Bulletin of the North Carolina Board of Health |
Previous | 56 of 70 | Next |
|
small (250x250 max)
medium (500x500 max)
Large
Extra Large
large ( > 500x500)
Full Resolution
|
This page
All
|
library of (Efye University of Hortb Carolina COLLECTION OF NORTH CAROLIXIA N A E X D O W E D B Y JOHN SPRUNT HILL of the class of 1889 This book must not be taken from the Library building. ua» >$& v& &* Form No. 471 MEDICAL LICENSE LAW, AS AMENDED. B°U OF THE North Carolina Board of Health. Published Afonthly at the Office of Secretary of the Board, Raleigh, X. C. Geo. G.TnoMAS,M.D.,Pmi., Wilmington. I C. J. O'Hagan, M. D Greenville. S. Westray Battle, M. D...Asheville. ! J. D. Spiceh, M. D Goldsboro. W. H. Harrell, M. D Williamston. | ,T. L. Nicholson, M. D Richlands. John Whitehead, M. J) Salisbury. J A. W. Shaffer, San. Eng Raleigh. Richard H. Lewis, M. D., Secretary and Treasurer, Raleigh. Vol. XIIjT APRIL, 1899. T No. fc*r The Smallpox Situation. The smallpox situation in the State is at this present writing (April 21) much the same as a month ago, though some-what improved. Of the nineteen coun-ties then reported as having the disease, seven, Tyrrell (?) (there is no Superin-tendent of Health in Tyrrell, we regret to say, and our information is hearsay), Columbus, Wilson, Edgecombe, Halifax, Northampton and Johnston have gotten rid of it, for the time being, at any rate; while in three others (Alamance, Moore and Warren) no new cases have been re-ported and the patients are about ready to be discharged. New cases since the March reports, however, have appeared in Anson (report from Anson unsatisfac-tory, but there are apparently several); Union. 2; Mecklenburg, 1 ; Chatham, one negro family, number attacked not given; Beaufort, 2; Iredell, 1, varioloid, and ad-ditional cases in Gates and Wake. So that there are now sixteen counties hav-ing smallpox instead of nineteen last month. In most instances the number of cases is small, the disease is mild in character, and the outbreaks are well managed. On the whole, the condition of affairs is much more satisfactory, for which credit is largely due to the earnest and well-directed efforts of our faithful and efficient Smallpox Inspector, Dr. Henry F. Long, of Statesville. We have received from the communities he has visited nothing but words of commenda-tion of his work and thanks to the Board for sending him. As we have said before, we find that where all the physicians pull together, and the authorities promptly institute thorough measures and the Health ( Mi'.ccr attends to his duties, there has been no trouble in controlling the disease. In this connection, as a suggestion to our medi-cal brethren in other counties, we take much pleasure in printing the following strong and pointed resolutions adopted by the physicians of Edgecombe when smallpox first appeared in that county: 120 BULLETIN OF THE NORTH CAROLINA BOARD OF HEALTH. "Whereas, A committee of the Aux-iliary Board of Health of Edgecombe county, after due investigation, has re-ported that the disease now prevailing in epidemic form in Hickory Fork town-ship, Edgecombe county, is smallpox; and, "Whereas, Vague rumors have reached the ears of the Board that some physi-cians are inclined to discredit such re-port, to discourage the efforts being made to prevent the spread of the contagion, and otherwise embarrass the members of the Board in the discharge of their duties; therefore, "Resolved, 1. That it is the opinion of the Auxiliary Board of Health of Edge-combe county that the epidemic now pre-vailing in No. 3, or Hickory Fork town-ship, is smallpox. "2. That any physician who shall be called to suspicious or well-marked cases, and shall fail to report same immedi-ately, shall be dealt with according to law." This has the right ring. We would remind our readers that the last clause in the resolutions means "shall be fined for each offense not less than ten nor more than twenty-five dollars." Similar action promptly taken would have saved much trouble in one or more counties we could name. A Word to the Boards of County Commissioners. At your next regular meeting, the first Monday in May, it will become your duty to elect a County Superintendent of Health, to hold office for one year. We would respectfully call your attention to the prime importance of selecting com-petent men for that very responsible posi-tion— men of intelligence, common sense, energy and conscientiousness. Those of you who have had smallpox in your counties doubtless realize this as you never did before, and those whose coun-ties have so far escaped would do well to bear it in mind, for the disease is likely to visit you any day. We also beg to call the attention of the Boards of the few counties having no superintendent to their helplessness without such an officer of the law in such a contingency, and to express the hope that they will remedy that condition. The term of office of all superintendents expires and a new term begins, under the law as amended in 1897, the first Monday in May. We feel sure that in making their selec-tion the commissioners will not be un-mindful of the sacrifices made by those superintendents who have to manage out-breaks of smallpox in the loss to their private practice entailed thereby. Unless this pecuniary loss has been offset by lib-eral extra pay, it seems to us that simple equity demands the re-election of such superintendents, provided they have shown themselves faithful and competent. The Medical Iaeense Law, as Amended. In 1849 the State Medical Society was organized by a handful of our leading physicians. Ten years afterwards, just forty years ago, it was incorporated by the General Assembly, and in the same bill were embodied provisions for regu-lating the practice of medicine in this State, requiring a license from a Board of Examiners to be elected by the State So-ciety. The penalty was inability to col-lect fees at law. According to our recol-lection, this was, with the exception of a meagre law enacted by the Legislature of New York early in the century, but which fell almost immediately into " in-nocuous desuetude," and therefore should not count—the first attempt made in the BULLETIN OF THE NORTH CAROLINA BOARD OF HEALTH. 121 United States to regulate the practice of medicine. For many years ours was the only law of the kind in the country, and slow old North Carolina was the leader in this important movement. In 1885, chiefly through the efforts of our predecessor in office, the late deeply lamented Thomas F. Wood, of Wilming-ton, the law was amended by making it a misdemeanor, punishable by fine and im-prisonment to practice without license. In 1889 the registration feature was added—the act allowing all in practice at the time to register whether licensed or not, but closing the doors finally on Jan-uary 1, 1892, to all except those holding a license from the Board of Medical Ex-aminers. While the Acts of 1885 and 1889 greatly strengthened the law, two serious defects remained to be cured. One was the right of any one, whether properly educated in medicine or not, to apply for license, and the other was the practical inability of the Board, owing to the fact that its ex-aminations were necessarily theoretical, to ascertain whether the applicant had received the necessary clinical instruc-tion. To cure these defects the Commit-tee on Legislation of the State Society, believing that public opinion had grown up to this point, and that the time was ripe for making the effort, drew a bill em-bodying these amendments and secured its enactment by the General Assembly of 1899. It received a unanimously fa-vorable report from the Judiciary Com-mittees of both the Senate and the House, and passed the Senate unanimously, but met with active opposition in the House, much to our surprise, as no one outside the Legislature, or in it, so far as known, was against it. The argument against it was directed chiefly to the provision re-quiring a diploma from a college requir-ing an attendance of three years, the speakers holding that it would debar some ambitious young men of limited means from entering the profession, the insinua-tion being made that The bill was a scheme on thepartof the physicians now in prac-tice to form a "doctor's trust" and re-duce competition. We know that this idea did not enter the minds of the Soci-ety's committee, and that they were act-uated by only two motives—the still fur-ther elevation of their profession and the more certain protection of the people against incompetency on the part of their medical advisers. Instead of lessening competition, the effect of the amendment will be to increase it by insuring the more thorough preparation of the new men coming in from year to year, while it will not sensibly diminish the number. There is no danger of a failure in the crop of doctors. Admitting that the requirement of a diploma from a respectable college-no college requiring less than three years' attendance ca:i now be called respecta-ble— will prevent a few young men from following the profession of medicine in-stead of some other calling equally hon-orable and frequently more lucrative, it should not even be so much as named in comparison with the greater protection to the health and lives of the people of the whole State. As nothing is so much calculated to ad-vance the cause of the public health as the thorough education of all the mem-bers of the medical profession, we feel that the acknowledgments of the Board are due the gentlemen of the Legislature who supported t he bill by speech and vote. Among so many friends we would not make any invidious distinctions, but we feel that it would be proper to men-tion particularly the Hon. M. H. Justice. of Rutherford, who introduced and chain- 122 BULLETIN OF THE NORTH CAROLINA BOARD OF HEALTH. pioned the bill in the Senate, securing its passage without a dissenting vote ; the Hon. B. E. Reeves, M. D., the Represen-tative from Ashe, who led the fight for it in the House, and the Hon. H. G. Con-nor, of Wilson, Speaker of the House, who, becoming concerned for the passage of the bill, left the Speaker's chair and advocated it on the floor in a speech of great weight, in the course of which he took occasion to pay an eloquent tribute to the physician—the country doctor in particular. This is the bill : An Act to Amend Chapter thirty-four of The Code and Chapter one hun-dred AND EIGHTY-ONE OF THE LAWS <>F 1889. The General Assembly of aorth Carolina do enact : Section 1. That chapter thirty-four of The Code be amended by inserting after the word "applicants" in line two of section three thousand one hundred and twenty-four, the following words: "who shall exhibit a diploma, or furnish satis-factory proof of graduation, from a medi-cal college in good standing requiring an attendance of not less than three years and supplying such facilities for clinical instruction as shall meet the approval of the said Board"; and by adding imme-diately after said section three thousand •one hundred and twenty-four the follow-ing words: " Provided, that the require-ment of three years' attendance shall not apply to those graduating prior to Jan-uary first, 1900. Provided fua&her, that license or other satisfactory evidence of standing as a legal practitioner in an-other State shall be accepted in lieu of a diploma and entitle to examination." Sec. 2. That section three thousand one hundred and twenty-five of The Code be amended by inserting after the word "applicant" in line three, the following words: " who shall comply with the re-quirements as to graduation prescribed in section three thousand one hundred and twenty-four as amended." Sec. 3. That section three thousand one hundred and twenty-seven of The Code be amended by adding immediately after said section the following words: " Provided, That the said Board may, in its discretion, meet not more than one week before the said society, hut always in the same place; and that one addi-tional meeting in each year may be held at some suitable point in the State if deemed advisable." Sec. 4. That chapter one hundred and eighty-one of the Laws of 1889 be amended by striking out all of section three from the word "words" in line four, down to the word "any" in line nine, the word " likewise " in line eleven and the word " such " in line fourteen; by striking out in section four all from the word " or" in line three to the num-ber "1885" in line six, inclusive, and the words " on oath" in line seven; and by striking out in section seven all after the word "act " in line three. Sec 5. That this act shall be in force from and after January first, 1900. So that the laws, as amended to date, read as follows : the laws regulating the practice of medicine in north carolina. (From The Code). Section 3121. Medical Society of the State, a Body Politic Private Laws. 1858-'9„ c 258, s. 1: The Association of regularly graduated 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 the State of Xorth Carolina." BULLETIN OF THE NORTH CAROLINA BOARD OF HEALTH. 123 Sec. 3122. Who May Pjractick. 1858-'9, 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 diseases for fee or reward, unless he shall have been first licensed so to do in t lie manner hereinafter provided. Sec. 3123. Board of Physician.- to Con-sist of Seven. 185S-'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 by the title of "The Hoard of Medical Examiners of the Stale of North Caro-lina," which shall consist of seven regu-larly graduated physicians. Sec 3124. Duty of Board. 1858-9, c. 25S, 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 Hygiene, Chemistry, Pharmacy, Materia Medica, Therapeutics, 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, live 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 furthi r, that license or other sat-isfactory evidence of standing as a legal practitioner in another State shall be ac-cepted in lieu of a diploma and entitle to examination. Sec. 3125. Temporary License. lS5S-'9, c. 258, s. 7: To prevent delay and inconvenience, two members of the Board of Medical Examiners may grant a temporary license to any applicant who shall comply with the requirements as to graduation pre-scribed 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 temporary license shall not continue in force longer than the next regular meet-ing of the Board, and such temporary license shall in no case be granted after the applicant has been refused a license by the Board of Medical Examiners. Sec. 3120. How Appointed. 1858-'9, c. 25S, s. 9: The Medical Society shall have power to appoint the Board of Medical Exami-ners. Sec. 3127. Where and When to Assem-ble. 1870-'l, c. —, s. 11: The Board of Medical Examiners shall assemble at the same time and place when and where the Medical Society as-sembles, which Society shail assemble at leasl mice in every year at such time and place as the said Society, at its next pre-ceding meeting, shall have fixed; and the said Board shall remain in session from day to day until all applicants who may present themselves for examination with-inthe first five days after its meeting shall have been examined and disposed of: 124 BULLETIN OF THE NORTH CAROLINA BOARD OF HEALTH. Provided, That the said Board may, at its discretion, 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, c. 258, s. 11 : The Board of Medical Examiners are authorized to elect all such officers and to frame all such by-laws as may be neces-sary, and in the event of any vacancy by death, resignation or otherwise, of any member of said Board, the Board, or a quorum thereof, is empowered to fill such vacancy. Sec. 3129. The Board of Examinees to Keep a Record. 1858-'59, 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 applicant licensed to practice medicine and surg-ery, 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 licensed in two of the newspapers published in the city of Ral-eigh, within thirty days after the grant-ing of the same. Sec. 3130. License. 185S-'9, c. 258, s. 13. The Board shall have power to demand 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. Sep. 3131. The Board ; their Compen-sation. 1S70-'1, 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 certificate of the Presi-dent of the Board of Medical Examiners. Sec 3132. Practicing Without License. 1858-9, c. 258, s. 15 ; 1885. c. 117 and 261. Any person who shall practice medicine 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 passage 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 ser-vices rendered in the practice of medi-cine or surgery, or any of the branches thereof, but shall also be guilty of a mis-demeanor, and upon conviction thereof shall be fined not less than twenty-five dollars nor more than one hundred dol-lars, or imprisoned at the discretion of the court, for each and every offence : Provided, that this act shall not be con-strued to apply to women who pursue the vocation of a midwife : And j>e<>ri<h<l further, that this act shall not apply to any reputable physician or surgeon resi-dent in a neighboring State or coming into this State for consultation with a reg-istered physician resident therein. But this proviso shall not apply to physicians BULLETIN OF THE NORTH CAROLINA BOARD OF HEALTH. 