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UN C CH HEALTH SCIENCES LIBRARY H00352060G i' ^bt Libtarp of t^t ^nitjersitp of H^ortb Carolina CnliotoeD b? ^^e SDiaUctic ano PSilantSropic &ocietie0 rsi86W v.5B-4» McJ. I.b. This hooh must not be taken from the Library building. 5^ LUNC-15M N.36 OP-13370 DIVISION OF DOCUMENTSt WASHIfJGTON, D. C. PuTDlislyedbH inL. N°KJI\QP^UMIK STATE. DPARDs^AE^LTA 1 Th)5 Bu]1elir\willbe 5er\t free to arwj citizen of Ihe 5tcrte upoi\ request j Entered as second-class matter at postogice at Raleigh, N. C, under Act of July 16, 1894, Published monthly at the office of the Secretary of the Board, Raleigh, N. C. Vol. XLI JANUARY, 1926 No. 1 HEALTH—THE STATE'S GREATEST ASSET MEMBERS OF THE NORTH CAROLINA STATE BOARD OF HEALTH J. Howell Wat, M.D., Pres Waynesville Cyrus Thompson, M.D Jacksonville Richard H. Lewis, M.D., LL.D. Raleigh E. J. Tucker, D.D.S Roxboro Thomas E. Anderson, M.D Statesville D. A. Stanton, M.D High Point A. J. Crowell, M.D Charlotte James P. Stowe, Ph.G Charlotte Charles O'H. Laughinghouse, M.D., Greenville EXECUTIVE STAFF G. M. Cooper, M.D., Assistant Secretary. H. A. Taylor, M.D., Deputy State Health Officer. C. A. Shore, M.D., Director State Laboratory of Hygiene. H. E. Miller, C.E., Chief of Bureau of Engineering and Inspection F. M. Reglster, M.D., Deputy State Registrar of Vital Statistics. M. L. Townsend, M.D., Director Bureau of Health Education. FREE HEALTH LITERATURE The State Board of Health publishes monthly The Health Bulletin, which will be sent free to any citizen requesting it. The Board also has available for distribution without charge special literature on the following subjects. Ask for any in which you may be interested. Adenoids and Tonsils Cancer Catarrah Care of the Baby Constipation Colds Clean-up Placards Chickenpox Diiihtheria Don't Spit Placards E.\es Flies Fly Placards German Measles Hookworm Dif-ease Infantile Paralysis Indigestion Influenza Malaria Measles Pellagra Public Health Laws Prenatal Care Sanitary Privies Scarlet Fever Smallpox Teeth Tuberculosis Tuberculosis Placards Typhoid Fever Typhoid Placards Venereal Diseases Water Sup])lies Whooping Cough FOR EXPECTANT MOTHERS The Bureau of Maternity and Infancy has prepared a series of monthly letters of advice for expectant mothers. These letters have been approved by the medical profession. They explain simply the care that should be taken during pregnancy and confinement, and have proved most helpful to a large number of \yomen. If you want them for yourself or a friend, send name to the State Board of Health, and give approximate date of expected confinement. CONTENTS Pneumonia 3 Biliousness 3 "I Never Thought of That" 5 Winning the Typhoid Fight 7 Condensed and Evapora ed Milk -Tr^ll The Advancing Knowledge ol" Cancer-- 14 ^e¥ Hr^len Public Health Nursing- Look to Wholesome Home Environment 24 Children Spoiled by too Much Love 25 Importance of Being a Parent 26 No Ventilation—Six Lives Lost 26 "Care^mw-'Iloothbrush 27 27 ;he Bath 30 RECEtVCO 19 The Story of JAN 1 f) 1926 nor~l IftiiPibi-re r\*\, ttLit-\%A I PU5LI5ALD BY TML nQR.TA CAgOLIhA 5TATE. BOAfgP g^MLALTM I Vol. Xlil JANUARY, 1926 No. 1 PNEUMONIA We are just now reaching the season when pneumonia is beginning to talce its most territic toll of human life. During January, February and March more people die from this disease than during the remaining nine months of the year. During these three months of 192.5 pneumonia killed, in North Carolina, at the rate of over five hun-dred per month. If you live in a village of five hun-dred people, think of an entire village tlie size of yours, men, women and chil-dren, being completely wiped off the map in this State each month during January, February and March. Re-member that is just what this one dibcase, pneumonia, is doing. The total is approximately 3,000 deaths per year. Pneumonia can much more easily be prevented than cured and prevention is a personal matter depending on each individual. The doctor will do all he possibly can to relieve a patient that is sick, but preventing the disease is a matter entirely in the hands of the in-dividual. The doctor cannot do that for him any more than he could eat his food for him or sleep for him. In one series of 1408 pneumonia pa-tients, taking them as they came 852 gave a history of having been ill with a common cold for several days previ-ous to the development of pneumonia. Some important measures in prevent-ing pneumonia which every one should know are : 1. Consider seriously and treat ade-quately all "common colds." 2. Dress to suit the weather, remem-bering that clothing is for protection, rather than alone for adornment. 3. Avoid sudden chilling, wet feet and wet clothing. 4. Vitality, or resistance to infection, is greatly lowered by lack of exercise, excessive fatigue, loss of sleep, excesses of any kind, and poor food. During dangerous seasons be especial-ly careful to maintain vitality at its very highest. 5. Avoid all unnecessary contact with persons sick with pneumonia, flu or colds. They are contagious. 6. Keep hands clean. 7. Do not let fingers or anything else except proper food and drink enter the mouth or touch the lips. 8. Avoid overheating of living rooms and be assured that there is ample ventilation to keep the air fresh. BILIOUSNESS The term "biliousness" may not be a strictly scientific word but hearing it calls to the mind of every man, woman and older child in North Carolina a certain definite and unhappy picture. By whatever name it may be called there is lack of appetite, a sense of malaise, indisposition to either mental or physical activity, drowsiness, often giddiness, a bad taste in the mouth and a bad breath, the tongue is cov-ered with a rather thick slimy coating, there is inactivity of the bowels and a peculiar "bilious" color in the skin, dark circles under the eyes and usually there is a severe and distressing head-ache. Sooner or later there will be nausea and vomiting. The vomited matter is a liquid, yellow, or greenish yellow in color and as "bitter as gall." This condition has been seen by every one and experienced by most persons. The Health Bulletin January, 1920 A condition of this sort confronts the "family doctor" more often, perhaps, than all others combined. Gallstones forming in the gall blad-der sometimes stop up the gall ducts and prevent the flow of bile into the in-testines. This dammed up bile is then reabsorbed into the blood and carried throughout the system and deposited in every tissue of the body. .This de-posited bile pigment is what gives to the skin and the whites of the eyes that "yellow as a pumpkin" jaundiced color. In at least a great many cases of so-called "biliousness" there is a slightly analagous condition caused by a con-centration of the bile. This interferes with its normal flow and results in its reabsorption into the blood, to be partly deposited in the tissues and partly to be re-eliminated by the liver. With each cycle, of course, it becomes more and more concentrated. In biliousness the bile is not dammed up as in gall-stones but because of the impeded flow of the thickened bile there is re-absorption into the blood and a deposit of bile pigment into the tissues. Because of the inactivity of the bowels in this condition there is neces-sarily a reabsorption also of the poisons from uneliminated waste in the intes-tines and this poison or toxin together with the reabsorbed bile gives rise to many of the symptoms noticed. Inseparably linked with the word biliousness is that other word, calomel. Calomel has a double action. It is a purgative and also a cholagogue (bile driver), hence calomel in "biliousness" empties the intestinal tract and also liquefies the bile and stimulates the liver cells to excrete more bile. Thus with the intestines emptied the bile ducts and gall bladder emptied and the liver cells filtering out of the blood the accumulated bile the condition speedily clears up. Calomel, however, has its disadvant-ages. It is of itself a very poor pur-gative and should never be taken, ex-cept upon the specific advice of a phy-sician. When taken into the stomach and absorbed into the blood it is an excellent stimulant to liver activity. Its absorption is rather slow, hence should be taken in the minimum needed doses to accomplish this purpose and given time to be absorbed before a purgative is taken to empty the bowels. Epsom salts and castor oil are ex-cellent purgatives. They do quickly and thoroughly empty the intestinal tract but they have no stimulating ac-tion on the liver and do not liquefy the bile. These drugs by themselves will not clear up the symptoms of the con-dition popularly known as biliousness. If, however, the bowel contents are never allowed to stagnate, then bilious-ness is much less likely to occur, and such drugs are much more valuable in preventing biliousness than in curing it. In recent years a mechanical method has been devised of draining the gall bladder without the use of purgation. It consists in the passage of a small tube by swallowing it very like a stomach tube through the stomach and into the duodenum (the upper small in-testine). The procedure is simple and usually gives the patient little incon-venience but does require some time. In cases where indicated it often gives most happy results. "Biliousness" may not be the proper name for it but the condition described is very real and very common. It is relieved by anything that empties the bowels to stop further toxemia and by emptying the gall bladder and clearing from the body tissues the accumulated bile and waste iwisons. The health oflicer who operates in a community where a substantial propor-tion of the citizens have received basic instruction in preventing disease and in the general activities of the health department is able to accomplish re-sults in the saving of lives of which we have scarcely dreamed in the phil-osophy of the past. — Dr. Ray Lyman Wilbur. Education is the basis on which any dental health program should be de-veloped. It should begin in the pre-natal clinics and should extend through the school life of the child. Filling a cavity is palliative treatment unless ! one understands and practices the | fundamentals of preventive dentistry. | —William A. Griffin, D. D. S. January, 1926 The Health Bulletin ''I NEVER THOUGHT OF THAT" One Reason Why Over Ten Thousand People Die Each Year in the State From Deg-enerative Diseases is Just Plain Carelessness "Hello, Sam, what's wrong with you? Been in a wreck?" That was the greeting of a fi-iend as Sam Jones limped painfully along to-wards his office on a snappy December morning. "No, nothing like that, Bob," Sam replied. "Fact is, it's nothing but a touch of rheumatism. Sure is talking to me this morning, though. Been troubling me a little in that left knee for some little time. Now it's moved on up into the hip, and it's just about all I can do to travel this morning." "What are you walking for? Where's the car?" Bob wanted to know. "It's over at the shop. I'm having it wne over thoroughly, like I do every three months. Say, Bob, that's the best investment I ever made. You know, I've had that car something over three years now, drive it pretty constantly, and repairs on it haven't amounted to hardly anything. Every three months I set it in the shop for an inspection, and they fix up what little minor trouble there may be, and it runs just as sweet now as it did when I got it. It's mighty good practice, and cheap insurance, I tell you." "How long since you have had a doc-tor look you over?" Bob inquired. "Let's see now, I don't believe I've had a doctor since I had the flu back in 1918. There's been nothing wrong with me except this rheumatism here lately." "Well, then, do you think more of your car than you do of yourself?" Bob wanted to know. "Or do you think at all? Here you have your car carefully looked over every three months to keep it from going bad, and you let your-self go for seven years. Why don't you apply the same reasoning to yourself as you do to your car? If you had you probably wouldn't be so crippled up with rheumatism that you can hardly walk down town. Besides, that rheuma-tism is only a symptom of something wrong inside. Better go right on over and have a careful examination made." "Bob, I reckon I'm just a plain fool, I never thought of that. I'm on my way right now." There are thousands in North Caro-lina just like Sam Jones. They go on day after day, and the days run into weeks, and months, and years, and they never think of giving their bodies a square deal. Their automobiles cost money, and so they spend money keep-ing them in good order, and spend money in preventing trouble from de-veloping. But only when sick, and too sick to work, do they seek relief. Then they want a quick job from the doctor, one that will put them back on their feet in a hurry, regardless of what may be the hidden trouble. At the beginning of another year, it is timely to suggest that a physical ac-counting be made. What are your health assets and liabilities, and how do your body accounts balance? You would not think of running your busi-ness without keeping some accounts, and the annual inventory is routine. Why run your body without getting at least a yearly balance to show if there are any losses or gains? It is a well-known fact that thou-sands of lives in infancy and childhood Lave been saved in the past few years by the spread of knowledge concerning the care of babies and child hygiene, and the medical inspection of school children. Not only have thousands of lives been saved, but these school chil-dren have been made healthier and more efficient in their school work. But while the death rate among chil-dren has been coming down rapidly, the death rate for adults has been climb-ing. We are saving infant life and wasting adult life. The "old age" diseases are creeping into middle life and carrying off men and women at the time when their lives are most useful, and when they should be enjoying life 6 The Health Bulletin January, 1926 to the fullest. At least a half million American citizens die annually from preventable or postponable diseases of the heart, arteries, kidneys and cancer. Here in North Carolina last year there occurred 11,964 deaths from a group of five preventable or curable diseases to vrhich persons of middle life It is estimated that 75 of each 100 deaths between the ages of 20 and 65 are caused by one of these diseases. The majority of the more than eleven thousand occurring from these causes were premature. They should have been prevented, cured, or postponed to be-yond seventy years of age. THOROUGH CHEST EXAMINATION Important part of physical examination to detect incipient tuberculosis. are especially susceptible. The figures Wonderful progress has been made are as follows : in North Carolina in improving the Nephritis 1,804 health of children; in the control of Heart Disease 3,661 the communicable diseases; in better- Apoplexy and arterio-scle- ing sanitary conditions throughout the rosis 2,509 State. There is much yet to be done. Cancer 1,289 however, and an imrwrtant next step Tuberculosis 2,701 must be towards the raising of the phy- • sical standard. By learning the lesson Total 11,964 of prevention we can get at these de- January, 1926 The Health Bulletin generative diseases in time to stop or cure them. Through a periodic physical examination, at least once a year, bodily defects and the early signs of the "breaking down" diseases of the heart, arteries and kidneys can be detected and the necessary remedy applied. The cost is negligible. Thirty minutes to an hour of your time, and a modest fee to the physician is all. The gain to you may be ten or twenty years of added life. It may be that you have no symptoms so far as you know, and don't feel sick, and yet a thorough physical inspection may reveal the first indications of a serious disease at the time when it may be headed off or cured. The 1,289 who died of cancer last year did not know they were sick until it was too late. Yet every one of them could have been saved had their trouble been discovered in time. Give j-ourself a square deal. Treat your body with as much care as you give to your car. Start the New Year with a physical inventory. / WINNING THE TYPHOID FIGHT How North Carolina Has Succeeded in Makings Typhoid Fever Comparatively Unknown in the State In the past eleven years the death rate from typhoid fever in North Caro-lina has been reduced by 72 per cent. From its position near the top in the United States the State has been pulled down to a place among those states having the least typhoid fever, and now heads the list of the Southern States with the lowest death rate fi-om this particular disease. To those whose memory goes back to the early days of the present century when typhoid fever was accepted as a natural accompaniment of the summer months, the question naturally arises, how has this disease been so nearly conquered? A prominent newspaper editor of the State last summer re-marked that he could remember when every week his paper carried the report of five or six or more deaths from ty-phoid, and now even a case in the county was unusual. The intensive fight against typhoid fever began in 1914, when definite plans were adopted to be carried into effect the following year. Vaccine for the prevention of typhoid fever had been thoroughly tested and its efficacy estab-lished. So the State Board of Health decided to attempt mass immunization on a large scale. Under the guidance of Doctor G. M. Cooper, then serving as director of rural sanitation for the Board, con-tracts were made with seventeen coun-ties under the terms of which the coun-ty authorities appropriated sums suf-ficient to pay the expenses of the field agents of the Board. Dispensary points in each county were selected that would be as convenient as possible for the people of each section to reach. An ad-vertising campaign designed to give full information with regard to the preva-lence of the disease, its dangers, and the means of prevention was inaugu-rated. In June the actual work was begun. In these counties a total of 52,000 complete inoculations were given that summer. That is, that many persons received three administrations of ty-phoid fever vaccine, the doses being given at intervals of one week. The response on the part of the people was enthusiastic. The results were much greater than had been anticipated, and this first year's campaign was consid-ered an unqualified success. For the first time in th-^ United States the effort had been made to reach a large mass of civilian population with preventive typhoid treatment. It was demonstrated that such a campaign could be successfully consummated. Due credit should be accorded the coun-ty authorities who made this preventive work possible, and to the citizens of those counties who so whole-heartedly responded. The seventeen counties were Alamance, Buncombe, Cabarrus, Cald-well, Craven, Cumberland, Durham, Edgecombe, Guilford, Henderson, New The Health Bulletin January, 1926 TABLE 1 Check mark indicates counties in wliich typhoid vaccination campaigns were conducted by State Board of Health, or local county health department, 1915-1925. Total complete vaccinations, 807,978. County January, 1926 The Health Bulletin TABLE 2 Twelve counties in which no typhoid vaccination campaigns was con-ducted, 1915-1925, showing death rate from typhoid fever by years for seven years, 1918-1924, inclusive. Cot7NTr 1£18 10 The Health Bulletin January, 1926 vear, the record complete being as fol-lows : 1915, 17; 1916, 15; 1917. 10; 1918, 14; 1919, 35; 1920, 32; 1921, 57; 1922, 53; 1923, 44; 1924, 48; 1925, 52. The frequency with which immuniza-tion campaigns have been conducted in individual counties is shown in the ac-companying table. It will be noted that in twelve of the counties there have been no campaigns throughout the pe-riod, while in some others there has been one each year continuously since the beginning of the work. Altogether for the eleven year period the State Board of Health has records showing 807,978 complete vaccinations. This in-cludes, of course, those persons who have followed the safe course and been re-vaccinated at intervals of three years. It does not include a large num-ber of inoculations given by physicians in the routine course of their practice. the number of which it is not possible to accurately estimate. Now all this was costly. It cost in time and energy and money. Did it justify itself in direct, tangible results? The answer is shown by the figures that follow. In 1914 the total deaths from typhoid in the State numbered 839, giving a death rate of 35.8 per 100,000 of popu-lation. In 1924 the deaths from typhoid in the State numbered 270, giving a death rate of 9.9 per 100,000 of popu-lation. The reduction in the death rate was 72 per cent. Or to put it another way, if no efforts had been made to eradicate typhoid fever, and the same death rate had prevailed in 1924 as in 1914, 967 citizens would have succumbed to the disease. For the year, as com-pared with eleven years previously, there was a saving of 697 lives, and ten times the saving in serious illness. The accumulated saving of lives year by year for the eleven years would total the population of a small- city. It has been noted that twelve coun-ties in the State have had no intensive anti-typhoid work. They are Ashe, Cherokee, Dare, Graham, Haywood, Jones, Macon, Madison, Pender, Polk, Transylvania and Tyrrell. These are nearly all located either in the moun-tains or on the coast, are small, and sparsely populated. The total popula-tion for the twelve Is only 155,521. No one of them contains any considerable groups of urban population. In such counties typhoid fever and other com-municable diseases would be expected only as sporadic cases, the opiwrtuni-ties for spread being extremely re-stricted. Against this group of twelve counties which have made no effort to eradicate typhoid fever may be compared a group of twelve others in which anti-typhoid efforts have been most continuous and intensive. These counties are Cabarrus, Cumberland, Durham, Guilford. New Hanover, Northampton, Pitt, Robeson. Rowan, Sampson, Wake and Wilson. Almost without exception the.se coun-ties are large and thickly populated. They contain many large groups of urban population, and present excellent opportunities for the quick spread of typhoid fever and other communicable diseases. The total population of these twelve is 589,358. Detailed statistics year by year for 1918-1924 inclusive are given for the two groups in an accompanying table. For convenience the first twelve, or those having had no anti-typhoid work, are called Group A. and the second twelve, or those having had the most intensive anti-typhoid work. Group B. The following is a comparative show-ing of the typhoid death rates in the two groups, the avei'ages for the seven years. 1918 1924 Reduction Group A .... 13.8 9.9 28% Group B .... 26.5 8.8 67% State 22.2 9.9 55% While the death rate dropped in the Group A counties from 13.8 to 9.9, a difference of 3.9, in the Group B coun-ties it dropped from 26.5 to 8.8., a dif-ference of 17.7. The comparison of the rates of reduction shows 39% greater reduction for the group of counties doing intensive work, and this in spite of their natural handicaps. From the showing made, it can be said that had the Group A counties made the same etScient efforts to eliminate typhoid as were made by Group B counties, then those counties now would be practically free from the disease. Expressing it in terms of total deaths rather than rates, in 1918 Group A counties had 29 deaths from typhoid and in 1924 they had 22, a difference January, 1926 The Health Bulletin 11 of only seven. Group B counties in 1918 had 128 deaths from typhoid and in 1924 had 56, a difference of 72. Had the same intensive anti-typhoid meas-ures been applied in Group A counties as were utilized by Group B counties, the results should have been certainly as successful, and probably more so be-cause of natural advantages in these counties. The same degree of reduction in typhoid would have meant a saving of 20 lives in these counties for 1924 as compared with 1918, instead of seven, and the sickness and loss sus-tained by having had about 150 pre-ventable cases of the disease. Consider-ing the nominal cost of securing ty-phoid vaccinations, it would appear that these counties practiced a false economy. Of course, other factors have con-tributed to the decline, in addition to the vaccinations that have been secured. Foremost among these other factors is the immensely improved sanitary conditions that have resulted from the enforcement of the sanitary privy law, enacted in 1919. The number of pro-tected public water supplies, and sew-erage systems, has been growing, and the total number of people so served more than doubled in the past ten years. Dependable milk control measures have been instituted by a number of communities. The general educational work of the Board has been amplified in character and has been constantly reaching an increasing number of peo-ple each year. But these additional factors affecting the typhoid death rate have been general, on a State-wide basis, so that the effect has been fairly evenly distributed over all counties. It would appear conclusive, therefore, that the determining factor in the reduction of the typhoid death rate in those coun-ties where it has been greatest has been the fact that a large portion of the population of those counties have been periodically vaccinated. Let us consider for a moment what a skillful owner of horses does for a very fine colt, the progeny of ex-traordinary parents—one that is worth 100 times as much as the average horse. His first consideration is to provide for it the right kind of food; food which experience has shown will be ample for the support of optimal growth and for the maintenance of health after growth is completed. Be-yond this he does little in any special way to look after its well-being other than to provide clean, wholesome sur-roundings and to give it an opportunity to take exercise as it desires. It is not put through a lot of contortions or made to lie on its back and kick its legs to get exercise of a suitable nature; it walks, trots or runs, it grows into a magnificent creature. It rests a great deal of the time.