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FIFTH BIENNIAL REPORT OP THE NORTH CAROLINA BOARD OF HEALTH, 1893-1894. Cfte Library of tipe llniumt^ of Jl^ottb Carolina ki ^5-t. /f-/ -b FIFTH BIENNIAL REPORT t OF THE NORTH CAROLINA BOARD or HEALTH, 1893-1894. RALEIGH: JosEPHus Daniels, State Printer and Binder. PRESSES OF E. M. UZZELL. 1895. 2.^970- MEMBERS OF THE BOARD ELECTED BY THE MEDICAL SOCIETY OF THE STATE OF NORTH CAROLINA. George GillETT Thomas, M. D., President: Wilniiugtou. Term Expires iSgy. S. Westray Battle, M. D Asheville. Term Expires 1897. W. H. Harrele, M. D Williamstou. Term Expires 1S95. John Whitehead, M. D Salisbury. Term EJxpires 1S95. APPOINTED BY THE GOVERNOR. W. H. G. Lucas, M. D White Hall. Term Expires 1895. W. P. Beael, M. D Greensboro. Term Expires 1S95. F. P. Venable, Ph. D., F. C. S Chapel Hill. Term Expires 1S95. John C. Chase, Sauitar}' Engineer Wilmington. Terni Expires 1895. Richard H. Lewis, M. D., Secretary Raleigh. Term Expires 1895. STANDING COMMITTEES. Epidemics—Drs. Lewis and Whitehead. Water Supply and Drainage—Dr. Thomas and Mr. Chase. Hygienics of Public Schools—Drs. Whitehead and Lucas. Climatology—Dr. S. W.' Battle. Adulteration of Food and Medicines—Prof. F. P. Venable. Sanitary Condition of State Institutions—Drs. Harrell and Beall. Vital Statistics—Drs. Lewis, Thomas and Harrell. LIST OF COUNTY SUPERINTENDENTS OF HEALTH IN THE STATE OF NORTH CAROLINA, DECEMBER 31, 1894. Alamance—Dr. R. A. Freeniau, Burliugton. Alexander—Dr. R. B. Killiau, Taylorsville. Alleghany—Dr. C. G. Fowlkes, Topia. Anson—Dr. E. S. Ashe, Wadesboro. Ashe—Dr. L. C. Gentr}-, Jefferson. Be.aUFORT—Dr. John C. Rodman, Washington. Bertie—Dr. H. V. Dunstau, Windsor. Bladen—Dr. Newton RoVjinson, Elizabethtown. Brunswick—Dr. D. I. Watson, Southport. Buncombe—Dr. H. L. Baird, Asheville. Burke—Dr. J. L. Laxton, Morgantou. Cabarrus—Dr. Leona M. Archey, Concord. Caldwell—Dr. A. A. Kent, Lenoir. Camden— Carteret—Dr. George N. Ennett, Beaufort. Caswell—Dr. W. O. Spencer, Yanceyville. Catawba—Dr. J. M. McCorkle, Newton. Ch.atham—Dr. L. A. Hanks, Pittsboro. Cherokee—Dr. J. F. Abemathy, Rlurphy. Chowan—Dr. R. A. Winborne, Barnitz. Clay—Dr. W. E. Sanderson, Hayesville. Cleveland—Dr. O. P. Gardner, Shelby. Columbus—Dr. I. Jackson, Wliiteville. Craven—Dr. Leinster Duffy, Newliern. Cumberland—Dr. J. H. Marsh, Fayetteville. Currituck— Dare—Dr. W. H. Peterson, Mauteo. Davidson—Dr. R. L. Payne, Jr., Lexington. Davie—Dr. James McGuire, Mocksville. Duplin—Dr. W. P. Kennedy, W'arsaw. Durham—Dr. John M. Manning, Durham. Edgecombe—Dr. Donald Williams, Tarboro. Forsyth—Dr. D. N. Dalton, Winston. Franklin—Dr. E. S. Foster, Louisburg. Gaston—Dr. J. H. Jenkins, Dallas. Gates—Dr. I W. Costen, Gatesville. Graham— Granville—Dr. W. O. Baskerville, Oxford. Greene—Dr. E. H. Sugg, Snow Hill. Guilford—Dr. A. R. Wilson, Greensboro. 4 LIST OF SUPERINTENDENTS OF HEALTH. Halifax—Dr. I. E. Greeu, Weldoii. Harnett—Dr. J. F. McKay, Dickiusou. Haywood—Dr. J. Howell Way, Waynesville. Henderson-Dr. J. L. Egertou, Heudersouville. Hertford—Dr. John W. Tayloe, Union. Hyde- Iredell—Dr. W. J. Hill, Statesville. Jackson—Dr. W. F. Tompkins, Webster. Johnston—Dr. R. J. Noble, Selma. Jones—Dr. R. A. Whitaker, Trenton. Lenoir—Dr. C. B. Woodley, Kioston. Lincoln—Dr. W. L. Crouse, Lincolnton. Macon—Dr. S. H. Lyle, Franklin. Madison—Dr. James K. Hardwicke, Marshall. Martin—Dr. W. H. Harrell, Williamston. McDowell—Dr. B. A. Cheek, Marion. Mecklenburg—Dr. H. INI. Wilder, Charlotte. Mitchell—Dr C. E. vSmith, Bakersville. Montgomery—Dr. W. A. Simmons, Troy. Moore—Dr. Gilbert McLeod, Carthage. Nash—Dr. J. J. Mann, Nashville. New Hanover—Dr. R. D. Jewett, Wilmington. Northampton—Dr. H. W. Lewis, Jackson. Onslow—Dr. E. L. Cox, Jacksonville. Orange—Dr. C. D. Jones, Hillsboro. Pamlico— Pasquotank—Dr. W. W. Griggs, Elizabeth City. Pender—Dr. George F. Lucas, Carrie. Perquimans-Dr. John F. Speight, Hertford. Person—Dr. C. G. Nichols, Roxboro. Pitt—Dr. W. H. Bagwell, Greenville. Polk—Dr. O. S. Missildine, Tryon. Randolph—Dr. J. M. Boyette, Ashboro. Richmond—Dr. J. M. Covington, Rockingham. Robeson—Dr. T. A. Norment, Jr., Lumbertou. Rockingham—Dr. D. W. Courts, Reidsville. Rowan—Dr. John Whitehead, Salisbury. Rutherford—Dr. W. A. Thompson, Rutherfordton. Sampson—Dr. John A. Stevens, Clinton. Stanly—Dr. D. P. Whitley, Millingport. Stokes—Dr. W. L. McCanless, Danbury. Surry—Dr. J. B. Hollingsworth, :Mt. Airy. Swain—Dr. R. L. Davis, Bryson City. Transylvania—Dr. C. W. Hunt, Brevard. LIST OF SUPERINTENDENTS OF HEALTH. 5 TyrreI/L—Dr. Ab. Alexander, Columbia. Union—Dr. J. K. Ashcraft, Monroe. V.\NCE— Dr. W. T. Cheatham, Henderson. Wake—Dr. P. E. Hiues, Raleigh. Warren—Dr. P. J. Macon, Warrenton. Washington— Watauga—Dr. W. B. Councill, Boone. Wayne—Dr. W. J. Jones, Jr., Goldsboro. Wilkes—Dr. J. W. White, Wilkesl)oro. Wilson—Dr. Albert Anderson, Wilson. Yadkin—Dr. T. R. Harding, Yadkiiiville. Yancey—Dr. J. L. Ra3-, Bnrnsville. LETTER OF TRANSMISSION. North Carolina Board of Health, Office of the Secretary, Raleigh, N. C, January 4, 1895. His Excellency^ Elias Carr, Governor of North Carolina^ Sir:—In accordance with Section 3, Chapter 214, Laws of 1893, I have the honor to present this the Fifth Biennial Report of the North Carolina Board of Health. With great respect, Yonr obedient servant, RICHARD H. LEWIS, M. D., Secretary and Treasurer. FIFTH BIE:NNIAL REPORT OP THE NORTH CAROLINA BOARD OF HEALTH. 1893=1894. lu the two years that have elapsed since our last re[)ort the cause of public hygiene iii our State has been markedly , advanced. The interest in this most important subject, both on the part of members of the medical profession and of the people generally, shows a very decided increase. While our work has been, and continues to be, largely "missionary" in character—to carry to those ignorant of, or indifferent to, its saving power the gospel of health — the Board has accomplished much positive good. We feel that we can claim without hesitation that the saving of many valuable lives and the prevention of a large amount of sickness can be directly traced to its efforts. The pro-visions of the law enacted by the last General Assembly requiring physicians to report immediately to the proper health officer cases of contagious and infectious disease and making it obligatory upon said health officer to see that such diseases "are properly quarantined and isolated within twenty-four hours after the case is brought to his knowl-edge, and that after the death or recovery or removal of a person sick of either of the diseases mentioned the rooms occupied and the articles used by the patient are thoroughly disinfected in the manner set forth in the printed instruc-tions, both as to quarantine and disinfection, which shall be furnished him by the Secretar}^ of the State Board of 8 NORTH CAROLINA BOARD OF HEALTH. Health," have alone saved a loss to the State in dollars and cents, considering death and sickness in terms of money, far more than has been expended upon the Board from its establishment. Unfortunately the evidence in support of sanitarv science is necessarilv nee:ative in character. Its function is not to cure disease and thus to positively save from death, Ijut to prevent the inauguration of disease in the first instance and thus to save the well from both sick-ness and death which in many instances would have surely come to them but for the effective precautions of the health officer. There are many other excellent features in the new law bearing upon the protection of school children from disease, upon the drinking waters of the State, regu-lating common carriers, and others, for a consideration of which we would refer the reader to the law itself which he will find in another part of this report. As a result of the marvelous advance in bacteriology a great discovery has been made in "antitoxine," which is regarded as a sure preventive of, and when used soon enough almost a sure cure for, diphtheria, the very name of which strikes terror to a parent's heart. The infec-tiousness of consumption is no longer disputed and know-ing the cause, it can often be prevented by resorting to suitable precautions. With more knowledge we hope to do better work, and in the next two 3^ears to save very many more than ever before in the same length of time from sickness and death. MEETINGS OF THE BOARD. MINUTES OF THE ANNUAL MEETING AT RALEIGH IN 1893. Raleigh, N. C, May 10, 1893. The North CaroUiia Board of Health met iii regular annual session in the private office of the Yarborough House at 6 p. m. In the temporary absence of the President Dr. George G. Thomas vras, on motion, called to the chair. Present : Drs. Bahnson, Harrell, Hodges, Thomas, Veuable, Mr. Chase and the Secretary. On motion of Dr. Venable the action taken by the Board in the matter of the Quarantine Station at Southport by letter was ratified. Dr. Bahnson, for the committee appointed to visit the School for the Deaf and Dumb at Morganton, and advise the Board of Directors of the same as to a water supply and system of sewerage, submitted a report of its work, stating that a copy had been sent to Dr. M. L. Reid, Chair-man of the Board of Directors. On motion the report was accepted and indorsed. A motion to proceed to the election of officers was car-ried, but as some doubt was expressed as to the tenure of office of the Secretary, whether he should hold for the un-expired term to which he was elected under the old law ('85), or whether he should be elected every two years, since the term of office of each member of the Board was made b}'' the new law ('93) only two years, the President was rec|uested to obtain the opinion of the Attorney Gen-eral and report to the meeting next morning, to which time the Board then adjourned. RICH'D H. LEWIS, Secretary. 10 NORTH CAROLINA BOARD OF HEALTH. Raleigh, X. C, May 11, 1893. The Board re-assembled in the Senate Chamber of the Capitol at 10 a. .m., President Bahnson in the chair. The President stated that he had consulted the Attorney General as to the term of office of the Secretary and that the latter had given it as his opinion that if the Secretary continued a member of the Board by re-appointment for so long a time he was entitled under the Constitution of the State to hold the office for the remainder of the six-year term of the late Secretar}^, Dr. Thomas F. Wood, to which he was elected. Dr. tienry T. Bahnson was nominated for President and unanimously re-elected. Messrs. Chase and Venable were appointed a committee to audit the accounts of the Treasurer. They reported them to be correct. Adjourned. RICH'D H. LEWIS, Secretary. FIFTH BIENNIAL REPOHT. 11 ACTION OF THE NORTH CAROLINA BOARD OF HEALTH, IN jREGARD TO THE RESIGNATION OF DR. J. A. HODGES AND THE ELECTION OF HIS SUCCESSOR. The following letter, which ex})lains itself, was sent to every member of the Board : North Carolixa Board of Health, Secretary's Office, Raleigh, November 6, 1893. My dear Doctor :—I am instructed by President Bahnson to notify the members of the Board of the resignation, upon his removal from the State, of Dr. J. A. Hodges, and to ask eacli member to indicate in a letter to the Secretary (in order to save tlie expense of a meeting for the purpose) what action he desires taken thereon, and his choice for his successor. Please write me promptly in accordance with the above and oblige, Yours truly, EICH'D H. LEWIS, Secretary. By the answers to the above letter received from all the members of the Board, and now on file in the Secretary's office, the resignation of Dr. Hodges was accepted and Dr. John Whitehead, of Salisbury, was unanimously elected to fill the vacancy. Dr. Whitehead was duly notified of his election and signified his acceptance of the position. RICH'D H. LEWIS, Secretary. 12 NOKTH CAROLINA BOARD OF HEALTH. MINUTES OF THE ANNUAL MEETING AT GREENSBORO IN 1894. Greensboro, N. C, May 15, 1894. TJie North Carolina Board of Health met in regular annual session in Room 15, Benbow House, at 9 p. m. There were present Drs. Bahnson, President; Harrell, Whitehead and Venable, Mr. Chase and the Secretary. • The minutes of the last meeting and of the action of the Board in regard to the resignation of Dr. J. A. Hodges and the election of his successor were read and approved. Messrs. Chase and Venable were appointed by the Presi-dent a committee to audit the accounts of the Treasurer. The matter of the erection of a first-class Quarantine Station at Southport was informally discussed. Great regret was expressed at the action of the authorities of the city of Wilmington in refusing to appropriate the $5,000 neces-sary as a preliminary condition to receiving $20,000 from the State. The transmission of typhoid fever was the subject of a general discussion of a very interesting character. On motion it was ordered that the Board meet hereafter three times a year—every four mouths—the annual meet-ing to be held as usual with the State Medical Society, and the other two in September and January at such place as the Board may select and on such day as the President may appoint. On motion Salisbury was selected as the place for the next or September meeting. The President was requested to appoint the day at his convenience. On motion it was ordered that the public institutions of the State, including the convict camps, be inspected as far as practicable during the current year. FIFTH BIENNIAL REPORT. 13 On motion the Secretary was instructed to i)urchase a library of reference books on sanitary subjects for the use of his office, and also similar books for the use of members of the Board. Adjourned to 12 o'clock to-morrow. RICH'D H. LEWIS, Secretary. Greensboro, N. C, May 1<3, 1894. The Board re-assembled in Room 15 of the Benbow House at 6:40 p. m.: President Bahnson in the chair. Present: Drs. Bahnson, Battle, Harrell and Whitehead, Mr. Chase, Passed Assistant Surgeon J. J. Kinyoun, M. H. S., and the Secretary. In response to an invitation from the Board to address them, Dr. Kinyoun made the following statement: The Surgeon General of the ]\Jarine Hospital Service, Dr. Wyman, is very anxious to have all the larger ports put in good shape. All the ports except Wilmington are already well provided with quarantine facilities. It is his earnest desire to have a perfectly equipped station at Wil-mington. The rules under the law of February, 1893, re-quire that the dunnage of any infected vessel must be disinfected by steam and the hold of said vessel by 10 per cent, sulphur. If such facilities do not exist at a port the vessel must be remanded to a port that is supplied. This would wreck the commerce of Wilmington as matters now stand, which the Government would be very loth to do. An order has been issued to captains from West Indies and South American ports having yellow fever to report at once to United States stations. All sailing vessels from an in-fected port in West Indies are advised to go by one of the national stations at Tortugas or Sapelo for inspection and disinfection. The Surgeon General wishes to know if a 14 NORTH CAROLINA BOARD OF HEALTH. properly equipped station cannot be established by the State. If not the United States have the law and ample means to do so. After a full discussion of the above statement from the Marine Hospital Service the following motion was intro-duced by Dr. Battle and unanimously adopted : Moved, that in view of the inability or the unwillingness of the city of Wilmington to contribute its part towards carrying out the act of the last General Assembly providing for the erection of a first-class Quaran-tine Station at Southport, the Secretary of this Board be instructed to officially request the United States Marine Hospital Service to take charge of and operate that station; and that the Secretary be authorized to explain this action on the part of the Board. The Auditing- Committee reported that they had exam-ined the accounts of the Treasurer and found them correct. Report adopted. On motion the Board adjourned to meet in Salisbury in Se^^tember. RICH'D H. LEWIS, Secretary. MINUTES OF THE MEETING AT SALISBURY, SEPTEMBER 13, 1894. Salisbury, N. C, September 23, 1894. The Board met after the adjournment of the Health Con-ference in private session at the Central Hotel. Present: Drs. Bahnsou, Battle, Thomas, Whitehead and Lewis. Drs. Bahnson and Lewis were elected delegates to the American Public Health Association. The appointment of delegates to the National Conference of State Boards of Health was left to the President. A letter from Dr. C. O. Probst, Secretary of the National Conference of State Boards of Health, stating that the annual dues of North Carolina for 1892, $10, had not been paid, was read. Upon a state- FIFTH 15IEXNIAL REPORT. 15 ment from the Treasurer of the Board that such was the fact, due doubtless to the prolouged ilhiess of the Treasurer at that tiuie, a motion was passed ordering it paid. On motion the Secretary Avas ordered to have printed in pamphlet form, and generally distributed, the article on "The Prevention of Tuberculosis," by Dr. S. Westray Bat-tle, and that on "Drinking Water in its Relation to Malarial Diseases," by the Secretary, just read before the Health Conference. On motion Mr. J. C. Chase, the Engineer of the Board, was requested to make a thorough inspection of the various State institutions and of tlie water supplies and sewerage sys-tems, present and prospective, of the more important cities and towns of the State and to report the results of the same to the Board. On motion tlie meeting adjourned. RICH'D H. LEWIS, Secretary. PROCEEDINGS HAD IX REGARD TO THE ELEC-TION OF A PRESIDENT OF THE BOARD TO SUCCEED DR. H. T. BAHNSON, RESIGNED. Having been notified by his Excellency the Governor of the resignation from the Board of Dr. H. T. Bahnson, of Salem, for many j-ears its active and efficient President, I addressed the following letters to each member of the Board. They show the method of the election of Dr. George Gillett Thomas, of Vvilmington, as his successor in the presidenc}^ : Raleigh, N. C, November 21, 1894. My dear Doctor :—Dr. Bahnson, being a member of two boards, has tbought it proper to resign from one of them, and has, I am sorry to say, elected to give up ours. We are, therefore, without a President, and tlie machinery of our law requires one. In order to save expense and time it has occurred to me that it would be best for me to call for 16 NORTH CAROLINA BOARD OF HEALTH. nominations by letter and then to send a list of the nominees to each member of the Board for his ballot. If you approve this plan please make a nomination. If not, let me have your views as to the best course of action, and oblige, Yours very truly, RICH'D H. LEWIS, Secretary, P. S.—If a majority of the Board should nominate the same person we will, if you approve, consider that an election. R. H. L. Raleigh, N. C, December 8, 1894. My dear Doctor:—The "returns" are all in, and Dr. G. G. Thomas has been nominated by six (6) members and Dr. S. W. Battle by two (2) members for President of the Board. According to the understanding had in my former letter—that if any one member should happen to be nominated by a majority of the Board we would, without further corre-spondence, consider him elected—I now announce the election of Dr George Gillett Thomas as President. Very truly yours, RICH'D H. LEWIS, Secretary. His ExcelleDcy the Governor appointed Dr. W. P. Beall, of Greensboro, to fill the vacancy on the Board caused by the resignation of Dr. Bahnson. PROCEEDINGS CONJOINT SESSIONS OF THE STATE BOARD OF HEALTH WITH THE State Medical Society in 1893 and 1894. The Conjoint Session at Raleigh, May 11, 1893. Dr. II. T. Bahnson was called upon to preside. He au-noLinced the first business in order to be the reading of the annual report of the Secretary : ANNUAL REPORT OF THE SECRETARY OF THE NORTH CAROLINA BOARD OF HEALTH. By Richard H. Lewis, M. D., Raleigh, N. C. By section 27 of the Act Relating to the Board of Health the Secretary is required to submit his annual report at this, the annual meeting of the Board. ITe is also required by section 3 of the same to make biennially to the General Assembly, through the Governor, a report of the work of the Board. In comjdiance with the latter the fourth bien-nial report for 1891-'92 was prepared and submitted, and the portion of it covering the period from the last annual meeting to January 1, 1893, is respectfully referred to as a part of this report. [Read from the biennial report the references to the life and work of Dr. Thomas F. Wood.] On January 2d an invitation to meet with the State Board of Health in a Health Conference on January 24th 18 NORTH CAROLINA BOARD OF HEALTH. iu the city of Raleigh was mailed to the number of six hundred and fifty to the officers of the State Government, members of the General Assembly, Mayors of towns, County Superintendents of Health, Chairmen of Boards of County Commissioners, physicians and other prominent men. The attendance was not ver}" large, but varied and of good quality. The number of County Superintendents of Health present (three, and one of them a member of the Legis-lature) was discouraging, particularly in view of the fact that one of the principal subjects for discussion named in the invitation was their own salaries, about which much complaint had been made. The following are the proceed-ings of the Health Conference: Raleigh, N. C, January 24, 1893. On a call from the President of the State Board of Health, Dr. H. T. Bahnson, of Salem, that body met in the city of Raleigh on the above date, there being present Drs. J. H. Tucker, J. A. Hodges, Geo. G. Thomas, Prof. F. P. Amenable and the Secretary. There were present also Superintendents of Health, prac-ticing physicians and other citizens interested in sanitation and the health of the State, all of whom were invited to meet with the State Board of Health in a Health Con-ference. In the absence of President Bahnson the Secretary called the Conference to order, stating the object of the Confer-ence to be a consideration of the best method to prevent the introduction of pestilential diseases into the State, the method of fixing the salaries of Superintendents of Health and other matters relating to the general health of the State. He introduced the Mayor of the cit}^ of Raleigh, who extended a cordial welcome to the Conference and assured FIFTH BIENNIAL KEPOKT. 1 H* it of his hearty support in its efforts to [)romote the welfare of the State in the all-important matter of healtli. The first order of business being the selection of a perma-nent chairman, Dr. Thomas nominated Col. W. 11. S. Burgwyn, a man who had shown himself to be actively interested in the health matters of North Carolina. Col. Burgw}'!! was unanimously elected Jind on assuming the cliair expressed himself as feeling highly honored by being-invited to preside over the meeting and gladly offered all the assistance in his power to the Conference in improving the safeguards against the ravages of plagues and epi-demics. The prosperity of the country is largely dependent upon the medical profession, and this is especially note-worthy of the next twelve months when the country is to undertake the stupendous task of entertaining the whole world and, at the same time, guard her citizens from the terrible plague which caused such destruction of life in Europe last 3''ear and wliich is apparently only waiting for the ap})roach of warm weather to renew its work of devas-tation and destruction. The Secretary presented as the first duty of the Con-ference the amendment of the health laws of the State, and read a co])y of a law suggested by the President, after which he stated that a substitute for the old law had been drawn up by himself for the consideration of the Con-ference. It was moved and decided that the Secretarv read his proposed substitute for the existing laws section by section and if there be no objection raised the section be consid-ered as approved by the Conference. Section 1. Adopted without objection. Sec. 2. There being some doubt as to whether the pro-posed reading would call for the election of six new mem-bers of the Board this year, it was corrected to make the 20 NORTH CAROLINA BOARD OF HEALTH. fact clear that the successors of the present incumbents were to be elected only at the expiration of the terms of the present members; each new member being elected for six years. Sec. 3. The important part of this section is the duty of the Board to inspect the public institutions of the State, and the Secretary explained that before any action was taken he had communicated with the chief officers of the asylums and of the Penitentiary and they had expressed the opinion that such inspection would be very proper and desirable. The section was approved ; but later Dr. .J. W. Jones thought that the inspection of the stockades should be made oftener than once a year, as frequently a stockade was not in existence so long as a year, and in that event it might not be inspected at all. An amendment was added to the section, providing for inspection as much oftener as requested by the "Board of Charities." The Secretary said that he had considered the advisability of having the superintendents of the public institutions make monthly reports to the Board of Health, but as the}' have to keep a record of these things any way, and include them in their regular reports, he thought it not well to impose this duty upon them. Sec. 4. Approved without discussion. Sec. 5. This section was amended so as to make eligible to membership in the County Boards of Health all prop-erly registered physicians. Sec. 6. Dr. Hodges thought the law regarding fines against Superintendents had been a dead law ; that he be-lieved these fines had never been collected. He had at times been delinquent in sending in his reports when he was a Superintendent and had never paid a fine. The Sec-retary explained that heretofore it had not been obligatory on the Secretarv to notifv the Countv Commissioners of the FIFTH BIENNIAL REPORT. 21 delinqiioiicy of the Supcniiteiulents. On motion the sec-tion was amended, making it the duty of the Secretary of the State Board to notify tlio Commissioners on the 11th of each month of any delinquenx?.y on the part of Superin-tendents to send in their reports by the 10th. As amended the .section was adopted. Sec. 7. This section, relating to the salaries of Superin-tendents of Health, provoked a very great deal of discus-sion by the members of the Conference generally. The Secretary thought the salaries of these officers should be imposed and regulated by legislative enactment so that they could act independently in performing their duties. There was a unanimity of opinion as to the fact that the salaries of the Superintendents were far from satisfactory, but there seeming to be an inabilitv to come to any con-elusion as to the best and wisest plan for improving them, Dr. Hodges moved that the matter be referred to a com-mittee who should consider it and report at the afternoon session. The motion was carried. Sec. 8. The Secretary explained that this section was introduced in its proposed form for the purpose of making one definite day for the election of Superintendents in all the counties of the State, and so that all terms of office would expire at the same time. Dr. Thomas thought the reason why local Boards of Health held such infrequent meetings was because they were invested with no power except to give advice and their advice generally resulted in nothing. The section was adopted. Sec. 9. Adopted. Sec. 10. Adopted. Sec. 11. Adopted. Sec. 12. Adopted. Sec. 13. Dr. Hodges thought we ouglit to deal with great tenderness with the affairs of the public schools. 22 NORTH CAROLINA BOARD OF HEALTH. Some committeemen lived ten miles apart, and it would be bard to get tbem togetber to consider these tilings. Tbe Secretary exrjlained that it was only tbe diseases tbat were really dangerous to life tbat were included in tbis section. The section is intended to apply especially to city schools, but should also apply to county schools. Dr. Grouse thought tlie last clause requiring tbe child wdio persisted in coming to school while it was in dangerous contact with contagious diseases at home, to be dismissed from the school for the remainder of tbe term, a hardship on tbe child and not a punishment on the pareut, where the blame should rest. After some discussion it was decided to leave tbis clause out, and as so amended the section was passed. Sec. 14. Adopted. Sec. 15. Amended so as to provide for tbe early removal of a suspect from tbe State, and was then adopted. Sec. 16. Adopted after a slight amendment. Sec. 17. This section was explained to refer to potable waters. It was then adopted. Sec. 18. Adopted after a slight amendment. The remaining sections were adopted without much discussion. TJie Chair attempted to appoint the committee to take into consideration the matter of salaries of Superintend-ents of Health, but there were none willing to assume the office, and on motion it was referred back to tbe whole meeting for action and then postponed to the afternoon session. Tbe Conference then adjourned to o p. m. FIFTH BIENNIAL KEPOKT. 23 AFTEKNOON SESSION. The Contereiice \va.s called to order by the Chairman at J o'clock. Section 7, relating to salaries of Superintendents, was introduced as the first order of business and again evoked much discussion, with liual result of ado])ting the section as it now stands. The matter of taking some action luokmg to seeuriug some law of compulsory vaccination elicited quite a spir-ited debate. All present seemed to agree as to the desira-bility of a more general practice of vaccination, but some were doubtful as to the advisability of attempting to secure legislation to require vaccination just at present, as it might jeopardize the whole bill. On motion the whole bill was adopted as a substitute for the present Act Helating to the Board of Health. By invitation Dr. W. G. Curtis, Quarantine Physician of the station at the month of the Cape Fear river, read a paper with a description of the station as it now is, a recital of the needs of the station and a discussion of the probability of cholera getting into this State the coming summer. During the latter part of the meeting Dr. Geo. G. Thomas presided, as Col. Burgwyu was obliged to leave. After the reading of Dr. Curtis's paper, which was lis-tened to with much interest, the Conference adjourned sine die. RICH'D H. LEWIS, Secretary. Upon request the President of the Senate and the Speaker of the House announced a joint meeting of their respective Committees on Public Health—the first com-mittees, by the way, on public health ever appointed by any Legislature in the history of the State, I am told—for 24 NORTH CAROLINA ROARD OF HEALTH. the niglit aftor the adjournment of tlie Conference, to con-sult with niemhors of the Board of Health in regard to sanitary matters generally, and the proposed legislation in the interest of the puhlic health in particular. Messrs. Hodges, Venable, Thomas and the Secretary appeared before them, and the bill was read over and explained. Senator Lucas, of Bladen (;ounty. Chairman of the Senate Committee on Public Health, who had just been appointed on the Board by Governor Carr, took charge of the bill and introduced it in the Senate. The Secretary again appeared before the Senate Committee, to which it was referred on its introduction, and it was favorably reported with unanimity. He also had a number of personal inter-views with Senators in regard to the importance of the act and besides sent a letter with a copy of the act to about one hundred physicians, County Superintendents and others, urging them to use their influence with their Senators and Representatives in effecting the passage of the bill. This letter bore fruit, and after some delay and much vexation of spirit on the part of your Secretary the bill passed the Senate by a vote of thirty-four to eight, though somewhat damaged by amendments. The House Com-mittee unanimously recommended its passage. Notwith-standing that fact when it came up on its second reading it was laid on the table in short order by a considerable majority, wdiich of course would have been the end of it but for the tact and parliamentary skill of the Hon. Edmund Jones, of Caldwell, a warm personal friend of 3'our Secre-tary, who got it up again and with the active assistance of a number of the best men in the House, medical and lay, secured its passage. I was very anxious to have some of the Senate amendments corrected in the House, but our friends in that body advised strongly against attempting anv amendment on the ground that if they ever began to FIFTH BIENNIAL REPORT. 