125 resident in a neighboring State regularly practicing in this State : Provided, that this section shall not apply to phy-sicians 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 thousand eight hundred and eighty-five. Sec. 3133. May Rescind License. 1858- '9, c. 258, s. 16: The said Eoard 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. Sec. 3134. Secretary. 1858-9, c. 258, B. 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 payment of all moneys that may come into his hands. Registration. 188S), c. 181. ss. 3 (in part), 4 5, (>, 7 : Sec. 3. That chapter thirty-four of The Code be amended by striking from sec-tion three thousand one hundred and twenty-live the words " for continua-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 resides or prac-tices within thirty days after obtaining a license from the Board of Medical Ex-aminers of the State, as now provided by law for registration." Sec. 4. That any person applying for registration as herein provided shall pro-duce and exhibit before the Clerk of the Superior Court a license obtained from the Board of Medical Examiners afore-said : and upon such exhibit being made as aforesaid, the Clerk shall register the date of registration with the name and residence of such applicant in a book to be kept for this purpose in his othee, marked "Register of Physicians and Surgeons," and shall issue to him a certificate of such registration under the seal of the Supe-rior 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 twen-ty- live cents. The person obtaining said certificate shall be entitled to practice med-icine 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 registration shall be made by said clerk without fee or charge, Provided, that any one having obtained a temporary license, as provided 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 prac-tice medicine or surgery in this State with-out first having registered and obtained the certificate as aforesaid shall lie guilty of a misdemeanor, and upon conviction thereof shall be lined not le>s than twen-ty- five dollars nor more than one hundred dollars, or he imprisoned at the discretion of the court, for each and i very offence : Provided, this act shall not apply to wo-men pursuing the vocation of midwife, uor to reputable physicians or surgeons resident in a neighboring State coming into the state for consultation with a reg-istered physician of this State. 126 BULLETIN OF THE NORTH CAROLINA BOARD OF HEALTH. Sec. 6. That any Clerk of the Superior Court who shall register or issue a certifi-cate to any person in any other manner than that prescribed by this act shall be guilty of a misdemeanor, and upon con-viction thereof shall be fined nof less than two hundred dollars and shall be removed from office. Sec. 7. That it shall be the duty of the Medical Society of the State of North Carolina to prescribe a proper form of certificate required by this act. Review of I>jhi>ases for March, 1889. (seventy six counties reporting). Eighty-two counties have Superintend-ents 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 otherwise indicated, its mere presence in the county is to be understood as reported. For the month of February the follow-ing diseases have been reported from the counties named: Measles.—Craven; Durham, 1; Har-nett, a great many; Macon, several; New Hanover, 6; Northampton; Pitt, Rowan, (>; Union, 6; Vance, many; Wayne, 8— 11 counties. German Measles.— McDowell. Whooping Cough.—Ashe, 14; Beau-fort, 30; Caldwell, 25; Craven; Pasquo-tank, 7; Perquimans, general; Rowan, 12; Wayne, S; Wilson, 10—9 counties. Scarlet Fever.—Iredell, 1; New Han-over, 1. Typhoid Fever.—Caldwell, 2; Colum-bus, 1; Jones, 2; Lincoln, 4; Mecklen-burg, 4; New Hanover, 2; Onslow, 1; Rowan, 1; Union, 4; Wayne, 2—10 coun-ties. Malarial Fever.—Columbus, Cumber-land, Gates, Pasquotank, Perquimans. Malarial Fever, Pernicious.—Pas-quotank, 1. Malarial Fever, Hemorrhagic.—Per-quimans, 1. Smallpox, (March).—Alamance, 20;. Beaufort, 2; Bertie, 1; Chowan, 10; Cur-rituck, 2; Gates, "several"; Halifax, 7, no cases now; Iredell, 1, varioloid, dis-charged; Moore, 1, discharged; Nash, 4; New Hanover, 1, discharged; Northamp-ton, 8, all discharged April 1); Pasquotank, 10; Perquimans, 1; Wake, 12; Warren, 4;. Wayne—20. Influenza.—Alamance; Ashe and Ber-tie, general; Caswell; Clay; Craven; Cur-rituck, general; Duplin; Forsyth, gen-eral; Gates; Granville; Haywood; Iredell and Jackson, general; McDowell; Macon; Madison and Martin, general; Moore, New Hanover; Pender, mild; Pitt and Stokes, general; Surry; Transylvania; Union; Vance; Wilkes; Yancey—30 coun-ties. Pneumonia.—Alamance; Ashe, in all parts; Clay; Cleveland; Forsyth, in all parts; Jackson, in all parts; Lincoln; Onslow; Pasquotank; Perquimans; Per-son; Vance; Watauga—13 counties. Mumps.— Caswell, Cleveland, Pitt. Roseola. —Cleveland. Cholera in Fowls.—Lincoln. Cholera in Hogs.—Chowan, Duplin, Mecklenburg. Rabies in Dogs.—Columbus. No diseases are reported from Alexan-der, Bladen, Buncombe, Carteret, Chat-ham, Cherokee, Davidson, Davie, Edge-combe, Franklin, Gaston, Henderson, Johnston, Polk, Randolph, Robeson, BULLETIN OF THE NORTH CAROLINA BOARD OF HEALTH. 127 Rutherford, Sampson, Swain, Washing-ton and Yadkin. No reports have been received from Anson, Burke, Catawba, Guilford, Hert-ford, Mitchell, Richmond and Rocking-ham. Summary of Mortuary Roj*" 8** tor March. 1S99. (twenty-two towns). Only those towns from which certified reports are received are included. White. Col'd. Total. Aggregate popula-tion 87,048 63,590 150,638 Aggregate deaths... 64 107 171 Representing tem-porary annual death rate per 1,000 8.8 20.2 13.6 Causes of Death. Typhoid fever 1 1 Malarial fever 2 2 Pneumonia 14 17 .'51 Consumption 5 20 25 Brain diseases 7 •"> 10 Heart diseases 5 7 12 Neurotic diseases... 3 4 7 Diarrhceal diseases 3 3 All other diseases.. 24 50 74 Accident 4 2 6 64 107 171 Deaths under rive years 11 24 3-5 Still-born - 7 7 14 EH 2> tithe via Antitoxin. We presume that practically all up-to-date physicians now employ antitoxin in the treatment of diphtheria, and of course all our readers are up to date; but it is pleasant to be backed up in our opinions, and 80 we are very glad to print the fol-lowing from the November report of the Health Departmentof the city of Chicago: TWENTY-SIX MONTHS OF ANTITOXIN TREATMENT. Attention is called to the results of the antitoxin treatment of diphtheria in the twenty-eixth months of this work by the Medical Inspectors of the Department. During November 163 reported cases of diphtheria were investigated; of these 98 were bacterially verified as true diphthe-ria and were treated with antitoxin. With four cases remaining under treat-ment from the previous month a total of 102 cases were treated, with 97 recover-ies, three deaths and two remaining un-der treatment at the end of the month. This gives a mortality rate of three per cent, for the completed histories. The gravity of the cases is shown by the large number (ten) requiring intubation. Of the deaths, two occurred among the intu-bations and all three fatal cases were first seen by the Department Inspectors later than the fourth day of the disease. The antitoxin treatment of diphtheria by the Department of Health was begun < Ictober 5, 1895. During the intervening twenty-six months, the Department phy-sicians have visited and examined 5,739 cases of reported diphtheria. Of this number 3,956 were found to be true diph-theria, and :-!,822 of these were treated by the Department—the remaining 134 be-ing treated by family physicians. Out of the total number treated by the Depart-ment 3,763 recovered and 259 died. This makes a mortality rate of between six and seven (6.77) in every hundred cases treated. Prior to the introduction of antitoxin the mortality rate of diphtheria in Chi-cago averaged about thirty-five in every hundred. At this rate there would have been 1,337 deaths among the number act-ually attacked, instead of 259. In the homes where these children were found there were also found 3,(it>3 other children exposed to the infection, and these were immunized or given the pre-ventive dose of antitoxin. Only 30 out of this number were subsequently at-tacked by the disease, but these all had light attacks and promptly recovered. Of these 3,600 and odd exposed fully one-half would have contracted the disease without the use of antitoxin, and of this number, under the former proportion of mortality, there would have been 635 deaths, which would make a total of 1,972 deaths among these 7,455 children who were actually attacked or exposed. Instead of this mortality there were only the aforesaid 259 deaths, Bhowing a saving of 1,713 lives during the twenty-six months. 228 BULLETIN OF THE NORTH CAROLINA BOARD OF HEALTH. Mortuary Report for April, 1S99. BULLETIN OF THE NORTH CAROLINA BOARD OF HEALTH. 129 County Superintendents of Health. Alamance Dr. W. R. Goley. Alexander Dr. T. F. Stevenson. Alleghany Anson ...'. Dr. E. S. Ashe. Ashe Dr. Manley Blivins. Beaufort Dr. Joshua Tayloe. Bertie Dr. H. V. Dunstan. Bladen Dr. Newton Robinson. Brunswick Dr. D. B. McNeill. Buncombe Dr. I. A. Harris. Burke Dr. J. L. Laxton. Cabarrus Caldwell Dr. A. A. Kent. Camden No Board of Health. Carteret Dr. F. M. Clark. Caswell Catawba Dr. D. M. Moser. Chatham Dr. H. T. Chapin. Cherokee Dr. S. C. Heighway. Chowan T. J. Hoskins. Clay Dr. W. E. Sanderson. Cleveland Dr. R. C. Ellis. Columbus Dr. J. F. Harrell. Craven Dr. L. Duffy. Cumberland Dr. J.Vance McGougan. Currituck Dr. H. M. Shaw. Dare - Davidson Dr. John Thames. Davie Dr. James McGuire. Duplin Dr. J. W. Blount. Durham Dr. John M. Manning. Edgecombe Dr. L. L. Staton. Forsvthe Dr. John Bynum. Franklin Dr. E. S. Foster. Gaston Dr. J. H. Jenkins. Gates Dr. R. C. Smith. Graham No Board of Health. Granville Dr. G. A. Coggeshall. Greene Dr. Joseph E. Grimslev. Guilford Dr. A. E. Ledbetter. Halifax Dr. I. E. Green. Harnett Dr. 0. L Denning. Haywood Dr. J. Howell Way. Henderson Dr. J. G. Waldrop Hertford Dr. John W. Tayloe. Hyde No Board of Health. Iredell Dr. Henrv F. Long. Jackson Dr. J. H. Wolff. Johnston Dr. L. D. Wharton. Jones Dr. S. E. Koonce. Lenoir Lincoln Dr. L. A. Crowell. McDowell Dr. B. A. Cheek. Macon Dr. F. L. Siler. Madison Dr. Jas. K. Hardwicke. Martin Dr. W. H. Harrell. Mecklenburg Dr. C. M. Strong. Mitchell Dr. C. E. Smith. Montgomery Moore Dr. Gilbert McLeod. Nash Dr. H. Brantley. New Hanover Dr. W. D. McMillan. Northampton Dr. H. W. Lewis. Onslow Dr. E. L. Cox. Orange Dr. C. D. Jones. Pamlico No Board of Health. Pasquotank Dr. I. Fearing. Pender Dr. George F. Lucas. Perquimans Dr. C. C. Winslow. Person Dr. J. A. Wise. Pitt Dr. E. A. Moye. Polk Dr. H. D. Shankle. Randolph Dr. T. T. Ferree. Richmond Dr. W. M. Fowlkes. Robeson Dr. H. T. Pope. Rockingham Dr. Sam Ellington. Rowan Dr. W. L. Crump. Rutherford Dr. W. A. Thompson. Sampson Dr. R. E. Lee. Stanly Stokes Dr. W. L. McCanless. Surry Dr. John R. Woltz. Swain Dr. A. M. Bennett. Transvlvania Dr. M. M. King. Tyrrell No Board of Health. Inion Dr. J. E. Ashcraft. Vance Dr. W. J. Judd. Wake Dr. R. B. Ellis. Warren Dr. T. B. Williams. Washington Dr. W. H. Ward. Watauga Dr. W. B. Councill. Wayne. Dr. Jas. H. Powell. Wil'kes Dr. J. W. White. Wilson Dr. C B. Walton. Yadkin Dr. M. A. Royall. Yancey lb-. .1. L. Ray. BULLETIN OF THE NORTH CAROLINA BOARD OF HEALTH. 131 [Yon 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 _. Cerebrospinal 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 .189.... N. c. ZB"crj-JnJ^:Tz^sr OF THE North Carolina Board o£ Health. Published Monthly at the Office of Secretary of the Board, Raleigh, X. C. Geo. G.THOMAS,M.D.,Pres.,Wilmington. | C. J. O'Hagan, M. D Greenville. S. Westray Battle, M. D...Asheville. j J. D. Spicer, M. D Goldsboro. W. H. Harrell, M. D ....Williamston. J. L. Nicholson, M. D Richlanda. John Whitehead, M. D Salisbury. A. W. Shaffer, San. Eng Raleigh. Richard H. Lewis, M. D., Secretary and Treasurer, Raleigh. Vol. XIV. MAY, 1899. No. 2. Recent Legislation In Regard To Wa-ter Supplies. As some of our readers may remember, we prepared and had introduced in the Legislature of 1897 a bill entitled "An Act to Protect Public Water Supplies," but action upon it could not be secured. Modifying it somewhat, so as to make it cover the bacteriological examination of suspected private supplies, for which our regular appropriation is insufficient, we had it introduced in the last General As-sembly, and finally secured its passage, though in an emasculated form. The lit-tle appropriation of five hundred dollars asked for to cover the cost of the biologi-cal tests was vigorously assailed and stricken out in the House, but no further damage was iuflicted upon it there. In the Senate, however, the three sections covering, particularly, the policing of the watersheds, were stricken out, on the around that they conferred too much power upon the city authorities; that an attempt by a city policeman to enforce their observance upon a resident of the country would stir up a hornet's nest. Recognizing the unfortunate feeling of antagonism against the towns, cherished by many of the people residing in the country—a feeling which seems to have become more intense of recent years—we were compelled to admit the force of this objection, and yield as gracefully as we could. Practically, however, under the law as amended, taken in connection with the general provisions for protecting wa-ter supplies embodied in the Act in Rela-tion to the Board of Health, all necessary machinery is furnished for preventing the infection of the water supplies if the city authorities aud the water companies really desire to do it. The provisions referred to are to be found iii the following two sections from the general act : "Sec. 20. Whoever wilfully or mali-ciously defiles, corrupts or makes impure any well, spriug or other source of water-supply or reservoir, or destroys or injure* 16 BULLETIN OF THE NORTH CAROLINA BOARD OF HEALTH. any pipe, conductor of water or other property pertaining to an aqueduct, or aids and abets in an}' such trespass, shall be guilt}' of a misdemeanor, and on con-viction shall be fined not exceeding one thousand dollars or imprisoned not ex-ceeding oue year. "Sec. 21. Any householder in whose family there is to his knowledge a person sick of cholera or typhoid fever, who shall permit the bowel discharges of such sick person to be emptied without first having disinfected them according to the instruc-tions to be obtained from the attending physician or the county superintendent of health shall be guilty of a misdemeanor, and upon conviction shall be fined not less than two nor more than twenty-five dpllars, or imprisoned not less than ten nor more than thirty days. And in cases where such undisinfected discharges are emptied on the watershed of any stream or pond furnishing the source of water-supply of anj' public institution, city or town the penalty shall be a fine of not less than twenty-five nor more than fifty dollars, or imprisonment for not more than thirty days. And any physician at-tending a case of cholera or typhoid fever who refuses or neglects to give the proper instructions for such disinfection as soon as the diagnosis is made shall be deemed guilty of a misdemeanor, and upon con-viction shall be fined not less than ten nor more than fifty dollars." Taking these two sections together with the recent act which we give below, it will be seen that all that is required to protect the water-supply from the specific infec-tion of typhoid fever or cholera, which is practically the only infection to be dreaded, is for some one to lodge a complaint against the violator of the law and prose-cute the case. The difficulty experienced in such cases is to find some one to make complaint, it being a very disagreeable thing to do, and not any particular per-son's duty. We know that an employee of each water company is not only au-thorized but ordered to make inspections of the watersheds, and as it is clearly to the pecuniary interest of the water com-pany, whether private or municipal, to prevent the poisoning of the water, we have a hope that the matter will be at-tended to when attention is demanded. Under the last clause of section 2, we would suggest the propriety of distributing among the residents upon watersheds of public supplies, a copy of this Bulletin, so that each householder may begin by learning what the law is. We will gladly supply the water companies with the nec-essary copies upon application thereof. "The necessary directions for the proper sanitary care of his premises" are sum-med up in this one sentence : Such an ar-rangement of privies, stables and pig-pens as will prevent the filth thereof from being washed into the supply by rains. For the country home there is no better arrangement than the tub and dry earth plan and the burial of the contents, at a safe distance from the family well or spring. From time to time we expect to send the superintendents of water com-panies "literature on pertinent sanitary subjects," and we hope they will interest themselves in seeing that it is distributed. The following is a copy of the law : [Laws of 1899—Chapter 670 ] AN ACT TO PROTECT WATER SUPPLIES. The General Assembly 0/North Carolina do enact: Section i. In the interest of the pub-lic health every person or company sell-ing water to the public for drinking and household purposes shall take every rea-sonable precaution to protect from con-tamination and assure the healthfulness of such water; and any provisions in any charters heretofore granted to such per-sons or companies in conflict with the pro-visions of this act are hereby repealed. SEC. 2. Those water companies deriving their supply from lakes or ponds or from small streams not more than fifteen miles in length shall have a sanitary inspection of the entire watershed not less under any BULLETIN OF THE NORTH CAROLINA BOARD OF HEALTH. 