Health bulletin

              library of
CI|e Unicerstty of Hortl] Carolina
COLLECTION OF
NORTH C A R O L I N I A N A
ENDOWED B Y
JOHN S P R U N T HILL
of the class of 1889
- AV?t
This book must not
be token from the
Librory building.
Form No. 471
IBTTIL^IL^Eiaril^T
OF THE
North Carolina Board oft Health,
Published MonOdy at the Office of the Secretary of the Board, Raleigh, iV. C.
Geo. G.Thomas, M.D.,Pres., Wilmington.
S. Westray Battle, M. D...Asheville.
Henry 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 Ml
J. L Ludlow, C. E Winston.
Richard H. Lewis, M. D., Secretary and Treasurer, Raleigb.
Vol. XVIII. APRIL, 1903. No. 1.
The Medical Liiceiise Law as Amended.
We print below our medical license
law as amended by the last Legislature.
The necessity for amendment arose frdin
the decision of our Supreme Court in
State V. McKnight to the eli'ect that
ministering to the sick without the use
of drugs or surgical operation was not
practicing medicine under the original
law. The decision was a surprise and
a disappointment to us, but there was
no help for it but to have the de-feet
corrected by the General As-sembly
if possible. And so the bill en-titled
"An act to Define the Practice of
Medicine and Surgery," which was print-ed
in the February Bulletin, was intro-duced.
After most vexatious delays it
was finally passed, but badly crippled by
the amendment exempting Christian
Scientists—in our deliberate judgment
the most dangerous to the public of all
the quacks, for the simple reason that
they claim to be equal to the successful
management of diseases of all kinds,
"Otherwise it (Christian Science) would
not be of God"—to use their own words.
There cannot possibly be anything more
dangerous in a physician, or one assum-ing
his functions, than a combination of
ignorance and overwhelming self-confi-dence,
even if it be called faith in God,
and our people are sure to suffer from it.
It is said that such a lol)by was sus-tained
as was never known in Raleigh
before—a half-dozen Christian Scien-tists,
on an average, at the Yaborough
House and in the Capitol continuously
for an even month, and three lawyers, two
of whom, skilled and experienced lob-byists,
were always on the ground.
I'^very individual member of the General
Assembly, it is said, was seen. But not-withstanding
all this, we confidently be-lieve,
in the light of the unanimously
favorable report of the joint committee
on health, and for other reasons, that the
l)ill would have passed without the Chris-tian
Science amendment if we had not
BULLETIN OF THE XOETII CAROLIXA BOAUD OF IIEALTir.
been most unfortunate from that point
of view in our selection of a father for it.
Showing it to one of the most distin-guished
and influential members of the
House, and our personal friend, he re-marked,
"I am in favor of that—very
much in favor of it"—whereupon we im-mediately
asked him to introduce it.
which he very kindly agreed to do.
Sometime afterwards Ave were astonished
to learn that he favored exempting the
Christian Scientists—not that he thought
any more of them than we did—appa-rently
not as much—from his remarks,
but that he did not believe in "fighting
a sentiment." That handicap was too
much for us.
The amendment in regard to osteopa-thists
we accepted as not being unrea-sonable,
although presented in a very
awkward form.
We print below the license law as
amended to date, the amendment just
adopted being all of section 3122, from
the words '"For the purposes of this
act," in line 7 to tlie end of that section.
We also append the by-laws, rules and
regulations of the last Board of Medical
Examiners, which will hardly be ma-terially
changed, and the names o.f the
members of the new Board, which will
begin its six years term at Hot Springs
on May 27th.
THE LAWS REGUL.VTIXG THE PRACTICE OF
MEDICINE IN NORTH CAROLINA.
{From The Code).
Section 3121. Medical Society of the
State, A Body Politic. Private L.\ws.
1858-'9, c. 258, s. 1:
The association of regularly gradu-ated
physicians, calling themselves '"The
State Medical Society," is hereby de-clared
to be a body politic and corporate,
to be known and distinguished by the
name of "The Medical Society of tlie
State of North Carolina."
Sec. 3122. Who May Practice. 1858-'J,
c. 258, s. 2:
Xo person shall practice medicine or
surgery, nor any of the branches thereof,
nor in any case prescribe for the cure of
disease for fee or reward, unless he shall
have been first licensed so to do in the
manner hereinafter provided.
For the purposes of this act the ex-pression
practice of medicine or surgery
shall be construed to mean the manage-ment
or treatment for fee or reward of
any case of disease, physical or mental,
real or imaginary, with or without drugs,
surgical operation, surgical or mechan-ical
appliances, or by any other method
whatsover: Provided, that this shall not
apply to midwivcs, nor to nurses: Pro-vided
fitrfher, that applicants not be-longing
to the regular school of medi-cine
shall not be required to stand an
examination except upon the branches
taught in their regular colleges, to-wit.
the osteopaths shall be examined only
upon Descriptive Anatomy, General
Chemistry, Histology, Physiology, Urin-alysis
and Toxicology, Hygiene, Regional
Anatomy. Pathology-, Neurology, Sur-gery.
Applied Anatomy. Bacteriology,
Gynecology, Obstetrics and Physical Di-agno.
sis: "Provided, this act shall not
apply to any person who ministers to or
cures the sick or suffering by prayer to
Almighty God, without the use of any
drug or material means."
Sec. 3123. Board of Physicians to
Consist of Seven. 1S58-'9. c. 258.
ss. 3, 4:
In order to the proper regulation of
the practice of medicine and surgery,
there shall be established a board of reg-ularly
graduated physicians, to be known
bv the title of "The Board of Medical
IJULLETIX OF THE NORTH CAEOEIXA BOARD OF HEALTH.
Examiners of the State of Xorth Caro-lina,"
which shall consist of seven regu-larly
graduated physicians.
Sec. 3124. Duty of Board. 1858-'9. c.
258, s. 5:
It shall be the duty of the said Board
to examine all applicants who shall ex-hibit
a diploma, or furnish satisfactory
proof of graduation, from a medical col-lege
in good standing requiring an at-tendance
of not less than three years and
supplying such facilities for clinical in-struction
as shall meet the approval of
the said Board, for license to practice
medicine or surgery, or any of the
branches thereof, on the following
branches of medical science: Anatomy,
Physiology, Surgery, Pathology, Medical
Hj'giene, Chemistry, Pharmacy, Materia
Medica, Therapeautics, Obstetrics, and
the Practice of Medicine, and if on such
examination they be found competent,
to grant to each applicant a license or
diploma, authorizing him to practice
medicine and surgery, or any of the
branches thereof: Provided, five members
of the Board shall constitute a quorum
and four of those present shall be agreed
as to the qualifications of the applicant
Provided, that the requirement of three
years' attendance shall not apply to those
graduating prior to January first, 1900:
Provided further, that license or other
satisfactory evidence of standing as a
legal practitioner in another State shall
be accepted in lieu of a diploma and
entitle to examination.
Sec. 3125. Temporary License. 1858-'9,
c. 258, s. 7:
To prevent delay and inconvenience,
two members of the Board of Medical
Examiners may grant a temporary li-cense
to any applicant who shall comply
with the requirements as to graduation
prescribed in section three thousand one
hundred and twenty-four as amended,
and make report thereof to the next reg-ular
meeting of the Board: Provided,
such temperorary license shall not con-tinue
in force longer than the next
regular meeting of the Board, and such
temporary license shall in no case be
granted after the applicant has-been re-fused
a license by the Board of Medical
Examiners.
Sec. 3126. How Appoixted. 1858-'9, c.
258, s. 9:
The ^Medical Society shall have power
to appoint the Board of Medical Exami-ners.
Sec. 3127. Where axd Whex to As-semble.
1870-'l, c. —, s. 11:
The Board of Medical Examiners shall
assemble at the same time and place
when and where the Medical Society
assembles, which Society shall assemble
at least once in every year at such
time and place as the said Society, at
its next preceding meeting, shall have
fixed; and the said Board shall remain
in session from day to day until all ap-plicants
who may present themselves
for examination within the first five
daj's after its meeting shall have been
examined and dispo.sed of: Provided,
that the said Board may, at its discre-tion,
meet not more than one week
before the said Society, but always in
the same place; and that one additional
meeting in each year may be held at
some suitable point in the State if
deemed advisable.
Sec. 3128. Officers, etc. 1858-'9, 258,
s. 11:
Tlie Board of Medical Examiners are
authorized to elect all such officers and
to frame all such by-laws as may be
necessary, and in the event of any va-cancy
by death, resignation or otlier-wise,
of any member of said Board, the
Board, or a quorum thereof, is em-powered
to fill such vacancy.
BULLETIN OF THE NOETH CAEOLINA BOAED OF HEALTH.
Sec. 3129. The Boakd ob^ Exaiiiners
TO KEEP A Record. 1858-'9, c. 258,
s. 12:
The Board of Examiners shall keep
a regular record of its proceedings in a
book kept for that purpose, which shall
always be open for inspection, and
shall cause to be entered on a book kept
for the purpose the name of each appli-cant
licensed to practice medicine
and surgery, and the time of granting
the same, together with the names of
the members of the Board present, and
shall publish the names of those li-censed
in two of the newspapers pub-lished
in the city of Raleigh, within
thirty days after the granting of the
same.
Sec. 3130. License. 1858-'9, c. 258,
s. 13:
The Board shall have power to de-mand
of every applicant thus licensed
the sum of ten dollars before issuing a
license or diploma, and the sum of five
dollars for each temporary license, to
be paid to the Secretary of the Board.
Sec. 3131. The Board; their Compen-sation.
1870-'l, c. ^, s. 14:
The members of the said Board shall
each receive as a compensation for their
services four dollars per day during the
time of their session, and in addition
thereto their traveling expenses to and
from their places of meeting by the
most direct route from their respective
places of residence, to be paid by the
Secretary of the Board out of any
moneys in his hands, upon the cer-tificate
of the President of the Board of
Medical Examiners.
Sec. 3132. Practicing Without Li-cense.
1858-'9, c. 258, s. 15; 1885,
c. 117 and 261:
Any person who shall practice medi-cine
or surgery without having first
applied for and obtained license from
the said Board of Examiners, shall not
be entitled to sue for or recover before
any court any medical bill for services
rendered in the practice of medicine or
surgery or any of the branches thereof.
And any person who shall begin the
practice of medicine or surgery in this
State for fee or reward, after the pas-sage
of this act [March 7th, 1885],
without first having obtained license
from said Board of Examiners, shall
not only not be entitled to sue for or
recover before any court any medical
bill for services rendered in the prac-tice
of medicine or surgery, or any uf
the branches thereof, but shall also be
guilty of a misdemeanor, and upon con-viction
thereof shall be fined not less
than tAventy-five dollars, nor more than
one hundred dollars, or imprisoned at
the discretion of the court, for each
and every ofi'ence: Provided, that this
act shall not be construed to apply to
women who pursue the vocation of a
midwife: Ajid provided further, that this
act shall not apply to any reputable
physician or surgeon resident in a
neighboring State or coming into this
State for consultation with a registered
physician resident therein. But this
proviso shall not apply to physicians
resident in a neighboring State regularly
practicing in this State: Provided, that
this section shall not apply to physi-cians
who have a diploma from a regu-lar
medical college, and were practicing
medicine or surgery in this State prior
to the seventh day of March, one thou-sand
eight hundred and eighty-five.
Sec. 3133. May Rescind License. 1858-
'9, c. 258, s. 16:
Said Board shall have the power to
rescind any license granted by them
when, upon satisfactory proof, it shall
appear that any physician thus licensed
has been guilty of grossly immoral con-duct.
BULLETIN OF THE NOETH CAROLINA BOAED OF HEALTH. 5
Sec. 3134. Secretary. 1858-'9, c. 258,
s. 17:
The Secretary of the Board of Medical
Examiners shall give bond, with good
security, to the President of the Board,
for the safe-keeping and proper pay-ment
of all moneys that may come into
his hands.
Registration. 1889, c. 181, ss. 3 (in
PART )
, 4, 5, 6, 7
:
Sec. 3. That chapter thirty-four of
The Code be amended by striking from
section three thousand one hundred and
twenty-five the words "for confirma-tion,"
and by adding immediately after
section three thousand one hundred and
thirty-four the following words: "'Any
person who shall begin the practice of
medicine or surgery in this State after
the passage of this act shall personally
appear before the Clerk of the Superior
Court of the county in which he re-sides
or practices within thirty days af-ter
obtaining a license from the Board
of Medical Examiners of the State, as
now provided by law for registration."
Sec. 4. That any person applying for
registration as herein provided shall
produce and exhibit before the Clerk of
the Superior Court a license obtained
from the Board of Medical Examiners
aforesaid; and upon such exhibit being
made as aforesaid the Clerk shall reg-ister
the date of registration with the
name and residence of such applicant in
a book to be kept for this purpose in
his office, marked "Register of Physi-cians
and Surgeons," and shall issue to
him a certificate of such registration
under the seal of the Superior Court
of the county upon the form furnished
him. as hereinafter provided, for which
the Clerk shall be entitled to collect
from said applicant a fee of twenty-five
cents. The person obtaining said cei'-
tificate shall be entitled to practice
medicine or surgery, or both, in the
county where the same was obtained,
and in any other county in this State:
but if he shall remove his residence to
another county he shall exhibit the said
certificate to the Clerk of such other
county and be registered, which registra-tion
shall be made by said Clerk with-out
fee or charge: Provided, that any
one having obtained a temporary license,
as nrovided in section three thousand
one hundred and twenty-five of The
Code, shall not be entitled to register,
but may practice during the time such
license shall remain in force.
Sec. 5. That any person who shall
practice medicine or surgery in this
State without first having registered
and obtained the certificate as aforesaid
shall be guilty of a misdemeanor, and
upon conviction thereof shall be fined
not less than twenty-five dollars nor
more than one hundred dollars, or be im
prisoned at the discretion of the Court,
for each and every offence: Provided,
this act shall not apply to women pur-suing
the vocation of midwife, nor to
reputable physicians or surgeons resident
in a neighboring State coming into the
State for consultation with a registered
physician of this State.
Sec. 6. That any Clerk of the Supe-rior
Court who shall register or issue a
certificate to any person in any other
manner than that prescribed by this act
shall be guilty of a misdemeanor, and
upon conviction thereof shall be fined
not less than two hundred dollars and
shall be removed from office.
Sec. 7. That ii shall be the duty of
the ]\Iedical Society of the State of
North Carolina to prescribe a proper
form of certificate required by this act.
BULLETI?: OF THE ]SrOETH CAROLINA BOARD OF HEALTH.
By-Ija«'s, Rules aud Regulations of tlie
Board of Medical E^xaiuiiiers of tlie
State of JVortli C'aroliua.
THE BOARD.
Section 1. The Board shall meet on
Wednesday afternoon preceding the reg-ular
meeting of the Medical Society of
the State of Xorth Carolina, at the
place designated for the meeting of said
Society and at such other time and
place as may be deemed necessary. It
shall continue in session until all busi-ness
regularly coming before it is dis-posed
of.
Sec. 2. Each member of the Board
shall attend promptly on the first day
of the session. He shall absent himself
from no meeting without a satisfactory
excuse; should he do so for two succes-sive
meetings, the Board shall declaie
his place vacant and proceed to fill same
as provided by law.
Sec. .3. The officers of the BoarJ shall
l)e a President, Secretary, and Treasurer.
