Health bulletin

              Cbe Library
of t|)e
OnJt)ec0itp of li^ottb Catolfna
Cntiotoeti b? ^^e ^Dialectic
ana
P^ilantfitopic &ocietie0
614.oe
M^d.Kb.
JUStPH RL'ZICKt
BOOKBiNO.f PS
This booh must not
be taken from the
Library building.
Mr^^^
LUNC-15M N.36
OP-13370
COUNTY HEALTH WORK NUMBER ^
BuHeiirvwillbe -seryt free to qa^ ateen of ^e State upoA'requestj
Tol. XXXV JANUARY, 1920 No. 1
Conference of Couisty Hi urn Officers, December, 1919
Group of County Health Oi i n i.i;s i_\ Co.nfekence With the State
Health Officer, January, 1919
FOREWORD
This issue of tlie Health Bulletin contains a review of cooperative
county health work in North Carolina and of the ways by Avhich
results have been attained in improving the health and sanitary
conditions of our homes. The results thus far are very gratifying and
the State Board of Health aims to enlarge the service of its Bureau
of County Health Work so that it may assist any county Avhich may
desire this service, whether it be a single unit, a public health nurse,
a whole-time health officer, or a cooperative health department.
Dr. K. E. Miller, of the United States Public Health Service, will be
the Director of the Bureau of County Health Work during 1920. Dr.
Miller has had a Avide service in rural health and sanitary work in this
and other states, and any county desiring information regarding public
health work should communicate with him.
With the exception of tAvo articles prepared by Dr. K. E. Miller, the
material in this issue of the Bulletin was prepared by Dr. B. E.
Washburn, Director of the Bureau of County Health Work from July
1, 1917, to December 31, 1919.
!nI(SM
North CaroVm
L2JI1 PU6U5AE£> BY TAL. nPRTA CAIgOUnA STATE, BQMgD ^h^lJK\jrh\ \
Vol. XXXV Ji^NUARY, 1920 No. 1
THE NEW PUBLIC HEALTH
The conceptions of health held by our ancestors, and still held by many
people, have undergone revolution during the past twenty years. Before
the facts regarding contagious diseases were learned, the causes and sources
of these diseases were unknown. Manj- thought that the acute infectious
diseases were inevitable and that the only thing to be done was to try and
get well after you became sick. Not knowing the causes lor these infections,
the sources were sought in the surroundings of man; in such things as the
air, the water, the climate, and the rise and fall of ground-waters. Tuber-culosis
was considered hereditary and non-infectious. The "catching"
diseases were thought to orignate in the s.lums and in the homes of the poor;
and when they invaded the home of a well-to-do, a leak in the plumbing
accounted for diphtheria, rotten potatoes in some part of the house for
typhoid, or malaria was thought to be due to dampness or exposure to the
night air.
A great change has taken place as a result of scientific investigation; we
now know that the infectious diseases are caused by germs and that their
source is not in man's surroundings but in man himself. The old public health
was concerned with the enviroment; the new is concerned with the individual.
But the public as as a whole has not been taught the principles of disease pre-vention
through control of infected individuals and does not appreciate the
health relation existing between the individual and the communitj'; the
public does not recognize that a person infected with disease germs is. unless
proper precautions are observed, a menace to his neighbors. The general
public still holds to the ideas of a previous generation and believes the
theories that have long been discarded in scientific circles.
The problem of public health is to educate the people regarding disease pre-vention
and health conservation; and this education must be conducted in
such a way as to cause our homes to apply sanitation and hygiene and
receive benefits. From the very nature of the infectious diseases this edu-cation
must be definite and presented in such a way as to establish individual
responsibility. Our State Board of Health is conducting its work from this
standpoint and the results are gratifying. But the problem is very definite
and it is manifestly impossible for the State to handle it alone; the smaller
units of government, the counties, must provide health instruction for the
people. Health problems have a local and a State-wide significance and can
best be solved by cooperation between the State Board of Health and the
I V"3"<County Board of Health. The county should provide public health work
4 The Health Bulletin
for its citizens while the State should coordinate the work of the different
counties in such a way as to increase county initiative and make the county
work more effective.
The importance of the initial effort in cooperative county health work,
as is described in this issue of the Bulletin, is realized when we reflect, first,
that the larger part of our country's population is rural, and, second, that on
the vitality and efficiency of the rural population depend the food supply
and the cost of living—the first consideration of every citizen whether of the
country or the city.
PEESENT STATUS OF COUNTY HEALTH WORK IN NORTH CAROLINA
In the Seventeenth Biennial Report of the State Board of Health, for
the years 1917-1918, Dr. W. S. Rankin, State Health Officer says: "The State
Board of Health, by its educational activities, has fostered, strengthened,
and directed an interest on the part of the counties in local health work
so that today North Carolina has sixteen counties, embracing a total popu-lation
of 687,634, or 28% per cent of the population of the State, under
whole-time county health officers. No State in the Union has developed its
county health work to a like extent."
During 1919, six additional counties provided for whole-time health officers,
making a total of twenty-two such counties in the State, comprising 38 per
cent of the State's population. Of the twenty-two, fourteen have county
health departments conducted in cooperation with the State Board of Health.
These counties, with the names and addresses of their health officers follow:
Wilson (organized Sept. 1, 1916) Dr. L. J. Smith, Wilson.
Nash (organized July 1, 1917) Dr. G. W. Botts, Nashville.
Davidson (organized July 1, 1917) Dr. E. F. Long, Lexington.
Northampton (organized Aug. 1, 1917) Dr. P. G. Parker, Jackson.
fLenoir (organized Aug. 15, 1917) . . .Dr. T. F. Wickliffe, Kinston.
Pitt (organized Dec. 1, 1917) Dr. P. J. Chester, Greenville.
IRobeson (organized Dec. 1, 1917) . .Dr. E. R. Hardin, Lumberton.
§Rowan (organized Jan. 1, 1918) .Dr. C. W. Armstrong, Salisbury.
Forsyth (organized Jan. 1, 1918) .Dr. A. C. Bulla, Winston-Salem.
TlEdgecombe (organized April 1, 1919) .Dr. C. L. Outland, Tarboro.
Cumberland (org. July 1, 1919) . .Dr. W. C. Verdery, Fayetteville.
Halifax (organized Sept. 1, 1919) Dr. P. C. Carter, Weldon.
Surry (organized Sept. 1, 1919) . .Dr. L. L. Williams, Mount Airy.
Granville (organized Sept. 1, 1919).... Dr. J. A. Morris, Oxford.
In addition to these fourteen, Bertie, Vance, Beaufort, Union, and Harnett
counties have made appropriations and asked for cooperation from the State
*Dr. F. M. Register, now State Epidemiologist, had charge of the cooperative department
in Northampton County until August 31, 1918.
fDr. ,T. S. Mitchener was health officer of Lenoir County until December 31, 1918.
JDr. W. A. McPhaul, at present health officer of Montgomery, Alabama, directed Robeson-
County Department until Sei.t. 30, 1919.
§Dr. A. J. Warren, now Assistant State Health Officer, was in charge of the Rowan County
Department until April 30, 1919.
HCooperative County health work was begun in Edgecombe on Jan. 1, 1917, along experi-mental
lines, the standard plan being adopted April 1, 1919.
The Health Bulletijst 5
Board of Health. As soon as these counties start their work fully 45 per
cent of the entire population of the State will be served by effective local
health organizations.
The following eight counties have whole-time health officers or health
departments conducted independently and without any cooperation or co-ordination
with the State Board of Health.
County Health Officer
New Hanover Dr. C. E. Low, Wilmington.
Sampson Dr. E. R. Hollinsworth, Clinton.
Guilford Dr. W. M. Jones, Greensboro.
Durham Dr. Arch Cheatham, Durham.
Buncombe Dr. W. H. Scruggs, Asheville.
Wake Dr. Percy Ahrons, Raleigh.
Cabarrus Dr. S. E. Buchanan, Concord.
Gaston Dr. W. B. Hunter, Gastonia.
DETELOPMENT OF COUNTY HEALTH WORK I> >ORTH CAEOLINA
Intensive county health work in North Carolina began with the hookworm
campaign of 1909 to 1914, conducted by the Rockefeller Sanitary Com-mission
and the State Board of Health. This campaign was essentially of
an educational nature and was carried on in 99 of the 100 counties in the
State, Ashe being the only county which did not provide for the work.
During the campaign every section of the State was visited, and the people
were taught the essentials of disease prevention. Following this, the State
Board of Health and the Rockefeller Sanitary Commission conducted a
number of community demonstrations in the eastern and southern parts of
the State. This community work was directed solely against hookworn
disease and soil pollution; but the result was that it proved conclusively
that as small a governing body as a county can deal effectively with its
definite health problems and get results. In each of these communities
house-to-house visits were made, and the people were instructed as to the
best methods of disease prevention, special emphasis being placed upon
soil pollution diseases.
The next step was taken by the counties and from 1913 to 1916 a number
of them became interested in health preservation to the extent of each employ-ing
a whole-time county health officer. In order to do this the county provided
the funds for the salary of the health officer and the county work was con-ducted
locally and without any connection with the State Board of Health.
Great good resulted in an educational way from the work of these whole-time
county health officers, our vital statistics records showing a decreased
death-rate in the counties due to this work. The whole-time county health
officers were handicapped, however, by the fact that each county was an
isolated unit and that no coordination existed between any of the counties or
between the counties and the State Board of Health. Then, too, the health
officer, in the majority of cases, was not provided with proper equipment or
6 The Health BuLLEXiiS'
assistance to conduct his most effective work. These things served to handi-cap
and prevent the full development of the county health program.
In counties which did not provide whole-time health officers the people
demanded other units than the hookworm and soil pollution work, and in
response to this demand the State Board of Health organized and supplied
to the counties a number of optional units of health work. These included
chiefly typhoid vaccination campaigns, medical inspection of schools, life
extension, quarantine units, and units against special diseases, such as
malaria and pellagra. Any county, by supplying the funds, could arrange
with the State Board of Health to have a director sent to the county for
several months to conduct the desired unit of work.
From September 1916 to June 1917 the State Board of Health and the
International Health Board cooperated with Wilson County in a county-wide
Soil Pollution Campaign, directed by Dr. B. E. Washburn of the In-ternational
Health Board. This campaign was followed by the organization
of the Wilson County Health Department, the first of ten co5perative
county health departments to be started. From January 1917 to March 1919
the State Board of Health and the United States Public Health Service
cooperated with Edgecombe County in a unit of county work directed by
Dr. K. E. Miller of the Public Health Service. On April 1, 1919, a cooperative
county department was organized in Edgecombe to work under the direction
of the Bureau of County Health Work.
By means of the work of the county health officers, the optional units con-ducted
by the State Board of Health, and the activity of the Bureau of Edu-cation
and Engineering of the State Board, the State had become educated
to the point of having the General Assembly of 1917 enact laws requiring
two prescribed units of health work for all the counties of the State. These
were the quarantine unit and a school unit.
The General Assembly of 1919 revised the law requiring the medical
Inspection of school children and made it more effective, providing $50,000
for the treatment of defective children. The enforcement of the school in-spection
law is placed under the direction of a Bureau of Medical Inspection
of Schools of which Dr. G. M. Cooper is director. The personnel of this
Bureau consists of from six to nine full-time dentists and six trained nurses.
With this staff dental and throat clinics are being held in all parts of the
State by a plan which will reach all the counties once every three years.
The General Assembly of 1919 also enacted a State-wide sanitary law
requiring the installation of a sanitary privy at every home within fly-range
(300 yards) of another home; together with means of inspection and pro-visions
for enforcing maintenance.
THE PROBLEM! OF ( OU^iTY HEALTH O >OBTH CAROLIXA
The general death-rate in North Carolina in 1917 (the last year for which
we have a published report) was 14.1 per thousand, while the birth rate
was 31.8 per thousand (52.812 white 23,727 colored). There were 33.989
deaths during the year (20,438 whites and 12,551 colored). An analysis
of these deaths will show something of the health problems of the State.
During 1917, 11.089 or more than 32 per cent of the total deaths, occurred
The Health Bulletin 7
among children two years or age and under; 6,735 deaths were from diseases
peculiar to adult life, such as cancer, diabetes, Bright's disease, apoplexy,
and organic heart conditions; 3,402 deaths were from tuberculosis; 4,384
deaths were from soil pollution diseases; and 2,080 from the acute infectious
diseases.
The majority of the people of North Carolina live in the country, 85 per
cent of the population being rural. About one-third of the people are negroes,
the greater part of whom live in the eastern section of the State. Agricul-ture
is, naturally, the chief industry, the manufacture of cotton being second
in importance. Less than a dozen of the towns of the State have more than
10,000 population, so the chief health problems are rural in nature; and the
only successful plan of work is one designed to reach and educate rural
people. Consideration must be given to the fact that the educational ad-vantages
of these people have been limited and that in some counties the
majority of the people are negroes.' many of whom are ignorant and super-stitious.
The Federal Government by its own methods of examination applied
to something like 10,000,000 men drawn from all walks of American life and
from the healthiest age group—from 21 to 31 years of age—pronounced 38
per cent of those examined unfit for military service.
