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Entered as second-class matter at Postoffi.ce at Raleigh, N. C, under Act of July 16, 18 9i.
Published monthly at the office of the Secretary of the Board, Raleigh, N. C.
Vol. XXXVI JANUARY, 1921 No. 1
GOVERNOR MORRISON ON HEALTH
We niust throw around the home and life of our people an enlightened world's
knowledge of preventive medicine, and make ceaseless war upon sickness, suffering
and death in this State. Our great department of health must be generously nour-ished
and equipped for this humane service. Disease cannot be successfully pre-vented
by individual effort alone. Modern statesmanship demands that every prac-tical
effort shall be made through organized health boards and expert officers to
protect the health of the people. Our health department has accomplished won-ders
with the means furnished. I believe I express the deep desire of our enlight-ened
people when I urge increased strength for this great department of our gov-ernment.
MEMBERS OF THE NORTH CAROLINA STATE BOARD OF HEALTH
J. Howell Way, M.D., Pres., Waynesville Chas. O'H. Laughinghouse, M.D.,
Richard H. Lewis, M.D., LL.D., Raleigh Greenville
J. L. Ludlow, C.E., . . Winston-Salem Cyrus Thompson, M.D., . . Jacksonville
Thomas E. Anderson, M.D., . Statesville F. R. Harris, M.D Henderson
A. J. Crowell, M.D Charlotte E. J. Tucker, D.D.S., .... Roxboro
EXECUTIVE STAFF
W. S. Rankin, M.D., Secretary State Board of Health and State Health Officer.
Ronald B. Wilson, Director Public Health Education.
C. A. Shore, M.D., State Laboratory of Hygiene.
L. B. McBrayer, M.D., Superintendent of the State Sanatorium for Treatment of Tuber-culosis
and Chief of Bureau of Tuberculosis.
G. M. Cooper, M.D., Chief of Bureau of Medical Inspection of Schools.
K. E. Miller, M.D., Director of County Health Work.
Miss Rose M. Ehrenfeld, R.N., Chief of Bureau of Public Health Nursing and Infant
Hygiene.
Millard Knowlton, M.D., Chief of Bureau of Engineering and Inspection.
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 Epidemiology.
SERVICE
The State Board of Health offers to the people of North Carolina, without
charge, the services of experts thoroughly trained with particular regard
to the needs of this State. Advice will be given promptly upon any question
affecting the public health. Address any inquiry to the State Board of
Health, Raleigh.
FREE LITERATURE
The State Board of Health has prepared special literature on a large
number of subjects which are offered without charge. If you are interested
in any one or more subjects affecting your health, write the State Board of
Health, ^Raleigh, requesting special literature, and it will be sent to you.
THE HEALTH BULLETIN
The Health Bulletin is issued monthly. It will be sent without charge
to all citizens of the State who request it.
Vol. XXXVI JANUARY, 1921 No. 1
DAMAGES FOR TRANSMITTING
DISEASE
A North Carolina woman has been
awarded damages in the sum of $10,000
against her husband because he in-fected
her with a venereal disease.
The case was appealed from the lower
court and affirmed by the Supreme
Court.
The decision, written by Chief Jus-tice
Walter Clark, is reprinted in full
on other pages of this issue of The
Health Bulletin. It marks a dis-tinct
advance in the public attitude
towards responsibility for venereal dis-ease.
Perhaps the advance in recog-nizing
the rights of a married woman
as an individual is more fundamental
and more far-reaching in its ultimate
effects, but the advance in recognizing
responsibility of an infected person for
transmitting the disease with which
he is infected is the question of imme-diate
concern here.
The rules and regulations of the
State Board of Health for the control
of venereal diseases require a person
infected with such disease to report to
a legally qualified physician for treat-ment.
This rule is based upon the idea
that the person infected is responsible
to the public and is under obligation
to seek proper treatment so as not to
transmit infection to others. This
principle of personal responsibility of
the infected person for the spread of
venereal diseases is now made a part
of the law of North Carolina through
the decision of the Supreme Court.
If a wife can collect damages from
her husband for infecting her with
venereal disease, any person can col-lect
damages from another for like
cause. Under other circumstances the
question as to the right to recover dam-ages
would not be complicated by the
marriage relation, and the discarded
notion that the wife is the husband's
chattel could not be invoked as miti-gating
the offense.
This decision marks a milepost along
the road being blazed in the attack on
venereal diseases. Recognition of the
basic principle of personal responsi-bility
is of the highest importance both
in formulating administrative proced-ures,
and in fixing standards of con-duct
to prevent the spread of such
diseases. The Supreme Court by this
action has placed North Carolina still
further in the forefront of the States
effectively dealing with public health.
GUARD AGAINST MEASLES
Parents are urged to guard their
children against measles. There are
still many people who feel that it is
a good thing for their children to have
measles, whooping-cough, and all the
other communicable diseases so com-mon
to childhood as early as possible.
"Let them have it and get it over with.
It won't hurt as bad as when they are
older," is the way one mother expressed
her sentiments when warned to keep
her children away from a home where
there was a case of measles. The prev-alence
of this sort of feeling largely
explains the fact that right now there
is in the State a very large number
of cases of communicable diseases, with
innocent children the sufferers.
Measles especially should be guarded
against with all possible care. The
evil companions of measles are weak
eyes, abscess of the ears that frequently
leads to deafness, and pneumonia.
Next to disorders of the stomach, mea-sles
is one of the most deadly of com-municable
diseases among children.
There is no specific treatment which
can be offered for protection. The only
The Health Bulletin
safe way is to keep your children very
carefully free from contact from others
in whose homes there are cases.
If a child has been exposed and de-velops
a cold, with red, watery eyes,
and is feverish, put the child to bed,
and call a physician. Be careful. But
it pays best to be careful first, and
protect the child from infection by
others.
A DECISION OF IMPORTANCE
It is very gratifying to find that the
Journal of the American Medical Asso-ciation
heartily approves of the de-cision
of the North Carolina Supreme
Court under which a woman is allowed
to recover damages from her husband
when he infects her with a foul dis-ease.
This medical authority says:
"In our medico-legal department this
week appears an abstract of a decision
of the Supreme Court of North Caro-lina
which recently affirmed a judg-ment
of a lower court, allowing dam-ages
of $10,000 to a wife against her
husband who had infected her with
venereal disease. This decision is of
importance from the standpoint of
public health as well as from a legal
standpoint. Legally, it sets aside the
old belief that the husband and wife
are one, he being that one, and that
she has no recourse against him for
any acts performed outside the law.
Primitive conditions making lie wife
a chattel have passed. Today the wo-man
is equally a citizen with her hus-band.
As already established by court
decisions, a husband is liable if he
assaults or slanders his wife. It is a
credit to the enlightenment of the
Supreme Court of North Carolina that
it should see that the communication
of a venereal disease is a greater in-jury
than the breaking of an arm or
other physical damage."
The opinion of the court in this
case was one of the most striking evi-dences
noted in a long time of an ad-vancing
moral standard in North Caro-lina.
The people look to men in high
place for leadership, for declarations
as to what are proper standards. The
condemnation of immoral living con-tained
in the decision sustaining the
lower court's judgment in this case
must have come home with something
of a jolt to many a young man.
Moral living is in considerable de-gree
dependent on public opinion. If
we have a public opinion that sternly
decries unclean lives there will be less
and less of that kind of living.
—
Raleigh News and Observer.
THE FRUITS OF QUACKERY
One of the best hotels in a great city,
towering high on a beautiful boule-vard,
almost within the business dis-trict
and yet overlooking the lake! In
a beautiful suite high up, away from
the noisy bustle of the city, sits a
kindly looking gray-haired man. A
touch of the wall-buttons brings serv-ants
scurrying to do his bidding, for he
is free with tips and with his smile. At
his word a seven-passenger Peugeot, of
the latest model, guided by a uniformed
chauffeur, rolls up to the entrance. He
wishes, perhaps, to attend the theater
or to take an airing in the park, or to
see a friend. Not too often the latter,
for he has few friends! The transient
guests inquire of the clerk as to his
identity. Perhaps he is a member of
some foreign royal family; perhaps a
magnate resting on the well-earned
laurels of some gigantic deal in copper
or in cotton! But no! It appears he
made his fortune by selling sugar and
salt. A pinch of salt and a pinch of
sugar in a barrel of hydrant water,
guaranteed to cure any disease if the
sufferer will only put one drop in each
eye night and morning—approximate
cost, 6 cents a gallon—selling price, $5
an ounce! Through the Middle West,
in little country graveyards, are the
bodies of some who read the advertise-ments
and believed. And the "profes-sor"
orders out his car and says to the
chauffeur with a lordly wave of his
hand: "To the park, James." The mills
of the gods grind slowly. . . . Obvi-ously.
—
Journal of A. M. A.
The Health Bulletin
ADVANCED STAND BY SUPREME COURT
In Crowell v. Crowell Highest Court Rules That Husband Must Pay
Damages For Infecting Wife With Venereal Disease
The majority opinion of the North
Carolina Supreme Court, written by
Chief Justice Walter Clark, in the case
of Crowell v. Crowell, from Mecklen-burg
County, broke new ground in the
construction of law affecting marital
relations, and in fixing personal re-sponsibility
upon one guilty of infect-ing
another with a venereal disease.
The opinion is of such importance that
The Health Bulletin herewith re-prints
it in full.
Lacy Crowell v. W. J. Crowell.
Appeal by defendant from Lane, J.,
May Term, 1920, of Mecklenburg.
This is an action by the wife against
the husband alleging in her complaint
the marriage and their living together
as man and wife; that the defendant
contracted a venereal disease, and that
he "took advantage of his marital re-lation
with said plaintiff and infected
her with said vile and loathsome dis-ease,"
and asks for judgment "for ac-tual
and punitive damages."
The defendant filed a written de-murrer
to the effect that the com-plaint
showing upon its face that the
parties were man and wife prior to,
and during all the time of the acts
complained of, that "the complaint
does not contain facts sufficient to
constitute a cause of action." And
further, that said action is "both with-out
law to warrant the maintenance
thereof, and also against the public
policy of the State."
The Court overruled the demurrer,
and thereupon the defendant filed an
answer, and upon the issues submitted
the jury found that the defendant
"wrongfully and recklessly infected
the plaintiff with a loathsome disease,
as alleged in the complaint," and as-sessed
the plaintiff's damages at
$10,000, and further, that at the in-stitution
of this action the defendant
was about to dispose of n:s property
and remove it from this State for the
purpose of defrauding the plaintitf.
The defendant excepted and ap-pealed
from overruling the demurrer;
for refusal to set aside the verdict;
for permitting the plaintiff to testify
that the day before they separated she
informed him that he had infected her
with venereal disease; and to testify
that she estimated the value of his
property to be worth between $25,000
and $50,000, and that he was disposing
of it very rapidly, getting her to join
in deeds for most of the property, and
he told her that he was going to Cuba
to make his home and to set up a bar
room.
The defendant also excepted to the
following paragraphs in his Honor's
charge
:
1. "If you find as facts from the
evidence, and by its greater weight,
that the defendant knew that he was
infected with a foul and loathsome
venereal disease; and thereafter, al-though
having such knowledge, he
wrongfully had sexual intercourse with
the plaintiff, and thereby infected her
with said disease, that he did so will-fully
and recklessly—that is, in reck-less
and wanton disregard of the plain-tiff's
rights, being indifferent to her
welfare, and not caring whether he
infected her or not—then you should
answer the first issue, 'Yes.'
2. "She would be entitled to a juL,t
and reasonable compensation for
whatever injuries she may have sus-tained
as a necessary and proximate
result of the defendant's wrong. She
would be entitled to a just and rea-sonable
compensation for any physi-cal
or mental suffering which followed
as a necessary and proximate result
of the defendant's wrong.
3. "If you come to the issue of dam-ages,
you might, if in your discretion
you saw fit, allow the plaintiff punitive
damages." Judgment and appeal.
6 The Health Bulletin
Stewart & McRae and John M. Rob-inson
for plaintiff.
Thaddeus A. Adams for defendant.
Clabk, C. J. The defendant made no
motion to nonsuit, and does not con-tend
that there was not sufficient evi-dence
to justify the verdict on the first
issue, "Did the defendant wrongfully
and recklessly infect the plaintiff with
a loathsome disease as alleged in the
complaint." He submitted no requests
for instructions. The exceptions to
the evidence do not require discussion.
Practically the only point presented
by this appeal is whether or not a
cause of action is alleged in the com-plaint.
Paragraph 5 of the complaint alleges
"that the defendant, by reason of his
illicit relations with lewd and profli-gate
women, contracted a venereal dis-ease
of a foul and loathsome char-acter,
and of a highly infectious and
malignant nature, and although he well
knew that he was so infected and well
knew the character of said disease, and
its dangerous and infectious nature,
he concealed from the plaintiff the fact
that he was so infected with said dis-ease,
and on or about the day of
, 1919, committed an assault and
trespass upon the person of the plain-tiff,
and infected her with said foul
and loathsome disease, injuring and
damaging her as hereinafter set out."
There can be no question, in this
day, that if the defendant had vio-lently
assaulted his wife and caused
serious bodily injury to her person,
and humiliation to her, she could main-tain
an action for damages against
him. Even under the obsolete ruling
of the courts (for it was never statu-tory)
that a husband could chastise
his wife with immunity, there was an
exception that he was liable if he
caused her serious bodily harm or per-manent
injury.