Sec. 4. The President shall be the ex-ecutive
officer of the Board, presiding at
all meetings, and exercising a general
supervision over all Inisiness of the
Board.
Sec. 5. The office of Secretary and
Treasurer shall be combined. He shall
perform the usual duties pertaining to
those offices, collect all fees, keep accu-rate
account of same, pay out all money
upon proper voucher, register candidates,
conduct all correspondence relating to
the business of the Board, keeping copy
of all letters written and file all let-ters
received, give due notice of all regu-lar
special meetings of the Board, and
furnish information at all times in re-gard
to matters pertaining to the Board.
He shall be custodian of all books, pa-pers
and records of the Board, and shall
see that same are carefully preserved for
transmission to his successor, and shall
perform such other duties as may be as-signed
to him. He shall give bond to
the Board for the proper keeping and
accounting of all money coming into his
hands, in the sum of one thousand dol-lars
($1,000). He shall receive such
compensation for his services as the
Board may see fit to allow, not exceed-ing
two hundred dollars ($200) per an-num.
APPLICANTS FOR LICENSE.
Sec. 6. All who contemplate applying
to the Board for license mu.st be pres-ent
on the first day of the regularly
advertised meetings and register with
the Secretary at the time appointed for
registration, due notice of which will be
given. No registration will be allowed
after the completion of the first exam-ination,
except by special permission of
the Board. Each applicant shall present
his diploma and file with the Secretary
cf tlie Bond, at the time of registration,
a certificate of good moral character at-tested
by two persons known to the
Board, and pay the fee of ten dollars
(which fee .shall be returned in the event
of the applicant's rejection). He shall
also, present a signed certificate, on a
blank to be furnished by the Secretary,
setting forth in detail his name in full,
place and date of birth, present resi-dence,
the months and years with names
of colleges in which he (or she) studied
medicine, the opportunities afforded the
applicant for clinical instruction, with
the date and college of graduation in
medicine, and names of two references
as to personal character. When all ap-plicants
have been registered these pa-pers
shall immediately be sealed by the
Secretary, and kept unopened until after
the ballot upon the numbers of the
applicants shall have been had, when
they shall be opened to complete the
records.
BUI.LP:TIX of the XORTII CAROI.IXA hoard of HEALTil.
Sec. 7. Applicanl.s \\ ill not be allouwl
to leave the examination room un-less
accompanied bj^ a member of the
Board, or to communic:ite with one
another for any purpose wliatever after
the examination is commenced.
Sec. 8. Each applicant before hand-ing
his papers to the Examiners shall
sign a pledge with his number, stating
that he has neither given nor received
assistance during the examination.
Should any one be found guilty of vio-lating
this pledge, he shall be rejected
and debarred from re-examination for
two years.
Sec. 9. Each member of the Board
shall on the first day of each session
submit for the consideration of the en-tire
Board a copy of the questions he
proposes to require answered by the
applicants upon his branch, and the
Board may alter or amend the same be-fore
approval. The order in which the
different examinations are to be conduct-ed
shall be determined by lot at this
meeting also, though the first and sec-ond
examinations are, as a rule, accorded
the President and Secretary.
Sec. 10. The examinations will com-mence
on Thursday at 9 a. ni. fol-lowing
the first day of the session, and
shall continue until completed (except
on Sunday), not to exceed five hours be-ing
allowed to each branch, with proper
allowance for rest and recreation as the
Board may deem necessary.
Sec. 11. All examinations shall be
written unless by special permission.
The applicant shall write only on the
paper furnished by the Board, and the
carrying into the ex;imination hall of
any other paper, books or materials cal
culatod to aid in any way in the ex-aminations
is strictly forbidden. Tlie
violation of this rule will in all cases
excuse applicants from further attend
ancc on the examinations. .\t the end of
each examia.tlion paper he .-^hall sign
his number (under no circumstances his
name or any sign or token indicative
of the same) and affix the pledge
thereto.
Sec. 12. When an applicant registers
with the Secretary he shall be given an
envelope with a number on the outside
and a blank card on the inside; on re-ceiving
this, applicant will write his full
name and address on the card, replace
same in envelope, seal the envelope and
return at once to the Secretary who shall
carefully preserve same. Each applicant
shall have a separate table assigned him
numbered to correspond with the num-ber
on his envelope. He will be allowed
to use no other during the examination,
and will be designated by this same
numl^er when each examiner grades his
examination, and voted on by it also, in
the ballot had when the grades of all the
examiners are summed up and com-pared.
Sec. 13. Not less than two mend)ers
of the Board shall always be present
during the progress of an examination,
one of whom shall be engaged in no
other business than supervising the ex-amination.
He shall note carefully any
irregularities and report the same to the
Board.
Sec. 14. To secure license an average
grade of not less than 80 (maximum
100) will be required of each applicant.
When the Board shall have concluded
the examinations a vote shall be taken
in the following way. A number is an-nounced,
when each examiner in turn,
after consulting his record, votes the
grade made by the applicant bear-ing
that number upon tlie exaniination
on his branch. The average grade is as-certained,
when if 80, or above, the
number is declared elected; and when
])elo\\ SO, rejected. The envelope bear-ing
tlie corresponding numbei- is then
BULLETIN OF THE NORTH CABOLINA BOARD OF HEALTH.
opened and the name of the applicant
ascertained, when the number, vote and
name are recorded and the consideration
of the next number taken up and dis-posed
of in like manner.
Sec. 15. An applicant receiving a
grade of 35. or less, on any one branch,
resardless of his grade on other
branches, shall be rejected. A vote re-jecting
an applicant cannot be recon-sidered
except to correct a manifest mis-take,
or by unanimous consent of the
Board. An applicant rejected at a regu-lar
session of the Board shall not be con-sidered
eligible to apply for temporary
license during the interval between the
time of such rejection and the next ses-sion
of the Board, though he mav be
examined regularly at the next session
of the Board following his rejection.
Sec. 16. Visitors will not be allowed
in the examination hall during the ex-amination,
except by permission of the
examiner in charge, and under no cir-cumstances
shall snch visitor communi-cate
with an applicant without permis-sion.
The Board of Medical Examiners of tlie
State of Nortli Caroliua, 1902-'8.
M. H. Fletcher, M. D., Asheville, Presi-dent,
Examiner in Physiology and Hy-giene;
Frank H. Russell, M. D., Wil-mington,
Examiner in Surgery; James
M. Parrott, M. D., Kinston, Examiner
in Anatomy and Histology; C. O'H.
Laughinghouse, M. D., Greenville, Ex-aminer
in Obstetrics and Gynecology;
A. A. Kent, M. D., Lenoir. Examiner in
Practice of Medicine; J. T. J. Battle,
M. D., Greensboro, Examiner in Materia
Medica and Therapeutics; George W.
Pressly, M. D., Secretary, Charlotte, Ex-aminer
in Chemistry and Pharmacy.
Revleiv of Diseases for Marcli, 1903.
EIGHTY-FIVE COUNTIES REPORTING.
Ninety-six counties have Superinten-dents
of Health.
Except in the case of the more conta-gious
and dangerous diseases the Super-intendent
has, as a rule, to rely upon his
own information alone, since few physi-cians
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 oth-erwise
indicated, its mere presence in
the county is to be understood as re-ported.
For the month of March the fol-lowing
diseases have been reported from
the counties named:
Measles.—Burke, 10 cases; Caldwell,
25; Chatham, 1; Cleveland, several; Da-vie,
2; Guilford, 2; McDowell, 45; Meck-lenburg;
Rockingham: Stokes, 20; Sur-ry,
25; Washington, epidemic; Yancey
—
13 counties.
Whooping-cough.—Beaufort, 5; Bla-den,
many; Caswell, several; Chowan,
in all parts; Cleveland, several; Cum-berland,
a few; Dare; Duplin, several;
Guilford, 7; McDowell. 30: Mecklen-burg;
New Hanover, many; Pender,
many; Perquimans, 25: Pitt; Richmond,
a few; Rockingham; Rowan, 6; Ruth-erford,
a few; Sampson, a few; Stokes,
10; Union, 15; Wake, 10; Washington,
in all parts; Wilkes. 2; Wilson, 3; Yan-cey,
several—27 counties.
Scarlet Fe\'er.—Alamance, 2; Cataw-ba,
3 ; Davie, 1 ; Granville, 2 ; Iredell, 1
Mecklenburg ; New Hanover, 2 ; Stanly
;
Wilkes, 1—9 counties.
Diphtheria.—Bladen, 1 : Brunswick,
2; Craven, 4; Currituck. 4: Gaston, 1;
Mecklenburg; Randolph, 3: Robeson. 1—
8 counties.
BULLETIN OF THE NOETH CAEOLHSTA BOARD OF HEALTH, 9
Typhoid Fever.—Alexander, a few:
Beaufort, 2; Brunswick, 2; Camden, 1;
Chatham, 2 ; Craven, 1 ; Davidson
Gates, 1; Graham, 1; Green, 2; Iredell,
1; Jones, 1: Lenoir, several; McDowell,
1; Martin, 2; Xash, 5; Onslow, 2; Pam-lico,
a few ; Perquimans. 1 ; Pitt, a few
Eandolph, 5; Piichmond, a few; Rock-ingham,
a few ; Rutherford, 1 ; Union,
3; Vance. 2: Wake, 6; Wilkes, 3;
Yancey, a few—29 counties.
Malarial Fever.—Bruns^^•ick ; Cam-den;
Caswell; Gaston; Gates. 6; Pender,
in all parts; Perquimans; Person—
8
counties.
Malarial Fever, Hemorrhagic.—
Brunswick, 2; Perquimans, 1; Person, 1.
Bowel Diseases.—Wayne.
Ixfll'exza. — Brunswick ; Carteret,
Caswell; Guilford; Johnston; Lenoir;
Montgomery; Moore; Person; Rich-mond;
Robeson; Rockingham, in all
parts; Samp.son: Scotland, in all parts;
Stokes; Vance, in all parts; Washing-ton,
in all parts; Yadkin—18 counties.
Mumps.—Burke, in nearly all parts;
Caswell; Cleveland; Currituck, many
cases; Dare; Gaston; Hyde, in all
parts; New Hanover, in all parts; Pam-lico;
Swain; Yancey—11 counties.
Pz^eumonia.—Alleghany, a few
Edgecombe, a few; Gaston; Graham, in
all parts; Greene; Johnston; Lenoir;
Moore ; Onslow ; Person ; Randolph
Robeson; Rockingham, in all parts;
Scotland, in all parts; Vance, in all
parts; Wilkes, in all parts—16 counties.
Roseola.—Caswell.
Varicella.—Columbus,in many parts;
Onslow, a few.
Small-pox.—Burke, 25; Cabarrus, 3;
Caldwell, 4; Catawba, 9; Chatham, 1;
Cleveland, 2; Davidson, 28; DaWe, 2;
Durham, 13; Forsyth, 15; Gaston, a
few; Graham, 5; Guilford, 11; Hay-wood,
11: Henderson. 5: Iredell, ti : Lin-coln,
5; McDowell, 20; Macon, 9; Madi-son,
4; Mecklenburg, 18; Orange, 6;
Polk, 2; Rockingham, 27; Rowan, 5;
Rutherford, 3; Sampson, 8 or 12; Stan-ly,
17; Stokes, 15; Surry, 3; Swain, 2;
Union, 3; Wake, 1; Wilkes, 10—34
counties.
Cholera, in Chickens.—Cleveland.
Cholera, in Hogs.—Hyde.
Distemper, in Dogs.—Vance.
Glanders, in Domestic Animals.—
Union.
Xo diseases reported from Anson,
Ashe, Bertie, Clay, Franklin, Hertford,
Jackson, Northampton, Pasquotank,
Transylvania and Warren.
Xo reports received from Buncombe,
Cherokee, Halifax, Harnett, Mitchell and
Warren.
Siimniary of Mortuary Report for
Marcli, 1903.
(twenty-five towns).
JVJiite. Col'd. Total.
Aggregate popula-tion
80,850 57,400 1.38,250
Aggregate deaths . . 99 115 214
Representing tem-porary
annual
death rate per
1,000 14.7 24.0 18.6
Causes of Death.
Typhoid fever 2 2
Malarial fever 2 2
Whooping-cough... 2 4 6
Measles Oil Pneumonia 20 17 37
Consumption 9 24 33
Brain diseases 9 7 16
Heart diseases 5 9 14
Neurotic diseases... 2 3 5
Diarrhoeal diseases 5 4 9
All other diseases.. 40 38 78
Accident 3 6 9
Suicide 10 1
Violence 10 1
99 115 214
Deaths under five
years 16 30 46
Still-born - 3 11 14
10 BULLETIN OF THE NORTH CAKOLINA BOARD OF HEALTH.
Mortuary Report for lllarcli, 1903.
TOWN.S
AND Reporters.
BL'LLETIX OF THE XOimi ( AEOLIXA BOARD OV llEAETH. 11
County Superintendents of Healtli.
Alamance Dr. H. R. Moore.
Alexander Dr. C. J. Carson.
Alleghany Dr. Robt. Thompson.
Atison Dr. J. H. Bennett.
Ashe Dr. J. W. Colvard.
Beaufort Dr. Jno. G. Blount.
Bertie Dr. H. V. Dunstan.
Bladen Dr. L. B. Evans
Brunswick Dr. J. A. McNeill.
Buncombe Dr. E. B. Glenn.
Burke Dr. J. L. Laxton.
Cabarrus Dr. R. S. Young.
Caldwell Dr. A. A. Kent.
Camden Dr. J. I<. Lister.
Carteret Dr. F. M. Clark.
Caswell Dr. R. A. Malloy.
Catawba Dr. Geo. H. West.
Chatham Dr. H. T. Chapin
Cherokee Dr. Oscar Patton
Chowan Dr. T. J. Hoskins.
Clay Dr. J O. Nichols.
Cleveland Dr. B. H Palmer.
Columbus Dr. I. Jackson.
Craven Dr. N. H. Street.
Cumberland Dr. Jno. D McRae.
Currituck Dr. H. M. Shaw.
Dare Dr. W. B. Fearing.
Davidson Dr. Joel Hill.
Davie Dr. James McGuire.
Duplin Dr. O. F. Smith.
Durham Dr. N. M. Johnson.
Edgecombe Dr. W. J. Thigpen.
Forsyth Dr. John Bynum.
Franklin Dr. E. 8. Foster.
(iaston Dr. J. H. Jenkins.
Gates Dr. W. O. P. Lee.
Graham Dr. R. J. Orr.
Granville Dr. S. D. Booth.
Greene Dr. C. S. Maxwell.
Guilford Dr. Edmund Harrison.
Halifax Dr. I. E. Green.
Harnett Dr. O. L. Denning.
Haywood Dr. S. B. Medford.
Henderson Dr. J. G. Waldro]).
Hertford Dr. J. H. Mitchell.
Hyde Dr. E. H. Jones.
Iredell Dr. M. R. Adams.
Jackson Dr. R. L. Davis.
Johnston Dr. L. D. Wharton
Jones Dr. S. E. Koonce.
Lenoir Dr. C. L. Pridgen.
Lincoln Dr. T. F. Costner.
McDowell Dr. G. S. Kirby.
Macon Dr. F. L. Siler.
Madison Dr. Jas. K. Hardwicke.
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. E. Wood.
Pender Dr. R. J. Williams
Perquimans Dr. C. C. Winslow
Person Dr. J. A. Wise.
