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fiiiiB mm B IHiilSlpfS' Hff X Library of The University of North Carolina COLLECTION OF NORTH CAROLINIANA ENDOWED BY JOHN SPRUNT HILL of the Class of 1889 2U\*ki0 8fc> 1^2.4 D*8 v# *** Wtf#* *j$>. ^EL HILl'9 N. c Published bM TRE. N°RmCAR°LI/m STATE. B^ARDs^ttmLTtt This Bujleti r\ will be seryt free to arxu citizen of the 5tcrte upon request! Vol. XXXVIII JANUARY-APRIL, 1923 Nos. 1-4 ,'23- mm^.. ^•^ No i9 ©HMurf c<nn«*«-iL-«<mj. Which Children Are Yours? MEMBERS OF THE NORTH CAROLINA STATE BOARD OF HEALTH J. Howell Way, M.D., Pres. Waynesville Richard H. Lewis, M.D., LL.D.—Raleigh CHA8. E. Waddell, C.E Asheville Thomas E. Anderson, M.D Statesville A. J. Crowe ll, M.D Charlotte Charles O'H. Laughinghouse, M.D., Greenville Cyrus Thompson, M.D Jacksonville P. R. Harris, M.D Henderson E. J. Tucker, D.D.S Roxboro EXECUTIVE STAFF W. S. Rankin, M.D., Secretary and State Health Officer. G. M. Cooper, M.D., Assistant Secretary. Ronald B. Wilson, Assistant to the Secretary. 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. J. S. Mitchener, M.D., Chief of Bureau of Medical Inspection of Schools. K. P. B. Bonner, M.D., Chief of Bureau of Maternity and Infancy. E. P. Long, M.D., Acting Director County Health Work. FREE HEALTH LITERATURE The State Board of Health has available for distribution without charge special literature on the following subjects. Ask for any that you may be interested in. Whooping-cough Hookworm Disease Public Health Laws Tuberculosis Laws Tuberculosis Scarlet Fever Infantile Paralysis Care of the Baby Fly Placards Typhoid Placards Tuberculosis Placards Clean-up Placards Don't Spit Placards Sanitary Privies Water Supplies Eyes Flies Colds Teeth Cancer Pre-natal Care Malaria Smallpox Adenoids Measles Germax Measles Typhoid Fever Diphtheria Pellagra Constipation Indigestion Venereal Diseases Catarrh 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. THE HEALTH BULLETIN The Health Bulletin is sent monthly without charge to all persons in the State who care to receive it. If you have friends or neighbors who will be interested, suggest that they write the State Board of Health, asking for The Bulletin each month. When you have finished with your copy, give it to some one else, thereby increasing its usefulness. The Road of the Loving Heart On an Enchanted Island Of the South Seas, where the shining water is ever the sky's blue looking-glass, runs the Ala Loto Alofa, the Road of the Loving Heart—a Road of Gratitude. The Road was built by the Samoan chiefs for their beloved "Tusitala" — Teller of Tales—as they called Rob-ert Louis Stevenson, the beloved of every nation. Stevenson's Road—paved with love and gratitude—led to the island home he built in a world-wide quest for health. The road still climbs up the mountainside to Vailima, and is trod yearly by hundreds who visit Stevenson's former home because of their gratitude for the priceless heri-tage of his life and writings. But a Far Greater Road is being built today—a road on which year after year more and more grate-ful people shall walk. A road which shall not only endure for hundreds of years, but for all time. A road which far-away descendants will remember and bless those who are laboring for them now. It is the Road of Health Its builders are far-seeing physicians and public and private agencies. The Road of Health is the only road upon which the sun shines. It is the only road from .which the real beauties of life can be seen. It is the road sign-posted with happiness and success. It is the road which leads to the delectable mountain of fulfilled hopes and ambitions. Health is not the monopoly of any one group or class. And so the road of Health is a great public highway open to all who keep themselves physically fit to travel it. For However Smooth a Roadbed However free from dangers, wrecks cannot be avoided unless the machine that travels the road is in good con-dition. And just as no locomotive or motor would be sent out, even on the best of roads, without occasional ex-amination, so the human body—the greatest machine in the world—must be thoroughly examined by your doc-tor and regularly overhauled, if wrecks along the Road of Life are to be avoided. Failure to have the complex human machine examined regularly means that you are ever in danger of being side-tracked to the Road of Sickness, a road over which many thousands needlessly struggle. The First Baby Steps should be taken on the safe, smooth Road of Health. On it the boy and girl should travel eagerly to school. From it the young busines man and woman must not be allowed to stray. Fathers and mothers will find it the one shining Road that leads to a Happy Home. Stretching clear and white before you is the untrodden Road of the New Year. Therefore be it Resolved to swing wide the Gateway to the Road of Health—the wonderful new Road of Gratitude. Take the first step today. Go to your doctor and have a thorough ex amination made of your body mech-anism. The man and woman who find out just how they stand physi-cally can, by proper care and right living, learn to avoid the Road of Sickness—can lengthen life and get far more out of it. Have your children examined. The examination of a child oftentimes means the discovery of disease ten-dencies or of defects which, taken in time, can be cured or corrected. It may save deformities, blindness, or suffering that would make death pre-ferable to life. (Adapted from Metropolitan Life Insurance Company.) The Health Bulletin ( ^ The Health Bulletin sometimes for months. It sometimes happens in diphtheria hospitals, where the cases can be watched and studied carefully, that a child who has come into the hospital with diphtheria, and has stayed until he is apparently well, goes home, and weeks later that child's brother, sister, or playmate develops diphtheria. The child who had diph-theria first and was apparently well is examined. His nose is found to con-tain diphtheria germs. He is taken back to the hospital and given a cura-tive dose of diphtheria antitoxin and the diphtheria germs disappear from his nose and throat. This child's germs were not making him sick, but they were giving diphtheria to other children. He was what is called a diphtheria "carrier." After typhoid fever, the germs may still for some weeks be discharged from the intes-tines in the excreta. In some cases they get a foothold in the gall bladder of the patient and live and grow there the remainder of his life. From the gall bladder they make their way into the intestines, and then, through the excreta, to the outside of the body, where they are free to infect other people. Such a person—well, but in-fected— is called a "carrier" of typhoid germs. Not only are there people who are carriers in tins way from having had the disease, but there are also those who have come in contact with the sick or with carriers, and have themselves become carriers without ever being sick at all. We have learned also that in most of the contagious diseases there are many mild cases—so mild and with so few symptoms that they are almost sure not to be noticed. A child with a slight sore throat, and practically no other symptoms, may be sent along to school witli little thought about it and without it being seen by a doctor. Yet many of these sore throats are really diphtheria, and the germs may cause a fatal case in the next one who con-tracts it. A man may have a slight "bilious attack," or merely feel "under the weather," for a few days, and really be a case of walking typhoid fever. If he is engaged in the milk business, it often happens that he is the cause of an epidemic of typhoid fever. These mild, unrecognized cases are called "missed cases." The number of germ carriers and of missed cases varies greatly in differ-ent diseases. There are not very many such cases in smallpox and measles. But for every recognized case of diph-theria properly isolated at home or in a hospital, there is probably a mild, unrecognized case going about among the people, and doubtless several well carriers doing the same thing. Almost three per cent of all cases of typhAid fever become permanent carriers. For every case of cerebro-spinal meningitis there are probably ten or twenty prac-tically well carriers. Moreover, in some diseases, as in measles, the dis-ease is intensely contagious for sev-eral days before signs develop which are likely to be recognized as the signs of measles. When a child is sick in bed with diphtheria, and every one knows it, the danger of the disease spreading is not one-tenth so great as it would be if the same child had a mild sore throat, not recognized as diphtheria, and was going to school and mingling with the other children at play. Most people try to keep the cases of contagious diseases quaran-tined, so that these are not so danger-ous when they are sick in bed. But it is from the carriers and mild cases which are missed that the danger comes, because these go about unsus-pected and spread the disease. Although we are surrounded by dis-ease germs, we can remain healthy if we take steps to keep them from enter-ing our bodies. So how, then, do they gain entrance to our bodies? Classi-fied according to how we get them, the germs of infectious diseases may be divided roughly into four groups: (1) Those which are transmitted by spit from the mouth, and by secretion from the nose in coughing and sneez-ing. (12) Those which come from the feces in open privies. From here flies bring them to our kitchen and dinner table. And water which drains from the privies washes them into wells and springs. (.1) Insects, such as mosqui-toes, fleas, and ticks, carry the serins of most of the blood diseases. (4) And by actual contact with another body which is infected, tin venereal diseases are transmitted. Among tne diseases transmitted by droplets of moisture from the mouth and nose in coughing and sneezing are The Health Bulletin The Health Bulletin scarlet fever, diphtheria, septic sore throat, measles, whooping-cough, mumps, chickenpox, smallpox, tubercu-losis, pneumonia, influenza, syphilis. cerebro-spinal meningitis, and infantile paralysis. The germ of the disease Is in the spit of the mouth, and the moisture of the nose is thrown into the air in a fine spray in coughing or sneezing, and is taken up by the people close by. When you sneeze or cough. you should be in the middle of a field alone. All well-informed and intelli-gent people try not to sneeze or cough at all, and whenever they must they do it into a handkerchief or turn the head away from every one and toward the floor or ground. This keeps their germs from being thrown to others. Since the influenza epidemic, people generally know more about this than they did before. Most people now feel uncomfortable when a person close by coughs or sneezes, and if one coughs or sneezes in a crowd he is looked upon as careless and dangerous, and is free to go elsewhere. Never cough or sneeze if you can help it. and if you must do so. use your handkerchief. It will look better for you. The diseases from the excreta of the body set back into the body by the germs being washed from the privies into wells or springs from which water is used to drink or to wash milk buck-ets : and by being carried by flies which walk on the excreta in the privies and then walk on your food. Typhoid fever, dysentery, and cholera are trans-mitted in this manner. All privies should be flyproof, and the excreta should fall into cans which do not leak. All windows should be screened, and every fly in the house should be "swat-ted." All water should come from deep-pump wells tightly covered and sealed. And whenever there is any doubt about the purity of the water or milk, these should be boiled before using. During the hot summer months it is wise to do this in the country, anyway. Insects carry the germs of several diseases. Certain mosquitoes carry malaria. The mosquito sucks the blood of a person who has malaria. The germ grows in the mosquito and is in its mouth. It then bites a well person and puts the malaria germ into his blood, and he has malaria. Flies carry typhoid fever and dysentery. These germs are present in the excreta of patients. The flies walk on it, get the germs on their legs, and then walk on your food. You eat the food, carrying the germs of typhoid into your intes-tines, and develop typhoid fever. The flies walk on the milk bottle of your baby, and it likewise gets dysentery- All swamps should be drained to de-stroy the breeding places of the mos-quito. All garbage should be destroyed and all manure screened to destroy the breeding places of the fly. And every home should be screened to keep out both the mosquito and the fly. By far the most important mode of infection is by contact. Many persons contract disease who have never been in contact with anyone else who was sick. So, people invented the theory that disease germs are wafted by the air, or originate in filth and dirt out-side of the body. But when it became known how many "walking cases" of typhoid fever, how many slight sore throats of diphtheria, how many well "carriers" of cholera or infantile paralysis there were which had for-merly been unrecognized, it was seen that disease spreads chiefly through contact of one person with another. "We can now easily see that the germs of most of our infectious dis-eases are in either the mouth or nose, or in the excreta of the body. Many people do not wash their hands after they have been to the toilet or privy, and on the hands of many people can be found at any time the germs which grow in the intestines. And- almost every one puts his hands to his nose and mouth countless times during the day. So, there is constant interchange between people of the germs which grow in the nose, mouth and intestines. It is unpleasant to think of—and to many, at first, seems incredible—that the germs of such diseases as typhoid fever, which are discharged from the intestinal tract, should be transferred to the mouth of another. But observa-tions have been made in a number of places which show that upon the hands of one in ten of medical students, nurses and physicians may be found germs which come only from the intes-tines. Among less careful persons, with less facility for cleanliness, the num-ber must be greater. 