In S. v. Monroe, 121 N. C, 677, it was
held that a druggist committed an as-sault
when he dropped croton oil on
a piece of candy and gave it to a
third party. It was a far greater
assault for the husband to communi-cate
to his wife, while concealing from
her the fact that he was infected
therewith, a foul and loathsome dis-ease—
which has caused her serious
bodily injury, and which the medical
books hold to be a permanent injury
of which she can never be entirely
cured.
In S. v. Fulton, 149 N. C, 485, the
Court held that the husband was in-dictable
for wantonly and maliciously
slandering his wife, under Rev., 3640,
now C. S., 4230, which made it indict-able
for "any one to slander an inno-cent
woman." The objection was there
taken that this did not apply to the
husband because of the marriage rela-tion,
and that this had been so held in
S. v. Edens, 95 N. C, 693. The Court
overruled S. v. Edens, though it held
by a divided Court that the defendant
in the Fulton case had a vested right
to rely upon S. v. Edens.
The plaintiff, who was 22 years of
age, and living with her father at the
time of her marriage, was shown to
be of good character at that time and
ever since by a minister of the gospel
and other witnesses, and even the de-fendant
testified that "the plaintiff was
a virtuous woman, and was faithful to
me during our married life, and yet is,
so far as I know—I don't say other-wise."
He further testified that he
was divorced from his first wife; that
he committed adultery while living
with his second wife, and furnished
her with witnesses to prove it by which
she got a divorce upon that ground;
that he had had trouble in Gastonia
on account of a woman, and says
"women have always been my trouble.
Have recently been convicted of being
drunk and carrying a pistol." It was
stated on the argument that the de-fendant
has recently been convicted in
Virginia under the white slave act and
sentenced to 2 years, and has also been
convicted and sentenced in that State
for abduction of a girl under 16, and
that case is pending on appeal.
The defendant also admitted on
cross-examination that he has had ven-ereal
disease, and said: "Sometimes it
takes me longer to get over a case
of gonorrhoea than others. Sometimes
it takes me a month, sometimes four
months, and sometimes six months.
The Health Bulletin
. . . On Sunday after this suit was
started I had a lewd woman in my
automobile, and passed the plaintiff's
house four times, I had my arm around
the back of the seat."
Notwithstanding that the defendant
had testified on the cross-examination
that his wife was a virtuous woman,
he intimated on being recalled that he
was forced to marry her because she
had become pregnant by him. The
plaintiff testified that he did not have
sexual intercourse with her until after
the marriage, and that he tried to get
her to procure a divorce from him,
offering to furnish her with witnesses
to prove his adultery while living with
her. He did not deny this, and ad-mitted
that he had done this with
his second wife to enable her to get
a divorce. The testimony of the plain-tiff
was that she had contracted the
disease from her husband, and as to
her humiliation and physical injury
sustained thereby, and the physician
testified that she was thus infected,
and that his diagnosis was confirmed
by clinical findings and by laboratory
tests of another expert. The defendant
testified that on one occasion "plaintiff
came to my office and could not get
in; I was locked in, the woman in there
got out."
As the plaintiff's counsel well said,
aside from the question of assault, it
is a well settled proposition of law
that a person is liable if he negli-gently
exposes another to a contagious
or infectious disease. Skillings v.
Allen, 173 (Minn.) N. W., 663. A for-tiori
the defendant would be liable in
the present case whether guilty of an
assault or not, and independent of the
fraud or concealment. In Schultz v.
Christopher, 65 Wash., 496, and in
Bandfield v. Bandfield, 117 Mich., SO
(cases cited by the defendant) the
court recognized that the infection of
the wife with venereal disease by the
husband was a tort, but held that upon
their statutes, which differ from those
in this state, the wife could not sue her
husband for a tort upon her person.
But in Prosser v. Prosser (1920), 102
S. E. (S. C.) 787, under a statute which
is verbatim our Rev., 408, C. S., 454;
it was held that "under such statute a
married woman can maintain an action
in tort against her husband for an as-sault
upon her," holding that while it
was otherwise at common law a proper
construction of this statute "gives to a
wife every remedy against the husband
for any wrong she might suffer at his
hands. More than this, a wife has a
right in her person, and a suit for a
wrong to her person is a thing in ac-tion;
and a thing in action is property,
and is her property, and the action is
therefore maintainable under Messervy
v. Messervy, 82 S. C, 550."
In Graves v. Howard, 159 N. C, 594,
Allen, J., said: "Rev., sec. 408, further
provides that the wife may maintain
an action without joinder of her hus-band:
(1) when the action concerns
her separate property; (2) when the
action is between herself and her hus-band;
and our court has construed this
section to confer upon the wife the
right to maintain an action against her
husband. Shuler v. Millsaps, 71 N. C,
297; McCormac v. Wiggins, 84 N. C,
279; Manning v. Manning, 79 N. C,
293; Robinson v. Robinson, 123 N. C,
137, and Perkins v. Brinkley, 133 N. C,
158."
The defendant objects that this ap-plies
only to property rights concerned
in actions, but damage or injury to her
person is a property right. Our Stat-ute,
1913, Ch. 13, provides: "The earn-ings
of a married woman by virtue of
any contract for her personal service,
and any damage for personal injuries,
or other torts sustained by her, can be
recovered by her suing alone and such
earnings or recovery shall be her sole
and separate property, as fully as if
she had remained unmarried." This
gives her the right of recovery of dam-ages
for any personal injury or other
tort sustained by her, and there is no
exemption of her husband from lia-bility
in an action by her which she is
authorized to bring under Rev., 4<iS,
C. S., 454. As long as the court held
(Price v. Electric Co., 100 N. C, 450)
that the recovery by the wife of dam-ages
for personal injuries was the
property of the husband, it was useless
for her to sue him under the right given
^ The Health Bulletin
by Rev., 408 (2), but the Act of 1913,
ch. 13, making such damages her prop-erty,
was promptly passed at the first
session of the General Assembly there-after,
curing this and enabled the wife
to maintain an action against her hus-band
to recover damages for injuries
committed upon her person by him.
For the same reason that in S. v.
Fulton, supra, the court held that the
statute making "anyone" liable to in-dictment
for the slander of a virtuous
woman made the husband liable to such
indictment, notwithstanding the com-mon
law theory and overruling the ex-press
decision in S. v. Edens, supra, to
the contrary, we must hold that the
statute of 1913, ch. 15, and Rev. 408,
gave the wife a right to recover dam-ages
for injuries to her person, or for
other torts sustained by her, against
her husband as fully as against anyone
else, as was held in Prosser v. Prosser,
supra.
In 26 R. C. L., 577, it is said: "The
fact that a case is novel does not ope-rate
to defeat a recovery if it can be
brought within the general rules appli-cable
to torts." In Brown v. Brown
(1914), 88 Conn., 42, that court perti-nently
says that "if the wife may sue
for a broken promise, why may she not
sue for a broken arm?" Like the S. C.
Court in the Prosser case, it holds that
her claim for damage is a property
right. It says: "The tort gives rise to
a claim for damages. Such a claim is
property, not in her possession, but
which she may by action reduce into
possession, just as she might before her
coverture, have had an action against
him for such a tort committed before
that event. The husband's delict,
whether a breach of contract or a per-sonal
injury, gives her a cause of ac-tion.
Both necessarily follow from the
fact that a married woman now retains
her legal identity and all her property,
both that which she possessed at the
time of marriage and that acquired
afterwards."
In Johnson v. Johnson (Ala.), 77 So.,
335, the court held that the statute of
that state authorizing the wife to re-cover
damages for injuries to her per-son
or reputation made the damages
her separate property and the statute
which authorized her to sue alone for
their recovery authorized her to sue
her husband for such injuries and torts,
abrogating the common law fiction of
identity between husband and wife to
that extent. The statutes of that State
upon that subject are almost identical
with ours above quoted.
Fielder v. Fielder, 42 Okla., 124, held
that a married woman could maintain
an action against her husband for in-juries
received from a gun shot
wound inflicted during coverture. That
case referring to Thompson v. Thomp-son,
218 U. S., 611, pointed out that the
latter decision was based upon the stat-utes
for the District of Columbia which
in this respect are not as liberal and
progressive as in most of the states,
and the court concurred in the dissent-ing
opinion of Justices Harlan, Holmes,
and Hughes (which in the opinion of
the writer was the "big end" of the
court at that time).
In Gilman v. Gilman, 78 N. H., 4, it
was held that the statute of that state,
providing that a married woman may
"sue and be sued on any contract by
her made, or for any wrong done, as if
she were unmarried," put husband and
wife on an equality as to property, torts,
and contracts, and that she could main-tain
an action against her husband for
assault as fully as she could against
any one else. In Fitzpatrick v. Owens,
124 Ark., 167, the court held that a mar-ried
woman may maintain an action
against her husband for a tort, in that
case for an assault, and when it re-sulted
in a wrongful death her adminis-trator
could maintain an action there-for.
And this is the trend of recent de-cisions
throughout the country, 13
R. C. L., 1397, and notes 1915 D., p. 73.
At common law neither civil nor
criminal actions could be maintained
by the wife against the husband be-cause
of the alleged unity of persons of
husband and wife, or rather the merger
of the wife's existence into the hus-band's.
The real reason was that by
marriage the wife became the chattel
of the husband (as a reminder of which
to this day at a marriage some man
"gives this woman away") and
The Health Bulletin" 9
therefore her personal property by the
fact of marriage became his, as was
the case in this state, as to wives, until
the Constitution of 1868, though as
slaves it had ceased on their emancipa-tion
in 1S65. The owner lost the right
to chastise his slaves in 1S65, but the
wife was not emancipated from the lash
of the husband till nine years later, in
1874, when in S. v. Oliver, 70 N. C, 60,
Settle, J., tersely said, "we have ad-vanced
from that barbarism." His au-thority
for making such ruling was
that ch. 5, Laws 1715, and ch. 133, Laws
1778, now C. S., 970, adopted such parts
only of the common law which are "not
abrogated, repealed, or become obso-lete."
So much of the common law as
exempted the husband from liability,
civilly or criminally, for assaults, slan-ders,
or other torts or injuries com-mitted
by him on his wife is invalid
now, both because it has become obso-lete
and at variance with the customs
and sense of right, and with our form
of government which confers "equality
before the law" upon all and because
they have been expressly abrogated and
repealed by the statutes above quoted
which confer upon the wife the right to
sue and be sued alone "when the ac-tion
is between herself and her hus-band,"
and to recover, suing alone, dam-ages
for her personal injuries or other
torts sustained by her (Laws 1913, ch.
13, now C. S. 2513) without exempting
her husband from such liability.
The true ground for the exemption
of the husband from liability to the
wife for his torts, and for his assump-tion
of her property, as already said,
was because by the marriage she be-came
his chattel. The fanciful ground
assigned for this doctrine, which was
far more unjust to married women than
that prevailing in other countries under
the civil law or even in the countries
under the rule of the Koran, is stated
by some of the old writers to be the
words in Genesis 2:23-24: "And Adam
said 'this is now bone of my bones and
flesh of my flesh," adding that a man
and wife "shall be one flesh." And now,
"speaking for myself and not by com-mandment"
(as St. Paul said on more
than one occasion. I Cor. 7:6, and II
Cor. 8:8) this statement was made by
Adam and not by Deity, and is untrue
as a matter of fact, besides Adam was
not a law-giver, but the most culpable
law-breaker known to all the ages. The
consequence of his law-breaking accord-ing
to the belief of multitudes was
the greatest and most universal of any
man, and according to orthodox teach-ings,
affects all mankind since, and if
we are to credit the vision of the great
English poet, had its immediate effect
upon* the inanimate world as well:
"Earth felt the wound; and nature from
her seat,
Sighing through all her works, gave
signs of woe
That all was lost."—Paradise Lost,
Bk. IX, line 782.
It is more than passing strange that
in this day of enlightenment this state-ment
by the greatest malefactor of his-tory,
who could frame no laws for any
future day and generation, nor keep
those made for himself, should be
solemnly cited to justify the continu-ance
of age-long injustice and degrada-tion
to one-half of the human race.
The origin of such treatment was per-haps
natural- in the economic conditions
of a barbarous age when superior
physical force made the wife the slave
of the husband. But those conditions
have passed. All the conditions and
customs of life have changed. Many
laws have become obsolete, even when
not changed by statute, and by the Con-stitution
of 1868, as this has been, and
no principle of justice can maintain the
proposition in law, or in morals, that a
debauchee, as the defendant admits him-self
to be, can marry a virtuous girl
and continue his round of dissipation,
keep up his intercourse with lewd wo-men,
contracting, as he admits, venereal
disease, communicate it to his wife, as
the jury find, subjecting her to humilia-tion,
and ruining her physically for life,
and seeking to run off with all his prop-erty,
abandoning her to utter indigence:
yet be exempted from all liability by
the assertion that he and his wife are
one, and that he being that one, he owes
no duty to her of making reparation to
10 The Health Bulletin
her for the gross wrong which he has
done her.
It must be remembered that there is
not and never has been, any statute in
England or this state declaring that
"husband and wife are one and he is
that one." It was an inference drawn
by courts in a barbarous age based on
the wife being a chattel, and therefore
without any rights to property or per-son.
It has always been disregarded
by courts of Equity. Public opinion and
the sentiment of the age as expressed
by all laws and constitutional provis-ions
since have been against it. The
anomalous instances of that conception
which still survive are due to courts
construing away the changes made by
corrective legislation or restricting
their application.
