolina but throughout the United States, their business will be seriously injured. In this way this law has a splendid influence in keeping commercial waters pure, not only at the springs and bottling plants in North Carolina, but also throughout the United States. THE LAW ESTABLISHING THE STATE LABORATORY OF HYGIENE. This law, Section 3057 of The Bevisal of 1905 as amended by the Legislature of 1909, finds ample justification in the following detailed statement : NUMBER OF SPECIMENS EXAMINED AT THE NORTH CAROLINA STATE LABORA-TORY OF HYGIENE FROM MARCH 1908 TO DECEMBER 31, 1910. 1908 January February March. 62 April 104 May 114 June 141 July 183 August 227 September 271 October 201 November 171 December 189 1909 16 NORTH CAROLINA BOARD OF HEALTH. Mississippi has just opened a laboratory, while Texas, Arkansas, Ken-tucky, and Tennessee have no organized laboratories for work of this character. The direct appropriation to the Laboratory by the Legislature is $2,000. The tax on water companies is approximately $4,000, thus making the income of the laboratory $6,000. Eleven thousand six hun-dred and forty-four different specimens were examined. The cost to the State of each examination made in 1910 was 51 1-2 cents. Among the specimens examined were 1,835 water analyses, each of which comprises from five to twenty-five distinct chemical and bacteriological tests. If each of these were estimated as separate tests the average cost would be greatly reduced. Out of the above sum also 160 patients were given the Pasteur anti-rabies treatment, as no appropriation is made for this work. OPINIONS OF ATTORNEY-GENERAL. In executing the State public health laws it has frequently been necessary to ask the advice of the Attorney-General. That official has always given us the most cordial co-operation and it is impossible to overstate our deep appreciation for his valuable opinions. A copy of these opinions will be found on pages 68-84 of this report. EDUCATIONAL FUNCTIONS OF THE STATE BOARD OF HEALTH. Section 4437 of The Revisal of 1905 as amended by the General As-sembly of 1909 reads as follows: "The Board of Health shall take cognizance of the health interests of the people of the State; shall make sanitary investigations and inquiries in respect to the people, employing experts when necessary; shall investigate the causes of dis-ease dangerous to the public health, especially epidemics, the sources of mortality, the effect of locations, employments and conditions upon the public health. They shall gather such information upon all these matters for distribution among the people, with the especial purpose of informing them about preventable diseases." The italics are ours. This educational provision for the improvement of public health is a most wise one. Out of education comes public sentiment ; through pub-lic sentiment, law is both enacted and enforced. At present ninety per cent of the work of the Board is of an educational nature. This work has been carried on through the Bulletin of the State Board of Health, through contributions to the newspapers, and through public addresses. THE BULLETIN. The Bulletin has grown in circulation from 3,500 in January, 1910, to 18,000 January, 1911, and with this increased circulation the size of the Bulletin has been enlarged from a ten page to a seventy page pub-lication. During the past four months, requests for the Bulletin have averaged thirty-five daily. At present the entire ministerial, legal and medical profession, about seven thousand out of the ten thousand school teachers, and a large number of other wide-awake people throughout the State receive this educational monthly. THIRTEENTH BIENNIAL REPORT. 17 To give a wider field of usefulness to the Bulletin, a contributory Board of Editors composed of the following gentlemen, have agreed to assist in its publication : 1. Governor W. W. KITCHIN, Raleigh, N. C. 2. Hon. A. H. ELLER, Winston-Salem, N. C. 3. Hon. E. W. SIKES, Wake Forest, N. C. 4. Hon. W. C. DOWD, Charlotte, N. C. 5. Mr. CLARENCE POE, Raleigh, N. C. 6. Mr. ARCHIBALD JOHNSON, Thomasville, N. C. 7. Rev. GEORGE W. LAY, Raleigh, N. C. 8. Dr. HENRY L. SMITH, Davidson, N. C. 9. Dr. FRANCIS P. VENABLE, Chapel Hill, N. C. 10. Dr. W. P. FEW, Durham, N, C. 11. Dr. WILLIAM L. POTEAT, Wake Forest, N. C. 12. Dr. F. L. STEVENS, West Raleigh, N. C. 13. Dr. CYRUS THOMPSON, Jacksonville, N. C. 14. Dr. CHAS. O'H. LAUGHINGHOUSE, Greenville, N. C. 15. Dr. L. B. McBRAYER, Asheville, N. C. 16. Dr. BENJ. K. HAYS, Oxford, N. C. 17. Dr. EDWARD J. WOOD, Wilmington, N. C. 18. Dr. WILLIAM DeB. MacNIDER, Chapel Hill, N. C. 19. Dr. H. A. ROYSTER, Raleigh, N. C. 20. Dr. J. L. NICHOLSON, Richlands, N. C. This means that the Bulletin through a greater variety of expres-sion and subject matter will be more attractive and more serviceable than ever before. It, of course, would be impossible without great ex-pense to republish the entire issues of the Bulletin during the past two years in this report. THE STATE PRESS. The press of the State has been most cordial in its co-operation with the Board for better public health. Always liberal in the use of their columns for the public service, they have, in the assistance given us, even exceeded their own enviable reputaton for generosity. The State press in calling repeated attention to the fact that the Bul-letin could be had for the asking, and that it was well worth a place in the homes of our people, have had much to do with building up a greater demand for that publication. During the months of July, Au-gust, September, and October many of the papers of the State pub-lished weekly articles on public health sent out from this office. To conclude, the assistance of the press has been of inestimable value. ADDRESSES. During the last twelve months a number of public health addresses — fifty or sixty—have been delivered to audiences representing different fields of activity. The Conferences of County Superintendents of Schools for 1909 and 1910, the North Carolina Teachers' Assembly, the North Carolina State Primary Teachers' Association, the Meeting of Conductors of Teachers' Institutes, a number of Teachers' Institutes, 18 NORTH CAROLINA BOARD OF HEALTH. the North Carolina Press Association, the Tri-State Medical Society, the Wake County Medical Society, the Guilford County Medical So-ciety, the North Carolina Society for the Study and Prevention of Tuberculosis, the Carolina Municipal Association, the State Federation of Women's Clubs, and many other gatherings of people have been ad-dressed on the fundamental problem of public health. Through the interest aroused in these various oganizations others have taken up the study of public health problems and these have succeeded in interesting many others. THE ANTI-HOOKWORM CRLSADE. Under the able direction of Assistant Secretary Dr. John A. Ferrell, the public have been seriously and actively interested in a general cam-paign against a disease the frequency of which probably totals all other diseases combined. Dr. Ferrell's report of the work accomplished is given in detail on page 93 and a very superficial perusal of this report will warrant the assertion that the work could not be in better hands. THIRTEENTH BIENNIAL REPORT. 19 Meetings of the Board Office of the Secretary, Kaleigh, ]ST. C, March 30, 1909. Called meeting. All the members of the Board present. The Presi-dent called upon the Secretary to explain the object of the meeting. In response he stated that the principal reason for calling the meeting was that such action might be taken by the Board as was rendered necessary by the amendment to the laws relating to the public health enacted at the recent session of the General Assembly. For the information of the Board the Secretary then read the four acts relating to the public health, the titles of which were as follows : An Act to Amend Sections 3045, 3058, 3457, 4440, 4442, 4444, 4457, 4460 and 4508 of The Revisal of 1905, Relating to the Public Health. An Act to Amend Section 3057 of The Revisal of 1905, relating to the State Laboratory of Hygiene. An Act to Provide for the Registration of Deaths in Municipalities of One Thousand Population and Over in the State of North Carolina. An Act to Provide Diphtheria Antitoxin for Indigent Persons Sick of Diph-theria. He also called attention to the fact that the annual appropriation for the support of the State Sanatorium for Tuberculosis had been in-creased by the Legislature from $5,000 to $7,500, and that an additional appropriation for permanent improvements of $15,000 a year for two years had also been made. Dr. Lewis then offered his resignation as Secretary and Treasurer, to take effect June 30th, the last day of the month in which the fiscal year ended. He gave as his principal reason for taking such a step the fact that the new law required the Secretary to devote his entire time to the cause of the public health and that he was unwilling to abandon his regular profession—his life work. He expressed his regret at giving up the work which had been for so many years largely a labor of love, but felt sure that it was best both for the work's sake and for his own. He explained to the Board that for some years he had realized that the great importance of the work demanded all the time of a competent Secretary with ample assistance, and believing the time to be auspicious for a forward movement, he had prepared a bill which if enacted into law, while legislating himself out of office, would bring this about. He also stated that believing the successful prosecution of the work to be dependent upon the qualifications in several respects of the new Secre-tary and that a mistake in the selection of the man would be a mis-fortune hard to remedy he had gone over in his mind the medical men of the State and assured himself that such a man was available and that if elected he would accept the position, before he wrote the bill. Hav-ing expressed his gratification at tho fact that he would still continue a member of the Board and his sincere appreciation of the unvarying 20 NORTH CAROLINA BOARD OF HEALTH. kindness, courtesy and cordial support of the Board during his in-cumbency of nearly seventeen years, he retired from the meeting. Minutes by Dr. Way, Secretary pro tern. Dr. Lewis resigned to take effect June 30, 1909, retiring from the hall. The President placed his resignation before the Board and asked their pleasure. Dr. Register expressed his great appreciation of the splendid work of seventeen years and his regard for Dr. Lewis and had felt that if he (Dr. Lewis) could be induced to continue he would ask him to do so. He wished his appreciation of Dr. Lewis's great work be recorded. Dr. Anderson reciprocated fully the words of Dr. Register. Dr. Spencer moved that a committee composed of Drs. Register and Thomas be appointed to confer with Dr. Lewis and ask if he can re-consider his resignation and serve out his full term. Carried. This committee through Dr. Thomas reported that Dr. Lewis felt compelled to consider his resignation as final. Dr. Thomas eulogized Dr. Lewis as one of the notably few men he had ever known fitted for the work. On motion of Dr. Burroughs seconded by Dr. Spencer, Dr. Lewis's resignation was accepted. Dr. Burroughs moved that a committee of three be appointed by the President at his convenience to prepare resolutions expressive of ap-preciation for the annual session of the Board in June. Carried. Dr. Lewis, returning, resumed his duties as Secretary. The chair announced that nominations for Secretary and Treasurer to fill the vacancy were in order. Dr. Lewis, prefacing his remarks by the state-ment that he felt that he ought to say that Dr. Way had been his first choice as his successor and that upon the assurance of the doctor that while he felt a deep interest in the work he could not afford to give up his lucrative practice and comfortable home, he had worked for and found another good man, placed in nomination Dr. Watson S. Rankin, Dean of the Medical Department of Wake Forest College, at a salary of $3,000 a year. He declared Dr. Rankin to be in his. opinion a man of character, ability, energy, enthusiasm and possessed of the altruistic spirit so helpful in work of this kind and admirably fitted for the position. The nomination of Dr. Rankin was seconded by Drs. Bur-roughs, Register and Way, and he was unanimously elected. Action on the election of an Assistant Secretary for the anti-tuber-culosis work was upon a motion of Dr. Way, postponed until the annual meeting in June. The Secretary called attention to the fact that under the new law one member of the Board must be elected to complete with the Presi-dent and the engineer ex officio, the Executive committee. On motion of Dr. Way, Dr. Lewis was elected to serve on the Executive Com-mittee. On motion, the salary of Dr. C. A. Shore, Director of the Laboratory of Hygiene, was increased from $2,000 to $2,500 a year; that of Miss Daisy Allen, Chemical Assistant, from $75 to $90 a month, and that of Miss Mabel P. Massey, Stenographer, from $50 to $75 a month, it being understood that she was to give her whole time to the work of the Board. All increase in salary to take effect July 1, 1909. THIRTEENTH BIENNIAL REPORT. 21 Dr. Way, representing the Board of Health of Waynesville, filed with the Board plans for a public water supply which had been approved by the sanitary engineer of the Board. The plans were approved. On motion, the Board adjourned. Bichard H. Lewis, Secretary. Battery Park Hotel, Ashevtlle, N". C, June 15, 1909. The Board met in annual session in the room of the Secretary, with President Thomas in the chair. Those present were Drs. Thomas, Anderson, Way, Spencer, Register, Burroughs, Col. Ludlow and the Secretary. The minutes of the last annual meeting at Winston-Salem and of the called meeting held at Raleigh, March 30, 1909, were read and ap-proved after the correction of the latter by the insertion of the follow-ing resolution which had inadvertently been omitted : "Resolved, That His Excellency the Governor be requested to reappoint Col. J. L. Ludlow as the Engineer member of the Board." Unanimously adopted. Drs. Ray and Robertson, of Yancey County, appeared before the Board at the request of the Chairman of the Board of Commissioners of that County to request the appointment by the Board of Health of a Superintendent of Health for that county, as the County Sanitary Com-mittee had failed to elect one. As the two months required by the statute before action could be taken by the State Board of Health had not expired, the matter, upon the motion of Dr. Spencer, was referred to the Executive Committee. The Secretary having called attention to the expiration of the term of Dr. Way as a member of the State Board of Embalming, he was re-elected for the full term of five years. Col. Ludlow called attention to the menace to the public water supply of the town of Greenville by the discharge of raw sewage into Tar river by the towns of Rocky Mount and Tarboro and offered the following resolution : "Resolved, That the Secretary of the Board shall give notice to the municipal authorities of the towns of Rocky Mount and Tarboro that Section 3051 of The Revisal of 1905 must be immediately complied with; and further, that in the event that said towns shall fail to provide and put into operation such sewage purification plants as said law requires within six months from this date, the Secretary of the Board is hereby instructed to take such legal steps as may be necessary to secure a restraining order from the courts of the State enjoining said towns from further discharge of raw sewage into Tar River and to take such steps as may be necessary to secure the conviction and punishment of either or both of said towns and the authorities thereof for committing a misdemeanor as defined and provided for, in the said public health laws of the State of North Carolina." This resolution was adopted. 22 NORTH CAROLINA BOARD OF HEALTH. Col. Ludlow then called attention to the menace to the Raleigh water supply by the town of Cary and offered the following resolution : "Resolved, That the Secretary shall give notice to the municipal authorities of the town of Cary that the provisions contained in Section 3052 of The Revisal of 1905 must be fully complied with immediately; and further, in the event said authorities shall fail to comply with said Section 3052 within three months of this date the Secretary is hereby instructed to take such steps as may be necessary to secure the conviction and punishment of said town authorities for committing a misdemeanor, as provided in said Section 3052 and in Section 3060." This resolution was adopted by the Board. The Engineer of the Board likewise set forth the danger of the con-tamination of the public water supply of the town of High Point and offered the following resolution : "Resolved, That the Secretary shall give notice to the General Manager and the Division Superintendent of the Southern Railway Company that in compliance with the provisions of the Public Health Laws of North Carolina and more par-ticularly of Section 3049 of The Revisal of 1905, the said railway company is instructed to issue orders, and to secure the enforcement thereof, that all water closets on trains shall be locked and disused between the depot of High Point, in Guilford County, and the bridge crossing Deep River; and further, that the casting from trains of sweepings from cars, dining car refuse, or other garbage shall not be permitted between said points where the said railway traverses the watershed of the High Point public water supply; and further, should this in-struction and said laws be violated, that the Secretary shall take such steps as may be necessary to secure the conviction and punishment of the said railway company and the officers thereof for committing a misdemeanor, as provided for in the Public Health Laws of the State of North Carolina. And further, that the Secretary shall give similar notice and take similar action in other cases where railways traverse the watershed of any public water supply within the State whenever the knowledge of such condition may be brought to his atten-tion." After considerable discussion the following substitute for the above resolution, suggested by the Secretary and offered by Dr. Anderson, was adopted : "Whereas, The Southern Railway runs across the watershed of the public water supply of the town of High Point and for a considerable distance quite close to the bank of the stream of supply and the impounding reservoir and, "Whereas, There is danger of infection of the said public water supply by the infections of the passengers ; therefore, be it "Resolved, That in compliance with Section 3047 of The Revisal of 1905 the Southern Railway Company be, and it is hereby requested to have all water closets locked between High Point and Deep River bridge." Dr. Way was elected the delegate to the next meeting of the American Public Health Association at Richmond and Dr. Lewis to that of the Conference of State and Provincial Boards of Health at Washington. Upon motion, the Executive Committee was empowered to exercise all THIRTEENTH BIENNIAL KEPOKT. 23 the powers of the Board of Health in the time between the meetings of the Board. The President appointed Dr. Spencer and Col. Ludlow a committee to audit the accounts of the Treasurer. Upon motion of the Secretary his successor, Dr. Rankin, was invited tc sit with the Board and take part in the proceedings. Accepting the invitation the doctor expressed his appreciation of the honor done him by the Board in his election as Secretary and Treasurer to succeed the present incumbent and pledged his faithful service. Upon his inquiry as to whether the Board or an individual would be expected to buy books for the library of the Board, expressing his willingness to make the pur-chases himself, Dr. Way moved—and the motion was carried—that the Secretary be authorized to purchase such books and subscribe to such journals relating to the public health as in his judgment might be needed and the available funds would permit. Upon motion of the outgoing Secretary, who agreed to look after the office during the absence of his successor, Dr. Rankin was authorized and requested to spend a month in investigating the practical methods pursued by the executive health officers of such States as he might select and in visiting the United States Hygienic Laboratory and the Bureau of the Census, his traveling and hotel expenses to be paid by the Board. Upon motion the Board adjourned to meet in conjoint session with the State Medical Society tomorroAv at noon. Richard H. Lewis, Secretary. Annual Session of the Board of Health. Asheville, 1ST. C, June 16, 1909. The Board reassembled at 3 p. m. with President Thomas in the chair and all the members present except Drs. Burroughs and Taylor. In compliance with the amended law the Secretary nominated Dr. C. A. Julian, the Secretary of the North Carolina Association for the Prevention of Tuberculosis, for the position of Assistant Secretary of the Board for Tuberculosis at a salary of three hundred dollars a year. Dr. C. A. Julian was duly elected. Upon the statement of the Secretary that Drs. E. J. Wood and H. Bellamy, of Wilmington, had expressed a willingness to do research work in the study of pellagra under the auspices of the Board they were appointed a commission to undertake it. Upon motion of Dr. Spencer, the Treasurer was instructed to pay the traveling and hotel expenses incurred by Dr. Lewis as delegate to the meeting of the American Public Health Association at Winnipeg, Manitoba. Upon motion the President appointed Drs. Way and Register a com-mittee to draft suitable resolutions in regard to the retirement of the present Secretary. The Auditing Committee reported that they had examined the ac-counts and vouchers of the Treasurer and found them correct. Upon motion the Board adjourned. Richard H. Lewis, Secretary. 24 NORTH CAROLINA BOARD OF HEALTH. In the transcription of the proceedings from the rough notes of the meeting of the 15th a sheet was inadvertently overlooked until after the above was signed. The part of the proceedings referred to were as follows : Upon motion of Dr. Way it was ordered that the Monthly Bulletin of the Board be enlarged in expense and scope and that its mailing list be enlarged as much as practicable. Upon motion of Dr. Way the Secretary was requested to furnish the Secretary of the Wake Medical Society a copy of the proceedings of the Board at its called meeting on March 30, 1909, and of this session for publication in the transactions of that society. Upon motion of Col. Ludlow the State Superintendent of Public In-struction was requested to require in the public schools not less than a five-minute period daily to be devoted to some subject bearing on health and the Secretary was requested to furnish the teacher with serviceable literature. Richard H. Lewis, Secretary. Conjoint Session of the North Carolina Board of Health with the Medical Society of the State of North Carolina. President G. G. THOMAS, Chairman. Asheville, N. C, June 16, 1909. The meeting was called to order by Dr. Thomas, of Wilmington, Chairman of the State Board of Health. Dr. Thomas : "This conjoint session marks a period in the history of the State Board of Health of North Carolina, which to us is very significant. It is the end of the service of Dr. R. H. Lewis, for so long the efficient Secretary. "Following Dr. Wood, the pioneer of sanitation in North Carolina, he took up the work with zeal and enthusiasm, which he has guided and carried on by his wonderful judgment to its present high state. To Dr. Lewis belongs the spread of sanitary knowledge in the State of North Carolina, and the present influence of the Board of Health in the com-monwealth. "All of you are aware that these steps towards the commanding posi-tion it now holds have been slow and faltering, but the State at large has come to realize the fact that the State Board of Health has done good work for it, and its recognition, I think, is thoroughly voiced in the action of the last Legislature, in largely increasing the fund for its support, at the suggestion of our Secretary, Dr. Lewis—which is the prime evidence of the confidence which has followed his work, which is as well based upon the character of the man. He has gained not only our confidence and respect, but that of the gentlemen who represent the different constituencies throughout the State. THIRTEENTH BIENNIAL REPORT. 