17 circumstances than once in every three calendar months and a sanitarj' inspection of any particular locality on said water-shed at least once in each calendar mouth, whenever in the opinion of the board of health of the city or town to which the water is supplied, or when there is no such local board of health iu the opiniou of the count}' superintendent of health or in the opinion of the state board of health, there is reason to apprehend the infection of the water by that particular locality. Said companies shall have made a sanitary inspection of any particular locality on said watershed at least once in each week whenever in the opinion of the board of health of the city or town to which the water is supplied, or when there is no such local board of health in the opinion of the county superintendent of health, or in the opinion of the state board of health, there is special reason to appre-hend the iufection of the water from that particular locality by the germs of ty-phoid fever or cholera. The inspection of the entire watershed as herein provided for shall include a par-ticular examination of the premises of every inhabited house on the watershed, and in passing from house to house a gen-eral inspection for dead bodies of animals or accumulations of filth. It is not in-tended that the phrase " entire water-shed " shall include uninhabited fields and wooded tracts that are free from sus-picion. The inspection shall be made b}' an em-ployee of and at the expense of the said water company in accordance with rea-sonable instructions as to method to be furnished by the secretary of the state board of health. The said sanitary in-spector shall give in person to the head of each household on said watershed, or in his absence to some member of said house-hold, the necessary directions for the proper sanitar}- care of his premises. It shall further be the duty of said inspector 1 to deliver to each family residing on the watershed such literature on pertinent sanitary subjects as may be supplied him by the municipal health officer or by the secretarj' of the state board of health. SEC. 3. In case of those companies ob-taining their supply of water from rivers or large creeks having a minimum flow of ten million gallons the provisions of sec-tion two shall be applied to the fifteen miles of watershed draining into the said river or creek next above the intake of the water works. SEC 4. Failure on the part of any water company to comply with the require-ments of sections two and three shall be punished by a deduction from any charges against the city or town supplied of twen-ty- five dollars for each and every such failure: Provided, that in no one year shall the sum of such forfeitures exceed five hundred dollars. When the water works are owned and operated by the city or town failure on the part of the munic-ipal officials having in charge the manage-ment of the water works to compl)' as above shall be a misdemeanor and pun-ished by a fine of not less than ten nor more than twenty-five dollars or by im-prisonment for not less than ten nor more than thirty days: Ptovided, the said offi-cial do not prove to the satisfaction of the court that iu spite of reasonable effort and diligence on his part he was prevented directly or indirectly by his superiors from doing his duty in this respect, in which case said superior officer or officers shall be deemed guilty of a misdemeanor and punishable by a fine of not less than fifty nor more than two hundred dollars or by imprisonment for not less than one nor more than six mouths. SEC. 5. Every city or town having a public water supply shall at its own ex- 18 BULLETIN OF THE NORTH CAROLINA BOARD OF HEALTH. pense have made at least ouce in every three mouths by one of its own officials a sanitary inspection of the entire water-shed of its water supply, and it shall be the duty of the said official making such inspection to report to the mayor any vio-lation of this act. SEC. 6. Every water company, whether owned by private individuals or corpora-tions or by the municipality, shall have made not less frequeutly than once in every three months at its own expeuse both a chemical and a bacteriological ex-aminatiou of its water drawn from a fau-cet used for drinking purposes, packed and shipped in accordance with the in-structions to be furnished by the secre-tary of the state board of health: Provi-ded, that when a supply is from artesian wells the analysis shall be made in the dis-cretion of the secretary of the state board of health, but not ofteuer than once in each year at the expense of the water com-pany. SEC. 7. Asa check and guarantee of the faithful performance of the requirements laid down in the preceding section of this act the state board of health shall make or have made by its authorized agents such inspections of the watersheds and such chemical and bacteriological examinations of the public water supplies of the state as may be deemed necessary to insure their purity. Should such inspections or ex-aminations show conditions dangerous to the public health the secretary of the state board of health shall notify the mayor, the municipal health officer and the superintendent or manager of the water works at fault and demand the im-mediate removal of said dangerous condi-tions. If at the end of thirty days after the service of said notice and demand the said dangerous conditions have not been removed to the extent that due diligence could accomplish such removal, the said secretary shall have printed in one or more of the local newspapers a plain state-ment of the facts for the information and protection of the citizens using the water. SEC. 8. Each sanitary inspector herein provided for is hereby authorized and em-powered to enter upon any premises and into any building upon his respective watershed for the purpose of making the inspections herein required. SEC. 9. This act shall be in force from and after its ratification. Ratified the 8th day of March, A. D. rS99- Review of Diseases for April, 1899, [seventy-five counties reporting.] Eighty -four counties had Superinten-dents of Health May 1st: Except in the case of the more conta-gious aud 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 otherwise indicated, its mere presence in the county is to be understood as reported. For the mouth of April the following diseases have been reported from the counties named: Measles.—Edgecombe, 50; Halifax, 2; Macon; Nash; New Hauover, 18; Pitt; Rockingham; Rowan, 6; Union, epidemic; Vance, several—10 counties. German Measles.—Burke, in nearly all parts; Gaston; Mecklenburg; Orange; Sampson. Whooping Cough.—Caldwell, 6; Pen-der, 1; Franklin; Perquimans, 50; Pitt; Vance, man}7 . BULLETIN OP THE NORTH CAROLINA BOARD OF HEALTH. 19 Scarlet Fever.—Currituck, i; Wake, 2; Warren, 2. Diphtheria.—Rockingham. Typhoid Fever.—Beaufort, 1; Burke, 1; Clay, 3; Columbus, 1; Iredell, a few cases; Jackson, 3; Jones, 1; Martin, 2; New Hanover, 1; Perquimans, 1: Stokes, 3; Surry, 1; Union, 2; Wake 1; Watauga, 2; Yancey, 1—16 couflties. Malarial Fever.—Caswell; Colum-bus; Gates; Halifax; Johnston; Jones; New Hanover; Perquimans—S counties. Malarial Fever, Pernicious. — Jones. Malarial Fever, Hemorrhagic— Halifax, 2; Johnston, 2; Perquimans, 2. Smallpox (April).—Anson, 2; Bertie, 1; Chatham, 2; Chowan, 15; Currituck, I; Gates, several; Hertford, 2; Iredell, 1; Martin, 3; Mecklenburg, 2; Moore, 4; Nash, 7; Union, 8; Wake, 43— 14 counties. Influenza.—Alamance, Bladen, Cra-ven, Gaston, Iredell, McDowell, Macon, Moore, New Hanover, Sampson, Rock-ingham, Stokes, Surry, Transylvania, Union, Vance, Washington— 17 counties. Mumps.—Cleveland, Craven, Johnston. Meningitis, CerEbro-Spinal.—Bun-combe, 3. Pneumonia. — Alamance, Ashe, Cra-ven, Gaston, Surry, Transylvania, Wash-ington, Watauga, 10 cases—S counties. Roseola.—Caldwell, Davidson, Gran-ville, Halifax, Johnston, McDowell, Nash, Rockingham—S counties. Varicella.—Davidson, Nash. Diarrhccal Diseases.—Gaston, Hali-fax, Jackson, Lincoln, Sampson. Cholera in Hogs—Nash. Staggers in Horses.—Edgecombe. No diseases are reported from Alexan-der, Carteret, Davie, Durham, Greene, Haywood, Henderson, Madison, Mitchell, Northampton, Onslow, Pasquotank, Per-son, Randolph, Robeson, Rutherford, Wilkes and Yadkin. No reports have been received from Cas-well, Catawba, Cherokee, Cumberland, Duplin, Forsyth, Guilford, Swain, Wayne and Wilson. Summary of Mortuary Report for April, 1S99. (twenty-one towns). Only those towns from which certified reports are received are included. White. Col'd. Total. Aggregate popula-tion 81,349 61,140 142,489 Aggregate deaths... 64 86 150 Representing tem-porary annual death rate per 1,000 9.4 16.9 12.6 Causes of Death. Typhoid fever 1 1 Malarial fever 5 5 Whooping-cough... 1 Measles 1 1 Pneumonia 11 15 26 Consumption 7 4 11 Brain diseases 5 5 10 Heart diseases 6 17 Neurotic diseases... 3 3 6 Diarrheal diseases 5 5 All other diseases.. 30 44 74 Accident 5 3 64 S6 150 Deaths under five years 18 30 * 48 Still-born - 5 14 19 20 BULLETIN OF THE NORTH CAROLINA BOARD OF HEALTH. Mortuary Report for April, 1899. Towns BULLETIN OF THE NORTH CAROLINA BOARD OF HEALTH. 21 County Superintendents of Health. Alamance Dr. T. S. Faucette. Alexander Dr. T. F. Stevenson. Alleghany Anson Dr. E. S. Ashe. Ashe Dr. Manley Blevins. Beaufort Dr. P. A. Nicholson. Bertie Dr. H. V. Dunstan. Bladen Dr. Newton Robinson. Brunswick Buncombe Dr. I. A. Harris. Burke Dr. J. L. Laxton. Cabarrus Caldwell Dr. A. F. Houck. Camden No Board of Health. Carteret Dr. F. M. Clark. Caswell Dr. P. A. Mallov. Catawba Dr. Geo. H. West. Chatham Dr. H. T. Chapin. Cherokee Dr. S. C. Heighway. Chowan Dr. T. J. Hoskins. Clay Dr. W. E. Sanderson. Cleveland Dr. B. H Palmer. Columbus Dr. J. F. Harrell. Craven Dr. R. DuVal Jones. Cumberland Dr. J. Vance McGougan. Currituck Dr. H. M. Shaw. Dare Davidson Dr. John Thames. Davie Dr. James McGuire. Duplin Dr. J. W. Blount. Durham Dr. John M. Manning. Edgecombe Dr. L. L. Staton. Forsyth Dr. John Bynum. Franklin Dr. E. S. Foster. Gaston Dr. J. H. Jenkins. Gates Dr. R. C. Smith. Graha m Xo Board of Health. Granville Dr. G. A. Coggeshall. Greene Dr. Joseph E. (Tiimsley. Guilford Dr. A. E. Ledbetter. Halifax Dr. I. E. Green. Harnett Dr. 0. L Denning. Haywood Dr. F. M. Davis. Henderson Dr. J. G. Waldrop Hertford Dr. John W. Tavloe. Hyde Xo Board of Health. Iredell Dr. Henrv F. Long. Jackson Dr. J. H. Wolff. Johnston Dr. L. D. Wharton. Jones Dr. S. E. Koonce. Lenoir Lincoln Dr. L. A. Crowed. McDowell Dr. B. A. Cheek. Macon Dr. F. L. Siler. Madison Dr. Jas. K. Hardwicke. Martin Dr. W. H. Harrell. Mecklenburg Dr. C. M. Strong. Mitchell. Dr. C. E. Smith. Montgomery Moore Dr. Gilbert McLeod. Xash Dr. J. P. Battle. Xew Hanover Dr. W. D. McMillan. Northampton Dr. H. W. Lewis. Onslow Dr. E. L. Cox. Orange Dr. C. D. Jones. Pamlico Xo Board of Health. Pasquotank Dr. H. T. Aydlett. Pender Dr. George F. Lucas. Perquimans Dr. C. C. Winslow. Person Dr. J. A. Wise. Pitt Dr. C. O'H. Laughing-house. Polk Dr. C. J. Kenworthv. Randolph Dr. T. T. Ferree. Richmond Robeson Dr. H. T. Pope. Rockingham Dr. Sam Ellington. Rowan Dr. W. L. Crump. Rutherford Dr. W. A. Thompson. Sampson Dr. R. E. Lee. Stanly Stokes Dr. W. L. McCanless. Surry Dr. John R. Woltz. Swain Dr. A. M. Bennett. Transvlvania Dr. M. M. King. Tyrrell Xo Board of Health. Union Dr. J. E. Ashcraft. Vance Dr. Goode Cheatham. Wake Dr. R. B. Ellis. Warren Dr. T. B. Williams. Washington Dr. W. H. Ward. Watauga Dr. W. B. Councill. Wayne Dr. Jas. H. Powell. Wilkes Dr. J. W. White. Wilson Dr. C. B. Walton. Yadkin Dr. M. A. Royall. Yancey Dr. J. M. Fafrchild. BULLETIN OF THE NORTH CAROLINA BOARD OF HEALTH. 23 [You are asked to fill out ami 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. 189--- N. C. iBizriL.X-.EiTinsr OF THE North Carolina Board of Health. Published Monthly at the Office of Secretary of the Board, Raleigh, N. C. Geo. G. ThomaSjM. D.,Pres., Wilmington. S. Westbay Battle, M. D...Aeheville. W. H. Harrell. M. D Williamston. Johx Whitehead, M. D Salisbury. C. J. O'Hagan, M. D Greenville. J. D. Spicer, M. D Goldsboro. J. L. Nicholsox, M. D Rich lands. A. W. Shaffer, Sax. Exg Raleigh. Richard H. Lewis, M. D., Secretary and Treasurer, Raleigh. Vol. XIV JUNE, 1899. No. 3. Annual Meeting; of the Board. As the law requires the annual meet-ing of fche Board to be held at the same time and place as that of the State Medi-cal Society, it was held this year at Ashe-ville on Tuesday and Wednesday, 30th- 31st May. It was the most satisfactory meeting we have had for years. The conjoint session with the Society was well attended by comparison with many former meetings of the kind, and those present showed a gratifying interest in the proceedings, listening attentively to the reports of the President, as repre-senting the committee appointed to in-vestigate the smallpox situation in some of the Eastern connties in the latter part of February; of the Secretary of the year's work, and of Smallpox Inspector Long — and taking part in the discussions in an earnest manner. The term of office of all the members expiring at this meeting the President announced the appointments by His Ex-cellency, the Governor, to be C. J. O'Hagan, M. D., of Greenville; J. L. Nicholson, ,M. D., Richlands; Albert Anderson, M. D., Wilson; A. W. Shaffer, Sanitary Engineer, Raleigh, and Richard H. Lewis, M. D., Raleigh. These were all re appointments with the exception of Dr. Anderson, who was selected to fill the vacancy caused by the resignation of Dr. Spicer. The election of the four members assigned to the Medical Society resulted in the unanimous choice of Drs. Geo. G. Thomas, Wilmington; S. West ray Battle, Asheville, re-elected; Henry YV. Lewis, Jackson, and H. PI. Dodson, Mil-ton. While the voluntary retirement <>(' Drs. Whitehead and Harrell was to be regretted, it was extremely gratifying that tin' Society acted up to tin- high standard it has always observed in its selections for this Board. Attention being called to the helpless condition of those counties having no 26 BULLETIN OF THE NORTH CAROLINA BOARD OF HEALTH. Superintendent of Health in case of an outbreak of smallpox within their bor-ders, and particularly to the condition of affairs in Gates county, whose County Commissioners failed to re-elect a Super-intendent on the first Monday in May, as required by law, notwithstanding the prevalence of smallpox in the county at the time, the Secretary was instructed to ask the opinion of the Attorney-General as to the proper method to be pursued to secure compliance with the law in this matter. In obedience to these instruc-tions the following letter was addressed to the Attorney-General and the sub-joined reply received : Raleigh, June 8th, 1899. Hox. Z. V. Walser, Attorney-General. Dear Sir:—At the recent annual meet-ing of the State Board of Health at Ashe-ville I was instructed to obtain your opinion as to the proper course to be pursued tc secure the performance by County Commissioners of the duty laid upon them in section 5 of chapter 214, Laws of 1893, viz.: the election of a County Superintendent of Health. In view of the prevalence of smallpox in the State at present, and the still greater prevalence probable next winter, and of the fact that the County Superin-tendent of Health is the only official empowered by law to take charge of out-breaks of contagious diseases, it is un-necessary to say that the interests of the people require such an official in every county. There are eleven counties with-out a Superintendent. An early reply would oblige, Yours very truly, Richard H. Lewis, M. P., Secretary. • Lexington, N. C, June 10, 1899. Dr. Richard H. Lewis, Secretary State Board of Health, Raleigh, X. C. Dear Sir:—In reply to your letter of recent, date, I will say that Section 711 of The Code makes it a misdemeanor for a County Commissioner to neglect to per-form any duty required of him by law, and subjects him to a penalty of 8200 for each offence. I have no doubt that if you will call the attention of the County Commissioners to the duty imposed upon them by section 5, chapter 214, Acts 1893, of electing a County Superintendent of Health, that they will comply promptly therewith. Very respectfully, Zeb. V. AValser, Attorney-Geneeal. Owing to press of private business, Dr. Henry F. Long offered his resignation as smallpox inspector. The Board, how-ever, appreciated his services so highly that they declined to accept it, but re-lieved him from active duty for the pres-ent, preferring to hold him in reserve for the greater work in his line anticipated for next winter. Dr. Joshua Tayloe of Wash-ington was elected an inspector, and was ordered to make immediately a thorough investigation of the smallpox situation in Gates and Currituck counties. [Dr. Tay-loe reports a deplorable condition in Gates county—thirty or more families, both white and colored, infected and no efforts whatever being made to check the spread of the disease. He interviewed the local authorities, county and municipal, and stirred up enough interest to bring about a conference of the Board of County Com-missioners, with all the physicians in the BULLETIN OF THE NORTH CAROLINA BOARD OF HEALTH. 