Pitt Dr. C. O'H. Laughing-house.
Polk
Randolph Dr. S. A. Henley.
Richmond Dr. F. J. Garrett.
Robeson Dr. H. T. Pope.
Rockingham Dr. Sam Ellington.
Rowan Dr. AV. L. Crumj).
Rutherford Dr. T. B. Twitty.
Sampson Dr. R. E. Lee.
Scotland Dr. A. W. Hamer.
Stanlv Dr. V. A. Whitlev.
Stokes Dr. W. V. McCanlesH
Surry Dr. John R. Woltz
Swain Dr. A. M. Bennet.
Transvlvauia Dr. C. W. Hunt.
Tyrrell
Union Dr. John M. Blair.
Vance Dr. H H. Bass.
Wake Dr. J. J. L. McCullers
Warren Dr. E. M. Gayle.
Washington Dr. W. H. Ward.
Watauga Dr. T. C. Blackburn.
Wavne Dr. Williams Spicer.
Wilkes Dr. W. P. Horion.
Wilson Dr. W. S. Anderson
Yadkin Dr. M. A. Royall.
Yancey Dr. J. L. Ray.
IBTTILjIL^ElTin^T
OF THE
North Carolina Board of Health,
Published Monthly at the Office of the Secretary of the Board, Raleigh, N. C.
(teo.G. Thomas, M.D.,Pms., Wilmington. W. P. Ivey. M. D Lenoir.
S. Westray Battle, M. D...Ashevil]e. Francis Duffy, M. D New Bern
Henry W. Lewis, M. D Jackson. ! W. H. Whitehead. M. D Rocky Ml
J. L. Nicholson, M. D Richlands. J. L. Ludlow, C. E Winston.
Richard H. Lewis, M. D., Secretary and Treasurer, Raleigh.
Vol. XVIII. MAY, 1903. No. 2
IVotice to Pliysiciaus.
Owing to the absence during the
month of June of Mr. McCarthy the
Biological Laboratory will be closed until
July 1st. After that date, for at least
three months, the demand for analyses
of waters suspected of conveying ty-phoid
fever will be much larger than
ordinarily, so that our sole Biologist
having to make monthlj- analyses of
all the municipal water supplies of
the State, will have very little time for
other work. Bkysicians are therefore
requested not to send specimens of spu-tum
during the time specified except in
ui'gent cases.
malaria and mosquitoes.
Keep in mind the demonstrated fact
that mo.squitoes transmit malaria and
that they can be exterminated by drain-ing
or oiling every ten days all stag-nant
pools in the neighborhood, and by
seeing Ihiit water is not allowed to
stand in barrels, etc.
Germs aud Germicides.
By Gerald McCarthy, Biologist.
In jiopular S2>eech the terms Disinfec-tant,
Germicide, Antiseptic and Deodo-rant
are used synonymously. But these
terms are not synonyms, and should not
be so used, at least by physicians and
public officers. A disinfectant is, strict-ly
speaking, am^ substance or agent
which will destroy infectious, pathoge-nic
matter. Such matter usually in-cludes
bacteria or "germs," but not ne-cessarily
so. Snake poison and pto-maines
are destroyed by disinfectants.
Fire, steam under pressure, strong min-eral
acids, corrosive sublimate, chloride
of lime and formaldehyde are disinfec-tants.
A germicide is a substance which will
destroy l)acteria and protozoan organ-isms,
llidiigh not necessarily enzjnnes
like snake venom or the chemical pro-ducts
of bacterial life. A disinfectant
is always a germicide, though a germi-cide
may not be always a disinfectant.
14 BULLETIN OF THE NORTH CAEOLIXA BOAED OF HEALTH.
An antiseptic is a substance which
will restrict the activity of putrefactive
bacteria. Diluted germicides are always
antiseptics.
A deodorant is a substance which
absorbs or combines chemically with
volatile matter. Charcoal and dry earth
are examples of deodorants.
In former ages the spread of epidem-ics
was supposed to be an "inscrutable
visitation of Providence." Latterly men
have learned that epidemics are always
the result of bacterial or microbic in-fection,
and such infections are the di-rect
result of ignorant oV wilful disre-gard
of the laws of health. Many peo-ple
still imagine that epidemics are
caused by some peculiar conjunction of
the planets or state of the atmosphere.
But those educated in sanitary science
know that the laws of life and health
are as invariable as the laws of physics.
They know that the planets possess no
appreciable influence over human health,
and that though conditions of weather
may restrain or favor the spread of
infectious diseases it can never originate
them. Xeither do germs or infectious
diseases ever arise spontaneously. The
accepted dogmas of modern science are
"Ex nihil, nihil fit" and "Omne vivum
ex vivo."
The germ theory of infectious dis-eases
was established in the latter half
of the last century by the united labors
of Pasteur, Tyndall and many lesser
lights in biology. In particular dis-eases
Koch discovered the microbe of
tuberculosis only in 1882. Eberth iso-lated
the bacillus of typhoid in 1880.
Laveran determined the germ of ma-laria
in the same year. Biologists are
liiisy to-day trying to identify the spe-cific
organisms of small-pox, scarlet
fever, yellow fever and many other dis-eases
which from indirect evidence we
know to be of bacterial origin, but are
as yet unable to locate the particular
species.
According to the best evidence, very
few cases of infectious diseases are of
congenital origination. Most tubercu-lous
mothers give birth to non-infected
ofi'spring. \Yhere infection takes place
it is nearlj- always post-natal and due
to connnunication of the germs of the
disease usually through the air or on
contaminated food or clothing which
passes from mother to child. Diseases
that are communicable are always pre-ventable.
The business of the sanita-rian
is to prevent the transmission of
disease-producing germs from person to
person and from locality to locality.
All rational health legislation has for
its end the same purpose. As people
become more civilized the importance of
drugs decrease and the dependence on
disinfectants, cleanliness and hygienic
measures increases.
Sanitarians have in the last few
years given to us lessons in the value of
municipal hygiene and cleanliness as
preventives of epidemics that the world
will never forget. Havana and Santi-ago
in Cuba have been for centuries
notorious as the breeding spots for yel-low
fever, one of the most destructive
diseases known to science. When the
Americans took possession of t..e cities
named they found there an incredible
amount of filth and the people living in
violation of the most elementary laws
of health. Col. ^Yaring in Havana and
Gen. Wood in Santiago set to work on
jobs that might have discouraged even
Hercules, the hero who cleansed the
Augean slables. But after a couple of
3'ears' active work the modern imita-tors
of the Grecian hero completed their
BULLETIN OF THE JSTORTH CAROLINA BOARD OF HEALTH. 15
respective labors, and with the removal
of the accumulated filth of centuries
they improved greatly the health of the
people.
The brilliant work of the U. S. Army
Commission under the late Surgeon
^Yalter Reed, in demonstrating the mos-quito
as the cause of yellow fever and
the clinching of the theory by Surgeon
Gorgas in his practical work abolishing
the disease from Havana marks an epoch
in sanitation.
In Porto Rico small-pox has been
endemic for generations, and the entire
population lias at length become accli-mated
to this filthy disease in so far
that it has nearly ceased to be fatal to
the natives. The Americans have intro-duced
compulsory vaccination, and by
this measure alone have now practically
freed the island from small-pox for the
first time since Columbus landed.
These lessons should be taken into
serious consideration by the law-makers
and all who have to do with the public
health in the Southern States. In this
section we have a large and ignorant
population very prone to disregard the
rules of hygiene and personal cleanli-ness.
We need active and well-directed
work along the same lines that have
been found so successful in the \Yest
Indies.
Among the best and most generally
attainable of modern disinfectants we
must give preference to the following
six. All of these are efficient where sur-roundings
are suitable, but for particu-lar
uses each possesses some advantage
over the others. There is no "best,"
all-around disinfectant. In a general
way, however, the practical value of the
several substances is in about the order
given
1. Hypochloride of lime — bleaching
powder.
2. Sulphate of copper—blue-stone.
3. Bichloride of mercury — corrosive
sublimate.
4. Dioxide of sulphur—sulphur fumes.
5. Carbolic acid.
0. Formalin.
Hypocliloride of Lime.—This substance
sold by druggists under the name of
bleaching powder is one of the most
active and effective of all disinfectants,
and for general household use we give
it preference to all others. It is not
poisonous. It acts by oxidizing or burn-ing
up organic matter. The action is
very prompt, and by the same action
the substance itself is destroyed or trans-formed
into another compound, so that
it soon becomes inert. The substance
comes in the form of a white powder,
which is very soluble in water and is
destructive to all known germs and
spores in strength of 4 per cent. Hypo-chloride
of lime sells at wholesale at
about .$1.50 per 100 pounds. It can be
bought of most druggists at 5 to 10
cents per pound. The odor of the con-centrated
powder is very powerful and
irritating, but when used as a solution
of 3 to 5 per cent, the odor is not dis-agreeable.
Tliis is the best of all dis-infectants
for chamber use. For use
dissolve 5 ounces in one gallon of clean
water and use immediately.
Sulphate of Copper.—This is the com-mon
spraying chemical so extensively
used by fruit-growers under the name of
"blue-stone." The method of action of
blue-stone is similar to that of the hypo-chloride
of lime, but is much slower,
and the substance does not so easily de-compose.
A 4 per cent, solution is
strong enough. This is made by adding
16 BULLETIN OF THE NORTH CAEOLINA BOARD OF HEALTPI.
o onnc'i'is of blue-stone to a gallon of
water. The blue-stone solution is of es-pecial
value for disinfecting the sputum
discharges of tuberculous people. The
solution corrodes metals, and must there-fore
be used only in earthen or glass
or fiber vessels. It is not jioisonous.
Bichlpride of Mercury.—This is the
well known corrosive sublimate. Cor-rosive
sublimate is our most active and
powerful disinfectant, and in proper
hands is tlie best of all for many pur-poses,
but it is extremely poisonous,
and therefore not a suitable household
disinfectant. It combines chemically
with organic matter, being at the same
time itself decomposed. It is, on this
account, less valuable than either the
lime or copper solutions named above
for disinfecting sputum or faeces. Cor-rosive
sublimate is chiefly used for dis-infecting
the hands and instruments
used in surgical operations. It is effect-ive
at a strength of 1 per 1.000. When
used for disinfecting large masses of
tissue it should be used at a strength
of 1 to 500. For ordinary use to make
a 1 to 1,000 solution dissolve one and
one-half ounce in 314 gallons of water.
In order to prevent accidents in use of
this substance add enough indigo or
washing blue to color the solution a
bright blue.
Dioxide of Sulphur.—This is the fumes
of burning brimstone. The fumes or gas
of brimstone has been used as a disin-fectant
from time immemorial. It is
still, for disinfecting cellars, ships and
large rooms, the best of all disinfec-tants.
Its disadvantage is that when
strong enough to be eft'ective it corrodes
metals and bleaches colors in wall paper
and upholstery. It is very cheap, how-ever,
and its penetrative power exceeds
that of anv other available substitute.
Used in the presence of moisture this gas
is as nearly perfect as we can hope to
find among practicable disinfectants.
The usual dosage is 3 pounds of roll
brimstone or "flowers of sulphur" for
1,000 cubic feet. A room 10 x 10 x 10
feet contains 1,000 cubic feet. The sul-phur
is placed in an iron pot. This is
in turn })laced in a large pan or tub,
with enough water in the outer vessel
to completely surround the inner one
and reach nearly to the top. A little
alcohol is poured upon the suli)hur and
ignited. The sulphur will burn until all
is consvnned. Before igniting the sul-phur
the room must be made as nearly
gas-tight as possible. \Yet strips of
common newspaper or the manilla paper
used by grocers will do. Press these
over cracks without using paste or glue.
The room must be so moist that the
water will not evaporate from these
strips, which will therefore remain tight
against the cracks. Not less than one
gallon of water should be in the outer
vessel, and this should preferably be
boiling hot. The room must be kept
closed for at least six hours after the
sulphur has begun to burn.
Carbolic Acid.—This substance has
long held a place in public estimation
inferior only to corrosive sublimate as
a general disinfectant. But recent
tests under rigorous scientific con-ditions
seem to indicate that it has
been over-rated. Only in strong solu-tions
is it eft'ective as a disinfectant,
though very useful as an antiseptic.
For disinfecting purposes the crude acid
is better tluin the refined, but both are
less active and more costly than either
the lime or copper solutions above de-scribed.
Formuldchiidc or "Fortiialin."—For-maldehyde
is a gas which, as found in
BULLETIN OF THE NORTH CAROLINA BOARD OF HEALTH. 17
commerce, is dissolved in water. Tlie
usual strength is 40 per cent. "For-malin"
was originally the trade name
of a 40 per cent, solution, but is now
the most common name for this sub-stance.
This is one of the newest and
best of the disinfectant class, though to
be efficient it must be properly ajiplied,
which is not always done by those who
use it. Whether used as a pure gas or
as a solution in water this substance
volatilizes, and when used as a disin-fectant
it must be treated as a gas, and
under similar conditions to those already
described for sulphur gas. As a dry gas
the germicidal power of formalin is
slight. It must be used in the presence
of abundant moisture. In any case the
penetrating power of formalin is slight
—
much less than that of sulphur gas. It
is therefore effective only for surface
disinfection and for thin and porous
materials. For each 1,000 cubic feet of
space the proper dose is 1^/4 pints of
40 per cent, formaldehyde or commer-cial
'"Formalin." The solution is added
to four times its volume of water and
evaporated over a heater in a closed
gas-tight room. There are many forms
cf "generators" on the market which
produce the pure gas by imperfect com-bustion
of wood alcohol, or from spe-cially
prepared "pastiles." These gen-erators
are, however, more expensive
and less efficient than a simple iron pot
and alcohol or kerosene lamp wiiich
boils "the dilute solution, thereby supply-ing
at once tlie nccessiiry gas and moist-ure.
Another method of using formalin
is to s])ray it on sheets hung in the
room to be fumigated. This method has
been found very unreliable and is not
reconnnended. Formalin or 40 per cent,
formaldehyde can be purchased in most
localities at about 25 cents per quart.
The special advantages of formalin over
sulphur gas is that it does not bleach
colors nor corrode metals. It can there-fore
be used freely in rooms containing
valuable furniture and ornaments with-out
danger of injuring these. Xeither
the gas nor solution are poisonous,
though they are irritating. ^Yhere sul-phur
fumes can be used without much
damage, sulphur fumigation is cheaper,
more effective and more desirable than
fumigation with formalin, but the latter
may be used where the former cannot.
The commercial water solution, diluted
with ten volumes of clear watei', may
be used as a liquid disinfectant for most
purposes for which other liquid disin-fectants
have been recommended, but for
such purposes formalin possesses no ad-vantage
and is more expensive than most
of the others.
In many households no proper dis-infectant
can be fovuid in cases of emer-gency.
In such cases a good substitute
can usually be found in common washing
soda, used as a 2 per cent, solution in
water. Tliis is made by boiling l^A
pounds of sal soda in one gallon of
water. This solution may be used to
cleanse soiled bedding or the body.
Clotliing soiled by tuberculous sputum
cr typhoid excreta may be sterilized by
soaking for six hours in this solution.
The clothing should tlien be dried in full
sunshine. A one per cent, solution of
caustic soda is equallj^ efficient. "Con-centrated
lye," as found in the stores,
may lie used in.stead of sal soda. Cre-sdl
and lysdl. two derivatives of coal
tar. posNcss strong disinfectant proper-ties,
which in certain cases may prove
of special value. But these are expen-sive
and not always available, so they
cannot be clas.-i'd among practicable dis-infectants.