—E. V. McCOLLUM. The most important of the laws of health relates to the character and quality of our food. Second in impor-tance is the effectiveness with which we rest. I would put exercise third. — E. V. McCOLLTTM. CONDENSED AND EVAPORATED MILK Frank E. Rice, A.B., Ph.D., Professor of Biological and Agricultural Chemis-try, N. C. State College, Raleigh, N. C. There is much confusion in most peo-ple's minds regarding the various kinds of canned milk found on the market. Really there are two, and only two, kinds of concentrated liquid milk put up in tin cans, although there are sev-eral manufacturers' brands. Both con-tain considerably less water than is found in ordinary fresh cow's milk; both are, therefore, condensed milks. Both are made by evaporating part of the water from cow's milk; both are, consequently, evaporated milks. The main difference between them is that the one contains a large amount of added sugar, while the other does not. Sweetened condensed milk, or what is commonly called condensed milk, is very thick or viscous, and is yellowish ir. color; it contains 40 to 457o ordi- 12 The Health Bulletin January, 192G nary granulated sugar. Unsweetened condensed milk, which is ordinarily designated as evaporated milk, is about the consistency of light cream, and is darker in color than condensed milk ; it contains no added substance. Condensed milk is kept from spoiling by the sugar in it, just as fruit pre-serves and molasses i-emain good almost indefinitely. Evaiwrated milk, on the other hand, after being sealed into the can perfectly tight, is heated to a very high temperature to kill the bacteria. This process can be compared to the ordinary method of canning fruit. It is well known that when canned fruit is once opened and exposed to the air it will spoil unless kept on ice ; the same is true of evaporated milk. But the sweetened variety after opening keeps just as well as before; there is no more necessity for keeping it cold than for keeping honey and molasses cold in order to prevent spoilage. Of course, if left undisturbed for weeks a little mold may grow on the surface, but the main body of the milk is un-harmed and unchanged. During the process of manufacture of both condensed and evaporated milk, the raw cow's milk is subjected to high temperatures. There has always been a diversity of opinion as to whether heated milk is as nutritious as that which has not been heated. The argu-ments seem to center around these questions: (1) Are the vitamins de-stroyed? (2) Is the milk rendered less digestible? (3) Are there not some peculiar living substances in milk which are beneficial to our health, but which are killed on exposure to heat? With regard to these points there should be found some difference between evaporated and condensed milk because the former is heated much longer and to a higher temperature than the latter. Of the principal vitamins so far dis-covered, the scurvy-preventing vitamin is usually present in milk in relatively small amounts and it is most easily destroyed by heat. Evaporated milk can be expected to contain none of the anti-scurvy substance ; while one or two investigators have found a little of this vitamin in sweetened condensed milk, it cannot be considered an important factor. Although a great deal depends upon the care taken by the manufacturer in preparing his i)roduct, both kinds of canned milk can be expected to contain practically as much of the other vita-mins as raw milk. With regard to digestibility,-—a few investigators claim that raw milk is better, but the large majority vote in favor of milk that has been heated. Raw cow's milk forms a tough clot in the stomach, while heated milk becomes finely divided and on this account is more easily handled by that organ. The protein of heated milk has been found to be acted on more easily by the diges five enzymes. Besides this, in the pro-cess of manufacturing condensed and evaporated milk the fat is rendered very finely divided which makes it more digestible also. All this is more im-portant in considering the feeding of infants and invalids than healthy adults. To the latter, raw milk is just as digestible as cooked milk. The im-portant point just now is that there is nothing peculiar about the process of manufacturing canned milk that renders it any less easily handled by the digestive system than it was origi-nally. However, there is one point of warn-ing in this connection.—Any white sedi-ment which is found in the bottom of a can should be carefully stirred in with the rest of the milk. It has been found that the process of heating may render some of the important mineral salts insoluble and cause them to settle out. Merely mixing this material with the rest of the contents prevents any loss. Many people have thought that there are some mysterious living substances in cow's milk beneficial to digestion and the health of man. They have thought that by heating the milk these things are destroyed and we are thus deprived of their good effect. But this has proved to be only supposition ; cow's milk does not contain more than the slightest trace of any digestive enzyme, nor is there any specific substance that can be destroyed with heat, such as an immune body, which might assist the bodies of children or grown-ups to re-sist disease. In answering the three questions above propounded, condensed and evap-orated milks are found to compare January, 1926 The Health Bulletin 13 quite favorably with natural cow's milk iu nutritive value. The one big objection to the canned milks, of course, is the taste. A glass of milk made by mixing evaporated milk and water, half and half, may be just as nutritious as raw milk in most resjiects, but it doesn't suit the palate. The "cooked milk" taste may come out sometimes in puddings and soups. But it is not difficult to get into the habit of using milk pi'oducts from tins. Immediately after the Spanish- American War the condensed milk busi-ness grew more than at any previous time. The soldiers had gotten used to it, and introduced it to their families when they got home. There are a great many ways that condensed and evaporated milk can be used in food preparation wherein the taste does not usually prove objection-able : custards, puddings, sauces, cream soups, ice cream, cakes, for adding to coffee and cereals and for making cocoa. Many people like sweetened con-densed milk on pancakes instead of sirup. The next question is,—How does the cost of canned milk compare with bot-tled milk? At the "Cash and Carry" stores in Raleigh one pound tins of unsweetened evaiwrated milk cost 11 cents and 12 cents depending on the brand ; suppose we take ll\'-2 cents as the average. By mixing this with an equal amount of water two pounds of milk of average composition is obtained. This is about 93% of a quart, which makes a quart cost us about 12% cents. Therefore, if we are paying more than this for bottled milk we would be saving money by using evaporated canned milk as much as possible. At the charge and delivery stores ihe same can costs 14 or 15 cents. By using an average of 14i/^ cents and calculat-ing iu the same way we find that it would cost about 15 1/^ cents to make a quart. Buying evaporated milk in the small six-ounce tins is considerably more ex-pensive as would be expected. Sweetened condensed milk comes mostly in 14-ounce tins ; one well known brand is put up in 15-ounce tins and another in 11-ounce. The label may be expected to show the exact net contents of the can since the laws are very strict in this regard. The 14-ounce size was found to cost 16 cents, the 15-ounce 20 cents, and the 11-ounce 14 cents at most of the stores. An inspection of these figures shows that the 14-ounce size is by far the most economical. It is unnecessary and unwise to pay fancy prices for any particular brand of canned milk just because it is a little more widely adver-tised. The pure food laws and sanitary regulations nowadays are so strict that one can depend upon it that one manu-facturer's brand will be as good as an-other. Sweetened condensed milk contains 289o milk solids ; ordinary cow's milk about 12.75%. With these figures it can be calculated that to make a quart (2.15 pounds) of milk it will require 1% 14-ounce cans, or 18 cents worth. However, since the product contains about 43% sugar, worth 6V^ cents a pound, there is present 2% cents worth of sugar. This deducted from 18 cents leaves 151/^ cents as the cost of making the quart. To sum up then,—unsweetened evap-orated milk at 11 or 12 cents per pound can is equivalent to natural cow's milk at 12% cents a quart. The value of the milk in a 14-ounce can of sweetened condensed milk is equal to natural milk at 15V4 cents per quart. Most bottled milk costs well above these figures in Raleigh, and this is perhaps true of the whole State of North Carolina. It is evident, therefore, that it is economi-cal to use these canned milks in the place of bottled milk in most cases. As far as cash value is concerned these are the facts. But there are some distinct advantages of canned milk over bottled whole milk :—It can be de-pended on to be free from dangerous bacteria. No matter if the cows have tuberculosis or the milkers have scarlet fever, the germs of these diseases can-not survive the manufacturing process ; so the finished product will be free from them. There is likely to be less waste in the use of cauntnl milk ; that which is not used today can be used tomorrow. Ice is not necessary before the tin is opened, nor for the sweet-ened variety after opening ; but un-sweetened evaporated milk should not 14 The Health Bulletin January, 1926 be kept more than a day after opening unless ice is used. Of course, the big advantage that has always been recognized is the porta-bility of milk in tins. For camping trips and for children on trains it is readily carried and most useful. It was once true that only on such special occasions was it practicable to use milk in tins. Now, with the price of tinned milk low and bottled milk high, it is economical to use these products every day in the household, especially un-sweetened evaporated milk. Inasmuch as the nutritive value of the canned milks is equal to fresh milk in most respects, we may well urge its use in those districts where fresh milk cannot be obtained. It should be possible to prevent pellagra by rounding out the diet with canned milk as well as with fresh milk. Of course, for this as well as for all other maladies due to improper nutrition fresh milk is best, but if it is not available, by all means, let canned milk form a part of the diet. It is good, and the price is reason able. THE ADVANCING KNOWLEDGE OF CANCER By George A. Soper, Ph.D., Managing Director The American Society for the Control of Cancer Some months ago the humorous re-mark of a prominent physician to the effect that nobody knew anything about cancer, taken literally by a reporter and published in evei-y newspaper in the country, led the public to obtain an utterly wrong idea of the state of knowledge of this disease. The doctor's remark produced a hearty laugh among the many physi-cians who heard it, for there was not one who was not aware that the speak-er's knowledge of the subject was ex-tensive and detailed, nor failed to sym-pathize with him in his exasperation at the fact that the discovery of a specific cure for cancer continued to elude investigation. It is as absurd to say that nobody knows anything about life itself as to say that nothing is known about can-cer. A great many things are known about life and about cancer, but of course a great many things have es-caped patient study in each case. How much we think we know about any-thing depends a good deal upon our point of view. As the Chinese say, our knowledge is like a fan which, held close before our eyes, appears to com-prise the universe, but to the eyes of others usually forms but a very small part of it. The Existing Knowledge of Cancer The information which exists today in regard to cancer is not only more extensive but of more practical value than many persons suppose. It is suffi-cient, if put into effect, to reduce the present death toll by one-half among women and one-third among men. At least this is the opinion of Dr. Charles P. Childe, President in 1923 of the British Medical Association, a dis-tinguished student of the cancer prob-lem. If we apply this estimate to the num-ber of deaths from cancer which occur among men and women in the United States, we shall find that over 40,000 people perish needlessly from this dis-ease each year in this country. In other words, according to Di*. Childe's opin-ion, the lives of over 40,000 men and women, most of them fathers and moth-ers, many of them in the prime of life and at the period of their greatest usefulness, are annually sacrificed to the failure to turn the knowledge which exists concerning the prevention and cure of cancer to account. In many quarters fundamental facts are being collected which are adding to the sum total of information which scientists and practicing physicians possess as to the cause and cure of the disease, and progress is being made in another direction : the facts already in existence are becoming better under-stood. What is referred to here as the knowledge of cancer is the composite knowledge of those who are recognized ' Januury, 1926 The Health Bulletin 15 by the medical profession as qualified students of that disease. As Dr. Joseph Colt Bloodgood has said in a recent letter to the l^ew York Times, the in-formation on the cancer question which is of real value is not the opinion of one person however eminent or intelli-gent he may be, but the consensus of opinion of the world's authorities based on the recorded experience of clinical work and experimental research. The reviewer of a book, in which the claim was advanced that a specific had been found that is a preventive and a cure for cancer, said, "Cancer is such a serious matter for the world at large that the premature claim of having ar-rived at a solution of this problem and the unwarranted hope held out to cancer sufferers by such an optimistic statement is a matter for grave con-sideration." Persons who would like to examine for themselves into the amount and character of the existing knowledge of cancer cannot do better than to begin with the work of Dr. Jacob Wolff, fol-low this up with the latest edition of "Neoplastic Diseases" by Dr. James Ewing, Professor of Pathology at the Cornell Medical School, and the refer-ences to be found in the Index Medicus, and so to the article in the latest An-nual of the Encyclopedia Americana by Dr. Francis Carter Wood, Director of the Institute of Cancer Research of Columbia University. Dr. Wolff's work, called "Die Lehre von der Krebskrank-heit," is in three volumes and contains 2,626 pages; Dr. Ewing's book is 1,054 pages in length. How the Knowledge is Increasing It has been said that more progress has been made toward an understand-ing of cancer during the past fifty years than during the preceding five hundred years, from which it is fair to infer that the advance which has been ac-complished within the last fifty years has been revolutionary. The progress has been in more direc-tions than can be stated within the limits of this article. In the direction of causation may be mentioned the dis-covery that chronic irritation is almost invariably one of the leading factors in the production of cancer. As to cure, the use of X-rays and radium has furnished methods of treatment of in-calculable service. Surgical procedures have been developed to a point which is believed to leave little more to be ac-complished in this direction. With reference to prevention, the whole idea of preventing cancer by means of hy-gienic procedures and minor surgical and radiological treatments is not only new but of so much value as to lead many to think that cancer is more often preventable than curable. One of the results of the new knowl-edge is that cancer can now be more accurately diagnosed than formerly and inestimable advantages are following in consequence. One of these advan-tages lies in the fact that there is today little reason for physicians to postpone a decision in those early cases which come to them until a cure is no longer possible. Diagnoses are still difficult and not in-frequently impossible in many early cases, but in some of the most usual and most curable forms and locations in which cancer occurs they can generally be made with certainty while there is still time for the patient to be cured. Cancer of the skin, for example, can and should be diagnosed and cured in practically every case, providing the patient does his or her part. And so with cancer of the lip, cancer of the breast and cancer of the uterus. Cancer of the buccal cavity is more readily diagnosed than cured, although there are many persons alive today who can testify that cancer in this location is not hopeless, by any means. In fact, cancer has been successfully treated in practically every location. Value of Radium, X-rays and Surgery As time passes, a better understand-ing is being reached as to the relative efticacj^ of radium, X-rays and surgery and the several fields of usefulness of these methods of treatment are being more and more clearly defined. The details of skillful operations are being recorded with increasing accu-racy and completeness, and the records are being tabulated in larger numbers and studied with increasing care. Mind-ful of the fact that cancer may recur after long intervals of time, the health of persons who have been treated is being watched for manv vears to see 16 The Health Bulletin January, 1926 how permanent their cures have been. It has been possible to collect statistics covering hundreds of cases and com-pare the effects produced by radium and X-rays with those obtained by sui'gery in the treatment of cancer in the various parts of the body where it occurs. Thus for example there was published in 1924 the report of a com-mittee headed by Dr. Robert B. Green-ough, which had been appointed by the American College of Surgeons, in which nearly one thousand cases of cancer of the cervix of the uterus were brought together witli the object of determining the relative value of surgery, X-rays and radium for the cure of cancer in this particular location. In England, the Ministry of Health has published an analysis of 20,000 cases of cancer of the breast, the object being to determine by the record the efficacy of the various methods of treatment employed. So far as irradiation is concerned, the net result of all the information thus far collected is to show that, like surgery, radium and X-rays have a dis-tinct place in the treatment of cancer, not only for the cure of that disease but for the amelioration of the suffer-ing in incurable cases. Not infrequently surgical operations are advantageously preceded and succeeded, one or both, by this treatment. Institutions Devoted to Cancel* Research The scientific knowledge which lies at the basis of a true conception of the causation, prevention and cure of can-cer is being added to through such re-search institutions as the Institute of Cancer Research of Columbia Univers-ity, the State Institute for the Study of Malignant Disease at Buffalo, the Can-cer Commission of Harvard University, the Imperial Cancer Research Fund of England, and hospital and research organizations such as the Collis P. Huntington Memorial Hospital, Boston; the Memorial Hospital, the New York Skin and Cancer Hospital, and the New York City Cancer Institute, in New York City ; the Barnard Free Skin and Cancer Hospital, St. Louis; the Albert Steiner Ward for Cancer and Allied Diseases, Atlanta; the George Chase Christian Hospital and Clinic, Uni-versity of Minnesota, Minneapolis ; The American Oncologic Hospital, Philadel-phia ; The Pennsylvania Cancer Com-mission ; The Middlesex Hospital in England, and others. The total number of persons who are working constantly for the discovery of new facts which may be usefully em-ployed in the control of cancer is large. Many of them are surgeons, others radiologists, and not a few are out-and-out research workers giving their whole time to this work. Unlike quacks who work secretly and do not take anyone into their confidence, these students of cancer are constantly discussing their results with one another and publish-ing their findings where all workers in this field can see and profit by them. Since 1907 there has been a well-established organization of scientists who are engaged in studying cancer, called The American Association for Cancer Research. The President is Dr. Channing C. Simmons, Surgeon of the Cancer Commission of Harvard Uni-versity, and the Secretary is Dr. Wil-liam H. Woglom, of the Institute of Cancer Research, Columbia University, New York. This Association has a membership of 148. The papers which are presented at the annual meeting are eagerly awaited by students of the cancer problem in Europe and America. They are published in the Journal of Cancer Research. What Everyone Should Know Twelve years ago, our Society was established to carry on a campaign of education as a means of turning the existing knowledge of cancer to the full-est account. The founders knew that it would not be necessary to wait until a complete cure for cancer had been dis-covered before systematic help could be given to the 250,000 or more sufferers from this disease who existed in the United States and Canada. The hopes of the organizers have been fully justified. During the dozen years of its existence, the American Society for the Control of Cancer, has given instruction by means of lectures, new.spaper articles, radio talks and other vehicles of publicity in all parts of the United States and in many of the Provinces of Canada, and it is esti-mated that not less than 50,000,000 people have thus obtained their first January, 1926 The Health Bulletin 17 lesson in regard to this disease. It will, of course, be necessary to follow this up with further Instruction. The public has received some knowledge of the early symptoms of cancer and has been told to go immediately to a competent physician upon the first appearance of the disease. About 25.0(X) volunteer workers are engaged in this educational work in the course of the year. The Society maintains national headquar-ters at 370 Seventh Avenue, New York City, where it is glad to answer in-quiries on any and all aspects of the cancer problem. How Cancers Start The new knowledge teaches that can-cers always start in a small way. At first they are miniature cancers. They grow slowly and insidiously. Conse-quently, the person who is attacked by one may not become aware that any-thing is seriously the matter for a long time. A cancer of the skin, for example, may continue for several years without causing pain or other marked incon-venience. Not only is a cancer small to begin with, but it appears to be a distinctly local disorder. Present day knowledge gives no reason to suppose that it is a constitutional or blood disease. On the contrary, the weight of evidence is op-posed to that supposition. No general disease is in any respect like it. No disease necessarily precedes it or is related to it. It often attacks persons who appear to be in perfect health. In its early stages the cancer does not affect the general health nor the patient's spirits, and this is particularly true if the patient does not know nor suspect that he has cancel-. It is only after the cancer has progressed con-siderably that the general health is impaired. If, while the cancer is small, it is completely removed by surgery or de-stroyed with X-rays or radium, or, in fact, by any other means, that is an end of it. This could not