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ELEVENTH BIENNIAL REPORT
OF THE
NORTH CAROLINA
BOARD OF HEALTH
1905-1906
RALEIGH
E. M. UzzELL & Co., State Printers and Binders
1907
^^
MEMBERS OF THE BOARD.
ELECTED BY THE MEDICAL SOCIETY OF THE STATE OF
NORTH CAROLINA.
S. Westbay Battle, M. D Asheville.
Term expires May, 1907.
Henry W. Lewis, M. D Jackson.
Term expires May, 1907.
Thomas E. Anderson, M. D Statesville.
Term expires May, 1911.
George G. Thomas. M. D., President Wilmington.
Term expires May, 1911.
APPOINTED BY THE GOVERNOR.
W. P. Ivey, M. D Lenoir.
Term expires May, 1907.
Richard H. Lewis, M. D., Secretary and Treasurer. . .Raleigh.
Term expires May, 1907.
.J. L. Ludlow, C. E.. Engineer Winston-Salem.
Term expires May, 1909.
W. O. Spencer, M. D Winston-Salem.
Term expires May, 1911.
J. Howell Way, M. D Waynesvllle.
Term expires May, 1911.
couWty superintendents of health.
Alamance Dr. George W. Long.
Alexander Dr. O. L. Hollar.
Alleghany Dr. B. E. Reeves.
Anson I >r. J. H. Bennett.
Ashe Dr. ^Manley Blevins.
Beaufort Dr. John G. Blount.
Bertie Dr. H. V. Dunstan.
Bladen Dr. L. B. Evans.
Brunswick Dr. J. ^Irthur Dosher.
Buncombe Dr. D. E. Sevier.
Burke Dr. J. L. Laxton.
Cabarrus Dr. R. S. Young.
Caldwell Dr. C. L. Wilson.
Camden Dr. C. G. Ferebee.
Carteret Dr. F. M. Clarke.
Caswell Dr. S. A. Malloy.
Catawba Dr. George H. West.
Chatham Dr. J. H. Taylor.
Cherokee Dr. J. A. Abernathy.
Chowan Dr. T. J. Hoskins.
Clay Dr. J. M. Sullivan.
Cleveland Dr. B. H. Palmer.
Columbiis Dr. H. B. Maxwell.
Craven Dr. Joseph F. Rhem.
Cumberland Dr. A. S. Rose.
Currituck Dr. H. M. Shaw.
Dare Dr. W. B. Fearing.
Davidson Dr. Joel Hill.
Davie Dr. M. D. Kimbrough.
Duplin Dr. A. J. Jones.
Durham Dr. T. A. Mann.
Edgecombe Dr. S. N. Harrell.
Forsyth Dr. S. F. Pfohl.
Franklin Dr. R. F. Tarborough,
Gaston Dr. L. N. Glenn.
Gates Dr. W. O. P. Lee.
Graham Dr. M. T. Maxwell.
Granville Dr. S. D. Booth.
Greene Dr. W. B. Murphy.
Guilford Dr. Edmund Harrison.
48278
r.IST OK SUPERINTENDENTS.
Halifax Dr. I. E. Green.
Harnett Dr. L. J. Arnold.
Haywood Dr. .T. R, McCracken.
Henderson Dr. J. G. Waldrop.
Hertford Dr. C. F. Griffin.
Hyde Dr. E. H. Jones.
Iredell Dr. M. 11. Adams.
Jackson Dr. William Self.
Johnston Dr. Thel Hooks.
Jones
Lenoir Dr. C. Ij. Pridgen.
Lincoln Dr. R. W. Petrie.
McDowell Dr. B. L. Ashworth.
Macon Dr. F. L. Slier.
Madison Dr. W. J. Weaver.
Martin Dr. W. E. Warren.
Mecklenburg Dr. C. S. McLaughlin.
Mitchell Dr. Virgil R. Butt.
Montgomery Dr. J. B. Shamburger.
Moore Dr. Gilbert McLeod.
Nash Dr. J. P. Battle.
New Hanover Dr. W. D. McMillan.
NorthamptoTi Dr. H. W. Lewis.
Onslow Dr. Cyrus Thompson.
Orange Dr. C. D, Jones.
Pamlico Dr. H. P. Underhill.
Pasquotanlv Dr. J. B. Griggs.
Pender Dr. Robert H. Bradford.
Perquimans Dr. C. C. Winslow.
Person Dr. J. A. Wise.
Pitt Dr. Joseph E. Nobles.
Polk Dr. C. J. Kenworthy.
Randolph Dr. A. M. Bulla.
Richmond Dr. L. D. McPhail.
Robeson Dr. H. T. Pope.
Rockingham Dr. Sam Ellington.
Rowan Dr. I. H. Foust.
Rutherford Dr. E. B. Harris.
Sampson Dr. J. O. Matthews.
Scotland Dr. A. W. Hamer.
Stanly Dr. J. N. Anderson.
Stokes
Surry Dr. John R. Woltz.
Swain Dr. R. L. Davis.
i.IST OK SUPERINTENDENTS.
Transylvanin Dr. C. W. Hunt.
Tyrrell
Union Dr. Henry D. Stewart.
Vance Dr. John Hill Tucker.
Wake Dr. J. W. McGee, .Tr.
AVarren Dr. P. J. Macon.
Wa.shington Dr. W. H. Ward.
Watauga Dr. H. McD. Little.
Wayne Dr. J. B. Outlaw.
Wilkes Dr. John Q. :Myers.
Wilson Dr. W. S. Anderson.
Yadkin Dr. M. A. Royall.
Yancey Dr. J. B. Gibbs.
LETTER OF TRANSMISSION.
North Carolina Board of HEA]/rH,
Office of the Secretary,
Raleigh, April 1, 1907.
His Excellency, Robert B. Glenn,
Governor of North Carolina.
Sir:—I have tlie honor to present herewith the Eleventh
Biennial Report of the North Carolina Board of Health.
Most respectfully yours,
Richard H. Lewis, M. I).,
Secretary and Treasurer.
ELEVE^s^TH BIEX^^IAL REPORT
OF THE
NORTH CAROLINA BOARD OF HEALTH.
1905-1906.
Since our last report tlie sanitary history of the State has
been for the most part uneventful, we are happy to say. There
has occurred no serious epidemic of any kind, and the mortality
of our people has been attributable to the common, every-day
diseases that are always with us. Owing to the fact that our
population is largely a rural one, which renders impracticable
the collection of vital statistics from the whole State, it is im-possible
to make an accurate comparison of the mortality of one
biennial period with that of another. There is reason to be-lieve,
however, that the work of the Board has borne fruit and
that a material advance has been made on sanitary lines. This
has been most noticeable in the work for the prevention of tuber-culosis,
in the installation of public water supplies and sewerage
systems, in an increased use of the Laboratory of Hygiene, and
in the establishment by the decision of the Supreme Court in
Durham r. Eno Cotton Mills, under the act to protect water
supplies, of the principle that no stream used for drinking pur-poses
can be polluted with raw sewage by any person or corpora-tion.
MEETINGS OF THE BOARD.
MIJSTUTES OF THE ANNUAL MEETING AT
GEEENSBORO.
Greensboro, N. C, May 23, 1905.
Annual meeting of the Board. Present: Drs. Battle, Ivey,
Lewis, H. "W., Nicholson, Spencer, Way and Whitehead, Mr.
Ludlow and the Secretary.
Dr. Whitehead was elected President pro tempore.
At their request, Messrs. Wehh, secretary and treasurei-, and
Arbuckle, superintendent, respectively, of the Eno Cotton Mills
at Hillsboro, appeared before the Board in relation to the mat-ter
of the purification of the sewage from the mills, as required
by the act to protect water supplies, complaint having been made
by the Durham Water Company of the emptying of the same
into the Eno River in its raw state. They proposed a plan of
purification by combining the exhaust steam and water of con-densation
with the sewage. This plan did not meet with the
approval of the Board, however. After a thorough discussion
of the septic-tank and contact-bed method of purification and
of the septic tank alone, it was decided that, while the septic tank
alone cannot be depended upon for a complete purification, yet,
in consideration of the local conditions and environments, on
motion of Mr. Ludlow, it was held that for the present sufficient
purification would be accomplished by means of a proper septic
tank having a capacity of not less than eighteen hours' flow
from the mills, the same to be constructed after design to be
approved by the Engineer of the Board.
Application was made by the Biologist, Dr. McCarthy, for an
increase of salary on the part of the Board to $1,000 per annum,
beginning with January 1, 1905. On motion of Dr. Nicholson,
this was granted.
On motion of Dr. Ivey, the Secretary was authorized, after
conference with the Biologist, to employ such assistance in the
laboratory as may be necessary and the funds may justify.
The Secretary was instructed to notify the manager of the
new knitting-mill building at Hillsboro of the laAv in regard to
sewage purification, and to transmit to the same a copy of the
act to protect water supplies.
ELEVENTH BIENNIAL REPORT. \)
Drs. H. W. Lewis and Ivey, who were appointed a committee
to audit tlie report of the Treasurer, reported it correct.
On motion, the Board adjourned to meet again in the conjoint
session with the State Medical Society at 12 M. to-morrow.
Richard H. Lewis,
Secretary/.
Greensboro, N. C, May 24, 1905.
Notification of the election of Drs. George G. Thomas and
Thomas E. Anderson by the House of Delegates of the Medical
Society having been made at the conjoint session, a meeting of
the Board as thus newly constituted in part was called and Dr.
Thomas was re-elected President.
Rev. Dr. McKelway appeared before the Board and asked to
be heard on the subject of child labor. Time not permitting the
reading of a paper he had prepared on the subject, it was, on
motion, ordered published in the Monthly Bulletin.
On motion the Board adjourned. RiCHARn H. Lewis,
Secretary.
NOTE.
Subsequeul to the lueeting of the Board a difference of opinion
arose l)etween the Biologist and the Secretary-Treasurer of tlie
Board as to the iiroper disposition of the fees received for extra
analyses and exaniinations not rccinired by the law to he made free
of charge. The Biologist contended that the work was done otitside
of laboratory hours, and that therefore the fees belonged to him per-sonally.
The Secretary-Treasurer took the position that this would
i)e, in his opinion, an unwise arrangement and that it would be lietter.
if necessary, to pay the Biologist a higher salary. The Biologist then
agreed that if he were paid $100 per month by the Board he would
be willing to resign all special fees. In order to avoid the expense of
a special meeting to settle the matter, the question was submitted by
rlie Secretar.v-Treasurer to all the members of the Board by letter,
with the reijuest that the.v would give their views as to its proper
settlement in theii' replies. The result of this ei)istolary vote was
that the Biologist should lie paid as that part of his remuneration
eoming from the Boai"d a tlat salary of .$100 per month beginning
with January 1, 100r>, making, with that paid by the Board of Agricul-ture,
an annual salary of .$1,0.30, and that all money received for
work in the laboratory from every source should b(> covered into the
treasury of the laboratory.
PROCEEDINGS OF THE ANNUAL CONJOINT SESSION
OF THE
MEDICAL SOCIETY OF THE STATE OF NORTH CAROLINA
AND THE
NORTH CAROLINA STATE BOARD OF HEALTH,
Held on Wednesday, May 24, 1905.
at gkeensboko, n. c.
At 12 M. on Wednesday, the second day's session of the Medi-cal
Society, in conformity to the nsual annual custom, a recess
of the Society was, on motion, ordered for the purpose of holding
a conjoint session with the State Board of Health.
The great majority of the members of the Society remaiued
in attendance.
The conjoint session Avas called to order by Dr. S. Westray
Battle, of the Board, who expressed the pleasure of the Board
in seeing the session so well attended.
The annual report of the Secretary Avas called for, and pre-sented
by the Secretary, Dr. R. H. Lewis, as follows
:
REPORT OF THE SECRETARY, MAY 1, 11)04. TO MAY 1, 1905.
During the past year the special worlc of yoxu- Secretary—in addi-tion
to the usual routine work of the office, which is always to the
fore, aud a statement of which in detail will be found in the biennial
report for 1903-'04—has consisted in promoting the crusade against
tuberculosis inangnrated in our last report. The snggestions therein
made have been carried out as fnlly as our very limited facilities
—
half the time of one stenographer—have permitted. The plan pur-sued
has been as follows
:
First, the preparation of a pamphlet on the "Causes and Preven-tion
of Consumption." The attempt was made to put the matter to
the people as simply and clearly as possible and at the same time
to make it as interesting as the narrow limits demanded by the nec-essary
conciseness would permit. As a copy of this publication has
been sent to you it is superfluous to further dwell upon it.
The question of getting the pamphlet into the hands of the people
was carefully considered, and it was decided that it would be much
ELEVENTH BIENNIAL REPORT. 11
l)ettei- to send it directly to the individual instead of depending
upon the "take one'' principle. In a population as large as ours a
selection of the individuals had to be made, of course, and the fol-lowing
classes, which were regarded as the most influential in this
work, were selected to be served first : Editors, physicians, minis-ters,
lawyers, teachers, and manufacturers employing in-door labor.
Realizing that literature that is not read is usually so much waste
paper, it was thought that if a short letter printed in typewriter type,
with the signature of the Secretary in script, was enclosed with the
pamphlet, it might excite interest, to some extent, at least. So a let-ter
to each of the classes named above was specially composed to suit,
earnestly appealing to them to read it and assist in spreading the
information contained in the pamphlet, and promising in every case to
send, free of charge, as many copies as the reader would agree to dis-tribute.