8 The Health Bulletin So, then, the fingers are a large fac-tor in transferring infection from one person to another. If one takes the trouble to watch other people, or even himself, it will surprise him to see how many times the fingers go to the nose or to the mouth, all unconsciously, for one purpose or another, or for no pur-pose whatever. In this general trade in spit, the fingers not only bring other people's germs to the mouth of their owner, but they carry his to every-thing that his hand touches. This hap-pens scores and hundreds of times dur-ing his day's rounds. The one who cooks distributes her germs to those who eat her food. What if she be a typhoid carrier? The man who sells you apples to eat gives you his germs. Money carries the germs of all those who handle it. Children are the worst of all, "swapping" candy and using each other's pencils. All babies put everything into their mouths. And also babies and children are the easiest prey of the contagious diseases. Dippers in public places are disap-pearing and separate cups or running fountains are replacing them. Mothers are learning that everybody should not kiss their babies. Coughing and sneezing in public stamps one as ig-norant or careless. The open privy is already looked upon as a menace, and the man who keeps one is talked about behind his back. Soon the sanitation officer will tell him about it to his face and take him to court if he refuses to build a safe flyproof one. Your friends will enjoy eating dinner with you better if they can look out through screened windows at clean premises. Those who keep their hands clean and keep them away from their nose and mouth carry less of other people's germs. To stay well: Stay away from sick people, avoid people who cough and sneeze and particularly in crowded, closed rooms. Keep your hands clean and keep them away from your nose and mouth. Don't drink after any one else. Keep your privy flyproof and make your neighbor keep his the same. Have your well deep, with a solid wall and a cement top. Screen your windows and destroy all breed-ing places of flies and mosquitoes. Every infectious and contagious dis-ease is caused by a germ and the dis-ease is impossible without its particu-lar germ. Germs are small plants and animals which can be grown or killed. It is possible, therefore, with the in-telligent cooperation of every one, to kill the germs and wipe their diseases from the earth. Every act of precau-tion to prevent germs from passing from one person to another helps the fight against disease just that much. VACCINATION AND SERA It is well known to every one that if a person has smallpox once he is not likely to have it again. This is also true of measles and largely true of typhoid fever. Why is it that if a person can have one of these diseases once he cannot likely have it again? If he goes into the room of a patient and drinks out of his glass he cer-tainly gets the germs which would give the disease to him if he bad not bad it. This shows that there must be something about him which keeps the germs which he takes into his body from growing there. This something which keeps the germs from growing we will call antibodies. The anti-bodies are substance- in the blood which fight the germs when they come into the body. If the antibodies kill the germs the body will not have the disease. Antibodies, then, are the defense against these diseases. There are dif-ferent ways of getting them. One way is by having the disease and making them ourselves. Take typhoid fever for an example. Let a man who has never had typhoid fever be fed some typhoid bacteria. In a number of days he will begin to feel tired and drowsy. He will develop a fever and become sick with typhoid fever. He gets worse for a week or ten days. The Health Bulletin During this time the bacteria are in-creasing in number and are making toxins (poisons) in his blood. If this continues he will die. But when the bacteria began work in his body his body also began making antibodies. The bacteria are working to kill the body with their toxins and the body is working to kill the bacteria with its antitoxin (or antibodies). Which will win? If the bacteria win the man dies. If the man produces enough antibodies he wins and the bacteria die, and he gets well. And when he gets well the antibodies which killed the germs and ended the disease still remain in the blood, standing guard, ready to make war upon the next ty-phoid germ which comes into the body. With the protection of this army of antibodies against the typhoid germ a second attack of the disease is made less likely. The presence of these pro-tecting antibodies after the disease ex-plains the immunity to such diseases as smallpox, measles and scarlet fever after the first attack. This kind of immunity is called an ACTIVE im-munity because the individual pro-duces his own antibodies. A PASSIVE immunity may be ac-quired by borrowing some one else's antibodies. Diphtheria antitoxin is an example of this. If a healthy horse is selected and once a week a dose of toxin from diphtheria germs injected into it, its blood produces antibodies (antitoxin, we call it). The blood is drawn and tested at intervals and when it contains enough antibodies the horse is bled a large quantity and the blood is allowed to clot. The serum, or watery part which contains the antibodies is then poured off. This is diphtheria antitoxin. When a child has diphtheria this antitoxin, contain-ing the antibodies produced against the toxin in the body of the horse, is Injected into the child and it quickly gets better and soon gets well. The antibodies given to the child by the horse kill the diphtheria germs for it. So then we are protected from germs by antibodies in our blood. And the antibodies may be produced by the fight in our own body or by the fight in some one else's body. And we are protected, or immune as the doctors say, by actively producing our own immunity or accepting a passive im-munity from some one else's activity. Another way of producing immunity is by the injection of dead bacteria, or their products, as is done in vaccina-tion against typhoid fever. In vacci-nation against smallpox, germs of smallpox which have been weakened by growing them on a cow are planted in the arm and allowed to grow. If they were strong enough we would have smallpox because they would grow to that stage before the blood could produce enough antibodies to kill them. But since the germs have been weakened before they were put into the arm, the blood can produce enough antibodies to kill them before they spread from the arm. In this way the sore of vaccination causes antibodies to be produced and left in the blood. When the vaccination sore is healed the antibodies are in the blood, just as they are after smallpox, and the per-son is protected against, taking small-pox. There is an antitoxin for tetanus (lockjaw) similar to that of diph-theria and prepared in the same way. The germ of tetanus does not grow well in the air and therefore does not grow well in the open wounds. It grows in puncture wounds, like that made by sticking a nail in the foot, and in deep dirty cuts in which the air cannot get to the bottom of the wound. There is usually a lot of tetanus after the Fourth of July be-cause of the kind of wounds produced by fireworks. In 1903. tetanus follow-ing Fourth of July accidents caused 417 deaths, while in 1915 there was only one. Much of the improvement was due to a "sane Fourth," but much was due also to the improved treat-ment of the wounds and the use of tetanus antitoxin early (as soon as the wound was made). There is a treatment with anti-rabic serum to prevent rallies or hydro-phobia. This is the disease in a hu-man being coming from the bite of a "mad" dog. Whenever a person is bit-ten by a "mad" dog he should take this treatment immediately. When-ever a person is bitten by any kind of a dog. the dog should be killed and his head should be examined by a laboratory specialist to see if the brain shows any signs of rabies. (A dog too valuable to be killed for biting 10 The Health Bulletin CoP/Ric-riT I4« ritALTK CAI<r»»K 5*K»ICt No. I? The Health Bulletin 11 can wear a muzzle.) If there are signs in the dog's brain of the germs which cause hydrophobia, even though the dog was u peaceable dog, the per-son bitten should take the Pasteur anti-rabic treatment. It will not cure the disease after it has developed but it often prevents the disease from de-veloping. In the home city of Pasteur before his discovery of the cause of hydrophobia and before his treatment of it, out of every 1,000 persons bitten by "mad" dogs 160 died. Out of those treated by Pasteur's treatment only 6 out of 1,000 died. Out of 1,000 people bitten his treatment saved 154 who would have died. His treatment can now be had in. North Carolina. It consists of injecting the attenuated germ of hydrophobia (weakened by growing it in rabbits and then drying the rabbit's nervous tissues), about twenty-four doses, one every day or two. This helps to produce antibodies to kill the germs from the dog bite be-fore they get a chance to grow, and keeps the bitten person from having the disease. Vaccines and sera mark a great ad-vance in medicine. They make it pos-sible to keep from ever having some diseases at all which we used to be glad to recover from. We used to lose more men in the army from smallpox and typhoid fever than we did from fighting. Now we do not lose any from these diseases at all. Once we had to stand by holding our hands while we watched the child with diphtheria get well or die as chance would de-cide. Now if we give it antitoxin the first day it is sick it does not die. During the last few years toxin-anti-toxin has been used to prevent diph-theria, and the children who have taken this treatment have remained comparatively free from diphtheria. It is the aim of medicine to find such a preventative for every disease. Many doctors are now at work on such a treatment for influenza, and think of what it will mean when the treat-ment is found. They are also working on such a treatment for scarlet fever. And some day they will lie found just as they have been found for smallpox, typhoid fever, diphtheria, lockjaw and hydrophobia. Lockjaw and hydrophobia are not so common. But every case of a deep or a dirty wound such as a nail punc-ture, bullet wound, or a deep cut re-ceived on the street or around the stable should have an intra-muscular injection of 1,500 units of tetanus anti-toxin as near the site of the wound as possible as soon as it has been well opened and cleansed. And every sus-picious dog bite should be treated with the Pasteur treatment. But there are three diseases, in par-ticular, against which every person should be vaccinated. These three diseases are smallpox, typhoid fever and diphtheria. They are dangerous and can be prevented. Vaccination will prevent them. You may say that you will avoid exposure to these dis-eases and keep from having them with-out being vaccinated. But nobody ex-poses himself purposely and every one hopes to avoid them. Still many people have the diseases. The germs are in drinking water and food which you think is pure, and upon the hands of people you do not suspect. Your only safe plan is to carry your protec-tion with you in your blood. North Carolina does not quarantine smallpox. Vaccination protects against it. Every one may have vaccination. The smallpox patient can go wherever he pleases. If you have been vacci-nated within the last five years you are safe. If you have not been vacci-nated you had better not go on the street or into a train or let anybody come into your home until you have been. The efficiency of vaccination in protecting against smallpox has been proven beyond the shadow of a doubt, and it is a safe procedure. In the Philippine Islands, before the United States took charge of them, it was necessary to erect a large temporary hospital in Manila each year to care tor the thousands of cases of smallpox, the majority of whom died. Vaccina-tion was introduced in 1907. Before then in six provinces around Manila at least 6.000 people died each year from smallpox. Since 1900 not one person has died of smallpox in Manila, and the few scattering cases which have occurred have been people who were not vaccinated. Vaccination is very simple and all trouble usually comes from neglect of the arm after vaccination. Up to 1911 over L',000.000 people in the 12 The Health Bulletin Philippines bad been vaccinated with-out the loss of a single life or limb and without any serious case of infec-tion. This record shows what a safe procedure vaccination is. Typhoid vaccination was first tried out on a big scale in the army. Two armies of about the same size were the Spanish-American Army of 10,000 in 1900 and the army of 12,000 mobil-ized on the Mexican border in 1911. The Spanish-American army was not vaccinated. The Mexican was. The unvaccinated army had 2,500 cases of typhoid fever and 250 deaths. The vaccinated army had only two cases of typhoid and no deaths, although there was typhoid fever among the natives around them. Typhoid vacci-nation was begun in North Carolina in 1914. At that time there were 839 people dying yearly from typhoid fever. Since then this death rate has been reduced to 307 last year. We are now saving 532 lives each year with typhoid vaccine in conjunction with sanitary privies, and the 307 who are dying from typhoid fever are among those who fail to be vaccinated. Typhoid vaccine is given, hypodermi-cally, once a week foi three weeks, and its protection lasts about three years. The vaccination should there-fore be repeated every three years. There are two serum treatments for diphtheria. One is toxin-antitoxin. It is given like typhoid vaccine and should be given to every child between six months and six years of age. It prevents diphtheria as typhoid vaccine prevents typhoid fever. This has been in use only a few years. The second, an older serum for diphtheria, is the antitoxin. Its worth has been proven so well that any doctor who fails to use it, or any patient who refuses to have it used, is looked upon as crimi-nal. It should be given at the earliest possible moment in the disease. The longer you wait the more damage the disease germs do before the antibodies in the antitoxin can overcome them. The following figures show the value of giving the antitoxin early. In 500 cases Antitoxin given 5th day of disease, 18 out of 100 died. Antitoxin given 4th day of disease, 16 out of 100 died. Antitoxin given 3d day of disease, 11 out of 100 died. Antitoxin given 2d day of disease, 4 out of 100 died. Antitoxin given 1st day of disease, none out of 100 died. Our valuable figure is the last one : of the 100 who received antitoxin on the first day of the disease none died. Toxin-antitoxin is given to the well child to prevent him from having the disease. Antitoxin is given to the child sick with diphtheria to help it get well of the disease. Certainly nobody wants to have smallpox, typhoid fever or diphtheria. If they can be prevented, then why do we have them? The people who have them fall into three classes, so far as vaccination is concerned: (1) Those who are intelligent and honestly mean to be vaccinated but are busy and neglect it until they unfortunately take the disease. (2) Those who are honest, but ignorant and do not know about vaccination ; or knowing about it, fail to see the importance of it, and die of their ignorance. (3) Those who know about it but do not believe in it and are openly opposed to it, talking their opposition to other people to make them believe as they them-selves do. In time these people will be killed off by the disease which they refuse protection from. It is fast coming to be a reflection upon a per-son to have smallpox, typhoid fever or diphtheria. Vaccination will prevent them. People are finding out what it means to have this protection, and the sanitary intelligence of a community is judged by the number of cases of these diseases it has. An intelligent community can be vaccinated and with proper sanitation can remain a well one from these diseases if it will keep ignorant, careless people out of it or make them be vaccinated when they come into it. The stock of the race actually improves itself by preserving the intelligent and weeding out the ignorant. It is nature's way. You select the best corn for seed, and feed