In North Carolina the explanation for this low ebb of vitality lies in the
prevalence of the subacute, devitalizing, crippling diseases found in our rural
sections. Among such diseases may be mentioned malaria, almost entirely
rural and affecting 25 per cent of our people; hookworm disease also almost
entirely rural and affecting about 30 per cent of the people; chronic con-stipation,
affecting 20 per cent of the people; suppurating gums, affecting
30 to 40 per cent of the population; adenoids, tonsils, defective vision and bad
teeth, all astoundingly prevalent and more frequently encountered among
rural people than in the towns and cities.
The relative importance of these crippling diseases is not properly ap-preciated,
since they rarely appear in the death list. They must, however,
occupy an important place in any plan of health work, as they exercise
a potent influence over the death rates indirectly through lowered vitality.
Public health work is accordingly aimed not only at the lowering of death
rates, but the increase of general efficiency.
PLAN OF COOPERATIVE COUNTY HEALTH WORK WITH A RECORD OF
ACC0MPLISH3IENTS
The General Assembly of 1917 also made an appropriation of $15,000 for
assisting county health work. The funds of the State were supplemented
by the International Health Board and a Bureau of County Health Work
was opened July 1, 1917. The object of the Bureau has been to demonstrate
the best methods of conducting county health work, and at the same time
demonstrate to a county that it (the county) is able to maintain an ade-quately
equipped, full-time health department.
The Bureau of County Health Work, in order to accomplish its object,
has since July 1917 cooperated with the following ten counties in a three-
8 The Health Bulletin
year plan of public health work: Davidson, Forsyth, Halifax, Lenoir, Nash,
Northampton, Pitt, Robeson, Rowan, and Wilson. The work in each county
consists of definite units on the more important health problems rather than
an attempt to cover the entire field of county health activity in a short
period of time. The more important units of work are concerned with public
health education; the prevention of soil pollution and its attending diseases,
such as typhoid fever, infant diarrhea, the dysenteries, and hookworm;
life extension work, which contemplates the early detection and pre-vention
of the diseases of adult life; the medical inspection and treatment of
school children; the quarantine of infectious diseases; the prevention of
tuberculosis; and infant hygiene work. During the first year of each county
health department, in addition to the educational work, three units of
work were undertaken; the quarantine, the soil pollution, and the school
units.
PUBLIC HEALTH EDUCATION
The policy of the North Carolina State Board of Health has been to con-duct
its activities from an educational standpoint. Its method has been
to present the facts of modern medicine and sanitation in such a way that
every citizen and every county may receive their benefits. In the county
this educational work is conducted by the health department staff through
lectures and demonstrations, newspaper articles, literature and special hand-bills,
clinics, and consultations. Special attention has been given to the
schools and a health catechism and other suitable literature has been prepared
for the use of the pupils. In Northampton and Lenoir counties a health
organization was perfected at each school to look after the health and san-itation
of the school district and make reports to the health ofiicer.
Cooperation has been received from the business men through the use of
their advertising space in the local newspapers to make announcements
regarding the work of the county department; the method being similar to
that used during the war to advertise Liberty Loan Drives. In Wilson
County, for example, the health officer personally visited each advertiser
and explained the purpose of this cooperative plan of advertising; each man
was asked to insert one or more of a list of health "Axioms" as part of his
advertisement and not a single firm failed to assist. The following will
illustrate the character of the advei'tisements:
The Health Bulletix
We Believe That
Typhoid Fever
Is an unnecessary disease. Protect your-self
by Vaccination and Sanitation.
Vaccination protects you against Ty-phoid
Fever.
Sanitation removes the cause of Ty-phoid
Fever.
Be Vaccinated against Typhoid Fever.
Sanitate your Homes. This will stop
Typhoid Fever. DO IT NOW
!
WILSON DRUG COMPANY
THE SERVICE STORE
Table No. 1 shows the manner in which the people have been reached
through the educational work.
Table No. 1.
RECORD OF PUBLIC HEALTH EDUCATIONAL WORK
County Date of
Organization
Number of Public Meetings with Attendance
1917
Wilson... I July 1
Davidson July 1
Nash. July 1
Northampton Aug. 1
Lenoir— j Aug. 15
Pitt
I
Dec. 1
Robeson... Dec. 1
Rowan | Jan. 1
Forsyth Jan. 1
Halifax Sept. 1
Totals
1917
1917
1917
1917
1917
1917
1917
1918
1918
191S
181
630
6,891
2,339
5,100
2,791
75
1,110
18,936
1918
51
129
46
117
137
38
99
97
70
2.838
10 The Health Bulletin
THE QUARANTINE UMT
The quarantine unit is the enforcement of the State quarantine law and,
aside from the educational work, is largely clerical and can be done by the
office assistant. This unit, of course, is continued throughout the entire
three years. The conduct of the quarantine unit is largely educational and
has for its object the prevention of the spread of the acute infectious
diseases. Monthly articles on the quarantine work of the county are sub-mitted
to the newspapers, as are also the names and addresses of each case
reported. Diseases are required to be reported by the attending physician
or by the householder. The health officer visits as many cases as possible
in order to give personal instructions as to the prevention of the spread
of the disease. When reports of contagious diseases are received literature
on each particular disease is sent to the householder and to the teacher of the
school in the district where the home is located, if the school is in session.
A record of each case reported is kept at the county health office and the
report is then sent to the State Board of Health. The health officer is
required to make detailed monthly reports to the State Epidemiologist. The
number of cases quarantined and visited is shown in Table No. 2.
Table No. 2.
REPORT OF QUARANTINE UNIT
County
The Health Bulletin 11
such as date of birth, age entering school, grades repeated if any, family
disease history, height, weight, chest expansion, condition of teeth, eyes,
ears, throat, and nutrition. The information for this card is procured
by the teacher and the completed cards are transmitted to the health officer,
who carefully considers each case. Each child found, from examination of
his card, to be abnormal is given a complete examination by the health
officer. This examination is made, whenever possible, in the presence of
the parents so that the necessity of treatment can be presented in a personal
manner.
The budgets of each county department provide $500 per year for the
treatment of defective children. During 1918 an effort was made to educate
the parents regarding the dangers of dental defects and impress the import-ance
of having such defects treated. In order to accomplish this the Bureau
of County Health Work cooperated with the Bureau of Medical Inspection
of Schools in providing free traveling dental service for the rural school
children. The success of these dental clinics was due to the efforts of Dr.
G. M. Cooper, Director of the Bureau of Medical Inspection of Schools. In
cbnductiug the clinics, six dentists were employed and each provided with
a portable dental outfit which could be set up in a schoolhouse or elsewhere,
ready for a patient, in fifteen minutes.
During 1918, 197 dispensaries and 80 lectures on oral hygiene were held
in seven counties and 5,759 children received free treatment. During 1919,
93 dispensaries have been held in six counties at which 3,751 children
have received treatment. Nine-tenths of the patients were very young chil-dren
whom most dentists do not like to treat; and at least 90 per cent of them
had never visited a dentist before. At practically every dispensary point
the health officer accompanied and assisted the dentist and while the dentist
was busy with the childern's teeth the health officer administered typhoid
vaccine, made examinations, and gave treatments for hookworm.
In addition to the dental work the children were treated, by operation,
for adenoids and diseased tonsils, part of this work being done through what
are called "Adenoid and Tonsil Clubs." In such clubs the services of a
first-class operator assisted by a trained nurse are secured. With an operat-ing
outfit this specialist visits a school where an emergency hospital has been
organized and performs, on an average, from sixteen to twenty operations
in a day, being assisted by a local doctor who acts as anesthetist. The cost
of the special service for such a day's work is about $150, and this amount is
paid by the parents or friends of the children; the remainder, including
supplies, equipment, and administration, is borne by the State Board of
Health. At least one-fourth of the operations have been performed on chil-dren
whose parents were unable to pay for this special work. In addition
to this plan, a number of public-spirited specialists gave reduced rates to
school children coming to their offices for treatment. Mention should be
made of the specialist at Salisbury who not only gave reduced rates to school
chldren, but also operated on children of indigent parents without charge.
By these methods 1174 school children in the ten counties have been operated
upon for diseased tonsils and enlarged adenoids.
Table No. 3 gives the details of the school work.
12 The Health Bulletin
Table No. 3
REPORT OF SCHOOL UNIT
The Health Bulletin 13
Making examinatious for hookworms and treating tliose found to be
Infected is an important part of the soil pollution unit. Because of the
difficulty in visiting homes in country districts it has been hard to secure
specimens for re-examination after treatment; and also the patient, as a
rule, upon receiving relief following the first treatment, seldom cares to go to
the trouble of a second examination to find out if he has been cured. Table
No. 5 shows the number of examinations and the number found infected.
Table No. 5.
RECORD OF HOOKWORM WORK
14 The Health Bulletin
III preventing typhoid fever, special vaccination campaigns are conducted
during the summers. During 1918, lipo-vaccine obtained from the War De-partment
was used with excellent results. This greatly facilitated the work
of vaccination as only one dose was required for immunization. During
these summer campaigns vaccinations are also given for smallpox. The
number of persons vaccinated against typhoid fever and smallpox is shown in
Table No. 6.
Table No. 6.
RECORD OF TYPHOID AND SMALLPOX VACCINATIONS
The Health Bulletin 15
are made of pei'sons who are suspected of having the disease. This is
done as part of the life extension unit, the medical staff of the Sanatorium
acting as consultants to the county health officers.
The life extension unit has proved very popular; in most instances the
more educated class taking advantage of it and, for this reason, it has
proved of great benefit in securing the interest and cooperation of influential
citizens.
Life extension examinations have been made as follows:
Table No. 7.
RECORD OF LIFE EXTENSION WORK
County
Wilson
Davidson
Nash ,
Northampton.
Lenoir
Pitt
Robeson..
Rowan
Foisyth
Halifax
Totals.
Date of
Organization
Number of Examinations Made
1917
July
July
July
Aug.
Aug.
Dec.
Dec.
Jan.
Jan.
Sept.
1. 1917
1, 1917
1, 1917
1, 1917
15, 1917
1, 1917
1, 1917
1, 1918
1. 1918
1, 1919
209
147
175
208
739
1918 1919
161
2
791
127
862
234
233
67
383
224
591
278
14
3,013
The results of the examinations are seen in the following findings from
the Davidson County work:
RESULTS OF LIFE EXTENSION EXAMINATIONS
Number of Examinations Made, 193
Defects
Nutrition
Overweight
Underweight
Posture and physique
Vision (uncorrected)..
Ears
Pulse
Arteries
Thyroid gland ....
Nervous system
Nose and throat
Mouth and tongue
Teeth and gums
Sinuses
Blood Pressure
Albumen
Hygienic errors
Num-ber
24
19
28
13
91
51
27
11
10
25
71
2
133
16
51
10
31
Per-centage
12.3
9.2
14.5
6.7
47.
31.7
14.
5.7
5.2
13.4
36.8
1.
69.
8.3
32.7
5.2
16.
Defects
Heart
Lungs
Abdomen
Mammary glands .
Lymphatic glands.
Rupture
Genito-urinary
Venereal _ _
.
Upper limbs
Lower limbs
Arches of feet-
Skin
New growth
Errors in diet
Blood
Sputum
Glucose
Num-ber
Per-centage
16.
11.4
5.2
1.
5.2
5.2
2.
.5
2.6
27.9
8.9
1.5
8.3
1.5
1.5
1.5-
16 The Health Bulletin
THE INFANT HYGIENE UNIT
The Infant Hygiene Unit is added at the beginning of the third year and
has for its purpose the lowering of the death-rate among babies and young
children by educating the mothers as to the best means of caring for their
young. The unit is conducted by a nurse who gets in touch with and secures
the cooperation of physicians, ministers, teachers, demonstration agents,
ciub women, and others who can assist her in reaching the mothers of the
county. Wherever possible, a rest room is established for the use of the
country women and children and for a clinic.
The work of the nurse consists of:
1. The instruction of mothers in the hygiene of pregnancy, infancy, and
childhood, through lectures, demonstrations, and personal visits.
2. The supervision and instruction of midwives.
3. Conducting a clinic at the health office and other places in the county.
4. Conducting an intensive study course for clubs and women's organiza-tions
concluding with a clinic conducted by the health officer. The study
course consists of eight daily periods, the subject of study for each period
being as follows:
a. Conditions necessary for general health. Sanitation, ventilation, proper
food, regular habits, cooperation with the health officer in preventive
measures and medical attention.
b. Hj'giene of pregnancy.
c. Confinement.
d. Care of the newborn baby, and care of the mother.
e. Necessity for maternal nursing.
f. The bottle-fed baby. The preparation of artificial food.
g. AVeaning. The child of pre-school age.
h. A clinic, conducted by the health officer, for the examination of chil-dren.
Literature for the study course is provided by the State Board of Health.
After the intensive course is completed the nurse arranges to meet with the
club once a month for the discussion of community health conditions and
for consultation by mothers.
In addition to the club work, the nurse makes an effort to get in touch
with all expectant mothers, mothers of bottle-fed babies and of babies with
diarrhea, and with homes where tuberculosis exists, and give personal in- j
struction in the proper care of these conditions. A tack map is kept showing
the location and the nature of the assistance given by the nurse.
An important feature of the infant hygiene unit is the control of the
practice of midwifery, through an ordinance of the county board of health
requiring each midwife to qualify before and secure a permit from the '
health officer.
Infant hygiene work has been conducted in Lenoir, Wilson, and Northamp-ton
counties and is being begun in Forsyth and Davidson. The county
nurses have worked in cooperation with the Bureau of Infant Hygiene of the
State Board of Health and under the direction of Mrs. Kate Brew Vaughn.