The editors of our State were exceedingly kind in noticing
the article in their papers, and in consequence there have been calls
for it from Indiana to Texas. Ministers and teachers have shown the
most interest and have agreed to do more distriliuting than any of the
others. While by far the most important of all in the solution of
this great problem is our own profession, they have, I deeply regret
to say. apparently felt no concern about it. I say apparently, because
they may and in very many cases no doubt have exerted them-selves
to instruct their tuberculosis patients and the members of
their households in the proper methods of prevention. For human-ity's
sake, and for the honor of the profession, let us hope and be-lieve
so at any rate. It was hoped that there would be a large de-mand
from them for the pamphlet for distribution among their
tuberculous families, but that hope, much to my disappointment, not
to say mortification, has proven an "iridescent dream"' so far. But
we will not despair. We cannot abandon the hope of securing the
earnest and interested co-operation in this great work, which means
more for suffering humanity than any other that can be mentioned,
and which is receiving at this time so much attention and sympa-thetic
aid from so many iiersons of all callings who love their fel-low-
men all over this great country of ours and throughout the
civilized world, from the one class who can do so much to advance it.
The county medical societies could be of much service in this
campaign against tuberculosis. I hope they will devote at least one
meeting e\evy year to it. halving some one read a paper and then
holding a symposium on the subject. As we know, the curability
of tuberculosis depends most of all upon an early diagnosis—before
the degenerative changes have begun—and a thorough discussion of
this one aspect of the subject would doubtless eventuate iu much
good. The chief benefit to be derived, however, would consist in an
increased interest in the subject and a keener appreciation of the
grave responsibility of the physician in relation to it, whether he
12 NORTH CAROLINA BOAUl) OF HEALTH.
wishes to admit it or not. This luight sufigest to some the advisa-bility
of personally, as well as professionally, aiding in the various
forms of effort—in helping towards the formation of anti-tuberculo-sis
societies and by giving an occasional lecture, for example.
As this subject has been considered more or less fully In the
tenth biennial report, the manuscript of which has been in the hands
of the printer for months, I will not further tax your patience with
it. Anybody desiring a copy of this report can get it, as soon as it
is printed, by sending a request for it to the Secretary.
Smallpox has continued to prevail throughout the State, and more
widely than ever before—the number of counties infected is 78.
The number of cases is, white .''.,6.36', colored 3,741, total 7,377; num-ber
of deaths, white l.">, colored 18. total 31. Death rate per cent,
for the whites 0.36, for the colored 0.48, for both races combined
0.42. The figures for the last smallpox year were, respectively, cases,
2.840, 2,530, 5,370; death rate, 1.23, 1.34. 1.28; for the year before
that—1002--03—1.801. 2,.j95, -4,456, with a death rate per cent, of
3.12, 4.04, 3.66. From these figures it appears that the disease has
been becoming more abundant and decidedly less fatal. As a conse-quence
of this mildness the difficiilty in controlling it has become
greater than ever. Indeed, it gives some color for reasonableness to
the suggestion that has l)een made to abandon the attempt to control
it at all, although, of course, that cannot, be seriously considered.
There is no telling when it may become very much more fatal. The
following is a tabulated statement of the smallpox in the State for
the past year. While it shows a larger number of cases than ever,
I am sure that a great many cases have never been reported
:
SMALLPOX REPORT FROM MAY 1, 1904, TO MAY 1, 1905.
Number of Cases.
County.
Alamance -
Alexander
-
Anson
Ashe
Beaufort -
Bertie
Bladen
Buncombe
Brunswick -
Burke
Cabarrus --.
White. Colored.
23
45
243
286
78
30
31
100
7
17
63
60
112
1
70
7
200
Total.
23
45
306
346
. 190
1
100
38
300
7
20
Number of Deaths.
White. Colored. Total
eleventh biennial kei'okt.
smallpox-Continued.
13
County.
Caldwell
Camden
Carteret
Catawba
Chatham
Chowan
Clay
Cleveland
Craven
Cumberland --
Currituck
Davidson
Davie
Duplin
Durham
Edgecombe ---
Forsyth
Franklin
Gaston
Gates
Granville
Greene
Guilford
Harnett
Haywood
Henderson ---
Hertford
Hyde
Iredell
Jackson
Johnston
Lenoir
Macon
Madison
Mecklenburg
Number of Cases.
White.
4
7
32
5
3
21
8
10
2
8
Colored.
13
205
2
2
21
1
11
18
35
14
30
40
25
75
21
28
38
86
5
100
4
57
2
6
27
23
36
40
43
6
10
3
7
53
34
40
15
6
18
225
62
36
7
122
4
5
51
Total.
17
212
34
5
26
57
8
50
45
14
10
5
28
54
45
58
50
20
48
40
25
300
83
64
38
93
127
4
8
100
9
108
• 2
6
34
Number of Deaths.
White. Colored. Total.
14 jVORTH CAROLINA BOARD OF HEALTH.
SMALLPOX—Continued.
County.
Mitchell
Moore
Nash
New Hanover
Northampton
Onslow
Orange
Pamlico
Pasquotank
Pender
Perquimans
Person
Pitt
Randolph
Richmond
Robeson
Rockingham
Rowan
Rutherford
Sampson
Scotland
Stanly
Swain
Transylvania
Wake
Washington
Warren :
Wayne
Wilkes
Wilson
Yancey
Total in 78 counties- --
Death rate, per cent.-
Number of Cases.
White.
6
24
17
39
26
126
1
191
5
5
25
100
35
25
40
12
4
1
12
,000
10
9
39
177
30
34
11
26
,636
Colored.
4
63
165
15
18
8
32
7
50
40
30
8
1
9
90
1,350
1
47
2
4
100
96
2
3, 739
TotaL
6
28
80
204
41
126
1
191
23
13
32
32
150
35
65
70
20
5
10
102
2,350
11
9
39
224
2
4
130
. 130
13
26
7,375
Number of Deaths.
White. Colored. Total.
13 18 31
0.36 0.48 0.42
ELEVENTH BIENNIAL REPORT. 15
The laboratory has continued to be of much assistance in our sani-tary
worlc—more than for any preceding year—but at the same time
it must be confessed that our physicians do not use it as they ought.
The report of the Biologist is appended.
In the Avay of sanitary legislation we have secured the passage
by the last Legislature of an act to establish a State Laboratory of
Hygiene, but failed to get an appropriation large enough to justify
cutting loose from the Agricultural Department. The ice, however,
has been broken and we hope to get sufficient money at the next
session of the General Assembly to put us on an independent basis.
We can then offer still greater facilities to the profession, although
it must be confessed that they do not take advantage of what we
have been offering as we believe they should.
In conclusion, I wish to bespeak the cordial co-operation and
assistance of our brethren of the profession in our work. While we
may accomplish something without this, their aid and help would
be simply invaluable.
The President : We have some papers on the programme of
the conjoint session. They are now in order. Dr. E. C. Levy,
of Richmond, Avill favor us with a paper on "Relative Value of
the Various Methods of Determining the Sanitary Qualities of
a Water Supply."
RELATIVE VALUE OF THE VARIOUS METHODS OF DETER-MINING
THE SANITARY QUALITY OF A WATER SUPPLY.
By Ernest C. Levy, M. D., Richmond, Va.
It is only within comparatively recent years that the importance
of pure water has come to be fully recognized. Up to that time little
more was asked of any source of supply than that it could be relied
upon to furnish an abundant quantity of water pleasing in appear-ance
and agreeable to taste.
In the dawn of the new era. when men began to realize that a
water possessing the above elementary requirements might still be
unwholesome and even dangerous for drinking purposes, the aid of
a chemist was called to settle the question. During this period things
were expected of the chemist which we of to-day know he was unable
to accomplish. It was then common practice to send him a bottle of
water, with no data as to its source or surrounding conditions, and
expect him, as a result of his laboratory investigation, to give a final
and absolute opinion.
With the advent of bacteriology, hopes were for a brief time enter-tained
that an infallible means had been found for determining the
16 NORTH CAROLINA BOARD OF HEALTH.
sanitary (juality of any water with uuerring accuracy. The really
Iiarniful factor iu a polluted water being the bacteria of disease
which might be present, the detection of these, it was argued, would
be the linal proof of the unfitness of a given water, while in their
absence a water could be considered at least not dangerous. But it
was soon found that, however well established the relation between
certain bacteria and the disease to which they give rise, and however
easy their identification in pure culture, yet the detection of these
bacteria in water was a task never easy and usually impossible.
Thus, because bacteriology stood self-confessed as unable to accom-plish
the supreme test demanded of it, the real possibilities of the
science were either overlooked or undervalued, and for a time, indeed
until quite recently, chemical methods again enjoyed the ascendancy,
though now decidedly shorn of almost superstitious reverence pre-viously
accorded them.
Along about this time it began to be recognized that the subject
of water sanitation was one of sufficient importance to constitute a
real specialty in itself, and .so, while most chemists and bacteriologists
were engaged in the futile and rather amusing attempt to claim
superiority for their respective sciences, a few, with wider vision,
began to attack the problem in the true modern spirit—by work
instead of words—and as a result of their labors, both directly and
in the impetus thus given to the whole subject, the modern water
expert came into being. The object of the present paper is to show
the necessitj' of bringing to bear all the available methods of research
in arriving at a trustworthy opinion of the sanitary quality of a
water supply. This can, of course, be done merely in outline in a
paper of this kind.
As above suggested, the work of a water expert is not the simple
matter it was formerly held to be. True, in many instances a given
water is so obviously and grossly contaminated that its unfitness for
drinking purposes is manifest to even the most casual observer.
Such cases need not be discussed here. At the other extreme stand
those woodland springs and streams (each year becoming more rare),
so removed from all possible contamination as to be unquestionably
pure. But the vast majoritj' of all possible stiurces of water supply
(excluding those so plainly contaminated as to be unworthy of con-sideration)
fall in the class where prudence suggests or demands an
investigation of their sanitary quality.
The opinion is still widely prevalent, not only among the general
public, but among members of the medical profession as well, that a
chemical examination of water for sanitary purposes is much the
same thing as an analysis for any other purpose ; such, for instance,
as the determination of the commercial value of an iron ore or the
purity of a food product. Such is by no means the case. In a sani-tary
water analysis the analytic processes themselves are for the
ELEVENTH BIENNIAL REPORT. 17
most part as satisfactory as in the instances above cited, but with
tbe iron ore or food product tbe interpretation is evident when once
the analysis has been made, while the water analysis merely fur-nishes
data to assist the judgment in arriving at an opinion. This is
a necessary state of affairs, arising from the fact that, in a water
contaminated by an ordinary sewage, chemistry does not detect the
presence of any substances injurious in themselves, or even any
substances actually characteristic of sewage, but merely gives evi-dence
of the presence of such things as, however harmless in them-selves,
have been found to be associated with polluted water. Thus,
were one to give to a chemist a sample of water to which had been
added a few spoonfuls of moderately salted broth, the analysis would
be pretty much the same, even before the broth had undergone any
change, as if an even larger amount of sewage were present ; yet the
broth is, of course, harmless, while the sewage might contain myriads
of typhoid or other disease germs.
In spite of iheir limitations, the importance of chemical analyses
must by no means be underestimated; but, except in cases of marked
pollution, they can seldom be relied upon themselves for furnishing
adequate information. Their greatest field of usefulness, perhaps, is
in affording a measure of the degree of pollution where this is very
great, rather than in giving evidence in more doubtful cases.
In one direction, at least, chemistry is able to do what can be
accomplished by no other means, namely, to afford evidence of the
fact that a spring or well water comes from a polluted source, even
when complete removal of the contained bacteria and oxidation of
the organic matter originally present in the water has been accom-plished.
In this way it can direct attention to the possibility of
future danger through interference with the soil filtration by which
purification is taking place at the time of the examination.
Bacteriological methods, like the chemical, fail as a rule to show the
presence of the actual things which make a water unwholesome or
dangerous, but they accomplish a much nearer approach to this end.
The real danger in a polluted water lies in the presence of bacteria
of disease, and especially, so far as our present knowledge goes, in
the presence of bacteria derived from individuals suffering from cer-tain
diseases in which the germs gain entrance to the body by the
mouth and leave it, enormously increased in numbers, from the other
end of the digestive tract. Bacteriological methods are able to de-termine,
with a high degree of accuracy, the presence of organisms
characteristic of sewage, and since a water supply which is shown
to contain sewage must be liable at any time to contain dangerous
micro-organisms (in case any of the individuals contributing this
regular sewage should be suffering from any of the water-borne dis-eases),
such water is very properly held to be dangerous.
18 NORTH CAROLINA BOARD OF HEALTH.
Not only can bacteriological methods determine the presence of
sewage contamination with greater directness than can be done by
chemistry, but they can detect its presence when the dilution is so
great that chemical methods fail utterly. In distinction to what has
been said of the ability of chemical examination to throw light on
past pollution and to predict, at times, the danger of serious condi-tions
in the future, the revelations of bacteriology are confined strictly
to conditions existing at the time of the examination.
Besides the chemical and bacteriological examinations, we are able
to gain valuable information in some cases by means of the physical
and direct microscopical examinations, which last afford a means of
ascertaining the character of the suspended matter present, includ-ing
organisms other than bacteria. These two methods, while having
their own field of usefulness, are not of as great value in this special
connection as those previously mentioned.
In determining the sanitary quality of a water supply, we have, in
addition to the laboratory methods above mentioned, two other
methods of the utmost value: (1) a study of the vital statistics of the
community supplied by the water in question, and (2) a sanitary
study of the watershed in the case of streams and of the more imme-diate
environment in the case of wells and springs.
The information to be gained by studying the vital statistics is, of
course, available only in connection with the water supply already in
use. In certain instances the information secured by this means is
more positive than that obtained by any of the above methods, but
this study must be conducted with the greatest care, avoiding the
many pitfalls always in wait for the unwary.