1! BULLETIN OF THE WOETH CAROLINA BOAED OF HEALTH,
The market is full of loudly adver-tised
proprietary disinfectants which, as
a general rule, are more or less worth-less,
or when possessing real value are
much more expensive than equally active
disinfectants which can be bought under
their proper names. The greatest expense
in marketing these proprietary remedies
is the advertising, therefore such articles
are necessarily more expensive to the
consumer than chemicals which are not
advertised. The great desideratum is to
encourage the free use of real disinfec-tants
in the household. To accomplish
this purpose we must economize in ex-pense,
and should always recommend and
use the disinfectant that, being efficient
for the i3articular case, is also the cheap-est.
^Ye therefore adA-ise against the
purchase or use of any of the proprie-tary
disinfectants on the market, since
in buying these the purchaser pays
chiefly for printer's ink—and manufac-turer's
"ffall."
Review of Diseases for April, 1903.
EIGHTY-FIVE COUKTIES REPORTING.
Ninety-six counties have Superinten-dents
of Health.
Except in the case of the more conta-giovis
and dangerous diseases the Super-intendent
has, as a rule, to rely upon his
own information alone, since few physi-cians
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 oth-erwise
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.—Burke, 14 cases; Caldwell,
10; Caswell, several; Cleveland, a few;
Craven, 3; Guilford, 2; Lincoln, a few;
McDowell, 25; Mecklenburg; Rocking-ham,
many; Rutherford, 2; Stokes, 75;
Surry, 25; Vance, 3; Washington, 50;
Wilkes, 2—16 counties.
Whooping-cough.—Beaufort, 5 ; Bruns-wick,
4; Caswell, several; Cleveland,
several; Duplin, several; Edgecombe, a
few; Greene, 12; Guilford, 4; Haywood,
a few; Lincoln, a few; McDowell, 15;
Mecklenburg; New Hanover, many;
Pender, epidemic; Perquimans, 20; Rich-mond,
a few; Rockingham; Rutherford,
a few; Sampson; Stokes, 25; Union, 10;
Wake, 31; Washington, 50; Wilson,
many; Yancey—25 counties.
Scarlet Fever.—Cabarrus, 1 ; David-son,
1 ; Davie, 1 ; Mecklenburg ; Rowan,
4; Stanly; Wake, 1—7 counties.
Diphtheria.—Craven, 2 ; Haywood, 1
;
Randolph, 1; Rockingham, a few; Ruth-erford,
2 ; Surry, 1 ; Wilson, 1—7 coun-ties.
Typhoid Fever.—Beaufort, 1 ; Bladen,
1 ; Brunswick, 2 ; Caldwell, 1 ; Chatham,
2; Chowan, 3; Craven, 4; Granville, 1;
Iredell, 3; Lenoir, sev^eral; Lincoln, 1;
McDowell, 2; Moore, 5 or 6; Onslow,
1 ; Pamlico, 1 ; Pender, 1 ; Perquimans,
1 ; Richmond 1 ; Rockingham, a few
Rowan, 2; Sampson, a few; Union, 10;
Vance, 1 ; Wake, 3 ; Wayne, 3 or 4
Wilkes, 1—26 counties.
Malarial Fever.—Caswell; Colum-bus,
a few; Craven; Currituck, 4;
Gates, 6; Hyde; Johnston; Pamlico;
Pender; Perquimans; Stanly—11 coun-ties.
jMalarial Fever, Hemorrhagic.—Cra-ven,
1; Hyde, 1; Perquimans, 1.
Bowel Diseases.—Gates, 3; Greene;
Lincoln, a few; Martin, in all parts;
Moore, a few; Onslow, in all parts;
BULLETIN OF THE NORTH CAROLINA BOARD OF HEALTH. 19
Richmond; Sampson; Wayne, in nearly
all parts—9 counties.
Influenza.—Brunswick; Caswell; Le-noir,
in all parts; Moore; Person; Ran-dolph;
Rockingham, in most parts;
Stanly; Transylvania, a few; Vance, in
all parts; Yadkin—11 counties.
Mumps.—Alexander, in all parts; Ber-tie;
Burke, in nearly all parts; Cam-den,
1; Cleveland; Currituck, many;
Hyde, in all parts; New Hanover, in all
parts; Pamlico; Pender; Transylvania,
a few; Wayne, in all parts; Yancey—13
counties.
Pneumonia. —Alleghany ; Caswell
Gaston, a few; Gates, 2; Graham, in
all parts; Perquimans; Rockingham, in
most parts; Vance, in all parts—8 coun-ties.
Varicella.—Alleghany; Columbus, in
many parts.
Small-pox.—Alamance, 1; Burke, 10;
Caldwell, 23; Catawba, 2; Chatham, 9;
Cleveland, 1 ; Davidson, 1 ; Davie, 7
Durham, 8; Forsyth, 15; Graham, 9;
Guilford, 23; Henderson, 4; Iredell, 1;
McDowell, 2; Macon, 12; Mecklenburg,
4; Moore, 1; Orange, 40; Randolph, 1;
Rockingham, 2; Rowan, 5; Rutherford,
12; Stanly, 20; Stokes, 25; Surry, 3;
Swain, 4; Union, 2; Wake, 2—29 coun-ties.
Cholera, in Fowls.—Cleveland.
Distemper, in Horses.—Cleveland.
No diseases reported from Anson, Ashe,
Carteret, Clay, Cumberland, Dare, Hert-ford,
Jackson, Pasquotank, Pitt, Robe-son
and Warren.
No reports received from Buncombe,
Cherokee, Halifax, Harnett, Jones, Mad-ison,
Mitchell, ilontgomery, Northamp-ton,
Polk and Watauga.
Suniinary of Mortwary Report for
April, 1903.
(twenty-four towns).
mate. Col'd. Total.
Aggregate popula-tion
70,150 49,950 120,100
Aggregate deaths.. 76 97 173
Representing tem-porary
annual
death rate per
1,000 13.0 23.3 17.3
Causes of Death.
Typhoid fever 3 3
VVhooping-cough... 5 5
Measles 1 1
Pneumonia 5 5 10
Consumjition 6 19 25
Brain diseases "^ ^ ^?
Heart diseases 9 8 17
Neurotic diseases... 3 3
Diarrhceal diseases 5 7 12
All other diseases.. 35 35 70
Accident 6 5 1
Suicide 2 2
Violence 1 1 2
76 97 173
Deaths under five
years 15 31 46
Still-born - 9 13 22
20 BULLETIN OF THE ISTOKTH CAEOLIIN'A BOAKD OF HEALTH.
mortuary Report for April, 1903.
Towns
AND RePORTEBS.
BULLETIN OF THE NOETH CAEOEIiS'A BOAED OF HEALTH. 21
County Superintendents of Healtb.
Alamance Dr. H. R. Moore.
Alexander Dr. C. J. Carson.
Alleghany Dr. Robt. Thompson.
Anson Dr. J. H. Bennett.
Ashe Dr. J. W. Colvard.
Beaufort Dr. Jnd. G. Blount.
Bertie Dr. H. V. Dunstan.
Bladen Dr. L. B. Evans
Brunswick Dr. J. A. McNeill.
Buncombe Dr. E. B. Glenn.
Burke Dr. J. L. Laxton.
Cabarrus Dr. R. S. Young.
Caldwell Dr. A. A. Kent.
Camden Dr. J. L. Lister.
Carteret Dr. F. M. Clark.
Caswell Dr. S. A. Malloy.
Catawba Dr. Geo. H. West.
Chatham Dr. T. A. Kirkman.
Cherokee Dr. Oscar Patton
Chowan Dr. T. J. Hoskins.
Clay Dr. J O. Nichols.
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. James McGuire.
Duplin Dr. A. J. Jones.
Durham Dr. N. .M. Johnson.
Edgecombe Dr. W. J. Thigpen.
Forsyth :.Dr. John Bynum.
Franklin Dr. E. S. Foster.
Gaston Dr. J. H. Jenkins.
Gates Dr. W. O. P. Lee.
Graham Dr. R. J. Orr.
Granville Dr. S. D. Booth.
Greene Dr. C. S. Maxwell.
Guilford Dr. Edmund Harrison.
Halifax Dr. L E. (ireen.
Harnett Dr. O. L. Denning.
Haywood Dr. J. F. Abel.
Fienderson Dr. J. G. Waldrop.
Hertford Dr. J. H. Mitchell.
Hyde Dr. E. H. Jones.
Iredell Dr. M. R. Adams.
Jackson Dr. R. L. Davis.
Johnston Dr. L. D. Wharton.
Jones Dr. S. E. Koonce.
Lenoir Dr. C. L. Pridgen.
Lincoln Dr. T. F. Costner.
McDowell Dr. G. S. Kirby.
Macon Dr. F. L. Siler.
Madison Dr. Jas. K. Hardwicke.
Martin Dr. W. H. Harrell.
Mecklenburg Dr. C. S. McLaughlin.
Mitchell Dr. V. R. Butt.
Montgomerv 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. C. O'H. Laughing-house.
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. Twilty.
Sampson Dr. R. E. Lee.
Scotland Dr. A. W. Hamer.
Stanly Dr. V. A. Whitley.
Stokes Dr. W. V. McCanless
Surrv Dr. John R. Woltz.
Swain Dr. A. M. Bennet.
Transvlvania Dr. C. W. Hunt.
Tvrreil
Union Dr. John M. Blair.
Vance Dr. H. H. Bass.
Wake Dr. J. J. L. McCullera.
Warren Dr. E. M. Gayle.
Wasliington Dr. W^ H. Ward.
Watauga Dr. T. C. Blackburn.
Wavne Dr. Williams Spicer.
Wifkes Dr. W. P. Horton.
Wilson Dr. W. S. Anderson.
Yadkin Dr. M. A. Royall.
Yancey Dr. J. L. Ray.
BULLETIN OF THE NORTH CAROLINA BOARD OF HEALTH. 23
[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.
:B"criL.iL.:H3Tiisr
OF THE
Morth 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. W. P. IvEY, M. D Lenoir.
S. Westray Battle, M. D...Asheville. Francis Duffy, M. D New Bern.
Henry W. Lewis, M. D Jackson. W. H. Whitehead, i\I. D Rocky Mt.
J. L. Nicholson, M. D Richlands. ; J. L. Ludlow, C. E Winston.
Richard H. Lewis, M. D., Secretary and Treasurer, Raleigh.
Vol. XVIII. JUNE, 1903. No.
Aiinnal Meeting of tlie Board of Healtli
aii<l of tlie State Medical Society.
The animal business meeting of the
Board of Health Avas held in the Moun-tain
Park Hotel, Hot Springs, on the
evening of Tuesday, June 2, Doctors
Thomas, Battle, Nicholson, Ivey, Duffy
and R. H. Lewis being present.
The transactions Avere of a routine
character, and without special features.
The Conjoint Session with the State
Medical Society was held as usual, at
12 M. on Wednesday. At this meeting
flie Secretary of the Board read his
annual report, which A\ill bo found be-low,
and a discussion of tul>erculosis,
more especially of the question of trans-mission
to men from infected cattle,
was had. The value ;ind interest of
tliis discussion were materially enhanced
by Iho participation therein of Dr.
Charles Wartfoll Stiles, Cliief of the
Division of Zoology of the C S. Public
Healtli and Marine Hospital Service,
and Dr. Tait Butler, our own State Vet-erinarian.
From the sanitary point of view the
feature of the gathering was the admir-able
address Tuesday night by Dr. Stiles
on Uncinariasis, or the Hook Worm
Disease, which was listened to with in-tense
interest. Dr. Stiles, having dis-covered
a new species of the hook worm
indigenous to our country, which he
named Uncinarid Ai)iericana, and having
demonstrated the disease caused by it in
numerous individuals in several of the
Southern States, including our own,
spoke as a master of the subject, and
always interestingly and instructively.
He made a fine impression, and his
address will do much good. Iii fact,
we feel justified in saying that his work
on this subject, which will bring sure
relief to so many afflicted ones in our
Southern country, enlitlcs Jiiin to the
name of benefactor of f)nr race. The
results of liis studies of the American
luiok worm and of the disease caused
l)y it. have been fully and clearly set
forth in P.nlletin No. 10 of the Hygienic
Lahoratorv of tlie U. S. P. U. and ,M.
26 BULLETIN OF THE NORTH CAROLINA BOARD OF HEALTH.
H. S., Washington, D. C, and any one
desiring a copy of the same can obtain
it simjily for the asking. Dr. Stiles
also kindly offered to make the diag-nosis
for any one sending him a small
amount of the feces. This could be
mailed in a small bottle enclosed in a tin
can or other carrier, and properly packed
to prevent breakage. But the general ap-perance
of the victims of uncinariasis
is so characteristic that the diagnosis
can be made with reasonable certainty
without the microscope, although the
demonstration of the eggs in the feces is
necessary to certainty. It is a disease
of the country, espeially the sandy coun-try,
and whenever the country doctor
encounters one of these pale, sallow,
flabby, not to say bloated, dull-eyed,
pot-bellied, thin-legged, listless individu-als
he may feel reasonably sure that ho
has hook worms to fight. The treatment
recommended for an adult is 15 grains
of thymol repeated in two hours and
followed in another two hours by a
dose of salts. In our next issue we hope
to present to our readers an abstract
of Dr. Stiles' article.
The matter of most interest before
the Medical Society was the question of
its re-organization on the liaes recoin
mended by the American Medical Asso-ciation.
Our good friend, Dr. McCor-mack
of Kentucky, was present in the
interest of the movement, and by his
charming personality and winning ways
obtained everything he wished. Some
say he "hoo-dooed" the Society. Be that
as it may, we liked the process, and will
be delighted to see him again.
A very interesting thing in connection
with this reorganization business is that
the Medical Society of North Carolina
was originally organized on lines almost
identical with those drawn by the Ameri-can
Medical Association in this latest
scheme. Theoretically it is a beautiful
scheme, and we hope it will work out
satisfactorily in practice. We wish it
well.
Report of tlie Secretary of the Nortli
Carolina Board of Health, June 1, lOOr.2,
to June 1, 1903.
A full statement in detail of the work
of the Board from the time of our last
meeting, consisting chiefly, in addition to
the routine work of the Secretary's office,
of inspections of the State institutions
and of the public water supplies, will be
found in the Biennial Report for 1901 to
1902. This report, notwithstanding the
fact that the copy for the same was
furnished the State Printer at the usual
time, is still in his hands, and I am
therefore unable, much to my disappoint-ment,
to distribute it at this meeting to
those interested. 'It will, however, be
mailed to any one asking for it as soon
as it comes from the press.
Since the beginning of the new bien-nial
period on January 1, 1903, our
most imjjortant work has been in the
line of legislation.
Believing that incompetent physicians
constitute one of the gieatest menaces to
the public health, I felt it to be my
duty to try to obtain from the General
Assembly, if possible, such an amend-ment
to our medical license laws as
would cure the defect existing therein
as declared by our Supreme Court in its
recent decision in State vs. McKnight.
We gained much, but not all we asked.