the nubbins to the hogs and chickens. We can be people whom nature selects for seed or we can be nubbins which we feed to the germ of smallpox, ty-phoid fever and diphtheria. Every one can protect himself against these diseases by vaccination. The Health Bulletin 13 Your family doctor will vaccinate you or will send you to some one who will. It is a sound business proposition for you to insure yourself against the ex-pense of the sickness and loss of time from work, as well as against the risk of life, from these diseases by being vaccinated. Addenda "The United States Public Health Service advises the following proced-ure in order to secure the best results from vaccination and to prevent pos-sible complications. The freshest pos-sible vaccine should be obtained. All vaccine packages, pending use, should be kept in a metal box in actual con-tact with ice. Vaccination should never be performed by cross-scratch-ing or scarification, but by one of the methods described below. If a prompt "take" is very necessary, as in case of direct exposure to smallpox, or if the first attempt has been unsuccessful, three or four applications of the virus should be made, but the insertions should be at least an inch apart. Whichever method is used, a control area may be first treated similarly, but without the virus, in order to esti-mate the amount of pressure necessary for insertion and in order to' demon-strate a possible early immune reac-tion in previously vaccinated indi-viduals. The skin of the upper arm, in the region of the depression formed bv the insertion of the deltoid muscle, should be thoroughly cleansed with soap and water if not seen to be clean, and in any case with alcohol or ether <>r sterile gauze. After evaporation of the alcohol or ether, a drop of the virus should be placed upon the cleansed skin. To expel the virus from a capillary tube, the tube should be pushed through the small rubber bulb which accompanies it, wiped with alco-hol, and one end broken off with sterile gauze : the other end may be broken inside the rubber bulb. The hole in the latter should be closed with the finger as the bulb is com-pressed to expel the virus. The under surface of the arm is grasped with the vaccinator's left hand so as to stretch the skin where the virus has been placed. The skin is kept thus stretched throughout the process. (a) The Method of Incision, Linear Abrasion. By means of a sterilized needle or other suitable instrument, held in the right hand, a scratch, not deep enough to draw blood, is made through the drop of virus, one-quarter of an inch long and parallel with the humerus. The virus is then gently rubbed in with the aid of the needle or other smooth, sterile instrument. Some blood-tinged serum may ooze through the abrasion as the virus is rubbed in, but this should not be suf-ficient to wash the virus out of the wound. (b) The drill method. A sterile drill, such as is used for the von Pir-quet cutaneous tuberculin test, shaped like a very small screw driver with a moderately sharp end not more than 2 millimeters (1-12 inch) wide, is held between the thumb and middle finger. and with a twisting motion and mod-erately firm pressure, a small circu-lar abrasion, the diameter of the drill, is made through the drop of virus ; this should draw no blood. (c) The Multiple Puncture Method. A sterile needle is held nearly paral-lel with the skin and the point pressed through the drop of virus so as to make about six oblique pricks or shal-low punctures, through the epidermis to the cutis, but not deep enough to draw blood. The punctures should be confined to an area not more than one-eighth of an inch in diameter. With methods (a) and (b) it is advisable to expose the arm after vaccination to the open air, but not to direct sun-light, for 15 minutes before the cloth-ing is allowed to touch it. With method (c) the virus may be wiped off immediately. The original vaccination wound should be made as small as possible, and all injury to the vaccinated arm should be guarded against. Any cover-ing which is tight, or more than tem-porary, tends to lacerate the tissues during the "take." This is to be avoided. No shield or other dressing should be applied at the time of vacci : nation. Customary bathing and daily washing of the skin may be continued, so long as the crust does not break. The application of moisture to the vaccinated area should not be enough 14 The Health Bulletin to soften the crust. If an early reac-tion of immunity is to be watched for. the patient should report on the first, second, fifth, and seventh days after vaccination. Otherwise, the patient should report on the ninth day, or sooner if the vesicle, pustule or crust breaks. Every effort should be made to prevent such rupture. However, should the vesicle, pustule, or crust break, and the wound thus become open, daily moisture dressings with some active antiseptic, such as mer-curic chloride or dilute iodine (one part tincture of iodine in nine parts of water) should be applied. Under no circumstances should any dressing lie allowed to remain on a vaccination wound longer than -4 hours, and no dressings should be applied so long as the natural protection is intact. On account of possible fouling by perspir-ation and to lessen the chance of ex-posure to street dust, primary vacci-nation should be performed preferably in cool weather. A child should be vaccinated by the time it has reached the age of 6 months, and the operation should be repeated at about 6 years of age and whenever an epidemic of smallpox is present." THE RELATION OF EYE, EAR, NOSE AND THROAT TO HEALTH _y The diseases of the eye, ear. nose and throat have become a well defined specialty in medicine. The diseases of the eye and ear tend to remain con-fined to the eye and ear* while those of the nose, and particularly those of the throat, tend to distribute them-selves to other parts of the body. But sight, hearing and smell are special senses which receive information for the brain from the outside world, and if the eye, ear or nose are diseased the happiness and usefulness of the indi-vidual are badly handicapped. So the diseases of all four organs are im-mensely important. The eye is a small camera. It takes pictures for the brain. Its various positions for getting different views are determined by six muscles which move it around in its socket. It is kept clean, in order to get clear pic-tures, by the tears which constantly wash it. And it is protected by the eyelids and eyelashes. A description of all the diseases of the eye would be too long to under-take here, but some of the more com-mon symptoms of important eye dis-eases, which should cause one to have his eyes seen by a doctor, are as fol-lows : (1) If the eye becomes red. painful and runs water. If the patient is a baby no time should he lost. Twenty-five per cent of the blindness in chil-dren is caused by an infection (op-thalmia neonatorum) which begins in this way. If the red, painful, water-ing eye of any one is only "pink eye" that affection is contagious, often runs in epidemics, and leaves many weak eyes behind it. (2) If a foreign body (dirt, dust. steel) sticks to the cornea (over the colored part of the eyeball) it should be taken to a doctor for removal. An awkward move, wounding this delicate part of the eyeball, might cause an ulcer which, after it heals, leaves a white scar, interfering with sight. (3) If a child, when it starts to school, becomes cross-eyed, or if occa-sionally an eye is crossed for only a ^Imrr period of time, or if the eyes run water, or if the child cannot read long without rubbing the eyes it should be taken to a doctor and have the proper glasses fitted. This will likely prevent the child from becoming permanently cross-eyed, and will keep it from get-ting tired, nervous and irritable from eyestrain. In adults many headaches are due to eyestrain. (4) In a person of middle age or past, aching pain in the eyeball, with or without disturbance of vision, should cause him to go to a doctor. Two serious diseases, which usually end in blindness, with, sometimes, the The Health Bulletin 15 need for removal of the eyeball, begin in this way. Early treatment may pre-vent their bad results. (5) If a person develops spots be-fore the eyes, which remain there, usually with headache, he should go to a doctor and have a thorough ex-amination, including that of his blood pressure and his urine. It may save him from apoplexy or uremic poison-ing. (6) A child or a young person, de-veloping light clouds in the colored part of the eyes, should go to a doctor and have his blood and possibly his spinal fluid examined for a blood dis-ease. (7) Practically everybody knows about cataracts and pterygia. These develop slowly, are not particularly dangerous, and are cured by opera-tion, with, usually, a useful return of sight. Points to be noted in the general care of the eyes are : Do not read in bed. Do not read in the bright sun-light or in a flickering light. If you get something in your eye, do not rub it. If, when you read very much, your eyes burn, smart, or become inflamed, see your doctor and follow his advice. Of all the blindness in the United States, nine out of ten are blind from one of two causes: (1) opthalmia neo-natorum: or (2) from the uncorrected eye defects of school age. Opthalmia neonatorum causes one out of six of these. It is a disease caused by a genu which gets into the baby's eyes while it is being born. If the eyes are carefully cleansed with one per cent silver nitrate immediately after birth, this disease can be prevented. All doc-tors and midwives should do this. There are 10,000 dependent blind peo-ple in the United States today because this was not done. The remaining five out of six are blind from diseases which could have been prevented if they had been treated early enough. Every year there should be a thorough, systematic examination of the eyes of school children. To set aside the ques-tion of blindness, many children who have credit for good eyes, but who have never been examined, do not have a fair chance in school, because of eye defects. A child who strains and squints at the blackboard attracts no particular attention, and if he fails to learn everything on the blackboard, or even in his books, he is considered lazy or stubborn. Recently, 91 children were examined in a country school in North Carolina ; 13 complained bitter-ly of headache and of being tired all the time. The teacher complained that they were "lazy." "hard - headed." "stubborn." or "wilfully intractable." When examined, they were found to have serious eye defects. When these were corrected, ten of them became tractable children, showed improve-ment, and some made two grades dur-ing the remainder of the session. Sometimes a child with defective vis-ion will complain that "the lines run together.'' If the eyes of all babies were cleansed with one per cent silver nitrate immediately after birth, and the eyes of all school children were examined yearly and the defective ones properly treated. 00 per cent of all blindness could be prevented in one generation. EAR The ear is divided into three parts — the outer, which extends from the out-side of the head inward to the ear-drum ; the middle, which extends from the ear-drum to the wall of the inter-nal ear, or third part, which lies in the bony wall of the skull. The part of the ear in which we are most interested is the middle part. It is the part in which most of our tar trouble takes place. It is where ab-scesses (risings) form. This part has air in it, which comes up from the throat through a tube which connects the ear with the upper part of the throat. This tube (the eustachian tube) is very important. If it becomes closed, we cannot hear as well, and in addition still more serious troubles may follow. Most of the ear troubles come from this tube being stopped. If we have a cold or a sure throat and the infection goes up (be tube to the ear. the tube becomes closed and an abscess forms in the ear. Children have more ear abscesses and running ears during (be winter and early spring months, when they are having more colds and sore throats, l ban at any other season of the year. The ton-sils and adenoids are situated near the openings of these tubes, in the upper 16 The Health Bulletin throat, and if they become too large, without being diseased, they may close these openings and cause partial deaf-ness. And if the tonsils and adenoids become diseased, the disease can easily go up to the eustachian tubes and pro-duce disease in the ears. When trouble begins in the ear, usually, the first symptom we notice is earache. A doctor should be seen then. If an abscess is forming, the ear-drum should be cut to let the ear run. If the abscess is allowed to wait until the ear-drum bursts, a large, jag-ged hole is made in the drum, which may leave a hole when it heals, with some deafness resulting. If the drum is cut, the opening is narrow and even, and it will heal again, when the abscess is well, with less damage to the ear, and usually with better hear-ing resulting than if the abscess is left to burst and drain itself. If the infection from the abscess in the middle ear extends backwards into the mastoid process, the area just be-lli nd the ear, the condition becomes serious. From here it can easily spread to the brain, with death as a result. If the mastoid area becomes tender whenever there is ear trouble. a doctor should be called immediately. If mastoiditis is developing, an opera-tion may be necessary at once. Symp-toms for which one should see a doc-tor, then, are deafness, earache, dis-charge from the ear, and immediately upon the development of severe head-ache, with tenderness behind the ear. The nose extends from its front openings above the mouth backwards to the upper part of the throat. It Is divided into two cavities by a septum, and from each outer wall three curved, scroll-like shelves of thin bone, the tur-binates, extend across toward the sep-tum, but not against it. The walls and the turbinates are covered by moist mucus membrane containing many hairs. This makes the nose an irregu-lar, crooked canal, with a warm, moist surface for the air to pass over. All air going into the lungs should be clean and warm, and nature designed the nose to do this, and planned for all air to be taken in through the nose. In the nose, also, are the special nerves of smell. If there is some condition in the nose which prevents the air from pass-ing through it, and it must come in through the mouth, bad effects may naturally be expected from the condi-tion. Exclusive of bad colds, during which time there is usually more or less temporary obstruction to breath-ing through the nose, the common causes of nasal obstruction are ade- The Health Bulletin 17 noids, deflection of the septum, en-larged turbinates, and nasal polyps. Inability to breathe through the nose, catarrh, or asthma are the symptoms which usually take the patient to the doctor. When the doctor examines the nose and finds out what is causing the obstruction or irritation, he then treats the condition which he happens to find according to what it needs adenoids or polyps are removed : en-larged turbinates shrunk or partially removed ; and deflected septum re-sected. The most frequent and important cause of nasal obstruction which con-cerns the greatest