25 amend it it would probably come out in worse shape than the Senate had left it. Your Secretary deferred to their wisdom, feeling that it was better to take what we had than to run a serious risk of losing much more. The act as finally passed differs from that proposed by the Health Conference essentially in these particulars: The appointment of five members instead of three out of the nine is given to the Governor and the term of office of all is made the same, two j'ears—an unfortunate change, I think, in both respects. The annual appropriation of $3,000 asked for was cut down to $2,000, the same as heretofore. In other respects it is essentiallv as introduced. On the whole we have made a decided advance, as a com-parison of the new with the old lavr will clearly show, I think. The old law, which was incorporated in the new, was imjjroved in many respects and many new and valua-ble sections, providing for much better protection against the introduction and spread of contagious and infectious diseases, and for the preservation of water su^^plies, as well as improvements in other respects, were added. AVhile our annual appropriation was not increased in dollars it was materially augmented by the removal of the $250 limit to our requisition on the State Printer for stationery and print-ing. The emergency fund was also increased from $2,000 to $5,000. The following is the law as it now stands: AN ACT IX RELATION TO THE BOARD OF HEALTH, RATIFIED MARCH 1, 1893. The General Assembly <>f Xortlt Carolina do enact ; Section 1. That the Medical Society of the State of North Carolina shall choose from its members by ballot four members, and the Governor of the !^tate shall appoint five other persons (one of -whom shall be a sanitary engineer) and they shall constitute "The North Carolina Board of Health." 26 XOETH CAROLINA I50AKD OF HEALTH. Sec. 2. The members of the Board of Health elected by the State Medi-cal Society shall be chosen to serve two years. Their term of office shall begin immediately upon the expiration of the meeting at which they were elected. Those appointed by the Governor shall serve two years, their term of otHce beginning with the first regular meeting of the Board after their appointment. In case of death or resignation the Board shall elect new members to fill the unexpired terms : Proridcd, the Governor shall fill such vacancies as may occur where he has made appointments. Sec. 3. Tliat the Xortli Carolina Board of Health shall take cognizance of the health interests of the people of the State, shall make sanitary investigations and inquiries in respect to the people, employing experts when necessary ; shall investigate the causes of disease dangerous to tlie public health, especially epidemics, the sources of mortality, the effect of locations, employments and conditions upon the public health. They shall gather such information upon ail these matters for distribution among the people, with the especial purpose of informing them about preventable diseases. They shall be the medical advisers of the State and are herein specially provided for, and shall advise the government in regard to the location, sanitary construction and management of all State institutions, and shall direct the attention of the State to such sani-tary matters as in their judgment affect the industries, prosperity, h.ealth and lives of the people of the State. They may make an inspection once in each year, and at such other times as they may be requested to do so by the State Board of Charities, of ail public State institutions, including all convict camps under the control of the State Penitentiary, and make a report as to their sanitarj^ condition, with suggestions and recommenda-tions to their respective boards of directors or trustees ; and it shall be the duty of the officials in immediate charge of said institutions to fur-nish all facilities necessary for a thorough inspection. The Secretary of the Board sliall make biennially to the General Assembly, through the Governor, a report of their work. Sec. 4. The State Board shall have a President and a Secretary, wiio shall also be Treasurer, to be elected from the members composing the Board. The President shall serve two years and the Secretary-Treasiirer two years. The Secretary-Treasurer shall receive such yearly compensa-tion for his services as shall be fixed upon by the Board, not to exceed one thousand dollars, but the other members of the Board shall receive no pay, except that each member shall receive four dollars a day and necessary traveling and hotel expenses when on actual duty attending the meetings of the Board or pursuing special investigations in the State, but when attending important sanitary meetings in other sections, the number of delegates thereto being limited to two, only actual traveling and hotel expenses shall be allowed. These sums shall be paid l>y the Treasurer on authenticated requisition approved and signed by the Presi-dent. FIFTH BIENNIAL REPORT. 27 Sec. 5. There shall be an auxiliary Board of Health in each county in the State. These Boards shall be composed of all registered physicians resident in the county, the ^layor of the county town, the Chairnian of the Board of County Commissioners and the City Surveyor, when there is such an otiicer; otherwise the County Surveyor. From this number one physician shall be chosen by ballot to serve two years, with the title of Superintendent of Health. His duty shall be to gather vital statistics upon a plan designated by the State Board of Health. He shall always promptly advise the Secretary of the State Board of tlie unusual prevalence of disease in his county, especially of typhoid fever, scai'let fever, diphtheria, yellow fever, small-pox, or cholera. His reports shall be made regularly, as advised by the State Board, through their Sec-retary; and he shall receive and carry out as far as possible such work as may be directed by the State -Board of Health. He shall make the medico-legal posf-rnorton examinations for coroners' inquests, and attend the prisoners in jail, home for the aged and infirm, and house of correction, and make an examination of lunatics for commitment. He shall be the sanitary inspector of the jail and home of his county, mak-ing monthly reports to the Board of County Commissioners : Provided, that if for any cause tlie County Board of Health should fail to meet as hereinafter set forth and elect a Superintendent, the County Commis-sioners shall elect from those physicians resident in the county eligible to membership in the County Board a Superintendent of Health : Pro-vidi'd farther, that it shall be unlawful for said County Commissioners to elect any one not eligible to membership in the County Board to the office of County Superintendent of Health, if any such qualified physician can be found in the county willing to accept the office. Sec. 6. IMonthly returns of vital statistics, upon a plan to be made by the State Board of Health, or their Secretary acting under their instruc-tions, shall be made by the County Superintendent to the Secretai-y of the State Board, and a failure to report by the tenth of the month for the preceding month shall subject the delinquent to a fine of one dollar for each day of delinquency, and this amount shall be deducted from the salary of the Superintendent by the Boardof County Commissioners on the statement of such delinquency by the Secretary of the State Board of Health; and the said Secretary is hereby required to notify, on the eleventh day of each month, the Chairman of the Board of County Com-missioners of such delinquency. The County Superintendent shall report to the Secretary of the State Board the presence in his county of any case of small-pox, yellow fever, typhus fever or cholera within twenty-four hours after it has come to his knowledge, and upon failure to make such report within the prescribed time the County Commissioners shall deduct five dollars from his salary for each day of delay in reporting. Sec. 7. The salary of the County Superintendent of Health shall be 28 NORTH CAROLINA BOARD OF HEALTH. paid out of the county treasury upon requisition and the proper vouchers as follows: The salary of the Superintendent of Health, or any other member of the Board who is requii-ed to do the service assigned him, sliall be in accordance witli the medical fees usual in his county, and for each inspection of the jail and county home, which he shall make monthly, he shall be paid as for one medical visit : Prodded, that a definite salary of not less than ten nor more than one thousand dollars may be paid in lieu of fees if mutualh^ agreeable to the Board of County Commissioners and the County Superintendent. Sec. 8. The biennial meeting for the election of officers shall be, for the State Board of Health, on the second day of the annual meeting of the Medical Society of tlie State of North Carolina in eighteen hundred and ninety-three and every two years thereafter; for the County Boards it shall be held in the county court-house between the hours of 12 >f. and 1 V. y\. on the first Monday in September, eighteen hundred and ninety-thi-ee, and each two years thereafter: Frurided, that the two-year term of office of any Superintendent shall not be curtailed thereby ; but his successor, who shall be elected at the meeting on the first Mon-day in September, eighteen hundred and ninety-tiiree, shall qualify upon the expiration of said term and hold office until the first Monday in September, eighteen hundred and ninety-five, Mhen all County Superin-tendents shall be elected for the full term of two years, beginning and end-ing with the first ^Monday in September. In order to secure uniformity and certainty of action it shall be the duty of the Secretary of the State Board of Health to mail to every person in the State eligible to member-ship in the County Boards of Health, whose address can be obtained, on or before the twentieth day of the August next preceding the time of meet-ing hereinbefore appointed, a printed notice of said meeting setting forth time and place. Sec. 9. Inland quarantine shall be under the control of the County Superintendent of Health, who shall see that diseases especially dan-gerous to the public health, viz., small-pox, diphtheria, scarlet fever, yellow fever, typhus fever and cholera, are proj)erly quarantined and iso-lated within twenty-four hours after the ca.se is brought to his knowledge ; and that after the death or recovery or removal of a person sick of either of the diseases mentioned the rooms occupied and the articles used by the patient are thoroughly disinfected in the manner set forth in the printed instructions, both as to quarantine and disinfection, which shall be furnished him by the Secretary of the State Board of Health. The expense of the quarantine and of the disinfection shall be borne by the householder in whose family the case occurs, if able; otherwise by the city, town or county of which he is a resident. The failure on the part of a County Superintendent of Health to perform the duties imposed in this section shall be punished by the deduction of five dollars for each FIFTH BIENNIAL REPORT. 29 day of delinquency from his salary by the Board of County Commis-sioners ; and if it shall appear to the satisfoction of the County Board of Health that the death of any person from the spread of the disease can justly be attributed to such failure of duty on his part, he shall be deposed from office and a successor immediately elected to fill out his unexpired term. Any person neglecting or refusing to comply with or in any way violating the rules promulgated in the manner above set forth on the subjects of quarantine and disinfection shall be deemed guilty of a misdemeanor, and upon conviction shall be fined or impris-oned, at the discretion of the court, not less than five nor more than fifty dollars, or less than ten nor more than thirty days. In case the offender be stricken with the disease for which he is quarantinable, he shall be subject to the penalty on i-ecovery, unless in the opinion of the Superintendent it should be omitted : Provich-d, hoirerer, that in any city or incorporated town having a regularly appointed medical health officer who is a member of the County Board of Health, the duties assigned in this section to the County Superintendent of Health shall be performed by the said medical health officer for the people of his city or town, and he shall be subject to the same penalties for dereliction of duty at the hands of the Board of Aldermen or Town Commissioners as are directed to be imposed by the County Commissioners and County Board of Health upon the Superintendent: Frotided further, that the quarantine of ports shall not be interfered with, but the officers of the local and State Boards shall render all aid in their power to quarantine officers in the discharge of their duties upon the request of the latter: Provided, tliat the custody and care of any child or other person may remain in custody of parent or family. Sec. 10. Wiien a householder knows that a person within his family is sick with either of the diseases enumerated in section nine he shall immediately give notice thereof to the health officer or Mayor, if he resides in a city or incorporated town, otherwise to the County Superin-tendent of Health, and upon the death or recovery or removal of such person the rooms occupied and the articles used by him shall be disin-fected by such householder in the manner indicated in Section Nine. Any person neglecting or refusing to comply with any of the above pro-visions shall be deemed guilty of a misdemeanor, and upon conviction shall be fined not less than one dollar nor more than fifty dollars. Sec. 11. When a physician knows that a person whom he is called to visit is infected with small-pox, diphtheria, scarlet fever, typhus fever, yellow fever or cholera he shall immediately give notice thereof to the health officer or :\Iayor, if the sick person be in a city or incorporated town, otherwise to the County Superintendent of Health, and if he refuses or neglects to give such notice of it in tv\enty-four hours he shall be guilty of a misdemeanor and shall be fined for each offen-e not less 30 NORTH CAROLIXA BOARD OF HEALTH. than ten nor more than twenty-five dollars. And it shall be the duty of the said County Superintendent, health officer or 3Iayor receiving such notice of the presence of a case of small-pox, yellow fever, typhus fever or cholera within his jurisdiction to communicate the same immediately by mail or telegraph to the Secretary of the State Board of Health. A failure to perform this duty for twenty-four hours after the receipt of the notice shall be deemed a misdemeanor, and shall subject the delinquent njton conviction to a fine of not less than ten nor more than twenty-five dollars. Sec. 12. The County Superintendents of Health, or the Boards of Health in the several cities and towns where organized, otherwise the authoi'i-ties of said cities or towns, shall cause a record to be kept of all reports received in pursuance of the preceding sections, and such records shall contain the names of all persons who are sick, the localities in which tiiey live, the diseases with which tliey are alfected, together with the date and names of all persons reporting any such cases. The Boards of Health of cities and towns wherever organized, and where not the Mayors of the same, and in other cases the County Superintendent of Health, shall give the .school committee of the city or town, the princi-pals of private schools and the Superintendent of Public Instruction of the county, when the schools are in se.'^sion, notice of all such cases of contagious diseases reported to them according to the provisions of this act. A failure to perform this duty for twenty-four hours after the receipt of the notice shall be deemed a misdemeanor, and subject the delinquent upon conviction to a fine of not less than ten nor more than fifty dollars. Sec. Ii5. The school committees of public schools, superintendents of graded schools and the principals of private schools shall not allow any pupil to attend the school under their control while anj^ member of the household to which said pupil belongs is sick of either small-pox, diph-theria, measles, scarlet fever, yellow fever, typhus fever or cholera, or during a i)eriod of two weeks after the death, recovery or i-emoval of such sick person ; and any pupil coming from such household shall be required to present to the teacher of the school the pupil desires to attend a certificate from the attending physician, city health officer or County Superintendent of Health of the facts necessary to entitle him to admission in accordance with the above regulations. A wilful failure on the part of any school committee to perform the duty required in this section shall be deemed a misdemeanor, and upon conviction shall subject each and every member of the same to a fine of not less than one nor more than twenty-five dollars : Provided, that the instruc-tions in accordance with the provisions of this section given to the teachers of the schools within twenty-four hours after the receipt of each and every notice shall be deemed performance of duty on the part of FIFTH BIEXXIAL REPORT. 31 the school committee. Any teacher of a i)ublic school and any ]n-inci-pal of a private school failing to carry out the requirements of this sec-tion shall be deemed guilty of a misdemeanor, and upon conviction shall be lined not less than one nor more than twenty-tive dollars. Sec. 14. When a person coming to a city or town from abroad or from some other place in this State is infected or has lately been infected with either of the diseases mentioned in Section Nine the local Board of Health where such exists, otherwise the Board of Aldermen or Board of Town Commissioners, shall make effective provision in the manner which it judges best for the safety of the inhabitants by removing such person to a separate house or otherwise, and by providing nurses and other assistance and necessaries, whicii shall be at the charge of the person himself or hisixirents, where able, otlierwise at the charge of the city, town or county to which he belongs. Sec. 15. The Board of Health, or, in case there is no Board of Health, the Board of Aldermen or Town Commissioners of a city or town near to or bordering upon either of tb.e neighboring States, may appoint, by writing, suitable persons to attend at places by whicii travelers may pass from infected places in other States, who may examine such travelers as may be suspected of bringing any infection dangerous to the public health, and if it need be may restrain them from traveling until licensed thereto by the Board of Healtii or Board of Aldermen or Town Com-missioners of the city or town to which they maj' come. A traveler coming from such infected places who, without such license, travels within this State (except to return by the most direct route to the State whence he came) after he has been cautioned to depart by the persons so appointed, shall be isolated or ejected, at the discretion of the local city or town or county Board of Healtii ; and upon refusal to comply with the regulations of the said Boards of Health or either of them on this subject shall be guilty of a misdemeanor, and upon conviction shall be fined not less than twenty-five nor more than fifty dollars or imprisoned not more than tliirty days. And all common carriers bringing into this State any such persons as named above are hereby required to return them to some point without this State, if required by a city, town or county Board of Health. Nothing in this section shall prevent the State Board of Health in time of epidemics from appointing such additional examiners as they may deem necessary to the preservation of the public health. Sec. 16. No railroad corporation or other common cari-ier or person shall convey or cause to be conveyed through or from any city, town or county in this State the remains of any person who has died of small-pox, measles, scarlet fever, diphtheria, typhus fever, yellow fever or cholera until such body has been disinfected and encased in such manner as shall be directed by the State Board of Health, so as to preclude any 32 NORTH CAROLINA BOARD OF HEALTH. danger of (.•oinmnnicatiiig the disea^^e to others by its transportation ; and no local registrar, clerk or heaUli otlicer, or any other person, shall give a permit for the removal of such body until he has received from the Board of Health of the city, or from the Board of Aldermen or Town Commissioners, or the County Superintendent of the city, town or county where the death occurred, a certificate stating the cause of death and that the said body had been prepared in the manner set forth in this section; which certificate shall be delivered in duplicate to the agent or person who receives the body, and one copy shall be pasted on the box containing the corpse ; said certificate shall be furnished in blank by the transportation company wh.en no local board of health exists. During an epidemic of cholera all common carriers shall so arrange their water-closets as to catch in water-tight receptacles the dejections of all persons using the same and shall disinfect the said dejections in a manner satis-factory to the State Board of Health befoi'e emptying them. Any person violating the provisions of this section shall be punished by fine not exceeding twenty-five dollars. Sec. 17. In times of epidemics of small-pox, yellow fever, typhoid fever, scarlet fever, diphtheria, typhus fever, cholera, the State Board of Health shall have sanitary jurisdiction in all cities and towns not having regularly organized local boards of health, and are hereby empowered to make all such regulations as they may deem necessarj- to protect the public health, and to enforce, in courts of justices of the peace, the same by the imposition of sucii penalties as come within tlic jurisdiction of a justice of the peace. Sec. is. Water and icater siipph/.—The State Board of Health .shall liave the general oversight and care of all inland waters and shall from time to time, as it may deem expedient, cause examinations of the said waters to be made for the purpose of ascertaining wliether the same are adapted for use as sources of domestic water sui)])lies, or are in a condition likely to iiupair the interests of the public or persons lawfullj' using the same, or imperil the public health. For the purpcses aforesaid it may employ such expert assistance as may be necessary. Sec. li). The said Board shall from time to time consult with and advise the boards of directors of all State in.stitutions, the authorities of cities and towns, corporations or firms already having or intending to introduce systems of water supply, drainage or sewerage, as to the most appropriate source of supply, the best practicable method of assuring the purity thereof, or of disposing of their drainage or sewerage, having regard to the present and prospective needs and interests of other cities, towns, corporations or firms which may be affected thereby. All such boards of directors, authorities, corporations and firms are hereby required to give notice to said Board of their intentions in the premises and to sub-mit for its advice outlines of their jnoposed plans or schemes in relation FIFTH BIENNIAL RKPOKT. So-to water .sni)ply and dis}n)sal of sewage, and no contraet sliall be entered into by any State institution, city or town for the introduction of a sys-tem of water supply or sewage dis})osal until said advice shall have been received and considered: Pruriiled, Jiou-frcr, that any city or town having a regularly organized Board of Health may seek advice therefrom or from its County Boai'd of Health in lieu of that of the State Board. Sec. 20. "Whoever willfully or maliciously defiles, corrupts or makes impure any well, spring or otlier .source of water supply or reservoir, or destroys or injures any pii)e, conductor of water or other property per-taining to an aqueduct, or aids and abets in any such trespass, shall be guilty of a misdemeanor, and on conviction shall be fined not exceeding one thousand dollars or imprisoned not exceeding one year. Sec. 21. Any hou.seholder in whose family there is to his knowledge a person sick of cholera or typhoid fever, who shall permit the bowel dis-charges of such sick person to be emptied without first having disinfected them according to the instructions to be obtained from the attending physician or the County Superintendent of Health shall be guilty of a misdemeanor, and upon conviction shall be fined not less than two nor more than twenty-five dollars, or imprisoned not less than ten norjnore than thirty days. And in cases where such undisinfected discharges are emptied on the water shed of any stream or pond furnishing the source of water supply of any public institution, city or town the penalty .shall be a fine of not less than twenty-five nor more than fifty dollars, or imprisonment for not more than thirty days. And any i)hysician attend-ing a case of cholera or typhoid fever who refuses or neglects to give the proper instructions for such disinfection as soon as the diagnosis is made shall be deemed guilty of a misdemeanor, and upon conviction shall be fined not less than ten nor more tlian fifty dollars. Sec. 22. Whenever and wherever a nui.sance upon premises shall exist which in the opinion of the County Superintendent of Health is danger-ous to the public health, it shall be his duty to notify in writing the parties occupying the premises (or the owner, if the premises are not occupied) of its existence, its character and the means of abating it. X^pon this notification the pjarties shall proceed to abate the nuisance, but fail-ing to do this shall be adjudged guilty of a misdemeanor and shall pay a fine of one dollar a day dating from twenty-four hours after the notifica-tion has been served, the amounts so collected to he turned over to the County Treasurer: Prodded, hoiren'r, that if the party notified shall make oath or afiirmation before a justice of the peace of his or her inability to carry out the directions of the Superintendent it shall 1)6 done at the expense of the town, citj' or county in which the offender lives. In the latter case the limit of the expense chargeable to the town^ city or county shall not be more than one hundred dollars in any case: ProriV/cr^ /*);//(('/•, that nothing in this section shall be construed to give 34 NORTH CAROLINA BOARD OF HEALTH. the Supcriiiteiident the power to destroy or injure property without a due process of law as now exists for the ahatement of nuisances. Sec. 2;]. Vaccinatioii.—On the appearance of a case of small-pox in any neighhorhood all due diligence shall be used by the Superintendent of Health that warning shall be given, and all persons not able to pay shall be vaccinated free of charge by him, and the County Superin-tendent shall vaccinate every person admitted into a public institution (jail, county home, public school) as soon as practicable, unless he is satisfied ujion examination that the person is already successfully vac-cinated ; the money for vaccine to be furnished by the County Commis-sioners. The authorities of any city <»r town, or the Board of County Commissioners of any county, may make such regulations and provis-ions for the vaccination of its inhabitants under the direction of the local or county Board of Health or a committee chosen for the purpose, and impose such penalties as they may deem necessary to protect the public health. Sec. 24. The Board of County Commissioners of eacli county is hereby authorized at any time to call a meeting of the County Board of Magis-trates or Justices of the Peace to take into consideration the health interest of the people of their county, and, with the approval of the said Board of Magistrates, to levy a special tax to be expended under the direction of a committee composed of the Chairman of the Board of County Commissioners, the Mayor of the county town and the County SuiJerintendent of Health for the preservation of the public health. Sec. 25. The authorities of any city or town are hereby authorized, not already authorized in its charter, to make such regulations, pay such fees and salaries and impose such penalties as in their judgment may be necessary for the protection and the advancement of the public health. Sec. 26. Bulletins of the outbreak of disease dangerous to the pul)lic health shall be issued by the State Board whenever necessary, and such advice freely disseminated to prevent and check the invasion of disease into any part of the State. It shall also be the duty of the Board to inquire into any outl^reak of disease by personal visits or Ity any method the Board shall direct. The compensation of members on such duty shall be four dollars a day and all necessary traveling and hotel expenses. Sec. 27. Special meetings of the State Board of Health may be called by the President through the Secretary. The regular annual meetings shall be held at the same time and place as the State Medical Society, at which time the Secretary shall submit his annual report. Sec. 28. For carrying out the provisions of this act two thousand dollars, or so much thereof as may be necessary, are hereby annually appropriated, to be paid on requisition to be signed by the Secretary FIFTH BIKXXIAF. KK1N)1;T. '.