The outline of work as well as the literature used in the unit were prepared
by Mrs. Vaughn.
The Health Bulletin 17
ADMIIVISTEATION OF THE COOPERATIVE COUNTY HEALTH
DEPARTMENTS
Each county department is directed by a health officer who is appointed
by the State Board of Health, with the approval of the county board of
health, and is an official of the State Board of Health. The health officer
is given an adequate corps of assistants to enable hiini to give as near as pos-sible
each unit of work to his entire county. An office assistant is provided
for the entire three years of work. During the intensive soil pollution
campaign from three to five assistants are provided for the field work.
After the first six months, a field worker for follow-up work is employed for
the remainder of the three years. In the medical inspection of schools the
health officer is assisted by a dentist.
As has already been stated, each county health department is organized
on a three-year plan and is under the joint control of the State and county
boards of health. The State Board of Health and the International Health
Board assist by suggesting the best methods of conducting the county de-partment
and also financially by providing (each contributing an equal
portion) 50 per cent of the budget of each county health department during
the first year, 40 per cent the second year, and 25 per cent the third year.
The budgets for the county health departments are as follows.
First Second Third
„ ,,, „ , Year Year Year
Health officer, salary.. ^o.m $2,100 $2,400
Traveling of health officer. 600 600 750
Clerical assistant, salary _ 600 600 900
Fixtures and supplies 500 100 100
Contingent fund j40 j^q j^q
Soil pollution unit 2,430 900 900
Quarantine and disinfection lOO lOO 100
School work unit. "!.';.'."."'"
500 500 500
Life extension unit
^qO
Infant hygiene unit _ "lOO
'^°*'^'^-
$6,970 $5,440 $5,890
The State Board of Health through the Bureau of County Health Work
coordinates and standardizes the work of the county departments. Each
health officer conducts the same plan of work, makes weekly and monthly
reports to the State Bureau on a regular form, and is supplied with reports
from the other nine counties. From these reports he can keep in touch
with the accomplishments of other health officers engaged in work similar
to his own. Reports of the work in all the counties are sent monthly to
the Board of County Commissioners of each cooperating county so that they
may compare the work of their department with that being done elsewhere.
The Director of the Bureau of County Health Work through letters, con-ferences,
and personal visits is able to assist the health officers and keep
them advised regarding methods being used in other counties. The State
Board of Health in its cooperative policy requires a standard plan of county
work and a means of comparing the work of the various counties, but always
leaves the details of conducting each unit to the initiative of the health
officer.
18 The Health Bulletin
RESULTS OF COOPERATIVE COUNTY HEALTH WORK
Up to November 30, 1919, the work in the ten cooperative counties had
heen conducted for an aggregate of 230 months and, in spite of the handicaps
caused by the war and the epidemic of influenza, had been successful and
produced definite results toward bettering health and sanitary conditions.
The following statement shows the average month's work of the average
health department in the average of the ten counties:
1. Xo. of public meetings held 8
Attendance 739
2. No. of articles published in county papers 9
3. No. of sanitary closets built 64
4. No. of hookworm specimens examined 136
5. No. of contagious diseases quarantined 34
6. No. of schools visited 6
7. No. of children examined 95
8. No. of children treated for defects 52
9. No. of life extension examinations 20
10. No. of people vaccinated against typhoid 299
11. No. of people vaccinated against smallpox 45
Among the results of the cooperative plan of work, the four most striking
are probably the increase in the number of counties providing whole-time
health officers or health departments, the new and progressive health legisla-tion
enacted by the General Assembly of 1919, the decrease in the death-rate
from the soil pollution diseases, and the recognition of the value of
county health work by officials, business men, and the people in general.
1. At the time of the organization of the Bureau of County Health Work,
July 1, 1917, Wilson and Edgecombe were the only two counties cooperating
with the State Board of Health and the work of these counties was ex-perimental
in nature. On November 30, 1919, in addition to the ten counties
included in the cooperative plan of work, four additional counties were con-ducting
health departments under the direction of the Bureau of County
Health Work, five other counties had made appropriations and asked for
cooperation, and two counties (Gaston and Cabarrus) had supplied whole-time
health officers independent of outside aid. The Edgecombe County
Department was organized on April 1, 1919, receiving assistance from the
State Board of Health and the United States Public Health Service. The
Cumberland County Department opened July 1, 1919, also receives aid from
the State Board of Health and the United States Public Health Service.
The counties of Granville and Surry receive cooperation from the State
Board of Health. Vance, Beaufort, Bertie, Union, and Harnett counties have
made appropriations for cooperative work but have not yet been organized.
2. As a result of the educational health work done by all the Bureaus ;
of the State Board of Health, together with the demonstrations in the
cooperating counties, the General Assembly of 1919 enacted a State-wide
law requiring the construction and maintenance of a sanitary privy at
every home within fly-range (300 yards) of another home. Provision is i
made for enforcing this law and also for the regular inspection of the privies i
from two to six times per year. The school medical inspection law was I
The Health Bulletin 19
amended and an appropriation of $50,000 made for the treatment of defective
children. The appropriation for county health work was increased from
$15,000 to $27,500 per j-ear.
3. There has been a marked decrease in the death-rate from the soil
pollution diseases. The prevalence of typhoid fever is usually considered
a fair index of the incidence of soil pollution diseases; and a reduction
in the death-rate from typhoid fever is an indication of a reduction in the
number of cases and deaths of all diseases which are spread through
pollution of the soil. In North Carolina we have statistics of typhoid fever
since 1914. The following tables give the average number of deaths from
the disease, together with the average death-rate, in each of the counties
for the period 1914-1917; and, also, give the same statistics for 1918. A
study of these tables will show the most important result of work to prevent
the spread of soil pollution. By considering the cost of a case of typhoid
fever (Roseuau places the average cost of a case at $400.00), and remember-ing
that there are at least ten cases to every death, an estimate may be made
of the financial saving to the counties from this single phase of the health
department work.
DEATHS FROM TYPHOID FEVER DURING THE YEARS 1914, 1915, 1916, AND 1917
(Death Rates per 100,000 Shown by Counties)
20 The Health Bulletin
From January 1 to November 30, 1919. there had been only 340 cases
of typhoid in the cooperating counties and the death-rate from the disease
will probably be as low as it was for 1918. In the town of Salisbury, Rowan
County, for example, there were 43 cases of typhoid during 1918, while only
two cases had been reported during 1919, the reduction undoubtedly being due
to the fact that during 1918 a sanitary pit privy was built at every home not
connected with the sewer.
A comparison of the hookworm examinations of the present work with
those of the campaign of 1911-1914 shows a reduction in the percentage of
infection. This is shown in table No. 8.
Table No. 8
REPORT OF EXAMINATIONS FOR HOOKWORMS
The Health Bulletist 21
sanitary surroundings. An applicant for a loan, in order to receive credit,
must live in a home provided with a sanitary privy. He and his family
must have been vaccinated against typhoid fever and be free from marked
evidences of hookworm disease. The bank's point of view regarding public
health was expressed by the cashier as "not sentiment but sound banking
precautions." The banks in the town of Wilson (four in number) and the
tobacco warehouse owners in making loans inquire if the home is provided
with a sanitary privy.
The Colored Farmers' Agricultural Society of Northampton County, at its
1918 meeting, unanimously passed the following resolution:
"Believing that good health is the greatest asset the members of anv
association can have, and believing that keeping ourselves and our families
well is largely in our own hands, then be it
"Resolved, that every member of the Northampton County Colored Agricul-tural
Society pledges himself or herself
—
1. "To have a sanitary toilet.
2. "To have all windows and doors screened against flies and mosquitoes.
3. "To look carefully after having pure drinking water.
4. "To see that the births of all children are duly registered."
It is gratifying to know that the medical profession endorses the work
of the county health departments. The State Board of Health has recently
received letters from a number of our leading physicians in which they have
expressed their interest in the health work and have offered their coopera-tion.
The following are examples of these and are from doctors living in
Wilson and Lenoir counties:
"It has been very gratifying to watch the marked progress of the health
work since I have been practicing medicine here in Wilson County.
"In 1913 when I first came here I was shocked by the prevalence of typhoid
fever. I treated forty-seven cases that year and fifty-two the following year
(1914) ; in 1915 forty-three cases. During the summer of 1915 the State
and County Boards of Health jointly put on a vaccination campaign, 1916
the reduction was very marked, only had 18 cases, 1917, 12 cases, 1918, S
cases, and 1919 this year only 5 cases.
"I consider this great reduction due to vaccination, education through
health propoganda, and improved sanitary conditions generally.
"The country people in our locality have been thoroughly convinced of the
importance of "drilled wells"; sanitary privies, and screened homes.
"I would not fail to mention the wonderful good accomplished in the hook-worm
work and life extension work done by the health department of our
county.
"I am thoroughly convinced that it is the greatest work being conducted
for the benefit of all the people in the county."
The second letter reads:
"Under separate cover I am mailing you a copy of yesterday afternoon's
local paper showing our health ofiicer's report to the County Commissioners.
In some respects the results of health work in this county are, I believe,
the most remarkable in this country. My records show (I can give histories
>
113 cases of typhoid in this community when I began practice in the year
1899. Of course the older doctors had as many. With an increase (many
fold) in population the health department has reduced the number to almost
nothing in a comparative way. Very clearly the health department saved
this county alone on the typhoid item $120,931—to say nothing of the
other preventable diseases. Has it paid us? If it was commercial stock
22 The Health Bulletin
that was paying this way people would fall over each other to buy it. Now
this estimate is based on finances. What of the anguish and suffering it
has prevented?
"You will remember that we were the first North Carolina county to get
in under the cooperative plan of work. Now let me see you prize us out.'
You can't get this county "prized out" of health work, now that the people
understand it, with a jack screw. Lenoir County has been running ahead
ever since we gave the State its first Constitutional Governor. Small wonder
that we have put it over the other counties in health work. Furthermore,
we are not yet through. Did you notice we put in two million dollars for
good roads? Well, we are going to pay for them with the health depart-ment."
RESPOIVSIBILITT FOR COUNTY HEALTH WORK
By Dr. K. E. Miller, United States Public Health Service, Director of Bureau of
County Health Work for 1920.
One can not view those counties which have equipped themselves with
splendid health machinery without a sudden flush of envy. I who am separated
from such blessings only by a county line can not help asking some pointed
questions. Why does no one come to me or my community to explain the
causes of catching diseases and show me how to avoid them? Why is there
no one to discover and warn me of the presence of catching diseases in my
neighborhood and to force affected persons and their families to keep their
diseases at home? W^hy does no one come to our school to teach my children
the simple lessons in preserving their health, life, and happiness? Why
does no one examine my children each year in the schools and advise me of
any physical ailments that may be the source of much suffering to them and
a clog to the growth of their minds and bodies? Why does no one make it
cheap and easy for me to have such defects corrected when found? Why do
I have to pay $4.00 a piece for getting myself and family vaccinated against
typhoid fever when it could be gotten free close at my door? Why can I not
likewise get free protection against smallpox, diphtheria, and pneumonia?
Having provided myself with a decent and sanitary privy, why is there no
one to force my neighbor across the road to do the same? Why is there
no one to come to my home and show me how to feed and clothe my little
baby in such a way as to give him a fair chance to live and gi-ow strong?
A thousand other whys I might ask but they all may be summed up by
asking why myself and my neighbors must, through ignorance, continue to
bear our scourge of preventable ills and diseases when a few dollars spent on
a good health department would do away with a very large portion of them.
The answer to these questions must be sought from the questioner himself
and his fellow-citizens. His county does not enjoy such advantages because
there has been no one to start a movement to procure them. It is true
that the County Commissioners are responsible for not having taken the
necessary action. But how did they know their people wanted a health
department? Indeed they will never take any action until they see a strong
popular demand for it. Few are the Commissioners who will disregard
such a demand when properly organized and presented. When they do dis-regard
it, then is the time to get a new set of commissioners.
The Health Bulletin 23
Having once made the necessary appropriation for a health department the
answer to these questions is still not complete. There is the proper man
to be secured for health officer, a nurse who is capable and industrious,
and a sanitary inspector with like qualifications. It is at this juncture that
the advantage of the State's cooperative plan becomes obvious. It is the
business of the State Board of Health to know the fitness of persons for
this kind of work, and to know those who might be available. It is there-fore
wise and logical to look to the State Board of Health to handle this
duty of selecting the proper workers who, of course, must be acceptable
to the county.
The end for which a health department is established is results. The
responsibility for satisfaction in this regard rests upon all concerned. Cer-tainly
the health officer and his assistants are first to be considered, but they
may be without fault and yet fall far short of expectations. They must
have the whole-souled cooperation of every individual and every group of
individuals if they are to do their best work. Thus the people themselves
bear a large portion of the responsibility. And again the State shares in
this responsibility. Much of the literature used is supplied by the State,
and all the vaccines, etc., are furnished in desired quantities by the State
Board of Health. Through its cooperative program the State is able to
furnish much timely advice gathered from methods and experiences of other
counties working under the same counditions and finally the State is able
to maintain a constant check upon the work of any county through com-parison
with the work of others and by this means is able to protect the
county against all grades of inefficiency.
Fl TFRE PLAN OF COUNTY HEALTH WORK
By Dr. K. E. Miller, United States Public Health Service, Director of Bureau of
County Health Work for 1920.