number of people is adenoids in children. About 10 per cent of all children have adenoids to some extent. This disease usually be-gins about the second, third, or fourth year, increases in severity up to the eighth, ninth, or tenth year, and then decreases, possibly disappearing be-tween the eleventh and fourteenth years, but during its existence the dis-ease may mar the child's features, stature, efficiency, and character for life. Adenoids are small swellings or little tumors that grow in the throat just above the back of the opening of the nose into the mouth, and in front of the opening of the two small tubes by which the ears are connected with the upper part of the throat. These little swellings or tumors are reddish-gray in color, soft and slimy in texture, and vary in size from that of a pea to a mass that almost completely fills the upper part of the throat. The harm done by adenoids depends upon their size, location, and whether or not they are treated. (1) They interfere with breathing. Normally, we take in the air (inspira-tion) through the nose, keeping the mouth closed. By passing over this surface, the air is warmed and much of the dust, dirt and germs in the air is filtered out on this sticky, mucus-covered wall, so that the air entering the lungs is warmer and purer than it would be if breathed in through the open mouth. We can readily see that if the adenoid growth in the back of the throat enlarges and grows over or into the back opening of the nose, it interferes with breathing through the nose, and forces the child to breathe through its mouth. A child who habit-ually breathes with an open mouth be-comes what is known a's a "mouth-breather." The air reaching the lungs in an unpurified condition predisposes such a child to frequent attacks of cold, bronchitis, and pneumonia; and, furthermore, with part of its air canal obstructed, the child does not get into its body as much air as the normal child consumes. Air is one of the im-portant foods of the body, the three kinds of food being air, water, and solids. Therefore, a child with its air food cut down doesn't grow as rapidly or as strong as a child that gets a suf-ficient amount of air food, or oxygen. This low resistance, this weakened condition, is another reason why the child with adenoids is more suscepti-ble to diseases in general than is a normal child. (2) The child with adenoids has an altered voice. The upper part of the throat, where adenoids grow, gives the quality known as resonance to the voice ; therefore, when that part of the throat is diseased with adenoids and more or less filled up, the voice loses that quality. The speech is stuffy ; the child, in pronouncing "teeth," says "reef" : in pronouncing "song," says "sogg" ; in pronouncing "common," says "cobbed" ; and in pronouncing "nose." says "dose." Instead of say-ing "Spring is coming," the child says "Sprig is cobbig," etc. (3) The child's nose, being more or less diseased and especially subject to colds, loses to a large extent the sense of smell. We all know that when we have a cold and lose the sense of smell, we nearly always lose, to a cer-tain extent, at least, our sense of taste. So it is with a child with adenoids — the senses of smell and taste are large-ly impaired. Appetite depends to a considerable extent upon our ability to enjoy food,- to taste it: so adenoids. through interfering with taste, inter-fere with appetite, and. therefore, with desire for food, with amount of food consumed, and with the digestion of food. In these ways they interfere again with the general growth and strength of the body. (4) Adenoids produce a peculiar facial expression. With the back part of the nose obstructed, partially or completely, and the mouth used as the 18 The Health Bulletin breathing tube, the roof of the mouth slowly bulges upwards to enlarge the mouth for its additional task. Now, with the pushing of the roof of the mouth upwards, the arch of the teeth becomes more acute and bends, caus-ing an overlapping of the teeth and a shortening of the upper lip. The nose, on the other hand, remains undevel-oped, small, and narrow. The extra effort of the child to breathe causes an unnatural arching of the eyebrows. All of these effects give us, after the disease has become fully established, the peculiar adenoid expression—the open mouth, the overlapping teeth, the short upper lip, the narrow, small nose, the high-arched eyebrows. (5) Adenoids cause disturbed sleep by interfering with breathing. The child, when awake, can use its volun-tary muscles to assist in the breathing process, but when it goes to sleep the breathing becomes impaired or insuf-ficient, thus causing the child to awake to put to work the additional muscles hence the restlessness at night and the bad dreams of a child suffering from adenoids. (6") Adenoids frequently interfere with hearing, causing various degrees of deafness. An adenoid growth, if placed over one of the eustachian tubes opening from the middle ear into the top of the throat, will prevent that ear from receiving air from the back of the throat, and, when the air to the ear is cut off, the ear fails to hear properly. An adenoid growth may be so small and at the same time so placed with reference to the ear tubes as not to cause any symptom, except deafness. Deafness, therefore, always suggests an examination of the throat. It not infrequently happens that chil-dren with adenoids, in addition to a certain amount of deafness in one or both ears, develop earache or abscess of the ear, on account of the ears be-coming infected through the obstructed and diseased tubes. If a child has adenoids they should be removed. If a child is under eight or nine years of age. the harm will almost certainly increase and, perhaps, the injury will become permanent. The operation for adenoids is relatively simple, and the danger is not much greater than the danger of an anaes-thetic. In other words, the treatment, as compared with the danger of leav-ing the adenoids alone, is a minimum danger compared with a maximum danger. Take your child to some physician who is known to treat ade-noids, or if convenient, to a nose and throat specialist. Do it now. The tonsils are two fleshy tumors, each normally about the size of the end of the thumb, situated one on each side of the throat, and are seen just above the back of the tongue when the tongue is depressed to bring them into view. The tonsils may stick out in the throat cavity and look large or they may be buried in the throat wall and look small and yet be the same size in both cases. So if there is trouble which the tonsils are sus-pected of causing it does not mean that there are little or no tonsils be-cause little or none are seen. They may be buried out of sight in the wall of the throat. In the tonsil are a number of pockets or crypts, as they are called, which open on the surface of the tonsil. The crypts are lined with the mucus mem-brane which covers the tonsil so that something may be in the pocket of the tonsil and at the same time not be inside the tonsillar tissue. The purpose of the tonsils has not yet been clearly made out. Their presence would seem to imply that they have one but it is known that no serious harm results from not hav-ing them. In some people they shrink to nothing and in others big or diseased ones are removed with no bad results. So we know that we can do very well without them. But the fact that one has tonsils is no reason why they should be removed. But since it does no harm to remove them they should be removed if they are doing positive harm. There are three conditions which should cause them to be re-moved: (1) If they are so large that they crowd the throat and interfere with swallowing or interfere with the tubes leading to the ears and cause deafness: (2) if there are repeated attacks of severe tonsilitis or periton-sillar abscess (called quinsy) ; (3) if there are signs of the body having germs and poisons in the blood, as in some cases of rheumatism, heart or kidney disease, and it cannot be made The Health Bulletin 19 out where the germs are coming from, the tonsils should be removed. The reason why apparently healthy tonsils should be removed in such rases is as follows : One of the pockets or crypts of a tonsil in which germs grow in an attack of tonsilitis may become sealed off at the mouth on the tonsil surface. The tonsil looks all right on the outside but inside there is a small abscess. This abscess eats through the wall of the crypt into the tonsillar tissues and the germs are fed into the blood stream and carried by the circulation all over the body. This tonsil would look healthy from the outside but when it is removed and the inside examined it would be found to contain this small hidden abscess which has been a spring -feeding germs and poisons to the rest of the body. The two common sore throats are acute follicular tonsilitis and diph-theria. In both of these there is a light colored exudate on the tonsils. In follicular tonsilitis the exudate is usually yellowish in color and arranged in patches. In diphtheria the exudate is usually a gray membrane on the tonsils or some other part of the throat. Every sore throat should be looked at. This is easily done by tilting the head backward in a good light and pressing the tongue down with the handle of a spoon. The spoon should then be dropped into boiling water and care should be taken to keep the patient from coughing into your face during the examination. If the tonsils or any part of the throat have any exudate on them the child should be kept at home and it should be seen by a doctor immediately. If it is diphtheria it should have diph-theria antitoxin as soon as possible. Defects of the eyes, ears, nose or throat in childhood are a great barrier to growth and development in both body and character. The children in school who are backward from these defects are not only a loss to them-selves but they hinder the progress of the healthier ones in the class who are capable of going ahead. Everyone dislikes discomfort. And when a child has eyes which give him headaches or make him nervous when he studies he will be cross when you try to make him study. And a child dull and de-pressed with adenoids cannot be very ambitious. These are the children who are to be the men and women of to-morrow. What kind of citizens shall they be? TUBERCULOSIS Tuberculosis is a disease seen most frequently affecting the lungs of people of late youth and early middle age. Here it is commonly called consump-tion. It is seen in children affecting the glands, bones and joints, where it is often called scrofula. It is caused by a germ and affects those with faulty habits of living. It is curable in the early stages by adopting good habits of living. In the late stages if is often hopeless. But, since the disease is caused by a germ and by habits of living, which can be changed, it is preventable. In North Carolina tuberculosis causes one of every eight deaths and one of every three preventable deaths during the wage earning period of life. It is killing more people in the United States than any other disease. It is killing more every four years than were killed during the Civil War, occupying an equal period of time. Why does such a devastating disease cause no more alarm and no more effort to stop it? We get excited about smallpox, cholera, yellow fever or a war because they are spectacular. But figures show that tuberculosis kills as many people in the United States every six months as yellow fever has killed in 115 years. Tuberculosis is a familiar disease, working quietly, saving us the shocks of sudden tragedies; but a summary at the end of the year shows that, within thai period, in North Carolina, the number of people, mostly of wage earning and family supporting ages, that have been so quietly eliminated, is 3,000. It is 20 The Health Bulletin our most devastating disease and it is preventable. It was once thought that tuberculo-sis was hereditary—that the parents passed the disease on to their children through their "blood." This is now knowu to be a mistake. The disease often runs in families, but it does so for the same reason that those most closely associated with any consump-tive are most likely to take it. Mem-bers of a family have much the same habits of living and are closely asso-ciated so that they keep one another infected and the disease runs in the family. In many families where a consumptive member is taught how to live without spreading his germs no other member takes the disease. It was also once thought that tuber-culosis was incurable. But this was because it was not recognized until the disease had almost consumed the patient (hence the name consumption) and he had no strength left with which to fight it. We are learning to recognize its early signs and if treat-ment is begun in the early stages it can usually be cured. Of the people whose bodies are opened and examined after death, many of those who die from other causes show healed scars from old tuberculosis in their lungs. This means two things : First, that they had tuberculosis which got well. Second, that many did not know it when they had it. What happened was something like this: From sick-ness or overwork they had become run down. There may have been deep colds or winter coughs or loss of appetite and weight, which improved after a rest or some special attention to the health. During this run down period there was a tuberculous lesion which healed with the improvement of the general health. If these people had not been careful of their health at their run down periods they would have developed tuberculosis on a con-sumptive scale. Tuberculosis is there-fore curable. The average death age from tuber-culosis is 35 years. The reason for this is plain. It is the time of life when people are giving most of them-selves to the wear and tear of hard work and the raising of families. They think of themselves less and neglect their health. Their vitality runs low and small tuberculous lesions, which they' might never have known that they had, develop into advanced tuber-culosis before they recognize anything serious. In addition to small tuberculous lesions, in many, which may not at-tract attention, all of us are frequently taking germs into our bodies on in-haled dust from dried sputum, coughed or spit by people who may not know that they are tuberculous. Why then, do not all of us have tuberculosis? There are two factors in the cause of the disease: (1) the strength of the germs and (2) the strength of the person. If a strong man takes in weak germs his body will likely kill them. If a weak man takes in strong germs they will likely grow and produce the disease. The same rule holds in the cure. The earlier treatment is begun, the smaller the amount of disease and the greater the strength of the patient and, therefore, the more likely his recovery. The later treatment is be-gun, the greater the amount of disease, the weaker the patient and the more unlikely is his recovery. The fresher the germs from the patients' sputa the stronger they are. The better our health, the stronger our resistance to them. We cannot choose the germs to be fought so it behooves us to keep ourselves in the best possible health, and to treat the earliest symptoms. It is of the utmost importance to recognize the early symptoms