\~) ami President of the State Board of Health ; and tlif printhiii: and s^ta-tionei'y necesFary for tlie board to be furni.shed ui)on requisition upon the State Printer. A yearly statement shall be made to the State Treasurer of all mone}'s received and expended in pursuance of this act. Sec. 29. A contingent fund of five thousand dollars is herel)y appro-priated, subject to the (iovernor'.s warrant, conntersigned and recorded by the Auditor of the State, to be expended in pursuance of the provis-ions of this act wlien rendered necessary by a visitation of cholera or any other pestilential disease. Sec. 30. All previous acts conflicting witli this act, and also all previous acts of appropriation for the jjublic health, are hereby repealed upon the passage of this act: Frovidt'd, that nothing herein shall operate as a repeal or abridgment of powers conferred by any special act on any local Board of Health. Sec. 31. Tliat this act shall be in force from and after its ratification. Ratified the 1st day of March, A. D. 1893. On Januaiy 27th letters with new blanks to be used for monthly reports were sent to all Connt}^ Superintendents and town reporters. On March 10th a letter and blank were sent to every Clerk of tlie Superior court in the State asking for a list of all the registered physicians in each county. On the 28th of March a second letter was sent to thirty-one Clerks who had not responded to first letter. On April 4th a letter of acknowledgment, together with a copy of the "Laws Regulating the Practice of Medicine in North Carolina," was mailed to all Clerks who had sent in lists. This letter explained to them the requirements for regis-tration, as the lists showed some illegal registrations had been made. While the administration of the laws regulating medical practice does not come technically within the jurisdiction of the Secretary of the State Board of Health it has a sufficient bearing on the health of the people, he thinks, to justify his action in availing himself of an opportunity to probably correct some errors in. the registration of physicians tr.at had 3(5 NORTH CAROLINA BOARD OF HEALTH. been made—an-l to prevent tlieir occurrence in the future, by calling the attention of the Clerks of Court especially to the law as it now stands. It is gratifying to know that his efforts were appreciated, by some of the Clerks at any rate, and that one to his certain knowledge recalled certificates which under a misapprehension had been incorrectly issued. In response to a call for a Conference of State Boards of Health to be held in N(,'W York on April 5, 1893, to consult upon the conditions of the quarantine stations of the coun-try and other matters pertaining to keeping out pestilential diseases, the President and Secretar}- attended as delegates from this Board. The principal business accomplished by this Conference over and above the good resulting from personal contact and interchange of ideas is set forth in the published report of the Secretary of that body. On April 12tli your Secretary received this letter: WiLMixGTOX, N, C, April 11, 1893. Dr. R. 11. Lewis, Secretary State Board of Health, Raleigh, X. C, DeaeDoctor:—TheQuarantineBoardof the port of Wilmington respect-fully submit that, in view of the opinion expressed bj' the Conference of Health Officers that the emergency demanded the erection and operation of disinfecting plants at seaport towns, the State Board of Health take up the question and consider the advisability of making available the appro-priation made for this port by the last Legislature. Respectfully, GEO. GILLETT THOMAS, Secretary Board of Quarantine, Fort of Wilmington, N. C. In consequence thereof I addressed the following letter to each member of the Board of Health, inclosing a copy of Dr. Thomas's letter with an abstract of the minutes of the Conference and of the legislative act making the appro-priation : FIFTH r.IKNXIAL REPORT. 37 Raleigh, N. C, April 14, 1893. Dear Doctor:—I have just received the following letter from the Sec-retary of the Board of Quarantine of the port of Wilmington: "The Quarantine Board of the port of Wilmington respectfully submit that, in view of the opinion expressed l>y the Conference of Healtli Officers that the emergency demanded the erection and operation of disinfecting plants at seaport towns, the State Board of Health take ujj the question and consider the advisability of making available the appropriation made for this port b}' the last Legislature." The following is an extract from a report of the proceedings of the Conference: "Dr. H. B. Baker, of Michigan, offered the following, which was unanimously adopted : ^ liesolred, That in the present emer-gency every State maintaining a maritime quarantine should possess a perfectly equipped station with all appliances necessary for thorough disinfection of infected vessels, unless there are special reasons to the contrary.' The last clause was added to cover the case of States like New Jersey, whicli can avail themselves of the stations of neigldioring States." As this is a matter of urgent imi^ortance, in order to save delay and the necessity of a special meeting of the Board so near the time of the regular meeting on the 10th pi'ox., I would thank you for an immediate expression of opinion by letter on the question. If a majority of tlie Board reply in the afiirmative, and the Governor approves, the Quarantine Board would feel authorized to give out the contracts at once, and more regular action could be taken by the Board of Health when it meets, if deemed necessary. The facts on which the above letter is based are these : The last Legis-lature appropriated •'?20,000 for a modern disinfecting jilant at Southport, which now has none at all, but attached the condition that the money should not be available until "in the opinion of the Governor and the State Board of Health the entrance of cholera into the port is imminent." Upon the construction of the word "imminent" hangs the decision. In Worcester's Comprehensive Dictionary the word "imminent" is detined "impending; threatening; near," tlie only meanings given. In th.e opin-ion of the recent Conference alluded to in the letter quoted cholera is "impending; threatening; near," as it doubtless is in the oi)inion of nearly every other person of any sanitary experience, owing to our con-stant intercourse with western FAirope. In this case the word imminent could not be taken to mean something "about to fall on the instant," for it would be manifestly absurd to wait until a ship with cholera on board had entered the mouth of the Cujie Fear before giving out the con-tract for apparatus requiring two or three months for its construction to prevent the entrance of the disease. So that in the opinion of the under-signed, as well as of two other members of the Board with whom he has 38 XOIITH CAROLINA KOARD OF HEALTH. spoken, "the diiiigev of the entrance of cholera into the port of Wilming-ton is imminent" in the sense in which the word can alone be reasonably applied to the case in hand. Please let me know by return mail whether yon agree or disagree with that opinion. Not a day is to be lost if any thing is to be done. Very truly yours, RICH'D H. LEWIS, Secrrtary. To tliis ictter replies were received from all the members, only one opposing the approi)riation. As soon as a majority had been heard from, reahzing the importance of getting to work on the Quaraiitine Station at the earliest possible moment, I wrote to his Excellency Governor Carr, who was then at Rocky Mount, which letter was delayed in reaching him. Immediately npon his return to the capital I laid the matter with the correspondence before him. He appointed an hour the same afternoon for me to call for his decision, but before it arrived he was unexpectedly sum-moned to Newbern. On his return, having received replies from every member of the Board, I addressed to him this communication: May ], 1893. His Excellency Elias Carr, Governor of Xorili Cnroluia, Sir:—Since my communication of the 17th ult., addressed to you at Rockj'^ Mount, stating that "replies from a majority (of the Board of Health) expressing the opinion that 'the entrance of cholera into the portof Wilmington as imminent' had been received," I have heard from every member. The replies from eight are as above, and from one to the effect that the entrance of cholera is no more imminent now than at the time of the passage of the act. I beg to dissent from that oiiinion, for the reason that a number of fresh cases have occurred on the west coast of Europe since the adjournment of the Legislature, and sanitarians now consider the outlook for the summer very gloomy. The Quarantine Board of Wilmington now awaits the concurrence of your Excellency in the opinion of the State Board of Health, a.s required by the act, before beginning this work of such great importance in pro-tecting the port and State from, the scourge which threatens us. With great respect, Your obedient servant, IlIOK'D H. LEWLS, Secretary. FIFTH BIENNIAL KEPORT. o9 To this letter the Governor rei:)lied as follows: May 1, 1893. Dr. Richard H. Lewis, Secretanj X. C. Board of Health, Raleigh, N. C , Dear Sir:—Eeplying to j'our kind favor of the 1st instant, I would state, in accordance with your views and the other members of the State Board of Health, and after viewing the situation as it is, that, section 2 of the act to amend section 2915 of The Code as follows : "For the purpose of carrying into effect the provisions of section 2915 as herein amended the sum of twenty thousand (?20,000) dollars is hereby appropriated out of any moneys in the State Treasury not otherwise appropriated, to be paid from time to time, as required in the prosecution of the work, on the requisition of the Treasurer of the Quarantine Board and aj)proved by its President: Provided, that the funds appropriated by this act shall not be paid over by the Treasurer until the Governor and State Board of Health of North Carolina shall certify to the Treasurer that there is imminent danger of cholera visiting the city of AVilmington or other sections of the State," makes it my plain duty to inform j^ou that the amount appropriated ($20,000) is now available, and can be used in carrying out the pi-ovisions of the act. With highest esteem, I am, Yours very truly, ELIAS CARE, (rorernor. I immediately wired the Secretary of the Quarantine Board of AVilmington: Govei'nor approves. Go ahead. If. H. LEWIS, Secretary. Afterwards I wrote him as i'oilows : May 2, 1893. Dr. Geo. G. Thomas, Secretary Board of Quarantine, Port of Wllmingtoii, My' dear Doctor:—In compliance with your communication of the 11th ult., calling upon the State Board of Health to "take up the question and consider the advisability of making available the appropriation made for the port by the last Legislature," I addressed a letter setting forth the facts to each member of the Board. Replies from all v>ere duly received—eight voting in favor and one against complying with the condition necessar\' to make the appropriation available. The whole correspondence was laid before his Excellency, the Gov-ernor, at the earliest opportunity, and to-day I received his decision. I inclose his letter, w'hich, after submitting it to your Board, you will please return and oblige. Yours trulv. RICH'D H. LEWIS, :\I. D., 3 Secretary. 40 NORTH CAROLINA BOARD OF HEALTH. While the securing of a quaruutine station with all the modern improvements for our chief seaport, a work of the liighest value, from a sanitary point of view, to the State, •cannot be credited to our Board, it is gratifvino- to know that the leader in that movement was one of our members. Dr. George G. Thomas, who v\'as most ably assisted by Dr. T. S. Burbank, Messrs. J. C. Stevenson, Alex. Sprunt and •others. Thanks to their efforts and to our enlightened and progressive Legislature North Carolina will soon be abreast of the most advanced communities in the matter of mari-time quarantine protection. In the performance of the duty imposed upon me in Section 9 of the Act Relating to the Board of Health I prepared the following 23amphlet containing Instructions for Quarantine and Disinfection : INSTRUCTIONS FOR QUARANTINE AND DISINFECTION. EXTRACT FROM SECTION NINE OF AN ACT RELATING TO THE BOARD OF HEALTH, RATIFIED MARCH i, 1S93. "Iiilaud quarantine shall be uuder the control of the County Superintendent of Health, who shall see that diseases especially dangerous to the public health, viz.: small-pox, diphtheria, scarlet fever, yellow fever, typhus fever and cholera, are prop-erlj' quarantined and isolated within t\vent3--four hours after the case is brought to his knowledge; and that after the death or recovery' or removal of a person sick of either of the diseases mentioned, the rooms occupied and the articles used by the patient are thoroughlj- disinfected in the manner set forth in the printed instructions, both as to quarantine and disinfection, which shall be furnished him bj' the Secretary of the State Board of Health. The expense of the quarantine and of the disinfection shall be t>orne by the householder in whose family the case occurs, if able, otherwise by the cit}', town or county of which he is a resident. * * * Any person neglect-ing or refusing to comply with or in any way violating the rules promulgated in the manner above set forth on the subjects of quarantine and disinfection shall be deemed guiltj- of a misdemeanor, and upon conviction shall be fined or imprisoned, at the dis-cretion of the court, not less than five nor more than fifty dollars, or less than ten nor more than thirtj' daj's. * * * In any city or incorporated town having a regularly appointed medical health officer who is a member of the County Board of Health, the duties assigned in this section to the Count}' Superintendent of Health shall be per-formed by the said medical health officer for the people of his city or town. * * * " 1. Every person sick of either of the diseases mentioned in the above •extract from section nine should be immediately isolated, with his nurses, in a separate room, if there is one. and nothing: should be taken out of FIFTH BIENNIAL REPORT. 41 such room at any time without having been previousl}' disinfected in the manner described under the head of disinfection. The mildness of the attack must not be laermitted to beget laxity in carrying out these hist ructions. 2. When any of the diseases mentioned above occurs in a house con-taining only one room, the house and all persons residing therein should be quarantined. The same rule should apply to the entire house, even if of sufticient size to permit the isolation of the sick person and his nurses in a separate room, in cases of small-pox, cholera, yellow fever, and typhus fever; but in cases of scarlet fever and diphtheria the quar-antine need extend only to the room occupied by the patient and his luirses and to the occu])ants thereof Whenever possible persons sick of small-pox, cholera, typhus fever or yellow fever should be immediately removed to quarters specially provided for the detention and treatment of such cases. Particular care should be taken to quarantine for a time sufficiently long to insure safety to others all persons who were exposed to infection before the removal of the patient. 3; When a house or room is in quarantine no one whatever except the .attending physician and the clergyman of the family slsould be admit-ted. The person doing the outside service for a quarantined family should take orders verbally from a distance, and should lay down at the entrance of the house or room any aiticles he may bring there. Xo pet •dog or cat should be allowed in the room. 4. When either of the diseases mentioned has declared itself in a house no work for trade purposes or for private families should be taken in by any one inhabiting the same, and all such work as may have been taken in before the outbreak of the disease should be disinfected before being sent home. 5. !Xo person recovering from either of these diseases, and no person who has nursed such a patient, should quit the house before receiving a certificate from the County Superintendent of Health, municipal medi-cal health officer, or attending physician, that the precautions required under the head of disinfection have been taken. Children must have certificate before re-entering school. See section 13 of the law. 6. No person residing in a quarantined house should go beyond the lot (or farm, provided there be no other })ersons living thereon) or put himself in direct communication with any one from outside. 7. When a house is quarantined any person residing therein, other than the patient, who wishes to leave for tlie purpose of changing his residence, may do so with the written permission of the County Super-intendent of Health or municipal medical health officer, provided he takes all the precautions required under disinfection. 8. The body of every person who has died of either of the diseases mentioned should be disinfected in the manner described below. It 42 XOKTH CAROLINA BOAKD OF HEALTH. should be kept isolated up to the moment of the funeral in the room occupied by such person during his illness. The funeral should take place as soon as possible, and in all cases be private, attended only by those absolutely necessary to the proper performance of the burial, unless the body having been disinfected be in a metal coffin hermetically sealed. Children should under no circumstances be present. 9. When there is a case of either of the diseases mentioned in a house a placard stating the name of the disease, to be furnished by the County Superintendent of Health, shall be posted on the front door of said house. This placard must not be removed in any case until the jjremises have been properly disinfected, and then only by the County Superin-tendent of Health or municipal medical health officer in per.son, or by exjiress permission of the same. DISINFECTIOX. I. DURING THE CONTINUANCE OF THE DI.SE.\SE. {a). All the sunlight possible and as much fresh air as the nature of the disease and the state of the weather will permit should be admitted to the sick-room. (/)). The expectorations and evacuations of the patient should be received in vessels in which there is a considerable quantity of bichloride of mercury, solution Xo. 2, or milk of lime, or an equal quantity of either of them should be added thereto and the mixture allowed to stand at least a half hour before throwing into the water-closet, if the house be connected with a system of sewers, or, otherwise, should be buried at a distance of not less than 100 feet from any well or spring. (c). Soiled body and bed-clothing, handkerchiefs, rags, etc., should, as soon as discarded, be immediately burned or immersed in a vessel of suffi-cient size, containing enough of the zinc or chloride of lime solution to completely cover them, and kept there until they can be thoroughly boiled for not less than a half hour in plain water, or better the zinc solution, and then washed and dried in the sun. (fZ). The remains of the food served to the patient should be burned in the room or soaked in one of the disinfecting solutions mentioned and then buried. II. AFTER THE RECOVERY, REMOVAL OR DEATH OF THE PATIENT. (a). Of the articles used and room occupied by the patient. The vessels should be washed with a disinfecting solution. Burn in a hot fire suffi-ciently fierce to consume quickly and completely such articles as are not too valuable. Others that can be boiled without injurv should be boiled hard for not less than a half hour, then thoroughly washed and dried in the sun. The remainder—furniture, curtains, woolen clothes, pillows, beds, mattresses (the contents of mattresses when straw, shucks or other FIFTH BIENNIAL REPORT. 43 cheap material should be burned and the ticks boiled) and all other articles which have been exposed to the infection should be hung on racks, or otherwise looselj^ distributed about the room, so as to permit free access of the gas to every part, the carpet, if there be one, being left on the floor, and then disinfected at the same time with the room by sulphur fumigation. Afterwards they should be taken into the open air and thoroughly beaten and sunned. If preferred, in cases where every article in the room can be subjected to the process to be named, or when the I'oom cannot be made tight enough to retain the sulphur fumes, every article in the room which can be should be boiled and the remainder, including the floor and wood-work, should be well washed with the bichloride solution No. 1. The walls and ceiling should have the same solution thorouf/JiIy applied to them or be well whitewashed. {b). Of the. person of the recovered patient. Wash the body, including the hair, with the bichloride solution No. 1 and put on clean clothes that have not been in the sick-room or that have been disinfected as prescribed in 1 (c). (e). Of the dead hodij. Wrap the bod}' in a well-sewed sheet thoroughly saturated with the bichloride solution No. 2 or with the chloride of lime solution. Put two pounds of chloride of lime in the coffin. (fO- Qf persons before leacing a house ivhicJi ]ias been, qnarantoied. Wash at least the uncovered portions of the body—hands, face, beard and hair —better the entire body—in the bichloride solution No. 1 and put on clean clothes that have not at any time been exposed to the infection or have been disinfected in the manner described. The notice of the attend-ing physician and visiting clergyman is called to the importance of their observing these precautions and at least washing their hands in the bichloride solution the last thing before leaving the room. {e). Of a vehicle used to carry the body, living or dead, affected witJi either of the diseases enumerated. Remove all cushions, curtains and other acces-sories and disinfect by boiling or soaking in the bichloride solution No. 1 and wash out the interior with bichloride solution No. 2. DISINFECTANTS. 1. Bichloride of mercury, solutinn No. 1. Bichloride of mercurj' 1 drachm, water 1 gallon. 2. Bicldoride of mercury, solution Xo. 2. Two drachms to the gallon. Owing to its poisonous character a solution of bichloride should be col-ored w itii bluing to prevent mistakes. It should be kept in earthen or wooden vessels, as it corrodes metals. 3. Ztuc solution. Sulphate of zinc (white vitriol) 4 ounces, salt 2 ounces, water 1 gallon. 4. Chloride of lime solution. Fresh chloride of lime 6 ounces, water 1 gallon. 44 NORTH CAROLINA BOARD OF HEALTH. 5. Milk of I'nne {irhneirash). Pour on 1 quart of quick-lime, broken into-small ijieces, 1 quart of water. As soon as reduced to powder add 3- quarts of water. Store in well-closed vessel. ^lake fresh supply every few days, as it does not keep well. Can be kept much longer by pouring: one-half cup of kerosene on top to exclude air. (j. Sulphur finnlgation. The room must be vacated. Close as tightly as possible every opening, fire-place by stutting tiiroat of chimney witli. old bags or plenty of straw; cracks around doors and windows by calk-ing with tow or cotton, etc. Place small lumps or powdered sulphur, in the proportion of 3 pounds for every 1,000 cubic feet of air space to be-disinfected, in an iron pot or pan free from cracks. Set the vessel, if it has no legs, on bricks in the bottom of a tub containing 2 or 3 inches of hot water (to put out fire in case burning sulphur should leak out or overflow); light with red-hot coals or by pouring on a tablespoonful of alcohol and applying a match. Be careful not to inhale the fumes. Close the door of exit as tight as possible. Keep the room closed for twelve hours, excei^t in cases where family has no other room to sleep, then, six hours. Then open all doors and windows and air thoroughly. NOTE. It i.« practically established that if the instructions given in this circu-lar ai'e faithfully carried out these justly dreaded diseases will not spreads Such being the fact the responsibility of those whose duty it is to carry them out is great. A positive })romise from the attending physician to the County Super-intendent of Health, or to the municipal medical health officer, to see that the instructions are faithfully carried out would relieve the latter of responsibility. The Count}' Superintendent of Health or the municipal medical health officer should not fail to promptly furnish to both the attending physi-cian and the liouseholder in whose family either of the diseases men-tioned in section 9 occurs a copy of these instructions. Any further information desired will be cheerfully furnished. RICH'D H. LEWIS, M. D., Secretary. A copy of these instructions, together with a copy of the new hiw, was mailed to every registered physician in ever}^ county in North Carolina except four, from the Clerks of which no reply has been received to either of mj-two letters: I shall write them a^ain.* The total number *The list of physicians has been made complete, and the instructions were promptly distributed. FIFTH BIKNNIAL KEPORT. 45- mailed so far is 1,517. The "instructions" in quantity will be sent to all County Superintendents and municipal health officers. With them will be sent the placards required to be posted on the front door of every house con-taining a case of either of the diseases mentioned in sec-tion nine. Continuing the plan of trying to educate the people in sanitary matters b}' popular articles in the newspapers, I sent an article, together with a copy of the Instructions for Quarantine and Disinfection, to every newspaper in the State with a request that they publish same. Just on this line members of the profession can be of great assistance, provided they approve of the plan and the articles, by using their influence with the editors of their local papers to get them to publish them. A public sentiment favorable to sanitation must be built up if we expect to make any substantial progress. The Anglo- Saxon people of this free country cannot be driven to the performance of what they do not approve. They must be persuaded of the importance of these restraints upon their liberties under certain circumstances before they can be successfully imposed. But the physicians of the State can be of much greater-service to the cause of the public health in another way,, and that is by giving to the law and the sanitary regula-tions imposed by it their own cordial support. Indeed the practical application of the law is in the hands of our medical men. If they give it their cordial support and urge its importance upon their patients it will be carried out, but if the}' are indifferent, and make light of and belittle it it will surely be largely of no effect. In view of the wholesale danger to life of the spread of contagious and infectious diseases, which can almost surely be pre-vented by the strict enforcement of .^anitary regulations, 46 NOIITH CAROLINA BOARD OF HEALTH. this is no light responsihiUty wliich rests upon us, whether Y\'o arc willino- to assume it or not. kSeetion 1!) of tlio law requires all Htatc institutions before adojiting a system of water supply and sewerage to consult the State Board of Health. In compliance with that requirement the President of the Board of Directors of the proposed School for the Deaf and Dumb at Morgan-ton addressed the following letter to the President of the Board of Health : BiLTMORE, N. C, March 31, 1893. /);. Herirn T. B<(himm, Scilcin, X. <'., Dear Sir:—I see that the Laws of 1803 make it the dut_y of the Board of Health of the State of North Carolina to consult and advise with all the State institutions already having or intending to introduce systems of water supply, drainage, or sewerage. The Board of the Deaf and Dumb School at Morganton are considering their water supply; we are considering two ways of furnishing same. One by gravitation, and to get it would have to lay a line of pipe about four miles at a cost of from $12,000 to $15,000, which is more money than the Board can pay if we can get that which will answer clieaper. We also have under considera-tion the "Gang Well'* system, which, if it is thought it will work well and the quality of the watei- is all right, will be a great deal cheaper. This system we will have ample means of testing, as the Morganton Tan-nery is putting in a gang well on adjoining property to that of the insti-tution. I do not think there will be a doubt as to quantity if the quality is what is desired. T go into the details so you can the l)etter advise us, and to do this would be glad to have you with us at our next Board n^iCcting on the 14th April. The sewage from tb.e building will be con-ducted in the usual sewage pipe one-half mile from building, emptying into a creek with a fall of about one hundred and fifty feet. Holding to hear from you on the subject, or, better, see you at our meeting, I am very truly, M. L. REID, Chairinau Board Deaf and Dumb School. In accordance therewith a committee composed of Drs. H. T. Bahnson and S. Westray Battle visited Morganton, examined carefully into the matter and made the follow-ing report: FIFTH lilKNXIAL KEPOET. 47 May o, 1893. To till' Honorable Board of DlnctorK Deaf and Dninh School at Morganton, X. <'., Gextlemex:—The committee appointed by the North Carolina Board of Health, in compliance with your request, to examine and advise your honoraVjle body relative to a water supplj- and sewerage system for the Deaf and Dumb School at ^lorganton, N. C, beg to submit tlie following report: A careful inspection of the site and surroundings has satisfied us that the sewage of the institution should be emptied directly into Hunting creek. The smaller stream to the rear of the school is objectionable on account of its limited water supply, and its liability to overflow during freshets and deposit the sewage on the lowlands in its course. The preva-lent westerly winds would thence convey its unpleasant and perhaps noxious efHuvia to the institution. Hunting creek furnishes so large a volume of water that this menace is enlirelj' avoided, and a conduit in a direct line, with ample and uninterrupted fall, would cost very little more. The water supply presents a more difficult problem. Wiiile there is no doubt in our minds that a pipe line from, a mountain stream, whose water shed could be owned and protected by the authorities of the institution, would furnish the best and safest supply, the great cost practically pro-hibits its adoption. A system of gang wells has been successfully employed by the large tannery on the adjoining property, which fur-nishes very much more water than will ever be I'equired bj- your institu-tion. This water is apparently pure and the plant required an outlay of less than one-fourth of the amount whicli a pipe line from the mountain would cost. The site in the rear of the school is apparently favorable for the adop-tion of a similar system. "Water ol)tained here would probably be free from mineral impurity, and the danger of contamination is so remote that it can safely be left out of consideration. Under the circumstances we cannot hesitate to recommend tliat an attempt be made to obtain a water sujiply from this source. Very respectfully, HENRY T. BAHNSOX, M. D., 8. WESTRAY BATTLE, M. D., Committee. It needs no argument to prove that the greatest danger from contagious and infectious diseases is where numbers of people are congregated together in close quarters, and therefore that the machinery for combating them should be 48 NORTH CAROLINA JJOAIID OF H1:ALTH. made as near perfect as possible in tlie cities and towns. To that end the organization of local municipal Boards of Health is a necessity. Section 25 of the law confers full powers upon all municipal corporations to make such regulations and impose such penalties for tlic preservation of the public health as thev mav deem necessary ; but the matter is always optional with them. In the hope of inducing as many as possible to organize Boards of Health with the necessary powers, I have prepared the following letter to be sent to the Mayors of all towns of more than 500 inhabitants: R.VLEiGH, X. C, May 8, 1893. Sis Honor Ihe Muyor, De.