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FIRST BIENNIAL REPORT
• F THE
NORTH CAROLINA
BOARD OF HEALTH,
1879-1880.
'h!^
RALEIGH
News & Observer, State Printers and Binders.
1881.
INortJi Carolina Board of Health,
REPORT OF THE SECRETARY,
Office of the Secretary op the
North Carolina Board of Health.
Wilmington, N. C, December 31st. ISSO.
To His Excellency, Thos. J. Jarvis,
Governor of the Stde of North Carolina :
Sir : I have the honor to present to you, according to
section 2 of the Act Supplemental to an Act creating a State
Board of Health, a report of the work done by the North
Carolina Board of Health for the two years ending Decem-ber,
1880.
Respectfully, your obedient servant,
THOMAS F. WOOD,
Sec. N. a Board of Health,
Wilmington, N. C, December 24th, 1880.
The organization of the North Carolina Board of Health
(according to chapter 117, sec. 2, laws of 1879) was begun
on the 21st day of May, 1879, in Greensborough, by the
election of the following gentlemen from the active list of
membership of the Medical Society of North Carolina
:
Dr. S. S. Satchwell, Rocky Point, N. C, to serve for six
years.
Dr. Thomas F. Wood, Wilmington, N, C.,to serve for six
years.
First Biennial Rqjort. 3
Dr. Charles J. O'Hagan, Greenville, N. C, to serve for
four years.
Dr. George A. Foote, Warrenton, N. C., to serve for four
years.
Dr, M. Whitehead, Salisbury, N. C, to serve for two years.
Dr. R. L. Payne, Lexington, N. C, to serve for two years.
Subsequently His Excellency the Governor appointed A.
R. Ledoux, Ph.D., William Cain, C. E., and Henry G.
WooDFiN, M. D., as members of the Board on the part of
the State.
At a meeting of the members elect in the McAdoo House
in Greensborough, on the afternoon of the 21st May, the
further organization was completed by the election of S. S.
Satchwell, M. D., President ; Thomas F. Wood, M. D.,
Secretary and Treasurer.
The following resolution was introduced by Dr. A. R.
Ledoux:
Besolved, That the execution of the Board of Health Law (chap, IIT,
sec. 2, laws X. C., 1879) shall be entrusted to the Secretary, tlje detail?
of its provisions being under his management, and that the Secretary
make his report to the next meeting of the Board.
Adopted.
Upon motion of Dr. Ledoux, a committee was appointed
to confer with the Department of Agriculture to make ar-rangements
for the chemical investigations by the Board.
Adopted.
Shortly after the adjournment of the Board, the proper
material was placed in the hands of the State Printer, and
as soon as the work could be delivered, the machinery of
the Board was put in motion.
The first subject to be considered was the organization of
County Boards of Health.
4 North Carolina Board of Health
The following Circulars were issued :
Office of Secretary N. C. Board of Health,
Wilmington, N. C, May 24th, 1S79,
Chairman of the County Commissioners:
Dear Sir : By direction of the Xorth Carolina Board of Health, I
have the honor to call your attention to the law passed by tlie Lei^isla-ture
of 1S79, entitled "An act supplemental to an act creating the State
Board of Healtii, which is herewitii presented.
It is earnestly desired by the Board that the auxiliary County Boards
^of Health be organized without delay. It is suggested that notification
?be served by tlie Ci'.airman of tlie County Commissioners upon tiie phy-sicians*
entitled to membership under this act, and also to the Mayor of
.the County Town, and the City or County Surveyor, and that tliey pro-ceed
to elect from the physicians composing the Board a suitable person
•for Superintendent. As soon as this organization is completed the
enclosed blank "List of Members" must bs tilled up and returned to this
office. Upon receipt of this li«t, or as soon thereafter as possible, the nec-essary
blanks will be furnished.
Respectfullj' j-ours,
Thomas F. Wood.
Sec'y N. C. Board of Health.
The organization of County Boards was proceeded with
in many counties, so that in September of the year 1879,
the following counties had completed an organization :
Alleghany, Dr. John L. Smith, Superintendent.
Ashe, Dr. James Wagg, "
Brunswick, Dr. F. W. Potter, „
Buncombe, Dr. M. L. Hilliard, "
Burke, Dr. W. A. Collett, "
Cumberland, Dr. AV. C. McDutiie, "
Cabarrus, Dr. F. M. Henderson, "
Catawba, Dr. James E.Campbell,.... ..
"
Cleveland, Dr. J. C.Gidney, "
*It may be necessary to explain that to be eligible to membership in the State
Medical Society the physician must be a licentiate of tlie Board of Medical Ex-aminers,
or must have commenced the practice of Medicine before the 15th
April, 1S59. A copy of the Constitution of the State Medical Society, and the
Board of Exau-iaer's law, will be sent on application.
First Bienhual Report. 5
Columbus, Dr, M. E. Morrison, Superintendent.
Duplin, Dr. J. D. Roberts, "
Edgecombe, Dr. A. H. MeXair, "
Franklin, Dr. E. S. Foster, "
Forsyth, Dr. S. J. Montague "
Greene, Dr. W, C. Galloway, "
Guilford, Dr, B. A. Ciieek "
Granville, Dr. J. Buxton Williams, "
Gaston, , Dr. E. B. Holland,
Halifax, Dr. Isaac E. Green,, ''
Haywood, Dr. G. D. S. Allen, "
Henderson, Dr. J. L. Edgerton "
Iredell, Dr. Thomas E. Anderson, "
Johnston, Dr. E. J, Xoble, "
Lincoln, Dr. J. M. Lawing, "
Macon, Dr. J. M. Lyle, ''
Mecklenburg Dr. H. M. Wilder, "
Montgomery, Dr. W. A. Simmons, "
Martin, Dr. Joshua Taylor, "
Mitchell, Dr. E. C. Brown, "
Xew Hanover, Dr. J. C. Walker, "
Xash Dr. E. A. Sills "
Onslow, Dr. W. J. Montfort, "
Pender, Dr. W. T. Ennett, "
Pitt, Dr. Wm. M. B. Brown "
Person, Dr. J. T. Fuller, "
Polk, Dr. J. G, Waldroj), Correspondent.
EobCiOn, Dr. E. F. Lewis, Suj)erintendent
Eichmond, Dr. J. M. Covington, "
Eowan, Dr. J. J. Summerell, "
Eandolph, Dr. W. A. Woollen, "
Stokes, Dr. L. H. Hill,
Sampson, Dr, C.Tate Murphy, "
Tyrrell, Dr. A. C. Alexander, "
Transylvania, Dr. J. Cain ''
Union, Dr. Isaac H. Blair, "
Wake, Dr. James McKee, ''
Wayne Dr. M. E. Eobinson.
Warren, Dr. Geo. A. Foote, "
Watauga, Dr. W. B. Council "
Wilkes, Dr. E. T. Hackett, "
During the year 1879, letters of enquiry were frequently
6 North Carolina Board of Health.
received by the secretary asking about the method of or-ganization,
and the following circular was issued :
XoRTH Carolina Board of Health,
Office of the Secretary,
Wilmington, X. C, June, 1S79.
To tlie County Superijitendents of Health:
In reply to questions frequently received by letter, as to the duties oS
County Superintendents of Health, tlie following general items of in-formation
are given :
THE DEATH RATE.
Preliminary to all work, the death rate should be carefully registered.
It will be impracticable for the Superintendent to know, personal!}^, of
deaths and their causes in his county ; and in order to aid in the collec-tion
of these statistics, memorandum books are furnished for distribu-tion,
not only to members of the County Board of Healtli, but also to
all practitioners of medicine in the county. In addition to tliis, Xo. 6,
death certificate, is furnished for distribution. In some sparsely settled
counties deaths occur and tliere is no attending physician to give the
certificate. In such cases it is best to send a blank to the officiating
minister, as an unprofessional record is better than the failure to get the
return.
DISEASES DANGEROUS TO THE PUBLIC HEALTH.
When such diseases occur, all diligence should be used to make early
enquirj'- as to the origin of the first case, and prompt means adopted to
quarantine them according to Section 9 of the Health Law. The physi-cians'
and househoLlers' blanks are furnished for distribution to physi-cians
and intelligent householders, that all items necessary to complete
the history of the invasion of the diseases mentioned may be investigated
and written up.
MEDICO-LEGAL POST-MORTEM EXAMINATIONS.
With a view to a uniform system for investigations untier this head, a
pamphlet containing minute directions, founded upon the Gei-man Law
First Biennual Report. 7
of 1876, lias been prepared, and it is earnestly desired that tlie returns of
examinations will be made complete.
BLANK "b" returns.
The blanks issued are intended to be returned annually. A careful
reading of it will show the scope of the observations necessary to carry
out the design. The work could be entrusted to the members of the
County Board of Health from the diflferent townships, to whom a blank
may be issued with explanations. The advice of the city or county sur-veyor
in the general report would aid the more accurate composition of
the report. To elucidate the topography, sketch-maps of townships
would be highly esteemed by the State Board of Health, with an ulti-mate
view to publication. If these reports are fully made, the labor of
making a saaitary map of the State will be materially lessened.
DRINKING WATER.
By consultation with Professor Ledoux, the Chemist of the Board, a
plan has been agreed upon, which will enable him to make for the Board
an examination of the drinking waters in the State. The secretary es-pecially
desires the co-operation of Superintendents of Health in this
work. It is desirable that several specimens of drinking water should
be selected from every^ county, keeping always in view the necessity of
having representative specimens, that a general idea may be obtained of
the condition of wells and springs in a given neighborhood, town or
eitj'. Specimens recommended bj^ superintendents will have early con-sideration
from the secretary. In every case the packing must be done
in aocordance with Dr. Ledoux's circular, and the freight expense borne
by the applicant, as no means have been given the Board for this pur-pose.
VACCINATION.
It must be insisted on, that every person entering the poor-house,
work-house and jail of the county shall be vaccinated by the superintend-ent
upon his first visit after new inmates have been received, except in
such cases in which he is satisfied that the persons are already protected.
Our State has been so long exempt from visitations from small pox that
it is highly desirable that vaccination, the only certain prophylactic
known, should be generously employed, that we may have continuous
exemption. A pamphlet is in preparation on this subject, which will
8 North Carotina Board of Health.
put before snperiiiteadents much of the neglected literature of vaccina-tion
brought down from the Jeiinerian times. Vaccine will be furnished
according to the provisions of Section 11 of the Health Law.
ABATEMENT OF NUISANCES,
In proportion to the diligence and intelligence with which the County
Superintendent carries out Section 10 of the Health Law will greatly
depend the sanitaiy condition of towns. Blanks are issued for the pur-pose
af notification, and will be furnished on application.
Superintendents of Health should furnish, as soon as practicable, a
complete list of the members of the Board of Health in their county.
This only includes those who are actually i^resent at the meeting of or-ganizat'on,
or who connect themselves with the Board afterwards. To
such members will be sent all the printed matter issued by the State
Board, and their assistance and co-aperation are earnestly desired.
PERMITS FOR BURIAL.
It will promote the accuracy of mortuary statistics if the County
Boards of Health will use their influence to have a rule made by the city
corporations and cemetery associations, forbidding the burial of any per-son
until a certificate is given by the last attending physician of the cause
of death. This plan is largely adopted already, and is not considered
burdensome by any.
Letters of enquiry upon any matters connected with the work of the
State Board will be promptly answered ; and suggestions looking to the
advancement of the interests of the North Carolina Board respectfully
solicited.
THOMAS F. WOOD, M. D.,
Secretari/,
The work of organization of Count}^ Boards of Health
was fraught with numerous difficulties. When it was un-derstood
that the Superintendent of Health was not only
the adviser of the people and officials in respect to the
health of the county in which he served, but was also ph}'--
sician to the poor-house, work-house and jail, and was ex-pected
to keep a register of vital statistics, and make a
monthly report to the Secretar}^ of the State Board, very
few physicians were willing to undertake the work, and
First Biennial Report 9
more especially as the pay for services was small in most
counties.*
A few Superintendents commenced their work with zeal,
but finding that their success was dependent upon the aid
they could get from the physicians composing the count};"
board, and that reports from these gentlemen were fitful
and uncertain, they abandoned the work to others.
It was at first thought possible that a complete record
could be obtained of all persons falling sick with certain
diseases, dangerous to the public health, and that deaths would
be accurately returned. This was very desirable, but the
machinery proved entirely inadequate to the accomplish-ment
of the plan. Some physicians sent in their monthly
statement of diseases and deaths with commendable punc-tuality,
but the total number as compared with the failures
in the counties not reporting, made the reports valueless for
comparison.
The plan set on foot for the collection of statistics was as
follows
Every physician was supplied with a memorandum book,
printed and ruled for evor}^ month in the year, with the
request that every month he should send in his report to
the Superintendent of the county. In addition to this,
blanks were distributed to householders and intelligent cit-izens
in order to facilitate the collection of statistical items
in regions where a physician was not at hand. This whole
plan of reporting was too imperfectly done, for reasons to
be hereafter explained, to be of any value. After careful
consideration the method was changed, and the plan hero
* Note.—The law only gave the Superintendent such amount as was spent in
the year 187S for medical attendance on the jail and poor-house and work-house,
and the amount paid for medico-legal examinations at coroners' inquests. In
some counties this was nothing, and in many of them it was very small, and
the Superintendents undertook their duties, impelled alone by their pride and
the interest they had in the work which had been inaugurated by the State
Medical profession.
