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THE LIBRARY OF THE UNIVERSITY OF NORTH CAROLINA AT CHAPEL HILL THE COLLECTION OF NORTH CAROLINIANA C61U N86 V.C31-32: 1916/18 FOR USE ONLY IN THE NORTH CAROLINA COLLECTION fhl$ IW£ti&_Bm MWMRUti®-- & "TV7 Published b4 TfiL^m CAROLINA 5WE.B?ARDs>7\mLTA ? This Bulletin, will "be ser\t free to arxq citizen of the 5tateupor\ request ! 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. G. Vol. XXXII JUNE, 1917 No. 3 GOVERNOR BICKETT AND PUBLIC HEALTH (EXTRACT FROM HIS INAUGURAL ADDRESS. JANUARY II, 1917) The State Board of Health shall he given ample funds to continue and enlarge its work. The law should require a careful examination of every child who enters a puhlic school, at least twice a year. This can he done by whole-time county health officers or by representatives of the State Board, as the conditions may warrant; but the law should compel it to be done. „m, . , .. _ ... "The riches of a Commonwealth Are free, strong minds, and hearts of health." To insure such riches, intelligent examination of the children at stated intervals is absolutely necessary. The State Board deserves the unqualified support of the General As-sembly in its campaign against quacks and quackery. The law requires a man to have a diploma from a first-class medical college and to stand a rigid examination before the North Carolina Board of Medical Exam-iners before he is allowed to write a single prescription for a patient in North Carolina. And yet we permit the sale of nostrums to our people without any adequate knowledge of whether or not they are injurious to health, or have any medicinal value whatever. I am in favor of a law making it a felony for any man to sell, offer for sale, or advertise for sale in North Carolina any proprietary or patent medicine purporting to cure cancer, consumption, diabetes, paralysis, epilepsy, Bright's disease, or any other disease for which the North Caro-lina Medical Association and the American Medical Association declare that no cure has been discovered. I am earnestly in favor of a law requiring all vendors of proprietary medicines to file with the State Board of Health a statement showing the exact composition of such medicines, and that the State Board be empow-ered to forbid the sale of such proprietary medicines in the State of North Carolina if, in its opinion, it is without curative value in the treatment of the disease it purports to cure. TABLE OF CONTENTS Editorial Brevities 75 New Health Laws 75 Medical Inspection of School Children 77 The Bacxwaed Ch h.tj 78 Make a Date fob Free Examina-tion 79 The Common House 1'i.v 80 How Disease Germs Live anq Grow. 82 On Early Detection of Tuber-culosis 84 For Hoarding House* and Sana-toria 86 Dental Hygiene 87 Teach Our Children How Best to Live 8!) Weigh the Baby Once a Week. ... 90 The Prevention of Pellagra 91 Typhoid an Accident 93 Li\ ing Love and Well 15 MEMBERS OF THE NORTH CAROLINA STATE BOARD OF HEALTH J. Howell Wat, M.D., Pres., Waynesville Richard H. Lewis, M.D., LL.D., Raleigh J. L. Ludlow, C.E., . . Winston-Salem Thomas E A vdkpshv. M.D.. . p*ito«-»-',ip E C. Register, M.D., . . . Charlotte Chas. O'H. Laughinghouse, Edward J. Wood. M.D., . . Cyrus Thompson, M.D., . P. R. Harris, M.D., . . M.D., Greenville Wilmington Jacksonville Henderson official Staff W. S. Rankin, M.D., Secretary of the State Board of Health and State Health Officer. C. A. Shore, M.D., Director of the State Laboratory of Hygiene. Warren H. Booker, C.E., Chief of the Bureau of Engineering and Education. L. B. McBrayer. M.D., Superintendent of the State Sanatorium. J. R. Gordon, M.D., Deputy State Registrar. G. M. Cooper, M.D.. Chief of the Bureau of Rural Sanitation. A. M. Crouch, M.D., Epidemologist. FREE PUBLIC HEALTH LITERATURE The State Board of Health has a limited quantity of health literature on the subjects listed below, which will be sent out, free of charge, to any citizen of the State as long as the supply lasts. If you care for any of this literature, or want some sent to a friend, just write to the State Board of Health, at Raleigh. A postcard will bring it by return mail. No. 12. No. 31. No. 32. No. 39. No. 50. No. 52. No. 53. No. 54. No. 60. No. 67. No. 70. No. 72. No. 73. No. 74. No. 75. No. 76. No. 77. No. 78. No. 79. No. 80. No. 81. No. 82. No. 83. Residential Sewage Disposal Plants. Whooping Cough. Diphtheria. Tuberculosis Leaflet. Baby Leaflet. Malaria and What Everybody Should Know About It. Disinfection After Diphtheria, Measles, or Whooping Cough. Disinfection After Scarlet Fever. Sanitary and Hygienic Care of Prisoners. Cancer Leaflet. Adenoids. Tuberculosis. Smallpox. Measles. Scarlet Fevrr. Baby Welfarp. Rave the Rnbv. Free medical examination, etc. Care of the Mouth and Teeth. Hygiene at Middle Life. Prevention of Degenerative Dis-eases. The Prevention of Colds. Underweight. ( >\ (:••« eight. No. 84. Indigestion. No. 85. Constipation. No. 86. Venereal Diseases. No. 87. Sanitary Privies. No. 88. Public Health Laws. No. 89. The Common House Fly. No. 90. Typhoid Fever. No. 91. Tuberculosis Laws. Teeth. Tou&ns. and Adenoids.* How to Live Long.* Hookworm Disease.* A War on Consumption.* Milk.* Periodic Medical Examina-tion. Typhoid Fever and How to Prevent It.* Concrete Septic Tanks}. Anti-Spitting Placards (5 inches by 7 inches). Anti-Fly Placards (14 inches by 22 inches). Anti-Typhoid Placards (14 inches by 22 inches). Anti - Tuberculosis Placards (14 inchpc hv °? irises'* Clean Up Placards ('14 in. by 23 in ) Furnished by courtesy of the Metropolitan Life Insurance Company. t Furnished by courtesy of Portland Cement Association. COWARDS a BROU jBI | PU5LI5ALD 5Y TAL HORXA CAROLINA 5TATL BQMgD s^MEALTM ||[gj. Vol. XXXII JUNE, 1917 No. 3 EDITORIAL BREVITIES To heal the sick was once the only aim of the physician. Now his great-est ambition is to prevent sickness. Why not apply the same sane com-mon sense to your health that you ap-ply to your business? As far as you yourself are concerned, and as far as your family and business are con-cerned, it is the most important thing in the world. Have you ever asked your doctor what causes and what prevents Bright's disease, heart failure, harden-ing of the arteries, and apoplexy? And have you ever asked him to look you over to see if any of these diseases are undermining your health, so that if such were the case you could ward them off? The average person can eat good, plain, wholesome food in moderation all his life without ever being aware that he has a digestive apparatus. It is only when he overeats or is other-wise indiscreet as to his meals that he knows he has a stomach and one that affects his whole being. As important to the soldier as are good feet, good eyesight, and good brains, neither of these is considered quite as important as good teeth. A soldier may have good feet, good eyes and brains, but if he hasn't good teeth so that he may properly chew his food and keep well and strong, of what service will good feet, good eyes, and good brains be to him? For the reason that the soldier's health de-pends so largely on the condition of his teeth, good teeth are said to be a soldier's first and most necessary equipment. NEW HEALTH LAWS What the Legislature Did in the Inter-est of Better Health in North Carolina v^jIHE last General Assembly, backed !^L by Governor T. W. Bickett, en-a ™° acted probably more modern and progressive health legislation than any other General Assembly North Caro-lina has ever seen. While there were several pieees of valuable legislation which failed of passage, there was enough other good legislation enacted to amply justify calling this a truly public health Legislature. Chief among the new health laws enacted were a State-wide Quarantine Law. a Medical Inspection of Schools Law, a Rural Sanitation Law, a Law for the Prevention of Blindness, a Hotel In-spection Law, and a Law Requiring the Inspection and Hygienic Care of Prisons and Prisoners. The Quarantine Law Heretofore the individual towns, cit-ies, and counties were left to their own devices for dealing with or not 76 THE HEALTH BULLETIN dealing with contagious and infectious diseases. It is unnecessary to describe the chaotic, inefficient methods that obtained. The results are reflected in our excessive death rates from con-tagious and infectious diseases. After July 1, 1917, all cases or sus-pected cases of contagious or infec-tious diseases will be reported by the physicians in attendance or household-ers to a county quarantine officer with-in twenty-four hours, and each county quarantine officer will report daily to the State Board of Health. Rules and regulations governing quarantine of all cases of contagious diseases will be promulgated. By the time this Bul-letin reaches its readers copies of these rules and regulations will probably be ready for distribution. Medical Inspection of Schools Law Elsewhere in this issue of the Bulle-tin will be found a complete resume of this important law. Briefly, it pro-vides for the physical examination of every school child in the State every third year, and it even goes so far as to make a nominal appropriation as the State's part to assist in defraying the expenses of treating physical de-fects. By virtue of this law every school child may receive two physical examinations during his school life, and as a result thousands upon thou-sands of school children will be re-lieved of unnecessary physical handi-caps of bad teeth, defective sight and hearing, enlarged tonsils, adenoids, hookworm disease, and other defects which greatly reduce their physical and mental growth and the efficiency of our rising generations. The Rural Sanitation Law The cooperative rural sanitation law makes an appropriation of $15,000 an-nually to be expended in the ratio of $1 for every $3 from other agencies. As a result of this law, effective co-operative health departments will be established in a number of counties and maintained in part from this fund, in part from funds from the Interna-tional Health Board, and in part from the respective counties in which these health departments are established. As the work becomes more thoroughly established, the support of the State will be gradually withdrawn in order to establish it in other counties. In this way well organized county health departments will ultimately be estab-lished in every county in the State. Prevention of Blindness The Legislature also enacted a law which provides for the proper treat-ment of the eyes of all new-born babies with a solution which effectu-ally prevents infant blindness. To make this law effective and to place the proper solution in the hands of every physician and midwife in the State requires an appropriation of $3,000. The net result will be the sav-ing of the sight of from 25 to 35 babies every year. The wisdom of this law is more apparent when it is considered that by this means the State converts a person, needlessly blind for life and who is always more or less of a charge upon the State and society generally, into an active productive person for life at an initial cost of only about $100. Hotel Inspection Law Through the efforts of the traveling men of the State a law was enacted requiring the State Board of Health to inspect and grade the sanitary condi-tions of all the hotels and restaurants. This is a very complete law, and it deals with practically every phase of the hotel question. It will do much toward improving the safety and com-fort of traveling, as well as to im-prove the general sanitary tone of the State. THE HEALTH BULLETIN 77 Prison Reform Law The new prison reform law is a landmark in human progress in North Carolina. It represents some of the most important advances in the hu-mane treatment of prisoners North Carolina or any other State has ever seen. It provides ample opportunity for those in charge of prisoners, pris-ons, jails, convict camps, and other places of confinement to reform and return true, valuable men and women to take responsible places in society, instead of grinding down the unfortu-nates with endless hard work under conditions anything but favorable to-ward their reformation, uplift, and proper training. While the State Board of Health had nothing to do with the promotion of this law, this board is made responsible for the san-itary and hygienic care of prisons and prisoners, be they city, county, or State institutions. MEDICAL INSPECTION OF SCHOOL CHILDREN Law of State-wide Application Passed by the Recent Legislature ly^jjHANKS to the untiring efforts of l ^^J Governor Thomas W. Bickett, the GMM iast General Assembly enacted a law providing for the medical inspec-tion of all school children in North Carolina every three years. The State Board of Health and the State Superintendent of Public In-struction are charged with the respon-sibility of executing this law. One-third of the State's counties accord-ing to population will be chosen this summer for beginning this work. The commissioners of each county will be required to pay a physician for the work. The physician must be selected by the Board of Education of each county. The State Board of Health 2 must be notified at once of the selec-tion of such physician. The teachers will be supplied with blanks by the State Board of Health and a compe-tent physician will instruct them how to fill out these blanks, one for each child in school. This work must be done at the time specified by the State Board of Health and the State Super-intendent of Schools. When the teacher completes his or her part of the work, the information contained in this record must be placed in the hands of the official in-specting physician. He in turn must have brought to a central point, not more than ten miles from each child's home, on Saturdays, as many children as he can carefully examine. The physician will require something like ten or twelve per cent of the total enrollment, including the children most in need of treatment, to be brought for examination. At the time of such ex-amination the physician must make a record of his findings and send a copy to the State Board of Health, and also give the parent or guardian specific advice as to the necessity for correcting any physical defect within the scope of this examination. After all the children have been ex-amined (one-third of the State each year), the State Board of Health may divide the sum of ten thousand dol-lars pro rata, according to school en-rollment, among the counties covered in the work each year, provided the county commissioners will provide an equal amount and the total sum does not exceed 40 per cent of the amount needed for treating the defective chil-dren. The balance of money neces-sary for paying physicians, dentists, specialists, etc., for this work at re-duced rates must, of course, be fur-nished by parents or from other pri-vate sources. This law provides for the careful examination, by a good physician, of at 78 THE HEALTH BULLETIN least twenty-five thousand defective children each year, and enables the State to put up one-fifth of the cash in providing a fund of fifty thousand dollars per year for getting these chil-dren treated. Not much, it is true, but just that much more than has ever been done before; and with the cordial and sympathetic cooperation of the authorities and people of each county it means the difference between misery and suffering, and health and happi-ness to twenty-five thousand children each year. The law makes no discrimination between the poor and the well-to-do; nor between the white and colored races. All are treated alike. THE BACKWARD CHILD Medical School Inspection a Friend to Backward Children ijTl HAT is really meant by the back- J^ ward child? It means a child ™™ who has begun to attend school, who fails to learn as other children do, and who, at the end of the term, is turned back to repeat the course. Backward children are usually regard-ed as mentally deficient, but the fact is they are usually either diseased or physically deficient. In this country there are said to be 20,000.000 children of school age, about 3,000,000 of whom are called "repeat-ers" because they remain in one grade at school more than one term. These children, however, are not "repeaters" by the will oc an inscruta-ble Providence, but rather by the law of cause and effect. Their physical condition is at fault. It may be that they have bad teeth and pus forming gums that are filling their systems with poisons that are diseasing, their eyesight is at fault, or that their hear-ing is bad, or perhaps they have dis-eased tonsils, or adenoids. Dr. A. C. Bulla, medical school inspector for the State Board of Health of this State, says that he finds at least 18 per cent of all school children suffering from defects of the eyes, ears, nose, and throat. Doctor Bulla believes that such de-fects as any one of these not only hin-ders a child in school, retarding his education and causing him to be called backward or a repeater, but that it goes with him through life, severely handicapping his efforts and crippling his efficiency. Furthermore, Doctor Bulla believes that the best time to remedy such defects and diseases is when the child is in the first, second, or third grade at school, before these defacing defects such as adenoids, bad teeth, or defective eyes, have gotten in their ugly work, and while they are yet in the stage when removal or cor-rection will be the most easy and ef-fective. Medical school inspection work is a feature of public health work done by the State Board of Health just to this end: to discover and remove these handicaps to health and education at a time when the results will be most valuable and easily accomplished. Last year three counties made provision for this educational health work, with the result that 10,000 children were ex-amined for defects of the eyes, ears, nose, throat, teeth, and for communi-cable diseases. This year six more counties, including a number of indi-vidual schools and communities, have made arrangements for this work, and thousands of school children are being benefited. Next year approximately one-third of the State will have medi-cal inspection of school children ac-cording to the new law proposed by Governor Bickett. Parents are coming to know what health means to the proper development of their children, and how to proceed that their children may have it. THE HEALTH BULLETIN 79 MAKE A DATE FOR FREE EXAMINATION Sanatorium Will Charge Fee of $5 for Tuberculosis Examination Unless Patient Makes a Date O HE State Sanatorium for the Treatment of Tuberculosis will continue to give examinations tuberculosis free to the people, ME for provided that physicians sending pa-tients there or the patients themselves write beforehand and make an en-gagement; otherwise a fee of $5 will be charged for such an examination. Another requirement connected with this free service is that patients pre-sent themselves between the hours of 8 and 11 a. m. on the date set for them; otherwise, they will not only have to wait till the next day for an examina-tion, but will also be charged the fee of $5. This ruling has been made necessary for the reason that so many people now demand this service, and at times such large numbers present them-selves for examination as to greatly interfere with the regular medical work of the institution. Besides, when the examinations are made out of regu-lar office hours or at any time the pa-tient happens to arrive, it works ex-cessive hardship on the medical staff and demands a service which the in-stitution is not able to meet. Last year 411 such examinations were made, and the indications are that a far greater number will ask for the serv-ice this year. ONE FOR PREVENTION; ELEVEN FOR CURE The United States is at the present time spending more than thirty-three million dollars yearly for the cure and care of patients afflicted with mental disease, and comparatively nothing for prevention. And yet the perusal of the report of almost any State hospital will show that in about 50 per cent of the cases admitted the mental disorder is due directly to definite causes which are clearly preventable. For instance, North Carolina expends $650,000 annually for the care of her insane and delinquents, and $55,500 annually for prevention. Where the State spends $1 for the prevention of disease it spends $11.60 for the care of the insane and delinquent. Much of insanity and delinquency has a preventable basis. Sixteen per cent of the insanity is due to syphilis. This means that there are 500 in-sane people in our asylums as the result of syphilis alone. The annual per capita cost of these 500 people is $170. Therefore, for the care of the syphilitic insane alone the State is