be so if cancer were a disease which affected the whole body. If, instead of being completely re-moved or destroyed, the original cancer, or any particle of it, is permitted to live, additional cancers are apt to fol-low either at the original site or else-where. Thanks to the increasing knowl-edge, the manner in which this happens has become more and more apparent. It has been proved that minute parti-cles of the original cancer may be car-ried to variovis parts of the body by the lymph and blood and there establish themselves as new cancers. The routes by which these cancer cells are carried are often known and in skillfully con-ducted operations, the places where the particles may have lodged are attended to when the cancer itself is removed. This information is of much value. A good many deductions of practical utility have been based on it. One is that surgery or radiation must be ap-plied before any migration of the little particles has taken place, for after this has occurred the removal of the original cancer alone will not produce a perma-nent cure. In early treatment lies the hope of cure. Gradually a more and more definite meaning is being attached to the word "cure" as applied to cancer. Physicians are less willing today to say that a patient has been cured of cancer than they were formerly. Recurrences from the growth of particles which have re-mained dormant for a very long time may occur. After five years, however, the chance of recurrence is relatively small. Consequently, physicians are coming to measure the success of the various methods of treatment which they employ in terms of the number of five-year cures which have been ef-fected. Not Contagious or Inheritable With the increasing knowledge, opin-ion is becoming more and more securely settled that cancer is not due to a para-site. It would be a great step for-ward if the public would learn to ac-cept this opinion, for the possession of it would dispel not a little of the fear with which cancer is regarded. It would also help to put an end to the promo-tion of some "cures" which do not cure, in other words, quackery, that greatest of all cruelties, as so many writers have declared. If cancer is not due to a parasite, it follows that the disease is not trans-missible from person to person. This 18 The Health Bulletin January, 1926 is true of all diseases. It also follows that a serum cannot be prepared which will stop it. It should be generally recognized that cancer is not communicable, for a belief that it is infectious has not infrequently led to the shameful neg-lect of patients who have had need of the best care and attention which could be given to the sick. Persons need have no fear to live or work near one who hr.s cancer. As to the inheritability of cancer, the general opinion among qualified stu-dents of this question is that the dis-ease itself is not inherited, but that a certain lack of resistance toward it may now and then exist in a family for two or three generations. Experi-ments which have been made in breed-ing large numbers of mice have led some i>ersons to get the wrong idea that cancer or a predisposition toward it might exist in some families in-definitely. It is true that by carefully selecting mates through hundreds of generations, strains or families of mice have been produced which are more susceptible to certain forms of trans-planted cancer than is commonly the case, but nothing like such a predis-position occurs among mice which are left to mate as they will. The great difficulty with which susceptibles can be produced shows that the results ai'e highly artificial. Apparently they have no analogy among human beings under the ordinary circumstances of every-day life. For practical purposes, it is reasonable to consider that cancer is not transmissible from parent to off-spring among human beings. The Prevention of Cancer Within the last few years it has been found that the inciting cause of cancer is in practically all instances some form of chronic irritation. At the site of the growth there has been for a considerable time a mechanical, chemi-cal, bacterial, or other irritating con-dition which has in some way so dis-turbed the natural resisting and re-pairing function of the tissues that they have at last given way and set out upon a career of unrestrained and un-restrainable growth. This theory has now been so thoroughly investigated as to be accepted universally as a funda-mental and completely established fact. To prevent cancer therefore is to pre-vent the chronic irritations which lead to it. One should beware of the broken tooth or dental plate which continually irritates the tongue, cheek or gums ; of the spectacles which make the head sore behind the ear, on the temples or nose ; of any sore which will not heal ; of the mole or wart that changes in color, size or appearance; of indiges-tion which will not stop and cannot be explained ; or any unusual and un-natural discharge from any part of the body and of any lump which does not go away. When any of these conditions occur, you should go at once to a capable doctor and do what he advises. At once means today. If the trouble is not cancer, your discomfort will thus be removed. If it is cancer, your promptness may save your life. In deal-ing with this disease, delay is not merely dangerous : it is fatal. When Johnny comes for his teeth to be examined and we find his teeth are poor and dirty, we teach him to brush his teeth but we should also find out why he has poor teeth. It is either one of two things—either Johnny is poorly nourished or Johnny's mother has been poorly nourished before or after Johnny was born, when she was un-able to give him tooth-building food. It is highly important to realize that we have emotional habits as well as habits of mind and body. We are coming to realize the importance of the psychology of the emotions in re-lation to mental and bodily health. We can definitely set for ourselves the goal of forming habits of happiness, of en-joyment and enthusiasm in our daily life, of courage and of generosity toward the opinions of others. Until we realize that negative emotional habits have just as much to do with ill health as germs, we have fallen far short of our standard. — Patty I. Hilx. Man's happiness consists in the means and not in the end ; in acquisi-tion and not in possession. January, 1926 The Health Bulletin 19 f PUBLIC HEALTH NURSING* 20 The Health Bulleti>' January, 1926 be accomplished with systematic visita-tions by a trained personnel to advise them regai'ding general and personal hygiene. In order to try out his theories in a practical way and to see whether the suffering and misery of the sick could not be alleviated by proper nursing and home conditions improved by instruc-tions in hygiene, he employed a nurse who had been attending his wife, and at his own expense, obtained her co-opei- ation in making these visits. The reports of these visits are most interesting. We learn that the nurse was instructed not only to give nursing care to the sick, but to teach the fami-lies how to take care of themselves and of their own sick and how to lead the proper kind of lives. So here again we find social service work inevitably bound up with visiting nursing, the public-health nurse becoming the social service worker as well. The results of this feeble beginning wex-e so satisfactory that, in 1859, with the aid of Miss Nightingale, other nurses were put on dutj' and of course the work grew. In reviewing an account of this work, we have found a tendency and a right one, to get away as far as possible from actual medication and to empha-size to the limit public-health hygiene and prophylaxis, even though the knowledge of the prevention of infec-tious diseases in that day and time was meager. We read that, in those times, nurses were "urged over and over again'' not to pauperize the patient by giving medical comforts unless they were actually necessary. Florence Nightingale also saw this danger and said : "If district nurses begin by giv-ing relief they will end by doing noth-ing but giving relief." In modern public-health nursing of today we are, in the same way, caution-ing the public health nurse not to fall into the error of practicing, to a great extent at least, bedside treatment—to remember that her duty is to preach prevention and to leave the treatment end of the disease to the practical nurse or practitioner. Public-health nursing in this country was rather slow in developing. In 1828 Doctor Warrington, of Philadelphia, on-ly 23 years of age, inaugurated the so-ciety of district nursing. At first it was merely for the purpose of qualified nursing attendance to poor women in childbirth, but the work was gradually extended to take care of all classes of cases. The first charter of this organ-ization read: (to) "Provide, sustain, and cause to be instructed, as far as iwssible. pious and prudent women as nurses, it being understood that the as-sociation does not confine itself to the supply of monthly nurses only, but for every variety of sickness of patients.'" A district nursing organization was started in Boston in 1886, and in 1888 the association was incorporated under the name "Instructive District Nursing Association," with the purpose not only of caring for the sick but for giving them instruction in home nursing and public health. The objects of the asso-ciation were stated to be — 1. To provide and support thor-oughly trained nurses who, acting under the immediate direction of the out-patient physicians of the Boston Dispensary, shall care for the sick poor in their own homes instead of in hospitals. 2. By precept and example to give such insti'uction to the fami-lies which they are called upon to visit as shall enable them hence-forth to take better care of them-selves and their neighbors by ob-serving the rules of wholesome liv-ing and by practicing the simple arts of domestic nursing. So, again, we see that the idea of public-health instruction as a funda-mental and most important duty of public health nursing was all promi-nent. This phase was being gradually accepted by all as the most sensible way of carrying on public health nurs-ing, the nurse thinking more of the community as a patient than of the individual sick. In 1893 Isabel Hampton, in an ad-dress to the International Congress of Nurses, said : In district nursing we are con-fronted with conditions which re-quire the highest order of work, but the actual nursing of the pa-tient is the least part of what her work and influence should be among the class which the nurse January, 1926 The Health Bulletin 21 will meet with. To this brauch of nursing: no more appropriate name can be given than "Instructive nursing,"' for educational, in the best sense of the word, it should be. The first special work in district nursing was undertaken in London in 1892, when a staff of visiting nurses was organized to visit the schools and inspect school children. However, the honor of inaugurating school nursing in America is due to Miss Wald. found-er of the Henry Street Settlement, who in 1902 suggested the use of nurses to supplement the work of doctors in the schools of New York. Medical inspec-tion of school children had been in vogue in the schools before that time, but it was merely a perfunctory exami-nation by a physician, the only thing accomplished being the exclusion of the child, nothing being done to prevent the cause of the illness, or a visitation at the homes of the school children to carry the principle and gospel of pre-vention of disabling illnesses. During these times of demonstrations in public health nursing and the ai'ous-ing of public interest in these demon-strations, gradual progress was being made in the requirements of those who wi.shed to enter the nursing and medi-cal professions. While nursing was reaching the plane which it has now attained as a profession, wonderful strides were being made in the medical profession toward the prevention of diseases, such as the use of antitoxin against diphtheria, inoculation to pre-vent typhoid fever, and the valuable work now being carried on toward the standardization of antitoxin against scarlet fever. The dangers of neglected teeth, the tonsil and adenoid evil, and the value of scientific baby care began to be considered by the laity along with their previous ideas of safeguarding the health of cattle and hogs. Dental prophylaxis, the outline of programs for prenatal hygiene, and the development of intensive school pro-grams are all accomplishments which demand highly trained nurses in the public-health field for service in all recognized full-time health departments. In the early history of public-health nursing we find that it had its incep-tion in centers of population — the cities. Those who lived in the country and in rural districts were indeed deemed fortunate. Living in the coun-try (and the same idea has held to the present day) was thought to be a pro-tection against sickness. For this rea-son public health of rural communities has been, and still is, greatly neglected. Thirteen years ago there was not one full-time county health department in. the United States among the three thousand and odd counties composing this country. We finally awoke to the fact that a real health problem existed in the coun-try, and one of even greater importance than the urban health question. The death rate was higher, the morbidity index was higher, and the rural dweller did not have a protected water supply, a protected milk supply, or proper methods of sewage disposal, as pro-vided by ordinances in cities. There-fore, he drifted along by himself, con-tracting typhoid fever from his own water supply, polluted by his own sew-age, and blaming the causation of the disease on God. the devil, tin cans, weeds, or whatever came to his mind. It took us a long time to realize these things, but since that realization full-time county health units have been organized and are in operation in over 280 counties in the country, with new ones developing every year through the financial cooperation of the Unite<i States Public Health Service, the In-ternational Health Board, and the State boards of health. I know of no greater service in pub-lic- health nursing than is given by nurses working in full-time county health units. Nor do I know of any better way in which a nurse can pro-duce real service in virgin fields than in this branch of nursing work, which in itself is a specialized branch of the profession. Just because an individual has M D. after his name is no index at all that he will make a health officer ; just be-cause an individual has R.N. after her name is no index that she will make a good public-health nurse. In both instances it is ab.solutely essential that certain periods of training and practi-cal experience be undertaken before the proper qualifications can be attained in this special field. The great difficulty 22 The Health Bulletin January, 1926 experienced in the development of full-time county health departments is to find properly qualified public-health of-ficers and properly qualified public-health nurses. The part which the public-health nurse of today plays in the general scheme of full-time health service—mu-nicipal or rural—is elaborated very • much in detail in a report of the "Com-mittee to Study Visiting Nursing," in-stigated by the National Organization for Public Health Nursing, with the as-sistance of the Metropolitan Life Insur-ance Co. This committee, in an effort to valu-ate the present status of visiting nurse associations and learn their cost, made a study of public-health nursing in 14 communities in various localities of the United States, including rural nursing as well as work in large and small cities. The various types of nursing work carried out in the various cities were as follows : Maternity nursing: Prenatal. Delivery. Postpartum. Infant welfare. Child welfare (preschool) : Orthopedic. Nutrition. School nursing. G neral medical and surgical nursing. Acute communicable disease nursing : Tuberculosis nursing. Venereal disease nursing. Health education. Industrial nursing. Nursing of chronics. Mental hygiene. In the summary of conclusions and recommendations in this exhaustive re-port it is recommended that — 1. Every agency should have an established routine for introducing new nurses into the work of the agency. 2. In addition to the initial period, there should be a more or less continu-ous staff educational program. 3. Adequate supervision is essential to the efficient admiqistration of every public health nursing agency. Of course there are other recommen-dations regarding the cost of nursing and routine methods of operation, but I mention the above to emphasize that, in present-day programs, there is a con-tinual cry for well-trained personnel, in realization of the fact that public-health nursing is indeed a separate and distinct specialty of your profession. Last year the United States Public Health Service, through Miss Lucy Min-nigerode, superintendent of nurses, sent a questionnaire to all State depart-ments of health, in order to obtain in-formation as to the status of public-health nursing as it is carried on by the several States. It was learned that 17 States and the Philippine Islands have separate divi-sions or bureaus of public-health nurs-ing ; 8 States have bureaus of public-health nursing and child hygiene com-bined ; 10 States have only bureaus of child hygiene; and 11 States and Alaska have no bureau of nursing of any description. A few .States were not heard from. The duties performed by the nurses in these State health departments in-cluded the follo\\'ing: 1. Child health conferences and dem-onstrations. 2. Organization of volunteer services. 3. Classes for midwives and mothers, with prenatal instructions. 4. School nursing, physical examina-tion of school children, inspections. 5. Health educational work and health talks. 6. Follow up of clinic and school cases. 7. Maternal and infant hygiene under the Sheppard-Towner Act. It might not be amiss to give verba-tim a few quotations from some of the State health otiicers regarding their ideas of public-health nursing as an aid in the State health program. One health officer said : "Public-health nursing is an in-dispensable aid, since the success of the entire program depends upon education of the public, and the public-health nurse is the best teaching agent we have yet found for dealing with individuals and families in the home." Another said : "Next to an efficient director, an efficient public-health nurse is the January, 1926 The Health Bulletin 23 most important part of any public-health unit." Still another : "It would take a manuscript to answer such a question as this." And another : "Much of the program of the State board of health is made pos-sible through the cooperation of local public health nursing ser-vices." With the need for public-health nurses, which we all can appreciate to-day, it is hoped that the time is not far distant when theoretical and prac-tical teaching in the public-health field will be a part of the nurse's training. At least the problem can be given to the probationer ; and if she feels the call of the public-health field, provision should be made to have her located with successfully functioning units, in order to get practical training to sup-plement her lectures. A start has been made in courses in public-health nursing which are in vogue at certain universities in the country ; but the number offering these facilities is certainly all too few to sup-ply the demand now existing for this type of health endeavor. In the work of a State board of health, the fundamental problem is the rural one. For that reason much con-centration and labor are being ex-pended in the development of new full-time county health projects and the standardization of those now in opera-tion. No rural health unit is complete without a nurse or nurses on the staff. The duties of these nurses are familiar to all of you—visits to schools, assist-ing in the inoculation and vaccination of school children, visits to contagious-disease cases, assistance in the keeping of records, giving health talks, and the like. With these duties it is all-impera-tive that the rural health nurse develop an attitude of social service. Social service has been a much mis-used term because its practical applica-tion has not been conducive to the best results, at least in some places. Certainly social service has a place in the public-health nursing program. But all too often we are prone to think of social service in terms of social uplift. The average person visited resents any attitude on the part of the visiting agency implying that he needs to be uplifted socially, and we can hardly blame him. Social service should carry with it a neighborly and friendly ad-vice which will help the family out of their difficulties. For example, a visit-ing nurse finds a case of tuberculosis in a family. The wage earner in the family goes to work every day in the factory and is in such a condition that tuberculosis might easily develop. It is not enough merely to say that the in-dividual should seek another line of work where he would not be subjected to the stifling atmosphere of the fac-tory. Real social service goes a step farther and tries to find for that man a position which would be best appli-cable to his case. It is not meant that real social-ser-vice work should be the crowning duty of the public-health nurse, but a part of her duty which is so interwoven and so cemented with her work that she cannot escape it. This is especially so in the communities in which we are laboring. In our enthusiasm for better rural health work, there is always the danger of overdeveloping specialized health service. I have been in counties where I have found a nurse attached to the county health unit doing routine work ; a nurse on duty with the tuberculosis association, looking up tuberculosis cases for specific diagnosis ; a nurse placed on duty especially by the public schools of the county for the purpose of school inspection ; a nurse represent-ing the Red Cross; and, in some places the Metropolitan Life Insurance Co. is doing most valuable work in the public-health units among the policyholders of its company. The result of this specialized, official-ly uncorrelated service is confusing and overlapping; and, in my own mind, there is a question as to whether the maximum results can be obtained by such service. Only recently I was talk-ing to the health officer of a large city where various agencies were carrying on public-health work in this way. I was told by him that, in one day, a home which occupied a rather strategic position just outside of the city was visited by five different nurses. I can 24 The Health Bulletin January, 1926 imagine the feeling of the householder when the fifth nurse arrived. One visit should have been enough to ob-tain all of the information that all of these different agencies wished to learn. It is not desired that the individual-ity of these different organizations be taken away, but it is essential at least that they report their findings to the county health board or the county health officer as the case may be. If the health officer wishes a case of tu-berculosis investigated, there does not seem to be any valid reason why he should not call upon the tuberculosis nurse or the Red Cross nurse to assist in the work, and no valid reason why the nurse placed on duty by the school board should not assist in the school examinations. If this correlation existed, we would find, in many counties, smoothly work-ing machines with an adequate nursing force to take care of all their needs. As a matter of fact, in one of our Western States last year the county tuberculosis association actually amal-gamated with the county health unit in the support of its program and for the better attainment of the purposes of both the county health unit and the county tuberculosis association. As yet public-health nursing is in its infancy. The future holds unlimited service for this branch of your pro-fession. The difficulty is to find the workers ; and it is our duty as public-health workers to present this problem before the nursing profession with a plea for the "trained" worker. This plea has been continuous from the days of the early church ; it is urgent now and will be ever sounding in the future. (Note: An abstract of "Evolution of Public-Health Nursing," by Annie M. Brainard, furnished some of the his-torical data used in this article.) LOOK TO WHOLESOME HOME ENVIRONMENT Many a home environment which to the superficial student might possess the appearance of being wholesome is detrimental, declares Dr. Joseph H. Marcus, who writes about the dis-obedient child in the December Hygeia. Parental solicitude for the child's welfare may be carried to such ex-tremes as to undermine the physical state and lay the foundation of appre-hension, dread, sluggishness and torpor. Because of this subtle interaction be-tween the child's individual constitu-tion and the