Only a short time ago the whole-time county health officer was a novelty.
The idea took root and developed with great rapidity in North Carolina,
so that approximately half the population of the entire State are living under
the protective influence of whole-time health officers. The whole-time health
officer has, therefore, become a fixture in the minds and lives of half our
entire State, so that the people would no better know how to get along with-out
their health officer than they would know how to dispense with their
Sheriff. But progress is a restless creature. We have even passed the
stage of talking and thinking in terms of whole-time health officer, and now
we think principally in terms of the health department consisting of a
health officer, a nurse, a sanitary inspector, and an office assistant. A health
department of this nature is the standard adopted for the State's coopera-tive
counties, and is within the reach of most counties in the State under
the cooperative plan. Unfortunately, however, the number of counties with
which the State can cooperate at present is limited on account of insuffi-cient
funds.
The next move of the State Board of Health will be to procure funds to
enable it to lend financial assistance to all counties desiring better facilities
24 The Health Bulletin
for health conservation. Through the passage of a bill now in Congress the
State Board of Health is hoping also to offer the aid of another cooperating
agency, namely, the United States Public Health Service. By joining the
funds from the county. State and Federal Government it will be easy for
any county to obtain effective health protection.
While a county health department, as referred to above, is desirable, it is
not the only organization capable of doing effective work. At least one
whole-time official, however, must be considered the minimum worthy of
consideration. Many of the smaller and sparsely settled counties may not
be in a position to afford a full-time health department. In such cases they
should strive to get a whole-time health officer or at least a whole-time pub-lic
health nurse. Even now without waiting for further legislation there
is no county in North Carolina so small or so poor as not to be able to
enjoy the services of a public health nurse. Miss Rose M. Ehrenfeld has
recently been appointed by the State Board of Health as Director of Public
Health Nursing activities, with authorization from the American Red Cross
to use Red Cross funds for the work of the public health nurses.
The plan of County Health Work for the future, therefore, may be summed
up as a program for a whole-time health organization of some kind for
every county in the State, consisting of either a nurse, a health officer,
or a complete health department. And be it emphasized that the facilities
for making a start are now available to any county.
Public Health is purchasable. To any
community health is a valuable asset. It in-sures
prosperity ; it increases the value of land.
Health can be maintained only through indi-vidual
and community effort. Within natural
limitations, any community 'can determine its
own death rate.
ENb
VENEREAL MENACE NUMBER
)miiii(
1 This Bunelinwillbe 3er\-t free to arxij citizen of ihe StateupoArequestJ
Entered as second-class matter at Postoffice at Raleigh, N. C, under Act of July 16 1894
Published monthly at the office of the Secretary of the Board, Raleigh, N. c'
7ol. XXXV FEBRUARY, 1920 No. 2
I
REMOVE THE HOODWINK
MEMBERS OF THE NORTH CAROLINA STATE BOARD OF HEALTH
J. Howell Way, M.D., Pres., Waynesville
Richard H. Lewis, M.D., LL.D., Raleigh
J. L. Ludlow, C.E., . . Winston-Salem
Thomas E. Anderson, M.D., Statesvllle
E. C. Register, M.D Charlotte
Chas. O'H. Laughinghouse, M.D.,
Greenville
E. J. Tucker, D.D.S Roxboro
Cyrus Thompson, M.D., . Jacksonville
P. R. Harris, M.D Henderson
Official Staff
W. S. Rankin, M.D., Secretary State Board of Health and State Health Officer.
A. J. Warren, M.D., Assistant State Health Officer.
Ronald B. Wilson, Director Public Health Education.
L. B. McBrayer, M.D., Superintendent of the State Sanatorium and Chief Bureau
of Tuberculosis.
F. M. Register, M.D., Deputy State Registrar and Epidemiologist.
G. M. Cooper, M.D., Chief of Bureau of Medical Inspection of Schools.
H. E. Miller, C.E., Chief of the Bureau of Engineering and Inspection.
Millard Knowlton, M.D., Chief of the Bureau off Venereal Diseases.
Miss Rose M. Ehrenfeld, R.N., Chief of Bureau of Public Health Nursing and
Infant Hygiene.
K. E. Miller, M.D., Director County Health Work.
FREE PUBLIC HEALTH LITERATURE
The State Board of Health has a limited quantity of literature on health subjects
for free distribution. If you are interested in one or more of the following subjects,
or want same sent to a friend, write to the State Board of Health for free literature
on that particular subject.
Whooping-cough
Hookworm Disease
Public Health Laws
Tuberculosis Laws
Tuberculosis
Scarlet Fevek
Infantile Paralysis
Care of the Baby
Fly Placards
Typhoid Placards
Tuberculosis Placards
Clean-up Placards
Spitting Placards
Sanitary Privies
Residential Sewage
Disposal Plants
Eyes
Flies
Colds
Teeth
Cancer
Malaria
Smallpox
Adenoids
Measles
German Measles
Typhoid Fever
Diphtheria
Pellagra
Constipation
Indigestion
SEX HYGIENE BULLETINS
Set a—For Young Men
A Reasonable Sex Life for Men.
Sexual Hygiene for Young Men.
Vigorous Manhood.
Smash the Line. (The case against the
restricted district.)
List of Reliable Pamphlets.
Set B—For Public Officials and
Business Men
Public Health Measures in Relation to
Venereal Diseases.
Venereal Diseases—A Sociological Study.
Smash the Line. The case against the
restricted district.)
The Need for Sex Education.
A State-wide Program for Sex Education.
List of Reliable Pamphlets.
Set C—For Boys
Vigorous Manhood. (Especially for boys
12 years of age and over.)
Note—For boys under 12, see
"When and How to Tell the Children"
(Set D) ; portions of "Vigorous Man-hood"
also may be read to younger
boys. Boys 15 years and over may be
given Bulletin "A Reasonable Sex Life
for Men" (see Set A), at the discretion
of the parent.
Sexual Hygiene for Young Men.
List of Reliable Pamphlets.
Set D—For Parents
When and How to Tell the Children.
Venereal Diseases—A Sociologic Study.
The Need for Sex Education.
List of Reliable Pamphlets.
Set E—For Girls and Young Women
Your Country Needs You. (Especially
for girls 11 years of age and over.)
Note.—For girls under 11, see
"When and How to Tell the Children."
(Set D) ; portions of "Your Country
Needs You" also may be read to
younger girls. Girls 15 and over may
be given "The Nation's Call to Young
Women," at the discretion of the
parent.
The Nation's Call to Young Women.
List of Reliable Pamphlets.
Set F—For Teachers
The School Teacher and Sex Education.
Sex Education in the Home and High
School.
Venereal Diseases—A Sociologic Study.
Smash the Line.
The Need for Sex Education.
Any of the above will be sent without charge,
for which you have definite use.
Please send for only those bulletins
VIS? mBmi
I PUBLI5AELD BY TML nQR.TA CAROLIMA 5TATL BOAigD »^MEALTM \\\2j
Vol. XXXV FEBRUARY, 1920 No. 2
THE VENEREAL MENACE AND THE REMEDY
Dr. MlLIiAKD Knowlton, M.D., C.P.H.
Director, Bureau of Venereal Diseases
One of the greatest victories in the
world war was the victory over dis-ease.
In previous wars the disease
death rate has been higher than the
battle death rate, but in this war the
ratio was reversed. Thus, five times
as many American soldiers died of
disease as were killed in battle in the
Spanish-American War, while less
than one-fourth of the deaths among
the American Expeditionary Forces
during the late war were due to dis-ease.
Furthermore, devastating epi-demics,
such as have followed other
great wars, have not resulted from
the scattering of returned prisoners
and demobilized troops to all parts
of the world since the armistice. This
is a victory of which public health au-thorities
may well be proud, for it
points the way to better health con-ditions
in times of peace.
Not only were the known diseases
kept under control, but in at least
one instance knowledge was gained
concerning a new disease which ap-peared
during the war. While the
battles were raging, American scien-tists,
with the aid of American men
who offered themselves as sacrifices
for the experiments, learned the
method by which trench fever is
transmitted and thus added a new
disease to the growing list of pre-ventable
diseases. This achievement
in wresting a new bit of knowledge
from Nature was made possible by
our modern conception of disease as
being a biological phenomenon sub-ject
to natural law instead of a visi-tation
of wrath in punishment for
sin.
Modern discoveries concerning the
causes and methods of transmission
of many diseases have been so im-pressed
upon the minds of the people
that scientific methods of prevention
are being extended into new fields.
Under the pressure of war necessity
for exerting a full measure of man-power,
it was possible to attack boldly
a group of diseases which, hereto-fore
have been mentioned only with
bated breath. The reason for such
great reticence, amounting to what
has been called a "conspiracy of
silence," concerning this group of
diseases, is that they are so fre-quently
incidental to a breach of
morality. But as the veil of super-stition
has been lifted and the light
of science allowed to illuminate dark
places, it has been found that fully
half the victims of venereal disease
are innocent of wrong-doing. An ap-preciation
of this fact has helped to
modify public opinion concerning
these diseases so as to permit the
development in record time of the
greatest disease prevention campaign
ever known in history.
The Health Bulletin
Comparative prevalence of Venereal Diseases and other important
communicable diseases in the U. S. Army.
Venereal Diseases 102.3
Other Communicable Diseases 29.-1
Pneumonia, scarlet fever, typhoid, and
paratyphoid. (Measles not included.)
The figures above represents the annual
rate per 1,000 for all troops in the United
States, based on the reports from Septem-ber
21, 1917, to May 31. 1918. These
figures are accurate for purposes of com-parison
only. Prepared from reports to the
Surgeon General of the Army.
Comparison of the number of cases of Venereal Diseases contracted
before and after enlistment.
Before enlistment .... 5
After enlistment 1
The number of cases before enlistment
Includes all uncured cases, old and new, as
compared with the new cases contracted
after enlistment. The great contrast, how-ever,
is mainly due to the better protection
given to soldiers than is given most men
and boys in civil life.
The above estimate is based on reports
from Camps Sherman, Lee, Upton, Meade,
Custer, Kearney, and the Western Depart-ment
from October 25, 1917, to May 1,
1918. (See Venereal Disease Control in the
Army. W. P. Snow, M.D., and W. A. Saw-yer,
M.D., Majors, M. R. C, U. S. Army.
Journal American Medical Ass'n, August 10,
1918, p. 456.)
This campaign, first launched as
an emergency war measure, proved
a success from the start. It is well
known that more ineffectiveness and
unfitness for military duty are caused
by venereal disease than by any other
group of diseases that sap the
strength of an army. Heretofore a
great increase in the prevalence of
venereal disease has always resulted
from war. Notwithstanding these
facts, the vigorous measures taken
for the protection of American sol-diers
were so effective that the Ameri-can
Expeditionary Forces had the
lowest venereal disease rate of any
army in the field.
These war measures were taken to
insure success in America's first com-bat
with a great military power. Now
that peace has come with its urgent
demand for production to make up for
the loss and waste of war, the neces-sity
for continuing the campaign
against venereal diseases in order to
maintain efficiency in industry is ap-parent
to all who are familiar with
the situation. To be sure, efficiency
in industry is a material end, but it
is an end calculated to make a strong
appeal to the man of affairs con-cerned
with the production and dis-tribution
of material necessities.
There is, however, a more impor-tant
reason why we humans should
combat venereal disease. One of
these diseases, namely, syphilis, may
be transmitted to offspring with
disastrous results. Gonorrhea often
produces sterility and causes many
marriages to be childless. Thus ve-nereal
diseases must be prevented, not
only for the sake of efficiency in in-dustry,
but also for the sake of pre-serving
the race and passing a herit-age
of health on to posterity.
In order to understand just what
the venereal menace really is, it is
necessary to know something of the
diseases themselves. There are two
or three diseases of minor impor-tance,
such as chancroid and balanitis
gangrenosa, but the two great dis-eases
which belong to this group are
gonorrhea and syphilis.
Gonorrhea is caused by a germ
which is a vegetable parasite that
grows on mucous membranes and
causes an inflammatory condition of
the membrane and underlying tissues.
The disease affects the sex organs
chiefly because it is usually trans-
The Health Bulletin
mitted by sex contact. It may, how-ever,
affect other parts of the body.
The disease may occur on any mucous
membrane. It not infrequently af-fects
the eyes. Inflammation of the
eyes in newly born babes, or babies'
sore eyes, is frequently due to the
germ of gonorrhea obtained from the
mother at the time of birth. Older
persons may also sometimes have the
eyes infected with the germ of gonor-rhea.
Much of the blindness in the
country is due to this cause. Some
authorities estimate that as muoh as
one-fourth of all the blindness at all
ages and three-fourths of the blind-ness
in young infants is due to gonor-rheal
inflammation of the eyes.
After growing for a while on a
mucous membrane, the germ of
gonorrhea, commonly called the gono-coccus,
may get into the blood and
reach other parts of the body. Some-times
the germs lodge in the heart
and cause serious disease of the
heart. They sometimes lodge in the
joints and cause gonorrheal rheuma-tism.
The germ of gonorrhea is a
very tiny germ and can be seen only
by the use of a powerful microscope,
but it causes much damage. Not
only does it cause much blindness and
crippling due to infection of the eyes
and joints, but it is a frequent cause
of sterility in both men and women,
thus depriving them of the privilege
of parenthood. This germ also makes
necessary most of the serious opera-tions
upon the sex organs of women.