spending 500 x $170, a total of $85,000 a year. Twenty per cent of insanity is traceable to alcohol. If this per-centage holds good for North Carolina, we have 600 insane in our asylums as the result of alcohol, the annual per capita cost being $170, making our bill for taking care of our alcoholic insane 600 x $170, a total of $102,000 a year. From 5 to 10 per cent more are func-tional disorders which probably could have been prevented by early treat-ment. Proper posture and carriage, with shoulders square, chest arched, head erect, and body well stretched from the waist up, will of its own account contribute much toward relieving our people of the many petty and not a few of the serious ills from which they are now suffering. It is the founda-tion of robust health, and should be insisted upon in children from the very beginning until it becomes a habit, and as such will displace the disease-breeding "slouchy" habit now so prev-alent among people of all ages and stations. i,.',i, i^r PUBLIC HEALTH and SANITATION THE COMMON HOUSE FLY The Best Way to Have a Flyless Home j^lOUSE FLIES used to be one of £~± the commonest things to be found ^™ in our kitchens and dining-rooms in the summer time. While they are not even now getting to be rare, they are not quite so common as to quan-tity or number but "exceedingly com-mon" as to quality. Chief among the reasons why the house fly is getting into such bad repute is because we are beginning to know him better. We are learning about his nativity—his ancestry and place of birth—the man-ner and method of his bringing-up, and, finally, about his every-day habits and mode of life. The Story of the Fly Instead of considering him a nice, clean, respectable little pet, as we once did, we know that his mother laid the eggs from which he and perhaps a hundred or more of his companions were hatched in some accumulation of warm, moist manure, waste, or de-caying filth. For fly eggs to hatch they must be laid in some kind of de-caying organic matter and supplied with a certain amount of heat and moisture. In from eight to ten hours they hatch into tiny white, squirming, wiggling maggots which burrow down into the manure or filth in which the eggs were laid. After from six to eight days, these maggots grow a shell or coating somewhat like a very small wheat grain in appearance. In two or three days more this shell opens and a full-grown fly emerges. While the fly is still wet and slippery, he bur-rows and works his way up through the manure to the open air. The Danger of the Fly The fly is no longer considered harmless. Instead of thinking of him as merely a tickling, crawling, both-ersome pest, we know him to be a car-rier of filth, a spewer and spreader of the vilest and deadliest poisons and disease germs. His daily habits of life lead him to feast on almost any-thing from manure, tuberculosis spu-tum, pus, or typhoid dejecta to cake, candy, pie, milk, sugar, or butter. The cost of his maintenance for food, how-ever, is trifling. We base one of our main objections to him upon the fact that his digestive tract is so simple and his digestive liquids so weak that typhoid, tuberculosis, or other germs eaten by him pass out an hour or two later unchanged and are deposited, frequently in a liquid and invisible form, on baby's face, lips, and hands, or on our food, dishes, and furniture. The common house fly, or typhoid fly, has lost caste not only because we know that over ninety per cent of his kind were bred in manure piles and open privies, or because he feasts on the vilest filth and later deposits it on our food, or because we know that he vomits up such material to dissolve such solids as sugar, and later eats the entire mixture, but also because we have found that the very hairy nature of his body and legs enables him to carry tiny quantities of nasty, nauseating, and disease-laden material to our food and drink. THE HEALTH BULLETIN 81 Remedies The question of prime importance is, What are we going to do about it? Theoretically, it is possible to clean up and keep so clean that flies cannot find sufficient decaying organic mat-ter in which to breed. To a large meas-ure this is practical in certain cities. Unfortunately, it is not practical in the country or in most of our villages and small towns, though undoubtedly a great deal can be done by proper means of cleanliness around stables, privies, hog pens, and other places toward controlling and reducing the number of flies. Ordinarily, it matters little how clean certain farms, homes, or premises are kept. Almost always there will be some near-by slothful, filthy neighbors who will breed enough flies for an entire county. For these reasons our present methods of ordi-nary cleanliness are far from being entirely successful in the fight against flies. Fly traps, particularly large fly traps, around barns, stables, grocer-ies, or placed on garbage cans, or other places where flies breed or fre-quent in large numbers, have been found to greatly reduce the fly popu-lation. Fly poisons, such as formaldehyde in the proportion of two tablespoon-fuls of formaldehyde to a mixture of a half pint of water and a half pint of milk, have been found to kill large numbers of flies, but flies will not drink such poison if other water or drink is available. Furtherfore, there is usually a certain element of danger in having fly poisons around the home. The Best Remedy By all odds the cheapest and the most effective means yet found for successfully combating the fly evil is THOROUGH SCREENING OF THE HOME AND PLACES WHERE FOOD IS HANDLED from April 1st to De-cember 1st, and swatting at least once a day the few stray flies that dodge in as the doors are opened. It is not sufficient to screen the doors and win-dows of the kitchen and dining room, or of the downstairs only. The back porch, where much of the food is pre-pared, should by all means be screened. Again, it is quite important that the upstairs windows be screened, as in-coming flies will follow the scent of savory or cooking foods and come down the stairway in discouraging numbers. Do not use cheap, ineffective exten-sion screens. They rarely fit the win- A Bad Type of Screen Extension screens rarely fit fly-tight. Flies get in between the screen and the lower sash, as shown by the lower set of arrows. They also work their way up between the upper and lower sashes and enter, as shown by the upper arrows. dow and make it fly-tight, and they al-low flies to come in between sashes. Wire screens, particularly those pro-tecting the entire window, are best. The present retail market price (March, 1917) of black is about two cents per square foot, and three cents per square 82 THE HEALTH BULLETIN foot for galvanized wire. Such screens will usually last from five to ten years, or longer. Where the cost of good wire screens seems prohibitive, excel-lent results may be obtained by the use of ordinary mosquito netting. Such Window Effectively Scr;ened "With Mosquito Netting The mosquito netting is secured at the top and sides by means of small three-quarter round mouldings or by tacks. It is unfastened at the bottom and left about eight inches too long. This permits closing the shutters from the inside. Such a screen costs about twenty cents. netting costs about 75 cents per bolt of eight yards in length by fifty-eight inches wide. A very effective and in-expensive method of screening with mosquito netting is to tack it on to the outside of the window frame or by tacking or fastening it with cleats or what is called three-quarter round moulding, to the outside window stop. Such moulding costs about a quarter of a cent a foot. Wherever it is de-sired to open and close shutters from the inside, cut the piece of mosquito netting six or eight inches longer than the window is high and leave it a bit "full" or loose at the bottom, so that' the shutter may be operated from the inside at will, as is shown in the ac-companying cut. Such mosquito net-ting screens will last from one to three years. For the doors there is nothing bet-ter than well fitting made-to-measure or machine-made screen doors well braced, carefully hung, and provided with spring hinges. Very satisfactory wire screen doors can be obtained for as little as $1.25, while the spring hinges and fasteners cost 25 cents more. The Finishing Touch—Swatting With the back porch and every door and window screened, the household will be practically free from the dan-gers and inconveniences of flies. What few flies find their way in as the doors are opened may be killed off once or twice a day by swatting. Thorough screening not only ex-cludes flies, but it also excludes mos-quitoes and prevents the danger of malaria. Once a decent, self-respect-ing North Carolina family enjoys the benefits of screens in the home, there will be no return to the dangerous, disgusting condition of common house flies. HOW' DISEASE GERMS LIVE AND GROW Dr. Be.vj. K. Hays, Health Officer of Granville County. It was formerly believed that the poison germs or virus which produce disease would live for long periods of time outside the body. It was believed that this poison would attach itself to furniture, books, and clothing, and THE HEALTH BULLETIN 83 that it was possible to contract a dis-ease by handling one of these articles years afterward. We used to hear of how people contracted yellow fever by handling a lock of hair from a per-son dead with the disease, and of how children contracted diphtheria from the toys of other children long since dead of diphtheria. We heard of how people contracted consumption from books that a consumptive had handled years before. A more accurate knowledge of the life history of disease-producing germs has changed our ideas of such things. So long as the old ideas con-tinue to prevail the contagious dis-eases will continue to claim our loved ones. Just as soon as we learn the truth about contagious diseases (pro-vided we live up to our knowledge) they will cease to appear in our midst. When germs leave the human body they tend to die. The life outside the body depends upon three things, viz., light, air, and moisture. Light and air tend to kill the germs. Moisture helps to keep them alive. Germs with-out moisture exposed to the direct rays of the sun live only a few hours. Germs without moisture in a well lighted and ventilated room, but not exposed to the direct rays of the sun, live only a few days. Germs embed-ded in sputum and deposited in the direct rays of the sun may live for two or three days. Germs imbedded in sputum and deposited on the floor of a well lighted and ventilated room, but not exposed to the direct rays of the sun, will live for two or three weeks. Germs imbedded in sputum and de-posited in a dark room, especially in the cracks of a floor that holds the moisture, may live for six months or longer. The poison (or germs) of diphtheria," measles, scarlet fever, whooping cough, tuberculosis, and typhoid fever do not grow outside the body except in one place, and that is in milk. It is well to remember that when disease-producing germs find their way into milk they will grow and reproduce there. It is also well to remember that horses and cats are sometimes subject to diphtheria, while almost all of the lower animals are subject to tuberculosis. From what has been said, it is clear that the sick room is not a common means of spreading disease. Let us suppose that one of the above named diseases has been present in a room. The patient is now up and out. All bedding, carpets, rugs, curtains, and other articles which hold dust have been taken out and boiled or sunned. The furniture, floors, and walls have been scoured with soap and water. The room is then thrown open to air and dry. Such a room may be con-sidered perfectly safe after two days. A moderately well cleaned room is safe after two weeks, while a room that is dark and without ventilation is never safe. How are contagious diseases spread? In nine cases out of ten it is by the passing of moisture directly from the mouth of one individual to that of an-other. This is done by coughing or sneezing into the faces of others; by the use of the common drinking cup or dipper; by the damnable habit of promiscuous spitting; by kissing upon the lips; by the use of towels, hand-kerchiefs, and napkins that have been used by others; by flies; by saliva upon the dirty hands of persons hand-ling food; by children carrying mar-bles and coins in their mouths, and by the passing of any substance from mouth to mouth. It may seem a simple thing to stop all of these things. When they are stopped it will save more than five thousand human lives in North Caro-lina every year. ffOBERCULOSlS ON EARLY DETECTION OF TUBERCULOSIS Case History, Temperature Record, Sputum Analysis, and Exami-nation Necessary <p\| OTHING aside from prevention *j^l is so important in the fight ™" against tuberculosis as an early diagnosis. But in spite of its impor-tance only about fifteen or twenty per cent of the one and a quarter million cases in the United States are diag-nosed in the incipient stage. This is due not so much to the fact that pa-tients don't apply for diagnosis and treatment until the disease is past its incipiency, as to the failure of the pro-fession to make the diagnosis until the patient is beyond the curable stage. This statement is corroborated by the experience of other sanatorium work-ers, and it is all the more serious when a close study of the situation reveals the fact that this failure to make an early diagnosis is due very largely to carelessness, to a failure to employ all the ordinary methods which are within the reach of every physi-cian. The four essentials in diagnos-ing tuberculosis are a careful history of the case, a proper temperature rec-ord, a sputum analysis, and a physical examination. An accurate history is very impor-tant, and a synopsis of the most prom-inent symptoms and of the course of the disease should always be recorded. Some authorities claim that a good history is of as much value as the physical examination. In early tuberculosis the sputum ex-amination rarely reveals the tubercle bacillus. Sanatorium records show that from 70 to 80 per cent of incipi-ent cases show negative finding. So that unless it is positive, a single sputum analysis is of little diagnostic value. The physician who will rule out tuberculosis because of one nega-tive sputum examination is criminally negligent of his patient's life. But it is of extreme importance that when-ever any expectoration is present that it be examined, because a positive find-ing will confirm the diagnosis. And in case of a negative report, it cannot be emphasized too strongly that at least five or six examinations should be made on successive days and the procedure repeated every month as long as the expectoration continues or until the bacilli are found. There is nothing in all the realm of medicine more characteristic than the subnormal or normal morning tem-perature with the afternoon or eve-ning rise in active tuberculosis. To such an extent is this true that the thermometer, properly used, is all that is needed in the large majority of cases to make a diagnosis. It is only natural that tuberculosis should often be confused with malaria and typhoid fever when the physician has no rec-ord of the temperature save at the time of his daily afternoon visit. If he would spend only a few minutes in teaching some one in the home how to take the temperature, and have it re-corded every two hours, the character-istic curve in tuberculosis would make clear the true nature of the disease. THE HEALTH BULLETIN 85 No chest examination is worthy of the name unless the patient is stripped to the skin above the waist line. The examination should be systematic, and the various methods of inspection, palpation, percussion, and ausculta-tion should be applied each in its turn to the whole of the chest. One frequent source of error consists in having the patient only open his shirt instead of removing it, and in limiting the exami-nation to the front of the chest. If there were a likelihood of one's house being on fire, who would be satisfied with anything short of a thorough search of the whole house, that the fire might be located and extinguished before the flames should become un-controllable? The victim of tubercu-losis has not simply his property, but his life at stake, and can we as guard-ians of his health and of his life put our consciences at rest until we have made a careful search over the whole of his chest, both front and back for every possible focus of infection? The most important feature of the chest examination and the one most frequently neglected is to have the patient cough. It is during the deep inspiration following the cough given at the end of expiration that adventi-tious sounds in tuberculosis are most frequently elicited. Oftentimes this cough will reveal rales in early tuber-culosis when all the other findings are normal. Since tuberculosis is many times the most common of all diseases, and since it is responsible for one-tenth of all the deaths and about one-third of all the sickness in the human race, let me urge, in conclusion, that the profes-sion adopt an attitude toward the great white plague of eternal vigilance and suspicion, and always eliminate tuber-culosis before making any other diag-nosis.— Dr. P. P. McCain, Sanatorium, N. C. 3% 8% 24% 34% 27% 17% 10% 5% 2y2% %o% TUBERCULOSIS CAUSES of all deaths below the age of 5. of all deaths ages 5 to 9. of all deaths ages 10 to 19. of all deaths ages 20 to 29. of all deaths ages 30 to 39. of all deaths ages 40 to 49. of all deaths ages 50 to 59. of all deaths ages 60 to 69. of all deaths ages 70 to 79. of all deaths ages 80 and over. 86 THE HEALTH BULLETIN FOR BOARDING HOUSES AND SANATORIA Rules Governing' Boarding Houses and Sanatoria for Tuberculous people. As to the rules and regulations gov-erning boarding houses and sanatoria for tuberculous people, the following requirements constitute the minimum standards as prescribed by the Tuber-culosis Directory, recently issued by the National Association for the Study and Prevention of Tuberculosis: 1. Provision for outdoor sleeping, either on sleeping porches or other-wise. 2. Sputum cups or similar devices must be used by patients and proper disposal of such sputum containers and sputum made. 3. The building or buildings must be clean, sanitary and in good repair; they must also have running water and suitable means of sewage disposal ; they must be adequately protected against fire. 4. Each room must be thoroughly cleaned and disinfected at regular in-tervals and before being used by an-other patient. The bedding must also be disinfected and aired before being used by a new patient. 5. Food must be of good quality, and the diet must include fresh milk and eggs. 6. Provision must be made for regu-lar monthly visits of inspection by a physician. All patients must be under the care of a physician. 