Biennial report of the North Carolina State Board of Health |
Previous | 34 of 44 | Next |
|
small (250x250 max)
medium (500x500 max)
Large
Extra Large
large ( > 500x500)
Full Resolution
|
This page
All
|
ofti)e DiV)t0ion of l^ealtb affalr0 OnitietiSitp of n^otti) Carolina ^ /VoC 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
Object Description
Description
Title | Biennial report of the North Carolina State Board of Health |
Other Title | Report of the North Carolina State Board of Health. |
Creator | North Carolina. State Board of Health. |
Date | 1905; 1906 |
Subjects |
North Carolina. State Board of Health--Statistics--Periodicals Public health--North Carolina--Statistics--Periodicals Public Health--North Carolina |
Place | North Carolina, United States |
Time Period | (1900-1929) North Carolina's industrial revolution and World War One |
Description | Report covers two calendar years (13th-18th); (19th) covers Dec. 1, 1920-June 30, 1922; thence each covers July 1-June 30 years.; Printer: 13th (1909/10)-18th (1919/20) by Edwards & Broughton; 19th (1921/22)-20th (1923/24) by Bynum; 21st (1925/26)-<44th (1970/72)> unnamed. |
Publisher | Raleigh :The Board,1911- |
Agency-Current | North Carolina Department of Health and Human Services |
Rights | State Document see http://digital.ncdcr.gov/u?/p249901coll22,63754 |
Physical Characteristics | v. ;24 cm. |
Collection | Health Sciences Library, University of North Carolina at Chapel Hill |
Type | text |
Language | English |
Format | Reports |
Digital Characteristics-A | 178 p.; 9.58 MB |
Series | Biennial report of the North Carolina State Board of Health |
Digital Collection |
North Carolina Digital State Documents Collection N.C. Public Health Collection |
Digital Format | application/pdf |
Related Items | Printer: 13th (1909/10)-18th (1919/20) by Edwards & Broughton; 19th (1921/22)-20th (1923/24) by Bynum; 21st (1925/26)-<44th (1970/72)> unnamed. |
Audience | All |
Pres File Name-M | pubs_biennialreportof11nort.pdf |
Pres Local File Path-M | \Preservation_content\StatePubs\pubs_edp\images_master\ |
Full Text | ofti)e DiV)t0ion of l^ealtb affalr0 OnitietiSitp of n^otti) Carolina ^ /VoC 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 .---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 |