10 North Carolina Board of Health.
substituted has been continued for the year 1880, with re-sults
as seen in reports on pages.*
The following circular was issued with instructions :
Office of the S'liperintendent of Health County^
Population of County Post Office, N. C,
Population of county town Date, 188....
To the Secretary of tlie North Carolina Board of Health :
For the month of ..the prevailing winds have been
and there ha.... been .rainy days.... ; there ha.... been
daj'.... of snow ; the average temperature has been degrees.
The prevailing diseases have been
and in^
- cases of Small Pox ha.... occurred.
" Measles ha.... occurred.
'• Whooping Cough ha.... occurred.
" Scarlatina ha.... occurred.
" Diphtheria ha.. . occurred.
" Yellow Fever ha.... occurred.
" Typhoid Fever h;i.... occurred.
" Pernicious Malarial Fever ha.... occurred.
" Choler<a ha.... occurred.
" Hcemorrliagic Malarial Fever h.... occurred.
The diseases among domestic animal?, coming to my knowledge, are
as follows :
There has been ^ epidemic of * prevailing.
^Remarks on Condition of Public Buildings:
There are prisoners confined in j;ul.
There are prisoners confined in work-house.
There are inmates of the poor-house.
* Refers to pages of tabulated reports.
First Biennial Report. 11
Jail.
12 North Carolina Board of Health.
General remarks upon sanitary matters, explaining more particularly
the forego5n<;- references,
THE COUNTY SUPERINTENDENTS OF HEALTH.
According to the law (section 5) the duties of the County
Superintendent of Health shall be " to gather vital statis-tics
upon a plan designated by the State Board of Health,
He shall make the medico-legal post-mortem examinations
for Coroner's inquests, and attend prisoners in jail, poor-house
and work-house. His reports shall be made regu-larly,
as advised by the State Board through their Secretary,
and he shall carry out, as far as practicable, such work as
may be directed by the State Board of Health."
The collection of vital statistics has been already men-tioned,
and will be taken up more fully hereafter.
As the law made the County Superintendent the medico-legal
examiner of the county, it was deemed necessary to
prepare a manual on the method of performing post-w.ortem
examinations, in order that these examinations siiould be
uniform and accurate. Accordingly such a pamphlet was
prepared and distributed in July, 1879. (See appendix A.)
In addition to this work, which also included the prepa-rations
of viscera, fluids of the body, &c., for examination
by the Chemist of the Agricultural Station, the Superin-tendent
was made, by law, the physician to the penal and
charitable establishments of the county. Sd that, wdiile
being the sanitary adviser of the citizens of the county in
which he served, his office wa^ no sinecure, but a position
requiring skillful and diligent service, without adding to
the expense of the county.
PAMPHLETS ISSUED BY THE BOARD.
In addition to the " Methods of Performing Post-Mortera
Examinations," in June, 1879, as the summer season ap-
First Biennial Report. 13
preached, a pamphlet was issued on " Disinfection, Drain-age,
Drinking Water and Disinfectants." (See Appen-dix
B.) So much interest was awakened by the issue of
this pamphlet, that Prof. William Cain, C. E., member of
the State Board, was requested to prepare a paper elabora-ting
the topics of the first. This was done in a pamphlet
entitled, " Sanitary Engineering." (See Appendix C.)
Later in the year diphtheria became quite prevalent in
many parts of -the State, and Dr. R. L. Payne, member of
the State Board, prepared, at the request of the Secretary, a
pamphlet on the "Limitation and Prevention of Diphtfieria."
So many demands had been made for Prof. Cain's first
treatise, that he kindly consented to prepare a more elabor-ate
work under the same title as the former
" SANITARY ENGINEERING."—)Appendix C.)
This valuable work, of which a large edition was printed,
was exhausted within a few months after its publication.
DRINKING WATER.
Believing the most important lesson to inculcated was
the consideration of drinking water in its sanitary aspect,
the attention of the public was called to the subject by
means of the pamphlets already mentioned, and through
the public press. One example served to excite attention
to the subject The circumstances are so interesting as to
be worthy of recital at this place.
A family residing upon the summit of a sand-hill, on a
rather thickly built street in Wilmington, had suffered se-verely
from sickness during a long period. The house was
of wood, surrounded by dense shrubbery. The well from
which the family drew its supply of water was located in
what was considered a favorable spot. The sickly condi-tion
of the children caused the head of the family great
/
14 North Carolina Board of Health.
anxiety. Shrubbery was cleared out to allow free access of
light and air. The house was carefully cleaned underneath
and whitewashed ; its ventilation was improved; but still
the sickness was unabated. Attention was called to the
drinking water, not heretofore suspected, and a specimen
analyzed by the Chemist of the Board.
The result of the analysis was the revelation that foul
impurities, the leaching of a neighboring ]>rivy, were found
in the water. The well was abandoned and the water sup-ply
secured from another source, and the result was marked.
This circumstance attracted the attention of others to
their drinking wateg-, and enquiries came to the Board from
many directions.
The result of these examinations is given below.
The form for conducting the examinations was designed
by Dr. A. R. Ledoux, Chemist of the Board of Health, as
follows
:
Laboratory of State Board of Health,
Chajjel Hill, N. C, June 20tli, 1879.
ANALYSIS FOR STATE BOARD OF HEALTH.
By an act of the Legislature of 1879, entitled, " An act supplemental
to an act creating a State Board of Health," the Chemist of the State
Experiment Station was made Chemist to the Board of Health. In com-pliance
with the requirements of tiie law, the Station is prepared to
make sucli analyses as may be approved by the Se;3retary of the Board.
The following
INSTRUCTIONS FOR SENDING SAMPLES
must be carefully complied with by those wishing to avail themselves of
the facilities afforded by the laboratoi'y of the Station and provided by the
law
:
1. In cases of suspected poisoning, the Coroners and County Superin-endents
of Health must comply with special instructions which have
already been sent them, or which may be had on application.
First Biennial Report. 15
2. Analyses of articles of food, drug?, etc., examinations incases of
suspected adulterati#ii of foods and medicines, and investi<?ations de-sired
in connection with tlie liygienic duties of the Superintendents of
Healtl), will be undertaken when authorized by the Secretary of the
Board.
3. Parties desiring a chemical examination of the waters of pul^lic or
private wells must first write to Dr. Thomas F. Wood, Secretary State
Board of Health, Wilmington, for permission. They will then proceed
to obtain a sample according to the following directions. These direc-tions
will also be complied with by agents of the Board, taking samples
of water by their order : Secure one or more glass bottles, or a denlT"'
John, which w^ill hold at least two gallons. These bottles must be per-fectly
CLEAN (better new.) Wiien possible, secure a sample by letting
tlie bottle down into the well, being careful not to stir up the bottom or
touch the sides. Cork tightly with netv corks and seal with wax. Mark
each bottle with designating numbers. Pack in saw-dust, straw or tan-bark,
and pre-pay the express charges to Chapl Hill.''
Having sent the samples, directed to The Experiment Station,
fill out and send by mai) the accompanying blank. Samples sent during
the winter run great risk of freezing and bursting the bottles.
By order of the Board of Health :
A. R. LEDOUX, Chemist.
Blank.
Dr. A. R. Ledoux :
Sir: I send by express to-day sample., of water, drawn by order
of the Secretary of the Board of Health, on the of , 18..., from
well.., in the town of , and marked as follows :
Remarks :
Yours truly,
[Signed]
.
The following analyses of drinking water were made for
the North Carolina Board of Health and reported by the
Chemist of the Agricultural Experiment Station, with his
comments thereon:
* The analyses will be made free of charge to the sender, but the Board ot
Health has no funds with which to pay express charges.
IG North Carolina Board of Health.
SOME OF THE DRINKING WATERS OF NORTH CAROLINA.
The Station having been for a considerable time occupietl in examin-ing
drinking waters it will be, we tliink, instructive to report Iiere in col-lected
form our results.
Tlie healthf idness of a water is determined by a partial analysis which
determines the total solids, Chlorine, "Free and Albuminoid Ammonia,
and tiie poisons metals."
Water containing undue amounts of organic fllth are very injurious to
heallli. Tiiey are often the cause of cliolera, typlioid fever, diarriicea, &c.
From the amount of free and albuminoid ammonia and of chlorine
we are enabled to judge whether tlie water contains any such contami-nation.
Chlorine alone does not necessarily indicate a filUiy water. More
than five grains per gallon of chlorine, accompanied by more than O.OS
parts per million of free ammonia, or more than 0.10 parts per million
of albuminoid ammonia, is a clear indication that the water is contami-nated
with sewage—decaj-ed animal matter, urine, &q. These are of
course, the most dangerous waters.
More than 0.10 albuminoid ammonia, without mnch chlorine, or more
than 0.08 parts per million of free ammonia, is evidence of contamina-tion
from vegetable matter—rather a bad water, though not positivelj- so
dangerous as that containing animal matter.
Free ammonia over 0.08 parts per million and aibuminated ammonia
over 10 parts per million render a water very suspicious, even without
much chlorine.
Total solids should not exceed 33 grains per gallon in drinking waters.
More than this, accompanied by an excess of albuminoid ammonia, ren-ders
the water very bad.
Our remarks upon the waters in the following tables are based on
these rules. Look at the results and see what unhealthy, in many
cases what dangerou.s, waters the people have in the places named been
driidiing.
Through the efficiency of our Secretary of the State Board of Health,
we have been enabled to examine quite a large number of waters from
Wilmington, It will be seen that they are almost uniformly bad. There
is evidence of organic contamination in most of them. Some are posi-tively
dangerous from distinct sewage contamination.
Some ot the waters examined from Durham show evidence likewise of
oro-anic contamination, though not finite so bad. Those from Goldsboro
are rather better.
There are not as yet data enough to generalize upon, but these facts
are sufficient to indicate that the proper surface drainage and cleaning of
wells and springs arc very much neglected in most cases.
Mrst Biennial Report. 17
See to it what sort of waters you are drinking ! Send for our direc-tions
how to take a sample of water, and get the permlssioa of Dr.
Thos. F. Wood, Secretary State Board of Health, Wilmington, N. C,
to have your waters analyzed.
CHAS. W. DABNEY, Jr.,
State CJieniist.
18 Nmth Carolina Board of Health.
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20 North Carolina Board of Health.
First Biennial BepoH. 21
The lessons which these anylses taught were given from
time to time in the daily papers. The public mind in Wil-mington
became agitated on the question of water supply,
and the matter is to be remedied by the erection of water-works
at no distant day.
From this lesson, up to others quite as essential for the
well-being of the citizens of North Carolina, it is the design
of this Board to lead the people.
VITAL STATISTICS.
The perplexing subject of vital statistics has always recur-red
during our work. We were constantly beset with the
fact that without a knowledge of the prevailing diseases
and the extent of insanitary conditions, we could not act
intelligently in pointing out special sanitary defects and
their remedies.
In another view of the case, we deemed it essential to the
success of the State in inducing immigration that we should
be able to issue all the items we could collect for the infor-mation
of the people who would be likely to seek for homes
in America. We were well satisfied that the general state-ment
that this or that county was " healthy " would have
but little weight with persons casting about for new homes.
Specific official statements would alone serve to assure such
enquirers, and these were not to be had. We made applica-tion
to do the work of collecting vital statistics to the Board
of Agriculture, but it was decided that as desirable as the
object was money could not be directed from its specific use
without authoritv.
Not discouraged by this failure, we undertook the work
alone, with no means save the very small sum of two hun-dred
dollars a year appropriated by the General Assembly.
We submit the results below, not because we believe them
to be what they should be, but to show how determined the
22 North Carolina Board of Health.
Board has been to enter upon a work so essential to the in-terests
of immigration.
I have tabulated, (see Appendix D,) for each county the
reports collected from our Monthly Bulletin, quite conscious
of their glaring imperfection as compared with what is de-sired
and proposed to be done when our means are increased.
I do not wish to disguise either the apathy or carelessness
of some of those gentlemen who from their official connec-tion
with our work morally pledged themselves to its sup-port,
but who, when the drudgery of observing and report-ing
was requested by the Superintendent of Healtli in their
county, did not put forth a single effort to sustain him, and
what was worse, in one instance, took sides with the avowed
opponents of the work.
The expenses of the Board paid by the Treasurer are as
follows:
For 1879.
Jan, 2d, Travehng expenses of Dr. Wood to Wash-ington,
$40 00
" 21st, Traveling expenses of Dr. G. A. Foote, 10 00
" 21st, " " "'Dr.S. S.Satchwell, 25 00
" 21st, " *' " Dr. Thos. F. Wood, 16 00
" 19th and 20th, Telegrams, 1 50
" " " 2 77
Feb'ry4th, « 95
May 24th, Traveling expenses to Dr. Ledoux, 10 00
Nov. 2 years' subscription Medical Journal,.. 6 00
Express, 18 20
Postage, 53 85
Postal Cards, 12 50
Printing, 12 50
Pigeon Holes for desk, 5 25
Engraving, 14 50
Clerk Hire, 240 00
Total for 1879, $469 02
First Blemiial Report. 23
For 1880.