7. Provision must be made for nurs-ing supervision of all patients, and for nursing care of patients who are bed-fast. Beware of pills and purgatives. They are habit-forming drugs. They should only be used like opium, or other habit-forming drugs, under the direct guid-ance and control of an intelligent and conscientious physician. FRESH AIR FOR SICK AND WELL The open-air treatment has been 100 much confined to the sick. Why should we force healthy, normal chil-dren, by compulsory education laws, into closed rooms, to breathe exhaled air from the lungs of forty or fifty of their fellows, and wait until the gen-eral health is undermined before con-structing open-air schools in which to restore them to vigorous health? Na-ture intends that children shall breathe fresh air, with its natural moisture content, not baked and pol-luted air. A most ridiculous propo-sition is the present-day method (in vogue in many city school systems) of pumping outside air over superheated steam coils and forcing it, dried of all natural, life-giving qualities, into the classrooms of modern school build-ings. And with what result? That your child and your neighbor's child sit for five hours a day in human dry-ing- kilns, with the warm, dry, thirsty air sapping most of the moisture from their little bodies. NECESSARIES FOR EFFICIENCY AND HEALTH The necessaries for the efficiency and health of an ordinary agricultural or of an unskilled town laborer and his family in this generation may be said to consist of a well-drained dwell-ing with several rooms, warm cloth-ing, with some changes of undercloth-ing, pure water, a plentiful supply of cereal food, with a moderate allow-ance of meat and milk, and a little tea, etc.; some education and some recreation; and, lastly, sufficient free-dom for his wife from other work to perform properly her maternal and her household duties. If in any dis-trict unskilled labor is deprived of any of these things, its efficiency will suffer in the same way as that of a horse that is not properly tended or a steam engine that has an inadequate supply of coal. — Alfred Marshall. HILDJIYGIME DENTAL HYGIENE The Care of the Teeth Iv^jIHE coming of baby's first tooth l^jjL is heralded as a great event — GHEI which it really is; yet the mother may be astonished when advised that the day after this tooth makes its ap-pearance is not too soon to commence the regular cleaning, which she must persistently continue until the child itself is old enough to realize the value of these "mouth jewels." If neg- EVERY MEMBER OF THE FAMILY ^SHOULD FORM THE HABIT OF BRUSHING THE TEETH THEFIRSl THING IN THE MORNING AND THE LAST THIN6 AT NIGHT. lected, the temporary teeth may be lost before the little jaw has grown sufficiently to accommodate the larger teeth of the permanent set, and crowd-ing will result—a condition not only unsightly, but also very conducive to decay. Many lines and wrinkles de-tracting from the beauty of the face may be traced to toothache—which is only another name for tooth-neglect. When the toothache signal is sounded it may be too late to save the tooth, but you should consult the dentist im-mediately and not decide to have your child's tooth extracted until, with the help of the dentist, you have taken every means to save it. Baby's first toothbrush is home-made. It is the mother's finger wrap-ped with soft linen and dipped in a solution of bicarbonate of soda, a tea-spoonful to a glass of water. It should be very gently used in cleaning the little tooth and gums. When baby has two teeth, side by side, a small, narrow, soft-bristle brush should also be used to remove the food particles which collect be-tween the teeth. See the Dentist Early The crowns of the teeth, with their beautiful enamel covering, are fully Eormed when they appear in the gums. It is very important that the mother should have the molars examined by the dentist as soon as they are fairly in place. Sometimes there are minute fissures in the enamel surfaces (es-pecially with the six-year molars) which require filling when the teeth first appear, but generally a perfect protection is given by keeping the enamel clean. At the Marion School in Cleveland, Ohio, an experimental class was formed of several backward or defi-cient scholars. Tests, both as to phys-ical and mental condition, were con-ducted before and after the teaching of tooth care was begun. So success-ful were the results obtained with this class in proving that the care of the teeth is necessary to good school work that particular attention is now given to the condition of the mouths of the pupils in the Cleveland schools. That general health demands proper tooth care is again forcibly expressed 88 THE HEALTH BULLETIN by a noted U. S. Army surgeon who states that "failure to care for the teeth is the direct cause of more dis-ease than any other single cause." The behavior, too, of a child is nat-urally affected by the condition of his teeth. The President of the New York, Juvenile Asylum is quoted as saying that "more than 90 per cent of the boys come to us with bad teeth"—in brief, bad teeth make bad boys. Proper Care of the Teetli Decay of the teeth is due to the de-velopment of bacilli in the human mouth, producing an acid which grad-ually eats away, first, the enamel, and then, much more rapidly, the dentine exposing the pulp, which speedily be-comes inflamed. Decay thus once started can never be stopped until it is eradicated from the dentine and the teeth are filled. Since the tooth structure grows denser with age, the ravages of decay are greater in youth—all the more reason for impressing young people with the importance of the faithful use of brush and dental cream. The bacilli increase and do their work in direct proportion to the neglect of thorough-ness of cleaning—conditions being more favorable for their development in some individuals than in others; but if all the cracks and fissures of the enamel are properly filled and the teeth are kept thoroughly cleaned there will be no decay. Brushing the Teeth Do not brush the teeth straight across. The outside of the upper teeth should be brushed downward from the gums; the lower teeth upward. Clean the inside of your teeth—next to your tongue—in the same way. The part of the teeth used for chewing food (the grinding surfaces) should be brushed in all directions. After each meal use a soft quill toothpick or floss silk to remove bits of food from between the teeth. Decay causes the teeth to ache, so by preventing decay you prevent pain. The best way to stop decay is to keep the teeth clean. Twice a year is none too often to see your dentist. DON'T DOPE THE BABY WITH PAREGORIC Among the baby killers there is nothing so deadly as dope. In some households it is the custom to keep paregoric on hand for an emergency. Some mothers are thoughtless and careless enough to dope their babies with this drug whenever they cry. Occasionally a mother is so heartless and even criminal that she will dope her baby to make it sleep while she works or goes calling. Paregoric contains opium, and ba-bies are very susceptible to opium or its alkaloids, the chief of which are codein, heroin, and morphine. Careless dosing with such drugs has sometimes killed babies or led to other very seri-ous consequences. Among other ill effects, opiates profoundly affect the digestive processes by retarding the secretion of digestive fluids. A baby's digestion is too important a function to be tampered with in this fashion. Perfect health, often even life itself, depends upon an unimpaired digestion. If cattle breeders believe that "scrub stock" is unprofitable, certainly hu-manity has a greater interest in hav-ing every child well born, free from hereditary diseases, and of parents whose habits are and have been free from drug, alcohol, tobacco, and other harmful influences and agencies, as far as possible insuring a sound mind and a sound body to the little stranger. THE HEALTH BULLETIN 89 TEACH OUR CHILDREN HOW BEST TO LIVE At college I saw fortunes spent every autumn to teach football candidates how to elude opposing tackles, but not a cent to teach them how to elude tuberculosis, typhoid, pneumonia, or cancer. We were required to dig out Latin roots and to unkink logarithmic PVERY MEMBER OF THE L, FAMILY SHOULD HAVE /{ TOOTHBRUSH AND USE IT. TEACH YOUR CHILDREN 7 THE TOOTHBRUSH DRILL. gnarls, but there was not required a course in intelligent living. There was a perennial, concerted, rock-ribbed, steel-girt conspiracy of silence against the human body. The educational system frowned upon bad taste in deportment, manners, lan-guage, and literature, but bad taste in life itself was quite the proper thing. It was deemed more important to know quadratic equations than the simple fact that to sleep healthily in a room where the sunbeams never enter is as suicidal as a nibble of cyanide, albeit somewhat slower. Long before New York's public school children of today learn how to decline "amo" they are taught to de-cline indiscriminate kisses. Long be-fore they learn how Gettysburg was fought, they learn how fire is fought. The toothbrush drill precedes the first spelling drill. They learn the intelli-gent way to sneeze or cough. Long before they take up the avenues of Caesar's entrance into Gaul, they are instructed in the avenue of entrance of regiments of bacilli into the human body. Gotham's tots learn the neces-sity of frequent airing of bedding, the proper cleaning of ice boxes, the cura-bility of phthisis. No longer the pa-thetic spectacle of Alice in Blunder-land. When Alice reaches the age of six and matriculates in New York's public schools she is now ushered at once into the wonderland of genuinely useful knowledge of her wisp of a body. And it begins to look as if the public schools of the future were to be a vast system of service stations on the highway of human life.—Newton A. Fuessle, in the Craftsman. BETTER BABIES—BETTER TOWNS The country-wide campaign for "bet-ter babies" has taken a new twist. Cities engaged in the work of lowering the infant mortality rate are using the results obtained to advertise the de-sirability of the home town. It is being pointed out that a city where the infant mortality rate is low is a good city to live in. Local boards of trade and similar or-ganizations, in conducting a campaign to boost the home town, have hitherto enlarged upon its broad avenues, its schools, its churches, its hospitals, its parks, but not a word has been said as to its infant mortality rate. This is a mistake. The best "talk-ing- point" for any community is now believed to be its infant mortality rate. If the rate is low, the community must be regarded as a healthful one. If it is high, the community is a dan-gerous one. While all the inhabitants of a city, old as well as young, are affected ad-versely by insanitary conditions, they react most severely and most notice-ably among infants under one year of age. That is why the infant mortality rate of a city may be regarded as an index to the community's sanitary status. — Wisconsin Health Bulletin. 90 THE HEALTH BULLETIN WEIGH THE BABY ONCE A WEEK Watch baby's weight carefully during the warm weather. If he does not hold his own or if he begins to lose weight something is wrong and it is time to call a doctor. To keep accurate tab on baby's weight the mother must weigh the child regu-larly. By comparing results she can tell if baby is thriving or losing weight and health. To weigh the baby, undress him and put him on the pan of the scales, which has first been covered with a clean light cloth or sheet of paper. After carefully weighing him make a note of the result. The weight of the average baby at birth is about seven pounds, boys being slightly heavier than girls. Still, a healthy baby 'may weigh as little as five or six pounds, or, on the other hand, as much as ten or twelve pounds at birth. These weights, however, are the exception. In the first few days after birth there may be a slight falling off in weight, but in four to ten days this loss is all re-gained and from then on the baby should show a constant gain. But a baby that gains weight too rap-idly is not always a healthy baby. The ideal in baby feeding is not to produce a fat baby, but a proportionately and well nourished one. The aim is to grow mus-cle, bone, blood and nerve tissue, not merelv fat. BABY SHOULD HAVE FRESH AIR Let fresh air blow health blossoms into the cheeks of your baby by keeping it in the open air all day during the hot weather. If you can arrange it let baby sleep out of doors on the porch, in the yard, or, if nothing better affords itself, near an open window. But always be sure that baby is shaded from hot, glaring sun, and protected from dust, strong winds and flies. A big clothes basket makes a splendid < outdoors "bed" for baby. Cover it with mosquito netting and place it in the yard or on the porch. Remember that babies must be kept quiet and that they require lots of sleep. ! Up to three years of age a child should sleep twelve hours at night and should have naps, both morning and afternoon. But baby should sleep alone and on a bed and with bed clothes that are clean, perfectly clean. Whether sleeping indoors or out of doors, cover the bed or crib with netting to keep out flies and mosquitoes. BATHE BABY EACH DAY OR OFTENER IN WARM WEATHER A bath every day for your baby will help to keep the doctor away. But on hot summer days a sponging off with lukewarm water two or three times a day is necessary to keep baby cool and comfortable. The water for baby's daily bath should be about body temperature or a degree or two higher. It is best to use a ther-mometer to determine the temperature. Always give the bath before baby's feeding time—never immediately after. When washing baby be especially care-ful to cleanse the body creases. After drying baby thoroughly, dust with talcum powder, but be sure it is of good grade. A city may be justly accused of criminal neglect that does not, when it can, pro-vide for a complete system of up-to-date school inspection, and thus permits per-petually in the schools, the existence of diphtheria, scarlet fever, measles, whoop-ing cough, mumps, chicken-pox, small-pox, pneumonia, parasitic affections, etc. Most of these are too frequently, alas, followed by a trail of death and grief. From the schools infected these diseases scatter among the people. THE PREVENTION OF PELLAGRA And How It May be Done by Decreas-ing the Cost of Living ; W By Edward J. Wood, Wilmington, N. C. ^p]N former times in Italy, which r~* was the home of pellagra, it was *BBi gaj^ that pellagra and poverty were interchangeable terms, and this was certainly true there and else-where. Today, in the light of recent investigation, it can be shown that the poor man can decrease the cost of his food and insure protection of his fam-ily against this scourge. Dr. Goldberger, of the United States Public Health Service, has proven that pellagra is due to unsuitable food; that it is not a poisoning, but a deficiency of certain essential substances which are normally present in our food. Modern Milling Responsible We have proven in North Carolina that it is safe to go a step further in these observations of Dr. Goldberger and find that some of the errors of modern civilization are really at fault. The appearance of pellagra was marked by numerous abuses in our manner of living which did not occur fifty years ago. Today our people think too much of ease and appear-ances. It is not always the pretty food which is safest, nor is it always the beautiful white flour of wheat or corn which gives us what our bodies demand if they are properly nour-ished. Modern milling methods are largely responsible for pellagra. If the old-fashioned mill of fifty years ago was now in use we would see pellagra disappear as rapidly as does ship scurvy when the sailors reach port and fresh fruit. The milling of today aims largely at a product which by its appearance will tempt the buyer. The dirty portion of the grain lies on the outside and is dirty in color be-cause of its composition. But this cortical layer contains a complex body or group of bodies which cannot be dispensed with without the appearance of certain disease conditions. This body is known as vitamin. Little is known of it except that it is one of the most essential bodies to life. It occurs in the outer layer of rice, and when rice is polished it is rubbed off, and as a result the consumer develops beriberi. The reader will ask, why, then, are there no more cases? The answer is that by the conservation of nature other foods make up the deficit. In those who live on one grain, as do the coolies of the East, beriberi re-sults if that one grain is deficient' or polished. In the South such condi-tions as living on one food alone are unknown, and so we do not have beri-beri, but we do have pellagra, which, in my opinion, is due to a partial in-sufficiency. Our wheat is ground in such an ele-gant way that the outside is discarded because of its dingy color, and so the cattle get what our children are dying for because of appearances. In the 92 THE HEALTH BULLETIN case of corn the matter is more exag-gerated. We have proven that the heart or germ of the corn contains practically all of the vitamin. We have produced experimentally in pigeons and chickens beriberi by feeding corn meal made after the plan of first re-moving the germ or heart. We have cured the condition by later feeding the portion of the grain removed. We know that this heart contains much fat and that the process of manufac-ture whereby this heart is removed was introduced because the meal made of the whole grain does not keep well and the dealers had much loss from rancid meal. When whole corn is ground at the water mill and we eat all of it we will never have pellagra, no matter how hard the times become. If we will buy from the grain dealers this heart of the grain which is called Corn Chops and make our bread of it, or add half or even a third to our ordi-nary corn meal, we will increase the nutritive value tremendously and be eating a much cheaper food. In the same way, if we will buy wheat mid-dlings or shorts and add a portion to our flour there will result the same protection. This decreases the cost of living very materially. It must be remembered that a clean mill can sup-ply us with clean corn chops or wheat middlings just as they supply clean meal or flour. We must not buy the sweepings of the floor, however. Soda and Baking-Powder Factors Another factor playing a most im-portant part in the production of pel-lagra in North Carolina is the use of soda and baking powder. Much has been done along this line by Professor Voegtlin of the Public Health Service, and it has been my privilege to confirm on man many of his views which are of the very first importance to the people of the South. I spoke above of ease, and I repeat that the love of ease is the chief cause of this second error. Bread can be made more rapidly and with a small fraction of work if these rising agents are used. When heat is applied in this manner of cooking car-bon dioxide is liberated, leaving be-hind a strongly alkaline preparation of soda which is very destructive to the vitamin. If sour milk had been used this danger would be largely off-set; but our country people as a rule do not use milk. Those who do are protected from pellagra in so many different ways that this article will not interest them. We are told that the alum baking powders have another danger of the same sort which cannot be dealt with here. The importance of the subject is to warn our people to eat yeast-raised bread, or kneaded or beaten, or old-fashioned hoe-cake or corn pone. Again, we see that a de-parture from the primitive plan has wrough great havoc. The cotton mill people have, in many instances, fallen into the pernicious habit of adding to all sorts of food soda or baking powder to hasten the cooking and to make the vegetables more tender. It is this class suffering most from pellagra today. Another pernicious practice is the uni-versal use of canned food. Vitamin is destroyed by an excess of heat, and these products are often exposed to an excess of heat in order to prevent any possibility of decomposition. One of my gravest cases in recent years was an old bachelor who had no serv-ant but a room full of empty cans was the silent witness to the source of his disease. Of course, canning done after the pasteurization plan is a very different thing and is to be en-couraged right now especially. The evidence is growing day by day in my work that the use of self-rising flour is a large factor in the production of pellagra. In the first place, the flour used is too highly milled, being thereby deprived of the essential sub- THE HEALTH BULLETIN 93 stance of vitamin. In the second place, the rising agents have a marked ten-dency to destroy the little vitamin which may have escaped the modern miller. It is not inconceivable that a self-rising product may be made which will not have this harmful effect, but it is much safer to avoid all such pro-ducts and return to Nature. Excessive Cooking Harmful Our people overcook nearly every-thing except those things needing much cooking, as do cereals, and these are universally undercooked. The choicest cuts of almost priceless beef and mutton are being cooked today in North Carolina to the point where every trace of vitamin is destroyed and, in fact, all the nutritious element is made worthless, leaving behind only those harmful extractives which we hear so much of in the causation of high blood pressure conditions. Cook your meats less, and then add to this rule a strong resolve to throw the frying pan out of the window. Apart from injurious effect of cooked grease on our digestive apparatus, an emi-nent New York physician has recently shown that the vehicle in which our food is cooked may destroy the vita-min. He found that by cooking orange juice in oil it would not protect the children from scurvy, while if the orange juice were cooked in water there was no loss of this power of protection. Therefore, we cannot af-ford to lessen the value of our precious foods by the addition of costly grease when we know that the grease in itself will cause a double danger. Nearly all the faulty methods of cooking in the South have been intro-duced to save trouble and work. It is to be hoped that the next generation of girls will be taught in the schools how to