The purity of our drinking waters
being one of the prime essentials of
health, legislation for the better protec-tion
of our municipal water supplies was
sought and obtained. Inasmuch as a
full statement in regard to these two
BULLETIN OF THE NORTH CAROLINA BOARD OF HEALTH. 27
matters, togetlier witli copies of the
acts, has already been printed in the
monthly Bulletix, it is \innecessary to
repeat them in this report.
I also prepared a bill appropriating
twelve hundred dollars to aid in our
bacteriological work, and succeeded in
getting a favorable report from the Com-mittee
on Appropriations of the House.
But that was the last of it. It appar-ently
fell immediately to sleep and never
waked. Besides the above, I likewise
assisted, at their request, the represen-tatives
of the State Nurses' Association
in preparing a bill for the registration of
trained nurses and in securing its pas-sage.
Tlie importance of thorough train-ing
on the part of the nurses is second
only to that rightly demanded of the
physicians, and this legislation is clearly
in the interest of the public health.
While not interfering with the right of
any one to nurse the sick, the act, after
January 1, 1904, permits the registra-tion
and tlie use of the title R. N. (reg-istered
luirse) only to those obtaining
a license from the State Board of Exam-iners,
consisting of two phy.sieians, to be
elected by the State Medical Society, and
three trained nurses, to be elected by the
State Nurses' Association. Hereafter
the appearance of the letters R. N. after
a nurse's name will be a guarantee of
lier thorough training, and if our physi-cians
will discriminate in their recom-mendations
in favor of that class, they
will create a very strong incentive on
llie part of all trained nurses to enroll
themselves in the fuluie among those
who will surely be recognized as the
best in their calling.
I'.IOI.OC.HAI, LAHOHATOUY.
Learning that the Stale Board of .\g
riciiltiiic )iiiglit he coinpclled to with-draw
their most valuable aid to the
cause of health in having made for us
biological analyses of suspected drink-ing
waters, sputum, etc., on account of
certain extra demands upon their in-come
made by the last Legislature, I
secured the concurrence of the State
\Yater-works Association in certain pro-visions
in the act to protect water sup-plies,
reqtiiring all water companies to
have made in our laboratory a monthly
analysis of their waters and pay five dol-lars
for each analysis. If the water
companies will comply with the law in
this respect, the expense of the labora-tory
can be shared by us, and the people
at the same time be more fully protected.
Upon the invitation of the Board of
Agriculture I appeared before them on
May 30th and explained the situation,
and our ability, under the act to pro-tect
water supplies, to assist in paying
part of the expense incident to the
liygienic work which they have been so
generously doing for us free of charge
since December, 1899. I proposed, speak-ing
for the Board of Health, to pay
one-half of the salary of the Biologist
and to furnish all new apparatus and
reagents that might be required for our
special work, the Board of Agriculture
to furnish the laboratory with its per-manent
equipment, attendance, water
and gas. At tlu'ir request I put the
proposition in writing, and it was for-mally
accepted by a unanimous vote on
their part.
SMALL-POX.
Small-pox, I regret to say, has been
much more prevalent during the past
year than ever before, and more fatal,
confirming our predictions to that effect
in view of the indifference of our local
authorities on the subject of vaccina-tion.
And unless there is a chanije in
28 BULLETIN OF THE ISTOKTH CAROLINA BOARD OF HEALTH.
this respect I see no reason to anticipate
anything else than a continuing recur-rence
of small- pox until all the people
have either been vaccinated or have had
the disease.
During the past year, May 1, 1902, to
May 1, 1903, small-pox has occurred in
fifty-eight counties, the number of cases
being, white 1,861, colored 2,595—total
4,456; with deaths, white 58, colored 105
—total 163, the death rate per cent, be-ing,
respectively, 3.12, 4.04, 3.G6. For the
first time in our experience the death rate
from this disease has been higher among
the negroes than among the whites, the
figures heretofore having been very much
in favor of the former. A comparison
by years, the first period, however, ex-tending
from the occurrence of the first
case on January 12, 1898, to May 1,
1899, a little over fifteen months, is
given in the following tabular state-ment
:
Year.
BULLETIN OF THE NORTH CAROLINA BOARD OF HEALTH. 29
SMALL-POX IN NORTH CAROLINA—MAY 1, 1902, TO MAY, 1903.
Counties.
30 BULLETIN OF THE NORTH CAROLINA BOARD OF HEALTH.
Review of Diseases for May, 1903.
EIGHTY-TWO COUNTIES REPORTING.
Ninety-six counties have Superinten-dents
of Health.
Except in the case of the more conta-gious
and dangerous diseases the Super-intendent
has, as a rule, to rely upon his
own information alone, since few physi-cians
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 oth-erwise
indicated, its mere presence in
the county is to be understood as re-ported.
For the month of May the following
diseases have been reported from the
counties named:
Measles.—Cleveland, a few cases;
Craven, 1; Forsyth, many; Greene, 12;
Guilford, 2; Lenoir, 2; McDowell, 10;
Mecklenburg; jSTorthampton ; Randolph;
Surry, 12; Wake, 1; Wilkes, 1; Yad-kin,
a few—14 counties.
Whooping-cough.—Beaufort, 40; Ber-tie,
several ; Chowan, several ; Cumber-land,
a few; Edgecombe, a few; Greene,
26; Guilford, 2; Henderson, 5; Lenoir,
several; Mecklenburg; Moore, several;
New Hanover, many ; Person ; Randolph
;
Richmond, a few; Robeson, several;
Rockingham; Rutherford, a few; Samp-son,
many; Union, 10; Wake, 1.3; Wash-ington,
general—22 counties.
Scarlatina.—Davidson, 2 ; Mecklen-burg;
Stanly; Wilkes.
Diphtheria.—Carteret, 2; Guilford,
1 ; Northampton, a few ; Person, 1
Union, 1—5 counties.
Typhoid Fever.—Beaufort, 6; Bladen,
1; Brunswick, 2; Caldwell, 2; Camden,
2; Carteret, 1; Chatham, 2; Clay, 2;
Craven, 2: Cumberland; Edgecombe, 3;
Franklin, .3 ; Gates, 1 ; Granville, 1
;
Gi-eene, 4; Guilford, 2; Iredell, 1; John-ston,
1; Lenoir, several; McDowell, 1;
Moore, 15; New Hanover, 5; Onslow, 4;
Peiuler, 6 ; Perquimans, 2 ; Person, sev-eral;
Randolpli, a few; Richmond, 6;
Rockingham; Sampson, a few; Surry, 1;
Union, 10; Vance, 2; Wake, 1; Wayne,
several; Wilkes, 1; Yadkin, a few—37
counties.
Malarial Fever.—Brunswick ; Cam-den;
Cvimberland; Currituck; Duplin;
Gates, 8 ; Hyde ; Orange ; Randolph
;
Sampson; Vance; Wayne—12 counties.
Malarial Fever, Hemorrhagic. -Hyde,
two.
Malarial Fever, Pernicious.—Vance,
one.
Bowel Diseases.—Alleghany; Anson,
a few; Bertie, mild general; Brunswick,
Buncombe, general; Caldwell, Camden;
Catawba ; Clay, general ; Columbus, Cur-rituck;
Davidson, general; Davie, gen-eral;
Duplin, Forsyth; Franklin, in
nearly all parts; Gates, general; Gra-ham,
general ; Granville ; Greene ; Hen-derson;
Iredell; Jackson, a few; Lin-coln;
Moore, general; Northampton,
general ; Onslow, general ; Orange, gen-eral;
Perquimans; Person; Richmond,
general; Robeson; Rockingham, general;
Surry; Vance, general; Wayne—36
counties.
Influenza.^—Lenoir, in all parts;
Pender; Richmond, in all parts; Yan-cey.
Mumps.—Alexander, in all parts:
Buncombe; Hyde, in all parts; New
BULLETIN OF THE NOKTH CAROLINA BOARD OF HEALTH. :U
Hanover, in all parts; Pamlico; Pender;
Sampson—7 counties.
Varicella.—Anson, a few; Colum-bus,
epidemic; Orange, a few; Pamlico.
Small-pox.—Buncombe, 18; Burke,
5; Chatham, 1; Cleveland, 4; Davie, 2;
Durham, 14; Forsyth, 25; Graham, 2;
Guilford, 45; Henderson, 2; McDowell,
2 ; Mecklenburg, 2 ; Moore,' 1 ; New Hano-ver,
1; Rutherford, 2; Surry, 8; Wake,
26; Warren, 3; Wilkes, 2; Wilson, 1
—
20 counties.
Cholera, in Chickens.—Clay, Cleve-land,
Gates.
Cholera, in Hogs.—Chowan, Duplin.
Northampton.
No diseases reported from Alamance,
Ashe, Cabarrus, Dare, Haywood, Macon,
Martin, Nash, Pasquotank, Polk, Scot-land,
Swain and Transylvania.
No reports received from Caswell,
Cherokee, Gaston, Halifax, Harnett,
Hertford, Jones, Madison, Mitchell,
Montgomery, Pitt, Rowan, Stokes and
Watauga.
Summary of Moj-tiiary Report for
May, 1903.
(twenty-two towns).
mate. Col'd. Total.
Aggregate popula-tion
71,650 51,000 122,650
Aggregate deaths.. 108 131 239
Representing tem-porary
annual
death rate per
1,000 18.9 30.8 23.4
Causes of Death.
Typhoid fever 5 5
Malarial fever 1 2 3
Whooping-cough... 3 4 7
Measles 1 1
Pneumonia 7 8 15
Consumption 14 18 32
Brain diseases 6 6 12
Heart diseases 4 "9 13
Neurotic diseases... 2 4 6
Diarrhoeal diseases 21 16 37
All other diseases.. 45 53 98
Accident 4 5 9
Violence 1 1
108 131 239
Deaths under five
years 34 58 92
Still-born - 5 7 12
32 BULLETIN OF THE NOKTH CAROLINA BOARD OF HEALTH.
Illortuary Report for May, 1903.
Towns
AND Reporters.
Cliarlotte
Dr. F. O. Hawley.
Diirliam
Dr. N. M. Johnson.
Edeutoii..
Dr. T. J. Hoskins.
Payettevllle
Dr. A. S. Rose.
Oreensboro
Jno. S. Michaux, C. C.
Lenoir
Dr. A. A. Kent.
Liexiiig'toii
J. H. Moyer, Mayor.
Monroe
Dr. Jno. M. Blair.
Oxford
Dr. S. D. Bootli.
Raleigh
T. P. Sale, Clerk B. H.
ReldsvUle
Jas. T. Smith, C. C.
Rocky Mount
Dr. G.L.Wimberley.Jr
Salem
F. E. Keehln.Supt.H.
Sallsltnry
Dr. W. W. McKenzie.
Soiithport
Dr. D. I. Watson.
Tarboro
Dr. Wm. J. Thigpen.
Wailesboro
Dr. J. H. Bennett.
Waslilngton
Dr. D. T. Taylor.
Waynesvllle
Dr. Tho.s. Stringfield.
Weldou
J. T. Gooch, Mayor.
Wilmington
Dr. Chas. T. Harper.
Wilson
Dr. W. S. Anderson.
Popula-tion.
11,000
7,200
8,000
5,000
1,200
1,800
2,.500
2,300
6,100
4,000
1,200
.300
j
800
500
1,850;
600!
1,200
1,100
8,000
5,800
2,900
1
1,300
1,600
1,500
3,300
350
3,900
2,500
900
500
2,000
500
1,000
700
j
3,000
2, 500
1
1,000
300
j
700!
750
j
10,000:
11,000
3,500
3,300
Tempobaet
Annual
Death Rate
PER 1,000.
18,5!00
13,000
3,000
4,800
10,100
1,500
1,300
2,450
2,300
13,800
4,200
3,100
3,650
6,400
1,400
2,500
1,700
5,500
1,300
1,4.50
21,000
6,800
29 4
28 3
12
31.2
10.0
13 3
48
15.6
23.6
36.0
20
0.0
0.0
0.0
6.5
20
30.0
54.5
18.0
37 2
16.5
185
15.0
15.7
10.9
34.3
18 5
19.2
0.0
0.0
12.0
24.0
12.0
34.3
12.0
19.2
0.0
120.0
51.4
32.0
156
37.1
13.7
18.2
29.0
10.0
9.8
18.7
15.3
ft,
'0
j2
a.
>>
BULLETIN OF THE NORTH CAROLINA BOARD OF HEALTH, 33
County Superintendents of Health.
Alamance Dr. H. R. Moore.
Alexander Dr. C. J. Carson.
Alleghany Dr. RoVjt. Thompson.
Anson Dr. J. H. Bennett.
Ashe Dr. Manlev Blevins.
Beaufort Dr. D. T. tayloe.
Bertie Dr. H. V. Dunstan.
Bladen Dr. L. B. P^vans.
Brunswick Dr. J. A. McNeill.
Buncombe Dr. E. B. Glenn.
Burke Dr. J. L. Laxton.
Cabarrus Dr. R. S. Young.
Caldwell Dr. A. A. Kent.
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. Oscar Patton.
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. Janes.
Durham Dr. N. M. Johnson.
Edgecombe Dr. W. J. Thigpen.
Forsyth Dr. W. O. Spencer.
Franklin Dr. E. S. Foster.
Gaston Dr. J. H. Jenkins.
Gates Dr. W. O. P. Lee.
Graham Dr. V. J. Brown.
Granville Dr. S. D. Booth.
Greene Dr. C. S. Maxwell.
Guilford Dr. Edmund Harrison.
Halifax Dr. I. E. Green.
Harnett Dr. O. L. Denning.
Haywood Dr. J. F. Abel.
Henderson Dr. J. G. Waldrop.
Hertford Dr. J. H. Mitchell.
Hyde Dr. E. H. Jones.
Iredell Dr. M. R. Adams.
Jackson Dr. R. L. Davis.
Johnston Dr. L. D. Wharton.
Jones Dr. S. E. Koonce.
Lenoir Dr. C. L. Pridgen.
Lincoln Dr. T. F. Costner.
McDowell Dr. G. S. Kirby.
Macon Dr. F. L. Siler.
Madison Dr. Jas. K. Hardwicke.
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. Griiigs.
Pender Dr. R. J. Williams
Perquimans Dr. C. C. Winslow
Person Dr. J. A. Wise.
Pitt Dr. C. O'H. Laughing-house.
Polk Dr. C. J. Kenworthy.
Randolph Dr. W. J. Moore.
Richuiond 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. Y. A. W^hitley.
Stokes Dr. W. Y. McCanlese.
Surry Dr. John R. Woltz.
Swain Dr. A. M. Bennet.
Transvlvania Dr. C. W. Hunt.
Tyrrell
Union Dr. John M. Blair.
Yance Dr. H. H. Bass.
"VVake Dr. J. J. L. McCullere.
Warren Dr. E. M. Gayle.
Washington Dr. W. H. Ward.
Watauga Dr. T. C. Blackburn.
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
:B"criL.iL.Eia:i2sr
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., Prcvs., Wilmington.
S. Westray Battle, M. D...Asheville.
Henry 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. XVIII. JULY, 1903. No. 4.
Hookworm Disease.
In our last issue we promised to give
this month an abst'-act of the admirable
report of Dr. Stiles upon the "Preva-lence
and Geographic Distribution of
Hookworm Disease (Uncinariasis or
Ancliylostomiasis) in the United States."
Since that promise was made, however,
we have found in the New York and
Philadelphia Medical Journal of July 4th
an article by Dr. Bondurant of Mobile,
based on an earlier monograph by Dr.