\r Sir:—The warm weather is upon us and it is time for those of us upon M'hom rests the responsibility of looking out for the protection of the health of the people to be bestirring ourselves. ^Yhenever there is a Board of Health organized it is clearly its duty; but otherwise, in cities and towns, it falls upon the Mayor and Board of Aldermen or Town Commissioners. It is best, however, to have a body whose special duty it is, and therefore it is expressl}' desirable that Boards of Health should be formed in all towns where they do not already exist. This is particularly the case just at this time, since the entrance of cholera into our countiy this summer is regarded as more than probable. Have you a Board of Health in your town? If so, will you be kind enough to send in the names of its ofhcers and a copy of its sanitary regulations? If not, will you not exert yourself to secure the form-ation of one as soon as possible? If desired, I would take pleasure in forwarding to you, free of charge, model ordinances, blanks, etc. Your aid in this important matter is asked in the interest of your own people, chiefly, but also for the sake of other citizens of the State who might incur disease from your town if the proper and necessary sanitary precautions are neglected. Your kind attention will oblige. Yours very respectfully, RICH'D H. LEWIS, M. D., Secretary. The subjoined letter, inclosing model ordinance, blanks, etc., was sent to every county-seat and other town of more than live hundred inhabitants: FIFTH lilKXXIAL KKPORT. 49 Raleigh, X. ('., June 0, 1S93. 77/1' IIiiiKirdhIr Miiijor mid Fxntrd of , (tentlemex:—I send herewith a copy of the Act Relating to the Board of tloalth (Chai)ter 214, Laws of 1893), a model health ordinance, based chieHy on the admirable one issued by the Pennsylvania P.oard of Health, and various blanks which explain themselves. I hope that you will adopt and enforce them, thereby materially advancing the cause of l)nblic health and pan jkihsu the i:>rosperity of your town. The ordi-dance may strike you as being rather voluminous, but a careful consid-eration of the same will, I think, show the reasonableness and impor-tance of each section. Still, if deemed necessary, it can be modified to suit the particular conditions of your town, though I would be glad to have it adopted as it stands in order to secure a uniform system in every town in the State. In cities and towns where people are more or less crowded together, and the danger of contamination of air and drinking water and of the spread of communicable diseases from person to person is in consequence greatly increased, the practical application of sanitary laws is especially important. The collection of vital statistics, particularly those relating to the cause of death, should be carefully looked to in order to ascertain those most prevalent, with a view to taking special precautions against them in the future. It is also of great importance from a material point of view. One of the liist inquiries made by intending immigrants is in regard to the healthfulness of tiieir contemplated destination, and that information would be sought for at this office. To give an opinion I must be assured of their coiiiplcteuess and accuracy. Those two essentials cannot be obtained unless the method recommended is faithfully carried out, viz., the positive refusal to allow the body of any one dying in the town to be buried or removed without a permit from a designated official, based upon a properly tilled out and signed death certificate giving the cause of death; or some other method e(}ually as reliable. The healthfuhiess of our State is one of its greatest attractions, and the only way to demonstrate it to strangers in these days of scientific accuracy is by means of reliable vital statistics. In our present stage of sanitary development these statistics can only be obtained from our cities and towns, and I trust y(ju will help your own immediate home and, at the same time, aid me in show'ing to the world our advantages in this most important item of health. Any further assistance in my power would be most gladly rendered l.-y. Yours very respectfully, RIGHT) H. LEWIS, SI. I)., Sccrettiri/. '~>0 NORTH CAROIJXA P.OARD OF HEALTH. ORDINANCE OF THE OF FOR THE BETTER PRESERVATION OF THE PUBLIC HEALTH AND TO PREVENT THE SPREAD OF C0M:\IUNICABLE DIS-EASES. In virtue of the powers conferred by section 25, chapter 214, Laws of 1893 of the State of Nortii Carolina, be it ordained by the-of thet ----of --,anditis hereby ordered by the authority of the same — Section' 1. That the Mayori shall constitute a Local Board of Health for thet of , whose duty it shall be to faithfully execute all Laws of the State (chapter 214, Laws of 1893—An Act Relating to the Board of Health) and all ordinances relating to the public health of thef of The Board of Health shall have power to make all necessary rules and regu-lations for the promotion and preservation of the public health and the collection and registration of vital statistics within thet of --.subject to the ratification of the* A majority of the members shall constitute a quorum. Sec. 2. The ]\Iayor shall be ex officio President of the Board of Health. Heshall convene the Board in regular session on the first*]^ in each month from April to Octol^er inclusive, and quarterly thereafter, and shall have power to call the said Board together in extra session whenever, in his judgment or in that of the health officer, the public health demands it. Sec. 3. The medical member| of the Board shall be e.v officio the health officer of thet , and shall be the executive officer of the *Insert City Couucil, Board of .-Vldermen or Board of Town Conunissiouers, as the •case may be. tCity or Towu. '^Foi- small lo7c!is insert '"the Town Clerk and the County Superintendent of Health " {if that official is a resident of the town and acceptable to the town authorities), otherw^ise insert "the Town Clerk and a resident registered physician to be elected bj- the Board of Towu Comiuissioners." F'or larger tozvns insert " the Towu Clerk and three resident registered physicians to be elected by the Board of Town Coniinissioners.'' If preferred insert "the Town Clerk and three other persons, one of whom shall be a resident registered physician to be elected, etc." For cities insert " Chief of Police, City ,\ttornej-. Chairman of the Sewer Committee. Chairman of the Water Committee, Chairman of the Street Committee and County Superintendent of Health" (if he be a resident of the city), otherwise " a resident regis-tered physician to be elected by the Board of Aldermeu." Perhaps it might be better to insert after City Attorney "the County Superintendent of Health and three other resident registered physicians to be elected by the Board of .\ldermen." •"Insert day of week. 5\Vhere there is more than one medical member of the Board substitute " The medi-cal member of the Board receiving the highest number of votes shall be the health officer." FIFTH niKXXIAr. i;Er(*RT. ol Board. He shall perform for the* the duties^ of the County Superintendent of Health as laid down in Chapter 214, l^awsof 189o, and such other duties as may be imposed by the Board, including the collec-tion of vital statistics, which he shall use every effort to make as full and accurate as possible, especially such as relate to the cause of death. He shall notify the Secretary of the State Board of Health of his election and shall make such reports and answer such inquiries concerning the sanitary condition of thef , diseases prevalent, vital statistics, etc., as may be required by the State Board of Health. He shall hold his office for years, and until his successor is appointed and has qualified. Sec. 4. The* Clerk shall be ex officio Secretary of the Board. He shall keep a full and accurate record of all business done at its meet-ings. He shall cause to be published in the newspapers of the* and by printed or written notices, to be posted inf , all orders, rules and regulations of the Board, which pablication shall be deemed legal notice of the same to all persons. He shall file and keep for refer-ence all reports, complaints, orders or other papers relating to the busi-ness of the Board. He shall also keep, in a book provided for the pur-pose, a full and complete record in detail of all vital statistics. Sec. 5. The Board of Health may, with the approval and consent of the Board of J electa speciaHj , or use one of the regular force, who shall be known as the Sanitary Inspector. He shall inspect at least once in every month, from April to October inclu-sive, the premises of every householder in the "^ He shall make a note of and report in writing to the health officer any violations of the orders, rules and regulations promulgated by the Board, and shall serve such legal notices as the Board may direct. His term of office and compensation shall be fixed by the Board ofi Sec. 6. The Board of Health, through its health officer, shall make a report annually in ]March, for the preceding twelve months ending with the last day of February, to tiie Board of j Sec. 7. Whatever is dangerous to human life or health, whatever ren-ders the air or food or water or other drink unwholesome, and whatever building, erection, or part or cellar thereof, is overcrowded or not pro-vided with adequate means of ingress and egress, or is not sufficiently supported, ventilated, drained, cleaned or lighted, are declared to be nuisances, and to be illegal; and every person having aided in creating or contributing to the same, or who may support, continue or retain any of them, shall be deemed guilty of a violation of this ordinance, and also be liable for the expense of the abatement and i-emed\' therefor. *City or Town, flnsert number and location of public places. |Town Commissioners or Aldermen. IConstable or policeman. 52 NUUTH CAROLINA Bt)AKL) OF HEALTH. Skc. 8. No house-refuse, oft'al, garbage, dead animals, decaying vegeta-ble matter or organic waste substance of any kind shall l)e thrown on any street, road, ditch, gutter or public place within the limits of this . , and no putrid or decaying animal or vegetable matter shall beTkept in any house, cellar or adjoining out-]»uilding or grounds for more than twenty-four hours. Sec. it. No person or persons without the consent of the Board of Health"" shall build or use any slaughter-house within the limits of this , and the keeping and slaughtering of all cattle, sheep and swine and the preparation and keeping of all meat, tish, birds, or other animal food, shall be in the manner best adapted to secure and continue their healthfulness as food; and the keeping of the premises shall be with such care and cleanliness as not to endanger the public health. No meat, fish, birds, fowls, fruit, vegetables, milk, and nothing for human food not being then healthy, fresh, sound, wholesome, tit and safe for such use, nor any animal or'fish that died by disease or accident, and no carcass of any calf, pig or lamb which at the time of its death was less than four weeks old, and no meat therefrom, shall be brought within the limits of this , or offered or held for sale as food any-where in said Sec. 10. No person or company shall erect or maintain within the limits of this— any manufactory or place of business danger-ous to life or detrimental to health, or where unwholesome, ofiensive or deleterioiis odors, gas, smoke, deposit or exhalations are generated, such as tanneries, refineries, manufactories of starch, glue, leather, chemicals, fertilizers, gas, etc., without the pernjit of the Board of Health,* and all such establishments shall be kept clean and wholesome so as not to be offensive or prejudicial to public health. Sec. 11. The keeper or keepers of a livery or other stable shall keep liis or their stable-j-ard clean, and shall not permit, between the first day of April and the first day of Novembei", more than loads of manure to accumulate in or near the same at any one time except by express permission of the Board of Health.* Sec 12. No pig-pen shall be built or maintained within the limits of this without a permit from the Board of Health,* or within one hundred feet of any well or spring of water used for drinking purposes, or within thirty feet of any street or of any inhabited house, or unless constructed in the following manner, viz., so that the floor of the same shall be not less than two feet from the ground in order that the filth accumulating under the same may be easily removed; and such filth accumulating in, about and under the same shall he removed at *Where there is no Board of Health organized snbstitute " Board of Town Commis-sioners " or " Board of Aldermen.'' FIFTH i'.TKXXIAL REPORT. 53 least once a Aveek, and oftener if so ordered, and on the fiulure of any owner or occupier of such premise;^ i^o to do, then the same sliall be done by the Sec. lo. Xo privy-vault, cess-pool or reservoir, into which a privy, water-closet, cess-pool or stable or sink is drained, shall be consti-ucted, dug or permitted to remain within the corporate lin)its of this Earth privies and earth closets, witli no vault, pit or depression below the surface of the ground, are allowed, but sufficient dry earth or ashes must Vje used daily to absorb all the fluid part of the deposit, and the contents must be completely removed at least once every month. •- Sec. 14. The following diseases are declared to be communicable and dangerous to the public health, viz.: small-pox (variola, varioloid), cholera (Asiatic or epidemic), scarlet fever, (scarlatina, scarlet rash), measles, diphtheria (diplitheritic croup, diphtheritic sore throat), typhoid fever, typhus fever, yellow fever, spotted fever (cerebro-spinal meningitis), epidemic dysentery, hydrophobia (rabies) and glanders (farcy), and shall ])e understood to be included in th.e following regulations, unless certain of them only are specified. Sec. 15. Whenever any householder knows that any person within his family or household has a communicable disease, dangerous to the public health, he shall, within twenty-four hours, report the same to the health otficer,t giving the street and numl)er or location of the house. Sec. 1(i. Whenever any jihysician finds that any person whom he is called upon to visit has a communicable disease, dangerous to the public health, he shall, within twenty-four hours, report the same to the health officer,t giving the street and number or location of the house, on the receipt of which report the health officer shall immediately notify the school committee of the public school, the superintendent of the graded school and the principals of private schools within the limits of this , at the same time calling their attention to Section 13, Chapter 214, Laws of 1893. Sec. 17. No person shall, within the limits of this , unless by permit of the health oflEicer,j carry or remove from one building to another any patient atFected with any communicable disease dangerous to the public health. Nor shall any person, by any exposure of any individual so afiected, or of the bodv of such individual, or of any *To towns and cities having- already or about to introduce a system of sewerage sug-gestions as to the proper ordinances will be gladly furnished by the Secretary of the State Board of Health. fWhere there is no medical health officer insert "County Superintendent of Health." as required by chapter 214, Laws of 1S93. tWhere there is no Board of Health insert "County Superintendent of Health." 54 NOKTH CAROLINA BOARD OF HEALTH. article capable of conveying contagion or infection, or by any negligent act connected with the care or custody thereof, or by a needless expo-sure of himself or herself, cause or contribute to the spread of disease from any such individual or dead body. vSec. 18. There shall not be a public or church funeral of any person who has died of Asiatic cholera, small-pox, typhus fever, diphtheria, yellow fever, scarlet fever or measles, within the limits of this and the family of the deceased shall in all such cases limit the attend-ance to as few as possible, and take all precautions possible to prevent the exposure of other persons to contagion or infection; and the person authorizing the public notice of death of such person shall have the name of the disease which caused the death appear in such public notice. Sec. 19. Xo person shall let or hii'e any house, or room in a house, in which a communicable disease, dangerous to the public health, has re-cently existed, until the room or house and premises therewith con-nected have been disinfected to the satisfaction of the Board of Health,'^ in accordance with the "Instructions for Quarantine and Disinfection" furnished by the Secretary of the State Board of Health; and for the purposes of this section the keeper of a hotel, inn, or other house for the reception of lodgers, shall be deemed to let or hire part of a house to any person admitted as a guest into such hotel, inn or house. Sec 20. Members of any household in which small-pox, diphtheria, scarlet fever or measles exists shall abstain from attending places of pub-lic amusement, worship or education, and fiom visiting other private houses except on express permission of the health officer.* Sec. 21. The clothing, bed-clothing and bedding of persons who have been sick with any communicable disease, dangerous to the public health, and the articles which they have used and the rooms which they have occupied during such sickness shall be disinfected under the direction of the Board of Health* in accordance with the "Instructions for Quar-antine and Disinfection" furnished by the Secretary of tlie State Board of Health. Sec. 22. Upon the appearance of a case of small-pox inf county it shall be the duty of every adult and every parent, guardian or master of every minor residing within the limits of thisi , who has not had small-pox or been vaccinated so as to have taken cow-pox regularly, to be, if an adult, vaccinated, or in the case of a minor, to cause such minor to be vaccinated within two weeks after the appear- *Where there is no Board of Health insert "County Superintendent of Health." tlnsert name of county in which town or city is situated, or if preferred substitute "within a radius of miles." JCity or town. FIFTH BIENNIAL REPORT. 55 ance of such case of small-pox unless unable to do so \)y reason of pov-erty; and it shall be lawful for any registered physician residing in this* , on application of such resident adult, or parent, mas-ter or guardian of such resident minor, as is unable by reason of poverty to pay the vaccination fee, to vaccinate said adult or said minor and present his bill therefor, properly authenticated, for an amount not exceeding the fee iisually charged for such services, and to recover the same of and from the corporation, f Sec. 23. Every undertaker or other person who may have charge of the funeral of any dead person shall procure a properly filled out cer-tificate of the death and its probable cause, in accordance with the form prescribed by the State Board of Health (no other to be valid), and shall present the same to the designated otlicer or member of the local Board of Health and obtain a burial or transit permit thereupon at least twenty-four hours before the time appointed for such funeral or removal; and neither lie nor an}- other person shall remove any dead body until such burial or transit permit shall have been procured. Sec. 24. Every person undertaking preparations for the burial of a body dead from communicable disease as hereinbefore enumerated shall adopt such precautions as are set forth in the "Instructions for Quarantine and Disinfection," furnished by the State Board of Health, to prevent the spread of such disease. Sec. 25. Every physician or midwife attending or present at the l)irih of any human being within the shall, wdthin twenty-four hours thereafter, certify the same to the health officerj upon blanks prescribed by the State Board of Health to be furnished by said health officer. In case there be no attending physician or midwife, then the next of kin or other person present at such birth shall, within twenty-four hours there-after, report the same to the health officer, who shall then have the proper blank filled out. Sec. 26. All physicians, midwives and undertakers practicing or doing business in this shall register their names and addresses with the Secretary of the Board of HealthlT within thirty daj-s after the pro-mulgation of this ordinance; and hereafter within ten days after begin-ning practice or business. Sec. 27. Such pertinent portions of chapter 214, Laws of 189o, as are not included in the above sections are hereby adopted as a part of this ordinance. Sec. 28. Every person violating any section of this ordinance shall be liable for every such offense, upon conviction before the mayor or other *City or town. flf preferred the vaccination of paupers might be required of the health officer, where there is one. the town furni.shin.s: the virus, or the fee might be fixed in advance by agreement with the physicians. The vaccination of tlie people is of tlie highest importance and everj' effort should be made to accomplish it. The amount of raw-material ready to be worked up by small-pox in this State is simply appalling. JWhere there is no health officer substitute " Citv or Town Clerk.'' IJWhere there is no Board of Health substitute "City or Town Clerk." 4 56 NORTH CAROLINA BOARD OF HEALTH. justice of the peace, to a fine of not less than S."5 nor more than $25, or imprisonment for not more than ten days, at the discretion of the con-victing justice, besides costs, which he may inflict in addition if he see fit. BIRTH CERTIFICATE. N. C, ISO-Date of Birth Name of Child, if named Name of Father Name of Mother Residence, No Street Ward Color Sex ^ Condition of Child Attendin'g» Physician or Midwife CERTIFICATE OF DEATH AND APPLICATION FOR BURIAL OR TRANSIT PERMIT. To the* of N. C: Date of Death Full Name of Deceased! Sex, Male or Female Age Years Months Days. Color Married, Single, Widow' or Widower Occupation Birthplace Place of Death, No. , Street, Ward. Cause of Death Duration of Last Sickness Place of Burial -_ ^ Date of Burial I M. D., f Undertaker f Medical Attendant. \ Place of Business j % Personally appeared before me on this the day of 189-- and made oath that the above statement in regard to the death of is true. ,J. P. *This certificate must be returned to the official selected for the purpose—Town Clerk, Chief of Police or some other— for Burial Permit. tif still-born, give names of parents on this line. jlu case there was no medical attendant, this certificate may be signed by the Health Officer, after careful inquirj' as to the facts required to be noted. Or it ma3' be signed on oath before a Justice of the Peace by the householder in whose house the death occurred, or by the next friend of the deceased who was present. Where there was an attending physician no other signature than his should be accepted. Note.—The apparent amount of " red tape" in this certificate in the matter of requir-ing the householder or next friend to make oath before a Justice of the Peace is ren-dered necessary by the fact that death certificates are often used in the courts as evi-dence, and the disposition of large sums of money may depend upon their accuracy and reliability. L'lFTH BIENNIAL REPORT. 57 nj so oO o •-^ W p ^ G 58 NORTH CAROLINA BOARD OF HEALTH. FORM FOR SAXITARY INSPECTION OF CITIES AND TOWNS. 1. Inspection-books are furnished as per Form No. 1. 2. The Inspector is presumed to have received intelligent drilling from the Health Officer in the many features of unsanitariness which will be met with, and is moreover, presumed to be a person of good judgment and discretion, and to have a high standard of sanitary methods, with his heart in the work. 3. The inspection districts having been designated by the Board, the Inspector begins work at a set point and makes an entire inspection of the district house by house, block by block, noting down the conditions in Inspection-book as provided under manner of Form No. 2. 4. Should any bad features exist the Inspector is to point out to the householder where the remedy can be applied and the necessity for it, and to leave upon the premises the notice of Form No. ;]. Should the existing conditions be not really bad, but clearly not good, the Inspector is required to inform the householder where the defect lies, and to urge upon liim the benefits resulting from thorough cleanliness. 5. After each inspection district has been gone over Inspector should make a report to the Health Officer or Mayor of total inspections and their results upon Form No. 4: this to be kept on file by the Secretary of Board for future comparisons. 6. A space of nine lines should be given to each lot in order that the record of the whole number of inspections made during the year (monthly from April to October, inclusive, and quarterly thereafter) may be arranged for easy comparison. The Inspector should not only call attention to violations of the sanitary rules and regulations and note bad conditions, but he should make it a point to encourage those who are evidently trying to do their sanitary duty. 7. At stated intervals a notice should be given through the public press of what the comparative results show, thereby enlisting an interest in the work from those who might not be reached bv other means. Although modified by myself in some respects, the credit for these forms is due to Mr. Alfred V. Wood. Secretary of the Board of Health of Brunswick, Ga., a brother of our late deepU' lamented Secretarj-, and a sanitary expert. FIFTH BIENNIAL REPORT. 59 Form No. i. SAMPLE PAGE OF INSPECTION BOOK. 1893-'94. April May June July Aug. Sept. Oct. Jan. April May June 124 Wolf Street, (I 1 T. PI. Jones, And so on down. 1 60 NORTH CAROLINA BOARD OF HEALTH. To be sent on the first day of each mouth for the mouth preceding to the Health Officer or Alayor. Form No. 4. SAXITARY INSPECTION DISTRICT No Month of 189- FIFTH BIENNIAL REPORT. 61 known to carry contagion. He invited members of the Society to visit the Station after its completion and see it in operation. Dr. Reagan deprecated the lack of interest on the part of members in the Conjoint Session, and thought this lethargy must be overcome before we can expect to excite the interest of the legislators and the laity. Dr. H. W. Lewis said it would take the stimulus of an epidemic to create an interest in sanitary matters among the physicians of his county. In making his reports as Superin-tendent of Health he had to depend almost entirely upon his own practice in enumerating the prevailing diseases. He thought the law, while probably as good as could be obtained, was defective in not making provision for the remuneration of Superintendents for their extra and especial services in case of epidemics. He understood the law to only give the Superintendent the right to charge for his visits to the poor-house and jail. (The Secretary explained that it gave him the right to demand the fees usual in his count}' for any services he might render). He regretted there had been no legislation in regard to vaccination. His county was raising a large crop for the Reaper should an epidemic of sraall-pox appear. The Secretary stated that in regard to vaccination tlie Conference were in accord as to the desirability of com-pulsory vaccination, but that such a clause in the bill would have jeopardized the whole bill. People cannot be driven in these matters. In this connection he referred to some remarks made by Dr. Lewis at the last meeting, when he stated that he had appointed a day on which to vaccinate the pupils at a county school, and when he arrived there he found that all the school had taken flight. The Secretary announced that the terms of office of him-self and Dr. Bahnson expired with this meeting, and that 62 NORTH CAROLINA BOARD OF HEALTH. imder the new law these vacancies would be filled by the Governor's appointment. There was some discussion as to whether it would be proper for the Society to recommend candidates for appoint-ment, but it was the sense of the meeting that it should be left for the Governor to ask for such recommendation should he desire it. The Secretary called the attention of Superintendents of Health to the fact that it is now made obligatory on him to notify the County^ Commissioners of the failure on the part of the Superintendents to make their reports. He also urged upon physicians to attend the meetings of the Board of Health for the election of Superintendents that proper men may be selected for these positions. On motion the Conjoint Session adjourned. RICH'D H. LEWIS, M. D., Secretary. CONJOINT SESSION AT GREENSBORO, MAY 15, 1894. At 12 M. the Board met in conjoint session with the State Medical Society, President Bahnson in the chair. Passed Assistant Surgeon Jos. J. Kinvoun, of the United States Marine Hospital Service, having accepted an invita-tion of the President of the Board to attend the meeting, was upon motion invited to a seat upon the floor and to partici-pate in the discussions. He acknowdedged the courtesy in an appropriate manner. The Secretary then read his annual repoi't as follows: FIFTH lUKXXIAL REPORT. 03 ANNUAL REPORT OF THE SECRETARY OF THE NORTH CAROLINA BOARD OF HEALTH. By Richard H. Lewis, M. D., Raleigh, N. C. AVhen your Secretary made his last annual report the sanitary sky to the eastward was overcast with the dark and lurid clouds of cholera. There was in the minds of people at large to some extent, hut more especially of those whose duty it was to stand as sentries upon the watch-towers, a feeling of apprehension lest these threatening clouds should reach our shores and deluge us with the dreaded pestilence. Later yellow fever appeared at Brunswick, Ga., almost at our doors, and our health officers ou our seaboard, particularly at our port of Wilmington, had their anxieties greatly increased. Still later small-pox began to spread over the country and is not 3'et, we regret to admit, stamped out. Notwithstanding these valid grounds for uneasiness our fears have not been realized. "We have to felicitate our-selves and the people of our State and generally of our whole country upon their escape. And in doing so we should make our acknowledgments to the United States Marine Hospital Service for its excellent management in keeping cholera (except one case at Jerse}'' City) out of our country and in practically bottling up the yellow fever at and near Brunswick. In making this report your Secretary does not
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 | 1893; 1894 |
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 |
(1876-1900) Gilded Age |