Whether a man has laid open his
wife's head with a bludgeon, put out
her eye, broken her arm, or poisoned
her body, he is no longer exempt from
liability to her on the ground that he
vowed at the altar to "love, cherish,
and protect" her. We have progressed
that far in civilization and justice.
Never again will "the sun go back ten
degrees on the dial of Ahaz": Isaiah
38:8.
Wives are no longer chattels. There
are half a million women voters in
North Carolina. They do not need to
beg for protection for their persons,
their property, or their characters.
They can command it.
GIVE THE YOUNG MOTHER A
CHANCE
Vera Cober Rockwell
It was six years since I had last seen
Nellie, six long years, and now—grand-mothers!
It seemed too ridiculous!
Why, it was only yesterday that we
were blue-ginghamed babies together,
climbing, in spite of thick, pudgy legs,
and parental protests, over the high,
awkward fence that separated our
homes. What fast little friends we
were as schoolmates and later, how
happy as young brides and mothers!
Our friendship had never wavered an
instant since the blue-ginghamed hours
of that yesterday, and now—grandmoth-mothers!
To prove it, there in the open door-way
stood Nellie, a lovely wide-eyed
grandson on her arm, who gravely
watched my suitcase as I, in spite of
my fifty years, almost ran up the porch
steps. She was the same old Nellie
—
I could tell that at a glance—with danc-ing
black eyes, dimpled cheeks, and
hair only a wee bit gray. How my
heart leaped at the sight of her! And
that dear baby!
"Elinor is gone for the day," she re-plied
to my query about her daughter,
"so I am playing nurse."
"Isn't that fun!" I rejoined enthusi-astically.
"I always feel like a young,
new mother when Virginia gives me
that privilege. Baby Marjorie and I
get on famously together. She's the
happiest little thing—just ten months
old today."
"She must be a darling!" exclaimed
my old chum, as she led me into the
cozy living room, motioned me to a
chair, and plumped the baby down in
my arms. "Gordon and I have a great
time, too," she laughed. "Don't we,
honey?" The little fellow gurgled, and
jumped in ecstacy as Nellie bent over
him in play.
"When the cat's away, you know!"
and she winked knowingly at the baby.
Then catching my puzzled look she ex-plained
gaily, "Elinor is fussy with her
baby, Jane—positively fussy. She's so
strict with his diet, and sleeping hours,
and all, and it's such nonsense. Why,
if she were here, baby would be in bed
fast asleep this very minute and not
down at the door to welcome Auntie
Jane, whom he's never seen before,
bless her!"
"Nellie!" I gasped in astonishment,
"You didn't keep him awake just for
me, when you knew I came prepared
to spend a week with you!"
"Oh, no," Nellie answered, lightly.
"I didn't keep him up, but I did awaken
him when I heard your train coming
in, and slipped another dress on him.
He had slept enough to last him till
night, anyway."
"Now listen, Nellie," I admonished
her, half jestingly, half seriously.
The Health Bulletin 11
"Don't you ever wake that baby up
again for me. He needs every bit of
sleep he can get. Besides," I added,
with a laugh, "I can assure you I
would never return the compliment for
you."
"Oh!" said Nellie, with quick sym-pathy,
"Is Virginia fussy, too?" and
then, not waiting for my answer, placed
Gordon in his play-yard. "Now be a
good boy for Auntie Jane," she coaxed,
"and we'll get her some luncheon in a
hurry."
At table, Gordon sat in state in his
handsome high-chair.
"He's beginning young," I remarked,
as Nellie fastened a snowy napkin
around his neck and prepared to feed
him. "He isn't eight months old yet,
is he?"
"Next week, the twentieth," ex-plained
my hostess. "We don't give
him much besides his milk. Elinor
feeds him every three hours, and then
in between times I insist, in the face of
her protests, that we give him old-fashioned
pap, milk thickened with
cornstarch, you know. I used to feed
it to Elinor, so, of course, it's all right.
Then when he sees us eating, naturally
he wants to eat, too, so we give him
—
or rather I do—a little piece of bread
to keep him quiet. Elinor did not want
to begin feeding him solids yet, but I
told her she was foolish to put it off
any longer—he has to begin sometime
—and he might as well be starting lit-tle
by little. So now she lets me go
ahead with the pap, and days like this
when he and I are alone, he gets a little
taste of everything, and nobody's the
wiser. Now this scalloped potato is so
tender and tasty, I know he'll like it,"
and she put a small bit between the
baby's eager lips.
To see that darling baby, without a
tooth in his head, rolling the potato
around in his little mouth, and then
swallowing it whole, to see him chok-ing
over wads of soft bread, was shock-ing
to me. My appetite that had been
so keenly whetted by the odor of
Nellie's cooking, fled. I wanted to pro-test,
and yet I did not want to hurt
dear old Nellie. But I could not keep
still.
"Nellie," I said, and she looked up
in surprise at the pleading note in my
voice. "Nellie, dear, don't you think
you are taking a terrible responsibility
upon yourself?"
"How?" she asked in astonishment.
"Well—in imposing your ideas upon
Elinor. It's her baby. Why should
she not have the privilege of bringing
him up as she wishes. You brought
yours up—
"
"As my mother wished," interposed
Nellie, quickly.
"Yes, and very probably she brought
hers up as her mother wished," I con-tinued.
"Don't you see what that
means? We've been using home-grown
and ingrown methods of culture for
our babies for years. It is only recently
that there have been physicians who
realized the need of specializing in the
development and growth of children.
Don't you think it smacks of Chinese
ancestor worship to cling so stubbornly
to the old ways instead of admitting
possible good in the modern ways?
Aren't you willing to try out the new
ways?"
"Jane!" exclaimed Nellie, in growing
astonishment. "You amaze me! Those
Red Cross lectures you have been going
to have certainly put a lot of new no-tions
into your head, and style, too!
But I see what you mean. At the same
time I've got a pretty fair specimen of
the good old way in Elinor. She is so
strong and healthy."
"Has she lost her old nervousness?"
I could not help asking.
"No—she's extremely nervous," ad-mitted
Nellie. "But you can't say that
was due to my feeding."
"No—I cannot say so; but disorders
of the stomach so quickly affect the
nervous system that we cannot say
definitely that it was not that until we
prove positively that it was something
else. Don't you see? In the same way
I cannot prove that the sick headaches
Virginia has been subject to all her life
were not the result of my ignorance of
how she should have been fed. The
whole thing resolved itself into this:
If Elinor rears her child by careful
feeding and modern methods and then
discovers he has some weakness or
12 The Health Bulletin
other, at least she knows that she is
not to blame—she has done her best.
And if you have not interfered, you too,
are blameless."
Here I hesitated a moment. It was
hard to give utterance to that which
had lain voiceless within my heart for
so many years—but I felt that I must
drive the point home.
"Nellie," I said softly, "You remem-ber
my baby boy? You remember he
was just a year and a half old. Did
you know—" again I paused. The hurt
of it was so poignant, so fresh after all
these years, and it seemed somehow
traitorous and unfilial to tell the story.
"You did not know," I began again,
"that it was my mother's insistence
upon wrong methods of feeding him
that took him away from us? Poor,
dear mother! She worried and grieved
over her interference all the remainder
of her life. I was young and inexperi-enced,
she thought her way was best,
and I followed her advice."
Nellie's cheeks paled as she looked
at me with startled eyes.
"Poor, dear Jane," she said, after a
pause.
"And poor dear mother!" I said
again. "The fault was not hers after
all. How could she know? It is so
recently that mothers have been' given
intelligent solutions of their problems.
In earlier times people did not have
such sources of expert knowledge as we
now have in magazines and handbooks,
and as specialists can give. For the
most part, I believe young mothers to-day
are eager to look around and ab-sorb
this knowledge, but in far too
many cases we older mothers won't
give them a chance. Does it seem fair,
Nellie?"
And Nellie, who was always the
frankest, finest pal anyone ever had,
said quite candidly, "No, Jane. I be-lieve
you are right. Only I am just a
wee bit jealous because I did not figure
it out for myself
—
From Mother and
Child.
Life is a battle with dirt. Keep up
the fight. There can be no loss in
keeping clean.
PERMANENT PROTECTION
AGAINST DIPHTHERIA
By Aldert Smedes Root, M.D.
In this day of progress every one
recognizes the value of antitoxine in
diphtheria, not only in cases where
diphtheria has already developed, but
in preventing the disease from occur-ing
in those who have been intimately
exposed to it. Unfortunately neither
the disease itself nor antitoxine will
protect the individual for any great
length of time, and upon being exposed
to an active case six months or a year
later he may again contract it.
Within the past five years there has
been discovered a means by which one
may gain protection against diphtheria,
probably for a life time.
The preparation used for this is
called toxine-antitoxine, and by giving
a small quantity of this (about 15
drops) under the skin by means of a
hypodermic needle each week for three
doses, the child will develop an active
immunity against the disease so that
even though exposed he will not con-tract
it. The injection of this sub-stance
does not usually make the child
sick at all, sometimes there is slight
fever for 12 to 24 hours, but not as
much as when typhoid vaccines are
given.
In spite of the use of antitoxine in
diphtheria there is an annual death
rate in the United States of about
23,500, almost equal to the combined
deaths from scarlet fever and measles.
A majority of these deaths are among
children under two years of age, who
are especially apt to have the laryngeal
type, commonly known as membranous
croup.
There is no excuse now for this great
loss of life, and the public should know
that there is a means of permanently
protecting one's child against this
dreaded disease, just as truly as there
is a means of protecting against ty-phoid
fever by the use of typhoid vac-cines
and against smallpox by the use
of smallpox vaccines.
There is a test called the Schick
test by which it can be told whether or
not an individual is susceptible to
The Health Bulletin 13
diphtheria. Over 90 per cent of child-ren
who were rendered nonsusceptible
to the disease by toxine-antitoxine five
years ago still are nonsusceptible, as
shown by the Schick test. We have
found out by this test the age at which
diphtheria is most apt to occur. The
danger period is between six months
and five years. After this one's suscep-tibility
decreases with age, so that
when adult life is reached between 90
and 95 per cent of people are immune,
that is are naturally protected against
it.
In order to stamp out diphtheria as
completely as is smallpox we have but
to follow this rule. Every child be-tween
six months and five years of
age should have three doses of toxine-antitoxine.
One cubic centimeter
(about 15 drops) should be given under
the skin by a hypodermic needle at
each dose, regardless of the age of the
child. This should be repeated each
week until the child has had three in-jections.
Children between five and
fifteen years of age should have a Shick
test made upon them and those who
are found to be susceptible should re-ceive
toxine-antitoxine.
It should be a part of the public
health work in every community to see
to it that this is carried out in the
public schools. The toxine-antitoxine
and Schick test outfits may be procured
from the New York Department of
Health at a nominal cost, or from some
of the commercial laboratories.
THE USE OF AIR
By W. S. Rankin, M.D.
VENTILATION: THE COMING OF THE WIND
Effects of Ventilation
If a perfectly comfortable, rested,
cheerful, alert, and reasonably ener-getic
person comes into a small closed,
room, especially if the temperature of
the room is above 70, there will gradu-ally
develop a disinclination to either
mental or physical effort, a little dull-ness,
perhaps a slight depression of
spirits. The longer the person remains,
the smaller the room, the higher the
temperature, or the more persons in the
room, the more pronounced the afore-mentioned
effects and the sooner will
there develop a distinct sense of dis-comfort,
some headache, faintness, and
nausea. In extreme form the effects of
insufficient ventilation or close air space
are well stated in the following descrip-tion,
borrowed from Professor Lee, of
Columbia University, of what hap-pened
in the tragedy of the Black Hole
of Calcutta:
"On one of the hottest of the hot nights
of British India, a little more than 150
years ago, Siraf-Uddaula, a youthful
merciless ruler of Bengal, caused to be
confined within a small cell in Fort
William, 146 Englishmen whom he had
that day captured in a seige of the city
of Calcutta. The room was large
enough to house comfortably but two
persons. Its heavy door was bolted; its
walls were pierced by two windows
barred with iron, through which little
air could enter. The night slowly
passed away, and with the advent of
the morning death had come to all but
a score of the luckless company. A
survivor has left an account of horrible
happenings within the dungeon, of
terrible strugglings of a steaming mass
of sentient human bodies for the insuf-ficient
air. Within a few minutes after
entrance every man was bathed in a
wet perspiration and was searching for
ways to escape from the stifling heat.
Clothing was soon stripped off. Breath-ing
became difficult. There were vain
onslaughts on the windows; there were
vain efforts to force the door. Thirst
grew intolerable, and there were rav-ings
for the water which the guards
passed in between the bars, not from
feelings of mercy, but only to witness
in ghoulish glee the added struggles
for impossible relief. Ungovernable
confusion and turmoil and riot soon
reigned. Men became delirious. If any
found sufficient room to fall to the floor
14 The Health Bulletin
it was only to fall to their death, for
they were trampled upon, crushed, and
buried beneath the fiercely desperate
wave of frenzied humanity above. The
strongest sought death, some by pray-ing
for the hastening of the end; some
by heaping insults upon the guards to
try to induce them to shoot. But all
efforts were in vain, until at last bodily
and mental agony was followed by
stupor. This tragedy of the Black Hole
of Calcutta will ever remain as the
most drastic demonstration in human
history of the bondage of man to the
air that surrounds him."
