Health bulletin

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library of
QIl)c Uutccrsity of Hortl] darolina
COLLECTION OF
NORTH CAROLINIANA
ENDOWED BY
JOHN SPRUNT HILL
of the class of 1889
C(3(l\- 3V^fc^
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This book must not
be token from the
Library building.
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Form No. 471
:B"criL,x^E:'xi3sr
OF THE
North Carolina Board of Health.
Published Monthly at the Office of the Secretary of the Board, Raleigh, N. C.
Geo. G.Thomas, M.D.,Pn's., Wilmington. I AV. P. Ivey, M. D Lenoir.
S. Westray Battle, M. D...AsheviIle. ] IJkancis Duffy, M. D New Bern.
Henry W. Lewis, M. D Jackson. i W. H. Whitehead, M. D Rocky Mt.
J. L. Nicholson, M. D Richlanda. I J. L. Ludlow, C. E Winston.
Richard H. Lewis, M. D., Secretary and Treasurer, Raleigh.
Vol. XIX. APRIL, 1904. No. 1.
Notice to Pliysicians.
According to the jDrinted rules of the
Biological Laboratory, it is closed during
the month of June to allow the Biologist,
who has no assistant, his well-earned va-cation.
This year he will take his vaca-tion
later, of which due notice will be
given. So, physicians desiring labora-tory
work can have it done without in-terruption
until they receive such notice.
Anunal Meeting of the State iMedical
Society and of tlie Board of Healtlt.
These bodies will meet in Raleigh on
Tuesday, the 24th instant. At 12 M. on
Wednesday the conjoint session of the
two will take place. It promises to be
unusually interesting and instructive,
and it is earnestly desired that every
superintendent of health 'who possibly
can will attend. Such gatheriners are
always helpful, and it is well for us to
get together at least once a year and
compare notes.
Dr. Kriiext P. Foster, Dr. Abuer
Alexander.
It is with sincere regret that wc chron-icle
the passing away of these two good
men. Dr. Foster, at the time of his
death, was Superintendent of Health of
Franklin county. He was always the
courteous gentleman and conscientious
official.. The same can be said of Dr.
Alexander. The latter was for several
terms a member of the Legislature, and
we wish to put it on record that the
cause of the piiblic health and the medi-cal
profession never had, in the writer's
experience, a more earnest and, when
his party was in power, a more efficient
friend in the General Assembly. May
they sleep well.
/
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Plate 1.—Fig. 1. Parasite op Quartan Malaria. Fig. 2. Parasite op Tertian Malaria.
Fig. 3. Parasite op Pernicious Malaria.
BULLETIN OF THE NORTH CAROLINA BOARD OF HEALTH.
Tlie Kllolo$>;y of Malaria.
BY GERALD MCCARTHY,
Biologist N. C, Board of health.
The disease variously called "Malaria,"'
''Chills and Fever," "Ague," and other
names, was clearly recognized by physi-cians
in the days of Aristotle. It was
then as now the peculiar scourge of
swampy regions, more especially in warm
climates. But until comparatively recent
times malaria was a common and fatal
disease even in northern countries. Up
to the beginning of the eighteenth cen-tury
malaria of the chronic, pernicious
type was epidemic and very fatal in
England. During the same centurj', ow-ing
to the great advances in hygiene
and the improved condition of the houses
of the common people, the disease lap-idly
declined, and soon after the begin-ning
of the nineteenth century became
practically extinct in England. At the
present time on the continent of Europe
a line drawn along the tops of the Pj're-nees
mountains and following the Lyo-nais
mountains through Lyons and the
upper Rhone valley, thence following
the tops of the Alps and through the
valley of the Danube by Vienna, thence
along" the tops of the Carpathian moun-tains
and northerly through Russia, un-til
lost in the swamps of the Dneiper,
will divide the continent into two parts,
north of which line malaria is now rare
and sporadic, while south of the line it
is endemic, and like a smouldering fire
ever ready, on the relaxation of hygienic
measures, to burst forth. In the north-ern
region of Europe ^only the tertian
form is known. In the south the quar-tan
form predominates, and in regions
notorious for bad hygienic conditions the
chronic and pernicious form is common.
In North Carolina so far the Laboratory
of the State Board of Health has received
no blood sample showing the quartan
parasite. Only the tertian form of ma-laria
seems to exist in this State. In all
legions of the north temperate zone the
three winter months—December to Feb-ruary,
inclusive — show the minimum
prevalence of malaria. The maximum
in the northern regions is from May to
September. In the more southern re-gions
the maximum occurs from August
to October.
THE CAUSE OF MALARIA.
Up to the year 1880 the universal
opinion, even among well-informed phy-sicians,
was to the effect that malaria
was an air-borne disease, due in some
�� mj-sterious way to emanations from de-caying,
water- soaked vegetation. In the
year named Dr. LaA'eran, a French army
surgeon, first clearly demonstrated the
connection between the disease and a
protozoan parasite, which is always
found in the blood during acute attacks
of malaria. Since 1880 numerous inves-tigators
in Italy, Germany, America and
England have verified and extended Lav-era
n"s observations. The most recent
and important advances in elucidating
the etiology of the disease are due to the
work of English physicians, among whom
the more noted names are those of Man-son,
MacCallum and Ross. Ross first
clearly determined by the experimental
method that the malarial parasite dur-ing
different parts of its life-cycle lives
in the bodies of humans and mosquitoes.
Further he showed that only mosquitoes
of the genus Anopheles act as malaria-carriers
for humans. The common mos-quitoes
of our houses, in both seacoast
and upland regions, is not Anopheles but
Culex. Culex acts as a disseminator of
malaria among birds but not among hu-mans.
BULLETIN OF THE NOETH CAROLINA BOARD OF HEALTH,
THE LIFE HISTORY OF THE MALAKIA
PARASITE.
Tliere are two very distinct species of
the malaiia organism. These are desig-nated
HceinumoEha tertiaiia and H. quar-
Uinu. They are directly correhited with
the forms of malaria from which they
take their specific names. The genus
HcemariKjebu belongs to the natural order
Sporozoa of unicellular animals, whicli
order also includes the parasites causing
malaria in birds and many animals and
splenetic or "Texas" fever in cattle.
Both species of the malarial organism
are obligatory parasites and are known
to exist only in the bodies of one or other
of their hosts—mankind and mosquitoes.
It is possible and probable that there is an
as yet unknown segment in the life-cycle
of these parasites. Many observations
and conservative deductions point that
way, but so far no one has discovered
the missing link. The principal grounds
for supposing the existence of an un-known
segment of the life-cycle of the
malarial parasites are as follows:
Malaria is known to be endemic in
poiticns of India and Africa where there
are no human inhabitants. . The power
of flight of the malaria mosquito is very
slight and the creature rarely ever flies
more than one mile from its place of
birth. Yet it exists in uninhabited re-gions
and seems able to convey malaria
to chance visitors to such regions. It
has long been known to physicians that
the tearing up of the soil during the so-called
malaria season frequently leads
to malaria in an epidemic form. Finally
it has been recently shown by Dr. J. M.
Smith in New Jersey that the true mala-ria
mosquito may exist in both of two
nearby towns which, so far any one can
see, have similar surroundings and same
class of people, with constant intercom-munication.
Yet in one town malaria
may be epidemic and in the other origi-nal
cases practically unknown, in Paris,
France, no case of original malaria has
developed within the memory of the
oldest living physician. Yet the malaria
mosquito. Anopheles iiiaculipennis, is not
uncommon in Paris, especially in the
parks and pul)lic gardens, where the pop-uliice
frequently gather in large crowds.
In Paris, too. t]ien> are numerous resi-dents
who liad f(nnierly C(mtracted ma-lari:
i in Algeria and otliei- notoriously
malarious countries. Tliese persons are
known to carry in their blood the resting
or crescent spores of the p^irasite. From
ou)- knowledge of the case and the theory,
such persons must be frequently bitten
by the .\nopheles. and tlieu the latter
will suiely bite citi/ens wholly free from
iiiabnia. (>nr present knowledge and
the accepted theory of the disease wduhl
require that every one bitten by the ma-laria-
infected Anopheles sliould contract
acute malaria, but the fact is. in Paris,
at least, tliey do not. Yet this exception
to the rule does not invalidati^ (he oft-proven
fact that there can, under ordi-nary
circumstances, be no acute malaria
without the bite of an Anopheles mos-quito.
:\Ialarial fevers are commonly classified
into the following kinds: Quotidian, or
paro.xysra recurring daily; Tertian, or
paroxysm recurring every second day;
Quartan, or paroxysm recurring every
third day. There is also the so-called
Estivo-autiunnal. or pernicious form.
Finally, physicians recognize clinically
two groups called' respectively benign
, and malignant malaria.
Biologists, however, recognize but two
species of parasite, and therefore only
two kinds of fever—tertian and quartan.
BUI-LETIN OF THE NORTH CAROLINA BOARD OF HEALTH.
Till' so-called quotidian fever is merely
a double infection of the ordinary tertian
and the so-called Estivo-autnmnal fever
is teitiau in a chronic or specially viru-lent
form. Plate 1, Fig. 1, shows the
life-cycle of the quartan parasite as it
exists in the human blood—« is the blood
corpuscle just infected: b, c, d, e, f, show
successive advances in the matui-ity of
the parasite; g and /; show the beginning
of sporulation. Figs. / and / are two
extra-corporeal conditions of the fullj--
grown spore. One should be flagellated,
but fiequently at this pait of the cycle
the i^arasite seems to live an arrested
life for a while and then degenerates and
fall to pieces.
Plate I, Fig. 2, shows the life-cycle of
the tertian parasite; a, h, c, d, c and /
show siiccessiA-ely maturing phases of the
parasite Avithin a blood corpuscle; g and
/( are the sporulating stages. In quar-tan
fever the stage g resembles a sym-metrical
daisy-like figure; in tertian fe-ver
this phase resembles more a Ininch
of grapes: / and _;' are extra-corporeal,
sexual forms or "gametes" of the spore—
-
the llagellate form being the male. These
coalesce and recommence the grand cj^cle,
but only outside the human lx)dy, i. e.,
natnirally within the body of the mosquito,
who lias abstracted the spores with blood
from some malaria-infected person. In
the liuman body alone the cycle ends at
/(, where the non-sexual spores break
from the corpuscle in which they had
developed, and after being carried about
in the blood .stream for awhile thej- find
their way into new corpuscles and so
begin again the cycle until the disease
is checked by quinine or other causes.
The bursting forth of the spore is con-commitant
with the chill' stage of the
disease, while the renewed attack of the
spores upon the blood cells is the cause
of the fever stajje.
Plate I, Fig. 3, shows tiie life-cycle of
tlie malignant or pernicious forms; a, b,
c, d, e, /', are the successive stages as in
the two preceding Hfiurcs; g shoMS a
double infection of a l)lood corpuscle,
conunon in malignant malaria; I and j
are the sporulating stages; k is the cres-cent
or '"resting- spore stage'' of the para-site
within the human body; /, in, n, o,
are stages of the development of the
crescent into the flagellate form. These
latter changes take place only otitside of
llie human body, ('. c, in nature they
occur only within the body of the mos-quito.
But these changes also may take
place in a sample of malarial blood kept
tinder the microscope on a glass slide.
5a- __. Fig. 4 is another il-e?£
l N lustration of the life-gs^
bo.' \ cycle of the pernicious
\ form of the malarial
;
; parasite within the hu- ^ ^'^
\ man body. 1 is the
spcrozoit introduced
^^ba- . into the blood by a
bite of Anopheles mos-
^ su' quito; 2 shows the
original sporozoit mul-
. / tiplied three fold; 3 ^ ""
/ shows a blood corpus-
/ cle invaded by one of
-® * / the parasites. At 5a-
I-VI the parasite com-j.^,.-''
pletes the cycle to the
free-spore stage, when
'^^ 1 it is ready to begin
"T again, as at 3.
Fig. 4.—Life Cycle of the Malarial Parasite
IN THE Human Body.
^^'e have followed the successive phases
of the cycle of the parasite within the
himian luxly. \Ahen an Anopheles mos-quito
sucks into its own body ])Io(mI
containing tlic crescent or resting spores
6 BULT.ETIN OF THE NORTH CAROLINA BOARD OF HEALTH
as previously shown, the crescents soon
proceed to develop into the forms shown
at i, j, Figs. 1 and 2, and at n, o, Fig. 3.
In all of these figures the rounded form
represents the female gamete and the
flagellate form the male gamete or body.
The result of the sexual fusion is the
production of a slender, rod-like- form
resembling 1 in Fig. 4, but wholly differ-ing
from that form in physiological sig-nificance.
The new form in the body of
the mosquito soon penetrates the wall of
the insect's stomach and attaches itself
to the exterior surface of that organ.
There it forms around itself a sort of
cyst, and within this it develops a vast
number of spores which soon in turn
rupture the walls of the cyst and swim
free for a time in the body cavity of the
mosquito. Eventually, by some unknown
attractive force, the new sporozoits gath-er
into the salivary gland and duct of
the mosquito and there remain ready to
infect a new human victim as soon as
the mosquito bites again. The mosquito
injects the parasite with the venom that
these insects always inject into the blood
when they bite, in order to render the
blood more fluid and easier to suck in.
In each and every stage here described,
those not illustrated as well as those
pictured, the phases and changes in the
complete life- cycle of the mosquito are
described from actual specimens and dis-sections.
There is no theory in it, nor
is there anything taken for granted.
Every stage as described is absolutely
known to exist, and the fact may be
verified by any one possessing the nec-essary
apparatus, time and skill.
The best time to find the parasite in
the human blood is six to eight hours
before or after a chill. The crescent
forms are never found in acute cases
until after some weeks of fever. The
ear is the best organ to puncture. A
new steel pen with one nib removed is
the best lancet. This need not be steri-lized,
nor is it necessaiy to wash the
ear with alcohol. Stretch skin lightly
over fingers and drive the lancet in one-eighth
inch with a single rapid blow.
Do not press or knead the part. Discard
first few drops. Blood is best examined
fresh and unstained with one-twelfth
inch oil immersion lens. A lower power
is not satisfactory. In pernicious ma-laria
the destruction of blood corpuscles
is rapid and very great—often four-fifths
the normal number are destroyed by the
parasites.
THE DIFFERENT SPECIES OF MOSQUITOES.
In the Eastern United States we have
only two genera of mosquitoes of much
economic importance. These are Culex,
the common brown-legged, clear-winged
mosquito, of which we have about twen-ty-
two species, but only two of real im-portance.
These are C. pipiens, the com-mon
house mosquito of the upland coun-try,
and C. sollicitans, the ring-legged
salt-water mosquito, which is the more
common species within twenty miles of
the seashore. The malaria mosquito is
Anopheles, of which we have three spe-cies,
but one is quite rare. Of the other
two, Anopheles maculipennis, the '"speck-led-
winged mosquito," is the malaria
species; the other species, A. punctipen-nis,
"smoky-winged mosquito."' The lat-ter
is suspected but not certainly known
to convey the malaria germ when it bites.
The other species has been proven beyond
cavil to be a common carrier of the in-fection.
Until we are better informed,
however, we should, as a matter of
safety, wage an uncompromising warfare
against all Anopheles mosquitoes, and
need not even spare Culex.
Fig. 5.
—
Anopheles Maculipennis.
(After Howard, Bull. 25, U. S. Dept. Agr. ).
Fig. 6.—Eggs ok Anopheles.
*: After Howard, Bull. 25 U. S. Dept. Agr.
BULLETIN OF THE NORTH CAROLINA BOARD OF HEALTH.
Fig. 5 shows Anopheles maculipennis, and at the riglit a hirva or wriggler"
male at left, female at right. Fig. 6 of Culex. Fig. 8 shows another view of
shows the eggs of Anopheles as usually the same larva as they lie feeding in the
laid l)y the insect upon water, and Fig. 7
shows at left the appearance of half-grown
larva or 'wrigglers," two stages.
water. Anopheles above lies just below
the surface; Culex below lies in an ob-lique
direction from surface.