ideas and ideals generated in his home atmosphere, the familial factor must at all times be cautiously viewed when interpreting the manifes-tations of the child. Impressions register on the infantile brain, even though in an immature manner, and of sufficient depth to create a more or less lasting impression. The spoiled baby will cry for a defi-nite purpose ; he may wish to be picked up. When he is lifted from the crib, his cries cease with the first sensation of motion. When the 2 a. m. feeding is eliminated, the infant manifests his desire for the accustomed feeding by arousing the household. If a bottle of water or an attitude of healthy in-attention is substituted, the baby is im-pressed with the fact that his w'hims will not be responded to ; soon he will accept this change of routine as a mat-ter of course and go to sleep. Good Habits Formed in Cradle In the cradle lies the foundation of regularity in habits, and responsive-ness to sound habits. The human in-fant, in spite of the potentiality which he carries with him to develop into the reasoning adult, is by far the most help-less and dependable of infants ; he is subject not only to his own laws of development, but to experimentation with certain doctrines on the part of untrained parents. Parents Are Untrained Parents have access to a mass of trashy literature on the subject of bringing up children ; this literature usually ignores the fact that no two children are quite alike in all respects and that no method of child rearing has been devised which would meet the requirements of all cases. It may be difficult to train a child to take nourishment, to attend his physi-cal functions at certain convenient intervals, to go to sleep naturally with- January, 1926 The Health Bulletik 25 out the necessity of lulling influences such as swinging the bed or rocking the cradle. These babies from earliest in-fancy may manifest a certain amount of stubborness which becomes more firmly rooted with the passing of time, so that with the advent of childhood the negative phase is implanted with great depth, owing to the extreme flexi-bility in the parental attitude. These wilful, but otherwise normal, children dominate their parents with powerful traits inherent only to them and obvi-ous before the period of connected articulation. These children are even more commanding when their helpless-ness is accompanied by a few meaning-less tears. They are obstinate, but their wilfulness should be opposed by in-creased stubbornness in the parent. Parents Need Instmction The situation created by these nega-tive children necessitates instruction of the parents, in order that they may appreciate the point of psychology in-volved and help in eradicating the maladjustment. In order to combat the negative atti-tude, parents should relegate themselves more to the background, allowing the children free play. If punishment is necessary, the storm must be weathered by all means. The child should be lauded for his good qualities and should be told about those qualities which parents wish him to achieve. The child cannot too early be taught to face reality and learn to appreciate the fact that life is a process of adjust-ment. Training the infant in regular habits is essential to a happy adaptability in childhood and adolescence ; displaying an attitude of stubbornness more forci-ble and lasting than the child will eliminate many negative traits ; healthy inattention is an excellent form of medication. CHILDREN SPOILED BY TOO MUCH LOVE The most essential thing to the child's mental well-being is a happy relation-ship between the parents, says Dr. Smiley Blanton, who tells about the Minneapolis Child Guidance Clinic in the December Hygeia. Parents who are glossing over, for the sake of the child, a real antagonism for each other are rarely capable of the evenness of discipline and coopera-tion necessary to the child's develop-ment. But unkindness or lack of love for the child are often not a bit more destructive than too much love and solicitude. Sometimes parents are more demon-strative toward one child than they are toward another. Even though they may not love one child more than the others, they often pet and brag about him more. A girl, 5 years old—a very moody child—became seclusive and unhappy and no longer cared to play with chil-dren, but sat brooding, and even weep-ing. Careful study of the home situa-tion showed that this girl felt herself neglected by her parents because her younger sister, who is superficially brighter and more vivacious, received all the attention from the teachers, neighbors and relatives. If such a condition had been allowed to go on the older child might have grown up with a marked feeling of jealousy toward her younger sister ; moody, unhappy, and perhaps bitter to-ward every one. Nagging Brings Negativism Another interesting case was that of a little girl who was absolutely nega-tive to all commands. It was difficult to understand the extreme negativism of this child until we obtained a whole record of the family situation. The mother was an anxious person and nagged the children constantly. As a result of this, the child not only re-fused to obey any commands, but al-ways did the opposite of what her mother told her to do. This attitude on the part of the child was a perfectly normal one under the circumstances. It was the only way she had of defending her personality against the constant nagging and flood of unwise commands. 26 The Health Bulletin January, 1926 THE IMPORTANCE OF BEING A PARENT By D. a. Thom, M.D. To the child the parent should be companion, friend, and confidant. The parent whose little child brings all his troubles and doubts to him for solution has established a relationship of tre-mendous value. This can never be brought about if the parent's attitude is cold and repelling. A mother who is too busy to bother with a little child's nonsenses will never be bothered by his real problems. A child should be treated with as much courtesy as an adult. Children have affaiis and plans of their own which they are following. These plans are frequently utterly disregarded by the "grown-up." If they must be inter-fei'ed with, let it be with some explana-tion and consideration for the children. The small daughter of a young couple was playing contentedly on the hearth by her father's feet when her mother called from upstairs for her to come to bed. Two or three oiinutes more and Betty could have completed the task she had in hand and, had mother known this, she would have waited before call-ing her. With a quivering chin and eyes filled with tears Betty turned to her father saying, "But, Daddy, I don't want to go. I want to finish." Father could see the little girl's point, and his answer was, "That's too bad, Betty. Mother didn't know how near through you were, or she would have let you finish ; but never mind, 'orders is orders,' so run oft to bed." And off she went. In this way he showed that he sympathized with her in her disappoint-ment and that he expected her to meet it bravely, and he also upheld the mother in her request—all in a con-siaerate, understanding way. It might here be said that one of the fundamental . rules of child training should be that parents present a united front to the child. If differences in judgment occur, let them be settled in private. There is no finer or more important job than being a parent. This genera-tion or the next will not handle it per-fectly. There is a great deal to learn, but much will be accomplished if the approach to the problems of childhood is not blocked nor impeded by anger, fear, over-solicitude, or the idea that be-ing a parent means at all times being obeyed. Kindness, common sense, and an effort to understand the child's own attitude toward his difliculties will do much to bring about an intelligent solution for most of the problems. "The Bible says there is gnashing of teeth In hell. If these were sound teeth the outlook would not be so dis-couraging; but most people have de-cayed and sensitive teeth before they get to their final reward, and gnashing these doubtless serves to make hell live up to the advance notions." NO VENTILATION—SIX LIVES LOST Recently in a village in the eastern part of the State volunteer firemen, arriving at a burning bungalow shortly after midnight, are reported to have found every window tightly closed and securely fastened and the rooms fes-tooned with soot, presumably from two kerosene heaters. Huddled in corners were the bodies of the owner, his wife and four children. A fifth child, a girl of sixteen, escaped by breaking the glass in one of the windows. From such evidence as can be gath-ered it appears that a visitor left the house about an hour previous to the time when the flames were discovered ; that the family then retired leaving the two kerosene heaters burning and that no provision for ventilation of the bed-rooms was made. From the loca-tion of the bodies it is probable that the victims were partially asphyxiated when aroused by the flames. Whether or not the evidence as here recorded is in accord with the facts will probably never be known. The tragedy, however, should indelibly im-press two health rules on the mind of every person in the State, namely: never to retire without first extinguish-ing every flame except those in stand-ard heaters, stoves or ranges, and second, to have adequate ventilation in bed-rooms during hours of sleep.— Health Netcs, N. Y. January, 1926 The Health Bulletin 27 CARE OF THE TOOTHBRUSH Very few people know how to care for a toothbrush. When buying a toothbrush gret one that is small enough to reach the back surface of the last tooth in the mouth and that will go under the tongue when cleaning the inside surfaces of the lower teeth. After using the brush rinse it well ; warm water, not hot, is best because all tooth powders and pastes have soap in them. Tooth paste has glycerine in it. These materials as well as the dirt and food left on it from the brushing should be washed out of the brush. Hang the brush in a clean, dry, and if possible sunny place. Never keep toothbrushes in a dusty dark corner. Cleanse the brush once a week. The best way to do this is to moisten the brush, and fill the bristles as full as possible with common salt. Then place the brush in a clean SUNNY spot. The chemical action produced by the sun, sterilizes the brush without ruining it as boiling will do. Many people keep two brushes in use all the time. This method is very good for those who do not like to use a soft brush. By being used every other time the brushes have plenty of time to dry and the bristles to stiffen. Discard any old brush that has be-come caked with dirt and tooth paste, at the base of the bundles of bristles. — Connecticut Health Bulletin. SEX HYGIENE The most important act of a liv-ing thing is the reproduction of itself. With its death all its interests stop, and nothing matters. With its reproduction its interests continue and give things their meaning. We have a long history of human life since Adam. It has been a continu-ous thing every moment since the beginning. But the long span of life has been lived only a generation at a time, by men and women who live only a comparatively short time. The continuation of life depends upon the renewing of it every few years. The sex act is the act by which the individual reproduces himself. It is the act which stops or continues life. And sex health largely deter-mines the quality of life which is passed on. As a link in the chain of the race, the boy and the girl are of sufficient importance to justify the use of any terms which are necessary to give them the information about themselves that they need in order to understand themselves and to solve their sex problems wisely. It is the duty of parents, teachers and physicians to give them this infor-mation early enough in life to make sure that they get it from intelligent, clean and serious people rather than from ignorant, lewd and frivolous ones, as they often do. As soon as the child manifests curiosity about such matters he should be told the simple truth, plainly and honestly. The lowest forms of life have only one cell, like a house of one brick. These forms reproduce by simple di-vision of one cell into two cells. No part dies or is lost. As we go up the scale we come to a type in which two cells unite and fuse to form one cell. This new cell then divides and redivides to form a greater number of cells. In still higher types the cells do not separate, each to itself, when they are split off, but stick together and arrange themselves, like bricks laid to form a house, according to a plan, to form a body like our own or like a tree. Then male and female types appear, and each one sets aside special cells to fuse with the special cells of the other. This fusion forms the new cell from which the new body grows. In the springtime the oak tree has two kinds of flowers One kind pro-duces the pollen or male cells. The other kind produces the female cells. The wind dusts the pollen on the female flower and the male cell com-bines with the female cell. A new cell forms and during the summer it develops into a small tree, so small that it is closely folded inside a thin shell, which is developed around it, and by fall it is an acorn. 28 The Health Bulletin January, 1926 The acorn is a small tree in a shell waiting for the proper conditions of the warmth and moisture of spring to make it burst its shell, sprout and grow. In chickens the rooster carries the male cell and the hen carries the female cell. By the union of these two cells in the hen a new cell is formed which collects yolk and white around it for food, and encloses it-self in a shell. In this form as a finished egg, it is laid by the hen. If this egg is kept at body tempera-ture by a hen or an incubator the re-productive cell in the egg grows, uses up the yolk and white of the egg for nourishment and in three weeks, steps out of the shell as a new chicken. In human beings the man carries the male cell and the woman the female cell. In the sex act the male cell is deposited where it finds its way to the female cell in the womb of the woman where the two cells unite to form a new cell from which a new baby grows. Instead of three weeks, as in the case of the chicken, in nine months a new baby steps out into the world. It is supplied with warmth and nourishment from the mother during this time. Birds, beasts and human beings all grow from a single cell, formed by the union of a special cell each from the male and the female. The sex organs of the man are the testicles in the scrotum, the seminal vesicles at the neck of the bladder and the penis. The male cells for reproduction are produced in the tes-ticles along with a secretion which carries them up into the seminal vesi-cles. In the sex act the seminal vesicles contract and force the secre-tion containing the cells for repro-duction, out into the urethra, through the penis to the entrance of the ute-rus of the woman. The sex organs of the woman are the uterus, a hollow muscular organ; two tubes, one on each side of the uterus, each leading from the cavity of the uterus to an ovary in each flank. The ovaries in the woman correspond to the testicles in the man. They produce the female cells for reproduction. These cells pass from the ovaries through the tubes to the cavity of the uterus. In or near the cavity of the uterus the male and female cells meet. They fuse to form a new cell. The new cell grows and forms a new baby. Now, that we understand the struc-ture of the sex organs, what will be the result if they become diseased? In the man, if the testicles are dis-eased, no cells will be produced. If the passages are closed by disease, the cells which are produced in the testicles cannot get out. And the man cannot become a father. In the woman, if the ovaries are diseased, no cells will be produced. If the tubes leading from the ovaries are closed by disease the cells which the ovaries produce cannot get out. And the woman cannot become a mother. The disease which most often causes these conditions is gonorrhea (clap). In the man it begins in the urethra and spreads backward to-ward the sex gland. It does not al-ways go this far, but it often does, and the consequences is castration. In the woman it begins in the ure-thra or in the entrance to the uterus and spreads upwards to the tubes and from the tubes outward to the ovaries. This is the usual course in women. The tubes become sealed off at both ends. Not only are the cells from the ovaries prevented from reaching the uterus, but the middle of the tube sealed off at the ends be-comes an abscess. Then she is a sick woman for life. An operation is the only cure, and in the operation it is often necessary to remove the ovaries with the tubes. Many of the tragedies of innocent married women are due to the mis-takes of well meaning but mistaken husbands. Men who have had gonor-rhea, but think that they are cured, marry with all feeling of safety. But in a year- or two a wife with one child or with no child at all fades and possibly becomes an invalid from sexual derangement. The man who thought he was well had the living germs of gonorrhea sleeping in his sex glands and in his sex acts they were thrown out and passed into the uterus of the woman. He has unin-tentionally given her the disease and January, 1926 The Health Bulletin 29 she and his children bear the penalty of his infection. Syphilis is a disease which is usu-ally transmitted in the sex act. It is a constitutional disease which affects the entire body and in its last stages it causes disease of the heart and arteries, and paralysis and insanity which are incurable. It is the dis-ease, spoken of in the Bible, which visits the sins of the father upon the third and fourth generations. The sex energy is the most vital energy of a living thing. In a man it determines whether he shall be a master or servant. A colt that is sexually healthy develops into a high grade spirited, strong horse that car-ries an arched neck and is anxious for a race. If a boy is castrated he will not make a successful football player nor lead his class in school. He lacks the secretions of his sex glands, which, if absorbed into his circulation would stimulate his nerves and brain and furnish him en-durance for hard work. If a boy spends his sex energy by self-abuse or in other sexual dissipation, the same thing happens. The vitality which should go to build nerve, brain and brawn is wasted. _Such men can-not father the strongest sons, and they themselves are not the leaders in their own communities. Until marriage all energy should be di-verted into channels of study and training for the fullest development of the body and the brain of the in-dividual. After marriage it will be divided between reproduction and the using of the faculties which he developed before his sex life began. Then when his sex life begins he is reproducing himself at his best. And the race is much stronger as the re-sult of the sex suppression, and the full development of the mind and the body of the individual before he turns his attention to his sex life. The company of fast and immoral people is unprofitable because it arouses passions which should re-main asleep and arrests mental de-velopment. It costs you your most valuable energy, for which there is nothing in return. In addition to arresting your development and dis-sipating your energy, it may incur disease which will destroy your abil-ity to become a parent. If girls are "fast" with you they are probably "fast" with others, although they may be clever enough to keep you from thinking so. Practically all prostitutes have gonorrhea or syph-ilis or both. Many men have no chil-dren or have blind and deformed children as the result of only one such party. A thing which is often misunder-stood and which quacks make much of, is seminal emissions at night. An occasional emission in the case of a man of clean life is perfectly normal. If the bladder becomes overfilled with water during sleep it presses upon the vesicles and may produce irritation enough to cause them to empty themselves. If there has been sexual excitement which overfills the vesicles with semen the discharge is still more likely to occur. If under such conditions the individual drinks coffe or whiskey or other stimulants which fills the bladder with urine and increases the irritability of the seminal vesicles a night seminal emission is even still more likely to occur. As many as three or four emissions may occur monthly without meaning anything abnormal, al-though some people do not have them at all. A temperate life of regular habits of eating, sleeping, bathing and exercise, and avoiding sexual ex-citement, is the best way to prevent them. No child should be permitted to grow up with a physical handicap which modern science can correct. Every child is entitled to a fair chance to make his way among his fellows with-out the limitations of which accom-pany a conspicuous, unsightly or dan-gerous deformity or defect.—C. N. Johnson, D.D.S., President-elect Ameri-can Dental Association. The study of healthful living must be more than personal and public hygiene concerned with physical and bodily health ; it must also deal with healthy mental life; and t( be complete it must touch sound health or social welfare of society. — Db. Mavbice Bige- LOW. 30 The Health Bulletin January, 1926 THE STORY OF THE BATH Mr. Lewis W. Britton, associate editor of the Domestic Engineering Publications of Cliicago, recently pre-pared for the New York State De-partment of Health "The Story of the Bath," which relates in semi-humorous vein the history of bath-ing from early times to the present. "This is not a bedtime story," said Br. Britton. "It is a bathtime story. Do you ever think, as you slip grace-fully on the soap, that the history of your bathtub reaches back into the days before people had soap on which to slip? There are, of course, stories of the bath that aren't true. I refer to the stories young boys tell of baths they take when not under a watchful eye. "When Egypt wore the crown of civilization, the Egyptians were fre-quent bathers; when Greece was the glory of the world, her bathing was the glory of the Greeks; when all roads led to Rome, all feet led to the Roman baths. "In Japan where everybody takes a bath a day and apologizes for not taking two, progress moves at a swift pace. In Russia, where mil-lions of people get only three baths in their whole lives—one after they are born, one before they are mar-ried, and one after they die—there is stagnation, poverty, misery. "So far as we know, the first bath-room was in the city of Cnossos, on the island of Crete, four thousand years ago. The ruins of a much later model, dating back only twenty-five hundred years, have been found in Tirgus, which is in Greece. "The Greeks were the first to use bath tubs, though the tubs they used were not tubs at all. They were bowls—overgrown punch bowls, you might say, which rested upon pedes-tals three feet high. They were large enough to hold the water for a bath, but not large enough to hold the bather. The bather stood on a stone slab, dipped water from a bowl and poured it over his body. The Greeks regarded warm water as weaken-ing —'effeminate' I think they called it—and so they took their baths cold. "Among other things, Moses taught hygiene, sanitation and the fine art of living. He knew that to keep clean is to prevent disease, and to prevent disease is to build a strong race of people. "The Roman bath was called Ther-ma, meaning heat, from which we get thermos—thermos bottle. The Ther-mas did not have canned music, elec-tric lights nor ash trays, but in mag-nificence, they outshone any club of this year of peace and plenty. "Rome knew only two classes of people—the washed and the un-washed. And then, as now, the un-washed were crowded beyond the pale of polite society. "The largest Therma covered a square mile of ground. The huge Diocletian could take care of thirty-two hundred bathers at one time, while the Caracalla, the finest of them all, had room for half as many. Besides hot and cold baths, the Ther-mas were provided with perspiring rooms, dressing rooms, swimming pools, athletic fields, gymnasiums, lecture halls, and places for rest, re-freshment and conversation. And there were Thermas for women as well as for men. "In those public baths the Romans exercised, kept their bodies clean, stimulated the circulation of their blood, rested, enjoyed the compan-ionship of their fellows and fed their souls with beautiful carvings of an-cient sculptors—all for one quad-rans, which in Uncle Sam's money, , would be one-fourth of one cent. "For six hundred years, so Pliny, the historian, says, Rome used no medicines but her baths. "A real Roman cleansing consisted of a sweat, a scrape and a shower. Or, as the invention of the shower ! was yet to be, perhaps 'pouring' is a better word. That is, after a sweat and scrape, water was poured over , the body until it was washed clean, j! Then came a massage