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 | 256 p.; 15.36 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_biennialreportof05nort.pdf |
Pres Local File Path-M | \Preservation_content\StatePubs\pubs_edp\images_master\ |
Full Text | FIFTH BIENNIAL REPORT OP THE NORTH CAROLINA BOARD OF HEALTH, 1893-1894. Cfte Library of tipe llniumt^ of Jl^ottb Carolina ki ^5-t. /f-/ -b FIFTH BIENNIAL REPORT t OF THE NORTH CAROLINA BOARD or HEALTH, 1893-1894. RALEIGH: JosEPHus Daniels, State Printer and Binder. PRESSES OF E. M. UZZELL. 1895. 2.^970- MEMBERS OF THE BOARD ELECTED BY THE MEDICAL SOCIETY OF THE STATE OF NORTH CAROLINA. George GillETT Thomas, M. D., President: Wilniiugtou. Term Expires iSgy. S. Westray Battle, M. D Asheville. Term Expires 1897. W. H. Harrele, M. D Williamstou. Term Expires 1S95. John Whitehead, M. D Salisbury. Term EJxpires 1S95. APPOINTED BY THE GOVERNOR. W. H. G. Lucas, M. D White Hall. Term Expires 1895. W. P. Beael, M. D Greensboro. Term Expires 1S95. F. P. Venable, Ph. D., F. C. S Chapel Hill. Term Expires 1S95. John C. Chase, Sauitar}' Engineer Wilmington. Terni Expires 1895. Richard H. Lewis, M. D., Secretary Raleigh. Term Expires 1895. STANDING COMMITTEES. Epidemics—Drs. Lewis and Whitehead. Water Supply and Drainage—Dr. Thomas and Mr. Chase. Hygienics of Public Schools—Drs. Whitehead and Lucas. Climatology—Dr. S. W.' Battle. Adulteration of Food and Medicines—Prof. F. P. Venable. Sanitary Condition of State Institutions—Drs. Harrell and Beall. Vital Statistics—Drs. Lewis, Thomas and Harrell. LIST OF COUNTY SUPERINTENDENTS OF HEALTH IN THE STATE OF NORTH CAROLINA, DECEMBER 31, 1894. Alamance—Dr. R. A. Freeniau, Burliugton. Alexander—Dr. R. B. Killiau, Taylorsville. Alleghany—Dr. C. G. Fowlkes, Topia. Anson—Dr. E. S. Ashe, Wadesboro. Ashe—Dr. L. C. Gentr}-, Jefferson. Be.aUFORT—Dr. John C. Rodman, Washington. Bertie—Dr. H. V. Dunstau, Windsor. Bladen—Dr. Newton RoVjinson, Elizabethtown. Brunswick—Dr. D. I. Watson, Southport. Buncombe—Dr. H. L. Baird, Asheville. Burke—Dr. J. L. Laxton, Morgantou. Cabarrus—Dr. Leona M. Archey, Concord. Caldwell—Dr. A. A. Kent, Lenoir. Camden— Carteret—Dr. George N. Ennett, Beaufort. Caswell—Dr. W. O. Spencer, Yanceyville. Catawba—Dr. J. M. McCorkle, Newton. Ch.atham—Dr. L. A. Hanks, Pittsboro. Cherokee—Dr. J. F. Abemathy, Rlurphy. Chowan—Dr. R. A. Winborne, Barnitz. Clay—Dr. W. E. Sanderson, Hayesville. Cleveland—Dr. O. P. Gardner, Shelby. Columbus—Dr. I. Jackson, Wliiteville. Craven—Dr. Leinster Duffy, Newliern. Cumberland—Dr. J. H. Marsh, Fayetteville. Currituck— Dare—Dr. W. H. Peterson, Mauteo. Davidson—Dr. R. L. Payne, Jr., Lexington. Davie—Dr. James McGuire, Mocksville. Duplin—Dr. W. P. Kennedy, W'arsaw. Durham—Dr. John M. Manning, Durham. Edgecombe—Dr. Donald Williams, Tarboro. Forsyth—Dr. D. N. Dalton, Winston. Franklin—Dr. E. S. Foster, Louisburg. Gaston—Dr. J. H. Jenkins, Dallas. Gates—Dr. I W. Costen, Gatesville. Graham— Granville—Dr. W. O. Baskerville, Oxford. Greene—Dr. E. H. Sugg, Snow Hill. Guilford—Dr. A. R. Wilson, Greensboro. 4 LIST OF SUPERINTENDENTS OF HEALTH. Halifax—Dr. I. E. Greeu, Weldoii. Harnett—Dr. J. F. McKay, Dickiusou. Haywood—Dr. J. Howell Way, Waynesville. Henderson-Dr. J. L. Egertou, Heudersouville. Hertford—Dr. John W. Tayloe, Union. Hyde- Iredell—Dr. W. J. Hill, Statesville. Jackson—Dr. W. F. Tompkins, Webster. Johnston—Dr. R. J. Noble, Selma. Jones—Dr. R. A. Whitaker, Trenton. Lenoir—Dr. C. B. Woodley, Kioston. Lincoln—Dr. W. L. Crouse, Lincolnton. Macon—Dr. S. H. Lyle, Franklin. Madison—Dr. James K. Hardwicke, Marshall. Martin—Dr. W. H. Harrell, Williamston. McDowell—Dr. B. A. Cheek, Marion. Mecklenburg—Dr. H. INI. Wilder, Charlotte. Mitchell—Dr C. E. vSmith, Bakersville. Montgomery—Dr. W. A. Simmons, Troy. Moore—Dr. Gilbert McLeod, Carthage. Nash—Dr. J. J. Mann, Nashville. New Hanover—Dr. R. D. Jewett, Wilmington. Northampton—Dr. H. W. Lewis, Jackson. Onslow—Dr. E. L. Cox, Jacksonville. Orange—Dr. C. D. Jones, Hillsboro. Pamlico— Pasquotank—Dr. W. W. Griggs, Elizabeth City. Pender—Dr. George F. Lucas, Carrie. Perquimans-Dr. John F. Speight, Hertford. Person—Dr. C. G. Nichols, Roxboro. Pitt—Dr. W. H. Bagwell, Greenville. Polk—Dr. O. S. Missildine, Tryon. Randolph—Dr. J. M. Boyette, Ashboro. Richmond—Dr. J. M. Covington, Rockingham. Robeson—Dr. T. A. Norment, Jr., Lumbertou. Rockingham—Dr. D. W. Courts, Reidsville. Rowan—Dr. John Whitehead, Salisbury. Rutherford—Dr. W. A. Thompson, Rutherfordton. Sampson—Dr. John A. Stevens, Clinton. Stanly—Dr. D. P. Whitley, Millingport. Stokes—Dr. W. L. McCanless, Danbury. Surry—Dr. J. B. Hollingsworth, :Mt. Airy. Swain—Dr. R. L. Davis, Bryson City. Transylvania—Dr. C. W. Hunt, Brevard. LIST OF SUPERINTENDENTS OF HEALTH. 5 TyrreI/L—Dr. Ab. Alexander, Columbia. Union—Dr. J. K. Ashcraft, Monroe. V.\NCE— Dr. W. T. Cheatham, Henderson. Wake—Dr. P. E. Hiues, Raleigh. Warren—Dr. P. J. Macon, Warrenton. Washington— Watauga—Dr. W. B. Councill, Boone. Wayne—Dr. W. J. Jones, Jr., Goldsboro. Wilkes—Dr. J. W. White, Wilkesl)oro. Wilson—Dr. Albert Anderson, Wilson. Yadkin—Dr. T. R. Harding, Yadkiiiville. Yancey—Dr. J. L. Ra3-, Bnrnsville. LETTER OF TRANSMISSION. North Carolina Board of Health, Office of the Secretary, Raleigh, N. C, January 4, 1895. His Excellency^ Elias Carr, Governor of North Carolina^ Sir:—In accordance with Section 3, Chapter 214, Laws of 1893, I have the honor to present this the Fifth Biennial Report of the North Carolina Board of Health. With great respect, Yonr obedient servant, RICHARD H. LEWIS, M. D., Secretary and Treasurer. FIFTH BIE:NNIAL REPORT OP THE NORTH CAROLINA BOARD OF HEALTH. 1893=1894. lu the two years that have elapsed since our last re[)ort the cause of public hygiene iii our State has been markedly , advanced. The interest in this most important subject, both on the part of members of the medical profession and of the people generally, shows a very decided increase. While our work has been, and continues to be, largely "missionary" in character—to carry to those ignorant of, or indifferent to, its saving power the gospel of health — the Board has accomplished much positive good. We feel that we can claim without hesitation that the saving of many valuable lives and the prevention of a large amount of sickness can be directly traced to its efforts. The pro-visions of the law enacted by the last General Assembly requiring physicians to report immediately to the proper health officer cases of contagious and infectious disease and making it obligatory upon said health officer to see that such diseases "are properly quarantined and isolated within twenty-four hours after the case is brought to his knowl-edge, and that after the death or recovery or removal of a person sick of either of the diseases mentioned the rooms occupied and the articles used by the patient are thoroughly disinfected in the manner set forth in the printed instruc-tions, both as to quarantine and disinfection, which shall be furnished him by the Secretar}^ of the State Board of 8 NORTH CAROLINA BOARD OF HEALTH. Health," have alone saved a loss to the State in dollars and cents, considering death and sickness in terms of money, far more than has been expended upon the Board from its establishment. Unfortunately the evidence in support of sanitarv science is necessarilv nee:ative in character. Its function is not to cure disease and thus to positively save from death, Ijut to prevent the inauguration of disease in the first instance and thus to save the well from both sick-ness and death which in many instances would have surely come to them but for the effective precautions of the health officer. There are many other excellent features in the new law bearing upon the protection of school children from disease, upon the drinking waters of the State, regu-lating common carriers, and others, for a consideration of which we would refer the reader to the law itself which he will find in another part of this report. As a result of the marvelous advance in bacteriology a great discovery has been made in "antitoxine," which is regarded as a sure preventive of, and when used soon enough almost a sure cure for, diphtheria, the very name of which strikes terror to a parent's heart. The infec-tiousness of consumption is no longer disputed and know-ing the cause, it can often be prevented by resorting to suitable precautions. With more knowledge we hope to do better work, and in the next two 3^ears to save very many more than ever before in the same length of time from sickness and death. MEETINGS OF THE BOARD. MINUTES OF THE ANNUAL MEETING AT RALEIGH IN 1893. Raleigh, N. C, May 10, 1893. The North CaroUiia Board of Health met iii regular annual session in the private office of the Yarborough House at 6 p. m. In the temporary absence of the President Dr. George G. Thomas vras, on motion, called to the chair. Present : Drs. Bahnson, Harrell, Hodges, Thomas, Veuable, Mr. Chase and the Secretary. On motion of Dr. Venable the action taken by the Board in the matter of the Quarantine Station at Southport by letter was ratified. Dr. Bahnson, for the committee appointed to visit the School for the Deaf and Dumb at Morganton, and advise the Board of Directors of the same as to a water supply and system of sewerage, submitted a report of its work, stating that a copy had been sent to Dr. M. L. Reid, Chair-man of the Board of Directors. On motion the report was accepted and indorsed. A motion to proceed to the election of officers was car-ried, but as some doubt was expressed as to the tenure of office of the Secretary, whether he should hold for the un-expired term to which he was elected under the old law ('85), or whether he should be elected every two years, since the term of office of each member of the Board was made b}'' the new law ('93) only two years, the President was rec|uested to obtain the opinion of the Attorney Gen-eral and report to the meeting next morning, to which time the Board then adjourned. RICH'D H. LEWIS, Secretary. 10 NORTH CAROLINA BOARD OF HEALTH. Raleigh, X. C, May 11, 1893. The Board re-assembled in the Senate Chamber of the Capitol at 10 a. .m., President Bahnson in the chair. The President stated that he had consulted the Attorney General as to the term of office of the Secretary and that the latter had given it as his opinion that if the Secretary continued a member of the Board by re-appointment for so long a time he was entitled under the Constitution of the State to hold the office for the remainder of the six-year term of the late Secretar}^, Dr. Thomas F. Wood, to which he was elected. Dr. tienry T. Bahnson was nominated for President and unanimously re-elected. Messrs. Chase and Venable were appointed a committee to audit the accounts of the Treasurer. They reported them to be correct. Adjourned. RICH'D H. LEWIS, Secretary. FIFTH BIENNIAL REPOHT. 11 ACTION OF THE NORTH CAROLINA BOARD OF HEALTH, IN jREGARD TO THE RESIGNATION OF DR. J. A. HODGES AND THE ELECTION OF HIS SUCCESSOR. The following letter, which ex})lains itself, was sent to every member of the Board : North Carolixa Board of Health, Secretary's Office, Raleigh, November 6, 1893. My dear Doctor :—I am instructed by President Bahnson to notify the members of the Board of the resignation, upon his removal from the State, of Dr. J. A. Hodges, and to ask eacli member to indicate in a letter to the Secretary (in order to save tlie expense of a meeting for the purpose) what action he desires taken thereon, and his choice for his successor. Please write me promptly in accordance with the above and oblige, Yours truly, EICH'D H. LEWIS, Secretary. By the answers to the above letter received from all the members of the Board, and now on file in the Secretary's office, the resignation of Dr. Hodges was accepted and Dr. John Whitehead, of Salisbury, was unanimously elected to fill the vacancy. Dr. Whitehead was duly notified of his election and signified his acceptance of the position. RICH'D H. LEWIS, Secretary. 12 NOKTH CAROLINA BOARD OF HEALTH. MINUTES OF THE ANNUAL MEETING AT GREENSBORO IN 1894. Greensboro, N. C, May 15, 1894. TJie North Carolina Board of Health met in regular annual session in Room 15, Benbow House, at 9 p. m. There were present Drs. Bahnson, President; Harrell, Whitehead and Venable, Mr. Chase and the Secretary. • The minutes of the last meeting and of the action of the Board in regard to the resignation of Dr. J. A. Hodges and the election of his successor were read and approved. Messrs. Chase and Venable were appointed by the Presi-dent a committee to audit the accounts of the Treasurer. The matter of the erection of a first-class Quarantine Station at Southport was informally discussed. Great regret was expressed at the action of the authorities of the city of Wilmington in refusing to appropriate the $5,000 neces-sary as a preliminary condition to receiving $20,000 from the State. The transmission of typhoid fever was the subject of a general discussion of a very interesting character. On motion it was ordered that the Board meet hereafter three times a year—every four mouths—the annual meet-ing to be held as usual with the State Medical Society, and the other two in September and January at such place as the Board may select and on such day as the President may appoint. On motion Salisbury was selected as the place for the next or September meeting. The President was requested to appoint the day at his convenience. On motion it was ordered that the public institutions of the State, including the convict camps, be inspected as far as practicable during the current year. FIFTH BIENNIAL REPORT. 13 On motion the Secretary was instructed to i)urchase a library of reference books on sanitary subjects for the use of his office, and also similar books for the use of members of the Board. Adjourned to 12 o'clock to-morrow. RICH'D H. LEWIS, Secretary. Greensboro, N. C, May 1<3, 1894. The Board re-assembled in Room 15 of the Benbow House at 6:40 p. m.: President Bahnson in the chair. Present: Drs. Bahnson, Battle, Harrell and Whitehead, Mr. Chase, Passed Assistant Surgeon J. J. Kinyoun, M. H. S., and the Secretary. In response to an invitation from the Board to address them, Dr. Kinyoun made the following statement: The Surgeon General of the ]\Jarine Hospital Service, Dr. Wyman, is very anxious to have all the larger ports put in good shape. All the ports except Wilmington are already well provided with quarantine facilities. It is his earnest desire to have a perfectly equipped station at Wil-mington. The rules under the law of February, 1893, re-quire that the dunnage of any infected vessel must be disinfected by steam and the hold of said vessel by 10 per cent, sulphur. If such facilities do not exist at a port the vessel must be remanded to a port that is supplied. This would wreck the commerce of Wilmington as matters now stand, which the Government would be very loth to do. An order has been issued to captains from West Indies and South American ports having yellow fever to report at once to United States stations. All sailing vessels from an in-fected port in West Indies are advised to go by one of the national stations at Tortugas or Sapelo for inspection and disinfection. The Surgeon General wishes to know if a 14 NORTH CAROLINA BOARD OF HEALTH. properly equipped station cannot be established by the State. If not the United States have the law and ample means to do so. After a full discussion of the above statement from the Marine Hospital Service the following motion was intro-duced by Dr. Battle and unanimously adopted : Moved, that in view of the inability or the unwillingness of the city of Wilmington to contribute its part towards carrying out the act of the last General Assembly providing for the erection of a first-class Quaran-tine Station at Southport, the Secretary of this Board be instructed to officially request the United States Marine Hospital Service to take charge of and operate that station; and that the Secretary be authorized to explain this action on the part of the Board. The Auditing- Committee reported that they had exam-ined the accounts of the Treasurer and found them correct. Report adopted. On motion the Board adjourned to meet in Salisbury in Se^^tember. RICH'D H. LEWIS, Secretary. MINUTES OF THE MEETING AT SALISBURY, SEPTEMBER 13, 1894. Salisbury, N. C, September 23, 1894. The Board met after the adjournment of the Health Con-ference in private session at the Central Hotel. Present: Drs. Bahnsou, Battle, Thomas, Whitehead and Lewis. Drs. Bahnson and Lewis were elected delegates to the American Public Health Association. The appointment of delegates to the National Conference of State Boards of Health was left to the President. A letter from Dr. C. O. Probst, Secretary of the National Conference of State Boards of Health, stating that the annual dues of North Carolina for 1892, $10, had not been paid, was read. Upon a state- FIFTH 15IEXNIAL REPORT. 15 ment from the Treasurer of the Board that such was the fact, due doubtless to the prolouged ilhiess of the Treasurer at that tiuie, a motion was passed ordering it paid. On motion the Secretary Avas ordered to have printed in pamphlet form, and generally distributed, the article on "The Prevention of Tuberculosis," by Dr. S. Westray Bat-tle, and that on "Drinking Water in its Relation to Malarial Diseases," by the Secretary, just read before the Health Conference. On motion Mr. J. C. Chase, the Engineer of the Board, was requested to make a thorough inspection of the various State institutions and of tlie water supplies and sewerage sys-tems, present and prospective, of the more important cities and towns of the State and to report the results of the same to the Board. On motion tlie meeting adjourned. RICH'D H. LEWIS, Secretary. PROCEEDINGS HAD IX REGARD TO THE ELEC-TION OF A PRESIDENT OF THE BOARD TO SUCCEED DR. H. T. BAHNSON, RESIGNED. Having been notified by his Excellency the Governor of the resignation from the Board of Dr. H. T. Bahnson, of Salem, for many j-ears its active and efficient President, I addressed the following letters to each member of the Board. They show the method of the election of Dr. George Gillett Thomas, of Vvilmington, as his successor in the presidenc}^ : Raleigh, N. C, November 21, 1894. My dear Doctor :—Dr. Bahnson, being a member of two boards, has tbought it proper to resign from one of them, and has, I am sorry to say, elected to give up ours. We are, therefore, without a President, and tlie machinery of our law requires one. In order to save expense and time it has occurred to me that it would be best for me to call for 16 NORTH CAROLINA BOARD OF HEALTH. nominations by letter and then to send a list of the nominees to each member of the Board for his ballot. If you approve this plan please make a nomination. If not, let me have your views as to the best course of action, and oblige, Yours very truly, RICH'D H. LEWIS, Secretary, P. S.—If a majority of the Board should nominate the same person we will, if you approve, consider that an election. R. H. L. Raleigh, N. C, December 8, 1894. My dear Doctor:—The "returns" are all in, and Dr. G. G. Thomas has been nominated by six (6) members and Dr. S. W. Battle by two (2) members for President of the Board. According to the understanding had in my former letter—that if any one member should happen to be nominated by a majority of the Board we would, without further corre-spondence, consider him elected—I now announce the election of Dr George Gillett Thomas as President. Very truly yours, RICH'D H. LEWIS, Secretary. His ExcelleDcy the Governor appointed Dr. W. P. Beall, of Greensboro, to fill the vacancy on the Board caused by the resignation of Dr. Bahnson. PROCEEDINGS CONJOINT SESSIONS OF THE STATE BOARD OF HEALTH WITH THE State Medical Society in 1893 and 1894. The Conjoint Session at Raleigh, May 11, 1893. Dr. II. T. Bahnson was called upon to preside. He au-noLinced the first business in order to be the reading of the annual report of the Secretary : ANNUAL REPORT OF THE SECRETARY OF THE NORTH CAROLINA BOARD OF HEALTH. By Richard H. Lewis, M. D., Raleigh, N. C. By section 27 of the Act Relating to the Board of Health the Secretary is required to submit his annual report at this, the annual meeting of the Board. ITe is also required by section 3 of the same to make biennially to the General Assembly, through the Governor, a report of the work of the Board. In comjdiance with the latter the fourth bien-nial report for 1891-'92 was prepared and submitted, and the portion of it covering the period from the last annual meeting to January 1, 1893, is respectfully referred to as a part of this report. [Read from the biennial report the references to the life and work of Dr. Thomas F. Wood.] On January 2d an invitation to meet with the State Board of Health in a Health Conference on January 24th 18 NORTH CAROLINA BOARD OF HEALTH. iu the city of Raleigh was mailed to the number of six hundred and fifty to the officers of the State Government, members of the General Assembly, Mayors of towns, County Superintendents of Health, Chairmen of Boards of County Commissioners, physicians and other prominent men. The attendance was not ver}" large, but varied and of good quality. The number of County Superintendents of Health present (three, and one of them a member of the Legis-lature) was discouraging, particularly in view of the fact that one of the principal subjects for discussion named in the invitation was their own salaries, about which much complaint had been made. The following are the proceed-ings of the Health Conference: Raleigh, N. C, January 24, 1893. On a call from the President of the State Board of Health, Dr. H. T. Bahnson, of Salem, that body met in the city of Raleigh on the above date, there being present Drs. J. H. Tucker, J. A. Hodges, Geo. G. Thomas, Prof. F. P. Amenable and the Secretary. There were present also Superintendents of Health, prac-ticing physicians and other citizens interested in sanitation and the health of the State, all of whom were invited to meet with the State Board of Health in a Health Con-ference. In the absence of President Bahnson the Secretary called the Conference to order, stating the object of the Confer-ence to be a consideration of the best method to prevent the introduction of pestilential diseases into the State, the method of fixing the salaries of Superintendents of Health and other matters relating to the general health of the State. He introduced the Mayor of the cit}^ of Raleigh, who extended a cordial welcome to the Conference and assured FIFTH BIENNIAL KEPOKT. 1 H* it of his hearty support in its efforts to [)romote the welfare of the State in the all-important matter of healtli. The first order of business being the selection of a perma-nent chairman, Dr. Thomas nominated Col. W. 11. S. Burgwyn, a man who had shown himself to be actively interested in the health matters of North Carolina. Col. Burgw}'!! was unanimously elected Jind on assuming the cliair expressed himself as feeling highly honored by being-invited to preside over the meeting and gladly offered all the assistance in his power to the Conference in improving the safeguards against the ravages of plagues and epi-demics. The prosperity of the country is largely dependent upon the medical profession, and this is especially note-worthy of the next twelve months when the country is to undertake the stupendous task of entertaining the whole world and, at the same time, guard her citizens from the terrible plague which caused such destruction of life in Europe last 3''ear and wliich is apparently only waiting for the ap})roach of warm weather to renew its work of devas-tation and destruction. The Secretary presented as the first duty of the Con-ference the amendment of the health laws of the State, and read a co])y of a law suggested by the President, after which he stated that a substitute for the old law had been drawn up by himself for the consideration of the Con-ference. It was moved and decided that the Secretarv read his proposed substitute for the existing laws section by section and if there be no objection raised the section be consid-ered as approved by the Conference. Section 1. Adopted without objection. Sec. 2. There being some doubt as to whether the pro-posed reading would call for the election of six new mem-bers of the Board this year, it was corrected to make the 20 NORTH CAROLINA BOARD OF HEALTH. fact clear that the successors of the present incumbents were to be elected only at the expiration of the terms of the present members; each new member being elected for six years. Sec. 3. The important part of this section is the duty of the Board to inspect the public institutions of the State, and the Secretary explained that before any action was taken he had communicated with the chief officers of the asylums and of the Penitentiary and they had expressed the opinion that such inspection would be very proper and desirable. The section was approved ; but later Dr. .J. W. Jones thought that the inspection of the stockades should be made oftener than once a year, as frequently a stockade was not in existence so long as a year, and in that event it might not be inspected at all. An amendment was added to the section, providing for inspection as much oftener as requested by the "Board of Charities." The Secretary said that he had considered the advisability of having the superintendents of the public institutions make monthly reports to the Board of Health, but as the}' have to keep a record of these things any way, and include them in their regular reports, he thought it not well to impose this duty upon them. Sec. 4. Approved without discussion. Sec. 5. This section was amended so as to make eligible to membership in the County Boards of Health all prop-erly registered physicians. Sec. 6. Dr. Hodges thought the law regarding fines against Superintendents had been a dead law ; that he be-lieved these fines had never been collected. He had at times been delinquent in sending in his reports when he was a Superintendent and had never paid a fine. The Sec-retary explained that heretofore it had not been obligatory on the Secretarv to notifv the Countv Commissioners of the FIFTH BIENNIAL REPORT. 21 delinqiioiicy of the Supcniiteiulents. On motion the sec-tion was amended, making it the duty of the Secretary of the State Board to notify tlio Commissioners on the 11th of each month of any delinquenx?.y on the part of Superin-tendents to send in their reports by the 10th. As amended the .section was adopted. Sec. 7. This section, relating to the salaries of Superin-tendents of Health, provoked a very great deal of discus-sion by the members of the Conference generally. The Secretary thought the salaries of these officers should be imposed and regulated by legislative enactment so that they could act independently in performing their duties. There was a unanimity of opinion as to the fact that the salaries of the Superintendents were far from satisfactory, but there seeming to be an inabilitv to come to any con-elusion as to the best and wisest plan for improving them, Dr. Hodges moved that the matter be referred to a com-mittee who should consider it and report at the afternoon session. The motion was carried. Sec. 8. The Secretary explained that this section was introduced in its proposed form for the purpose of making one definite day for the election of Superintendents in all the counties of the State, and so that all terms of office would expire at the same time. Dr. Thomas thought the reason why local Boards of Health held such infrequent meetings was because they were invested with no power except to give advice and their advice generally resulted in nothing. The section was adopted. Sec. 9. Adopted. Sec. 10. Adopted. Sec. 11. Adopted. Sec. 12. Adopted. Sec. 13. Dr. Hodges thought we ouglit to deal with great tenderness with the affairs of the public schools. 22 NORTH CAROLINA BOARD OF HEALTH. Some committeemen lived ten miles apart, and it would be bard to get tbem togetber to consider these tilings. Tbe Secretary exrjlained that it was only tbe diseases tbat were really dangerous to life tbat were included in tbis section. The section is intended to apply especially to city schools, but should also apply to county schools. Dr. Grouse thought tlie last clause requiring tbe child wdio persisted in coming to school while it was in dangerous contact with contagious diseases at home, to be dismissed from the school for the remainder of tbe term, a hardship on tbe child and not a punishment on the pareut, where the blame should rest. After some discussion it was decided to leave tbis clause out, and as so amended the section was passed. Sec. 14. Adopted. Sec. 15. Amended so as to provide for tbe early removal of a suspect from tbe State, and was then adopted. Sec. 16. Adopted after a slight amendment. Sec. 17. This section was explained to refer to potable waters. It was then adopted. Sec. 18. Adopted after a slight amendment. The remaining sections were adopted without much discussion. TJie Chair attempted to appoint the committee to take into consideration the matter of salaries of Superintend-ents of Health, but there were none willing to assume the office, and on motion it was referred back to tbe whole meeting for action and then postponed to the afternoon session. Tbe Conference then adjourned to o p. m. FIFTH BIENNIAL KEPOKT. 23 AFTEKNOON SESSION. The Contereiice \va.s called to order by the Chairman at J o'clock. Section 7, relating to salaries of Superintendents, was introduced as the first order of business and again evoked much discussion, with liual result of ado])ting the section as it now stands. The matter of taking some action luokmg to seeuriug some law of compulsory vaccination elicited quite a spir-ited debate. All present seemed to agree as to the desira-bility of a more general practice of vaccination, but some were doubtful as to the advisability of attempting to secure legislation to require vaccination just at present, as it might jeopardize the whole bill. On motion the whole bill was adopted as a substitute for the present Act Helating to the Board of Health. By invitation Dr. W. G. Curtis, Quarantine Physician of the station at the month of the Cape Fear river, read a paper with a description of the station as it now is, a recital of the needs of the station and a discussion of the probability of cholera getting into this State the coming summer. During the latter part of the meeting Dr. Geo. G. Thomas presided, as Col. Burgwyu was obliged to leave. After the reading of Dr. Curtis's paper, which was lis-tened to with much interest, the Conference adjourned sine die. RICH'D H. LEWIS, Secretary. Upon request the President of the Senate and the Speaker of the House announced a joint meeting of their respective Committees on Public Health—the first com-mittees, by the way, on public health ever appointed by any Legislature in the history of the State, I am told—for 24 NORTH CAROLINA ROARD OF HEALTH. the niglit aftor the adjournment of tlie Conference, to con-sult with niemhors of the Board of Health in regard to sanitary matters generally, and the proposed legislation in the interest of the puhlic health in particular. Messrs. Hodges, Venable, Thomas and the Secretary appeared before them, and the bill was read over and explained. Senator Lucas, of Bladen (;ounty. Chairman of the Senate Committee on Public Health, who had just been appointed on the Board by Governor Carr, took charge of the bill and introduced it in the Senate. The Secretary again appeared before the Senate Committee, to which it was referred on its introduction, and it was favorably reported with unanimity. He also had a number of personal inter-views with Senators in regard to the importance of the act and besides sent a letter with a copy of the act to about one hundred physicians, County Superintendents and others, urging them to use their influence with their Senators and Representatives in effecting the passage of the bill. This letter bore fruit, and after some delay and much vexation of spirit on the part of your Secretary the bill passed the Senate by a vote of thirty-four to eight, though somewhat damaged by amendments. The House Com-mittee unanimously recommended its passage. Notwith-standing that fact when it came up on its second reading it was laid on the table in short order by a considerable majority, wdiich of course would have been the end of it but for the tact and parliamentary skill of the Hon. Edmund Jones, of Caldwell, a warm personal friend of 3'our Secre-tary, who got it up again and with the active assistance of a number of the best men in the House, medical and lay, secured its passage. I was very anxious to have some of the Senate amendments corrected in the House, but our friends in that body advised strongly against attempting anv amendment on the ground that if they ever began to FIFTH BIENNIAL REPORT. 