To reverse the picture, a person who
is suffering from the effects of dimin-ished
air space, when brought into cool,
commodious, and moving aerial sur-roundings
is at once revived, nausea
disappears, if it existed, the headache
subsides, there is no longer any dizzi-ness
or faintness, the spirits revive, the
person becomes cheerful, alert, and in-terested
and ready for ordinary mental
or physical exertion.
The Cost of Poor Ventilation
As pointed out on other occasions, it
is not those taxes suddenly imposed
and with overwhelming and tragic
effect upon the vitality of relatively
small numbers, as in the fatal Black
Hole incident, that are of any real con-sequence,
but those taxes on the vital-ity
of great masses of people imposed
to such a slight extent and so gradually
as not to cause a reaction. Human na-ture
reacts instantly and effectively
against an excessive tax on life or
purse, but condones and adjusts itself
to an injury gradually imposed over
long periods of time. There is a nat-ural
law to the effect that a stimulus
must have a certain intensity in order
to produce a reaction; hence the para-dox
that those injuries that hurt us
least, injure us most. We lose our
lives, our vital surplus, as we lose our
money, our bank account. The bank
does not suddenly fail, leaving us com-plete
bankrupts, but we waste the
money gradually, in small and useless
expenditures, over a period of years.
And so it is with our vital surplus.
Deaths from violence, accidents, rare
and spectacular diseases, are compara-tively
infrequent. We die from the ef-fects
of minor injuries and long con-tinued,
unhygienic, and unsanitary
practices. We waste our vital surplus
as our financial surplus, in driblets.
The Black Holes of Calcutta occur but
once in centuries, and it is only now
and then that we read of a person being
suffocated—usually an infant from be-ing
lain upon by the mother; on the
other hand, the minor effects of insuf-ficient
air, of poor ventilation, going
on from day to day, affecting not the
few but the millions, in schools, mines,
and factories, causing them to lose in
productiveness and also in vitality (re-sistance
to disease), from 5 to 10 or 15
per cent, in the annual grand total
reach into billions of dollars and into
the hundreds of thousands of lives.
The Cause of Poor Ventilation
The Theory of Diminished Oxygen
Supply was extensively held for many
years. As an explanation of the effects
of poor ventilation it was quite natural
to assume that the continuous consump-tion
of the oxygen of the air in respira-tion
would bring about an impoverish-ment
of the air in this vital constituent
that would result in deleterious effects
upon the body. Furthermore, it was
known that a mouse placed under a
small bell jar dies from oxygen starva-tion,
and that occasionally men in the
manholes of sewers and in the depths of
mines died because of an absence of
oxygen. Such deaths, however, were
known to be rare, while the evil effects
of ventilation were known to be fre-quent.
Furthermore, a study of the
percentage of oxygen in the air in
rooms where both the conditions and
effects of poor ventilation were evident
has shown that under such conditions
the percentage of oxygen in the air is
never less than 20 (the normal per
cent is 20.94). It was known, too, that
in the mines the percentage of oxygen
was frequently kept down to 17 in
order to prevent explosions and with-out
evil effect upon the workers. Still
further evidence against diminished
oxygen supply as the cause of poor ven-tilation
was seen in the good health,
The Health Bulletin 15
and even the exceptional vigor, of peo-ple
living at high altitudes—in some
places (the City of Potossi, in the An-des,
for example) where the air was so
rare or light as to have a pressure
which gave the oxygen supply an
equivalent of only 13 per cent. Finally,
it has been shown that the percentage
of oxygen may be reduced at least one-half,
to about 10 per cent, without per-ceptibly
injurious effects. Below this
point there is difficulty in breathing
and when the oxygen supply is reduced
to 6 or 7 per cent, about one-third of the
normal supply, there is convulsions and
death.
In conclusion, the important point to
be remembered, in this connection, is
that a diminished oxygen supply does
not serve as a plausible explanation for
the evil effects of ventilation, for the
reason that in rooms where ventila-tion
is known to be poorest the per-centage
of oxygen is never found to be
under 20 per cent, and, other condi-tions
being favorable, we know that the
percentage of oxygen may be very much
reduced without injurious effects.
The Theory of Excessive Carbon
Dioxide as the cause of poor ventila-tion
is still widely held. Recent text-books
give an excess of carbon dioxide
in the air as the agent producing the
symptoms associated with insufficient
air supply. When attention was first
directed to carbon dioxide in its rela-tion
to ventilation it was considered as
an index, a means of measuring the
vitiation of the air by the breath, and
not as the explanation of the effect of
diminished air space. Subsequent
studies advanced its importance to that
of cause instead of simply an index of
poor ventilation. "We now know that as
oxygen is never so deficient under ordi-nary
conditions as to explain the effects
of poor ventilation so carbon dioxide is
never so excessive under ordinary con-ditions
as to explain the symptoms.
Ordinarily there are four parts of car-bon
dioxide per 10,000 parts of air. No
evil effect whatever arises from breath-ing
air in which there are 100 parts of
carbon dioxide per 10,000—25 times the
ordinary amount. Persons may be kept
for considerable periods of time in very
small chambers, 180 cubic feet per per-son,
in which the carbon dioxide ac-cumulates
from 25 to 200 parts per
10,000 parts of air and without suffer-ing
any disagreeable effects, provided
the air in the small chamber is kept
cool and changed slowly. In certain
parts of breweries there are 200 parts
carbon dioxide to 10,000 parts of air
and no ill effect is noticed except a
slight increase in the depth of breath-ing.
With 300 parts of carbon dioxide
per 10,000 parts of air there is a slight
increase in the rapidity of breathing;
with from 500 to 1,000 parts per 10,000
there is difficult breathing and death
follows when the carbon dioxide rises
to 4,000 or 5,000 parts per 10,000, prac-tically
one-half.
In conclusion, the excess of carbon
dioxide found under ordinary condit-ions
of bad ventilation is not in itself
sufficient to explain the disagreeable
feelings that follow.
The Theory of Organic Effluvia in-truded
itself into the consideration of
the cause of poor ventilation when it
became quite clear that the effects
could not be related to either deficient
oxygen or excessive carbon dioxide. Bad
odors, due to decomposition of organic
matter in the mouth, on the skin, and
in the clothes, suggested that such ef-fluvia
in amounts appreciable and in
amounts unappreciable might be the
cause of the disagreeable effects of close
air supply. These effluvia of uncertain
composition have been spoken of as
"crowd poison." Experiments in con-densing
the moisture of the breath and
injecting it into animals have been
without effect. Other experiments, in
forcing animals to breath expired air
in concentrated form have been with-out
effect, provided the air about the
experimental animals was kept cool
and in motion. Moreover, animals sub-jected
to the disagreeable odors from
putrifying flesh and excreta show a
normal growth curve and no loss of re-sistance
to infectious germs. To make
a long story short, no experimental evi-dence
has been produced in support of
the theory that the ill effects of poor
ventilation are due to effluvia from the
body of mysterious composition.
1G The Health Bulletin
The Facts, Not Theory, of Tempera-ture
and Humidity: As far back as
1883 it was suggested that the ill ef-fects
from poor ventilation were not
due to any of the aforementioned
causes, to wit: the deficient oxygen, ex-cessive
carbon dioxide, or organic ef-fluvia
from the body, but were due to
temperature and humidity in such ex-cess
as to derange the heat regulating
mechanism of the body. In 1905 there
was a considerable amount of work
done which tended to substantiate the
idea of temperature and humidity as
the cause of the effects from poor ven-tilation.
This early work has been con-firmed
and extended by subsequent in-vestigators
and all these workers are
agreed that the ill effects of ventila-tion
are due to temperature and humid-ity,
as shown in many experiments sim-ilar
in general character to the follow-ing:
From six to a dozen men inclined to
be cheerful, active and energetic, men-tally
and physically, are placed in a
small, closed chamber and kept there
for several hours. After a short time
they become less talkative, less inter-ested
in their surroundings and de-pressed.
Still later the depression deep-ens,
some of them have a slight head-ache
and feel faint, in short all the evi-dences
of poor ventilation manifest
themselves. These men are now per-mitted
to place their faces in masks
connected with the outside air by a
large tube and to breathe freely of the
outside air. No change whatever in
their condition takes place, even after
an hour or so and their symptoms of
bad ventilation become more aggra-vated.
At the same time that the men
in the chamber begin to breathe out-side
air through tubes an equal num-ber
of men in outside air, through
masks and tubes, breathe the inside air
of the chamber without any noticeable
change in their feeling or actions. The
experiment so far seems to indicate
clearly that it is not the air breathed
that produces the ill effects of bad ven-tilation.
If, now, electric fans placed
in the chamber are set in motion the
spirits of the men in the chamber re-vive,
their headache and depression dis-appear,
they become cheerful and in-terested
in their surroundings. In
short, all the ill effects of bad ventila-tion
disappear. Experiments like the
above, performed many times and by
many investigators, have consistently
demonstrated that it is not the air
that we breathe that produces bad ven-tilation
but the temperature and the
humidity of the air about our bodies.
In conclusion, to quote Professor
Lee, "bad ventilation is physical, not
chemical; cutaneous, not respiratory."
The next article on the "Use of Air"
will deal with the effect of temperature
and humidity, explaining the way in
which these conditions impair the
functions of the body.
A DEFINITION OF SANITATION
AND HYGIENE
"In the battle of life, just as in ac-tual
warfare, there are two great forces
brought into action—offensive and de-fensive.
Sanitation may be compared to
the former, and hygiene to the latter.
In sanitation we wage an active cru-sade
against the germs of disease—we
burn them with fire, we poison them
with antiseptics, we demolish their
strongholds of filth, and in every way
actively pursue them to their death.
In hygiene we strengthen our fortifi-cations
and look after the well being
and equipment of the garrison, so that
we can resist almost any attack. The
human system is supplied with those
defensive forces known as the power
of resistance or immunity, and by
obedience to the rules of hygiene—of
right living—they insure us against
many attacks of disease."
—
Dr. R. H.
Leicis.
The enemies of life and health are
|
always ready to attack the weak and
unguarded places in your physical ar-mour.
Knowledge of health laws is one
of your strongest lines of defense. For »
having health knowledge you are fore-warned,
and thus you are forearmed
against the foes of health.
This Bulletin willbe *aM free to ana citizen of foe State mxttMeguestl
Entered as secortd-ciass matter at Poatotfce at Raleigh, "-C-'™*?**** J"lv
c
16
'
"'**
Published monthly at the office of the Secretary of the Board, Raleigh, N. C.
ol. XXXVI FEBRUARY, 1921 Xo. 2
A THOUGHT FOR THE YEAR
JOHN GALSWORTHY entreats us not to "drag the hands
of the world's clock backward" by our neglect of the
health of mothers and babies. He says
:
"How do things stand? Each year in this country
about 100,000 babies die before they have come into the world
;
and out of the 800,000 born, about 90,000 die. Many mothers
become permanently damaged in health by evil birth conditions.
Many children grow up mentally or physically defective. One
in four of the children in our elementary schools are not m a
condition to benefit properly by their schooling. What sublime
waste ! Ten in a hundred of them suffer from malnutrition
;
thirty in the hundred have defective eyes ; eighty in the hun-dred
need dental treatment ; twenty odd in the hundred have
enlarged tonsils or adenoids. Many, perhaps most, of these
deaths and defects are due to the avoidable ignorance, ill-health,
mitigable poverty, and other handicaps which dog poor mothers
before and after a baby's birth. One doesn't know which to
pity most—the mother or the babies. Fortunately to help the
one is to help the other. * * *
"There are many districts all over the country where there
are no centers to come to ; no help and instructions to be got,
however desperately wanted. Verily this land of ours still goes
like Rachel, mourning for her children. Disease, hunger, de-formity,
and death still hound our babies, and most of the
hounding is avoidable. We must and shall revolt against the
evil lot, which preventable ignorance, ill health, and poverty
bring on hundreds of thousands of children.
"It is time we had more pride. What right have we to the
word 'civilized' till we give mothers and children a proper
chance? This is but the Alpha of decency, the first step of
progress.
"Into the twilight of the world are launched each year these
myriads of tiny ships. Under a sky of cloud and stars they
grope out to the great waters and the great winds—little sloops
Df life, on whose voyaging the future hangs, they go forth blind,
feeling their way. Mothers, and you who will be mothers, and
you who have missed motherhood, give them their chance."
MEMBERS OP THE NORTH CAROLINA STATE BOARD OF HEALTH
J. Howell Way, M.D., Pres., Waynesville Chas. O'H. Laughinghouse, M.D.,
Richard H. Lewis, M.D., LL.D., Raleigh Greenville
J. L. Ludlow, C.E., . . Winston-Salem Cyrus Thompson, M.D., . . Jacksonville
Thomas E. Anderson, M.D., . Statesville F. R. Harris, M.D., .... Henderson
A. J. Crowell, M.D Charlotte E. J. Tucker, D.D.S., .... Roxboro
EXECUTIVE STAFF
W. S. Rankin, M.D., Secretary State Board of Health and State Health Officer.
Ronald B. Wilson, Director Public Health Education.
C. A. Shore, M.D., State Laboratory of Hygiene.
L. B. McBrayer, M.D., Superintendent of the State Sanatorium for Treatment of Tuber-culosis
and Chief of Bureau of Tuberculosis.