or rubdown, \ followed by a good rest. Thus from i Rome, by the way of Turkey, arrived j the Turkish bath, which finally | reached America in 1865. i. January, 1926 Thk Health Bulletix 31 "A clean nation is a progressive nation, and a progressive nation is a ruling nation. But alas, alack, the thirst for power—the spirit of con-quest reaching out and out for more and more—and Rome crumbled, and progress crumbled with her. And the world went to sleep and slept for a thousand years, or to say it in an-other way, a thousand years without a bath. "A thousand years without a bath. Surely those were Dark Ages—dark with dirt. But wait: "The Order of the Bath, from whence emerged the Knights of the Bath, was a little pleasantry set agoing by Henry the Fourth of Eng-land in the year thirteen hundred ninety-nine. But was it a pleasan-try? One can never tell about an Englishman. Henry may have been serious. He lived in a serious time, and serious times make serious peo-ple. Europe was beginning to run its eyes and creep out of the filth of ten mouldy centuries Perhaps King Henry thought it time to wash up, which is to wake up. "In days of old, the knights were bold," so the poet wrote—but not bold enough to take a bath. Henry knew this. He knew that a knight shied at water like an elephant shies at a mouse. Hence the Order of the Bath. "Candidates for this order were selected by the King. But, before a candidate could be initiated, he must take a bath. Ah! there was the rub! "Having been led into the bath, and having survived the shock, the knight became a shining example to others, who, though less favored, were equally in need of water. "More than three thousand years after Moses went up into the moun-tain and forgot to come back, another teacher, John Wesley, the first Meth-odist, was riding along a road in England when he came to the dirty little village of Burslem. "It so happened that in Burslem there lived a poor, lame potter by the name of Josiah Wedgwood. This potter was to become the richest man in England, who up to that time had made his own fortune; also, he was to become the grandfather of Charles Darwin, the world's greatest scien-tist. "Now Wedgwood was a worker who mixed much teaching with his work. John Wesley drew rein as he saw Wedgwood trying to teach his potters the lesson Moses had tried to teach—that keeping clean increased health, which increases energy, which increases efficiency. And there, sit-ting on his horse, and seeing what he saw, Wesley spoke for the first time the now famous phrase: 'Clean-liness is next to Godliness.' "And Wedgwood looked up, smiled and added: 'Yes, and sometimes it is next to impossible.' "Great as we are, and smart as we are, we Americans have not moved so fast, sanitarily speaking. It is only a hundred years since the first pumping station in this country started to pump. Chicago was our first city to have a real sewerage system, and that was not until 1855. We had no public baths until 1891. Even today some families think so little of their bath tubs that they use them for coal or vegetable bins. "The science of living, or sanita-tion— they mean the same—has to do with heat, light, water, cleanli-ness and ventilation. And these have to do with the five most important things of life—comfort, health, am-bition, efficiency, happiness. Where sanitation is a stranger, sickness is a constant guest." It has been wisely said that spite and ill nature are the most expensive luxuries of life. We are continually in the presence of disease germs ; almo.st daily we are exposed to contagious or infectious diseases, yet the body in health is able to protect itself and ward off the casual agents of disease. The first general biological law or general attribute of living matter is that of self preserva-tion. The first biological acts of living protoplasm are, therefore, nutritional. For perfect health there must be ap-propriation, assimilation and elimina-tion.— Dr. Charles Clyde Sutter. FOR 1926 I RESOLVE IN ALL WAYS TO GUARD MY HEALTH AND TO DISCOVER WAYS AND MEANS OF BECOMING HEALTHIER AND HAPPIER AND THEREBY BE MORE USEFUL TO MYSELF AND THE STATE Putli5\ed h^ T/m N°KJI\ Qf^Lm^ 5TATL E)<?ARD s^AEALTA This Eiillelin. will be serxlfree to ar\-g citizen of "the 5tcrteupoATequest| Entered as second-class matter at postoffice at Raleigh, N. C, under Act of July 16, 1894, Published monthly at the office of the Secretary of the Board, Raleigh, N. O. Vol. XL,I FEBRUARY, 1926 No. 2 HEALTH—THE STATE'S GREATEST ASSET MEMBERS OP THE NORTH CAROLINA STATE BOARD OF HEALTH J. Howell Way, M.D., Pr('*.__Waynesville Cyeus Thompsox, M.D Jacksonville Richard H. Lewis, M.D., LL.D.—Raleigh E. J. Tucker, D.D.S Roxboro Thomas E. Anderson, M.D Statesville D. A. Stanton, M.D High Point A. J. Crowell, M.D Charlotte James P. Stowe, Ph.G Charlotte Charles O'H. Laughinghouse, M.D., Greenville EXECUTIVE STAFF G. M. Cooper, M.D., Acting Secretary. H. A. Taylor, M.D., Director Bureau Maternity and Infancy. C. N. SiSK, M.D., Director Bureau of County Health Work. C. A. Shore, M.D., Director State Laboratory of Hygiene. H. E. Miller, C.E., Chief of Bureau of Engineering and Inspection F. M. Register, M.D., Deputy State Registrar of Vital Statistics. M. L. TOWNSEND, M.D., Director Bureau of Health Education. FREE HEALTH LITERATURE The State Board of Health publishes monthly The Health Btjlletin, which will be sent free to any citizen requesting it. The Board also has available for distribution without charge special literature on the following subjects. Ask for any in which you may be interested. Adenoids and Tonsils Cancer Catarrah Care of the Baby Constipation Colds Clean-up Placards Chickenpox Diphtheria Don't Spit Placards Eyes Flies Fly Placards German Measles Hookworm Disease Infantile Paralysis Indigestion Influenza Malaria Measles Pellagra Public Health Laws Prenatal Care Sanitary Privies Scarlet Fever Smallpox Teeth Tuberculosis Tuberculosis Placards Typhoid Fever Typhoid Placards Venereal Diseases Water Supplies Whooping Cough FOR EXPECTANT MOTHERS The Bureau of Maternity and Infancy has prepared a series of monthly letters of advice for expectant mothers. These letters have been approved by the medical profession. They explain simply the care that should be taken during pregnancy and confinement, and have proved most helpful to a large number of women. If you want them for yourself or a friend, send name to the State Board of Health, and give approximate date of expected confinement. CONTENTS North Carolina Oysters 3 Five Thousand Deaths Without Medical Care 9 Fifteen Cases of Typhoid in One Faiiiily 13 Another County Sanatorium 13 Value of Milk and the Cost of Bottled Milk 14 lnl®ali Vol. XLI FEBRUARY, 1926 No. 2 NORTH CAROLINA OYSTERS A dainty morsel that will tickle ttie palate of the most fastidious epi-curean ! What? No oysters of the Atlantic coast are more luscious and none are more abso-lutely free from any possibility of con-tamination than are those taken from North Carolina waters. Throughout the entire length of the North Carolina coast line there extends a sand bank upon which the tides and storms of the mighty Atlantic beat. Be-hind this bank of sand (which varies in width from a few yards to three miles) there are sounds and bays, with relatively very shallow and quiet water. Back of this shallow water, on the mainland, are many miles of low-land and marsh, upon which there are no large cities and where the poptila-tion is sparse. These thousands of square miles of shallow water, fed daily through the inlets, by the tides, with fresh sea water, and isolated from human habitation, furnish an almost unlimited area for ideal oyster beds. These beds, protected from the ele-ments by a natural barrier, and pro-tected from pollution by a wide area of sparsely settled country, are capable of producing, and do produce a superior quality of shell fish perfectly safe for human consumption. For lack of concerted effort on the part of the oystermen this great North Cai-olina harvest has gone, year after year, to the advertised markets of other coast states. For this reason the oyster scare of last year, when cases of typhoid fever were traced to raw oysters, resulted in as great demoralization of the North Carolina oyster industry as it did in those regions containmg polluted beds. There was no justification for this, for North Carolina oysters were always pure and wholesome. The trouble was that they were sold under foreign brands from doubtful markets. The North Carolina Fisheries Com-mission knew, and the oystermen knew, that North Carolina oysters were safe and that they were suffering unjustly for the faults of others. The demoral-ized condition of the industry last year brought the state face to face with the necessity of proving this fact to the world. The experience was not only an expensive one to the producer, but deprived the consumer of an abundant supply of pure and wholesome food. It no doubt, however, was a blessing in disguise. It taught the state to market its own pure products under its own state brands. Assisted by the Governor to finance the plans, the State Board of Health, working in conjunction with the Fisheries Commission and directed by the United States Public Health Service, equipped one of the Commission's pa-trol boats, the "Pamlico," with labora-tory suitable for operating over North Carolina oyster beds, making bacterio-logical examinations of shell fish and run tests, and analysis of the top and bottom waters of the sounds. To date the reports of the results of the find-ings of the scientists on board show that there is not sufficient evidence of contamination to condemn a single bed where oysters are being taken. The entire area has now been covered and every North Cai-olina oyster has been proven beyond peradventure to be safe. With a proven safe original supply the next move was to throw additional safeguards around the handling of oysters on board the boats, in the shucking houses and canning plants. A survey has been made of these plants, The Health Bulletin February, 1926 MAP SHOWING DISTRIBUTION OF SHELLFISH PRODUCTION AND OYSTER SHUCKING HOUSES ALONG THE COAST OF NORTH CAROLINA LEGEND O^stlRS . ii'IiiS^i^ CLAMS ;'wi~":i\wtSS'!iji» OYSTERS ANo CLAMS ?!?:;Z<5SS.^f5! CANNING PLANT ^ SHUCKING HOUSE O A. J jL J I fC ^L 1 1 X_ Fehruary, 1926 The Health Bulletin Ab oyster boat on its way to join the fleet. An oyster fleet dredging oysters. The Health Bulletin February, 1926 The "Pamlico," a former patrol boat, equipped with complete laboratory, for the examination of shellfish, and making water analysis. An inside view of one side of the laboratory on the "Panilico." February, 1926 The Health Bulletin and the operators have been found to be very glad and anxious to provide every suggested measure, in the way of steam sterilizers, enamel pails, etc., intended for additional safety. Having secured a standard of safety complying with every sanitary require-ment it was next necessary to provide an inspection system and organization that would guarantee the maintenance of this condition. The laboratorv boat. Thus, whether sold within the state or taken without the state, every North Carolina oyster intended for market must pass this rigid inspection. Pure to start with, every step from bed to (able is carefully guarded. Although the catch last season was fully 33 l-39« less than normal because of the unfavorable publicity, and did not by any means exhaust the available supply, there were: A steaming plant on Core Sound. Oysters are not the only pure sea food handled at this port, see the fish nets drjdng on the reels in the foi-egi-ound. the "Pamlico" with its complete labora-tory equipment and competent labora-tory i)ersonnel, remains permanently on the job. A corps of inspectors in small power boats are scattered throughout the area and every cargo of oysters is inspected. An in.spection fee of 11/4 cents per bushel is charged, which sum is applied toward main-tenance of the sy.stem. At the time of inspection the insi>ector gives the skipper not only his tax receipt, but also a sanitary certificate. Before he can sell his cargo to shuckers or cau-ners he must produce this receipt and certificate. Since all oyster boats leav-ing North Carolina waters for other markets must pass through the Dismal Swamp canal, an insi)ector is stationed at the locks in this canal and no cargo of oysters can leave the state without complying with the law. Dredged in N. C. waters 301,095 bu. Exported in the shell.... 30,245 bu. Steamed within the state, but exported to to be sold under for-eign label 211,047 bu. Shucked within the state and exported fresh to be sold under foreign label 58,303 bu. Sold in shell within the state 1,500 bu. This brings us to the most lamentable phase of the oyster situation. Although North Carolina oysters are the best and purest on the market, the consumer has not been so advised. The above figures furnished by the Fisheries Commissioner for last season show that practically the entire North Carolina oyster crop was disposed of 8 The Health Bulletin February, 1926 incognito. Thirty thousand bushels were taken in the shell outside the state to be shucked and sold under a foreign label. About 270,000 bushels (one bushel or tub of best grade oysters will shuck about one gallon) were steamed or shucked within the state but taken out of the state without label to be marketed under a foreign label. Many of these were shipi>ed back into the state for consumption. The con-sumer really ate North Carolina oysters but thought he was getting an out-of-the-state product. With all this round about handling there is not only much delay in reach-ing the dealer, but the dealer pays an average of $1.00 per gallon more for North Carolina oysters which he buys from a Norfolk or Baltimore shipper than he would pay for the same oysters bought from a North Carolina shipper. The dealer can scarcely be blamed for this for he must supply what his customers call for—they are the ones who pay the bill. The customer has eaten "Norfolk" and "Baltimore" oysters so long (without knowing that in many instances they came from North Carolina waters) that he thinks he must have "Norfolk"' or "Baltimore" oysters. When consumers leaim the facts and call for "North Carolina oy.sters" the dealers will be glad to supply them. The appended list shows the name, address and permit number of 74 North Carolina packers and shippers. Ship-ping tins are now labeled "N. C. Permit No " When your dealer shows you a can with this label stamped in the tin or painted thereon you may be sure that the oysters it contained when it left the hands of the packer were safe for food. LIST OF OYSTER SHUCKERS AND PACKERS IN NORTH CAROLINA Name Addrex Permit Number Woodland & Company Southgate Packing Co Washington Fish Co George N. Ives G. W. Bowden. Lupton Fish and Oyster Co Reuben Williams -. George Baker George Moore P. Speight . E. S. Lupton ,/. S. F. McCotter Charles H. Squires _ J. W. Rollins... S. E. Styron Almon Hamilton Wilbert Lewis C. W. Greene ^-. Ford Seafood Company _. Manning Brothers Amos H. Dudley A. M. Boyd U. S. Boyd Swmdell-Fulford Co Norfolk-Southern Meat Market H. J. Shaw A. Marbley George Dudley .- John Henry Becton Elihu Boyd Stephen Davis Amos Dudley Walter Bell Pamlico Fish Company.. Morehead City. Beaufort Washington New Bern New Bern New Bern Belhaven Belhaven Washington New Bern New Bern Vandemere New Bern Manteo Davis New Bern Stacy New Bern Manteo New Bern Morehead City Morehead City Morehead City Washington New Bern New Bern Morehead City Morehead City Morehead City Morehead City Marshallberg... Morehead City Morehead City Washington N. C. N. C. N. C. N. C. N. C. N. C. N. C. N. C. N. C. N. C. N. C. N. C. N. C. N. C. N. C. N. C. N. C. N. C. N. C. N. C. N. C. N. C. N. C. N. C. N. C. N. C. N. C. N. C. February, 1926 The Health Bulletin LiIST OF OYSTER SHUCKERS AND PACKERS—Continued Permit Number Eastern Fish Company Henrietta Carter.. George R. Russell Henry Bryant James T. Salter Willis Seafood Co John Monroe Jim Tillery W. P.Boyd Finer Brothers Adams & Company Tom T. Lassiter C. H. Harris Tolson-Sniith Charles V. Webb Duffy Wade Haywood Bell Mott Hester Emma Dudley A. W. Walston Bert Tillery Delia Jones V. Taylor Packing Co. . Ernest Mattocks W. H. Varnum George Gorham R. T. Alford J. F. Morris & Son Frank Ewing T. J. Franks C. L. Bowden Lender Swindell W. 1. Wilson J. O. Bowden Jim Pigott X. M. Pigott A. H. Parker J. E. Hines J. L. Phillips E. .M. Chadwick Washington Morehead City Beaufort, R. F. D Morehead City Davis Beaufort Morehead City Morehead City Morehead City Morehead City Morehead City New Bern New Bern Morehead City Morehead City Morehead City Morehead City Morehead City Morehead City New Bern... Morehead City Morehead City Sealevel Morehead City Supply Washington Seagate New Bern Wilmington.. Seagate Wilmington James City Wilmington Wilmington Morehead City Shallotte Shallotte Seagate _.. Washington Gloucester C. 35 C. 36 C. 37 C. 38 C. 39 C. 40 C. 41 C. 42 C. 43 C. 44 C. 45 C. 46 C. 47 C. 48 C. 49 C. 50 C. 51 C. 52 C. 53 C. 54 C. 55 C. 56 C. 57 C. 58 C. 59 C. 67 C. 68 C. 69 C. 70 C. 71 C. 72 C. 73 C. 74 FIVE THOUSAND DEATHS WITHOUT MEDICAL CARE I During the year 1924 there were in North Carolina 5,515 persons who died without medical care. That is, there were this number whose death certifi-cate show no doctor attended them. In addition to this number tliere were many more for whom the doctor was called only at the last moment. In this case he signed the certificate but actually had not attended the patient during the illness. Many of these deaths could have been prevented by the aid of a physician. And this is the lamentable thing. What does it avail for medical science to be efficient in the curing of disease if medical science has no opportunity to exercise its skill? We cannot believe it was physically impossible for some physician to have reached practically every one of these imattended deaths. As a class, no pro-fession is more liberal with its services, therefore it is hardly probable that any one of these unattended deaths could not have gotten a physician had an ef-fort been made to do so, however poor the patient may have been. Furthermore, society is generally awake to the needs of its fellows and 10 The Health Bulletin February, 1926 provision is quite frequently made to care for ttiose, at public expense, wlio are themselves unable to bear the ex-pense. The only actual reason then for these unattended deaths is a matter of ignorance—or carelessness. Ignorance on the part of the family—or careless-ness on the part of society. Public sentiment througliout the state should be aroused to the degree that those responsible should be held in dis-gi'ace if they allow any person in the state to die without every effort being made to secure adequate medical care. Privilege brings responsibility and every person who is granted the privi-lege of wielding an influence in his community is held morally responsible for that influence. These are the per-sons— these intelligent persons with in-fluence— who are responsible for these five or six thousand unattended deaths each year in North Carolina. "Am I my brother's keeper?" is a question that must have an individual—a personal-answer. But privilege is never given except with commensurate responsi-bility. An incident comes to mind, of which the fact of every detail can be vouched for, which illustrates an almost uni-versal situation. The mother of nine children was taken seriously and mortally ill. The father was an honest, hi.rd-working man whose every efCort and every penny of earning was de-voted to his family. They lived in a rather densely populated and wealthy county. The sick mother was taken to a hospital where she remained until it seemed impossible for the father to raise more money to pay hospital bills. The phjsicians attending her were the best in the country but her malady could not be cured and she was taken home. One of the physicians who had seen her in the hospital, along with the other physicians, undertook to attend her at home, although he knew he could not in any possible way expect any pay, and knew that her illness would be prolonged. None of the surgeons who had attended her in the hospital had received any pay and did not ex-pect any. This physician visited her in the home 83 times. He took with him in consultation, at different times, six different physicians. He did, at the house, three minor operations which required the assistance of his ofiice nurse. The minimum total foes this doctor should have received for his services to that home would have been at least $300, yet he did the work as willingly and as efiiciently without re-ceiving one penny as if he had known the money was forthcoming. This case is no exception. Doctors are doing the same thing everywhere. In this case the responsibility was no more on this doctor as a citizen of his community than it was on every other citizen. The doctor pays his city, coun-ty, state and federal taxes, and is charged by his state a special tax of $25 per year for the "privilege"' of practicing medicine. The burden is a community burden and in this one case this doctor paid, in services and ex-pense, the equivalent of $300 tax, over and above all the other taxes which the butcher and baker and candlestick-maker had to pay. And he paid a special tax of $25 per year for the privilege of doing it. Today the doctor called ten miles in the country to see a deserving, but poor patient, will usually go, (doctors are human and there are some who would not go) but first he must drive by the filling station to get gas for his automobile. This he pays for in cash. Then he remembers that his medicine case needs filling, (for this is ten miles in the country) so he drives by the drug store, and some way even drug supply houses have a habit of insist-ing that drugs be paid for. Finally after taking two or three dollars in cash out of his pocket he goes to his patient. He returns with a clear con-science but wonders where he will get the price of a beefsteak and a loaf of bread to carry home for his supper. There were very few of these five or six thousand persons who died uilat-tended in this state in one year who could not have got medical aid in some manner. There is no spot in the state where you, who read this, could not have very soon got medical aid had your child, your wife or husband, or your parent been sick unto death. "Where there is a will there is a way" and YOU would have found a way. The responsibility is yours and mine to see that unattended deaths do not occur. As the matter now stands, the charity of the medical profession. February, 1926 The Health Bulletin 11 (freely offered to the needy individual, but NOT to the well-to-do city, county or state) may have to be accepted. As soon as arrangements can be made, the burden should be distributed to the shoulders of those whose duty it is to bear it. The county hospital is one plan advocated by many, and is a plan which deserves the most serious con-sideration. The following table is appended purely as a statement of facts. There is no intent to make comparisons and no need of further comment. Table showing the total number of deaths during 1924 by race and by counties. ALso showing the number of deaths
Object Description
Description
Title | Health bulletin |
Other Title | Bulletin of the North Carolina State Board of Health; Bulletin of the North Carolina Board of Health |
Creator | North Carolina. State Board of Health. |
Date | 1926 |
Subjects |
Children--Health and hygiene Diseases Hygiene Public Health--North Carolina--Periodicals Sanitation |
Place | North Carolina, United States |
Time Period | (1900-1929) North Carolina's industrial revolution and World War One |
Description | Volume 41, Issues 1-12. Issues for Feb.-May 1917 and for Jan.-July 1918 not published. |
Publisher | Raleigh,North Carolina State Board of Health. |
Agency-Current | North Carolina Department of Health and Human Services |
Rights | State Document see http://digital.ncdcr.gov/u?/p249901coll22,63754 |
Physical Characteristics | 61 v. :ill. ;23 cm. |
Collection | Health Sciences Library, University of North Carolina at Chapel Hill |
Type | text |
Language | English |
Format | Bulletins |
Digital Characteristics-A | 24,547 KB; 342 p. |
Digital Collection |
Ensuring Democracy through Digital Access, a North Carolina LSTA-funded grant project North Carolina Digital State Documents Collection |
Digital Format | application/pdf |
Related Items | Imprint varies: published later at Raleigh, N.C. |
Title Replaces | Bulletin of the North Carolina Board of Health** |
Audience | All |
Pres File Name-M | pubs_edp_healthbulletin1926.pdf |
Pres Local File Path-M | \Preservation_content\StatePubs\pubs_edp\images_master\ |
