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&bz Librarp of tbt Ontoersitp of Jl3ortb Carolina Cntiotooeti bp TO* SDialectic ano ^fjtlant&ropfc &ociette0 614.06 N8>6h v. 35-36 jyuJ.'« b- JOStPHRL'ZICKt BOOMBINO/ PS I This booh must not be taken from the Library building. —et - LUNC-15M N.36 OP-13370 This Bulletin WO! be »sr\\ free to or\\j citizen of "the State upot\requesU 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
Object Description
Description
Title | Health bulletin |
Other Title | Bulletin of the North Carolina State Board of Health; Bulletin of the North Carolina Board of Health |
Creator | North Carolina. State Board of Health. |
Date | 1921 |
Subjects |
Children--Health and hygiene Diseases Hygiene Public Health--North Carolina--Periodicals Sanitation |
Place | North Carolina, United States |
Time Period | (1900-1929) North Carolina's industrial revolution and World War One |
Description | Volume 36, Issues 1-12. Issues for Feb.-May 1917 and for Jan.-July 1918 not published. |
Publisher | Raleigh,North Carolina State Board of Health. |
Agency-Current | North Carolina Department of Health and Human Services |
Rights | State Document see http://digital.ncdcr.gov/u?/p249901coll22,63754 |
Physical Characteristics | 61 v. :ill. ;23 cm. |
Collection | Health Sciences Library, University of North Carolina at Chapel Hill |
Type | text |
Language | English |
Format | Bulletins |
Digital Characteristics-A | 16,849 KB; 244 p. |
Digital Collection |
Ensuring Democracy through Digital Access, a North Carolina LSTA-funded grant project North Carolina Digital State Documents Collection |
Digital Format | application/pdf |
Related Items | Imprint varies: published later at Raleigh, N.C. |
Title Replaces | Bulletin of the North Carolina Board of Health** |
Audience | All |
Pres File Name-M | pubs_edp_healthbulletin1921.pdf |
Pres Local File Path-M | \Preservation_content\StatePubs\pubs_edp\images_master\ |
Full Text |
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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 |