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