Stiles on "'Uncinaria and its Influence in
the Causation of Disease in Man," which
sets forth in an excellent manner the
essential features of Dr. Stiles' observa-tions
and discoveries in regard to this
subject, together with the personal expe-rience
of himself and some other Ala-bama
physicians, which will "fill the bill"'
probably better than an abstract by the
writer. It surely will, when considered
in a sense as an amplification of Dr.
Stiles' own summarj' of his paper, which,
while very concise, is also essentially
complete. But those interested in this
extremely important subject, as every
physician doing country practice in
North Carolina or any part of the South
ought to be, should write to the Hy-gienic
Laboratory, Public Health and
Marine Hospital Service, Washington,
D. C, for Bulletin No. 10, the same be-ing
the complete article profusely illus-trated.
Especially should every physi-cian
using a microscope have this article
for the pictures of the eggs of the hook-worm.
With the aid of the pictures and
the instructions given, the diagnosis is
very easily made. Any physician, how-ever,
can have the diagnosis made for
him by writing to Mr. Gerald McCarthy,
Biologist, Department of Agriculture,
enclosing six cents for postage, for a
suitable mailing case, and sending him
a small specimen of the fseces. ^\e sin-cerely
hope that our physicians will all
take advantage of this ofi'or and wipe
(Hit this serious disease, whicli is cer-tainly
(]iiite prevalent in <iur Stale.
'I'd prc\t'iit the spread (if tliis disease,
38 BULLETIN OF THE NORTH CAROLINA BOARD OF HEALTH.
the infection being by the embryo worms
in the surface soil, the two most impor-tant
precautions to be taken are: (1)
The cure of the disease, which will at once
stop the supply of eggs; and (2) the
invariable use of a pri^y provided with
a flap behind to keep out the chickens
and pigs, and the removal at proper in-tervals
and burial of the faeces. In this
way the spreading broadcast of the eggs
over the premises would be prevented,
and they could not get en the hands and
bare feet of the children, nor into the
drinking water. The head of every
household should compel the systematic
and unfailing use of the priAy by every
member of the family. And every school
committee should see to it that this sani-tary
convenience, one for each sex, is
provided for every public school.
We give belcnv the summary and the
article referred to above.
SUMMARY OF DR. STILES' ARTICLE.
Convinced from theoretical deductions
that hookworm disease (uncinariasis)
must be more or less common in the
South, a trip was made from Washing-ton,
D. C. to Ocala, Fla., stopping at
penitentiaries, mines, farms, asylums,
schools, and factories, and the fact was
established that the chief ansmia of the
Southern rural sand districts is due to
uncinariasis, while clay districts and
cities are not favorable to the develop-ment
of this disease.
In the Old World, hookworm disease
Avas probably known to the Egj'ptians
nearly three thousand five hundred years
ago, but its cause was not understood
until about the middle of the nineteenth
century, when it was shown to be due
to an intestinal parasite, Agchylostoma
» (An article by Dr Pitt, "who savs that along the Roanoke River, North Carolina, malaria or dirt-eating
prevails mostly among the poor white people and negroes and originates in my opmion from a
deficiency of nourishment."—Ed.)
duodenale. Until 189.3 no authentic
cases of this disease were recognized as
such in the United States, but between
1893 and 1902 about thirty-five cases
were diagnosed. In 1902 it was shown
that a distinct hookworm, Uncinaria
americana, infests man in this country,
and this indicated very strongly that
the disease must be present, although
not generally recognized. It is now
established that in addition to the few
cases of Old World hookworm disease
imported into the United States, we
have in the South an endemic uncinaria-sis
due to a distinct cause, Uncinaria
americana. This disease has been
known for years in the South, and can
be traced in medical writings as far
back as 1808,* but its nature was not
understood. Some cases have been con-fused
with malaria, others have been at-tributed
to dirt-eating.
The hookworms are about half an inch
long. They live in the small intestine,
where they suck blood, produce minute
hemorrhages, and in all probability also
produce a substance which acts as a
poison. They lay eggs, which cannot de-velop
to maturity in the intestine. Tliese
ova escape with the fa?ces and hatch in
about twenty-four hours; the young
Avorm sheds its skin tAvice, and then is
ready to infect man. Infection takes
place through the mouth, either by the
hands soiled Avith larva? or by infected
food. Infection through the drinking
Avater may possibly occur. Finally, the
larA-iE may enter the body through the
skin and eventually reach the small in-testine.
Patients may be divided into light
cases, in Avhich the symptoms are very
obscure; medium cases, in Avhich the
BULLETIN OF THE NORTH CAROLINA BOARD OF HEALTH. 39
anaemia is more or less marked, and
severe cases, represented by the dwarfed,
edematous, anaemic dirt-eater. Infection
occurs chiefly in rural sand districts.
Above the frost line the symptoms are
more severe in summer than in winter,
and whites appear to be more severely
affected than negroes. Persons who come
in contact with damp earth are more
commonly infected than others; so that
the disease is found chiefly among farm-ers,
miners, and brickmakers. Severe
cases are more common in women and
children than in men over twenty-five
years of age. Uncinariasis is a disease
which occurs in groups of cases, and if
one case is found in a family the chances
are that other members of the same
family are infected.
The testimony of patients severely in-fected
is unreliable. Recalling that any
one or more symptoms may be absent
or subject to variation, it may be noted
that the period of incubation (at least
before the malady can be diagnosed by
finding the eggs) is from four to ten
weeks. Stages are not necessarily dis-tinctly
defined, but are described as (1)
stage of purely local symptoms, corre-sponding
to the light cases; (2) stage of
simple anaemia, corresponding to the
medium cases; and (3) dropsical stage,
corresponding more or less to the severe
cases. The duration of the disease after
isolation from the source of infection
lias been traced for six years and seven
months; how much longer infection will
last is not established. If a patient is
subject to cumulative infection, the dis-ease
may last five, ten, or even fifteen
years, and in case of light infection per-haps
longer.
External appearance. — In extreme
cases there is a general lack of develop-ment;
skin wa.xy white to yellow or tan;
hair is found on the head, but is more
or less absent from the body; breasts
are undeveloped; nails white; external
genitalia more or less rudimentary; face
anxious, may be bloated; conjunctives
pale; eyes more or less dry, pupil dilates
readily; membranes pale according to
the anaemia; teeth often irregular;
tongue frequently marked with purple or
brown spots; cervical pulsations promi-nent;
thorax emaciated; heart beats
often visible; abdomen frequently with
"pot belly" ; extremities emaciated, fre-quently
edematous, and with wounds or
ulcers of long standing.
Urine 1010 to 1015; in advanced cases
albumin witnout casts; acid or alkaline.
Feces reddish brown, contain eggs, and
may contain blood.
Circulatory system. — Anaemia pro-nounced,
according to degree and dura-tion
of infection; blood watery, with
decreased red blood corpuscles and with
eosinophilia ; '"heart disease" very com-monly
complained of; haemic murmurs
present; pulse 80 to 132 per minute.
Temperature.—Subnormal, normal, or
to 101° or 102° F.
Respiratory system.—Breathing may
be difficult, slow, or increased to as high
as 30.
Muscular system. — Emaciation and
great physical weakness.
Digestive syste))i.—Appetite poor to
ravenous; abnormal appetite often de-veloped
for pickles, lemons, salt, coffee,
sand, cla}', etc.; pain in epigastrium;
constipation or diarrhoea.
Nervoiis system.—Headache, dizziness,
nervousness, mental lassitude, and stu-pidity.
Genital system.—^lenstruation irregu-lar
or absent; if present, it occurs chiefly
in winter; tliero is a marked tendency
to abortion.
40 BULLETIi:*; OF THE NORTH CAROLINA BOARD OF HEALTH.
Europe, and some tropical countries, its
great prevalence in the southern United
States has until recently been unrecog-nized.
Prior to 1893, no authentic
American case had been reported, and
up to two years ago less than forty
cases had been placed on record.
The subject of uncinariasis in America
has been most exhaustively studied by
Dr. Charles Wardell Stiles, chief of the
Division of Zoology, Hygienic Labora-tory
of the Marine Hospital Service,
Washington, D. C, whose excellent
monograph on the iincinaria and its in-fluence
in the causation of disease in
man is included in the report of the
Bureau of Animal Industry for 1901.
This paper is by far the most valuable
contribution to our knowledge of this
form of parasitic disease which has thus
far been made; and to Dr. Stiles, who,
by the way, is not a physician, but a
doctor of philosophy, belongs the credit
of having first suggested the probable
great prevalence of uncinariasis in the
South. His allegations have been fully
corroborated by every one who has taken
up the study of the hookworm disease.
Some mqnths ago Dr. W. T. Hender-son
saw, in consultation with Dr. S. S.
Pugh, some cases of extreme and pecu-liar
angemia in children living in the
manufacturing suburb of Pritchard, near
Mobile. Suspecting infection by the
uncinaria, Dr. Henderson brought the
bowel discharges from several of these
cases to me for microscopical examina-tion.
In all of them I readily demon-strated
the presence of ova of the hook-worm.
It was the discovery of these
cases which first actively directed my
attention to the disease.
A few days after this, a ten-year-old
white boy was brought to me from the
* Read at the meeting of the Medical Association of the State of Alabama, at Talladega, April 22,
23, 24, and 25, 1903.
Diagnosis.—The safest plan is to make
a microscopic examination of the faeces
to find the eggs; or, if faeces are placed
on white blotting paper, a blood-like
stain will be noticed.
Treatment.—Thymol, or male fern
(or ? calomel) ; iron, and good food.
Prognosis.—Good, if patient is not too
far gone at time of treatment.
Lethality.—Not yet determined.
Prevention.—Treat all cases found
and dispose of faeces.
Economically, uncinariasis is very im-portant.
It keeps children from school,
decreases capacity for both physical and
mental labor, and is one of the most
important factors in determining the
present condition of the poorer whites of
the sand and pine districts of the South.
The disease is carried from the farms
to the cotton mills by the mill hands,
but does not spread much in the mills;
nevertheless, it causes a considerable
amount of anaemia among the opera-tives.
THE HOOKWORM DISEASE IN ALABAMA.*
BY E. D. BONDURANT, M. D.,
MOBILE, ALABAMA,
Professor of Neurology and Pathology in the
Medical Department of the Uuiversity
of Alabama.
The form of anaemia due to the pres-ence
in the intestinal tract of the unci-naria,
or hooked thread worm, has been
variously named: uncinariasis; ankylos-tomiasis;
mountain cachexia; miner's
anaemia; brickmakers' anaemia; St.
Gothard tunnel disease; tunnel anae-mia;
Egyptian chlorosis; hookworm
disease. Although known in Egj'pt more
than three thousand years ago, and in
our ovsTi time extensively distributed
throughout northern Africa, southern
BULLETIN OF THE NORTH CAROLINA BOARD OF HEALTH. 41
hill country west of Mobile. He was
undersized, emaciated, ghastly pale,
short of breath, and so feeble that he
could scarcely walk. He was listless,
dull, indifferent, suffered from headache,
showed oedema of eyelids and ankles,
had a ravenous appetite, no bowel dis-order,
a trace of albumin and a few
hyaline casts in the urine. Examina-tion
of the blood showed only 25 per
cent, of hiiemoglobin, although the cor-puscular
count was near normal. The
child had been ailing for four years, and
since long-continued treatment for sup-posed
malaria, anaemia, heart disease,
and several other maladies, had proved
unavailing, his mother had concluded
that he must have some nervous dis-order,
and brought him to me. A micro-scopical
examination of the faeces was at
once made, and the eggs of the hook-worm
were found in abundance. After
administration of thymol, adult worms
were expelled to the number of many
hundreds, and the boy began a rapid
improvement, which terminated in entire
recovery in a few weeks.
A day or two later a young man,
twenty-five years old, came into my
office, giving a history of physical fee-bleness
and mental sluggishness, with
incapacity for work during many years
past. He was emaciated, weak, nervous,
apathetic, and obviously anaemic. Blood
examination gave him 40 per cent, of
haemoglobin, 4,000,000 red corpuscles.
Microscopical search of the bowel dis-charges
revealed the ova of uncinaria,
and thymol expelled the worms in large
numbers. Improvement was rapid and
recovery complete.
Since then I have succeeded in inter-esting
a number of my professional
friends in the study of the disease, and
have had many specimens of bowel dis-charge
in suspected cases submitted to
me for microscopical examination. In
all, I have diagnosticated about fifty
cases from Mobile, Monroe, Escambria,
Crenshaw and Covington counties in
Alabama, with one case from Missis-sijDpi
and one from west Florida.
The cases of Dr. Pugh and Dr. Hender-son
have already been referred to. They
were reported by Dr. Henderson in the
February number of the Mobile Medical
and Surgical Journal.
Dr. L. D. Parker of Searight, in Cren-shaw
county, writes me that he has some
thirty cases in his practice. I have con-firmed
the diagnosis by microscopical
examination in twelve of these, and
have no doubt that the remaining cases
are of similar nature.
Dr. Charles A. Mohr of Mobile has
seen and treated a number of cases,
from fifteen to twenty in all.
Dr. C. K. Roe of Spring Hill, five
miles west of Mobile, tells me that he
has even a hundred or more cases among
the poor whites of the sandy-hill coun-try
thereabouts.
Dr. G. H. Searcy, physician in charge
of the colored insane hospital at Mt.
Vernon, Mobile county, has found one
nineteen-year-old colored insane patient
affected, and several cases in Avhite chil-dren
living in or near the village of
Mt. Vernon. Two specimens of faeces
sent me by Dr. Searcy contained hook-worm
ova.
Dr. S. B. Mc:\Iillan of ]SIonroe county
writes me that he has found, and is now
treating, quite a number of cases. He
sent me several specimens of fiecal mat-ter
for diagnostic examination, all of
which were proved to contain hookworm
ova.
In view of the facts now at hand,
there can no longer be any question of
42 BULLETIN" OF THE NORTH CAROLINA BOARD OF HEALTH,
the exceeding frequency of this disease,
not only in Alabama, but throughout
the South. Stiles, during the autumn
of 1902, made a tour of investigation
through Virginia, the Carolinas and
Georgia, finding the hookworm anaemia
widely prevalent. Harris, of Atlanta,
who has diagnosticated numerous cases
in Georgia, expresses the opinion that
"by far the greater number of cases of
anaemia in Georgia, Florida and Ala-bama
are due, not to malaria, but to
ankylostomiasis." Allen J. Smith of
Galveston has reported cases in Texas,
some of these being discovered by Smith
nearly ten years ago, long before any
general interest in the disease was
shown.
I feel justified in saying that every
physician present here to-day, whose
practice extends into the country and
among the poorer class of whites, has
seen not a few, but many cases of un-cinariasis.
There is good reason for the
belief that the hookworm disease is one
of the most widely prevalent and one
of the most serious with which the
poorer class of our white population
have to contend.
The disease is easily recognized so
soon as one's attention is directed to it,
and when discovered in time, easily. and
quickly cured; while, if its true nature
is not recognized, it is practically in-curable
and often fatal. Furthermore,
every person suffering from the hook-worm
disease is a source of serious and
constant danger to other members of
his family and to the community in
which he lives, since the soil, water and
some kinds of vegetable food are sure
to become infected by the many millions
of hookworm embryos which the suf-ferer
from uncinariasis casts abroad
with his bowel movements. It therefore
becomes the duty of us all to recognize
quickly the existence of the disease in
our midst, to the end that prompt relief
may be given the individual patient,
and further spread of the disease
averted.