25 "I say, then, when this good man feels that he must lay down this work,—not because he is feeble or infirm ; I assure you of the contrary, it is because he can not relinquish his active professional work to take up the work of the State Board of Health exclusively,—it is time to feel grateful for the work he has done for the State and for the medical profession." (Applause.) Report of the Secretary read by Dr. Lewis. KEPORT OF THE SECRETARY, MAY 20, 1908, JUNE 11, 1909. Your Secretary, in this, his last report, is much gratified at heing able to say that his last year of service has witnessed the greatest advance of the cause of preventive medicine in our State, in a like period of time, since the establish-ment of the State Board of Health. For several years he has realized that, owing to the exactions of his private professional work, .the time he could- give to the work of the Board was entirely inadequate. He believed also, that, owing to the very small salary allowed the secretary, on account of the meager appro-priation, no one else could be expected to give more attention to it and make a proper living, and so he waited before taking action until, in his judgment, the outlook was favorable for an attempt at a forward movement. Upon the assem-bling of the last Legislature the conditions, in his opinion, justified making a trial for better things. Consequently, having found a man whom he believed to be well qualified for the position and having obtained from him a positive prom-ise to accept an election, if tendered him by the Board, your Secretary prepared a bill, while incidentally legislating himself out of office, as he could not afford to abandon his private practice, that would provide the means for work far in advance of anything heretofore attempted for the public health. The essential feature of the bill was an increase of the annual appropriation from two to ten thousand dollars, authorizing the payment to the Secretary of a salary of three thousand dollars a year and requiring him to give his entire time to public health work. While the Legislature cut down the appropriation asked for to six thousand dollars, it still left an increase of 200 per cent and a sum sufficient to secure all the time of a competent secretary, the one thing absolutely essential to any marked progress. As you already know, the present incumbent, at a call meeting on March 30th last, tendered his resignation, which was accepted, to take effect July 1st, and Dr. Watson S. Rankin, Dean of the Medical School at Wake Forest College, was unanimously elected as his successor. The public health laws were also materially and advantageously amended in many other respects, particularly those sections relating to the control of public water supplies by the State Board of Health, in the preparation of which latter amendments, invaluable aid was rendered by the engineer of the Board, Col. J. L. Ludlow. Section 3057 of The Revisal of 1905, relating to the State Laboratory of Hy-giene, was amended by specifically requiring analyses of drinking waters sold in bottles or other packages and imposing upon those selling them an annual tax graduated in proportion to the gross receipts from sales. While the. original act imposed an annual tax of $G4 upon all individuals, firms and corporations selling water to the people, it was found, upon investigation, that in many instances this was out of proportion to the business done, and it was deemed both right and wise to make the tax equitable and at the same time to make it perfectly clear 26 NORTH CAROLINA BOARD OF HEALTH. that bottled waters came within the law. The necessity for analysis of this class of waters was startlingly shown by analyses your Secretary had made in the laboratory in the genera] cause of the public health and for the purpose of supplying ammunition with which to meet an attack upon the law, threatened by the president of one of the companies selling a water of this class. Of sixty-one samples from twenty-nine springs thirty-two were found to be infected with colon bacilli. Although the gentleman referred to passed away before the General Assembly met, the information thus obtained was of service in securing the de-sired legislation. The section was further amended so as to require analyses of the waters of springs "maintained and treated as an adjunct to any hotel, park or resort for the accommodation or entertainment of the public," and an annual tax of $15 was imposed upon all such sources of water supply, with an addi-tional tax on all waters sold therefrom in bottles, in accordance with the schedule referred to above. Probably the weakest spot in our sanitary legislation has been the lack of reliable vital statistics. The only statistics we have had heretofore have been those collected by some twenty-odd cities and towns in various and manifestly, in some instances, very imperfect ways, and incomplete and inaccurate vital statistics are practically worthless. A model vital statistics bill for States was sent us by both the Bureau of the Census and by the American Medical Asso-ciation. Theoretically, it was an excellent bill, and for densely populated, highly organized communities it is doubtless practicable, but for our State, with its large, widely scattered rural population, and one-third of that negroes, it would have been little short of absurd. After a very careful consideration of the sub-ject it was decided that any attempt at the collection of reliable vital statistics holding out the least hope of success, for the present at least, would have to be limited to incorporated towns. So, desiring that our statistics might fit in with those of the United States Census Bureau, a request was made of Dr. Cressy L. Wilbur, Chief Statistician, to have prepared for us a bill applying only to cities and towns of one thousand population and over. Taking the bill he kindly and promptly sent as a basis, it was modified to fit our conditions. After its passage in its completed state it was very gratifying to learn from Dr. Wilbur that it was the first practical vital statistics law to be enacted in the South, and, more-over, that it contained a provision for the enforcement, new to him and in his opinion valuable. This provision was placing the responsibility for carrying out the law solely upon the mayor, and making him liable to a fine of not less than $10 for failure of duty in this respect: and at the same time making it mandatory upon the solicitor to institute a criminal action for its collection, upon complaint of the State Begistrar or Secretary of the State Board of Health. It really looks now as if vital statistics of real value, though necessarily partial, were in sight. The high price of diphtheria antitoxin being prohibitory to the poor, the pro-priety of making provision for its supply free to indigent cases of the disease should not be questioned by any humane person. The suggestion of the advisa-bility of such legislation came from Dr. B. E. Beeves, of Alleghany County, in a letter, accompanied by a tentative bill, to Senator B. L. Doughton, of the same county. The suggestion was cordially received, and at his request Dr. Beeves's bill was modified and amplified into the law as we now have it. Another forward step was the increase in the annual appropriation for the support of the State Sanatorium for Tuberculosis, from $5,000 to $7,500, and the THIRTEENTH BIENNIAL REPORT. 27 appropriation of $30,000 for improvements. This institution, which is ideally located, was opened for patients in November last, and promises to be of much value in the campaign against tuberculosis. The most gratifying and encouraging thing in connection with the health legis-lation by the late General Assembly is that, with the exception of the cutting down of the appropriation of ten thousand dollars asked for to six and an imma-terial amendment to the bill relating to the Laboratory of Hygiene, requiring reciprocity in the matter of analyses of bottled waters with other States having similar laboratories and requirements, all the bills relating to the public health in any way were passed without amendment and without a single vote in the negative. This signifies a remarkable growth in favorable public opinion and justifies the hope of more rapid progress in the near future. As this report is made to the conjoint session of the State Board of Health with the Medical Society, and as nothing is of more importance to the public health than well-qualified physicians, reference to the strictly medical legislation is in order. A bill, prepared by the Board of Medical Examiners, the essential feature of which was the requirement of a preliminary education equal to graduation from a high school of all applicants for license, was introduced in the House by one of its most influential members. The requirement was certainly a most reasonable one, and, as a matter of fact, of special value to the prospective student of medi-cine but it was bitterly fought with the usual demagogic arguments of "Medical Trust," "poor boy," and, after three hot contests, was finally defeated by a majority of one. The amendment to the license law, authorizing the Board of Medical Exam-iners, in its discretion, to modify the requirements of the law and to grant a limited license, when the conditions in the neighborhood from which the applicant came demanded it, met with no opposition. Sjjecial acts licensing certain physi-cians had been introduced and the indications were that they would be passed. To prevent this kind of legislation, which would mean in the end the practical destruction of our license law, this amendment was suggested as a compromise and accepted by the introducers of the bills. This action on the part of those having the matter in charge has been criticised in some quarters, but it should be said that a copy of the amendment was sent to every member of the Committee on Legislation and of the Board of Medical Examiners and was approved or as-sented to by all, with the exception of a single member of the Board of Medical Examiners. Those on the ground and familiar with the conditions as they actu-ally existed in the Legislature felt no doubt whatever as to its wisdom. Before leaving the subject of legislation, acknowledgment should be made of the valuable assistance rendered by Dr. Albert Anderson of the committee. After nearly seventeen years of active and loving service your Secretary lays down the work with regret, although he realizes that it is best for the work's sake as well as for his own. He is conscious of many things left undone that ought to have been done, and perhaps some things have been done that ought not to have been done, but he has tried to be of some service to the State. In conclusion, he wishes to express his deep and heartfelt appreciation of the unfailing and unvarying kindness and courtesy he has received at your hands, and to most cordially commend to you his successor, Dr. Rankin. Dr. Rankin he believes to be a man of character, ability, energy, enthusiasm and possessed of the altruistic spirit so helpful in work of this kind. If the profession in the 28 NORTH CAROLINA BOARD OF HEALTH. State will hold up his hands and give him their cordial support and co-operation he will do great things in the coming years for North Carolina. SMALLPOX REPORT. Counties. THIRTEENTH BIENNIAL REPORT. 29 The amount of work accomplished by Dr. Shore, the director, and his two assist-ants, Miss Allen, Chemist, and Mr. Kellogg, Biologist, when compared with that of some other laboratories, is, to say the least, unusual. A perusal of the report of the director, which is appended hereto, will show this. Twenty-three hundred and ninety-two examinations of specimens of various kinds and the administra-tion of the Pasteur treatment to eighty-three patients in addition, in one year, by so small a force, is most gratifying. This could not have been done but for the kindness of the United States Hygienic Laboratory in furnishing us the virus free of charge. Not a case has died, and our records, so far, could not be bettered. In January last the Laboratory was moved to very commodious quarters; it has been thoroughly furnished with the most approved apparatus and manned by a force as good as any, and we can confidently expect its increasing usefulness. The following is the report of examinations made in the State Laboratory of Hygiene from May 20, 1908, to May 20, 1909: 143 Examinations of feces — Positive. Negative. Hookworm 65 50 Oxyuris vermicularis 1 Ascaris lumbricoides 2 Amoebe coli 2 1 Fly larvae 3 Taenia saginata 1 Tubercle bacilli 2 9 Blood 4 2 Cancer cells • • 1 277 Examinations of sputum for tubercle bacilli 108 169 271 Examinations for diphtheria bacilli 169 102 43 Examinations for malaria 9 34 135 Examinations for Widal reaction 56 79 18 Examinations for gonocoeci 7 11 65 Examinations of brains for rabies 47 18 2 Examinations, bacterial, of pus. 6 Differential leucocyte counts. 122 Specimens of urine, with a variety of bacterial and chemical determinations. 74 Examinations of pathological tissue, as follows: Carcinoma 15 Chronic inflammation 19 Benign hypertrophies 14 Sarcoma 6 Chondroma 1 Colloid goitre 2 Tuberculosis 10 Pyaemia 2 Verruca 1 Necrosis 1 Doubtful (tissue not well preserved) 1 Placenta 2 2 Examinations of gastric fluid. 1,234 Examinations of water. 2,392 Total. 30 NORTH CAROLINA BOARD OF HEALTH. Eighty-three patients received Pasteur treatment at this laboratory. Of these, 65 were bitten by dogs in which the disease was demonstrated either by micro-scopic examination, inoculation experiments in laboratory or by subsequent death of other animals from a bite; in 17 cases only a clinical history of rabies in the attacking animal was obtained; in 1 the history was found to be erroneous and treatment was discontinued; 13 of these cases paid for treatment and the remain-ing 70 were given free treatment. C. A. Shore, Director. Dr. Albert Anderson : "As a member of the State Medical Society, I think some expression of appreciation ought to be made at this time of Dr. Lewis's work as Secretary of the State Board of Health, and I am very sorry I am not prepared to speak as the subject demands, for what I shall say will be from my heart, and what I can remember of his work, and not extensively said. "I would be untrue to myself and untrue to the Medical Society not to say that the North Carolina State Medical Society fully appreciates and loves Dr. Lewis for the great work he has done as Secretary of the State Board of Health. "I am old enough to remember the work of his predecessor, and re-member when be took charge of this work as Secretary of the Board. "Dr. Lewis went into it with intelligence, with love and with en-thusiasm. I have been somewhat in touch with his work from the be-' ginning. I know how wisely he has planned and how enthusiastically he has executed his work in every advanced movement. I know, in the first years of his service, that he planned for large things, and for the universal good of the people. "I had the honor to be appointed to take instruction in the Govern-ment Laboratory, to do some water analyses, many years ago, at his suggestion, and while my service was small and insignificar* it started the work that has been more intelligently and wisely done si: je I quit. "In connection with Dr. Bate, we tried to render the best service that we could, as beginners, and after we stopped the work was taken up by the State Laboratory of Hygiene and carried on by better trained men. Finally the State Board of Health, through Dr. Lewis, secured Dr. Shore, who stands, I suppose, equal to any man in his work, by long training and intelligent service that he is now rendering to the State. "The prospect for State preventive medicine is good, and not only the Medical Society, but the State of North Carolina, will ever owe Dr. Lewis a debt of gratitude. He has made history that will never be for-gotten, and I feel that it would be unjust to ourselves not to say that we appreciate his services and will always love him for what he has done in the spread of a better general knowledge of hygiene and pre-ventive medicine in the State." Dr. F. R. Harris, Henderson : "I desire to say what I can in refer-ence to Dr. Lewis. I am not a speaker, but I have a great deal in my heart to say. I say this because I think preventive medicine in the State is the most important field, as I see it today, and I want to en-dorse what Dr. Anderson has said and, furthermore, to endorse Dr. Shore. THIRTEENTH BIENNIAL REPORT. 31 "We had an outbreak of diphtheria last season, and I had occasion to send many specimens to him, and I want to say that the reports that Dr. Shore made were in accord with the clinical picture, and I believe they were correct, and he has my confidence, and I desire to commend him for his work." Dr. J. T. J. Battle : "I am one of a committee of three appointed to draft suitable resolutions to express, in some slight degree, the high esteem in which the Society holds Dr. Lewis, and for the great work he has done for the Society and for the State." The Chairman asked all who were in favor of the above to signify it by rising vote, and the motion was unanimously carried. Dr. W. S. Rankin : "Mr. President : If I may interrupt for just a word: I feel that it is a little out of place for me to express myself here, and I am absolutely unable to express my admiration of Dr. Lewis's able work in North Carolina. I think that the spirit that has governed and directed this work is the true altruistic spirit, and I feel that Dr. Lewis is a greater man than we North Carolinians recognize. I know that the public health workers of the United States look up to Dr. Lewis as one of the greatest authorities ; as one of the originators of public health movements. My slight acquaintance with these men has convinced me of this fact. I know that Dr. Lewis is a national figure in hygiene (applause), and has not received the appreciation at home that he has received abroad. "In taking up his work the highest ambition that I can cherish is that I may wear the cloak that he lets fall, half as well as he has worn it." (Applause.) Dr. Stiles, being asked by the Chairman for remarks, said : "First of all I would like to endorse this resolution offered in regard to Dr. Le7-is, but I have a delicacy in speaking, as I am an outsider. "I endo/se, however, the regret the physicians of this State feel in having Dr. Lewis retire, and this is seconded all over the country. I have heard many expressions of regret that he was going to give up the office of Secretary. It is generally recognized, however, that he has se-lected a good man as his successor. "To turn to another subject that I was discussing with Dr. Lewis, just before the meeting came to order ; it was understood that several gentle-men were going to speak on sanitary matters, and I suggested that when they spoke we might take up the question of the sanitary privy, so necessary in this State. "I think, perhaps, Mr. President, what I have to say on the subject would come in better after these gentlemen have read their papers, and I therefore ask that you let me present later what I have to say, after these papers have been read." Dr. Lewis : "Mr. President : I would like to announce that there will be a meeting of the State Board of Health in room 123 at a quarter of three o'clock, for the purpose of finishing certain work not attended to on yesterday. There will also be a meeting of the County Superin-tendents of Health in the tea room at 3 :30, for the purpose of forming a 3 32 NORTH CAROLINA BOARD OF HEALTH. State organization. I hope these gentlemen will attend, so that we may have a quorum. "I desire to say that we have had one hundred and one cases in which persons have been bitten by rabid dogs since June last, and we have se-cured from those persons who were able to pay $831.40—the fifty-dollar fee—for the support of the laboratory." The Board then adjourned until a quarter to three o'clock. RESOLUTIONS ADOPTED BY THE STATE MEDICAL SOCIETY ON THE RETIREMENT OF DR. RICHARD H. LEWIS AS SECRETARY OF THE BOARD OF HEALTH. Whereas, Our former and most efficient secretary of the Board of Health, Dr. R. H. Lewis, has decided it necessary to resign from the position; and whereas, for the long period of seventeen years of most arduous and difficult labor, he has accomplished so much, by unfaltering zeal and devotion, for the upbuilding and the honor of the profession, both of the State of North Carolina and the nation; and whereas he has so carefully safeguarded the people against the threatened inroad of disease as to save innumerable lives, the suffering incident thereto, and great pecuniary loss; and whereas, during these strenuous years, we have seen and appreciated the results of his great labors: now, wishing to express the esteem in which he is held, not alone by the profession, but the laity, be it hereby Resolved, first, That this Society express its conviction that he has done more, both in his official and individual capacity, than would have been possible for any other one to have done. Resolved, second, That we with reluctance accept his resignation, realizing that we lose in some measure his great capabilities and far-reaching influence. Resolved, third, That he, having been such a potent factor with the Legislature, has saved us from impending adverse legislation and secured such salutary meas-ures as are responsible for our present advanced position in sanitary work. Resolved, fourth, That we earnestly implore him to give us yet his wise counsel and help in time of difficulty and threatened legislation. Resolved, fifth, That it is our sincere wish and prayer that he, having done so much for sanitation and the health of others, may himself be blessed with many future years of vigorous health and abundant enjoyment of the blessings and happiness of life. AN APPRECIATION. In the retirement of Dr. Richard H. Lewis as their secretary, the State Board of Health has lost a most efficient officer and the public a most devoted servant. Dr. Lewis's tenure of office has bridged an important stage in the development of public health work. Our understanding of the true nature of communicable disease had its beginning in the discovery of Van Loewenhoek, a lens polisher, of Delf, Holland, in 1G83. From its beginning, in that year, to 1850, the idea that minute germs caused disease was but a theory, and but little more than theory, supported by only circumstantial evidence, till 1880, when Robert Koch transformed the theory into a scientific fact, and in so doing laid the sure foun-dation for preventive medicine and public health. For the next ten years these new facts filtered slowly through the medical profession, reaching the general public about 1890, when the public began to grasp the true meaning of preventive medicine. THIRTEENTH BIENNIAL REPORT. 33 As Dr. Lewis was elected secretary of the Board of Health in 1892, the begin-ning of his official life was coincident with the real beginning of preventive medi-cine. It therefore became his task to nurse this great movement in its early and tender years, in the years so important to future development, when the founda-tion so essential to what is to follow is being laid. How well he has performed this task is not for the writer to say, for on this question the present status of public health in North Carolina and the best public health authorities in America have handed down an opinion. As the present condition of public health in North Carolina is largely the result of Dr. Lewis's labors, in conjunction with the Board of Health, it may be taken as the best evidence of his ability as a sanitarian. His best work is prob-ably recorded in the statute books of the State. With the exception of the act establishing the State Sanatorium for Tuberculosis and an act separating the tuberculous prisoners from the well, he either drew up entirely or materially modified before introduction all the laws bearing on public health, and was active in securing their passage by the various Legislatures. In this connection credit is due Col. J. L. Ludlow, the able sanitary engineer of the Board, for preparing the sections in the amendment to The Revisal of 1905 adopted by the last Legislature, giving the Board more power in controlling public water sup-plies and in suggesting the advisability of analyzing the waters of springs at resorts while open for the entertainment of the public. As long ago as 1902 North Carolina was recognized by the American Public Health Association as one of four of the foremost States in water legislation. Dr. Lewis, with the con-currence of the Board of Health, developed the Laboratory of Hygiene upon the original plan of taxing all corporations or individuals selling water to the public for its support, supplemented by an annual appropriation of $2,000 which he secured from the Legislature of 1907. Another law very much to his credit is our new vital statistics law. Dr. Creesy L. Wilbur, Chief Statistician of the United States Bureau of the Census, has said of this law that it was "the first practical vital statistics law enacted in any of the Southern States." As correct vital statistics form the very basis of intelligent public health work, the value of this law is at once evident. As law is the result of public sentiment, and public sentiment the result of education, these laws are the result of an effectual educational campaign for the improvement of public health. To this Dr. Lewis has contributed through his editorial work in the Bulletin of the State Board of Health and through many noteworthy publications and addresses. Among these may be mentioned his "Drinking Water in Relation to Malarial Diseases," which started the change in Eastern Carolina in the domestic water supply from open wells to driven pumps; his "Instructions for Quarantine and Disinfection"; his leaflets on typhoid and malaria ; his pamphlet on the prevention of tuber-culosis, pronounced by good judges to be the best of its kind. A leading health officer of the State of New York has said that 90 per cent of the anti-tuberculosis work in that State was based upon Dr. Lewis's presidential address before the National Conference of State and Provincial Boards of Health of North America. The opinion of the great health officials of America of Dr. Lewis is shown by the recognition they have accorded him in having made him president of both the great national public health associations. In 1905 he was president of the National Conference of State and Provincial Boards of Health of North America, and in 1907 he was president of the American Public Health Association. It is therefore \ery evident that the retiring secretary is a national figure in public health work. 34 NORTH CAROLINA BOARD OF HEALTH. When it is remembered that the small amount of $2,000, out of which clerk's hire, etc., was to be taken, was all appropriated by our State, it can readily be seen that the secretary's service was largely a labor of love. Forced on account of this small appropriation to practice his profession, as an oculist, to earn a living, he has given his resting hours to the service of his country, thereby show-ing a self-sacrifice for public weal which should always be an inspiration to those who follow him. The writer fully realizes the embarrassment he takes upon himself in calling attention to the high standard set by his predecessor, but a sense of gratitude and duty, both as an individual and as a public official, will be satisfied with nothing less. In assuming his official cloak I shall always be mindful of him who wore it so worthily. Meetings of Executive Committee Office of the Secretary, Raleigh, K 0., August 10, 1909. At the request of the President, the Executive Committee was called to meet at the office of the Secretary in Raleigh on August 10th, 1909 ; the object of the meeting being to consider the sanitary condition of the State Sanatorium for the Treatment of Tuberculosis, the purification of sewage at Rocky Mount and Tarboro, the purity of the Reidsville water supply and to confer regarding Public Water Supplies, Circular B. Dr. Thomas, President, called the meeting to order at twelve o'clock, Dr. Lewis and Col. Ludlow being present. Dr. Gordon, President of the Board of Directors of the State Sana-torium for the Treatment of Tuberculosis, and Dr. Julian, Assistant Secretary for Tuberculosis of the State Board of Health, appeared be-fore the Board. Dr. Julian's report* of the sanitary condition of the State Sanatorium was read, to which Dr. Gordon replied: DR. GORDON'S STATEMENT. "1. In regard to there being 'no matron or nurse in the institution,' the ex-planation is: One reason that there is no matron and no nurse is that we have no place for white help, no means for providing such a place and that it is abso-lutely impossible to get a nurse or matron there and expect them to live with the inmates of the institution. "2. That the 'windows and doors are not provided with screens; the kitchen and dining room swarm with flies' : Now, if you remember, the appropriation made for this institution was one of the last bills passed by the last Legislature and, if I remember correctly, I called a meeting of the directors perhaps early in April. I was not at that meeting, being unable to attend. Since then we have let a contract to Mr. Dew to screen the windows and doors and also to provide screens to keep out rain, for every apartment in the institution. For some cause he was very slow about it. He got part of the material there and failed to get the remainder. The result was that the doors and windows were never screened, that is, not until now. He is doing this work, now. •See page 88 for Dr. Julian's report. THIRTEENTH BIENNIAL REPORT. 