Full Text | UN C CH HEALTH SCIENCES LIBRARY H00352060G i' ^bt Libtarp of t^t ^nitjersitp of H^ortb Carolina CnliotoeD b? ^^e SDiaUctic ano PSilantSropic &ocietie0 rsi86W v.5B-4» McJ. I.b. This hooh must not be taken from the Library building. 5^ LUNC-15M N.36 OP-13370 DIVISION OF DOCUMENTSt WASHIfJGTON, D. C. PuTDlislyedbH inL. N°KJI\QP^UMIK STATE. DPARDs^AE^LTA 1 Th)5 Bu]1elir\willbe 5er\t free to arwj citizen of Ihe 5tcrte upoi\ request j Entered as second-class matter at postogice at Raleigh, N. C, under Act of July 16, 1894, Published monthly at the office of the Secretary of the Board, Raleigh, N. C. Vol. XLI JANUARY, 1926 No. 1 HEALTH—THE STATE'S GREATEST ASSET MEMBERS OF THE NORTH CAROLINA STATE BOARD OF HEALTH J. Howell Wat, M.D., Pres Waynesville Cyrus Thompson, M.D Jacksonville Richard H. Lewis, M.D., LL.D. Raleigh E. J. Tucker, D.D.S Roxboro Thomas E. Anderson, M.D Statesville D. A. Stanton, M.D High Point A. J. Crowell, M.D Charlotte James P. Stowe, Ph.G Charlotte Charles O'H. Laughinghouse, M.D., Greenville EXECUTIVE STAFF G. M. Cooper, M.D., Assistant Secretary. H. A. Taylor, M.D., Deputy State Health Officer. C. A. Shore, M.D., Director State Laboratory of Hygiene. H. E. Miller, C.E., Chief of Bureau of Engineering and Inspection F. M. Reglster, M.D., Deputy State Registrar of Vital Statistics. M. L. Townsend, M.D., Director Bureau of Health Education. FREE HEALTH LITERATURE The State Board of Health publishes monthly The Health Bulletin, which will be sent free to any citizen requesting it. The Board also has available for distribution without charge special literature on the following subjects. Ask for any in which you may be interested. Adenoids and Tonsils Cancer Catarrah Care of the Baby Constipation Colds Clean-up Placards Chickenpox Diiihtheria Don't Spit Placards E.\es Flies Fly Placards German Measles Hookworm Dif-ease Infantile Paralysis Indigestion Influenza Malaria Measles Pellagra Public Health Laws Prenatal Care Sanitary Privies Scarlet Fever Smallpox Teeth Tuberculosis Tuberculosis Placards Typhoid Fever Typhoid Placards Venereal Diseases Water Sup])lies Whooping Cough FOR EXPECTANT MOTHERS The Bureau of Maternity and Infancy has prepared a series of monthly letters of advice for expectant mothers. These letters have been approved by the medical profession. They explain simply the care that should be taken during pregnancy and confinement, and have proved most helpful to a large number of \yomen. If you want them for yourself or a friend, send name to the State Board of Health, and give approximate date of expected confinement. CONTENTS Pneumonia 3 Biliousness 3 "I Never Thought of That" 5 Winning the Typhoid Fight 7 Condensed and Evapora ed Milk -Tr^ll The Advancing Knowledge ol" Cancer-- 14 ^e¥ Hr^len Public Health Nursing- Look to Wholesome Home Environment 24 Children Spoiled by too Much Love 25 Importance of Being a Parent 26 No Ventilation—Six Lives Lost 26 "Care^mw-'Iloothbrush 27 27 ;he Bath 30 RECEtVCO 19 The Story of JAN 1 f) 1926 nor~l IftiiPibi-re r\*\, ttLit-\%A I PU5LI5ALD BY TML nQR.TA CAgOLIhA 5TATE. BOAfgP g^MLALTM I Vol. Xlil JANUARY, 1926 No. 1 PNEUMONIA We are just now reaching the season when pneumonia is beginning to talce its most territic toll of human life. During January, February and March more people die from this disease than during the remaining nine months of the year. During these three months of 192.5 pneumonia killed, in North Carolina, at the rate of over five hun-dred per month. If you live in a village of five hun-dred people, think of an entire village tlie size of yours, men, women and chil-dren, being completely wiped off the map in this State each month during January, February and March. Re-member that is just what this one dibcase, pneumonia, is doing. The total is approximately 3,000 deaths per year. Pneumonia can much more easily be prevented than cured and prevention is a personal matter depending on each individual. The doctor will do all he possibly can to relieve a patient that is sick, but preventing the disease is a matter entirely in the hands of the in-dividual. The doctor cannot do that for him any more than he could eat his food for him or sleep for him. In one series of 1408 pneumonia pa-tients, taking them as they came 852 gave a history of having been ill with a common cold for several days previ-ous to the development of pneumonia. Some important measures in prevent-ing pneumonia which every one should know are : 1. Consider seriously and treat ade-quately all "common colds." 2. Dress to suit the weather, remem-bering that clothing is for protection, rather than alone for adornment. 3. Avoid sudden chilling, wet feet and wet clothing. 4. Vitality, or resistance to infection, is greatly lowered by lack of exercise, excessive fatigue, loss of sleep, excesses of any kind, and poor food. During dangerous seasons be especial-ly careful to maintain vitality at its very highest. 5. Avoid all unnecessary contact with persons sick with pneumonia, flu or colds. They are contagious. 6. Keep hands clean. 7. Do not let fingers or anything else except proper food and drink enter the mouth or touch the lips. 8. Avoid overheating of living rooms and be assured that there is ample ventilation to keep the air fresh. BILIOUSNESS The term "biliousness" may not be a strictly scientific word but hearing it calls to the mind of every man, woman and older child in North Carolina a certain definite and unhappy picture. By whatever name it may be called there is lack of appetite, a sense of malaise, indisposition to either mental or physical activity, drowsiness, often giddiness, a bad taste in the mouth and a bad breath, the tongue is cov-ered with a rather thick slimy coating, there is inactivity of the bowels and a peculiar "bilious" color in the skin, dark circles under the eyes and usually there is a severe and distressing head-ache. Sooner or later there will be nausea and vomiting. The vomited matter is a liquid, yellow, or greenish yellow in color and as "bitter as gall." This condition has been seen by every one and experienced by most persons. The Health Bulletin January, 1920 A condition of this sort confronts the "family doctor" more often, perhaps, than all others combined. Gallstones forming in the gall blad-der sometimes stop up the gall ducts and prevent the flow of bile into the in-testines. This dammed up bile is then reabsorbed into the blood and carried throughout the system and deposited in every tissue of the body. .This de-posited bile pigment is what gives to the skin and the whites of the eyes that "yellow as a pumpkin" jaundiced color. In at least a great many cases of so-called "biliousness" there is a slightly analagous condition caused by a con-centration of the bile. This interferes with its normal flow and results in its reabsorption into the blood, to be partly deposited in the tissues and partly to be re-eliminated by the liver. With each cycle, of course, it becomes more and more concentrated. In biliousness the bile is not dammed up as in gall-stones but because of the impeded flow of the thickened bile there is re-absorption into the blood and a deposit of bile pigment into the tissues. Because of the inactivity of the bowels in this condition there is neces-sarily a reabsorption also of the poisons from uneliminated waste in the intes-tines and this poison or toxin together with the reabsorbed bile gives rise to many of the symptoms noticed. Inseparably linked with the word biliousness is that other word, calomel. Calomel has a double action. It is a purgative and also a cholagogue (bile driver), hence calomel in "biliousness" empties the intestinal tract and also liquefies the bile and stimulates the liver cells to excrete more bile. Thus with the intestines emptied the bile ducts and gall bladder emptied and the liver cells filtering out of the blood the accumulated bile the condition speedily clears up. Calomel, however, has its disadvant-ages. It is of itself a very poor pur-gative and should never be taken, ex-cept upon the specific advice of a phy-sician. When taken into the stomach and absorbed into the blood it is an excellent stimulant to liver activity. Its absorption is rather slow, hence should be taken in the minimum needed doses to accomplish this purpose and given time to be absorbed before a purgative is taken to empty the bowels. Epsom salts and castor oil are ex-cellent purgatives. They do quickly and thoroughly empty the intestinal tract but they have no stimulating ac-tion on the liver and do not liquefy the bile. These drugs by themselves will not clear up the symptoms of the con-dition popularly known as biliousness. If, however, the bowel contents are never allowed to stagnate, then bilious-ness is much less likely to occur, and such drugs are much more valuable in preventing biliousness than in curing it. In recent years a mechanical method has been devised of draining the gall bladder without the use of purgation. It consists in the passage of a small tube by swallowing it very like a stomach tube through the stomach and into the duodenum (the upper small in-testine). The procedure is simple and usually gives the patient little incon-venience but does require some time. In cases where indicated it often gives most happy results. "Biliousness" may not be the proper name for it but the condition described is very real and very common. It is relieved by anything that empties the bowels to stop further toxemia and by emptying the gall bladder and clearing from the body tissues the accumulated bile and waste iwisons. The health oflicer who operates in a community where a substantial propor-tion of the citizens have received basic instruction in preventing disease and in the general activities of the health department is able to accomplish re-sults in the saving of lives of which we have scarcely dreamed in the phil-osophy of the past. — Dr. Ray Lyman Wilbur. Education is the basis on which any dental health program should be de-veloped. It should begin in the pre-natal clinics and should extend through the school life of the child. Filling a cavity is palliative treatment unless ! one understands and practices the | fundamentals of preventive dentistry. | —William A. Griffin, D. D. S. January, 1926 The Health Bulletin ''I NEVER THOUGHT OF THAT" One Reason Why Over Ten Thousand People Die Each Year in the State From Deg-enerative Diseases is Just Plain Carelessness "Hello, Sam, what's wrong with you? Been in a wreck?" That was the greeting of a fi-iend as Sam Jones limped painfully along to-wards his office on a snappy December morning. "No, nothing like that, Bob," Sam replied. "Fact is, it's nothing but a touch of rheumatism. Sure is talking to me this morning, though. Been troubling me a little in that left knee for some little time. Now it's moved on up into the hip, and it's just about all I can do to travel this morning." "What are you walking for? Where's the car?" Bob wanted to know. "It's over at the shop. I'm having it wne over thoroughly, like I do every three months. Say, Bob, that's the best investment I ever made. You know, I've had that car something over three years now, drive it pretty constantly, and repairs on it haven't amounted to hardly anything. Every three months I set it in the shop for an inspection, and they fix up what little minor trouble there may be, and it runs just as sweet now as it did when I got it. It's mighty good practice, and cheap insurance, I tell you." "How long since you have had a doc-tor look you over?" Bob inquired. "Let's see now, I don't believe I've had a doctor since I had the flu back in 1918. There's been nothing wrong with me except this rheumatism here lately." "Well, then, do you think more of your car than you do of yourself?" Bob wanted to know. "Or do you think at all? Here you have your car carefully looked over every three months to keep it from going bad, and you let your-self go for seven years. Why don't you apply the same reasoning to yourself as you do to your car? If you had you probably wouldn't be so crippled up with rheumatism that you can hardly walk down town. Besides, that rheuma-tism is only a symptom of something wrong inside. Better go right on over and have a careful examination made." "Bob, I reckon I'm just a plain fool, I never thought of that. I'm on my way right now." There are thousands in North Caro-lina just like Sam Jones. They go on day after day, and the days run into weeks, and months, and years, and they never think of giving their bodies a square deal. Their automobiles cost money, and so they spend money keep-ing them in good order, and spend money in preventing trouble from de-veloping. But only when sick, and too sick to work, do they seek relief. Then they want a quick job from the doctor, one that will put them back on their feet in a hurry, regardless of what may be the hidden trouble. At the beginning of another year, it is timely to suggest that a physical ac-counting be made. What are your health assets and liabilities, and how do your body accounts balance? You would not think of running your busi-ness without keeping some accounts, and the annual inventory is routine. Why run your body without getting at least a yearly balance to show if there are any losses or gains? It is a well-known fact that thou-sands of lives in infancy and childhood Lave been saved in the past few years by the spread of knowledge concerning the care of babies and child hygiene, and the medical inspection of school children. Not only have thousands of lives been saved, but these school chil-dren have been made healthier and more efficient in their school work. But while the death rate among chil-dren has been coming down rapidly, the death rate for adults has been climb-ing. We are saving infant life and wasting adult life. The "old age" diseases are creeping into middle life and carrying off men and women at the time when their lives are most useful, and when they should be enjoying life 6 The Health Bulletin January, 1926 to the fullest. At least a half million American citizens die annually from preventable or postponable diseases of the heart, arteries, kidneys and cancer. Here in North Carolina last year there occurred 11,964 deaths from a group of five preventable or curable diseases to vrhich persons of middle life It is estimated that 75 of each 100 deaths between the ages of 20 and 65 are caused by one of these diseases. The majority of the more than eleven thousand occurring from these causes were premature. They should have been prevented, cured, or postponed to be-yond seventy years of age. THOROUGH CHEST EXAMINATION Important part of physical examination to detect incipient tuberculosis. are especially susceptible. The figures Wonderful progress has been made are as follows : in North Carolina in improving the Nephritis 1,804 health of children; in the control of Heart Disease 3,661 the communicable diseases; in better- Apoplexy and arterio-scle- ing sanitary conditions throughout the rosis 2,509 State. There is much yet to be done. Cancer 1,289 however, and an imrwrtant next step Tuberculosis 2,701 must be towards the raising of the phy- • sical standard. By learning the lesson Total 11,964 of prevention we can get at these de- January, 1926 The Health Bulletin generative diseases in time to stop or cure them. Through a periodic physical examination, at least once a year, bodily defects and the early signs of the "breaking down" diseases of the heart, arteries and kidneys can be detected and the necessary remedy applied. The cost is negligible. Thirty minutes to an hour of your time, and a modest fee to the physician is all. The gain to you may be ten or twenty years of added life. It may be that you have no symptoms so far as you know, and don't feel sick, and yet a thorough physical inspection may reveal the first indications of a serious disease at the time when it may be headed off or cured. The 1,289 who died of cancer last year did not know they were sick until it was too late. Yet every one of them could have been saved had their trouble been discovered in time. Give j-ourself a square deal. Treat your body with as much care as you give to your car. Start the New Year with a physical inventory. / WINNING THE TYPHOID FIGHT How North Carolina Has Succeeded in Makings Typhoid Fever Comparatively Unknown in the State In the past eleven years the death rate from typhoid fever in North Caro-lina has been reduced by 72 per cent. From its position near the top in the United States the State has been pulled down to a place among those states having the least typhoid fever, and now heads the list of the Southern States with the lowest death rate fi-om this particular disease. To those whose memory goes back to the early days of the present century when typhoid fever was accepted as a natural accompaniment of the summer months, the question naturally arises, how has this disease been so nearly conquered? A prominent newspaper editor of the State last summer re-marked that he could remember when every week his paper carried the report of five or six or more deaths from ty-phoid, and now even a case in the county was unusual. The intensive fight against typhoid fever began in 1914, when definite plans were adopted to be carried into effect the following year. Vaccine for the prevention of typhoid fever had been thoroughly tested and its efficacy estab-lished. So the State Board of Health decided to attempt mass immunization on a large scale. Under the guidance of Doctor G. M. Cooper, then serving as director of rural sanitation for the Board, con-tracts were made with seventeen coun-ties under the terms of which the coun-ty authorities appropriated sums suf-ficient to pay the expenses of the field agents of the Board. Dispensary points in each county were selected that would be as convenient as possible for the people of each section to reach. An ad-vertising campaign designed to give full information with regard to the preva-lence of the disease, its dangers, and the means of prevention was inaugu-rated. In June the actual work was begun. In these counties a total of 52,000 complete inoculations were given that summer. That is, that many persons received three administrations of ty-phoid fever vaccine, the doses being given at intervals of one week. The response on the part of the people was enthusiastic. The results were much greater than had been anticipated, and this first year's campaign was consid-ered an unqualified success. For the first time in th-^ United States the effort had been made to reach a large mass of civilian population with preventive typhoid treatment. It was demonstrated that such a campaign could be successfully consummated. Due credit should be accorded the coun-ty authorities who made this preventive work possible, and to the citizens of those counties who so whole-heartedly responded. The seventeen counties were Alamance, Buncombe, Cabarrus, Cald-well, Craven, Cumberland, Durham, Edgecombe, Guilford, Henderson, New The Health Bulletin January, 1926 TABLE 1 Check mark indicates counties in wliich typhoid vaccination campaigns were conducted by State Board of Health, or local county health department, 1915-1925. Total complete vaccinations, 807,978. County January, 1926 The Health Bulletin TABLE 2 Twelve counties in which no typhoid vaccination campaigns was con-ducted, 1915-1925, showing death rate from typhoid fever by years for seven years, 1918-1924, inclusive. Cot7NTr 1£18 10 The Health Bulletin January, 1926 vear, the record complete being as fol-lows : 1915, 17; 1916, 15; 1917. 10; 1918, 14; 1919, 35; 1920, 32; 1921, 57; 1922, 53; 1923, 44; 1924, 48; 1925, 52. The frequency with which immuniza-tion campaigns have been conducted in individual counties is shown in the ac-companying table. It will be noted that in twelve of the counties there have been no campaigns throughout the pe-riod, while in some others there has been one each year continuously since the beginning of the work. Altogether for the eleven year period the State Board of Health has records showing 807,978 complete vaccinations. This in-cludes, of course, those persons who have followed the safe course and been re-vaccinated at intervals of three years. It does not include a large num-ber of inoculations given by physicians in the routine course of their practice. the number of which it is not possible to accurately estimate. Now all this was costly. It cost in time and energy and money. Did it justify itself in direct, tangible results? The answer is shown by the figures that follow. In 1914 the total deaths from typhoid in the State numbered 839, giving a death rate of 35.8 per 100,000 of popu-lation. In 1924 the deaths from typhoid in the State numbered 270, giving a death rate of 9.9 per 100,000 of popu-lation. The reduction in the death rate was 72 per cent. Or to put it another way, if no efforts had been made to eradicate typhoid fever, and the same death rate had prevailed in 1924 as in 1914, 967 citizens would have succumbed to the disease. For the year, as com-pared with eleven years previously, there was a saving of 697 lives, and ten times the saving in serious illness. The accumulated saving of lives year by year for the eleven years would total the population of a small- city. It has been noted that twelve coun-ties in the State have had no intensive anti-typhoid work. They are Ashe, Cherokee, Dare, Graham, Haywood, Jones, Macon, Madison, Pender, Polk, Transylvania and Tyrrell. These are nearly all located either in the moun-tains or on the coast, are small, and sparsely populated. The total popula-tion for the twelve Is only 155,521. No one of them contains any considerable groups of urban population. In such counties typhoid fever and other com-municable diseases would be expected only as sporadic cases, the opiwrtuni-ties for spread being extremely re-stricted. Against this group of twelve counties which have made no effort to eradicate typhoid fever may be compared a group of twelve others in which anti-typhoid efforts have been most continuous and intensive. These counties are Cabarrus, Cumberland, Durham, Guilford. New Hanover, Northampton, Pitt, Robeson. Rowan, Sampson, Wake and Wilson. Almost without exception the.se coun-ties are large and thickly populated. They contain many large groups of urban population, and present excellent opportunities for the quick spread of typhoid fever and other communicable diseases. The total population of these twelve is 589,358. Detailed statistics year by year for 1918-1924 inclusive are given for the two groups in an accompanying table. For convenience the first twelve, or those having had no anti-typhoid work, are called Group A. and the second twelve, or those having had the most intensive anti-typhoid work. Group B. The following is a comparative show-ing of the typhoid death rates in the two groups, the avei'ages for the seven years. 1918 1924 Reduction Group A .... 13.8 9.9 28% Group B .... 26.5 8.8 67% State 22.2 9.9 55% While the death rate dropped in the Group A counties from 13.8 to 9.9, a difference of 3.9, in the Group B coun-ties it dropped from 26.5 to 8.8., a dif-ference of 17.7. The comparison of the rates of reduction shows 39% greater reduction for the group of counties doing intensive work, and this in spite of their natural handicaps. From the showing made, it can be said that had the Group A counties made the same etScient efforts to eliminate typhoid as were made by Group B counties, then those counties now would be practically free from the disease. Expressing it in terms of total deaths rather than rates, in 1918 Group A counties had 29 deaths from typhoid and in 1924 they had 22, a difference January, 1926 The Health Bulletin 11 of only seven. Group B counties in 1918 had 128 deaths from typhoid and in 1924 had 56, a difference of 72. Had the same intensive anti-typhoid meas-ures been applied in Group A counties as were utilized by Group B counties, the results should have been certainly as successful, and probably more so be-cause of natural advantages in these counties. The same degree of reduction in typhoid would have meant a saving of 20 lives in these counties for 1924 as compared with 1918, instead of seven, and the sickness and loss sus-tained by having had about 150 pre-ventable cases of the disease. Consider-ing the nominal cost of securing ty-phoid vaccinations, it would appear that these counties practiced a false economy. Of course, other factors have con-tributed to the decline, in addition to the vaccinations that have been secured. Foremost among these other factors is the immensely improved sanitary conditions that have resulted from the enforcement of the sanitary privy law, enacted in 1919. The number of pro-tected public water supplies, and sew-erage systems, has been growing, and the total number of people so served more than doubled in the past ten years. Dependable milk control measures have been instituted by a number of communities. The general educational work of the Board has been amplified in character and has been constantly reaching an increasing number of peo-ple each year. But these additional factors affecting the typhoid death rate have been general, on a State-wide basis, so that the effect has been fairly evenly distributed over all counties. It would appear conclusive, therefore, that the determining factor in the reduction of the typhoid death rate in those coun-ties where it has been greatest has been the fact that a large portion of the population of those counties have been periodically vaccinated. Let us consider for a moment what a skillful owner of horses does for a very fine colt, the progeny of ex-traordinary parents—one that is worth 100 times as much as the average horse. His first consideration is to provide for it the right kind of food; food which experience has shown will be ample for the support of optimal growth and for the maintenance of health after growth is completed. Be-yond this he does little in any special way to look after its well-being other than to provide clean, wholesome sur-roundings and to give it an opportunity to take exercise as it desires. It is not put through a lot of contortions or made to lie on its back and kick its legs to get exercise of a suitable nature; it walks, trots or runs, it grows into a magnificent creature. It rests a great deal of the time.