May 15tb, Traveling Expenses of Dr. Wood to
Washington, $40 00
Postage, 49 30
" Express and freight, 26 61
" Office expenses, 7 00
Clerical help, 240 00 ti
Total for 1880 $362 97
Total for 1879, 469 02
Total expenses for two years, 1879 and 1880, |831 99
Received appropriation for 1879, $200 00
" 1880, 200 00
400 00
Balance expended from private means by Treasurer, $431 99
I present herewith my statement of account of money
received and expended. I found it necessary, in order to
keep the machine in running order until help would come,
to expend from my private means $431.99. I did this, hav-ing
full faith in the appreciation, in due time, of the great
importance of the work. Economy has been our perpetual
care.
The County Boards have cost onl}'- the amount hereto-fore
expended for the necessary medical services in the dif-ferent
counties, and the analyses of drinking water, food
,
&c., were done by the Agricultural Experiment Station. In
every way the Board has demonstrated its fitness to live
and be sustained at the hand of our State.
At the last meeting of the North Carolina Board of Health,
upon the suggestion of the Secretary, it was resolved that
steps be taken to secure the registration of vital statistics at
24 North Carolina Board of Health.
the annual tax listing. The appended draft for a bill em-bodies
the suggestion.
AN ACT TO ENSURE THE ANNUAL. REGISTRATION OF VITAIi STA-TISTICS.
The General Assembly of North Carolina do enact :
Section 1. It shall be the duty of each and every person annually,
at the time when he or she or they shall list property for taxation, to
to make out and sign and deliver to the township assessor, on a blank
prepared and furnished as hereafter prorided, a statement as follows,
to-w:t:
1st. Whether married, unmarried, widow or widower.
2nd. Number of birtlis in the family within the year immediately pre-ceding.
3rd. Number of deaths in the family within the same time, and the
names of the diseases causing the deaths, as far as known.
4th. Whether any cases of the following diseases have occurred in the
family for the year immediately preceding : Small-pox, scarlet fever,
diphtheria, yellow fever, cholera.
Sec. 2. It shall be the duty of the State Board of Health annually to
prepare and furnisli to the commissioners of each county, at least thirty
days before the time appointed bylaw for the listing of taxes, a sufficient
number of blank forms, or lists, in which each tax-payer or lister shall
make out the statement required by section 1 of this act, which said
blanks shall be distributed by the commissioners aforesaid to the town-ship
assessors at least five days before the time appointed by law for the
listing of taxes. The form of said blanks shall be prescribed by the Sec-retary
of the State Board of Health, and may be accompanied by a cir-cular
from said officer giving instructions in regard to filling out the same
and information desired.
Sec. 3. Tlie blanks so made out and delivered to the assessors, as pro-vided
for in section 1 of this act, shall be forwarded by them to tlie clerk
of the board of commissioners in each and every county at the same time
required by law for the return of the abstract of the tax list to said clerk.
And it shall be the dutj^ of said clerk to forward at once all of said blanks
so returned to him to the Secretary of State, who, after noting the same
for record in his office, shall forward them to the Secretary of the State
Board of Health.
Sec. 4. This act shall be in force from and after its ratification.
First Biennial Report. 25
AN ACT SUPPLEMENTAL TO AN ACT CREATING A STATE BOARD OF
HEALTH.
[Proposed amendments are printed in italics.]
The General Assembly of North Carolina do enact :
! Section 1. That the Medical Society of North Carolina shall choose
from its active members, by ballot, six members, and the Governor shall
appoint three other persons, (one of whom sliall be a civil engineer,)
and these shall constitute the North Carolina Board of Health.
Sec. 2. That the North Carolina Board of Health shall take cogni-zance
of the health interest of the citizens of the State ; shall make san-itary
investigations and enquiries in respect to the people, employing ex-perts
ichen necessary • the causes of diseases dangerous to the public
health, especially epidemics ; the sources of mortality ; the eflfects of
locations, employments and conditions upon public health. They shall
gather such information upon all of these matters for distribution among
the people, with the especial purpose of informing them about prevent-able
diseases. They shall be tlie medical advisers of the State, and are
herein specially provided for, and shall advise the government in regard
to the location, sanitarj^ construction and management of all public in-stitutions,
ujMu application of the proper authorities, and shall direct the
attention of the State to such sanitary matters as in their judgment
aflfect the industry, prosperity, liealth and lives of the citizens of the
State. The Secretary of the Board shall make annually to the General
Assembly, through tlie Governor, a report of their work for the year.
Sec. 3. The members of the Board of Health, as elected by the State
Medical Soeietj^, shall be chosen to serve, two for six years, two for four
years, two for two years. Those appointed by the Governor shall serve
two years. In case of death or resignation, the Board will elect new
members to fill the unexpired terms.
Sec. 4. The State Board shall hare a President and Secretary, who
shall be Treasurer, to be elected from the members comprising the
Board. The President shall serve two years, and the Secretary and
Treasurer six years. The Secretary and Treasurer shall receive such
compensation a year for his services as »hall be fixed upon by the Board at
its annual meeting ; but the otlier members of tlie Board shall receive no
pay, except that while on actual duty at meetings of the Board, or oa
duty during the time special investigations are being pursued, each
member shall receive $2-00 a day and necessary travelling expenses.
These sums shall be paid by the Treasurer on duly authenticated requisi-tions
signed approved by the President of the Board.
SjiC. 5. There shall be an Auxiliary Board of Health in each county in
the State. These Boards shall be composed of the physicians eligible to
26 North Carolina Board of Health.
membership in the State Medical Society, the mayor of county town, the
chairman of the county commissioners, and the city surveyor, vrhere
there is sucli an officer, otherwise the county surveyor. From this number
one physician shall be chosen bj' ballot to serve two years, with the title
of Superintendent of Health. His duties shall be to gather vital statis-tics
upon a plan designated by the State Board of Health. He shall
make the medico-legal post-mortem examinations for coroners' inquests,
and attend prisoners in jail, poor-house, and work-house. He shall be the
sanitary inspector of the jail and poor-house of his county monthly making
reports to the Board of County Coinmissioners. His report shall be made
regularly as advised by the State Board through their Secretary, and
they sliall receive and carry out as far as practicable such work as
may be directed by the State Board of Health.
Sec. 6. The salary of ttie County Superintendent of Health is to be
paid out of the co(uity treasur}', upon requsition and proper voucher, as
follows : Hie salary of Su])erintendent of Health shall be such sum as the
county commissioners shall deem just and proper for his services as physi-cian
to the public charitable and penal institutions of the county and as a
health officer.
Sec. 7. The organization of the Xorth Carolina Board of Health shall
be completed imniediatel}' after the passage of this act, and not later
than six months after the passage of the same. The biennial meetings
for the election of officers, shall, after the meeting of organization, be
for the County Boards on tlie first day of January, and of State Board
of Iltaltli on the tirst day of the annual meeting of the Medical Society
of North Carolina.
Sec. 8. Montiily returns of vital statistics, upon a plan to be devised
by the State Board of Health, shall be made by the County Superin-tendents,
and a failure to report b}'' the tenth of tiie month, for the pre-ceding
month, shall subject the delinquent superintendent to a fine of
one dollar for each day Of delinquency.
Sec. 9. Inland quarantine shall be under the control of the County
Superintendent of Health, who, acting by the advice of tlie local Board,
shall see that di.seases dangerous to the public health, viz : small-pox,
scarlet fever, yellow fever and cholera, shall be properly quarantined or
isolated, (at the expense of the city or town in whicli it occurs). Any
violation of the rules promulgated on this subject by the Superintendent
of Health shall subject the oft'ender to a fine of twentyfive dollars and
imprisonment for not longer than twenty days in the county jail. In
case the offender be stricken with disease for which he is quarantinable,
he will be subject to the penaltj^ on recovery, without, in the opinion
of the Superintendent, it should be remitted. Quarantine of ports sliall
not be interfered with, but the officers of the local and State Boards
First Biennial Report. 27
ghall render all aid in their power to quarantine officers in discharge of
their duties upon request of the latter.
Sec. 10. Abatement of Nuisances.—Wherever and whenever a
nuisance upon premises shall exist, which in the opinion of tl)e County
Superintendent of Health is dangerous to the public health, it shall be
his dut}'^ to notify the parties occupying the premises, (or the owner of
the premises if not occupied), of its existence, its character, and the
means of abating it, in writing. Upon this notitlcation the parties shall
proceed to abate the nuisance, but failing 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 notification has been served : Pro-vided,
however, 'That if the party notified shall make oath or affirmation
before a magistrate of his or her inability to carry out tlie directions of
the superintendent, it shall be done at the expense of the town, city or
county. In the latter case the limit of the expense chargeable upon the
town, city or county shall not be more than one hundred dollars in anj''
case.
Sec. 11. Vaccination.—The Secretary of the State Board of Health
shall keep a suppl}^ of fresh animal vaccine virus at his command, and
he shall issue quantities, in value not to exceed one dollar for one requi-sition,
to county superintendents in case of a threatened outbreak of
small-pox. The county superintendent* shall vaccinate and re-vaccinate
all applying for sucli service, free of charge, tlie virus for such purpose
being furnished by the Secretary of the State Board of Health. The
county superintendent shall vaccinate every person admitted into a pub-lic
institution, (jail, work-iiouse, poor-house, public school), as soon as
praclicalale, witiiout he is satisfied upon examination that the person is
already successfully vaccinated. On the appearance of a case of small-l)
ox in a neighborhood, all due dilligence shall be used by the superinten-dent
that warning shall be given, and all persons not able to pay, to be
vaccinated free of charge by him. Two hundred dollars are hereby an-nually
appropriated for this purpose, to be accounted for by the Treas-urer
of the Jjoard.
Sec. 12. Bulletins of the outbreak of diseases dangerous to the public
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 en-quire
into any outbreak of disease, by personal visits or by any metiiod
the Board shall direct. Tlie compensation of meml)ers on such duty
shall be five dollars a day and the necessary traveling expenses.
Sec. 13. 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 of the State Medical Society
at which time the Secretary shall submit his annual report.
28 North Carolina Board of Health.
Sec. 14. When the county Superintendeut of Health shall in the
course of his investigation required at coroner's inquest, think it neces-sary,
to subserve the ends of justice, that a clieniical analysis of the
viscera or fluids of the body be made, he shall carefully pack up and seal
the suspected article in a proper receptacle in the presence of a witness
and forward it to the chemist of the agricultural station for analysis.
Such analysis sliall be made free of charge, and be returned to the coro-ner
of tiie county, such analysis having precedence over other matters of
investigation not of a similar character, then in the labratory of the
chemist. Analyses for purposes connected with the hygenic duties of
the Superintendent of Health shall in like manner be made by the said
chemist, upon requisition sighed and approved by the Secretary of the
State Board of Health. Such analj'ses will include soil, drinking water,
articles of food, air, &c., to be packed for transmission by direction of
the chemist of the agricultural station.
Sec. 15. For carrying out tlie provisions of this act two thousand five
hundred dollars are hereby annually appropriated, to be paid on requisi-tion
signed by the Treasurer and President of the State Board of Health,
and the printing and stationery necessary annually for the Board to be
furnished on requisition. A yearly statement shall be made to the Leg-islature
of all moneys received and expended in pursuance of tliis act.
Sec. 16. All previous acts conflicting with this are hereby repealed
upon tiie passage of this act.
It is proper to state in this report the extent of the move-ment
in sanitary matters in other States and by the general
governmen t. Up to the time of the great epidemic disaster
in the Valley of Mississippi, in 1880, there had been organ-izations
in several States, viz: in Massachusetts in 1869 ; in
California, 1870 ; in Michigan and Louisiana in 1871, and
in Minnesota and Virginia in 1872. But it was the great
epidemic of yellow fever in 1878, which demonstrated to the
people of this country the importance of organizations, by
which to avert the invasion of epidemics as far as possible
or disarm their virulency and afford relief to the suffer-ing
when once established. As if by one great impulse,
cities and States, even those remote from the scene of the
epidemic, sent their representatives to unite with the Ameri-can
Public Health Association, in their meeting in Rich-mond,
Va., in 1878, an association already in vigorous work.
First Biennial Report. 29
ing order, to initiate a new era of sanitary education and
reform.
Prof. J. L. Cabell, M. D., says of this meeting :
" It will be
remembered by those who attended this meeting, that all
its proceedings indicated a prevailing impression that the
time had arrived for immediate and earnest efforts to secure
effective sanitary legislation, both by separate States and by
the general government. Numerous resolutions foreshadow-ing
some such result as an event near at hand, were referred
to the executive committee, who were to have the aid and
counsel of a special advisory committee, composed of one
member from each State represented in the Association, and
a representative from each of the three branches of the Na-tional
Medical Service, together with the Commissioner of
Education." From the conference of these committees came
forth a bill, which essentially became the National Board of ^
Health law.
Since the time of this meeting nearly every State in the
Union has a Board of Health in some stage of development,
and all these States have representation in the American
Public Health Association. This Association meets annual-ly,
discussing the great problems of sanitary progress, and
educating the nation in the work to be done. At its last
meeting, in December, 1880, in New Orleans, the Honorable
Erastus Brooks, of New York, presented a paper on *' What
the State owes the Peopled This paper was deemed of sufficient
important to call forth a resolution, asking that the legisla-tive
bodies of the States be called especially. A copy of it
is herewith transmitted. (Appendix E.)