35 '"I stayed at Montrose a few days, in order to ascertain the true conditions. I ate in the dining room every meal, save one, while I was there, and there were some flies, but I do not think there was the number of flies indicated by the report here. I have certainly seen a great many more flies than I ever saw in that dining room, and I did not note that there was an unusual number of flies in the kitchen, although I had my own table and there may have been more flies at the other table. "The food was fairly well prepared, and while I was there the quality and quantity was fairly good. "3. 'Xo protection from rain,' etc.: I replied to that a while ago. Last year, when the institution was opened, we curtained the building with heavy ducking strung on wire so that during rains the curtains might be used to protect; but the wind is so strong there that this arrangement was found to be a failure; the ducking was blown off and it was finally taken down. "4. I do not know when the floors had been cleaned. When I went down there" I went to look after the installation of an electric plant. Dr. Brooks informed me that he wanted to go away for a little rest, and asked me if I would look after the patients. I told him that I would do the best I could. He met me at Aberdeen. He did not go out to the institution with me, and told me nothing, leaving me thus uninformed. I introduced myself to the patients, examined them and saw them every morning and afternoon while I was there, in the meantime looking after the building and installation of the plant. My observation is that the cracks in the floors were unusually small, but it is possible that there was some dust and dirt in them. The floors had not been swept the morning Dr. Julian a.nd Dr. Stanton were there, and the beds, I suppose, had not been made up that day. "I think it but due to Dr. Brooks that I make this statement. The doctor has found it impossible to get efficient help. One of the reasons is the reason already stated, that he has no place to keep efficient help. No one would stay there except inefficient help. He was exacting and insistent on their doing what he said. The only way he kept his cook was by not paying him, so he could not go away. He was dreadfully handicapped. His laundryman would not work for him. When I got there I found the laundry had not been done for some time, and Miss Lock told me she could not get it done. Miss Lock was a patient there who had improved and was acting as matron. She told me that laundry work was needed to be done badly. I asked whom she could get. She said it had been done by a woman, but she had quit and could not be induced to return. I asked regarding the cook, and she said she was a good washerwoman. Miss Lock said if Charlotte, the cook, would do the laundry, she, with the help of William, would do the rest, and so I made arrangements to have her wash the bed linen. I kept Charlotte at that for a number of days. She laundered all the bed linen, except what was then in use. I found the blankets had all been used and needed to be laundered, so I sent for the party that had done laundry work for them since the institution opened there, and she agreed to launder the blankets and the bed linen, as well as to do the laundry work for the patients. I got her to do this work until I left there. All the blankets had been used, but had not been used an unreasonable length of time. "5. 'Ventilation of the rooms bad' : We have a number of windows in the assembly hall, and my observation was that the windows were nearly always 36 NORTH CAROLINA BOARD OF HEALTH. open. At any rate this hall was used very little except for lavatory purposes and writing. The patients sleep out of doors and live out of doors. "The slops while I was there were kept thoroughly disinfected with bichloride of mercury, and Dr. Brooks claims he has also used a large amount of bichloride of mercury. While they did not look sanitary, they were all right. "6. 'No bath tubs': Well, there are no bath tubs. We intend to put in shower baths, instead, but have no money with which to put in any. "7. 'There are two privies. There was no evidence that they have been cleaned. No disinfectants have been found, no covers to stools, and odor offensive.' You can not get any negro in that country to clean out one of these privies for the institution, and the only means was to take a hand from the farm to do it. I asked this man about the privies—he cleans them out—and he said he had been intending to do it for several days. I asked him how long it had been since they were cleaned out, and he said two weeks. I told him to clean them out, and Dr. Brooks has since burned them down. "8. There is nothing in this to reply to. He states it is crude and also thinks it might have been more sanitary. We admit that : it could have been and should have been. I think Dr. Brooks should have due credit. He had no efficient help and no matron capable of filling the position, because no one would stay there. No trained nurse would stay there. There was no place for colored help, the only place being a pallet in the kitchen and one in the entry or butler's pantry. I think Dr. Brooks should be credited with the fact that no provision had been made by which he could keep efficient help, and he is certainly due the credit of having appeared before the Executive Committee and insisted that the institu-tion be closed during the hot weather and pending the improvements that were contemplated. He insisted on it and one member of the Executive Board was very much opposed to closing the institution, and I think the Executive Board is solely to blame for its not being closed at the proper time. "The whole thing in a nutshell is this: The Board of Directors, in their zeal to demonstrate to the Legislature the good that could be derived from the in-stitution, permitted the institution to be opened before it was properly equipped —that is, before we had an institution. That was the mistake made, and we feel that the members of the Board realize that now. At the same time we thought it would help us in getting additional appropriation, without which we could not have continued the work. (Dr. Lewis: "It did help.") "If you will permit me, I should like to express my views in regard to this report. It is no reflection on Dr. Julian. Dr. Julian did his duty as he saw it, and I do not mean to reflect on anybody. At the same time it seems to me that, as officials of the State and in the interest of the entire people of the State, it would be unwise to make a public document of this report, believing, as I do, that it will raise up and interfere, very materially, with any additional appro-priation that may be asked for at the hands of the Legislature." DR. JULIAN'S STATEMENT. "In the first place, I desire to say that the condition shown us by Dr. Gordon was just as good as it possibly can be and just as nice as his defense today. When I was down there he gave me every opportunity to examine the institution. He very kindly took us over the grounds; and I wish to say that the grounds, elevation and soil are ideal, and that I know of no place in North Carolina that would equal it for this work. These conditions are the best I have ever seen THIRTEENTH BIENNIAL REPORT. 37 and the elevation I am sure is sufficient for the treatment of tubercular affections, and in fact I think the possiiblities are really greater than in any other place in North Carolina. "I also wish to say, that there may be no prejudice to my report, that I have had no communications from any one in North Carolina, layman or doctor, in regard to this institution, except from Dr. Eankin, by letter, that I am not in sympathy with any man or men that are trying to get the superintendency of the institution, and that I really had expected to visit Montrose in the capacity of the Assistant Secretary for Tuberculosis, and was glad to make this visit officially, at the request of Dr. Rankin, our Secretary. '•When I arrived at Aberdeen I found the little Rockfish and Aberdeen was in such perfect condition sanitarily; the coaches were so clean, that I made the remark to one of my friends that if we found the institution as well cared for, I would be well pleased. I desire to say this, so that it will be understood that I am not prejudiced. "I also wish to say that I took the names of every person in the institution before I told them my mission; inquiring into their habits and treatment, and that except for Dr. Gordon, who was held in very high esteem, the treatment was a joke among the patients. They spoke very highly of Dr. Gordon, but the treatment was a joke. "I looked around for appliances for examination. They had no microscope or stethoscope. (Dr. Gordon: "I had that in my pocket." ) One patient complained that he had been in bed two weeks with a temperature of 105 and that he had only had his temperature taken by himself. That the doctor had not taken his temperature all the while. Now, I have in my grip the names of every one who gave me this information. I was told by one patient that from the time he had entered until that day he had never had an examination, percussion, or aus-cultation, or anything. "Miss Lock was the only one that did anything at all in -he way of a matron. She informed me that she was a patient, without salary, and was left to do as best she could, without directions or orders, except what she received from Dr. Gordon. It seems that they had no cows, and the first churning was done the day I arrived at the institution. The butter and eggs were ordered from Aber-deen and were usually stale. The other food was good. It appears that the visits from the doctor in charge were only from Aberdeen and that he did not remain at the institution. It is also claimed that the beds were changed from one part of the porch to another by a negro man when it rained at night. One patient informed me he had been there thirty-four days and, to his knowledge, there had been no change of linen in that time. Others claimed that the linen had not been changed for about two weeks. The beds on the porches were in dis-order. They were turned helter-skelter, the sheets were dirty, and, as Dr. Gordon remarked, after the sheets were used they were thrown up in a heap on an old bed in one part of the porch in an unsanitary condition. It had rained the night before and that part of the porch was wet and in an unsightly condition. A patient informed me that he had accidentally turned his spit cup over on his linen and that the only way he could get rid of it was to wash it out himself. I observed the patients sitting around with rolls of toilet paper near by. They would cough and expectorate into this toilet paper and then slip it into a bag, and after that was filled it was disposed of in the fire. That I saw. "A patient informed us that the porch had not been swept for a month and 38 NORTH CAROLINA BOARD OF HEALTH. that the rooms had been swept once in two weeks, and that with a dry broom. There was no cloth to moisten the floor. The sweeping was done by dry cleaning. These were patients in advanced stages of tuberculosis, others without tempera-ture and others with temperature and were then huddled in, and of course rein-fection could occur with the sweeping, everywhere there was a dry sweeping. "In answer to Dr. Gordon I should say the talk I had with him was satisfactory and that I have the highest regard for him. He said Dr. Brooks had given him no information in regard to the institution and he was obliged to go to work for himself. He went out there handicapped. They were living there with no method of ordering, except for this woman (Miss Lock), who was a self-appointed matron. "In regard to the cracks: They were no larger than ordinary cracks. They were not filled like this floor, and all the dirt that could, accumulated in the cracks. The floors should be waxed, and there is no excuse for neglecting this matter, as turpentine and beeswax could easily be mixed together and the floors waxed therewith. "In answer to that part of Dr. Gordon's defense of Dr. Brooks, wherein he states that he could not get a trained nurse, all that is Dr. Brooks's fault. The report from Whitehaven and like institutions show that the danger of infection of nurses and help is less in sanatoriums than in private houses. "There is no reason why any physician should fear to sleep in any part of such an institution, and there is no reason why any woman who has been trained as a nurse should object to going to any kind of an institution if she is capable of taking care of it. "In regard to the kitchen and dining room, the use of the word 'swarm' does look a little harsh, but they were preparing vegetables and the negro cook was spreading them all over the table, and, in the absence of screens, there was no reason why the flies should not be on the food; of course, on the cooked food as well as on the raw. One patient told me that while one of them ate at the table another would keep the flies off with a flybrush. "I did observe a bed in the dining room, one in the pantry, and one in the kitchen. These were without bedsteads; just piled down on the floor. A negro man slept in the kitchen and a negro woman in the dining room. "The privies are near the institution. The seat was some distance from the ground and the accumulation of fecal matter extended from the ground to within a few inches of the seat. The seat was without a cover, and no lime or other disinfectant was seen around the privies. "Besides the sanitary condition, the possibilities are so great that the insti-tution must, in somebody's hands, or by your wise directions, be made an honor to the State of North Carolina. The sanitary conditions of the institution are inexcusable, It is inexcusable to have beds in the condition I found them in, there. It is inexcusable to leave stools from early in the evening until the next day at 12 o'clock, and this I saw. "Suppose a patient comes there in the more advanced stage of tuberculosis — suppose he should have a hemorrhage at night. Who is to take care of patients at night?" Resolution : Introduced by Col. Ludlow. "1st. That the Executive Committee endorse the activity and zeal on the part of the Secretary and Assistant Secretary for Tuberculosis in their investigation and complaint they have lodged against the State Sanatorium for Tuberculosis. THIRTEENTH BIENNIAL REPORT. 39 That the Committee, after hearing this report and the discussions, does refer the entire matter to the board of directors of the institution for their further consideration and action. Further, that the Executive Committee, acting in its official capacity as custodian of the public health of the State, the matter having been referred to them officially, recommend to the board of directors of the in-stitution that it shall not be opened for the treatment of patients until the con-templated improvements have reached such a stage that the patients entering can be properly cared for. ''Further: In reference to the complaint lodged by Dr. J. R. Williams, it is likewise referred to the board of directors for their consideration and action." The question of sewage disposal at Rocky Mount and Tarboro being brought up, Mr. Battle said : "It is useless for us to discuss the matter with you on a scientific basis. "We insist that we are situated 68 miles above the only intake of a public water supply. In view of that distance, the slow flow of the stream, the size of the river at Rocky Mount and Greenville, and the amount of sewage produced by Rocky Mount, your order was entirely unnecessary and we insist that it be revoked. At the same time we know the law,—no sewage shall be turned into a stream from which water is taken below. "The town of Rockv Mount, without any fault of its own, is entirelv out of money with a floating debt of $20,000. It is absolutely impossible for us to raise that amount of money, in any way. Our only recourse would be to break the sewer entirely and keep sewage from running into the river. This would cause a pestilence in the town, besides ruin-ing our new $20,000 hotel. We can not consider giving up the sewerage system. The whole matter of sewage purification is in an exceedingly incoherent (?) state; as just shown by the Westinghouse agent. To put our town to an expense that in a year or two would prove to be unwise and inexpedient is unjust and oppressive. "I would like to file with you the annual financial report of the city of Rocky Mount (gives the Secretary a paper). "What we wish to do, when our funds permit, is to install a septic tank." Mr. Bassett, for Rocky Mount, states financial condition of Rocky Mount : "Our town has an increased demand of $8,000, and a decreased rev-enue of $12,000, by reason of the prohibition law. The estimated flow of sewage is 150 gallons per minute. The estimated flow of the river is 1,275 gallons per minute. (Reads Section 3058 of Revisal of 1905.) Greenville has filed no complaint. It is absolutely beyond the means of Rocky Mount to install the system required by Colonel Ludlow. (Reads a letter describing the system suggested by Colonel Ludlow.) Xo en-gineer would require more of the country of England than Colonel Ludlow requires of Rocky Mount. We will leave this matter in your hands, absolutely assured that we will be dealt with justly and fairly." 40 NORTH CAROLINA BOARD OF HEALTH. Mr. W. O. Howard, for Tarboro : "We feel that we are almost unable, in fact, that it would be almost impossible for us to comply with your order. We are poorer than any Eastern town. Tarboro has the highest tax of any Eastern North Car-olina town, being $2.58 per hundred, for the town, county and State. I am here to ask you to revoke your order for the present. With the next meeting of the Legislature we may be able to comply. The system demanded by Colonel Ludlow would require the expenditure of $68,000 and the annual running expenses would probably be $1,000. If you can not revoke the order, do not require us to put in such an expensive system. Greensboro has a septic tank which cost only $2,000. We cer-tainly can not comply within six months. In order to do this, we shall have to make some provision for levying more tax." Colonel Ludlow : If Greenville's filter should fail to work one day, the health of the town would be endangered. I can not possibly weigh the danger to Greenville against the financial condition of Rocky Mount. On motion of the Chairman, it was resolved that the time for the installation of hygienic purification plants by the towns of Rocky Mount and Tarboro be extended to July 1st, 1910. REIDSVILLE. Colonel Ludlow showed chlorin in this supply to be too high at all times. It was decided that the Secretary should visit Reidsville and look into the matter of their water supply. On motion the Engineer and the Secretary of the Board and the Directors of the Laboratory of Hygiene were directed to make an in-spection of the electrical purification of water and its practical appli-cation. Raleigh, K C, February 9, 1911. Dr. Jno. A. Ferrell, having been recommended to the Rockefeller Sanitary Commission by Dr. Richard H. Lewis and Hon. J. Y. Joyner, was requested by Dr. Lewis to meet Dr. Wyckliffe Rose, Administrative Secretary of the Rockefeller Sanitary Commission in Raleigh, Feb-ruary 8th, 1910. At this meeting Dr. Rose decided to recommend Dr. Ferrell's ap-pointment, provided the State Board of Health, through its Executive Committee, would approve the appointment. The following day, Colonel J. L. Ludlow was called up by long dis-tance telephone by Dr. W. S. Rankin, Secretary to the Board, and put into possession of all the facts relating to Dr. Ferrell's appointment. Thereupon he approved the appointment. Dr. Thomas later approved the appointment by letter. Dr. Ferrell was then appointed by the Rockefeller Sanitary Com-mission as Assistant Secretary for the Eradication of Hookworm of the State Board of Health. After arranging his local business he came to Raleigh, taking charge of his official duties March 12, 1910. THIRTEENTH BIENNIAL REPORT. 41 Annual Sessipn of the Board of Health Wrightsville, N. C, June 21, 1910. The annual session of the Xorth Carolina State Board of Health was called to order by President Thomas. Members present : Doctors Lewis, Anderson, Tayloe, Register, Way, Spencer, and Colonel J. L. Ludlow. Minutes of Asheville meeting June 15-16, 1909, were read. Colonel Ludlow corrected the minutes by requesting that he be not referred to as "Sanitary Engineer of the Board," but as a member of the Board. The minutes were then approved. The minutes of the meeting of the Executive Committee on August 10th, 1909, were then read and approved. Letters, under dates of June 2 and June 4, 1910, from Jno. A. Wed-dell, Clerk of Tarboro, and Hon. T. T. Thorne, Mayor of Rocky Mount, were read. Both of these letters requested an extension of the time pre-viously allowed the towns of Tarboro and Rocky Mount from July 1, 1910, to November 1, 1909. The Board, appreciating the cordial spirit of co-operation expressed in these letters, and accepting in good faith their statement to the effect that it was impossible for them to comply, through no fault of their own, with the requirement for installing sew-age purification plants by July 1st, passed the following motion intro-duced by Dr. Lewis : "Moved that the towns of Tarboro and Rocky Mount be granted an extension of time to January 1, 1911, for installing sewage purification plants." As above stated this motion was carried. Dr. Lewis suggested that the Secretary remind the above towns to submit to the Board plans of the proposed purification plants according to Section 3058, Subsection (b), before proceeding with their installation. The minutes of the approval by the Executive Committee of Dr. Jno. A. Ferrell's appointment as Assistant Secretary for the Eradication of Hookworm were read and approved by the Board. Dr. "Way officially notified the Board of the death of one of its mem-bers, Dr. James A. Burroughs, and moved that a committee be appointed to draft suitable resolutions regarding his death. Dr. Way was then appointed by President Thomas a committee of one to prepare such resolutions. Dr. Anderson moved that Mr. H. W. Simpson be re-elected a mem-ber of the Board of Embalmers. This motion was unanimously carried. Dr. Lewis moved that the Board go into the election of a new member to fill the vacancy made by the death of Dr. Burroughs. Dr. Way nominated Dr. J. E. Ashcraft, of Monroe, for this position. Dr. Ashcraft's nomination was seconded by Dr. Spencer and Colonel J. L. Ludlow. Dr. Register made a number of commendatory remarks concerning Dr. Ashcraft. Dr. Ashcraft Avas then unanimously elected. President Thomas then appointed Colonel Ludlow and Dr. Spencer an auditing committee to audit the accounts of the Treasurer of the 42 NORTH CAROLINA BOARD OF HEALTH. State Board of Health and the State Laboratory of Hygiene. The ac-counts, statements, checks, and receipted bilts were then turned over by the Treasurer to Dr. Spencer. Dr. Spencer moved that the meeting be adjourned. The motion was carried. W. S. Rankin, Secretary. Conjoint Session of the North Carolina Board of Health with the Medical Society of the State of North Caro-lina, at Wrightsville, June 22, 1910. President G. G. THOMAS, Chairman. REPORT OF SECRETARY STATE BOARD OF HEALTH. Mr. President, Members of the North Carolina State Board of Health, and Mem-bers of the Medical Society of the State of North Carolina. I have the honor to submit herewith my annual report as Secretary of the North Carolina State Board of Health as authorized by Section 4442 of The Re-visal as amended by the Legislature of 1909. My first record is a sad one, namely, to note the death of the lamented Dr. James A. Burroughs, a member of this Board and late President of this Society. Dr. Burroughs heard the summons of our common adversary, and on December 28, 1910, fell in the front line of the battle of science against death. His death leaves a vacancy on the Board of Health which should be filled at this meeting. The most important, as well as the most encouraging, change that has taken place since our last meeting is the continued and vigorous growth of the public interest in the question of health. This growing interest finds expression through several sources. Medical inspection of schools, carried on during the last three years and in-cluding schools in England and in various parts of the United States with an aggregate of about one million pupils, has shown that 20 per cent of the children have defective eyes, 5 per cent of them have defective ears, and about 10 per cent defective throats. The large number of children examined and the extensive geographical distribution of these statistics establish a condition that is general. So large a number of physical defectives in the schools means the retardation of the entire school; means a tremendous loss through the retardation of all the children, and the inability of a large number of children to use what is taught them ; means that many physical defectives are unjustly punished, whereby many sweet dispositions are soured and many characters are twisted. These facts, to-gether with the general growth of public health interest, have gone a long way in causing the school people to recognize the fundamental value of health and in making of them one of the strongest forces in the public health movement. Through the deep interest of State Superintendent of Public Instruction Joyner, your Secretary has addressed both the Association of County Superin- THIRTEENTH BIENNIAL REPORT. 