G. M. Cooper, M.D., Chief of Bureau of Medical Inspection of Schools.
K. E. Miller, M.D., Director of County Health Work.
Miss Rose M. Ehrenfeld, R.N., Chief of Bureau of Public Health Nursing and Infant
Hygiene.
Millard Knowlton, M.D., Chief of Bureau of Engineering and Inspection.
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 Epidemiology.
SERVICE
The State Board of Health offers to the people of North Carolina, without
charge, the services of experts thoroughly trained with particular regard
to the needs of this State. Advice will be given promptly upon any question
affecting the public health. Address any inquiry to the State Board of
Health, Raleigh.
FREE LITERATURE
The State Board of Health has prepared special literature on a large
number of subjects which are offered without charge. If you are interested
in any one or more subjects affecting your health, write the State Board of
Health, Raleigh, requesting special literature, and it will be sent to you.
THE HEALTH BULLETIN
The Health Bulletin is issued monthly. It will be sent without charge
to all citizens of the State who request it.
P-57
Vol. xxxn FEBRUARY, 1921 No. 2
NORTH CAROLINA LEADS IN
BIRTHS
North. Carolina now leads the entire
United States with the highest birth
rate in the Union, according to statis-tics
for 1920, compiled by the State
Board of Health. At the same time
this State has one of the lowest death
rates.
Reports during the past year show a
total of 83,966 births in the State, a
rate of 32.8 per thousand. The deaths
totaled for the same period 33,228, a
rate of 12.9 per thousand. These fig-ures
do not include the still births,
which amounted to 4,171 for the year.
During 1920 every six minutes a new
life was born into the world; every
fifteen minutes another life was
snapped off. That the births are so far
in excess of the deaths accounts for
the large increase in the population of
the State during the last decade, as
shown by the last census figures, for
the State has had little increase by rea-son
of immigration.
A comparison for the past three
years shows the following: 1918, total
births, 76,175, or rate of 30.8, and total
deaths, 42,411, or rate of 17.6; 1919,
total births, 69,791, or rate of 29.3, and
total deaths, 30,114, or rate of 12.4.
The very high death rate for 1918 was
caused by the epidemic of influenza,
and this probably also accounts for the
lessened rate of both births and deaths
during the following year of 1919. In
1920 the birth rate went forward con-siderably
while the death rate shows a
difference of onl~ five per hundred
thousand.
North Carolina has been exceeded in
birth rate heretofore only by Utah,
which, in 1918, had a rate of 31.9. The
rate for the entire registration area of
the country the same year was 24.4.
For the same year the death rate for
the same area was 18.2.
"CERTIFIED WATER"
Within the last twelve months the
danger to railway travelers of infec-tion
with typhoid fever, dysentery, and
other water-borne diseases has been re-duced
to a minimum throughout the
greater part of the country by the co-operation
of the U. S. Public Health
Service with the different State boards
of health in the testing of the water
used on railway trains for drinking and
cooking. And, within the next few
months similar protection will be af-forded
to passengers on river and lake
steamers and to ocean steamships sail-ing
from American ports. This will
tend to end the severe outbreaks of
typhoid fever that have from time o
time been traced to ships (especially
to excursion boats) as well as to the
probably more numerous but far less
easily traced illnesses of rail >/ay travel-ers
from similar pollution.
"The work," said Surgeon General
Cumming, of the U. S. Public Health
Service, "was really begun in June of
last year, when at the convention of
State and Territorial Health Officers,
in session at Washington, D. C, a plan
was decided upon whereby the Service
was to cooperate with the states in re-ducing
typhoid fever either by sending
them sanitary engineers to investigate
their water supplies or by helping <hem
to organize State divisions cf sanitary
engineering to look after the work."
"Woik has since been done in nearly
half the states of the Union, in many
of which sanitary divisions were lack-ing.
In nearly all of these such bodies
have been or are now being organized;
Tup: Health Bulletin
and in about half of them surveys have
been made of many or all important
wateV supplies, most of which have
been found safe for use on trains.
Periodic inspection is, however, of
course, neessary."
"In carrying out this work the Pub-lic
Health Service has grouped the
states east of the Mississippi River into
four districts and it will group those
west of the Mississippi into five other
districts as soon as may be practicable.
Each district will be provided with a
sanitary engineer from the Service,
who will render aid to the State sani-tary
officers in his group when re-quested."
In North Carolina this work has
been in progress for several months, a
member of the staff of the State Labora-tory
of Hygiene being entrusted with
the duty of making investigations and
certifying the sources of supply of
water used on trains operated within
the State.
THE TUBERCULOSIS CLINIC
The State Board of Health, the
North Carolina Tuberculosis Associa-tion
and the physicians of the State
have during the past year cooperated
in the conduct of a number of tubercu-losis
clinics, held in many different
sections of the State. Few undertak-ings
in public health work have proved
as popular, or more thoroughly demon-strated
their value.
The "plan of work has been simple.
An expert diagnostician has been sup-plied
through the North Carolina Tu-berculosis
Association. A nurse as his
assistant has been furnished by the
Bureau of Public Health Nursing and
Infant Hygiene of the State Board of
Health. The local county public health
nurse and the physicians of the several
communities have united in assisting
in making the examinations a success.
When a person affected with tubercu-losis
has reached that stage of the dis-ease
where the signs of it are so
plainly imprinted upon the frame and
countenance that there is no mistaking
the cause of the trouble a point has
been reached where the chances are
largely against a cure being effected.
On the other hand, when the presence
of the disease can be discovered in its
incipiency or earlier stages there is a
very good chance that a cure can be
effected. It is for this reason that the
endeavor is being made to supply a
service to the people of the State by
which such cases may be discovered.
One of the most recent clinics held
was at Kinston, Lenoir County. Speak-ing
of the clinic there the Free Press,
the Kinston afternoon newspaper,
says:
"The Tuberculosis Clinic for Lenoir
County has just closed after sev-eral
days spent in investigation at two
points in the county. The clinic was
conducted by Dr. Spruill, a specialist
from Sanatorium, and Miss Marion
Manning, a trained nurse from the
State Department of Health. Clinics
scheduled for the county had to be
abandoned on account of bad roads, ex-cept
for Kinston and LaGrange, where
access could be had by railroad.
"The report shows that 130 exami-nations
were made of men; women, and
children. Diagnosis showed that IT of
those examined gave positive evidence
of having tuberculosis and 97 were dis-charged
as free from the disease. In
the case of one the disease had been
arrested; 5 were classed as doubtful, 6
were said to be probable glandular, 3
probable, 1 doubtful.
"Eight of the cases examined were
advised to go to Sanatorium for treat-ment,
1 for X-Ray diagnosis, and 4 for
further examination. Nineteen were
advised to have their temperature care-fully
recorded, 20 to have sputum ex-amined,
4 to have tonsils and adenoids
removed, 4 to have tonsils removed, 1
to consult a throat specialist, 1 for
hookworm examination, 31 advised to
sleep in the open, 5 to take rest in bed,
4 to rest as much as possible, 15 to
have milk added to their diet, and IS
to take milk and egg diet.
"The county health department paid
the expenses of the clinic. It is a com-pliment
to Miss Nettie Simpson, our
county health nurse, that the .visitors
declared the clinic to be the most suc-cessful
yet arranged by a county health
nurse.
The Health Bulletin
"The clinic emphasizes the necessity
of the State making adequate prepara-tion
for the treatment and prevention
of tuberculosis. The Kinston Rotary
Club has gone on record as asking the
General Assembly to authorize this
step; and it appears quite probable
that action will be taken to this effect.
In fact the $20,000,000 bond issue that
educational leaders are now urging has
in view the enlargement of all the
State's institutions, charitable as well
as educational."
LITTLE DANGER FROM TYPHUS
Last year there were in North Caro-lina
several sporadic cases of typhus
fever. Two deaths were reported dur-ing
the year from this cause. Within
the past few weeks there have been
many alarming reports sent out from
New York, and printed in the newspa-pers
of the State, with regard to the
presence of typhus fever among immi-grants
arriving in this country and the
danger of its spreading to other sec-tions
of the country. As a matter of
fact there is no reason for any fear of
the spread of this disease over the
country.
In view of the extraordinary public-ity
given the typhus situation at New
York, and the erroneous impression
which has been created in the minds of
many, the following statement of facts
has been made by Surgeon-General
dimming, of the United States Public
Health Service:
"The menace to this country from
the introduction of typhus from Europe
is not of recent development and is no
greater today than it was six months
ago. Even before the armistice the
Surgeon-General recognized the poten-tialities
of the disease spreading to the
United States if adequate precaution-ary
measures were not taken when im-migration
was resumed. During the
past year medical officers of the Public
Health Service have been stationed at
American Consulates at chief European
ports of embarkation to supervise
measures to be applied against ships
and passengers for the prevention of
the spread not only of typhus, but also
of plague and cholera. While the
measures enforced at the European
ports have by no means been perfect
their value is indicated in the fact
that several hundred thousands immi-grants
have come from typhus-infected
areas on several hundred ships and
that out of all this number typhus in-fection
occurred only on eight vessels.
With the exception of the S. 8. Presi-clente
Wilson, which arrived at New
York on February 1, infection on the
ships was detected by the quarantine
officer at New York and effective pre-cautionary
measures applied. Upon
arrival of the 8. 8. Presidente Wilson
at New York there were three cases in
the sick bay of what the quarantine
officer diagnosed as broncho-pneumonia
but which later proved to be typhus.
The doctor was experienced in the de-tection
of typhus, but the cases pre-sented
no eruption and the mistake
was by no means inexcusable. Still
under the custodial care of the immi-gration
authorities the sick people
were sent to the Long Island College
hospital, which takes care of sick im-migrants,
and the correct diagnosis
later became apparent. Fortunately
the error was discovered before the
other passengers in the steerage were
released, and the vessel and the immi-grants
were remanded to quarantine
and appropriate treatment applied to
prevent the spread of the infection.
The incident was unquestionably de-plorable,
but it indicated neither a
breakdown of the New York quarantine
station nor any unreasonable laxity.
"The system of quarantine protec-tion
developed by the Public Health
Service consists of a double line of de-fense,
first the medical officers at for-eign
ports who supervise preventive
measures specified in the United States
quarantine regulations, and, second,
the facilities at United -States quaran-tine
stations. If infection evades the
first barrier the ship still has to un-dergo
inspection and treatment at her
American port of arrival.
"Several weeks before the arrival of
the 8. 8. Presidente Wilson the Sur-geon-
General had taken very definite
steps to strengthen the quarantine de-fense
at European ports by having
6 The Health Bulletin
American consular officials instructed,
through the State Department, to with-hold
bills of health from vessels whose
passengers had not been satisfactorily
disinfected. As early as January 17
quarantine officers at Atlantic ports
were advised that on account of the
unsatisfactory delousing procedure
carried out at Danzig all passengers ar-riving
at their ports should be held in
quarantine and treated for the destruc-tion
of vermin. It must, therefore, be
evident to any fair-minded person that
the Federal health authorities have
been most diligent in carrying out anti-typhus
measures, and that any state-ment
that either the Federal Health
Service or the State officials of New
York have been derelict or indifferent
to the typhus situation is obviously
untrue. Nevertheless administrative
efforts of this sort cannot be expected
to be perfect or to eliminate mistakes
by individual officials.
"Typhus is not transmitted by lice in
general, but only by lice that have pre-viously
bitten persons infected with ty-phus.
A louse is by no means an exotic
insect, as one might infer by some of
the interviews in New York papers. It
is widespread throughout the United
States, but is found chiefly in the slum
districts of large cities. In the absence
of typhus it is of no sanitary signifi-cance
or danger, so far as the present
situation is concerned. Typhus fever
develops in four to twelve days, and it
is readily apparent to any trained sani-tarian
that if cases do not develop
within this period it can safely be as-serted
that the infection is not present.
This applies particularly to overseas
vessels that have been out twelve days
or more.
"Much confusion has resulted from
the statements in newspaper interviews
in New York City as to responsibility
of '"he Immigration Service at Ellis
Island for the exclusion of typhus fever.
Immigration officials are not vested
with any authority administering quar-antine
laws. Furthermore they have
no equipment for enforcing quarantine
measures—naturally so because they
have control over aliens and not
over citizens of the United States, al-though
the latter returning from Eu-rope
are just as serious a menace from
the typhus standpoint as is an alien.
It is true that Ellis Island has always
proved a valuable line of second de-fense
for the port, but the responsibil-ity
for the exclusion of typhus and
other quarantinable diseases rests
solely upon the quarantine authorities.
As a matter of ordinary decency and
personal hygiene delousing facilities
should be provided at Ellis Island, but
since the prevention of the introduction
of typhus relates to returning citizens
as well as aliens, the quarantine station
is the one place where effective preven-tive
measures can be carried out.
"As to the statement that 'one in-fected
immigrant might spread a
plague that would cause a million
deaths in six weeks in New York' it is
interesting to note that, while not gen-erally
known, typhus fever has existed
in New York City for years. About
1910 Dr. Nathan Brill recorded a series
of somewhat less than 200 cases which
he had observed in the previous ten
years, and during 1911 34 such cases
occurred in New York City, and others
have occurred from time to time since
that date. For the most part they were
of isolated occurrence and indicated that
conditions in New York City were not
conducive to any serious spread of the
infection. Goldberger and Anderson of
the United States Public Health Serv-ice,
in 1911, demonstrated by labora-tory
tests that the so-called 'Brill's dis-ease'
was identical with old-world ty-phus;
that the clinical manifestations
were very similar but much milder in
type, that the disease was transmitted
by the louse in the same way as old-world
typhus, and while not so viru-lent,
sometimes resulted fatally."