The work of the North Carolina Board of Health has been
then only a part, I fear a very small part, of the general
sanitary movement in the United States. The field we
found large enough to occupy all of our strength and time
had there been means at our command to take advantage of
our opportunities. We have shown our willingness to be
pioneers in an undertaking which w^e deem essential to the
l^
30 North Carolina Board of Health.
future prosperity of our commonwealth. It now remains
for this great State, so eager in the race for the supremacy
among her sister States, to do her duty, and supply this
Board with immediate and substantial means.
m-
APPENDIX A.
METHOD FOK PERFORMING POST-MORTEM EX-AMINATIONS.*
The following directions for medico-legal post-mortem
examinations are prepared for the use of the County Super-intendents,
for the purpose of placing before them the latest
and most approved plans for conducting such examinations,
and to establish a uniform method throughout the State.
The law makes it obligatory upon the County Superinten-dents
(Section 5) to perform these examinations, and in or-der
to make the monthly statistical returns of the greatest
value, a careful observance of the following directions is de-sired
by the State Board:
I.
—
General Directions.
1. The Medical Officers who are to perform the
Examinations, and their Duties.—The examination of a
dead body for medico-legal purposes is, in accordance with
the existing law, to be undertaken by the County Superin-tendent
of Health. The Superintendent performing the
examination is charged with the duties of a medico-legal
expert.
2. Time of Performance.—Autopsies should not, as a
rule, take place until twenty-four hours after death ; but
the mere inspection of the dead body may be made earlier.
* Adapted from the German regulations of 1S77, by Dr. Thomas F.
Wood, Secretary of the North Carolina Board of Health. Translation
irom '•'' Medical (London) Examiner.''^
32 North Carolina Board of Health.
3. Course to be adopted when the Corpse is in a
STATE OF Putrefaction.—The presence of putrefaction is
not, as a general rule, a sufficient reason for omitting the
examination, and does not justify the Superintendent in re-fusing
to proceed with his duties. For even if putrefaction
be very far advanced, any abnormalities and injuries of the
bones can still be ascertained, and likewise many other cir-cumstances,
such as the color and state of the hair, the ab-sence
of limbs, &c., which may assist in establishing the
identity in doubtful cases. Foreign substances within the
body may also be discovered, as also the presence or absence
of pregnancy and of poisons. When, therefore, the question
arises of disinterring a dead body for the purpose of gain-ing
information with reference to conditions of this kind, it
is the duty of the physician to recommend the exhumation,
regardless of the time that has elapsed since death took place.
4. Instruments.—The Superintendent should be pro-vided
with the following instruments, which are requisite
for the performance of the examination : Four to six scal-pels—
two small, with a straight edge, and two large, with a
curved edge ; one razor ; two strong cartilage knives ; two
pairs of Jforceps ; two double hooks ; two pairs of scissors
—
one pair large, having one blade with the point rounded ofiF,
the other sharp—the other pair small, one blade probe-pointed,
the other sharp pointed ; one pair of scissors for
laying open intestines ; one blow-pipe ; one thick probe, and
two fine ones ; one saw ; a mallet and chisel; a pair of bone
forceps ; six curved needles of various sizes ; a pair of calli-per
compasses ; a tape measure or other measure ; pair of
scales, with weights up to 10 lbs ; a good magnifying glass;
litmus and tumeric paper.
5. Place for the Examination and Light.—For the
examination a sufficiently spacious and light room should
be chosen, where the body can be placed in a suitable posi-tion,
and in a quiet situation. It is not best to perform
autopsies by artificial light, except in cases which admit oi
First Biennial Report. 33
no delay. In such a case the fact must be expressly alluded
to in the notes, and mention made of the reason which ren-dered
the performance at such a time imperative.
6. Bodies that are Frozen.—If the body is frozen, it is
to be brought into a warm room, and the examination is
not to be proceeded with u^til the parts are sufficiently
thawed. The employment of warm water or other warm
materials for expediting the thawing is not advisable.
7. Transport of Dead Bodies.—In moving the dead
body in any way, and particularly in moving it from place
to place, the greatest care must be taken to avoid api:)lying
any great pressure to any portion of it ; and the large cavi-ties
should be kept as nearly as possible in a horizontal
position.
II.—Proceedings at Post-Mortem Examinations.
8. The Judicial Objects op the Examination.—Those-charged
with making the examination should keep their
attention fixed upon the judicial objects in view, and all
things which are subservient to these objects must be inves-tigated
with minuteness and completeness.
Anything that appears important must be noted down in
a minute book, which will be provided on application to
the Secretary of the Board.
9. Duties of those charged avith the Examination
with reference to the ascertaining of Peculiar Cir-cumstances
connected with the Case.—It is the duty of
those charged with the examination, in cases where it ap-pears
to them to be requisite, before the examination is com-menced,
to request the magistrate for permission to inspect
the place where the body was found, and ascertain the j)Osi-tion
which it occupied, and also to examine the clothes
which were found on the deceased,
10. Chemical Examination.—In all cases in which a
chemical examination is necessary, the directions issued by
3
34 North Carolina Board of Health.
the Chemist of the Board (Prof. Ledoux, Chapel Hill,*)
should be' strictly followed.
11. The Examination of the Body.—The examination
of the dead body consists of two principal parts :
—
A. The external examination (inspection).
B. The internal examination (the dissection).
12. External Examination.—The external examination
includes that of the external surface of the body in general
and of its separate portions.
With reference to the condition of the body generally, the
following are the points to be noticed :
—
1. Age; sex; size; bodily conformation ; general state
.of nutrition ; any signs of disease, such as ulcers
•about the legs, peculiar abnormalities, as spots, ci-catrices,
marks of tattooing, excess or deficiency of
limbs.
2. The signs of death and of any decomposition which
may be present.
Should the body be soiled with blood, faeces, dirt and the
like, these must be washed off, and it must then be ascer-tained
whether rigor mortis is present or not; the color of
the skin generally must be noticed, and the kind and de-gree
of any coloration or discoloration due to decomposition
that may be present in an}' part, also the color, position and
extent of the post-mortem stains, which must be cut into
and examined carefully, in order to discriminate between
such appearances and those due to extravasations of blood.
With reference to individual portions of the body, the fol-lowing
points must be attended to :
—
1. When the body is that of a person unknown, the
color, and other peculiarities of the hair (of the
head and the beard), and likewise the color of the
eyes are to be noted.
*See note
l^irst Biennial ReporL 35
2. The presence of any foreign substances in the natural
apertures of the body, the state of the teeth, and the
condition and position of the tongue.
3. Tlien are to be examined the neck, the chest, the
abdomen, tlie back, the anus, the external organs
of generation, and lastly, the limbs.
Should there be an injury on an}' portion of the bod\', a
description must be given of the shape, position and direc-tion,
with reference to fixed points; also its length and
breadth in actual measurement. In this external exami-nation,
any probing of wounds and injuries is, as a general
rule, to be avoided, inasmuch as the depth can be readily
ascertained during the internal examination of the body
and of the injured parts. If those performing the autopsy
deem it necessary to introduce a probe, they must do this
very carefully, and state their reasons for so doing in the
notes of the proceedings.
When wounds have been discovered, the condition of their
borders and surrounding parts is to be determined, and
after the examination and description of the wound in its
original state, it should be enlarged in order to ascertain
the internal condition of its borders and base.
When the body presents wounds and injuries which have
clearly nothing to do with the cause of death—for example,
marks made in attempts at rescue, bites of animals and the
like—it is sufficient that such appearances should be sum-marily
noted.
13. Internal Examination—General Directions.—In
the internal examination, the three principal cavities of the
body, viz., the head, the thorax and the abdomen are to be
opened.
The opening of the vertebral canal, or of separate joints,
is never to be omitted in cases in wdiich any information
may be expected from such examination.
When there is any definite suspicion with regard to the
cause of death, that cavity is first to be opened in which the
principal changes are supposed to exist; but in other cases,
36 Nortli Carolina Board of Health.
the head is to be opened first, then the thorax, and lastly
the abdomen.*
In each of these cavities, the first thing to be done is to
determine the position of the organs therein contained;
then the color and condition of their surfaces, the presence
or absence of any unnatural contents, especially of foreign
bodies, gases, fluids, or coagula; and with regard to the last
two substances, their size and weight should be determined.
Each separate orgon is finally to be examined both exter-and
internally.
14. The Cavity of the Skull.—Unless there are any
injuries which have to be avoided by the knife, and which
would necessitate some other method of procedure, the head
is to be opened by means of an incision carried across the
middle of the skull from one ear to the other, the soft parts
covering the head are then to be reflected backwards and
forwards.
Attention having been paid to the condition of the soft
parts and of the surface of the bones, these latter are to be
sawn through in a circular manner and the skull-cap is to
be removed. The cut surface, the internal surface, and the
general condition of the cranial arch are to be minutely
investigated.
In the next place the external surface of the dura mater
is to be examined, the superior longitudinal sinus opened
and its contents determined ; the dura mater is then to be
divided on one side and turned back and its inner surface
examined, as also the condition of the exposed portion of
pia mater.
After this has been done on the other side, the brain is
to be carefully removed and the base of the skull is to be
examined for any unusual contents. Attention must be
paid to the condition of the dura and pia mater at the base
and side of the skull, and to that of the large arteries.
* With regard to new-born children see paragraphs 22 and 23.
Fird Biennial Report. 37
The transverse sinuses are next to be opened and also the
other sinuses (if there is any cause for so doing) and their
contents are to be determined. The size and shape of the
brain are next to be ascertained, and the color, the fullness
of the vessels, and the consistence and structure of the or-gan
are to be determined by 'means of a series of incisions
through individual portions, viz., the hemispheres of the
cerebrum, the great ganglia (the optic thalamus and corpus
striatum), the corpora quadragemina, the cerebellum, the
pons varolii, and the medulla oblongata.
In addition to this, attention must always be paid to the
condition of the tissue and vessels of the Velum interposi-tum
and choroid plexus.
The extent and contents of the different ventricles, and
likewise the condition and amount of fulness of the various
venus plexuses are to be carefully demonstrated, and the
presence or absence of any coagular external to the vessels
is to be determined.
Finally, the bones of the base and lateral portions of the
skull are to be examined, for which purpose the dura mater
must be previously removed.
15. The Face, Paeotid Gland and Eak.—When it is
necessary to lay bare the internal parts of the face and to
examine the parotid gland or the ear, the incision carried
over the head is to be prolonged behind the ears to the neck,
and the skin is to be dissected forward, in order to spare it
as much as possible. Particular attention is to be paid to
the condition of the large arteries and veins.
16. The Vertebral Column and the Spinal Cord.—
The vertebral column is, as a rule, to be opened from the
posterior aspect. The skin and the subcutaneous fat. are
first to be divided exactly over the spinous processes ; the
muscles are then to be removed from the sides of these lat-ter
and from the arches uf the vertebrae. Extravasations of
blood, lacerations and other injuries, particularly fractures
of the bones, are carefully to be looked for.
38 North Carolina Board of Health.
Then a chisel is to be taken, or a vertebral saw, if at hand,
and the spinuos processes, together with the adjoining por-tions
of the vertebral arches, are to be detached and removed.
The dura mater is now exposed, and after its external sur-face
has been examined, it is to be carefully slit open long-itudinally
and the presence of any serum, or extravasated
blood or other abnormal matters is to be determined. The
color, the appearance and general condition of the posterior
portion of the pia mater are next to be noticed, and the
resistance to pressure of the spinal cord is to be ascertained
by gently passing the finger over it.
The roots of the nerves are next to be divided on both
sides by a longitudinal incision ; the lower end of the cord
is to be carefully taken out, its anterior connections are next
to be gradually separated and finally the superior extremity
is to be removed from the occipital foramen.
In carrying out these directions, great care must be taken
that the spinal cord be neither pressed nor bent. When re-moved,
the condition of the pia mater oii the anterior as-pect
is first to be examined, then the size and color (exter-nal)
of the spinal cord are to be noted, and lastly numerous
transverse incisions are to be made with a very sharp and
thin knife, to determine the internal condition of the spinal
cord, both of its white strands and of the gray substance.
Lastly, the dura mater is to be removed from the bodies of
the vertebrae, and the dissector is to examine for effusions
of blood, or injuries or alterations in the bones or interver-tebral
cartilages.
First Biennial Pieport 39
TABULAR PLAN OF ^PARTS OPPOSITE THE SPINES OF THE
VERTEBRA.*
f7th. Apex of the lung: higher in the female than iu
"s I the male.
{
I
I
v^
i-
1st.
2nd.
3rd. Aorta reaches spine. Apex of lower lobe of lung.
Angle of bifurcation of trachea.
4th. Aortic arch ends. Upper level of heart.
5th.
6th.
7th.
8th. Lower level of heart. Central tendon of dia-phragm.
9th. QEsophagus |ind vena cava through diaphragm.
Upper edge of spleen.
10th. Lower edge of lung. Liver comes to surface pos-teriorly.
Cardiac orifice of stomach.
11th. Lower border of spleen. Renal capsule.
12th. Lowest part of pleura. Aorta through diaphagm.
Pylorus.
fist. Renal arteries. Pelvis of kidney.