43 tendents of Public Instruction and the North Carolina Teachers' Assembly, in addition to several teachers' institutes, on the question of public health. The November issue of the Bulletin was a teachers' edition and dealt with the re-lation of the public school to health. Four thousand North Carolina teachers are on the mailing list of the Bulletin. In December your Secretary prepared a pamphlet dealing with the construction and care of sanitary schoolrooms and the examination of children by teachers for defective eyes and ears. The major part of this pamphlet was taken from a silimar publication prepared several years ago by former Secretary Lewis. This pamphlet was issued and distributed by the State Department of Public Instruction. In February of this year another pamphlet on the subject of tuberculosis was prepared by Assistant Secretary C. A. Julian. This was published by the State Department of Public Instruction, but, on account of some delay, it was thought best to wait until the next public school year to distribute it. While, at present, the study of sanitation and preventive medicine is not pre-scribed in the public school course, many influences are at work toward this end. The teachers are feeling the effect of the popular demand for health study, and in many schools health is receiving attention in one way or another. I am led to believe, from a recent conversation with State Superintendent Joyner, that at the next meeting of the Board for the Selection of Text-books, some time dur-ing the year 1911, the subject of sanitation and preventive medicine will be pre-scribed for the public school system. At the request of Superintendent Joyner, a series of sixty health talks, cover-ing the subject of public health, will be prepared during the summer for the public school teachers. The talks will be published in convenient form for the use of the teachers, and distributed. The teachers will use them as the basis for three ten-minute talks to the school each week on the subject of health. In this connection I wish to call your attention to and ask your support for the School Betterment Associations. These associations, now established and active in many counties, are doing much for public health by insisting on better sanitary conditions in and around schoolhouses. Many physicians have made health addresses before schools and teachers' in-stitutes during the last year, and, in this way, have contributed much to the public welfare. Permit me to commend this practice to all those physicians whose public interest is seeking a wider sphere of usefulness. The churches, along with all other organized influences, have deepened their in-terest in the question of health, and many pulpits have contributed largely to the cause of more efficient and cleaner living as a means of better preparation for the other life. In March of this year a special Preachers' Bulletin was issued for Sanitary Sunday, April 24th. This Bulletin contained the endorsement, for its use by the preachers of various denominations, of many of the leading clergy-men in the State. I am sure this Bulletin was used by many of the pulpits, and I desire here and now to make grateful acknowledgment of this fact. The press of the State is showing its awakening sense of responsibility for public health by more frequent expressions on this subject. Your Secretary had the pleasure of addressing the Press Association on their relation to the public health, at their recent meeting in this place. They seemed to be deeply interested and promised their cordial cooperation with the State Board of Health for health improvement. I am quite sure that the press is becoming seriously interested in this problem, and their interest will go a long way toward creating a demand for a better health administration, local and State. 44 NORTH CAROLINA BOARD OF HEALTH. The American Tuberculosis Exhibit, under the direction of Mr. E. G. Routzahn, has been at work in our State since March 15th. It has already given three ex-hibitions of three weeks each, in the cities of Greensboro, Raleigh, and Winston- Salem. It will go to Durham later this summer, and it is hoped that Charlotte will secure the exhibit for the fall. The effect of this exhibit is to tremendously augment the local health interest wherever it is given, and to create a general interest in health in the surrounding country. Last, but by no means least, of the organized influences that have seriously interested themselves in better health is the State Federation of Women's Clubs. At their recent annual meeting in Henderson your Secretary addressed them on the subject of public health, and they expressed their deep concern in the cause by passing resolutions emphasizing its importance and organized a Health De-partment of the Federation. Mrs. W. N. Hutt, of Raleigh, was made chairman of this department. The Monthly Bulletin of the Board of Health has been increased in its circulation from 3,500 to 11,500, and its mailing list includes all the doctors, preachers, lawyers, and 4,000 of the 10,000 school teachers in the State. There are, in addition, a number of other names on the mailing list. The Bulletin also reaches most of the newspapers of the State. The Legislature of 1909 passed three important public health measures: A law relating to the control and care of public water supplies, a law requiring the registration of all deaths occuring in towns or cities having a population of a thousand or more at the last decennial census, and a law providing for the distribution of diphtheria antitoxin to the indigent. Former Secretary Dr. Lewis has already called attention, in the March (1909) Bulletin, to the nature of these laws. All of them have been put in operation during the last year. The law relating to water supplies requires the authorities of every public water supply to file certified duplicate plans and surveys prepared according to rules and regulations furnished them by the Secretary of the State Board of Health. Of the 63 public water supplies of the State, 45 have complied with this requirement. Eighteen have not complied, and the attention of the solicitor has been called to the infringement of this law in the case of one company, the other fourteen having rendered acceptable excuses for their delay. This law further requires the authorities in charge of all public water supplies to make quarterly ins
Object Description
Description
Title | Biennial report of the North Carolina State Board of Health |
Other Title | Report of the North Carolina State Board of Health. |
Creator | North Carolina. State Board of Health. |
Date | 1909; 1910 |
Subjects |
North Carolina. State Board of Health--Statistics--Periodicals Public health--North Carolina--Statistics--Periodicals Public Health--North Carolina |
Place | North Carolina, United States |
Time Period | (1900-1929) North Carolina's industrial revolution and World War One |
Description | Report covers two calendar years (13th-18th); (19th) covers Dec. 1, 1920-June 30, 1922; thence each covers July 1-June 30 years.; Printer: 13th (1909/10)-18th (1919/20) by Edwards & Broughton; 19th (1921/22)-20th (1923/24) by Bynum; 21st (1925/26)-<44th (1970/72)> unnamed. |
Publisher | Raleigh :The Board,1911- |
Agency-Current | North Carolina Department of Health and Human Services |
Rights | State Document see http://digital.ncdcr.gov/u?/p249901coll22,63754 |
Physical Characteristics | v. ;24 cm. |
Collection | Health Sciences Library, University of North Carolina at Chapel Hill |
Type | text |
Language | English |
Format | Reports |
Digital Characteristics-A | 156 p.; 9.81 MB |
Series | Biennial report of the North Carolina State Board of Health |
Digital Collection |
North Carolina Digital State Documents Collection N.C. Public Health Collection |
Digital Format | application/pdf |
Related Items | Printer: 13th (1909/10)-18th (1919/20) by Edwards & Broughton; 19th (1921/22)-20th (1923/24) by Bynum; 21st (1925/26)-<44th (1970/72)> unnamed. |
Audience | All |
Pres File Name-M | pubs_biennialreportof13nort.pdf |
Pres Local File Path-M | \Preservation_content\StatePubs\pubs_edp\images_master\ |
Full Text | THIRTEENTH BIENNIAL REPORT OF THE NORTH CAROLINA STATE BOARD OF HEALTH 1909-1910 iilil I lillllll llillllll iliijlljlsllijijj !: THE LIBRARY OF THE UNIVERSITY OF NORTH CAROLINA (mm THE COLLECTION OF NORTH CAROLINIANA C6U.06 N87 1909-10 c.2 DANiEL & WARREN THIRTEENTH BIENNIAL REPORT OF THE NORTH CAROLINA STATE BOARD OF HEALTH 1909-MO RALEIGH Edwards & Broughton Printing Co., State Printers 1911 Members G. G. Thomas, M.D., Pies., Wilmington. Thomas E. Axdersox, M.D., Statesville. J. Howell Way, M.D., Waynesville. W. 0. Spexcer, M.D., Winston-Salem. Edw. C. Register, M.D., Charlotte. David T. Tayloe, M.D., Washington. *J. A. Burroughs, M.D., Asheville. J. L. Ludlow, C.E., Winston-Salem. Richard H. Lewis, M.D., Raleigh. •Deceased. Succeeded by J. E. Asheraft M.D.. Monroe. County Superintendents of Health Alamance Dr. G. Alexander Dr. 0. Alleghany Dr. B. Anson Dr. J. Ashe Dr. J. Beaufort Dr. P. Bertie Dr. J. Bladen Dr. L. Brunswick Dr. J. Buncombe Dr. D. Burke Dr. I. Cabarrus Dr. J. Caldwell Dr. C. Camden Dr. C. Carteret Dr. W Caswell Dr. S. Catawba Dr. H. Chatham Dr. L. Cherokee Dr. J. ( lmwan Dr. H. Clay Dr. J. Cleveland Dr. T. Columbus Dr. H. Craven Dr. J. Cuml>erland Dr. W, Currituck Dr. H. Dare Dr. . . Davidson Dr. E. Davie Dr. M Duplin Dr. T. Durham Dr. X. Edgecombe Dr. S. Forsyth Dr. J. Franklin Dr. J. Gaston Dr. X. Gates Dr. G. Graham Dr. M. Granville Dr. S. Greene Dr. W Guilford Dr. A. Halifax Dr. I. Harnett Dr. L. Haywood Dr. J. Henderson Dr. J. Hertford Dr. J. Hyde Dr. K W. Long Graham. L. Hollar Taylorsville. 0. Choat Sparta. M. Covington Wadesboro. C. Testerman Jefferson. A. Nicholson Washington. L. Pritchard Windsor. B. Evans Clarkton. A. Dosher Southport. E. Sevier Asheville. W. Phifer Morganton. W. Wallace Concord. L. Wilson Lenoir. G. Ferebee Gregory. E. Headen Morehead City. A. Malloy Yanceyville. E. Rowe Newton. E. Farthing Pittsboro. F. Abernethy Murphy. M. S. Cason Edenton. M. Sullivan Hayesville. E. McBrayer Shelby. B. Maxwell Whiteville. F. Rhem Xew Bern. S. Jordan Fayetteville. M. Shaw Shawboro. J. Buchanan Lexington. . D. Kimbrough Moeksville. O. Coppedge Kenansville. M. Johnson Durham. P. Bass Tarboro. K. Pepper Winston. E. Malone Louisburg. L. Glenn Gastonia. D. Williams Gatesville. T. Maxwell Robbinsville. D. Booth Oxford. . B. Murphy Snow Hill. T. Fortune Greensboro. E. Green Weldon. F. Arnold Lillington. R. McCracken Waynesville. G. Waldrop Hendersonville. H. Mitchell Ahoskie. E. Windlev Lake Landing. Iredell Dr. M. E. Adams Statesville. Jackson Dr. A. S. Nichols Sylva. Johnston Dr. A. H. Rose Smithfield. Jones Dr. A. F. Hammond Pollocksville. Lee Dr. J. P. Monroe Sanford. Lenoir Dr. N. A. Whitaker Kinston. Lincoln Dr. J. W. Saine Lincolnton. McDowell Dr. Guy S. Kirby Marion. Macon Dr. S. H. Lyle Franklin. Madison Dr. W. J. Weaver Marshall. Martin Dr. W. E. Warren Williamston. Mecklenburg Dr. C. S. McLaughlin Charlotte. Mitchell Dr. V. E. Butt Bakersville. Montgomery Dr. C. Daligny Troy. Moore Dr. Gilbert McLeod Carthage. Nash Dr. J. P. Battle Nashville. New Hanover Dr. W. D. McMillan Wilmington. Northampton Dr. H. W. Lewis Jackson. Onslow Dr. Cyrus Thompson Jacksonville. Orange Dr. C. 0. Jones Hillsboro. Pamlico Dr. D. A. Dees Bayboro. Pasquotank Dr. H. T. Aydlett Elizabeth City. Pender Dr. E. H. Bradford Burgaw. Perquimans Dr. T. S. McMullen Hertford. Person Dr. W. T. Long Eoxboro. Pitt Dr. W. M. Fountain Greenville. Polk Dr. Earl Grady Tryon. Eandolph Dr. J. V. Hunter Asheboro. Eichmond Dr. W. P. Webb Eockingham. Eobeson Dr. W. A. McPhail Lumberton. Eockingham Dr. Samuel Ellington Wentworth. Eowan Dr. M. L. Smoot Salisbury. Eutherford Dr. E. B. Harris Eutherfordton. Sampson Dr. A. M. Cooper Clinton. Scotland Dr. Peter McLean Laurinburg. Stanly Dr. J. F. Laton Albemarle. Stokes Dr. J. W. Xeal Walnut Cove. Surry Dr. J. E. Woltz Dobson. Swain Dr. A. M. Bennett Bryson City. Transylvania Dr. Goode Cheatham Brevard. Tyrrell Dr. J. L. Spruill Columbia. Union Dr. H. D. Stuart Monroe. Vance Dr. E. F. Fenner Henderson. Wake Dr. J. J. L. McCullers McCullers. Warren Dr. M. P. Perry Macon. Washington Dr. W. H. Ward Plymouth. Watauga Dr. H. McD. Little Boone. Wayne Dr. T. M. Bizzell Goldsboro. Wilkes Dr. E. M. Hutchens North Wilkesboro. Wilson Dr. W. S. Anderson Wilson. Yadkin Dr. T. E. Harding Yadkinville. Yancev Dr. W. B. Eobertson Burnsville. Letter of Transmittal JSTorth Carolina State Board of Health, Office of the Secretary, Raleigh, X. C, August 3, 1911. His Excellency, W. W. Kitchen, Governor of Xorth Carolina. Sir:—Under the authority of Section 4137 of The Revisal of 1905, I have the honor to submit the Biennial Report of the State Board of Health for the years 1909 and 1910. In making this report I desire to express the sincere appreciation of the State Board of Health for your deep interest in the fundamental question of public health, for the strong recommendation for the in-crease in the State appropriation for this purpose contained in your last message to the Legislature, and for your cordial co-operation un-stintedly given at all times in assisting us in dealing with public health situations of peculiar interest. Very respectfully yours, "W. S. Rankin, Secretary and Treasurer. Legislation by General Assembly of 1909 Chapter 389. AN ACT TO PROVIDE DIPHTHERIA ANTITOXIN FOR INDIGENT PERSONS SICK OF DIPHTHERIA. The General Assembly of North Carolina do enact: Section 1. That the North Carolina Board of Health is hereby authorized and directed to arrange for a sufficient supply of diphtheria antitoxin for the treat-ment therewith, free of charge, of indigent persons sick of diphtheria, and for immunizing against infection such indigent persons as may be exposed to the dis-ease, and to extend the facilities for making the diagnosis of the disease. Sec. 2. That the said board of health shall keep on hand in the State Labora-tory of Hygiene a supply of reliable diphtheria antitoxin, and shall distribute, through the said laboratory, to the several counties of the State, whenever the boards of county commissioners thereof shall request it, and shall notify the Sec-retary of the State Board of Health that they will pay for the same upon presen-tation of a bill, and shall designate the person or persons with whom it shall be deposited. The antitoxin shall be furnished at the lowest figure obtainable for a reliable preparation. Sec. 3. That whenever a physician is called to a case of diphtheria in an indi-gent person or one in immediate need and unable to pay for antitoxin, he may obtain the same from one of the depositories or diphtheria stations by filling out and signing in duplicate the blank requisition form to be supplied with the anti-toxin by the said board of health, and presenting the same to the county superin-tendent of health or any member of the county sanitary committee, or to such person as the said county sanitary committee may appoint, who, after satisfying himself as to the indigency of the person or persons for whom the antitoxin is intended, shall approve and countersign in duplicate the requisition. The person dispensing the antitoxin shall retain one copy of the requisition and shall mail the duplicate promptly to the director of the laboratory of hygiene. He shall also return to the said director all packages of antitoxin in his possession as soon as they become out of date. Sec. 4. The provisions of this act shall apply to cities and towns upon the same conditions as it does to counties. Sec. 5. That for carrying out the provisions of this act the sum of five' hundred dollars annually is hereby appropriated. Sec. 6. That this act shall be in force from and after its ratification. Ratified this the 26th dav of Februarv, A. D. 1909. Chapter 722. AN ACT TO PROVIDE FOR THE REGISTRATION OF DEATHS IN MUNICI-PALITIES OF ONE THOUSAND POPULATION AND OVER IN THE STATE OF NORTH CAROLINA. The General Assembly of North Carolina do enact: Section 1. That all deaths that occur in cities or towns having a population of one thousand or over by the last preceding federal census shall be registered bv the clerks or other officials designated bv the board of aldermen or town com- 6 NORTH CAROLINA BOARD OF HEALTH. missioners thereof, who are hereby constituted local registrars of deaths, within three days after the occurrence of said deaths and before the bodies are removed, interred or otherwise disposed of: Provided, that in cities or towns now having satisfactory registration of deaths under their ordinances the health officer or other official now acting as local registrar shall continue as such, but shall con-form to the provisions of this act and to the regulations of the State Board of Health adopted thereunder. Sec. 2. That a certificate of death, of standard form, provided by the State Board of Health, shall be filed with the local registrar by the undertaker or other person in charge of the removal, interment or other disposal of the body of the deceased person, and a permit shall be issued by said local registrar for such removal, interment or other disposal of the body only after such certificate of the cause of death, signed by the attending physician, or, in case there shall be no attending physician, by the health officer, or, in case there is no health officer of the city or town, by the local registrar, who shall give the medical cause of death, as nearly as he can determine it, after full inquiry, in regard thereto, of the householder in whose family the death occurred: Provided, that under no circum-stances shall the local registrar sign the death certificate when there has been an attending physician or there is a municipal health officer. No sexton or superin-tendent of a cemetery in cities and towns having a population of one thousand or over shall permit interment, and no railway company or other common carrier shall transport a body of a deceased person whose death occurred in this State unless accompanied by the local registrar's permit. Sec. 3. That the local registrar shall number each certificate as received, record it in a local register of deaths, and promptly by the fifth day of the following calendar month send all of the original certificates to the secretary of the State Board of Health, at Raleigh, who is hereby constituted State Registrar of Vital Statistics. The said registrar, with the approval of the State Board of Health, shall maintain in his office a bureau of vital statistics, preserve, index and com-pile the original returns, and make copies thereof for legal or other purposes, as may be necessary, which copies, when officially certificated, shall be prima facie evidence of the facts therein set forth, in all the courts of the State, for all pur-poses of this act. The State registrar shall prepare and distribute all blanks and instructions necessary for the execution of this act, and shall see that the pro-visions of this act are faithfully enforced; and the solicitors of the several dis-tricts and the Attorney-General shall aid him, upon his request, and enforce the penalty of the law, in case of its violation. Each of the said local registrars shall be entitled to a fee of twenty-five cents for his service, under this section, to be paid by the city or town. Sec. 4. That any undertaker, sexton or superintendent of a cemetery, agent of a transportation company, local registrar or other person who violates the pro-visions of this act, and any attending physician who fails or neglects to certify to the cause of death when the certificate is presented to him for the purpose, and every local registrar who shall neglect to perform any of the duties required of him by section three of this act shall be guilty of a misdemeanor, and upon con-viction thereof shall be liable to a fine of not less than five nor more than fifty dollars or imprisonment for not less than ten nor more than thirty days, and shall also be liable to a penalty of twenty-five dollars in favor of any person who shall sue for the same. Sec. 5. The mayor of each city or town of one thousand or more inhabitants THIRTEENTH BIENNIAL REPORT. 7 shall be responsible for the enforcement of this act in his jurisdiction. Failure on his part to so enforce its provisions shall be a misdemeanor, and he shall be liable to a fine of not less than ten nor more than fifty dollars; and it shall be the duty of the solicitor of the judicial district in which the city or town is situate, upon complaint of the State registrar or of the secretary of the State Board of Health, to institute a criminal action for the enforcement of said fine. Sec. 6. That this act shall be in force from and after its ratification. Ratified this the 6th day of March, A. D. 1909. Chapter 793. AN ACT TO AMEND SECTIONS 3045, 3058, 3457, 4440, 4442, 4444, 4457, 44G0 AND 4508 OF THE REVISAL OF 1905, RELATING TO THE PUBLIC HEALTH. The General Assembly of North Carolina do enact: Section 1. That section three thousand and forty-five of The Revisal of one thousand nine hundred and five be amended by inserting after the word "method," in line twenty-eight, the words "scope and detail," and by adding at the end of said section three thousand and forty-five the following: "Full reports, in dupli-cate, of all such inspections shall be made promptly to the secretary of the State Board of Health and their accuracy certified by the affidavit of the inspector or such officer or person as the said secretary may direct." Sec. 2. That section three thousand and fifty-eight of said Revisal be amended by adding thereto, as subsections (a), (b) and (c), the following: "(a) The State Board of Health shall have the general care and oversight of all inland waters, and shall, from time to time, as it may deem advisable, cause examinations of said waters and their sources and surroundings to be made, for the purpose of ascertaining whether the same are adapted for use as water sup-plies for drinking and other domestic purposes or are in a condition likely to impair the interests of the public or of persons lawfully using the same, or to imperil the public health. For the purpose aforesaid it may employ such expert assistance as may be necessary. The said board shall make such rules and regu-lations as in its judgment may be necessary to prevent contamination and to secure such purification as may be required to safeguard the public health. Any individual, firm, corporation or municipality, or the person or persons responsible for the management of the water supply, failing to comply with said rules and regulations shall be guilty of a misdemeanor, and upon conviction shall be fined or imprisoned, or both, at the discretion of the court. "(6) The said board shall from time to time consult with and advise the boards of directors of all State institutions, the authorities of cities and towns, corpora-tions or firms already having or intending to introduce systems of water supply, drainage or sewerage as to the most appropriate source of supply, the best prac-tical method of assuring the purity thereof or disposing of their drainage or sewage, having regard to the present and prospective needs and interests of other cities, towns, corporations or firms which may be affected thereby. All such boards of directors, authorities, corporations and firms are hereby required to give notice to said boards of their intentions in the premises, and to submit for its advice outlines of their proposed plans or schemes in relation to water supply and 8 NORTH CAROLINA BOARD OF HEALTH. disposal of sewage; and no contract shall be entered into by any State institu-tion, city or town for the introduction of a system of water supply or sewage disposal until said advice shall have been received, considered and approved by said board. Violation of the provisions of this subsection (5) shall be a misde-meanor, and upon conviction those responsible therefor by neglect of duty shall be fined not less than fifty dollars nor more than two hundred dollars, at the dis-cretion of the court. "(c) That for the purpose of carrying out the general provisions of the said section three thousand and fifty-eight, as set forth in subsections (a) and (6), every municipal or private corporation, company or individual supplying or au-thorized to supply water for drinking or other domestic purposes to the public shall file with the secretary of the State Board of Health, within ninety days after receipt of notice from said secretary, certified plans and surveys, in dupli-cate, pertaining to the source from which the water is derived, the possible sources of infection thereof, and the means in use for the purification thereof, in accord-ance with the directions to be furnished by the said secretary. Failure to file said plans and surveys, as required in this subsection (c), shall be a misde-meanor, and upon conviction those responsible therefor by neglect of duty imposed thereby shall be fined not less than fifty nor more than one hundred dollars, at the discretion of the court ; and every delay of one calendar month after the expi-ration of the said ninety days shall be a separate offense." Sec. 3. That section three thousand four hundred and fifty-seven of said Re-visal be amended by adding thereto as subsection (a) the following: "(a) That for any violation of this section or of the laws relating in any way to the public health it shall be the duty of the solicitors of the several judicial districts, upon complaint of the board of health, or of any of its officers, or of any individual injured or likely to be injured, to institute a criminal action against the person, firm, corporation or municipality charged with such violation in their respective districts, and prosecute the same." Sec. 4. That section four thousand four hundred and forty of said Revisal be amended by striking out all after the heading and substituting in lieu thereof the following: "The State Board of Health shall have a president, a secretary (who shall also be treasurer) and an executive committee, said executive committee to have such powers and duties as may be assigned it by the board of health. The president shall be elected from the members of the board and shall serve six years. The secretary-treasurer shall be elected from the registered physicians of the State and shall serve six years. The executive committee shall be composed of the president and the engineer member of the board, ex officio, and one other member of the board, to be elected from those composing it. The executive office of the board shall be in the city of Raleigh and the secretary shall reside there. The secretary shall be the executive officer of the board, and shall, under its direction, devote his entire time to public health work and shall be known as the State Health Officer. He shall receive for his services such yearly compensation as shall be fixed by the board, not to exceed three thousand dollars and his actual traveling and hotel expenses when engaged in the work of the board. The board may in its discretion elect as a special assistant to the State Health Officer, for the anti-tuberculosis work, the Secretary of the State Association for the Preven-tion of Tuberculosis, at an annual salary not to exceed six hundred dollars. The members of the board shall receive no pay, except that each member shall receive four dollars a day and necessary traveling and hotel expenses when on actual duty THIRTEENTH BIENNIAL REPORT. 