cook and how not to cook, and the reason why. An authority on this matter of cooking has said that the next best thing Mr. Rockefeller could do after the eradication of the hook-worm would be to send through the South a force of authorities to teach the people to discard the frying pan. If, then, our people will grow their own corn and wheat and take it in small amounts to the local mill and have it ground, and if our housewives will learn again the art of making yeast if too far away to get the manu-factured product, and if the soda and baking powder are thrown away, we will see the rapid disappearance of pellagra, our greatest scourge. It will matter then very little what the price of meat is, for we can do very well without it. The high price of wheat and corn will not affect us, and the waste in this new-fangled milling will not be charged up to us and our chil-dren. In addition to pellagra, the evi-dence is growing that many of our nervous disturbances are caused di-rectly by this faulty but beautiful food. Let our slogan, then, be, Back to the soil and the old water mill. TYPHOID AN ACCIDENT Court Ruling on Death From Typhoid Fever Sets a Precedent v^TlHE Supreme Court of the State of ^ Wisconsin has ruled that a victim ^**° of typhoid fever died an acciden-tal death and has sustained a verdict in his favor against the company that em-ployed him. The mere fact that the man took ty-phoid fever while in the employ of the company, would not constitute a charge that he sustained an accidental injury within tha meaning of the stat-ute. Rut the allegation goes further; it states that he contracted the dis-ease through drinking polluted water furnished by the defendant, and the presence of bacteria in the water was the undesigned and unexpected occur-rence. The court holds this due to the 94 THE HEALTH BULLKTIX negligence of the company that fur-nished the water. Scientists have proved long ago that typhoid fever is not an act of God, but on the contrary, an entirely hu-man disgrace. Now if the courts go a step further and decide that it is not a disgrace only, but a prima facie evi-dence of criminal negligence, another long step will have been taken to-ward the elimination of the disease. City authorities who furnish water to the public have a duty to know what kind of water they are furnishing. As soon as they assume public responsi-bility of office in a city or town it be-comes their duty to know that the public water supply is safe, just as it is their duty to know that their public bridges are safe or that their public schools are not fire traps. The sooner officials appreciate the full significance of this public health principle and their responsibility, the better for them and their constituents. GUARDING TOUR HEALTH We constantly read in the daily press accounts of persons dying suddenly who were not suspected of even being in bad health, and also it frequently happens that we are surprised to learn that a friend that we had met within a day or two apparently in perfect health is suddenly found to be desper-ately ill. The reason for this is that many diseases are so insidious that the dam-age to vital organs goes on without warning until the breaking point comes and with it sudden death. Knowing this to be true, would it not be wise to have an examination made of your physical condition, say at least once a year, in order that you may feel assured that you are not liv-ing in a state of false security? If a thorough examination reveals that you are normal, that knowledge alone is worth the trouble and small expense involved, and if such an examination should reveal that you have some ab-normal condition, surely such knowl-edge is vital to you, that you may have the advantage of remedies applied while there is yet time, to say nothing of the saving in expense and lost time that would inevitably come later. (VISE AND PREVENTION OF DE-GENERATIVE DISEASES Many diseases are largely due to de-fective elimination, or chronic accumu-lation of toxics in our body, due to one or more of the following causes: 1st—Overeating, especially of meat and highly seasoned foods after middle life. As some one has aptly expressed it, we too often dig our graves with our teeth. 2d—Insufficient exercise, or too much or too strenuous exercise. 3d—Social diseases. 4th—The use of alcoholics and the excessive use of tobacco. In fact, in-temperance of any kind. Probably the greatest determining factor is "the strenuous life." The mad rush for the almighty dollar, and un-due worry and anxiety, interfere more or less with all the normal functions of the body. Worry is ten times more dis-astrous than work. THINK HEALTH! "It is not a fear of illness or of death that we should encourage, but a love of health, a sense of responsibility for the care of our bodies, a desire for bodily endurance and efficiency and full achievement, "If the mind is fixed on these ideals, and the already known means of ap-proaching them are utilized, the need-less miseries that embitter the lives of so many may be left to take care o: themselves. "It is not so much necessary to fight disease as to cultivate health for the happiness, contentment and moral gain that it brincis." THE HEALTH BULLETIN 95 LIVING LONG AND WELL In Every Case the Well Balanced Life is the Longest and Best frf\ HAT profiteth a man that he gain w the whole world yet lose his ^8 heaith? In the race for power and place, for ease of circumstance and relief from the stimulus of hunger, the modern man is apt to forget that unless he is careful of his body he will soon be made to suffer for the infraction of Nature's inexorable physical law. With the loss in body tone comes an equal loss in mental acuity, and the brain which for a time was able to operate despite the complaints of an over-fed. under-exercised, self-poisoned body, stops working. Statisticians have discovered that the mortality rate of persons in the United States over 45 years of age is increasing. The strenuous life of to-day is not alone responsible for this. Lack of health-giving exercise, super-fluity of diet, lack of restoring sleep, over-stimulation, the high pressure of the race for power, wealth, and posi-tion, plus physical neglect—these bring early decay. The goal is reached—wealth is amassed—honor, position, and power are just being grasped, when the apple of accomplish-ment turns to ashes of dissolution. The brilliant mind becomes clouded, the steady hand is no longer accurate, the eye which once gazed fearlessly on the whole world is dimmed, and it is not long before the final break-up occurs. All of this was entirely pre-ventable. Other, things being equal, it is the man who leads the well balanced life who lasts the longest, whose work to the end is uniformly the best—he who neither overworks nor overplays, neither overeats, overdrinks, nor over-sleeps, he who maintains a standard of simple, healthy diet in moderation, who offsets mental work with physical recreation, who is as honest with his own body as he is with his own busi-ness. When success comes to such an one his physical and mental condition is such that he can enjoy in peace of mind and contentment of body the fruits of his labors. ON TAKING TABLETS FOR INDIGESTION "Do not diet. Eat what you please, as much as you please, and then some. After each meal take one of Slickem's Mysteriosa Digestive Tablets. These tablets are a scientific combination of seventeen of the best flesh producing chemicals known to medical science. They will make you strong, healthy and vigorous. If you are thin you will get fat. If you are fat you will get thin." Evidently there must be millions of fools who really believe that you may safely outrage Nature and then escape the consequences by means of a tablet. With a cocktail before a meal, and a tablet after, you may worry along for a few years. Then, if you continue to suppress symptoms of an outraged stomach—to sit on the safety valve and turn a deaf ear to Nature's protests— you will find yourself afflicted with a more serious disease than dyspepsia— perhaps Bright's disease, or rheuma-tism, or hardening of the arteries— and even the nature cure may not be able to save you from suffering pre-mature death.—Harry Ellington Brook. Bright's disease is common in Amer-ica because so many men work their kidneys harder than they do their heads or their hearts.—St. Louis Bul-letin. CLEAN UP ! Cleanliness Is Nex* lb Godliness ——S—ta—l—e Board of Health , Raleigh. N.C. —IBII lllllllllll I I IH II l«iMi| Ul> ——^M———f—— J Large placards of this cut 14" x 22" may re obtained free of charge by addressing the State Board of Health, Raleigh, N. C. U^T NOTiCE 10 READER- When you finish reading this', magazine plffiL 1 place a one-cent stamp on this notice, hand same to any postal em- *'/Sl7fl Mltftliyeefand it will be placed in the hands of our soldiers or sailors Published b4 TATL^RTACARPLIrtA STATE. B?ARD s^ATiALTA This Bulletin, will be seryt free to ar\u citizen of the 5tateupoa request ! Entered as second-class matter at Postoffi.ee at Raleigh, N. C, under Act of July 16, 1894. Published monthly at the office of the Secretary of the Board, Raleigh, 2V. G. Vol. XXXII JULY, 1917 No. 4 rE :ir=ir==ir=ir=ir=nr= ir==if=i r—ii ir=ir= n CONSERVE LIFE AND HEALTH GOVERNOR T. W. BICKETT .f^ZZZ^.'^*1 ' Y17E say that human life is priceless. Yet statistics indicate that in North Carolina we are losing, yea needlessly wasting, thousands of precious human lives every year, together with the efficiency, the earning capacity and the real joy of living for tens of thousands of others. All this is preventable. Much of it is easily preventable. When shall we awaken to the full gravity of the situation? Now, if ever, in war times, every North Carolinian should be at his maximum efficiency, free from all preventable physical handicaps, and in the best physical condition, ready to do a man's full part in waging this world war to a speedy, successful conclusion. To win this war we. must conserve our health, vigor and efficiency; we must do health work, U both personal and public, as never before. ! — ii ir===ir==^ r==^r=^r=^P==^ r==i r==^r==^r====ir===i r==n i nJ TABLE OF CONTENTS Editorial Brevities 99 Vital Conservation for War... 100 What is the Red Cross 101 President Wilson and the Red Cross 102 Mason's Iron Cross 103 Protect Your Community From Contagious Diseases 105 An Old Fable 106 Controlling the Midiwfe Prob-lem 108 Don't Let This Happen to You. 109 Hot Weather Health no Rheumatism a Preventable Dis-ease H2 The Teacher's Part in Medical School Inspection 114 Chronic Constipation in Women. 115 Tuberculosis a County Problem 117 Symptoms of Tuberculosis 119 Tuberculosis a Most Curable Disease 119 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., . Statesville E. C. Register, M.D., . . . Charlotte Chas. O'H. Laughinghousk, M.D., Greenville Edward J. Wood, M.D., . . Wilmington Cyrus Thompson, M.D., . . Jacksonville P. R. Harris, M.D., . . . Henderson Official Staff W. S. Rankin, M.D., Secretary of the State Board of Health and State Health Officer. O. A. Shore, M.D., Director of the State Laboratory of Hygiene. Warren H. Booker, C.E., Chief of the Bureau of Engineering and Education. L. B. McBrayer. M.D., Superintendent of the State Sanatorium. J. R. Gordon, M.D., Deputy State Registrar. G. M. Cooper, M.D., Chief of the Bureau of Medical Inspection of Schools. A. McR. Crouch, M.D., Epidemiologist. B. E. Washburn, M.D., Director of County Health Work. FREE PUBLIC HEALTH LITERATURE The State Board of Health has a limited quantity of health literature on the subjects listed below, which will be sent out, free of charge, to any citizen of the State as long as the supply lasts. If you care for any of this literature, or want some sent to a friend, just write to the State Board of Health, at Raleigh. A postcard will bring it by return mail. No. 107. Life Saving Facts About Diph-theria. No. 116. Scarlet Fever. No. 117. Tuberculosis. No. 118. Measles. No. 119. Whooping Cough. No. 120. Hookworm Disease. No. 121. Sanitary Management of Hotels. No. 122. Poliomyelitis or Infantile Paral vsis. No. 123. Typhoid Fever. No. 126. Indigestion. Teeth, Tonsils, and Adenoids.* How to Live Long.* A War on Consumption.* Milk.* Periodic Medical Examina-tion. Typhoid Fever and How to Prevent It* Concrete Septic TanksJ Anti-Spitting Placards (5 inches by 7 inches) . Anti-Fly Placards (14 inches by 22 inches). Anti-Typhoid Placards (14 inches by 22 inches). Anti - Tuberculosis Placards (14 inches by 22 inches). Clean Up Placards (14 in. by 23 in.) •Furnished by courtesy of the Metropolitan Life Insurance Company. t Furnished by courtesy of Portland Cement Association. No. 12. PUBLI5ALD ST TML mPRTM CARPUMA 5TATE. BQMgD s^MEALTH Vol. XXXII JULY, 1917 No. 4 EDITORIAL BREVITIES Keep well—the first service you owe to your country. Are you a member of the Red Cross? Are you doing all that you can for the health and comfort of those who are fighting for you? Do you have good, made-to-measure wire screens, or at least mosquito net-ting screens at every door and window this summer? If you do not, you are missing a lot of solid comfort, greatly increasing an unnecessary summer an-noyance, and needlessly exposing the lives and health of yourself and family. Screen the flies and mosquitoes out! Every neighborhood, town, or com-munity, especially every industrial center, should have one or more classes in First Aid. All that is nec-essary to form such a class is to se-cure not less than four nor more than twenty-five members, the minimum age limit being sixteen years, and the consent of a qualified physician in act-ive practice to act as instructor. The name and qualification of the physician and the number in the class are then sent by the class secretary to the First Aid Division, American Red Cross, Washington, D. C, for approval, where-upon a class roll, a catalogue of sup-plies, and necessary information will be forwarded to the secretary and the class will be ready to begin work. When you dream of your work and worry over it, it is time for you to take a vacation. Don't think you can't afford it. It is cheaper and better for you to take it now than to take a longer enforced leave of absence later. A crying shame it is that it takes such an emergency as a great war to drive us to the realization that an appalling number of our young men are not physically fit to cope in battle with an enemy. If bad teeth, hook-worm disease, malaria, constipation, adenoids, defective eyes, ears, under-weight, and other equally unnecessary, sometimes disgraceful and nearly al-ways easily preventable, defects can so seriously affect our young manhood, how about our young womanhood? How about our middle-aged men and women, those that should be the real factors in the world's work? Let's put an end to such inefficiency. Medi-cal inspection of schools is the im-mediate step in providing for the fu-ture, while periodic medical examina-tions for adults and sanitation and public health work offer much hope for us of today. Don't get the idea that good health is merely absence of disease or sick-ness. It is far more. One may not feel sick at all and still be only 60, 70, or 75 per cent efficient. Good health is 100 per cent of physical efficiency. It is that physical state of being where life is a joy, and plenty of hard work is a pleasure. LOO THE HEALTH BULLETIN VITAL CONSERVATION FOR WAR Why and How We Should Conserve Our Greatest Waste at This Time W&a AR, waste, and conservation ara words that are kept ringing in our ears these days. That we are involved in the greatest war the world has ever known, that our own fate and future are absolutely and in-separably dependent upon the outcome of this war, is a certainty. If we win, democracy and freedom of peoples win. If we lose, democracy and freedom lose, autocracy wins, and we stand liable to pay tremendous indemnities to our enemies that will make our seven-billion-dollar Liberty Loan look small. There is but one solution to this situation: WE MUST WIN. But to win is going to tax our resources to the utmost. Already from far and wide are going out appeals for larger food crops and greater economy and conservation along this line. But we cannot afford to be short-sighted, penny-wise or pound-foolish. It takes more than food to win a war. It takes men and women, and money and resources of every kind to win a war. Before we can have money and resources we must have men and women that are men and women to produce and supply, and continue to produce and supply, money and food and resources of every kind. A nation of weaklings will fail, just as Rome failed, when her people, because of drunkards and debauched victims of disease, neglected to take proper care of their physical machine. Similarly, we cannot expect to win a war with a nation of young men wno do not pass even a moderately rigid physical ex-amination. Nor can we expect the physical culls and seconds left at home to supply food, munitions, money, and supplies almost without end to sustain our own and other armies of fighting men abroad. War requires men that are all men, full of physical vitality and working up to the fullest possible efficiency. In such a gigantic strug-gle as we now face, every weakling and every sick and inefficient person in our land who is not more than taking care of himself, is just that much dead weight. Similarly, every individual who is pegging along at 60, 70, or 80 per cent of his possible physical ef-ficiency lacks just that much of doing "his bit." War is a tremendous tax and ex-pense in every way upon a nation. In order to meet this tax, this terrific loss of our best manhood, money and re-sources, we must conserve, avoid every possible waste, and make for efficiency in a large way. From time imme-morial we have continued to suffer a tremendous and unnecessary loss of life, health, happiness, and efficiency from needless and easily preventable disease. Now, if ever, we must "about face" and stop this needless loss and waste. While it is estimated that North Carolina wastes annually per-haps $20,000,000 worth of food, we are at the same time wasting much more in absolutely needless sickness and loss of life, when figured in cold dol-lars and cents. For instance, it is es-timated that every year about 14,700 North Carolinians die from easily pre-ventable or postponable diseases. If we estimate a person's life to be worth only $1,700, we have an annual loss from this one item of over $24,- 000,000. It is estimated that over one per cent of our population are need-lessly sick at all times, and that their annual earning capacity is only $700. This gives us an annual time loss from sickness of 23,000 times $700, or $16,100,000. It is estimated that the average family in North Carolina THE HEALTH BULLETIN 101 spends $27 annually for medicines and doctors' bills for needless sickness— another loss for our 400,000 families of $10,800,000. The total of these three items of $24,000,000 for needless deaths, $16,100,000 for needless loss of time, $10,800,000 for doctors' bills and medicines for needless sickness, is over $50,000,000 annual health loss for North Carolina from these three items alone. There are, of course, many other items not included, such as loss of efficiency when not sick enough to stop work or call a doctor, and fur-thermore this estimate does not take into account intangible values such as broken family ties, love, friendship, or the value of pain and suffering. Is it not time to set our house in order, and not only stop this gigantic loss, but place ourselves on an effi-cient basis as never before? We can-not put in our best efforts, either in war or in civil life, while laboring under such unnecessary vital losses. To make real headway in this work means better attention to child hy-giene, the education of mothers in the matter of raising healthier, stronger, babies; it means better medical inspec-tion of school children so that they don't have to spend four years in school doing three years' work; it means better home sanitation so that we are not cursed with malaria, ty-phoid, tuberculosis, hookworm disease, etc. It means at least annual, careful, painstaking medical examinations of every adult by a competent physician to determine any oncoming diseases. In brief, it means the establishment of an active city or county health de-partment in every city and county in the State, such department to be armed with nurses, sanitary inspectors, a quarantine officer, medical inspectors, lecturers, and a laboratory. With such we will begin to see results with-in a year or two. The death rate will decline and the whole physical and moral tone of the city, county, and State will