Regarding the sanitary study of the watershed, it is right here
that a mistake is frequently made. While it is universally acknowl-edged
that only the chemist and bacteriologist can carry out the
methods of these special sciences, it is by no means uncommon to
regard the ability to draw correct deductions from a sanitary study
of the watershed as independent of such training. As a matter of
fact, the ability to give their proper value to the various features
present and to sum up intelligently the influence of all the factors
involved comes only from long experience. Even then cases will
arise in which the water expert must draw upon his judgment rather
than upon any precedent, either in his own experience or that of
others.
A careful investigation of all possible factors of contamination
must be entered into. The relation of the volume of the stream to the
amount of the polluting material, the distance of the source or sources
of pollution from the intake of the water supply, the time taken by
the stream in flowing between the points in question under both
normal and flood conditions, are among the most important consid-erations
where a running stream is concerned. In this connection
ELEVENTH BIENNIAL REPORT. 19
it may be mentioned that modern scientific opinion tends more and
more to the view that, ia the present built-up condition of our coun-try,
very few streams indeed furnish a water entirely satisfactory
from a sanitary standpoint without the adoption of some means of
artificial purification. In the case of springs or wells the points to be
observed are different, and usually relate to rather immediate environ-ment,
except in cases of deep (real or so-called artesian) wells,' the
waters of which may come from greater distances. The geological
structure of the region must always be given consideration. In a
recent case of the writer's the fact that certain shallow wells were
in rocks of igneous origin led to the expression of an opinion quite
different from what would have been given had they been in sandy or
gravelly soil.
From what has been said it must be evident that forming an opin-ion
as to the sanitary quality of a given water is a thing demanding
more than a mere chemical and bacteriological examination. Both
of these are necessary, hut in addition to this there are a great many
other things to be done. Even so far as the analyses themselves are
concerned, the real test of skill is in the ability to put a correct inter-pretation
on the analyses after they are made. The analytic data
themselves may aptly be compared to the symptoms which enable the
physician to make his diagnosis, and every member of this Society
knows the skill demanded in this connection, and how, at times, some
apparently trivial symptom, which one of less experience might en-tirely
overlook, may lead the skilled diagnostician to his final judg-ment
of the true condition.
The study of the surroundings should never be neglected. To do so
would be much the same as for a physician to be contented with
making his diagnosis and deciding on his line of treatment after mak-ing
a laboratory examination of the urine, sputum and blood without
even having seen his patient, or having even learned anything of his
past history or present symptoms. At times this might be possible,
but generally it is a thing few would care to attempt. Of course, it is
possible in many instances to have a division of the labor between a
skilled observer in the field and the chemist and bacteriologist in the
laboratory, in the same manner as the laboratory worker and the
attending physician may co-operate.
The writer wishes, in conclusion, to urge upon the members of the
medical profession the importance of becoming acquainted with the
work which has been done in recent years in connection with water
sanitation. While such a degree of familiarity with the subject as
can be acquired by the busy practitioner will not, of course, make
him an expert in this line, it will still enable him to do an immense
amount of good in calling attention intelligently to some of the more
palpable transgressions against the laws of health, which are now
reaping their regular harvest of illness and death.
20 NORTH CAROLINA BOARD OF HEALTH.
DISCUSSION.
Dr. W. J. Martin : Mr. President, if you will pardon ine, I
would like to say a word about this very interesting paper, be-cause
I have myself been interested in it and paid some atten-tion
to it. There are two things which I w^ant to say correlative
of this paper : One is in regard to the way samples are sent for
water analyses. The average person sending you in a sample
for examination will put it in an old jug with an old stopper, or
in an old bottle, and put absolutely no mark on it, and send it
along and request you to tell them whether it is fit for drinking
or not, and whether it can be condemned or not. I have had
others to do it under the direction of the physicians, thinking
that the chemist, like a magician, can put his wand in the bot-tle
and draw forth a conclusion in regard to the water. H^ow,
chemistry cannot bear that. The chemist, in order to make his
report fairly, honestly and intelligently, must have before him
all the facts of the case, and there are no facts more important
to him in forming his opinion of the water than those facts
which are gotten by the survey of the field of the source of the
water. He must know the history of this water, so far as
it can be known and intelligently given. If not, it is not fair
to expect him to give a proper diagnosis of the water condi-tion.
I wish you would burn that into your memories, into
your consciousness and into the memory and consciousness of
your patients—those whom you are concerned about. When-ever
you send to a chemical laboratory a sample of water
for examination, do you, as the scientific expert of your commu-nity,
see to it that a minute history of that water goes along
with it, and throw any light that can be thrown on the subject,
and, before you send it, write to the expert as to how you send it
and how you collect the sample. I have heard people say, "If I
am going to tell you all about the water, I don't want you to tell
me about it." You may think that is casting a slur upon the
chemist's ability, but all of our abilities are limited, and with
that knowledge we can give you much better service, and what
we want is the service.
There is another question, Mr. President, that was not directly
touched upon there, and in which I have been very much inter-ested
of late. This gives me a chance to say something about it.
ELEVENTH BIENNIAL REPORT. 21
I suppose that a vast majority of the cases of contamination of
water are sewage contamination. By sewage contamination we
do not necessarily mean the sewage contamination of cities, but
of local conditions. Our sewage is deposited somewhere around
the neighborhood of the well or the spring, and it gets into that
well or spring after a time. I have heard men say that their
father or grandfather was raised off that water, and they don't
believe me when I say that this well is not pure and wholesome.
They fail to remember that the ground, like a sponge, not only
takes up water, but holds microbes. And the sewage is deposited
there and works deeper and further year by year, until finally
—
it may be after decades—years have passed, the contamination
does reach the Avell, and disease results. Xow, it becomes impor-tant
that we should recognize that as soon as possible, and, while
the presence of chlorine does not necessarily mean that the
water has been contaminated with sewage, with the knowledge
before us of local conditions and the normal chlorine content
of the water of that location, it will tell us a great deal. If I
know the local chlorine content of water, and I find in another
water that persistently and continuously for a length of time
the chlorine is in excess of the normal in that location, it is a
mighty strong indication to me, supplemented by connection
with other parts of the examination, that that water has been
contaminated by sewage. ISTow, there are cases on record in
your own family in Avhich the ice-cream freezer has been dumped
out near the well, and if, twenty-four hours after that, you had
examined that water, you would have found an increase of chlo-rine
in the water. But where, day after day and month after
month, the chlorine content is higher than the normal for that
locality, you may suspect trouble. That simply leads me to this
:
If we had a knowledge of the normal chlorine content of waters
of the different points of the State, it would put in the hands of
even the physician a very powerful means of making a rapid
examination of the water Avitli reference to a supposed contami-nation
in his own neighborhood. Now, I believe (you can prob-ably
tell me if I am mistaken) that for our country only two
States have done that. Massachusetts and Connecticut have
established well-defined chlorine curbs throughout the State. I
believe it would pay if means were raised whereby well water.
22 NORTH CAROLINA BOARD OF HEALTH.
spring water, lake water, surface water—all kinds of water
—
could be sent in from every locality of the State to the labora-tory
and an examination be made from time to time throughout
different parts of the year, until finally we could establish a
chlorine map that would give us, to a great extent, the chlorine
content of the waters throughout the State, and then we would
be able, with a very simple examination—one that you could
make almost at any time, especially through a range of a week
or a month—whether there was any probable contamination of
the water. I think that it is a thing that the Medical Society
could very well take up, which the Board of Health could push
this matter of obtaining a chlorine map of the State.
Dr. Joseph Graham, of Kaleigh, was then requested to read
his paper on "A Proper Milk Supply for the Cities and Towns
of North Carolina," but he requested that he be allowed, as
everybody was tired, to postpone his paper until after dinner,
which was allowed.
Dr. Ivey then asked to be informed whether that meant that
the conjoint session adjourn for another year, or for them to
have the paper in the Medical Society. The President sug-gested
that the Medical Society should take it up in the regular
session immediately after dinner.
On motion, it was so ordered, if found agreeable to the Presi-dent
of the Society.
A very interesting talk was made on "Effects of Child Labor"
by Dr. A. J. McKelway, of Charlotte.
The conjoint session then adjourned sine die.
The State Board of Health held a short session, at which the
Secretary announced the appointment by Grovernor R. B. Glenn
of Drs. J. Howell "Way and W. O. Spencer, and the election by
the Society of Drs. George G. Thomas and Thomas E. Ander-son
members for the ensuing term of six years.
On request of the President, the members of the Board of
Health remained, and a short executive session of the Board was
held.
ELEVENTH BIENNIAL REPORT. 23
PHYSICAL EVILS OF CHILD LABOR.
By A. J. McKelway, Assistant Secretary National Child Labor
Committee,
When the health and vitality of a large number of our own people
are concerned, to whom shall we go save to the physician, whose
ministry it is to usher life into the world, to save it and to prolong
it, and to whom, therefore, life itself should be a more sacred thing
than to the ordinary man? When I think of our little children of the
Southern States with their splendid physical inheritance, and how
much it costs to bear them and rear them and train them, it does
seem a pity that this stock should be depreciated by putting the child
to work for the man's long working day.
The evil is a national and not a sectional evil. But because of its
newness in the South we have been the last to remedy it by legisla-tion,
and the proportion of child to adult workers is four times as
large in the South as in the Northern and Western States. The
physiological question is, whether children under fourteen years
should be allowed to work in a factory for twelve hours a day ; espe-cially
whether 3'oung girls between the ages of twelve and fourteen,
in this climate should be allowed to do the spinning and weaving
that falls to them, at this critical period of their lives, during the
twelve-hour working day, which is the rule in North Carolina and
the cotton-manufacturing States of the South ; whether children of
either sex under fourteen should be allowed to work during the
night.
It may be of interest to you to know that the first public protest
made against this evil, which has been the curse of the cotton mills
especially for a hundred and fifty years, was made by physicians.
Dr. Thomas Percival, author of "Medical Ethics," made an investi-gation
of the causes of an epidemic of fever in the Manchester cotton-mill
districts, which had been accompanied by frightful mortality
among the children. Dr. Percival and his associates were unable to
ascertain how the fever originated, but they were unanimous in their
opinion that it had been "supported, diffused and aggravated by the
injury done to young persons through confinement and too long-continued
labor, to which evils the cotton mills have given occasion."
And they passed the following recommendations to the Manchester
magistrates
:
"We earnestly recommend a longer recess at noon and a more
early dismissal in the evenings to all those who work in the cotton
mills ; that we deem this indulgence essential to the present health
and futui'e capacity for labor to those who are under the age of four-teen,
for the active recreations of childhood and youth are necessary
to the right conformation of the human body."
24 NORTH CAKOLINA BOARD OF HEALTH.
This was in 1784. lu 17SG Dr. Percivul aud bis associates in the
medical profession had formed themselves into the Manchester Board
of Health. They felt it incumbent to lay before the public the result
of their inquiries into the condition of the cotton mills of Man-chester.
They said : "It appears that the children and others who
work in large cotton factories are peculiarly disposed to be affected
with the contagion of fever." And among the causes of this they found
one to be, "the want of active exercise which nature points out as
essential to childhood and youth to invigorate the system and to fit
our species for the employments and the duties of manhood." They
went on to say : "The untimely labor of the night and the protracted
labor of the day, with respect to children, not only tends to diminish
future expectations as to the general sum of life and industry by
impairing the strength and destroying the vital stamina of the rising
generation, but it too often gives encouragement to idleness, extrava-gance
and profligacy in the parents, who, contrary to the order of
nature, subsist by the oppression of their offspring."
It would have been well if Englaud had followed the advice of her
physicians at once instead of fighting over the question inch by inch
for a hundred years, for in that time the physical vitality of the
factory population has been fatally sapped. This is now known to be
the real secret of the disaster of the British army in the South
African war.
Dr. Charles W. Roberts, of England, gives the following striking
results of the examination of 39,840 boys and men. of whom 5,915
belonged to the non-laboring class and 13,031 to the artisan class.
The difference in height, weight and chest girth from thirteen to six-teen
years of age. is as follows
:
HEIGHT (inches).
Non-laboring class
Artisan class
Class.
13.
58.79
55.93
Age.
14.
61.11
57.76
15.
63.47
60.58
16.
66.40
62.93
WEIGHT (pounds).
Non-laboring class
Artisan class
88.60
78.27
99.21
84.61
110.42
%.79
128.34
108. 70
CHEST GIRTH (inches).
Non-laboring class
Artisan class
28.41
25.24
29.65
26. '28
30.70
27.51
33.08
28.97
ELEVENTH BIENNIAL REPORT. 25
And among the artisans the people of tlie cotton mills stand lowest
in tbe physical scale.
Commenting on these figures, Dr. W. W. Keen, of Philadelphia,
says :
"Constant standing and superintending a loom, or other similar
work re(iuiring constant standing, itself stunts the growth of chil-dren
at these plastic ages. The ages in question, thirteen to sixteen
years, are precisely the ages when, under favorable circumstances,
these children develop physically with great rapidity. This is espe-cially
true of girls. To confine these children in mills, with lack of
opportunity for schooling, is to prevent both the physical and mental
development of such children to a degree which is most injurious,
not only to them, hut also to the community—that is to say, the
State.
"In my clinics for the past forty years I have had many hun-dreds
of such children, under-developed in mind and body, ill-fitted
to enjoy life themselves or to transmit vigorous minds and healthy
bodies to their children."
The same process which Mr. Chamberlain is trying to counteract
in England by a protective tax on the products of the farm, thus
sending the people back to the country from the overcrowded factory
districts, is being repeated on a tremendous scale in the South and in
North Carolina. From one little village, called Clyde's, near Waynes-ville,
during the past year fifteen hundretl of our splendidly devel-oped
mountain people have gone to the cotton mills of South Car-olina.