DOES YOUR COUNTY HAVE A PUBLIC HEALTH NURSE?
By Rose M. Ehbenfeld, R.N., Dieectoe Bukeau of Public Health Nuesinq
and Infant Hygiene
"Bureau Public Health Nursing and
Infant Hygiene" read the little eleva-tor
boy from a door at the State De-partments
Building, as he inquired,
"What does that mean?"
"That means this is a department of
the State Board of Health," replied one
of the clerical assistants.
"Are you a nurse?" he asked.
"No, I look after the babies and send
literature to their mothers."
"What does Miss E— do?"
"She has charge of the Bureau."
"Well, where are the nurses?" he
questioned.
"They're out in the field," was the
reply.
With a half-satisfied "Oh" he walked
to the elevator and some hours later,
when about to leave the building, the
clerk was confronted with, "Say, where
is the field?"
"The field" is rightfully defined by
the boundary line of the State, and as
one hundred counties, although only
twenty-five are at present provided with
a public health nurse, as both rural
field and the bureau are "young, but
promising."
Frequent inquiries of "How can we
get a county nurse?" "How is the work
administered?" "What does she do?"
etc., are received, and the attempt is
here made to answer these inquiries.
The counties having such workers
were not determined by choice or parti-ality,
but by the counties themselves.
Two things are necessary to secure a
public health nurse: The county desir-ing
such a worker must provide salary
and transportation and should employ
one whom the State Board of Health
and Red Cross can endorse, viz.: quali-fied
by a public health nursing course at
one of the universities giving same, or
schools for social work and public
health meeting the standard of the Na-tional
Organization for Public Health
Nursing and American Red Cross.
(Both county and nurse share the pro-tection
of such preparation as in time
the former would expect results the lat-ter,
if untrained in preventive medi-cine,
public sanitation and hygiene,
etc., would be unable to effect.) In all
except two counties the work is
financed by county Red Cross chapter
funds, which represent free-will gifts of
the people; and in authorizing expendi-ture
of same there must be offered in
exchange an equivalent in value. (A
graduate nurse without public health
preparation is no more an acceptable
substitute than is a dentist for a health
officer.
)
Administration
Administration and supervision are
provided by the State Board of Health
and American Rea Cross, through a
jointly established bureau, and the pro-gram
of work based on the vital needs
of the State is carried out on a county
basis. When assigning a nurse for
county work, should there be a county
health department with full-time
health officer, she is detailed for duty
with such department and works under
its direction. Although financed by
chapter funds (or budget made up from
several chapters or supplemented from
other source) the worker and work
come directly under the county health
department and thf chapter acts as a
supplementary agency to the official
health agency. This is ever the posi-tion
of the Red Cross, whether in rela-tion
to State, county, or municipal
health department. However, where no
such department exists the county
nurse is assigned to work under an
advisory council (or nursing commit-tee)
appointed by the chapter financ-ing
the work. (It so happens the ma-jority
of the nurses are in counties
without health departments, but they
are never offered as a substitute for a
health officer, but desire to create senti-ment
for such a development.)
The Health Bulletin
Public health nursing is considered a
vital educative function of a new de-mocracy
and I have recently defined the
county public health nurse as "the miss-ing
link" (between health department
and homes) and feel, if the vital needs
of a rural state are to be met, it will
necessitate this combination of teacher-social
worker-nurse being supplied for
100 counties instead of 25, from a more
permanent financial source than chapter
treasuries upon which so many claims
for their limited funds are made. In
spite of the recent strides in preventive
medicine the practical application in
the homes of the people suffers a con-stant
check because of "the missing
link." Two of the counties have ex-pressed
their appreciation of the first
year's demonstration (made possible by
Red Cross funds) by assuming finan-cial
responsibility of the work, believ-ing
that public health nursing shoulc"
become a public responsibility and sup-ported
by public funds. Many states
have mandatory or permissive legisla-tion
regarding county public health
nursing.
What Does She Do?
(From an article elsewhere in the
Bulletin it would seem there is noth-ing
she does not do, but it brings out
the value of a worker more than the
program usually undertaken by one
worker to a county.)
When considering the State's vital
needs, cognizance was taken of the
1917 births, totaling 69,791, offset, how-ever,
by 19,522 deaths under 5 years, of
which 7,.
r>96 were under one year.
Cognizance was also taken of the
3,300 annual deaths from tuberculosis,
which indicates thousands of cases ill
in rural homes, and it was decided that
if the county nurse is going to be a
practical instrument in meeting the
vital needs of a rural state, there must
be included in her program definite
units of work that primarily emphasize
maternity and infant welfare and tu-berculosis.
(The nurse spends a day at the
Bureau office in advance of going to her
county, and is acquainted with the or-ganization
of the State Board of
Health, given a copy of the Compila-tion
of N. C. Public Health Laws, a
copy of the Units of Work to be under-taken,
and a list of midwives in her
county, and is later furnished a list of
reported cases of tuberculosis.)
1. The County Public Health Nurse
as a factor in reducing infant and ma-ternity
mortality. She gets in touch
with every midwife in her county, ac-quainting
each with laws regarding
midwifery, viz.: that
(a) Midwives must be registered
with State Board of Health;
(b) Must report births;
(c) Must use silver nitrate in new-born
babies' eyes;
teaching the midwife to fill out birth
certificate—if able to write—and de-monstrating
the use of silver nitrate.
(Surely every baby in North Carolina
should be assured of protected sight
and official cognizance of its birth, to
which he is entitled.
In some counties group instruction,
in others individual is given, and
numerous illiterate, superstitious, and
aged women, not registered, have been
located.
The county nurse is a force in dis-couraging
midwifery by emphasizing
to the expectant mother the importance
of medical supervision and attendance
at confinement. By periodic visits she
becomes acquainted with the expect-ant
mother and is in position to note
danger signals, to recommend early
medical examination, urinalysis, etc.,
that avert a termination of pregnancy
disastrous to two lives. (Possibly
"THE Problem" confronting the public
health profession today is the fact
that more than 50 per cent of infants'
deaths are due to causes affecting the
mother before the birth of the child.)
By registering such cases the nurse
gives expectant mothers an opportunity
to receive a series of advisory letters
and other literature approved by the
medical profession, which help her to
safeguard a mother's welfare during
this period of nature under a strain
and give to a future citizen the best
possible start in life. (In December
and January 822 prenatal cases were
registered, of which 403 were reported
by county nurses, 49 by physicians, and
138 by women who had received such
The Health Bulletin 9
literature themselves.) The nurse will
instruct any expectant mother regard-ing
preparation for confinement and is
especially desirous of being of service
to mothers of bottle-fed babies in de-monstrating
and teaching preparation
of artificial feedings or formulae pre-scribed
by physicians for individual
babies; care of bottle and nipples, milk,
etc., and in giving demonstrations of
baby care; also making known the
cause and prevention of summer diar-rhea
and importance of sanitary im-provements.
(In three years, 1916,
1917, and 1918, North Carolina re-turned
an average death rate per
100,000 for children under two years
of age, from diarrhea, of 85, as com-pared
with South Carolina's 7f>.4 and
Virginia's 64.2. Maine's rate dropped
from 60.3 to 39.1 in two years and In-diana's
from 62.6 to 47.1 in same time,
showing what can be done.)
This one unit (of Infant Hygiene) in
the county nurse's program will place
a new slant on the prevalence of blind-ness,
as well as maternity and infant
mortality statistics of the State.
2. A Factor in Reducing Tuberculosis.
By personal contact with the tubercu-lous
cases in homes throughout the
county the nurse suggests medical su-pervision
(by the physician of their
preference) to a large number of cases
without such protection. She demon-strates
bedside care and teaches mem-bers
of the family to render similar
service to the patient; how to protect
themselves from infection and to use a
thermometer. She makes known
"early symptoms," disuse of patent
medicines, etc., and in homes so visited
finds many suspects who are desirous
of taking advantage of the rural tuber-culosis
diagnostic clinics. The county
nurses have worked up thirteen such
clinics at fifty-two points in ten coun-ties,
which resulted in 1,403 examina-tions
by a diagnostician from State Tu-berculosis
Sanatorium. A supervisory
nurse from this bureau is sent for all
such clinics and physicians in the coun-ties
and health officers cooperate in the
interest of locating incipient tuberculo-sis
which adds to the chances for re-covery.
By follow-up visits to the
homes the nurse encourages faithful
continuous compliance with recommen-dations
made. Tuberculosis pictures
are shown by the nurse to schools
throughout the county and talks on
the subject are given.
3. How She Keeps Well Children
Well.
While emphasis is placed on tubercu-losis
and maternity and infant welfare,
the preschool age children (who have
not heretofore shared equal benefits
with infants and school children) are
included in her program. It is here
that possibilities for even greater serv-ice
are offered than for infant welfare,
as the baby in the home has frequently
one, two, or even three brothers or sis-ters
of this age group—and the oppor-tunities
for nutritional work are many;
also for advice concerning care of first
teeth, protection from contagions, im-portance
of vaccination, etc., etc., which
have a direct bearing on the child's
physical fitness to benefit from the op-portunity
for education which will be
his a year or two later. The personal
contact of the nurse in the home, aided
by height and weight cards indicating
the average gain of normal children, to-gether
with guiding diet sheets (sup-plied
by this bureau for children of
this age group) has been the means
of securing splendid cooperation from
mothers who gladly fall in with the
plan of "keeping well children well."
4. Inculcating Health Habits.
The county nurses have been a factor
in inculcating health habits in thous-ands
of children. In one county every
school in the county has enrolled its
pupils as Modern Health Crusaders.
This daily systematically following the
"rules of the game" will be the pre-ventive
measure that eliminates neces-sity
for a lot of corrective work at a
later age.
5. Health Teaching.
In this connection some of the county
nurses have been instrumental in
teaching the teachers how to make the
physical inspection of pupils required
by law and, in their second year are
giving "Home Hygiene and Care of the
Sick" courses in the high schools in
addition to similar instruction among
10 The Health Bulletin
women throughout the county—thus
preparing large groups of women to in-telligently
care for the sick in their
homes (a service most women are
sooner or later called on to render) and
incidentally to meet epidemic emergen-cies.
One of the most gratifying pieces of
infant welfare work undertaken has
been "Little Mothers' Leagues"—
a
course on "baby care" for girls over
twelve years. Upon completion of ten
lessons the girls are given a L. M. L.
pin and certificate furnished by this
bureau—the latter being signed by the
county nurse. Thus little girls are en-couraged
in rendering in their homes
intelligent assistance in the care of the
younger children, and incidentally fu-ture
mothers are being better prepared
for greater and graver responsibility
which will later be theirs.
The nursing profession has always
appreciated the confidences of the sick
room and homes with which they so in-timately
come in contact; for which
reason the greatest need for work of
the nature described in this article I
hardly feel privileged to discuss, but I
should like to ask—not for our own pro-fession,
but for the most sublime pro-fession
in the world, that of mother-hood,
which gave to North Carolina in
1920 83,966 new citizens—that cogni-zance
of the welfare of our women and
babies be given a greater degree of in-telligent
consideration.
Should the problem of tuberculous
infected cattle be more intelligently
considered than the problem of the tu-berculous
mother (in the home and
without knowledge of protection)
breast-feeding the baby? Should there
be considered provision for the expect-ant
mother in the barnyard in a pro-portion
not complimentary to the State
when compared with the need for pro-vision
for its most valuable resource
—
its child life?
Just as we feed our bodies thought-fully
in order that they may sustain
our thought—so should the State pro-vide
for the welfare of its unborn citi-zens
in order that the citizens of the
future may survive to protect the fu-ture
welfare of the State.
Are the vital needs of your county
being met?
Is there a "missing link"?
FATIGUE
By De. Hugo Muench
In these enlightened days, when the
proud father of the family stays home
from church on Sunday mornings to
tinker with the flivver, there are
mighty few of us who don't know
enough about machinery to tell the
spark plug from the radiator and use
profusely illustrated language while
trying to get an undersized tire on an
oversized rim. True—we don't think of
our bodies as machines. But they have
all the essentials of the most compli-cated
motor cars. And, speaking of
fatigue—did you ever have your Lizzie
lie down and go to sleep when you were
trying to make the 5:15? Oh, man!
Fatigue is caused by two things:
First, the using up of the power that is
in the muscle which is working; second,
the poisons which are produced by the
action of the muscle. The first is the
simplest to understand.
You know that if the fuel-pipe on
your car is clogged up, so that the
motor isn't getting enough gas, it won't
run to any large extent. And if the
gasoline is of worse quality than usual,
so that the carburetor can't break it
up, the motor won't develop its full
power. And, of course, if you run out
of gas, that's as far as you go.
Just the same way, if the fuel-pipes
to the muscles are clogged; if we cut
off the circulation from the muscles by
tight clothes, so that the arteries can't
bring them their supply of energy as
quickly as it is needed, they will tire
much more quickly than they other-wise
would. One grade of gasoline
will give your flivver more "pep" than
another. Some forms of food can be
used for energy much more easily than
others. Sugar gives us energy which
can be used at once, while it takes lon-ger
to change other foods into a form in
which they can be burnt up. If you
eat a lot of sugar you are immediately
ready for a long, hard job. That's the
The Health Bulletin 11
reason why men in the army had such
an appetite for chocolate, and why
children, who use much more energy
per pound of weight than grown-ups,
have such a craving for sweet things.