25 amend it it would probably come out in worse shape than the Senate had left it. Your Secretary deferred to their wisdom, feeling that it was better to take what we had than to run a serious risk of losing much more. The act as finally passed differs from that proposed by the Health Conference essentially in these particulars: The appointment of five members instead of three out of the nine is given to the Governor and the term of office of all is made the same, two j'ears—an unfortunate change, I think, in both respects. The annual appropriation of $3,000 asked for was cut down to $2,000, the same as heretofore. In other respects it is essentiallv as introduced. On the whole we have made a decided advance, as a com-parison of the new with the old lavr will clearly show, I think. The old law, which was incorporated in the new, was imjjroved in many respects and many new and valua-ble sections, providing for much better protection against the introduction and spread of contagious and infectious diseases, and for the preservation of water su^^plies, as well as improvements in other respects, were added. AVhile our annual appropriation was not increased in dollars it was materially augmented by the removal of the $250 limit to our requisition on the State Printer for stationery and print-ing. The emergency fund was also increased from $2,000 to $5,000. The following is the law as it now stands: AN ACT IX RELATION TO THE BOARD OF HEALTH, RATIFIED MARCH 1, 1893. The General Assembly <>f Xortlt Carolina do enact ; Section 1. That the Medical Society of the State of North Carolina shall choose from its members by ballot four members, and the Governor of the !^tate shall appoint five other persons (one of -whom shall be a sanitary engineer) and they shall constitute "The North Carolina Board of Health." 26 XOETH CAROLINA I50AKD OF HEALTH. Sec. 2. The members of the Board of Health elected by the State Medi-cal Society shall be chosen to serve two years. Their term of office shall begin immediately upon the expiration of the meeting at which they were elected. Those appointed by the Governor shall serve two years, their term of otHce beginning with the first regular meeting of the Board after their appointment. In case of death or resignation the Board shall elect new members to fill the unexpired terms : Proridcd, the Governor shall fill such vacancies as may occur where he has made appointments. Sec. 3. Tliat the Xortli Carolina Board of Health shall take cognizance of the health interests of the people of the State, shall make sanitary investigations and inquiries in respect to the people, employing experts when necessary ; shall investigate the causes of disease dangerous to tlie public health, especially epidemics, the sources of mortality, the effect of locations, employments and conditions upon the public health. They shall gather such information upon ail these matters for distribution among the people, with the especial purpose of informing them about preventable diseases. They shall be the medical advisers of the State and are herein specially provided for, and shall advise the government in regard to the location, sanitary construction and management of all State institutions, and shall direct the attention of the State to such sani-tary matters as in their judgment affect the industries, prosperity, h.ealth and lives of the people of the State. They may make an inspection once in each year, and at such other times as they may be requested to do so by the State Board of Charities, of ail public State institutions, including all convict camps under the control of the State Penitentiary, and make a report as to their sanitarj^ condition, with suggestions and recommenda-tions to their respective boards of directors or trustees ; and it shall be the duty of the officials in immediate charge of said institutions to fur-nish all facilities necessary for a thorough inspection. The Secretary of the Board sliall make biennially to the General Assembly, through the Governor, a report of their work. Sec. 4. The State Board shall have a President and a Secretary, wiio shall also be Treasurer, to be elected from the members composing the Board. The President shall serve two years and the Secretary-Treasiirer two years. The Secretary-Treasurer shall receive such yearly compensa-tion for his services as shall be fixed upon by the Board, not to exceed one thousand dollars, but the other members of the Board shall receive no pay, except that each member shall receive four dollars a day and necessary traveling and hotel expenses when on actual duty attending the meetings of the Board or pursuing special investigations in the State, but when attending important sanitary meetings in other sections, the number of delegates thereto being limited to two, only actual traveling and hotel expenses shall be allowed. These sums shall be paid l>y the Treasurer on authenticated requisition approved and signed by the Presi-dent. FIFTH BIENNIAL REPORT. 27 Sec. 5. There shall be an auxiliary Board of Health in each county in the State. These Boards shall be composed of all registered physicians resident in the county, the ^layor of the county town, the Chairnian of the Board of County Commissioners and the City Surveyor, when there is such an otiicer; otherwise the County Surveyor. From this number one physician shall be chosen by ballot to serve two years, with the title of Superintendent of Health. His duty shall be to gather vital statistics upon a plan designated by the State Board of Health. He shall always promptly advise the Secretary of the State Board of tlie unusual prevalence of disease in his county, especially of typhoid fever, scai'let fever, diphtheria, yellow fever, small-pox, or cholera. His reports shall be made regularly, as advised by the State Board, through their Sec-retary; and he shall receive and carry out as far as possible such work as may be directed by the State -Board of Health. He shall make the medico-legal posf-rnorton examinations for coroners' inquests, and attend the prisoners in jail, home for the aged and infirm, and house of correction, and make an examination of lunatics for commitment. He shall be the sanitary inspector of the jail and home of his county, mak-ing monthly reports to the Board of County Commissioners : Provided, that if for any cause tlie County Board of Health should fail to meet as hereinafter set forth and elect a Superintendent, the County Commis-sioners shall elect from those physicians resident in the county eligible to membership in the County Board a Superintendent of Health : Pro-vidi'd farther, that it shall be unlawful for said County Commissioners to elect any one not eligible to membership in the County Board to the office of County Superintendent of Health, if any such qualified physician can be found in the county willing to accept the office. Sec. 6. IMonthly returns of vital statistics, upon a plan to be made by the State Board of Health, or their Secretary acting under their instruc-tions, shall be made by the County Superintendent to the Secretai-y of the State Board, and a failure to report by the tenth of the month for the preceding month shall subject the delinquent to a fine of one dollar for each day of delinquency, and this amount shall be deducted from the salary of the Superintendent by the Boardof County Commissioners on the statement of such delinquency by the Secretary of the State Board of Health; and the said Secretary is hereby required to notify, on the eleventh day of each month, the Chairman of the Board of County Com-missioners of such delinquency. The County Superintendent shall report to the Secretary of the State Board the presence in his county of any case of small-pox, yellow fever, typhus fever or cholera within twenty-four hours after it has come to his knowledge, and upon failure to make such report within the prescribed time the County Commissioners shall deduct five dollars from his salary for each day of delay in reporting. Sec. 7. The salary of the County Superintendent of Health shall be 28 NORTH CAROLINA BOARD OF HEALTH. paid out of the county treasury upon requisition and the proper vouchers as follows: The salary of the Superintendent of Health, or any other member of the Board who is requii-ed to do the service assigned him, sliall be in accordance witli the medical fees usual in his county, and for each inspection of the jail and county home, which he shall make monthly, he shall be paid as for one medical visit : Prodded, that a definite salary of not less than ten nor more than one thousand dollars may be paid in lieu of fees if mutualh^ agreeable to the Board of County Commissioners and the County Superintendent. Sec. 8. The biennial meeting for the election of officers shall be, for the State Board of Health, on the second day of the annual meeting of the Medical Society of tlie State of North Carolina in eighteen hundred and ninety-three and every two years thereafter; for the County Boards it shall be held in the county court-house between the hours of 12 >f. and 1 V. y\. on the first Monday in September, eighteen hundred and ninety-thi-ee, and each two years thereafter: Frurided, that the two-year term of office of any Superintendent shall not be curtailed thereby ; but his successor, who shall be elected at the meeting on the first Mon-day in September, eighteen hundred and ninety-tiiree, shall qualify upon the expiration of said term and hold office until the first Monday in September, eighteen hundred and ninety-five, Mhen all County Superin-tendents shall be elected for the full term of two years, beginning and end-ing with the first ^Monday in September. In order to secure uniformity and certainty of action it shall be the duty of the Secretary of the State Board of Health to mail to every person in the State eligible to member-ship in the County Boards of Health, whose address can be obtained, on or before the twentieth day of the August next preceding the time of meet-ing hereinbefore appointed, a printed notice of said meeting setting forth time and place. Sec. 9. Inland quarantine shall be under the control of the County Superintendent of Health, who shall see that diseases especially dan-gerous to the public health, viz., small-pox, diphtheria, scarlet fever, yellow fever, typhus fever and cholera, are proj)erly quarantined and iso-lated within twenty-four hours after the ca.se is brought to his knowledge ; and that after the death or recovery or removal of a person sick of either of the diseases mentioned the rooms occupied and the articles used by the patient are thoroughly disinfected in the manner set forth in the printed instructions, both as to quarantine and disinfection, which shall be furnished him by the Secretary of the State Board of Health. The expense of the quarantine and of the disinfection shall be borne by the householder in whose family the case occurs, if able; otherwise by the city, town or county of which he is a resident. The failure on the part of a County Superintendent of Health to perform the duties imposed in this section shall be punished by the deduction of five dollars for each FIFTH BIENNIAL REPORT. 29 day of delinquency from his salary by the Board of County Commis-sioners ; and if it shall appear to the satisfoction of the County Board of Health that the death of any person from the spread of the disease can justly be attributed to such failure of duty on his part, he shall be deposed from office and a successor immediately elected to fill out his unexpired term. Any person neglecting or refusing to comply with or in any way violating the rules promulgated in the manner above set forth on the subjects of quarantine and disinfection shall be deemed guilty of a misdemeanor, and upon conviction shall be fined or impris-oned, at the discretion of the court, not less than five nor more than fifty dollars, or less than ten nor more than thirty days. In case the offender be stricken with the disease for which he is quarantinable, he shall be subject to the penalty on i-ecovery, unless in the opinion of the Superintendent it should be omitted : Provich-d, hoirerer, that in any city or incorporated town having a regularly appointed medical health officer who is a member of the County Board of Health, the duties assigned in this section to the County Superintendent of Health shall be performed by the said medical health officer for the people of his city or town, and he shall be subject to the same penalties for dereliction of duty at the hands of the Board of Aldermen or Town Commissioners as are directed to be imposed by the County Commissioners and County Board of Health upon the Superintendent: Frotided further, that the quarantine of ports shall not be interfered with, but the officers of the local and State Boards shall render all aid in their power to quarantine officers in the discharge of their duties upon the request of the latter: Provided, tliat the custody and care of any child or other person may remain in custody of parent or family. Sec. 10. Wiien a householder knows that a person within his family is sick with either of the diseases enumerated in section nine he shall immediately give notice thereof to the health officer or Mayor, if he resides in a city or incorporated town, otherwise to the County Superin-tendent of Health, and upon the death or recovery or removal of such person the rooms occupied and the articles used by him shall be disin-fected by such householder in the manner indicated in Section Nine. Any person neglecting or refusing to comply with any of the above pro-visions shall be deemed guilty of a misdemeanor, and upon conviction shall be fined not less than one dollar nor more than fifty dollars. Sec. 11. When a physician knows that a person whom he is called to visit is infected with small-pox, diphtheria, scarlet fever, typhus fever, yellow fever or cholera he shall immediately give notice thereof to the health officer or :\Iayor, if the sick person be in a city or incorporated town, otherwise to the County Superintendent of Health, and if he refuses or neglects to give such notice of it in tv\enty-four hours he shall be guilty of a misdemeanor and shall be fined for each offen-e not less 30 NORTH CAROLIXA BOARD OF HEALTH. than ten nor more than twenty-five dollars. And it shall be the duty of the said County Superintendent, health officer or 3Iayor receiving such notice of the presence of a case of small-pox, yellow fever, typhus fever or cholera within his jurisdiction to communicate the same immediately by mail or telegraph to the Secretary of the State Board of Health. A failure to perform this duty for twenty-four hours after the receipt of the notice shall be deemed a misdemeanor, and shall subject the delinquent njton conviction to a fine of not less than ten nor more than twenty-five dollars. Sec. 12. The County Superintendents of Health, or the Boards of Health in the several cities and towns where organized, otherwise the authoi'i-ties of said cities or towns, shall cause a record to be kept of all reports received in pursuance of the preceding sections, and such records shall contain the names of all persons who are sick, the localities in which tiiey live, the diseases with which tliey are alfected, together with the date and names of all persons reporting any such cases. The Boards of Health of cities and towns wherever organized, and where not the Mayors of the same, and in other cases the County Superintendent of Health, shall give the .school committee of the city or town, the princi-pals of private schools and the Superintendent of Public Instruction of the county, when the schools are in se.'^sion, notice of all such cases of contagious diseases reported to them according to the provisions of this act. A failure to perform this duty for twenty-four hours after the receipt of the notice shall be deemed a misdemeanor, and subject the delinquent upon conviction to a fine of not less than ten nor more than fifty dollars. Sec. Ii5. The school committees of public schools, superintendents of graded schools and the principals of private schools shall not allow any pupil to attend the school under their control while anj^ member of the household to which said pupil belongs is sick of either small-pox, diph-theria, measles, scarlet fever, yellow fever, typhus fever or cholera, or during a i)eriod of two weeks after the death, recovery or i-emoval of such sick person ; and any pupil coming from such household shall be required to present to the teacher of the school the pupil desires to attend a certificate from the attending physician, city health officer or County Superintendent of Health of the facts necessary to entitle him to admission in accordance with the above regulations. A wilful failure on the part of any school committee to perform the duty required in this section shall be deemed a misdemeanor, and upon conviction shall subject each and every member of the same to a fine of not less than one nor more than twenty-five dollars : Provided, that the instruc-tions in accordance with the provisions of this section given to the teachers of the schools within twenty-four hours after the receipt of each and every notice shall be deemed performance of duty on the part of FIFTH BIEXXIAL REPORT. 31 the school committee. Any teacher of a i)ublic school and any ]n-inci-pal of a private school failing to carry out the requirements of this sec-tion shall be deemed guilty of a misdemeanor, and upon conviction shall be lined not less than one nor more than twenty-tive dollars. Sec. 14. When a person coming to a city or town from abroad or from some other place in this State is infected or has lately been infected with either of the diseases mentioned in Section Nine the local Board of Health where such exists, otherwise the Board of Aldermen or Board of Town Commissioners, shall make effective provision in the manner which it judges best for the safety of the inhabitants by removing such person to a separate house or otherwise, and by providing nurses and other assistance and necessaries, whicii shall be at the charge of the person himself or hisixirents, where able, otlierwise at the charge of the city, town or county to which he belongs. Sec. 15. The Board of Health, or, in case there is no Board of Health, the Board of Aldermen or Town Commissioners of a city or town near to or bordering upon either of tb.e neighboring States, may appoint, by writing, suitable persons to attend at places by whicii travelers may pass from infected places in other States, who may examine such travelers as may be suspected of bringing any infection dangerous to the public health, and if it need be may restrain them from traveling until licensed thereto by the Board of Healtii or Board of Aldermen or Town Com-missioners of the city or town to which they maj' come. A traveler coming from such infected places who, without such license, travels within this State (except to return by the most direct route to the State whence he came) after he has been cautioned to depart by the persons so appointed, shall be isolated or ejected, at the discretion of the local city or town or county Board of Healtii ; and upon refusal to comply with the regulations of the said Boards of Health or either of them on this subject shall be guilty of a misdemeanor, and upon conviction shall be fined not less than twenty-five nor more than fifty dollars or imprisoned not more than tliirty days. And all common carriers bringing into this State any such persons as named above are hereby required to return them to some point without this State, if required by a city, town or county Board of Health. Nothing in this section shall prevent the State Board of Health in time of epidemics from appointing such additional examiners as they may deem necessary to the preservation of the public health. Sec. 16. No railroad corporation or other common cari-ier or person shall convey or cause to be conveyed through or from any city, town or county in this State the remains of any person who has died of small-pox, measles, scarlet fever, diphtheria, typhus fever, yellow fever or cholera until such body has been disinfected and encased in such manner as shall be directed by the State Board of Health, so as to preclude any 32 NORTH CAROLINA BOARD OF HEALTH. danger of (.•oinmnnicatiiig the disea^^e to others by its transportation ; and no local registrar, clerk or heaUli otlicer, or any other person, shall give a permit for the removal of such body until he has received from the Board of Health of the city, or from the Board of Aldermen or Town Commissioners, or the County Superintendent of the city, town or county where the death occurred, a certificate stating the cause of death and that the said body had been prepared in the manner set forth in this section; which certificate shall be delivered in duplicate to the agent or person who receives the body, and one copy shall be pasted on the box containing the corpse ; said certificate shall be furnished in blank by the transportation company wh.en no local board of health exists. During an epidemic of cholera all common carriers shall so arrange their water-closets as to catch in water-tight receptacles the dejections of all persons using the same and shall disinfect the said dejections in a manner satis-factory to the State Board of Health befoi'e emptying them. Any person violating the provisions of this section shall be punished by fine not exceeding twenty-five dollars. Sec. 17. In times of epidemics of small-pox, yellow fever, typhoid fever, scarlet fever, diphtheria, typhus fever, cholera, the State Board of Health shall have sanitary jurisdiction in all cities and towns not having regularly organized local boards of health, and are hereby empowered to make all such regulations as they may deem necessarj- to protect the public health, and to enforce, in courts of justices of the peace, the same by the imposition of sucii penalties as come within tlic jurisdiction of a justice of the peace. Sec. is. Water and icater siipph/.—The State Board of Health .shall liave the general oversight and care of all inland waters and shall from time to time, as it may deem expedient, cause examinations of the said waters to be made for the purpose of ascertaining wliether the same are adapted for use as sources of domestic water sui)])lies, or are in a condition likely to iiupair the interests of the public or persons lawfullj' using the same, or imperil the public health. For the purpcses aforesaid it may employ such expert assistance as may be necessary. Sec. li). The said Board shall from time to time consult with and advise the boards of directors of all State in.stitutions, the authorities of cities and towns, corporations or firms already having or intending to introduce systems of water supply, drainage or sewerage, as to the most appropriate source of supply, the best practicable method of assuring the purity thereof, or of disposing of their drainage or sewerage, having regard to the present and prospective needs and interests of other cities, towns, corporations or firms which may be affected thereby. All such boards of directors, authorities, corporations and firms are hereby required to give notice to said Board of their intentions in the premises and to sub-mit for its advice outlines of their jnoposed plans or schemes in relation FIFTH BIENNIAL RKPOKT. So-to water .sni)ply and dis}n)sal of sewage, and no contraet sliall be entered into by any State institution, city or town for the introduction of a sys-tem of water supply or sewage dis})osal until said advice shall have been received and considered: Pruriiled, Jiou-frcr, that any city or town having a regularly organized Board of Health may seek advice therefrom or from its County Boai'd of Health in lieu of that of the State Board. Sec. 20. "Whoever willfully or maliciously defiles, corrupts or makes impure any well, spring or otlier .source of water supply or reservoir, or destroys or injures any pii)e, conductor of water or other property per-taining to an aqueduct, or aids and abets in any such trespass, shall be guilty of a misdemeanor, and on conviction shall be fined not exceeding one thousand dollars or imprisoned not exceeding one year. Sec. 21. Any hou.seholder in whose family there is to his knowledge a person sick of cholera or typhoid fever, who shall permit the bowel dis-charges of such sick person to be emptied without first having disinfected them according to the instructions to be obtained from the attending physician or the County Superintendent of Health shall be guilty of a misdemeanor, and upon conviction shall be fined not less than two nor more than twenty-five dollars, or imprisoned not less than ten norjnore than thirty days. And in cases where such undisinfected discharges are emptied on the water shed of any stream or pond furnishing the source of water supply of any public institution, city or town the penalty .shall be a fine of not less than twenty-five nor more than fifty dollars, or imprisonment for not more than thirty days. And any i)hysician attend-ing a case of cholera or typhoid fever who refuses or neglects to give the proper instructions for such disinfection as soon as the diagnosis is made shall be deemed guilty of a misdemeanor, and upon conviction shall be fined not less than ten nor more tlian fifty dollars. Sec. 22. Whenever and wherever a nui.sance upon premises shall exist which in the opinion of the County Superintendent of Health is danger-ous to the public health, it shall be his duty to notify in writing the parties occupying the premises (or the owner, if the premises are not occupied) of its existence, its character and the means of abating it. X^pon this notification the pjarties shall proceed to abate the nuisance, but fail-ing to do this shall be adjudged guilty of a misdemeanor and shall pay a fine of one dollar a day dating from twenty-four hours after the notifica-tion has been served, the amounts so collected to he turned over to the County Treasurer: Prodded, hoiren'r, that if the party notified shall make oath or afiirmation before a justice of the peace of his or her inability to carry out the directions of the Superintendent it shall 1)6 done at the expense of the town, citj' or county in which the offender lives. In the latter case the limit of the expense chargeable to the town^ city or county shall not be more than one hundred dollars in any case: ProriV/cr^ /*);//(('/•, that nothing in this section shall be construed to give 34 NORTH CAROLINA BOARD OF HEALTH. the Supcriiiteiident the power to destroy or injure property without a due process of law as now exists for the ahatement of nuisances. Sec. 2;]. Vaccinatioii.—On the appearance of a case of small-pox in any neighhorhood all due diligence shall be used by the Superintendent of Health that warning shall be given, and all persons not able to pay shall be vaccinated free of charge by him, and the County Superin-tendent shall vaccinate every person admitted into a public institution (jail, county home, public school) as soon as practicable, unless he is satisfied ujion examination that the person is already successfully vac-cinated ; the money for vaccine to be furnished by the County Commis-sioners. The authorities of any city <»r town, or the Board of County Commissioners of any county, may make such regulations and provis-ions for the vaccination of its inhabitants under the direction of the local or county Board of Health or a committee chosen for the purpose, and impose such penalties as they may deem necessary to protect the public health. Sec. 24. The Board of County Commissioners of eacli county is hereby authorized at any time to call a meeting of the County Board of Magis-trates or Justices of the Peace to take into consideration the health interest of the people of their county, and, with the approval of the said Board of Magistrates, to levy a special tax to be expended under the direction of a committee composed of the Chairman of the Board of County Commissioners, the Mayor of the county town and the County SuiJerintendent of Health for the preservation of the public health. Sec. 25. The authorities of any city or town are hereby authorized, not already authorized in its charter, to make such regulations, pay such fees and salaries and impose such penalties as in their judgment may be necessary for the protection and the advancement of the public health. Sec. 26. Bulletins of the outbreak of disease dangerous to the pul)lic health shall be issued by the State Board whenever necessary, and such advice freely disseminated to prevent and check the invasion of disease into any part of the State. It shall also be the duty of the Board to inquire into any outl^reak of disease by personal visits or Ity any method the Board shall direct. The compensation of members on such duty shall be four dollars a day and all necessary traveling and hotel expenses. Sec. 27. Special meetings of the State Board of Health may be called by the President through the Secretary. The regular annual meetings shall be held at the same time and place as the State Medical Society, at which time the Secretary shall submit his annual report. Sec. 28. For carrying out the provisions of this act two thousand dollars, or so much thereof as may be necessary, are hereby annually appropriated, to be paid on requisition to be signed by the Secretary FIFTH BIKXXIAF. KK1N)1;T. '.