In reviewing the clinical symptoms of
uncinariasis we find the one ever-present
feature to be anaemia. This may be very
slight, but in all typical cases is well
marked, and in severe cases extreme. It
has been noted that the diminution in
haemoglobin percentage is out of propor-tion
to the reduction in number of
red blood corpuscles. Both of the
cases in which the opportunity of ex-amining
the blood was afforded me
showed this peculiai-ity; an excess of
eosinophile cells has also been found.
The pallor of the skin and mucous
surfaces is in many cases quite ex-ceptional.
Almost as characteristic as
the anaemia are the associated mental
and physical feebleness, apathy, indiffer-ence
and inability and disinclination to
work. Normal development is markedly
checked, and the subjects are usually
undersized, and the growth of hair is
scanty. Haemic heart murmurs are fre-quent.
Oedema of the feet and eyelids
is often met with. The appetite is ca-pricious,
sometimes ravenous, and a
liking for clay, chalk, dirt and other in-digestibles
is shown. The bowel symp-toms
are not characteristic. There may
be constipation or diarrhoea, or no ab-normity.
In many instances the faecal
matter is blood-stained, or colored by
altered and partly digested blood which
has oozed from the wounds made in the
intestinal mucosa by the parasites. The
"dirt-eaters" of our sand-hills are excel-lent
examples of this disease, and any
one who can recall the appearance and
mental characteristics of a little stupid,
BULLETIN or THE NORTH CAROLINA BOARD OF HEALTH. 43
tallow-faced, dirt-eating boy, has a typi-cal
picture of uncinariasis.
While the symptoms are often suffi-cient
for diagnosis, the only absolute
differentiation between this and other
forms of auicmia is made by the finding
of the ova of the parasites in the bowel
discharges. The method of examination
for these is the simplest possible; a
small bit of faecal matter is placed upon
a slide, a cover-glass applied and pressed
down, so as to spread the mass out into
a thin, translucent film, and the speci-men
is examined with a medium high
power. The segmented ova are com-paratively
conspicuous objects, and pos-sess
features which readily distinguish
them from the eggs of ascaris, taenia, or
other intestinal worm. The number of
eggs found will give some indication
as to the number of adult worms in the
intestine, and of the severity of the case.
Remember that the eggs only are found
by microscopical examination; the adult
parasites are never present in the fsecal
discharge unless some anthelmintic has
been previously given. If, for any rea-son,
microscopical examination of the
f«ces is impossible, in su.spected cases
the patients may be given thymol,
and the faecal matter subsequently
passed examined for adult worms. The
discovery of the parasites will confirm
the diagnosis.
The treatment of uncinariasis consists
in expelling the worms by the use of
thymol or male fern, and building up the
blood quality and physical strength by
iron tonics and good food. Thymol is
preferred to male fern by most writers,
is practically a specific, and has been
used in all the cases which I have
treated or known of. The patient
should be allowed only liquid food for
one day, and be given a full dose of
calomel. The following morning, before
any food is taken, from forty to sixty
grains of thymol are administered, in
capsules preferably, either in two doses
of twenty to thirty grains each, or tej«
grains every twenty minutes, which lat
ter is the plan I have followed. Foui
hours after the last of the thymol is
given, a dose of Epsom or Eochelle salts
is used, to insure complete emptying of
the intestinal tract. The result is usual-ly
very satisfactory, hundreds of worms
being passed. Several microscopical ex-aminations
of the faeces should be made
during the following week, and if ova
are still present, the thymol should be
repeated. About one month later it is
considered advisable to give a full dose
of thymol as a precautionary measure.
It is best not to give thymol in alcoholic
or other solution, on account of the dan-ger
of poisoning from the very large
dose it is necessary to give; and, for
the same reason, alcohol, oil or other
solvent should not be taken into the
stomach for some hours after thymol is
administered. Sixty grains is the dose
for vigorous, half-grown children and
adults. In younger children, and in
those who are very weak, forty grains
is safer. In one case reported to me
by a friend sixty grains of thymol given
to an eight-year-old child came near
proving fatal, the child becoming pulse-less,
comatose, and lying in articulo
mortis for three hours.
The spread of uncinariasis can be
guarded against by disinfecting or de-stroying
the stools, and to a great ex-tent
by simply preventing the faecal
matter from being indiscriminately scat-tered
about. Personal cleanliness and
the avoidance of water or food which
may possibly have become infected
should always be insisted upon.
Wlien discovered in time, and properly
treated, tlie prognosis of the hookworm
44 BULLETII^ OF THE NORTH CAEOLINA BOARD OF HEALTH.
disease is uniformly good. There is a
rapid improvement in appearance, mus-cular
strength, and mental activity,
keeping pace with the rapid increase in
haemoglobin percentage. When permit-ted
to run its course, a considerable pro-portion
of cases end in death. Four
fatalities from uncinariasis have al-ready
come to my knowledge.
And now a few words regarding tlie
parasite which causes this disease.
The uncinaria is a nematode worm
about half an inch in length, the female
somewhat larger than the male, thread-like,
white or pink in color, and curved
at the anterior end. It gains entrance
to the intestinal tract during one of its
several phases of embryonic develop-ment,
completes its growth in the intes-tine,
and then attaches itself to the
mucous surface of the gut by means
of the several hook-like appendages of
its oral orifice. It sucks blood directly
from the capillaries, but at intervals lets
go its hold and attaches itself in a new
place. The number of parasites varies
from a few in mild cases to many hun-dreds
or even thousands in the severe
ones. My friend. Dr. Parker, who took
the trouble to count the worms ex-pelled
from two of his patients, found in
one of them 953, and in the other more
than 1,700.
Closely related species of uncinaria
are found in dogs, sheep and other ani-mals,
as well as in man. The human
species has been variously named Un-cinaria
duodenalis ; Ankylostoma duode-nale;
Dochmius duodenalis; Sfrongylus
duodenalis, etc. Stiles has made the
interesting and important discovery that
the endemic imcinariasis of this country
is caused, not by the Uncinaria duode-nalis
of the old world, but by a distinct
species for which he proposes the name
Uncinaria americana. Adult worms
from several of my cases wei"e submitted
to Dr. Stiles, and by him pronounced
to be specimens of Uncinaria americana.
The ova of this worm, so important
in diagnosis, are some twenty times the
size of a red-blood cell, oval in shape,
have a transparent, colorless but very
distinct capsule, and a gray or brown
granular segmented protoplasm. In
faeces which have been kept for a day
or two during warm weather, different
stages of intracapsular embryonic de-velopment
may be met with, as well as
free, actively-moving embryos, ready to
carry infection. These eggs are dis-charged
with the fseces to the number
of countless millions daily. They find
in the fa;cal mass and the surface of
the ground upon which it is thrown,
conditions favorable to their continued
life and development, and persons living
in an infected locality are in great dan-ger
of contracting the disease by swal-lowing
food or water containing hook-worm
embryos. Persons who work in
earth, such as farmers, brickmakers and
miners, and children who play in the
dirt, go barefooted and eat with soiled
hands, are particularly endangered. In
the South the disease is, according to
Stiles, found chiefly on sandy soil. It
is never met with in cities or towns
having a clean water supply and a sys-tem
of sewage disposal. Not a single
case originating in the city of Mobile
has come to my knowledge.
It has not been my aim to review the
subject of imcinariasis in its entirety,
but simply to lay before you some evi-dence
showing the prevalence of the dis-ease
among us, and to urge upon you
the importance of a prompt recognition
of the proved facts and the necessity for
commencing an immediate crusade
against the malady.
10.5 St. Joseph Street.
BULLETIN OF THE NORTH CAROLINA BOARD OF HEALTH. 45
Revle^v of Diseases for Jnue, 1903.
EIGIITY-SIX COUNTIES REPORTING.
Ninety-six counties have Superintend-ents
of Health.
Except in the case of tlie more conta-gious
and dangerous diseases the Super-intendent
has, as a rule, to rely upon his
own information alone, since few physi-cians
can be induced to report cases of
non-contagious diseases to him.
Where the nmnber of cases is not
given, or tlie prevalence of a disease
otherwise indicated, its mere presence in
the county is to be understood as re-ported.
For the month of June the following
diesases have been reported from the
counties named
:
Measles.—Cumberland, a few cases;
Duplin, 2; Greene, 2; Guilford, 5; Mc-
Dowell, G; Northampton; Perquimans,
2; Randolph, several; Rockingham, a
few; Watauga, 20; Yancey, a few—11
counties.
Whooping-cough. — Burke, a few
;
Caldwell, 6; Caswell; Chowan, several;
Craven, epidemic; Durham, a few;
Greene, 25; Guilford, 4; Henderson,
many; Johnston, several; Lincoln;
Moore, several ; New Hanover, many
;
Orange, a few; Pasquotank, 7; Per-quimans,
1; Pitt, 8; Polk, many; Ran-dolph,
several; Rockingham, many;
Rutherford, 2; Sampson, many; Vance,
in all parts; Wake, 1.5; Washington,
many; Wilkes, .3; W'ilson, several—27
counties.
Diphtheria. — Brunswick, 1 ; Cleve-land,
1 ; Currituck, 2 ; Mecklenburg.
New Hanover, 1 ; Rutherford, 2—6 coun-ties.
Scarlet Fever.—Brunswick, 1 ; Cleve-land,
1; Currituck, 12; Graham, 1;
Mecklenburg; New Hanover, 1; Stanly,
2—7 counties.
Typhoid Fever.—Alamance, 5 ; Alex-ander,
many; Bertie, 1 ; Bladen, 1 ; Bruns-wick,
3; Buncombe, 5; Burke, 10; Cald-well,
4; Camden, 4; Caswell; Catawba,
2 ; Chatham, 3 ; Chowan, 2 ; Clay, sev-eral;
Cleveland, several; Columbus, sev-eral;
Craven, 6; Cumberland, a few;
Davidson; Duplin, 4; Edgecombe, a few;
Forsji;h, several ; Franklin ; Gates, 3
;
Granville, 1; Greene, 10; Guilford; Hay-wood,
1; Iredell, 27; McDowell, 4; Ma-con,
1; Martin, 4; Mecklenburg; Moore,
a few; Nash, 8; New Hanover, 7; North-ampton,
a few; Onslow, 8; Orange, 1;
Pasquotank, 1 ; Pender, several ; Person
;
Pitt, 5; Randolph, a few; Richmond, 6
or 8; Robeson, many; Rockingham, a
few; Rutherford, 6; Sampson, a few;
Scotland, 12; Stanly, 2; Surry, 3;
Union. 20; Vance, in all parts; Wake,
11; Washington, 1; Wilkes, 3; Yadkin,
20—58 counties.
Malari.^l Fever. — Bertie, in all
parts; Brunswick; Camden, in all
parts; Cumberland; Currituck, in all
parts; Duplin; Gates, 8; Greene; Hyde;
Iredell, in all parts; Johnston; Martin,
in all parts; Onslow, in all parts; Pam-lico;
Perquimans, in all parts; Person;
Pitt; Randolph; Rockingham; Vance;
Wake—21 counties.
Malarial Fever, Perniciou s.—
Wake, 2.
iLA.LARIAL F E V E R, IlEirORRIIAGIC.
Hyde, 2; Martin, 1; Pitt, 1.
Bowel Diseases. — Alleghany, gen-eral;
Burke; Catawba; Cleveland; Co-lumbus;
Currituck, general; Forsyth;
Franklin; Gates, general; Graham, gen-eral;
Granville, in many parts; Hen-derson,
general; Iredell, general; Jack-son,
a few; Northampton, general; Or-
46 BULLETIN OF THE NORTH CAROLINA BOARD OF HEALTH.
ange, general; Surry, general; Swain,
general—18 counties.
Influenza.—Macon ; Richmond.
Mumps.—Henderson, many; New Han-over,
in all parts.
Pneumonia.—Caswell ; Yadkin.
Roseola.—Caswell.
Vakicella.—Cumberland.
Smallpox.—-Alamance, 2 ; Buncombe,
7; Burke, 4; Chatham, 3; Cleveland, 5;
Davie, 2; Durham, 10; Gaston, 7; Guil-ford,
9; McDowell, 2; Madison, 15; New
Hanover, 2; Randolph, 1; Rockingham,
2; Rutherford, 2; Stanly, 20; Warren,
4; Wilkes, 1—18 counties.
No diseases reported from Anson,
Beaufort, Cabarrus, Carteret, Dare and
Transylvania.
No reports received from Cherokee,
Halifax, Harnett, Hertford, Jones, Le-noir,
Mitchell, Montgomery, Rowan,
Stokes.
Sutuitiary of Mortnary Report for
June, 1903.
(twenty-five towns).
Wliite. Col'd. Total.
Aggregate popula-tion
82,150 58,850 141,000
Aggregate deaths.. 119 130 249
Representing tem-porary
annual
death rate per
1,000 17.4 26.8 21.2
Causes of Death.
Typhoid fever 2 3 5
Malarial fever 3 3
Whooping-cough... 1 10 11
Measles 1 1
Pneumonia 14 5
Consumption 10 17 27
Brain diseases 8 3 11
Heart diseases 8 9 17
Neurotic diseases... 5 6 11
Diarrhoeal diseases 19 14 33
All other diseases.. 58 57 115
Accident 4 3 7
Suicide 2 1 3
119 130 249
Deaths under five
years 47 49 96
Still-born 6 18 24
BULLETIN OF THE NORTH CAROLINA BOARD OF HEALTH.
Iflortuary Report for June, 1903*
47
Towns
AND Reporters.
Charlotte (
Dr. F. O. Hawley. \
Dnrliaiii f;
Dr. N. M. Johnson. \ '
Edentoii (
Dr. T. J. Hoskins. (
Fayettevllle f I
Dr. A. S Rose. \
Goldsboro j i
Robt. .4. Creech, H. O. )
Greensboro f
J no. S. Michaux, C. C. I
Heudersoii
Dr. John H. Tucker,:i
Lianrluburg )
Dr. A. W. Hamer. 1
Leiiolr f
Dr. A. A. Kent. \
£>exins^ton (
J. H. Moyer, Mayor. \
Monroe. f
Dr. Jno. M. Blair. \
Oxford f
Dr. S. D. Booth. 1
Raleigh j
T. P.siale.Clerk B.H.)
Reldsville f
Jay. T. Smith, C. C. \
Rocky Monnt /
-Dr.G~. L.Wimberley,Jri
Salem. )
S. E. Butoer, Mayor. )
Salisbury f
Dr. H. T. Trantham. \
Sontbport (
Dr. D. I. Watson. \
Tarboro f
Dr. VVm. J. Thigpen. I
Wailesboro f
Dr. J. H. Bennett. J
Washington : (
Dr. D. T. Tayloe. (
Waynesville j
Dr. Tho.s. Stringfield. I
IVeldon (
J. T. Gooch, Mayor. )
Wilmington f
Dr. Chas. T. Harper. (
Wilson (
Dr. W. S. Anderson. \
Popula-tion.
11,1 11 H)
7,200
18,'.'.0U
l.iOO
1,S(M)
2,5()()
2,:iOii
3,5t10
2,6U0
6,1(M)
4,0110
2,1110
1,700
9iM)
6iiO
1,200
300
500
1,850
600
1,200
1,2.50
8,0(K>
5,800
2,noo
1,3(XJ
l,f)l)0
1,510
3,300
350
3,!)00
2,500
900
5(X)
2,IKM)
5(M)
1,000
700
3,"(K»
2,.500
1,000
300
700
750
10,(H)0
11,(KK>
3,.500
3,300
Tempobabt
Annual
Death Rate
PER 1,000.