Fig. 7.—Larv^ Forms of Anopheles (at
( After Howard, Bull.
These illustrations of mosquito larvae
should be carefully .studied by every one
living in a malarious neighborhood. As
will be seen, the appearance of the An-opheles
and Culex larva are very dis-similar,
and it should be an easy matter
to determine which genus we find in our
rain-water barrels, or in chance pools,
ponds or ditches within a lialf mile of
the house. Whenever the narrow-headed,
slender wriggler is found in any pond
or other water, that water should at
once be removed by drainage or the sur-face
should be kept covered with a thin
stratum of oil, as will be described fur-ther
on. .As a general rule, the wrig-glers
found in rain-water liarrcls and in
left) and Culex (at right) Mosquitoes.
25, U. S. Dept. Agr.).
foul or polluted ditches or ponds near
houses belong to the genus Culex. But
Anopheles is frequently founfl also in
such places, though it prefeis remoter
pools where green alga and water plants
abound. Neither genus is likely to be
found in ponds or vessels containing tad-poles,
crabs or fishes. Ditches and pools
having weedy or grassy margins are ex-cellent
places to look for Anopheles lar-va'.
I'he Anopheles thrives in salty or
brackish watei', according to Dr. .J. ~Sl.
Smith of New Jersey, who has for the
last few years devoted much time to the
study of the celebrated and fciocious
mosquitoes of that State.
BULLETIN OF THE NORTH CAROLINA BOARD OF HEALTH.
In addition lo minnows, wliicli are
probably the best anti-mosqnito animals,
the more important enemies of moscpiito
arc water-beetles and bu<>s, which are
nearly always carnixorons, frogs, tad-poles,
drasfon-flics and insectivorous
l)irds.
Fig. 9.—Pupal Form of Anopheles.
(After Howard, Bull. 25 U. S. Dept. Agr. I.
Fi»'. fl sliows the pupal form of An-opheles,
lliis is tlie stage intermediate
between the larva and the winged forms.
It usually lasts but a day or 1 wo. Fig.
10 shows the egg masses and hir\a of
C'ulex. witli one enlarged wriggler at
right. l-'ig. 11 shows the |)upal stage
of Culex.
.\s will be HDliceil, i1 is niuch snniller
tli.ui the similar phase (if Anopheles.
Fig. Li shows tlie mature form of ('iilc.v
pijiicii.s. the (•<i)inn(in house mn-,(|nilii of
(inr uplands. The female is pictured
above, the male hclow.
I"'cw ])ci's(ins excr sec a male mostpiito.
The males iic\ci- hilc. They li\c up<m
frnil juices .ilonc and as a iiilc ne\'cr
come into linu-cs or .iliglil upon peo])le's
hands or face. The female nn>sqnito
10 BULLETIN OF THE NORTH CAROLINA BOARD OF HEALTH.
Fig. 10.—Egg Masses and
(From Harward, Bull,
alone is blood-thirsty. This particular
and favorite beverage of the female mos-quito
is supposed to be correlated with
her egg-laying duties. It is imagined
that mosquito eggs will not mature un-less
stimulated by human blood, but as
Fig. 11.—Pupal Form of Culex.
(After Harward, Bull. 25 U. S. Dept. Agr. I.
Larv^ form of Culex.
25 U. S. Dept. Agr. i.
millions of mosquitoes live and propa-gate
in swamps remote from human hab-itation,
it is impossible that they can
always secure blood to stimulate the
activity cf the ovaries.
It is important that every person ex-posed
to punctures of the malaria mos-quito
should be able to distinguish the
mature or winged form of Anopheles
from the winged fonns of the Culex mos-quitoes.
The following are the more ob-vious
distinctions:
Culex is comparatively smaller and
more heavily built; Anopheles is larger
and lighter. Culex has comparatively
short legs and when at rest is graceful
in appearance; Anopheles has very long
legs and appears clumsy when at rest.
Culex has clear wings; Anopheles has
black spotted or smoky wings. Culex
when standing on a more or less level
surface or biting lias the body nearly
parallel with this surface and the head
BULLETIN OF THE NORTH CAROLINA BOARD OF HEALTH. 11
projects beyond the front legs; Anophe-les
in a similar situation has the body
oblique or nearly perpendicular to the
supporting surface and the front legs
are away beyond the head. The body
of Culex is humped or bent at the tho-liibeinates
in the holes left in trees and
dry banks by swallows, squirrels and
other wild burrowing creatures. Culex
seems more tender than Anopheles, and
always disappears early in the autumn.
Anopheles may usually be found flying
Fig. 12.—Mature Form of Culex (Female above).
(After Howard. Bull. 25 U. S. Dept. Agr.).
Tax; that of Anopheles is nearly a
straight line from the tail to the beak.
The upland Culex and Anopheles mos-quitoes
pass the winter in the winged
state. They lie hidden in cellars, stables,
attics, and in the hollows of trees, etc.
Anopheles also, according to Dr. Smith,
as late as December in North Carolina,
and in houses or cellars heated by a
furnace these insects may remain active
all winter and bite people, conveying
malaria at any time. As we have said,
the upland Culex breeds only in water
not very .saltv, but it may be vei'v foul.
12 BULLETIN OF THE NORTH CAROLINA BOARD OF HEALTH.
The seacoast mosquito breeds only in
salt or bracki.sli water, never in fresh
water. Anopheles can breed in water
either fresh or salt, but is not usually
found in streams or ponds grossly pol-luted,
by sewage. The running of citj-pools,
hollows of trees, and among water
plants lining the margins of ponds, etc.,
make the extermination of this species
in any given locality impracticable. We
must lie content to repress it to keep its
numbers down. The limits of practica-
FiG. 13.—Resting Positions of Culex (above) and Anopheles (below).
(After Howard, Bull. 25 U. S. Dept. Agr.).
sewage into streams does not, therefore,
tend to induce or increase malaria, as
many seem to think. The facility with
which the malaria mosquito can hide
during the cold season and breed in any
sort of water, and even in vcrv shallow
jjle work are, however, quite important.
We can at a coinparativelj- small cost
reduce the prevalence of all the mosquito
pests to from three-fourths to nine-tenths
the ordinary uncontrolled numbers and
annoyance. Drainage is the great and
BULLETIN OF T]IK NORTH CAROLINA ROARD OF HEALTH.
all-iuiiiortant leinedy for mosquitoes.
The (Iniiiiaye must be tlioiuugli, so as
to leave no hollows or pools. Even the
depression made by the foot of a man
walking o\er soft ground may ser\e to
bleed hundreds of mosquitoes. Perma-nent
bodies of water sliouM !)( stocked
witli tish, especially the tup minnow
—
FuikIuIks in fresh and (lit inbHsiu in
salt watei'. Pikes and other predacious
fishes are not desirable in such ponds,
as they destroy the useful insect-eating
lishes. The margins of all ponds and
sluggish creeks should be kept free from
weeds and grasses. Sluggish wateis
which caiuuit l)e stocked with tish should
l)e oiled with crude petrolemu once every
three or four weeks from June 1st to
November 1st—one ounce of oil to fifteen
square feet is suflficient. Fishes are
better than oil. and as oil is liable to
destroy the tish in a ]i(ind or stream, it
should not be used wlicrc i1 is possible
to stock the water with minnows. Aqua-tic
water insects, crabs and frogs should
never be harmed, as they do good work
in reducing tlu' numbers of mosquitoes.
Finally it must be said that mosquitoes
breed only in stagnant or very slow-flow-ing
and shallow waters. Bold streams
with rapid currents, or lai'ge deep ponds
with clean margins, will not breed these
pests.
There are every season advertisements
of the wonderful anti-malarial effect of
some new tree or plant when grown near
houses. The only grain of truth in these
stories is that all fast-growing plants
cause the ex'aporation of a consideiable
amount of water from the soil. One
plant is ;is good as another f(n- this
j)Ui]M;se if the same amount of leaf sui-face
is exposed to the sun. Hut drainage
by ditching and the otiier treatments
above described are cheaper and far more
effectual than soil-drying plants of any
kind. There have been of recent years
put upon the market by enterprising
manufacturers many anti-nio.squito nos-trums
of the usual patent, self-acting,
miraculous kind. These nostrums are
invariably "fakes" intended solely to
convey money into the pocket of the atl-
\'eitiser. There is no chemical treatment
of water iov mosquitoes more etlectual
or cheaper than crude petroleum.
The salt-water mosquito is a daylight
Hier, but the upland C'ulex and tiu' An-opheles
mosquitoes are twilight tliers.
Therefore to escape being iiitten by the
malaria mosquito we have cnly to make
our houses insect-tight with wiie screens
and remain within from an hour l)efore
sunset until an hour after suniise. This
simple and practicable precaution is an'
absolute protection against malaria,
even in the most notorious uuilarial
sections. Ijai-ge railroad construction
gangs have in tliis way been jtrotected
fiom malaria while building through
swamps where malaria was known to be
endemic among the natixes.
In 1902 two English physicians were
sent by the English war otiice to t^st
the \alue of wii-e screens against malaria
ity living in the district at the mouth of
the Tiber in Italy. The district named
has from time immemorial been noted
f(n- the fatal and inveteiate type of ma-laria
there endemic. The I'higlishmen
took no ((uinine and went freely about
among the malaiia-st ricken inhabitants,
drinking swamp water t'ldiii a ditch
which flowed past their door. They mide
their house, whirh was ;in (irdiiiiiy
st i-aw-thatched hut. insert -t ight liy hi:' ins
of wire sci-eens. They weie careful lo
be within doors one hour liefme >undowii
and rei!iaine<l within until one hour afler
NUUii^e. They kept u|) llii> life for the
thi'ce most malarious month- nt' the rea-son
and did not contract malaria, where-
u BULLETIN OF THE NORTH CAROLINA BOARD OF HEALTH.
as all around them the natives were
regularly shaking. This was a crucial
test of the value of wire screens and
is a lesson that should be remembered by
physicians in malarious regions. ^\Tiere
it is impossible for all persons to remain
within doors during the dangerous hours
as above described, the same end can and
has on many occasions been attained by
enclosing the head and neck in a mos-quito-
proof veil and the hands in thick
gloves. This veil should be of double
thickness and should be carefully stitch-ed
to the cap above and at bottom sewn
to firm cloth flaps arranged to slip down
over the shoulders and be tied under
the arms. The hands must be encased
in heavy leather gloves free from holes.
The gloves must come well up on the
arms and be tied there to prevent slip-ping
off. The coat and pants should be
thick enough to prevent the insect from
3)iercing through with her beak.
The only other mosquito-repellant
worth mentioning is oil of citronella.
This oil is the commonly-used odor in
cheap toilet soap. It can be bought at
any drugstore. A few drops may be
added to a teaspoonful of lard or a little
vaseline and rubbed lightly upon the
parts whicli must be exposed to insect
bite. This protection is not satisfactory
against Anopheles, but it is an almost
certain preventative as against the sea-coast
mo>quito and other Culex species.
Visitors to the seashore and sportsmen
in swamn^- regions, even where malaria
is not feared, would do well to carry with
them a small phial of oil of citonella.
A few drops of this oil placed upon the
pillow on retiring will prevent visita-tions
from mosquitoes during sleep.
Where oil of citronella may not be at
"hand, a fair substitute is ordinary cheap
scented toilet soap rubbed or smeared dry
• on hands and other exposed parts. A
fresh onion rubbed on the skin is a good
repellant, as is oils of pennyroyal and
lavender. But all these are inferior to
oil of citronella.
Review of Diseases for March, 1904.
SEVEXTY-EIGUT COL NTIKS UEPORTIXG.
Kinety-six counties have Superintend-ents
of Health.
Except in the case of the more con-tagious
and dangerous diseases the Su-perintendent
has, as a rule, to rely upon
his own information alone, since few
physicians can be induced to report cases
of non-contagious diseases to him.
Where the number of cases is not
gi\eu, or the prevalence of a disease
otherwise indicated, its mere presence in
the county is to be understood as re-ported.
For the month of March the following
diseases have been reported from the
counties named
:
[NLeasles.—Alleghany, in ;ill parts;
Ashe, 20 cases; Bladen, 12; Burke,
many; Caldwell, 20; Caswell, several;
Catawba, 23; Chatham; Clay, in all
parts; Cleveland, several; Cumberland;
Davidson; Duplin. 10; Durham, a few;
Edgecombe, several ; Forsyth ; Gaston,
many; Pitt, .3; Polk, many; Rowan, 50;
Rutherford, a few; Scotland, 10; Surry,
a few; Swain; Union, 10; Vance, 16;
Wake, 8; Watauga, 10 or 15; Wilkes, 2;
Yadkin, many; Yancey, many—31 coun-ties.
Whoopixg-cough.—Burke, in all
parts; Craven, several; Durham; Edge-combe,
a few; Forsyth; Gaston, a few;
Granville, 15; Iredell, 4; Jackson, 10;
Jones, a few; Martin, many; Mecklen-burg;
Nash, many; Onslow, 10; Pitt, 6;
Rutherford, a few; Surry, 20; Swain;
Wake, 55; Wayne, a few—20 counties.
BULLETIN' OF TH K XOKTH rAK<:>LINA BOARD OF HEALTil. 15
Scarlatina.—Davidson, 1 ; Forsyth,
15; Iredell, 1; McDowell, C; Randolph,
a few ; Rockingham, a few ; Stanly
Surry, 5; Wilkes, 1—9 counties.
DiPHTiiEKiA.—Buncombe, 1; Cabarrus,
1; Cumberland, 1; Edgecombe, 2; For-syth,
4; Haywood; Lincoln, 1; New Han-over,
1; Perquimans, 1; Pitt, 3; Ran-dolph,
3; Stanly; Wake, 1; Wilkes, 1—13
counties.
Typhoid Fevek.—Alamance, 2; Ashe,
2; Bladen, 1; Gates, 2; Iredell, 1; Jones,
1 ; ^ladison, 8 ; Xew Hanover, 4 ; Per-quimans,
2 ; Pitt, 1 ; Robeson, a few
;
Union, 10; Wake, 7; Watauga, a few;
Wilkes, 1; Yadkin, several—16 counties.
Malakiai. Fever.—Chatham, Duplin,
Jones, Pamlico and Pender—5 counties.
ZklALARiAL Fever, Pernicious.—Chat-ham,
2.
Malarial Fever, Hemorrhagic.—
Pamlico.
Influenza.—Alamance, general ; Cas-well;
Clay; Cumberland, general; Curri-tuck;
Davie, general; Gaston; Gates,
Henderson, general; Hertford; Lincoln;
^Sloore ; Onslow, general ; Pender ; Person
;
Rockingham ; Transylvania ; Vance, gen-eral;
Wake; Warren, general; Watauga;
Yancey—22 counties.
Pneumonia. — Alexander ; Camden
Cumberland, in all parts; Currituck;
Davie, in all parts; Gates, 4; Harnett, a
few; Henderson, some in all parts; Hert-ford,
a few; Hyde, in all parts; Jones,
8; Martin; Onslow, in all parts; Pamlico,
several; Person; Randolph; Wake, in
manj' parts; Watauga—18 counties.
Mumps.—-Caswell; Randolph, in many
parts; Scotland; Swain; Vance, in all
parts—5 counties.
Roseola.—Caswell, Randolph.
German Measles.—Rockingham, epi-demic.
Varicella.—Clay, in all parts; Gas-ton;
Scotland.
Small-pox.—Alamance, 10; Anson,.