improve. Will we do it? Will we take this step to win the war and to make life fuller and richer after the war? It is up to us now as never before. WHAT IS THE RED CROSS? Good Samaritan to all People in Trouble—Our Part in the Great War s^7|HE Red Cross is to the men of ^-^ the army what the "Good Sa- **™° maritan" was to the man who "fell among thieves, which stripped him of his raiment and wounded him. and departed, leaving him half dead." The American Red Cross is a branch of the great international organization and has recognition from all for-eign governments. It is chartered by Congress, has the President of the United States as its president, and has its accounts audited by the United States Treasury Department. It is the only volunteer relief agency auth-orized by the government to render aid to its land and naval forces in time of war. Its services are guaranteed to reach the needy and render aid in the most efficient way. The Red Cross grew out of the generous impulse of the human heart to relieve human suffering met by war or disaster. It has grown from a lonely nurse dressing the wounds of soldiers on the battlefield to the great-est humanitarian society in the world. It is altogether a philanthropic or-ganization, is supported by voluntary subscriptions, and is neutral in war, knowing no race, sect, or religion. It is indeed the Good Samaritan to all folk in their darkest hour. The work of the Red Cross in time 102 THE HEALTH BULLETIN of war consists in all forms of relief work, from administering to the wounded and suffering of the army and navy to taking care of the dependent families of soldiers and sailors and se-curing employment for men disabled in the country's service. In time of peace it not only prepares for war, but maintains that state of prepared-ness that enables it to relieve distress caused by disaster in the quickest and most efficient way possible. Every chapter has its workrooms and auxiliaries. It furnishes trained instructors for the making of medical and surgical supplies and gives courses in accident and disease pre-vention, as well as in rendering first aid to the injured. It also provides courses in home care of the sick, home dietetics, and various means of disease and accident prevention. The purpose of what has above been said concerning the Red Cross is to commend it, its work and its support, to the readers of the Health Bulletin, as the Red Cross is the big brother to the medical profession and all health workers. We believe that every town and community in the State should form either a chapter or an auxiliary, which is a branch of a chapter, and should actively engage in this great work of relief and mercy by making medical and surgical supplies for hos-pitals, by learning how to care for the sick and wounded and by giving of their means to support this work. It is the only way those who do not go to the front have of showing their appreciation for, and giving aid to, those who are doing the fighting. The Government provides for their food, clothing and ammunition, but it leaves it to us to provide for their lives in case they are wounded or sick, and for their families in case they leavr them dependent and helpless. Information for forming a Red Cross chapter, an auxiliary, or a class in First Aid may be had by writing to the American Red Cross at Wash-ington, D. C. Write for further information and circulars today and proceed at once with the work in your own community among your neighbors and friends. They will appreciate your taking the lead. It is a small part of your pa-triotic duty and theirs. Do it now. PRESIDENT WILSON AND THE RED CROSS Earnestly Recommends it to the Con-fidence and Support of the People j^lELIEF work is undoubtedly ahead ffL of us," was asserted by President Wilson in a letter sent to the Washington branch of the American Red Cross, saying that as the official volunteer aid organization of the Uni-ted States the society should receive the generous support of the American people. "In order that the relief work, which is undoubtedly ahead of us, should be made thoroughly efficient," wrote the President, "it is most desirable that it should be coordinated and concen-trated under one organization. "Having been made the official vol-unteer aid organization of the United States, the American Red Cross comes under the protection of the treaty of Geneva and has received due recogni-tion from all foreign governments. Its status both at home and abroad is thus definitely determined and assured. "The surgeons general of the War and Navy Departments are members of the executive committee of the Amer-ican Red Cross. By act of Congress medical officers of both branches of the service are detailed for service with it in order that its military relief may be so organized as best to supplement THE HEALTH BULLETIN 103 the medical services of our fighting forces. "Until the civilian relief is under a trained and experienced personnel es-pecially fitted to care for soldiers' families and other non-combatants, the accounts of the association are audited by the War Department in order thoroughly to safeguard the funds con-tributed by the public. "Recent experience has made it more clear than ever that a multi-plicity of relief agencies tends to bring about confusion, duplication, de-lay, and waste. Moreover, it affords temptations to dishonest persons to take advantage of the general willing-ness of the public to subscribe to such agencies to defraud subscribers and rob the soldier of the assistance he so much needs. Wherever in the present war sufficient volunteer aid has been rendered either to soldiers or to non-combatants it has been ren-dered under a well organized central body. Experience is certainly the most convincing teacher, and we should learn by these European ex-amples how to conduct our own relief work with the most thorough efficiency and system. With its catholicity and its democracy the Red Cross is broad enough to embrace all efforts for the relief of our soldiers and sailors, the care of their families, and for the as-sistance of any other non-combatants who may require aid. "As the president of the American Red Cross, our branch of the great in-ternational organization, I most earn-estly commend it to your confidence and your support. Upon your aid, upon the amounts and promptness of your gifts and cooperation must de-pend the fulfillment of the duties that are imposed upon it. It serves so noble and beneficent a purpose that it must appeal to all who love their country and love humanity." MASON'S IRON CROSS Valerie D. Ohrenstein sends us this poser from Chicago: "Have we any right to expect any-thing from Congress which is idealis-tic, or for the good of the many, as opposed to the immediate benefit of the few, when we elect men of the type of ex-Senator William E. Mason [now a member of the House of Representa-tives from Illinois], who is willing to sell his title for the price of a patent-medicine testimonial? The inclosed advertisment appeared in the Chicago 'American.' . . ." Miss Ohrenstein takes too blue a view of the case. Chicago has, to be sure, a Mason in Congress, a Thomp-son in the mayor's chair, but there are cities with better mayors, and Chicago itself has better representatives than Mason. Mason is a hold-over from the patent-medicine school of American politics, and as a young nation we must not be too impatient with our elders. Collier's Chicago friend in-closes in her letter the "American's" three-column advertisement, with its far-flung headline telling how Mason says NUXATED IRON INCREASED HIS POWER AND ENDURANCE SO MUCH THAT IT OUGHT TO BE MADE KNOWN TO EVERY NERVOUS, RUN-DOWN, ANEMIC MAN, WOMAN AND CHILD. If that's so, it's a pity that the ex-senator didn't take some "Nuxated Iron before telling Congress, on the eve of the war declaration, that "Ger-many had given us no cause for war." "Nuxated Iron," if it is much good, ought to have kept him from saying: "I am against this war because . . . it is a dollar war." It might have kept him, after the declaration, from counseling delay in respect to war measures: "Gentlemen, we have plenty of time. . . ." Mason's tribute to 104 THE HEALTH BULLETIN "Nuxated Iron" starts like this: "I have often said I would never recom-mend medicine of any kind—" and on second thought he hasn't broken his pledge, either. "Nuxated Iron" con-tains only about a five-hundredth of a grain of nux vomica alkaloids to a tab-let, and a twenty-fifth of a grain of iron—which is shown in an analysis by the American Medical Association. "Nuxated Iron" comes about as near to being a medicine and to having "valuable blood, nerve force, and tis-sue- building properties" (see the wrap-per) as Mason comes to being a pa-triot and a statesman. The other day Mason had an article by Mayor Thomp-son of Chicago attacking the Govern-ment's war loan and its food-regula-tion plans printed as an "extension of remarks" in the Congressional Record. Only a few days later Mr. Hastings of Oklahoma was reported to have charged him with treason because of certain remarks on our military law and policies. (Later the word "trea-sonable" was expunged from the Rec-ord.) Chicago is not fortunate in all its statesmen, but Chicago is a big city after all, and we think Miss Ohren-stein need not be much depressed just because Herr Mason has earned a "Nuxated" Iron Cross.— Collier's Weekly. PATRIOTISM AND YOUR HEALTH Why not add at least 3 or 4 per cent to your personal efficiency so as to be better able to meet all coming needs? The sanitary sharps agree that the average citizen loses between nine and twelve working days each year because of preventable sickness. Now, if this war is to mean anything to the average man, it ought to mean shaking off only semisensible habits and living up to his best. No one is even suggesting a tax on water; why not drink it and have more money to buy war loan securities? Air is as free as ever—take your full share. Fewer of us will be in danger of over-eating these next few years, and there will be work enough to make us all sleep when bedtime comes. Now is a good chance to get rid of any foolish-ness about clothes; shoes that curse the feet, collars that cut the wind, and any other nonsensical items in be-tween. This is a 100 per cent war, and we can ill afford to carry the burden of preventable sickness. Tak-ing care of yourself is more than sense now—it is a duty.—Collier's Weekly. There never has been a time when there were so many reasons why one should keep well and do all in his power to prevent disease as now. The first and the last reason, perhaps, is that sickness is expensive; it costs both time and money, to say nothing of the valuable human life that it wastes annually; and if this country is to win in this great war, it cannot afford to have any of its resources spent on anything so unnecessary as disease. On the other hand, it would be better to spend money to prevent disease. Disease is no respecter of persons. There is not one kind of consumption for the white people and another kind for the black. A town is like the sky at night: for as a flash of lightning in one quarter of the heavens lights up all the rest, so disease in the poorest section of the town reaches out its fingers and blights the remote home of the wealthy. As to pellagra, a safe conclusion of the whole matter is that the farm that has a good cow, a pea patch, and a hen coop will not have pellagra on it. :: : i , ' :: ^ PUBLIC HEALTH and SANITATION PROTECT YOUR COMMUN-ITY FROM CONTAGIOUS DISEASES Ten Righteous People Can Do It I ND the Lord said, If I find in ^J Sodom fifty righteous within the ^ma city, then I will spare all the place for their sakes." "And he (Abraham) said, . . . Peradventure ten shall be found." "And He (the Lord) said, I will not destroy it for ten's sake." The salvation of communities still and always, as in the days of Sodom, depends upon a few righteous, respon-sive individuals, and not upon the mul-titude, the irresponsive herd—the shepherd saves the flock. To every township with from three to five interested, responsive citizens and to every town or city with one or two interested, responsive citizens for each thousand of the population, North Carolina, under a law which went into effect August 1st, can promise safety from unnecessary contagion. This does not mean all contagion, but it does mean a very large proportion of it. On the other hand, the State is helpless to protect those communities where nobody knows, or, which is worse, where nobody cares. Won't you, in this vital matter of protecting the health and lives of your disinter-ested neighbors and of their helpless children, be one of the ten righteous? Will you make and keep a trade with your conscience, unconditioned on any supplementary pay from the crowd? If so, you can effectually assist our State in protecting your community from epidemics. But before you should be expected to do this, the State and county must make it possible, first, for you to be able to recognize violations of the State quarantine law, and, sec-ond, for you to report such violations without becoming involved in legal en-tanglements or social embarrassments. How You May Recognize Unmistaka-ble Violations of the Quarantine Law If you know of a home in which there is a person sick with whooping cough, measles, diphtheria, scarlet fever, smallpox, infantile paralysis, ty-phoid fever, or cerebro-spinal menin-gitis and on the front of which there is not fastened a large yellow placard with the name of the disease printed thereon, you may know positively that the quarantine law is being violated. When the law is violated, one of three parties is guilty—the quarantine offi-cer, the attending physician, or the householder. When the Quarantine Officer is Guilty.—The quarantine officer has sworn "that he will well and duly exe-cute and perform all the duties as county quarantine officer prescribed by chapter 263 of the Public Laws of 1917, and such duties as are now or may hereafter be prescribed in and by the regulations promulgated by the North Carolina State Board of Health under the authority conferred by sec-tion 10, chapter 263, of the Public Laws of 1917." Under this oath it is the duty of the quarantine officer to see that every home in which one of the aforementioned diseases has been reported to exist shall receive a yellow placard with the name of the disease printed thereon, and shall receive the law and the rules and regulations re-quiring the posting of the placard and 106 THE HEALTH BULLETIN prescribing other necessary precau-tions for public safety to be carried out by the householder. It is hardly conceivable that the quarantine officer, under the obligation of a solemn oath and with a full realization of the im-portance of prompt and effective quarantine, has failed to do his duty. When the Attending Physician is Guilty.—If the physician in attend-ance upon a case of whooping cough, measles, diphtheria, scarlet fever, When the Householder is Guilty.— First, if one of the above mentioned diseases is so mild as not to have necessitated the calling in of a physi-cian, the householder, under the re-quirements of the law, should have re-ported the case of sickness to the quarantine officer. If he has not done so, he has, either ignorantly or know-ingly, violated the law; and if he has willfully violated the law, he is guilty of a misdemeanor. Second, if the AN OLD FABLE /^VNCE UPON A TIME there was a city with a street ^-^ running along a cliff. In dark and stormy weather so many people were injured by falling over the edge that the citizens gathered together to see what they could do about it. They decided to use their resources to build a hospital at the foot of the cliff so that the injured might receive immediate attention. Now, it chanced that a great physician visited their land, and the inhabitants showed him the hospital with great pride. But he, looking up at the cliff, said : "Wouldn't it have been cheaper in lives and money to build a wall of protection along the cliff?" smallpox, infantile paralysis, typhoid fever, or cerebro-spinal meningitis fails to report the case to the quaran-tine officer, he has failed to perform his duty and is guilty of a misde-meanor. Practically all physicians are interested to a sufficient extent in the prevention of disease and realize suf-ficiently the vital importance of well-enforced quarantine laws to cause them to report the "catching" diseases. Occasionally, however, physicians are careless or forgetful in performing this their most important civic obli-gation. householder has not posted the yellow placard received from the quarantine officer and has not complied with the rules and regulations furnished him in writing by the quarantine officer, he is guilty of a misdemeanor. How You Can, Without Expense, In-convenience, or Embarrassment, See That Violations Are Investigated and Punished. First, you can notify the quarantine officer of your county, whose name and address appear on page 107 of this Bulletin, of probable violations of the quarantine law. The quarantine THE HEALTH BULLETIN 107 officer should regard the information you supply him as strictly confiden-tial. He should investigate the possi-ble violation, and if he finds the law has been violated he should, in accord-ance with his oath, indict the guilty parties. In investigating the complaint and in bringing the indictment, the quarantine officer can secure the nec-essary evidence without involving his assistant and informer in legal pro-ceedings or social embarrassment. The Control of Contagion Rests Pri-marily on Complete Reporting of Contagious Diseases A fire department can't put out a fire until it is notified. The State and county machinery for restricting the spread of contagion cannot be put into operation until the disease is reported. The reporting of contagious diseases, every case, is the first and absolutely necessary step in any system of con-trol. After the disease is reported, the BROUGHT UP TO DATE ONCE UPON A TIME a great country went to war and needed her strong men to fight her battles. But when her sons were called together only half of them were found fit to do battle, the others being deficient in health and lacking in physical strength. What shall we do?" said the people. "Unless our men are strong in body they will lose in battle. Let us ask Congress to appropri-ate a great sum and build hospitals where they may receive treatment and be cured of their diseases." And this Con-cress approved. , But some said: "A pity it is that great sums of money should be spent for this purpose now, whereas small sums spent a few years ago when these were boys would have made this unnecessary and saved the country s manhood from this blight of ill health and inefficiency. And the people said, "Yea, truly ! A poorer nation, but a wiser one, will we be when the war is over. Second, if you do not care to report direct to your county quarantine offi-cer, you can report to the State Epi-demiologist, Raleigh, North Carolina. The State officer will regard your in-formation as confidential, and will im-mediately communicate with your county quarantine officer in regard to the probable violation of the law, and in doing so will not use your name. The State Board of Health would ad-vise, however, that wherever possible interested citizens cooperate directly with their local authorities in the en-forcement of the quarantine law. responsibility for controlling its spread rests largely with the State and coun-ty, and in the order mentioned. NAMES AND ADDRESSES OF QUARAN-TINE OFFICERS. Counties. Alamance Dr. Alexander Dr. Alleghany Dr. Anson ..Dr. Ashe Avery Beaufort Dr. Bertie Bladen Dr. Brunswick Dr. Buncombe Dr. Burke Cabarrus Dr. Caldwell Dr. Camden Dr. Carteret. Dr Caswell Mr. Catawba Dr. Name. Address. C. T. Vernon Burlington. S. T. CrowBon—Taylorsville. J. L. Doughton.. Sparta. J. H. Bennett Wadesboro. J. G. Blount Washington. G. F. Bullard Elizabethtown. J. A. Dosher Southport. D. E. Sevier Asheville. R. M. King Concord. L. H. CofTev Lenoir. C. G. Ferebee Camden. P, B. Loftin Beaufort; Henry S. Turn< r.Yaneeyville. ( ieoige W . Shipp.Newton. 