If there is not gasoline enough in our
tanks—if we are almost starved, and
the energy which the muscles need
simply isn't there, we can do mighty
little before we're tired out.
The other cause of fatigue is the
poison which is produced by the action
of the muscles. To understand this we
must know something about what goes
on in the muscle when it works. You
know that the products of a motor's
action are poisonous—the exhaust gas
will choke both folks and automobiles
if enough of it is breathed in.
Well—a muscle contains a substance
which is called glycogen, and which
furnishes its fuel. The muscle itself
has only enough of it to last it a short
time, and it must then be replaced
from the body's great glycogen store-house,
the liver. When this glycogen
is used up in doing work, two' main
things are produced: carbon dioxide
and lactic acid. Carbon dioxide is
always produced when burning goes
on. The lactic acid is a complicated
substance, which is also found in sour
milk. Neither of them is poisonous in
itself, but they depress the muscle if
they accumulate—they fill the cylin-ders
full of carbon.
There are also some other poisons,
which we have not yet traced out. We know that these poisons exist, be-cause
the tiring out of one muscle will
tire all the others, even though they
have not been used. And if an animal
which has been thoroughly fatigued is
killed and its blood is injected into an-other,
this second animal will become
tired even though it has done no work.
An Italian gentleman, by the name
of Mosso, invented a machine some-where
around 1890 which he called the
"Ergograph," or "work recorder." This
instrument is arranged so that we can
make one muscle (the one which bends
the middle finger) lift a weight many
times in succession, and record the
height to which it is lifted each time.
We still use this apparatus, and have
learned a number of interesting things
from it.
You know that as a motor warms up
it gets more powerful, until it gets too
hot. The "Ergograph" shows that at
first the contractions of a muscle get
stronger for a short time, before they
get weaker. A good deal depends upon
the speed of the work. A flivver in
good working order which is not over-loaded
will not overheat, no matter
how long it is run. A muscle which is
working slowly enough does not get
fatigued. The poisons form so slowly
that the blood can carry them off as
they form, while it can keep the muscle
supplied with fuel.
If your motor is run at too great a
load you know that it will begin to
overheat and knock. In the same way,
a muscle which works so hard that the
blood can't carry away poisons as
quickly as they form, gets tired. The
motor has to rest to get cool, and the
muscles must rest to recover from its
fatigue; in other words, to give it time
to get rid of the poisons. If you start
up your motor again before it has
cooled you are liable to injure it. If
you work a muscle before it has rested,
it will take a much longer time to re-cover
finally.
If your cooling system is not working
properly, you know that you can drive
farther by going slow. Just as you can
do more actual work in the end by tak-ing
it easier and giving the muscle
time to recover while it is working. In
this way the poisons do not accumulate
fast enough to produce a state of
fatigue. The normal heart rests long
enough between beats to get rid of its
poisons and acquire new energy. So
that it never gets tired. It is only when
it is overworked continually that it
tires out.
So far we have been talking only of
muscles. The nervous system works
in pretty much the same way. The
storage-battery of your car runs down
if it is used faster than it is recharged.
The connecting wires, though, don't
show any signs of tiring.
In the cells of the brain there are
certain small bodies which are called
"Nissl Granules." When the brain is
12 The Health Bulletin
fatigued, these disappear, but come back
when the cells are rested. They are
evidently stored-up nourishment, and
correspond to the glycogen in the mus-cles.
The nerves, themselves, do not
seem to get tired at all under ordinary
conditions. The amount of energy
they use is so small that the poisons
they produce are easily gotten rid of.
When it is made impossible for the
nerve to get rid of these poisons, how-ever,
it will show fatigue after a time.
Our senses are tired out after a while,
too, if they are stimulated continually
by the same thing. When we enter a
room we may smell an odor which es-capes
us after we have been in the room
for some time. If we stare long enough
at some object it turns gray and blurs.
A monotonous sound grows fainter un-til
iinally we are deaf to it altogether.
We don't feel the pressure of the clothes
we always wear. And so forth.
Pain is a warning to us that some-thing
is wrong with our bodies which
needs attention. It is a wise life-saving
provision of nature. If it were not for
pain we should be burning and cutting
and eating ourselves to death several
times a day.
Fatigue also gives us a warning, in
the shape of "that tired feeling." Some-times
we heed it—then again we don't.
It is one of the great blessings and
curses of our race that our will-power
can overcome many purely physical
hindrances.
A muscle which has been stimulated
by an electric shock until it is so tired
that it will contract no longer, will
come to attention and get back to work
at the summons of a stimulus from the
brain. Like Scaevolus, the Roman who
forced his hand to remain in the fire
until it was consumed, we can whip our
flagging bodies to renewed effort, until
even the commanding brain must give
in. Sadly enough we often do just that.
That's why we have so many "nervous
wrecks," so much alcohol and drug tak-ing.
We tire ourselves so much that
our bodies cannot recover without the
help of artificial stimulation. After
all, olcl Scaevolus was the sensible man
—for he lost only a hand.
THE OPPORTUNITIES AND OBLIGATIONS WHICH
CONFRONT US AT THIS TIME
By Dr. B. U. Brooks, President Durham-Orange Medical Society,
Delivered Before the Society January 21
As we stand tonight on the thresh-old
of the new year when our highest
thoughts and best impulses are upper-most,
the thought must come to us all,
"What will be my contribution to
mankind during the year?" "Wherein
will my life be of greater service dur-ing
the incoming year than it has been
in the one just passed?"
With these thoughts in mind I have
chosen for my theme tonight, "The Op-portunities
and Obligations Which Con-front
Us at This Time." As the great-est
obligations and opportunities in our
lives are in the prevention of useless
suffering and useless waste of life, I
have chosen three fields as the basis of
my discussion, namely: Cancer, Vener-eal
Disease, and Infant and Child-life.
Let us consider first the facts concern-ing
cancer, that disease of middle life
and old age which claims annually in
North Carolina over one thousand and
two hundred victims, in the United
States over seventy-five thousand vic-tims,
which claims more than one man
of every eleven over thirty-five years
of age, and one woman of every eight
over thirty-five years of age. The
actual facts in the case of cancer are
that probably only one case of cancer
in every ten is cured, whereas, if it
were recognized early and properly
treated probably only one case in ten
would die. These conditions are due
to the fact that the public is not en-
The Health Bulletin 13
lightened in the matter of cancer and
does not suspect the disease until it is
too late, or if suspected, put Off seek-ing
proper treatment until it is too
late. If cancer in its early stage were
painful these things would not be so,
because our patients would come to us
for the relief of pain. But the sad
and fatal feature is, that when cancer
reaches the stage that it becomes pain-ful
it is generally incurable.
Let us consider 'in the second place
the facts in the case of venereal dis-ease,
gonorrhoea, that curse which has
caused more suffering to the innocent
women of our country than all other
diseases combined, and syphilis, that
grim reaper that year in and year out
claims two out of every thirteen deaths
that occur in the United States, lead-ing
by a wide margin its next highest
competitor—tuberculosis. The actual
facts in the case of venereal disease are
that the whole matter has been
shrouded in so much mystery, the real
state of affairs has been so successfully
concealed from the public life that the
whole country is riddled and infected
with these terrible diseases and is not
aware of it.
The poor woman who has suffered
for years with "female complaint" has
never been told that it is more than
likely due to a gonorrhoeal infection;
nor has the unfortunate mother of the
more unfortunate and pitiful child,
blind from birth, been told that this is
almost surely due to gonorrhoeal infec-tion;
nor has the unfortunate woman
afflicted with oft times and repeated
abortions and miscarriages, ever been
told that her trouble is of syphilitic
origin. The poor woman who volun-tarily
enters the race with death, who
endures the birth pangs with patience
and fortitude, that a child may be born
into the world, and who turns to us
with her first conscious breath, after
she has passed through this ordeal, and
anxiously inquires if the baby is all
right, does not realize that this ques-tion
has been made necessary by the
fact that so many babies have been
born into the world bearing the marks
and effects of a syphilitic infection.
I believe it is a fact that there is not
one single family in this State which
taken over a period of one generation
has not felt the curse and suffering of
venereal disease in some form. This is
a bold statement to make; a hideous
truth to reveal.
Gentlemen, who are the chief offend-ers?
I leave that to you to answer.
Who are the chief sufferers? I leave
that question to you also to answer.
These are the facts of venereal dis-ease.
Permit me to bring to your attention
in the third place the matter of infant
and child mortality; that useless waste
of human life which would seem to be
breaking down the very foundations of
our country. The facts in this case are
that annually two hundred and fifty
thousand infants in the United States
die within the first year of life, and
that of all the babies born in the
United States, one in every eight dies
within the first two years of life, that
of thirty-three thousand deaths annu-ally
in the State of North Carolina
eleven thousand are within the first
five years of life, and that this needless
loss of life is mostly due to the ignor-ance
of the parents.
The errors of diet in the first three
years of life are so flagrant as to be
little short of criminal. It is of daily
occurrence to see babies under one
year of age eating the same foods from
the table that the parents and older
children eat. It is of no infrequent oc-currence
to see mothers chewing food
and passing it from her mouth to that
of her helpless infant. It is more the
rule than an exception to see children
under five years of age eating candy,
cheap cakes and other articles of food
which destroy their appetite for whole-some
and nutritious foods and thus
bring on a state of malnutrition and
undernourishment, from which it takes
them years to recover.
These, gentlemen, are the facts that
stare us in the face daily.
What are we to do about it? Are we
to sit idly by and see these countless
lives lost through ignorance? Are we
to continue in our way heedless and dis-regarding
the waste of life, when we
have within our power the means to
prevent it? No physician worthy of
the name will answer in the affirma-
14 The Health Bulletin
tive. Our part, as I see it, is to ac-quaint
people with the actual condit-ions
as they exist, to speak the en-couraging
words that give them hope,
to stretch forth a helping hand to
these suffering victims and do our full
part in this battle for life. That is our
highest service to humanity, that is
our greatest contribution to our nation.
In the matter of cancer we should ac-quaint
the public with the fact that, in
its early stages, and only in its early
stages, is cancer curable; that the so-called
advertised cancer cures are
fakes ; that the only safe cure of cancer
is early and radical removal by a com-petent
surgeon.
It should be freely made known to
the public that a small, painless lump
in the breast of a woman past 35 years
of age is of no small significance; that
bleeding from the female organs, after
the change of life, almost always means
cancer, but cancer in a curable state if
seen and treated by a competent sur-geon.
That men, especially constant smok-ers,
are very susceptible to cancer of
the mouth, lips or tongue, and that any
sore or swelling of these parts, espec-ially
after the person so affected has
reached forty year" of age, should be
examined and treated by a competent
person. The public should know that
any long and continued irritation of
any one spot is liable to produce cancer
and should, therefore, be avoided.
In the matter of venereal disease our
obligation is probably greater on ac-count
of the mystery and secrecy which
heretofore have shrouded this terrible
scourge, to which crime, be it spid to
our shame, we have given our sanction
and lent our support. One of the great-est
benefits which we have derived from
the great world war, with its untold
suffering and destruction, is our change
in attitude towards venereal disease.
When the searchlight of the army phy-sical
examination was brought to bear
upon the youth of our land it exposed
in all its hideousness this vampire
which is sapping the life-blood and
mankind of our nation. It made us
stop and take stock of our greatest na-tional
asset, the young men, and in-evitably
brought us to the conclusion
that if our nation is to live and develop
into a greater and be ter nation this
scourge must be understood by the
whole people, and the fight brought out
into the open.
This great battle heretofore has been
fought in the trenches with tremendous
suffering and loss of life, but in order
to attain success this foe must be
brought into the open, where he can be
relentlessly attacked on all sides and
by all the forces at our command. It
remains for the American physician to
bring this enemy into the open and
when once in the open countless rein-forcements
will be added to our army
and the battle will surely be won.
In order to do this the fundamental
facts of venereal disease must be given
to the public. They must know that
every case of locomotor ataxia, every
case of paresis, is of syphilitic origin;
that three miscarriages or still births
is, in itself, very strong proof of a
syphilitic infection; that two of every
thirteen deaths in the United States is
due to syphilis; Ahat syphilis claims an-nually
almost, if not quite, as many
victims as did the plague of influenza
in 1918 when it was at its worst; that
the great majority of deformed and de-generate
and imbecile infants and chil-dren
may be attributed to the effects
of syphilis.
The public should know that gon-orrhoea
is undoubtedly the greatest
source of suffering to which the women
of our land are subjected; that to this
source must be attributed the great ma-jority
of pelvic and abdominal opera-tions
on women; that the greater por-tion
of the so-called "female complaint"
have their origin in gonorrhoea. The
public should know that gonorrhoea is
one of the most difficult diseases to
cure, and, frequently, when thought to
be cured, it recurs. The public should
know that the only way to arrive defi-nitely
at a diagnosis of syphilis and
gonorrhoea is by laboratory examina-tion,
conducted by a competent expert,
and that a diagnosis of syphilis can-not
be positively made otherwise. They
should know that many fakes and
quacks and imposters are applying
The Health Bulletin 15
their so-called cures and they should
be taught to beware of them.
In the matter of the waste of infant
and child life, what is our obligation?