An appreciation of all the damage
done by gonorrhea has led to a great
change in point of view concerning
its importance. No longer is it re-garded
as of no more consequence
than a bad cold, but a better knowl-edge
of its far-reaching effects has
caused it to be classed as one of the
great diseases of mankind. It is one
of the most prevalent of the serious
diseases which afflict the people of
North Carolina.
The other important venereal dis-ease,
usually regarded as in some re-spects
the more important of the two,
is syphilis. This disease is caused
by a tiny animal parasite or germ
shaped somewhat like a corkscrew.
This parasite must enter the body and
get into the blood before it can cause
the disease. It may enter the body
through any portion of the skin or
mucuous membrane. The spirocheta,
as the germ is called, has the power
to move around freely in a fluid and
is believed to have the power to pene-trate
the unbroken skin or mucous
membrane with which it comes in
contact if kept moist a sufficient
length of time. It certainly has the
power to penetrate through any
scratch or other break in the protec-tive
covering of the body. At the
point of entrance there develops in
the course of three or four weeks a
hard lump or nodule which is called
a chancre. This nodule or chancre
usually forms an open sore, which
may or may not give much annoyance
at the time. In fact, a chancre on
the lip is not infrequently mistaken
for an ordinary cold sore in the be-ginning.
The chancre is the first
stage of syphilis.
In a few weeks, if proper treat-ment
is not given, the second stage
of syphilis comes on, in which there
is a rash or an eruption on the body
that may look like the eruption of
The Health Bulletin
almost any other disease. During
this stage the hair often falls out and
the mouth gets sore. If improper or
insufficient treatment is given, or
sometimes even when no treatment
is given, this rash may disappear
after a while and the infected person
may think he is getting well. But
the genus have only gone to the
deeper tissues where they survive
and cause trouble later in life.
germs frequently cause degenerative
changes in the blood vessels, the
heart, the liver, the kidneys or other
parts of the body. Many of the
cases of paralysis or apoplexy occur-ring
in early or middle life are due
to syphilitic infection of the blood
vessels. Many deaths from heart
disease are caused by syphilitic infec-tion
of the heart muscle. Many
deaths due to degenerative changes in
SPIROCHAETA
The germ of syphilis (Spirocliaeta pallida) by dark field illumination in the secretions from a
syphilitic wart (condyloma). The living spiral organism highly magnified. The bright
circles are red blood cells.
These later troubles, which are
many in number and varied in char-acter,
constitute what is called the
third stage of syphilis. They may
come on fifteen or twenty years or
even longer after the first stage of
the disease. In case the germs at-tack
the nervous system they may
cause locomotor ataxia, or they may
cause a form of insanity known as
paresis or softening of the brain. The
other vital organs are also attributed
to syphilis. Thus syphilis is fre-quently
an indirect cause of death.
Indeed, it is regarded by some au-thorities
as ranking along with
tuberculosis in importance as a cause
of death. For this reason syphilis
and tuberculosis are looked upon as
the two most important diseases in
the temperate zone. Both together
are held responsible for about one-
The Health Bulletin
THE PAEENTB
PART
GIVE THE CHILD A SQUARE DEAL
8 The Health Bulletin
fifth of all deaths in countries like
England and the United States.
These two great diseases are alike
in another respect. Each may affect
almost any part of the body, and may
closely resemble almost any other
disease. So true is this of syphilis
that Dr. Osier once remarked that if
a physician knows syphilis in all its
forms he knows all possible forms
and manifestations of any other
disease.
But this is not all the damage
wrought by syphilis. It is the one
great disease we know which may be
transmitted from one generation to
another. Without stopping to dis-cuss
the point as to whether or not
it is congenital or truly hereditary
according to the more technical mean-ings
of the terms, it is enough for
practical purposes to know that the
child of a syphilitic parent may be
born with syphilis. In fact, it may
be born dead, or it may die before
time for birth as a result of syphilitic
infection. When born alive such a
child may show symptoms of the dis-ease
at once or may appear normal
at birth and develop symptoms later.
These, then, are some of the trage-dies
which follow "the sowing of wild
oats." Thinking he is cured of an old
infection, a man may marry and set-tle
down only to find that his wife
soon becomes a chronic invalid or is
compelled to undergo a mutilating
surgical operation; that he cannot
have children or can have only one;
that his children are born dead or
diseased, or that he himself becomes
a chronic sufferer from some of the
after effects of venereal disease, or
is stricken helpless by paralysis or
insanity in the very prime of life.
Fortunately venereal diseases can be
cured if proper treatment by a skilled
physician is continued for a sufficient
length of time. These diseases can
also be prevented and prevention is
far better than cure.
Methods of Transmission
The germs of venereal disease do
not live long outside the body except
under very special conditions. They
are sensitive to changes of tempera-ture
and are usually readily killed by
drying. Such delicate germs are not
conveyed from one person to another
through the air. They must be trans-ferred
from the infected to the unin-fected
in a moist state if they are to
be kept alive and cause disease. This
is why the diseases are usually trans-mitted
by sex contact, but there are
also other methods of transmission.
The germs of gonorrhea may be con-veyed
to the eyes by means of a
towel. A toilet seat soiled with
gonorrheal pus is a possible means of
transmission, especially in the case of
little girls. The germs may also be
conveyed by means of a syringe used
by an infected person.
Syphilis may be transmitted by
kissing, by the use of the common
drinking cup or by otherwise coming
in close contact with an infected per-son.
A case is on record where a
young man with the first sore of
syphilis on his lip went to a party
where kissing games were played. He
kissed about a dozen girls and half
of them developed chancre of the lip.
Syphilis may also be spread by the
ordinary contact of school life. An
instance that comes to mind in this
connection is that of a large school
in a w^estern city where eleven cases
of syphilis were found among the
school children. Apparently most of
them had been contracted by the ordi-nary
contact incident to their associa-tion
in school. Not infrequently a
physician or nurse contracts syphilis
by handling syphilitic patients. Thus
syphilis may be said to be in a sense
an occupational disease with physi-cians
and nurses.
All of these facts serve to empha-size
the point that no one is entirely
free from danger so long as venereal
The Health Bulletin
X . ^'}
s
10 The Health Bulletin
diseases exist. No matter how ex-emplary
one's conduct may be, there
is always a chance, which is not so
remote as many of us imagine, for an
accidental infection or an infection
acquired from a husband, or occasion-ally
from a wife. Many women are
infected by their husbands who
thought they were cured before they
married.
For the reasons indicated above,
some persons regard the term "ven-ereal
disease" as a misnomer. It is
no doubt true that the term is some-what
unfortunate in view of present
knowledge, but long usage has firmly
fixed it in the language, and there
is no other satisfactory term for this
group of diseases. After all, the
name is of secondary importance. We
have come to realize that because of
the large number of accidental and
innocent infections these diseases
must be looked upon as misfortunes
the same as any other disease, and
treated accordingly. Even when ac-quired
by illicit relations, humani-tarian
considerations require that the
infected persons be treated, both for
their own sake and for the sake of
those with whom they come in con-tact,
and also for the sake of their
offspring. It is an appreciation of
this fact that has led to the estab-lishment
of clinics for the treatment
of venereal disease, that has led hos-pital
authorities to open hospital
doors heretofore closed to such cases,
that has induced rnunicipalities.
States and the Federal Government
to make appropriations to provide
treatment for indigent patients who
are infected, and that has changed
in an important way the whole atti-tude
of the public toward the venereal
disease problem and toward those
who are infected with such diseases.
The Prevalence of Venereal Diseases
The revelations of the war concern-ing
the prevalence of venereal dis-eases
have been astounding. The ex-amination
of so large a number of
drafted men gave an opportunity to
measure the prevalence in the aver-age
population. When North Caro-lina's
quota of the second draft came
up for examination it was found that
six and three-fourths per cent, or
about one out of every fifteen, were
suffering from venereal disease at
the time of examination. This does
not include the number who had been
infected and cured before they were
drafted. Some notion of what this
rate of infection means to industry
may be gained by considering that
out of every 1,000 men of military
age employed in a large industry, 67
would have their efficiency impaired
at all times by infection with ve-nereal
disease. This fact must of
necessity enter into the calculation of
wage scales, prices of products and
other adjustments in the industrial
world. Thus it is to the interest of
the employer and the employed alike
to limit the spread of venereal dis-ease.
Other figures available concerning
the prevalence of venereal disease are
more or less fragmentary in character
but some of them are of sufficient
importance to be mentioned. For ex-ample,
six and one-half per cent of
nearly 5,000 persons coming to au-topsy
at Bellevue Hospital in New
York had some ailment resulting
from syphilis which was apparent to
the eye without the use of a micro-scope.
Dr. Warthin, of Ann Arbor,
Michigan, has made a careful study
of persons coming to autopsy at the
hospital of the medical school in that
city, and claims that 40 per cent of
them showed the effects of syphilitic
infection when the tissues were ex-amined
with a microscope. These
figures are so startling 'that other
workers hesitate to accept them with-out
corroboration. The estimation
usually made of the prevalence of
syphilis in the general population
varies from 5 to 15 per cent. Warthin
The Health Bulletin 11
12 The Health Bulletin
is of the opinion that these figures
are too low. He thinks that double
this proportion would still be a con-servative
estimate. It is a well-known
fact that gonorrhea is far
more prevalent than syphilis.
The importance of syphilis as a
cause of death has already been men-tioned.
Some authorities regard it
as the greatest single cause of death
among English speaking peoples. It
is true that not many deaths are at-tributed
to syphilis in the death re-ports,
but it is an indirect cause of
many deaths attributed to apoplexy,
paralysis, hemorrhage in the brain,
heart disease, hardening of the
arteries, and degenerative diseases of
other organs. On account of its in-direct
relation to death from some of
these other causes, syphilis is held
responsible for a very large number
of deaths of men between the ages
of 40 and 60. The disease is not so
severe for women as for men.
One of the important aspects of the
venereal disease problem is its rela-tion
to child life and reproduction.
In a study of syphilis in relation to
infant mortality, Dr. P. C. Jeans, of
St. Louis, concluded that from 10 to
20 per cent of adult males and 10 per
cent of married women are syphilitic;
that 75 per cent of the offspring of
syphilitic families are syphilitic; that
30 per cent of pregnancies in syphi-litic
families result in death before
term as against the normal rate of
10 per cent; that 30 per cent of living
children in syphilitic families die in
infancy; that 25 to 30 per cent of
syphilitic infants die of syphilis; that
but 17 per cent of all pregnancies in
syphilitic families result in healthy
children who survive infancy; that
about 5 per cent of all infants are
syphilitic and that about 3% per cent
of all infant deaths in St. Louis were
due to syphilis.
The British Royal Commission for
the study of venereal diseases made
a study of 150 families that were
syphilitic and 150 that were not
syphilitic and found the same disas-trous
results of syphilitic infection
to child life as were reported by Dr.
Jeans. Thus one of the big problems
in child hygiene is the venereal dis-ease
problem, especially syphilis.
In North Carolina as many as
1,000 cases of venereal disease per
month have been reported to the State
Board of Health by physicians, while
druggists have reported as many as
2,000 sales of venereal disease reme-dies
per month. This does not show
all the cases that occur, for not all
physicians and druggists have begun
reporting as yet. It does mean, how-ever,
that venereal diseases are more
prevalent in North Carolina than
other communicable diseases. The
next question that naturally arises is
what to do about it.
How to Combat Venereal Disease
In considering methods of combat-ing
venereal disease it may be well
to emphasize again the fact that
these diseases are not punishment for
sin. About half the cases of infec-tion
are innocently acquired, and
nearly all the innocent victims are
women and children. Surely no one
would wish to have innocent women
and children suffer unnecessarily for
the conduct of the husband and
father; yet this is exactly what has
happened as a result of our past at-titude
toward venereal disease. The
more modern view that such disease
is incidental to sex irregularity,
rather than a punishment therefor,
has resulted in an entirely different
attitude towards persons w^ho are in-fected
with these diseases. Owing to
this change in attitude, it is now pos-sible
to approach the subject from a
scientific point of view, and handle
venereal diseases in a rational com-mon-
sense manner, the same as other
diseases are handled.
The Health Bulletin 13
VICTIMS OF GONORRHEA
These children were recent patients at a venereal clinic, each one a victim of gonorrhea.
Faces are covered to prevent identification
Three distinct lines of activity are
essential in any complete program of
venereal disease control. These are:
1. Medical measures, including the
treatment of persons infected with
venereal disease to render them non-infectious,
and the forcible detention
under quarantine of infected persons
who cannot be trusted to avoid ex-posing
others to infection while
under treatment.
2. Repressive measures against
prostitution, which is recognized as
the great source of venereal disease.
3. Educational measures for the
purpose of disseminating accurate
information concerning venereal dis-eases
and arousing the public to
adopt vigorous methods for their pre-vention.
The provision of facilities for
proper recreation is a fourth impor-tant
activity in the indirect attack
upon venereal disease. Infection oc-curs
during leisure time. Wholesome
recreation diverts attention and les-sens
exposure to infection. Recrea-tion
is a community problem rather
than a strictly public health problem.
It cannot be adequately discussed
here, but is mentioned for the sake of
completeness.
The necessity for proper treatment
of infected persons is more urgent in
venereal disease than in some other
communicable diseases. This is due
to the fact that venereal diseases fre-quently
become chronic and the pa-tient
may thus become a "carrier,"
capable of transmitting infection to
others for a long period of time.