of the disease. The late symptoms belong to a si age which too often cannot be cured. The popular picture of tuber-culosis is a thin, pale, consumptive. with a racking cough, possibly spitting blood. This stage is usually incurable. But if taken early the disease is cur-able. Important early symptoms are a ('instant tired and weak feeling: a steady and unaccountable loss of weight; loss of appetite with indiges-tion : a cough that lasts longer than three weeks : hoarseness vrbich does not get well under ordinary treat-ment ; unusual sweating at night ; per-sistent pain in the chest or shoulder; attacks of pleurisy. Blood spitting is nearly always tuberculous. But many patients never have it. Absence of the germs in the sputum does not mean that the disease is not present. The Health Bulletin 21 They are present in advanced stages. Tuberculosis is the most common chronic disease, and particularly of the lungs. When chronic bronchitis lingers after pneumonia, grippe or a common cold . be suspicious of early tubercu-losis. Treatment will do no harm and it will restore your health and possibly prevent the disease from developing. To get well of tuberculosis, do not depend on drugs. The doctor may oc-casionally use a medicine to increase appetite, control cough or hemorrhage, to induce rest, or to meet some such temporary symptom, but no medicine is given to act directly upon the germ. Quacks who advertise consumption "cures" are not trying to cure you so much as they are trying to get rich while you are spending your money trying to get well. The cause of the disease is a weakened resistance of the body, and only those things which build up the general health will cure it. These things are four—(1) rest, (2) fresh air, (3) food. (4) a cheerful mind. And, in time, the proper exer-cise. When one finds that he has tubercu-losis, he should, if possible, stop work entirely for six months and at once begin a rest cure at home on his porch or in his backyard ; or if this cannot be done, rest in his room, with every window wide-open. He should rest constantly in the open air, and should lie down if he has any fever, and con-tinue in bed until he has been without fever for at least a month. Then, gradually and cautiously, he can begin taking a little exercise—a few minutes only—slowly increasing each day, and stopping at once on the slightest re-turn of fever, or if it causes him to get short of breath or to become tired. In winter, wear enough warm, but light, loose clothing. Do not bundle up enough to cause perspiring. That will cause cold. Have the rooms kept clean by scrubbing with soap and water. Open wide all blinds and put up the window shades, so that the fresh air and sunlight can enter freely. The windows should be left open, sum-mer and winter, day and night. Sleep, if possible, on a porch or in a tent. But if you have to sleep in a room, have every window open. Have plenty of warm, but light, bed clothing, and place the bed near one of the windows. Get the best and most nourishing food you can afford. Eat meat at least once a day — preferably broiled or roasted—and take plenty of good, fresh milk, butter and eggs. A certain amount of fruit and green vegetables are needed for a well-balanced diet. Eat anything that you can- digest. Drink plenty of water. Do not drink any alcoholic liquors. Worry will break down the resist-ance of a well man. It is worse for a sick one. Happy surroundings, cheer-ful faces, and healthy minds and bodies in the house will be a great fac-tor in the recovery of the patient and in keeping those around him well. His disease is curable, and he should keep this in mind and spend his time in the most pleasant manner possible. The greatest possible care must be observed by the patient and by those attending him to keep the infection from spreading to others. The germ is in the sputum of the patient. All his sputum must go into a sputum cup, which is burned. A convenient one is a pasteboard cup in a metal container. The cup must be made so that flies cannot get into it. The patient must cover his mouth with a cloth or paper whene\er he coughs or sneezes, and these must be burned. Avoid raising a dust. Have the room well screened and keep the sputum cups where flies cannot get to them. The patient's eat-ing utensils, after use, must be scalded in hot water and washing soda and wiped dry. He should have his own. and use no other. All his linens and clothing must be boiled before being sent to the general wash. He should occupy a separate room, or at least a separate bed. The prevention of tuberculosis de-pends upon maintaining a good stand-ard of health and avoiding the sources of tuberculosis germs. To maintain a high standard of health means to live more or less as a tubercular patient would. What will make him well will keep another well. Tuberculosis is a house disease. Tuber-cle bacilli cannot live in the fresh air and sunshine, but they can live in the air of closed rooms. Therefore, be out-doors as much as possible, and have plenty of fresh air and sunlight in the home. The North American Indian never had tuberculosis until he lived 22 The Health Bulletin The Health Bulletin 23 in the white man's houses. Eat plenty of plain, simple food, and drink plenty of pure water. Sleep eight hours every night, and avoid dissipation. The ultimate source of the tubercu-losis germ is the saliva of the patient. He may know that he has tuberculosis, or he may not. If he does not, he is all the more dangerous, because he will be the more careless. When he coughs, with the mouth uncovered, the fresh, virile germs may be inhaled from the fine spray of droplets which he throws into the air, or they may be inhaled from the dust which brings them up from the floor after they have fallen and dried. When he spits, flies may feed upon the fresh sputum and carry the germs to food which they feed upon next. The promiscuous cougher and spitter is a disease spreader. He spreads it in the home, shop, factory, store, and sometimes on the street. An additional source of infection, to children in particular, is the milk from tuberculous cows. The county should see that all milk sold within its limits comes from nontuberculous cows. A tuberculous mother usually gives the disease to her baby if she suckles it. The conquest of tuberculosis is for the community as well as the doctors. It is more a matter of education than of medicine. Hygiene and sanitation must be thoroughly drilled into the children at school. Laws against spit-ting must be enforced to cultivate a proper public sentiment against it. The county nurses should be complimented upon their excellent work in instruct-ing patients as to how to make them-selves safe for their families and friends. Everybody should read all the publications on the disease by the vari-ous boards of health. The cure and prevention of tubercu-losis rests, in the end, upon the con-duct of every individual person. Tuber-culosis is a slow disease. It might be called an error in the way of living. It develops slowly, after repeated ex-posures to the disease, rather than rapidly, after a single exposure. And it is cured by patient and careful cor-rection of the habits of living for life, rather than by an intensive course of treatment for a limited period of time The arrested case cannot discard his good habits, which he practiced during his treatment, without dangers of a re'aose. And the well person cannot remain well unless his habits of work-ing, eating and sleeping are good. If he is careful only when he knows that he is in danger, he is not protected from the many sources of germs that no one knows about. It is only the habit of good sanitation and hygiene that will give protection all of the time. These good habits, in addition to keeping the germs out of the body, will build up a strong physical consti-tution, which will kill the germs when-ever they do happen to be accidentally taken into the body. The habits to be relied upon to cure tuberculosis and to keep it from ever developing are: plenty of fresh air, out of doors, plenty of nourishing food, and plenty of sunlight, out of doors or through an open window, straight from the sun. BEWARE OF MEASLES During the latter part of March there has been an unusual preva-lence of measles. Many parents still feel that their children must have all the common communicable diseases, and that the sooner they have them the better. On this theory some parents even deliberately expose their children to infection. A greater mistake could not be made. Measles is especially dangerous because of the frequent im-pairment of sight and hearing which follows, and because of the large number of cases that prove fatal. Guard your child against measles and all other contagious diseases just as much as possible. 24 The Health Bulletin coPyRiGtfT N0.I6 HEAmlcARTooK 5«Wft Nature's Best Ally—Fresh Air "-P / jd n a n i :j . IN . U . > CHAPEL HILL, N Published by TAE. N?RTA QPRSUFUK STATE. D°ARD </AEMJA Thi5 Bu)ktir\ will be -serxl free to ar\u citizer\ of the Stale upoi\ request. I Vol. XXXVIII MAY, 1923 No. 5 __J THE BABIES* HOSPITAL The Babies' Hospital on Wrightsville Sound between Wilmington and Wrightsville Beach is a public hospital for sick babies. It is situated on the sound in order to have the benefits of salt air and sea breezes with none of the disadvantages incident to a location on the ocean front. Its purpose is to treat sick babies, and through its excellent milk feeding station to keep well babies from getting sick. It is open to any physician, and serves a near-by population of at least 200,000 people. MEMBERS OF THE NORTH CAROLINA STATE BOARD OF HEALTH J. Howell Way, M.D., Pres. Waynesville Richard H. Lewis, M.D., LL.D.—Raleigh Chas. E. Waddell, C.E Asheville Thomas E. Anderson, M.D Statesville A. J. Crowell, M.D Charlotte Charles O'H. Laughinghouse, M.D., Greenville Cyrus Thompson, M.D Jacksonville P. R. Harris, M.D Henderson E. J. Tucker, D.D.S Roxboro EXECUTIVE STAFF W. S. Rankin, M.D., Secretary and State Health Officer. G. M. Cooper, M.D., Assistant Secretary. Ronald B. Wilson, Assistant to the Secretary. 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. J. S. Mitchener, M.D., Chief of Bureau of Medical Inspection of Schools. K. P. B. Bonner, M.D., Chief of Bureau of Maternity and Infancy. FREE HEALTH LITERATURE The State Board of Health has available for distribution without charge special literature on the following subjects. Ask for any that you may be interested in. Whooping-cough Hookworm Disease Public Health Laws Tuberculosis Laws Tuberculosis Scarlet Fever Infantile Paralysis Care of the Baby Fly Placards Typhoid Placards Tuberculosis Placards Clean-up Placards Don't Spit Placards Sanitary Privies Water Supplies Eyes Flies Colds Teeth Cancer Pre-natal Care Malaria Smallpox Adenoids Measles German Measles Typhoid Fevee Diphtheria Pellagra Constipation Indigestion Venereal Diseases Catarrh 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. . THE HEALTH BULLETIN The Health Bulletin is sent monthly without charge to all persons in the State who care to receive it. If you have friends or neighbors who will be interested, suggest that they write the State Board of Health, asking for The Bulletin each month. When you have finished with your copy, give it to some one else, thereby increasing its usefulness. Inteal; ',[°3 | PUBLI5AE.D BYTML nORTM CAgOLIHA 5TATL EPA^D ^MEALTH~1 |l_£j Vol. XXXVIII MAY, 1923 No. 5 ANNOUNCEMENT A number of changes in the administrative staff of the State Board of Health became effec-tive on March first. Dr. G. M. Cooper, who has been a member of the staff for the past eight years, was appointed Assistant Secretary of the Board, becoming responsible for the educational work and Editor of THE HEALTH BULLETIN. The Bureau of Epidemiology was discontinued as a separate administrative unit, its functions being combined with the Bureau of Vital Statistics under the direction of Dr. F. M. Register. Dr. J. S. Mitchener, formerly State Epidemiologist, became director of the Bureau of Medical Inspec-tion of Schools, succeeding Dr. Cooper. The Bureau of County Health Work was discontinued, its functions being merged into the office of the Secretary of the Board. To aid in the develop-ment of county health work the State was divided into five districts with the following division directors: Dr. E. F. Long, Dr. R. C. Mitchell, Dr. M. L. Ilsley, Dr. H. A. Taylor, and Miss Rose M. Ehrenfeld, R. N. With regard to THE HEALTH BULLETIN, every effort will be exerted to maintain the previous high standard of this publication, and to continue to publish in simple, understandable language as much accurate, scientific information about the prevention of disease as possible. An earnest endeavor will be made to send out each issue as near the first of the month as possible. The Health Bulletin SERVICE TO THE PEOPLE WHAT THE STATE BOARD OF HEALTH HAS TO OFFER TO THE PEOPLE OF NORTH CAROLINA The only reason for the existence of a State Health Department is be-cause of a necessary service such a division of government must render to the State's citizens in the pursuit of health and the protection of life. In response to the growing demands of a great progressive state, and on account of the complexities of mod-ern business, it has been necessary, in order to render efficient service, in an economical manner, to organ-ize the work of the Board of Health into separate divisions with a re-sponsible director at the head of each division. In order to set forth con-cisely and specifically just the char-acter and scope of service and co-operation the State Board of Health extends to the public, the Editor of the Bulletin has asked the director of each department to prepare a state-ment carefully describing precisely what service his department is pre-pared to render. The publication of these articles should supply valuable information to the public and espe-cially to the medical profession, health officials and organizations of teachers. Any individual, organization, county or municipality, desiring ad-ditional information concerning any of the departmental activities de-scribed in the following papers or to avail themselves of the services of-fered, may obtain a prompt response by simply writing to the director of the particular department interested in, care of the State Board of Health, Raleigh, N. C. I. WHAT THE BUREAU OF COUNTY HEALTH WORK OFFERS TO THE COUNTIES The Bureau of County Health Work offers to the counties of the State material assistance and expert advice. In this offer the Bureau seeks neither direction nor super-vision over local health work. The Board of Health is definitely and firmly committed to the policy of im-proving health by educational appeal and assistance rather than by legal compulsion. The practice of legally requiring local governments to do certain things, a practice in general use in most of the states and used with respect to certain phases of gov-ernment in North Carolina, is not necessary in work of the character of that which interests the State Board of Health. The health idea has enough merit in it to get it across to the public. It is not neces-sary to hold the nose of the public and make it swallow health. Failure to influence the average county to take reasonable measures for the protection of the health of its people is not due to