15; Ashe, 200; Bladen, 10; Cabarrus, 10;
Caswell, 32; Catawba, 3; Cleveland, ti;
Cumberland, 4; Davidson, 7; Davie, 7;
Duplin, 7; Durham, 125; Forsyth, 23;
Gaston, 4; Granville, 13: Greene, 30 or
40; Guilford, 14; Iredeil, 6; Mecklen-burg,
2; Xew Hanover, 7; Person, 1;
Pitt, 4; Polk, 1; Randolph, 2; Rich-mond,
26; Robeson, several; Rowan, 2;
Rutherford, 8; Scotland, several; Surry^
12; Swain, 2; Vance, 42; Wake, 1;
Wayne, several; Wilkes, 40 or more;
Yadkin, 1—37 counties.
Distemper, in Horses.—Burke and
Clay.
Xo diseases reported from Bertie, Car-teret,
Dare, Johnston, Xorthampton,
Pasquotank, Washington and Wilson.
Xo reports received from Beaufort,
Brunswick, Cherokee, Columbus, Frank,
lin, Graham, Halifax, Lenoir, Macon,
Mitchell, Montgomery, Orange, Sampson
and Stokes.
Summary of Mortuary Reports for
.Tlareli, 1904.
(twenty-five towns.)
White. Col'd. Total.
Aggregate popula-tion
8(5,150 50,550 145,700
Aggregate deaths .
.
109 148 257
Representing tem-porary
annual
death rate per
1,000 15.2 29.8 21.2
Causes of Death.
Tvphoid fever 2 2
Scarlet fever 1 1
Malarial fever 1 1
Diphtheria ] 1
Wliooping-cough .. Oil Measley 1 1 2
Pneumonia 16 28 44
Consumption 14 24 38
Brain diseases 7 4 11
Heart diseases 11 20 31
Neurotic diseases... 5 4 9
Diarrhoeal diseases 3 14 All other diseases.. 47 54 101
Accident 2 7 9
Violence 11 2
109 148 257
Deaths under five
years 12 30 51
Still-born 4 11 23
16 BULLETIN OF THE NORTH CAROLINA BOARD OF HEALTH.
Mortuary Report for March, 1904.
Town?
AND Reporters.
Charlotte
Ur. K. O. Hawley.
Durliam
Dr. N. JM. Johnson.
Kdeutoii
Dr. T. J. Hoskins.
Elizabeth City
Dr. I. Fearing.
FayettevlUe
Dr. A. S. Rose.
Greensboro
J no. S. Micliaux.C. C.
Heiitlersoii
Dr. .John H. Tucker.
liaarlnbarg
Dr. G. D. Everington.
Lienolr
Dr. S. W Shell.
Lexington
J. H. .vloyer,',Mayor.
Marlon
Dr. B. L. AshworUi.
Monroe
Dr. .Jno. M. Blair.
Oxford
Dr. S. D. Booth.
Raleigh
T. P. rfale, Clerk B. H.
Rocky Monnt
Dr.J.T.Shubrick.H.G,
Salecu
S. E. Butner, Supt. H
Salisbury
Dr. H. T. Trantham.
Sonthport
Dr. D. I. Watson.
Tarboro
Dr. Wm. J. Thigpen.
Wadesboro ,
Dr. J. H. Bennett.
Waynesvllle
Dr. Thos.Stringfield,
Weldon
J. T. Gooeh, Mayor.
Vfllmlngton ,
Dr. Cha.-<. T. Harper.
AVllson
Dr. W. S. Anderson.
AVlnston
Dr. J. L. Hane.s.
Popula-tion.
W.
c.
w.
i;.
w.
c.
w.
c.
w.
c.
w.
c.
w.
c.
w.
c.
w.
c.
w.
c.
w.
c.
w.
c.
11,000
7,200
8,000
1,200
1,900
."i.OOO'
3,000
2,500
2,300
6,10(1
4,000
2,100
1,700
900
6110
1,200
300
800
500
800
400
1,850
600
1,200
1,250
8,000
5,800
1,600
1,500
3,.300
Bin
3.900
2,.500
900
500
2,W0
500
1,000
700
1,600
400
700
750
Temporabt
BULLETIN OF THE NORTH CAROLINA BOARD OF HEALTH. 17
County Superintendents of Health.
Alamance Dr. T. S. Faucette.
Alexander Dr. C. J. Carson.
Alleghany Dr. Robt. Thompson.
Anson Dr. J. H. Bennett.
Ashe Dr. Manlev Blevins.
Beaufort Dr. D. T. tayloe.
Bertie Dr. H. V. Dunstan.
Bladen Dr. L. B. Evans.
Brunswick Dr. J. A. McNeill.
Buncombe Dr. D. E. Sevier.
Burke Dr. J. L. Laxton.
Cabarrus Dr. R. S. Young.
Caldwell Dr. W. P. Ivey.
Camden Dr. J. L. Lister.
Carteret Dr. F. M.Clarke.
Caswell Dr. S. A. Malloy.
Catawba Dr. Geo. H. West.
Chatham Dr. T. A. Kirkman.
Cherokee Dr. B. B. Meroney.
Chowan Dr. T. J. Hoskins.
Clav Dr. P. R. Killian.
Cleveland Dr. B. H. Palmer.
Columbus Dr. I. Jackson.
Craven Dr. Joseph F. Rhem.
Cumberland Dr. A. S. Rose.
Currituck Dr. H. M. Shaw.
Dare .Dr. W. B. Fearing.
Davidson Dr. Joel Hill.
Davie Dr. M. D. Kimbrough.
Duplin Dr. A. J. Jones.
Durham Dr. N. M. Johnson.
Edgecombe Dr. W. J. Thigpen.
Forsyth Dr. W. O Spencer.
Franklin Dr. E. S. Foster.
Gaston Dr. H. F. Glenn.
Gates Dr. W. 0. P. Lee.
Graham Dr. V. J. Brown.
Granville Dr. S. D. Booth.
Greene Dr. C. S. IMaxwell.
Guilford Dr. Edmund Harrison.
Halifax Dr. I. E. Green.
Harnett Dr. 0. L. Denning.
Haywood Dr. J. F. Abel.
Henderson Dr. J. G. Waldrop.
Hertford Dr. C. F. Griffin.
Hyde Dr. E. H. Jones.
Iredell Dr. M. R. Adams.
Jackson Dr. R. L. Davis.
Johnston Dr. Thel Hooks.
Jones Dr. N. G. Shaw.
Lenoir Dr. C. L. Pridgen.
Lincoln Dr. John W. Saine.
McDowell Dr. B. L. Ashworth.
Macon Dr. F. L. Siler.
Madison Dr. W. J. Weaver.
Martin Dr. W. H. Harrell.
Mecklenburg Dr. C. S. McLaughlin.
Mitchell Dr. V. R. Butt.
Montgomery Dr. M. P. Blair.
Moore Dr. Gilbert McLeod.
Nash Dr. J. P. Battle.
New Hanover Dr. W. D. McMillan.
Northampton Dr. H. W. Lewis.
Onslow Dr. E. L. Cox.
Orange Dr. D. C. Parris.
Pamlico Dr. H. P. Underbill.
Pasquotank Dr. J. B. Griggs.
Pender Dr. R. J. Williams.
Perquimans Dr. C. C. Winslow
Person Dr. J. A. Wise.
Pitt Dr. Zeno Brown.
Polk Dr. C. J. Kenworthy.
Randolph Dr. W. J. Moore.
Richmond Dr. F. J. Garrett.
Robeson Dr. H. T. Pope.
Rockingham Dr. Sam Ellington.
Rowan Dr. W. L. Crump.
Rutherford Dr. T. B. Twitty.
Sampson Dr. John A. Stevens.
Scotland Dr. A. W. Hamer.
Stanly Dr. V. A. Whitlev.
Stokes Dr. W. V. McCanlesB.
Surry Dr. John R. Woltz.
Swain Dr. A. M. Bennet.
Transylvania Dr. C. W. Hunt.
Tyrrell
Union Dr. John M. Blair.
Vance Dr. H. H. Bass.
Wake Dr. J. J. L. McCullers.
Warren Dr. M. P. Perrv.
Washington Dr. W. H. Ward.
Watauga Dr. C. W. Phipps.
Wayne Dr. Williams Spicer.
Wilkes Dr. W. P. Horton.
Wilson Dr. W. S. Anderson.
Yadkin Dr. T. R. Harding.
Yancey Dr. J. L. Ray.
BULLETIN OF THE NORTH CAROLINA BOARD OF HEALTH. 19
[You are asked to fill out and mail one of these forms to the Superintendent of Health of your
couDf.y on or before the third of each month, that he may use it in making his report to the Secretary
of the State Board.
Have any of the following diseases occurred in your practice during the month
just closed. If so, state number of cases.
Whooping-cough Typhoid Fever
Measles Typhus Fever
Diphtheria Yellow Fever
Scarlet Fever Cholera -
Pernicious Malarial Fever Smallpox
Hemorrhagic Malarial Fever Cerebro-spinal Meningitis
What have been the prevailing diseases in your practice?
Has any epidemic occurred among domestic animals? If so, what?
What is the sanitary condition of your section, public and private?
General Remarks:
M. D.
190 -- N. C.
:B"C7IL.I-.E11:I2^T
OF THE
North Carolina Board of Health,
Published Monthly at the Office of the Secretary of the Board, Raleigh, N. C.
Geo. G. Thomas, M. D., Pres., Wilmington.
S. Westray Battle, M. D...Asheville.
Henry W. Lewis, M. D Jackson.
J. L. XicHOLSox, M. D Richlands.
W. P. IvEY, M. D Lenoir.
Francis Duffy, M. D New Bern.
W. H. Whitehead, M. D Rocky Mt.
J. L. Ludlow, C. E Winston.
Richard H. Lewis, M. D., Secretary and Treasurer, Raleigh.
Vol. XIX. MAY, 1904. No. 2.
House lufectiou of Tuberculosis.
BY LAWRENCE F. FLICK, U. V.,
Director of the Phipps Institute for the Study,
Prevention and Cure of Tuberculosis,
Philadelphia.
[We earnestly commend this admirable
article by Dr. Flick, one of the highest
authorities on tuberculosis, to our read-ers,
and we hope that our physicians
will transmit this knowledge to the fami-lies
under their care, especially those
having and predisposed to consumption
;
and that they will be deeply impressed
thereby with the great importance of
the thorough ventilation of living and
sleeping apartments and of the disinfec-tion
of rooms occupied by consumptives.
—Ed.]
The kaleidoscopic phenomena of this
earth as we see them around us are the
result of a continuous alternation of
life and death. In this beautiful pano-rama
death is as necessary as life.
Something is always dying that some-thing
else may liA^e. Inorganic matter
continuovisly is being changed into or-ganic
matter and organic into inorganic.
For changing organic matter into inor-ganic
matter God has created the micro-organic
world.
A micro-organism which, perliaps, has
slipped away from its natural place in
organic nature, and in consequence has
done much damage to man, is the tu-bercle
bacillus. In the great division
of organic matter it generally is cred-ited
to the vegetable kingdom. In a
classification of micro-organisms it is
technically known as a facultative sapro-phyte.
By this is meant that ordinarily
it gets its living as a parasite on some
higher organism, but that it may sub-sist
on dead organic matter as a sapro-phj-
te. In a sub-classification of micro-
*Read at the Maryland Tuberculosis Exposition, January 26, 1904. From Maryland Medical Jour-nal,
February, 1904.
22 BULLETIN OF THE NORTH CAROLINA BOARD OF HEALTH.
organisms it is known as a facultative
anaerobic parasite. By this is meant
that ordinarily it grows in a tissue from
which air is excluded, but that it may
grow in some substances, under certain
conditions, in the presence of air.
When the tubercle bacillus giows in
the tissue of a human being or of an ani-mal
it gives rise to a condition which
has forcibly arrested the attention of
man because of the suffering, sorrow and
misery which accompany it and follow in
its wake. In the early history of medi-cine
this condition, was named phthisis
and consumption. In the more recent
times it has been divided into two epochs,
the earlier being called tuberculosis
and the latter consumption. In ear-lier
times, too, the condition was ^-iewed
by mankind generally as a providential
visitation, the punishment for sin, touch-ing
not only the immediate offender,
but reaching the offspring to the third
and fourth generation. Science has dem-onstrated
that it is a mere episode in
nature subject to natural laws and abso-lutely
under the control of man's will.
Man is interested in tuberculosis be-cause
it is a disease. The same pro-cesses
and phenomena in other fields of
nature give pleasure to man, but here
they give discomfort, and are followed by
sorrow and misery, because man him-self
is the field of operation. Tlie word
disease means want of ease. Quite natu-rally,
man has given much thought to
how to avoid getting tuberculosis and
how to get rid of it when it afflicts him.
By reason of his superior intelligence,
man has always been able to control his
organic foes so far as visible objects are
concerned, but in his fight against the
micro-organic world he is confronted
with a much more serious problem.
Much has been done, however, to throw
light upon this newly-discovered enemy,
and already it is demonstrated that men
need no longer get tuberculosis, and that
if he is so unfortunate as to get it, he
need not die of it. Unfortunately, the
knowledge which makes this new dispen-sation
possible is still in the hands of
a few.
All diseases which are caused by mi-cro-
organisms are communicable. This
is a self-evident proposition. Whatever
is living can only come from a parent,
and phenomena which are due to the
growth and development of living organ-isms
cannot arise except by reason of
the growth and development of those
organisms. There is a difference, how-ever,
in the manner in which parasitic
micro-organisms are conveyed from one
person to another. Some are conveyed
through the instrumentality of insects,
some by means of water and others by
contact, direct or indirect. Some para-sites
have two kinds of hosts, a major
and a minor host; some can reproduce
themselves outside of a host, and others
always remain dormant when out of the
host. Parasites which have two hosts
and parasites which can reproduce them-selves
outside of a host can be conveyed
from one person to another over long
distances, while parasites which are con-veyed
by contact can only be conveyed
within a limited, circumscribed environ-ment.
Tlie yellow fever parasite, for
instance, is conveyed through the mos-quito,
the typhoid fever parasite by
water, and the tubercle bacillus by con-tact.
All diseases which are conveyed by
contact are termed contagious. Conta-gious
diseases are not necessarily alike,
however. There is a great difference in
the intensity of contagion. The acute
contagious diseases are much more in-tensely
contagious than the chronic con-
BULLETIN OF THE NORTH CAROLINA BOARD OF HEALTH. 23
tagioiis diseases. In principle the conta-gion
of all is the same, but in practice
the method differs widely. Small-pox,
measles and scarlet fever, for instance,
are contagious in exactly the same sense
as tuberculosis, so far as the principle
is concerned—that is, they are conveyed
by contact—but the intensity of the con-tagion
is so much greater with them
than with tuberculosis that practical
measures for the prevention of the for-mer
would in no sense apply to the lat-ter.
Small-pox, measles and scarlet fever
affect the whole body, and contagion is
rapidly given off from the entire body.
Tuberculosis is a local disease, and con-tagion
is given off from one or two points
only. In smallpox, measles and scarlet
fever the matter which carries the micro-organisms
may be invisible; in tubercu-losis
it always is gross and easily seen.
In small-pox, measles and scarlet fever
places and things soon become intensely
contaminated; in tuberculosis it takes a
long time to produce such a result. In-timate
association, therefore, with a per-son
suffering from small-pox, measles
and scarlet fever without contracting the
disease is impossible unless the person
thus e.xposed has an immunity from
A'accination or previous attack, while in-timate
association with a consumptive
without contracting the disease is quite
feasible.
The contagion of tuberculosis, indeed,
is of a kind by itself. It differs some-what
from the contagion of every other
disease of which we have knowledge. It
is so imique that writers have had some
difficulty in finding an epithet descrip-tive
of it. This is the reason why many
writers object to calling tuberculosis con-tagious.
Some would have us call it
communicable, but this term is too gen-eric.