They have been tempted from the farm by the prospect
of getting wages from every member of the family, fi'om eight
to ten years up. There is just now unprecedented demand in the
factories for labor, and the demand is being met by the employment
of children on a larger scale than ever before. It is a conservative
estimate to say that there are fifteen thousand children under four-teen
years of age working in the cotton mills of North Carolina
twelve hours a day or night, and the greater part of these are girls,
the future mothers of the race. "It is a shame for a nation to make
its young girls weary."
Is it not time for such protest to be made by the physicians of
North Carolina against the extension of this evil as was made by the
physicians of old England more than a hundred years ago? The
science of medicine has advanced almost infinitely since that day.
But the fundamental facts regarding childhood and its rights remain
unchanged with the centuries.
26 NORTH CAROLINA BOARD OF HEALTH.
A PROPER MILK SUPPLY FOR THE CITIES AND TOWNS OF
NORTH CAROLINA.
By Joseph Graham, M. D., Raleigh, N. C.
Next to bi'ead and water, milk is more commonly used than any
other article of food or drink.
In cities and towns almost every home receives daily a supply of
milk and cream. This is used at every meal and, with few exceptions,
by every member of the household. It is an ai'ticle of food in which
every one may be said to be interested. Milk is a nutritious, eco-nomical,
and with many a favorite food. It is a very cheap food, as it
contains more nutritive matter than can be obtained at the same
cost in other foods.
Milk is generally used in the raw state. Most other foods are
cooked before they are eaten, and most, if not all, the bacteria they
contain are killed by the heat.
We have no simple means by which we can definitely determine the
purity of milk. The quality of most foods can be judged by their
appearance. This is not the case with milk. There is no article
of food which can be adultei-ated or contaminated, without changing
its appearance, to such an extent as milk. The fact that milk ap-pears
perfectly sweet is not a proof of its purity, for if the germs
are already in it the harmful change may take place after it enters
the stomach. Then, too, some disease-producing germs do not cause
souring of the milk, and therefore their presence is not detected.
Impure milk may cause serious and even fatal diseases. Frequently
cow's milk is the only nourishment taken by infants and invalids, and
it is these who are least able to stand the ill effects of impure foods.
Every year more children have to be nourished with substitutes for
mother's milk. Usually cow's milk is selected, and, when pure, there
is no superior food for this purpose.
About one-third of all deaths are of infants, and a very large per-centage
of these die from diseases of the digestive tract. These
diseases are mainly due to impure food. It is, therefore, reasonable
to assert that the mortality of infants has a close relationship to the
wholesomeness of the milk supply.
Milk is the most suitable culture medium we possess for the growth
of germs. These germs grow and elaborate poisons both before and
after taken into the infantile stomach.
The agency of milk in the spread of contagious diseases has only
lately been appreciated. Outbreaks of disease have been definitely
traced to infected milk. Among the most common' diseases carried
in this way are typhoid fever, diphtheria and scarlet fever. There is
little doubt that tuberculosis is also spread in the same way. In
1900, Kobor Collected records of 330 epidemics which were spread by
ELEVENTH BIENNIAL REPORT. 27
milk. These illustrate very well how the milk most frequently be-comes
infected. There were 195 outbreaks of typhoid fever, 99 of
scarlet fever, and .30 of diphtheria. In the typhoid epidemics the dis-ease
prevailed at the dairy in 148 instances ; in 67 the milk was
diluted with infected well water ; in 34 cases the employees acted as
nurses, and in 10 they continued to work for a while, although them-selves
suffering from the disease. In one instance it was found that
the milk cans were washed with cloths used about patients ; in two
cases the dairy employees were connected with the night-soil service.
Of the 99 epidemics of scarlet fever, there were diseases at the
farm or dairy in 68 instances ; in the other instances the dairy em-ployees
acted as nurses or lodged in infected houses. As it is diffi-cult
to procure cow's milk sufficiently free from germs, we have tried
to find some safe way to destroy the germs already present. There
are two classes of apparatus used to destroy germs : one known as a
sterilizer, which sterilizes the milk at a boiling temperature (212
degrees F.), the other, called a pasteurizer, killing germs at a much
lower temperature.
There are cei-tain disadvantages in sterilized milk. The taste is
very considerably changed ; such milk is very much more consti-pating
and more difficult of digestion ; also it seems to be less nutri-tious—
certainly children do not thrive as well when fed on sterilized
milk as when nourished with pure cow's milk. Pasteurization of the
milk produces less change in the constituents of the milk than ster-ilization,
and, as it is sufficiently thorough in the destruction of germs,
it has become the most popular method of sterilization.
Sterilization of milk has certain limitations. Heating milk de-stroys
only living organisms; it does not kill spores, nor does it re-move
toxins or poisons. Before sterilization milk may already con-tain
the products of bacterial growth in such quantity and of such a
character as to render it wholly unfit for food. Even though just
sterilized, it may still be poisonous to an infant, for sterilization will
not kill the products of bacterial growth. It is, therefore, very im-portant
that sterilization be done at the earliest possible moment.
We must always remember that sterilized milk is much more diffi-cult
of digestion. The only value of sterilization is in the pre-venting
of disease: first, by enabling us to feed infants on milk in
which no considerable fermentative changes have occurred ; and
second, by destroying disease-producing germs with which the milk
may have become accidentally contaminated. Milk can never be
made pure after it has once been badly contaminated. These meth-ods
are only meant for someichat improvlnci conditions tvhich should
have lieen prevented. The expediency of pasteurization as well as
sterilization may be considered doubtful. It would be far more
desirable to use absolutely natural milk from perfectly healthy cows,
and so have it good, pure and safe.
28 NORTH CAROLINA BOARD OF HEALTH.
The milk supply of Raleigh, my home tiiwn, so far as I have investi-gated,
is iiunecessarily impure. This fact I have learned through
sad hedside experiences, inspection of the dairies, and by repeated
examinations of samples of milk bought in the open market. The
attention of the Board of Health was called to this matter and a
committee was appointed by the Board of Health to inspect all the
dairies and to employ a bacteriologist and chemist to examine sam-ples
of millv from all of our dairies. This committee was instructed
to devise a plan to correct any evils they might find. The result of
the dairy inspections, together witli the bacteriological and chemical
reports, showed conclusively that the milk supply was unnecessarily
impure.
Forty samples of cow's milk were examined by Dr. F. L. Stevens,
of the Agricultural and Mechanical College. These examinations
showed that the nutritive quality of the milk was very satisfactory.
Twenty-two samples were examined for streptococci. In one
instance streptococci were found in considerable numbers. In five
other instances streptococci were recorded as being present. There-fore
streptococci were found to be present in thirty per cent, of the
samples examined.
Of the forty samples examined there was no sample bearing less
than 34,000 germs to the cubic centimeter, and only eight samples
ran less than 100,000. These eight were all collected on cool days.
Seventeen samples out of 39 ran above 1,000,000 germs per cubic
centimeter, four samples ran above 4,000,000, and six samples were
between 500,000 and 1,000,000.
These numbers are exceedingly high, very much higher than would
be expected, or has been found in any city the size of Raleigh in
which the milk reached the consumer so soon after milking.
The relation between the number of germs and the amount of dirt
in the milk is clearly set forth in the following table, representing
the analysis of three samples
:
Sample Number.
ELEVENTH BIENNIAL REPORT. 29
and second, failure to cool out the animal heat immediately after
milking, and the improper temperature at which the milk has been
kept.
Therefore the committee suggested to the Board of Health that
they request the Board of Aldermen to appoint a milk commission
to control and regulate the milk supply. This milk commission should
consist of five members—the Mayoi", Superintendent of Health and
three representative citizens. The Board of Aldermen should re-quire
each dairyman selling milk in the cit^' to procure a milk
license. This license should be revoked if the milk commission ad-vised
revocation, for good and sufficient reasons. This milk commis-sion
should employ a chemist and bacteriologist to examine samples
of milk at least once a month, and to examine the animals for tuber-culosis
at least once a year. I consider the tuberculin test very
important, for recently, in one Raleigh herd of 18 cattle, 6, or 331^^
per cent., were found to have tuberculosis. All new cattle should be
tested for tuberculosis before they are bought hij the dairymen and
added to the dairy herds.
It should be the duty of the dairy inspector to examine the cattle,
drainage, ventilation, food, water, yards, pastures, methods of milk-ing
and handling the milk, and all the matters connected with the
health management and care of the animals. He should see espe-cially
to the health of the animals, cleanliness of barns, proper dis-posal
of manure. Also he should see that there is an abundance of
pure water, that the milk is immediately cooled after millciny and
that there are proper facilities for cleaning and sterilizing all bottles
and dairy utensils.
The Superintendent of Health should examine all persons working
about the dairy or in any way connected with the care of the ani-mals,
milk, or utensils and the transportation and delivery of milk,
in relation to their habits of cleanliness as well as for transmittible
diseases.
The bacteriologist should examine the milk to test the efficiency
of the methods in force. He should take samples from the consumer,
in original packages as delivered by the dairymen, and by bacterologi-cal
and microscopical examinations determine the nature of the
bacterial contents, and if pus cells are present. His examinations
should he made every few weeks, and will be the truest indication of
the thoroughness with which the milk commission's requirements are
being followed. I think that the bacterial standard of purity should
not be adopted until the commission has been working for several
months, so as to ascertain the proper standard.
The chemical examinations should be made sufficiently often to
determine if the milk is of correct composition, of requisite richness
and free from adulterations. In our examinations we found the milk
of proper fat content and free from chemical adulterations.
30 NORTH CAROLINA BOARD OF HEALTH.
It is sincerely hoped that our Board of Aldermen will adopt some
such plan. I believe this is the ideal way in which to control and
regulate the milk supply. I believe it is practicable and will produce
the desired result, and at the same time exert little hardship upon
our dairymen.
This plan is not expensive. We estimate that we can operate our
milk commission and employ a dairy inspector and a bacteriologist
and chemist for $000 a year. The dairymen will have to bear only
a small part of this expense, as they will be charged a very moderate
fee for license to sell milk.
For the production of pure milk fine buildings, fine cattle and ex-pensive
apparatus are not at all necessary. At least 99 per cent, of
the contamination of milk occurs after the milk leaves the cow. To
prevent such contamination cleanliness and constant care are abso-lutely
necessary.
At present it is impossible in most of the towns of this State to
get the health authorities to adopt proper ordinances for the control
of the milk supply. The greatest obstacle to municipal control of the
milk supply is the fact thaf tJie public does not yet appreciate the
absolute necessity for such control and the danger of using impure
milk.
In every community much can be done toward improving at least
a portion of the milk supply. Each local medical society can form an
agreement with the leading dairymen of the town to furnish milk
according to their requirements in return for their endorsement of
the purity of their milk.
A certificate, given by the local medical organization and stating
that a dairy is conducted in an approved manner, would be very useful
to a milk seller by enabling him to secure better prices and new trade,
for many of the best class of milk users would value the assurance
thus given. When it becomes known throughout a town that a cer-tain
dairy has been awarded a certificate on account of the excellence
of its methods, its business will immediately increase, and to such
an extent that other dairies will soon be pressing for examinations
in order that they may secure similar certificates. In order to make
the plan still more attractive to the dairymen, it would be well to
bring the matter before the public by periodically publishing the list
of approved, certificated dairies and making brief but pointed state-ments
of the objects of the system and the way to obtain the endorse-ment.
Any one, seeing the list, would naturally look for his milkman's
name on the list ; and, if not found, explanations would be sought.
Without doubt many would insist that those supplying them be on
the list. In this way the dairyman would receive a better price for
his milk and would be enabled to pay the fee of the local milk com-mission
for examining his dairy and product.
ELEVENTH BIENNIAL REPORT. 31
The objection may be made that the small dairyman cannot afford
to conduct his place in the proper way, and that, therefore, the plan
proposed is unfair. The ans\Yer to this objection is that a small dairy
can be conducted in a cleanly way as well as a large one. Those hav-ing
only a few cows and whose interests are mainly in other lines
might not find it profitable, but the necessary improvements need not
be out of the reach of farmers with large or even small herds, if
they are determined to do the thing right and give it all the necessary
attention. There is no good reason why those who wish to progress
should be deterred by the fact that all cannot reach the highest
standard.
One of the principal advantages of this plan is that it can be easily
inaugurated and that those who wish to be helped by it can quickly
get the benefits. That numerous class who w^o'uld oppose the enact-ment
of these regulations into laws (for the reason that they would
not care to be governed by them) would have no ground for valid
objection because of the voluntary feature of the plan suggested. No
one would be compelled to come under the commission and its rules.
The second advantage is, that it gives reliable information to con-sumers
as to where to secure the best milk produced, and they are
no longer compelled to depend upon appearances of the milk or the
statements of the dairyman.
The marked improvement of a few dairies would have a benefi-cial
effect on the entire supply, and the badly kept dairies would be
obliged to improve to keep their trade. The increased receipts from
higher prices and enlarged trade should enable the dairymen to pay
moderate prices for certificates.
In some cases it might be better for the local medical organization
to establish a milk commission upon a philanthropic basis and demon-strate
its value, when the dairymen would gladly pay its expenses.
MINUTES OF THE ANNUAL MEETING AT
CHARLOTTE.
Charlotte, N. C, May 29, 1906.
The Board met in aiiiiual session, with President Thomas in
the chair. Present : Drs. Thomas, Ivey, Anderson, Spencer,
Way, E. H. Lewis and Mr. Ludlow. A telegram from Dr. Bat-tle,
expressing regret that unavoidable circumstances had pre-vented
his attendance, was read.
The minutes of the last meeting were read and approved.