^ I 2nd. Termination of spinal cord. Pancreas. Duode-g
J
nuni just below. Receptaclum chyli.
^ I
3rd. Umbilicus. Lower border of the kidney.
4th. Division of aorta. Highest part of ilium.
^5th. -
17. Neck, Thorax, and Abdomen.—Gfnernl Direc-tions.—
In opening the neck, thorax and abdomen, it is
generally sufficient to make one long incision from the chin
to the pubes, passing to the left of the umbilicus. In ordi-nary
cases, the incision is to be carried right into the ab-
* Holden's Landmarks, Amer. Ed., p. 51.
40 North Carolina Board of Health.
dorainal cavity, care being taken not to injure any of the
contents. The best plan is to make at first a very small in-cision
into the peritoneum. Notice must be taken whether
any gas or fluid escapes. First one and then a second finger
is introduced, the integuments are raised from the contents,
and the further incision through the peritoneum is to be
made between the two fingers.
Notice must then be taken of the position, color, and ap-pearance
in other respects of the exposed viscera, and of any
foreign contents that may be present, and the position of
diaphragm is to be determined by examination with the
hand.
The examination of the abdominal organs is not to be
continued at this stage unless there be particular reasons for
believing that the cause of death will be found in the ab-dominal
cavity (Section 13). As a general rule, the exami-nation
of the thorax must precede the further examination
of the abdomen.
18. The Thorax.—For opening the thorax it is necessary
that the soft part of the chest should first be dissected back
beyond the points of attachment of the cartilages to the
ribs. The cartilages are then to be divided with a strong
knife about a third of an inch internal to their attachments.
Care must be taken to avoid injuring the lung or the heart.
When the cartileges are ossified, the best plan is to divide
the ribs with a saw or bone-forceps a little external to the
attachments of the cartileges. The clavicles are then to be
separated from the manubrium of the sternum by means of
a crescentic incision, the knife being held vertically, and the
junction with the first rib, whether cartilaginous or bony, is
to be divided with the knife or bone-forceps, the greatest
care being taken to avoid injuring the vessels lying beneath.
Then the attachments of the diaphragm, between the ends
of the two incisions, are to be divided close to the cartileges
of the false ribs and the ensiform cartilege, the sternum is
to be turned upwards, and the mediastinum cut through,
First Biennial Report. 41
care being taken to avoid injuring the pericardium and large
vessels.
After removing the sternum, the condition of the pleural
cavities is to be determined ; the presence, condition, and
quantity of any abnormal contents, the state of distention
and the general appearance of the exposed portions of lung
are to be noticed. If, in the removal of the sternum, any
vessel has been injured, this must be tied, or a piece of
sponge must be applied to it to prevent the blood from
escaping into the pleural sac, Vv'here its presence might give
rise to mistakes. The condition of the mediastinum, the
state of the thymus gland, and likewise the condition of the
large vessels outside the pericardium (which vessels, how-ever,
are not yet to be opened) are now to be noticed.
Then the pericardium is to be opened, and its condition
noticed and the heart examined. With regard to the latter,
its size, the fulness of the coronary vessels and of its separate
cavities (auricles and ventricles,) its color and consistence
(post-mortem rigidity) are all to be noticed before any
incision is made and before the heart is removed from the
body. Then, while the heart is still unsevered from its
natural connections, each ventricle and each auricle are to
be separately opened and the contents of each cavity are to
be determined with regard to their quantity, state of coagu-lation
and general appearance, and the size of the auriculo-ventricular
valves is to be tested by introducing two fingers
from the auricle. Then the heart is to be removed ; the
condition, of the arterial openings is first to be tested by
pouring in water, and then, after an incision has been made,
the condition of the muscular tissue of the heart is to be
noticed with reference to its color and general appearance.
If there be reason to suppose that the muscular structure
has undergone considerable alteration—fatty degeneration,
for example—a microscopical examination must always be
made. *
42 North Carolina Board of Health.
The examination of the heart is to be followed by that of
the large vessels, but the descending aorta is to be left' until
the lungs have been examined. In order to examine the
lungs minutely, they must.be removed from the thoracic
cavity. Their removal must be effected with great care, and
the lung-tissue must not be torn or squeezed. If extensive
adhesions exi<t, and particularly if they are old-standing,
they must not be divided, but a portion of the costal pleura
should be removed with the attached adhesions. After
removal of the lungs, their surface is to be again carefully
examined, in order that recent changes—for example, the
commencement of inflammatory exudation—may not be
, overlooked. The capacit}'^ for air, the color, and the con-sistence
of each jx.rtion of the lungs, are to be noticed;
finally, large smooth incisions are to be made, and the fol-lowing
points attended to : the state of the cut surfaces ; the
amount of air, blood, and serum ; the presence of any solid
contents in the pulmonary vesicles; the condition of the
bronchial tubes and puhnonary artery, with especial refer-erence
to obstruction, &c., in the latter. For this purpose
the air- passages and the large branches of the pulmonary
artery are to be divided with the scissors, and followed out
to their finer ramifications.
In cases where it is suspected that foreign matters have
entered the air-passages, and where substances, the nature
of which is not evident on s'mple inspection, are found in
the air-tubes, recourse should be had to the microscope to
determine their nature. :
19. The Neck.—According as circumstances may require,
the neck may be examined either before or after the open-ing
of the thorax or the removal of the lungs. Those per-forming
theautops}', may, if they think fit, make a special
examination of the larynx and air tubes, if such investiga-tion
be of particular importance, as, for instance, in cases
of death from strangulation or drowning.
First Biennial Report. 43
As a general rule, the best plan is first to examine the
large vessels and the nerve-trunks, and afterwards to open
the larynx and trachea b}^ an incision carried along their
anterior aspect, and to examine their contents. In cases
where it is especially important to examine these parts,
they should be looked to before the lungs are removed from
the body, and pressure should be carefully made upon these
latter organs in order to see whether any liquid matters, &c.,
ascend into the trachea.
The larynx is then to be removed, together with the
tongue, the soft palate, the pharynx, and the oesophagus;
each of these parts is to be incised, and its condition ascer-tained,
the state of the mucous membrane being particularly
noticed. The tliyroicl gland, the tonsils, the salivary glands,
the cervical lymphatic glands, are all to be examined.
In cases where the larynx or trachea has been injured, or
where important changes are supposed to exist in these parts,
an incision is not to be made into them until they have
been removed from the body, and they are then to be opened
from their pesterior aspect.
Where death has resulted from strangulation, or presum-ably
from suffocation, and the carotid arteries are opened in
order to ascertain v/hether there is any injury of the lining
membrane, the vessels should be examined while still in
their natural position.
Finally, the state of the cervical vertebrse and of the deep
muscles of the neck should be noticed.
20. The Abdomen.—In the further examination of the
abdominal cavity and of its contents, a certain order of se-quence
is always to be adopted, so that the removal of an
organ shall not interfere with the minute investigation of its
relations to other parts. Thus the duodenum and biliary
ducts should be examined before the removal of the liver.
As a general rule, the following order of sequence is advisa-ble:—
The omentum. 2. The spleen. 3. The kidneys and
suprarenal capsules. 4. The urinary bladder. 5. The
44 North Carolina Board oj Health.
organs of generation (in the male subject, the prostate gland
and vesiculas seiuinales, the testicles, the penis, with the
urethra; in the female, the ovaries, Fallopian tubes, uterus,
and vagina). 6. The rectum. 7. The duodenum and sto-mach.
8. The gall duct. 9. The liver. 10. The pancreas.
11. The mesentery. 12. The small intestine. 13. The
large intestine. 14. The large blood vessels in front of the
vertebral column, their contents to be examined and deter-mined.
The Spleen.—The length, breadth, add thickness of the
spleen are to be ascertained while the organ is lying free and
not when placed in the hand, and the spleen is not to be
compressed by the measure. A longitudinal incision is then
to be made, and if any alterations of structure are manifest
the organ should be incised in various directions. The
quantity of blood is always to be noticed.
The Kidneys.—Each kidney is to be removed by a ver-tical
incision through the peritoneum, external to and be-hind
the ascending or descending colon, the intestine is to
be pushed aside, and the kidney detached from its connec-tions.
The capsule is then to be carefully removed, a long
incision being made into it over the convex border of the
kidney. The surface thus exposed is to be noticed with re-ference
to the size, shape, color, quantity of blood contained,
and any morbid appearance that may be present. A long
incision is then to be made through the kidney, as far as its
pelvis, the cut surface is to be washed with water, and de-scribed
with reference to the condition of the cortical and
medullary substa^nce, vessels, and parenchyma.
The Pelvic Organs.—The organs of the pelvi?(the blad-der,
the rectum, and the generative organs therewith con-nected)
are best removed together, but the bladder should
first be opened in situ, and its contents determined. Then
the parts should be further examined, the generative organs
being taken last. The vagina should be opened and exam-ined
before the uterus. In examining the body of a woman
who has died after delivery, special attention should be paid
First Biennial Rcpmi. 45
to the condition of the veins and lymphatics, both in the
inner surface of the uterus and in its walls and appendages,
the size and contents of the vessels being especially noted.
The Stomach and Duodenum.—The condition externally
of the stomach and duodenum is first to be ascertained while
the parts are in siUi. Then, with a pair of scissors, the duo-denum
is to be slit up on its anterior aspect, and the stomach
along the great curvature ; the contents are then to be ex-amined,
the perlfieabilit}'- of the gall duct and an}^ matter
contained therein are also to be noticed, and then the parts
are to be removed for further examination.
The Liver.—The external appearance of the liver is first
to be described, and the organ is to be removed after the
examination of the excretory ducts. Long, smooth inci-sions
are then to be carried transversely through the organ,
and the amount of blood and general condition of the pa-renchyma
are to be ascertained. The description is to con-tain
a short account of the general condition of the lobules,
the appearance of their centres and circumference being
particularly noticed.
Small and Large Intestines.—The small and large in-testines
are to be examined w^th reference to a degree of
distension, color, and other external appearances; they are
then to be removed together, the mesentery being cut
through close to the intestines. After removal, the intestine
is to be slit up with the scissors along the line of the at-tachment
of the mesentery. As this is being done, the con-tents
of each portion are to be noticed and estimated. Then
the intestine is to be well cleansed with water, and the con-dition
of' the various portions noticed, particular attention
being paid to the agminate and solitary glands, the villi,
and valvula3 conniventes of the small intestine. In every
case of peritoneal inflammation, examine carefully the ver-miform
appendage.
2L Cases of Poisoning.—In cases where poisojiing is
suspected, the abdominal cavity is to be first examined.
46 North Carolina Board of Health.
Before anything further is done, attention is to be paid to
the external appearance of the principal viscera, their posi-tion
and size, the fullness of their vessels, and also as to
whether there be any odor perceptible.
With regard to the vessels, the points here to be deter-mined,
as in other important organs, areas follows: Kvq tlie
vessels arteries or veins? Does the congestion prevail in
the finer ramifications, or onlv in the trunk and branches
of a certain size? Are the intervascular spaces of consider-able
extent or not?
Double ligatures are then to be placed around the ter-minal
portion of the oesophagus, just above the cardiac orifice,
and two more around tlie duodenum, below the opening of
the gall duct. The parts are to be divided between the lig-atures.
The stomach is then to be removed with the duo-denum,
care being taken to avoid injuring the parts. They
are then to be opened as described in Section 20.
The contents are to be examined with regard to the quan-tity,
consistence, color, composition, reaction and smell, and
placed in a clean porcelain or glass vessel, following the di-rections
of the Chemist of the Board of Health.
The raucous membrane is then to be washed with water,
and its color, thickness, surface and consistence are to be
noticed. Particular attention is to be paid to the state of
the blood vessels, and to tlie tissue of the mucous membrane
generall}', and of each of the principal portions of the
stomach. Care should be taken to ascertain particularly
whether any blood that may be present is within the ves-sels
or extravasated, also whether it is recent or altered by
putrefaction or digestion, and under these circumstances has
penetrated by imbibition into the parts around. If extra-vasated,
its situation should bo determined—whether on
the surface or in tlie tissue, and whether coagulated or not.
The surface of the mucous membrane is to be carefully
examined for any breaches of continuit}^ such as loss of
substance, erosions, or ulcers. The question as to whether
First Biennial Report. 47
the alterations manifested may have occurred after death,
from natural decomposition, or from the action of the fer-menting
contents of the stomach, is to be carefully kept in
mind.
This examination having been completed, the stomach
and duodenuai are to be placed in the vessel which contains
the contents (see above,) and delivered to the Chemist of
the Board, for further investigation. The oesophagus having
been tied in the*neck and divided above the ligature, and
subjected to examination, is also to be placed in the same
vessel. In a case where the stomach contains but ver}^ little
the contents of the jejunum should be retained in like
manner.
Lastly, other materials and portions of organs, such as
blood, urine, pieces of liver, kidneys, &e., are to be taken
from the body separately for further examination. The
urine is. to be placed in a separate vessel. The blood is to
be kept separately only in cases where a definite conclusion
may be anticipated from spectrum -analysis.
Portions of organs reserved are to be placed together in
one vessel.
Each vessel is to be carefully closed, sealed, and marked.
If on simple inspection, the gastric mucous membrane
appears particularly opaque and swollen, no time should be
lost in examining it with a microscope, especial attention
being paid to the condition of the peptic glands.