Others have suggested the epithet
infectious for it, and this does not fit
at all, because it has a specific meaning
which only applies to such diseases as
malaria and yellow fever. The most
striking feature about the communica-bility
of tuberculosis is that it depends
almost entirely upon the house. An in-elosure
of some kind is so necessary for
the conveyance of the disease from one
person to another that contagion is im-practicable
without it. It is, therefore,
with good reason that we use the phrase
house infection of tuberculosis when we
speak of the practical manner in which
the disease is spread in a community.
The word infection, of course, is used in
the broad sense of conveyance, and the
word house in the broad sense of an
inclosure. The phrase tells pretty nearly
the whole story of the communicability
of tuberculosis, and covers the entire
proceeding from the beginning to the
end—garnering the seed, preparing the
soil, implantation, rearing the tender
plant, nurturing the full-grown shoot,
maturing and harvesting.
The house is the granary of the tuber-cle
bacillus outside of its host. Were it
not for the house the tubercle bacillus
would soon have to perish from the face
of the earth. It could not be preserved.
Sunlight, air and water are its natural
enemies. The water dissolves it out of
its cache, and the sunlight and air de-stroy
it. How long tvibercular matter
may remain vital in the open air has not
been definitely determined, but all agree
that the time is very sliort. Even when
the bacilli in such matter are not killed
they are weakened so that they will not
readily take root when planted. In the
house, on the contrary, tubercular matter
may remain vital for a long time, because
it becomes dry and the broken-down tis-sue
serves as a cache for the bacilli.
24 BULLETIN OF THE NORTH CAROLINA BOARD OF HEALTH.
Even ^vhen the matter becomes finely piil-rerized
so that the bacilli no longer have
so much protection, it remains vital for
a long time, because the sun and air can-not
get to it.
Ordinarily the tubercle bacillus is de-pendent
upon other micro-organisms for
its exit from its host. These are the
streptococcus and the staphylococcus.
They are pus-producing organisms, and
are very adept at destroying tissue.
\Yhen they join forces with the tubercle
bacillus they kill and soften the tissue
which has been invaded by the tubercle
bacillus, and then nature casts it out. A
double purpose is served in this way, the
tubercle bacillus is helped out of its host
and is given a protective covering to-wards
preservation while out of the host.
The broken-down tissue which is thrown
out forms the protective covering.
In the transition of the tubercle bacil-lus
from one host to another we have
a beautiful illustration of nature's jeal-ous
care of every form of life. The tu-bercle
bacillus is a motionless, helpless
niioro-organism, which can grow and
reproduce itself only under certain con-ditions
in a definite soil, and which re-quires
during the interim between its
exit from one host and its entrance into
another special protection, and for ad-mission
into a new host special oppor-tunities.
Tliese are secured for it in-directly
through its toxin and the toxins
of its associates. By sensations set up
in the neiwous system it lures its vic-tim
into the veiy place where exist the
best conditions for the preservation of its
species and the best opportunities of
finding a new host. Consumption is the
autumn of tuberculosis, the blossom
grown into ripe fruit. When it comes on
the Aictim, by reason of his chilliness,
malaise, and general feeling of helpless-ness,
seeks shelter in some inclosure,
and is deluded with the idea that the
farther he can get away from sunshine
and fresh air the better are his chances
of recovery. The house thus becomes
the harvest field of the ripe tubercle ba-cillus,
and the seed quite naturally falls
into the very place which by nature is
intended for its granary.
The house also prepares soil for the
tubercle bacillus. We have every reason
to believe that the bacillus cannot get a
foothold in perfectly healthy, normal tis-sue.
It is quite likely, indeed, that pri-mordially
the tubercle bacillus was a
saprophyte only, and that its function in
the world Avas to change dead organic
matter into inorganic matter. It is easy
to conceive how gradually it may have
evolved into a parasite by growing on
tissue which, while not dead, was much
debased. At any rate, even at the pres-ent
time it does not seem to be able to
invade tissue until the tissue has been
injured in some way, either by malnu-trition,
by traumatism, or through the
agency of some other micro-organism.
Malnutrition is one of the most common
predisposing causes of tuberculosis.
Tlie physical life of man and animals
is a chemical process. There is a com-bination
of certain elements through the
instrumentality of a living cell, with
evolvement of beings endowed with life.
Food, air and water are the substances
used in the process. In proportion as
these substances are at hand in proi>er
quantities the being evolved is a healtliy
one, and in proportion as any of the
substances are deficient or defective the
being is an unhealthy one. Of the three
substances required in this chemical p»o-cess,
air is perhaps the most important,
and certainly the most necessary. Life
mav be maintained for some days without
BULLETIN OF THE NORTH CAROLINA BOARD OF HEALTH. 25
food and water, but for a few iiunutes
only without air. The same is true of
health. A person may keep fair health
on a stinted supply of food and water for
a long time, but soon succumbs to a
stinted supply of air. This probably is
due to the fact that air plays a double
role in health. It not only carries in
oxygen for cheraioal purposes, but it car-ries
out poisonous products of chemical
action. It is believed by some that re-breathed
air produces soil for the tuber-cle
bacillus more through the poisonous
products of combustion Avhieh are dis-seminated
in the air than by reason of
deticiencj' of oxygen. Probably it does
by both. At any rate, housed human
beings and animals are very prone to
tuberculosis. Deficiency of oxygen cer-tainly
leads to malnutrition. Too much
food and too little air not only lead to de-fective
metabolism, but throw upon the
organs of the body poisonous products
which must be gotten rid of to the detri-ment
of the whole system.
Implantation of the tubercle bacillus
is greatly facilitated by the house. For
implantation prolonged intimate contact
with a person, place or thing which has
been intensely contaminated with tuber-cular
matter is necessary. The mere pres-ence
of a few tubercular bacilli is not
sufficient. Everybody has some resisting
power to tuberculosis, and with every one
there is a minimal dose of tubercle ba-cilli
which will give an implantation.
Xo doubt this dose differs Avith diffei-ent
people, but resisting power of some kind
exists to some extent in every one. Even
in inoculation experiments on animals a
minimal dose has been found bolow whicli
injections prove negative. This minimal
dose in a sense measures the individual's
fighting capacity against the disease. So
long as the minimal dose is not reached.
an implantation cannot take place. Fre-quent
warfare against a dose below the
minimal dose increases the resisting
power of an individual and raises the
minimal dose. With animals the mini-mal
dose which can give an implantation
gradually can be increased until an al-most
complete immunity has been estab-lished.
Experiments upon animals have
been made by inoculation. It is quite
probable that by the natural mode of
entrance of the tubercle bacillus into the
system the minimal dose is larger than
by inoculation. The natural mode of
entrance is by the alimentary canal or
the respiratory tract. At both of these
I>orts of entry there is strong opjxisition
to admission. The gastric juice has
some germicidal powers, and all along
the respiratory tract there are devices for
keeping out micro-organisms. Beyond
the ports of entry lie the lymphatics and
lymphatic glands, and beyond these the
phagocytic bodies of the blood, all of
\\hich wage war against micro-organisms
that maj' pass the ports of entry. From
what has been done experimentally on
animals and from what we have been
able to observe clinically on man, we
have good reason to believe that the mini-mal
dose of tubercle bacilli necessary
for an implantation by the natural mode
of entrance is quite large. This is not
a mere speculation, either. Out of every
five people who are intimately exposed
to the contagion of tuberculosis for a
long period of time under the most fa-vorable
conditions for an implantation,
only one person develops the disease.
This shows that implantation is exceed-ingly
difficult, even under most favorable
circumstances.
An inclosure is the one place in which
contamination with tubercular matter
can become sufficienth- intense to create
26 BULLETIN OF THE NORTH CAROLINA BOARD OF HEALTH.
an environment capable of overcoming
the resisting power of man and producing
an implantation. It is only in an inclo-sure
that vital tubercular matter can
accumulate. In the open air, water, sun-light
and air devitalize it nearly as rap-idly
as it is given off. Tubercular mat-ter
ejected in a house, unless immediately
devitalized, artificially dries and is dis-tributed
about in particles vai-ying in
size from big chunks to impalpable dust.
In these particles the bacilli are cached
and preserved. Gradually all the parti-cles
are reduced to dust, either by tritu-ration,
oxidation, or the action of sapro-phytes.
This tubercle-laden dust settles
on the walls, on furniture, and on every-thing
in the inclosure. In the course of
time there is qviite an accumulation of
vital tubercular matter in such a place,
and every time the air is disturbed tuber-cle-
laden dust is set in motion. Here,
then, finally is an environment capable of
giving an implantation of tuberculosis.
Occupancy of such a room means con-stant
inhalation and frequent deglutition
of tubercular matter. Tubercle bacilli
continuously find their way into the sys-tem,
and it is only a question of time
when more have gained entrance than can
be successfully withstood by the guards
and disease-fighters of the body. The re-sult
is implantation of tuberculosis.
The kind of inclosure which offers the
best environment for the implantation of
the tubercle bacillus is, first, the home,
and second, the workshop. The home is
of all places most prolific of new implan-tations
of tuberculosis. It was on this
account that in by-gone days tuberculosis
earned for itself the reputation of being
an inhei'ited disease. Tubei-culosis is a
family disease. It can most easily be im-planted
around the hearthstone. It fol-lows
the family tree in its distribution,
and when it once gets into a family
it follows that family in all direc-tions
until it either has exterminated
the family or exhausted the soil, and has
made what is left of the family immune.
Tlie part of the home in which implanta-tions
most frequently take place is the
bedroom, and next to the bedroom the
dining-room. The bedroom usually is the
place where the victim of tuberculosis
spends his last weeks or months—
a
period during which the disease is most
intensely contagious. Among the very
poor the dining-room often is used as a
bunking-place for the stricken one until
a day or two before death. Under such
circumstances the dining-room becomes
very much contaminated and becomes a
prolific source of new implantation.
The workshop is a very common means
of spreading tuberculosis. By workshop,
of course, is meant any inclosure in
which one or more people are employed.
Tuberculosis is an extremely chronic dis-ease,
and usually runs a long course even
in its contagious stage before its victim
is incapacitated for his usual occupation.
Some people work with the contagious
stage of tuberculosis for the greater part
of a working life-time, occasionally being
thrown out of employment for a few
weeks or months on account of an exacer-bation,
and again returning with as much
vigor as before. Unfortunately, habits
of men and women in the matter of
spitting make it easy for a consumptive
to contaminate his immediate environ-ment
in a shop, if not the entire shop.
One consumptive, perhaps, cannot con-taminate
a large shop so as to produce
an infectious environment of the entire
shop, but he can produce an environment
around his own stand capable of implant-ing
the disease in one or more of those
next to him, and before long he has asso-
BULLETIN OP THE NORTH CAROLINA BOARD OF HEALTH. 27
ciates in the task of polluting the shop.
In a workshop in which a case of tuber-culosis
exists careful investigation will
reveal the presence of other cases in vari-ous
stages of the disease. Deaths will
occur from such a shop at regular inter-vals
for an indefinite period so long as
the shop is permitted to remain contami-nated.
Inclosures such as hotels, churches,
public halls, places of amusement, and
public conveyances, in which people stop
for a short time only, are not apt to give
rise to many implantations of tubercu-losis
for two reasons. First, because a
consumptive rarely remains in them long
enough to produce a contagious environ-ment
capable of gi\dng an implantation,
and secondly, because healthy people sel-dom
remain in them long enough to get
an implantation. There is some danger
of contracting the disease in such places
for people who are employed in them in
the capacity of cleaners and caretakers,
but for the casual visitor practically
there is no danger.
Things which have been intensely con-taminated
by having been used for a long
time by a consumptive may give the dis-ease
to others when kept or used indoors.
In the open air they may be harmless,
unless worn upon the person. Contami-nated
furniture, carpet, and hangings of
various kinds, when taken into a per-fectly
sterile house, may themselves con-taminate
the house sufficiently to create
an environment capable of implanting the
disease. The tubercular matter adhering
to such articles is distributed about and
settles on Avails and floors. In the open
air, on the other hand, tubercle-laden
dust from such articles is apt to be scat-tered
about over such a wide area as to
make it impracticable for any one person
to get enough of it to give rise to an im-plantation.
The house nurtures the tubercular
gro\A-th when an implantation has taken
place. Mere implantation of the tubercle
bacillus does not necessarily mean a de-devolpment
of a full-fledged tuberculosis.
The disease always begins in a very small
way, and then attracts practically no at-tention.
The first crop develops and runs
through its course, and a second follows
perhaps a little larger than the first. This
is followed by a third and fourth, each a
little larger than the preceding one, and
thereafter another larger still, until
finally so much tissue has been invaded
and destroyed as to make death in-evitable.
At any time during the prog-ress
of the disease prior to the destruc-tion
of tissue essential to normal func-tions
of the body the economy has within
itself the power of throwing off the dis-ease.
Autopsies prove that this often is
accomplished by nature unaided by medi-cine.
It probably would be accomplished
in all cases were it not for the house.
In the beginning of the tubercular pro-cess
the tendency to recovery is so great
that the slightest aid to nature may turn
the tide toward recovery. The process
by which recovery takes place probably
is healthy metabolism—that is, a perfect
change of food into tissue. Implantation
has taken place because the individual
temporarily has been a little below par
as a result of improper food, insufficient
air, overwork, dissipation, an attack of
some other disease, or some such matter,
one or all. Under proper conditions the
implantation is rooted up before it can
grow into tuberculosis. All that may be
needed is a little rest, a little extra food,
and a little more fresh air. In some
cases recovery might take place if a little
28 BULLETIN OF THE NORTH CAROLINA BOARD OF HEALTH.
rest could be' had, even without extra
food aud air; in others if better food
could be had, even though no rest could
be taken and the air supply could not be
changed. But in all recovery would al-most
surely follow a life in the open air,
in spite of bad food supply and over-work.
Life in the open air enables one
to digest coarser food and to do more
work without fatigue than is possible in-doors.
This is probably due to the fact
that in the open air the poisonous pro-ducts
of combustion are promptly re-moved
from the system, and thus are pre-vented
from embarrassing the entire or-ganization.
To cure tuberculosis we must
have perfect metabolism, and this we only
can have when enough fresh air is taken
into the system night and day to oxidize
the food and cleanse the blood. Imper-fect
metabolism predisposes to tubercu-losis
by debasing the tissues and making
soil for the tubercle bacillus.
House life undoubtedly plays an im-portant
role througliout the entire course
of tuberculosis to its culmination in con-sumption
and death. With every re-curring
crop of tubercle the organs of
the body become more embarrassed, and
the economy is less able to carry on the
warfare against the disease. When the
disease is in the lungs, as it frequently
is, the air supply grows less with each
destruction of lung tissue. Fortunately,
nature has given all air-breathing crea-tures
ample lung capacity, enough aud to
spare, so that a great deal of lung tissue
may be destroyed without interfering
^\-ith the functions of the body, provided
the air supply is right. Under these cir-cumstances
other organs, no doubt, sup-plement
the lungs in their functions of
elimination. Everything hinges upon an
ample supply of fresh air, however.
When this is at hand healthv metabolism
may be maintained even when the disease
is advanced, and through this health may
again be reached. Tuberculosis makes its
progress because its A-ictim is shut up in
a house where he cannot get fresh air.
Unfortunately for the poor, an ample
supply of fresh air is impossible. Their
homes, as well as their workshops, have
been constructed on a mistaken idea that
Avhatever shuts out air, heat and cold is
conducive to health. The large death
rate from consumption really must be
ascribed in a great measure to bad venti-lation
in home and workshop.
The last scene of conflict in tubercu-losis
between the victim and liis foe is
the house. Tuberculosis develops into
consumption because of the house. This
does not mean that people could not get
tuberculosis if they lived out of doors, for
birds of the air and animals of the field
get the disease. Tuberculosis, however,
in itself would seldom prove fatal. Both
animals and human beings may go
through life with tuberculosis and reach
old age without being seriously incon-venienced
by it. Lots of animals and
people do. Dr. Trudeau has shown by
experiments on animals that life in the
open air greatly retards the development
of tuberculosis and promotes recovery.