The Secretary called attention to the vote taken by letter dur-ing
the year, by which the salary of the Biologist in charge of
the laboratory Avas ordered increased from $83.33 1-3 per month
to $100 per month, with the understanding that all fees received
by him for extra analyses not required by the law to be made
free of charge should be covered into the treasury of the labora-tory.
This action by letter was ratified.
On motion of Mr. Ludlow, the Secretary was authorized to
expend $35 per month for the services of a stenographer and
clerk.
The Secretary-Treasurer called the attention of the Board to
the fact that he had never been required to give bond as Treas-urer
of the Board or as ex officio Treasurer of the State Labora-tory
of Hygiene, expressed the opinion that as a matter of busi-ness
he should be made to give a proper bond, and formally re-quested
that it be required of him. Thereupon, on motion of
Dr. Spencer, the Treasurer was ordered to execute a bond of
$5,000 in some security and bonding company of good standing,
and instructed to pay for the same out of the two funds in his
custody, pro rata.
Drs. Spencer and Way were appointed a committee to audit
the accounts of the Treasurer.
In discussing the subject of desirable health legislation, the
advisability of having diphtheria antitoxin made by the State
for free distribution to the poor was suggested by Dr. Spencer.
While agreeing as to the importance and desirability of such
ELEVENTH BIENNIAL REPORT. 33
manufacture, the consensus of opinion was that the time was not
ripe for such a movement in our State, and no action was taken.
On motion of Dr. Way, it was
Resolved, That the thanks of the State Board of Health are hereby
tendered the State Board of Agriculture for its invaluable aid in
conducting sanitary work in its laboratory to the great benefit of the
people, and that it is requested to continue this help for another
year, at the end of which time it is hoped the laboratory may be able
to stand alone.
The following communication from the Mayor of the town of
Waynesville was read
:
Mayob's Office,
Waynesvelle, N. C, May 26, 1906.
At a special meeting of the Mayor and Board of Aldermen of the
town of Waynesville, held May 26, 1906, at the Mayor's office, the
following resolution was unanimously adopted
:
"That the State Board of Health be requested to send their Engineer
here to examine and report to the proper authorities health condi-tions
in the town of Waynesville, and particularly to examine and
report upon the water supply of the town ; also that said Engineer
report upon watersheds near Waynesville.
"That the Mayor be requested to forward to the State Board of
Health a copy of above resolution."
The foregoing is a true copy.
H. R. Ferguson, Mayor.
After careful consideration of the matter, the Engineer of the
Board was requested to examine the analyses of the water sup-ply
for the past six months and report thereon to the municipal
authorities, this report to he supplemented by a letter from the
Secretary. It was decided that this is as far as the law requires
action.
Dr. R. H. Lewis was elected the delegate to represent the
Board at the next annual meeting of the American Public
Health Association,
The Auditing Committee reported that they had examined
the accounts of the Treasurer and found them correct.
Committees were appointed to inspect the public institutions
of the State.
On motion, the Board adjourned to meet to-morrow, at noon,
in conjoint session with the State Medical Society.
BicHARD H. Lewis,
3 Secretary.
PROCEEDINGS OF THE ANNUAL CONJOINT SESSION
OF THE
MEDICAL SOCIETY OF THE STATE OF NORTH CAROLINA
AND THE
NORTH CAROLINA STATE BOARD OF HEALTH,
Held at Noon, Wednesday, May 30, 1906,
AT CHARLOTTE, N. C.
At 12 o'clock Dr. Thomas, President of the State Board of
Health, called that body to order, in conjoint session with the
Society. The following members were present: George G.
Thomas, M. D., President, Wilmington; S. Westray Battle,
M. D., Asheville; Thomas E. Anderson, M. D., Statesville;
W. P. Ivey, M. D., Lenoir; J. Howell Way, M. D., Waynes-
\dlle; W. O. Spencer, M. D., Winston-Salem; J. L. Lndlow,
C. E., Winston-Salem ; Richard H. Lewis, M. D., Secretary and
Treasurer, Baleigh.
Dr. Thomas said: Instead of taking up your time with any
remarks, I wish to say that there is a movement on foot in l^orth
Carolina now for the organization of a society for the preven-tion
of tuberculosis—this being a State organization—and also
participation in a national movement to that end.
I deem it unworthy of remark to this body of intelligent men
to say that any step taken toward the control of the "Great
White Plague" is valuable. The movement which will be offered
to you this morning is the beginning of an educational cam-paign,
and, I take it, logically to be carried on by this associa-tion
throughout the State by its members, whom they hope to
enthuse with the zeal it now inspires, and by all manner of
means, consistent with the best interests of the people at large,
as well as the association, to propagate this movement and bring
it to a highly successful end. Dr. Stevens, appointed by your
President the chairman of this committee, will be glad to pre-sent
to you a tentative constitution and by-laws of this associa-tion.
Dr. Hays, the secretary of this committee, has this consti-tution,
and will be very glad to read it to you. (I am very glad
ELEVENTH BIENNIAL REPORT. 35
to say the President put me upon this committee, for which I
thank him.) The committee will be very glad, after this is pre-sented,
if it appeals to you (and you all are, I think, interested
in this subject). We want you to come and join this organiza-tion
and do whatever lies in your power to further the object
Avhich it presents to you.
Constitution read by Dr. Hays. (See index for paper and
other data.)
Dr. Thomas : Now, gentlemen, you have heard this. These
gentlemen, Dr. Stevens and Dr. Hays, will give you a card, and
from that will take your consent to become a member of this
association, and later on they will send you out such literature
as is necessary. I will be glad to have the report of the Secre-tary
of the Board of Health.
Dr. R. H. Lewis, Secretary of the State Board of Health:
They want one dollar, I think it is, from each of you to organize
this society. This is^not a part of the State Board of Health's
work, but is merely supplementary to it. I explain by these few
words so that you will understand what we are driving at. We
want to get a sufficient number of subscribers so that the society
can be organized now.
Dr. E. H. Lewis, Secretary of the Board of Health, read his
report
:
REPORT OF THE SECRETARY, MAY 20, 1905. TO MAY 20, 1906.
During the past year our State has not suffered from any epidemic
of serious nature and our people have enjoyed tlie bealtb attendant
upon normal conditions. It is true that smallpox has continued to
prevail in various localities, as we anticipated and predicted, but, as
appears from the detailed report given below, it has been less preva-lent
and even less fatal than usual. Owing to this more pronounced
milduess the people, and the authorities in some communities, have
been very neglectful of it.
In this connection it is proper to call attention to two incidents in
relation to this disease occurring during the past year—both calling
forth an opinion of the Attorney-General. In the first case the ques-tion
raised by the county attorney of Hyde was as to the power of the
County Sanitary Committee to order compulsory vaccination. The
matter was referred to your Secretary by the County Superintendent
for settlement. While in my opinion there was not the slightest doubt
as to this power I thought it wisest to have the opinion of our Attor-ney-
General, which would be authoritative. In unequivocal terms he
36 NORTH CAROLINA BOARD OF HEALTH.
declared the statute conferring this power upon county sanitary com-mittees
to be valid.
In the second case the question was essentially the same, although
the occasion of it was somewhat different. The County Sanitary Com-mittee
of Washington County, in addition to ordering compulsory vac-cination
in a certain township infected with smallpox, forbade any
teacher to teach or any child to attend school who coiild not present a
certificate of vaccination. This order was resisted by the County
Superintendent of Public Instruction, and hence the appeal to me by
the County Superintendent of Health. I immediately took the matter
up with the State Superintendent of Public Instruction. To be per-fectly
sure of his ground he obtained a ruling from the Attorney-
General. This supporting our position, he at once ordered compli-ance
on the part of his subordinate.
One matter of very great and far-reaching importance, involving a
new question in our State, has come up for adjudication since my last
report. This is the pollution of streams used for drinking purposes.
Section 13 of "An Act to Protect Water Supplies" reads as follows : "No
person, firm, corporation or municipality shall flow or discharge sew-age
Into any drain, brook, creek or river trovA which a public drink-ing
water supply is taken, unless the same shall have been passed
through some well-known system of sewage purification approved by
the Board of Health. Any person, firm or corporation, or any oflJcer
or any municipality having this work in charge, who shall violate this
section shall be guilty of a misdemeanor, and the continued flow and
discharge of such sewage may be enjoined by any person." The
Eno Cotton Mills, at Hillsboro, empties its raw sewage into the Eno
River, from which the Durham Water Company obtains a part of its
supply lower down the stream. The cotton mills refusing to comply
with the requirements of the act, a suit to enjoin them from emptying
their raw sewage into the river was brought by the city of Durham.
The case was decided in the lower court in favor of the plaintiff,
and the defendant cotton mills appealed to the Supreme Court. The
case has been argued and a decision will doubtless be handed down
before adjournment—in the next few days. That this decision may
certify the validity of the act is greatly to be desired. It is a most
Important matter in its bearing upon the health of our people. People
must have water to drink, and thej^ have a right to demand that it
be safe water. Owing to the geological formation artesian wells are
impossible in a large part of the State, and consequently the water
of streams must be used. It is true, also, that people must get rid
of their excreta, and the most satisfactory way of doing this is by
water carriage through sewers into an adjacent stream. The law
does not forbid this, but merely that a community adopting this plan
shall, before emptying its sewage into a stream used for drinking pur-poses
by another community below, submit it to such process of purifi-cation
as may be appx'oved by the State Board of Health. This is a
ELEVENTH BIENNIAL REPORT. 37
reasonable requirement, and one which a due regard for the public
health demands. From the present outlook it appears that North
Carolina is destined to be a great manufacturing State, and many
who now hear me will live to see a factory and its accompanying vil-lage
or town on the banks of nearly every stream within our borders.
It is, therefore, extremely important that this question should be set-tled
now, in the beginning, comparatively speaking, of our industrial
life, and consequently we await the decision of our court of last
resort with anxious solicitude.*
Upon request of the authorities investigation of sewerage problems
have been made during the year for the town of Southern Pines and
the State Hospital at Morganton and advice given. The reports will
be printed in the next biennial report.
Tuberculosis continues, of course, to be our most fatal disease and
its prevention the greatest as well as the most difficult problem we
have to consider. Owing to the very small amount of money at our
command and the other demands upon that, our efforts are, necessa-rily,
greatly circumscribed. The policy outlined in my last report
—
that of appealing directly to the individual by sending him, through
the mail, the pamphlet on the Prevention of Consumption, with an
accompanying letter calling attention to it and asking its careful
reading—has been pursued during the past year. One hundred thou-sand
copies of this pamphlet have been printed, and over eighty thou-sand
have been distributed to date. Many letters of acknowledgment
and appreciation and asking for additional copies, to the number in
some instances of .500, have been received, and there is no doubt that
interest in the subject has been quickened and much good, it is be-lieved,
has been done. As it could be done without materially adding
to the postage bill, slips ou the prevention of typhoid fever and of
malarial fevers have been inserted between the leaves of the pam-phlets.
In this way at a very trifling cost information in regard to
these diseases has been widely disseminated. The most discouraging
thing in this campaign of education has been the entire lack of inter-est
and co-operation on the part of our profession. In the very begin-ning
a pamphlet with a letter, earnestly appealing to them for their
help in this most important work, was mailed to practically every
physician in the State. As they came in contact with nearly every
case of tuberculosis in their professional work, it was hoped that
they would be glad to supplement their words of instruction to their
patients and their exposed families with the pamphlet. But the hope
has been unfulfilled, not half a dozen physicians having applied for
l)amphlets for distribution. Consequently we have received no help
from the most powerful and potentially effective agency that could
possibly be eulisted in this great work for suffering humanity.
The State Laboratory of Hygiene, while it has done more work than
in any preceding year, has not been utilized by the profession to the
' The Supreme Court sustained the validity of the act.
38 NORTH CAROLINA BOARD OF HEALTH.
extent one would have expected. The interest is growing, however,
and will doubtless continue to increase. As time will not permit the
reading in full the report of the Biologist I will give a few short ex-tracts.
The total number of samples examined was 1,096, divided as
follows : Public water samples from 47 water-works, 591 : private
and physicians' water samples, 210 ; pathological samples, 295. Of
the last-named about one-fourth were diphtheritic exudates, one-half
tuberculosis sputum, and the rest chiefly feces examined for hook
worm. An interesting statement by the Biologist, who is a reader of
French and German scientific periodicals, is that "The consensus of
opinion among working biologists in Europe is that tuberculosis is
rarely transmitted directly from cows to humans. This does not
mean that there is any radical or specific difference between the
germs of human and bovine tuberculosis. It simply means that germs
habituated to parasitism on bovines do not easily or at once adapt
themselves to the human environment, and as a consequence are less
virulent and less able to overcome or counteract the natural protective
secretions of the human organism."
Smallpox, as stated in the beginning, has been less prevalent and
less fatal than usual. A comparison with last year shows the total
number of cases to have been 6,051, against 7,.375 ; and the number
of deaths 12, one white and 11 colored, as against 1?> and 18 white and
colored, respectively, for last year.
The following is a detailed report of smallpox for 1905-'06
:
SMALLPOX REPORT, FROM MAY 1, 1905, TO MAY 1, 1906.
eleventh biennial keport.
smallpox-Continued.
39
Counties.
Chowan
Clay
Cleveland
Columbus
Craven
Cumberland -—
Currituck
Dare
Davidson
Davie
Duplin
Durham
Edgecombe
Forsyth
Franklin
Gates
Granville
Greene
Guilford
Halifax
Harnett
Henderson
Hertford
•Hyde
Lenoir
Macon—^
Madison
Martin
Mecklenburg -
Montgomery - -
.
Moore
Nash
New Hanover
Northampton
Number of Cases.