Some communicable diseases like
smallpox are called "self-limited"
diseases, because the patient soon re-covers
and becomes incapable of
transmitting infection to others.
Treatment for the great majority
of venereal disease patients will be
given by physicians in private prac-tice
employed by the patients for
that purpose. There are a number
of patients, however, who cannot af-ford
to pay for treatment. The obli-gation
of the community to provide
14 The Health Bulletin
treatment for such cases is becoming
more generally recognized; in fact
the community is obliged to provide
treatment as a means of self-protec-tion,
for a person infected with ve-nereal
disease in an infectious stage
is a menace to all with whom he
comes in contact. In the larger cen-ters
of population the most conven-ient
and economical way of providing
treatment at public expense for such
patients is by means of clinics. In
carrying out the government pro-gram
for treatment in North Caro-lina,
clinics have been established in
the cities of Asheville, Charlotte,
Clinton, Fayetteville, Goldsboro,
Greensboro, High Point, Rocky
Mount, Raleigh, Wilmington and
Winston-Salem. This includes all the
cities in North Carolina, except Dur-ham,
with an estimated population of
fifteen thousand or more, and a few
of smaller size. The total population
of these cities and the counties in
which they are located is about 20 per
cent of the population of the entire
State. Thus the establishment of
clinics in these larger cities does not
provide for the treatment of indigent
patients in the smaller towns and
rural communities, where about 80
per cent of the people reside. Plans
are under way for insuring proper
treatment to all who require it and
are not able to pay a physician in
private practice for his service.
It is clearly recognized that no
one but a skilled physician is quali-fied
to administer proper treatment
for venereal disease. In fact, the law
prohibits any one but a legally quali-fied
physician from prescribing treat-ment
for such cases. Still there are
a number of people who foolishly buy
alleged remedies at drug stores and
try to treat themselves. Fortunately,
as the public gains information on
this point, the number of persons who
try to treat themselves for venereal
disease is steadily diminishing.
With regard to the second great
line of activity necessary for the pre-vention
of venereal disease, it may
be noted that the positive stand taken
on this question by health authorities
generally is a distinct advance over
views formerly held. Throughout the
ages numerous attempts at regulat-ing
prostitution have been made, but
no such attempts have ever proven
successful. At last it has been
clearly recognized that the only atti-tude
society can assume toward pros-titution
with any hope of success in
combating venereal disease is one of
unremitting antagonism. Prostitu-tion
in all its various forms and
manifestations must be repressed
with a strong hand if venereal dis-ease
control measures are to suc-ceed.
The stand on this point is posi-tive
and uncompromising. No truly
enlightened community will permit
an open red light district to exist,
and most communities are now tak-ing
active measures against prosti-tution
in all its forms.
In carrying out repressive meas-ures
it is essential that the strong
hand of the law fall with equal weight
upon both men and women who are
engaged in commercialized vice. The
laws of North Carolina make the
male partner of the prostitute equally
guilty with the prostitute herself.
Thus there is no warrant in law for
prosecuting one and not the other.
Experience has shown, however, that
from the standpoint of repressing
prostitution it is also necessary to
punish the male accomplice. The
male accomplice is the taxi driver,
the porter, the bell boy or other per-son
who acts as a solicitor for pros-titutes.
Vigorous prosecution of such
persons has been found effective in
rendering prostitution unprofitable,
and causing prostitutes to seek other
means of gaining a livelihood. Thus
after red-light districts are closed
and prostitutes find it necessary to
The Health Bulletin 15
employ accomplices to bring them
trade, one of the most effective means
of combating prostitution is to pun-ish
the accomplice.
There are plenty of laws in North
Carolina for the repression of pros-titution;
the only thing needful to
make these laws .effective is an
aroused public opinion to back up the
ofRcials in enforcing them. In gen-eral
it may be said that the officials
of any community are as efficient in
enforcing the laws as the public
wants them to be. It is possible for
prostitution to be practically wiped
out of the State if the public so de-sires.
With prostitution wiped out,
the venereal disease problem would
soon be greatly diminished in impor-tance,
because of the greatly lessened
prevalence of such diseases. The
law of North Carolina requires health
officials to co-operate with other offi-cials
whose duty it is to enforce laws
against prostitution.
In planning the educational cam-paign
it is essential to keep clearly in
mind the ends to be attained. The
mere giving of information concern-ing
venereal disease is not enough. In
building for permanent results it is
necessary to build into the moral
fiber of the people. Recognition of
this fact is one of the factors that
has led to the inclusion of sex educa-tion
as a part of the educational pro-gram
in the campaign against ve-nereal
disease. Sex education efforts
have taken rather definite form in the
"Keeping Fit" campaign being waged
throughout the country among boys
of high school age, and the corre-sponding
campaign among girls.
Eventually, this line of activity will
be turned over to the schools where
it belongs, and the health authorities
will attend to the more strictly medi-cal
aspects of the problem. At pres-ent
the health authorities are pointing
the way toward sex education as a
part of the indirect attack upon ve-nereal
disease.
An illustration of building into the
moral fiber of the people is afforded
by the growing demand for a single
standard of sex conduct for men and
women. The present high standard for
women has developed to meet a race
necessity. If the race is to progress
through utilizing the lengthened
period of infancy in the human
species for educating the young, it is
necessary to know who are the fath-ers
of children so that responsibility
for their education may be fixed. For
this reason the conduct of the mother
must be above reproach, and civilized
humanity has fixed the standard of
sex conduct for women higher than
for men. The necessity for maintain-ing
the high standard for women is
just as urgent as ever, and the neces-sity
for establishing and maintaining
a high standard for men is now
realized.
At no time in the world's history
have greater demands been made
upon individual power and endurance
than at present. If civilized men are
to meet these demands it is essential
to eliminate elements of weakness,
either physical or mental. Thus the
control of venereal disease is now
looked upon as a necessity if the hu-man
race is to continue progress to-ward
a realization of its highest as-pirations.
An appreciation of this
necessity will cause a high standard
of sex conduct to be fixed for men as
a matter of racial self-preservation.
The race will not permit men to con-tinue
bringing venereal disease into
the family as in the past.
To be effective in attaining this
end, educational measures must make
the point clear to all concerned that
venereal disease is a race menace, and
that every male member of society
is under obligation to himself and his
family to avoid exposure to such dis-eases.
When the necessity for main-taining
an untainted race stock is felt
as keenly as the necessity for know-ing
the paternity of offspring, there
16 The Health Bulletin
J .
I 1
The Health Bulletin 17
18 The Health Bulletin
will be a basic motive for a single
standard of sex conduct for men and
women.
Thus, whether the discussion be
limited to health and efficiency in in-dustry
or extended into the field of
morals, it all comes back to venereal
disease as an individual and a race
menace. The eradication of these
diseases requires proper treatment
for infected persons, the repression
of prostitution, and the education of
the people concerning the menace.
Successful educational efforts will
seek first to influence individual con-duct
through the promotion of self-control,
both because it is the decent
and proper thing to do and because
lack of self-control carries a hazard
of infection, and second, to stimulate
public action for the treatment of in-fected
persons and the repression of
prostitution.
EDUCATIONAL PROGRAM
Henry P. Coor
Director of Division of Education, Bureau of Venereal Diseases
For the reasons that the venereal
diseases spread largely because of
public ignorance concerning them,
and education is one of the most im-portant
and fundamental ways of
preventing their occurrence, the Edu-cational
Division of the Bureau of
Venereal Diseases will function
largely in the State-wide campaign
to control or eliminate these diseases.
Funds are available for an Intensive
campaign and plans have been de-veloped
to carry to the people of the
State detailed information concerning
the
Venereal Menace
Since the venereal diseases are not
respecters of persons—all alike, rich
and poor, old and young, innocent and
immoral, are open to infection—
a
very strenuous effort will be made to
reach all colors, classes, sorts and
conditions of people over the State
with definite information concerning
the diseases.
Purpose
The purpose of this educational ef-fort
is threefold:
1. To take to the people of the
State detailed, authentic information
concerning
—
(a) The startling prevalence and
ravages of the diseases and the rapid
way in which they are undermining
the race.
(b) The methods and availability
of treatment. The harm done indi-viduals
and society because of the use
of "Quack Medicines" and the prac-tice
of "Quack Doctors."
(c) The necessity for the repres-sion
of "prostitutes," the chief car-riers
of the diseases.
(d) The methods and measures now
being used by both the State Board
of Health and the United States Pub-lic
Health Service in combating these
diseases.
2. To stimulate leaders, organiza-tions
and institutions to a new and
vital interest in sex as it is related
to life and as an important factor in
the elimination of venereal diseases.
3. To enlist the live interest and
active co-operation of every available
person, organization and institution
in this great "People's War" against
the VENEREAL MENACE.
Methods
Publicity.—Foremost among the
methods used to take the venereal
message to the people of the State
The Health Bulletin 19
are the news and editorial columns of
the daily and weekly press. No
agency can reach so many people or
is more willing to be used than the
press. A campaign of publicity is
now under way and steady streams
of illuminating information concern-ing
the diseases in North Carolina as
already indicated will flow over the
State.
Sex Education.—In today's war-fare
on venereal diseases, as declared
by the Government, it is being dis-covered
anew that this generation is
suffering not only from its own sins,
but also from those of its parents and
grandparents. In the interpretation
of this rediscovery, however, insuffi-cient
emphasis is placed upon the
sins of omission, for it was the short-comings
of our parents as well as
their transgressions which have left
us this heritage of venereal diseases.
Chief among the shortcomings of
the last generation was the failure to
sanely instruct this generation in the
fundamentally important and su-premely
vital message of sex. The
recent careful investigation by M. J.
Exner among one thousand college
men revealed the startling fact that
less than 10 per cent of parents as-sume
their responsibilities in this re-spect.
In other words, over 90 per cent
of the nation's youth is gaining its
sex information from unwholesome,
"open sewer" sources and simultane-ously
failing to receive the advantage
of the high degree of immunitization
from subsequent venereal infection
which adequate education affords.
In any modern warfare, propaganda
plays an important role, and it is
only the employment of the finest
strategy, for the Government in its
THESE BOYS ARE BLIND
Because their mothers had gonorrhea, In most cases caught from the father. Most of the
blindness of babies is caused by the germs of gonorrhea
20 The Health Bulletin
TWO KINDS OF SEX EDUCATION
Effect of First Sex Impressions from Boy and Girl Associates and Mis-cellaneous
Sources
The statements of college men indicate that 91.5 per cent received their first perma-nent
impression about sex from unwTaolesome sources.
In answer to the question, "What, in general, was the effect of this information upon
you as you look back on it now?" 79 per cent (indicated by black) said the eftect was bad.
Effect of Sex Instruction from Lectures, Parents, and Other
Wholesome Sources
The statements of college men indicate that 94.5 per cent had received some sex instruc-tion
from parents, teachers, pamphlets, lectures, and other wholesome sources.
In answer to the question, "Please give fully your opinion regarding the influence of this
instruction on your life," only 1.2 per cent (indicated by black) said the effect was bad.
These diagrams are based on the results of Dr. Exner's study of 948 college men.
The Health Bulletin 21
22 The Health Bulletin
warfare on venereal diseases, to
undertake a system of "back-fire,"
educational propaganda to overcome
the enemy. This generation must not
fail to adequately instruct the com-ing
generation in the matter of sex,
if the scourge of venereal diseases,
with their heart-rending wake of in-sanity,
infirmity, suffering and death,
is to be eradicated.
Moving Pictures and Exhibits.
—
Another very effective method that
will be used to take information con-cerning
the venereal diseases is the
medium of Motion Pictures. The best
available films telling the story of the
Venereal Menace, at once interesting
and accurate, for adults and older
young men and women, such as "Fit
to Win," "The End of the Road,"
"Animated Diagram" and "How Life
Begins," have been secured. The
plan for the larger cities is that these
films will be shown for a period of
three or four days under the auspices
of the State Board of Health and the
United States Public Health Service
in co-operation with a local com-mittee.
Special showings will be
made separately for men, older boys,
women and older girls of both races.
In connection with the showing of
the films, a series of attractive card
and slide exhibits dealing with the
whole px-oblem of venereal diseases,
the causes, the danger and the reme-dies
will be displayed. A "Keeping
Fit" exhibit for older boys and adults
will also be shown.
The co-operation of such State
agencies as the Home Demonstration
Department, State Board of Public
Welfare, Bureau of Community Serv-ice
and others will make possible the
taking of both the motion pictures
and exhibits to that very large con-stituency,
the rural population of the
State.
The colleges, both male and female,
offer an unusual opportunity to fur-nish
our future leaders and parents
with definite information concerning
the diseases. In addition it is an op-portunity
to challenge them to share
in the task of completely crushing
the greatest present-day enemy of
the nation and race.
In the industrial communities a
special campaign will be conducted
in an effort to get employer and em-ployee
to join hands in a combined
attack on the diseases, for, aside from
other questions involved, the venereal
diseases pay neither in happiness nor
in profit to employer or employee.
THE '^KEEPING FIT" CAMPAIGN
W. L Hughes
Associate Director Division of Education, Bureau of Venereal Diseases
The "Keeping Fit" campaign in
North Carolina is based upon an ex-hibit
prepared by the United States
Public Health Service. The exhibit
is available in either display card or
lantern slide form, in both of which
some excellent color effects have been
accomplished. Leading educators,
clergy and social workers unite to
heartily endorse it, as enunciating
just the challenging message to older
boys for which they have been eager-ly,
but for the most part vainly,
groping.