27 county. This conference was barren of results, we deeply regret to say, beyond a declared intention to furnish vaccine virus free to any one who would use it. The Board ofCommissioners absolutely re-fused to elect a Superintendent of Health, on the ground that "it would be giving one man too much authority." It may be that the three Commissioners of Gates county are wiser and more humane than three or four hundred other County Com-missioners in the State, or than the mem-bers of several successive Legislatures, which defined and confirmed the powers of the Superintendent of Health, but we doubt if the people of their stricken county think so—if they do now, they will not before another year rolls around—and we are very sure that an enlightened pub-lic does not. The situation in Currituck, which has a superintendent of health, was much more satisfactory, although there were at the time of Dr. Tayloe's visit eight or ten cases.]* While we have given our readers month by month a statement of tne smallpox situation as it was at the time, we believe that a recapitulation, so that they may view the subject en bloc, would be of in-terest. We therefore extract from the annual report of the Secretary to the con-joint session so much of it as bears upon SMALLPOX IX NORTH CAROLINA. The first case occurred in Wilmington on January 12th, L898, in the person of a negro train-hand on the Atlantic Coast Line, whose run was into South Carolina, in which State the disease was prevail-ing— warning of which was given in the Bulletin for December, 1897. Prior to May 1, 1898, it showed itself in Charlotte, five cases, two deaths, all colored, origin South Carolina; in Salisbury, one case, colored mail-agent running between that point and Knoxville, origin Tennessee; in Buncombe, two cases, colored, origin South Carolina; Alamance, two cases, colored, origin Alabama; Clay, ten cases, white, origin Georgia. Since May 1st the disease has occurred in all the coun-ties named except Clay, and in thirty-two other counties, making in all thirty-eight counties that have been visited by it, the infection in most outbreaks com-ing from Norfolk, Va., and vicinity. The official reports for the month of April show smallpox still present in the follow-ing counties: Anson, 2; Bertie, 1; Chat-ham, 2; Chowan, 15; Currituck, 1; Gates, several; Hertford, 2; Iredell, 1; Martin, 3; Mecklenburg, 2; Moore, 4; Nash, 7; Union, 8; Wake, 43—14 counties. While new outbreaks have been re-ported since May 1st, 18-99, in Catawba (Hickory), Edgecombe (Rocky Mount), Gates, Rockingham (Mayodan), and Burke (Morganton), the last named is the only one which does not appear in the tabulated statement given below. There have been so far fourteen cases in Morganton, with two deaths among the whites. The reporter did not separate the races. The total number of cases from the introduction of the disease into the State on January 12th, 1898, to May 1st, when the report closed, was 616, with seventeen deaths, or 2.76 per cent, Of this number 162 were whites, with eight deaths, 4.93 per cent., and 454 colored, with nine deaths, 1.1)7 per cent. This death rate is somewhat larger than appears to have been the case in some other States whose *Since the above was written a letter lias been received from the Chairman of the Hoard of Com-missioners of Gates < ounty giving reasons ,.f some weight for tin- failure to elect a Superintendent heretofore, and promising that one would be elected in a few days. He also asked for advice as to the management of the situation, and the outlook is now much brighter. Since we went to pies.- notice has been received of the election oi Dr. W. 0. P. Lee as Superin-tendent of Health of Gates County. 28 BULLETIN OF THE NORTH CAROLINA BOARD OF HEALTH. records can be depended on. Ohio, for instance, where of 770 cases only seven died, or less than 1 per cent. Indeed, our smallpox death rate has been quite respectable in view of the fact that many wiseacres have persisted in asserting that the disease was not smallpox, but " chickenpox," "Cuban itch," "ele-phant itch," etc. But still the mortality was very low, and that very fact in-creased the difficulty of managing the outbreaks by rendering the people more indifferent to the importance of vaccina-tion. Formerly, when asked my opinion as to the best method of getting the peo-ple vaccinated, I would say: "A case of smallpox." Now I must say a number of cases, with several deaths. In view of the rapid spread of the dis-ease during the latter part of February it was thought advisable by the President of the Board to investigate the matter by a personal inspection of some of the in-fected districts on the part of a commit-tee from the Board. This inspection of several of our Eastern counties was made by himself and Dr. O'Hagan, and the conditions were found to be such that he called a meeting of the Board at Raleigh on March 5th to consider them. At this meeting the report of the committee was received and the situation fully dis-cussed, the unanimous conclusion being that the time had arrived for calling upon the Governor for authority to ex-pend part of the emergency fund appro-priated in section 29 of the Act in Rela-tion to the Board of Health. In pur-suance of this decision the members of the Board present waited upon His Ex-cellency and laid the facts before him. He showed his intelligent appreciation of the situation by promptly giving the authority desired. Reassembling, it was decided to employ a competent physician who should, under the title of Smallpox Inspector, visit infected points, decide doubtful diagnoses, interview the local health officers, explain to the county and municipal authorities the gravity of the situation, and the best way of meet-ing it, and impress upon the people the overwhelming importance of vaccination. Dr. Henry F. Long, of Statesville, Super-intendent of Health of Iredell County, in view of his intelligent management of a considerable outbreak of smallpox in his own county, was selected for the place. The results have shown the wisdom of the action of the Board and of their selection, as the unanimous testimony from the points he has visited has been that his presence and advice have been of great assistance. I am satisfied that the State never spent the same amount of money to better advantage than the $395.85 spent in this cause from March loth to May 1st. Owing to the blessed fact that epi-demics of infectious disease of any mag-nitude have been extremely rare in our State, our people are unaccustomed to the restraints and duties incident to the proper management of them according to the principles of modern hygiene, and this fact, combined with the mildness of the disease, engendering indifference to its dangers— such indifference in some in-stances at first, before the public were generally awakened to the fact that gen-uine smallpox was among us, that the patients not feeling sick much would not call in a physician, increased the difficul-ties of management. The exposures re-sulting from this were necessarily very numerous, and why so many unvac-cinated persons escaped, as unquestion-ablv did, is a mystery. But strange as it may seem, the greatest trouble has come from our own profession. In some BULLETIN OF THE NORTH CAROLINA BOARD OF HEALTH. 29 instances it arose from inexperience with the disease and the consequent failure to make promptly the correct diagnosis and report the case to the health officer. This was, perhaps, in some instances ex-cusable, although it must be said that a knowledge of, or a regard for, the ele-mentary principles of sanitary manage-ment would have insured the taking of the proper precautions. This, however, was a small matter, compared 10 obstruc-tions to the proper control of the disease which arose in another way, caused probably by unfortunate factional dis-agreements in the profession in certain communities—very few, I am glad to say. I refer to the denial of the correctness of the diagnosis of smallpox by some phy-sicians, thereby furnishing a centre for the intractable members of the com-munity to rally around, and rendering the enforcement of the necessary regula-tions very much more difficult. Where the dissenting physician saw the case, or cases, in person, it was doubtless an honest difference of opinion, but usually he refused to visit the patient, while he continued to publicly express his opinion. With the lights before me I can see no sufficient justification for this attitude on the part of a medical man. In the mat-ter of disease the physician occupies with the people a position of authority, and as a patriotic citizen, to say nothing of his professional obligation, the abuse of that high position, from whatever motive, in a way calculated to increase the mis-fortunes of his neighbors is, to express it in the mildest terms possible, extremely indiscreet. In every instance where the profession was united no trouble was ex-perienced, the authorities, both county and municipal, responding promptly to their suggestions. In addition to directing the movements of the Inspector I have written a great many letters to Superintendents of Health, Mayors, County Commissioners, and others, and have prepared two cir-culars, the first in July, 1893, which was sent, with a letter to the editor, to the newspapers of the State for publication, and the second in March, 1899, which was printed in the form of a poster, a copy of which is attached, which was sent to the Superintendents of Health with a letter requesting them to post in conspicuous places. On the whole, when we take into con-sideration the conditions already alluded to, and, in addition, the imperfections in our sanitary machinery, I think there is good ground for congratulating ourselves and the State that the various outbreaks have been generally so well managed and that so many of the people have been vaccinated. While there has been a great deal of opposition to vaccination it is gratifying to know that several enter-prising communities, with officials of nerve, carried it out under compulsion, going so far in more than one instance as to commit the recalcitrant to jail, or to work upon the roads, until a more en-lightened frame of mind was reached. This is fortunate, for the seeds having been widely distributed, there is reason to fear the recrudescence of the disease next winter, and probably in severer form. The following is a tabulated stetement of smallpox in the State from January 12th, 189S, to May 1st, 1899, when the last official reports were received: 30 BULLETIN OF THE NORTH CAROLINA BOARD OF HEALTH. Smallpox Record from January 12, 1S98, to May 1, 1899. Counties. Cases. W. C. Total. Alamance -ii Anson Beaufort Bertie Buncombe .... Catawba Chatham Chowan Clay Columbus Craven Currituck Durham Edgecombe 43 Gates 4 Guilford '! Halifax Hertford Iredell Johnston Lenoir McDowell Martin ... Mecklenburg Moore Nash New Hanover. Northampton.. Pasquotank .... Perquimans ... Rockingham. Rowan Tyrrell Union. Wake Warren Wayne Wilson 22 5 •l 12 11 13 19 21 111 4 1 40 8 56 34 :; 9 3 73 1 17 14 3 8 6 14 6 9 49 1 1 Deaths. VV. C. Total. BULLETIN OF THE NORTH CAROLINA BOARD OF HEALTH. 31 Rutherford, Sampson, Stanly, Surry, Union, Vance, Wayne and Yadkin—41 counties. Meningitis, Cerebro-spin al—Bun-combe, 2; Beaufort, 2. Mumps.—Pitt, Sampson. Roseola.—Beaufort; Gaston; Jackson. Smallpox.—Bertie, 4; Burke, 22; Ca-tawba, 1; Chowan, 1; Currituck, 6; Gates, many cases; Hertford, 4 ( varioloid); Mc- Dowell, 1; Moore, 1; Nash, several; Northampton, 1; Rockingham, 14; Rowan, 1; Wake, 4; Wayne, 7—15 counties. Cholera, in Chickens.—Greene; Hay-wood. Cholera, in Hogs.—Greene. Distemper, in Horses.—Johnston; Yan-cey. Epidemic of "Kidney Trouble."—Ala-mance, several deaths. No diseases are reported from Alexan-der, Buncombe, Cleveland, Davidson, Davie, Edgecombe, Henderson, Madison, Pender, Polk, Randolph, Transylvania, Warren, Washington and Wilkes. No reports have been received from Anson, Caldwell, Cumberland, Duplin, Guilford, Stokes and Wilson. Summary of Mortuary Iteport lor May, 1S99. (eighteen towns). Only those towns from which certified reports are received are included. White. Col'd. Total. Aggregate popula-tion 77,778 57,425 135,203 Aggregate deaths... 101 100 201 Representing tem-porary annual death rate per 1,000 15.6 20.9 17.8 Causes of Death. Typhoid fever 2 1 3 Malarial fever 3 2 5 Whooping-cough... 2 2 Pneumonia 2 2 4 Consumption 9 16 25 Brain diseases 7 5 12 Heart diseases 2 3 5 Neurotic diseases... 2 2 Diarrhceal diseases 21 15 36 All other diseases.. 48 49 97 Accident 3 5 8 Suicide 2 2 101 100 201 Deaths under five vears 38 33 71 Still-born 6 11 17 32 BULLETIN OE THE NORTH CAROLINA BOARD OF HEALTH. Mortuary Report for May, 1899. Towns and Reporters. Asheville 1 Dr. M. H. Fletcher. J Charlotte 1 Dr. F. 0. Hawley. J Dnrham I Dr. Z. T. Brooks. j Greensboro "I J. S. Miehaux, C. Ck. J Henderson I Dr. Goode Cheatham, f Millsboro 1 Dr. C. D. Jones. j Marion I Dr. B. A. Cheek. ( Jfewbern I H. J. Lovick, C. Ck. / Oxford 1 Dr. S. A. Cannaday. j Raleigh > T. P. Sale, Clerk B. H. | Rocky Mount ) Dr. G. L. Wimberley. / Salem 1 S. C. Butner, Mayor, j Salisbury \ Dr. W. \V. McKenzie. j Scotland Neck \ J. A. Perry, Mayor, j Tarboro ) Dr. L. L. Staton. J Warrenton 1 Dr. P. J. Macon. J Washington \ Dr. P. A. Nicholson. J M'<>l«i«n \ J. T. Gooch, Mayor. J Wilmington > Dr. W. D. McMillan, j Wilson \ Dr. Albert Anderson. J Popula-tion. 8,110(1 5,000 17,153 9,000 4,000 2,000 6,000 4,000 2,250 2,000 400 300 S00 400 3,500 0,000 1,200 1,100 8,500 7,500 1,600 1,000 4,100 450 4,000 2,000 775 425 1,300 1,200 970 765 3,500 2,500 700 750 11,000 15,500 2,500 2,300 Temporary Annual Death Rate per 1,000. - 13,000 26,153 6,000 10,000 4,250 700 1,200 9,500 2,300 16,000 2,600 4,550 6,000 1,200 2,500 1,735 6,000 1,450 26,500 4,800 12.0 36.0 13.3 18.7 12.0 36.0 12.0 15.0 26.7 18.0 30." 0.0 45.0 0.0 10.2 16.0 10.0 43.6 12.7 12.8 15.0 12.0 17.6 53.3 9.0 24.0 15.5 0.0 46.1 0.0 12.4 0.0 6.8 14.4 17.1 16.0 20.7 20.1 28.8 41.7 21.2 15.1 20.0 13.2 22.6 17.1 30.0 13.8 20.1 12.7 13.8 21.1 14.0 10.0 0.0 6.8 10.0 16.5 20.4 35.0 — t" c a 5 s:£ lj l "I x i' * _ BULLETIN OF THE NORTH CAROLINA BOARD OF HEALTH. 