any fault of the county; neither is it due to any inherent weakness or defect in the idea of health protection or advancement; the fault, nine times in ten, lies with the sort of salesmanship behind the idea. Physical salvation, like spirit-ual salvation, sells itself when prop-erly presented. All that is needed, and this the Bureau of County Health Work attempts to supply, is to prop-erly present the possibility and prac-ticability of health protection and improvement and to offer enough as-sistance, in the way of material sup-port and intelligent planning, to in-sure a good start. The material assistance, which the Bureau of County Health Work has to offer, is $2,500 annually to the county which establishes and main-tains a full-time health department and which itself expends an equal sum. The material assistance of the Bureau is not conditioned upon who is to be elected health officer. The county selects its own health officer without any dictation—political, per-sonal, or otherwise—from the State Board of Health. Only when the Bureau is requested by the county The Health Bulletin authorities to assist in finding an available health officer, does the Bureau take any part; moreover, when the Bureau has found a health officer its function has ceased and the responsibility of selecting a health officer devolves entirely upon the county authorities. The Bureau helps to find, but it never selects. The material assistance of the Bureau is not conditioned upon the development of some particular plan of work. Each county may originate its own plan with or without the as-sistance of the Bureau of County Health Work, as the county may choose. The material assistance of the Bureau is conditioned upon the county health department keeping a record of the items of work which it performs, and reporting to the Bureau monthly what work it has accomplished with the funds ex-pended, in order that the Bureau, which is responsible to the General Assembly and to the State for the funds which it has supplied the county, may account to the General Assembly not only for what was spent, but, which is far more impor-tant, for what was accomplished with the money expended. The expert advice, which the Bureau of County Health Work of-fers to the counties, is supplied through a personnel of exceptionally well-trained health officers; more-over, these health officers are, through their contacts with county health departments that make use of them in the planning of their work and through the reports of work ac-complished reported to them by county health departments, familiar with what is being accomplished in all the counties of the State having full-time departments, and with how the accomplishments of these depart-ments are effected. The expert per-sonnel of the Bureau is available at any time and all times to the county authorities, to the County Medical Society and other interested groups of citizens to confer with them in regard to the possibilities of improv-ing the work of the local depart-ment. II. WHAT THE STATE LABORATORY OF HYGIENE OFFERS TO THE MEDICAL PROFESSION AND THE PUBLIC The work of the State Laboratory of Hygiene may best be understood by dividing it into three divisions: (1) the examination of specimens, (2) the supervision of water sup-plies, and (3) the distribution of serums and vaccines. The chief examinations are the following: Throat swabs for diph-theria, sputum for tuberculosis, blood for typhoid fever, both by means of the Widal agglutination test and by culture, blood for the Wassermann test for syphilis, pus for gonococci, brains of dogs and other animals for rabies, specimens of faeces for intestinal parasites, blood for malaria, and spinal fluid for meningococci or other infection. All these examinations are made entirely without charge, but reports are sent to physicians only. There are certain other examinations which clearly belong to the private practice of medicine; there is no more reason why the State should make gastric analyses or blood sugar tests, for in-stance, than that it should make a business of performing appendec-tomies. The line is at times hard to define but the distinction exists just the same. We have tried to solve the problem of tumor examination and Urine analyses by charging a small fee. These examinations do not usually fall under the head of public health work but they occa-sionally do, and the laboratory is protected from abuse by the fee. It is manifest that the examination of specimens for life insurance is not a part of the work of a public health laboratory. The examination of water is an important division of the laboratory work. It is recognized that an iso-lated examination of one sample does not give much definite information, but we have a system of regular and periodic examination of all public water supplies which works in har-mony with an efficient engineering department under the control of the 6 The Health Bulletin Board of Health. This work has led to great improvements in the public water supplies and in the commercial bottled waters. The third division includes the dis-tribution of prophylactic serums and vaccines. Typhoid vaccine, Triple (Typhoid, paratyphoid A, and para-typhoid B) vaccine, pertussis vac-cine and smallpox vaccine are dis-tributed entirely without charge. Diphtheria antitoxin in 1000, 3000, 5000, and 10000 unit packages are distributed at twenty-five cents each, and prophylactic doses of tetanus antitoxin at fifty cents each. The complete Pasteur antirabic treatment accompanied with a good Luer syringe is supplied at $5. Diphtheria toxin-antitoxin mixture is distributed at ten cents for three doses (one complete treatment). This mixture promises to be efficient in the pre-vention of diphtheria as the typhoid vaccine is for typhoid fever. These nominal charges are not placed for the purpose of producing revenue, but as a protection against waste. Without the charge it is cer-tain that many products would be ordered which would not be used, and if this should occur to any great extent we could not hope to supply the whole State. The State Laboratory of Hygiene is at the service of every citizen of the State, but for the most part these services are of such a character that they must be rendered through the medical profession. In no sense does the laboratory take the place of the physician—rather it attempts to aid him in giving better service to his patients. There is probably not a community in the State, however re-mote, which is not served in one way or another by the laboratory. Dur-ing the present year further exten-sion of its service is planned. III. WHAT THE BUREAU OF SANI-TARY ENGINEERING AND IN-SPECTION OFFERS TO THE CITIZENS OF NORTH CAROLINA The North Carolina State Board of Health, through its Bureau of Sani-tary Engineering and Inspection, offers the following service to the citizens of North Carolina: Division of Sanitary Inspection A field force of eleven sanitary inspectors whose duties are: 1. Enforcement of the provisions of the State Sanitary Privy law, re-quiring construction and mainten-ance of privies in towns and villages in accordance with the rules and regulations adopted by the State Board of Health under authority of Chapter 71, Public Laws of 1919. This service is available in all towns and villages, whether incorporated or unincorporated. The inspectors' jurisdiction under provisions of this law extends in all directions one mile from the corporate limits of an in-corporated town or village, and one mile from the geographical center of an unincorporated village. 2. The inspection and rating of hotels and cafes. The jurisdiction of the inspector includes all hotels with more than 10 rooms for tran-sient guests, and all cafes where tables and seating arrangements are such as to permit the serving of not less than 12 guests at any one time. 3. The inspection of all State in-stitutions. 4. The inspection of all county jails. 5. The inspection of all State and county convict camps. 6. The distribution of information upon any of the foregoing subjects. The above duties are carried out in accordance with a definitely ar-ranged plan, in such manner as to cover the entire State, at least once every twelve months, but in case of conditions requiring immediate at-tention, any of the above items of service may be secured upon the ap-plication of any person. Division of Sanitary Engineering A force of three sanitary engineers, whose duties are: 1. Examination of all plans and specifications for proposed public water supply and sewerage systems and improvements, and approval of such features as relate to or may affect the protection of the public health. The Health Bulletin 2. Investigation of existing public water supplies and sewerage systems, advising the governing boards of the necessity of any improvements, alter-ations or changes in such systems that may be necessary for the better protection of the public health. 3. Advising with the engineer, representing the governing body con-templating improvements, with re-gard to the best means of protection or purification of public water sup-plies, or the disposal of sewage, for the better protection of the public health. 4. The instruction and advice of persons charged with the operation of water and sewage purification plants and devices for the purpose of securing at all times, for the pro-tection of the public health, the greatest possible effectiveness that such plants and devices are capable of producing. The above items of service are available upon the request of any governing body having in its charge the construction or operation of water supply or sewerage system serving* the public, or upon applica-tion of any authorized representative of such board or governing body. 5. The distribution of information upon any of the foregoing subjects. This service may be secured upon the application of any person. All of the service rendered by the Bureau of Sanitary Engineering and Inspec-tion is available upon application, as cited above, and is furnished free of any charge. IV WHAT THE BUREAU OF VITAL STATISTICS HAS TO OFFER THE PEOPLE OF NORTH CARO-LINA As the State Treasurer has the financial interests of North Carolina to look after and by his books show the receipts and disbursements of the money of the people, so the Bureau of Vital Statistics shows the ebb and flow of the human family and the amount of sickness from certain dis-eases. This service is free to the people of North Carolina. If you are interested in any par-ticular county as to the number of deaths by race, by sex, by age, or from any particular disease, just write the Bureau of Vital Statistics, Raleigh, N. C, enclosing stamped en-velope and such information as is de-sired will be sent you. We have the same information tabulated for the fourteen (14) largest towns in the State. If you are putting on a drive for sale of tuberculosis seals, or for the erection of a tubercular hospital in any county or city in the State, we can furnish you with the number of deaths from tuberculosis in that par-ticular county or city. Or, if you are thinking of employ-ing a nurse to do maternity and in-fant welfare work in a county, we can inform you as to the number of births, how many white, how many colored, number of births attended by physicians, number attended by midwives, and how many stillbirths. Or, if you are thinking of doing a piece of welfare work, we can tell you how many illegitimate white and colored births occur annually in any particular county, the number of married people dying under twenty-five years, etc. Or, if you are a physician and want to locate in a particular county, we can give the number of births in a county, and number attended by phy-sicians. We can give you the amount of sickness from contagious diseases in any particular county or city or the number of deaths from diarrhoea and enteritis and of moth-ers dying in the puerperal state. If you are a manufacturing com-pany and wish to establish a plant in any county, we can give you valu-able information as to the health of this county, based on deaths from certain contagious diseases as com-pared to other localities in this and other states. We can give great service to the legislators, by giving the number of people killed annually by trains, au-tomobiles, firearms, burns, suicide, homicide, machinery, etc., and on these facts base laws for greater safety to the human race. Insurance companies when called upon to settle death claims, can get a copy of the ORIGINAL death cer-tificate of the decedent from the 8 The Health Bulletin Bureau of Vital Statistics. The Bureau of Vital Statistics of the State Board of Health is the ONLY holder of the original certificate. A copy from any other source is a copy of a copy. Ex-service men filing claims for compensation can obtain copies of original birth certificates of their children. Any one in North Carolina can, by enclosing a stamped envelope, and writing the Bureau of Vital Statis-tics, ascertain if the births of their children are registered, provided child was born since 1913, the year the Bureau was established. Or if your child was born prior to 1914, and you desire to have the birth reg-istered, write to the Bureau of Vital Statistics, Raleigh, N. C, enclosing stamp and request a blank birth cer-tificate. One requiring affidavit will be sent to you to be filled and re-turned to the Bureau of Vital Statis-tics and it will be registered. Registration of births is probably one of the most far-reaching and im-portant functions of your State Gov-ernment. Any one requiring or desiring a certified copy of a birth or death cer-tificate can obtain same by sending the fee of fifty cents to the Bureau of Vital Statistics, Raleigh, N. C. In return for the above service, the State of North Carolina only asks for the hearty co-operation of her citizens, both professional and lay-men, and we promise you that the service will be constantly improved in response to such co-operation. V. WHAT THE BUREAU OF MEDICAL. INSPECTION OF SCHOOLS OFFERS TO SCHOOL CHILDREN OF THE STATE The Bureau of Medical Inspection of Schools offers to the citizens of the State the following: (1) The State Board of Health school nurses are sent into a large number of counties every three or four years to inspect the school chil-dren for certain defects. The teeth, eyes, ears and throats are carefully observed. Attention is called to the height and weight of the child as compared with the normal child. Counties are taken more or less in their order, but preference is given to those who request dental and ton-sil and adenoid clinics. The nurse spends sufficient time in the county to visit each school. There is no cost to the county. The State defrays all expenses. (2) Tonsil and adenoid clinics are conducted in counties after the in-spection is carried out. For the clinic to be conducted in a county, an invitation signed by the members of the County Board of Health and the County Health Officer; also their choice of qualified specialists selected by them must be forwarded to the State Board of Health before ar-rangements can be made for a clinic. The nurse who carried out the in-spection visits the county in the sum-mer to get the children to the clinic and to make arrangement for a place to house the hospital. Children from families who can pay, are charged $12.50, while those who are unable to pay the fixed fee are admitted free. The charge is simply to help* defray the actual cost of the work, and so make the service possible. (3) Free dental examination and actual treatment is offered to chil-dren between the ages of six and twelve years inclusive. All the work that the children need cannot be done, as correcting the position of teeth, filling permanent teeth when the nerves are exposed, etc., but care-ful attention is given to the six-year molars, treating temporary teeth by extracting, filling and cleaning, and a lecture on "Care of the Teeth." Visits are made to country, as well as town schools. When dental serv-ice is desired, one should write to the State Board of Health for details of the plan. VI. WHAT THE BUREAU OF MATER-NITY AND INFANCY OFFERS TO THE PEOPLE Since the organization of the Bureau of Maternity and Infancy of the State Board of Health in April, 1922, under the provisions of the The Health Bulletin 9 Federal Sheppard-Towner Act, many questions have been asked relative to what this Bureau had to offer to the people of North Carolina. To secure the funds appropriated by the United States Government it was agreed that they should be expended only for ap-proved items of public health work having direct bearing on the promo-tion of the welfare and hygiene of maternity and infancy. To correct an erroneous impression that is prevalent, it is well to state that no direct subsidy is paid to any indi-vidual, as the law specifically pro-hibits this. In conformity with the above policy, this Bureau has the following to offer to the people of the State: 1. It offers to a limited number of counties, where no county health de-partment exists and until the avail-able funds are exhausted, to assist in the establishment of a county unit to deal with problems affecting ma-ternity and infancy; to be under the supervision of a whole-time nurse specially trained in maternity and in-fancy work. This Bureau will con-tribute $1,2 5 toward the year's bud-get, conditional upon not less than a like amount being raised locally. 