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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
Object Description
Description
Title | Bulletin of the North Carolina Board of Health |
Other Title | Bulletin of the North Carolina State Board of Health; Bulletin of the North Carolina Board of Health |
Creator | North Carolina. State Board of Health. |
Date | 1903; 1904 |
Subjects |
Diseases--Reporting Genealogy Mortality--Statistics Public Health--North Carolina--Periodicals |
Place | North Carolina, United States |
Time Period | (1900-1929) North Carolina's industrial revolution and World War One |
Description | Volume 18, Issues 1-12, April 1903-March 1904. |
Publisher | Wilmington, N.C. :Secretary of the Board, |
Agency-Current | North Carolina Department of Health and Human Services |
Rights | State Document see http://digital.ncdcr.gov/u?/p249901coll22,63754 |
Physical Characteristics | 61 v. :ill. ;23 cm. |
Collection | Health Sciences Library. University of North Carolina at Chapel Hill |
Type | text |
Language | English |
Format | Bulletins |
Digital Characteristics-A | 8,533 KB; 152 p. |
Digital Collection |
Ensuring Democracy through Digital Access, a North Carolina LSTA-funded grant project North Carolina Digital State Documents Collection |
Digital Format | application/pdf |
Related Items | Imprint varies: published later at Raleigh, N.C. |
Title Replaced By | Health bulletin** |
Audience | All |
Pres File Name-M | pubs_edp_bulletinboardofhealth190304.pdf |
Pres Local File Path-M | \Preservation_content\StatePubs\pubs_edp\images_master\ |
Full Text |
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 |