The exhibit is reinforced by a vei-y
attractive pamphlet of the same title,
which carries on its front page a per-sonal
letter from Governor Bickett
to the State's older boyhood. The
pamphlet is intended primarily for
distribution at the close of a display
of the exhibit.
The Health Bulletin 23
Intensive campaign methods have
been adopted in the hope of reaching
every high school in the State before
June. The State has been divided
into fourteen districts vi^ith a super-visor
in charge of each. The district
supervisors in turn are organizing
Keeping FTt
AN EXHIBIT
FOR BOYS AND MEN
ArGYou in Condition?
Can You Wall. 20 VUles In a Day?
Can You Work a 10-Hour Day In Uie Field?
Can You Run 2 Miles?
Can You "Chin Yourself 10 Times? i
their counties with a county super-visor
in each county. Extreme care
is being exercised in the selection of
these men, in order to get men who
have a friendly approach to boys and
who can create a high-toned atmos-phere
in which to present the exhibit.
Each man is given proper credentials
from the State office to make it patent
to all co-operating schools or other
organizations that the supervisor is
officially representing the Bureau.
The exhibit, with accompanying
literature, is intended for boys in the
three upper grades of high school and
such other boys, whether in school or
out, who are their equal in physiologi-cal
development. The age limits of
this group are roughly fifteen to
twenty years. Of these ages there
are approximately in this State 32,739
employed boys, 68,116 rural boys and
15,169 school boys. The campaign
contemplates reaching with the
"Keeping Fit" message all the school
boys and nearly 50 per cent of the
others by July.
Schools, churches, factories, mills,
community organizations, etc., may
arrange to use without cost the ex-hibit
among boys of the ages men-tioned
by making written applica-tion.
In presenting the exhibit a
"sex" vocabulary is not needed.
Either cards or slides speak for them-selves.
Complete printed directions
will be furnished with each exhibit.
The card exhibit consists of twenty-four
cards each 22 x 28 inches and the
slide exhibit contains fifty slides.
Pamphlets to accompany the exhibit
will also be supplied in any quantity
without cost.
Governor Bickett has challenged
the older boyhood of the State to "Get
Fit and Keep Fit." In a ringing mes-sage
of challenge to a high cause the
THE PITY OF IT
The Innocent, like this little blind
from gonorrhea and syph
girl, suffer
ilis
24 The Health Bulletin
Governor bids the State's youth to
come through clean for tomorrow.
The letter follows:
Raleigh, N. C, Nov. 11, 1919.
To the Younger Men of North Caro-lina:
Is there grit enough in your make-up
that a man's challenge to you
would strike fire? THERE IS!
Do I not recall with a thrill that
today is the world's first anniversary
of the world war armistice, and do
I not recall with even greater thrill
that the first smash of the boasted
German line was administered by the
sons of North Carolina ? That heroic
event, paving the way for the armis-tice,
is proof sufficient that the boys
of the Old North State will rise to a
man's challenge, even when the stake
is life or death.
There are issues not far removed
in the future, determining the whole
course and destiny of our national
life, and even the peace of the world,
which must of necessity be solved by
you, the younger citizens of today.
Think with me for a moment. Isn't
the Government employing the finest
strategy in determining to spend its
greatest effort in training its next
generation to fullest fitness ?
As Governor of your Common-wealth,
as a father and friend of
younger men, as I prefer to call to-day's
boys, but greatest of all as an
American citizen, I appeal to you to
read and reread this pamphlet. Actu-ally
absorb it. And then, under
Heaven, soberly pledge that you will
earnestly endeavor to come through
to mature American citizenship, as-suming
whatever duties that glorious
citizenship may impose, clean-limbed,
strong-moraled, clear-eyed and keen-minded.
Younger men of today—I challenge
you man to man.
Personally yours,
(S) T. W. BICKETT.
WORK AMONG WOMEN AND GIRLS
Anne Jane Simpson
Director of Women's Work, Division of Education, Bureau of Venereal Diseases
Reasons
Work among women and girls in
the State of North Carolina has come
to the front because of the important
part they play in the controlling,
combating and eliminating of ve-nereal
diseases. The fact that there
are so many women in our charitable
and State institutions today because
of venereal diseases proves to us that
not only from a standpoint of health
but from a standpoint of economics
the work must be carried on through
the woman as well as through the
man.
Woman has been loath to recog-nize
and acknowledge home condi-tions
or those of her community and
she has put forth very little effort to
become enlightened. She has been
utterly ignorant of the causes of most
of her illnesses with which she has
come in contact, and this is more true
of venereal diseases than any other,
partly because of the many names
and phases under which they appear.
Through the State-wide program she
must be made to see and know that
venereal diseases are communicable,
contagious and infectious. She must
be encouraged to put aside the old
idea that "it is not my business" and
"I just can't talk about such things."
To educate her to the larger Interpre- '
tation of the crying need and oppor- [
tunity for usefulness to herself, her i
community and her State is our goal, |
but unless she can be made to see ;
The Health Bulletin 25
LU
26 The Health Bulletin
that venereal diseases and prostitu-tion
are incompatible with a right
interpretation of the greatest power
of life for happiness, she will not be
doing her part. Hence the need for
education.
Education
Ignorance of the laws of life has
almost spelled disaster for woman,
and this must be overcome. Woman
should have an understanding knowl-edge
of life's development and its
stages, both as an individual being
and as a social being. Hence the laws
of society, which should be interpreted
as the greater opportunity to attain
our ideals in life, home and heaven.
Mothers and teachers are most im-portant
factors and the message to
them must be clear. To our school
girls, our future mothers, it must be
put in such a way as to develop in
them the longing for real home at-mosphere,
care and protection, to-gether
with the right aim and ambi-tion
for the children that are to come.
An understanding of the facts of re-production
and the responsibility of
reproduction, with the reason for con-trol
of sex impulses in life, are very
essential. But facts are not all-suf-ficient;
they should only lead to an
understanding of life as an oppor-tunity.
Methods
We hope to reach every woman and
girl over fourteen years of age in the
State of North Carolina with a clean,
clear sex message. This is to be done
through lectures, literature, films and
card and slide exhibits.
The National Board of the Young
Women's Christian Association has,
LOOKING FOR THE GERMS OF SYPHILIS
Whenever gonorrhea or syphilis is suspected careful laboratory examinations
should be made
The Health Bulletin 27
as its contribution, loaned to the State
for a period of one month five women
physicians to carry the message.
These women lectured all over the
country during the war and had
marvelous success.
An intensive campaign covering
twenty days was put on through the
State Board of Health with splendid
results, Dr. Hannah Morris, of New
York City, being the lecturer in
charge.
Before July 1, 1920, we hope to
reach out into the smaller cities and
counties, and in this we are looking
forward to further assistance from
the Young Women's Christian Asso-ciation,
not only in lecturing but in
helping to raise up leaders to assist
us in carrying on a permanent work.
The fullest co-operation from Wo-men's
Clubs, Parent-teachers Associ-ations,
Home Demonstration Agents,
Mothers' Clubs, educators and all or-ganized
groups as well as individuals
is absolutely essential for full success
in this campaign.
VENEREAL DISEASE CAMPAIGN AMONG
COLORED PEOPLE IN NORTH CAROLINA
Dr. Aldrich R. Burton
U. S. Public Health Service
and
Dr. Walter J. Hughes
N. C. State Board of Health
Whether or not it is advisable to
carry out the educational phase of
the venereal disease campaign sepa-rately
among the races, we think, has
been definitely decided by the results
of the demonstration now being con-ducted
in the State of North Carolina.
The campaign, as far as the medical
and the law enforcement phases are
concerned, must be carried on without
reference to race or nationality. It is
not a question of who has the higher
percentage of infection but rather of
stamping out the menace wherever
it exists. It is believed that one of
the most important factors in dimin-ishing
the prevalence of the venereal
diseases—gonorrhea and syphilis—is
to remove from the mind of every
individual the widespread notion that
they are trivial and that their effects
are evanescent, and to impress them
with the gravity, seriousness and last-ing
effects and fatality of these dis-eases.
The campaign in North Carolina is
no longer in the experimental stage.
It was designed and has been carried
on as a demonstration of what can
be done in this particular line. The
benefits which eventuated in the army
from the publicity and lectures on the
venereal disease menace have con-vinced
us that similar results might
be expected in dealing with the civil-ian
population.
To do this, as many persons as pos-sible
must be reached, and the method
which is most forceful and most ac-cessible
is the best. In keeping with
this idea it was thought that to more
effectually reach the colored portion
of the population colored physicians
should be employed. As Captain
Arthur B. Spingarn has said, "they
are familiar with race psychology and
can make a special appeal to race
pride and desire to excel."
Our message to the people consists
of a statement and a plea. A state-ment
of the causes, predisposing and
direct, course and pathological effects
on the individual and his family and
the economic effects on the com-munity.
A plea for the support of
the positive, correcting agencies as
28 The Health Bulletin
sex education, proper recreational
facilities, improved sanitary condi-tions
and for prompt, proper and
thorough treatment of all existing
cases. It is manifestly impossible to
reach every one in the State directly,
but we hope to do so indirectly by the
use of literature and follow-up work.
It was predicted that the people were
not ready for this message, but this
has never materialized. It has been
very gratifying to find the leaders,
with hardly an exception, realizing
the necessity for instruction along
these lines, and willing and anxious
to receive and pass on with zeal any
DUTY OF POLICE
Citizens have a right to demand that officials enforce the laws that have been enacted for the
suppression of prostitution. This is particularly a police duty
The Health Bulletin
information and to support our efforts
in every way. We recognize that lec-tures
are most effective when followed
up by organized and permanent effort.
This is being done by ministers in
their sermons, physicians in private
and public talks, colored social work-ers
and welfare organizations.
The plan of the campaign is to
reach as many cities as possible, es-pecially
where there are clinics, and
to meet the leaders en masse, as in
church conferences, fraternal organi-zations,
State associations, etc. If
the leaders are properly reached it
will not be too great a task to mobi-lize
the whole social force of the col-ored
communities. In each city we
visit we get in touch with the city
and county health officers, colored
physicians, teachers, ministers, and
hold group meetings with parents and
give lectures at schools, churches,
lodges, Y. M. C. A., industrial plants,
and business and social welfare clubs.
The co-operation of colored min-isters
should be obtained, for they
have an influence and social force in
their various communities that is far-reaching.
Thus we are able to reach
a large majority of colored people
through the churches with a message
concerning venereal diseases. Dur-ing
November and December we ad-dressed
five ministers' conferences
embracing a membership of 766 min-isters,
573 of these engaged in the
active ministry. Through them we
have lectured in 48 churches to 7,978
adult persons. The message in all
cases was well taken. To use the ex-pression
of a woman who attended
one of these lectures, "I should have
had this message twenty years ago,
but I am benefited inasmuch as I can
impart it to my children."
The support received from educa-tors
is very encouraging. By their
aid we have had several group meet-ings
with teachers and covered
twenty-three grammar schools, five
high schools and eight colleges, reach-ing
in that way 1,279 boys and young
men and 1,745 girls and young women.
This work does not cease with a mes-sage
but is followed up with litera-ture
and the organization of clubs.
We recognize the fact that there is
a class that cannot be reached either
through church, schools, or society.
We do, however, get the message to
them by going directly to the shops,
factories and lumber plants where
they are employed. Of the fourteen
plants we have visited we have had
the co-operation of the authorities,
and the interest manifested by them
is highly praiseworthy.
The educational work has been
highly gratifying and generously re-ceived
by all. We have had the sup-port
of all classes. The medical men
have rendered valuable assistance
wherever we have gone. The minis-ters
have turned their churches over
to us and given us their moral sup-port.
The educators have given us
space in their classrooms and wel-comed
the message as a long-needed
necessity. During November and De-cember
we delivered 124 lectures to
a total of 17,590 persons. Much re-mains
to be done, and not until we
have given the work enough mo-mentum
to be self-propelling and last-ing
will we consider our part in the
work completed.
FREE PAMPHLETS
The true facts of sex are presented
in a wholesome manner and the truth
is told about Venereal Diseases in a
series of pamphlets issued in six sets,
as follows:
Set A. For Young Men.
Set B. For the General Public.
Set C. For Boys.
Set D. For Parents.
Set E. For Girls and Young
Women.
Set F. For Educators.
Any of these pamphlets will be
sent free upon request.
Address the North Carolina State
Board of Health, Raleigh, N. C.
30 The Health Bulletin
VENEREAL DISEASE CLINICS IN NORTH CAROLINA
The clinics listed below are operated through cooperative
arrangements between the North Carolina State Board of
Health, the U. S. Public Health Service, and the local health
authorities.
ASHEVILLE—Third floor Old Library Building.
Daily except Sunday, 9:30-11:00 A.M.
Dr. a. F. Toole, Chief of Clinic.
Dr. C. V. Reynolds, Health Officer
CHARLOTTE—Seventh floor Realty Building.
Daily except Sunday, 2:30-5:30 P.M.
Dr. S. R. Thompson, Chief of Clinic.
Dr. C. C. Hudson, Health Officer
CLINTON—County Health Office, Lee Building.
Saturdays, 1 :00-5 :00 P.M.