Rabbits which he inoculated and penned
up died, while rabbits which he inocu-lated
and permitted to run at large main-tained
good health, although they de-veloped
tuberculosis. In sanitoria where
consumptives are made to live out of
doors wonderful improvement sets in, even
when the case is incurable. Frequently
all the symptoms of consumption disap-pear,
and the patient becomes comfortable
even when so much tissue has l)een de-stroyed
that recovery is physically impos-sible.
In other words, even consumption
in the open air loses all its most .serious
BULLETIN or THE NORTH CAROLINA BOARD OF HEALTH. 29
symptoms. The house makes and main-tains
consumption, and consumption
kills.
Consumption may be well termed a
house disease. Without the house it can-not
exist. It depends upon the house for
its implantation, propagation, and for
evolution of all its phenomena. The
house is the place where the tubercle
bacillus lies dormant in wait for its host;
it is the place where the new host gets
his implantation; it is the place where
the tubercular subject gradually becomes
a consumptiA^e, and it is the place where
the consumptive dies.
In studying the progress of civilization
in the light of modern science one is
struck with the egregious blunders into
which man has been led by his desire for
privacy and comfort. He has built his
house to keep out his enemies, to protect
himself from heat and cold, and to screen
himself from the curiosity of his neigh-bor.
He has sought to make his home
his castle, but in reality he has made it
the place wherein he courts death.
If man desires to free himself from the
great white plague, he will have to re-trace
his steps from some of what he con-siders
advanced points of civilization.
He will have to learn, among other
things, that fresh air is God's greatest
gift on earth, and that whatever shuts
out fresh air shuts out health and hap-piness.
In house infection he will find
the key to the entire problem of stamp-ing
out tuberculosis.
SUMMARY.
1.—Tuberculosis is a disease due to
the parasitic growth of a micro-organism
on the tissues of a .human being or ani-mal.
Being due to organic life, it is
communicable.
2.—Tuberculosis is contagious. The
contagion of tubei'culosis is different
from the contagion of acute contagious
diseases, however. It is slow and can be
avoided easily in the presence of a con-sumptive,
while that of acutely conta-gious
diseases is rapid and cannot be
avoided in the pi'esence of those who
have such diseases.
3.—The contagion of tuberculosis is
closely associated with the house. An
inelosure of some kind is necessary to
make it effective.
4.—Tlie house is the granary of the
tubercle bacillus. It is the place in which
tuberculous matter is kept vital until the
bacillus can find a new host.
5.—Out of doors tubercular matter be-comes
devitalized in a short time through
water, light and air. Enough cannot ac-cumulate
in a vital state to create a con-tagious
environment.
6.—Everyone has some resisting power
to tuberculosis. Some have more than
others. Practically all have sufficient re-sisting
power to withstand occasional ex-posure
to tuberculosis and exposure out
of doors.
7.—For an implantation of tuberculosis
prolonged intimate exposure and an in-tensely
contagious environment is neces-sary
to overcome resisting power. This
is had in the home and the workshop.
8.—The house prepares soil for the
tubercle bacillus.
RevleAV of Diseases for April, 1904;.
SEVEXTY-NIXE COUXTIE.S REPORTIXG.
Xinety-six counties liave Superintend-ents
of Health.
Except in the case of the more con-tagious
and dangerous diseases tlip Su-
30 BULLETIN OF THE NORTH CAROLINA BOARD OF HEALTH.
perinteiident has, as a rule, to rely upon
his own information alone, since few
physicians can be induced to report cases
of non-contagious diseases to him.
Where the number of cases is not
given, or the prevalence of a disease
otherwise indicated, its mere presence in
the county is to be understood as re-ported.
For the month of April the following
diseases have been reported from the
counties named:
Measles.—Alleghany, many cases;
Bladen, 15; Burke, many; Caldwell, in
all p^rts; Catawba, 5; Cherokee, 35;
Cleveland, many; Cumberland, many;
Davidson, many; Duplin, 4; Durham, a
few; Edgecombe, in all parts; Franklin,
a few; Gaston, a few; Granville, 8; Lin-coln,
6; McDowell, 5; Mecklenburg, 12;
Nash, many; New Hanover, 167; Polk,
3; Randolph, a few; Rockingham;
Rowan, 100; Surry, 14; Swain, several;
Transylvania, several; Vance, many;
Wake, 4; W\^tauga, 20 or 30; Wilson,
many; Yancey, several—32 counties.
Whooping-cough.—Cherokee, 40; Cho-wan,
1; Clay, several; Craven, a few;
Duplin, 2; Edgecombe, several; Frank-lin,
in all parts; Gaston, many; Gran-ville,
6; Haywood, in all parts; Hertford,
'
7 ; Martin, many ; New Hanover, 25
;
Onslow, 3 ; Pamlico, many ; Pitt, 6 ; Ran-dolph,
a few; Sampson, many; Suriy,
50; Swain, several; Vance, a few; Wake,
21—21 counties.
Scarlatina.—^Durham, 3; Forsyth,
15; Randolph, a few; Rockingham, a few.
Diphtheria.—Chowan, 1: Durham. 2;
Edgecombe, 7; Forsyth, 3; Iredell, 1;
Mecklenburg, 2; New Hanover, 1; Ons-low,
3; Perquimans, 1; Pitt, 1; Stanly,
2; Wake, 2—12 counties.
Typhoid Fever.—Bladen, 1; Chatham
Craven, 1; Duplin, 1; Gaston, a few
Gates, 1; Harnett, a few; Iredell, 1
Madison, 5; Onslow ,1; Pender, 2; Pitt
1; Randolph, 2; Rowan, 6; Stanly, 2
Wake, 5; Washington, 2; Wayne, 1
Yadkin—19 counties.
Malarial Fever.—Caswell ; Duplin
;
Gates, 12; Hertford; Pamlico; Sampson;
Vance; Wake—8 counties.
Malarial Fever, Pernicious.—Samp-son,
a few; Wake, 1.
Malarial Fever, Hemorrhagic.—
Pamlico, 1.
Influenza.—Anson, general ; Cald-well,
general; Caswell; Cumberland;
Currituck, general; Davie, general;
Duplin; Gaston; Lincoln; Pamlico, gen-eral;
Randolph, general; Scotland;
Transylvania; Watauga, general; Yan-cey—
15 counties.
Pneumonia. — Alexander ; Caswell
;
Currituck, in all parts; Gates, 6; Hyde,
in all parts; Pamlico, in all parts; Pen-der,
1; Pitt; Randolph, in most parts;
Sampson; Transylvania; Watauga, in
nearly all parts—12 counties.
German Measles.—Craven, a few;
Rockingham, in all parts.
Mumps.—Caswell; Clay; Cumberland;
Mecklenburg, 8; New Hanover, 24; Ran-dolph;
Sampson; Scotland—8 counties.
Varicella. — Camden; Cleveland;
Mecklenburg.
Small-pox.—Alamance, 17 ; Alleghany,
7; Anson, several; Ashe, 25; Bladen, 3;
Buncombe, 5; Cabarrus, 24; Caswell, 3;
BULLETIN OF THE NORTH CAROLINA BOARD OF HEALTH. 31
Catawba, 1; Chatham. 3; Cumberland,
3; Da^adson, 7; Davie, 11; Durham, 100;
Forsyth, 27; Gaston, 3; Granville, 1;
Guilford, 14; Henderson, 46; Johnston,
1; Mecklenburg, 2; New Hanover, 10;
Pender, 1; Pitt, 1; Randolph, 6; Rich-mond,
17; Rowan, 2; Rutherford, 6;
Sampson, 8; Scotland, a few; Stanly, 4;
Swain, 2; Wake, 13; Wayne, 6; Wilkes.
78—35 counties.
Cholera, ix Hogs.—Clay, Hertford,
Sampson, Washington.
Distemper, in Horses.—Ashe, Burke,
Lincoln.
Rabies, in Dogs.—Sampson.
No diseases reported from Bertie, Car-teret,
Jackson, Northampton, Pasquo-tank,
Robeson and Warren.
No reports received from Beaufort,
BrunsMdck, Columbus, Dare, Graham,
Greene, Halifax, Jones, Lenoir, Macon,
Mitchell, INIontgomery, Moore, Orange,
Person, Stokes and Union.
Summary of Mortuary Reports for
April, 1904.
(twextv-six towns.)
]Miite. CoVd. Total.
Aggregate popula-tion
98,450 67,450 165,900
Aggregate deaths.. 87 129 216
Representing tem-porary
annual
death rate per
1,000 10.6 22.9 15.6
Causes of Death.
Typhoid fever 2 2
Malarial fever 1 1
Whooping-cough.. Oil Pneumonia 12 20 32
Consumption • 8 28 36
Brain diseases 8 8 16
Heart diseases 6 5 11
Neurotic diseases... 3 7 10
Diarrhoeal diseases 7 18 All other diseases.. 42 51 93
Accident 14 5
Violence 1 1
87 129 216
Deaths under five
years 16 34 50
Still-born 9 10 19
32 BULLETIN OF THE NORTH CAROLINA BOARD OF HEALTH.
Iflortuarj Report for April, 1904.
BULLETIN OF THE NORTH CAROLINA BOARD OF HEALTH. 33
County Superintendents of Health.
Alamance Dr. T. S. Faucette.
Alexander Dr. C. J. Carson.
Alleghany Dr. Eobt. Thompson.
Anson Dr. J. H. Bennett.
Ashe Dr. Manlev Blevins.
Beaufort Dr. D. T. tayloe.
Bertie Dr. H. V. Dunstan.
Bladen Dr. L. B. Evans.
Brunswick Dr. J. A. McXeill.
Buncombe Dr. D. E. Sevier.
Burke Dr. J. L. Laxton.
Cabarrus Dr. R. S. Young.
Caldwell Dr. W. P. Ivey.
Camden Dr. J. L. Lister.
Carteret Dr. F. M. Clarke.
Caswell Dr. S. A. Malloy.
Catawba Dr. Geo. H. West.
Chatham Dr. T. A. Kirkman.
Cherokee Dr. B. B. Meroney.
Chowan Dr. T. J. Hoskins.
Clav Dr. P. B. Killian.
Cleveland Dr. B. H. Palmer.
Columbus Dr. I. Jackson.
Craven Dr. Joseph F. Rhem.
Cumberland Dr. A. S. Rose.
Currituck Dr. H. M. Shaw.
Dare Dr. W. B. Fearing.
Davidson Dr. Joel Hill.
Davie Dr. M. D. Kimbrough.
Duplin Dr. A. J. Jones.
Durham Dr. N. M. Johnson.
Edgecombe Dr. W. J. Thigpen.
Forsyth Dr. W. 0. Spencer.
Franklin Dr. R. F. Yarborough.
Gaston Dr. H. F. Glenn.
Gates Dr. W. O. P. Lee.
Graham Dr. V. J. Brown.
Granville Dr. S. D. Booth,
Greene Dr. W. B. Murphv, Jr.
Guilford Dr. Edmund Harrison.
Halifax Dr. I. E. Green.
Harnett Dr. 0. L. Denning.
Haywood Dr. J. F. Abel.
Henderson Dr. J. G. Waldrop.
Hertford Dr. C. F. Griffin.
Hyde Dr. E. H. Jones.
Iredell Dr. M. R. Adams.
Jackson Dr. R. L. Davis.
Johnston Dr. Thel Hooks.
Jones Dr. N. G. Shaw.
Lenoir Dr. C. L. Pridgen.
Lincoln Dr. John W. Saine.
McDowell Dr. B. L. Ashworth.
Macon Dr. F. L. Siler.
Madison Dr. W. J. Weaver.
Martin Dr. W. H. Harrell.
Mecklenburg Dr. C. S. McLaughlin.
Mitchell Dr. V. R. Butt.
Montgomery Dr. M. P. Blair.
Moore Dr. Gilbert McLeod.
Nash Dr. J. P. Battle.
New Hanover Dr. W. D. McMillan.
Northampton Dr. H. W. Lewis.
"
Onslow Dr. E. L. Cox.
Orange Dr. D. C. Parris.
Pamlico Dr. H. P. Underhill.
Pasquotank Dr. J. B. Griggs.
Pender Dr. R. J. Williams.
Perquimans Dr. C. C. Winslow.
Person Dr. J. A. Wise.
Pitt Dr. Zeno Brown.
Polk Dr. C. J. Kenworthy.
Randolph Dr. W. J. Moore.
Richmond Dr. F. J. Garrett.
Robeson Dr. H. T. Pope.
Rockingham Dr. Sam Ellington.
Rowan Dr. W. L. Crump.
Rutherford Dr. T. B. Twitty.
Sampson Dr. John A. Stevens.
Scotland ....Dr. A. W. Hamer.
Stanly Dr. V. A. Whitley.
Stokes Dr. W. V. McCanlesB.
Surry Dr. John R. Woltz.
Swain Dr. A. M. Bennet.
Transylvania Dr. C. W. Hunt.
Tyrrell
Union Dr. John M. Blair.
Vance Dr. H. H. Bass.
Wake Dr. J. J. L. McCuUere.
Warren Dr. M. P. Perry.
Washington Dr. W. H. Ward.
Watauga Dr. C. W. Phipps.
Wayne Dr. Williams Spicer.
Wilkes Dr. W. P. Horton.
Wilson Dr. W. S. Anderson.
Yadkin Dr. T. R. Harding.
Yancey Dr. J. L. Ray.
BULLETIN OF THE NORTH CAROLINA BOARD OF HEALTH. 35
[You are asked to fill out and mail one of these forms to the Superintendent of Health of your
county on or before the third of each month, that he may use it in making his report to the Secretary
of the State Board.
Have any of the following diseases occurred in your practice during the month
just closed. If so, state number of cases.
Whooping-cough Typhoid Fever
Measles Typhus Fever
Diphtheria Yellow Fever
Scarlet Fever Cholera
Pernicious Malarial Fever Smallpox
Hemorrhagic Malarial Fever Cerebro-spinal Meningitis
What have been the prevailing diseases in your practice?
Has any epidemic occurred among domestic animals? If so, what?
What is the sanitary condition of your section, public and private?
General Remarks:
M. D.
.190-— N. C.
ZBTTILiIL^EITinsr
OF THE
North Carolina Board of Health.
Published Monthly at the Office of the Secretary of the Board, Raleigh, N. C.
Geo. G. Thomas, M. D., Pres., Wilmington.
S. Westray Battle, M. D...Asheville.
Hexry W. Lewis, M. D Jackson.
J. L. Nicholson, M. D Richlands.
W. P. Ivey, M. D Lenoir.
Francis Duffy, M. D New Bern.
W. H. Whitehead, M. D Rocky Mt.
J. L. Ludlow, C. E Winston.
Richard H. Lewis, M. D., Secretary and Treasurer, Raleigh.
Vol. XIX. JUNE, 1904. No. 3.
Annual Report of the Secretary of tlie
IVorth Carolina Board of Health,
May 1, 1903—May 1, 1904.
[Read at the conjoint session of the State Board
of Health with the State Medical Society, at
Raleigh, May 24, 1904.]
As must always be the case, the work
of your Secretary during the past year
has been largely of the usual routine
character, dealing with the common
every-day affairs of sanitation. These,
however, are none the less important be-cause
they are commonplace, as they
practically cover the whole field of hy-giene.
But we have one entirely new
subject as applying to our State of great
interest and importance, viz.
:
uncinariasis or hookworm di.sease.