\~) ami President of the State Board of Health ; and tlif printhiii: and s^ta-tionei'y necesFary for tlie board to be furni.shed ui)on requisition upon the State Printer. A yearly statement shall be made to the State Treasurer of all mone}'s received and expended in pursuance of this act. Sec. 29. A contingent fund of five thousand dollars is herel)y appro-priated, subject to the (iovernor'.s warrant, conntersigned and recorded by the Auditor of the State, to be expended in pursuance of the provis-ions of this act wlien rendered necessary by a visitation of cholera or any other pestilential disease. Sec. 30. All previous acts conflicting witli this act, and also all previous acts of appropriation for the jjublic health, are hereby repealed upon the passage of this act: Frovidt'd, that nothing herein shall operate as a repeal or abridgment of powers conferred by any special act on any local Board of Health. Sec. 31. Tliat this act shall be in force from and after its ratification. Ratified the 1st day of March, A. D. 1893. On Januaiy 27th letters with new blanks to be used for monthly reports were sent to all Connt}^ Superintendents and town reporters. On March 10th a letter and blank were sent to every Clerk of tlie Superior court in the State asking for a list of all the registered physicians in each county. On the 28th of March a second letter was sent to thirty-one Clerks who had not responded to first letter. On April 4th a letter of acknowledgment, together with a copy of the "Laws Regulating the Practice of Medicine in North Carolina," was mailed to all Clerks who had sent in lists. This letter explained to them the requirements for regis-tration, as the lists showed some illegal registrations had been made. While the administration of the laws regulating medical practice does not come technically within the jurisdiction of the Secretary of the State Board of Health it has a sufficient bearing on the health of the people, he thinks, to justify his action in availing himself of an opportunity to probably correct some errors in. the registration of physicians tr.at had 3(5 NORTH CAROLINA BOARD OF HEALTH. been made—an-l to prevent tlieir occurrence in the future, by calling the attention of the Clerks of Court especially to the law as it now stands. It is gratifying to know that his efforts were appreciated, by some of the Clerks at any rate, and that one to his certain knowledge recalled certificates which under a misapprehension had been incorrectly issued. In response to a call for a Conference of State Boards of Health to be held in N(,'W York on April 5, 1893, to consult upon the conditions of the quarantine stations of the coun-try and other matters pertaining to keeping out pestilential diseases, the President and Secretar}- attended as delegates from this Board. The principal business accomplished by this Conference over and above the good resulting from personal contact and interchange of ideas is set forth in the published report of the Secretary of that body. On April 12tli your Secretary received this letter: WiLMixGTOX, N, C, April 11, 1893. Dr. R. 11. Lewis, Secretary State Board of Health, Raleigh, X. C, DeaeDoctor:—TheQuarantineBoardof the port of Wilmington respect-fully submit that, in view of the opinion expressed bj' the Conference of Health Officers that the emergency demanded the erection and operation of disinfecting plants at seaport towns, the State Board of Health take up the question and consider the advisability of making available the appro-priation made for this port by the last Legislature. Respectfully, GEO. GILLETT THOMAS, Secretary Board of Quarantine, Fort of Wilmington, N. C. In consequence thereof I addressed the following letter to each member of the Board of Health, inclosing a copy of Dr. Thomas's letter with an abstract of the minutes of the Conference and of the legislative act making the appro-priation : FIFTH r.IKNXIAL REPORT. 37 Raleigh, N. C, April 14, 1893. Dear Doctor:—I have just received the following letter from the Sec-retary of the Board of Quarantine of the port of Wilmington: "The Quarantine Board of the port of Wilmington respectfully submit that, in view of the opinion expressed l>y the Conference of Healtli Officers that the emergency demanded the erection and operation of disinfecting plants at seaport towns, the State Board of Health take ujj the question and consider the advisability of making available the appropriation made for this port b}' the last Legislature." The following is an extract from a report of the proceedings of the Conference: "Dr. H. B. Baker, of Michigan, offered the following, which was unanimously adopted : ^ liesolred, That in the present emer-gency every State maintaining a maritime quarantine should possess a perfectly equipped station with all appliances necessary for thorough disinfection of infected vessels, unless there are special reasons to the contrary.' The last clause was added to cover the case of States like New Jersey, whicli can avail themselves of the stations of neigldioring States." As this is a matter of urgent imi^ortance, in order to save delay and the necessity of a special meeting of the Board so near the time of the regular meeting on the 10th pi'ox., I would thank you for an immediate expression of opinion by letter on the question. If a majority of tlie Board reply in the afiirmative, and the Governor approves, the Quarantine Board would feel authorized to give out the contracts at once, and more regular action could be taken by the Board of Health when it meets, if deemed necessary. The facts on which the above letter is based are these : The last Legis-lature appropriated •'?20,000 for a modern disinfecting jilant at Southport, which now has none at all, but attached the condition that the money should not be available until "in the opinion of the Governor and the State Board of Health the entrance of cholera into the port is imminent." Upon the construction of the word "imminent" hangs the decision. In Worcester's Comprehensive Dictionary the word "imminent" is detined "impending; threatening; near," tlie only meanings given. In th.e opin-ion of the recent Conference alluded to in the letter quoted cholera is "impending; threatening; near," as it doubtless is in the oi)inion of nearly every other person of any sanitary experience, owing to our con-stant intercourse with western FAirope. In this case the word imminent could not be taken to mean something "about to fall on the instant," for it would be manifestly absurd to wait until a ship with cholera on board had entered the mouth of the Cujie Fear before giving out the con-tract for apparatus requiring two or three months for its construction to prevent the entrance of the disease. So that in the opinion of the under-signed, as well as of two other members of the Board with whom he has 38 XOIITH CAROLINA KOARD OF HEALTH. spoken, "the diiiigev of the entrance of cholera into the port of Wilming-ton is imminent" in the sense in which the word can alone be reasonably applied to the case in hand. Please let me know by return mail whether yon agree or disagree with that opinion. Not a day is to be lost if any thing is to be done. Very truly yours, RICH'D H. LEWIS, Secrrtary. To tliis ictter replies were received from all the members, only one opposing the approi)riation. As soon as a majority had been heard from, reahzing the importance of getting to work on the Quaraiitine Station at the earliest possible moment, I wrote to his Excellency Governor Carr, who was then at Rocky Mount, which letter was delayed in reaching him. Immediately npon his return to the capital I laid the matter with the correspondence before him. He appointed an hour the same afternoon for me to call for his decision, but before it arrived he was unexpectedly sum-moned to Newbern. On his return, having received replies from every member of the Board, I addressed to him this communication: May ], 1893. His Excellency Elias Carr, Governor of Xorili Cnroluia, Sir:—Since my communication of the 17th ult., addressed to you at Rockj'^ Mount, stating that "replies from a majority (of the Board of Health) expressing the opinion that 'the entrance of cholera into the portof Wilmington as imminent' had been received," I have heard from every member. The replies from eight are as above, and from one to the effect that the entrance of cholera is no more imminent now than at the time of the passage of the act. I beg to dissent from that oiiinion, for the reason that a number of fresh cases have occurred on the west coast of Europe since the adjournment of the Legislature, and sanitarians now consider the outlook for the summer very gloomy. The Quarantine Board of Wilmington now awaits the concurrence of your Excellency in the opinion of the State Board of Health, a.s required by the act, before beginning this work of such great importance in pro-tecting the port and State from, the scourge which threatens us. With great respect, Your obedient servant, IlIOK'D H. LEWLS, Secretary. FIFTH BIENNIAL KEPORT. o9 To this letter the Governor rei:)lied as follows: May 1, 1893. Dr. Richard H. Lewis, Secretanj X. C. Board of Health, Raleigh, N. C , Dear Sir:—Eeplying to j'our kind favor of the 1st instant, I would state, in accordance with your views and the other members of the State Board of Health, and after viewing the situation as it is, that, section 2 of the act to amend section 2915 of The Code as follows : "For the purpose of carrying into effect the provisions of section 2915 as herein amended the sum of twenty thousand (?20,000) dollars is hereby appropriated out of any moneys in the State Treasury not otherwise appropriated, to be paid from time to time, as required in the prosecution of the work, on the requisition of the Treasurer of the Quarantine Board and aj)proved by its President: Provided, that the funds appropriated by this act shall not be paid over by the Treasurer until the Governor and State Board of Health of North Carolina shall certify to the Treasurer that there is imminent danger of cholera visiting the city of AVilmington or other sections of the State," makes it my plain duty to inform j^ou that the amount appropriated ($20,000) is now available, and can be used in carrying out the pi-ovisions of the act. With highest esteem, I am, Yours very truly, ELIAS CARE, (rorernor. I immediately wired the Secretary of the Quarantine Board of AVilmington: Govei'nor approves. Go ahead. If. H. LEWIS, Secretary. Afterwards I wrote him as i'oilows : May 2, 1893. Dr. Geo. G. Thomas, Secretary Board of Quarantine, Port of Wllmingtoii, My' dear Doctor:—In compliance with your communication of the 11th ult., calling upon the State Board of Health to "take up the question and consider the advisability of making available the appropriation made for the port by the last Legislature," I addressed a letter setting forth the facts to each member of the Board. Replies from all v>ere duly received—eight voting in favor and one against complying with the condition necessar\' to make the appropriation available. The whole correspondence was laid before his Excellency, the Gov-ernor, at the earliest opportunity, and to-day I received his decision. I inclose his letter, w'hich, after submitting it to your Board, you will please return and oblige. Yours trulv. RICH'D H. LEWIS, :\I. D., 3 Secretary. 40 NORTH CAROLINA BOARD OF HEALTH. While the securing of a quaruutine station with all the modern improvements for our chief seaport, a work of the liighest value, from a sanitary point of view, to the State, •cannot be credited to our Board, it is gratifvino- to know that the leader in that movement was one of our members. Dr. George G. Thomas, who v\'as most ably assisted by Dr. T. S. Burbank, Messrs. J. C. Stevenson, Alex. Sprunt and •others. Thanks to their efforts and to our enlightened and progressive Legislature North Carolina will soon be abreast of the most advanced communities in the matter of mari-time quarantine protection. In the performance of the duty imposed upon me in Section 9 of the Act Relating to the Board of Health I prepared the following 23amphlet containing Instructions for Quarantine and Disinfection : INSTRUCTIONS FOR QUARANTINE AND DISINFECTION. EXTRACT FROM SECTION NINE OF AN ACT RELATING TO THE BOARD OF HEALTH, RATIFIED MARCH i, 1S93. "Iiilaud quarantine shall be uuder the control of the County Superintendent of Health, who shall see that diseases especially dangerous to the public health, viz.: small-pox, diphtheria, scarlet fever, yellow fever, typhus fever and cholera, are prop-erlj' quarantined and isolated within t\vent3--four hours after the case is brought to his knowledge; and that after the death or recovery' or removal of a person sick of either of the diseases mentioned, the rooms occupied and the articles used by the patient are thoroughlj- disinfected in the manner set forth in the printed instructions, both as to quarantine and disinfection, which shall be furnished him bj' the Secretary of the State Board of Health. The expense of the quarantine and of the disinfection shall be t>orne by the householder in whose family the case occurs, if able, otherwise by the cit}', town or county of which he is a resident. * * * Any person neglect-ing or refusing to comply with or in any way violating the rules promulgated in the manner above set forth on the subjects of quarantine and disinfection shall be deemed guiltj- of a misdemeanor, and upon conviction shall be fined or imprisoned, at the dis-cretion of the court, not less than five nor more than fifty dollars, or less than ten nor more than thirtj' daj's. * * * In any city or incorporated town having a regularly appointed medical health officer who is a member of the County Board of Health, the duties assigned in this section to the Count}' Superintendent of Health shall be per-formed by the said medical health officer for the people of his city or town. * * * " 1. Every person sick of either of the diseases mentioned in the above •extract from section nine should be immediately isolated, with his nurses, in a separate room, if there is one. and nothing: should be taken out of FIFTH BIENNIAL REPORT. 41 such room at any time without having been previousl}' disinfected in the manner described under the head of disinfection. The mildness of the attack must not be laermitted to beget laxity in carrying out these hist ructions. 2. When any of the diseases mentioned above occurs in a house con-taining only one room, the house and all persons residing therein should be quarantined. The same rule should apply to the entire house, even if of sufticient size to permit the isolation of the sick person and his nurses in a separate room, in cases of small-pox, cholera, yellow fever, and typhus fever; but in cases of scarlet fever and diphtheria the quar-antine need extend only to the room occupied by the patient and his luirses and to the occu])ants thereof Whenever possible persons sick of small-pox, cholera, typhus fever or yellow fever should be immediately removed to quarters specially provided for the detention and treatment of such cases. Particular care should be taken to quarantine for a time sufficiently long to insure safety to others all persons who were exposed to infection before the removal of the patient. 3; When a house or room is in quarantine no one whatever except the .attending physician and the clergyman of the family slsould be admit-ted. The person doing the outside service for a quarantined family should take orders verbally from a distance, and should lay down at the entrance of the house or room any aiticles he may bring there. Xo pet •dog or cat should be allowed in the room. 4. When either of the diseases mentioned has declared itself in a house no work for trade purposes or for private families should be taken in by any one inhabiting the same, and all such work as may have been taken in before the outbreak of the disease should be disinfected before being sent home. 5. !Xo person recovering from either of these diseases, and no person who has nursed such a patient, should quit the house before receiving a certificate from the County Superintendent of Health, municipal medi-cal health officer, or attending physician, that the precautions required under the head of disinfection have been taken. Children must have certificate before re-entering school. See section 13 of the law. 6. No person residing in a quarantined house should go beyond the lot (or farm, provided there be no other })ersons living thereon) or put himself in direct communication with any one from outside. 7. When a house is quarantined any person residing therein, other than the patient, who wishes to leave for tlie purpose of changing his residence, may do so with the written permission of the County Super-intendent of Health or municipal medical health officer, provided he takes all the precautions required under disinfection. 8. The body of every person who has died of either of the diseases mentioned should be disinfected in the manner described below. It 42 XOKTH CAROLINA BOAKD OF HEALTH. should be kept isolated up to the moment of the funeral in the room occupied by such person during his illness. The funeral should take place as soon as possible, and in all cases be private, attended only by those absolutely necessary to the proper performance of the burial, unless the body having been disinfected be in a metal coffin hermetically sealed. Children should under no circumstances be present. 9. When there is a case of either of the diseases mentioned in a house a placard stating the name of the disease, to be furnished by the County Superintendent of Health, shall be posted on the front door of said house. This placard must not be removed in any case until the jjremises have been properly disinfected, and then only by the County Superin-tendent of Health or municipal medical health officer in per.son, or by exjiress permission of the same. DISINFECTIOX. I. DURING THE CONTINUANCE OF THE DI.SE.\SE. {a). All the sunlight possible and as much fresh air as the nature of the disease and the state of the weather will permit should be admitted to the sick-room. (/)). The expectorations and evacuations of the patient should be received in vessels in which there is a considerable quantity of bichloride of mercury, solution Xo. 2, or milk of lime, or an equal quantity of either of them should be added thereto and the mixture allowed to stand at least a half hour before throwing into the water-closet, if the house be connected with a system of sewers, or, otherwise, should be buried at a distance of not less than 100 feet from any well or spring. (c). Soiled body and bed-clothing, handkerchiefs, rags, etc., should, as soon as discarded, be immediately burned or immersed in a vessel of suffi-cient size, containing enough of the zinc or chloride of lime solution to completely cover them, and kept there until they can be thoroughly boiled for not less than a half hour in plain water, or better the zinc solution, and then washed and dried in the sun. (fZ). The remains of the food served to the patient should be burned in the room or soaked in one of the disinfecting solutions mentioned and then buried. II. AFTER THE RECOVERY, REMOVAL OR DEATH OF THE PATIENT. (a). Of the articles used and room occupied by the patient. The vessels should be washed with a disinfecting solution. Burn in a hot fire suffi-ciently fierce to consume quickly and completely such articles as are not too valuable. Others that can be boiled without injurv should be boiled hard for not less than a half hour, then thoroughly washed and dried in the sun. The remainder—furniture, curtains, woolen clothes, pillows, beds, mattresses (the contents of mattresses when straw, shucks or other FIFTH BIENNIAL REPORT. 43 cheap material should be burned and the ticks boiled) and all other articles which have been exposed to the infection should be hung on racks, or otherwise looselj^ distributed about the room, so as to permit free access of the gas to every part, the carpet, if there be one, being left on the floor, and then disinfected at the same time with the room by sulphur fumigation. Afterwards they should be taken into the open air and thoroughly beaten and sunned. If preferred, in cases where every article in the room can be subjected to the process to be named, or when the I'oom cannot be made tight enough to retain the sulphur fumes, every article in the room which can be should be boiled and the remainder, including the floor and wood-work, should be well washed with the bichloride solution No. 1. The walls and ceiling should have the same solution thorouf/JiIy applied to them or be well whitewashed. {b). Of the. person of the recovered patient. Wash the body, including the hair, with the bichloride solution No. 1 and put on clean clothes that have not been in the sick-room or that have been disinfected as prescribed in 1 (c). (e). Of the dead hodij. Wrap the bod}' in a well-sewed sheet thoroughly saturated with the bichloride solution No. 2 or with the chloride of lime solution. Put two pounds of chloride of lime in the coffin. (fO- Qf persons before leacing a house ivhicJi ]ias been, qnarantoied. Wash at least the uncovered portions of the body—hands, face, beard and hair —better the entire body—in the bichloride solution No. 1 and put on clean clothes that have not at any time been exposed to the infection or have been disinfected in the manner described. The notice of the attend-ing physician and visiting clergyman is called to the importance of their observing these precautions and at least washing their hands in the bichloride solution the last thing before leaving the room. {e). Of a vehicle used to carry the body, living or dead, affected witJi either of the diseases enumerated. Remove all cushions, curtains and other acces-sories and disinfect by boiling or soaking in the bichloride solution No. 1 and wash out the interior with bichloride solution No. 2. DISINFECTANTS. 1. Bichloride of mercury, solutinn No. 1. Bichloride of mercurj' 1 drachm, water 1 gallon. 2. Bicldoride of mercury, solution Xo. 2. Two drachms to the gallon. Owing to its poisonous character a solution of bichloride should be col-ored w itii bluing to prevent mistakes. It should be kept in earthen or wooden vessels, as it corrodes metals. 3. Ztuc solution. Sulphate of zinc (white vitriol) 4 ounces, salt 2 ounces, water 1 gallon. 4. Chloride of lime solution. Fresh chloride of lime 6 ounces, water 1 gallon. 44 NORTH CAROLINA BOARD OF HEALTH. 5. Milk of I'nne {irhneirash). Pour on 1 quart of quick-lime, broken into-small ijieces, 1 quart of water. As soon as reduced to powder add 3- quarts of water. Store in well-closed vessel. ^lake fresh supply every few days, as it does not keep well. Can be kept much longer by pouring: one-half cup of kerosene on top to exclude air. (j. Sulphur finnlgation. The room must be vacated. Close as tightly as possible every opening, fire-place by stutting tiiroat of chimney witli. old bags or plenty of straw; cracks around doors and windows by calk-ing with tow or cotton, etc. Place small lumps or powdered sulphur, in the proportion of 3 pounds for every 1,000 cubic feet of air space to be-disinfected, in an iron pot or pan free from cracks. Set the vessel, if it has no legs, on bricks in the bottom of a tub containing 2 or 3 inches of hot water (to put out fire in case burning sulphur should leak out or overflow); light with red-hot coals or by pouring on a tablespoonful of alcohol and applying a match. Be careful not to inhale the fumes. Close the door of exit as tight as possible. Keep the room closed for twelve hours, excei^t in cases where family has no other room to sleep, then, six hours. Then open all doors and windows and air thoroughly. NOTE. It i.« practically established that if the instructions given in this circu-lar ai'e faithfully carried out these justly dreaded diseases will not spreads Such being the fact the responsibility of those whose duty it is to carry them out is great. A positive })romise from the attending physician to the County Super-intendent of Health, or to the municipal medical health officer, to see that the instructions are faithfully carried out would relieve the latter of responsibility. The Count}' Superintendent of Health or the municipal medical health officer should not fail to promptly furnish to both the attending physi-cian and the liouseholder in whose family either of the diseases men-tioned in section 9 occurs a copy of these instructions. Any further information desired will be cheerfully furnished. RICH'D H. LEWIS, M. D., Secretary. A copy of these instructions, together with a copy of the new hiw, was mailed to every registered physician in ever}^ county in North Carolina except four, from the Clerks of which no reply has been received to either of mj-two letters: I shall write them a^ain.* The total number *The list of physicians has been made complete, and the instructions were promptly distributed. FIFTH BIKNNIAL KEPORT. 45- mailed so far is 1,517. The "instructions" in quantity will be sent to all County Superintendents and municipal health officers. With them will be sent the placards required to be posted on the front door of every house con-taining a case of either of the diseases mentioned in sec-tion nine. Continuing the plan of trying to educate the people in sanitary matters b}' popular articles in the newspapers, I sent an article, together with a copy of the Instructions for Quarantine and Disinfection, to every newspaper in the State with a request that they publish same. Just on this line members of the profession can be of great assistance, provided they approve of the plan and the articles, by using their influence with the editors of their local papers to get them to publish them. A public sentiment favorable to sanitation must be built up if we expect to make any substantial progress. The Anglo- Saxon people of this free country cannot be driven to the performance of what they do not approve. They must be persuaded of the importance of these restraints upon their liberties under certain circumstances before they can be successfully imposed. But the physicians of the State can be of much greater-service to the cause of the public health in another way,, and that is by giving to the law and the sanitary regula-tions imposed by it their own cordial support. Indeed the practical application of the law is in the hands of our medical men. If they give it their cordial support and urge its importance upon their patients it will be carried out, but if the}' are indifferent, and make light of and belittle it it will surely be largely of no effect. In view of the wholesale danger to life of the spread of contagious and infectious diseases, which can almost surely be pre-vented by the strict enforcement of .^anitary regulations, 46 NOIITH CAROLINA BOARD OF HEALTH. this is no light responsihiUty wliich rests upon us, whether Y\'o arc willino- to assume it or not. kSeetion 1!) of tlio law requires all Htatc institutions before adojiting a system of water supply and sewerage to consult the State Board of Health. In compliance with that requirement the President of the Board of Directors of the proposed School for the Deaf and Dumb at Morgan-ton addressed the following letter to the President of the Board of Health : BiLTMORE, N. C, March 31, 1893. /);. Herirn T. B<(himm, Scilcin, X. <'., Dear Sir:—I see that the Laws of 1803 make it the dut_y of the Board of Health of the State of North Carolina to consult and advise with all the State institutions already having or intending to introduce systems of water supply, drainage, or sewerage. The Board of the Deaf and Dumb School at Morganton are considering their water supply; we are considering two ways of furnishing same. One by gravitation, and to get it would have to lay a line of pipe about four miles at a cost of from $12,000 to $15,000, which is more money than the Board can pay if we can get that which will answer clieaper. We also have under considera-tion the "Gang Well'* system, which, if it is thought it will work well and the quality of the watei- is all right, will be a great deal cheaper. This system we will have ample means of testing, as the Morganton Tan-nery is putting in a gang well on adjoining property to that of the insti-tution. I do not think there will be a doubt as to quantity if the quality is what is desired. T go into the details so you can the l)etter advise us, and to do this would be glad to have you with us at our next Board n^iCcting on the 14th April. The sewage from tb.e building will be con-ducted in the usual sewage pipe one-half mile from building, emptying into a creek with a fall of about one hundred and fifty feet. Holding to hear from you on the subject, or, better, see you at our meeting, I am very truly, M. L. REID, Chairinau Board Deaf and Dumb School. In accordance therewith a committee composed of Drs. H. T. Bahnson and S. Westray Battle visited Morganton, examined carefully into the matter and made the follow-ing report: FIFTH lilKNXIAL KEPOET. 47 May o, 1893. To till' Honorable Board of DlnctorK Deaf and Dninh School at Morganton, X. <'., Gextlemex:—The committee appointed by the North Carolina Board of Health, in compliance with your request, to examine and advise your honoraVjle body relative to a water supplj- and sewerage system for the Deaf and Dumb School at ^lorganton, N. C, beg to submit tlie following report: A careful inspection of the site and surroundings has satisfied us that the sewage of the institution should be emptied directly into Hunting creek. The smaller stream to the rear of the school is objectionable on account of its limited water supply, and its liability to overflow during freshets and deposit the sewage on the lowlands in its course. The preva-lent westerly winds would thence convey its unpleasant and perhaps noxious efHuvia to the institution. Hunting creek furnishes so large a volume of water that this menace is enlirelj' avoided, and a conduit in a direct line, with ample and uninterrupted fall, would cost very little more. The water supply presents a more difficult problem. Wiiile there is no doubt in our minds that a pipe line from, a mountain stream, whose water shed could be owned and protected by the authorities of the institution, would furnish the best and safest supply, the great cost practically pro-hibits its adoption. A system of gang wells has been successfully employed by the large tannery on the adjoining property, which fur-nishes very much more water than will ever be I'equired bj- your institu-tion. This water is apparently pure and the plant required an outlay of less than one-fourth of the amount whicli a pipe line from the mountain would cost. The site in the rear of the school is apparently favorable for the adop-tion of a similar system. "Water ol)tained here would probably be free from mineral impurity, and the danger of contamination is so remote that it can safely be left out of consideration. Under the circumstances we cannot hesitate to recommend tliat an attempt be made to obtain a water sujiply from this source. Very respectfully, HENRY T. BAHNSOX, M. D., 8. WESTRAY BATTLE, M. D., Committee. It needs no argument to prove that the greatest danger from contagious and infectious diseases is where numbers of people are congregated together in close quarters, and therefore that the machinery for combating them should be 48 NORTH CAROLINA JJOAIID OF H1:ALTH. made as near perfect as possible in tlie cities and towns. To that end the organization of local municipal Boards of Health is a necessity. Section 25 of the law confers full powers upon all municipal corporations to make such regulations and impose such penalties for tlic preservation of the public health as thev mav deem necessary ; but the matter is always optional with them. In the hope of inducing as many as possible to organize Boards of Health with the necessary powers, I have prepared the following letter to be sent to the Mayors of all towns of more than 500 inhabitants: R.VLEiGH, X. C, May 8, 1893. Sis Honor Ihe Muyor, De.