35
5
6
56
285
37
4
50
1
3
15
54
50
11
25
900
1
12
13
5
12
2
I
21
16
33
80 '
0)
o
77
6
19
10
30
14
4
2
1
12
2
1
150
2
100
1,100
5
24
4
60
33
97
40
o H
112
5
12
75
10
315
51
8
2
8
5
6
12
4
1
200
1
3
15
58
50
13
125
2,000
1
12
13
10
36
6
81
49
130
120
Number of Deaths.
JS
•V
<u uo
"o o
Eh
40 NORTH CAROLINA BOARD OF HEALTH.
SMALLPOJC-CONTINUED.
I
Number of Cases.
Counties.
Onslow
Pamlico
Pasquotank
Pender
Perquimans
Person
Pitt
Polk
Richmond
Robeson
Rockingham
Rowan
Sampson
Scotland
*Stanly
Union
Wake
Warren
Washington
Wayne
Total in 67 counties-
-
Death rate, per cent.
1
2
28
50
150
1
4
2
50
2
12
1
2
40
18
2,805
6
67
100
400
1
5
12
o
2
10
3
2
150
120
180
3,246
95
150
550
1
6
4
14
50
2
2
13
6
2
162
1
JL.
2
160
198
Number of Deaths.
0) u
3
O
6,051 11
0.036 0.34
o
Eh
12
0.19
"Estimated.
Dr. Thomas : Gentlemen, the report is before you. What will
you do with it ? Any discussion ? . .
Dr. Lewis : Mr. Chairman, I will be very glad indeed to hear
from some of the gentlemen present in regard to the pamphlet
and its distribution. The trouble may be with the pamphlet.
I^ow, I am a great believer in advice and suggestions from other
people. I like to know what other people think ; then, of course,
I do what I think is right afterwards ; but I like to get the wise
suggestions from others. I would like to hear from the gentle-
ELEVENTH BIENNIAL REPORT. 41
men in regard to the pamphlet—if it is too abstruse, or any-thing.
Dr. Julian : Mr. President, I want to say that I read the
pamphlet, and it embraces everything, I am quite sure, for the
prevention of tuberculosis that we know to-day, and I don't
think there will be any adverse criticism on that pamphlet, and
it is what every physician needs. The American Congress have
done the same thing; the Anti-Tuberculosis League in Atlanta
have done the same thing, and the only reason the thing falls flat
is because the physicians neglect to call the attention of the
families to it. They are afraid to distribute literature in fami-lies
where there are supposed cases of tuberculosis. I think we
ought to advocate the early diagnosis of tuberculosis—that
tuberculosis is not consumption ; to show them that it is curable
and preventable, and, as it is curable, it surely is preventable;
that there is no other way except through enlightenment and
through knowledge, and it is the only way, through such pam-phlets,
that we can educate the physician and the community,
and there should not be any adverse criticism on that, and it is
only the negligence of the physician in bringing it to the atten-tion
of the families ; and I think we should, through this Health
Board, get our Legislature to require physicians to report all
cases of tuberculosis, just as they do diphtheria, smallpox, etc.
Dr. Templeton : I have joined this society* to-day ; hence,
any remai'ks will probably be in order. It seems to me it Avould
be well to incorporate in that organization-—in the resolution
there—that we propose to stamp out and prevent malarial dis-eases.
If it be in order, sir, I move that that be incorporated
as one of the duties of that organization.
Dr. Rose, Superintendent of Health of Cumberland County:
Mr. President, as Superintendent of the Health Board of
my county, the greatest trouble I have in the county of Cum-berland
is with the class of people who cannot read that circu-lar—
the people that are ignorant and cannot read the circular.
The instruction that I give them falls flat, as you say your cir-cular
has fallen upon the ears of the society. They forget it as
soon as I am out of the house. The great trouble I have with it
there is amongst the negroes. Unfortunately, we have a class of
negroes that have been migrating to the ISTorth in recent years,
• state Anti-Tuberculosis Society.
42 NORTH CAROLINA BOARD OF HEALTH.
and I suppose in tlie last two years there have been probably a
hundred cases of tuberculosis that have gone to the North and
have contracted consumption and have come home to die; and
I know of one instance of one family that I attended some
time back—when one son went to the JSTorth he came back (there
was a family of eight)—and five of them up to this date have
died of tuberculosis, contracted from this one case. That is the
trouble that I find with the tuberculosis there. We have a great
deal of it, of that class of it that is brought back from the !N^orth,
and in that class of patients the pamphlet falls flat, because they
cannot read it and the instruction that I can give them is not of
much avail.
I agree with Dr. Julian ; there ought to be a law to force the
physicians to i-eport tuberculosis, the same as they do smallpox,
so the houses can be fumigated.
Now, after the death of a patient, in one or two instances I
have had the house fumigated and have had the thing stopped,
but I find that year after year they are dying. I know in Fay-etteville
now two out of one family have tuberculosis, and three
out of the same family have died within the past two years.
Dr. Mason, of Charlotte : When the pamphlet was received
it may have been that just at the moment the doctor had no case
to whom he could give it. It may be in two or three weeks he
can give it out, and if lie knows where he can conveniently get
them he will give them out. If you don't send them to the Sec-retary
of the County Society I would suggest that each secre-tary
be supplied with these, and that the secretary notify the
physicians that he has these papers and that at any time they
are needed he will be glad to supply them.
In regard to reporting cases of tuberculosis, I think that we
would make a mistake if we passed a law that every case be re-ported,
because there are many cases that if we would tell them
they had tuberculosis we would sound their death knell; but
every case that has progressed to a certain extent should be told,
and every house that has had cases of tuberculosis in it should
be fumigated—we know that ; but I don't think we should be so
strict that we should make every man who has tuberculosis aware
of that fact. We have to use judgment in the matter, in my
opinion. We can't tell every man that he has tuberculosis, has
ELEVENTH BIENNIAL REPORT. 43
beeii my experience; if you do, it has a depressing effect upon
him, and we want the opposite effect; we want the patient to
believe he is going to get well, and for him to know that he has
tuberculosis at this time—when they don't believe they are
going to get well—if you tell a man he has tuberculosis he will
die. It is a campaign of education, I think, before we pass that
law. We want to educate the physician.
Dr. Julian : Mr. President, I want to reply to Dr. Mason in
this. He says he don't think the time ripe now to report these
cases. So long as you are afraid to report your cases of tuber-culosis,
so long as you are afraid to take care of them, you will
have them.
As to reporting them : It isn't consumption until it reaches a
certain point. The public can be told that it isn't consumption,
and they can be educated to the subject and lives saved. I told
the mother of a boy the other night : "Your son has tuberculosis
;
put him out in the sun." He is now in the open air, and I am
sure he will live a long time. He would probably have died next
spring. I am sure now that he will live a long time.
Dr. Ferguson : Mr. President, we know it is a disease of the
masses—a disease existing all over the civilized world. Re-searches
of recent years have demonstrated that this disease,
under certain conditions, is a disease susceptible of arresting,
and, under some conditions, of a cure, and, above all, that it is
a preventable disease. The physicians of all the civilized world
know this, and are directing their efforts more or less to the con-summation
of this end; and, whatever principles have been
established that will stand the test of time in this matter, one
fact is without question, and that is, intelligent co-operation of
the masses to the consummation of this end; and if the physi-cians,
the teachers and employers, men and women of talent and
inclination in this direction, are united in one purpose, to the
attainment of this end, much can be done. The greatest cause,
probably, of propagating this disease is general ignorance in the
matter of hygienic living. There is one objection, there is one
fault, it seems to me, comes from information spread by dis-tribution
of literature suitable to this end, and that is its great
lack of sticking qualities. In the treatment of tubercular cases
that have never been in the sanitarium, have never been required
44 NORTH CAROLINA BOARD OF HEALTH.
to live in conformity with any fixed methods of hygienic prac-tices,
while they will hear you along this line, it is exceedingly
difficult, in ray experience, to get them to conform in their daily
habits of living to any measure of hygienic practices which is
essential to the cure and to the limitation of this disease.
Dr. Weaver : Mr. President, old Kip Van Winkle has always
been noted for his conservatism.
I doubt at this time the feasibility of reporting the tubercu-losis
cases. I think the pamjihlet issued by the Board of Health
covers the ground thoroughly. As the gentlemen have aptly
said, it is a campaign of education, and I doubt whether the
profession is educated up to that point whereby they can reach
the laity yet. Tuberculosis is not so infectious as we may have
been taught to believe. We should teach the people one thing—
the essential thing—and that is the care of the sputum; that it
is only dangerous in its dry state; that while it is in its moist
state probably it is not very contagious. The laity should be
taught how to prevent tuberculosis. They should be taught to
take care of the cuspidors, those who are aifected with it—to
have the contents destroyed by burning.
It is the people in the rural districts that need to be educated
;
not so much in the towns. You must remember that there is
from 90 to 95 per cent, of rural population in ISTorth Carolina,
and that there are more cases of tuberculosis in proportion to
population in the rural than there are in the thickly settled dis-tricts—
in the cities of over eight thousand inhabitants. And
why? Because the people have never been taught the impor-tance
of taking care of the sputum; and the laity, visiting a
family where there is an infection, probably sit in the doorway
and around the hearthstones and spit, and the tubercle bacilli
arise in the air and thereby disseminate the disease in half a
dozen families.
I have one instance—ra sad instance—I might relate, where I
was called to see a young lady and she had tuberculosis—no, she
had consumption. I warned the family of the danger of it and
how to prevent it, but they took no heed of it, and six months
later I was called to see her, but she was in a dying condition,
and in a few days was dead. A few months after that T was
called to see the second member of the family, a daughter, and
ELEVENTH BIENNIAL KEPOKT. 45
she had already passed the stage of tuberculosis and was in con-sumption.
The father was sitting there, and said: "Doctor, I
want you to examine me. The doctor that was attending me
this spring told me I had an abscess on my lungs." I examined
the two patients and they both had incurable consumption. Two
months from that time they both were buried the same day, in
the same grave—all on account of the family physician not tell-ing
them how to take care of their sputum in the first patient.
This is the present idea : "Teach the laity," and we cannot
do it better than by the dissemination of the literature, and then
the time will come when we can pass these compulsory laws.
The time will come when we can have sanitariums over the
State for the indigent poor. We have our hospitals for the in-sane.
Why not for the much more afflicted tubercular patients,
which, I must say, to our chagrin, amount to more in the State
of JSTorth Carolina than in the great States of Massachusetts and
J^ew York. Their percentage isn't more than 12% per cent.,
while ISTorth Carolina and her sister State—Tennessee—and the
Ohio Valley is 14 per cent. It is astonishing, and should wake
up every physician; he should be, as Osier said, "the man be-hind
the gun" to enlighten the people. Only 2 per cent, of the
people are treated in the sanitariums of the United States, and
98 per cent, are left to the ravages of the "Great White Plague"
;
so let us, through pamphlets, like our Secretary has suggested,
distribute them all over the State, and then the time wilf come
for legislation.
Dr. Faison, of Charlotte: I am always delighted when the
State Board meets with us, because it always means something
good for J^orth Carolina. We have had enough talk within the
past twenty-four hours to make every man think that some germ
already had him.
Mr. Chairman, I am one who stands out with the opinion that
there are so many laws—I am opposed to this namby-pamby
way of doing things. There is but one way to manage tubercu-losis,
and that is to prevent it. This thing of curing tubercu-losis
is one of the things you put down among the exceptions of
things. The only way to cure it is through prevention, and if
I had the power in my hand to-day I would pass a law that
would isolate every man, woman and child in N"orth Carolina
46 NORTH CAROLINA BOARD OF HEALTH.
who had tuberculosis. xVs Dr. Ferguson said in his paper, "it
is one of the most easily prevented of all infectious diseases;
and if it is so easy (and I agree with him), then we should pass
laws that are right. I stand here abashed and ashamed that
Charlotte, in her hundred years of history, has no law for
the prevention of tuberculosis. All the law she has is the State
law ; but when I grow stronger, with the power of God Almighty,
I propose to put on the statute books in Charlotte a law that
will be a law that is worth something.
ISTow, gentlemen, in discussing tuberculosis, I do wish the
medical men in JSTorth Carolina would quit using the word
"contagious" in talking about tuberculosis. I know Dr. Weaver
knows better than to talk about "contagion" in tuberculosis. It
doesn't come in that class at all; the sooner they realize and
accept this fact, the better. Tuberculosis isn't a contagious dis-ease.
It is a plain communicable disease that 'is preventable if
you will do it—and we have the power to prevent it.
Dr. Weaver : Let me correct the gentleman. I meant infec-tious.
Dr. Faison : I want them to understand it is not contagious.
We have only four or five contagious diseases in the world, and
why you want to put down these things in that class is beyond
my comprehension; but it is one of the infectious diseases that
we should have to do with. Some are not so easily prevented
as others, but this one—tuberculosis—we can put the doctors
out of business if we will do what we ought to. Grentlemen, it
is a preventable disease, and so long as you talk about educating
the laymen to do this, it isn't worth a cent. Do something. Put
your hand on them with the law and make them do ; that is the
way to teach the people to do things. I am absolutely of the
opinion that that is the way to do, and I propose to stand here
and do so, and the sooner we can get laws passed, the better.
There is no question about that. I know that it will be hard,
I know that men kick at new things. We have seen it in this
town, where men have nearly been kicked to death because they
wanted to do what was right. But who cares if he does get
kicked when he is in the right ? I would rather be kicked in the
right than succeed in the wrong.
Dr. x\lbert Anderson : I just want to say a few words. I
heartily agree with what Dr. Faison has said. I think the best
ELEVENTH BIENNIAL REPORT. 47
way to do this is by way of statute. I asked our Representa-tive
last year to introduce a bill in the Legislature, which he
didn't do. He was so taken up with the bucket-shop bill that
he never introduced this law on the subject of tuberculosis.
