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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
Object Description
Description
Title | Health bulletin |
Other Title | Bulletin of the North Carolina State Board of Health; Bulletin of the North Carolina Board of Health |
Creator | North Carolina. State Board of Health. |
Date | 1920 |
Subjects |
Children--Health and hygiene Diseases Hygiene Public Health--North Carolina--Periodicals Sanitation |
Place | North Carolina, United States |
Time Period | (1900-1929) North Carolina's industrial revolution and World War One |
Description | Volume 35, Issues 1-12. Issues for Feb.-May 1917 and for Jan.-July 1918 not published. |
Publisher | Raleigh,North Carolina State Board of Health. |
Agency-Current | North Carolina Department of Health and Human Services |
Rights | State Document see http://digital.ncdcr.gov/u?/p249901coll22,63754 |
Physical Characteristics | 61 v. :ill. ;23 cm. |
Collection | Health Sciences Library, University of North Carolina at Chapel Hill |
Type | text |
Language | English |
Format | Bulletins |
Digital Characteristics-A | 21,858 KB; 304 p. |
Digital Collection |
Ensuring Democracy through Digital Access, a North Carolina LSTA-funded grant project North Carolina Digital State Documents Collection |
Digital Format | application/pdf |
Related Items | Imprint varies: published later at Raleigh, N.C. |
Title Replaces | Bulletin of the North Carolina Board of Health** |
Audience | All |
Pres File Name-M | pubs_edp_healthbulletin1920.pdf |
Pres Local File Path-M | \Preservation_content\StatePubs\pubs_edp\images_master\ |
Full Text |
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COUNTY HEALTH WORK NUMBER ^
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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" |