33 County Superintendents of Health. Alamance Dr. T. S. Faucette. Alexander Dr. T. F. Stevenson. Alleghany Anson Dr. E. S. Ashe. Ashe Dr. Man ley Blevins. Beaufort Dr. P. A. Nicholson. Bertie Dr. H. V. Dunstan. Bladen Dr. Newton Robinson. Brunswick [>e Dr. E. R. Morris. Dr. J. L. Laxton. Ca^ Caldwell Dr. A. F. Houck. Camder No Board of Health. Carte Dr. F. M. Clark. Cas Dr. S. A. Malloy. Cah Dr. Geo. H. West. Cha Dr. H. T. Chapin. Che Dr. S. C. Heighway. Choi Dr. T. J. Hoskins. Clav Dr. W. E. Sanderson. Clevelai 1 Dr. B. H. Palmer. Columbus Dr. J. F. Harrell. Craven Dr. R. DuVal Jones. Cumberland Dr. J.Vance McGougan. Currituck Dr. H. M. Shaw. Dare Davids Dr. John Thames. Davie Dr. James McGuire. Duplin Dr. J. W. Blount. Durham Dr. Z. T. Brooks. Edge" ibe Dr. L. L. Staton. Foi Dr. John Bynum. Frai Dr. E. S. Foster. Gas' Dr. J. H. Jenkins. Gates Graham No Board of Health. Granville Dr. G. A. Coggeshall. Greene Dr. Joseph E. Grimsley. Guilford Dr. B. W. Best. Halifax Dr. I. E. Green. Harnett Dr. 0. L Denning. Haywood Dr. F. M. Davis. Henderson Dr. J. G. Waldrop Hertford Dr. John W. Tayloe. Hyde No Board of Health. Iredell Dr. Henry F. Long. Jackson Dr. J. H. Wolff. Johni on Dr. L. D. Wharton. Jones Dr. S. E. Koonce. Lenoir Lincoln Dr. L. A. Crowell. McDowell Dr. B. A. Cheek. Macon Dr. F. L. Siler. Madison Dr. Jas. K. Hardwicke. Martin Dr. W. H. Harrell. Mecklenburg Dr. C. M. Strong. Mitchell Dr. C. E. Smith. Montgomery' 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. C. D. Jones. Pamlico No Board of Health. Pasquotank Dr. H. T. Aydlett. Pender Dr. George F. Lucas. Perquimans Dr. C. C. Winslow. Person Dr. J. A. AYise. Pitt Dr. C. O'H. Laughing-house. Polk Dr. C. J. Kenworthv. Randolph Dr. T. T. Ferree. Richmond Dr. J. M. Covington. Robeson Dr. H. T. Pope. Rockingham Dr. Sam Ellington. Rowan Dr. W. L. Crump. Rutherford Dr. W. A. Thompson. Sampson Dr. R. E. Lee. Stanly Dr. J. W. Littleton. Stokes Dr. W. L. McCanless. Surry Dr. John R. Woltz. Swain Dr. A. M. Bennett. Transvlvania Dr. M. M. King. Tyrrell No Board of Health. Union Dr. J. E. Ashcraft. Vance Drs. W. T. & (J. Cheat-ham. Wake Dr. P. E. Hines. Warren Dr. T. B. Williams Washington Dr. W H. Ward. Watauga Dr. W. B. Councill. Wayne. Dr. Jas. H. Powell. Wilkes Dr. J. W. White. Wilson Dr. C. B. Walton. Yadkin Dr. M. A. Royall. Yancey Dr. .1. M. Fairchild. 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. 189 ... N. C. BTTX-iX-iETXILT OF THE North Carolina Board of Health. Published Monthly at the Office of the Secretary of the Board, Raleigh, N. C. Geo. G. Thomas, M. D., Pres., Wilmington S. Westray Battle, M. D...Asheville. Henry W. Lewis, M. D Jackson. Henry H. Dodson, M. D Milton. Richard H. Lewis, M. D., , . C. J. O'Hagan, M. D Greenville. J. L. Nicholson, M. D Richlands. Albert Anderson, M. D Wilson. A. W. Shaffer, San. Eng Raleigh. Secretary and Treasurer, Raleigh. Vol. XIV. JULY, 1899. No. 4. Texas Cattle Fever and Malaria. The appearance at several points in the State during the past month of Texas cattle fever makes the reprinting of the appended paper by Dr. Theobald Smith, the discoverer of its true pathology, and the highest au-thority ou the subject, appropriate at this time. But the fact that the season of the vear when malaria is most abundant — August and September—is just beginning, makes it still more opportune. For some time we have regarded Manson's theory of the transmission of malaria by mosquitoes as the most satisfactory yet enunciated, and in view of the positive demonstration of the trans mission of splenic fever in cattle—a disease very closely allied to malarial disease in the human being—as decidedly the most prob-able. To our mind it meets the conditions more fully than any other. As some of our readers may perhaps remember, we pub-lished several years ago a pamphlet on "Drinking Water in its Relation to Malarial Diseases," the said pamphlet being made up chiefly of the evidence we had collected. This evidence satisfied us that the malarial poison was introduced into the human sys-tem through the medium of drinking water from surface wells, however else it might be transmitted. But there was one particular statement that we could not explain. That was the fact that in many instances the use of water from a pump driven into the soil in the immediate vicinity of the open well, and but little, if any, deeper, brought about a marked decrease in malarial attacks. Ou the mosquito theory it seems simple enough. 38 BULLETIN OF THE NORTH CAROLINA BOARD OF HEALTH. The female mosquito, which is the one that stings, and in whose body thephsmodium ma-larias, which is now generally accepted as the germ of the disease is found, lays her eggs on the surface of still water, immediately there-after dies, sinks to the bottom, and in time dis-integrates, thereby freeing the germs, which are then swallowed by persons drinking the water. If this is true, as we think more than probable, tightly closing the top of the original well and using a pump to draw the water would have had the same effect as driving a pump in a new place. We would thank some of our readers who are now using open wells and are afflicted with ma-larial troubles to try this plan of effectually sealing their wells against mosquitoes and drawing the water by means of a pump. Another good reason for doing this is the following from a recent letter from Dr. W. T. Pate, one of the bacteriologists of the Board, on another aspect of the water ques-tion : "I do not think we can condemn too severely the open well and the bucket method of hoisting drinking water. Quanti-ties of organic material and numbers of bacteria dangerous to health are introduced from the top of these wells. I have ex-amined the water from numbers of such supplies in this section, and invariably find large numbers of putrefactive bacteria." This suggestion means, of course, the doom of the "Old Oaken Bucket that hung in the well," and that stands out so prominently in the scenes of our childhood so dear to our hearts, etc., and it is with a sigh for the good old days that we consign it to its place among the memories of the past. It would entail very little expense, would probably save much sickness as well as money, and would at the same time, perhaps, famish very valuable information. The practical lesson to be drawn from the article below will we found in the last para-graph, and that is to remove, as far as possible, all mosquito-breeding conditions. In the first paragraph the impression is made that the theory of the transmission of malaria by mosquitoes is Koch's, whereas, as we understand it, it originated with Man-son, .an English physician, as Dr. Smith incidentally states in the body of his paper: THE AETIOLOGY OF TEXAS CATTLE FEVER, WITH SPECIAL REFERENCE TO RECENT HYPOTHESES CONCERNING THE TRANS-MISSION OF MALARIA.* By Theobald Smith, M. IK, George Fabyan Professor of Comparative Pathol-ogy in the Medical Department of Harvard University; Pathologist to the State Board of Health of Massachusetts. The studies upon human and animal dis-eases carried on recently by Koch in the heart of Africa, and his enunciation of an hypothesis concerning the transmission of malaria by stinging insects, more particularly by mosquitoes, have drawn attention to the aetiology of Texas cattle fever, upon which his hypothesis was based. Our studies on Texas fever have been so fully recorded! *Read before the New York Academy of Medi-cine, April (3, 1899. (•Theobald Smith and F. L. Kilborne. Investi-gations into the Nature, Causation, and Preven-tion of Sotithern Cattle Fever, Washington. 1893, pp.304. For an abridged reprint, see the Eighth and Ninth Annual Reports of the Bureau of Ani-mal Industry (1891, 1S92). A brief summary by the writer may be found in Centralblalt f. Bac-teriologie, vol. xiii, 1893, p. 511, and some additional data in Transactions of the Association of Ameri-can Physicians for 1893. BULLETIN OF THE NORTH CAROLINA BOARD OF HEALTH. 39 that the only excuse I have in accepting the invitation of your president to bring out once again the salient facts in the aetiology of this most interesting disease is the moral support which it may tend to give to the inoculation hypothesis of malaria, in which I have been a firm believer for several years, until it can either be disproved or satisfactorily demonstrated to be true. It was known for a good many years by farmers and agriculturists of the United States that healthy cattle driven north be-yond a certain line during the warm season of the year would infect pastures with a virus highly fatal to the native cattle grazing on them. When in 1868 the early slow process of driving cattle afoot was abandoned, and the steamboat and the railroad were substituted, this peculiar disease was disseminated over a wide territory, even reaching this city. It was also known that cattle driven south from the northern side of this line con-tracted the same disease. The investiga-tions of Dr. D. E. Salmon during the years 1880-84 defined more accurately this line, and showed the existence of a large per-manently infected territory, including most of the Southern States. At present the national government issues annually rules and regulations governing the movement of the cattle from this enzootic territory, so as to protect the live-stock interests of the North. But even now the rules are some-times broken, and in 1897 the disease ap-peared in a number of cows about Boston. The virus had been dropped in the Albany stock-yards, and from there taken to those near Boston. The line, as drawn at present by the Department of Agriculture, me nders across the country between the twenty-ninth and forty-second parallels of latitude. The importance of knowing something of the mysterious agencies of this disease led the government and some of the States to induce a number of persons to investigate it. Beginning with 1868, various reports have been issued, the most satisfactory of these being one by R. C. Stiles on investiga-tions made in this city in 1868 for the then Metropolitan Board of Health. Its only disfigurement is the part added by Ernst Haliier, of Jena, on the aetiology, which serves well to illustrate the vagaries of pseudo-science. Of the other reports deal-ing with the aetiology, the less is -aid the belter. They can be resurrected by anyone so desiring, by consulting the references in our full report. In 1888 I was first introduced to this sub-ject by examining portions of the organs of animals which had succumbed to it in Maryland and Virginia. These were brought to the laboratory at Washington on ice. At this time the only report which pretended to make any detailed statements concerning the lesions produced by Texas fever was the one by R. C. Stiles. It was therefore neces-sary to study the subject from the bottom to get some data on which to found the aeti-ological work. From the pieces examined in the summer of 1888 I became convinced that a corpuscle-destroying parasite was at work. Laveran's discovery and subsequent researches by Italian writers, more particu-larly Golgi, had p.tved the way for this assumption. The material was not in any satisfactory condition for studies of the blood, and this part of the work was post-poned until the blood of a living animal could be examined. In the meantime ap-peared Babes's work on the haemoglobinuria of cattle in Roumania.* Babes found in this disease a coccus within the red corpuscles, which he cultivated, though with difficulty, and passed through several rabbits. Subse-quent events showed that he saw the true parasite, but went astray in assuming that it * Archiv f.pathol. Anatomu\ vol. CI 40 BULLETIN OF THE NORTH CAROLINA BOARD OF HEALTH. was a bacterium, and in cultivating some other organism, possibly that of rabbit septicaemia. He regarded the drinking troughs as disseminators of the disease. Since his first communication Babe-: has gradually converted his diplococcus into a protozoan parasite, and has reported the presence of ticks upon Roumanian cattle. Through the efforts of Dr. Salmon, chief of the Bureau of Animal Industry, my wish to have diseased animals within e.ssy reach of the laboratory was carried out in the sum-mer of 1889, and the very first cases revealed the intraglobular parasite.* It was only necessary now to interpret certain peculiar appearances of the blood-corpuscles, due to the extreme anaemia, f which might have been taken for stages in the life history of the parasite, and we had a ready means of diagnosis. The microscope and Thoma's blood-corpuscle counter, aided by the clini-cal thermometer, were thereafter the chief means of recognizing the disease. The work accomplished in the summer of 1889 fur-nished us with certain data concerning the pathology of Texas fever and the micro-organism to which I shall very briefly allude before takiDg up the mechanism of its trans-mission. The acute type of the disease begins with a high fever, reaching not infrequently 107° and 108° F. The animal may succumb after three or four days of fever or after a week. In rare cases recovery takes place. During the fever only several per cent, of the red corpuscles in the peripheral circulation con-tain parasites. There is, however, verv rapid destruction going on at the average rale of half a million of red corpuscles per cubic millimetre a day, leading in many cases to a fall from six to 1.5 million in a week. The lesions vary from case to case, depending on * Medical News, December 4, 1889. t Transactions of the Association of American Physicians for 1891. the duration of the disease. "When the animal succumbs in the first week, the spleen is found enormously engorged, the pulp partly disintegrated. The liver is greatly enlarged, of a yellowish or saffron hue, and the bile is of the consistence of chewed grass. In sections of the fresh organ a beautiful net-work of bile canaliculi in-jected with a semi-solid bile may be seen. In later stages this has disappeared, and the central portion of the lobule in now in a state of coagulation necrosis. The kidneys are enlarged, oeleraatous, suffused with the coloring matter of blood, and frecpiently the fatty tissue around them is in a state of hemorrhagic oedema. The bladder is full of wine-red or even blackish urine. Red corpuscles are not present in it. Haemor-rhagic spots are quite common in the heart muscle, especially under the endocardium. If these various organs are examined in smear preparations, a very large number of infected corpuscles may be found in the spleen, liver, -kidney, heart muscle, and plexuses of the brain. Iu the kidney they are largely free and resemble cocci of vary-ing dimensions. In sections the infected corpuscles are found in the form of capillary plugs, traceable in thick sections for some distance. The parasite in the acute disease is thus largely restricted to the capillaries of the internal organs. The heart muscle has generally furnished me with the most abundant and characteristic parasites. Starting from this acute type we may en-counter all gradations down to the mildest manifestations, recognizable only by the study of the red corpuscles and the blood count. Superficial examination may even miss the rare parasites in the peripheral circulation, but in all cases the marked fall in the number of red corpuscles and, in de-fault of an enumeration, the characteristic basophilic substance in the red cells of oligocythemia, staining diffusely or in BULLETIN OF THE NORTH CAROLINA BOARD OF HEALTH. 41 granules with LorHer's methylene blue, may furnish a satisfactory diagnosis. Any detailed description of the morphology of the parasite would be out of place in this paper, the more so as nothing new has been added to our knowledge since 1S93. Cer-tain statements made by Koch* concerning the earlier stages are easily harmonized with existing information. It is sufficient to state that the reproductive stage of the micro-organism has not been made out. There are several points, however, to which I should like to allude briefly. The earliest stage of intraglobular life I believe to be a motile, rodlike form of very small dimensions, whose movements within the corpuscle from one side to the other can be followed in the fresh blood. It is not brought out by staining. In the further development of the organism it is highly probable that there are two different modes of reproduction, similar to those first suggested by R. Pfeiffer for Coccidium ovi forme, and recently made out by the com-bined labors of MacCallum, Siinoud, Sied-lecki, Leger, and others for other sporozoa — namely, a reproductive process adapted for rapid multiplication within the host and one for an environment different from that of the host. This theory harmonizes m ny puzzling phenomena, among them the very rapid multiplication of the parasite in the susceptible animals leading to acute disease and the slow, but continuous, reproduction in the immune. None of these many ani-mals other than cattle inoculated with in-fectious blood were found susceptible. The work was thereby made much more labori-ous and expensive. That ticks carry the disease was suspected for many years. In 1868 Mr. John Gamgee, imported from England to study this plague for the government, wrote: " The tick theory has gained quite a renown during the past summer, but a little thought should have satisfied any one of the absurdity of the idea." When the disease was first pro-duced near Washington by the importation of healthy North Carolina cattle, F. L. Kil-borne, then superintendent of the govern-ment farm where the field experiments were conducted and in charge of the experimental animals, suggested two experiments—the infection of fie'ds with ticks alone and the removal of ticks from Southern cattle to be penned with the natives. These were car-ried out and repeated during three suc-cessive seasons. They showed quite satis-factorily that the popular belief that the tick is necessary to the infection of pastures was well founded. They naturally led at first to the assumption that pastures are in-fected by ticks drawing the parasite with the blood, and that the native animals are in-fected by grazing over the infected soil, somewhat analogous to Manson's theory of" the relation of mosquitoes to malaria. In order *hat we may understand the reasons that led to a wholly different result, a brief review of the life history of the tick is neces-sary. While studying this ectoparasite in 1889 I noticed that the female would lay her eggs in captivity. This fact enabled us to fill in the gaps in the life history not easily observed in the field, and Cooper Curtice,* then helminthologist of the Department of Agriculture, studied more in detail the de-velopment of the tick by placing the young upon a heifer and watching their growth. The young six-legged arachnid, after emerg-ing from the egg, fails to develop until placed on its special host. I have kept individuals from December to May in cul-ture dishes without noticing any change be-yond a gradual destruction due to the arti-ficial environment. When placed on cattle, their growth begin* at once, and in about a *Reiseberichtc, Berlin, Springer, 1898. *Journal of Comparative Medicine and Veteri-nary A:, in. es, L891 and L892. 