Dr. E. T. Hollingsworth, Chief of Clinic and Health
Officer.
FAYETTEVILLE—City Hall.
MEN, Monday, Wednesday, and Friday, 7 :00 P.M.
WOMEN, Tuesday, Thursday, and Saturday, 9-11 A.M.
Arsphenamine to all patients, Friday, 2 :00 P.M.
Dr. R. a. Allgood, Chief of Clinic.
Dr. W. C. Verdery, Health Officer.
GOLDSBORO—2001/^ East Walnut Street.
Daily except Sunday, 11-12 A.M., 4-5 and 7-8 P.M.
Dr. Richard Spicer, Chief of Clinic.
H. B. Larner, Health Officer.
GREENSBORO—City Hall.
Daily except Sunday, 4-6 P.M.
Dr. D. R. Wolff, Chief of Clinic.
Dr. B. B. Willl^ms, Health Officer.
HIGH POINT—Over Ring Drug Company.
Daily except Sunday, 7-9 P.M.
Dr. T. M. Stanton, Chief of Clinic.
Dr. J. J. McAnnally, Health Officer.
RALEIGH—Wake County Free Clinic, 15 W. South St.
Week days except Thursday, 1 :30-3 :30 P.M.
Dr. C. O. Abernathy, Chief of Clinic.
Dr. Percy Akrons, Health Officer.
ROCKY MOUNT—
Dr. H. Lee Large, Chief of Clinic and Health Officer.
WILMINGTON—Courthouse.
Daily except Sunday, 4—6 P.M.
Dr. a. McR. Crouch, Chief of Clinic.
Dr. Chas. E. Low, Health Officer.
WINSTON-SALEM—Wachovia Bank and Trust
Building.
Daily Except Sunday, 4-6 P.M.
Dr. V. M. Long, Chief of Clinic.
Dr. R. L. Carlton, Health Officer.
The Heaxth Bulletin 31
WHAT WE KNOW ABOUT CANCER
A HANDBOOK FOR THE MEDICAL PROFESSION
Prepared by a Committee of the
American Society for the Control of Cancer
and Published Jointly by the
American Society for the Control of Cancer
and the
Council on Health and Public Instruction of the
American Medical Association
For Free Distribution by the
North Carolina State Board of Health
Raleigh, N. C.
Every Physician in North Carolina Should Have a Copy.
It Will be Sent Free Upon Request.
32 The Health Bulletin
"? S S E
s
tXCRETA DISPOSAL NUMBER
Published bL) TAZ. ^°Rm CARPLU^A STATE.B?ARD s^Amun
Thi5 £)ulklir\willbe -seAl free to oixg citizer\ of lihe State \ipoi\requesH
Entered as second-class matter at Postoffice at Raleigh, N. C, under Act oj July 16, lS9i.
Published monthly at the office of the Secretary of the Board, Raleigh, N. C.
ol. XXXV MARCH. 1920
LET THERE BE LIGHT"
Vol. XXXV MARCH, 1920 No. 3
INTRODUCTION
It is the purpose of this bulletin to trace the principles of excreta disposal
from the instinctive tendencies of lower animals through the history of man's
conception of improved methods of excreta disposal, up to and including the
most modern sewage disposal practices which are being so generally adopted
in North Carolina. In the development of this purpose the material in this
bulletin is groufied into five articles, as follows: (1) Excreta Disposal and
Animal Existence; (2) Development of Excreta Disposal Methods; (3) Privy
Sanitation Under the State Board of Health; (4) Sewage Disposal in the
Private Home; (5) Sewerage Problem in Towns and Villages.
The methods of excreta disposal recognized and approved by the State
Board of Health embrace two general groups : ( 1 ) Certain specified types of
sanitary privies; (2) Sewerage systems, either public or private, of approved
design. In the Bulletin for July, 1919, which was devoted entirely to privies,
a rather exhaustive and somewhat technical presentation of this subject was
given. It is, therefore, neither necessary nor proper here to repeat the general
consideration of privies as factors in excreta disposal. Since the appearance
of the Special Privy Bulletin, howejver, the principles set forth therein have
been subjected to the acid test of practicability through the active operation
of the State Privy Law since October 1, 1919. A statement of progress and
developments under this law rightly belongs in this bulletin, as it will serve
to supplement and brinu up to date the privy side of the excreta disposal
question.
More and more is it heing realized by the people of our State that the
ultimate goal to strive for in the disposal of human excreta is sewerage sys-tems.
It is, therefore, logical and i^ecessary not only to describe the immense
enthusiasm shown for sewer construction throughout the State, but to point
out the way to success and economy for those who are contemplating installa-tion
of either public or private systems.
The second, fourth and fifth articles of this bulletin were prepared by Mr.
H. E. Miller, Director of the Bureau of Engineering and Inspection; the first
and third were contributed by Dr. K. E. Miller, Director of the Bureau of
County Health Work.
EXCRETA DISPOSAL AND ANIMAL EXISTENCE
In drafting the plans for the Universe the Supreme Architect provided
certain fundamental and never-failing laws by which all animal life must be
governed in order to live and flourish, and in disregard of which it must surely
die. No animal life can exist without food. When food is consumed by the
animal organism it undergoes certain marvelous and obscurely understood
chemical changes by which a certain portion of it is absorbed and either trans-formed
into animal heat and energy or stored up in the body as a reservoir
of strength, or used to supply the elements of natural growth and development.
The remaining portion of food taken into animal bodies has, to say the least,
no useful purpose to perform, and so is cast off. Especially such detrimental
or poisonous substances as may be separated from the food consumed is denied
admission into the animal body, the House Beautiful, which is indeed the
earthly dwelling place of the Most High. Not only so, but we find that life and
growth is a continuous process of building up and tearing down, the portion
torn down being harmful, else it would otherwise be allowed to remain. More-over,
the refuse matter, in the course of its passage through the bodies of
higher animals, becomes infested with swarms of germ life, none of which
contribute anything to the body's welfare, and in some instances are most
dangerous and deadly to its existence. Whatever may be the origin of the
various elements of body waste, the purpose is invariably the same, namely,
to rid the body of such substances as would otherwise hinder or destroy it.
The Master Mind has not overlooked the means to accomplish this purpose,
having provided the lungs, skin, kidneys and intestines, their importance being
in the ascending order as named. Our principal concern, therefore, is with the
kidney and bowel excretions.
Since Nature has made it imperative that waste matters must be removed
from the body, common sense teaches us none the less forcibly that they
should never be allowed to reenter in any form. In the lower animals natural
instinct operates most potently in this direction, by virtue of that most power-ful
instinct, self-preservation. Few indeed are the dumb beasts that will be-foul
their own habitations if given an opportunity to do otherwise.
Up to this point the human animal obeys the laws of Nature like all other
animals. Were he a creature actuated by pure instinct, as other animals, there
would be little call for preachments on excreta disposal. But no, he differs
from other animals in having a highly developed intellect and rationality. It
is his rationality that allows him to drink water contaminated with human
excreta, and to eat food bedaubed with focal matter, carried thither by swarms
of carrion -flies. Repulsive as is this plight in wliich rationality has placed the
human animal, it might be tolerated if this were all, but unfortunately it is
not. For some obscure reason, man's rationality allows a goodly portion of the
race to offer themselves and their helpless babes as needle.ss sacrifices to
typhoid fever, dysenteries, and hookworm disease, just as the soldier who
aifaslessly rears his head above the trenches for a target to the enemy.
The diseases here mentioned are the offspring of human excreta. When
disposed of in such a way that no portion of it can gain readmission into the
human body, human excreta is absolutely harmless. The fact, however, that
wo have 500 deaths from typhoid fever, and more than 2,000 deaths from other
diarrheal diseases yearly in the State is positive proof that excreta is no small
item in the dietary of North Carolina.
4 The Health Bulletin
Health and life ai-e depeiulout upon a continuous struggle between the forces
that would destroy, and those that \\ould preserve and build up the body. The
destructive forces are guided, as it were, by some evil genius which keeps them
ever active and alert to perform the works of mischief and accomplish man's
downfall. The constructive forces, on the other hand, are guided largely by
man's own intellect and will. Herein lies the weak point in man's defensive
armor. Man's intellect, the acme of creation, is commonly derelict and incom-petent
in its guardianship of the temple of the soul. Man con.sumes human
excreta because he has not willed to do otherwise.
Careless di.sposal of human excreta allows it to be carried by drainage and
other factors into the drinking water supply, to be visited by the filthy fly. by
which it is in turn carried to articles of food ; and again, the scatterment
effected by winds, rains, chickens, pigs and other animals impregnates the
soil in which green vegetables, such as lettuce, radishes, and the like, are
frequently grown. These vegetables are often eaten uncooked and commonly
have particles of polluted soil adhering to them when eaten. In these ways
human excreta carelessly managed is. during certain seasons of the year,
unwittingly, but none the less certainly, an almost constant article of diet.
Assuming that man consumes human exci'eta by accident, rather than pref-erence,
there should be a reasonable assurance that any information towards
ways and means of abolishing this noisome custom should receive hearty
approbation and universal adoption. The solution of the excreta disposal
problem, in brief, consists in the use of either (1) A properly constructed
privy in accordance with the plans and specifications prescribed by the State
Board of Health (see The Bulletin, July, 1919), or (2) a public or private
sanitary sewer .system. The latter method will be fully discussed in this
bulletin.
DEVELOPMENT OF EXCRETA DISPOSAL METHODS
It would be interesting to trace from the remotest antiquity the practices
of the human race in respect to the disposal of waste matter from the body.
Space, however, does not sufhce for this. Our most noteworthy example of
this kind is found in the laws laid down by Moses, leaving no doubt that the
purpose involved is the protection of! the health of his people.
SFhVERS
There are records of sewers in audient cities, dating as far back. as Nineveh
and Babylon, in the seventh century before Christ. There is considerable
information available regarding the sewers of ancient Jerusalem, and there
are many lengthy and detailed discussions of the huge arched masonry con-duits
used as sewers in Rome in the early stages of its development.
Even the sewers of Rome, however, which were developed in a period fairly
recent in comparison to the eai'lier systems, were of very little sanitary value,
except in the abatement of nuisance. They served to rid the city of domestic
wastes only in the sense that it was the practice to dump rubbish and filth in
the gutters, from which it wa« washed into the sewers during the periodic
flushing of the streets. The recognized system of disposal of excr.eta and
The Health Bulletin 5
other domestic wastes at that time, and even much later, was the cesspool.
Cesspools were constructed with porous sidewalls and bottom, allowing the
liquid sewage to seep away into the surrounding earth. It is recorded that
in 1S20 the whole subsoil of the city of Paris was on the point of becoming
putrid from cesspool filth.
Sanitarians of that period were divided into two schools, one advocating
"dry"' and the other "water carried" methods of collecting human excreta.
The "dry" method consisted in the collection and removal of excreta in pails,
while the "water carried" method consisted of flushing into the sewers. In
the division of opinion of this period is recognized the basis of development
of the two general classifications of excreta disposal methods, privies and
.sewers, respectively.
The first instance cited in reliable records in which a separate sewer system
for the collection and removal of domestic wastes was advocated, was in
1842 by an English engineer. The first notable instance of this kind in this
country was in the city of Memphis in 1880. This system, however, owes its
notoriety to its defects rather than its virtues. The Raleigh system of sepa-rate
or sanitary sewers constructed in 1887 was among the very first in this
country to operate successfully.
Although the value of .sewerage as an indispensible facility for the protec-tion
of health in cities and urban communities is now quite generally appre-ciated,
we are forced to recognize that until very recently sewers were used
mainly for surface drainage and abatement of nuisance, while cesspools were
the common method of disposal of excreta. The last city of consequence in
the United States to banish cesspools was Baltimore. While a report of an
investigation in 1879 shows 80,000 cesspools in use in the city, with the attend-ant
pollution of 92 per cent of all samples of water examined from sources
within the city, no definite action was taken until 1906, when a study of the
city was made by engineers, which lead to the installation of a comprehensive
system of separate sewers and treatment devices. It was not until after
modern medical practice demonstrated that many diseases are preventable by
proper disposal of disease-bearing human filth that the public health pro-tective
value of sewerage began to receive proper recognition. It is a deplor-able
fact that even the limited sewerage in many towns and villages today
owes its existence too often to an appreciation of the comfort and convenience,
rather than the public health protection which it affords.
A complete modern system of sewerage consists of a system of sewers for
collection of sewage from house drains and conduction of it to a point of dis-charge,
where it passes through treatment and purification devices, varying in
character with the amount of purification required. On account of the in-creasing
density of population and growing tendency to obtain drinking water
supplies from impounded streams and other surface sources, treatment of
s:ewage has liecome the rule, rather than the exception.
PRIVIES
The "dry" method of excreta disposal advocated in contrast to the "water
carried" system by one of the two opposing schools of sanitarians over a cen-tury
ago has received but little attention from that day to this. The first
noteworthy attention wliich was given to this method was less than a decade
ago. when the United States Public Health Service began its rural health
6 The Health Bulletin
campaigns in 1914, which have furnished a basis for other rural sanitation
projects. For instance, the International Health Board, recognizing the signifi-cance
of rural sanitation, is offering financial cooperation to health organiza-tions
all over the world, to assist educational campaigns for the construction
of privies, and have set aside funds for cooperating in tvsenty counties in
North Carolina alone. Laboratory and practical investigations of various types
of privies, promising inval