108 THE HEALTH BULLETIN Counties. Name. Address. Chatham Dr. L. E. Farthing. ..Pittsboro. Cherokee Dr. H. J. Tilson Murphy. Chowan Dr. J. S. Mitchener ..Edenton. Clay Cleveland Dr. E. B. Lattimore.. Shelby. Columbus Dr. R. C. Sadler Vineland. Craven Dr. J. F. Rhem New Bern. Cumberland .Dr. J. W. McXeilL—Fayetteville. Currituck - Daie ..Dr. Franklin P.Gates Manteo. Davidson Dr. E. F. Long. Lexington. Davie ..Dr. J. W. Rodwell Mocksville. Duplin Dr. J. W. Fairior Kenansville. Durham Dr. Arch Cheatham..Durham. Edgecombe.. .Dr. K. E. Miller Tarboro Forsyth Dr. A. C. Bulla Winston Salem. Franklin Dr. J. E. Malone Louisburg. Gaston Dr. L. N. Glenn Gastonia. Gates Graham Granville Dr. B. K. Hays Oxford. Greene ...Dr. W. B. Murphy.. .Snow Hill. Guilford Dr. W. M.Jones Greensboro. Halifax. Dr. I. E. Green Weldon. Harnett Dr. J. W. Halford ...Chalybeate Springs. Haywood Dr. J. R. McCracken.Waynesville. Henderson ...Dr. J. F. Cranford ...Hendersonville. Hertford Dr. \V. B. Pollard.. ..Winton. Hoke Dr. R. T. Wilkins ....Raeford. Hyde. Dr. L. H. Swindell.. .Swanquarter. Iredell Dr. R. S. McElwee...Statesville. Jackson Johnston .Dr. Thel. Hooks Smithfiend. Jones.. Lee Dr. Lynn Mclver Sanford. Lenoir Dr. G. S. Mitchener.. Kinston. Lincoln Dr. J. W. Sain. Lincolnton. Macon. ..Dr. H. T. Horsley ...Franklin. Madison. Dr. Frank Roberts. ..Marshall. Martin Dr. W. E. Warren Williamston. McDowell Dr. J. F. Jones Marion. Mecklenburg. Dr. C. S. McLaughlinCharlotte. Mitchell Dr. C. C. Smith Toecane. Montgomery. Dr. C. Daligny.. Troy. Moore Dr. A. McN. Blue Carthage. Nash Dr. Ambler Speight.. Nashville. New HanoverDr. C. T. Nesbit Wilmington. NorthamptonDr. F. M. Register Jackson. Onslow Dr. R. H. Noell. Swansboro. Orange Dr. A. J. Warren Hillsboro. Pamlico Dr. G. S. Attimore... Stonewall. Pasquotank.. Dr. Zenas Fearing ...Elizabeth City. Pender Dr. P. E. Lucas Burgaw. Perquimans. -Dr. F. S. McMillan. ..Hertford. Person Dr. Arch Bradsher__.Roxboro. Pitt. Di. M. T. Edger-ton, Jr. Greenville. Polk.. ..Dr. Earle Grady Tryon. Randrlph Dr. L. M. Fox Asheboro. Richmond Dr. J. M. Maness Ellerbe. Robeson Dr. B. W. Page Lumberton. Roc ki:igham Rowan Dr. C. W. Woodson. .Salisbury Rutherford Sampson Dr. E. T. Hollings-worth Clinton . Scotland Dr. Peter McLean Laurinburg. Stanly Dr. J N. Anderson..Albemarle. Stokes ..Dr. W. L. McCauless.Danbury. Surry Dr. Ira S. Gambill.-.Dobson. Swain. Dr. P. R. Bennett Bryson City. Transylvania Dr. C. W. Hunt Brevard. Tyrrell Dr. C. A. Flowers Columbia. Union .Dr. S. A. Stevens Monroe. Vance.. Wake Dr. Z. M. Caviness...Raleigh. Warren Dr. Ghas. H. Peete...Warrenton. Washington ..Dr. W. H. Ward Plymouth. Watauga Dr. M. G. Anders Boone. Wayne Dr. W. H. Smith Goldsboro. Wilkes Dr. J. M. Turner No. Wilkesboro. Wilson Dr. J. C. Braswell.Jr. .Wilson. Yadkin Dr. V. F. Couch Yadkinville. Yancey Dr. J. B. Gibbs Burnsville. CONTROLLING THE MID-WIFE PROBLEM Rocky 3Iount Board of Health Re-quires all Midlives to Pass Satisfactory Examination qjOCKY MOUNT has led all other ^^ towns in the State, and prob-ably in the South, for all we know, in conducting a school for mid-wives, even to the extent of requiring them to stand an examination and make a satisfactory grade in order to obtain a permit to practice their work. The city board of health passed an ordinance making it unlawful for any midwife in the city to practice her profession after January 1, 1917, with-out having passed a satisfactory ex-amination in the elementary principles of midwifery. Free instructions were given by the city health officer, no fee being charged for the examination or for issuing the permit. The result has been, according to the city health officer, a noticeable falling off in the infant death rate, while at the same time an increase in the birth rate has been noticed, due to complete birth registration, the im-. portance of which was one essential made known to the midwives. The place filled by widwives in this country, from a health standpoint, is a big problem. The question is, how shall the midwife be so trained and controlled as to become of greatest value, rather than a menace, to those who from ignorance, traditions, en-vironment, or for financial reasons, still seek her services? This, it is believed, can be achieved through training, licensure, and control by State and local boards of health, as the city board of health of Rocky Mount has recently found out. The extent to which the midwife problem affects North Carolina is seen THE HEALTH BULLETIN 109 through the following figures: Last year there were 55,512 white births in North Carolina and 24,408 colored births, a total of 79,920. Of the white births, 80 per cent were attended by physicians and 20 per cent by mid-wives, while 80 per cent of the colored births were attended by midwives and only 20 per cent by physicians. That almost twice as many colored babies in North Carolina die during the first \veek of life as white babies, accord-ing to figures from the Vital Statistics Department, is thought to be largely due to the ignorant midwife. That more women from fifteen to forty-four years old die from conditions caused by child-birth than from any disease except tuberculosis is also thought to be largely due to the ignorant mid-wife. These facts point to the need of stricter laws governing midwives, par-ticularly as it affects their training and ability. D0>'T LET THIS HAPPE> TO YOU OK TOUR HOUSEHOLD The doctor said "TYPHOID!" How you dread that word! It strikes ter-ror to you now as you hear, in your imagination, the muffled tread of foot-steps and low voices near the bedside of the stricken patient, and you ask what cause has brought such sorrow to your unsuspecting household! Your own home had sanitary facil-ities, sewers and screens, perhaps, and clean, well-kept grounds, and yet typhoid came unbidden—the unwel-come guest. WHY? you ask. Look about you for the reason. Watch that little fly buzz-ing harmlessly near the sick-room door. Where does he come from and what is his business here? Ah! You have it! Over in yonder hollow is a plain, ordinary, outdoor privy. Nothing un-usual about it. You have seen it be-fore. Perhaps there are others nearer or even farther away! BUT THERE IS THE CAUSE! One little fly regaled himself in yonder closet, took his fill of filth and cov-ered his body and legs with the deadly typhoid germs, then came to your own kitchen and dining-room to walk upon the butter, feast upon the cake, or scrape his feet on the rim of the baby's bottle; and found you and your family disarmed. But how? You had promised yourself that when this summer came, you and your household would be vaccinated against typhoid fever; but did you? You kept putting it off till a more convenient season, and already the doctor has said "typhoid"! What would you not give to have that peace of mind that comes from having done one's duty? You saw yours, but you neglected it. Oh, yes, you will never let it occur again. You and the remainder of your household will at once be vaccinated. But it may be too late to save you. It certainly will not save the stricken patient from suffering weeks and per-haps months of burning fever. It may not save you of, perhaps, a funeral, but it could have saved you all. Talk Health. The dreary, never-changing tale Of mortal maladies is worn and stale. You cannot charm or interest or please By harping on that minor chord — disease. "Whatever the weather may be," says he— "Whatever the weather may be, It's the songs you sing and the smiles you wear, That's a-making the sun shine every-where." HOT WEATHER HEALTH How to Keep Cool, Comfortable, and Healthy During Hot Weather OON'T dread or worry about the __ hot weather. That makes its "^ coming all the worse. Recognize that it is coming, then get ready for it. Much can be gained by really get-ting ready for hot weather. For in-stance, did it ever occur to you what a tremendous drain it is on your nerve force, in other words, your "pep," in hot weather to be bothered with house flies crawling over and tickling your anatomy by day, to say nothing of the mosquitoes by night? Without screens flies materially disturb one's rest or prevent us from getting our full eight hours sleep each day. To successfully battle against hot weather requires that we get a full eight hours good sleep out of every twenty-four, and if this is shortened or disturbed by flies, even this handicap may be enough to spell the difference between health and sickness during the hot weather. Good screens or even mosquito netting at every door and window would solve this problem for the entire family all summer long. Furthermore, if good wire screens are installed they may confidentally be expected to last for five to ten years. Now one more word about that "full eight hours of good sleep." You can hardly expect to be living, working, and feeling at your best if you have to retire to a hot, stuffy bedroom with one or two small windows where it is so hot you have to swelter for hours until it cools off enough to permit you to get to sleep, only to have to get up before you have been fully refreshed. The remedy is simple: Knock out one or two sides of your old-fashioned room and replace them with windows. Then you'll have a modern sleeping-porch, and then you will be able to sleep in comfort and rise in the morn- SCREENS WOULD SAVE ALL THIS, AND MORE. ing feeling like the proverbial "two-year- old." Just before retiring, a tem-perate or cool bath about seventy-five to eighty-five degrees forms a splendid "night cap" after a hot day. It is a splendid introduction to a good night's sleep, although many find a cool bath, plunge or dip in the morning as an "eye-opener" even more to the point to start the day off right. At all events, get a bath every day at least in summer. What one eats and drinks has a lot THE HEALTH BULLETIN 111 to do with the way one feels during hot weather. Fat meats, concentrated foods, and heat and energy producing foods were certainly not intended for summer use. This is the time to elimi-nate meats and heat and energy foods, or at least reduce them to a minimum and live on fruits and vegetables. Learn to eat "greens" and all kinds of THE BEST KIND OF A NIGHT-CAP OR AN EYE-OPENER TOR HOT WEATHER "garden sas." Keep the bowels moving freely at least once or twice a day by means of a fruit and vegetable diet, lots of cool (not cold) drinking water, and a little bran gruel, if necessary. Avoid the ice-cold soft drinks of all kinds. "Adam's ale," the pure, unadul-terated kind and in large quantities, is far better. Don't overdress in summer. Save your clothes for winter wear. A bit of good summer advice along this line is to wear as little as the law of the land will allow, and that is mighty little these days—equal rights for men. Much of our summer discomfort may be avoided by the proper planning of our work. By a little forethought house-wives can arrange to minimize the time spent over a hot kitchen stove, and do much of the ironing, preparing of vegetables, sewing, etc., on a shady porch or in the breezy, fresh air. Work that has to be done in hot places can usually be done during the coolest parts of the day. Finally, one should not try to go through a summer physically handi-capped in any way, unless absolutely necessary. Life is rough enough and hard enough in places, anyway, with-out having to bear any unnecessary physical ills. For any person to ex-pect to keep up, to say nothing of win-ning, in this fierce race of life while handicapped by some physical dis-order, is the height of folly. It is just as impossible and as ridiculous for a man or woman to try to live up to his rated efficiency while handicapped by bad teeth, constipation, or any one or more of a score of needless ailments, as it is to expect a horse to win a race on three legs or an automobile "hitting on three cylinders." Get fixed up. Go to the best doctor you can find, put your case entirely in his hands. Have him find out what is wrong with you. In the vast majority of cases it will probably be some simple living habit. Correct that habit, hit on all four cylinders, and you will be sur-prised to see how work and difficulties disappear before you and how much real comfort and joy there is in life in the Good Old Summer Time. A healthful, well balanced diet calls for a liberal allowance of vegetables. This is why, both for health and economy's sake, we should plant gar-dens. If people all over the country will only plant gardens and not be so largely dependent on city markets for their table vegetables, not only will there be a big reduction in prices, but a correspondingly big increase in the good health and happiness of the peo-ple generally. 112 THE HEALTH BULLETIN RHEUMATISM A PREVENT-ABLE DISEASE Pus Poisoning From Teeth, Gums or Tonsils Often the Source of Infection By EDWARD J. WOOD, M.D., Wilmington Y focal infection is meant an ac-cumulation of pus somewhere in the body which is discharged into the circulation, producing certain damaging changes to vulnerable parts. All tissues of the body are not equally resistant to this pus poisoning. The parts which are more apt to suffer are the lining membrane of the heart, in-cluding the valves, the kidneys, and the joints. Recently it has been found that the heart muscle is often danger-ously affected by infections of this kind without producing any visible signs for the doctor to observe until the damage is beyond repair. One Cure for Rheumatism Dr. Osier said only a few years ago that rheumatism was a reproach to the medical profession because no progress had been made in the dis-covery of its cause; hence, no remedy could be intelligently applied. But today any case of rheumatism calls for a searching investigation on the part of the physician, for there is locked up somewhere in the body one or more pockets of pus which must be removed to prevent a further rheumatic in-volvement and also to cure the present trouble. All of the hitherto used rem-edies for rheumatism only relieved ant" never cured. There can be only one cure, and that calls possibly for the combined attack of a good nose ant" throat specialist, a modern dentist who works for a higher purpose than the outward appearance of the teeth and who will intelligently use the help of the X-ray when needed, and a con-scientious physician who is not content to have as the rule of professional ac-tivity, "What is to be must be." If the physician does his part the patient will be directed to the proper dentist and the proper nose and throat man, their findings will be brought together in an intelligent manner and the pa-tient will find relief. The reader will be impressed with the expensive nature of this investi-gation. If the patient lives in the country, it becomes necessary to gc to the city for the X-ray part of the work, at least. While it is costly, it is much cheaper than the numerous se-cret remedies advertised, and which will only relieve pain at best, and that often at the expense of kidney irrita-tion or heart depression Toothbrush and Dentist Best Preventives It would be far better to prevent all of this trouble, and it can be in the next generation, by a little education, which had better be done in the public schools. The one preventive measure above all others is the use of the tooth-brush. Like all other things, the use of the toothbrush must be made care-fully and thoroughly and the child must not be expected to have been born with a knowledge of its use. Many people think that the use of a toothbrush is a part of respectability. While this may be true, from a med-ical point of view, the average tooth-brush used in my practice is almost worse than nothing at all. The tooth-brush has only a limited life, and it is worse than useless after it is worn out. Again, a toothbrush to retain its stiff-ness must be dried out between usings, and should, therefore, not be kept in a toothbrush container. Each indi-vidual should have two or more of these useful articles in constant use and should be careful to use them in rotation in order to favor drying and a return of the normal stiffness of the THE HEALTH BULLETIN 113 bristles. But, in spite of all this, the individual must not expect to keep the mouth normal without the help of a competent, conscientious, patient dentist, who is not too busy or too prosperous to have time to practice preventive dentistry. Everyone should visit such a dentist every three or six months and have him carefully ex-amine every tooth. If there are no cavities, he will, at least, clean the teeth of the deposit known commonly as tartar, which cannot be removed except with a sharp instrument, which must be applied skilfully even below the gum. This is sometimes called scaling. If the teeth are kept dentally clean by this scaling process, as deep down as the dentist finds necessary, pyorrhea or Rigg's disease will soon become a negligible factor. The idea in the minds of the laity that the use of the ipecac preparations, as emetine, by the mouth or hypodermically will prevent and cure this gum condition is very fallacious. Without the dental cleaning of the teeth such a drug is entirely wasted and should never be used except by the dentist's advice as an aid to what he will do with his instruments. As a physician it is now my custom to begin all examinations with an ex-amination of the teeth. It is often a very embarrassing duty to have to tell intelligent patients that their mouths are dirty, uncared for by themselves, and needing dental treatment. It is surprising to find how few well dressed people are acquainted with the personal touch of the toothbrush. Tonsils Often Source of Infection The next important focus of this kind of infection is the tonsils. Many tonsils that apparently are normal or that cannot be seen on the ordinary examination are "submerged," and when drawn out by the throat spec-ialist's instrument are found to be exuding pus. Such tonsils probably cause more trouble than the large tonsils, which are usually removed. A case recently under my care was strongly suspected of tuberculosis, but after the removal of the tonsils the little fever immediately ceased and the patient is now well. Tonsils are •very important in any study of the source of rheumatism, heart disease, or kidney disease. I recently had under my care two young women with acute Bright's disease which had its origin in infection of the tonsils. There are other cavities in the head which become infected, especially after colds, which may be the sources ol focal infections and require expert attention. Anything but the best at-tention in such cases is worse than useless. Fortunately for most of us this is the least common source of trouble. It emphasizes the real need for a more thoughtful consideration of the danger of colds. Colds lower the resistance and prepare the way for many infections. Many focal infec-tions would be prevented if we would protect ourselves from colds. There are other sources of focal in-fection to be found in certain cases, but these cannot concern us here ex-cept in a general way. The public must learn that rheumatism is a pre-ventable disease; that the doctor must find the focus or direct them to some place where the investigation can be made; that the charge so often made that this new teaching is a fad had better be suspended until a fair trial is made. In conclusion, let me say that no sin-gle development in medicine and hy-giene can rank in importance with this. It opens up a new field which will almost immediately increase the normal expectation of life. By this means it is reasonable to expect a marked decrease in rheumatism, in heart disease, in Bright's disease, and in other conditions. Many cases of 114 THE HEALTH BULLETIN neurasthenia or nervous prostration are curable by this means and still more cases of neuralgia and eye strain cease to exist after the patient has been conscientiously studied in this way. THE TEACHER'S PART IN MEDI-CAL INSPECTION OF SCHOOLS Sometime ago when a physician was explaining the few simple but im-portant items which relate to the teacher's part in the medical inspec-tion of schools under the law enacted by the General Assembly of 1917, a teacher was overheard to remark in a loud whisper, "Who is going to pay the teacher for this?" That teacher has been teaching for twenty-two years, and has never taught more than five months in any one year, and her highest salary at any time has been forty dollars per month. She has prob-ably been paid entirely too much for the service rendered, if that sp
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 | 1917; 1918 |
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 32, Issues 3-9. 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 | 9,257 KB; 144 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_healthbulletin191718.pdf |
Pres Local File Path-M | \Preservation_content\StatePubs\pubs_edp\images_master\ |
Full Text |
THE LIBRARY OF THE
UNIVERSITY OF
NORTH CAROLINA
AT CHAPEL HILL
THE COLLECTION OF
NORTH CAROLINIANA
C61U
N86
V.C31-32:
1916/18
FOR USE ONLY IN
THE NORTH CAROLINA COLLECTION
fhl$ IW£ti&_Bm MWMRUti®--
&
"TV7
Published b4 TfiL^m CAROLINA 5WE.B?ARDs>7\mLTA
? This Bulletin, will "be ser\t free to arxq citizen of the 5tateupor\ request !