42 BULLETIN OF THE NORTH CAROLINA BOARD OF HEALTH. week the first moult takes place, when the animal appears provided with another pair of legs. In another week a second monit introduces the sexually mature period. Fertilization then takes place, and the female begins to swell up with the growth of eggs and the large amount of imbibed blood. After about three weeks of parasitic exist-ence the ripe female falls to the ground, deposits one to two thousands eggs, and dies. The period of development of the embryos on the soil varies within very wide limits, depending entirely on the temperature. Fifteen days is the shortest period I have observed. After emerging from the egg the young at once seek to attach themselves to their host and begin the life cycle anew. The age of one generation, embracing the period of incubation of the ovum and the parasitic life, averages from forty to seventy days. It will be seen from this sketch that the cattle tick is exclusively parasitic in its habits, and that it does not pass from one host to another, but completes its life upon -one animal. In the second summer season, after the pathology and parasitology of the disease and the life history of the tick had been fairly apprehended, the sudden simultaneous appearance of high fever in the animals ex-posed in infected fields, and the new brood •of ticks upon them, forced upon me like a flash the conviction that we were here in the presence of a wholly new fact in the domain of aetiology. Everything pointed to the young tick as introducing the disease by inoculation, in spite of the newness and ap-parent awkwardness, as it -were, of this hypothesis. Especially strong testimony in its favor was the long period of incubation. The susceptible animals penned with South-ern animals or in fields infected with ticks remained absolutely well for five weeks or longer after the earliest date < f field infec-tion; then with a bound the temperature rose, and in a week the majority were dead. I ransacked the older records to obtain more evidence upon the period of incubation, but the few instances recorded confirmed our field observations. This period, it should be borne in mind, dates from the infection of the pasture and not from the date of exposure of cattle on it. The tick embryos continue their development whether cattle are present or not. After the young brocd has ap-peared, a week or even less time suffices for the outbreak of disease. This hypothesis, that the progeny of the infected tick pro-duces the disease, left me in doubt for a time concerning the [etiological relation of the blood parasite. Could not a poison be introduced by the young tick into the biood of cattle which destroyed certain inhibitory mechanisms, and thereby favored the multi-plication of an ordinary blood parasite? This doubt was nurtured by the occasional discovery of very minute refringent bodies of varying outline within red corpuscles of susceptible but healthy native cattle. Two lines of experiments Were carried out to meet these new developments: First, the rearing of young ticks artificially in the laboratory and the infection of cattle with them ; second, the transmission of the disease from one animal to another by the injection of infected blood without the intermediation of the tick. Both were successful. The first demonstrated the infections character of the young tick, the second that the blood parasite, and not any poison introduced by the tick, is the real cause of the lesions. The disease produced directly with young ticks appeared to be somewhat less fatal than the natural exposure. This may be due to cer-tain interferences with nature's processes, such as the removal of female ticks before they are quite ready to drop, and the arti-ficial incubation of the ova. This disease may now be produced by any one, in midsummer, by sending to the per- BULLETIN OP THE NORTH CAROLINA BOARD OF HEALTH. 43 rnanently infected territory for ripe female ticks and incubating the eggs laid in con-finement. As the disease does not spread from an inclosure, and as the ectoparasite is destroyed by frost, any danger to live stock is out of the question, if a little care is exer-cised. Any spot of ground once infected may remain so during the warm season, owing to the persistent vitality of the young tick until frost comes. The disease may in this way be exploited, if sufficient means are at hand, in the interest of a broader aetiology and pathology than that fostered for the promotion of agriculture by our national government. I would warn any one, how-ever, against the danger of drawing con-clusions from the study of too few cases. The wide range of pathological changes in the blood and tissues and the variable de-gree of blood infection should always be borne clearly in mind. The life of the blood parasite in the tick lias not yet been elucidated. It seems most in harmony with biological science to assume that the ova become infected, and that in the young tick certain organs analogous to salivary glands, connected with the operation of drawing blood, discharge the parasite into the blood of the host. Since the aetiology of the American dis-ease has been cleared up the same malady has been found to exist in Finland, Rou-mania, Italy, Australia, South Africa, and German East Africa. It will probably be found in other similarly situated countries whenever a migration of cattle shall have taken place which will tend to mingle im-mune and susceptible animals. It is strange that so little attention has hitherto been given by others to the transmission of the disease. Koch showed his unusual sagacity in seizing upon this one feature of the aetiol-ogy and investigating it to satify himself. Undoubtedly the fairy-story element about the transmission of the disease by the progeny of the infected ectoparasite, as Koch himself expresses it, led the various ob-servers to take the position of John Gamgee, that "a little thought should have satisfied any one of the absurdity of the idea." There are several phases of this remark-able disease which have a very important bearing upon ^etiological studies of malaria; to these I wish to allude briefly before con-cluding. The persistence of the parasite of Texas fever in the blood after recovery, and for years after the immune Southern animal has left the enzootic territory,* shows that a kind of symbiosis has been established be-tween host and parasite. This symbiosis begins early in the life of the Southern cat-tle, with perhaps several mild attacks of fever, and thereafter, though they remain well, they are never' heless the carriers of a fatal infection for the non-immune Northern cattle. Their blood produces the acute type of Texas fever when injected under the skin.f This fact I regard as next in importance to the demonstration of the transmission of infection by the offspring of ectoparasites, because it proves that the blood parasite of Texas fever may exist for some time inde-pendent of the tick. Whether, under such conditions, in the course of time it may lose the power of existing in the body of the cat-tle tick, and thereby become non-transmissi-ble excepting by direct inoculation, is quite within the domain of probability..! Another important fact determined by these investi-gations is the acquisition of immunity to-ward protozoan diseases. This was so thor-oughly demonstrated that I need not dwell on it here. A high degree of immunity is "Bulletin No. ,,\ />'n>rciu of Animal Industry, Washington, 1893, pp. 67-73. t'l'he persistence of the blood parasite in highly immune cattle and the infectious character of their blood must be rather discouraging to those who look forward to a malarial autitoxine. I For an analag'His problem in the life of An-guillula intestinalis, see LeichtensterD, Central-blatt f. Bacteriologie, vol. xxv, 1899, p. 228. 44 BULLETIN OF THE NORTH CAROLINA BOARD OF HEALTH. not so easily acquired, however, as Koch's recent statements would lead us to suppose. I am inclined to believe, after a careful study of his experiment, that he was dealing with animals already endowed with considerable resistance. We know from the various re-searches on bacterial immunity that a partly immime animal becomes highly re-istant after but little treatment. A very interest-ing clinical confirmation of the capacity of animals toward the acquisition of immunity is provided for us by the course of the dis-ease itself. When animals are infected in the early months of summer the disease assumes the acute form, with high continued fever and rapid destruction of corpuscles. If the animal passes the first week alive it may recover. The tempenture then falls and a rapid reproduction of red corpuscKs takes place. Then there may be one or two very brief periods of high temperature with evident loss of red corpuscles and the tran-sient appearance of parasites in the blood. Three to five weeks after tlu first attack there is ushered in a modified or mild type of the disease, not suggested by any outward signs of disease, but recognizable by a higher evening temperature, by persistent anaemia, and by the appearance in the peripheral circulation of large numbers of infected cor-puscles. The blood parasite in this mild type or relapse appears in a form not en-countered in the first acute attack. It is very small, coccuslike, and situated on the periphery of the red corpuscle. These bodies, associated with very rare forms of the large pyriform bodies, may persist for four or five weeks, or until- the colder weather comes. Then their disappearance ushers in the period of normal temperature and rapid rise in the number of red cor-puscles. This type of fever is common in the fall, the acute stage preceding it being short and frequently not noticed. I have interpreted the peculiar features of this mild type or relapse as a resultant of partial, acquired immunity, in virtue of which the development of the blood parasite is greatly retarded, and perhaps modified, and the in-fected corpuscle may circulate a longer time before it becomes caught as a foreign body in the capillaries of the internal organs. These two facts, the persistence of the blood parasite and the acquisition of immu-nity, I have used in building up a working hypothesis in studying the dissemination of tertian malaria in Massachusetts under the direction of the State Board of Health since 1896. This hypothesis assumes first of all the introduction of the malarial parasite into a region in the body of human beings. If the conditions are favorable — i. e., if the infected individuals live near standiug water to which mosquitoes may speedily repair and lay their eggs, and if individuals are readily accessible to the young brood for infection—the disease is likely to take root and become endemic. The blood parasite is protected over winter in the body of the in-fected human being. The larger the num-ber of these, the more difficult the eradica-tion of the disease will become unless the insects are suppressed. The harmlessness of mosquitoes in regions still free from ma-laria is a well established fact. Whether they can perpetuate their own infectious-ness, either by transmi-sion of the sporozoa from brood to brood or by using some sus-ceptible animal as host, the future must settle with the other factors of the problem. Experiments with ticks point to a loss of infectious power when they are restricted to Northern animals, but no absolute proof of this has yet been published. The appear-ance of malaria during the work of excava-tion I attribute first to the introduction of the blood parasite into the bodies of chroni-cally infected workmen, and secondly to the accessibility of these to the insects, owing to the favorable conditions usually created BULLETIN OF THE NORTH CAROLINA BOARD OF HEALTH. 45 during such work for breeding and for stinging the unprotected workmen. This hypothesis embraces all those conditions and phenomena regarded as necessary by older theories, but it interprets them differently. It is based wholly on analogy with Texas fever. The assumption that attacks of malarial disease beget immunity is not at all weak-ened by the occurrence of relapses. It should be remembered that the quinine treatment interferes with the immunizing process. In the second place, relapses may simply mean a temporary interference with the protective mechanism, a congestion or temporary stagnation of the blood some where which enables the parasites to get at the red corpuscles in defiance, perhaps, of the leucocytes fur the time being. It is along such lines of reasoning that we can explain the attachment of the South to the hydric theory of malaria. The bad ground water produces digestive derangements in individuals already infected, and an attack of malaria is called forth. That the human beings of warm climates may not harbor malaria! parasites as universally as t heir cattle do the Texas fever organism remains to be seen.* The clinical expression of acquired im-munity does not seem to have been studied, but it deserves attention and may lead to valuable results. Certainly the analogous conditions in the cattle malaria cited above should stimulate such studies. In the ex-amination of blood films from cases of tertian malaria occurring in a town which has been infected with it for a number of years, it has seemed to me as if in the repeated attacks of permanent infections the parasites were so scarce in the peripheral circulation that *In a recent article f Yearbook of the Depart-ment of Agriculture, 1898, p. 466) Norgaard cites facts which show that Texas fever in a fatal form may be developed in apparently immune cattle by sudden extreme changes of temperature and by treating them with oil to remove the ticks. they could not be found, although the phy-sician who has had much experience feels positive of the character of the disease. Here we are confronted by the probability that the parasites, frequently so ahundant in the peripheral circulation, are gradually confined by the growth of immunity to some restricted territory representing the locus minoris resistentice during derangements of health. The recent investigations of Ross, con-firmed and materially extended by Koch and his colleagues,* showing that in the Proteosoma infection of certain birds the blood parasite completes its cycle of devel-ment in one and the same insect by reap-pearing finally in the salivary glands, so that the insect becomes infectious a certain number of days after drawing infected blood, introduces a most interesting modification of the course pursued by the blood parasite in Texas fever. In the insect the absorption and dispensing of the infection is made possible by the powers of locomotion. In the obligatory parasitism of the tick the only mode of transmission possible is through the following generation. Evidently the former is the earlier process, the latter the modifi-cation which became established during the evolution of obligatory parasitism in the cattle tick. If the life cycle of the malaria parasite should be found the same as that of the Proteosoma of birds, the hypothesis of the transmission of the blood parasite to the immediate progeny of the infected mos-quitoes need not be abandoned unless demonstrated to be false. In my field ob-servations the peculiar distribution of cases of tertian fever in a newly infected territory seemed to point to the scattering of an in-fected brood rather than to the direct trans-mission from one individual to another. Both modes of dissemination may eventually be found in use. * Deutsche medicinische Wochenschrift, 1899, February 2. 