9 in attending the meetings of the board or of the executive committee or in pursu-ing special investigations in the State; but when attending important sanitary meetings beyond the limits of the State, the number of delegates thereto being limited to one, in addition to the secretary, only actual traveling and hotel ex-penses shall be allowed. These sums shall be paid by the treasurer on authenti-cated requisition, approved and signed by the president." Sec. 5. That section four thousand four hundred and forty-two of said Eevisal be amended by adding thereto the following: "The executive committee shall meet at such time as the president of the board may deem necessary, and he shall call such meetings through the secretary." Sec. 6. That section four thousand four hundred and forty-four of said Revisal be amended by adding thereto the following: "Provided, that if the sanitary committee of any county shall fail to elect a county superintendent of health with-in two calendar months after the time set in section four thousand four hundred and forty-one of said Eevisal for such election, the State Board of Health shall appoint a registered physician of good standing, resident in the said county, who shall serve the remainder of the regular two-year term, and shall fix his compen-sation, to be paid by the said county, in proportion to the salaries paid by other counties for the same service, having in view the amount of taxes collected by the said county." Sec. 7. That section four thousand four hundred and fifty-seven of said Revisal be amended by striking out, in line two, the word "two" and inserting in lieu thereof the word "six." Sec. 8. That section four thousand four hundred and sixty of said Eevisal be amended by adding thereto as subsection (a) the following: "(a) Any householder in whose family there is to his knowledge a person sick of cholera or typhoid fever, who shall permit the bowel discharges of such sick person to be emptied without first having disinfected them according to in-structions to be obtained from the attending physician or the county superintend-ent of health, shall be guilty of a misdemeanor, and upon conviction shall be fined not less than two nor more than twenty-five dollars or imprisoned not less than ten nor more than thirty days. In cases where such undisinfected discharges are emptied on the watershed of any stream or pond furnishing the source of water supply for any public institution, city or town, the penalty shall be a fine of not less than twenty-five nor more than fifty dollars or imprisonment for not more than thirty days. And any physician attending a case of cholera or typhoid fever who refuses or neglects to give the proper instructions for such disinfection as soon as the diagnosis is made shall be deemed guilty of a misdemeanor, and upon conviction shall be fined not less than ten nor more than fifty dollars." Sec. 9. That section four thousand five hundred and eight of said Eevisal be amended by inserting after the word "mention," in line eight, the words "or of tuberculosis or typhoid fever." Sec. 10. That this act shall be in force from and after its ratification. Ratified this the 8th day of March, A. D. 1909. 10 NORTH CAROLINA BOARD OF HEALTH. CHANGES IN PERSONNEL OF BOARD. In amending section 4440 of The Eevisal of 1905 the General Assem-bly of 1909 greatly benefited the cause of public health. This amend-ment increased the appropriation for the Board from $2,000 to $6,000, thereby, making it possible to further amend this section by requiring the entire time of the executive officer of the Board to be devoted to the public health work of the State. In securing the favorable consideration of the General Assembly for this extension of the work of the Board, former Secretary Dr. Richard II. Lewis was chiefly instrumental. The act, by requiring the entire time of the Secretary, made it necessary for the father of the bill to culminate seventeen years of patriotic devotion to the State's greatest asset, the health of her people, in his own official self-sacrifice. Along the trail that this pioneer sanitarian blazed through discouragement, super-stition and incredulity, his followers will endeavor to propel, with the force of public opinion awakened to its civic obligations in the pre-vention of unnecessary death, the life saving legislation of the future. On March 30, 1909^ the State Board of Health met in a called meet-ing in the office of the Secretary, at Raleigh. Dr. Lewis then explained the amended law which required the executive officer to devote his entire time to the work of the Board. After stating that he could not afford to surrender his practice, he tendered his resignation as Secre-tary. The Board, after insisting in vain upon the withdrawal of the resignation, reluctantly accepted it. Dr. W. S. Rankin, of Wake For-est, was elected to succeed Dr. Lewis. The present incumbent took charge of his duties July 1, 1909. Another change in the personnel of the Board was caused by the untimely death of Dr. James A. Burroughs, of Asheville, on December 28, 1909. Dr. James E. Ashcraft, of Monroe, Avas elected by the Board at Wrightsville on June 22, 1909, to fill the vacancy made by the death of Dr. Burroughs. Colonel J. L. Ludlow, of Winston-Salem, whose term of office expired in May, 1909, Avas reappointed by the Governor. POLICY AND DUTIES OF STATE BOARD OF HEALTH. In pursuance of the policy inaugurated by his predecessor, the present Secretary has recognized the functions of the Board of Health as execu-tive and advisory or educational. Of the two duties the last is of first importance. Even the enactment of law, and much more the execution of law, is dependent upon an approving public sentiment, and public sentiment is the direct offspring of education. The Earl of Derby was therefore correct in saying, "Sanitary instruction is even more im-portant than sanitary legislation." With the great amount of indifference to the enforcement of sanitary laws on the part of the people, public health education, carried on through all available agencies, press, special literature and platform, is the most urgent, important and gigantic task of the Board. Neverthe- THIRTEENTH BIENNIAL REPORT. 11 less, the will of the people as expressed through their representatives makes the executive duties of the Board mandatory, and for this reason they will be first considered. Executive Functions of Boards of Health. DIFFERENCE IN PRINCIPLE OF STATE AND LOCAL HEALTH LAWS. The executive function of the State Board of Health consists in see-ing to the enforcement of all State health laws, with the exception of the Food and Drug Act. Health laws are and always will be divisible into State and local laws—municipal and county health laws. State health laws should control all those conditions affecting the public health that are not limited to the jurisdiction of counties; that is, that are inter rather than mira-county concerns. Those conditions that affect the public health and that conform to this principle are sanitary control of watersheds, the law requiring the registration of deaths, the sanitary supervision of State institutions and the enforce-ment of quarantine. The reasons for this are perfectly clear. The only available water supply of a town may be taken from a river that flows through another county before reaching the one in which the town supplied is located. Under such conditions, the necessary, just and only protection of the purity of such water supply must be furnished by the State. The same thing holds true for the law requiring the registration of deaths. If each county had its own system of death registration, there would be no uniformity, and, for comparison (and this is the only value of sta-tistics), the records would be almost worthless. The sanitary super-vision of State institutions that care for the afflicted and criminal, not of one county but of the entire State, should be, as it is, under State control. A GRAVE DEFECT IN THE STATE HEALTH LAWS. Contagion is no respecter of county boundaries, and the law controll-ing the prevalence of contagious diseases should be enforceable through State officials. Right here is one of the most serious defects in the health laws of our State. At present quarantine, that is, the control of contagious diseases, is entirely within the jurisdiction of the county superintendent of health. An inefficient county superintendent of health, elected and retained in office by a responsible board of county commissioners, may neglect or refuse to quarantine or disinfect until an epidemic in his county spreads and involves other contiguous and even distant counties. In this way it is in the power of a board of county commissioners to permit their county to become a hotbed for the dis-semination of disease, a public nuisance, and an expensive neighbor to sister counties and even other States. Under such conditions the State at present is powerless. A large number of appeals from county super-intendents of health to the secretary of the State Board of Health ask-ing protection for their counties against contagion turned loose through ignorance, indifference, or deliberate political play of moral weakness to ignorant popular favor, are now on file in the office of the secretary. 12 NORTH CAROLINA BOARD OF HEALTH. \ To these appeals we were, under our present quarantine law, debarred from extending the necessary assistance. A bill will be introduced in the present General Assembly to give the State authority to enforce the quarantine laws, making it possible thereby to protect the majority of intelligent, health-loving counties from a few county health governments remarkable for lax quarantine enforcement. PRESENT STATE HEALTH LAWS. The present enforceable State health laws are : The law requiring the registration of deaths in towns or cities with a population of 1,000 or over, according to the last decennial census; the law relating to the inspection of State institutions ; the law requiring the distribution of diphtheria antitoxin to the indigent sick of diphtheria ; the law requir-ing the appointment of a county superintendent of health when this duty is not performed by the county sanitary committee; the law per-taining to the sanitary control of public water supplies and the law governing the work of the State Laboratory of Hygiene. THE VITAL STATISTICS LAW. To the health officer vital statistics are what the chart and compass are to the mariner. Without them he knows not whence he came nor whither he goes. By vital statistics he is warned against danger. A timely warning, an opportune application of the ounce of prevention, and many lives are saved. For example, the vital statistics of a certain town show that that town has twice the average death rate of other towns in which the same climatic conditions prevail. This fact, but for these statistics, would escape notice, for people die slowly, and neighbors, without some comparative record, would regard their deaths as natural. An inves-tigation follows the disclosure of these statistics, and the cause of this increased death rate is discovered ; the cause is then removed and proper precautions are taken to prevent its continued morbid effect and the loss of many lives is prevented. By vital statistics the health officer's course—progression or retro-gression— is both indicated and measured. Some measure of supposed sanitary value is put into operation. Its value will be measured almost wholly by the statistical returns. If it is without effect, the cost of operating it will be saved; if it is life-saving, others may know and take advantage of it. By vital statistics justice often finds her way clear and travels quickly, whereas, without them, she creeps along with difficulty or loses altogether the indistinct trail of the murderer, abortionist, or suicide. Without them the child labor law is often administered by an ignorant or cruel parent. ~No birth registration, no efficient child labor laws. Our vital statistics law, chapter 722, Laws of 1909, pronounced by Chief Statistician Wilbur, of the United States Bureau of the Census, to be the only practical vital statistics law in the South, has been in operation since September, 1909. This authority and government ex-pert on the enforcement of vital statistics laws made an inspection of THIRTEENTH BIENNIAL REPORT. 13 the results of the enforcement of our vital statistics law through a per-sonal visit and examination of the certificates filed in the office at Raleigh, in the early part of April, 1910. It is encouraging to those of us concerned in its execution to know that he was well pleased with its enforcement. The approval of the execution of this law encour-ages us to hope that North Carolina will at an early date he accepted by the Federal Government as a registration State. At present our vital statistics law applies only to cities and towns with a population of 1,000 or over, according to the last decennial census. This gives us a registration area containing about 450,000 people, or about one-fifth of our State's population. THE LAW GOVERNING SANITARY INSPECTION OF STATE INSTITUTIONS. This law has been faithfully executed. In every instance the inspec-tion was made without previous notification, and the conditions found may therefore be regarded as a fair index to the everyday conditions obtaining in our State institutions. The official report of these inspec-tions will be found on pages 85-92 of this report. THE LAW REQUIRING THE DISTRIBUTION OF DIPHTHERIA ANTITOXIN. In accordance with this act, passed by the Legislature of 1909, 67 counties and 8 cities have availed themselves of the opportunity of obtaining antitoxin at a very reduced rate for their poor. The State Laboratory of Hgyiene acts as a distributing depot, and ships the antitoxin, on demand, to any point in the State. By the contract with the manufacturers, the special rate can be obtained only for indigent cases when paid for by the county or municipality. The benefits of the act do not apply to that largest class of the population, the independent poor, those who do not want to be classed with the indigent, yet can ill afford to pay the high prices charged for diphtheria antitoxin. It is therefore recommended that the General Assembly be requested to fur-nish diphtheria antitoxin to its citizens free of charge or at least ar-range to furnish it to all its citizens at actual cost. It is possible that the latter arrangement could be made without a change in the law, and it is recommended that a new contract be sought with this in view. It may be desirable ultimately for the State to manufacture its own anti-toxin, but meanwhile the same good can be accomplished at approxi-mately the same cost if the General Assembly sees fit to buy all the anti-toxin needed for its citizens. A bill will be introduced in the next legislature asking for a change in this law. THE LAW REQUIRING THE APPOINTMENT OF A COUNTY SUPERINTENDENT OF HEALTH. The proviso in Section 4444, Revisal of 1905, as amended by the General Assembly of 1909, authorizes the Secretary of the State Board of Health to appoint a county superintendent of health in counties where the sanitary committee have failed to elect that official. In only one instance has it been necessary for the secretary to comply with this proviso of the law during the last two years. 14 NORTH CAROLINA BOARD OF HEALTH. THE LAWS RELATING TO THE PUBLIC WATER SUPPLY. The laws governing the protection of public water supplies against pollution requires the filing in duplicate by the superintendent of the water company of certified plans and surveys of the watershed made in accordance with instructions furnished by the State Board of Health. These instructions are embodied in "Circular A," an exact copy of which is reproduced on page 98 of this report. The law protecting the public water supplies against pollution further requires that a quarterly inspection and report of the sanitary condi-tion of the watershed and all surface supplies be made in accordance with reasonable rules and regulations of the State Board of Health. In accordance with these rules and regulations the sanitary inspectors of the different surface supplies are furnished with instructions for making the inspection. These instructions are embodied in "Circular B," an exact copy of which is reproduced on page 101 of this report. In making the inspection of a watershed the inspector leaves at each home a copy of "Circular C," which instructs the householder and family in regard to their duties in the protection of the public water supply through the proper sanitary care of their premises. This circular is reproduced on page 108 of this report. Finally, the inspector after having made his inspection in accordance with "Circular A," and after having instructed the residents on the watershed in accordance with "Circular C," makes out his report in duplicate on "Form A," an exact copy of which is reproduced on page 110 of this report, and then mails these reports to the Secretary of the State Board of Health. In connection with the sanitary supervision of the public water sup-plies, I feel that as the State health officer I should violate both my sense of duty and my public trust if I failed to make grateful acknowl-edgment of the cordial, untiring and almost unlimited assistance ren-dered me in my efforts to protect the public water supplies by Colonel J. L. Ludlow, of the State Board of Health. His able service has been given so unstintedly to the public water supply interests that I feel that it is a considerable imposition on the part of the State to accept these services further without some material compensation. The sanitary patrol and inspection of watersheds for the purpose of preventing water-borne disease is reinforced in its purpose by the law requiring monthly analyses of the various public water supplies. It has never yet been necessary to apply to the courts to enforce the law requiring water companies to send samples of their water monthly for analysis, but the penalty for the enforcement of this law is so small that Ave hope the General Assembly of 1911 will see fit to increase it. Analyses to the number of 14,826 have been made in accordance with this law from January 1, 1909, to December 31, 1910. The law protecting public water supplies also applies to springs from which water is sold either at summer or health resorts or in bottles. This law requires that these springs shall pay a graduated tax or procure a license, through which revenue the State Laboratory of Hygiene shall be able to analyze the waters of these springs. The law further pro- THIRTEENTH BIENNIAL REPORT. 15 vides that if any bottled water be found polluted in three successive analyses, publication of that fact shall be made in the Monthly Bul-letin of the State Board of Health. Very little trouble has been experienced in the enforcement of this law. During the last two years three bottled waters have been found polluted, and notice thereof given to the public through the Bulletin. Here I wish to call attention to the wide and beneficent scope of this law. Those placing bottled waters on the market, knowing that sooner or later some of the water will find its way into the State Laboratory of Hygiene and there be analyzed, realize that if it is found polluted and published through the Monthly Bulletin of the State Board of Health, not only to the people of ISTorth Carolina but throughout the United States, their business will be seriously injured. In this way this law has a splendid influence in keeping commercial waters pure, not only at the springs and bottling plants in North Carolina, but also throughout the United States. THE LAW ESTABLISHING THE STATE LABORATORY OF HYGIENE. This law, Section 3057 of The Bevisal of 1905 as amended by the Legislature of 1909, finds ample justification in the following detailed statement : NUMBER OF SPECIMENS EXAMINED AT THE NORTH CAROLINA STATE LABORA-TORY OF HYGIENE FROM MARCH 1908 TO DECEMBER 31, 1910. 1908 January February March. 62 April 104 May 114 June 141 July 183 August 227 September 271 October 201 November 171 December 189 1909 16 NORTH CAROLINA BOARD OF HEALTH. Mississippi has just opened a laboratory, while Texas, Arkansas, Ken-tucky, and Tennessee have no organized laboratories for work of this character. The direct appropriation to the Laboratory by the Legislature is $2,000. The tax on water companies is approximately $4,000, thus making the income of the laboratory $6,000. Eleven thousand six hun-dred and forty-four different specimens were examined. The cost to the State of each examination made in 1910 was 51 1-2 cents. Among the specimens examined were 1,835 water analyses, each of which comprises from five to twenty-five distinct chemical and bacteriological tests. If each of these were estimated as separate tests the average cost would be greatly reduced. Out of the above sum also 160 patients were given the Pasteur anti-rabies treatment, as no appropriation is made for this work. OPINIONS OF ATTORNEY-GENERAL. In executing the State public health laws it has frequently been necessary to ask the advice of the Attorney-General. That official has always given us the most cordial co-operation and it is impossible to overstate our deep appreciation for his valuable opinions. A copy of these opinions will be found on pages 68-84 of this report. EDUCATIONAL FUNCTIONS OF THE STATE BOARD OF HEALTH. Section 4437 of The Revisal of 1905 as amended by the General As-sembly of 1909 reads as follows: "The Board of Health shall take cognizance of the health interests of the people of the State; shall make sanitary investigations and inquiries in respect to the people, employing experts when necessary; shall investigate the causes of dis-ease dangerous to the public health, especially epidemics, the sources of mortality, the effect of locations, employments and conditions upon the public health. They shall gather such information upon all these matters for distribution among the people, with the especial purpose of informing them about preventable diseases." The italics are ours. This educational provision for the improvement of public health is a most wise one. Out of education comes public sentiment ; through pub-lic sentiment, law is both enacted and enforced. At present ninety per cent of the work of the Board is of an educational nature. This work has been carried on through the Bulletin of the State Board of Health, through contributions to the newspapers, and through public addresses. THE BULLETIN. The Bulletin has grown in circulation from 3,500 in January, 1910, to 18,000 January, 1911, and with this increased circulation the size of the Bulletin has been enlarged from a ten page to a seventy page pub-lication. During the past four months, requests for the Bulletin have averaged thirty-five daily. At present the entire ministerial, legal and medical profession, about seven thousand out of the ten thousand school teachers, and a large number of other wide-awake people throughout the State receive this educational monthly. THIRTEENTH BIENNIAL REPORT. 17 To give a wider field of usefulness to the Bulletin, a contributory Board of Editors composed of the following gentlemen, have agreed to assist in its publication : 1. Governor W. W. KITCHIN, Raleigh, N. C. 2. Hon. A. H. ELLER, Winston-Salem, N. C. 3. Hon. E. W. SIKES, Wake Forest, N. C. 4. Hon. W. C. DOWD, Charlotte, N. C. 5. Mr. CLARENCE POE, Raleigh, N. C. 6. Mr. ARCHIBALD JOHNSON, Thomasville, N. C. 7. Rev. GEORGE W. LAY, Raleigh, N. C. 8. Dr. HENRY L. SMITH, Davidson, N. C. 9. Dr. FRANCIS P. VENABLE, Chapel Hill, N. C. 10. Dr. W. P. FEW, Durham, N, C. 11. Dr. WILLIAM L. POTEAT, Wake Forest, N. C. 12. Dr. F. L. STEVENS, West Raleigh, N. C. 13. Dr. CYRUS THOMPSON, Jacksonville, N. C. 14. Dr. CHAS. O'H. LAUGHINGHOUSE, Greenville, N. C. 15. Dr. L. B. McBRAYER, Asheville, N. C. 16. Dr. BENJ. K. HAYS, Oxford, N. C. 17. Dr. EDWARD J. WOOD, Wilmington, N. C. 18. Dr. WILLIAM DeB. MacNIDER, Chapel Hill, N. C. 19. Dr. H. A. ROYSTER, Raleigh, N. C. 20. Dr. J. L. NICHOLSON, Richlands, N. C. This means that the Bulletin through a greater variety of expres-sion and subject matter will be more attractive and more serviceable than ever before. It, of course, would be impossible without great ex-pense to republish the entire issues of the Bulletin during the past two years in this report. THE STATE PRESS. The press of the State has been most cordial in its co-operation with the Board for better public health. Always liberal in the use of their columns for the public service, they have, in the assistance given us, even exceeded their own enviable reputaton for generosity. The State press in calling repeated attention to the fact that the Bul-letin could be had for the asking, and that it was well worth a place in the homes of our people, have had much to do with building up a greater demand for that publication. During the months of July, Au-gust, September, and October many of the papers of the State pub-lished weekly articles on public health sent out from this office. To conclude, the assistance of the press has been of inestimable value. ADDRESSES. During the last twelve months a number of public health addresses — fifty or sixty—have been delivered to audiences representing different fields of activity. The Conferences of County Superintendents of Schools for 1909 and 1910, the North Carolina Teachers' Assembly, the North Carolina State Primary Teachers' Association, the Meeting of Conductors of Teachers' Institutes, a number of Teachers' Institutes, 18 NORTH CAROLINA BOARD OF HEALTH. the North Carolina Press Association, the Tri-State Medical Society, the Wake County Medical Society, the Guilford County Medical So-ciety, the North Carolina Society for the Study and Prevention of Tuberculosis, the Carolina Municipal Association, the State Federation of Women's Clubs, and many other gatherings of people have been ad-dressed on the fundamental problem of public health. Through the interest aroused in these various oganizations others have taken up the study of public health problems and these have succeeded in interesting many others. THE ANTI-HOOKWORM CRLSADE. Under the able direction of Assistant Secretary Dr. John A. Ferrell, the public have been seriously and actively interested in a general cam-paign against a disease the frequency of which probably totals all other diseases combined. Dr. Ferrell's report of the work accomplished is given in detail on page 93 and a very superficial perusal of this report will warrant the assertion that the work could not be in better hands. THIRTEENTH BIENNIAL REPORT. 