SHo ^^.0™
3,000
4,800
6,100
10,100
3,800
1,500
1,.500
1,300
2,450
2,450
13,800
4,200
3,100
3,650
6,400
1,400
2,500
1,700
5,500
1,300
1,450
21,000
fi,80(
10 9
217
18
30.0
10.0
0.0
14 4
31.3
27.4
32.3
13.8
27.0
11.4
63.5
133
20.0
00
0.0
30.0
00
6.5
2O0
28.8
15.0
12.4
24.8
64.6
15.0
16.0
29 1
34 3
9.2
19.2
1.3.3
24.0
0.0
0.0
0.0
17 1
20.0
24.0
3i!.0
0.0
0.0
32.0
31.2
33.8
27.4
21.8
15.2
24.9
4.0
22.5
29.5
19.0
34.7
16.0
14.7
13.9
37.0
15.8
29.6
13.1
17.1
0.0
70
21 8
27.7
16.5
32.6
24.7
5
is 5 ' c
2
5
311
6
2
1 2
2 ...
N. B.—The reporters for the cities and towns printed in Black Type have signed this certificate
:
" I hereby certify that this report gives the wholr number of deaths occurring within the corporate limits
during the above month."
48 BULLETIN OF THE NORTH CAROLINA BOARD OF HEALTH.
Counter Superintendents of Health.
Alamance Dr. H. R. Moore.
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. E. B. Glenn.
Burke Dr. J. L. Laxton.
Cabarrus Dr. R. S. Young.
Caldwell Dr. A. A. Kent.
Camden Dr. J. L. Lister.
Carteret Dr. F. M.Clarke.
Caswell Dr. R. A. Malloy.
Catawba Dr. Geo. H. West.
Chatham Dr. T. A. Kirkman.
Cherokee Dr. Oscar Patton
Chowan Dr. T. J. Hoskins.
Clay 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. O. P. Lee.
Graham Dr. V. J. Brown.
Granville Dr. S. D. Booth.
Greene Dr. C. S. Maxwell.
Guilford Dr. Edmund Harrison.
Halifax Dr. L E. Green.
Harnett Dr. O. L. Denning.
Haywood Dr. J. F. Abel.
Henderson Dr. J. G. Waldrop.
Hertford Dr. J. H. Mitchell.
Hyde Dr. E. H. Jones.
Iredell Dr. M. R. Adams.
Jackson Dr. R. L. Davis.
Johnston Dr. Thel Hooks.
Jones Dr. S. E. Koonce.
Lenoir Dr. C. L. Pridgen.
Lincoln Dr. T. F. Costner.
McDowell Dr. G. S. Kirby.
Macon Dr. F. L. Siler.
Madison Dr. Jas K. Hardwicke.
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. Kenworthv.
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. McCanless.
Surry Dr. John R. Woltz
Swain Dr. A. M. Bennet.
Transvlvania Dr. C. W. Hunt.
Tyrrell
Union Dr. John M. Blair.
Vance Dr. H. H. Bass.
W^ake Dr. J. J. L. McCullera.
Warren Dr. E. M. Gayle.
Washington Dr. W H. Ward.
Watauga Dr. T. C. Blackburn.
Wayne Dr. Williams Spicer.
Wilkes Dr. W. P. Horlon.
Wilson Dr. W. S. Anderson.
Yadkin Dr. T. R. Harding.
Yancey Dr. J. L. Ray.
zB'cnLji-.EiTzn^
OF THE
Morth Carolina Board of Health.
Published Monthly at the Office of the Secretary of the Board, Raleigh, N. C.
Geo. G. Thomas, M.D.,Pr^s., Wilmington. W. P. Ivey, M. D Lenoir.
S. Westray Battle, M. D...Asheville.
Henry W. Lewi.s, M. D Jackson.
J. L. XicHOLSON, M. D Richlands.
Fraxcis 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. XVIII. AUGUST, 1903. No. 5,
Iial>oratory Notes.
The Biological Laboratory of the
Board of Health is located on the third
floor of the Agricultural Building in
Raleigh. There are two large and one
small rooms, furnished with water, gas
and electricity. The rooms have all
necessary shelving, tables and other con-veniences.
The equipment includes two
hot-water incubators, hot-air and steam
Sterilizers, a centrifuge, small boilers,
agate and glassware in sufficient quan-tity.
There are also two microscopes,
a microtome, embedding and dissecting
apparatus and a full supply of stains
and reagents.
The biological work of both the Board
of Agriculture and the Board of Health
is done in this laboratoiy. The special
work of the Board of Health is de-scribed
below.
water analysis.
The bacteriological examination of
drinking water is the most important
of the different lines carried on. Usually
about three hundred free analyses of
waters are made each year for physi-cians
who wish to determine the con-nection
of the water supply with typhoid
cases. This year, owing to an act of
the recent Legislature, the laboratory is
required to make a monthly analysis of
each public water supply in the State.
This means about doubling our last
year's work in water analysis.
Water samples in this laboratory re-ceive
a three-fold examination—physi-cal,
chemical and bacteriological. The
bacteriological work is always done in
duplicate, with frequent blank or wit-ness
tests to assure accuracy. The num-ber
of germs per cubic centimeter (a
centimeter is about 16 minims) is de-termined,
and also the particular spe-cies.
In special cases the species of
algje and infusoria present are also de-termined.
Water samples for a complete report
require a minimum of six days in the
laboratory. A special report, based
upon the physical and chemical results.
60 BULLETIN OF THE NORTH CAROLINA BOARD OF HEALTH.
can usually be made within twenty-four
hours, and this is sometimes done, but
as a rule only tlie complete report is
required.
SPUTUM EXAMINATIOIs^^S.
Neit to water analysis, sputum ex-aminations
are most in demand. Un-like
water work, sputum comes in about
equal volume every month in the year.
This class of samples is the most dan-gerous
that comes to the laboratory.
The United States postal authorities
have promulgated special and very rea-sonable
rules for transmitting sputum
samples through the mails. Such sam-ples
are required to be sent in glass
jars of an approved pattern, and these
must be enclosed within tw^o water-tight
metallic mailing cases. There is
a hea\y fine provided for sending such
dangerous material through the mails in
any but the official mailing cases.
Human tuberculosis, "the great white
plague," seems to have a firm foothold
in this State. The great majority of
the samples sent to this laboratory con-tain
Bacillus tuberculosis. Sputum ex-aminations
are made directly with the
microscope, after fixing and staining a
portion of the sampled sputum on a
microscopical cover glass. The examina-tion
takes about fifteen minutes, and a
report is usually made within twenty-four
hours after the sample is received.
MILK EXAMINATIOJfl^S.
In the spring of 1902 it was deter-mined
to find out whether any of our
cities and larger towns were being fur-nished
with tubercle-infected milk.
About one hundred samples of milk
from various towns and cities were care-fully
examined for the bacillus of tuber-culosis,
but in only one case was the
bacillus found, and a second sample
from same dairy failed to show the
germ, indicating some chance contami-nation.
The apparent freedom of our
milk supplies from tubercle contamina-tion
is very gratifying and is in great
contrast with the statistics of many
European cities, which show a consider-able
contamination.
DIPHTHERITIC EXUDATES.
We fear that many of our physicians
do not appreciate fully the importance
of a prompt diagnosis and the very
great value of diphtheria antitoxin. We
commend this matter to their earnest
consideration.
During the cooler months of the year,
or from October 1st to May 1st, there
is a regular and considerable demand
upon the laboratory for examinations of
exudates from suspected cases of diph-theria.
The value of anti-diphtheritic
serum, when promptly administered in
cases of diphtheria, makes bacteriologi-cal
diagnosis of special value in this
disease. In some other States the de-mand
for diphtheritic work is, in pro-portion
to the population, far more ex-tensive
than it is with us.
Diphtheritic exudates are collected
upon swabs of sterilized cotton specially
prepared in the laboratory. A supply
of these swabs were sent out to County
Superintendents of Health in the spring
of 1902, but very few of these have
ever been returned. Any regular prac-tising
physician can secure three outfits
by applying to the Secretary of the
Board of Health and enclosing four
cents postage on each outfit.
In the laboratory diphtheritic exu-
BULLETIN OF THE NOKTH CAROLINA BOARD OF HEALTH. 61
dates are transferred from tlie collect-ing
swab to a tube of coagulated blood
serum, and incubated for twelve to
twenty-four hours at 37 degrees C. A
portion of the growth is then examined,
after being fixed and stained on a mi-croscopical
cover glass. The bacillus
shows a very characteristic dumb-bell
form when double- stained. Reports on
exudates can, as a rule, be made in
twenty-four hours or less. When the
bacillus is found, the report is always
telegraphed when the sender can be
reached by telegraph.
BLOOD EXAIIINATIONS.
So far, comparatively little demand
has been made on the laboratory for
the Widal test for typhoid. This test
is verj' troublesome to make, as the
culture to be clumped by the serum or
blood from suspected case must be fresh
and virulent, which condition cannot as
a rule be maintained in vitro longer than
three or four months. A new culture
must then be obtained from the corpse
of a person dead of typhoid.
Of the few samples reaching the lab-oratory,
still fewer were properly taken
or prepared. The Widal test is quanti-tative,
and a definite quantity of blood
must be diluted with a certain quantity
of water. Full and explicit directions
for taking the sample are furnished
with each outfit sent out from the lab-oratory.
There is really no excuse for
sending samples which cannot be used
for the purpose intended.
We receive a few samples of blood
for examination for the parasites of
malarial fevers, and these samples are
sometimes satisfactory, but more often
the physician, in defiance of the rule,
puts the cover glass down upon the
fi-esh, undried blood film, ruining the
sample for subsequent microscopic ex-amination.
» * »
F.^ECES EXAMINATIONS.
The recent development of interest in
the '"Hook-worm" (Uncinaria Ameri-cana),
or, as the newspapers call it,
"the germ of laziness," has induced us
to add faeces examination to our regular
work. This work is undertaken to
demonstrate the presence of the eggs of
hook-worms, jiin-worms or tape-worms
in the fieces. There is reason for
thinking that the presence of the
hook-worm in the intestines of chil-dren,
young persons especially, living in
the rural districts of the State, espe-cially
in the sandy regions, is much
more prevalent than is supposed, and is
of more importance, from both a medi-cal
and social standpoint, than is gen-erally
credited. It is desired and hoped
that the physicians of the State will,
during the coming fall and winter, co-operate
with the Board of Health in
the endeavor to discover just how wide-spread
and injurious this parasite is in
North Carolina. Sampling outfits will
be furnished upon application, enclosing
four cents for postage on each outHt.
Work of this character can be most
conveniently carried on during the cooler
months of the year.
GENERAL REMARKS.
In every case, without exception,
samples for analysis or cxtimination in
this laboratory must be sent in the ves-sels
and cases sterilized and specially
prepared in the laboratory. We do not
want sanipU's put up in any other way.
The work of a liygienic biologist is very
62 BULLETIN OF THE NORTH CAROLINA BOARD OF HEALTH.
laborious and expensive. Unless sterile
containers and the necessary precau-tions
to avoid chance contaminations are
attended to from the start, the results
of the work must go for naught. The
Board has provided an abundant supply
of ajjproved vessels and mailing cases,
and these can be had on application by
those entitled to them. There is, there-fore,
no excuse for sending samples in
I^icked-up bottles. Physicians who vio-late
this rule may expect to have their
samples rejected.
We must insist upon exact eonipU-anee
icith the instructions and direc-tions
for talking and shipping samples.
The free analyses made in the labora-tory
of the Board of Health are intended
specially for the accommodation of
regular practising physicians, and more
especially for those in country districts.
Proprietary sanatoria and hospitals will
not be given free work of this charac-ter,
but, so far as our facilities permit,
work will be done for sanitoria and hos-pitals
on payment of a small fee for
each case.
Physicians who send samples for free
analysis are expected to exercise due
care that the privilege is not abused.
Especially is this to be kept in mind
in regard to water samples. It is, for
example, not proper for a physician to
send a sample of water from a new well,
or, in fact, from any well, except when
he has STRONG reasons for believing
the well is polluted or has caused ty-phoid
fever.
When citizens or corporations owning
wells desire, out of curiosity or abun-dant
caution, to examine the quality of
the water, this will be done in the lab-oratorv
of the Board of Health only on
payment of a fee of $5 for each analy-sis.
The fee must accompany the appli-cation.
* * *
The Board of Health has at present
only one man in the laboratory, and a
portion of his time is given to biological
work for the Board of Agriculture. In
order to secure the greatest possible
result from present facilities, it is neces-sary
that the rules established by the
Board for conducting the work of the
laboratory be rigidly enforced. A copy
of these rules is sent with each sam-pling
outfit.
The report of the Biologist is always
made in duplicate, one copy being filed
in the office of the Secretary of the
Board of Health. These reports are in-tended
to be plain and self-explanatory.
Physicians are requested by the Biolo-gist,
on account of the press of work
upon him, to refrain from writing long
letters and from asking for any more
information than is contained in the re-port.
Address correspondence to the
Secretary of the Board.
Physicians will please preserve this
for reference when wishing information
about the laboratory and its work.
Tlie Fly as a Carrier of Typlioicl Fever.
The epidemic of typhoid fever in Chi-cago
during July, August, September
and October of 1902 was most severe in
the Nineteenth ward, which, with one-thirty-
sixth of the city's population, had
over one-seventh of all the deaths from
this disease. The concentration of the
epidemic in this locality could not be
explained by contamination of the
drinking water or of food, or on the
ground of ignorance and poverty of the
BULLETIN OF THE NORTH CAROLINA BOABD OF HEALTH. 63
.inhabitants, for the Nineteenth ward
does not differ in these respects from
several other parts of the city. An in-vestigation
of the sanitary conditions of
this region showed that many of the
street sewers were too small, and that
only 48 per cent, of the houses had sani-tary
plumbing. Of the remaining 52 per
cent., 7 per cent, had defective plumb-ing,
22 per cent, water-closets with in-termittent
water supply, 11 per cent,
had privies with no sewer connection.
Tlie streets in which the sanitary ar-rangements
Avere worst had the largest
number of cases of typhoid fever during
this epidemic, irrespective of the poverty
of the inhabitants.
Flies caught in two undrained privies,
on the fences of two yards, on the walla
of two houses, and in the room of a
typhoid patient were used to inoculate
eighteen tubes, and from five of these
tubes the typhoid bacillus was isolated.
When the discharges from typhoid pa-tients
are left exposed in privies or
yards, flies may be an important agent
in the dissemination of the typhoid in-fection.—
Alice Hamilton (Journal of the
American Medical Association, February
28, 1903) .—Bulletin Dclauare Board of
Health for July.
Coiignniptloii is Chiefly Caused by tlie
Filtliy Habit of Spitting.
The following circular regarding con-sumption
is published in English, Ger-man,
Hebrew and Italian by the New
York City Department of Health :
:
Consumption is a disease of the lungs,
which is taken from others, and is not
simply caused by colds, although a cold
may make it easier to take the disease.
It is caused by very minute germs,
which usuallv enter the body with the
air breathed. The matter w