The microscope is also to be used in cases where the
stomach contains any suspicious substances, such as portions
of leaves or other vegetable matters, th.e remains of animal
substances taken as food, &c.
Where trichiniasis is suspected, the contents of the stom-ach
and upper part of the jejenum are first to be subjected
to microscopical examination, but portions of the muscular
tissue (of the diaphragm, cervical and pectoral muscles) are
to be put aside for further investigation.
48 Nortli Carolina Board of Health.
22. New BORN Children : Determination of Maturity
AND Period of Development.—In the post-mortem ex-amination
of new-born children special attention is to be
directed to the following points in addition to the above-mentioned
general rules :
In the first place, the signs indicative of maturity and
period of development must be ascertained.
These are—the length and weight of the child, the condi-tion
of the gene'-al integuments and of thefumbilical cord,
the length and state of the hair of the head, the size of the
fontanelles, the diameter of the cranium (longitudinal,
transverse, and diagonal,) the condition of the eyes (mem-brana
pupillaris,)the state of the cartilages of the ndse and
ear, the length and condition of the nails, the transverse
diameter of the body at the shoulders and hips; in male
infants, the condition of the scrotum and position of the
testicles; in females, the condition of the external organs of
generation. Finally, we must examine the size of the cen-tre
of ossification (if present) in the inferior epiphysis of the
femur. For this purpose, the knee-joint must be opened by
means of a transverse incision below the patella, the joint
fully bent and the patella removed ; thin layers are then to
be cut from the cartilaginous end of the femur, till the
greatest transverse diameter of the centre of ossification (if
present) be reached ; this is to be measured.
Should the condition of the foetus be such as clearly to
prove that it was born before the completion of the thirLieth
week, it is not necessary to proceed further wdth the exami-nation.
23. De:termination of the Question whether the
Child has Breathed.—If it shall appear that the child has
been born after the thirtieth week, we must in the next
place ascertain wdiether it has breathed during or after birth.
For this purpose the respiration test must be applied, and
the proceedings conducted in the following order—
First Biennial Report. 49
(a). Immediately on opening the abdominal cavity the
position of the diaphram is to be ascertained with
reference to the corresponding ' rib, and on this
account in new-born children the abdomen is al-ways
to be opened first, and afterwards the thorax
and cranium.*
(6). Before opening the thorax a ligature is to be placed
around the trachea above the sternum.
(c). The thorax is then to be opened, and attention
must be paid to the amount of dilatation of the
lungs and their position dependent upon such di-latation,
particularly with reference to the peri-cardium.
The color ind consistence of the lungs
should also be ascertained.
{d). The pericardium is then to be opened, and its con-dition
and that of the heart externally are to be
ascertained.
(e). The cavities of the heart are then to be opened,
and their contents to be examined, and the condi-tion
of the heart in other respects is to be deter-mined.
(/). The larynx and the portion of the trachea above
the ligature are then to be opened by means of a
longitudinal incision, the condition of their walls
is to be ascertained, and any contents are to be ex-amined.
{g). The trachea is to be divided above the ligature
and removed, together with all the organs of the
thorax.
iji). After removing the thymus gland and the heart,
the lungs are to be placed in a capacious vessel
filled with clean cold water, in order to test their
buoyancy.
*The dissection, however, of the ahdominal organ is never to precede the open
ing and examination of the thorax.
50 North Carolina Board of Health.
(i). The lower part of the trachea and its sub-divisions
are to be laid open and examined, especially with
reference to their contents.
{k). Incisions are to be made in both lungs, and notice
taken whether any crepitating sound be heard, and
also with reference to the amount and quality of
the blood issuing from these cut surfaces on slight
pressure.
{I). Incisions are to be made into the lungs below the
surface of the water, in order to see whether any
air-bubbles rise from the cut surfaces.
(m). Both lungs are next to be separated into their lobes
and these are to be divided into several small
pieces, and the buoyancy of each of these portions
is to be tested.
{n). The oesophagus is to be opened and its condition
ascertained.
(o). Lastly, in cases where it is suspected that air can-not
gain access to the lungs in consequence of the
filling up of their cells and pessages with morbid
products (hepatization) or foreign substances (mu-cus,
meconium), the lung-tissue is to be examined
with the microscope.
24. Other Examinations.—In the last place it is the
duty of those performing the examination to examine all
other organs or parts not mentioned by name in the regula-tions,
in any case in which the parts in question are found
to be injured or otherwise abnormal.
25. End of the Examination—The Cavities to be
CLOSED.—The examination being completed and the body
cleansed as far as possible, it is the duty of the Superin-tendent
to close up carefully those cavities of the body which
have been opened.
First Biennial Rqjorf. 51
III.
—
Making the Report of the Examination.
26. The .Report of the Examination.—A report of
everything connected with the post-mortem examination
should be made out at once on the blanks furnished, adding
additional remarks on the back if necessary.
27. Arrangement and Drawing up of the Reporj.—
The technical portion of the report of the autopsy must be
made out by the Superintendent of Health ; it must be clear,
definite and intelligible.
The appearances found must be accurately described as
matters of fact and not in the form of mere opinions (e. g.,
"inflamed," "gangrenous," "healthy," "normal," a "wound,"
an " ulcer," and the like.) But the Superintendents may,
if they please, for the sake of distinctness, add to the state-ment
expressions in parentheses to indicate what they have
actually observed.
In every case a statement must be given with regard to
the quantity of blood in each important part, and what is
required in a terse description, and not merely an opinion
expressed in such terms as " intensely'," " moderately,"
" somewhat," or " very reddened," " full of blood," " blood-less."
In the description, the size, shape, color, and consis-tence
of the various parts are to be observed and noted be-fore
making any incisions,
28. Opinion.—At the conclusion of the autopsy, if any
particular facts influencing his opinion have come to his
knowledge, whether from the proceedings or otherwise,
these should be briefly mentioned.
If the cause of death has not been discovered, the fact
must be expressly mentioned. It is never sufficient to say
that the death has resulted from internal cause or from dis-ease
; the disease must be specified.
In cases where further technical examination is necessary,
or where there are any doubtful circumstances, it is better
52 North Carolina Board of Health.
for the Superintendent to postpone his opinion until more
minute examination is made.
29. Supplemental Explanation with regard to Weap-ons.—
If there be any injuries on the dead body which may
have been the cause of death, and if it be suspected that a
weapon that has been discovered has been used to cause the
injuries, then the Superintendent of Health must institute
a comparison between them, and must state whether and
what injuries could have been caused by the weapon, and
whether any conclusions can be drawn from the position
and condition of the injury as to the mode in which the
perpetrator has acted, and as to the force used.
Should weapons not be forthcoming, the Superintendents
should express an opinion, as far as the appearances will
permit, with regard to the way in wdiich the injuries may
have originated, and with reference to the nature of the
weapons employed.
The report of the examination is to be signed by the
Superintendent of Health, and if another physician has
assisted at the autopsy, it should be stated.
jSTote.—Virchow'^s directions as to how incisions sTiould he made.—It
may serve as a useful hint, even to those quite familiar with old time
methods, to quote from Prof. Yirchow's '' Method of performing post-mortem
examinations.'''' " For all ordinary purposes of pathological dis-section,
I now grasp the handle of the knife in the palm of my hand,
so that when I stretch out my arm the blade appears as a dh-ect pro-longation.
I fix then relatively, if not absolutely, the joints of the
fingers and hand, and make" the cutting movements with the entire arm,
so that the principal movements occur in the shoulder-joints, the sec-ondary
ones in the elbow. In this way I am able to make long and use-ful
incisions, and smooth ones as well, for I can utilize the whole force of
the arm, and especially of the muscles about the shoulder; and it is only
on surfaces produced by such incisions as these that we are able to see
anything really satisfactory." English Edition, p. 25.
" * * A good pathological anatomist is perfectly able to dissect all
the viscera of one subject, or even of two, with one knife; a pathologi-cal
' layman,' holding his knife as he would a pen, requires three or four
knives for one autopsy." p. 26,
First Biennial Report. 53
*' I maintain that a free incision, even when wrongly done, is, as a rule,
to be preferred to a small though accurate one, and is almost alwayi
better than several or many small cuts. The large even cut is peculiarly
the one for demonstration purposes. To make it, I look carefully at each
separate organ, to find where I can get the largest surface on section. I
therefore cut through a ^pleeu from above downwards, over the middle
of its outer (convex) surfarce, a kidney from without and within (from
the external to the internal border), a liver from right to left in a hori-zontal
direction; the testicle 1 cut into two equal parts in a perpendicu-lar
direction from its free to its attached border, and snap the parts
asunder. I divide each lobe of tlie lung by a perpendicular incision
directed from above downwards, and from its thicker border towards
the inner (anterior, medial, sharp) one. Each hemisphere of the cere-bellum
I divide by an incision which commences in the fourth ventricle,
in the direction of the crus cerebelli, and is carried obliquely outwards."
METHOD OF PROCEDURE IN CASES OF SUSPECTED
POISONING.
Laboratory of the N. C. Experiment Station,
Chapel Hill, April 24th, 1878.
To the Coroners and County Superintendents of Health of the
State of North Carolina
:
I beg to call attention to section 14 of "An Act Supple-mental
to an Act creating a State Board of Health," passed
by the late Assembly and ratified on March 14th. This sec-tion
is as follows:
" Sec. 14. When the County Superintendent of Health
shall, in the course of his investigation required at coroner's
inquest, think it necessary to subserve the ends of justice
that a chemical analysis of the viscera or fluids of the body
be made, he shall carefully pack up and seal the suspected
article in a proper receptacle, in the presence of a witness,
and forward it to the chemist of the agricultural station for
analysis. (Such analysis shall be made free of charge, and
54 North Carolina Board oj Health.
be returned to the coroner of the county, such analysis hav-ing
precedence over other matters of investigation not of a
simila*r chara*cter th*en in*the la*borator*y of th*e chemist.)" The Board of Agriculture, recognizing not only the claims
of the law but the claims of humanity upon them, have
made arrangements by which the analyses in question can
be made through the Experiment Station. Knowing that
were I compelled to make such analysis in person it would
occasion great delay and serious interference with my work,
especially during my long absences from ni}'- post when
testifying at court, &c., they adopted the following resolu-tion
:
" Resolved, That the Chemist of the Board be authorized
to employ such additional labor as may be necessary to
prosecute the analyses in cases of suspected poisoning, as
required by section 14 of an act supplemental to an act
creating a State Board of Health, at an expense for the same
of not more than dollars per annum."
In compliance with the above resolution of the Board, I
have secured the co-operation of Prof. A. F. Kedd, of the
University, who will devote himself to any cases which may
arise under the provisions of the law above cited. Prof.
Redd has made all the analyses of this character that have
been required in the State during the last two years, so far
as I am informed. Your attention is called to the following
instruction?, which should be followed as nearly as possible
to comply with the law and to secure an analysis which will
stand in court:
1st. Except in special cases, it will be sufficient to place
the stomach, the whole of the liver and spleen and the blad-der
each in a separate, perfectly clean glass jar, with tightly
fitting glass top (a fruit jar serves well). Care should be
taken that none of the contents of the stomach or bladder
escape. No disinfectant or preservative should be added in
any case.
Jfirst Bie7i7iial Report 55
2d. Seal each jar thoroughly and label distinctly with the
name of its contents,
3d. Secure, if possible, any vomit or urine voided imme-diately
before death, .and also any liquids, powders or other
substances which are suspected of having caused death, or
any vials or other receptacles which may have contained
the poison, sealing each as before.
4th. Let these jars be delivered at the station by some
one, properly authorized, in person. Do not send by ex-press.
The person bringing the jars should never allow
them (or the receptacle in which they may be packed), to
get out of his sight, unless to go under a lock, to which the
carrier holds the key. The messenger will bring the jars to
the Experiment Station and deliver them to me, or to Prof.
Redd in my presence.
The expense of these analyses will be defrayed by the
Department of Agriculture, but the pay of Prof. Redd in
attendance upon court will still be regulated by the laws
specially providing for the remuneration of witnesses and
experts.
Respectfully,
ALBERT R. LEDOUX,
Chemist to the Department of Agriculture.
Appendix b.
CIRCULAR ON VENTILATION, DRAINAGE, DRINK-ING
WATER AND DISINFECTANTS.
The months of August, September and October being the
season of the greatest rain-fall attention is called to the con-dition
of cellars, drains, ditches, and wells. While it has
not been settled that soil-soakage is the cause of diphtheria,
or typhoidal diseases, it has been the experience in some of
the sea-coast towns, that the greatest prevalence of diphthe-ria
has been at this period. It is at this season that the
malignant and simpler forms of malarial fever abound in
alluvial tide water districts ; that the cellars of houses are
more apt to become harmful; that the water in wells oftener
becomes contaminated by the rapid percolation of the soil
by rain-water.
The fruits ripening at this season, too, have been thought
to be the cause of disease, so that some persons avoid scup-pernong
grapes and melons, thinking that this is the secret
of their escape from fever. Mullet and other fish have also
the reputation of causing fever. It is hardly necessary to
say it, but we repeat what many physicians say daily in
their professional rounds, that fruit and fish in good condi-tion
are safe articles for those with whose digestion they
ordinarily agree.