Inspired by the admirable address of
Dr. Charles Wardell Stiles, Zoologist of
the U. S. Public Health and Marine
Hospital Service, at our last meeting at
Hot Springs on the Uncinaria Ameri-cana,
of which he was the discoverer,-
and its prevalence in our Southern
States, I promptly set to work to inter-est
our physicians in the subject. In
several issues of the Bulletin the mat-ter
was called to their attention, a sum-mary
of Dr. Stiles' official report and
other articles being printed, and the
medical reader was urged to send speci-mens
of faeces from suspected cases to
our laboratory for diagnosis. The re-sponse
to this, I regret to say, has been
discouraging, as only thirty-two applica-tions
for the examination have been
made during the year. This, however,
does not represent, by any means, all the
work done in relation to the hookworm
disease. Dr. W. S. Rankin, of Wake
Forest, in the early fall offered to give
a month of his time to the Board with-out
charge, other than his actual ex-penses,
in making a personal investiga-tion,
proposing to visit with his micro-scope
the physicians in a number of our
eastern counties and make the diagnosis
for them on the spot. Authority was
38 BULLETIN OF THE NORTH CAROLINA BOARD OF HEALTH.
obtained by correspondence Avith the
members of the Board to accept Dr.
Rankin's offer. He began his investiga-tion
by a trip during Christmas week
to Northampton and Edgecombe coun-ties.
The results were so meagre and
discouraging, as will appear in his re-port,
which he will read, that we agreed
that it would not pay to continue the
personal work, and the spring tour of
three weeks was accordingly abandoned.
He has, however, done other work on this
line by correspondence and among the
students of the college, as he will detail
to you. The physical signs of uncinari-asis
are so striking and the diagnosis
from the mere general appearance of a
victim to it, taken together with his en-vironment,
is so easy, that I have no
doubt the diagnosis has been made in
many instances without resort to the
microscope and the proper remedy ad-ministered.
From the facts in our possession it is
certain that uncinariasis is very preva-lent
in our State, and that it is not lim-ited
to the sandy section, as Stiles sug-gests.
It deserves and should receive
the careful attention of all practition-
<'rs. With the lights before me I would
say unhesitatingly that every case of
pronounced ana-mia, especially in young
persons living in the country, should be
investigated with a special view to this
very harmful intestinal parasite.
TUBERCULOSIS.
Tuberculosis continues our most fatal
disease. Experience has demonstrated
that much can be done for its preven-tion.
We should therefore make an
earnest effort to check its ravages as far
as possible. I therefore bring the mat-ter
forward in order that it may be dis-cussed
in the conjoint session, so that we
may have the benefit of the wisdom that
is said to appertain to a multitude of
counsellors.
The question of the prevention of
tuberculosis is theoretically easy but
practically most difficult, very much
more so in our southern country than
elsewhere on account of the large num-ber
of negroes. The infectious principle
being existent only in sputum and other
discharges from tuberculosis cases and
in the infected milk and meat of the
lower animals, the thing to do, of
course, is to destroy the sputum and pre-vent
the sale and consumption of the
tuberculous milk and meat. But how
to accomplish this in actual practice to
more than a most superficial extent is
the question. The answer to this ques-tion
is: By the thorough education of
the public mind on the subject. So the
practical problem is how to reach and
influence the people, especially those
having the disease and their immediate
families who necessarily are in close and
constant contact with them.
The first step in the solution of this
problem is to locate the tuberculous pa-tients.
To accomplish this a few States
and cities have resorted to legislation,
requiring compulsory notification of
tuberculosis as of other contagious dis-eases,
so that the proper instructions
may be given, inspections made and dis-infection
practised. This looks well on
paper, and in large cities with thor-oughly
organized health and police de-partments
and sufficient money to sup-port
them it is no doubt of much prac-tical
value. But in communities such
as our State, the population of which
is chiefly rural or resident in small
cities, towns and villages without the
full facilities for enforcement indicated,
we cannot expect very much from this
BULLETIN OF THE NORTH CAROLINA BOARD OF HEALTH. 39
means. Especially is this true of the
colored people. Their temperament,
training, and environment make the so-lution
of the problem in their case, to
all intents and purposes, hopeless—for
many years to come at any rate. And
it is among them the disease is most
prevalent, in the proportion of nearly
three to one of the whites. That
we cannot expect much is the more
apparent when we call to mind the
fact—the most discouraging fact—that a
very large percentage of our physicians,
although required to do so by law, will
not report the more actively contagious
diseases, such as scarlet fever, diph-theria
and even small-pox, although the
last named disease is, we believe, gen-erally
reported, but not so much because
the law requires it as because the doc-tor
wants to get rid of it. In the pres-ent
state of public sentiment the indis-position
to rejwrt tuberculosis will be
much greater. At the same time it is
desirable to have this done if it can be
brought about. We are glad to say that
our own citj' of Raleigh has enacted
stringent legislation on this line, and
the results will be watched with much
interest, as it is the first movement in
tlie State for compulsory notification,
although anti-spitting ordinances have
been in force several years, first in Ashe-ville
and later in Raleigh.
The methods usually resorted to for
the education of public sentiment are
tul)erculosis congresses, the organization
of anti-tuberculosis societies, public ad-dresses,
newspaper articles, the distribu-tion
to the individual of literature bear-ing
on the subject and the establishment
of special sanatoria. And this crusade
has evidently borne fruit, for the de-crease
in the death-rate from tuberculo-sis
has been much more marked in the
decade 1891-1900 than in any similar
period previously. It is interesting to
note, however, that the death-rate had
been steadilj' diminishing in our larger
cities before Koch's discovery of the
bacillus and the demonstration of its
contagious character. This is attribut-able
to the improvement in the condition
of the masses, better housing, better
food, shorter hours of labor, the bicy-cle,
athletic out-door games and the
open-air life which has come to be the
vogue, thereby begetting greater resist-ing
power. In these respects the ad-vance
has been much greater in the past
decade than before and it is no doubt to
no inconsiderable degree responsible for
the decreased death-rate.
In the prevention of infection with
the tubercle bacillus there are three
princi|>al objects to be sought: 1. The
building up of greater resisting power
in the individual; 2. The prevention as
far as possible of the development of the
bacilli; 3. The prevention of their dis-tribution
by their prompt destruction.
I. The dangers of the inspiration or
ingestion of the bacilli are so great that
it is a matter of doubt if any one living
even a few years has not at one time or
another taken them into his system, and
yet only about one-ninth of the popula-tion,
it is estimated, become fatally in-fected.
This is due to the protective or
resisting power inherent in every one to
a greater or less extent. It is well es-tablished
that this power to resist dis-ease,
to repel it entirely, or to overcome
it, is greatest in those who are in vigor-ous
health. And this state of vigorous
health is to be attained and preserved
by living in accordance with the princi-ples
of hygiene, special stress being laid
upon the paramount importance of pure,
fresli air in tlie greatest abundance an(?
40 BULLETIN OF THE NORTH CAROLINA BOARD OF HEALTH.
at all times as near an ont-door life as
possible.
2. The prevention of the development
of the bacilli is to be accomplished chiefly
by an early diagnosis, when the disease
is a pure tuberculosis and before the de-generative
changes which constitute con-sumption
have taken place. In the for-mer
the bacilli, being tied up in the un-broken
tubercles, are not thrown off to
any extent, while in the latter they are
discharged in the sputum by the million.
I would earnestly commend to your care-ful
perusal a very able article, appearing
originally in the Xew York Medical Jour-nal
and reprinted in our January Bul-letin,
on the subject of '"The Relation
of Early Diagnosis and Treatment to the
Prevention of Tuberculosis," by Dr. Pot-tenger,
President of the Anti-tuberculosis
League of Southern California. He esti-mates
that from 75 to 95 per cent, of
early cases with jiroper care should be
cured, thereby preventing the develop-ment
and distribution of the myriads
upon myriads of bacilli from the same
cases going on in the consumptive stage.
Dr. Pottenger says that the expert in tu-berculosis
"should be able to determine
the presence of the disease in the vast
majority of cases before bacilli appear
in the sputum by the clinical history
and physical examination. If not by
these," he goes on to add, '"the tubercu-lin
test can be used with confidence and
safety." I beg to emphasize this last
statement, for while I know that some
object to the use of the tuberculin test
in the human, claiming that it is some-times
harmful, the early diagnosis in the
tuberculosis stage is of such overwhelm-ing
importance to both the patient and
public, that inasmuch as it will enable
the comparatively inexpert to make the
diagnosis with cortaintv, tlie little risk.
if there be any, should, in my judgment,
be taken in doubtful cases. In any event,
there can be no excuse for failure, to
resort at once to the microscope in every
suspicious case for the detection of the
bacilli upon their first appearance in the
sputiun, for tlie examination will be
made free of charge for any phj-sician
applying to the laboratory of the Board
of Health.
3. The prevention of the distribution
of the bacilli must be accomplished by
the patient himself. He can do this by
the invariable habit of expectorating
only into spittoons partially filled with
some disinfectant, or into the fire, when
in the house, and by the use of a pocket
spittoon, bits of cloth or paper napkin.s
(never the handkerchief) tliat cm be
burned, when out of doors. In a word,
he must never let his sputum get away
from him except into a disinfectant or
the fire—never turn it loose to dry and
assume the form of dust, especially in
the house.
Having thus outlined the problem very
inadequately, but as fvilly as the limits
of this report and your time permits,
we now come to the all-important ques-tion
as to how we can best solve it.
The most conspicuous movement at
present is towards the establishment by
the State of special sanatoria for the tu-berculous.
Experience has demonstrated
their great success, not only in curing
the disease in its incipient stage—-in
over 50 per cent.—but chiefly as educa-tors
of the people, for every patient
returning to his home, thoroughly trained
in the proper management of his case
so as to prevent the re-infection of him-self
and the infection of ethers, is an
educator for his neighborhood. But at
present, and doubtless for some years to
come, we cannot liope for an apprcpria-
BULLETIN OF THE NORTH CAROLINA BOARD OF HEALTH. 41
tion by the State for this purpose. The
other methods generally employed to
educate the people and prevent the spread
of disease by compulsory notification,
distribution of literature, organization
of societies, etc., have already been re-ferred
to, but it seems to me that the
most effective method of reaching and
attacking the very citadel of the enemy
has never been sufficiently emphasized.
This method I believe to be through the
family physician. It is the family phy-sician
who first locates the case of tu-berculosis;
it is he who is sought for
advice by the patient and his friends,
no one can get so near to the problem
as he, and no one can have such influ-ence
as he in securing the proper man-agement
of the case on the part of both
the patient and family. Xo health of-ficial
nor organization can compare with
him in the practical accomplishment of
this work, if he can be induced to do
it. Even if all the eases of the disease
could be located and the proper instruc-tions
for prevention furnished—a mani-fest
impossibility without his aid—they
would make but little impression unless
re-inforced by his endorsement and earn-est
personal advice. He is the medium
—
and the only medium in the vast majority
of cases—through whom the principles of
preventive management can effectively
reach the individual case. It would be
superfluous to argue this matter further.
It is self-evident thot the solution of
this great and difficult problem, the
greatest health problem of this or any
age, turns chiefly on the attitude of the
attending physician. Tlie practical ques-tion
before us, then, is: how can we
arouse his interest and secure his cor-dial
co-operation in the work. It is
this particular question that I wish to
hear discus.sed, that I may be helped in
the performance of my official duty in
the premises.
I w ould respectfully suggest that this
body, composed of a very large propor-tion
of the leading physicians of the
State, put itself on record by adopting
some such resolutions as the following:
Whereas, Tuberculosis, of all diseases
the mo.st fatal, being the cause of death
in about one-ninth of all who die, is a
contagious and therefore preventable dis-ease,
and
Whereas, Its prevention depends upon
the early diagnosis, upon the strict ob-servance
of certain precautions in the
relations between the patient and his as-sociates,
and upon a mode of life in ac-cordance
with the well-established prin-ciples
of hygiene, and
Whereas, These matters come within
the immediate jurisdiction of the attend-ing
physician, whose influence in secur-ing
their observance is far greater than
all other influences combined: therefore
be it
Resolved, That it is the sense of the
iledical Society of the State of Xorth
Carolina and of the Xorth Carolina
Board of Health, in conjoint session as-sembled,
that the spread of tuberculosis,
the greatest scourge of mankind, can be
most effectively prevented only with the
active aid and cordial co-operation with
the health authorities of the family phy-sician.
Resolved, That not only every member
of this body but every physician in the
Slate is earnestly requested to use every
effort, professional and personal, to pro-mote
this great work for humanity.
I would also suggest the propriety of
adopting the following:
Resolred, That it is the sense of the
State Board of Health and of the State
Medical Society, in conjoint session as-
42 BULLETIN OF THE NORTH CAROLINA BOARD OF HEALTH.
se'mbled. that provision should be made
in our hospitals for the insane and in
the State's Prison, and in the county
jails as far as practicable, for the sep-aration
of tuberculous cases from the
otlier inmates uninfected with the dis-ease.
(Both resolutions were adopted unani-mously
)
.
SMALL-POX.
As was anticipated in our last report,
small-pox has continued with us to an
increased extent. The total number of
cases during our small-pox year—May
1 to May 1—is 5,370 as against 4,456
the year before. Of this number, 2,840
were white and 2,530 colored, with 35
and 34 deaths, respectively. It will be
noted that for the first time the disease
was more prevalent among the whites.
The death-rate was the smallest in the
history of the recent outbreak, being 1.23
per cent, among the whites and 1.34 per
cent, among the colored. We have ex-perienced
the same difficulties in the man-agement
that have confronted us all
along, due chiefly to the extreme mild-ness
of the disease, although they have
been somewhat less than heretofore.
At the request of the authorities of
the city of Durham, who were experi-encing
much opposition to vaccination, I
visited that city and addressed the people
on the subject, with good results follow-ing.
The general small-pox outlook seems to
be the same it was a year ago. It will
continue from year to year until all the
people have been successfully vaccinated
or had the disease.
The following is a report in detail
for the past year:
BULLETIN' OF THE NORTH CAROLINA BOARD OF HEALTH. 43
REPORT OF SMALL-POX FROM MAY, 1903, TO MAY, 1904.
Counties.
44 BULLETIN OF THE NORTH CAROLINA BOARD OF HEALTH.
LABORATORY.
The following is the rei)ort of Dr.
McCarthy, the Biologist, in detail of the
work clone for the Board of Health in
the joint labi.iratory of the Department
of Agriculture and the Board of Health,
during the past year:
REPORT OF BIOLOGIST.
Raleigh, May 5, 1904.
Dr. Richard H. Lewis, Secretary,
y. C. State Board of Health,
Raleigh, A'. C.
Dear Sir:—I herewith submit a de-tailed
report of the work done in the
laboratory of the Board of Health during
the twelve months included in the period
from May 1, 1903, to April 30, 1904.
Total number of anah^ses and deter-minations
522
(These include the following samples,
to-wit ) :
Public water supplies, monthly an-alyses
226
Analyses of water for physicians and
health officers of counties 136
Examinations of sputum for physi-cians
57
Examinations of throat exudates,
diphtheritic 53
Examinations of blood for Plasmo-dium
malariffi 18
Examinations of fiBces for hook-wcrm
32
Total 522
The official examinations of public
water supplies, under the law -passed
by the last Legislature, was begun in
May, 1903.
Xo work was done in tlie laboratory
during June. The full number of analy-ses
required of the water companies un-der
the law was therefore 11. Tliis
number was actually taken by only four
companies, the others, by carelessness or
other causes, falling below the require-ments
of the law, as shown by the an-nexed
list
:
Xo. of
Water Analyses
Companies. Taken.
Asheville 7
Concord 2
Charlotte 10
Dunn '. . . 1
Durham 10
Fayetteville (mimicipal) 8
Fayetteville (old system)
Gastonia 9
Goldsboro 10
Greensboro 11
Henderson S
Hendersonville 5
High Point 6
Lumberton 6
Monroe 8
Xew Bern 5
Raleigh 11
Reidsville 6
Rocky Mount 10
Roxboro 6
Salem 9
Sanfcrd 6
Salisbury . . .• 10
Southern Pines 9
Statesville 7
Tarboro 7
Waynesville 6
Washington 7
Wadesboro 3
Wilson 11
Wilmington 11
Winston 10
It must be said in ju.stice to a few
of these water companies that they began
business during the year and could not
therefore take the full number of analy-ses.