2. It offers to the prospective mothers of North Carolina, gratis, prenatal information through the medium of a series of nine letters ex-tending through the period of preg-nancy. These letters are supple-mented by other pamphlets and literature dealing with this subject. Those desirous of this service should give their name, address and the ap-proximate date of expected confine-ment. 3. It offers to the mothers of the State advisory literature dealing with all phases of the problems affecting the physical welfare of their babies. Send the name, address, and age of the baby. 4. It distributes without cost solu-tion of silver nitrate to hospitals, institutions, health departments, phy-sicians and midwives. 5. It keeps a record of and has an investigation made of all cases of in-fected eyes in babies, as this Bureau is charged with the responsibility of the enforcement of the State laws relating to the prevention of blind-ness. 6. This Bureau has the supervis-ion of the registration of midwives that is now required by law, and dis-tributes literature to the midwives of the State. It assists county health departments and county nurses in securing midwives' conferences to elevate the general standard of pro-ficiency of the midwives. 7. This Bureau offers special serv-ice in the way of general advice upon problems relating to maternity and infancy, but refers such cases to the family physician where indicated. 8. This department is in touch with nurses available for service, and assists health departments, counties and towns in securing public health nurses. 9. Sends speakers to address audi-ences upon questions of maternity and infancy. 10. Offers the assistance of this Bureau in the organization and con-duct of baby examinations and ad-visory clinics. It will send repre-sentatives to assist in the supervision and conduct of the work. 11. The county health nurse or-ganizes and instructs classes of Mod-ern Health Crusade, Little Mothers' League, and Home Care of the Sick, and holds home conferences with mothers relative to themselves and their babies. Further and more detailed infor-mation, relative to any of the above services offered by the department, may be secured by writing to the Bureau of Maternity and Infancy, State Board of Health, Raleigh, N. C. 10 The Health Bulletin The Health Bulletin 11 KEEPING THE BABY WELL BY J. BUREN SIDBURY, M.D., Pediatritian to the Babies' and James Walker Hospitals, Wilmington, N. C. (Dr. Sidbury has crowded so much sound common-sense advice in this excellent article that we earnestly hope every physician and the parents of every baby under one year old, in North Carolina will read carefully and preserve for reference all through the summer.—Editor.) 1. Keep the Baby at the Breast. One cannot properly advise how-to keep the baby well without stress-ing first the importance of keeping the baby at the breast for the first nine months. Early weaning is re-sponsible for more diarrhoea and gastro-intestinal disorders than any other five agencies combined. Every one knows that breast milk is the ideal food for the infant, and even though the amount be scant the baby should not be deprived of that small amount. With breast milk the most illiterate can rear a big healthy baby, but if this same mother is deprived of breast milk for her baby the picture will be an entirely different one. Before the baby is weaned from the breast because of insufficient milk supply, certain steps should be taken. First, the baby should be weighed before and after nursing to deter-mine the amount of milk the baby gets from the breast. If this quan-tity is not enough then the baby should be nursed from both breasts at each feeding time, and if there is not a reasonable gain in the weight for one week then the second step should be taken—that is, after nurs-ing both breasts the baby should be given a formula prescribed by the doctor. This feeding should be given immediately after the nursing, two, three or four times daily as the need requires. This routine should be fol-lowed in all cases before the baby is weaned. 2. Regularity of habits and of feeding is a very essential feature in successful feeding of babies. The baby should have a regular routine and should not be handled any more than is absolutely neces-sary for the first six or eight months. He should sleep twenty hours out of twenty-four, and this the baby cannot • do if he is carried around in the mother's arms all day. A baby should never be fed more often than every three hours during the day and four hours at night. The longer the interval between feed-ings the less likely are you to have a vomiting baby or one with a gastro-intestinal upset. Normally it takes two and a half to three hours for the stomach to empty iteslf, and if food is added before the stomach is empty, trouble will sooner or later ensue. In the hot summer months the stom-ach and intestines of these little babies have a diminished tolerance for food and less demand should be made of them. If this law of nature is not followed, an explosion is very likely to occur. During the very hot weather dilute the baby's food one-third or one-fourth with boiled water and give all the plain boiled water the baby will take. At this time think more of keeping the baby well than of trying to make him gain one or two more ounces that week. 3. The Artificially Fed Baby, (a) When breast milk is not to be had for the baby, then the next best food for the baby is cow's milk prop-erly modified. Cow's milk must be obtained from an inspected and tuberculin-tested herd, (b) It should not be too rich, for babies do not take care of high fats in the hot summer months. If the milk is Jersey milk, the cream, or some part of it, should be removed—the amount removed should be directed by the attending physician. (c) All cows' milk, however clean, should be boiled from two to five minutes before giv- 12 The Health Bulletin ing it to the baby, from the first of May throughout the summer months. The doctor who feeds cow's milk raw to a baby under two years old through the summer months is in-viting calamity, which will sooner or later befall him. ALL COWS' MILK MUST BE BOILED BEFORE GIV-ING TO THE BABY DURING THE SUMMER MONTHS. A baby should get at least one and a half ounces of cow's milk per pound of body weight each twenty-four hours, and should get three ounces of fluid per pound of body weight each twenty-four hours. This is the minimum requi-site for their proper growth and de-velopment. 4. Dried Milks. In the event that fresh cow's milk cannot be obtained for the baby, the next best food is some one of the dried milks. Either Dryco Dry Milk, which is skimmed cow's milk dried, or Klim Whole Milk, which is whole cow's milk with the water taken out, is good. These may be handled as cow's milk if one remembers that one level tablespoonful of Dryco dry milk to one ounce of water makes skimmed milk or its equivalent, and one level tablespoonful of Klim whole milk to two ounces of water makes whole cow's milk or its equivalent. 5. When to Wean the Baby. The baby should be weaned some time between the ninth and four-teenth months. If the baby is twelve months old in July or August and has not been doing very well, it might be well to postpone weaning the baby till the fall of the year, but it is advisable to give two or three feedings of cereals and modified milk each day in addition to keep nutri-tion up to the proper state. When it is possible, I feel that it is better to wean the baby at nine months and get the baby started on a good substantial diet before the hot months come in. The average nor-mal baby has enough iron stored up in the liver for the first six or eight months. After that time there is no reserve, and unless some iron is put in from outside sources the baby be-comes anemic and undernourished. Iron is best supplied in the form of fresh vegetables such as spinach and carrots cooked in plain water with a little salt. The water soluble sub-stance is of greatest value. The baby should be given water from the bottle from birth. This will teach him to take more water as well as to be of great help when you wish to begin weaning the baby. Babies that have never had anything but the breast for ten or twelve months are often very hard to get started on other foods, and if abrupt weaning of this type of baby becomes necessary during the hot months, you have a very difficult problem to handle and one that is often handled unsuccessfully. It is very undesir-able to change the baby's feeding during the hot months. Changing from one cow's milk to another's has often been the cause of upsetting the baby. Whenever possible, the same milk should be continued. Taking the baby visiting is, in most cases, an unpardonable sin. I am so often asked the question, how soon it will be before the baby can safely be taken to see the grand-parents. I feel very strongly that the place for the baby for the first year at least is at home. If the grandparents or aunts wish to see the baby let them come, but keep the baby at home where he may be properly taken care of and where the general routine will not be dis-turbed. 5. Clothing. Dress the baby lightly and have clothes loose enough for the baby to take exercise freely. Burn the ab-dominal bands as soon as the navel is sufficiently healed not to require a dressing. Tight abdominal bands cause the baby to vomit. It is well known that the abdominal band is never over the abdomen where it was put. In the hot months give the baby three or four tub baths daily. This will assist in eliminating heat and in many cases prevent intestinal upsets caused from getting over-heated. DON'TS 1. Don't give raw milk in the sum-mer- time. 2. Don't let baby eat between meals, but have regular feeding hours. The Health Bulletin 13 3. Don't let the child have coffee, tea or bottled drinks from the drug store. 4. Don't give store-bought ice cream. It is never made from boiled milk but is very often made from sour milk. 5. Don't feed the baby from the table. 6. Don't give the baby unboiled water during the summer-time. 7. Don't let the baby use a paci-fier. 8. Don't put anything in the baby's mouth which has not first been boiled. 9. Don't give the baby candy. THE HOUSE-FLY PROBLEM It is probable that in the month of May more people are concerned about the house-fly pest than during any other month of the year, and they should be, because there is no doubt that the high sickness rate, at least among infants, in this month is due to infection carried by the fly. Dr. L. O. Howard, of the U. S. Govern-ment Service at Washington, and the foremost authority on the subject in America, has long ago designated the house fly as "the most dangerous ani-mal that exists." In the April issue of Hygeia, the new journal of health published by the American Medical Association, Dr. Howard has a most valuable illustrated article on "The House Fly—Carrier of Disease." In his introductory paragraph to that article Dr. Howard makes the follow-ing interesting observation: "When we consider that the house fly may carry thirty distinct diseases and parasitic organisms, and that its oc-currence in great numbers is due en-tirely to man and his actions, can we fail to marvel at man's utter and even criminal stupidity? The house fly is a domestic animal; its English name is appropriate; and the Latin name, Musca domestica, which Lin-naeus gave it in 1758, conveys the right idea in this respect, for the species could barely exist away from what is called civilization. If Lin-naeus, with prophetic vision of later discoveries, had named it musca hor-rida, or mortifera, or perniciosa, or funesta, or damnosa, perhaps human-ity would have begun to fight flies at an earlier date." It seems to be a fairly well estab-lished fact now, for the South at least, that the house fly survives the winter in the larval or pupal stage. So it is easy to realize anew the im-portance of keeping clean premises through the winter months and especially to have all possible breed-ing places such as stables scrupu-lously cleaned before the disappear-ance of frost, that is before the last of March. The problem for cities is to thoroughly police every nook and corner and keep all premises clean. One neglected stable is sufficient breeding place for enough flies to overrun an entire town for a sum-mer, even though every other part of the municipality is clean. Also every dwelling house, large and small, should be carefully screened, the windows with solid screens extending over all window space, and the doors having strong springs in order to keep them automatically closed. For the country the problem is the same but the solution different. Different because a farm family has no appeal to a police power requiring his more careless neighbor to keep his prem-ises free from a fly-breeding menace. It is recognized now through experi-ments carefully made, that contrary to general belief, house flies may migrate several miles. So, it is more apparent than ever that the house-fly problem is a community problem. No city, town or rural community, civically speaking is any cleaner than the dirtiest residence lot or farm in it. The same principle from a health standpoint as the chain and the weak link. The farmer can, and should, have his own house just as carefully screened