19 Meetings of the Board Office of the Secretary, Kaleigh, ]ST. C, March 30, 1909. Called meeting. All the members of the Board present. The Presi-dent called upon the Secretary to explain the object of the meeting. In response he stated that the principal reason for calling the meeting was that such action might be taken by the Board as was rendered necessary by the amendment to the laws relating to the public health enacted at the recent session of the General Assembly. For the information of the Board the Secretary then read the four acts relating to the public health, the titles of which were as follows : An Act to Amend Sections 3045, 3058, 3457, 4440, 4442, 4444, 4457, 4460 and 4508 of The Revisal of 1905, Relating to the Public Health. An Act to Amend Section 3057 of The Revisal of 1905, relating to the State Laboratory of Hygiene. An Act to Provide for the Registration of Deaths in Municipalities of One Thousand Population and Over in the State of North Carolina. An Act to Provide Diphtheria Antitoxin for Indigent Persons Sick of Diph-theria. He also called attention to the fact that the annual appropriation for the support of the State Sanatorium for Tuberculosis had been in-creased by the Legislature from $5,000 to $7,500, and that an additional appropriation for permanent improvements of $15,000 a year for two years had also been made. Dr. Lewis then offered his resignation as Secretary and Treasurer, to take effect June 30th, the last day of the month in which the fiscal year ended. He gave as his principal reason for taking such a step the fact that the new law required the Secretary to devote his entire time to the cause of the public health and that he was unwilling to abandon his regular profession—his life work. He expressed his regret at giving up the work which had been for so many years largely a labor of love, but felt sure that it was best both for the work's sake and for his own. He explained to the Board that for some years he had realized that the great importance of the work demanded all the time of a competent Secretary with ample assistance, and believing the time to be auspicious for a forward movement, he had prepared a bill which if enacted into law, while legislating himself out of office, would bring this about. He also stated that believing the successful prosecution of the work to be dependent upon the qualifications in several respects of the new Secre-tary and that a mistake in the selection of the man would be a mis-fortune hard to remedy he had gone over in his mind the medical men of the State and assured himself that such a man was available and that if elected he would accept the position, before he wrote the bill. Hav-ing expressed his gratification at tho fact that he would still continue a member of the Board and his sincere appreciation of the unvarying 20 NORTH CAROLINA BOARD OF HEALTH. kindness, courtesy and cordial support of the Board during his in-cumbency of nearly seventeen years, he retired from the meeting. Minutes by Dr. Way, Secretary pro tern. Dr. Lewis resigned to take effect June 30, 1909, retiring from the hall. The President placed his resignation before the Board and asked their pleasure. Dr. Register expressed his great appreciation of the splendid work of seventeen years and his regard for Dr. Lewis and had felt that if he (Dr. Lewis) could be induced to continue he would ask him to do so. He wished his appreciation of Dr. Lewis's great work be recorded. Dr. Anderson reciprocated fully the words of Dr. Register. Dr. Spencer moved that a committee composed of Drs. Register and Thomas be appointed to confer with Dr. Lewis and ask if he can re-consider his resignation and serve out his full term. Carried. This committee through Dr. Thomas reported that Dr. Lewis felt compelled to consider his resignation as final. Dr. Thomas eulogized Dr. Lewis as one of the notably few men he had ever known fitted for the work. On motion of Dr. Burroughs seconded by Dr. Spencer, Dr. Lewis's resignation was accepted. Dr. Burroughs moved that a committee of three be appointed by the President at his convenience to prepare resolutions expressive of ap-preciation for the annual session of the Board in June. Carried. Dr. Lewis, returning, resumed his duties as Secretary. The chair announced that nominations for Secretary and Treasurer to fill the vacancy were in order. Dr. Lewis, prefacing his remarks by the state-ment that he felt that he ought to say that Dr. Way had been his first choice as his successor and that upon the assurance of the doctor that while he felt a deep interest in the work he could not afford to give up his lucrative practice and comfortable home, he had worked for and found another good man, placed in nomination Dr. Watson S. Rankin, Dean of the Medical Department of Wake Forest College, at a salary of $3,000 a year. He declared Dr. Rankin to be in his. opinion a man of character, ability, energy, enthusiasm and possessed of the altruistic spirit so helpful in work of this kind and admirably fitted for the position. The nomination of Dr. Rankin was seconded by Drs. Bur-roughs, Register and Way, and he was unanimously elected. Action on the election of an Assistant Secretary for the anti-tuber-culosis work was upon a motion of Dr. Way, postponed until the annual meeting in June. The Secretary called attention to the fact that under the new law one member of the Board must be elected to complete with the Presi-dent and the engineer ex officio, the Executive committee. On motion of Dr. Way, Dr. Lewis was elected to serve on the Executive Com-mittee. On motion, the salary of Dr. C. A. Shore, Director of the Laboratory of Hygiene, was increased from $2,000 to $2,500 a year; that of Miss Daisy Allen, Chemical Assistant, from $75 to $90 a month, and that of Miss Mabel P. Massey, Stenographer, from $50 to $75 a month, it being understood that she was to give her whole time to the work of the Board. All increase in salary to take effect July 1, 1909. THIRTEENTH BIENNIAL REPORT. 21 Dr. Way, representing the Board of Health of Waynesville, filed with the Board plans for a public water supply which had been approved by the sanitary engineer of the Board. The plans were approved. On motion, the Board adjourned. Bichard H. Lewis, Secretary. Battery Park Hotel, Ashevtlle, N". C, June 15, 1909. The Board met in annual session in the room of the Secretary, with President Thomas in the chair. Those present were Drs. Thomas, Anderson, Way, Spencer, Register, Burroughs, Col. Ludlow and the Secretary. The minutes of the last annual meeting at Winston-Salem and of the called meeting held at Raleigh, March 30, 1909, were read and ap-proved after the correction of the latter by the insertion of the follow-ing resolution which had inadvertently been omitted : "Resolved, That His Excellency the Governor be requested to reappoint Col. J. L. Ludlow as the Engineer member of the Board." Unanimously adopted. Drs. Ray and Robertson, of Yancey County, appeared before the Board at the request of the Chairman of the Board of Commissioners of that County to request the appointment by the Board of Health of a Superintendent of Health for that county, as the County Sanitary Com-mittee had failed to elect one. As the two months required by the statute before action could be taken by the State Board of Health had not expired, the matter, upon the motion of Dr. Spencer, was referred to the Executive Committee. The Secretary having called attention to the expiration of the term of Dr. Way as a member of the State Board of Embalming, he was re-elected for the full term of five years. Col. Ludlow called attention to the menace to the public water supply of the town of Greenville by the discharge of raw sewage into Tar river by the towns of Rocky Mount and Tarboro and offered the following resolution : "Resolved, That the Secretary of the Board shall give notice to the municipal authorities of the towns of Rocky Mount and Tarboro that Section 3051 of The Revisal of 1905 must be immediately complied with; and further, that in the event that said towns shall fail to provide and put into operation such sewage purification plants as said law requires within six months from this date, the Secretary of the Board is hereby instructed to take such legal steps as may be necessary to secure a restraining order from the courts of the State enjoining said towns from further discharge of raw sewage into Tar River and to take such steps as may be necessary to secure the conviction and punishment of either or both of said towns and the authorities thereof for committing a misdemeanor as defined and provided for, in the said public health laws of the State of North Carolina." This resolution was adopted. 22 NORTH CAROLINA BOARD OF HEALTH. Col. Ludlow then called attention to the menace to the Raleigh water supply by the town of Cary and offered the following resolution : "Resolved, That the Secretary shall give notice to the municipal authorities of the town of Cary that the provisions contained in Section 3052 of The Revisal of 1905 must be fully complied with immediately; and further, in the event said authorities shall fail to comply with said Section 3052 within three months of this date the Secretary is hereby instructed to take such steps as may be necessary to secure the conviction and punishment of said town authorities for committing a misdemeanor, as provided in said Section 3052 and in Section 3060." This resolution was adopted by the Board. The Engineer of the Board likewise set forth the danger of the con-tamination of the public water supply of the town of High Point and offered the following resolution : "Resolved, That the Secretary shall give notice to the General Manager and the Division Superintendent of the Southern Railway Company that in compliance with the provisions of the Public Health Laws of North Carolina and more par-ticularly of Section 3049 of The Revisal of 1905, the said railway company is instructed to issue orders, and to secure the enforcement thereof, that all water closets on trains shall be locked and disused between the depot of High Point, in Guilford County, and the bridge crossing Deep River; and further, that the casting from trains of sweepings from cars, dining car refuse, or other garbage shall not be permitted between said points where the said railway traverses the watershed of the High Point public water supply; and further, should this in-struction and said laws be violated, that the Secretary shall take such steps as may be necessary to secure the conviction and punishment of the said railway company and the officers thereof for committing a misdemeanor, as provided for in the Public Health Laws of the State of North Carolina. And further, that the Secretary shall give similar notice and take similar action in other cases where railways traverse the watershed of any public water supply within the State whenever the knowledge of such condition may be brought to his atten-tion." After considerable discussion the following substitute for the above resolution, suggested by the Secretary and offered by Dr. Anderson, was adopted : "Whereas, The Southern Railway runs across the watershed of the public water supply of the town of High Point and for a considerable distance quite close to the bank of the stream of supply and the impounding reservoir and, "Whereas, There is danger of infection of the said public water supply by the infections of the passengers ; therefore, be it "Resolved, That in compliance with Section 3047 of The Revisal of 1905 the Southern Railway Company be, and it is hereby requested to have all water closets locked between High Point and Deep River bridge." Dr. Way was elected the delegate to the next meeting of the American Public Health Association at Richmond and Dr. Lewis to that of the Conference of State and Provincial Boards of Health at Washington. Upon motion, the Executive Committee was empowered to exercise all THIRTEENTH BIENNIAL KEPOKT. 23 the powers of the Board of Health in the time between the meetings of the Board. The President appointed Dr. Spencer and Col. Ludlow a committee to audit the accounts of the Treasurer. Upon motion of the Secretary his successor, Dr. Rankin, was invited tc sit with the Board and take part in the proceedings. Accepting the invitation the doctor expressed his appreciation of the honor done him by the Board in his election as Secretary and Treasurer to succeed the present incumbent and pledged his faithful service. Upon his inquiry as to whether the Board or an individual would be expected to buy books for the library of the Board, expressing his willingness to make the pur-chases himself, Dr. Way moved—and the motion was carried—that the Secretary be authorized to purchase such books and subscribe to such journals relating to the public health as in his judgment might be needed and the available funds would permit. Upon motion of the outgoing Secretary, who agreed to look after the office during the absence of his successor, Dr. Rankin was authorized and requested to spend a month in investigating the practical methods pursued by the executive health officers of such States as he might select and in visiting the United States Hygienic Laboratory and the Bureau of the Census, his traveling and hotel expenses to be paid by the Board. Upon motion the Board adjourned to meet in conjoint session with the State Medical Society tomorroAv at noon. Richard H. Lewis, Secretary. Annual Session of the Board of Health. Asheville, 1ST. C, June 16, 1909. The Board reassembled at 3 p. m. with President Thomas in the chair and all the members present except Drs. Burroughs and Taylor. In compliance with the amended law the Secretary nominated Dr. C. A. Julian, the Secretary of the North Carolina Association for the Prevention of Tuberculosis, for the position of Assistant Secretary of the Board for Tuberculosis at a salary of three hundred dollars a year. Dr. C. A. Julian was duly elected. Upon the statement of the Secretary that Drs. E. J. Wood and H. Bellamy, of Wilmington, had expressed a willingness to do research work in the study of pellagra under the auspices of the Board they were appointed a commission to undertake it. Upon motion of Dr. Spencer, the Treasurer was instructed to pay the traveling and hotel expenses incurred by Dr. Lewis as delegate to the meeting of the American Public Health Association at Winnipeg, Manitoba. Upon motion the President appointed Drs. Way and Register a com-mittee to draft suitable resolutions in regard to the retirement of the present Secretary. The Auditing Committee reported that they had examined the ac-counts and vouchers of the Treasurer and found them correct. Upon motion the Board adjourned. Richard H. Lewis, Secretary. 24 NORTH CAROLINA BOARD OF HEALTH. In the transcription of the proceedings from the rough notes of the meeting of the 15th a sheet was inadvertently overlooked until after the above was signed. The part of the proceedings referred to were as follows : Upon motion of Dr. Way it was ordered that the Monthly Bulletin of the Board be enlarged in expense and scope and that its mailing list be enlarged as much as practicable. Upon motion of Dr. Way the Secretary was requested to furnish the Secretary of the Wake Medical Society a copy of the proceedings of the Board at its called meeting on March 30, 1909, and of this session for publication in the transactions of that society. Upon motion of Col. Ludlow the State Superintendent of Public In-struction was requested to require in the public schools not less than a five-minute period daily to be devoted to some subject bearing on health and the Secretary was requested to furnish the teacher with serviceable literature. Richard H. Lewis, Secretary. Conjoint Session of the North Carolina Board of Health with the Medical Society of the State of North Carolina. President G. G. THOMAS, Chairman. Asheville, N. C, June 16, 1909. The meeting was called to order by Dr. Thomas, of Wilmington, Chairman of the State Board of Health. Dr. Thomas : "This conjoint session marks a period in the history of the State Board of Health of North Carolina, which to us is very significant. It is the end of the service of Dr. R. H. Lewis, for so long the efficient Secretary. "Following Dr. Wood, the pioneer of sanitation in North Carolina, he took up the work with zeal and enthusiasm, which he has guided and carried on by his wonderful judgment to its present high state. To Dr. Lewis belongs the spread of sanitary knowledge in the State of North Carolina, and the present influence of the Board of Health in the com-monwealth. "All of you are aware that these steps towards the commanding posi-tion it now holds have been slow and faltering, but the State at large has come to realize the fact that the State Board of Health has done good work for it, and its recognition, I think, is thoroughly voiced in the action of the last Legislature, in largely increasing the fund for its support, at the suggestion of our Secretary, Dr. Lewis—which is the prime evidence of the confidence which has followed his work, which is as well based upon the character of the man. He has gained not only our confidence and respect, but that of the gentlemen who represent the different constituencies throughout the State. THIRTEENTH BIENNIAL REPORT. 25 "I say, then, when this good man feels that he must lay down this work,—not because he is feeble or infirm ; I assure you of the contrary, it is because he can not relinquish his active professional work to take up the work of the State Board of Health exclusively,—it is time to feel grateful for the work he has done for the State and for the medical profession." (Applause.) Report of the Secretary read by Dr. Lewis. KEPORT OF THE SECRETARY, MAY 20, 1908, JUNE 11, 1909. Your Secretary, in this, his last report, is much gratified at heing able to say that his last year of service has witnessed the greatest advance of the cause of preventive medicine in our State, in a like period of time, since the establish-ment of the State Board of Health. For several years he has realized that, owing to the exactions of his private professional work, .the time he could- give to the work of the Board was entirely inadequate. He believed also, that, owing to the very small salary allowed the secretary, on account of the meager appro-priation, no one else could be expected to give more attention to it and make a proper living, and so he waited before taking action until, in his judgment, the outlook was favorable for an attempt at a forward movement. Upon the assem-bling of the last Legislature the conditions, in his opinion, justified making a trial for better things. Consequently, having found a man whom he believed to be well qualified for the position and having obtained from him a positive prom-ise to accept an election, if tendered him by the Board, your Secretary prepared a bill, while incidentally legislating himself out of office, as he could not afford to abandon his private practice, that would provide the means for work far in advance of anything heretofore attempted for the public health. The essential feature of the bill was an increase of the annual appropriation from two to ten thousand dollars, authorizing the payment to the Secretary of a salary of three thousand dollars a year and requiring him to give his entire time to public health work. While the Legislature cut down the appropriation asked for to six thousand dollars, it still left an increase of 200 per cent and a sum sufficient to secure all the time of a competent secretary, the one thing absolutely essential to any marked progress. As you already know, the present incumbent, at a call meeting on March 30th last, tendered his resignation, which was accepted, to take effect July 1st, and Dr. Watson S. Rankin, Dean of the Medical School at Wake Forest College, was unanimously elected as his successor. The public health laws were also materially and advantageously amended in many other respects, particularly those sections relating to the control of public water supplies by the State Board of Health, in the preparation of which latter amendments, invaluable aid was rendered by the engineer of the Board, Col. J. L. Ludlow. Section 3057 of The Revisal of 1905, relating to the State Laboratory of Hy-giene, was amended by specifically requiring analyses of drinking waters sold in bottles or other packages and imposing upon those selling them an annual tax graduated in proportion to the gross receipts from sales. While the. original act imposed an annual tax of $G4 upon all individuals, firms and corporations selling water to the people, it was found, upon investigation, that in many instances this was out of proportion to the business done, and it was deemed both right and wise to make the tax equitable and at the same time to make it perfectly clear 26 NORTH CAROLINA BOARD OF HEALTH. that bottled waters came within the law. The necessity for analysis of this class of waters was startlingly shown by analyses your Secretary had made in the laboratory in the genera] cause of the public health and for the purpose of supplying ammunition with which to meet an attack upon the law, threatened by the president of one of the companies selling a water of this class. Of sixty-one samples from twenty-nine springs thirty-two were found to be infected with colon bacilli. Although the gentleman referred to passed away before the General Assembly met, the information thus obtained was of service in securing the de-sired legislation. The section was further amended so as to require analyses of the waters of springs "maintained and treated as an adjunct to any hotel, park or resort for the accommodation or entertainment of the public," and an annual tax of $15 was imposed upon all such sources of water supply, with an addi-tional tax on all waters sold therefrom in bottles, in accordance with the schedule referred to above. Probably the weakest spot in our sanitary legislation has been the lack of reliable vital statistics. The only statistics we have had heretofore have been those collected by some twenty-odd cities and towns in various and manifestly, in some instances, very imperfect ways, and incomplete and inaccurate vital statistics are practically worthless. A model vital statistics bill for States was sent us by both the Bureau of the Census and by the American Medical Asso-ciation. Theoretically, it was an excellent bill, and for densely populated, highly organized communities it is doubtless practicable, but for our State, with its large, widely scattered rural population, and one-third of that negroes, it would have been little short of absurd. After a very careful consideration of the sub-ject it was decided that any attempt at the collection of reliable vital statistics holding out the least hope of success, for the present at least, would have to be limited to incorporated towns. So, desiring that our statistics might fit in with those of the United States Census Bureau, a request was made of Dr. Cressy L. Wilbur, Chief Statistician, to have prepared for us a bill applying only to cities and towns of one thousand population and over. Taking the bill he kindly and promptly sent as a basis, it was modified to fit our conditions. After its passage in its completed state it was very gratifying to learn from Dr. Wilbur that it was the first practical vital statistics law to be enacted in the South, and, more-over, that it contained a provision for the enforcement, new to him and in his opinion valuable. This provision was placing the responsibility for carrying out the law solely upon the mayor, and making him liable to a fine of not less than $10 for failure of duty in this respect: and at the same time making it mandatory upon the solicitor to institute a criminal action for its collection, upon complaint of the State Begistrar or Secretary of the State Board of Health. It really looks now as if vital statistics of real value, though necessarily partial, were in sight. The high price of diphtheria antitoxin being prohibitory to the poor, the pro-priety of making provision for its supply free to indigent cases of the disease should not be questioned by any humane person. The suggestion of the advisa-bility of such legislation came from Dr. B. E. Beeves, of Alleghany County, in a letter, accompanied by a tentative bill, to Senator B. L. Doughton, of the same county. The suggestion was cordially received, and at his request Dr. Beeves's bill was modified and amplified into the law as we now have it. Another forward step was the increase in the annual appropriation for the support of the State Sanatorium for Tuberculosis, from $5,000 to $7,500, and the THIRTEENTH BIENNIAL REPORT. 