The companies included in this
BULLETIN OF THE NORTH CAROLINA BOARD OF HEALTH. 45
latter category are Dunn, Hendersonville,
Eoxboro.
The law directs the Board of Health
to make these analyses for a charge of
$5 each. The usual cost of biological
analyses of water is $10 each. When
we began this work it was with the idea
of making only the biological analyses
in tlie laboratory of the Board of Health,
the chemical analyses to be made, if
possible, by the Department of Agricul-ture.
But in fact the chemical work
was not done except in a very irregular
way. The Department of Agriculture is
supported by a special tax levied upon
tlie farmers of the State. It is supposed
to devote its energies entirely to strictly
agricultural work. What work the De-partment
can do in other lines must
depend upon the chemists being unen-gaged.
Water analyses, to be of much value,
must be made regularly and systemati-cally.
It was therefore determined to
do the chemical as well as the biological
work in the laboratory of the Board of
Health.
Soon after starting the chemical work
we found that the larger part of the
water companies were using too much
alum in their filters and passing a part
of this into the filtered water. The va-rious
companies were notified of this
fact, and though there was at first some
indignation expressed upon the imputa-tion
cast upon theif waters, the com-panies
soon improved their services and
apparatus, so that the last or April series
of analyses showed for the entire State
but two supplies giving the reaction for
alum, and both these for onlj^ very min-ute
(|ua;itities. We are now fully justi-fied
in stating that no State or country
anywhere has municipal water supplies
superior to that of Xorth Carolina—so
far as regards freedom from pollution
and injurious chemical compounds.
There are thirty public water companies
in the State. The water of all is very
soft, and, with a few exceptions, is free
from organic matter. All of the supplies
derived from deep wells, in number 5,
contain much dissolved earthy matter,
and a few approach the quality of min-eral
waters. The deep waters are much
harder than the surface waters.
The quality and safety of the public or
municipal water supplies of the State is
enormously superior to the average qual-ity
of the well waters sent to the labora-tory.
So great is the difference that the
Biologist, as the result of four years'
work in this line in Xorth Carolina, is
disposed to say that no incorporated town
having 1,000 inhabitants can afford to
permit its citizens to be supplied by pri-vate
wells of the ordinary shallow type.
The danger of typhoid hangs like the
sword of Damocles over every community
getting water from shallow wells. This
danger is minimized for communities
having a common supply wliich is closely
guarded and the quality kept up to the
standard by monthly analyses such as
our State law requires. It would there-fore
seem to be the duty of health offi-cers
and physicians to advise even small
towns to abandon shallow private wells
for a common public water supply.
As regards the samples of well water
sent by physicians and county health
superintendents, I am able to say that
the average quality is superior to that
received during the preceding year. There
were fewer grossly polluted samples.
Of the fifty-seven samples of sputum
received, about one-third were free from
bacillus tuberculosis. The samples show-ing
the bacillus came from different parts
of the State, but chiefly from the cen-tral
and piedmont regions.
46 BULLETIN OF THE NORTH CAROLINA BOARD OF HEALTH.
Of diphtheritic exudates, fifty-three
were received and all but two showed
the bacillus. Nearly all samples of exu-dates
were described by attending physi-cians
as "tonsillitis" or 'membranous
croup." Determinations of diphtheritic
exudates were given precedence over all
other lines of work in the laboratory and
the result is in all cases where the phy-sician
can be reached by telegraph so
transmitted, usually within one hour
after sample reaches the laboratory. We
could handle more of this class of work.
In examinations of blood for the ma-laria
parasite, our facilities are not yet
appreciated by the medical profession, or
else the type of malaria found in North
Carolina is easily diagnosed clinically.
Only eighteen samples came in and the
larger part of these were free from the
germ. Only the tertian parasite has
been found.
Of freces we have recived thirty-two
samples and all but four contained the
hookworm or its eggs. Most of the
samples also showed large quantities of
sand, indicating recent geophagism. The
ages of the patients as given by physi-cians
varied between six and sixty-one
years. The larger part were under twen-ty-
five years. The samples came from
the following counties: Caldwell, Iredell,
Granville, Johnston, New Hanover, Meck-lenburg,
Nash, .Stokes and Wake.
During the past twelve months, as in
the preceding period, a few applications
were received for the Widal test for
typhoid fever. At considerable trouble
and the expenditure of time and mate-rials,
the Biologist stocked suitable cul-tures
for this work at three different
times in the two years, but the demand
for this work proved too small to justify
us in keeping up the cultures. Tlie
average demand is only about four per
year. For the Widal test the culture
of bacillus typhosus must be virulent and
not over four or five months at longest
from the spleen of a person dead of ty-phoid.
The culture must also be trans-ferred
from tube to tube at least once a
week, thus entailing much labor and
eonsinnption of material. With so much
other work pressing upon the laboratory,
we could not afford for the small de-mand
to keep up the typhoid culture as
required, so at present we decline appli-cations
for the Widal test. The clinical
alternative is usually between typhoid
and malaria, and an examination of the
blood by microscope will determine
whether or not it is malaria.
A part of the Biologist's time is given
lo the work of the State Department of
Agriculture. The work of the Board of
Health alone is more than enough to
occupy the entire time of one ^man.
Therefore until such time as the Legisla-ture
sees fit to provide for the entire
support of tlie laboratory no further ex-tension
of the work is possible.
Eespectfully submitted,
Gerald McCarthy, D.Sc,
Biologist.
It will be observed that many of the
public water supplies have been quite
derelict in the matter of monthly analy-ses.
The Act to protect Avater supplies
requires every company selling water to
the public to have an analysis made
every month by the Board of Health, or
in such laboratory as it may select, and
j^et in a. total of 334 analyses required
only 226 sent samples. I have tried
faithfully to induce them by gentle means
to send the samples regularly and
promptly. My last letter has borne fruit,
but there are some still that neglect
this duty. While the law provides a
penalty for failure to have the analyses
BULLETIN OF THE NORTH CAROLINA BOARD OF HEALTH. 47
made it is manifestly undesirable to
resoi"t to the courts. Public opinion is
the best lever to employ, and if the phj^-
sicians living in cities and towns having
public supplies would interest themselves
in the matter the companies would be
more apt to respond. It is of great
importance that they should, not only
as a guarantee to consumers of the jju-rity
of the water sold them, but also as
a means of support to the laboratory.
Thanks to an enlightened, broad-minded
Board of Agriculture and a Commissioner
cordially in sympathy with this work for
the people, we have been enabled to do
the very creditable amount of work for
the public health shown in the repoit,
but times change and men change with
them, and the support of the laboratory
is extremely precarious. It should be
sustained by a direct appropriation by
the State for the purpose and it is to
be hoped that it may be made by the
next Legislature.
While Dr. McCarthy, having no assist-ance,
could hardly do more work than
he has done, still it is discouraging to
note how comparatively few of our phy-sicians
avail themselves of the privileges
offered free of cost beyond a few cents
of postage. The number, however, is
growing and will no doubt increase more
and more as time passes.
In conclusion, I appeal to the members
of our noble profession to lend their in-terested
support in this great work in
which wo are engaged. While some are
disposed to sneer, and wliile it must be
admitted that the spirit of commercialism
which pervades all callings at the present
time has not left us untouclied, it still re-mains
true that, excepting, perhaps, the
sacred ministry, there is no body of men
wliose hearts are so open to tlic cry of dis-tress
or wliose minds and liands are so
ready to administer to its relief without
2>ecuniary reward as the physicians of our
country. It is a noble profession, and
on the princiijle of noblesse oblige it is
the duty of every physician, and should
be his pleasure, not only to cure disease
and suffering but also to aid in their
prevention.
Microbes and tlie Milk Supply.
By GERALD MCCARTHY, D.Sc. Biologist.
Milk is the first, most perfect and
most generally used of all human food-stuffs.
In its fresh state, or as butter,
cheese or fermented drink, milk occupies
the most important jilace in the dietaries
of all civilized nations. But milk is
also an almost ideal food for bacteria
—
those minute but formidable organisms
which modern science has shown to be
the chief cause of epidemics and prema-ture
deaths among mankind. Not all
species of bacteria are noxious—many
are among our most useful servants,
Init like other servants, these, when they
get out of their proper sphere, are lia-ble
to take on the characters of very
obnoxious masters. The milk used in
its natural or fresh condition, more es-pecially
during hot weather, cannot be
too pure or too free from bacteria. Bad
milk is the cliief cause of infant mor-tality
in summer.
Tlie "fresh" milk delivered to consum-eis
in cities is usually from 24 to 48
hours old, and is often as rich in putre-factive
bacteria as the sewage which
flows beneath the streets in the same
cities, ^fore than this, the buctcria in
the sewage and those in the milk are
apt to be largely the same species. The
following table shows the numbers of
bacteria which have been found in the
milk delivered to consumers in the cities
48 BULLETIN OF THE NORTH CAROLINA BOARD OF HEALTH.
named. The measure used, cubic centi-meter,
is equivalent to 16 minims or
drops from an ordinary medicine dropper.
Boston, Mass 4,577,000
Middletown, Conn 8.452,000
Madison, Wis 3.674,000
Naples, Italy 3,600,000
Wurzburg, Germany 7,330,000
Odessa, Russia 29,850,000
New York, N. Y 10,000,000
The average bacterial contents of fresh
milk immediately after drawing, as found
in the milk pails of careful dairymen,
is about 10,000 per cubic centimeter.
Under the average farm conditions, the
number of bacteria so found is at least
ten times as great. Bacteria increase
in numbers only very slowly while the
temperature of the surrounding fluid is
below 40°F. Under the ordinary tem-perature
of the barn or milk room, most
bacteria connnonly found in milk double
their numbers by the simple process
of dividing their single-celled bodies
every half-hour.
It is therefore of the utmost impor-tance
to the keeping qualities of the milk
and to the health of those who consume
the milk that the conditions surround-ing
the cow and milker at the time of
milking should be such as to insure the
lowest possible bacterial contamination
and further, it is very important that
the milk, as soon as drawn, be cooled
to below 40°F. and held there until con-sumed.
The bacteria ordinarily found in milk
are the same species found in excrement
of cattle. The species vary according to
the kind of food given the cows. The
common bacteria are not particularly in-jurious,
since they are normally found
in the hinnan intestines as well in those
of cattle, but when present in great num-bers,
and more especially when the milk
is more than twelve hours old, these bac-teria
may excrete toxins which are more
or less injurious. These toxins, the
product of milk bacteria, arc without
doubt one of the chief causes of intesti-nal
diseases in children during hot
weather ilany parents already recog-nize
the connection between milk and
diarrhceal diseases of children and seek
to avoid the trouble by using instead of
fresh milk condensed milk and the '"in-fants'
foods" sold by druggists. But
such substitution is rarely effective. Chil-dren
do not thrive on condensed milk,
and it is well known that those children
fed upon the much- advertised "foods"
are apt to develop rickets and to suc-cumb
suddenly under the accidental
strains to which all children are more
or less exposed. Next to mothers' milk
there is no food so well adapted for
feeding children of tender age as fresh
cow's milk having a low bacterial con-tent.
There is in all food-stuffs an
elusive but very important principle
called "life." This principle is absent
in canned and preserved foods of all
kinds. Therefore no one thrives when
fed largely or exclusively upon such
"dead" foods.
The New York Board of Health last
summer made a very extensive study of
the effect of feeding various grades of
milk to the children of the tenement dis-tricts
of that city. The results as re-ported
by Dr. ^^'illiam H. Park in the
Medical Yews for December, 1903, were
substantially as follows
:
1. The raw milk used by different
families contained per cubic centimeter
from 10,000 to 100,000,000 bacteria. Milk
heated to 170°F. usually contained when
used less than 500 bacteria per cc. After
boiling milk contained less than 5 bac-teria
per cc. Boiling milk usually de-stroys
or attenuates the toxins already
present in the milk. But boiling also
BULLETIN UF THE NORTH CAROLINA BOARD OF HEALTH. 49
injures the digestibility of milk. Heat-ing
to 140°F., unless continued for sev-eral
hours, does not destroy such toxins.
2. During cold weather no apparent
differences in health of children were
traceable to the difi'erent qualities of
milk.
3. During hot weather the kind of
milk fed had a most important and
easily detected influence on the health
of children under observation. The worst
results were obtained from condensed
milk and the cheap milk of grocery
stores.
4. One million bacteria per cubic
centimeter of milk was found to be the
limit of safety. When milk containing
more than tliis was fed raw evil results
followed promptly. When such milk was
boiled before using not much injury fol-lowed.
5. Heating to ITO'F. for a short time
seemed to destroy the toxins in milk
unless the milk was very old and con-tained
an excessively large Ijacterial con-tent.
G. ]Milk pasteurized"' by heating to
140°F., or any degree short of boiling,
and then kept under ordinary household
conditions for thirty-six hours contained
over 100,000,000 bacteria per cc, and
was very deleterious.
7. Good bottle feeding of infants was
found to be nearly as satisfactory as
breast feeding. But good bottle feeding
is rarely practiced. The feeding of fruit
or ordinary table foods to children un-der
two years was found to be one of the
principal factors in the mortality of
teneiiicnt-house children.
^Most druggists sell, or can ])rocuro.
houscliohl milk-pa.steurizing outfits suit-able
for ])reparing milk for children's
use. Such outfits cost about $3. Much
clieaper and equally effective apparatus
can be improvised in most households.
Ordinary four-ounce or six-ounce, wide-mouthed
bottles with glass stoppers can
be had from most druggists at about
fifty cents per dozen. But in the ab-sence
of such, common glass jelh' tum-blers
or small fruit jars maj^ be used.
Corks should be used to close such ,ves-sels.
Rubber or glass stoppers kept scru-pulously
clean or metal caps may be
used or a clean sheet of glass may be
laid down over the mouths of the ves-sels.
The best results will be obtained
by heating the milk to 140°F. for one
hour, followed by heating to 18o°F. for
two minutes. Where the milk is known
to be reasonablj' fre.sh and where no
pathogenic germs are suspected, the
higher temperature is not necessary.
After heating milk cool at once and
keep as near 40°F. as possible until
milk is consumed. Never keep the milk
longer than twenty-four hours.
Each vessel should contain only as
much milk as will be consumed at one
feeding. Any residue should be thrown
away.
The best way to heat milk is to place
the vessels containing the milk in a
basin of cold water, with the water at
about the same level as the milk, and
heat to the required temperature. The
period of heating is to be reckoned from
the time the temperature reaches the de-sired
point. In this matter guess work
will not do; a good dairy thermometer
costing about fifty cents is necess;uy.
Besides the ordinary saprophytic bac-teria
found in milk, we may look for the
germs of tuberculosis, typhoid, diphthe-ria
and possibly scarlet fever. The most
frequent and important pathogenic bacte-liuni
liable to be disseminated in milk
is bacillus tuberculosis. A recent in-vestigation
into the milk supjilies of En-glish
cities has shown that about 23 per
cent of all the samples collected con-tained
the germ of tuberculosis. Tlie tu-
50 BULLETIN OF THE NORTH CAROLINA BOARD OF HEALTH.
beicular contamination of milk supplied
to American cities is very much less than
this, but it is still known to exist. The
tuberculosis germ has also been fre-quently
found in butter, and in cheese
less than four months old. There can
be no reasonable doubt that tuberculosis
is more frequently disseminated in con-taminated
milk, butter and cheese than
has been commonly supposed.
Probably very few persons could be
induced to eat the flesh of an animal
killed on account of infection by tuber-culosis.