as the city dweller and should of course keep all stables and barns clean in order to destroy the breeding places of flies. Cleaning and screening with inside swatting is the only treatment worth while pre-scribing for the fly danger. As usual prevention is much more important, and abolishing all breeding places is the only course to advise. There is no doubt, but that the 14 The Health Bulletin substitution of the family flivver and its back-yard garage for "old Dob-bin" and his ill-kept stable; and the success of the commercial dairy en-terprises has tended for the past year or two to greatly diminish the danger in some cities. But there are plenty of breeding foci left in all such towns to require constant vigilance on the part of every citizen. MEDICAL HISTORY (Each month, under the above heading, for the purpose of furnishing in-formation to physicians as well as to the people generally, will be pub-lished something of the wonderful record of the history of medicine.) SMALLPOX _j When we hear a subject mentioned that we have heard discussed all our lives, like the weather, hard^ times, or high prices, and nothing much ever done about it, we naturally prefer to change the conversation and talk about the new school board, or the next candidate for governor, or some-thing else in which something is al-ways being done about it. However, the subject of smallpox, although one we have always heard discussed, is a subject that will continue to be a problem until preventive vaccination is made universal in all lands. Re-cently a judge of the Superior Court contracted a case of smallpox while holding court in one of the largest cities in North Carolina. Still more recently, a woman 27 years old and the mother of three children, died in Eastern North Carolina. She had re-fused to be vaccinated or to allow either of her children to be so pro-tected. Thus, in the one case the whole machinery of a court costing hun-dreds of dollars a day, and unneces-sary expense to hundreds of people, was disorganized for two weeks; and in the other case three small chil-dren are left motherless in order to pay the penalty for somebody's prejudice or carelessness. We like to think that in the case of the judge it was simply carelessness or lack of thoughtfulness in protecting himself, but in the case of the mother it was simply blind prejudice on the part of some fanatic who had poisoned her mind to the extent of costing her life rather than provide herself with the protection so easily procured through simple vaccination. Smallpox is one of the oldest dis-eases in the world. Complete ex-amples of its ravages have been dis-covered, establishing proof of its ex-istence in epidemic form in Egypt 3,500 years ago. A Syrian epidemic occurring in 302 A. D. has been vaguely described in medical writings of that time. The word "variola" was used to describe the disease by a bishop in the 6th century. It has been estimated that in the century ending with the discovery of vacci-nation by Jenner about 17 98 that it caused the death of 100,000,000 peo-ple. Some form of innoculation had been known and practiced for cen-turies, even in Oriental countries be-fore Jenner placed vaccination through the use of vaccine on a thoroughly sound scientific basis. Gilbert, a great exponent of Anglo- Norman medicine, first mentioned smallpox as a contagious disease in the thirteenth century. While his statement was denied by more or less eminent authorities for two or three hundred years afterward, we now know that it is one of the most con-tagious diseases in the world. It is caused by an organism so infinitesimal that so far it has been impossible to isolate it. In its confluent form it is a very fatal disease. Where com-munities have been free from its ravages for several years, or where they have been protected through vaccination and then become careless about vaccination for a period of years, allowing large numbers of chil- The Health Bulletin 15 dren to grow up unvaccinated or an influx of people from among an un-protected population, an outbreak is exceedingly serious. The city of Den-ver, Colorado, had such an experi-ence in 19 22. From January to De-cember inclusive 805 people had the disease and 2 47 of them died. About 30 per cent. That was worse than an epidemic of typhoid fever ever did at its worst. If a majority of sensible people through the earth were to listen to the crack-brained fanatics and their propaganda of falsehood for a period of say 25 years, the disease would again be-come a menace to civilization in all the world. The preparation of vaccine today is done under U. S. government supervision and the process from start to finish is absolutely clean. There can be no possibility of con-veying disease or contamination. As practiced by a majority of physicians and health departments the pro-cedure is as safe as anything can be, and it protects. The North Carolina State Board of Health through its Laboratory of Hygiene prepares and distributes free of charge to physi-cians and health departments a thoroughly reliable product. One of the best requirements any County Board of Education can make and en-force is that no child can enter the public schools of the county or city as the case may be until successfully vaccinated. When this is done before a child is 6 years of age it disturbs the child very little and is soon over, and the child is nrotected to some ex-tent for life. Every health officer, whether whole-time or part-time, in North Carolina should be required to vaccinate free of charge any citizen at any time during working hours on office days. He should be required to visit schools and vaccinate the children there at least once a year. COFFEE If all of us could be told of our failings repeatedly it is more than probable that most of us would eventually do something about it. It is with such a feeling that we take pleasure in publishing here a particu-larly pertinent and accurate criticism of one of our most pernicious cus-toms, a custom which licenses every fellow who has ever made a failure of everything else to run a public cafe or restaurant and purvey food to helpless but hungry transients. The South, of course, has no monop-oly in making and serving coffee that is unfit for human consumption, but without a doubt we are more guilty than some other sections. This, from one of Berton Braley's syndicate articles as published in the Raleigh Times, certainly hits the mark: The Southland I like the South—a lot of it—though now and then some spot of it Does not exactly thrill me through and through; And in this Southern latitude I sure am full of gratitude For all the friendly things that people do. They have a joyous way with them that brightens up your stay with them, And they're not out to rob you of your chink, But one unkindly reference I make with all due deference: I wish that they'd make coffee fit to drink! It's muddy as their rivers are! I wonder what folks' livers are Who drink this Southern coffee every day; A spoon will scarcely sink in it, there must be lye and ink in it, It's strong enough to pull a heavy dray. By some infernal trickery they fill it full of chickory And then, as if that were not quite enough, Thoy stew it for an hour or two, thus giving it the power to Compete with T. N. T. as potent stuff. Sometimes, by hick that's notable, you find the coffee potable, A drink that anybody can imbibe; But mostly it's incredible, a bever-age so dreadable 16 The Health Bulletin That nothing in the language could describe. Oh, Southerners, you've treated me superbly, and you've greeted me With courtesy wherever I have stayed I love you most adoringly, but still I cry imploringly, "I wish you'd learn how coffee should be made! " There you have it. The question is, why do we do it? Good, properly-prepared, health-promoting coffee is just as easy to make and only costs a trifle more. If only we would de-mand it. There are perhaps a few homes left in which good coffee is yet prepared and served; but cer-tainly no cafes or quick lunches and but few hotels in these parts. The only remedy we can think of would be to require the mayor and health officer of every city, town, and vil-lage in this State at least, where these places are licensed, to drink 16 cups each a day at 10 cents a cup until the amount of each place's license tax is consumed, that is if the first round did not kill these officers who are responsible. In other words, force the officials who are responsible to "take it out in trade." We say guardedly this might help. No person under 21 years of age should of course drink even good coffee, for up to that time a healthy young person needs nothing of the kind. But after maturity, with the coming of the ordinary responsibili-ties of life, there is no pleasure like enjoying one or two cups of real coffee each day. For such young people who have reached the ripe age of 21 during the past few years and so have never seen, to say nothing of tasted, a cup of properly prepared coffee, the following simple formula ought to help some: To Prepare Good Toffee 1. Purchase only the best grade of pure coffee that can be had. 2. Spend at least $4 in getting a combination coffee pot in which the coffee (solid particles) is held in a sieve near the top of the pot, and In which the boiling water is poured over the coffee, the top tightly closed and the product after steaming is poured off from bottom. Xo egg set-ting is necessary and no "grounds" can escape into the cup. 3. Never boil coffee under any cir-cumstances if it is to be fit to drink. Boiling extracts the tannic acid and thus makes it a most injurious drink as well as destroys the aroma. 4. Never use "over" by adding a portion of fresh coffee to "old" sedi-ment or "grounds." HEALTH LAWS Necessary for Protection of Liberty and the Control of License Necessary, reasonable and just health laws have been enacted by all civilized governments and are always upheld by all the courts from lowest to highest of all such governments. These laws exist solely for the pro-motion of liberty and the protection of the aggregate rights of the people and to curb and control license which the unscrupulous always purposely confuse with liberty. Health laws are necessary to guarantee freedom of action for each individual up to the line where such freedom would injure one's fellow-man. Beyond that line liberty becomes license and must be controlled for the sake of the welfare of society. Reasonable health laws, humanely enforced are not oppressive; and officers of the law exist solely for the protection of the people. By necessary enforce-ment of proper laws our liberties are assured; without enforcement of such laws, license would run riot and none of us would have any liberty. Plague and pestilence would spread over the land like a devastating blast from an inferno. These facts should be endlessly and repeatedly empha-sized, especially to growing children. Distinction should ever be made be-tween reasonable laws honestly en-forced and foolish laws executed by tyrants, petty or otherwise. In other words, the law itself and the purpose behind the law is not at fault, but weak, selfish human nature is to blame when justice becomes op-pressive to any individual. :j rt r Ji u 11 Co^eA n-r? §Mmm^cmmMM^) Pubn5\edb4 i:fjlwkji\qp$sunik STATE. B°ARDs^A^\LTA I This Bulletin will be ser\t free to arxy citizen of the State upoi\ request ! Entered as second-class matter at postoffice at Raleigh, N. C, under Act of Jul)/ 10, 1S94 Published monthly at the office of the Secretary of the Board, Raleigh, _Y. < . Vol. XXXVIII JUNE, 1923 No. 6 CAPITAL CITY WATER PLANT Raleigh, the Capital City, is just completing improvements of its water supply system that will make it among the best of the municipal plants of the State. Shown in the picture above is the pump-ing station, the filter plant, and the clear water basin. Raleigh, in conjunction with the county of Wake, has an efficient health department under the direction of Dr. A. C. Bulla. The annual budget of the department is $27,500. MEMBERS OF THE NORTH CAROLINA STATE BOARD OF HEALTH J. Howell Way, M.D. Pres Waynesville Richard H. Lewis, M.D., LL.D Raleigh James P. Stowe .Charlotte Thomas E. Anderson, M.D Statesville A. J. Crowell, M.D Charlotte Charles O'H. Ladghinghouse, M.D., Greenville Cyrus Thompson, M.D Jacksonville D. A. Stanton, M.D High Point E. J. Tucker, D.D.S Roxboro EXECUTIVE STAFF W. S. Rankin, M.D., Secretary and State Health Officer. G. M. Cooper, M.D., Assistant Secretary. Ronald B. Wilson, Assistant to the Secretary. 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. J. S. Mitchener, M.D., Chief of Bureau of Medical Inspection of Schools. K. P. B. Bonner, M. D., Chief of Bureau of Maternity and Infancy. FREE HEALTH LITERATURE The State Board of Health has available for distribution without charge special literature on the following subjects. Ask for any that you may be interested in. Whooping-cough Hookworm Disease Public Health Laws Tuberculosis Laws Tuberculosis Scarlet Fever Infantile Paralysis Care of the Baby Fly Placards Typhoid Placards Tuberculosis Placards Clean-up Placards Don't Spit Placards Sanitary Privies Water Supplies Eyes Flies Colds Teeth Cancer Pre-natal Care Malaria Smallpox Adenoids Measles German Measles Typhoid Fever Diphtheria Pellagra Constipation Indigestion Venereal Diseases Catarrh 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. THE HEALTH BULLETIN The Health Bulletin is sent monthly without charge to all persons in the State who care to receive it. If you have friends or neighbors who will be interested, suggest that they write the State Board of Health, asking for The Bulletin each month. When you have finished with your copy, give it to some one else, thereby increasing its usefulness. | PUBLI5AAJLDIBY TML HPRTM CAROLIhA STATE. EPAFgD VMEALTH Vol. XXXVIII JUNE, 1923 No. 6 NEW MEMBERS ON BOARD To succeed themselves for terms of six years Dr. J. Howell Way, of Waynesville, and Dr. A. J. Crowell, of Charlotte, have been appointed members of the State Board of Health by Governor Morrison. Dr. Way enters upon a fourth term, hav-ing begun his service on the Board by appointment of Governor Glenn in 1905. Dr. Crowell was appointed in 1919 by Governor Bickett to fill the unexpired term of Dr. E. C. Reg-ister, of Charlotte. The resignation of Mr. Charles E. Waddell, appointed in 1921 to suc-ceed Col. J. L. Ludlow, has been ac-cepted by Governor Morrison and Mr. James P. Stowe, of Charlotte, has been appointed to fill the unex-pired term. At the annual meeting of the Med
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 | 1923 |
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 38, 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 | 21,415 KB; 274 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_healthbulletin1923.pdf |
Pres Local File Path-M | \Preservation_content\StatePubs\pubs_edp\images_master\ |
Full Text |
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COLLECTION OF
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ENDOWED BY
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of the Class of 1889
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This Bujleti r\ will be seryt free to arxu citizen of the 5tcrte upon request!
Vol. XXXVIII JANUARY-APRIL, 1923 Nos. 1-4
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