—E. V. McCOLLUM. The most important of the laws of health relates to the character and quality of our food. Second in impor-tance is the effectiveness with which we rest. I would put exercise third. — E. V. McCOLLTTM. CONDENSED AND EVAPORATED MILK Frank E. Rice, A.B., Ph.D., Professor of Biological and Agricultural Chemis-try, N. C. State College, Raleigh, N. C. There is much confusion in most peo-ple's minds regarding the various kinds of canned milk found on the market. Really there are two, and only two, kinds of concentrated liquid milk put up in tin cans, although there are sev-eral manufacturers' brands. Both con-tain considerably less water than is found in ordinary fresh cow's milk; both are, therefore, condensed milks. Both are made by evaporating part of the water from cow's milk; both are, consequently, evaporated milks. The main difference between them is that the one contains a large amount of added sugar, while the other does not. Sweetened condensed milk, or what is commonly called condensed milk, is very thick or viscous, and is yellowish ir. color; it contains 40 to 457o ordi- 12 The Health Bulletin January, 192G nary granulated sugar. Unsweetened condensed milk, which is ordinarily designated as evaporated milk, is about the consistency of light cream, and is darker in color than condensed milk ; it contains no added substance. Condensed milk is kept from spoiling by the sugar in it, just as fruit pre-serves and molasses i-emain good almost indefinitely. Evaiwrated milk, on the other hand, after being sealed into the can perfectly tight, is heated to a very high temperature to kill the bacteria. This process can be compared to the ordinary method of canning fruit. It is well known that when canned fruit is once opened and exposed to the air it will spoil unless kept on ice ; the same is true of evaporated milk. But the sweetened variety after opening keeps just as well as before; there is no more necessity for keeping it cold than for keeping honey and molasses cold in order to prevent spoilage. Of course, if left undisturbed for weeks a little mold may grow on the surface, but the main body of the milk is un-harmed and unchanged. During the process of manufacture of both condensed and evaporated milk, the raw cow's milk is subjected to high temperatures. There has always been a diversity of opinion as to whether heated milk is as nutritious as that which has not been heated. The argu-ments seem to center around these questions: (1) Are the vitamins de-stroyed? (2) Is the milk rendered less digestible? (3) Are there not some peculiar living substances in milk which are beneficial to our health, but which are killed on exposure to heat? With regard to these points there should be found some difference between evaporated and condensed milk because the former is heated much longer and to a higher temperature than the latter. Of the principal vitamins so far dis-covered, the scurvy-preventing vitamin is usually present in milk in relatively small amounts and it is most easily destroyed by heat. Evaporated milk can be expected to contain none of the anti-scurvy substance ; while one or two investigators have found a little of this vitamin in sweetened condensed milk, it cannot be considered an important factor. Although a great deal depends upon the care taken by the manufacturer in preparing his i)roduct, both kinds of canned milk can be expected to contain practically as much of the other vita-mins as raw milk. With regard to digestibility,-—a few investigators claim that raw milk is better, but the large majority vote in favor of milk that has been heated. Raw cow's milk forms a tough clot in the stomach, while heated milk becomes finely divided and on this account is more easily handled by that organ. The protein of heated milk has been found to be acted on more easily by the diges five enzymes. Besides this, in the pro-cess of manufacturing condensed and evaporated milk the fat is rendered very finely divided which makes it more digestible also. All this is more im-portant in considering the feeding of infants and invalids than healthy adults. To the latter, raw milk is just as digestible as cooked milk. The im-portant point just now is that there is nothing peculiar about the process of manufacturing canned milk that renders it any less easily handled by the digestive system than it was origi-nally. However, there is one point of warn-ing in this connection.—Any white sedi-ment which is found in the bottom of a can should be carefully stirred in with the rest of the milk. It has been found that the process of heating may render some of the important mineral salts insoluble and cause them to settle out. Merely mixing this material with the rest of the contents prevents any loss. Many people have thought that there are some mysterious living substances in cow's milk beneficial to digestion and the health of man. They have thought that by heating the milk these things are destroyed and we are thus deprived of their good effect. But this has proved to be only supposition ; cow's milk does not contain more than the slightest trace of any digestive enzyme, nor is there any specific substance that can be destroyed with heat, such as an immune body, which might assist the bodies of children or grown-ups to re-sist disease. In answering the three questions above propounded, condensed and evap-orated milks are found to compare January, 1926 The Health Bulletin 13 quite favorably with natural cow's milk iu nutritive value. The one big objection to the canned milks, of course, is the taste. A glass of milk made by mixing evaporated milk and water, half and half, may be just as nutritious as raw milk in most resjiects, but it doesn't suit the palate. The "cooked milk" taste may come out sometimes in puddings and soups. But it is not difficult to get into the habit of using milk pi'oducts from tins. Immediately after the Spanish- American War the condensed milk busi-ness grew more than at any previous time. The soldiers had gotten used to it, and introduced it to their families when they got home. There are a great many ways that condensed and evaporated milk can be used in food preparation wherein the taste does not usually prove objection-able : custards, puddings, sauces, cream soups, ice cream, cakes, for adding to coffee and cereals and for making cocoa. Many people like sweetened con-densed milk on pancakes instead of sirup. The next question is,—How does the cost of canned milk compare with bot-tled milk? At the "Cash and Carry" stores in Raleigh one pound tins of unsweetened evaiwrated milk cost 11 cents and 12 cents depending on the brand ; suppose we take ll\'-2 cents as the average. By mixing this with an equal amount of water two pounds of milk of average composition is obtained. This is about 93% of a quart, which makes a quart cost us about 12% cents. Therefore, if we are paying more than this for bottled milk we would be saving money by using evaporated canned milk as much as possible. At the charge and delivery stores ihe same can costs 14 or 15 cents. By using an average of 14i/^ cents and calculat-ing iu the same way we find that it would cost about 15 1/^ cents to make a quart. Buying evaporated milk in the small six-ounce tins is considerably more ex-pensive as would be expected. Sweetened condensed milk comes mostly in 14-ounce tins ; one well known brand is put up in 15-ounce tins and another in 11-ounce. The label may be expected to show the exact net contents of the can since the laws are very strict in this regard. The 14-ounce size was found to cost 16 cents, the 15-ounce 20 cents, and the 11-ounce 14 cents at most of the stores. An inspection of these figures shows that the 14-ounce size is by far the most economical. It is unnecessary and unwise to pay fancy prices for any particular brand of canned milk just because it is a little more widely adver-tised. The pure food laws and sanitary regulations nowadays are so strict that one can depend upon it that one manu-facturer's brand will be as good as an-other. Sweetened condensed milk contains 289o milk solids ; ordinary cow's milk about 12.75%. With these figures it can be calculated that to make a quart (2.15 pounds) of milk it will require 1% 14-ounce cans, or 18 cents worth. However, since the product contains about 43% sugar, worth 6V^ cents a pound, there is present 2% cents worth of sugar. This deducted from 18 cents leaves 151/^ cents as the cost of making the quart. To sum up then,—unsweetened evap-orated milk at 11 or 12 cents per pound can is equivalent to natural cow's milk at 12% cents a quart. The value of the milk in a 14-ounce can of sweetened condensed milk is equal to natural milk at 15V4 cents per quart. Most bottled milk costs well above these figures in Raleigh, and this is perhaps true of the whole State of North Carolina. It is evident, therefore, that it is economi-cal to use these canned milks in the place of bottled milk in most cases. As far as cash value is concerned these are the facts. But there are some distinct advantages of canned milk over bottled whole milk :—It can be de-pended on to be free from dangerous bacteria. No matter if the cows have tuberculosis or the milkers have scarlet fever, the germs of these diseases can-not survive the manufacturing process ; so the finished product will be free from them. There is likely to be less waste in the use of cauntnl milk ; that which is not used today can be used tomorrow. Ice is not necessary before the tin is opened, nor for the sweet-ened variety after opening ; but un-sweetened evaporated milk should not 14 The Health Bulletin January, 1926 be kept more than a day after opening unless ice is used. Of course, the big advantage that has always been recognized is the porta-bility of milk in tins. For camping trips and for children on trains it is readily carried and most useful. It was once true that only on such special occasions was it practicable to use milk in tins. Now, with the price of tinned milk low and bottled milk high, it is economical to use these products every day in the household, especially un-sweetened evaporated milk. Inasmuch as the nutritive value of the canned milks is equal to fresh milk in most respects, we may well urge its use in those districts where fresh milk cannot be obtained. It should be possible to prevent pellagra by rounding out the diet with canned milk as well as with fresh milk. Of course, for this as well as for all other maladies due to improper nutrition fresh milk is best, but if it is not available, by all means, let canned milk form a part of the diet. It is good, and the price is reason able. THE ADVANCING KNOWLEDGE OF CANCER By George A. Soper, Ph.D., Managing Director The American Society for the Control of Cancer Some months ago the humorous re-mark of a prominent physician to the effect that nobody knew anything about cancer, taken literally by a reporter and published in evei-y newspaper in the country, led the public to obtain an utterly wrong idea of the state of knowledge of this disease. The doctor's remark produced a hearty laugh among the many physi-cians who heard it, for there was not one who was not aware that the speak-er's knowledge of the subject was ex-tensive and detailed, nor failed to sym-pathize with him in his exasperation at the fact that the discovery of a specific cure for cancer continued to elude investigation. It is as absurd to say that nobody knows anything about life itself as to say that nothing is known about can-cer. A great many things are known about life and about cancer, but of course a great many things have es-caped patient study in each case. How much we think we know about any-thing depends a good deal upon our point of view. As the Chinese say, our knowledge is like a fan which, held close before our eyes, appears to com-prise the universe, but to the eyes of others usually forms but a very small part of it. The Existing Knowledge of Cancer The information which exists today in regard to cancer is not only more extensive but of more practical value than many persons suppose. It is suffi-cient, if put into effect, to reduce the present death toll by one-half among women and one-third among men. At least this is the opinion of Dr. Charles P. Childe, President in 1923 of the British Medical Association, a dis-tinguished student of the cancer prob-lem. If we apply this estimate to the num-ber of deaths from cancer which occur among men and women in the United States, we shall find that over 40,000 people perish needlessly from this dis-ease each year in this country. In other words, according to Di*. Childe's opin-ion, the lives of over 40,000 men and women, most of them fathers and moth-ers, many of them in the prime of life and at the period of their greatest usefulness, are annually sacrificed to the failure to turn the knowledge which exists concerning the prevention and cure of cancer to account. In many quarters fundamental facts are being collected which are adding to the sum total of information which scientists and practicing physicians possess as to the cause and cure of the disease, and progress is being made in another direction : the facts already in existence are becoming better under-stood. What is referred to here as the knowledge of cancer is the composite knowledge of those who are recognized ' Januury, 1926 The Health Bulletin 15 by the medical profession as qualified students of that disease. As Dr. Joseph Colt Bloodgood has said in a recent letter to the l^ew York Times, the in-formation on the cancer question which is of real value is not the opinion of one person however eminent or intelli-gent he may be, but the consensus of opinion of the world's authorities based on the recorded experience of clinical work and experimental research. The reviewer of a book, in which the claim was advanced that a specific had been found that is a preventive and a cure for cancer, said, "Cancer is such a serious matter for the world at large that the premature claim of having ar-rived at a solution of this problem and the unwarranted hope held out to cancer sufferers by such an optimistic statement is a matter for grave con-sideration." Persons who would like to examine for themselves into the amount and character of the existing knowledge of cancer cannot do better than to begin with the work of Dr. Jacob Wolff, fol-low this up with the latest edition of "Neoplastic Diseases" by Dr. James Ewing, Professor of Pathology at the Cornell Medical School, and the refer-ences to be found in the Index Medicus, and so to the article in the latest An-nual of the Encyclopedia Americana by Dr. Francis Carter Wood, Director of the Institute of Cancer Research of Columbia University. Dr. Wolff's work, called "Die Lehre von der Krebskrank-heit," is in three volumes and contains 2,626 pages; Dr. Ewing's book is 1,054 pages in length. How the Knowledge is Increasing It has been said that more progress has been made toward an understand-ing of cancer during the past fifty years than during the preceding five hundred years, from which it is fair to infer that the advance which has been ac-complished within the last fifty years has been revolutionary. The progress has been in more direc-tions than can be stated within the limits of this article. In the direction of causation may be mentioned the dis-covery that chronic irritation is almost invariably one of the leading factors in the production of cancer. As to cure, the use of X-rays and radium has furnished methods of treatment of in-calculable service. Surgical procedures have been developed to a point which is believed to leave little more to be ac-complished in this direction. With reference to prevention, the whole idea of preventing cancer by means of hy-gienic procedures and minor surgical and radiological treatments is not only new but of so much value as to lead many to think that cancer is more often preventable than curable. One of the results of the new knowl-edge is that cancer can now be more accurately diagnosed than formerly and inestimable advantages are following in consequence. One of these advan-tages lies in the fact that there is today little reason for physicians to postpone a decision in those early cases which come to them until a cure is no longer possible. Diagnoses are still difficult and not in-frequently impossible in many early cases, but in some of the most usual and most curable forms and locations in which cancer occurs they can generally be made with certainty while there is still time for the patient to be cured. Cancer of the skin, for example, can and should be diagnosed and cured in practically every case, providing the patient does his or her part. And so with cancer of the lip, cancer of the breast and cancer of the uterus. Cancer of the buccal cavity is more readily diagnosed than cured, although there are many persons alive today who can testify that cancer in this location is not hopeless, by any means. In fact, cancer has been successfully treated in practically every location. Value of Radium, X-rays and Surgery As time passes, a better understand-ing is being reached as to the relative efticacj^ of radium, X-rays and surgery and the several fields of usefulness of these methods of treatment are being more and more clearly defined. The details of skillful operations are being recorded with increasing accu-racy and completeness, and the records are being tabulated in larger numbers and studied with increasing care. Mind-ful of the fact that cancer may recur after long intervals of time, the health of persons who have been treated is being watched for manv vears to see 16 The Health Bulletin January, 1926 how permanent their cures have been. It has been possible to collect statistics covering hundreds of cases and com-pare the effects produced by radium and X-rays with those obtained by sui'gery in the treatment of cancer in the various parts of the body where it occurs. Thus for example there was published in 1924 the report of a com-mittee headed by Dr. Robert B. Green-ough, which had been appointed by the American College of Surgeons, in which nearly one thousand cases of cancer of the cervix of the uterus were brought together witli the object of determining the relative value of surgery, X-rays and radium for the cure of cancer in this particular location. In England, the Ministry of Health has published an analysis of 20,000 cases of cancer of the breast, the object being to determine by the record the efficacy of the various methods of treatment employed. So far as irradiation is concerned, the net result of all the information thus far collected is to show that, like surgery, radium and X-rays have a dis-tinct place in the treatment of cancer, not only for the cure of that disease but for the amelioration of the suffer-ing in incurable cases. Not infrequently surgical operations are advantageously preceded and succeeded, one or both, by this treatment. Institutions Devoted to Cancel* Research The scientific knowledge which lies at the basis of a true conception of the causation, prevention and cure of can-cer is being added to through such re-search institutions as the Institute of Cancer Research of Columbia Univers-ity, the State Institute for the Study of Malignant Disease at Buffalo, the Can-cer Commission of Harvard University, the Imperial Cancer Research Fund of England, and hospital and research organizations such as the Collis P. Huntington Memorial Hospital, Boston; the Memorial Hospital, the New York Skin and Cancer Hospital, and the New York City Cancer Institute, in New York City ; the Barnard Free Skin and Cancer Hospital, St. Louis; the Albert Steiner Ward for Cancer and Allied Diseases, Atlanta; the George Chase Christian Hospital and Clinic, Uni-versity of Minnesota, Minneapolis ; The American Oncologic Hospital, Philadel-phia ; The Pennsylvania Cancer Com-mission ; The Middlesex Hospital in England, and others. The total number of persons who are working constantly for the discovery of new facts which may be usefully em-ployed in the control of cancer is large. Many of them are surgeons, others radiologists, and not a few are out-and-out research workers giving their whole time to this work. Unlike quacks who work secretly and do not take anyone into their confidence, these students of cancer are constantly discussing their results with one another and publish-ing their findings where all workers in this field can see and profit by them. Since 1907 there has been a well-established organization of scientists who are engaged in studying cancer, called The American Association for Cancer Research. The President is Dr. Channing C. Simmons, Surgeon of the Cancer Commission of Harvard Uni-versity, and the Secretary is Dr. Wil-liam H. Woglom, of the Institute of Cancer Research, Columbia University, New York. This Association has a membership of 148. The papers which are presented at the annual meeting are eagerly awaited by students of the cancer problem in Europe and America. They are published in the Journal of Cancer Research. What Everyone Should Know Twelve years ago, our Society was established to carry on a campaign of education as a means of turning the existing knowledge of cancer to the full-est account. The founders knew that it would not be necessary to wait until a complete cure for cancer had been dis-covered before systematic help could be given to the 250,000 or more sufferers from this disease who existed in the United States and Canada. The hopes of the organizers have been fully justified. During the dozen years of its existence, the American Society for the Control of Cancer, has given instruction by means of lectures, new.spaper articles, radio talks and other vehicles of publicity in all parts of the United States and in many of the Provinces of Canada, and it is esti-mated that not less than 50,000,000 people have thus obtained their first January, 1926 The Health Bulletin 17 lesson in regard to this disease. It will, of course, be necessary to follow this up with further Instruction. The public has received some knowledge of the early symptoms of cancer and has been told to go immediately to a competent physician upon the first appearance of the disease. About 25.0(X) volunteer workers are engaged in this educational work in the course of the year. The Society maintains national headquar-ters at 370 Seventh Avenue, New York City, where it is glad to answer in-quiries on any and all aspects of the cancer problem. How Cancers Start The new knowledge teaches that can-cers always start in a small way. At first they are miniature cancers. They grow slowly and insidiously. Conse-quently, the person who is attacked by one may not become aware that any-thing is seriously the matter for a long time. A cancer of the skin, for example, may continue for several years without causing pain or other marked incon-venience. Not only is a cancer small to begin with, but it appears to be a distinctly local disorder. Present day knowledge gives no reason to suppose that it is a constitutional or blood disease. On the contrary, the weight of evidence is op-posed to that supposition. No general disease is in any respect like it. No disease necessarily precedes it or is related to it. It often attacks persons who appear to be in perfect health. In its early stages the cancer does not affect the general health nor the patient's spirits, and this is particularly true if the patient does not know nor suspect that he has cancel-. It is only after the cancer has progressed con-siderably that the general health is impaired. If, while the cancer is small, it is completely removed by surgery or de-stroyed with X-rays or radium, or, in fact, by any other means, that is an end of it. This could not be so if cancer were a disease which affected the whole body. If, instead of being completely re-moved or destroyed, the original cancer, or any particle of it, is permitted to live, additional cancers are apt to fol-low either at the original site or else-where. Thanks to the increasing knowl-edge, the