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of ti)B ^m\itmtv oi Ji^ortb Cacolina ano pf)ilanti)ropic ^mttits WA 1 , -^0 «J~*->t^-/^-c^ c. / •v % ^ \- - -. 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. H % H Q O o 52 -go. he u (D (S ?: 05 3 a ao H o S 3 "> r;*^ ii-^ •inv pTonTtHnqiv '3 5 M w ce ail ^Il1 § O be "Ha « J2 OO O oo SD o Kcq •a o *-§ ^^ eS O ooooo ui t;inoratuv a»Jjl ooooo uoh'bS aed sure.i3 III auuomo eg © a ss •73 -3 o o •a-a H a aft «: X 3 5 c a o o c a © © 02 OQ d) © ©^ •O © a ©^ a' to © a c3 to oo oo ooooo oo oo — oo o'o' 'r:o -r'^;:^—*c/?xa) ccc^ coco coo c^i-f O O O O O ^J O O O O CO O O O O C CO o'o' oo'oo'o'oo o'o o'o oo OO ooioooijjoo 00301000 Ci 'T* 10 04 -r o 05 I* f-'C^ LOO t^cqoi 00 'I'O oco'oJ^'co'oco'o ^^c-io'^-^'^ cJco 00 00 m' oi Ol CO 03 CO uon«3 jad suiisaS u| spiios iw;ox C; 35 t-; x_ x o X r-; ^'c4—ico'c^ix'—-'lO oo'co't-'-)«oio First Biennial Pi.epor(. 19 •a T3-r . o .o • O !>, o t>, S iiti— iC-otJ c cs o ce o .2 -a S » 3 c3 O S O X' >^ s^ -^ «^ 1^ ^ o o O ci o bo o O O O O MfcC o o E C— iJ O «3 te o ej W)2 s •:i fe ^ M £C S '^ f^' t. CO O Sj-^ o <D -*^ w CS c3 •?^ fc.' c a cs c a ,w ^'^ O ci iS 0K« be rt to » !,,_ c S 3 2 ? '3 o c3 OJCB <U o o ^ o o tf <v ^ 7i e3.0 a l^ -d c3 o o bo 3 V c3 ^ s eS •s g c3 0, be K h S O 50 oo o- O ooooo •o 1^ Q 33 c) ic 1^ i: r- X oi ol c-i ?5 —< T^j —. o —; o o o o o o o c o o o o o o oo ^ a: c-i o o : o'oc oo ooo ^ :o l^ ^ 01 0o(oi^o-r'rr>ocDOc:'0 t~-_ i <; CO cc lo » ^- 1- 0>0-H Ot^^wiOlOiOCO (N "N 'N -* C-^ ^H C-) ^-t ^^ ? O O -f Oi c^ c5 o' -^ lO -O 'XJ lO <NO—i-hO 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
Object Description
Description
Title | Biennial report of the North Carolina State Board of Health |
Other Title | Report of the North Carolina State Board of Health. |
Creator | North Carolina. State Board of Health. |
Date | 1879; 1880 |
Subjects |
North Carolina. State Board of Health--Statistics--Periodicals Public health--North Carolina--Statistics--Periodicals Public Health--North Carolina |
Place | North Carolina, United States |
Time Period |
(1876-1900) Gilded Age |
Description | Report covers two calendar years (13th-18th); (19th) covers Dec. 1, 1920-June 30, 1922; thence each covers July 1-June 30 years.; Printer: 13th (1909/10)-18th (1919/20) by Edwards & Broughton; 19th (1921/22)-20th (1923/24) by Bynum; 21st (1925/26)-<44th (1970/72)> unnamed. |
Publisher | Raleigh :The Board,1911- |
Agency-Current | North Carolina Department of Health and Human Services |
Rights | State Document see http://digital.ncdcr.gov/u?/p249901coll22,63754 |
Physical Characteristics | v. ;24 cm. |
Collection | Health Sciences Library, University of North Carolina at Chapel Hill |
Type | text |
Language | English |
Format | Reports |
Digital Characteristics-A | 214 p.; 11.65 MB |
Series | Biennial report of the North Carolina State Board of Health |
Digital Collection |
North Carolina Digital State Documents Collection N.C. Public Health Collection |
Digital Format | application/pdf |
Related Items | Printer: 13th (1909/10)-18th (1919/20) by Edwards & Broughton; 19th (1921/22)-20th (1923/24) by Bynum; 21st (1925/26)-<44th (1970/72)> unnamed. |
Audience | All |
Pres File Name-M | pubs_biennialreportof01nort.pdf |
Pres Local File Path-M | \Preservation_content\StatePubs\pubs_edp\images_master\ |
Full Text |
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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.
" Cholerrivy, 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 r;*^ ii-^
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