The public should be taught that the
care of the child should begin with
conception; that the mother should be
well cared for and kept in good physi-cal
condition throughout her pregnancy
in order that she may bring into the
world a well nourished and physically
perfect infant, and that she may be
able to produce the necessary milk,
nature's best infant food for the proper
development of her infant during its
first year of life. She should be taught
that, as this tender life must have a
slow, gradual, steady, physical growth,
so must it have a slow, gradual, steady,
digestive growth, the digestive growth
extending over a period of time almost
equal to the period of time necessary
for the physical growth. She should be
taught that, as her child is unable to
combat adult physical problems, so it
is unable to combat adult disease prob-lems,
and so should be constantly
guarded against useless exposure to dis-ease.
She should be taught that the
greatest single factor in the proper care
and development of her child is the
selection and use of a diet adjusted to
its needs, a diet suitable to build bone,
and muscle, and strength, and robust-ness
sufficient to enable the child to
resist the exposure to disease which is
inevitable. She should be shown that
over feeding, and not underfeeding, is
the error into which she is most likely
to fall; she should be shown that the
great danger of the second summer,
that bugbear of motherhood, is not
teething, but improper feeding. She
should be taught that the price of the
well baby is, in the vast majority of
cases, eternal vigilance and care in the
selection and adjustment of its food;
she must be shown that fresh air and
sunshine are as essential to the proper
development of her infant as is the
proper food.
The facts presented are only a few
of the most glaring facts, which must
stagger us with their significance and
"bring us a full realization of the obliga-tion
resting upon us.
What is the remedy? The remedy
rests with us and therein is our oppor-tunity.
The remedy is enlightenment
of the people to the stage that this
useless waste of life will be looked upon
as the crime that it is. Heretofore, it
has been called "Providence." We must
brand it in its true light as ignorance,
superstition, and crime. The trouble
is not unwillingness of the public to be
relieved of this suffering but ignorance
of the conditions as they exist and
ignorance of its remedy. It is our
work to bring enlightenment where
there is now ignorance.
Forces are already at work through-out
our land to bring about this en-lightenment.
These forces have only
touched in spots; we, the medical pro-fession,
in the actual practice of medi-cine,
are one of the spots touched,
probably the most vital spot, in that
through us this enlightenment could
best be disseminated and it remains for
us to spread this gospel among the peo-ple,
the everyday people of the world.
To accomplish this every faculty at
our command must be enlisted. Law-yers,
teachers, clergymen, and above
all the public press must be given fun-damental
facts as we have seen them
and their aid enlisted in this great
cause. The truth must be told in pub-lic
addresses, private talks, and the
thousand and one ways in which knowl-edge
is spread. Steps should be taken
to have these subjects incorporated in
the curriculum of our schools. School
children should live daily with these
facts before them and about them in
such a manner that strict observance
of the correct principle of living and
prevention of disease would be second
nature. Until we reach that stage our
work is still unfinished. The move-ment
must be slow as all great move-ments
are slow, but once it has gained
its full momentum it will move with
an irresistible force. I know not when
the fruits of our labors may begin to
show definite results. I know not that
it will be within the lifetime of any
gentleman here present, but this I
know, that, as surely as the night fol-lows
the day, the truths thus spoken,
the seed thus sown, shall as surely pass
on to ages to bless generations yet un-born.
16 The Health Bulletin
A DAYS AVORK OF A COUNTY
NURSE
Just as I was starting for the L
—
School a man stopped me and asked if
I would go to E— to see a girl who
was "mighty bad off." He denied any
knowledge of the case, except that the
neighbors said she was "bout to die." I
went immediately and found a fifteen-year-
old girl, unmarried, in labor. She
had been deserted a few weeks before
by her father and had come here to a
cousin, who did not want her. She
was absolutely destitute, had not a
single article of clothing for her baby,
and only a few rags for herself. I
delivered the baby under the most un-sanitary
conditions imaginable, then
wrapped it in the cleanest thing I
could find and hurried back to town to
get some clothes from Lne Red Cross.
I went to several women in the neigh-borhood
and finally persuaded one to
look after the patients until the next
day, when the Superintendent of Pub-lic
Welfare investigated the case and
turned it over to the Associated Chari-ties,
who furnished a nurse for a week.
As it was then too late to do any
school work until after lunch I visited
a prenatal case in the same community.
Mrs. K. was near the end of her preg-nancy
and had not consulted a doctor.
As she showed definite symptoms of
toxemia, I made her promise to send
for her doctor post haste, which she
did. She afterwards told me that the
doctor found her kidneys in very bad
condition and began treatment immeui-ately.
She has since given birth to her
baby and had no complications.
After lunch I went to the L— School,
inspected forty first-grade children and
found thirty-five of the forty defective.
Some of these youngsters were in such
poor physical condition it was impos-sible
for them to do good work in
school. I talked to them on the care of
the teeth, and promised to come back
and give them the tooth-brush drill as
soon as they all got tooth-brushes. I
have heard since that they have ex-hausted
the supply of tooth brushes in
the town.
When school was dismissed at 3:30
I went on to see a family that had been
reported as having '"fluenza." I found
the mother and two children in bed
with high temperatures—the mother
quite ill with pneumonia. The house
was in wretched condition, very dirty
and smelly, with a red-hot stove, and
the windows nailed down for the win-ter.
I bathed the children and made
them as comfortable as possible, at the
same time trying to teach the oldest
daughter what to do for them. I also
wrote out a diet list for her to follow
and showed her how to make the egg
custard her mother had expressed a
desire for. The father came in and told
me he had put sulphur in his shoes
and "assefidity" around the necks of
the little children, and he firmly be-lieves
that this will keep off the '"flu-enzy."
I was too tired to spend any
energy trying to disabuse his mind of
his ideas of prevention, for I realized
that he would never believe that "asse-fidity"
would be powerless against the
germs expelled with every cough, but
I made a mental note that it would be
wise to introduce the handkerchief
drill in the L— School during the sea-son
of bad colds and grip.
On the way home I stopped to visit a
child I had sent from school with a
very bad looking throat. I found a
family of seven children, all under
fourteen years of age, and the mother
cheerfully expecting another the next
month. The fifteen-months-old baby
seemed quite sick—had "the brown-chitus,"
the mother said, and was
squirming under an onion poultice.
The entire family had colds and sore
throats. I took the children's tempera-tures,
gave some advice about their
diet, and made the mother promise to
send for the doctor.
I got back to town in time for a bite
of supper and then went twelve miles
to C— to attend a community meeting.
To my great surprise, although it was a
cold night the little school-room was
packed with mothers. I talked to them
on Social Hygiene, and how to tell the
story of life to their children; using
lantern slides to illustrate. They all
seemed very much interested and in-vited
me to attend the next meeting of
their parent-teachers association.
At 10:30 I drove my Chevrolet into
the shed, went home and called it a day.
MiMMQ)
Published bH TAf^°£TACAR?LI^A. STATE. 5?ARD sTAEMJA
Thi5 Bulletin will be seryt free to arxy citizen of "the 5ta~teupor\ request. |
Entered as second-class matter at Postoffice at Raleigh, N. C, under Act of July 16, 189^.
Published monthly at the office of the Secretary of the Board, Raleigh, N. C.
Vol. XXXVI MARCH 1921 No. 3
TIME FOR WISE DECISION
MEMBERS OF THE NORTH CAROLINA STATE BOARD OF HEALTH
J. Howell. Way, M.D., Pres., Waynesville Chas. O'H. Laughinghouse, M.D.,
Richard H. Lewis, M.D., LL.D., Raleigh Greenville
J. L. Ludlow, C.E., . . Winston-Salem Cyrus Thompson, M.D., . Jacksonville
Thomas E. Anderson, M.D., Statesville F. R. Harris, M.D Henderson
A. J. Crowell, M.D., . . . Charlotte E. J. Tucker, D.D.S Roxboro
EXECUTIVE STAFF
W. S. Rankin, M.D., Secretary State Board of Health and State Health Officer.
Ronald B. Wilson, Director Public Health Education.
C. A. Shore, M.D., State Laboratory of Hygiene.
L. B. McBrayer, M.D., Superintendent of the State Sanatorium for Treatment of
Tuberculosis and Chief of Bureau of Tuberculosis.
G. M. Cooper, M.D., Chief of Bureau of Medical Inspection of Schools.
K. E. Miller, M.D., Director of County Health Work.
Miss Rose M. Ehrenfeld, R.N., Chief of Bureau of Public Health Nursing and
Infant Hygiene.
Millard Knowlton, M.D., Chief of Bureau of Venereal Diseases.
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 Epidemiology.
SERVICE
The State Board of Health offers to the people of North Carolina, without
charge, the services of experts thoroughly trained with particular regard
to the needs of this State. Advice will be given promptly upon any question
affecting the public health. Address any inquiry to the State Board of
Health, Raleigh.
FREE LITERATURE
The State Board of Health has prepared special literature on a large
number of subjects which are offered without charge. If you are interested
in any one or more subjects affecting your health, write the State Board of
Health, Raleigh, requesting special literature, and it will be sent to you.
THE HEALTH BULLETIN
The Health Bulletin is issued monthly. It will be sent without charge
to all citizens of the State who request it.
TIS?
PUBLI5ME.D 5Y TAL. MPRTM CAROLINA STATE, BQajgD s^MEALTH [
Vol. XXXVI MARCH, 1921 No. 3
MARCH
Clean up and keep clean.
The best thing about a window—raising it.
Fresh air in the lungs is better than money in the bank.
It is easier to ventilate a room than to dig a grave.
A fool and his health are soon parted—and seldom reunited.
Feed yourself plenty of oxygen.
Tuberculosis can be cured if discovered in time.
The undertaker comes seldom to the home of open windows.
Sleeping in the open air is the best life insurance.
It is better to sleep in a cold room than a cold grave.
Keep the windows open and the pill box shut.
Fresh air is cheaper than drugs and better than doctors.
The only cure for tuberculosis is fresh air, good food, and rest.
Patent medicines are not made to cure—they are made to sell.
Fake tuberculosis cures guarantee just one thing—death.
To give other people tuberculosis—spit on floors and sidewalks.
When you dont know what to eat, eat nothing.
Good health can be bought, but not in a bottle.
The best nerve restorer—keeping clean in mind and body.
The Health Bulletin
A FORGOTTEN LAW
In nearly every town and village
of North Carolina there is a local
ordinance with regard to spitting on
the sidewalks or upon the floors of
public buildings. The penalty varies
from one to ten dollars. Aside from
the city of Asheville the law is a
dead letter in every community where
it is supposed to be in force.
In a certain county seat town in
the State the commissioners have
posted signs in the courthouse calling
attention to the fact that spitting on
the floor is punishable by a fine of
five dollars. One first Monday not
so long ago the chairman of the board
of commissioners stood in the hall-way
talking with a friend. Just back
of him on the wall was the printed
sign, "five dollars fine for spitting on
the floor," in large black letters. As
the county official stood and talked
he expectorated voluminously in the
general direction of a nearby corner.
On one of the principal corners of
the Capital City the other day a
policeman, off duty, stood and con-versed
with passing acquaintances.
And as he leaned against the corner
building for support he from time to
time relieved himself by spitting on
the sidewalk. Yet there is a city
ordinance in Raleigh making such an
offense punishable by a fine.
These examples are picked at ran-dom.
Similar ones could be found
in almost any place in the State. In
a generous mood for correcting an
evil the people have caused a law
to be passed, and then utterly forgot-ten
about the law. It is a habit of
mind that seems to affect North Caro-linians
peculiarly. Pass a law, and
thereby stop any or all evils.
The person who carelessly spits in
a public place is a menace to society.
It is a filthy habit entirely without
excuse, even if it were not a danger-ous
one. But a public spitter may
very easily become a murderer.
Muzzle the cough and sneeze, and
stop spitting on sidewalks, and in
other public places. Have some
thought for the comfort and well-be-ing
of other people, and endeavor at
least to create the impression that
you have the rudiments of good man-ners.
The enforcement of the law would
help as a reminder.
GUARD AGAINST TYPHOID
For every day of February there
was a death in North Carolina caused
by typhoid fever. This was an in-crease
of twenty death over the
same month of last year.
The State is experiencing an un-usually
early spring. This means a
longer fly season, and thus a greater
period of danger this year for ty-phoid.
But typhoid fever can be prevented.
Inoculation gives insui-ance against
this disease for a period of two or
three years, and perhaps longer. It
causes no sore arms, no loss of time
from work, and the vaccine is fur-nished
without cost by the State labo-ratory.
The peak of typhoid incidence is
reached in August, and ordinarily the
summer months, which are also the
fly months, are considered the ones
when typhoid is most dangerous. It
is true that the disease is most prev-alent
during those months, but at
the same time there is always danger,
even in the midst of winter, of be-coming
infected. The safe plan is
to be inoculated, to take the three
treatments which will render you im-mune.
Several counties have already
planned to have anti-typhoid cam-paigns
this spring and summer, and
some of these are doing the wise thing
and starting early. It is much safer
in the early spring than in the late
summer. Wherever county campaigns
are to be waged they should be started
as early as possible. Where there
are no county campaigns the indi-
The Health Bulletin
viduals should at once take advantage
of the safe protection that is offered
through their local physicians or
health officers.
ALCOHOL AND HEALTH
For twelve years North Carolina
has been prohibiting the manufacture
or sale of intoxicating liquors within
its borders. For more than a year
the Nation has had a clause in the
Constitution forbidding the same
thing, with limited exceptions. Yet
today No