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. G.
Vol. XXXII JUNE, 1917 No. 3
GOVERNOR BICKETT AND PUBLIC HEALTH
(EXTRACT FROM HIS INAUGURAL ADDRESS. JANUARY II, 1917)
The State Board of Health shall he given ample funds to continue and
enlarge its work. The law should require a careful examination of every
child who enters a puhlic school, at least twice a year. This can he done
by whole-time county health officers or by representatives of the State
Board, as the conditions may warrant; but the law should compel it to
be done. „m, . , .. _ ...
"The riches of a Commonwealth
Are free, strong minds, and hearts of health."
To insure such riches, intelligent examination of the children at stated
intervals is absolutely necessary.
The State Board deserves the unqualified support of the General As-sembly
in its campaign against quacks and quackery. The law requires
a man to have a diploma from a first-class medical college and to stand
a rigid examination before the North Carolina Board of Medical Exam-iners
before he is allowed to write a single prescription for a patient in
North Carolina. And yet we permit the sale of nostrums to our people
without any adequate knowledge of whether or not they are injurious to
health, or have any medicinal value whatever.
I am in favor of a law making it a felony for any man to sell, offer for
sale, or advertise for sale in North Carolina any proprietary or patent
medicine purporting to cure cancer, consumption, diabetes, paralysis,
epilepsy, Bright's disease, or any other disease for which the North Caro-lina
Medical Association and the American Medical Association declare
that no cure has been discovered.
I am earnestly in favor of a law requiring all vendors of proprietary
medicines to file with the State Board of Health a statement showing the
exact composition of such medicines, and that the State Board be empow-ered
to forbid the sale of such proprietary medicines in the State of North
Carolina if, in its opinion, it is without curative value in the treatment of
the disease it purports to cure.
TABLE OF CONTENTS
Editorial Brevities 75
New Health Laws 75
Medical Inspection of School
Children 77
The Bacxwaed Ch h.tj 78
Make a Date fob Free Examina-tion
79
The Common House 1'i.v 80
How Disease Germs Live anq Grow. 82
On Early Detection of Tuber-culosis
84
For Hoarding House* and Sana-toria
86
Dental Hygiene 87
Teach Our Children How Best to
Live 8!)
Weigh the Baby Once a Week. ... 90
The Prevention of Pellagra 91
Typhoid an Accident 93
Li\ ing Love and Well 15
MEMBERS OF THE NORTH CAROLINA STATE BOARD OF HEALTH
J. Howell Wat, M.D., Pres., Waynesville
Richard H. Lewis, M.D., LL.D., Raleigh
J. L. Ludlow, C.E., . . Winston-Salem
Thomas E A vdkpshv. M.D.. . p*ito«-»-',ip
E C. Register, M.D., . . . Charlotte
Chas. O'H. Laughinghouse,
Edward J. Wood. M.D., . .
Cyrus Thompson, M.D., .
P. R. Harris, M.D., . .
M.D.,
Greenville
Wilmington
Jacksonville
Henderson
official Staff
W. S. Rankin, M.D., Secretary of the State Board of Health and State Health Officer.
C. A. Shore, M.D., Director of the State Laboratory of Hygiene.
Warren H. Booker, C.E., Chief of the Bureau of Engineering and Education.
L. B. McBrayer. M.D., Superintendent of the State Sanatorium.
J. R. Gordon, M.D., Deputy State Registrar.
G. M. Cooper, M.D.. Chief of the Bureau of Rural Sanitation.
A. M. Crouch, M.D., Epidemologist.
FREE PUBLIC HEALTH LITERATURE
The State Board of Health has a limited quantity of health literature on the subjects
listed below, which will be sent out, free of charge, to any citizen of the State as long as
the supply lasts. If you care for any of this literature, or want some sent to a friend, just
write to the State Board of Health, at Raleigh. A postcard will bring it by return mail.
No. 12.
No. 31.
No. 32.
No. 39.
No. 50.
No. 52.
No. 53.
No. 54.
No. 60.
No. 67.
No. 70.
No. 72.
No. 73.
No. 74.
No. 75.
No. 76.
No. 77.
No. 78.
No. 79.
No. 80.
No. 81.
No. 82.
No. 83.
Residential Sewage Disposal Plants.
Whooping Cough.
Diphtheria.
Tuberculosis Leaflet.
Baby Leaflet.
Malaria and What Everybody
Should Know About It.
Disinfection After Diphtheria,
Measles, or Whooping Cough.
Disinfection After Scarlet Fever.
Sanitary and Hygienic Care of
Prisoners.
Cancer Leaflet.
Adenoids.
Tuberculosis.
Smallpox.
Measles.
Scarlet Fevrr.
Baby Welfarp.
Rave the Rnbv.
Free medical examination, etc.
Care of the Mouth and Teeth.
Hygiene at Middle Life.
Prevention of Degenerative Dis-eases.
The Prevention of Colds.
Underweight.
( >\ (:••« eight.
No. 84. Indigestion.
No. 85. Constipation.
No. 86. Venereal Diseases.
No. 87. Sanitary Privies.
No. 88. Public Health Laws.
No. 89. The Common House Fly.
No. 90. Typhoid Fever.
No. 91. Tuberculosis Laws.
Teeth. Tou&ns. and Adenoids.*
How to Live Long.*
Hookworm Disease.*
A War on Consumption.*
Milk.* Periodic Medical Examina-tion.
Typhoid Fever and How to Prevent
It.*
Concrete Septic Tanks}.
Anti-Spitting Placards (5 inches by
7 inches).
Anti-Fly Placards (14 inches by 22
inches).
Anti-Typhoid Placards (14 inches
by 22 inches).
Anti - Tuberculosis Placards (14
inchpc hv °? irises'*
Clean Up Placards ('14 in. by
23 in )
Furnished by courtesy of the Metropolitan Life Insurance Company.
t Furnished by courtesy of Portland Cement Association.
COWARDS a BROU
jBI | PU5LI5ALD 5Y TAL HORXA CAROLINA 5TATL BQMgD s^MEALTM ||[gj.
Vol. XXXII JUNE, 1917 No. 3
EDITORIAL BREVITIES
To heal the sick was once the only
aim of the physician. Now his great-est
ambition is to prevent sickness.
Why not apply the same sane com-mon
sense to your health that you ap-ply
to your business? As far as you
yourself are concerned, and as far as
your family and business are con-cerned,
it is the most important thing
in the world.
Have you ever asked your doctor
what causes and what prevents
Bright's disease, heart failure, harden-ing
of the arteries, and apoplexy? And
have you ever asked him to look you
over to see if any of these diseases are
undermining your health, so that if
such were the case you could ward
them off?
The average person can eat good,
plain, wholesome food in moderation
all his life without ever being aware
that he has a digestive apparatus. It
is only when he overeats or is other-wise
indiscreet as to his meals that he
knows he has a stomach and one that
affects his whole being.
As important to the soldier as are
good feet, good eyesight, and good
brains, neither of these is considered
quite as important as good teeth. A
soldier may have good feet, good eyes
and brains, but if he hasn't good teeth
so that he may properly chew his
food and keep well and strong, of
what service will good feet, good eyes,
and good brains be to him? For the
reason that the soldier's health de-pends
so largely on the condition of
his teeth, good teeth are said to be a
soldier's first and most necessary
equipment.
NEW HEALTH LAWS
What the Legislature Did in the Inter-est
of Better Health in North
Carolina
v^jIHE last General Assembly, backed
!^L by Governor T. W. Bickett, en-a
™° acted probably more modern and
progressive health legislation than any
other General Assembly North Caro-lina
has ever seen. While there were
several pieees of valuable legislation
which failed of passage, there was
enough other good legislation enacted
to amply justify calling this a truly
public health Legislature.
Chief among the new health laws
enacted were a State-wide Quarantine
Law. a Medical Inspection of Schools
Law, a Rural Sanitation Law, a Law for
the Prevention of Blindness, a Hotel In-spection
Law, and a Law Requiring
the Inspection and Hygienic Care of
Prisons and Prisoners.
The Quarantine Law
Heretofore the individual towns, cit-ies,
and counties were left to their
own devices for dealing with or not
76 THE HEALTH BULLETIN
dealing with contagious and infectious
diseases. It is unnecessary to describe
the chaotic, inefficient methods that
obtained. The results are reflected in
our excessive death rates from con-tagious
and infectious diseases.
After July 1, 1917, all cases or sus-pected
cases of contagious or infec-tious
diseases will be reported by the
physicians in attendance or household-ers
to a county quarantine officer with-in
twenty-four hours, and each county
quarantine officer will report daily to
the State Board of Health. Rules and
regulations governing quarantine of
all cases of contagious diseases will
be promulgated. By the time this Bul-letin
reaches its readers copies of these
rules and regulations will probably be
ready for distribution.
Medical Inspection of Schools Law
Elsewhere in this issue of the Bulle-tin
will be found a complete resume
of this important law. Briefly, it pro-vides
for the physical examination of
every school child in the State every
third year, and it even goes so far as
to make a nominal appropriation as
the State's part to assist in defraying
the expenses of treating physical de-fects.
By virtue of this law every
school child may receive two physical
examinations during his school life,
and as a result thousands upon thou-sands
of school children will be re-lieved
of unnecessary physical handi-caps
of bad teeth, defective sight and
hearing, enlarged tonsils, adenoids,
hookworm disease, and other defects
which greatly reduce their physical
and mental growth and the efficiency
of our rising generations.
The Rural Sanitation Law
The cooperative rural sanitation law
makes an appropriation of $15,000 an-nually
to be expended in the ratio of
$1 for every $3 from other agencies.
As a result of this law, effective co-operative
health departments will be
established in a number of counties
and maintained in part from this fund,
in part from funds from the Interna-tional
Health Board, and in part from
the respective counties in which these
health departments are established. As
the work becomes more thoroughly
established, the support of the State
will be gradually withdrawn in order
to establish it in other counties. In
this way well organized county health
departments will ultimately be estab-lished
in every county in the State.
Prevention of Blindness
The Legislature also enacted a law
which provides for the proper treat-ment
of the eyes of all new-born
babies with a solution which effectu-ally
prevents infant blindness. To
make this law effective and to place
the proper solution in the hands of
every physician and midwife in the
State requires an appropriation of
$3,000. The net result will be the sav-ing
of the sight of from 25 to 35
babies every year. The wisdom of
this law is more apparent when it is
considered that by this means the State
converts a person, needlessly blind for
life and who is always more or less
of a charge upon the State and society
generally, into an active productive
person for life at an initial cost of only
about $100.
Hotel Inspection Law
Through the efforts of the traveling
men of the State a law was enacted
requiring the State Board of Health to
inspect and grade the sanitary condi-tions
of all the hotels and restaurants.
This is a very complete law, and it
deals with practically every phase of
the hotel question. It will do much
toward improving the safety and com-fort
of traveling, as well as to im-prove
the general sanitary tone of the
State.
THE HEALTH BULLETIN 77
Prison Reform Law
The new prison reform law is a
landmark in human progress in North
Carolina. It represents some of the
most important advances in the hu-mane
treatment of prisoners North
Carolina or any other State has ever
seen. It provides ample opportunity
for those in charge of prisoners, pris-ons,
jails, convict camps, and other
places of confinement to reform and
return true, valuable men and women
to take responsible places in society,
instead of grinding down the unfortu-nates
with endless hard work under
conditions anything but favorable to-ward
their reformation, uplift, and
proper training. While the State
Board of Health had nothing to do
with the promotion of this law, this
board is made responsible for the san-itary
and hygienic care of prisons and
prisoners, be they city, county, or
State institutions.