manner in which this happens has become more and more apparent. It has been proved that minute parti-cles of the original cancer may be car-ried to variovis parts of the body by the lymph and blood and there establish themselves as new cancers. The routes by which these cancer cells are carried are often known and in skillfully con-ducted operations, the places where the particles may have lodged are attended to when the cancer itself is removed. This information is of much value. A good many deductions of practical utility have been based on it. One is that surgery or radiation must be ap-plied before any migration of the little particles has taken place, for after this has occurred the removal of the original cancer alone will not produce a perma-nent cure. In early treatment lies the hope of cure. Gradually a more and more definite meaning is being attached to the word "cure" as applied to cancer. Physicians are less willing today to say that a patient has been cured of cancer than they were formerly. Recurrences from the growth of particles which have re-mained dormant for a very long time may occur. After five years, however, the chance of recurrence is relatively small. Consequently, physicians are coming to measure the success of the various methods of treatment which they employ in terms of the number of five-year cures which have been ef-fected. Not Contagious or Inheritable With the increasing knowledge, opin-ion is becoming more and more securely settled that cancer is not due to a para-site. It would be a great step for-ward if the public would learn to ac-cept this opinion, for the possession of it would dispel not a little of the fear with which cancer is regarded. It would also help to put an end to the promo-tion of some "cures" which do not cure, in other words, quackery, that greatest of all cruelties, as so many writers have declared. If cancer is not due to a parasite, it follows that the disease is not trans-missible from person to person. This 18 The Health Bulletin January, 1926 is true of all diseases. It also follows that a serum cannot be prepared which will stop it. It should be generally recognized that cancer is not communicable, for a belief that it is infectious has not infrequently led to the shameful neg-lect of patients who have had need of the best care and attention which could be given to the sick. Persons need have no fear to live or work near one who hr.s cancer. As to the inheritability of cancer, the general opinion among qualified stu-dents of this question is that the dis-ease itself is not inherited, but that a certain lack of resistance toward it may now and then exist in a family for two or three generations. Experi-ments which have been made in breed-ing large numbers of mice have led some i>ersons to get the wrong idea that cancer or a predisposition toward it might exist in some families in-definitely. It is true that by carefully selecting mates through hundreds of generations, strains or families of mice have been produced which are more susceptible to certain forms of trans-planted cancer than is commonly the case, but nothing like such a predis-position occurs among mice which are left to mate as they will. The great difficulty with which susceptibles can be produced shows that the results ai'e highly artificial. Apparently they have no analogy among human beings under the ordinary circumstances of every-day life. For practical purposes, it is reasonable to consider that cancer is not transmissible from parent to off-spring among human beings. The Prevention of Cancer Within the last few years it has been found that the inciting cause of cancer is in practically all instances some form of chronic irritation. At the site of the growth there has been for a considerable time a mechanical, chemi-cal, bacterial, or other irritating con-dition which has in some way so dis-turbed the natural resisting and re-pairing function of the tissues that they have at last given way and set out upon a career of unrestrained and un-restrainable growth. This theory has now been so thoroughly investigated as to be accepted universally as a funda-mental and completely established fact. To prevent cancer therefore is to pre-vent the chronic irritations which lead to it. One should beware of the broken tooth or dental plate which continually irritates the tongue, cheek or gums ; of the spectacles which make the head sore behind the ear, on the temples or nose ; of any sore which will not heal ; of the mole or wart that changes in color, size or appearance; of indiges-tion which will not stop and cannot be explained ; or any unusual and un-natural discharge from any part of the body and of any lump which does not go away. When any of these conditions occur, you should go at once to a capable doctor and do what he advises. At once means today. If the trouble is not cancer, your discomfort will thus be removed. If it is cancer, your promptness may save your life. In deal-ing with this disease, delay is not merely dangerous : it is fatal. When Johnny comes for his teeth to be examined and we find his teeth are poor and dirty, we teach him to brush his teeth but we should also find out why he has poor teeth. It is either one of two things—either Johnny is poorly nourished or Johnny's mother has been poorly nourished before or after Johnny was born, when she was un-able to give him tooth-building food. It is highly important to realize that we have emotional habits as well as habits of mind and body. We are coming to realize the importance of the psychology of the emotions in re-lation to mental and bodily health. We can definitely set for ourselves the goal of forming habits of happiness, of en-joyment and enthusiasm in our daily life, of courage and of generosity toward the opinions of others. Until we realize that negative emotional habits have just as much to do with ill health as germs, we have fallen far short of our standard. — Patty I. Hilx. Man's happiness consists in the means and not in the end ; in acquisi-tion and not in possession. January, 1926 The Health Bulletin 19 f PUBLIC HEALTH NURSING* 20 The Health Bulleti>' January, 1926 be accomplished with systematic visita-tions by a trained personnel to advise them regai'ding general and personal hygiene. In order to try out his theories in a practical way and to see whether the suffering and misery of the sick could not be alleviated by proper nursing and home conditions improved by instruc-tions in hygiene, he employed a nurse who had been attending his wife, and at his own expense, obtained her co-opei- ation in making these visits. The reports of these visits are most interesting. We learn that the nurse was instructed not only to give nursing care to the sick, but to teach the fami-lies how to take care of themselves and of their own sick and how to lead the proper kind of lives. So here again we find social service work inevitably bound up with visiting nursing, the public-health nurse becoming the social service worker as well. The results of this feeble beginning wex-e so satisfactory that, in 1859, with the aid of Miss Nightingale, other nurses were put on dutj' and of course the work grew. In reviewing an account of this work, we have found a tendency and a right one, to get away as far as possible from actual medication and to empha-size to the limit public-health hygiene and prophylaxis, even though the knowledge of the prevention of infec-tious diseases in that day and time was meager. We read that, in those times, nurses were "urged over and over again'' not to pauperize the patient by giving medical comforts unless they were actually necessary. Florence Nightingale also saw this danger and said : "If district nurses begin by giv-ing relief they will end by doing noth-ing but giving relief." In modern public-health nursing of today we are, in the same way, caution-ing the public health nurse not to fall into the error of practicing, to a great extent at least, bedside treatment—to remember that her duty is to preach prevention and to leave the treatment end of the disease to the practical nurse or practitioner. Public-health nursing in this country was rather slow in developing. In 1828 Doctor Warrington, of Philadelphia, on-ly 23 years of age, inaugurated the so-ciety of district nursing. At first it was merely for the purpose of qualified nursing attendance to poor women in childbirth, but the work was gradually extended to take care of all classes of cases. The first charter of this organ-ization read: (to) "Provide, sustain, and cause to be instructed, as far as iwssible. pious and prudent women as nurses, it being understood that the as-sociation does not confine itself to the supply of monthly nurses only, but for every variety of sickness of patients.'" A district nursing organization was started in Boston in 1886, and in 1888 the association was incorporated under the name "Instructive District Nursing Association," with the purpose not only of caring for the sick but for giving them instruction in home nursing and public health. The objects of the asso-ciation were stated to be — 1. To provide and support thor-oughly trained nurses who, acting under the immediate direction of the out-patient physicians of the Boston Dispensary, shall care for the sick poor in their own homes instead of in hospitals. 2. By precept and example to give such insti'uction to the fami-lies which they are called upon to visit as shall enable them hence-forth to take better care of them-selves and their neighbors by ob-serving the rules of wholesome liv-ing and by practicing the simple arts of domestic nursing. So, again, we see that the idea of public-health instruction as a funda-mental and most important duty of public health nursing was all promi-nent. This phase was being gradually accepted by all as the most sensible way of carrying on public health nurs-ing, the nurse thinking more of the community as a patient than of the individual sick. In 1893 Isabel Hampton, in an ad-dress to the International Congress of Nurses, said : In district nursing we are con-fronted with conditions which re-quire the highest order of work, but the actual nursing of the pa-tient is the least part of what her work and influence should be among the class which the nurse January, 1926 The Health Bulletin 21 will meet with. To this brauch of nursing: no more appropriate name can be given than "Instructive nursing,"' for educational, in the best sense of the word, it should be. The first special work in district nursing was undertaken in London in 1892, when a staff of visiting nurses was organized to visit the schools and inspect school children. However, the honor of inaugurating school nursing in America is due to Miss Wald. found-er of the Henry Street Settlement, who in 1902 suggested the use of nurses to supplement the work of doctors in the schools of New York. Medical inspec-tion of school children had been in vogue in the schools before that time, but it was merely a perfunctory exami-nation by a physician, the only thing accomplished being the exclusion of the child, nothing being done to prevent the cause of the illness, or a visitation at the homes of the school children to carry the principle and gospel of pre-vention of disabling illnesses. During these times of demonstrations in public health nursing and the ai'ous-ing of public interest in these demon-strations, gradual progress was being made in the requirements of those who wi.shed to enter the nursing and medi-cal professions. While nursing was reaching the plane which it has now attained as a profession, wonderful strides were being made in the medical profession toward the prevention of diseases, such as the use of antitoxin against diphtheria, inoculation to pre-vent typhoid fever, and the valuable work now being carried on toward the standardization of antitoxin against scarlet fever. The dangers of neglected teeth, the tonsil and adenoid evil, and the value of scientific baby care began to be considered by the laity along with their previous ideas of safeguarding the health of cattle and hogs. Dental prophylaxis, the outline of programs for prenatal hygiene, and the development of intensive school pro-grams are all accomplishments which demand highly trained nurses in the public-health field for service in all recognized full-time health departments. In the early history of public-health nursing we find that it had its incep-tion in centers of population — the cities. Those who lived in the country and in rural districts were indeed deemed fortunate. Living in the coun-try (and the same idea has held to the present day) was thought to be a pro-tection against sickness. For this rea-son public health of rural communities has been, and still is, greatly neglected. Thirteen years ago there was not one full-time county health department in. the United States among the three thousand and odd counties composing this country. We finally awoke to the fact that a real health problem existed in the coun-try, and one of even greater importance than the urban health question. The death rate was higher, the morbidity index was higher, and the rural dweller did not have a protected water supply, a protected milk supply, or proper methods of sewage disposal, as pro-vided by ordinances in cities. There-fore, he drifted along by himself, con-tracting typhoid fever from his own water supply, polluted by his own sew-age, and blaming the causation of the disease on God. the devil, tin cans, weeds, or whatever came to his mind. It took us a long time to realize these things, but since that realization full-time county health units have been organized and are in operation in over 280 counties in the country, with new ones developing every year through the financial cooperation of the Uniteector gives the skipper not only his tax receipt, but also a sanitary certificate. Before he can sell his cargo to shuckers or cau-ners he must produce this receipt and certificate. Since all oyster boats leav-ing North Carolina waters for other markets must pass through the Dismal Swamp canal, an insi)ector is stationed at the locks in this canal and no cargo of oysters can leave the state without complying with the law. Dredged in N. C. waters 301,095 bu. Exported in the shell.... 30,245 bu. Steamed within the state, but exported to to be sold under for-eign label 211,047 bu. Shucked within the state and exported fresh to be sold under foreign label 58,303 bu. Sold in shell within the state 1,500 bu. This brings us to the most lamentable phase of the oyster situation. Although North Carolina oysters are the best and purest on the market, the consumer has not been so advised. The above figures furnished by the Fisheries Commissioner for last season show that practically the entire North Carolina oyster crop was disposed of 8 The Health Bulletin February, 1926 incognito. Thirty thousand bushels were taken in the shell outside the state to be shucked and sold under a foreign label. About 270,000 bushels (one bushel or tub of best grade oysters will shuck about one gallon) were steamed or shucked within the state but taken out of the state without label to be marketed under a foreign label. Many of these were shipi>ed back into the state for consumption. The con-sumer really ate North Carolina oysters but thought he was getting an out-of-the-state product. With all this round about handling there is not only much delay in reach-ing the dealer, but the dealer pays an average of $1.00 per gallon more for North Carolina oysters which he buys from a Norfolk or Baltimore shipper than he would pay for the same oysters bought from a North Carolina shipper. The dealer can scarcely be blamed for this for he must supply what his customers call for—they are the ones who pay the bill. The customer has eaten "Norfolk" and "Baltimore" oysters so long (without knowing that in many instances they came from North Carolina waters) that he thinks he must have "Norfolk"' or "Baltimore" oysters. When consumers leaim the facts and call for "North Carolina oy.sters" the dealers will be glad to supply them. The appended list shows the name, address and permit number of 74 North Carolina packers and shippers. Ship-ping tins are now labeled "N. C. Permit No " When your dealer shows you a can with this label stamped in the tin or painted thereon you may be sure that the oysters it contained when it left the hands of the packer were safe for food. LIST OF OYSTER SHUCKERS AND PACKERS IN NORTH CAROLINA Name Addrex Permit Number Woodland & Company Southgate Packing Co Washington Fish Co George N. Ives G. W. Bowden. Lupton Fish and Oyster Co Reuben Williams -. George Baker George Moore P. Speight . E. S. Lupton ,/. S. F. McCotter Charles H. Squires _ J. W. Rollins... S. E. Styron Almon Hamilton Wilbert Lewis C. W. Greene ^-. Ford Seafood Company _. Manning Brothers Amos H. Dudley A. M. Boyd U. S. Boyd Swmdell-Fulford Co Norfolk-Southern Meat Market H. J. Shaw A. Marbley George Dudley .- John Henry Becton Elihu Boyd Stephen Davis Amos Dudley Walter Bell Pamlico Fish Company.. Morehead City. Beaufort Washington New Bern New Bern New Bern Belhaven Belhaven Washington New Bern New Bern Vandemere New Bern Manteo Davis New Bern Stacy New Bern Manteo New Bern Morehead City Morehead City Morehead City Washington New Bern New Bern Morehead City Morehead City Morehead City Morehead City Marshallberg... Morehead City Morehead City Washington N. C. N. C. N. C. N. C. N. C. N. C. N. C. N. C. N. C. N. C. N. C. N. C. N. C. N. C. N. C. N. C. N. C. N. C. N. C. N. C. N. C. N. C. N. C. N. C. N. C. N. C. N. C. N. C. February, 1926 The Health Bulletin LiIST OF OYSTER SHUCKERS AND PACKERS—Continued Permit Number Eastern Fish Company Henrietta Carter.. George R. Russell Henry Bryant James T. Salter Willis Seafood Co John Monroe Jim Tillery W. P.Boyd Finer Brothers Adams & Company Tom T. Lassiter C. H. Harris Tolson-Sniith Charles V. Webb Duffy Wade Haywood Bell Mott Hester Emma Dudley A. W. Walston Bert Tillery Delia Jones V. Taylor Packing Co. . Ernest Mattocks W. H. Varnum George Gorham R. T. Alford J. F. Morris & Son Frank Ewing T. J. Franks C. L. Bowden Lender Swindell W. 1. Wilson J. O. Bowden Jim Pigott X. M. Pigott A. H. Parker J. E. Hines J. L. Phillips E. .M. Chadwick Washington Morehead City Beaufort, R. F. D Morehead City Davis Beaufort Morehead City Morehead City Morehead City Morehead City Morehead City New Bern New Bern Morehead City Morehead City Morehead City Morehead City Morehead City Morehead City New Bern... Morehead City Morehead City Sealevel Morehead City Supply Washington Seagate New Bern Wilmington.. Seagate Wilmington James City Wilmington Wilmington Morehead City Shallotte Shallotte Seagate _.. Washington Gloucester C. 35 C. 36 C. 37 C. 38 C. 39 C. 40 C. 41 C. 42 C. 43 C. 44 C. 45 C. 46 C. 47 C. 48 C. 49 C. 50 C. 51 C. 52 C. 53 C. 54 C. 55 C. 56 C. 57 C. 58 C. 59 C. 67 C. 68 C. 69 C. 70 C. 71 C. 72 C. 73 C. 74 FIVE THOUSAND DEATHS WITHOUT MEDICAL CARE I During the year 1924 there were in North Carolina 5,515 persons who died without medical care. That is, there were this number whose death certifi-cate show no doctor attended them. In addition to this number tliere were many more for whom the doctor was called only at the last moment. In this case he signed the certificate but actually had not attended the patient during the illness. Many of these deaths could have been prevented by the aid of a physician. And this is the lamentable thing. What does it avail for medical science to be efficient in the curing of disease if medical science has no opportunity to exercise its skill? We cannot believe it was physically impossible for some physician to have reached practically every one of these imattended deaths. As a class, no pro-fession is more liberal with its services, therefore it is hardly probable that any one of these unattended deaths could not have gotten a physician had an ef-fort been made to do so, however poor the patient may have been. Furthermore, society is generally awake to the needs of its fellows and 10 The Health Bulletin February, 1926 provision is quite frequently made to care for ttiose, at public expense, wlio are themselves unable to bear the ex-pense. The only actual reason then for these unattended deaths is a matter of ignorance—or carelessness. Ignorance on the part of the family—or careless-ness on the part of society. Public sentiment througliout the state should be aroused to the degree that those responsible should be held in dis-gi'ace if they allow any person in the state to die without every effort being made to secure adequate medical care. Privilege brings responsibility and every person who is granted the privi-lege of wielding an influence in his community is held morally responsible for that influence. These are the per-sons— these intelligent persons with in-fluence— who are responsible for these five or six thousand unattended deaths each year in North Carolina. "Am I my brother's keeper?" is a question that must have an individual—a personal-answer. But privilege is never given except with commensurate responsi-bility. An incident comes to mind, of which the fact of every detail can be vouched for, which illustrates an almost uni-versal situation. The mother of nine children was taken seriously and mortally ill. The father was an honest, hi.rd-working man whose every efCort and every penny of earning was de-voted to his family. They lived in a rather densely populated and wealthy county. The sick mother was taken to a hospital where she remained until it seemed impossible for the father to raise more money to pay hospital bills. The phjsicians attending her were the best in the country but her malady could not be cured and she was taken home. One of the physicians who had seen her in the hospital, along with the other physicians, undertook to attend her at home, although he knew he could not in any possible way expect any pay, and knew that her illness would be prolonged. None of the surgeons who had attended her in the hospital had received any pay and did not ex-pect any. This physician visited her in the home 83 times. He took with him in consultation, at different times, six different physicians. He did, at the house, three minor operations which required the assistance of his ofiice nurse. The minimum total foes this doctor should have received for his services to that home would have been at least $300, yet he did the work as willingly and as efiiciently without re-ceiving one penny as if he had known the money was forthcoming. This case is no exception. Doctors are doing the same thing everywhere. In this case the responsibility was no more on this doctor as a citizen of his community than it was on every other citizen. The doctor pays his city, coun-ty, state and federal taxes, and is charged by his state a special tax of $25 per year for the "privilege"' of practicing medicine. The burden is a community burden and in this one case this doctor paid, in services and ex-pense, the equivalent of $300 tax, over and above all the other taxes which the butcher and baker and candlestick-maker had to pay. And he paid a special tax of $25 per year for the privilege of doing it. Today the doctor called ten miles in the country to see a deserving, but poor patient, will usually go, (doctors are human and there are some who would not go) but first he must drive by the filling station to get gas for his automobile. This he pays for in cash. Then he remembers that his medicine case needs filling, (for this is ten miles in the country) so he drives by the drug store, and some way even drug supply houses have a habit of insist-ing that drugs be paid for. Finally after taking two or three dollars in cash out of his pocket he goes to his patient. He returns with a clear con-science but wonders where he will get the price of a beefsteak and a loaf of bread to carry home for his supper. There were very few of these five or six thousand persons who died uilat-tended in this state in one year who could not have got medical aid in some manner. There is no spot in the state where you, who read this, could not have very soon got medical aid had your child, your wife or husband, or your parent been sick unto death. "Where there is a will there is a way" and YOU would have found a way. The responsibility is yours and mine to see that unattended deaths do not occur. As the matter now stands, the charity of the medical profession. February, 1926 The Health Bulletin 11 (freely offered to the needy individual, but NOT to the well-to-do city, county or state) may have to be accepted. As soon as arrangements can be made, the burden should be distributed to the shoulders of those whose duty it is to bear it. The county hospital is one plan advocated by many, and is a plan which deserves the most serious con-sideration. The following table is appended purely as a statement of facts. There is no intent to make comparisons and no need of further comment. Table showing the total number of deaths during 1924 by race and by counties. ALso showing the number of deaths |