27 appropriation of $30,000 for improvements. This institution, which is ideally located, was opened for patients in November last, and promises to be of much value in the campaign against tuberculosis. The most gratifying and encouraging thing in connection with the health legis-lation by the late General Assembly is that, with the exception of the cutting down of the appropriation of ten thousand dollars asked for to six and an imma-terial amendment to the bill relating to the Laboratory of Hygiene, requiring reciprocity in the matter of analyses of bottled waters with other States having similar laboratories and requirements, all the bills relating to the public health in any way were passed without amendment and without a single vote in the negative. This signifies a remarkable growth in favorable public opinion and justifies the hope of more rapid progress in the near future. As this report is made to the conjoint session of the State Board of Health with the Medical Society, and as nothing is of more importance to the public health than well-qualified physicians, reference to the strictly medical legislation is in order. A bill, prepared by the Board of Medical Examiners, the essential feature of which was the requirement of a preliminary education equal to graduation from a high school of all applicants for license, was introduced in the House by one of its most influential members. The requirement was certainly a most reasonable one, and, as a matter of fact, of special value to the prospective student of medi-cine but it was bitterly fought with the usual demagogic arguments of "Medical Trust," "poor boy," and, after three hot contests, was finally defeated by a majority of one. The amendment to the license law, authorizing the Board of Medical Exam-iners, in its discretion, to modify the requirements of the law and to grant a limited license, when the conditions in the neighborhood from which the applicant came demanded it, met with no opposition. Sjjecial acts licensing certain physi-cians had been introduced and the indications were that they would be passed. To prevent this kind of legislation, which would mean in the end the practical destruction of our license law, this amendment was suggested as a compromise and accepted by the introducers of the bills. This action on the part of those having the matter in charge has been criticised in some quarters, but it should be said that a copy of the amendment was sent to every member of the Committee on Legislation and of the Board of Medical Examiners and was approved or as-sented to by all, with the exception of a single member of the Board of Medical Examiners. Those on the ground and familiar with the conditions as they actu-ally existed in the Legislature felt no doubt whatever as to its wisdom. Before leaving the subject of legislation, acknowledgment should be made of the valuable assistance rendered by Dr. Albert Anderson of the committee. After nearly seventeen years of active and loving service your Secretary lays down the work with regret, although he realizes that it is best for the work's sake as well as for his own. He is conscious of many things left undone that ought to have been done, and perhaps some things have been done that ought not to have been done, but he has tried to be of some service to the State. In conclusion, he wishes to express his deep and heartfelt appreciation of the unfailing and unvarying kindness and courtesy he has received at your hands, and to most cordially commend to you his successor, Dr. Rankin. Dr. Rankin he believes to be a man of character, ability, energy, enthusiasm and possessed of the altruistic spirit so helpful in work of this kind. If the profession in the 28 NORTH CAROLINA BOARD OF HEALTH. State will hold up his hands and give him their cordial support and co-operation he will do great things in the coming years for North Carolina. SMALLPOX REPORT. Counties. THIRTEENTH BIENNIAL REPORT. 29 The amount of work accomplished by Dr. Shore, the director, and his two assist-ants, Miss Allen, Chemist, and Mr. Kellogg, Biologist, when compared with that of some other laboratories, is, to say the least, unusual. A perusal of the report of the director, which is appended hereto, will show this. Twenty-three hundred and ninety-two examinations of specimens of various kinds and the administra-tion of the Pasteur treatment to eighty-three patients in addition, in one year, by so small a force, is most gratifying. This could not have been done but for the kindness of the United States Hygienic Laboratory in furnishing us the virus free of charge. Not a case has died, and our records, so far, could not be bettered. In January last the Laboratory was moved to very commodious quarters; it has been thoroughly furnished with the most approved apparatus and manned by a force as good as any, and we can confidently expect its increasing usefulness. The following is the report of examinations made in the State Laboratory of Hygiene from May 20, 1908, to May 20, 1909: 143 Examinations of feces — Positive. Negative. Hookworm 65 50 Oxyuris vermicularis 1 Ascaris lumbricoides 2 Amoebe coli 2 1 Fly larvae 3 Taenia saginata 1 Tubercle bacilli 2 9 Blood 4 2 Cancer cells • • 1 277 Examinations of sputum for tubercle bacilli 108 169 271 Examinations for diphtheria bacilli 169 102 43 Examinations for malaria 9 34 135 Examinations for Widal reaction 56 79 18 Examinations for gonocoeci 7 11 65 Examinations of brains for rabies 47 18 2 Examinations, bacterial, of pus. 6 Differential leucocyte counts. 122 Specimens of urine, with a variety of bacterial and chemical determinations. 74 Examinations of pathological tissue, as follows: Carcinoma 15 Chronic inflammation 19 Benign hypertrophies 14 Sarcoma 6 Chondroma 1 Colloid goitre 2 Tuberculosis 10 Pyaemia 2 Verruca 1 Necrosis 1 Doubtful (tissue not well preserved) 1 Placenta 2 2 Examinations of gastric fluid. 1,234 Examinations of water. 2,392 Total. 30 NORTH CAROLINA BOARD OF HEALTH. Eighty-three patients received Pasteur treatment at this laboratory. Of these, 65 were bitten by dogs in which the disease was demonstrated either by micro-scopic examination, inoculation experiments in laboratory or by subsequent death of other animals from a bite; in 17 cases only a clinical history of rabies in the attacking animal was obtained; in 1 the history was found to be erroneous and treatment was discontinued; 13 of these cases paid for treatment and the remain-ing 70 were given free treatment. C. A. Shore, Director. Dr. Albert Anderson : "As a member of the State Medical Society, I think some expression of appreciation ought to be made at this time of Dr. Lewis's work as Secretary of the State Board of Health, and I am very sorry I am not prepared to speak as the subject demands, for what I shall say will be from my heart, and what I can remember of his work, and not extensively said. "I would be untrue to myself and untrue to the Medical Society not to say that the North Carolina State Medical Society fully appreciates and loves Dr. Lewis for the great work he has done as Secretary of the State Board of Health. "I am old enough to remember the work of his predecessor, and re-member when be took charge of this work as Secretary of the Board. "Dr. Lewis went into it with intelligence, with love and with en-thusiasm. I have been somewhat in touch with his work from the be-' ginning. I know how wisely he has planned and how enthusiastically he has executed his work in every advanced movement. I know, in the first years of his service, that he planned for large things, and for the universal good of the people. "I had the honor to be appointed to take instruction in the Govern-ment Laboratory, to do some water analyses, many years ago, at his suggestion, and while my service was small and insignificar* it started the work that has been more intelligently and wisely done si: je I quit. "In connection with Dr. Bate, we tried to render the best service that we could, as beginners, and after we stopped the work was taken up by the State Laboratory of Hygiene and carried on by better trained men. Finally the State Board of Health, through Dr. Lewis, secured Dr. Shore, who stands, I suppose, equal to any man in his work, by long training and intelligent service that he is now rendering to the State. "The prospect for State preventive medicine is good, and not only the Medical Society, but the State of North Carolina, will ever owe Dr. Lewis a debt of gratitude. He has made history that will never be for-gotten, and I feel that it would be unjust to ourselves not to say that we appreciate his services and will always love him for what he has done in the spread of a better general knowledge of hygiene and pre-ventive medicine in the State." Dr. F. R. Harris, Henderson : "I desire to say what I can in refer-ence to Dr. Lewis. I am not a speaker, but I have a great deal in my heart to say. I say this because I think preventive medicine in the State is the most important field, as I see it today, and I want to en-dorse what Dr. Anderson has said and, furthermore, to endorse Dr. Shore. THIRTEENTH BIENNIAL REPORT. 31 "We had an outbreak of diphtheria last season, and I had occasion to send many specimens to him, and I want to say that the reports that Dr. Shore made were in accord with the clinical picture, and I believe they were correct, and he has my confidence, and I desire to commend him for his work." Dr. J. T. J. Battle : "I am one of a committee of three appointed to draft suitable resolutions to express, in some slight degree, the high esteem in which the Society holds Dr. Lewis, and for the great work he has done for the Society and for the State." The Chairman asked all who were in favor of the above to signify it by rising vote, and the motion was unanimously carried. Dr. W. S. Rankin : "Mr. President : If I may interrupt for just a word: I feel that it is a little out of place for me to express myself here, and I am absolutely unable to express my admiration of Dr. Lewis's able work in North Carolina. I think that the spirit that has governed and directed this work is the true altruistic spirit, and I feel that Dr. Lewis is a greater man than we North Carolinians recognize. I know that the public health workers of the United States look up to Dr. Lewis as one of the greatest authorities ; as one of the originators of public health movements. My slight acquaintance with these men has convinced me of this fact. I know that Dr. Lewis is a national figure in hygiene (applause), and has not received the appreciation at home that he has received abroad. "In taking up his work the highest ambition that I can cherish is that I may wear the cloak that he lets fall, half as well as he has worn it." (Applause.) Dr. Stiles, being asked by the Chairman for remarks, said : "First of all I would like to endorse this resolution offered in regard to Dr. Le7-is, but I have a delicacy in speaking, as I am an outsider. "I endo/se, however, the regret the physicians of this State feel in having Dr. Lewis retire, and this is seconded all over the country. I have heard many expressions of regret that he was going to give up the office of Secretary. It is generally recognized, however, that he has se-lected a good man as his successor. "To turn to another subject that I was discussing with Dr. Lewis, just before the meeting came to order ; it was understood that several gentle-men were going to speak on sanitary matters, and I suggested that when they spoke we might take up the question of the sanitary privy, so necessary in this State. "I think, perhaps, Mr. President, what I have to say on the subject would come in better after these gentlemen have read their papers, and I therefore ask that you let me present later what I have to say, after these papers have been read." Dr. Lewis : "Mr. President : I would like to announce that there will be a meeting of the State Board of Health in room 123 at a quarter of three o'clock, for the purpose of finishing certain work not attended to on yesterday. There will also be a meeting of the County Superin-tendents of Health in the tea room at 3 :30, for the purpose of forming a 3 32 NORTH CAROLINA BOARD OF HEALTH. State organization. I hope these gentlemen will attend, so that we may have a quorum. "I desire to say that we have had one hundred and one cases in which persons have been bitten by rabid dogs since June last, and we have se-cured from those persons who were able to pay $831.40—the fifty-dollar fee—for the support of the laboratory." The Board then adjourned until a quarter to three o'clock. RESOLUTIONS ADOPTED BY THE STATE MEDICAL SOCIETY ON THE RETIREMENT OF DR. RICHARD H. LEWIS AS SECRETARY OF THE BOARD OF HEALTH. Whereas, Our former and most efficient secretary of the Board of Health, Dr. R. H. Lewis, has decided it necessary to resign from the position; and whereas, for the long period of seventeen years of most arduous and difficult labor, he has accomplished so much, by unfaltering zeal and devotion, for the upbuilding and the honor of the profession, both of the State of North Carolina and the nation; and whereas he has so carefully safeguarded the people against the threatened inroad of disease as to save innumerable lives, the suffering incident thereto, and great pecuniary loss; and whereas, during these strenuous years, we have seen and appreciated the results of his great labors: now, wishing to express the esteem in which he is held, not alone by the profession, but the laity, be it hereby Resolved, first, That this Society express its conviction that he has done more, both in his official and individual capacity, than would have been possible for any other one to have done. Resolved, second, That we with reluctance accept his resignation, realizing that we lose in some measure his great capabilities and far-reaching influence. Resolved, third, That he, having been such a potent factor with the Legislature, has saved us from impending adverse legislation and secured such salutary meas-ures as are responsible for our present advanced position in sanitary work. Resolved, fourth, That we earnestly implore him to give us yet his wise counsel and help in time of difficulty and threatened legislation. Resolved, fifth, That it is our sincere wish and prayer that he, having done so much for sanitation and the health of others, may himself be blessed with many future years of vigorous health and abundant enjoyment of the blessings and happiness of life. AN APPRECIATION. In the retirement of Dr. Richard H. Lewis as their secretary, the State Board of Health has lost a most efficient officer and the public a most devoted servant. Dr. Lewis's tenure of office has bridged an important stage in the development of public health work. Our understanding of the true nature of communicable disease had its beginning in the discovery of Van Loewenhoek, a lens polisher, of Delf, Holland, in 1G83. From its beginning, in that year, to 1850, the idea that minute germs caused disease was but a theory, and but little more than theory, supported by only circumstantial evidence, till 1880, when Robert Koch transformed the theory into a scientific fact, and in so doing laid the sure foun-dation for preventive medicine and public health. For the next ten years these new facts filtered slowly through the medical profession, reaching the general public about 1890, when the public began to grasp the true meaning of preventive medicine. THIRTEENTH BIENNIAL REPORT. 33 As Dr. Lewis was elected secretary of the Board of Health in 1892, the begin-ning of his official life was coincident with the real beginning of preventive medi-cine. It therefore became his task to nurse this great movement in its early and tender years, in the years so important to future development, when the founda-tion so essential to what is to follow is being laid. How well he has performed this task is not for the writer to say, for on this question the present status of public health in North Carolina and the best public health authorities in America have handed down an opinion. As the present condition of public health in North Carolina is largely the result of Dr. Lewis's labors, in conjunction with the Board of Health, it may be taken as the best evidence of his ability as a sanitarian. His best work is prob-ably recorded in the statute books of the State. With the exception of the act establishing the State Sanatorium for Tuberculosis and an act separating the tuberculous prisoners from the well, he either drew up entirely or materially modified before introduction all the laws bearing on public health, and was active in securing their passage by the various Legislatures. In this connection credit is due Col. J. L. Ludlow, the able sanitary engineer of the Board, for preparing the sections in the amendment to The Revisal of 1905 adopted by the last Legislature, giving the Board more power in controlling public water sup-plies and in suggesting the advisability of analyzing the waters of springs at resorts while open for the entertainment of the public. As long ago as 1902 North Carolina was recognized by the American Public Health Association as one of four of the foremost States in water legislation. Dr. Lewis, with the con-currence of the Board of Health, developed the Laboratory of Hygiene upon the original plan of taxing all corporations or individuals selling water to the public for its support, supplemented by an annual appropriation of $2,000 which he secured from the Legislature of 1907. Another law very much to his credit is our new vital statistics law. Dr. Creesy L. Wilbur, Chief Statistician of the United States Bureau of the Census, has said of this law that it was "the first practical vital statistics law enacted in any of the Southern States." As correct vital statistics form the very basis of intelligent public health work, the value of this law is at once evident. As law is the result of public sentiment, and public sentiment the result of education, these laws are the result of an effectual educational campaign for the improvement of public health. To this Dr. Lewis has contributed through his editorial work in the Bulletin of the State Board of Health and through many noteworthy publications and addresses. Among these may be mentioned his "Drinking Water in Relation to Malarial Diseases," which started the change in Eastern Carolina in the domestic water supply from open wells to driven pumps; his "Instructions for Quarantine and Disinfection"; his leaflets on typhoid and malaria ; his pamphlet on the prevention of tuber-culosis, pronounced by good judges to be the best of its kind. A leading health officer of the State of New York has said that 90 per cent of the anti-tuberculosis work in that State was based upon Dr. Lewis's presidential address before the National Conference of State and Provincial Boards of Health of North America. The opinion of the great health officials of America of Dr. Lewis is shown by the recognition they have accorded him in having made him president of both the great national public health associations. In 1905 he was president of the National Conference of State and Provincial Boards of Health of North America, and in 1907 he was president of the American Public Health Association. It is therefore \ery evident that the retiring secretary is a national figure in public health work. 34 NORTH CAROLINA BOARD OF HEALTH. When it is remembered that the small amount of $2,000, out of which clerk's hire, etc., was to be taken, was all appropriated by our State, it can readily be seen that the secretary's service was largely a labor of love. Forced on account of this small appropriation to practice his profession, as an oculist, to earn a living, he has given his resting hours to the service of his country, thereby show-ing a self-sacrifice for public weal which should always be an inspiration to those who follow him. The writer fully realizes the embarrassment he takes upon himself in calling attention to the high standard set by his predecessor, but a sense of gratitude and duty, both as an individual and as a public official, will be satisfied with nothing less. In assuming his official cloak I shall always be mindful of him who wore it so worthily. Meetings of Executive Committee Office of the Secretary, Raleigh, K 0., August 10, 1909. At the request of the President, the Executive Committee was called to meet at the office of the Secretary in Raleigh on August 10th, 1909 ; the object of the meeting being to consider the sanitary condition of the State Sanatorium for the Treatment of Tuberculosis, the purification of sewage at Rocky Mount and Tarboro, the purity of the Reidsville water supply and to confer regarding Public Water Supplies, Circular B. Dr. Thomas, President, called the meeting to order at twelve o'clock, Dr. Lewis and Col. Ludlow being present. Dr. Gordon, President of the Board of Directors of the State Sana-torium for the Treatment of Tuberculosis, and Dr. Julian, Assistant Secretary for Tuberculosis of the State Board of Health, appeared be-fore the Board. Dr. Julian's report* of the sanitary condition of the State Sanatorium was read, to which Dr. Gordon replied: DR. GORDON'S STATEMENT. "1. In regard to there being 'no matron or nurse in the institution,' the ex-planation is: One reason that there is no matron and no nurse is that we have no place for white help, no means for providing such a place and that it is abso-lutely impossible to get a nurse or matron there and expect them to live with the inmates of the institution. "2. That the 'windows and doors are not provided with screens; the kitchen and dining room swarm with flies' : Now, if you remember, the appropriation made for this institution was one of the last bills passed by the last Legislature and, if I remember correctly, I called a meeting of the directors perhaps early in April. I was not at that meeting, being unable to attend. Since then we have let a contract to Mr. Dew to screen the windows and doors and also to provide screens to keep out rain, for every apartment in the institution. For some cause he was very slow about it. He got part of the material there and failed to get the remainder. The result was that the doors and windows were never screened, that is, not until now. He is doing this work, now. •See page 88 for Dr. Julian's report. THIRTEENTH BIENNIAL REPORT. 35 '"I stayed at Montrose a few days, in order to ascertain the true conditions. I ate in the dining room every meal, save one, while I was there, and there were some flies, but I do not think there was the number of flies indicated by the report here. I have certainly seen a great many more flies than I ever saw in that dining room, and I did not note that there was an unusual number of flies in the kitchen, although I had my own table and there may have been more flies at the other table. "The food was fairly well prepared, and while I was there the quality and quantity was fairly good. "3. 'Xo protection from rain,' etc.: I replied to that a while ago. Last year, when the institution was opened, we curtained the building with heavy ducking strung on wire so that during rains the curtains might be used to protect; but the wind is so strong there that this arrangement was found to be a failure; the ducking was blown off and it was finally taken down. "4. I do not know when the floors had been cleaned. When I went down there" I went to look after the installation of an electric plant. Dr. Brooks informed me that he wanted to go away for a little rest, and asked me if I would look after the patients. I told him that I would do the best I could. He met me at Aberdeen. He did not go out to the institution with me, and told me nothing, leaving me thus uninformed. I introduced myself to the patients, examined them and saw them every morning and afternoon while I was there, in the meantime looking after the building and installation of the plant. My observation is that the cracks in the floors were unusually small, but it is possible that there was some dust and dirt in them. The floors had not been swept the morning Dr. Julian a.nd Dr. Stanton were there, and the beds, I suppose, had not been made up that day. "I think it but due to Dr. Brooks that I make this statement. The doctor has found it impossible to get efficient help. One of the reasons is the reason already stated, that he has no place to keep efficient help. No one would stay there except inefficient help. He was exacting and insistent on their doing what he said. The only way he kept his cook was by not paying him, so he could not go away. He was dreadfully handicapped. His laundryman would not work for him. When I got there I found the laundry had not been done for some time, and Miss Lock told me she could not get it done. Miss Lock was a patient there who had improved and was acting as matron. She told me that laundry work was needed to be done badly. I asked whom she could get. She said it had been done by a woman, but she had quit and could not be induced to return. I asked regarding the cook, and she said she was a good washerwoman. Miss Lock said if Charlotte, the cook, would do the laundry, she, with the help of William, would do the rest, and so I made arrangements to have her wash the bed linen. I kept Charlotte at that for a number of days. She laundered all the bed linen, except what was then in use. I found the blankets had all been used and needed to be laundered, so I sent for the party that had done laundry work for them since the institution opened there, and she agreed to launder the blankets and the bed linen, as well as to do the laundry work for the patients. I got her to do this work until I left there. All the blankets had been used, but had not been used an unreasonable length of time. "5. 'Ventilation of the rooms bad' : We have a number of windows in the assembly hall, and my observation was that the windows were nearly always 36 NORTH CAROLINA BOARD OF HEALTH. open. At any rate this hall was used very little except for lavatory purposes and writing. The patients sleep out of doors and live out of doors. "The slops while I was there were kept thoroughly disinfected with bichloride of mercury, and Dr. Brooks claims he has also used a large amount of bichloride of mercury. While they did not look sanitary, they were all right. "6. 'No bath tubs': Well, there are no bath tubs. We intend to put in shower baths, instead, but have no money with which to put in any. "7. 