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Library of
The University of North Carolina
COLLECTION OF
NORTH CAROLINIANA
ENDOWED BY
JOHN SPRUNT HILL
of the Class of 1889
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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
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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
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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
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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«
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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
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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