46 BULLETIN OF THE NORTH CAROLINA BOARD OF HEALTH. In presenting these hypotheses I must beg your indulgence, for, setting aside cer-tain very important exceptions, the making of hypotheses is usually a less arduous task than the process of demonstrating their truth. However, I am strongly convinced that the time has come for public health authorities to take some definite stand on this matter of the spreading of tertian ma-laria in our own climate. The eradication of this and severer forms from the tropical colonial possessions of northern nations may be destined to remain a pious wish, and the exploiting of the natives and their induction into the advantages of our social and politi-cal organization may have to be left, as here-tofore, to a few hardy pioneers, or to "im-munes." At any rate, this is the only comfort we can get from nature herself just at present. In our own climate, however, it is not too late to stay the diffusion of malaria, and vigorous efforts to that end should be made, both by popular instruction and with the help of sanitary engineering. Much of the evil which manifests itself in the increasing prevalence of the mosquito is due to the carelessness and indifference of private persons, corporations, and even pub-lic authorities, who create and perpetuate the conditions which favor the silting up and the partial drying up of our streams and smaller water-courses and the stagna-tion of surface water. The inoculation theory of malaria is a safe one with which to begin the warfare against the disease, as it has the support of analogy, of partial demonstration, and of almost all the older theories. — Hew York Medical Journal. Malaria and ^fosqnitoes. Major Ross, I. M. S., the recently ap-pointed lecturer in the School of Tropical Diseases, delivered an interesting illustrated lecture on the "Relations of the Malarial Parasite to the Mosquito," in the Physi-ological Theatre of University College, Liver-pool. The Lancet of May 27th gives a brief report of this lecture. Major Ross says that malaria is not so dramatic a disease as cholera. It does not kill so quickly, but it kills far more people. In India the deaths due to malaria are estimated at 5,000,000 a year. It is also a politically important dis-ease, because it checks the progress of civil-ization in the richest districts of the world, and kills more of the English soldiers than are killed by the enemy. Malaria is cer-tainly due to a parasite in the blood. Of this Major Ross is absolutely certain, having studied the subject for ten years in the tropics. The lecturer explained how the parasite gradually develops, destroying the corpuscles of the blood, leaving them mere shells. When fully developed, it scatters, and attacks other corpuscles, destroying and poisoning them likewise. Even if not numerous enough to cause fever on account of being bred in comparatively small num-bers, they cause an indifferent condition of health. The treatment is quinine, but this does not always help. What we require to know is how malarial fever is produced. To do this we must find the parasite in ex-ternal nature, and this problem has been solved by Dr. Patrick Manson. Besides the forms of malarial parasites described, other forms are found. Dr. Manson described how, in watching a drop of blood drawn from a malarial patient, there was seen in eleven minutes the remarkable effect of snake-like forms wriggling away and disappearing. He came to the conclusion that the life his-tory of the malarial parasite, when it leaves the human being, is carried on in the mos-quito, and therefore that malarial fever is propagated by the mosquito. Major Ross described how in the tropics he followed out Dr. Manson's theory beyond the point where the latter left it. The mosquito, which is not an ephemeral insect, but one which will BULLETIN OF THE NORTH CAROLINA BOARD OF HEALTH. 47 Jive for months, under favorable conditions, he found to be furnished, in certain species, with an internal process which develops the parasite in its present poison and lodges it in the poison gland opening into the crea-ture's proboscis. The mosquito, in punctur-ing the skin, thus inoculates the human being with the malarial poison. — N. C. Medical Journal. Review of Diseases for Jnne, 1899. (SEVENTY-EIGHT COUNTIES REPORTING) Eighty-seven counties have Superinten-dents of Health. Except in the case of the more contagious and dangerous diseases, the Superintendent has, as a rule, to rely upon his own informa-tion alone, since few physicians can be in-duced to report cases of noncontagious dis-eases to him. Where the number of cases is not given, or the prevalence of a disease otherwise in-dicated, its mere presence in the county is to be understood as reported. For the month of June the following dis-seases have been reported from the counties named : Measles.—Ashe, 10; Craven, 4; Durham ; Hertford, 4; Nash, 2; Pitt, in all parts; Wa-tauga, 20—7 counties. Scarlet Fever.—Wake, 1. Whooping-cough.—Ashe, 12; Beaufort, epidemic; Caldwell; Chowan; Columbus, many cases; Craven, 21; Cumberland, 4; Mecklenburg; Perquimans, 5; Pitt, in all parts; Rockingham; Stanly; Union, 12; Wayne, 10—14 counties. Diphtheria.—Mecklenburg, 1. Typhoid Fever.—Alamance, 4; Alex-ander, 1; Beaufort, 4; Burke, 2; Cabarrus, 8; Caldweil, 10; Chatham, 1; Cherokee, 1; Chowan, 4 ; Columbus, 2 ; Craven, 6; David-son, 6; Forsyth, in all parts; Franklin; Gaston; Greene, 3 ; Guilford, 3; Harnett, a few; Haywood; Hertford, 3; Iredell, in ail parts; Jones, 6; McDowell, 10; Mecklen-burg: Mitchell, 6 ; Moore, 2 ; Nash, 6; New Hanover, 6; Northampton, 8; Onslow, 2 Pasquotank, 1; Pender, 1; Perquimans, 6 Pitt; Polk, 2; Randolph, 2; Richmond Robeson; Rockingham ; Rowan, 16; Ruther ford, a few: Stanly; Stokes, 3; Surry, 8 Transylvania, 3; Union, 3; Wake, 4; War-ren, a few; Watauga, 2, Wayne, 6; Yad-kin, 3 ; Yancey, 2—52 counties. Malarial Fever.—Alamance; Cabar-rus; Carteret; Caswell; Catawba, 6; Chat-ham; Chowan; Columbus; Craven; David-son; Durham; Guilford; Halifax; Moore; New Hanover; Northampton; Orange, a few; Perquimans, in all parts; Person; Pitt; Richmond; Robeson, in all parts; Sampson; Surry; Wayne—25 counties. Malarial Fever, Pernicious.—Bertie, 1; New Hanover, 1; Pitt; Rowan, 1; Surry, 1. Diarrhceal Diseases.—Alamance, Ber-tie, Cabarrus, Carteret, Catawba, Chowan, Currituck, Gaston, Greene, Guilford, Hali-fax, Harnett. Haywood, Iredell, Jackson, McDowell, Orange, Randolph, Richmond, Rockingham, Union, Vance, Wilkes and Yancey—24 counties. Mumps.—Northampton ; Pitt, in all parts. Rubella.—Richmond. Small-pox.—Bertie, 1; Burke, 6; Cald-well, 13; Caswell, 6; Currituck, 4 ; Halifax, 2; Hertford, 8; Iredell, 1; McDowell, 1; Mecklenburg, 1; Nash, 5; Person, 1; Ran-dolph,!; Rockingham, 4; Rowan, 1 ; Wake, 4—1H counties. Cholera, in Chickens —Greene and Yancey. Cholera, in Hogs.—Greene and Wash-ing on. Distemper, in Horses.—Jackson. Staggers, in Horses.—Bladen. No diseases are reported from Bladen, Cleveland, Davie, Edgecombe, Granville, Johnston, Lincoln, Madison and Washington. No reports have been received from An-son, Duplin, Henderson, Martin, Swain and Wilson. 48 BULLETIN OF THE NORTH CAROLINA BOARD OF HEALTH. Summary of Mortuary Reports for June, 1899. (twenty-two towns). Only those towns from which certified reports are received are included. White. Col'd. Total. Aggregate popula-tion 87,748 63,390 151,138 Aggregate deaths... 122 131 253 Representing tem-porary annual death rate per 1,000 16.7 24.8 20.1 Causes of Death. Typhoid fever 4 4 8 Scarlet Fever 10 1 Malarial fever 1 9 10 Whooping-cough... 3 3 Measles 10 1 Pneumonia 3 7 10 Consumption 5 13 18 Brain diseases 9 1 10 Heart diseases 8 4 12 Neurotic diseases... 3 3 Diarrhceal diseases 19 23 42 All other diseases.. 66 64 130 Accident 2 3 5 122 131 253 Deaths under five years 60 47 107 Still-born - 7 10 17 School Directors as Boards of Health. The law of Pennsylvania, passed last win-ter, authorizing the school boards of the various townships in the rural districts to act as boards of health, is as follows: Section 1. Be it enacted, etc., that the School Directors in each township of the State of Pennsylvania shall, in "addition to the power vested in them by existing laws, have full power and authority to make and enforce all needful rules and regulations to prevent the introduction and spread of con-tagious or infectious diseases, by the regula-tion of intercourse with infected places, by prohibiting from attending any public school aoy child or other person belonging to or residing with the family of any person, or residing in the same house in which any person may be suffering from cholera, small-pox (variola varioloid), scarlet fever, typhus fever, yellow fever, relapsing fever, diph-theria, diphtheritic croup or membraneous croup, or any other contagious disease; and it shall be the duty of all physicians prac-ticing within the several townships to report to the secretary of such school board the names and residences of all persons coming under their professional care, afflicted with any of the aforesaid contagious or infectious diseases, within twenty-four hours after the development of any such disease. Sec. 2. Li the case of the prevalence of any contagions or infectious disease in any township of this Commonwealth, the Board of School Directors of such townships shall have power by themselves, or by a sanitary agent to be by them appointed, to enter at any time upon any premises in the said township in which there is suspected to be any contagious or infectious disease, or nuisance productive of such disease or detri-mental to the public health, for the purpose of examining the said premises and abating any nuisance found thereon detrimental to the public health. Sec 3. Before appointing any sanitary agent to aid in enforcing the rules and regu-lations of the board, as aforesaid, the board shall make application to the Court of Common Pleas of the county in which the township is located, or to a law judge thereof, setting forth paiticuiarly the reasons which, in their judgment, make the applica-tion of such agent necessary, setting forth also the compensation which the board deems proper to pay for the services of such sani-tary agent, and if the said court or judge thereof shall approve the reasons given by the said board for the appointment of such sanitary agent, and shall also approve the compensation deemed proper therefor, said board shall have the authority to appoint such sanitary agent for such term as may be designated by the said court or judge thereof, the said compensation to be paid out of the school fund of the respective townships. — The Sanitarian. BULLETIN OF THE NORTH CAROLINA BOARD OF HEALTH. 49 Mortuary Report for June, 1899. Towns and Reporters. Popula-tion. Temporary Annual Death Rate PER 1,000. « Asheville Dr. M. II. Fletcher. Charlotte Dr. F. 0. Hawley. Durham Dr. Z. T. Brooks. Fayetteville Dr. J. V. McGougan. Oreensboro J. S. Michaux, C. Ck. Henderson Dr. W. J. Judd. Hillsboro Dr. C. D. Jones. Marion Dr. B. A. Cheek. Monroe Dr. J. M. Blair. Oxford. Dr. S. H. Canuady. Raleigh T. P. Sale, Clerk B. H. Rockingham Dr. J. M. Covington. Rocky Mount Dr. G. L. Wimberley. Salem S. E. Butner, Mayor. Salisbury.. Dr. W. W. McKenzie. Scotland Neck J. A. Perry, Mayor. Tarboro Dr. L. L. Staton. Warrenton Dr. P. J. Macon. Washington Dr. P. ATNicholson. Weldon J. T. Gooch, Mayor. Wilmington Dr. W. D. McMillan. Wilson Dr. Albert Anderson. 1 w. 50 BULLETIN OF THE NORTH CAROLINA BOARD OF HEALTH. County Superintendents of Health. Alamance Dr. T. S. Faucette. Alexander Dr. T. F. Stevenson. Alleghany Anson Dr. E S Ashe. A«he Dr. Manlev Blevins. Beaufort Dr. P. A. Nicholson. Bertie Dr. H. V. Dnnstan. Bladen Dr. Newton Robinson. Brunswick Buncombe Dr. E. R. Moms. Burke Dr. J. L. Laxton. Cabarrus Dr. R. S. Young. Caldwell Dr. A. F. Houck. Camden Dr. W. D. Kellam. Carteret Dr. F. M. Clark. Caswell Dr. S. A. Malloy. Catawba Dr. Geo. H. West. Chatham Dr. H. T. Chapin. Cherokee Dr. 8. C. Heighway. Chowan Dr. T. J. Hoskms. Qlav Dr. W. E. Sanderson. Cleveland! Dr. B. H. Palmer. Columbus Dr. I. Jackson. Craven Dr. R. DuvalJones. Cumberland Dr. J.Vance McGougan. Currituck Dr. H. M. Shaw. Dare T , _, Davidson Dr. John Thames. Davie Dr. James McGmre. Duplin Dr. .7. W. Blount. Durham Dr. Z. T.Brooks. Edgecombe Dr. L. L. Staton. For«vth Dr. John Bvnum. Franklin Dr. E. S. Foster. Ga«ton Dr. J. H. Jenkins. Gates : Dr. W. 0. P. Lee. Graham Granville Dr. S. A. Cannady. Greene Dr. Joseph E. Grimsley. Guilford Dr. B. W. Best. Halifax Dr. I. E. Green. Harnett Dr. 0. L. Denning. Havwood Dr. F. M. Davis. Henderson Dr. J. G. Waldrop Hertford Dr. John W. Tayloe. Hyde Iredell Dr. Henry F. Long. Jackson Dr. J. H. Wolff. Johnston Dr. L. D. Wharton. Jones Dr. S. E. Koonce. Lenoir Lincoln Dr. L. A. Crowell. McDowell Dr. B. A. Cheek. Macon Dr. F. L. Siler. Madison Dr. Jas. K. Hardwicke. Martin Dr. W. H. Harrell. Mecklenburg Dr. C. M. Strong. Mitchell Dr. C. E. Smith. Montgomery 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. C. D. Jones. Pamlico Pasquotank Dr. H. T. Aydlett. Pender Dr. George F. Lucas. Perquimans Dr. C. C. Winslow. Person Dr. J. A. Wise. Pitt Dr. C. O'H. Laughing-house. Polk Dr. C. J. Kenworthy. Randolph Dr. T. T. Ferree. Richmond Dr. J. M. Covington. Robeson Dr. H. T. Pope. Rockingham Dr. Sam Ellington. Rowan.^ Dr. W. L. Crump. Rutherford Dr. W. A. Thompson. Sampson Dr. R. E. Lee. Scotland Stanly Dr. J. W. Littleton. Stokes Dr. W. L. McCanless.- Surry Dr. John R. Woltz. sWain Dr. A. M. Bennett. Transylvania Dr. M. M. King. Tvrrell Union Dr. J. E. Ashcraft. Vance Drs. W. T. & G. Cheat-ham. Wake Dr. P. E. Hines. Warren Dr. T. B. Williams. Washington Dr. W. H. Ward. Watauga Dr W. B. Councill. Wayne Dr. W. J. Jones. Wilkes Dr. J. W. White. Wilson Dr. E. G. Moore. Yadkin Dr. B. B. Flauser. Yancey Dr. J. M. Fairchild. BULLETIN OF THE NORTH CAROLINA BOARD OF HEALTH. 51 [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 Cerebrospinal 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. .189. -N. C. ZBTTI-X^TXILSP OF THE North Carolina Board of Health. Published Monthly at the Office of the Secretary of the Board, Rakigh, X. < . Geo. G. Thomas, M. D., Pees., Wilmington. C. J. O'Hagan, M. I) Greenville. S. Westray Battle, M. D...Asheville. J. L. Nicholson, M. D Richlands. Henry W. Lewis, M. D Jackson. Albert Anderson, M. D "Wilson. Henry H. Dodsox, M. D Milton. A. W. Shaffer, San. Eng Raleigh. Richard H. Lewis, M. D., Secretary oral Treasurer, Raleigh. Vol. XIV. AUGUST, 1899. Xo. 5. Yellow Fever. The announcement on July 30th of the existence of a number of cases of yellow fever in the Soldiers' Home at Hampton, Va., and later that it had appeared in Phcebus, caused us considerable anxiety, lest it should extend to Norfolk and thence to our own State. But remember-ing that the Home was an institution of the United States Government, and hav-ing confidence in the efficiency of the Marine Hospital Service in such work, we rested comparatively easy. That our confidence was not misplaced the result so far has shown, and it is with profound satifaction that we note the control and restriction of the disease. "We cordially congratulate Surgeon-General Wyman and his associates in the Service on their admirable management of the outbreak. The Doctor as a Carrier of Disease.* BY JOHN T. HOWELL, M. I>., NEWBURGH, N. Y. In these times of successful quarantine and disinfection there yet remains a much neglected danger, which every physician, to be consistent, should carefully consider and endeavor to prevent. We have fought with pride the victori-ous battles against sepsis and contagion and have drawn the restrict
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 | 1899; 1900 |
Subjects |
Diseases--Reporting Genealogy Mortality--Statistics Public Health--North Carolina--Periodicals |
Place | North Carolina, United States |
Time Period | (1876-1900) Gilded Age |
Description | Volume 14, Issues 1-12, April 1899-March 1900. |
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 | 8,774 KB; 174 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_bulletinboardofhealth18991900.pdf |
Pres Local File Path-M | \Preservation_content\StatePubs\pubs_edp\images_master\ |
Full Text |
library of
(Efye University of Hortb Carolina
COLLECTION OF
NORTH CAROLIXIA N A
E X D O W E D B Y
JOHN SPRUNT HILL
of the class of 1889
This book must not
be taken from the
Library building.
ua»
>$& v&
&*
Form No. 471
MEDICAL LICENSE LAW, AS AMENDED.