And my idea was this : that if it is found in any community that
any person is suffering with a cough for any length of time,
make the laws so that he will have to have his sputum examined,
and if it should be found that he has the bacilli in the sputum,
then make it unlawful for him to ever spit on the ground again.
Let each county furnish these people with cuspidors or paraffine
bags to spit in, and in this way you bring it to the homes of the
people who are suffering with this disease, and it will be the
greatest means of curing the people that we could devise. And
I agree with Dr, Faison that the way to do a thing is to do it.
Dr. Mann : Mr. President, I feel a delicacy in saying some-thing
after the older men have been talking, but I would like to
tell something of what we have been doing in Durham. We
have been working very faithfully on tuberculosis for the last
four or five months. One man said he didn't believe in report-ing
tuberculosis to a patient—that it would be bad for him.
That is all out of reason. Now, if it is right to report diseases
in the cities and towns, it is right to do so in the country, and
for that reason I am heartily in favor of having the cases in the
country and towns reported. In Durham we have passed ordi-nances
making the physicians report under penalty. It is true
you can't go right down and make every physician report; the
health officer must co-operate with the men and reason with
them. I have gone to them personally and gotten reports that I
Avould not otherwise have had. We have had this in force about
one month, and I have already seen it is going to work well, and
we have had several cases reported and the people have been
totally ignorant of the disease and they have been glad to get
the literature which we have given them. We have prepared
special literature for the people to read. Most of the literature
was copied from the northern cities. It is going to work well,
and it will be altogether practicable to make it compulsory, and
it is working that way in Durham.
Dr. Hays : Mr. Chairman, it seems exceedingly difficult to
get some very learned men in JSTorth Carolina to find out that
48 NORTH CAROLINA BOARD OF HEALTH.
public opinion is the law of the 4and. This body does not make
the laws of ISTorth Carolina, nor could we, if we had the power
to make the laws, make men live under them or obey them. The
law is but the expression of public opinion, and there is but one
way for us to reach this problem, and we have got to write that
way deep upon our hearts and remember it in our prayers,
night and morning. It is : Education ! Education ! Education !
ISTow, Ave are dealing with a condition and not with a theory,
and I hope that no man who follows me will use any hair-split-ting
differences between definitions and fine theories. If it goes
abroad that we have this day agreed among ourselves that tuber-culosis
is not contagious, it had been better had we had no meet-ing
whatever. I do not question the gentleman's learning, but
we have not time for hair-splitting differences. What we want
to know is, if we can take any action here to-day by which
fewer people in the next twelve months in ISTorth Carolina would
die of tuberculosis than if we had not met here.
Gentlemen, I wish to make a few suggestions. We will have
to become teachers of teachers, and I would suggest that we
start with our schools. I have been impressed time and time
again that the average man, woman and child in North Caro-lina
is not reached so much through the printed page as
through the spoken word; that the bacillus of tuberculosis is
not so much in evidence where the people get their ideas through
the printed page, and for that reason, and that alone, the pam-phlet
has not done all that we desire. ISTow, those who are going
to leave the papers must carry the message where the pamphlet
is not read. We must carry it first to the school-teachers. One
of the best schools in North Carolina is a female school in my
town. One of my nieces studied there this year. She studied
all the ologies—more than I ever heard of before, but when it
came to hygiene, which conies at the back of the book, the
teachers stopped and went on, and she didn't know one bit more
how to take care of herself, her health or the health of those
hereafter dependent upon her, than if she had not been to that
school. Therefore, I think we ought to make the effort to teach
the teachers of North Carolina to disseminate the laws of
health. First, in the graded schools we should ask the teachers
to teach the little fellows the danger of sitting in a heated room,
ELEVENTH BIENNIAL REPORT. 49
SO that they would not be willing to do so at home; and we
should teach them the danger of sleeping in a room where there
is no ventilation, so that they will tell their parents that they
must not sleep in a room with the windows and doors closed.
We can do that if we go to the teachers and ask them to teach
those things. That is the second suggestion.
I would suggest that we make an appeal to the preachers. I
have been to a patient and found that some good pastor had
suggested to the patient that he take such and such a patent
medicine. (Much applause.) That is an every-day occurrence,
but I have never in my life heard a preacher in the pulpit (and
I am a pretty regular church-goer) say anything about the laws
of health or of ventilation ; and I go to church and to the opera-house,
where the authorities do not take the least precaution to
see that the building is properly ventilated. jN^ow, we might ask
our preachers to read the pamphlet—not ask the poor, ignorant
patient to read it—but we might take them to the preachers and
ask those preachers to take them as the message from God. It
may be that Dr. Lewis is the messenger all right, but he didn't
originate the message; and if they will teach their congregation
that the laws of health are the laws of God, then we will see
tuberculosis stamped out in North Carolina.
In the third place, I would suggest that we tell our intelligent
families, and whoever have influence and who can bring about
reform, the danger that exists in permitting the laundry of our
best people to be taken into houses that are infected with tuber-culosis,
smallpox, etc. ]^ow, we know that tuberculosis is more
prevalent among them; that they are less sanitary; that they
live in rooms without a fii'e-place; that the windows are pulled
down, the stove red-hot, the thermometer is about one hundred,
and tuberculosis germs fill the air, and our laundry goes into
that atmosphere, and when our clothes come home, if they have
not been well ventilated, then beware ! If we could take two or
three practical suggestions and work along these practical lines
and forget our fine theories and hair-splitting differences ; if we
would make a special campaign to the teacher, make a special
campaign to the preacher, make a special campaign to the peo-ple
who ai*e going to influence the ignorant people, we would do
50 NORTH CAROLINA BOARD OF HEALTH.
something, at least, to save a few human lives in ISTorth Caro-lina,
and that in the near future.
Dr. Kirk, Hendersonville : I have listened to these views,
Mr. President, but we cannot be too stringent in our lives, or
in the enforcement of them, to correct this trouble; but while
we are educating the public, while we are trying to disseminate
all of this information and knowledge among the ignorant, let
us not forget the poor unfortunate who has tuberculosis. We
forget sometimes that they have feelings, you know, and if we
expect to have a law efficiently carried out, there are very
few men who wouldn't observe an expectoration ordinance
—
who wouldn't observe everything else, if they were not shunned
and looked upon as lepers. Let's help our brother who has
tuberculosis. I know of an institution that has a patient of
mine who told me he was in New York; he pulled out a glass
and expectorated in it in the street-car and almost caused a
stampede,, and he was shunned. He said he got off that car,
and he expectorated next time on the floor, in another car, and
nobody paid any attention to him. We want to show sympathy
and tolerance to those who are afflicted, and not want to drive
them like dumb cattle.
A man who has tuberculosis is not criminal. He is a danger
to society, I will admit, but let's make the laws such as he can
obey and he will be willing to do it. Every man has some love
for his fellow-man ; then let's not make it harder than we can
help for him to obey the laws. I am not here to say that I do
not believe in the most intelligent laws, but I am here to make
a plea for those who are so imfortunate as to be afflicted by
tuberculosis, that we may, in every way that we can, make it
easier for him to obey those laws, and not shun him, but look
upon him as a man who is trying to help his fellow-men and not
disobeying the law.
Dr. Lewis : I w^ould like to say a word in explanation. I do
not wish the session to understand that the pamphlet has fallen
flat on the whole ; the only place that the pamphlet has actually
fallen flat is among the medical profession. This pamphlet has
been sent to every preacher in l^orth Carolina, begging him to
read it and carry it out among his people, to preach the doc-trine
of prevention. The same way with the teachers. Every
ELEVENTH BIENNIAL REPORT. 51
teacher in N'orth Carolina, white and colored, has had it, with
a letter, and not only to instruct the children, but the families.
Of course, we desire education. It isn't worth while to talk
about laws until public opinion has been educated. Just to give
you an illustration : To take the compulsory notification of
tuberculosis—the doctors are here, but they "ain't a-gwine."
[N'ow, that theory is quite bad, but practically it is the truth.
The subject was brought up in Ealeigh, and I was appealed to
to have a law passed, under penalty, reporting all cases of
tuberculosis to the health officers of that city. When the gen-tlemen
came to me, who were very much interested, I threw
cold water on it, and they were very much astonished, no doubt
;
but I said to them, as I said to Governor Aycock at the time,
"I simply cannot afford to advocate, with apparent sincerity
even, something that I know perfectly well is not practical." I
said, "Of course, I am not going to oppose it outright." It was
tried, and what was the result? Six months afterwards—the
penalty was twenty dollars for not reporting—I asked the health
officer, "How many cases have been reported?" He said, "One !"
My friend on the left said he is afraid to tell the patient him-self
he has tuberculosis. If the doctor isn't going to tell the
patient himself he has tuberculosis and give him warning if he
doesn't follow such a course of action he is dead sure to die;
if he doesn't tell the family—whether you call the disease infec-tious,
communicable, or catching (applause), it doesn't make any
difference what word you use, but it is a catching disease, and
I agree with one gentleman that it would be a great misfortune
if it should ever get out among the people that tuberculosis or
consumption is not contagious, because "contagious" is the
word the people use—he would, in my opinion, be criminally
negligent. We scientific men make certain fine-drawn distinc-tions,
but when we come to define the difference between infec-tious,
contagious and communicable, it is a mighty hard matter
for me to get at the difference.
Dr. Hays is right about it. The appeal was to enlist the
physicians' co-operation for the people. The whole thing hinges
upon the cordial co-operation of the doctor. You may pass any
number of laws you please, you may distribute around among
the laity all the information you please, but if the family physi-
52 NORTH CAROLINA BOARD OF HEALTH.
cian, in "vvhom tlie people have more confidence tlian other
folks, if the family physician is indifferent on the subject, if
he doesn't insist upon it, they don't care a thing for it; but if
the physician says to the people, "Here is a case of consump-tion
in your family ; it is a catching disease ; if you don't have
the members of your family take certain precautions (which
you will explain to them), the probability is that he will die,
and other members of the family will catch it ; it is my duty to
let you know this fact," they will take these precautions. I will
illustrate it by telling you that in the county of Richmond, in
J^orth Carolina, there lived in a certain house an old consump-tive
ex-Confederate, with a family of eleven ; one was burned to
death and the other ten died of tuberculosis. A negro man and
his wife, already having consumption, moved in, and she died
there. Three months after that another negro family, perfect
types of health, ten in all, moved in, and every single one died of
tuberculosis.
If the doctor has it in his heart to prevent the spread of this
disease, and will put it to the patient and impress upon him
that he should take these precautions, or otherwise infect the
other members of the family, who are dearer to him than any-body
else, and then tell the family if they don't take certain
precautions they themselves will have the disease—if the doc-tor's
heart is in it, I am satisfied in many cases (of course I
realize the difficulty of managing the ignorant) those precau-tions
would be observed. What we want is the active and cor-dial
co-operation of the physicians of ilSTorth Carolina in the
education of the people as to the communicability of tubercu-losis,
as to the fact that it can be prevented, and to also give
them hope that if it is taken in time it can be cured.
Dr. Burroughs : Mr. Chairman, I move that the Secretary's
report be accepted.
Dr. Thomas : It has been moved, sir, and has been ordered
to be printed.
Dr. Thomas : Before we adjourn, gentlemen, I will say Dr.
Stevens will take what measures he sees fit to expedite the fur-ther
organization of the society for the prevention of tuber-culosis
; and if there is nothing else before this conjoint session,
it stands adjourned.
ELEVENTH BIENNIAL REPORT. 53
The Vice-Presibent : I wanted to state that the cards dis-tributed
a few moments ago were for the names of those inter-ested
in this crusade against tuberculosis and who are willing
to operate in the organization of a society for the prevention
of tuberculosis. ISTo money is wanted now. Those who are
interested are requested to go across into the room occupied by
the House of Delegates, and we will organize immediately.
This can be done in about three minutes, and will not make any
one late for dinner.
The Society here adjourned until 3 o'clock.
THE T^OKTH CAEOLINA ASSOCIATION FOE THE
PREVENTION OF TUBERCULOSIS.
Pursuant to a call issued by a committee appointed by the
President of the State Medical Society, under resolution oifered
at the 1905 session, a number of the medical gentlemen in at-tendance
on the fifty-third annual meeting of the Society at
Charlotte, N. C, May 30, 1906, met together and organized
the above-named association.
A constitution was adopted, which is herewith appended,
after which the following directors were elected
:
M. L. Stevens, Asheville ; R. H. Lewis, Raleigh ; J. Howell Way,
Waynesville; George G. Thomas, Wilmington; James A. Burroughs,
Asheville ; James M. Parrott, Kinston ; Ben. K. Hays, Oxford
;
W. H. H. Cobb, Goldsboro ; Charles A. Julian, Thomasville ; Watson S.
Rankin, Wake Forest ; Albert Anderson, Wilson : Kenneth M. Fer-guson,
Southern Fines.
On the following afternoon the directors met and held a
short meeting.
Dr. M. L. Stevens, of Asheville, was elected President. Dr.
J. Howell Way, of Waynesville, was elected Secretary, but de-clined,
and suggested Dr. Ben. K. Hays, who was unanimously
elected. Dr. Charles A. Julian was elected First Vice-Presi-dent.
Dr. Albert Anderson, of Wilson, was elected Second
Vice-President.
It was resolved to hold the annual session of 1907 at the
same time and place as the State Medical Society. Each mem-ber
was requested to become a subscriber to a publication called
Outdoor Life, published in the interest of the prevention of
tuberculosis.
On motion of Dr. Julian, the Secretary was requested to
issue a general invitation to the profession and other interested
persons in the State to unite with the association and aid in
its beneficent work.