Yet such flesh is perfectly safe
to eat if thoroughly cooked. The cook-ing
destroys both the germs and their
toxins.
There is urgent need in North Caro-lina,
as well as other States, of efficient
hygienic oversight of dairy farms, to
the end that tuberculosis-infected cattle
may be excluded from herds supplying
the public with milk, and also that all
persons having consumption may be ex-cluded
from handling the milk or uten-sils
used by dairymen. Until we secure
such oversight and control of the milk
supply, we may expect tuberculosis to
carry off each year, as it does at present,
more human lives than war, flood and
famine combined.
Review of Diseases for May, 190-1:.
SEVEXTY-SIX fOrXTIES REPORTING.
Ninety-six counties have Superintend-ents
of Health.
Except in the case of the more con-tagious
and dangerous diseases the Su-perintendent
has as a rule to rely upon
his own information alone, since few
phj'sicians can be induced to report cases
-of non-contagious diseases to him.
Where the number of cases is not
given, or the prevalence of a disease
otherwise indicated, its mere presence in
tlie county is to be understood as re-ported.
For the month of May the following
diseases have been reported from the
counties named:
Mea.sles.—Alleghany, several cases;
Ashe, 12; Burke, many, Caldwell, many;
Cherokee. 15; Craven, 3; Davidson,
many; Durham, many; Edgecombe, epi-demic
; Forsyth ; Granville, 4 ; Guil-ford,
2 ; Henderson, several ; Hertford,
1; McDowell, 6; Macon, several; Martin,
10; Mecklenburg; Mitchell; New Hano-ver,
30; Person, several; Pitt, 3; Polk,
a few; Randolph, in the western part;
Richmond, a few; Robeson, a few; Rock-ingham;
Rowan, 30; Transylvania, a
few: Wake, 5; Watauga, 15 to 20; Wil-son,
many—32 counties.
Whoopixg-covgh. — Brunswick, 20;
Cherokee, 40; Clay, 25; Craven, 2; Dur-ham;
Edgecombe, a few; Forsyth; Hay-wood,
in all parts; Hertford, a few;
Iredell, 2; Macon, several; Martin,
many: Mecklenburg; Pamlico; Pitt, 6;
Randolph, a few; Sampson; Swain, in
all parts: Union, 10; Wake, 6—20 coun-ties.
Scarlet Fever.—Durham, 5; Fors}i;h,
3; Gaston, 1; New Hanover, 1; Rocking-ham,
a few—5 counties.
Diphtheria.—Chowan, 1 ; Craven, 1
;
Cumberland, 1 ; Edgecombe, 1 ; Ga.ston,
1 ; Haywood. 5, no physician attending,
3 deaths; Iredell, 4: Mecklenburg—
8
counties.
Typhoid Fever.—Ashe, 3 ; Brunswick,
1; Caldwell, a few; Cleveland, a few;
Craven. 2 ; Edgecombe, 2 ; Forsyth,
many; Guilford, 1; Madison, 3; New
Hanover, 4; Pamlico, 1: Pender, a few;
Pitt. 3; Robeson, a few; Rockingham,
BULLETIN OF THE NORTH CAROLINA BOARD OF HEALTH. 51
very few; Rowan, 6; Scotland, 2; Union,
20; ^Ya^^en, 2; Washington, 1—20 coun-ties.
^Ialarial Fever.—Brims\\ ick ; David-son;
Duplin; Gates, 10: Hertford, sev-eral;
Martin, in all parts; Pamlico;
Pitt; Vance, in all parts—9 counties.
Malarial Fever, Perxicious.—Bruns-wick,
1 ; Davidson, 1 ; Pamlico, 1—
3
counties.
Bowel Diseases. — Anson, several;
Brunswick; Burke; Catawba; CleA'eland;
Cumberland; Currituck; Duplin; Gates,
21; Harnett; Hertford; Martin, in all
parts; Mitchell; Xorthampton ; Pender;
Richmond; Robeson; Rowan; Sampson;
Stanh". in all parts; Washington, in all
parts—21 counties.
Impetigo.—Burke.
IxFLUEXZA.—Alamance, in all parts;
Caldwell, in all parts; Cumberland;
Gates; Lincoln; Madison; Randolph, in
all parts; Transylvania, in all parts
—
8 counties.
Pneumonia.—Caswell; Gates, 3; Hert-ford,
A-ery few; ]\IcDowell, in all parts;
Martin, in all parts; Transylvania, sev-eral—
6 counties.
Mumps.—Alleghany; Caswell; Clay;
Xew Hanover ; Randolph, in western
part; Scotland—6 counties.
Small-pox.—Alamance, 2; Alleghany,
7; Anson, 3; Ashe, 60; Buncombe, 21;
Catawba, 4; Chatham, 14; Cleveland,
3; Davidson, 2; Duplin, 1; Durham,
disappearing, only one case in the city
of Durham, June 2, the date of the re-port;
Forsyth, 16; Gaston, 12; Guilford,
22, all well but 3 at date of report, June
6, and no danger of spread; Henderson,
1 ; Johnston, 2 ; Mecklenburg, 1 ; Mitch-ell,
1 ; Xash, 1 ; Xew Hanover, 1 ; Person,
6; Pitt, 2; Richmond, 4; Rutherford,
2; Stanly, 2; Swain, 8; Washington,
1, one suspect under guard, all exposed
persons vaccinated and all infected ar-ticles
burned; Wilkes, 8, now about free
of it, two cases under guard. June 9
—
28 counties.
Cholera ix Chickex's.—Pamlico.
Cholera ix Hogs.—Clay; Sampson.
Distemper ix Horses.—Ashe.
Xo disease reported from Alexander,
Bertie, Camden, Carteret, Davie, Hyde
and Pasquotank.
Xo reports received from Beaufort,
Cabarrus, Columbus, Dare, Franklin,
Graham, Greene, Halifax, Jackson, Jones,
Lenoir, Moore, Onslow, Orange, Perqui-mans,
Stokes, Surry, Wayne and Yadkin.
Summary of mortuary Reports for
May, 1904.
(twenty-six towns.)
mdie. Col'd. Total.
Aggregate popula-tion
91,350 63,050 154,400
Aggregate deaths.. 112 158 270
Representing tem-porary
annual
death-rate per
1,000 14.7 30.1 21.0
Causes of Death.
Typhoid fever 2 2
t^carlet fever 1 1
Malarial fever 2 2
Diphtheria 2 2
Whooping-cough.. 2 13 Measles 1 1
Pneumonia 8 13 21
Consumption 14 34 48
Brain diseases 12 9 21
Heart diseases 12 12 24
Xenrotic diseases... 2 6 8
Diarrhoeal diseases 21 IG 37
All other diseases.. 34 57 91
Accident 15 6
Suicide 1 1 2
Violence 1 1
112 158 270
Deaths under five
years 34 51 85
Still-born 5 18 23
52 BULLETIN OF THE NOETH CAEOLINA BOARD OF HEALTH.
Mortuary Report for May, 1904.
Towns
AND Repobteks
Popula-tion.
Burlington ,
Dr. C. A. Anderson.
Charlotte
Or. K. O. Hawley.
Diirliain ,
Dr. N. M. Johnson.
E^cleutoii ,
Dr. T. J. Hoskins.
Elizabeth City
Dr. I Fenring.
Fayetteville
Dr. A. S. Rose.
O<»lil!4boro
Ri)bt. A Creech, H. O.
Green.sboro
.Jno. .S Michaux.C.C,
Heuderson
Dr. .lohn H. Tucker.
JLaiirliihnrg
Dr. G. D. Everington.
liexiugtou
J. H. vioyer, Mayor.
Marlon
Dr. B L. Ashworth.
Moiiroe
Dr. .Ino. M. Blair.
Oxford
Dr. S. D. Booth.
Raleigh
T. P.8ale,Clerk B. H.
Reidsvllle
R.S. .Montgomery.Clk,
Rocky Mount.
Dr.J.T.Shubrick.H.O,
Saleai ,
S. E. Butner, Supt. H
Sallshnry ,
Dr. H. T. Trantham.
Sonthport
Dr. D. I. Watson.
Tarhoro ,
Dr. \Vm. .J. Thigpen.
Wadeshoro
Dr. J. H. Bennett,
liVaynesvllle ,
Dr. Thos. Stringfield
WeldoM
J. T. Gooch, Mayor.
Wllinln^on
Dr. Chas. T. Harper.
Wilson
Dr. \V. S. Anderson.
Winston
Dr. J. L. Hanes.
3,<i'>(i
500
n,()(K)
7,200
8,000
5,nu0
1,200
1,800
6,000
3,000
2,.500
2,;«xi
3,500
2,600
i 6,100
4,000
i 2,100
I
1,700
900
eoo
800
500
800
: 400
1,850
I
600
1 1,200
i 1,250
8,000
5,800
2,900
I
l,.30O
1 1,600
I
1,500
I
3,.S0(>
i 350
I 3,900
2,500
I 900
500
2,000
500
1,000
i 700
j 1,600
I 400
700
750
|ll,000
10,000
3,500
3,300
6,000
4,500
Tempobart
Annual
Death Rate
PER 1,000.
3,500
I'l
i8,20oj 2«;5
i3,ooo|
i^;|
3,000| '^,
' 19 2
8,000| ^9.^
19 2
4,800
;^;^
6,100:
13.7
27.7
lO'^oOj 33:0
3,800| 28:"
1 13 3
1,500,
'l-J^
1,300
1,200
2,4.50
2,450
13,800
4,200
3,100
3,650
15.0
0.0
15.0
0.0
6.5
20.0
20.0
9.6
21.0
35.5
8.3
18.5
7.5
8.0
32.7
0.0
6,400 ll'l
13 3 ^M 0.0
1,700 ,?:?
2.000;
0.0
0.0
1 450' "•"
''*°"| 16.0
17 4
21,000 1^12
13 7
6,800 [gjg
10,500, ^
I
0.0
15.8
19.4
4.0
25.5
30.0
19.7
19.0
12.6
8.0
9.2
10.0
9.8
14.7
27.8
11.4
7.7
29.6
30,0
8.6
19.2
7.1
0.0
6.0
29.7
15.9
29.7
BULLETIN OF THE NOKTII CAROLINA BOARD OF HEALTH. 53
County Superintendents of Healtb.
Alamance Dr. T. S. Faucette.
Alexander Dr. C. J. Carsou.
Alleghany Dr. Robt. Thompson.
Anson Dr. J. H. Bennett.
Ashe Dr. Manlev Blevins.
Beaufort Dr. I > T. tayloe.
Bertie Dr. H. V. Dunstan.
Bladen Dr. L. B. Evans
Brunswick Dr. J. A. McNeill.
Buncombe Dr. D. E. Sevier.
Burke Dr. J. L. Laxton.
Cabarrus Dr. R. S. Young.
Caldwell Dr. W. P. Iveyr
Camden Dr. J. L. Lister.
Carteret Dr. F. M. Clarke.
Caswell Dr. S. A. Malloy.
Catawba Dr. Geo. H. West.
Chatham Dr. T. A. Kirkman.
Cherokee Dr. B. B. Meroney.
Chowan Dr. T. J. Hoskins.
Clay Dr. P. B. Killian.
Cleveland Dr. B. H. Palmer.
Columbus Dr. I. Jackson.
Craven Dr. Joseph F. Rhem.
Cumberland Dr. A. S. Rose.
Currituck Dr. H. M. Shaw.
Dare Dr. W. B. Fearing.
Davidson Dr. Joel Hill.
Davie Dr. M. D. Kimbrough.
Duplin Dr. A. J. Jones.
Durham Dr. N. M. Johnson.
Edgecombe Dr. W. J. Thigpen.
Forsyth Dr. W. O. Spencer.
Franklin Dr. R. F. Yarborough.
Gaston Dr. H. F. Glenn.
Gates Dr. W. O. P. Lee.
Graham Dr. V. J. Brown.
Granville Dr. S. D. Booth.
Greene Dr. W. B. Murphy, Jr.
Guilford Dr. Edmund Harrison.
Halifax Dr. I. E. (ireen.
Harnett Dr. O. L. Denning.
Flaywood Dr. J. F. Abel.
Henderson Dr. J. G. Waldrop.
Hertford Dr. C. F. Griffin.
Hyde Dr. E. H. Jones.
Iredell Dr. M. R. Adams.
Jackson Dr. R. L. Davis.
Johnston Dr. Thel Hooks.
Jones Dr. N. G. Shaw.
Lenoir Dr. C. L. Pridgen.
Lincoln Dr. John W. Saine.
McDowell Dr. B. L. Ashworth.
Macon Dr. F. L. Siler.
Madison Dr. W. J. Weaver.
Martin Dr. W. H. Harrell.
Mecklenburg Dr. C. S. McLaughlin
Mitchell Dr. J. Warren Bailey.
Montgomery Dr. M. P. Blair.
Moore Dr. Gilbert McLeod.
Nash Dr. J. P. Battle.
New Hanover Dr. W. D. McMillan.
Northampton Dr. H. W. Lewis.
Onslow Dr. E. L. Cox.
Orange Dr. D. C. Parris.
Pamlico Dr. H. P. Underbill.
Pasquotank Dr. J. B. Griggs.
Pender ..Dr. R. J. Williams
Perquimans Dr. C. C. WMnslow
Person Dr. J. A. Wise.
Pitt Dr. Zeno Brown.
Polk Dr. C. J. Kenworthv.
Randolph Dr. W. J. Moore.
Richmond Dr. F. J. Garrett.
Robeson Dr. PL T. Pope.
Rockingham Dr. Sam Ellington.
Rowan Dr. W. L. Crump.
Rutherford Dr. T. B. Twitty.
Sampson Dr. John A. Stevens.
Scotland Dr. A. W. Hanier.
Stanlv Dr. V. A. Whitlev.
Stokes Dr. W. V. McCanleee.
Surry Dr. John R. Woltz.
Swain Dr. A. i\L Bennet.
Transylvania Dr. C. W. Hunt.
Tyrrell
Union Dr. John M. Blair.
Vance Dr. H. H. Bass.
Wake Dr. J. J. L. McCullere.
Warren Dr. M. P. Perrv.
Washington Dr. W H. Ward.
Watauga Dr. C. W. Phipps.
Wayne Dr. Williams Spicer.
Wilkes Dr. W. P. Horton.
Wilson Dr. AV. S. Anderson.
Yadkin Dr. T. R. Harding.
Yancey Dr. J. L. Ray.
BULLETIN OF THE NORTH CAROLINA BOARD OF HEALTH. 55
[You are asked to fill out and mail one of these forms to the Superintendent of Health of your
county on or before the third of each month, that he may use it in making his report to the Secretary
of the State Board.]
Have any of the following diseases occurred in your practice during the month
just closed. If so, state number of cases.
Whooping-cough Typhoid Fever
Measles Typhus Fever
Diphtheria Yellow Fever
Scarlet Fever Cholera
Pernicious Malarial Fever Smallpox
Hemorrhagic Malarial Fever Cerebro-spinal Meningitis
What have been the prevailing diseases in your practice?
Has any epidemic occurred among domestic animals? If so, what?
What is the sanitary condition of your section, public and private?
General Remarks:
M. D.
.190-— N. C.
^"crx^iL.E!a:i3^
OF THE
North Carolina Board of Health,
Published Monthly at the Office of the Secretary of the Board, Raldgh, N. C.
Geo. G.Thomas, M.D.,Prf.?., Wilmington. W. P. Ivey, M. D Lenoir.
S. Westr.w Battle, M. D...Asheville. Francis Duffy, M. D New Bern.
Henry W. Lewis, M. D Jackson. \V. H. Whitehead. M. D Rocky Mt.
J. L. Nicholson, M. D Richlands. , J. L. Ludlow, C. E Winston.
Richard H. Lewis, M. D.,