'There are two privies. There was no evidence that they have been cleaned. No disinfectants have been found, no covers to stools, and odor offensive.' You can not get any negro in that country to clean out one of these privies for the institution, and the only means was to take a hand from the farm to do it. I asked this man about the privies—he cleans them out—and he said he had been intending to do it for several days. I asked him how long it had been since they were cleaned out, and he said two weeks. I told him to clean them out, and Dr. Brooks has since burned them down. "8. There is nothing in this to reply to. He states it is crude and also thinks it might have been more sanitary. We admit that : it could have been and should have been. I think Dr. Brooks should have due credit. He had no efficient help and no matron capable of filling the position, because no one would stay there. No trained nurse would stay there. There was no place for colored help, the only place being a pallet in the kitchen and one in the entry or butler's pantry. I think Dr. Brooks should be credited with the fact that no provision had been made by which he could keep efficient help, and he is certainly due the credit of having appeared before the Executive Committee and insisted that the institu-tion be closed during the hot weather and pending the improvements that were contemplated. He insisted on it and one member of the Executive Board was very much opposed to closing the institution, and I think the Executive Board is solely to blame for its not being closed at the proper time. "The whole thing in a nutshell is this: The Board of Directors, in their zeal to demonstrate to the Legislature the good that could be derived from the in-stitution, permitted the institution to be opened before it was properly equipped —that is, before we had an institution. That was the mistake made, and we feel that the members of the Board realize that now. At the same time we thought it would help us in getting additional appropriation, without which we could not have continued the work. (Dr. Lewis: "It did help.") "If you will permit me, I should like to express my views in regard to this report. It is no reflection on Dr. Julian. Dr. Julian did his duty as he saw it, and I do not mean to reflect on anybody. At the same time it seems to me that, as officials of the State and in the interest of the entire people of the State, it would be unwise to make a public document of this report, believing, as I do, that it will raise up and interfere, very materially, with any additional appro-priation that may be asked for at the hands of the Legislature." DR. JULIAN'S STATEMENT. "In the first place, I desire to say that the condition shown us by Dr. Gordon was just as good as it possibly can be and just as nice as his defense today. When I was down there he gave me every opportunity to examine the institution. He very kindly took us over the grounds; and I wish to say that the grounds, elevation and soil are ideal, and that I know of no place in North Carolina that would equal it for this work. These conditions are the best I have ever seen THIRTEENTH BIENNIAL REPORT. 37 and the elevation I am sure is sufficient for the treatment of tubercular affections, and in fact I think the possiiblities are really greater than in any other place in North Carolina. "I also wish to say, that there may be no prejudice to my report, that I have had no communications from any one in North Carolina, layman or doctor, in regard to this institution, except from Dr. Eankin, by letter, that I am not in sympathy with any man or men that are trying to get the superintendency of the institution, and that I really had expected to visit Montrose in the capacity of the Assistant Secretary for Tuberculosis, and was glad to make this visit officially, at the request of Dr. Rankin, our Secretary. '•When I arrived at Aberdeen I found the little Rockfish and Aberdeen was in such perfect condition sanitarily; the coaches were so clean, that I made the remark to one of my friends that if we found the institution as well cared for, I would be well pleased. I desire to say this, so that it will be understood that I am not prejudiced. "I also wish to say that I took the names of every person in the institution before I told them my mission; inquiring into their habits and treatment, and that except for Dr. Gordon, who was held in very high esteem, the treatment was a joke among the patients. They spoke very highly of Dr. Gordon, but the treatment was a joke. "I looked around for appliances for examination. They had no microscope or stethoscope. (Dr. Gordon: "I had that in my pocket." ) One patient complained that he had been in bed two weeks with a temperature of 105 and that he had only had his temperature taken by himself. That the doctor had not taken his temperature all the while. Now, I have in my grip the names of every one who gave me this information. I was told by one patient that from the time he had entered until that day he had never had an examination, percussion, or aus-cultation, or anything. "Miss Lock was the only one that did anything at all in -he way of a matron. She informed me that she was a patient, without salary, and was left to do as best she could, without directions or orders, except what she received from Dr. Gordon. It seems that they had no cows, and the first churning was done the day I arrived at the institution. The butter and eggs were ordered from Aber-deen and were usually stale. The other food was good. It appears that the visits from the doctor in charge were only from Aberdeen and that he did not remain at the institution. It is also claimed that the beds were changed from one part of the porch to another by a negro man when it rained at night. One patient informed me he had been there thirty-four days and, to his knowledge, there had been no change of linen in that time. Others claimed that the linen had not been changed for about two weeks. The beds on the porches were in dis-order. They were turned helter-skelter, the sheets were dirty, and, as Dr. Gordon remarked, after the sheets were used they were thrown up in a heap on an old bed in one part of the porch in an unsanitary condition. It had rained the night before and that part of the porch was wet and in an unsightly condition. A patient informed me that he had accidentally turned his spit cup over on his linen and that the only way he could get rid of it was to wash it out himself. I observed the patients sitting around with rolls of toilet paper near by. They would cough and expectorate into this toilet paper and then slip it into a bag, and after that was filled it was disposed of in the fire. That I saw. "A patient informed us that the porch had not been swept for a month and 38 NORTH CAROLINA BOARD OF HEALTH. that the rooms had been swept once in two weeks, and that with a dry broom. There was no cloth to moisten the floor. The sweeping was done by dry cleaning. These were patients in advanced stages of tuberculosis, others without tempera-ture and others with temperature and were then huddled in, and of course rein-fection could occur with the sweeping, everywhere there was a dry sweeping. "In answer to Dr. Gordon I should say the talk I had with him was satisfactory and that I have the highest regard for him. He said Dr. Brooks had given him no information in regard to the institution and he was obliged to go to work for himself. He went out there handicapped. They were living there with no method of ordering, except for this woman (Miss Lock), who was a self-appointed matron. "In regard to the cracks: They were no larger than ordinary cracks. They were not filled like this floor, and all the dirt that could, accumulated in the cracks. The floors should be waxed, and there is no excuse for neglecting this matter, as turpentine and beeswax could easily be mixed together and the floors waxed therewith. "In answer to that part of Dr. Gordon's defense of Dr. Brooks, wherein he states that he could not get a trained nurse, all that is Dr. Brooks's fault. The report from Whitehaven and like institutions show that the danger of infection of nurses and help is less in sanatoriums than in private houses. "There is no reason why any physician should fear to sleep in any part of such an institution, and there is no reason why any woman who has been trained as a nurse should object to going to any kind of an institution if she is capable of taking care of it. "In regard to the kitchen and dining room, the use of the word 'swarm' does look a little harsh, but they were preparing vegetables and the negro cook was spreading them all over the table, and, in the absence of screens, there was no reason why the flies should not be on the food; of course, on the cooked food as well as on the raw. One patient told me that while one of them ate at the table another would keep the flies off with a flybrush. "I did observe a bed in the dining room, one in the pantry, and one in the kitchen. These were without bedsteads; just piled down on the floor. A negro man slept in the kitchen and a negro woman in the dining room. "The privies are near the institution. The seat was some distance from the ground and the accumulation of fecal matter extended from the ground to within a few inches of the seat. The seat was without a cover, and no lime or other disinfectant was seen around the privies. "Besides the sanitary condition, the possibilities are so great that the insti-tution must, in somebody's hands, or by your wise directions, be made an honor to the State of North Carolina. The sanitary conditions of the institution are inexcusable, It is inexcusable to have beds in the condition I found them in, there. It is inexcusable to leave stools from early in the evening until the next day at 12 o'clock, and this I saw. "Suppose a patient comes there in the more advanced stage of tuberculosis — suppose he should have a hemorrhage at night. Who is to take care of patients at night?" Resolution : Introduced by Col. Ludlow. "1st. That the Executive Committee endorse the activity and zeal on the part of the Secretary and Assistant Secretary for Tuberculosis in their investigation and complaint they have lodged against the State Sanatorium for Tuberculosis. THIRTEENTH BIENNIAL REPORT. 39 That the Committee, after hearing this report and the discussions, does refer the entire matter to the board of directors of the institution for their further consideration and action. Further, that the Executive Committee, acting in its official capacity as custodian of the public health of the State, the matter having been referred to them officially, recommend to the board of directors of the in-stitution that it shall not be opened for the treatment of patients until the con-templated improvements have reached such a stage that the patients entering can be properly cared for. ''Further: In reference to the complaint lodged by Dr. J. R. Williams, it is likewise referred to the board of directors for their consideration and action." The question of sewage disposal at Rocky Mount and Tarboro being brought up, Mr. Battle said : "It is useless for us to discuss the matter with you on a scientific basis. "We insist that we are situated 68 miles above the only intake of a public water supply. In view of that distance, the slow flow of the stream, the size of the river at Rocky Mount and Greenville, and the amount of sewage produced by Rocky Mount, your order was entirely unnecessary and we insist that it be revoked. At the same time we know the law,—no sewage shall be turned into a stream from which water is taken below. "The town of Rockv Mount, without any fault of its own, is entirelv out of money with a floating debt of $20,000. It is absolutely impossible for us to raise that amount of money, in any way. Our only recourse would be to break the sewer entirely and keep sewage from running into the river. This would cause a pestilence in the town, besides ruin-ing our new $20,000 hotel. We can not consider giving up the sewerage system. The whole matter of sewage purification is in an exceedingly incoherent (?) state; as just shown by the Westinghouse agent. To put our town to an expense that in a year or two would prove to be unwise and inexpedient is unjust and oppressive. "I would like to file with you the annual financial report of the city of Rocky Mount (gives the Secretary a paper). "What we wish to do, when our funds permit, is to install a septic tank." Mr. Bassett, for Rocky Mount, states financial condition of Rocky Mount : "Our town has an increased demand of $8,000, and a decreased rev-enue of $12,000, by reason of the prohibition law. The estimated flow of sewage is 150 gallons per minute. The estimated flow of the river is 1,275 gallons per minute. (Reads Section 3058 of Revisal of 1905.) Greenville has filed no complaint. It is absolutely beyond the means of Rocky Mount to install the system required by Colonel Ludlow. (Reads a letter describing the system suggested by Colonel Ludlow.) Xo en-gineer would require more of the country of England than Colonel Ludlow requires of Rocky Mount. We will leave this matter in your hands, absolutely assured that we will be dealt with justly and fairly." 40 NORTH CAROLINA BOARD OF HEALTH. Mr. W. O. Howard, for Tarboro : "We feel that we are almost unable, in fact, that it would be almost impossible for us to comply with your order. We are poorer than any Eastern town. Tarboro has the highest tax of any Eastern North Car-olina town, being $2.58 per hundred, for the town, county and State. I am here to ask you to revoke your order for the present. With the next meeting of the Legislature we may be able to comply. The system demanded by Colonel Ludlow would require the expenditure of $68,000 and the annual running expenses would probably be $1,000. If you can not revoke the order, do not require us to put in such an expensive system. Greensboro has a septic tank which cost only $2,000. We cer-tainly can not comply within six months. In order to do this, we shall have to make some provision for levying more tax." Colonel Ludlow : If Greenville's filter should fail to work one day, the health of the town would be endangered. I can not possibly weigh the danger to Greenville against the financial condition of Rocky Mount. On motion of the Chairman, it was resolved that the time for the installation of hygienic purification plants by the towns of Rocky Mount and Tarboro be extended to July 1st, 1910. REIDSVILLE. Colonel Ludlow showed chlorin in this supply to be too high at all times. It was decided that the Secretary should visit Reidsville and look into the matter of their water supply. On motion the Engineer and the Secretary of the Board and the Directors of the Laboratory of Hygiene were directed to make an in-spection of the electrical purification of water and its practical appli-cation. Raleigh, K C, February 9, 1911. Dr. Jno. A. Ferrell, having been recommended to the Rockefeller Sanitary Commission by Dr. Richard H. Lewis and Hon. J. Y. Joyner, was requested by Dr. Lewis to meet Dr. Wyckliffe Rose, Administrative Secretary of the Rockefeller Sanitary Commission in Raleigh, Feb-ruary 8th, 1910. At this meeting Dr. Rose decided to recommend Dr. Ferrell's ap-pointment, provided the State Board of Health, through its Executive Committee, would approve the appointment. The following day, Colonel J. L. Ludlow was called up by long dis-tance telephone by Dr. W. S. Rankin, Secretary to the Board, and put into possession of all the facts relating to Dr. Ferrell's appointment. Thereupon he approved the appointment. Dr. Thomas later approved the appointment by letter. Dr. Ferrell was then appointed by the Rockefeller Sanitary Com-mission as Assistant Secretary for the Eradication of Hookworm of the State Board of Health. After arranging his local business he came to Raleigh, taking charge of his official duties March 12, 1910. THIRTEENTH BIENNIAL REPORT. 41 Annual Sessipn of the Board of Health Wrightsville, N. C, June 21, 1910. The annual session of the Xorth Carolina State Board of Health was called to order by President Thomas. Members present : Doctors Lewis, Anderson, Tayloe, Register, Way, Spencer, and Colonel J. L. Ludlow. Minutes of Asheville meeting June 15-16, 1909, were read. Colonel Ludlow corrected the minutes by requesting that he be not referred to as "Sanitary Engineer of the Board," but as a member of the Board. The minutes were then approved. The minutes of the meeting of the Executive Committee on August 10th, 1909, were then read and approved. Letters, under dates of June 2 and June 4, 1910, from Jno. A. Wed-dell, Clerk of Tarboro, and Hon. T. T. Thorne, Mayor of Rocky Mount, were read. Both of these letters requested an extension of the time pre-viously allowed the towns of Tarboro and Rocky Mount from July 1, 1910, to November 1, 1909. The Board, appreciating the cordial spirit of co-operation expressed in these letters, and accepting in good faith their statement to the effect that it was impossible for them to comply, through no fault of their own, with the requirement for installing sew-age purification plants by July 1st, passed the following motion intro-duced by Dr. Lewis : "Moved that the towns of Tarboro and Rocky Mount be granted an extension of time to January 1, 1911, for installing sewage purification plants." As above stated this motion was carried. Dr. Lewis suggested that the Secretary remind the above towns to submit to the Board plans of the proposed purification plants according to Section 3058, Subsection (b), before proceeding with their installation. The minutes of the approval by the Executive Committee of Dr. Jno. A. Ferrell's appointment as Assistant Secretary for the Eradication of Hookworm were read and approved by the Board. Dr. "Way officially notified the Board of the death of one of its mem-bers, Dr. James A. Burroughs, and moved that a committee be appointed to draft suitable resolutions regarding his death. Dr. Way was then appointed by President Thomas a committee of one to prepare such resolutions. Dr. Anderson moved that Mr. H. W. Simpson be re-elected a mem-ber of the Board of Embalmers. This motion was unanimously carried. Dr. Lewis moved that the Board go into the election of a new member to fill the vacancy made by the death of Dr. Burroughs. Dr. Way nominated Dr. J. E. Ashcraft, of Monroe, for this position. Dr. Ashcraft's nomination was seconded by Dr. Spencer and Colonel J. L. Ludlow. Dr. Register made a number of commendatory remarks concerning Dr. Ashcraft. Dr. Ashcraft Avas then unanimously elected. President Thomas then appointed Colonel Ludlow and Dr. Spencer an auditing committee to audit the accounts of the Treasurer of the 42 NORTH CAROLINA BOARD OF HEALTH. State Board of Health and the State Laboratory of Hygiene. The ac-counts, statements, checks, and receipted bilts were then turned over by the Treasurer to Dr. Spencer. Dr. Spencer moved that the meeting be adjourned. The motion was carried. W. S. Rankin, Secretary. Conjoint Session of the North Carolina Board of Health with the Medical Society of the State of North Caro-lina, at Wrightsville, June 22, 1910. President G. G. THOMAS, Chairman. REPORT OF SECRETARY STATE BOARD OF HEALTH. Mr. President, Members of the North Carolina State Board of Health, and Mem-bers of the Medical Society of the State of North Carolina. I have the honor to submit herewith my annual report as Secretary of the North Carolina State Board of Health as authorized by Section 4442 of The Re-visal as amended by the Legislature of 1909. My first record is a sad one, namely, to note the death of the lamented Dr. James A. Burroughs, a member of this Board and late President of this Society. Dr. Burroughs heard the summons of our common adversary, and on December 28, 1910, fell in the front line of the battle of science against death. His death leaves a vacancy on the Board of Health which should be filled at this meeting. The most important, as well as the most encouraging, change that has taken place since our last meeting is the continued and vigorous growth of the public interest in the question of health. This growing interest finds expression through several sources. Medical inspection of schools, carried on during the last three years and in-cluding schools in England and in various parts of the United States with an aggregate of about one million pupils, has shown that 20 per cent of the children have defective eyes, 5 per cent of them have defective ears, and about 10 per cent defective throats. The large number of children examined and the extensive geographical distribution of these statistics establish a condition that is general. So large a number of physical defectives in the schools means the retardation of the entire school; means a tremendous loss through the retardation of all the children, and the inability of a large number of children to use what is taught them ; means that many physical defectives are unjustly punished, whereby many sweet dispositions are soured and many characters are twisted. These facts, to-gether with the general growth of public health interest, have gone a long way in causing the school people to recognize the fundamental value of health and in making of them one of the strongest forces in the public health movement. Through the deep interest of State Superintendent of Public Instruction Joyner, your Secretary has addressed both the Association of County Superin- THIRTEENTH BIENNIAL REPORT. 43 tendents of Public Instruction and the North Carolina Teachers' Assembly, in addition to several teachers' institutes, on the question of public health. The November issue of the Bulletin was a teachers' edition and dealt with the re-lation of the public school to health. Four thousand North Carolina teachers are on the mailing list of the Bulletin. In December your Secretary prepared a pamphlet dealing with the construction and care of sanitary schoolrooms and the examination of children by teachers for defective eyes and ears. The major part of this pamphlet was taken from a silimar publication prepared several years ago by former Secretary Lewis. This pamphlet was issued and distributed by the State Department of Public Instruction. In February of this year another pamphlet on the subject of tuberculosis was prepared by Assistant Secretary C. A. Julian. This was published by the State Department of Public Instruction, but, on account of some delay, it was thought best to wait until the next public school year to distribute it. While, at present, the study of sanitation and preventive medicine is not pre-scribed in the public school course, many influences are at work toward this end. The teachers are feeling the effect of the popular demand for health study, and in many schools health is receiving attention in one way or another. I am led to believe, from a recent conversation with State Superintendent Joyner, that at the next meeting of the Board for the Selection of Text-books, some time dur-ing the year 1911, the subject of sanitation and preventive medicine will be pre-scribed for the public school system. At the request of Superintendent Joyner, a series of sixty health talks, cover-ing the subject of public health, will be prepared during the summer for the public school teachers. The talks will be published in convenient form for the use of the teachers, and distributed. The teachers will use them as the basis for three ten-minute talks to the school each week on the subject of health. In this connection I wish to call your attention to and ask your support for the School Betterment Associations. These associations, now established and active in many counties, are doing much for public health by insisting on better sanitary conditions in and around schoolhouses. Many physicians have made health addresses before schools and teachers' in-stitutes during the last year, and, in this way, have contributed much to the public welfare. Permit me to commend this practice to all those physicians whose public interest is seeking a wider sphere of usefulness. The churches, along with all other organized influences, have deepened their in-terest in the question of health, and many pulpits have contributed largely to the cause of more efficient and cleaner living as a means of better preparation for the other life. In March of this year a special Preachers' Bulletin was issued for Sanitary Sunday, April 24th. This Bulletin contained the endorsement, for its use by the preachers of various denominations, of many of the leading clergy-men in the State. I am sure this Bulletin was used by many of the pulpits, and I desire here and now to make grateful acknowledgment of this fact. The press of the State is showing its awakening sense of responsibility for public health by more frequent expressions on this subject. Your Secretary had the pleasure of addressing the Press Association on their relation to the public health, at their recent meeting in this place. They seemed to be deeply interested and promised their cordial cooperation with the State Board of Health for health improvement. I am quite sure that the press is becoming seriously interested in this problem, and their interest will go a long way toward creating a demand for a better health administration, local and State. 44 NORTH CAROLINA BOARD OF HEALTH. The American Tuberculosis Exhibit, under the direction of Mr. E. G. Routzahn, has been at work in our State since March 15th. It has already given three ex-hibitions of three weeks each, in the cities of Greensboro, Raleigh, and Winston- Salem. It will go to Durham later this summer, and it is hoped that Charlotte will secure the exhibit for the fall. The effect of this exhibit is to tremendously augment the local health interest wherever it is given, and to create a general interest in health in the surrounding country. Last, but by no means least, of the organized influences that have seriously interested themselves in better health is the State Federation of Women's Clubs. At their recent annual meeting in Henderson your Secretary addressed them on the subject of public health, and they expressed their deep concern in the cause by passing resolutions emphasizing its importance and organized a Health De-partment of the Federation. Mrs. W. N. Hutt, of Raleigh, was made chairman of this department. The Monthly Bulletin of the Board of Health has been increased in its circulation from 3,500 to 11,500, and its mailing list includes all the doctors, preachers, lawyers, and 4,000 of the 10,000 school teachers in the State. There are, in addition, a number of other names on the mailing list. The Bulletin also reaches most of the newspapers of the State. The Legislature of 1909 passed three important public health measures: A law relating to the control and care of public water supplies, a law requiring the registration of all deaths occuring in towns or cities having a population of a thousand or more at the last decennial census, and a law providing for the distribution of diphtheria antitoxin to the indigent. Former Secretary Dr. Lewis has already called attention, in the March (1909) Bulletin, to the nature of these laws. All of them have been put in operation during the last year. The law relating to water supplies requires the authorities of every public water supply to file certified duplicate plans and surveys prepared according to rules and regulations furnished them by the Secretary of the State Board of Health. Of the 63 public water supplies of the State, 45 have complied with this requirement. Eighteen have not complied, and the attention of the solicitor has been called to the infringement of this law in the case of one company, the other fourteen having rendered acceptable excuses for their delay. This law further requires the authorities in charge of all public water supplies to make quarterly ins |