The association adjourned to meet upon call of the President
on the occasion of the fifty-fourth annual session of the State
Medical Society, to be held at Morehead City, N. C, May,
1907. M. L. Stevens, M. D.,
BenJ. K. Hays, M. D., President.
Secretary.
ELEVENTH BIENNIAL REPORT. 55
CONSTITUTION.
ARTICLE I. NAME.
The name of the Association shall be "The North Carolina Associa-tion
for the Prevention of Tuberculosis."
ARTICLE II. OBJECT.
The object of the Association shall be the prevention of tubercu-losis
: (a) by the study of the disease in all of its forms and rela-tions;
(b) by the dissemination of knowledge concerning its causes,
prevention and treatment, and by supplementing the work of the
State Board of Health in this cause; (c) by such other means as may
from time to time be deemed advisable.
ARTICLE III. MEETINGS.
The meetings of the Association may be held at such times and in
such places as may be directed in the by-laws.
ARTICLE IV. INCORPORATION.
The names and residences of the incorporators are : M. L. Stevens,
M. D., Asheville, N. C. ; R. H. Lewis, M. D., Raleigh, N. C. ; J. Howell
Way, M. D., Waynesville, N. C. ; James M. Parrott, M. D., Kinston,
N. C. ; W. H. H. Cobb, M. D., Goldsboro, N. C. ; James A. Burroughs,
M. D., Asheville, N. C. ; Albert Anderson, M. D., Wilson, N. C.
;
Ben. K. Hays, M. D., Oxford, N. C, ; George G. Thomas, M. D., Wil-mington,
N. C. ; Charles A. Julian, M. D., Thomasville, N. C. ; Watson
S. Rankin, M. D., Wake Forest, N. C. ; Kenneth M. Ferguson, M. D.,
Southern Pines. N. C.
BY-LAWS.
ARTICLE I. MEMBERS.
Section 1. Any person who shall pay .$1 or more into the treasury
of the Association shall have his name enrolled as a member for the
year in which such payment is made.
Sec. 2. The payment of .$2.j at one time shall entitle a member
to a life membership.
Sec. 3. Persons who have, l)y original research or as sanitarians
or as philanthropists, eminently aided in combating tuberculosis may
be elected honorary members.
article II.—OFFICERS.
Section 1. The Association shall, at its first meeting and annually
thereafter, elect a Board of Directors. This board shall consist of
twelve members, but may hereafter, at any regular or a special meet-
56 NORTH CAROLINA BOARD OF HEALTH.
ing, be increased by electing one Director Iroiu each comity (of the
State) in which this Association lias members.
Sec. 2. The Board of Directors shall make its own rules and shall
have entire charge of the business and work of the Association. Com-mittees
shall have the power to execute only what is directed by the
board.
Sec. 3. The Board of Directors shall annually elect from its own
members a President, two Vice-Presidents, a Secretai'y and a Treas-urer,
who shall be the otficers of the Association.
ARXrCLE TTI. COMMITTEES.
Section 1. The Board of Directors shall appoint an Executive Com-mittee
of five Directors, of which the President and the Seci'etary
shall be members (•/ officio, to which shall be entrusted all the execu-tive
work of the Association.
Sec. 2. The Board of Directors is empowered to appoint representa-tives
to the International Congress on Tuberculosis, the National As-sociation
for the Study and Prevention of Tuberculosis and the North
Carolina State Medical Society. It shall also, from time to time, ap-point
such committees as may be necessary for scientific and educa-tional
work, and for the holdiug of meetings and congresses.
ARTICLE IV. QUORUM.
P'ive Directors shall constitute a quorum of the Board of Directors.
ARTICLE V.—MEETINGS.
There shall be one stated meeting of the Association each year at a
time and place to be fixed by the Board of Directors. Other meetings
of the Association may be called by the Board of Directors at such a
time as it shall deem 'proper. The I*]xecutive Committee shall hold
stated and other meetings as may be directed by the rules of the
Board of Directors.
ARTICLE VI.—MONEYS.
The moneys received from membership fees and from all other
sources shall be used for defraying the expenses of the Association
and for furthering its objects, under the direction of the Board of
Directors.
ARTICLE VIT. AMENDMENTS OF CONSTITUTION.
Propositions to amend the Constitution may be pi-esented in writing
at any meeting of the Board of Directors, or of the Association, and
may be voted on at the meeting of the Association next following:
Provided, lioiccver. that no proposition for amendment shall be voted
on within thirty days after its presentation, nor without at least
twenty days' notice of the meeting at which it is to come up for con-sideration,
which notice shall set forth the proposed amendment in
full. An affirmative vote of two-thirds of the members present shall
be required for the adoption.
EIiEVENTH BIENNIAL REPORT. . 57
ABTICLE VIII.—AMENDMENT OF BY-LAWS.
The By-laws may be amended in the same manner as the Constitu-tion
or by a two-thirds vote of the members present at a meeting of
the Board of Directors: Provided, that in the latter case the propo-sition
to amend has been presented in writing at a previous meeting
of the Association, or of the Board of Directors, and that subsequently
to such presentation twenty days' notice in writing has been given of
the proposed amendment in the call for the meeting.
STATE LABOEATOEY OF HYGIENE.
BIENNIAL REPORT OF THE BIOLOGIST.
The State Laboratory of Hygieue was establisbecl by an act of the
Legislature ratified March 4, 1905. It has remained from the begin-ning
under the directorship of the present Biologist with one scientific
assistant, a part of the time a stenographer, and an office boy, as
working staff.
From March, 1905, to January 1, 1907. being one year and eight
months, 2,749 samples have been analyzed in the laboratory. During
the eight months of 1905 the number of samples was 692. During
the twelve months of 1906 the number ^f samples was 1,136.
During both years approximately one-half the samples analyzed
were sent in by public water companies. 'Of the rest about one-half
were samples of water, representing as many different wells, sent in
by phj^sicians who suspected these waters to have caused typhoid
fever. The remaining samples included tuberculosis sputa, diph-theritic
exudates, feces, blood, urine, vomit and samples of parasitic
worms.
The number of letters and reports mailed trom the laboratory dur-ing
1900 was about 7,600. In addition a large number of circulars
and notices to public water companies were mailed.
The Biologist has during this period prepared for the Bulletin of
the Board of Health a number of special papers on health topics.
One of these papers was republished entire in another State.
During 1905 there were registered in the laboratory forty-seven
public water companies. During 1906 the number had increased to
fifty-one, where it now remains.
The following table shows the general character of each of these
water supplies
:
Water Company
or Supply.
Albemarle
Ownership.
Corporate
Asheville 1 Municipal —
(city).
Asheville
(Buckeye Co.)
Brevard
Charlotte
(city).
Charlotte
(Dilworth).
Concord
Dunn-
Corporate
..-do
Municipal
Corporate
..-.do
Municipal
Durham do
Edenton
Elizabeth City.
Fayetteville —
...-do
Corporate --
Municipal --
Source of Supply.
Artesian well
Surface stream—
.—do
,—do
.—do
.-__do
Shallow well
Artesian well
Surface stream—
Artesian well
Surface stream—
.—do
Type of
Filter used.
None
.—do
.—do
.—do
Mechanical—
None
.—do
.—do
Mechanical—
None
Mechanical—
None
Average Hygienic
Quality.
Pure; rather hard.
Very pure; soft.
do.
do.
Fair to good; soft.
Fair; soft.
Poor; soft.
Fair; soft.
Poor to good; soft.
Poor to fair; soft.
Poor to fair; hard.
Poor; soft.
ELEVENTH BIENNIAL BEPORT. 59
Water Company
or Supply.
Ownership. Source of Supply. Type Of
Filter used.
Average Hygienic
Quality.
Fayetteville
( Fountain Head)
.
Graham
Gastonia
Goldsboro --
Greensboro
Greenville-.
Henderson .
Corporate
Municipal
.._-.do
.-.do
._..do
.—do
.—do
Hendersonville do
Hickory do
Hot Springs Corporate —
Kinston Municipal
-
Lexington >.---do
Springs
Artesian well
Surface stream—
.-__do
—.do
....do
..-.do
..-do
—do
-.-do
None
....do
Mechanical..
-
....do
.—do
...-do
....do
None
Slow sand bed
None
Artesian well do
-do. -do
Lincolnton .
Louisburg..
Lumberton .
-do
-do
-do
Monroe do .
Morganton Corporate —
Mount Airy Municipal-
New Bern ' do
Oxford 1 Corporate -.
Pinehurst Private
Raleigh Corporate -
Reidsville ' Municipal --
Rocky Mount do
Roxboro do
Salem , Corporate --
Salisbury 1 Municipal --
Sanford do
Southern Pines do
Statesville do
Spencer do
Wadesboro do
Tarboro do
Washington ' Corporate —
Waynesville Municipal --
Wilmington Corporate --
Wilson 1 Municipal --
Winston ' do
Shallow well ' do
Surface stream—i Mechanical --
....do L.-do
Artesian well None
do 1 do
Surface stream— do
Artesian well do
do do
Spring do
Surface stream— Mechanical . -
Shallow wells None
Surface stream— Mechanical—
Artesian well 1 None
Surface stream— Mechanical—
do do
-do.
-do
-do.
None
..—do
Mechanical
.
Artesian well do
Board well do
Artesian well None
do ' do
Surface stream— do
do Mechanical.
do 1 None
—do ' Mechanical.
Poor; soft.
Fair to good; soft.
Fair to good; soft.
do.
Good; soft.
do.
Poor to fair; soft.
Good; very soft.
Fair to good; soft.
Good; soft.
do.
Good; hard
Good; soft.
do.
Very poor; soft.
Good; hard.
Very pure; soft.
Pure; soft.
Fair; hard.
Good; hard.
Very pure; .soft.
Good; soft.
Variable; general
quality unsatis-factory.
Fair; soft.
Good; soft.
do.
do.
do.
do.
do.
do.
do.
do.
Good; hard.
Fair to good; soft.
Good; soft.
Poor; soft.
Good; soft.
60 NORTH CAROLINA BOARD OF HEALTH.
lu connection with tlie iibove table it is only fair to say that the
showing is, as a whole, very creditable to the State. The average
quality of all but a very few of these water supplies is excellent.
When the laboratory first began these systematic analyses in 1903,
we found that many of the water companies using the mechanical
filtering process were running alum into the filtered water. At the
present time we rarely find any trace of alum in the filtered waters
sent us. The germ contents of all these filtered waters are compara-tively
low, and the groups represented are. in most cases, harmless,
sporiferous saprophytes. The alum used as a coagulent in filtering
water by the mechanical process has a powerful bactericidal effect.
It acts in a destructive way upon these organisms, both mechanically
and physiologically.
Artesian wells as sources of public water supplies for small towns
seem to be growing in favor in this State, and most of the recently
established supplies are of this class. All of the artesian waters of
this State contain a high percentage of total solids, chiefly the sul-phates
and chlorides of soda, lime and magnesia. These artesian
waters are wholesome, though they are apt to disagree at first with
those who have been accustomed to soft, surface water. They are
not well suited for steam boilers and other industrial uses. We
have advised the managers of the more highly mineralized artesian
supplies to install a softening plant, which will remove the larger
part of the dissolved minerals—chiefly lime—and thus render the
water soft and more desirable for both domestic and industrial uses.
In pathological work done for phjsicians the number of samples of
suspected tuberculous sputum sent in is steadily increasing. About
three-fourths of all samples of this kind now received show bacillus
tuberculosis.
In this connection the Biologist desires to say that he keeps him-self
informed as to the most recent developments in controlling human
tuberculosis, as published in German and Frencli scientific periodi-cals.
The consensus of opinion among working European biologists
is that tuberculosis is rarely transmitted directly from cows to
humans. This does not necessarily mean that there is any radical
or specific difference between the germs of human and bovine tuber-culosis.
It simply means that germs habituated to parasitism on
bovines do not easily or at once adapt themselves to the human
environment, and as a consequence are less virulent and less able to
overcome or counteract the natural protective secretions of the
healthy human organism. In other words, most new cases of human
tuberculosis seem to arise from some pre-existent human case or
infection. The plain moral inculcated by this fact is that such possi-ble
infection should be more rigorously guarded against. There
should be a stringent law requiring all public assembly and waiting
rooms, public carriages, cars, jails, asylums, hotels, etc.. to l)e period-
ELEVENTH BIENNIAL REPORT. 61
ically fumigated, and rented houses should be fumigated before a
new tenant is admited. The frequent sprinkling of city streets dur-ing
the dry weather, and the daily, or more properly nightly, sweep-ing
of such streets has an important influence upon preventing the
spread of tuberculosis. A further desirable precaution is the en-forced
registration of consumptives with local boards of health, this
registration to include transient visitors as well as permanent resi-dents.
All such registered consumptives should be furnished with
literature giving special rules for hygienic living, with the view of
preventing infection of others.
In the line of feces examination during 1906 much less work than
in 1905 has been done in this laboratory. Nearly all the samples of
this kind now sent in do, in fact, contain the hook-worm. A very few
samples of feces showing tape-worm have been received, but this
parasite seems rare in North Carolina.
The demand for examination of feces for hook-worm was very
brisk during 1905, but during 1906 has greatly decreased. This de-crease
is probably due to the ease of diagnosing this disease from
symptoms, as a typical case once determined by biological examina-tion
enables the physician to diagnose similar cases by the symptoms.
Regularly each fall, within a week or ten days after schools open,
physicians begin to send in samples of throat exudate from suspected
cases of diphtheria. The demand for this kind of work increases
rapidly and averages three or four samples per day until about De-cember
15th, when the demand begins to slacken and practically ceases
about February 1st, to begin again the ensuing September.
There is a con