B°U
OF THE
North Carolina Board of Health.
Published Afonthly at the Office of Secretary of the Board, Raleigh, X. C.
Geo. G.TnoMAS,M.D.,Pmi., Wilmington. I C. J. O'Hagan, M. D Greenville.
S. Westray Battle, M. D...Asheville. ! J. D. Spiceh, M. D Goldsboro.
W. H. Harrell, M. D Williamston. |
,T. L. Nicholson, M. D Richlands.
John Whitehead, M. J) Salisbury.
J
A. W. Shaffer, San. Eng Raleigh.
Richard H. Lewis, M. D., Secretary and Treasurer, Raleigh.
Vol. XIIjT APRIL, 1899.
T
No. fc*r
The Smallpox Situation.
The smallpox situation in the State is
at this present writing (April 21) much
the same as a month ago, though some-what
improved. Of the nineteen coun-ties
then reported as having the disease,
seven, Tyrrell (?) (there is no Superin-tendent
of Health in Tyrrell, we regret
to say, and our information is hearsay),
Columbus, Wilson, Edgecombe, Halifax,
Northampton and Johnston have gotten
rid of it, for the time being, at any rate;
while in three others (Alamance, Moore
and Warren) no new cases have been re-ported
and the patients are about ready
to be discharged. New cases since the
March reports, however, have appeared
in Anson (report from Anson unsatisfac-tory,
but there are apparently several);
Union. 2; Mecklenburg, 1 ; Chatham, one
negro family, number attacked not given;
Beaufort, 2; Iredell, 1, varioloid, and ad-ditional
cases in Gates and Wake. So
that there are now sixteen counties hav-ing
smallpox instead of nineteen last
month. In most instances the number
of cases is small, the disease is mild in
character, and the outbreaks are well
managed. On the whole, the condition
of affairs is much more satisfactory, for
which credit is largely due to the earnest
and well-directed efforts of our faithful
and efficient Smallpox Inspector, Dr.
Henry F. Long, of Statesville. We have
received from the communities he has
visited nothing but words of commenda-tion
of his work and thanks to the Board
for sending him.
As we have said before, we find that
where all the physicians pull together,
and the authorities promptly institute
thorough measures and the Health ( Mi'.ccr
attends to his duties, there has been no
trouble in controlling the disease. In this
connection, as a suggestion to our medi-cal
brethren in other counties, we take
much pleasure in printing the following
strong and pointed resolutions adopted
by the physicians of Edgecombe when
smallpox first appeared in that county:
120 BULLETIN OF THE NORTH CAROLINA BOARD OF HEALTH.
"Whereas, A committee of the Aux-iliary
Board of Health of Edgecombe
county, after due investigation, has re-ported
that the disease now prevailing in
epidemic form in Hickory Fork town-ship,
Edgecombe county, is smallpox;
and,
"Whereas, Vague rumors have reached
the ears of the Board that some physi-cians
are inclined to discredit such re-port,
to discourage the efforts being made
to prevent the spread of the contagion,
and otherwise embarrass the members of
the Board in the discharge of their duties;
therefore,
"Resolved, 1. That it is the opinion of
the Auxiliary Board of Health of Edge-combe
county that the epidemic now pre-vailing
in No. 3, or Hickory Fork town-ship,
is smallpox.
"2. That any physician who shall be
called to suspicious or well-marked cases,
and shall fail to report same immedi-ately,
shall be dealt with according to
law."
This has the right ring. We would
remind our readers that the last clause
in the resolutions means "shall be fined
for each offense not less than ten nor
more than twenty-five dollars." Similar
action promptly taken would have saved
much trouble in one or more counties we
could name.
A Word to the Boards of County
Commissioners.
At your next regular meeting, the first
Monday in May, it will become your duty
to elect a County Superintendent of
Health, to hold office for one year. We
would respectfully call your attention to
the prime importance of selecting com-petent
men for that very responsible posi-tion—
men of intelligence, common sense,
energy and conscientiousness. Those of
you who have had smallpox in your
counties doubtless realize this as you
never did before, and those whose coun-ties
have so far escaped would do well to
bear it in mind, for the disease is likely
to visit you any day. We also beg to call
the attention of the Boards of the few
counties having no superintendent to
their helplessness without such an officer
of the law in such a contingency, and to
express the hope that they will remedy
that condition. The term of office of all
superintendents expires and a new term
begins, under the law as amended in
1897, the first Monday in May.
We feel sure that in making their selec-tion
the commissioners will not be un-mindful
of the sacrifices made by those
superintendents who have to manage out-breaks
of smallpox in the loss to their
private practice entailed thereby. Unless
this pecuniary loss has been offset by lib-eral
extra pay, it seems to us that simple
equity demands the re-election of such
superintendents, provided they have
shown themselves faithful and competent.
The Medical Iaeense Law, as Amended.
In 1849 the State Medical Society was
organized by a handful of our leading
physicians. Ten years afterwards, just
forty years ago, it was incorporated by
the General Assembly, and in the same
bill were embodied provisions for regu-lating
the practice of medicine in this
State, requiring a license from a Board of
Examiners to be elected by the State So-ciety.
The penalty was inability to col-lect
fees at law. According to our recol-lection,
this was, with the exception of a
meagre law enacted by the Legislature of
New York early in the century, but
which fell almost immediately into " in-nocuous
desuetude," and therefore should
not count—the first attempt made in the
BULLETIN OF THE NORTH CAROLINA BOARD OF HEALTH. 121
United States to regulate the practice of
medicine. For many years ours was the
only law of the kind in the country, and
slow old North Carolina was the leader in
this important movement.
In 1885, chiefly through the efforts of
our predecessor in office, the late deeply
lamented Thomas F. Wood, of Wilming-ton,
the law was amended by making it a
misdemeanor, punishable by fine and im-prisonment
to practice without license.
In 1889 the registration feature was
added—the act allowing all in practice at
the time to register whether licensed or
not, but closing the doors finally on Jan-uary
1, 1892, to all except those holding
a license from the Board of Medical Ex-aminers.
While the Acts of 1885 and 1889 greatly
strengthened the law, two serious defects
remained to be cured. One was the right
of any one, whether properly educated in
medicine or not, to apply for license, and
the other was the practical inability of
the Board, owing to the fact that its ex-aminations
were necessarily theoretical,
to ascertain whether the applicant had
received the necessary clinical instruc-tion.
To cure these defects the Commit-tee
on Legislation of the State Society,
believing that public opinion had grown
up to this point, and that the time was
ripe for making the effort, drew a bill em-bodying
these amendments and secured
its enactment by the General Assembly
of 1899. It received a unanimously fa-vorable
report from the Judiciary Com-mittees
of both the Senate and the House,
and passed the Senate unanimously, but
met with active opposition in the House,
much to our surprise, as no one outside
the Legislature, or in it, so far as known,
was against it. The argument against it
was directed chiefly to the provision re-quiring
a diploma from a college requir-ing
an attendance of three years, the
speakers holding that it would debar some
ambitious young men of limited means
from entering the profession, the insinua-tion
being made that The bill was a scheme
on thepartof the physicians now in prac-tice
to form a "doctor's trust" and re-duce
competition. We know that this
idea did not enter the minds of the Soci-ety's
committee, and that they were act-uated
by only two motives—the still fur-ther
elevation of their profession and the
more certain protection of the people
against incompetency on the part of their
medical advisers. Instead of lessening
competition, the effect of the amendment
will be to increase it by insuring the more
thorough preparation of the new men
coming in from year to year, while it will
not sensibly diminish the number. There
is no danger of a failure in the crop of
doctors. Admitting that the requirement
of a diploma from a respectable college-no
college requiring less than three years'
attendance ca:i now be called respecta-ble—
will prevent a few young men from
following the profession of medicine in-stead
of some other calling equally hon-orable
and frequently more lucrative, it
should not even be so much as named in
comparison with the greater protection
to the health and lives of the people of
the whole State.
As nothing is so much calculated to ad-vance
the cause of the public health as
the thorough education of all the mem-bers
of the medical profession, we feel
that the acknowledgments of the Board
are due the gentlemen of the Legislature
who supported t he bill by speech and
vote. Among so many friends we would
not make any invidious distinctions, but
we feel that it would be proper to men-tion
particularly the Hon. M. H. Justice.
of Rutherford, who introduced and chain-
122 BULLETIN OF THE NORTH CAROLINA BOARD OF HEALTH.
pioned the bill in the Senate, securing its
passage without a dissenting vote ; the
Hon. B. E. Reeves, M. D., the Represen-tative
from Ashe, who led the fight for it
in the House, and the Hon. H. G. Con-nor,
of Wilson, Speaker of the House,
who, becoming concerned for the passage
of the bill, left the Speaker's chair and
advocated it on the floor in a speech of
great weight, in the course of which he
took occasion to pay an eloquent tribute
to the physician—the country doctor in
particular.
This is the bill :
An Act to Amend Chapter thirty-four
of The Code and Chapter one hun-dred
AND EIGHTY-ONE OF THE LAWS <>F
1889.
The General Assembly of aorth Carolina
do enact
:
Section 1. That chapter thirty-four of
The Code be amended by inserting after
the word "applicants" in line two of
section three thousand one hundred and
twenty-four, the following words: "who
shall exhibit a diploma, or furnish satis-factory
proof of graduation, from a medi-cal
college in good standing requiring an
attendance of not less than three years
and supplying such facilities for clinical
instruction as shall meet the approval of
the said Board"; and by adding imme-diately
after said section three thousand
•one hundred and twenty-four the follow-ing
words: " Provided, that the require-ment
of three years' attendance shall not
apply to those graduating prior to Jan-uary
first, 1900. Provided fua&her, that
license or other satisfactory evidence of
standing as a legal practitioner in an-other
State shall be accepted in lieu of a
diploma and entitle to examination."
Sec. 2. That section three thousand
one hundred and twenty-five of The Code
be amended by inserting after the word
"applicant" in line three, the following
words: " who shall comply with the re-quirements
as to graduation prescribed
in section three thousand one hundred
and twenty-four as amended."
Sec. 3. That section three thousand
one hundred and twenty-seven of The
Code be amended by adding immediately
after said section the following words:
" Provided, That the said Board may, in
its discretion, meet not more than one
week before the said society, hut always
in the same place; and that one addi-tional
meeting in each year may be held
at some suitable point in the State if
deemed advisable."
Sec. 4. That chapter one hundred
and eighty-one of the Laws of 1889 be
amended by striking out all of section
three from the word "words" in line
four, down to the word "any" in line
nine, the word " likewise " in line eleven
and the word " such " in line fourteen;
by striking out in section four all from
the word " or" in line three to the num-ber
"1885" in line six, inclusive, and
the words " on oath" in line seven; and
by striking out in section seven all after
the word "act " in line three.
Sec 5. That this act shall be in force
from and after January first, 1900.
So that the laws, as amended to date,
read as follows :
the laws regulating the practice of
medicine in north carolina.
(From The Code).
Section 3121. Medical Society of the
State, a Body Politic Private Laws.
1858-'9„ c 258, s. 1:
The Association of regularly graduated
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 the
State of Xorth Carolina."
BULLETIN OF THE NORTH CAROLINA BOARD OF HEALTH. 123
Sec. 3122. Who May Pjractick. 1858-'9,
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
diseases for fee or reward, unless he shall
have been first licensed so to do in t lie
manner hereinafter provided.
Sec. 3123. Board of Physician.- to Con-sist
of Seven. 185S-'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
by the title of "The Hoard of Medical
Examiners of the Stale of North Caro-lina,"
which shall consist of seven regu-larly
graduated physicians.
Sec 3124. Duty of Board. 1858-9, c.
25S, 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
Hygiene, Chemistry, Pharmacy, Materia
Medica, Therapeutics, 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, live 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 furthi r, that license or other sat-isfactory
evidence of standing as a legal
practitioner in another State shall be ac-cepted
in lieu of a diploma and entitle to
examination.
Sec. 3125. Temporary License. lS5S-'9,
c. 258, s. 7:
To prevent delay and inconvenience,
two members of the Board of Medical
Examiners may grant a temporary license
to any applicant who shall comply with
the requirements as to graduation pre-scribed
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
temporary license shall not continue in
force longer than the next regular meet-ing
of the Board, and such temporary
license shall in no case be granted after
the applicant has been refused a license
by the Board of Medical Examiners.
Sec. 3120. How Appointed. 1858-'9, c.
25S, s. 9:
The Medical Society shall have power
to appoint the Board of Medical Exami-ners.
Sec. 3127. Where and When to Assem-ble.
1870-'l, c. —, s. 11:
The Board of Medical Examiners shall
assemble at the same time and place
when and where the Medical Society as-sembles,
which Society shail assemble at
leasl mice in every year at such time and
place as the said Society, at its next pre-ceding
meeting, shall have fixed; and the
said Board shall remain in session from
day to day until all applicants who may
present themselves for examination with-inthe
first five days after its meeting shall
have been examined and disposed of:
124 BULLETIN OF THE NORTH CAROLINA BOARD OF HEALTH.
Provided, That the said Board may, at its
discretion, 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, c.
258, s. 11
:
The Board of Medical Examiners are
authorized to elect all such officers and to
frame all such by-laws as may be neces-sary,
and in the event of any vacancy by
death, resignation or otherwise, of any
member of said Board, the Board, or a
quorum thereof, is empowered to fill such
vacancy.
Sec. 3129. The Board of Examinees to
Keep a Record. 1858-'59, 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 applicant
licensed to practice medicine and surg-ery,
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 licensed in two of the
newspapers published in the city of Ral-eigh,
within thirty days after the grant-ing
of the same.
Sec. 3130. License. 185S-'9, c. 258,
s. 13.
The Board shall have power to demand
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.
Sep. 3131. The Board ; their Compen-sation.
1S70-'1, 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 certificate of the Presi-dent
of the Board of Medical Examiners.
Sec 3132. Practicing Without License.
1858-9, c. 258, s. 15 ; 1885. c. 117 and
261.
Any person who shall practice medicine
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 passage 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 ser-vices
rendered in the practice of medi-cine
or surgery, or any of the branches
thereof, but shall also be guilty of a mis-demeanor,
and upon conviction thereof
shall be fined not less than twenty-five
dollars nor more than one hundred dol-lars,
or imprisoned at the discretion of
the court, for each and every offence
:
Provided, that this act shall not be con-strued
to apply to women who pursue the
vocation of a midwife : And j>e<>ri |