\r Sir:—The warm weather is upon us and it is time for those of us upon M'hom rests the responsibility of looking out for the protection of the health of the people to be bestirring ourselves. ^Yhenever there is a Board of Health organized it is clearly its duty; but otherwise, in cities and towns, it falls upon the Mayor and Board of Aldermen or Town Commissioners. It is best, however, to have a body whose special duty it is, and therefore it is expressl}' desirable that Boards of Health should be formed in all towns where they do not already exist. This is particularly the case just at this time, since the entrance of cholera into our countiy this summer is regarded as more than probable. Have you a Board of Health in your town? If so, will you be kind enough to send in the names of its ofhcers and a copy of its sanitary regulations? If not, will you not exert yourself to secure the form-ation of one as soon as possible? If desired, I would take pleasure in forwarding to you, free of charge, model ordinances, blanks, etc. Your aid in this important matter is asked in the interest of your own people, chiefly, but also for the sake of other citizens of the State who might incur disease from your town if the proper and necessary sanitary precautions are neglected. Your kind attention will oblige. Yours very respectfully, RICH'D H. LEWIS, M. D., Secretary. The subjoined letter, inclosing model ordinance, blanks, etc., was sent to every county-seat and other town of more than live hundred inhabitants: FIFTH lilKXXIAL KKPORT. 49 Raleigh, X. ('., June 0, 1S93. 77/1' IIiiiKirdhIr Miiijor mid Fxntrd of , (tentlemex:—I send herewith a copy of the Act Relating to the Board of tloalth (Chai)ter 214, Laws of 1893), a model health ordinance, based chieHy on the admirable one issued by the Pennsylvania P.oard of Health, and various blanks which explain themselves. I hope that you will adopt and enforce them, thereby materially advancing the cause of l)nblic health and pan jkihsu the i:>rosperity of your town. The ordi-dance may strike you as being rather voluminous, but a careful consid-eration of the same will, I think, show the reasonableness and impor-tance of each section. Still, if deemed necessary, it can be modified to suit the particular conditions of your town, though I would be glad to have it adopted as it stands in order to secure a uniform system in every town in the State. In cities and towns where people are more or less crowded together, and the danger of contamination of air and drinking water and of the spread of communicable diseases from person to person is in consequence greatly increased, the practical application of sanitary laws is especially important. The collection of vital statistics, particularly those relating to the cause of death, should be carefully looked to in order to ascertain those most prevalent, with a view to taking special precautions against them in the future. It is also of great importance from a material point of view. One of the liist inquiries made by intending immigrants is in regard to the healthfulness of tiieir contemplated destination, and that information would be sought for at this office. To give an opinion I must be assured of their coiiiplcteuess and accuracy. Those two essentials cannot be obtained unless the method recommended is faithfully carried out, viz., the positive refusal to allow the body of any one dying in the town to be buried or removed without a permit from a designated official, based upon a properly tilled out and signed death certificate giving the cause of death; or some other method e(}ually as reliable. The healthfuhiess of our State is one of its greatest attractions, and the only way to demonstrate it to strangers in these days of scientific accuracy is by means of reliable vital statistics. In our present stage of sanitary development these statistics can only be obtained from our cities and towns, and I trust y(ju will help your own immediate home and, at the same time, aid me in show'ing to the world our advantages in this most important item of health. Any further assistance in my power would be most gladly rendered l.-y. Yours very respectfully, RIGHT) H. LEWIS, SI. I)., Sccrettiri/. '~>0 NORTH CAROIJXA P.OARD OF HEALTH. ORDINANCE OF THE OF FOR THE BETTER PRESERVATION OF THE PUBLIC HEALTH AND TO PREVENT THE SPREAD OF C0M:\IUNICABLE DIS-EASES. In virtue of the powers conferred by section 25, chapter 214, Laws of 1893 of the State of Nortii Carolina, be it ordained by the-of thet ----of --,anditis hereby ordered by the authority of the same — Section' 1. That the Mayori shall constitute a Local Board of Health for thet of , whose duty it shall be to faithfully execute all Laws of the State (chapter 214, Laws of 1893—An Act Relating to the Board of Health) and all ordinances relating to the public health of thef of The Board of Health shall have power to make all necessary rules and regu-lations for the promotion and preservation of the public health and the collection and registration of vital statistics within thet of --.subject to the ratification of the* A majority of the members shall constitute a quorum. Sec. 2. The ]\Iayor shall be ex officio President of the Board of Health. Heshall convene the Board in regular session on the first*]^ in each month from April to Octol^er inclusive, and quarterly thereafter, and shall have power to call the said Board together in extra session whenever, in his judgment or in that of the health officer, the public health demands it. Sec. 3. The medical member| of the Board shall be e.v officio the health officer of thet , and shall be the executive officer of the *Insert City Couucil, Board of .-Vldermen or Board of Town Conunissiouers, as the •case may be. tCity or Towu. '^Foi- small lo7c!is insert '"the Town Clerk and the County Superintendent of Health " {if that official is a resident of the town and acceptable to the town authorities), otherw^ise insert "the Town Clerk and a resident registered physician to be elected bj- the Board of Towu Comiuissioners." F'or larger tozvns insert " the Towu Clerk and three resident registered physicians to be elected by the Board of Town Coniinissioners.'' If preferred insert "the Town Clerk and three other persons, one of whom shall be a resident registered physician to be elected, etc." For cities insert " Chief of Police, City ,\ttornej-. Chairman of the Sewer Committee. Chairman of the Water Committee, Chairman of the Street Committee and County Superintendent of Health" (if he be a resident of the city), otherwise " a resident regis-tered physician to be elected by the Board of Aldermeu." Perhaps it might be better to insert after City Attorney "the County Superintendent of Health and three other resident registered physicians to be elected by the Board of .\ldermen." •"Insert day of week. 5\Vhere there is more than one medical member of the Board substitute " The medi-cal member of the Board receiving the highest number of votes shall be the health officer." FIFTH niKXXIAr. i;Er(*RT. ol Board. He shall perform for the* the duties^ of the County Superintendent of Health as laid down in Chapter 214, l^awsof 189o, and such other duties as may be imposed by the Board, including the collec-tion of vital statistics, which he shall use every effort to make as full and accurate as possible, especially such as relate to the cause of death. He shall notify the Secretary of the State Board of Health of his election and shall make such reports and answer such inquiries concerning the sanitary condition of thef , diseases prevalent, vital statistics, etc., as may be required by the State Board of Health. He shall hold his office for years, and until his successor is appointed and has qualified. Sec. 4. The* Clerk shall be ex officio Secretary of the Board. He shall keep a full and accurate record of all business done at its meet-ings. He shall cause to be published in the newspapers of the* and by printed or written notices, to be posted inf , all orders, rules and regulations of the Board, which pablication shall be deemed legal notice of the same to all persons. He shall file and keep for refer-ence all reports, complaints, orders or other papers relating to the busi-ness of the Board. He shall also keep, in a book provided for the pur-pose, a full and complete record in detail of all vital statistics. Sec. 5. The Board of Health may, with the approval and consent of the Board of J electa speciaHj , or use one of the regular force, who shall be known as the Sanitary Inspector. He shall inspect at least once in every month, from April to October inclu-sive, the premises of every householder in the "^ He shall make a note of and report in writing to the health officer any violations of the orders, rules and regulations promulgated by the Board, and shall serve such legal notices as the Board may direct. His term of office and compensation shall be fixed by the Board ofi Sec. 6. The Board of Health, through its health officer, shall make a report annually in ]March, for the preceding twelve months ending with the last day of February, to tiie Board of j Sec. 7. Whatever is dangerous to human life or health, whatever ren-ders the air or food or water or other drink unwholesome, and whatever building, erection, or part or cellar thereof, is overcrowded or not pro-vided with adequate means of ingress and egress, or is not sufficiently supported, ventilated, drained, cleaned or lighted, are declared to be nuisances, and to be illegal; and every person having aided in creating or contributing to the same, or who may support, continue or retain any of them, shall be deemed guilty of a violation of this ordinance, and also be liable for the expense of the abatement and i-emed\' therefor. *City or Town, flnsert number and location of public places. |Town Commissioners or Aldermen. IConstable or policeman. 52 NUUTH CAROLINA Bt)AKL) OF HEALTH. Skc. 8. No house-refuse, oft'al, garbage, dead animals, decaying vegeta-ble matter or organic waste substance of any kind shall l)e thrown on any street, road, ditch, gutter or public place within the limits of this . , and no putrid or decaying animal or vegetable matter shall beTkept in any house, cellar or adjoining out-]»uilding or grounds for more than twenty-four hours. Sec. it. No person or persons without the consent of the Board of Health"" shall build or use any slaughter-house within the limits of this , and the keeping and slaughtering of all cattle, sheep and swine and the preparation and keeping of all meat, tish, birds, or other animal food, shall be in the manner best adapted to secure and continue their healthfulness as food; and the keeping of the premises shall be with such care and cleanliness as not to endanger the public health. No meat, fish, birds, fowls, fruit, vegetables, milk, and nothing for human food not being then healthy, fresh, sound, wholesome, tit and safe for such use, nor any animal or'fish that died by disease or accident, and no carcass of any calf, pig or lamb which at the time of its death was less than four weeks old, and no meat therefrom, shall be brought within the limits of this , or offered or held for sale as food any-where in said Sec. 10. No person or company shall erect or maintain within the limits of this— any manufactory or place of business danger-ous to life or detrimental to health, or where unwholesome, ofiensive or deleterioiis odors, gas, smoke, deposit or exhalations are generated, such as tanneries, refineries, manufactories of starch, glue, leather, chemicals, fertilizers, gas, etc., without the pernjit of the Board of Health,* and all such establishments shall be kept clean and wholesome so as not to be offensive or prejudicial to public health. Sec. 11. The keeper or keepers of a livery or other stable shall keep liis or their stable-j-ard clean, and shall not permit, between the first day of April and the first day of Novembei", more than loads of manure to accumulate in or near the same at any one time except by express permission of the Board of Health.* Sec 12. No pig-pen shall be built or maintained within the limits of this without a permit from the Board of Health,* or within one hundred feet of any well or spring of water used for drinking purposes, or within thirty feet of any street or of any inhabited house, or unless constructed in the following manner, viz., so that the floor of the same shall be not less than two feet from the ground in order that the filth accumulating under the same may be easily removed; and such filth accumulating in, about and under the same shall he removed at *Where there is no Board of Health organized snbstitute " Board of Town Commis-sioners " or " Board of Aldermen.'' FIFTH i'.TKXXIAL REPORT. 53 least once a Aveek, and oftener if so ordered, and on the fiulure of any owner or occupier of such premise;^ i^o to do, then the same sliall be done by the Sec. lo. Xo privy-vault, cess-pool or reservoir, into which a privy, water-closet, cess-pool or stable or sink is drained, shall be consti-ucted, dug or permitted to remain within the corporate lin)its of this Earth privies and earth closets, witli no vault, pit or depression below the surface of the ground, are allowed, but sufficient dry earth or ashes must Vje used daily to absorb all the fluid part of the deposit, and the contents must be completely removed at least once every month. •- Sec. 14. The following diseases are declared to be communicable and dangerous to the public health, viz.: small-pox (variola, varioloid), cholera (Asiatic or epidemic), scarlet fever, (scarlatina, scarlet rash), measles, diphtheria (diplitheritic croup, diphtheritic sore throat), typhoid fever, typhus fever, yellow fever, spotted fever (cerebro-spinal meningitis), epidemic dysentery, hydrophobia (rabies) and glanders (farcy), and shall ])e understood to be included in th.e following regulations, unless certain of them only are specified. Sec. 15. Whenever any householder knows that any person within his family or household has a communicable disease, dangerous to the public health, he shall, within twenty-four hours, report the same to the health otficer,t giving the street and numl)er or location of the house. Sec. 1(i. Whenever any jihysician finds that any person whom he is called upon to visit has a communicable disease, dangerous to the public health, he shall, within twenty-four hours, report the same to the health officer,t giving the street and number or location of the house, on the receipt of which report the health officer shall immediately notify the school committee of the public school, the superintendent of the graded school and the principals of private schools within the limits of this , at the same time calling their attention to Section 13, Chapter 214, Laws of 1893. Sec. 17. No person shall, within the limits of this , unless by permit of the health oflEicer,j carry or remove from one building to another any patient atFected with any communicable disease dangerous to the public health. Nor shall any person, by any exposure of any individual so afiected, or of the bodv of such individual, or of any *To towns and cities having- already or about to introduce a system of sewerage sug-gestions as to the proper ordinances will be gladly furnished by the Secretary of the State Board of Health. fWhere there is no medical health officer insert "County Superintendent of Health." as required by chapter 214, Laws of 1S93. tWhere there is no Board of Health insert "County Superintendent of Health." 54 NOKTH CAROLINA BOARD OF HEALTH. article capable of conveying contagion or infection, or by any negligent act connected with the care or custody thereof, or by a needless expo-sure of himself or herself, cause or contribute to the spread of disease from any such individual or dead body. vSec. 18. There shall not be a public or church funeral of any person who has died of Asiatic cholera, small-pox, typhus fever, diphtheria, yellow fever, scarlet fever or measles, within the limits of this and the family of the deceased shall in all such cases limit the attend-ance to as few as possible, and take all precautions possible to prevent the exposure of other persons to contagion or infection; and the person authorizing the public notice of death of such person shall have the name of the disease which caused the death appear in such public notice. Sec. 19. Xo person shall let or hii'e any house, or room in a house, in which a communicable disease, dangerous to the public health, has re-cently existed, until the room or house and premises therewith con-nected have been disinfected to the satisfaction of the Board of Health,'^ in accordance with the "Instructions for Quarantine and Disinfection" furnished by the Secretary of the State Board of Health; and for the purposes of this section the keeper of a hotel, inn, or other house for the reception of lodgers, shall be deemed to let or hire part of a house to any person admitted as a guest into such hotel, inn or house. Sec 20. Members of any household in which small-pox, diphtheria, scarlet fever or measles exists shall abstain from attending places of pub-lic amusement, worship or education, and fiom visiting other private houses except on express permission of the health officer.* Sec. 21. The clothing, bed-clothing and bedding of persons who have been sick with any communicable disease, dangerous to the public health, and the articles which they have used and the rooms which they have occupied during such sickness shall be disinfected under the direction of the Board of Health* in accordance with the "Instructions for Quar-antine and Disinfection" furnished by the Secretary of tlie State Board of Health. Sec. 22. Upon the appearance of a case of small-pox inf county it shall be the duty of every adult and every parent, guardian or master of every minor residing within the limits of thisi , who has not had small-pox or been vaccinated so as to have taken cow-pox regularly, to be, if an adult, vaccinated, or in the case of a minor, to cause such minor to be vaccinated within two weeks after the appear- *Where there is no Board of Health insert "County Superintendent of Health." tlnsert name of county in which town or city is situated, or if preferred substitute "within a radius of miles." JCity or town. FIFTH BIENNIAL REPORT. 55 ance of such case of small-pox unless unable to do so \)y reason of pov-erty; and it shall be lawful for any registered physician residing in this* , on application of such resident adult, or parent, mas-ter or guardian of such resident minor, as is unable by reason of poverty to pay the vaccination fee, to vaccinate said adult or said minor and present his bill therefor, properly authenticated, for an amount not exceeding the fee iisually charged for such services, and to recover the same of and from the corporation, f Sec. 23. Every undertaker or other person who may have charge of the funeral of any dead person shall procure a properly filled out cer-tificate of the death and its probable cause, in accordance with the form prescribed by the State Board of Health (no other to be valid), and shall present the same to the designated otlicer or member of the local Board of Health and obtain a burial or transit permit thereupon at least twenty-four hours before the time appointed for such funeral or removal; and neither lie nor an}- other person shall remove any dead body until such burial or transit permit shall have been procured. Sec. 24. Every person undertaking preparations for the burial of a body dead from communicable disease as hereinbefore enumerated shall adopt such precautions as are set forth in the "Instructions for Quarantine and Disinfection," furnished by the State Board of Health, to prevent the spread of such disease. Sec. 25. Every physician or midwife attending or present at the l)irih of any human being within the shall, wdthin twenty-four hours thereafter, certify the same to the health officerj upon blanks prescribed by the State Board of Health to be furnished by said health officer. In case there be no attending physician or midwife, then the next of kin or other person present at such birth shall, within twenty-four hours there-after, report the same to the health officer, who shall then have the proper blank filled out. Sec. 26. All physicians, midwives and undertakers practicing or doing business in this shall register their names and addresses with the Secretary of the Board of HealthlT within thirty daj-s after the pro-mulgation of this ordinance; and hereafter within ten days after begin-ning practice or business. Sec. 27. Such pertinent portions of chapter 214, Laws of 189o, as are not included in the above sections are hereby adopted as a part of this ordinance. Sec. 28. Every person violating any section of this ordinance shall be liable for every such offense, upon conviction before the mayor or other *City or town. flf preferred the vaccination of paupers might be required of the health officer, where there is one. the town furni.shin.s: the virus, or the fee might be fixed in advance by agreement with the physicians. The vaccination of tlie people is of tlie highest importance and everj' effort should be made to accomplish it. The amount of raw-material ready to be worked up by small-pox in this State is simply appalling. JWhere there is no health officer substitute " Citv or Town Clerk.'' IJWhere there is no Board of Health substitute "City or Town Clerk." 4 56 NORTH CAROLINA BOARD OF HEALTH. justice of the peace, to a fine of not less than S."5 nor more than $25, or imprisonment for not more than ten days, at the discretion of the con-victing justice, besides costs, which he may inflict in addition if he see fit. BIRTH CERTIFICATE. N. C, ISO-Date of Birth Name of Child, if named Name of Father Name of Mother Residence, No Street Ward Color Sex ^ Condition of Child Attendin'g» Physician or Midwife CERTIFICATE OF DEATH AND APPLICATION FOR BURIAL OR TRANSIT PERMIT. To the* of N. C: Date of Death Full Name of Deceased! Sex, Male or Female Age Years Months Days. Color Married, Single, Widow' or Widower Occupation Birthplace Place of Death, No. , Street, Ward. Cause of Death Duration of Last Sickness Place of Burial -_ ^ Date of Burial I M. D., f Undertaker f Medical Attendant. \ Place of Business j % Personally appeared before me on this the day of 189-- and made oath that the above statement in regard to the death of is true. ,J. P. *This certificate must be returned to the official selected for the purpose—Town Clerk, Chief of Police or some other— for Burial Permit. tif still-born, give names of parents on this line. jlu case there was no medical attendant, this certificate may be signed by the Health Officer, after careful inquirj' as to the facts required to be noted. Or it ma3' be signed on oath before a Justice of the Peace by the householder in whose house the death occurred, or by the next friend of the deceased who was present. Where there was an attending physician no other signature than his should be accepted. Note.—The apparent amount of " red tape" in this certificate in the matter of requir-ing the householder or next friend to make oath before a Justice of the Peace is ren-dered necessary by the fact that death certificates are often used in the courts as evi-dence, and the disposition of large sums of money may depend upon their accuracy and reliability. L'lFTH BIENNIAL REPORT. 57 nj so oO o •-^ W p ^ G 58 NORTH CAROLINA BOARD OF HEALTH. FORM FOR SAXITARY INSPECTION OF CITIES AND TOWNS. 1. Inspection-books are furnished as per Form No. 1. 2. The Inspector is presumed to have received intelligent drilling from the Health Officer in the many features of unsanitariness which will be met with, and is moreover, presumed to be a person of good judgment and discretion, and to have a high standard of sanitary methods, with his heart in the work. 3. The inspection districts having been designated by the Board, the Inspector begins work at a set point and makes an entire inspection of the district house by house, block by block, noting down the conditions in Inspection-book as provided under manner of Form No. 2. 4. Should any bad features exist the Inspector is to point out to the householder where the remedy can be applied and the necessity for it, and to leave upon the premises the notice of Form No. ;]. Should the existing conditions be not really bad, but clearly not good, the Inspector is required to inform the householder where the defect lies, and to urge upon liim the benefits resulting from thorough cleanliness. 5. After each inspection district has been gone over Inspector should make a report to the Health Officer or Mayor of total inspections and their results upon Form No. 4: this to be kept on file by the Secretary of Board for future comparisons. 6. A space of nine lines should be given to each lot in order that the record of the whole number of inspections made during the year (monthly from April to October, inclusive, and quarterly thereafter) may be arranged for easy comparison. The Inspector should not only call attention to violations of the sanitary rules and regulations and note bad conditions, but he should make it a point to encourage those who are evidently trying to do their sanitary duty. 7. At stated intervals a notice should be given through the public press of what the comparative results show, thereby enlisting an interest in the work from those who might not be reached bv other means. Although modified by myself in some respects, the credit for these forms is due to Mr. Alfred V. Wood. Secretary of the Board of Health of Brunswick, Ga., a brother of our late deepU' lamented Secretarj-, and a sanitary expert. FIFTH BIENNIAL REPORT. 59 Form No. i. SAMPLE PAGE OF INSPECTION BOOK. 1893-'94. April May June July Aug. Sept. Oct. Jan. April May June 124 Wolf Street, (I 1 T. PI. Jones, And so on down. 1 60 NORTH CAROLINA BOARD OF HEALTH. To be sent on the first day of each mouth for the mouth preceding to the Health Officer or Alayor. Form No. 4. SAXITARY INSPECTION DISTRICT No Month of 189- FIFTH BIENNIAL REPORT. 61 known to carry contagion. He invited members of the Society to visit the Station after its completion and see it in operation. Dr. Reagan deprecated the lack of interest on the part of members in the Conjoint Session, and thought this lethargy must be overcome before we can expect to excite the interest of the legislators and the laity. Dr. H. W. Lewis said it would take the stimulus of an epidemic to create an interest in sanitary matters among the physicians of his county. In making his reports as Superin-tendent of Health he had to depend almost entirely upon his own practice in enumerating the prevailing diseases. He thought the law, while probably as good as could be obtained, was defective in not making provision for the remuneration of Superintendents for their extra and especial services in case of epidemics. He understood the law to only give the Superintendent the right to charge for his visits to the poor-house and jail. (The Secretary explained that it gave him the right to demand the fees usual in his count}' for any services he might render). He regretted there had been no legislation in regard to vaccination. His county was raising a large crop for the Reaper should an epidemic of sraall-pox appear. The Secretary stated that in regard to vaccination tlie Conference were in accord as to the desirability of com-pulsory vaccination, but that such a clause in the bill would have jeopardized the whole bill. People cannot be driven in these matters. In this connection he referred to some remarks made by Dr. Lewis at the last meeting, when he stated that he had appointed a day on which to vaccinate the pupils at a county school, and when he arrived there he found that all the school had taken flight. The Secretary announced that the terms of office of him-self and Dr. Bahnson expired with this meeting, and that 62 NORTH CAROLINA BOARD OF HEALTH. imder the new law these vacancies would be filled by the Governor's appointment. There was some discussion as to whether it would be proper for the Society to recommend candidates for appoint-ment, but it was the sense of the meeting that it should be left for the Governor to ask for such recommendation should he desire it. The Secretary called the attention of Superintendents of Health to the fact that it is now made obligatory on him to notify the County^ Commissioners of the failure on the part of the Superintendents to make their reports. He also urged upon physicians to attend the meetings of the Board of Health for the election of Superintendents that proper men may be selected for these positions. On motion the Conjoint Session adjourned. RICH'D H. LEWIS, M. D., Secretary. CONJOINT SESSION AT GREENSBORO, MAY 15, 1894. At 12 M. the Board met in conjoint session with the State Medical Society, President Bahnson in the chair. Passed Assistant Surgeon Jos. J. Kinvoun, of the United States Marine Hospital Service, having accepted an invita-tion of the President of the Board to attend the meeting, was upon motion invited to a seat upon the floor and to partici-pate in the discussions. He acknowdedged the courtesy in an appropriate manner. The Secretary then read his annual repoi't as follows: FIFTH lUKXXIAL REPORT. 03 ANNUAL REPORT OF THE SECRETARY OF THE NORTH CAROLINA BOARD OF HEALTH. By Richard H. Lewis, M. D., Raleigh, N. C. AVhen your Secretary made his last annual report the sanitary sky to the eastward was overcast with the dark and lurid clouds of cholera. There was in the minds of people at large to some extent, hut more especially of those whose duty it was to stand as sentries upon the watch-towers, a feeling of apprehension lest these threatening clouds should reach our shores and deluge us with the dreaded pestilence. Later yellow fever appeared at Brunswick, Ga., almost at our doors, and our health officers ou our seaboard, particularly at our port of Wilmington, had their anxieties greatly increased. Still later small-pox began to spread over the country and is not 3'et, we regret to admit, stamped out. Notwithstanding these valid grounds for uneasiness our fears have not been realized. "We have to felicitate our-selves and the people of our State and generally of our whole country upon their escape. And in doing so we should make our acknowledgments to the United States Marine Hospital Service for its excellent management in keeping cholera (except one case at Jerse}'' City) out of our country and in practically bottling up the yellow fever at and near Brunswick. In making this report your Secretary does not |