Ventilation.—Ventilation of the cellars of houses by
freely opening the doors and windows, cleansing and white-washing,
and sprinkling unsJacked lime in the moist places,
is a prime necessity to keep the air of the house pure. The
o8 North Carolina Board of Health.
drainage of the soil adjacent should be looked after, and
especially should all waste pipes and sewer pipes be inspected
with care.
A house imperfectly supplied with large enough windows
and doors is not easy to remed}'. But in most of our houses,
the old fashioned broad fire place still has ascendency, fur-nishing
a means of ventilation of a superior character.
Now if care is taken that in the occupied rooms a little fire
is built morning and night, a free circulation of air is ef-fected,
and the air of these rooms is made pure. This pre-caution
has long been observed in the tide-water regions of
this State. Even in the warmest days the hearth is made
cheerful at night by the ruddy glow of the lightwood fire.
The chief obstacles to ventilation in the average houses be-ing
too low ceilings and too small windows.
Where the simple construction we have mentioned does
not prevail, and by mistaken economy stoves and grates
have taken the place of the open fire place, ventilation
should be remedied by the means mentioned in Mr. William
Cain's paper on Ventilation, issued by this Board.
Ditches.—It is a question that should be settled with
thougtful deliberation, to what extent ditches should be
opened in August and September, or indeed before the oc-currence
of frost. Nearly all Southern cities have adopted
the rule of forbidding the disturbance of the soil to lay gas
pipes, digging out foundations for building, and opening
ditches between certain months, say from June until No-vember.
This is a good rule and should be adhered to
most rigidly in sea-coast towns, especially where there has
ever been an epedmic of yellow fever. So much stress, too,
was laid upon this matter by the rice planters on the Cape
Fear river before the war, that the negroes were not allowed
to dig out the ditches in August after the crop was " laid
by," and while the weather was hot, as less sickness was
known to result from the same work in winter.
It is safe to say though, that ditches draining the site
First Biennial Report. 59
upon which dwellings stand, should be opened even in Au-gust,
if the necessities of the case demand, or the proprietor
has neglected it in its proper time. It is far more prudent
to turn up the soil than to have the surface water wash into
the well, or that standing ponds, or constantly wet places
should go unremedied. In cities, though, we would advise
against this course. If the needed work has been neglected,
the extent of work done should be limited to opening drains
and ditches which have been plugged up by floating debris,
or by caving; and for the more urgent reason of saving
property from destruction, such as the undermining of the
foundation of buildings and conduits.
Wells and Dkinking Water.—Wells are so universally
used that many cautions are necessary for their main-tenance
in such a condition as to be pure sources of water.
The picture constantly before the eyes of the watchful sani-tarian
is that of a well dug in porus soil, a few feet from the
privy, and cow shed, and house ; dug deeper than the un-ceraented
vault of the privy, and serving as a drain into
which impure water gravitates. Sometimes these views are
looked upon as existing mainly in the imagination of the
officers of the health department ; " for," says the doubter,
"we have been drinking this water, and our neighbors come
from distances to get it because it is cool and pure." Never-theless,
even in such cases, where the owner may have the
utmost confidence that his well water needs no improve-ment,
it is foul with the impurities which his perverted and
blunted taste no longer detects.
One noteworthy instance among many others which have
come to light since this Board commenced the analysis of
drinking water was that of the well of a gentleman living
in Wilmington. On a high sandy ridge his well had been
dug many years ago. His neighbor to the east of him had
an uncemented privy vault 20 feet off. His own privy was
not twice the distance. The family, consisting of seven or
eight, did not enjoy as good health as their neighbors. The
60 North Carolina Board of Health.
doctor's phaeton was often at the door. The gentleman be-lieving
something to be wrong in the surroundings of his
residence, caused all the undergrowth to be cut out. His
house, which was a wooden structure, raised from the ground
on brick pillars, was ventilated underneath, and lime sprink-led
freely to dry up and purify the moist soil. The venti-lation
of the rooms was improved ; articles of diet were
carefully looked after, but no adequate improvement fol-lowed.
He was advised by the Board of Health to have his
drinking water analyzed. This was done by the chemist of
tho Board, revealing shocking impurities from the suspected
sources. The well water was abandoned for drinking and
cooking purposes.
A sanitary map of the city of Wilmington, for which
material is being collected, shows the depressions in the soil,
where, in the rainy days of fall, the water ponds, sometimes
for weeks. One particular locality, bounded by McCum-ber's
alley on the N. W., Ninth street on the E., and Chest-nut
street on the S. (very nearly), forms a basin or depres-sion
in the sand, upon which many small dwellings are
crowded. The houses facing on Macumber's alley and
those on Chestnut street, having their privies midway the
triangular block, the wells of these houses being also in
close proximity. Over this area, in times of great rain-fall,
the soil-soakage was deep, the water standing in the three
boundary streets to such a depth that it is necessary to dig
ditches to carry it away to the regular ditches farther to the
east. For several years the occurrence of diphtheria and
enteric fever were so common that the casual relation be-tween
soil-soakage and these severe cases was a matter of
discussion by physicians.
It is true that after this time diphtheria became quite
prevalent elsewhere, even in the best drained portions of the
city ; but it was only after it had gained sufficient intensity
in its original sites that it invaded the more salubrious
First Biennial Report. 61
quarters, and at no time was the disease so prevalent or so
malignant as along the course of these rain ponds.*
It would be folly for rational people to wait until, by di-rect
proof of the casual relation between contaminated drink-ing
water and the typhoidal diseases, they are convinced.
It is much more to the purpose to accept such reasoning as
we are able to give wuth our imperfect knowledge, to-wit:
Sickness prevails in a family ; all other sources of contami-nation
are sought for with negative results ; the drinking
water is examined. It reveals albuminoid ammonia, living
organisms—products of stercoraceous infiltration. The well
is abandoned; pure water is secured; the family is restored.
The neighbors around, who persist in using the water des-pite
the warning, keep sick, and they, too, after abandoning
it for pure water, are restored. These are the demonstra-tions
reasonable persons will appreciate.
Furthermore, a natural disgust for impure water should
cause householders to look carefully into this subject.
Prof. A. R. Ledoux, Chemist of the State Board of Health,
has written an article on fDrinking Waters, from which we
quote the following
:
" The most dangerous poisons in well water are the drain-ings
of sewers, sinks, yards and privies, and the refuse from
towns.
" These organic poisonous matters ooze through the soil
into wells and springs, and, as before said, may not show
any bad effect for some time, but sooner or later disease and
death will surely visit the unsuspecting household and the
physician's aid be sought in vain ; for with every draught
of water which passes the fevered lips the sufferer imbibes
new poison and hastens the inevitable end. Moreover, the
germs of many contagious diseases, which feed on filth and
* The objection that might be raised that dlphtlieria has prevailed where none
of these conditions exists, we do not deny. The condition certainly Intensifies
tlie disease and increases the mortality.
t North Carolina Medical Journal, April, 1879.
62 North Carolina Board of Health.
multipl}'- in foul water, are nurtured and preserved in warm
climates through winter weather, by the equable tempera-ture
of wells and cisterns, and are ready to start anew on
their errand of death when a favorable moment arrives.
"The city of Wilmington is no doubt above the general
average of Southern cities in sanitary condition, but what a
picture the February number of the Journal showed us.
Think of it
" ' There ivas one well twojeet from the privy, two ivells four feet
from the privy, thirty-three wells ten feet from the privy, tiuo hun-dred
and twenty wells from twenty to thirty feet P
" The soil upon which Wilmington is located ' being nearly
as w^hite as the sea-shore and as permeable ! P
" It is not our purpose at present to depict the danger of
such neglect of sanitary precautions, so much as to point to
a remedy.
" 1st. We say unhesitatingly, if a well shows signs of contami-nation
by sewerage or other like matter, fill it up !
" 2d. Build all sinks and primes as far as possible from the
well.
" Through permeable soils and strata, dangerous liquids
may ooze to a distance of many feet. We know of cases
where wells have been used for years with no bad effect, when
suddenly disease and death appeared. The poison, though
slow in its course, had finally reached the well and a chem-ical
analysis revealed contamination from privies thirty feet
or more distant.
"The living organisms which are found in water are,
some of them, injurious; some beneficial.
" Under favorable conditions of light, warmth, &c., count-less
millions of living things will spring into life in any
water; the more impure the more abundant they will be.
If the water is alkaline they will be animalculas or infusoria
;
if acid, fungi, algte, &c.
"They are never found in fresh rain water, but abundant
in nearly every cistern. The office of infusoria is in water
First Biennial Report. 63
that of the buzzard on land : they are scavengers, and puri-fy
the liquid by feeding upon the decaying matters it con-tains.
But the microscope reveals to us in water, contami-nated
with sewerage for instance, minute germs capable of
motion, which, as in the case of the infusoria, live on t^ie
organic matter, but are believed to accompany, if not cause
many forms of contagious disease, filling even the air in
times of epidemic.
" To detect many of these impurities and dangers, chem-ical
analysis and the microscope are sometimes indispensa-ble,
but the following rules may awaken suspicion and lead
to a scientific investigation of the quality of drinking water
in some cases
:
" A good drinking water is perfectly colorless and transparent,
vnthout smell or noticeable taste and agreeable to the palate. It
shovXd not lose its clearness in boiling and should have a very srna I
residue on evaporation.
" Where impurities are suspected, an analysis should be
obtained, if possible,* if not, filtering through charcoal or
sand, or boiling, will often either remove or render harm-less
various dangerous ingredients."
Disinfectants and Deodorants.—There is much misap-plied
energy, and much money wasted, upon deodorants and
disinfectants. The folly of making the various substances
coming under this head take the place of thorough cleans-ing
is seen daily, and more especially in the summer
months, when there is apprehension of the visitation of epi-demics.
If the truth were correctly stated, it would have
to be acknowledged that it is only in these seasons of appre-hension
that such work is done at all, and then all lapses
into a state of neglectfulness not to be accounted for on any
other ground than that of ignorance of the objects to be
attained.
•Analyses of suspected waters will be performed free of charge by the State
Chemist on application to Dr. Thomas F. Wood, Secretary of the Board, Wil-mington.
64 Eorth Carolina Board of Health.
We quote from the circular issued to householders, city
authorities, boards of health, &c., by the New Jersey State
Board of Health, this season, the following on
Disinfectants and How to Use Them.
Drafts of air for all floating foulness;
Dry rubbing for all easily detached foulness;
Wiping and water scrubbing for all attached foulness in
most cases admit of no effective substitution.
Submersion in boiling water is applicable to the cleansing
of all garments, utensils, &c., admitting of such a method
;
and dry boiling heat or freezing cold will also neutralize
infective particles.
To disinfect a room, ship or building so needing disinfec-tion
that its contents and surfaces cannot be easily dealt
with singly : Close the room or building, its windows, doors,
and chimneys, so as to exclude the outer air as far as possi-ble.
Vacate the house. Break roll sulphur in small pieces,
place it on an iron plate or other metalic dish, and set this
on a pair of tongs or other cross bar over an iron pot in
which there is water, or over a large box of sand, so as to
avoid danger of fire from small particles of burning sulphur.
Light it by a few hot coals or some alcohol poured around
the sulphur and lighted. Then leave and shut the door
after you. A pound and a half of sulphur is sufficient for
1,000 cubic feet of space. The sulphur will convert all the
oxygen of the air into sulphurous acid, and all organic par-
' tides are likely to be changed. Keep closed three hours after
the burning has ceased, and then air well six hours before
occupying. Clothing and bedding needing disinfection
may be hung on lines and left in the room. Most furni-ture
is not permanently injured, but needs dry wiping and,
then washing off afterward.
Chloride of Lime.—A valuable disinfectant, chiefly because
it contains from 30 to 35 per cent, of chlorine, which is lib-
First Biennial Report 65
erated under proper methods of use. If purchased for cities,
it should be tested as to the amount. It is not overrated as
a disinfectant if only its quality is known and its mode of
use is judicious.
It needs slight moistening, frequent stirring, and some-times
the addition of an acid, as vinegar or common spirits
of salt. The test of its efficiency is that the odor of it be
kept constantly perceptible.
Chloi'inated Soda.—Usually known as Labarraque's solu-tion,
is a convenient liquid preparation valuable for use in
saucers in the sick room or in utensils. Its odor should bo
perceptible to strangers entering.
Lime—Plaster— Charcoal—Dry earth—Sifted ashes.—All
these have value, chiefly to be tested by the rapidity with
which they correct odors. Fresh slaked lime should be
scattered in all places of foul odor. It or charcoal or plaster
may be scattered over heaps emitting foul odors. Calx pow-der
is made by pounding one bushel of dry fresh charcoal
and two bushels of stone lime and mixing them, and is of
great practical use.
All these substances absorb foul gases and dry up moist-ure,
and so help to retard decomposition, or else absorb its
results. Where lump charcoal is used it may be refitted for
use by reheating it.
Quick lime and ground plaster should not be used where
they may be washed into pipes and form lime soap or ob-struct
by hardening.
The Metallic Disinfectants.—Sulphate of iron (copperas or
green vitrei,) two pounds to a gallon of water, to be sprink-led
freely in drains, cesspools, privy closets, soiled vessels or
heaps of decaying matter which cannot be removed at once.
One half of the strength will do where it is to stand in con-tact
with the surfaces or in spittoons, water closets, houses,
vessels or vaults.
One half pound of sulphate of iron (green vitrei), or one
ounce of sulphate of zinc (white vitrol), or one ounce of sul-
5 •
66 North Carolina Board of Health.
pbate of copper (blue vitrol), or one ounce of chloride of
zinc, (butter of zinc), or one ounce of chloride of lime
(bleaching powder), put to a quart of water—any one of these
is available for neutralizing discharges or for sinks, used in
quantities suflBcient to cover the bulk they are inteded to
disinfect.
Soiled garments may be put to soak in a half pound of
sulphate of zinc (white vitrol), to three gallons of water. It
will not stain or discolor most fabrics. One ounce of the
chloride of lead dissolved in a pint of hot water and then
a pailful of water added into which a handful of common
salt has been thrown, serves a similar purpose. Also a half
ounce of permanganate of potash to a gallon of water.
For washing, soiled garments should be put in boiling
water, unless the character of the fabric forbids it. Pow-dered
borax, one quarter of a pound to a gallon of water, is
a good cleanser of clothing. Soiled hair, brushes, etc., are
cleansed by it. Chloride of zinc, one quarter of a pound to
a gallon of water, does not stain or discolor fabrics.
Parkes recommends two ounces of cloride of lime, or one
ounce of sulphate of zinc, or one-half of a fluid ounce of
chloride of zinc, to be added to each gallon of the boiling
•water in which the garments are thrown. On clothing that
cannot be washed and does not need to be burned, after
"thorough shaking and airing, the sulphate of zinc or chlo-ride
of zinc solution may be sprinkled.
For general disinfection the following compound is avail-able
and valuable, and far better than most of the patented
.articles offered
:
Sulphate of iron, (copperas,) forty pounds.
Sulphate of lime, (gypsum of plaster,) fifty pounds.
Sulphate of zinc, (white vitriol,) seven pounds.
Powdered charcoal, two pounds.
Mix well and scatter dry or wet it in small quantities and
make into balls ready for use. Where a liquid is needed,
First Biennial Report. 67
stir in water in the proportion of a pound of the powder or
ball to a gallon of water, and sprinkle when needed.
Carbolic Acid is valuable as an out-door disinfectant, to be
added to the sulphate of iron solution, or to be used sepa-rately.
Because of its own odor we cannot well test its effect
in correcting other smells. We would test specimens or use
only Sqibbs' Liquid, No. 1, because sure of its strength to
be diluted by adding from fifty to one hundred parts of
water, according to the mode of its employment. It is sel-dom
required if the other articles named are properly used.
Carbolic acid and cloride of lime must not be used to-gether.
Reinember that we do not know that any chemical disin-fectants
destroy the germs of a disease.
They only neutralize or suspend the action of those arti-ficial
disease producers or fertilizers which the bad admin-istration
of cities or householders, or interference with nat-ural
laws, or neglect of cleanliness has provided. We are
to rely on these paliatives or correctives only while we are
preparing for radical methods of prevention.
N. B.—The only reason why the death rate of your city
or your township is over 15 to the 1,000, or why the sick-ness
and invalid rate is a multiple of this, is because you
are the victims of nuisances which admit of abatement.
Present Wholesale Prices of Disinfectants
:
Sulphate of Iron (Copperas, Green Vitriol), IJ cents per
pound.
Sulphate of Zinc (Vitriol), 6 cents.
Chloride of Lime (in bulk), 2 cents per pound ; in pack-ages,
6 cents.
Sulphur Roll, 2| cents per pound.
Carbolic Acid (No. 1 Squibbs), 30 cents per pound.
Zinc and Carbolic Acid, disinfectant of N. Y. Board of
Health, 40 cents per gallon.
68 North Carolina Board of Health.
Permanganate Crystals, $1.10 per pound.
Fifty per cent, solution Chloride of Zinc, 25 cents per
pound.
Solution of Chlorinated Soda (Labarraque's), 10 cents a
pound.
The National Board of Health issued directions relative
to disinfection and precautionary measures, from which we
quote. This circular was prepared more especially for limit-ing
the spread of yellow fever, but is marked with modera-tion
and sound sense.
The National Board deems it prudent to adopt the word
" germ " to signify that " something which is capable of
growth and propagation outside the living human body
that this germ flourishes, especially in decaying organic
matter or filth, and that disinfection must have reference
both to the germ and to that in or on which it flourishes."
1. Disinfection, when used in a place not infected, for the
purpose of rendering filth, or foul soils, waters, &c., incapa-ble
of propagating disease germs, is a poor substitute for
cleanliness, and is mainly useful to make the process of
cleansing odorless and harmless. The best disinfectants for
this purpose are sulphate of iron, carbolic acid, fresh quick-lime,
fresh charcoal powder, chloride of zinc, chloride of
aluminium, and permanganate of potash.
" 2. The two great difficulties in destroying the vitality
of the germ of yellow fever are, first, to bring the disinfect-ing
agent into actual contact with the germ; and, second,
to avoid injuring or destroying other things whick should
be preserved.
" When the germ of yellow fever is dry or partially dried no
gaseous disitifedants can be relied on to destroy it. It must
either be moistened or subjected to a dry heat of not less
than 250° F. to obtain security,
"4. In disinfecting or destroying infected clothing, bed-ding,
or movable articles, move them if 'possible while dry.
First Biennial Report. 69
Before disturbing them have them thoroughly moistened
either with a chemical disinfecting solution or with boiling
watpr, in order to prevent the diffusion of dried germs in the
air in the form of dust.
"5. The best method of disinfecting rooms, buildings,
ships, &c., is still doubtful, owing to the difficulty of destroy-ing
the vitality of dried germs.
The Board proposes to have this subject carefully investi-gated,
and in the meantime advises thorough scrubbing
and moist cleansing to be followed by the fumes of burning
sulphur at the rate of 18 ounces per 1,000 cubic feet of space
to be disinfected.
The sulphur should be broken in' small pieces, burned
over vessels containing water or sand, which vessels should
be distributed in the closed space to be disinfected at the
rate of one pound to each 100 square feet of area of floor.
" 6. No patented compound known to the Board is supe-rior
as a disinfectant to the agents above mentioned, and
none is so cheap. Some of these patent disinfectants are
good deodorants, but the removal of an unpleasant odor is no
proof that true disinfection has been accomplished.
It is important to observe in the above advice how much
stress is laid upon the difficulty of destroying the infective
principle of disease (germs) in houses occupied or on cloth-ing
worn by sick persons, when moisture is not previously
applied, a thought that will lead to good results.
Appendix C.
SANITARY ENGINEERING,
By Whxiam Cain, C. E.
CHAPTER I.
GENERAL CONSIDERATIONS.
Death Rates Lowered by Sanitary Works.—We are
told upon the best authority that in England there occurs
annually upwards of four million cases of preventable sick-ness;
and that 125,000 persons are premature cut off every
year from a neglect of sanitary precautions.
Now if this be true in a country which has adopted the
best known sanitary precautions, at great expense, how much
more significant will the records in this State appear,
where the only outlay that may be classed under the head
" sanitary," is generally made in meeting doctors^ bills and
funeral expenses.
It is further stated that in England, since the sanitary
precautions have been instituted, that the death rate has
been lowered by from one-fourth to one-third, and is besides
decreasing from year to year. The following table, refer-ring
to a feiv localities in England, taken from Latham's
" Sanitary Engineering," speaks more forcibly than all the
other arguments that may be presented, especially to those
who have paid but little attention to sanitary subjects, and
I'irst Biennial Report. 71
are inclined to be skeptical as to the great actual saving of
life that may be attained. 1 presume the table is made out
for 1873, the date of the publication, and that the "works"
are of the " water sewerage" kind
:
Name of Place,
72 North Carolina Board of Health.
aspects : thus Latham has taken Cro3'don, where the total
cost of sewers, &c., was $943,800, and estimated the saving
in fimei^als, in sickness (allowing that for every life saved 25
would escape sickness, the saving being estimated at $5 for
every sick person,) and in the labor, for 6|- years only, by
the prevention of premature death, at a total of over $1,000,-
000, which thus exceeds, in the short space of 6J years, the
total cost of the sanitary works.
Yellow Fever Caused by Filth.—How much more
striking would be the result, were we to take some of our
own plague stricken cities in America! Where has the yelloiv
fever its origin f In the filthiest port in the world, Havana,
where " the tide being almost imperceptible, all the empty-ings
of the sewers remain in the harbor until they become
a foetid and revolting mass of corruption." From there the
seeds of the yellow fever are carried by ships to other ports ;
and when these are foul the scourge begins.
Gen. Butler at least has the merit of having to a great
extent kept New Orleans clean and free from the epidemic
during his occupancy of the city. In 1878, however, in
consequence of the foulness of the city, she suffered the
most terrible visitation ; whilst in 1879, through the ener-getic
workings of some of her most public-spirited citizens,
in carrying out sanitary measures, the mortality from yellow
fever was very much reduced.
Galveston was kept clean and escaped the plague. Hunts-ville,
Ala., actually sheltered yellow fever victims with im-punity
; whilst Memphis, in 1879, again suffered from her
foulness.
What more instructive lesson than the facts just given ?
Advantages of Keeping Clean.—If we keep clean there
is less chance of dying, greater enjoyment of life from in-creased
health, fewer bereavements, and a positive pecuniary
gain to the community, even including the cost of sanitary
works. Health, population, and money values also, gen-erally
go hand in hand, when other conditions are favorable.
Fii'st Biennial Report 73
On the contrary, if we disobey the Divine Will, by run-ning
counter to natural laws, we are punished for the sin
of disobedience. Here we have rewards and punishments
—
both teaching their own moral lessons. Choose between
them.
Is North Carolina Clean.—Let us now inquire as to
our own cleanliness, which, the Good Book .tells us, is next
to Godliness. The result of this inquiry would be, that
typhoid fevers, diphtheria, and certain interic fevers that are
now classed as " fiiih diseases,^' are common, especially in the
larger towns of the State ; and that these diseases are suffi-ciently
accounted for by bad iuells,foul yards, privies and cess-pools
; the latter tainting the air with their gases and the
water with their dissolved impurities.
There are but few privies in the State that ought not to
be abolished, and some good S3'stem substituted in their
place. It is one object of this paper to suggest such systems.
But it is not sufficient that our own house alone be free
from reproach. The individual may suffer when it is only
his neighbors who are to blame. The whole community,
as a unit, must practice cleanliness.
The germ of disease, engendered amid the surroundings
of filth, if wafted to the palace, can strike as deadly a blow
there as in the dirty hovel, as recent examples show.
Filth and Disease go Hand in Hand.—Of the exact
nature of the poison generated by filth we know little ; but
it has certainly been demonstrated in numerous cases that
the ravages of epidemics are in direct proportion to the
foulness of the locality. Thus in one city, diphtheria fol-lowed
the line of bad sewers ; in another, of bad wells.
Bad water is one of the most efficient agents in spreading
disease.
The cholera of 1853, in London, attacked districts fur-nished
with unfiltered Thames water with 3^ times the
severity experienced by neighboring districts supplied with
Thames water filtered through sand and charcoal.
74 North Carolina Board of Health.
It has become as it were an accepted truth in sanitary-science
that the fatal effects of epidemics may either be pre-vented,
or their spread materially hindered by a proper at-tention
to sanitary precautions. These precautions simply
consist in the having, at all times, pure air, wholesome food,
and good ivater. It is only the first and last of these requi-sites
that will be considered in what follows, as they pertain
more especially to the science of "Sanitary Engineering;"
though it is to be observed that wholesome food is to a cer-tain
extent dependent upon the good water or milk used in
the cooking.
By a disregard of these prerequisites to health—and they
are more or less disregarded by us all—we enfeeble the sys-tem,
suffer a loss of vital energy, and are thus fit subjects
for an attack by the first epidemic.
The " debilitating effects " of large cities are mainly due
to the poisonous gases, generated by the putrid matter of
sinks, sewers, &c., which gases find their way into chambers
through faulty pipes and traps, or are otherwise diffused
through the atmosphere. When the debilitated person seeks
the pure water and bracing air of the mountains, the relief
is almost instantaneous, thus proving the life-giving qual-itiei
of pure air and pure water.
The Science of Prevention.—The Science of Medicine,
so long confined to the art of healing alone, now declares in
favor of the Science of Prevention as the higher philosophy.
Let us, then, state the principles of this latter science
clearly and succinctly ; not entering into many details, but
giving mainly those principles and facts that should be
known by every one. Any system proposed must be a sim-ple
one—the simplest is generally the best—to meet the
needs and comprehension of all classes.
The law organizing the North Carolina Board of Health
requires a monthly report from each county on vital statis-tics.
It is of great importance that this law be faithfully
First Biennial Report. 75
carried out, so that the effect of the suggestions given below,
where carried out, may be ascertained.
The same act requires that the Board " shall gather in-formation,
for distribution among the people, with the espe-cial
purpose of informing them about preventable diseases."
Disease may be prevented, other conditions being favor-able,
by a proper attention to drainage, ventilation, water sup-ply,
and the prompt disposition of sewage matters.
We shall consider the subject in the above order.
CHAPTER 11.
DRAINAGE.
Wet and D