MEDICAL INSPECTION
OF SCHOOL CHILDREN
Law of State-wide Application Passed
by the Recent Legislature
ly^jjHANKS to the untiring efforts of
l ^^J Governor Thomas W. Bickett, the
GMM iast General Assembly enacted a
law providing for the medical inspec-tion
of all school children in North
Carolina every three years.
The State Board of Health and the
State Superintendent of Public In-struction
are charged with the respon-sibility
of executing this law. One-third
of the State's counties accord-ing
to population will be chosen this
summer for beginning this work. The
commissioners of each county will be
required to pay a physician for the
work. The physician must be selected
by the Board of Education of each
county. The State Board of Health
2
must be notified at once of the selec-tion
of such physician. The teachers
will be supplied with blanks by the
State Board of Health and a compe-tent
physician will instruct them how
to fill out these blanks, one for each
child in school. This work must be
done at the time specified by the State
Board of Health and the State Super-intendent
of Schools.
When the teacher completes his or
her part of the work, the information
contained in this record must be
placed in the hands of the official in-specting
physician. He in turn must
have brought to a central point, not
more than ten miles from each child's
home, on Saturdays, as many children
as he can carefully examine. The
physician will require something like
ten or twelve per cent of the total
enrollment, including the children most
in need of treatment, to be brought for
examination. At the time of such ex-amination
the physician must make
a record of his findings and send a
copy to the State Board of Health,
and also give the parent or guardian
specific advice as to the necessity for
correcting any physical defect within
the scope of this examination.
After all the children have been ex-amined
(one-third of the State each
year), the State Board of Health may
divide the sum of ten thousand dol-lars
pro rata, according to school en-rollment,
among the counties covered
in the work each year, provided the
county commissioners will provide an
equal amount and the total sum does
not exceed 40 per cent of the amount
needed for treating the defective chil-dren.
The balance of money neces-sary
for paying physicians, dentists,
specialists, etc., for this work at re-duced
rates must, of course, be fur-nished
by parents or from other pri-vate
sources.
This law provides for the careful
examination, by a good physician, of at
78 THE HEALTH BULLETIN
least twenty-five thousand defective
children each year, and enables the
State to put up one-fifth of the cash
in providing a fund of fifty thousand
dollars per year for getting these chil-dren
treated. Not much, it is true, but
just that much more than has ever
been done before; and with the cordial
and sympathetic cooperation of the
authorities and people of each county
it means the difference between misery
and suffering, and health and happi-ness
to twenty-five thousand children
each year.
The law makes no discrimination
between the poor and the well-to-do;
nor between the white and colored
races. All are treated alike.
THE BACKWARD CHILD
Medical School Inspection a Friend to
Backward Children
ijTl HAT is really meant by the back-
J^ ward child? It means a child
™™ who has begun to attend school,
who fails to learn as other children
do, and who, at the end of the term, is
turned back to repeat the course.
Backward children are usually regard-ed
as mentally deficient, but the fact
is they are usually either diseased or
physically deficient.
In this country there are said to be
20,000.000 children of school age, about
3,000,000 of whom are called "repeat-ers"
because they remain in one grade
at school more than one term.
These children, however, are not
"repeaters" by the will oc an inscruta-ble
Providence, but rather by the law
of cause and effect. Their physical
condition is at fault. It may be that
they have bad teeth and pus forming
gums that are filling their systems
with poisons that are diseasing, their
eyesight is at fault, or that their hear-ing
is bad, or perhaps they have dis-eased
tonsils, or adenoids. Dr. A. C.
Bulla, medical school inspector for the
State Board of Health of this State,
says that he finds at least 18 per cent
of all school children suffering from
defects of the eyes, ears, nose, and
throat.
Doctor Bulla believes that such de-fects
as any one of these not only hin-ders
a child in school, retarding his
education and causing him to be called
backward or a repeater, but that it
goes with him through life, severely
handicapping his efforts and crippling
his efficiency. Furthermore, Doctor
Bulla believes that the best time to
remedy such defects and diseases is
when the child is in the first, second,
or third grade at school, before these
defacing defects such as adenoids, bad
teeth, or defective eyes, have gotten in
their ugly work, and while they are
yet in the stage when removal or cor-rection
will be the most easy and ef-fective.
Medical school inspection work is a
feature of public health work done by
the State Board of Health just to this
end: to discover and remove these
handicaps to health and education at a
time when the results will be most
valuable and easily accomplished. Last
year three counties made provision for
this educational health work, with the
result that 10,000 children were ex-amined
for defects of the eyes, ears,
nose, throat, teeth, and for communi-cable
diseases. This year six more
counties, including a number of indi-vidual
schools and communities, have
made arrangements for this work, and
thousands of school children are being
benefited. Next year approximately
one-third of the State will have medi-cal
inspection of school children ac-cording
to the new law proposed by
Governor Bickett. Parents are coming
to know what health means to the
proper development of their children,
and how to proceed that their children
may have it.
THE HEALTH BULLETIN 79
MAKE A DATE FOR
FREE EXAMINATION
Sanatorium Will Charge Fee of $5 for
Tuberculosis Examination Unless
Patient Makes a Date
O HE State Sanatorium for the
Treatment of Tuberculosis will
continue to give examinations
tuberculosis free to the people,
ME
for
provided that physicians sending pa-tients
there or the patients themselves
write beforehand and make an en-gagement;
otherwise a fee of $5 will
be charged for such an examination.
Another requirement connected with
this free service is that patients pre-sent
themselves between the hours of
8 and 11 a. m. on the date set for them;
otherwise, they will not only have to
wait till the next day for an examina-tion,
but will also be charged the fee
of $5.
This ruling has been made necessary
for the reason that so many people
now demand this service, and at times
such large numbers present them-selves
for examination as to greatly
interfere with the regular medical
work of the institution. Besides, when
the examinations are made out of regu-lar
office hours or at any time the pa-tient
happens to arrive, it works ex-cessive
hardship on the medical staff
and demands a service which the in-stitution
is not able to meet. Last
year 411 such examinations were made,
and the indications are that a far
greater number will ask for the serv-ice
this year.
ONE FOR PREVENTION; ELEVEN
FOR CURE
The United States is at the present
time spending more than thirty-three
million dollars yearly for the cure and
care of patients afflicted with mental
disease, and comparatively nothing for
prevention. And yet the perusal of
the report of almost any State hospital
will show that in about 50 per cent of
the cases admitted the mental disorder
is due directly to definite causes which
are clearly preventable.
For instance, North Carolina expends
$650,000 annually for the care of her
insane and delinquents, and $55,500
annually for prevention. Where the
State spends $1 for the prevention of
disease it spends $11.60 for the care
of the insane and delinquent. Much
of insanity and delinquency has a
preventable basis. Sixteen per cent
of the insanity is due to syphilis.
This means that there are 500 in-sane
people in our asylums as the
result of syphilis alone. The annual
per capita cost of these 500 people is
$170. Therefore, for the care of the
syphilitic insane alone the State is
spending 500 x $170, a total of $85,000
a year. Twenty per cent of insanity
is traceable to alcohol. If this per-centage
holds good for North Carolina,
we have 600 insane in our asylums as
the result of alcohol, the annual per
capita cost being $170, making our bill
for taking care of our alcoholic insane
600 x $170, a total of $102,000 a year.
From 5 to 10 per cent more are func-tional
disorders which probably could
have been prevented by early treat-ment.
Proper posture and carriage, with
shoulders square, chest arched, head
erect, and body well stretched from
the waist up, will of its own account
contribute much toward relieving our
people of the many petty and not a
few of the serious ills from which they
are now suffering. It is the founda-tion
of robust health, and should be
insisted upon in children from the
very beginning until it becomes a habit,
and as such will displace the disease-breeding
"slouchy" habit now so prev-alent
among people of all ages and
stations.
i,.',i, i^r
PUBLIC HEALTH
and SANITATION
THE COMMON HOUSE FLY
The Best Way to Have a Flyless Home
j^lOUSE FLIES used to be one of
£~± the commonest things to be found
^™ in our kitchens and dining-rooms
in the summer time. While they are
not even now getting to be rare, they
are not quite so common as to quan-tity
or number but "exceedingly com-mon"
as to quality. Chief among the
reasons why the house fly is getting
into such bad repute is because we
are beginning to know him better. We
are learning about his nativity—his
ancestry and place of birth—the man-ner
and method of his bringing-up,
and, finally, about his every-day habits
and mode of life.
The Story of the Fly
Instead of considering him a nice,
clean, respectable little pet, as we
once did, we know that his mother laid
the eggs from which he and perhaps a
hundred or more of his companions
were hatched in some accumulation
of warm, moist manure, waste, or de-caying
filth. For fly eggs to hatch
they must be laid in some kind of de-caying
organic matter and supplied
with a certain amount of heat and
moisture. In from eight to ten hours
they hatch into tiny white, squirming,
wiggling maggots which burrow down
into the manure or filth in which the
eggs were laid. After from six to
eight days, these maggots grow a shell
or coating somewhat like a very small
wheat grain in appearance. In two or
three days more this shell opens and
a full-grown fly emerges. While the
fly is still wet and slippery, he bur-rows
and works his way up through
the manure to the open air.
The Danger of the Fly
The fly is no longer considered
harmless. Instead of thinking of him
as merely a tickling, crawling, both-ersome
pest, we know him to be a car-rier
of filth, a spewer and spreader of
the vilest and deadliest poisons and
disease germs. His daily habits of
life lead him to feast on almost any-thing
from manure, tuberculosis spu-tum,
pus, or typhoid dejecta to cake,
candy, pie, milk, sugar, or butter. The
cost of his maintenance for food, how-ever,
is trifling. We base one of our
main objections to him upon the fact
that his digestive tract is so simple
and his digestive liquids so weak that
typhoid, tuberculosis, or other germs
eaten by him pass out an hour or two
later unchanged and are deposited,
frequently in a liquid and invisible
form, on baby's face, lips, and hands,
or on our food, dishes, and furniture.
The common house fly, or typhoid
fly, has lost caste not only because we
know that over ninety per cent of his
kind were bred in manure piles and
open privies, or because he feasts on
the vilest filth and later deposits it on
our food, or because we know that he
vomits up such material to dissolve
such solids as sugar, and later eats
the entire mixture, but also because
we have found that the very hairy
nature of his body and legs enables
him to carry tiny quantities of nasty,
nauseating, and disease-laden material
to our food and drink.
THE HEALTH BULLETIN 81
Remedies
The question of prime importance is,
What are we going to do about it?
Theoretically, it is possible to clean
up and keep so clean that flies cannot
find sufficient decaying organic mat-ter
in which to breed. To a large meas-ure
this is practical in certain cities.
Unfortunately, it is not practical in
the country or in most of our villages
and small towns, though undoubtedly a
great deal can be done by proper
means of cleanliness around stables,
privies, hog pens, and other places
toward controlling and reducing the
number of flies. Ordinarily, it matters
little how clean certain farms, homes,
or premises are kept. Almost always
there will be some near-by slothful,
filthy neighbors who will breed enough
flies for an entire county. For these
reasons our present methods of ordi-nary
cleanliness are far from being
entirely successful in the fight against
flies.
Fly traps, particularly large fly
traps, around barns, stables, grocer-ies,
or placed on garbage cans, or
other places where flies breed or fre-quent
in large numbers, have been
found to greatly reduce the fly popu-lation.
Fly poisons, such as formaldehyde
in the proportion of two tablespoon-fuls
of formaldehyde to a mixture of
a half pint of water and a half pint of
milk, have been found to kill large
numbers of flies, but flies will not
drink such poison if other water or
drink is available. Furtherfore, there
is usually a certain element of danger
in having fly poisons around the home.
The Best Remedy
By all odds the cheapest and the
most effective means yet found for
successfully combating the fly evil is
THOROUGH SCREENING OF THE
HOME AND PLACES WHERE FOOD
IS HANDLED from April 1st to De-cember
1st, and swatting at least once
a day the few stray flies that dodge in
as the doors are opened. It is not
sufficient to screen the doors and win-dows
of the kitchen and dining room,
or of the downstairs only. The back
porch, where much of the food is pre-pared,
should by all means be screened.
Again, it is quite important that the
upstairs windows be screened, as in-coming
flies will follow the scent of
savory or cooking foods and come
down the stairway in discouraging
numbers.
Do not use cheap, ineffective exten-sion
screens. They rarely fit the win-
A Bad Type of Screen
Extension screens rarely fit fly-tight. Flies
get in between the screen and the lower sash,
as shown by the lower set of arrows. They
also work their way up between the upper
and lower sashes and enter, as shown by the
upper arrows.
dow and make it fly-tight, and they al-low
flies to come in between sashes.
Wire screens, particularly those pro-tecting
the entire window, are best. The
present retail market price (March,
1917) of black is about two cents per
square foot, and three cents per square
82 THE HEALTH BULLETIN
foot for galvanized wire. Such screens
will usually last from five to ten years,
or longer. Where the cost of good
wire screens seems prohibitive, excel-lent
results may be obtained by the
use of ordinary mosquito netting. Such
Window Effectively Scr;ened "With
Mosquito Netting
The mosquito netting is secured at the top
and sides by means of small three-quarter
round mouldings or by tacks. It is unfastened
at the bottom and left about eight inches too
long. This permits closing the shutters from
the inside. Such a screen costs about twenty
cents.
netting costs about 75 cents per bolt of
eight yards in length by fifty-eight
inches wide. A very effective and in-expensive
method of screening with
mosquito netting is to tack it on to
the outside of the window frame or by
tacking or fastening it with cleats or
what is called three-quarter round
moulding, to the outside window stop.
Such moulding costs about a quarter
of a cent a foot. Wherever it is de-sired
to open and close shutters from
the inside, cut the piece of mosquito
netting six or eight inches longer than
the window is high and leave it a bit
"full" or loose at the bottom, so that'
the shutter may be operated from the
inside at will, as is shown in the ac-companying
cut. Such mosquito net-ting
screens will last from one to
three years.
For the doors there is nothing bet-ter
than well fitting made-to-measure
or machine-made screen doors well
braced, carefully hung, and provided
with spring hinges. Very satisfactory
wire screen doors can be obtained for
as little as $1.25, while the spring
hinges and fasteners cost 25 cents
more.
The Finishing Touch—Swatting
With the back porch and every door
and window screened, the household
will be practically free from the dan-gers
and inconveniences of flies. What
few flies find their way in as the doors
are opened may be killed off once or
twice a day by swatting.
Thorough screening not only ex-cludes
flies, but it also excludes mos-quitoes
and prevents the danger of
malaria. Once a decent, self-respect-ing
North Carolina family enjoys the
benefits of screens in the home, there
will be no return to the dangerous,
disgusting condition of common house
flies.
HOW' DISEASE GERMS
LIVE AND GROW
Dr. Be.vj. K. Hays, Health Officer of Granville
County.
It was formerly believed that the
poison germs or virus which produce
disease would live for long periods of
time outside the body. It was believed
that this poison would attach itself to
furniture, books, and clothing, and
THE HEALTH BULLETIN 83
that it was possible to contract a dis-ease
by handling one of these articles
years afterward. We used to hear of
how people contracted yellow fever
by handling a lock of hair from a per-son
dead with the disease, and of how
children contracted diphtheria from
the toys of other children long since
dead of diphtheria. We heard of how
people contracted consumption from
books that a consumptive had handled
years before.
A more accurate knowledge of the
life history of disease-producing
germs has changed our ideas of such
things. So long as the old ideas con-tinue
to prevail the contagious dis-eases
will continue to claim our loved
ones. Just as soon as we learn the
truth about contagious diseases (pro-vided
we live up to our knowledge)
they will cease to appear in our midst.
When germs leave the human body
they tend to die. The life outside the
body depends upon three things, viz.,
light, air, and moisture. Light and
air tend to kill the germs. Moisture
helps to keep them alive. Germs with-out
moisture exposed to the direct
rays of the sun live only a few hours.
Germs without moisture in a well
lighted and ventilated room, but not
exposed to the direct rays of the sun,
live only a few days. Germs embed-ded
in sputum and deposited in the
direct rays of the sun may live for two
or three days. Germs imbedded in
sputum and deposited on the floor of a
well lighted and ventilated room, but
not exposed to the direct rays of the
sun, will live for two or three weeks.
Germs imbedded in sputum and de-posited
in a dark room, especially in
the cracks of a floor that holds the
moisture, may live for six months or
longer.
The poison (or germs) of diphtheria,"
measles, scarlet fever, whooping
cough, tuberculosis, and typhoid fever
do not grow outside the body except
in one place, and that is in milk. It
is well to remember that when disease-producing
germs find their way into
milk they will grow and reproduce
there. It is also well to remember
that horses and cats are sometimes
subject to diphtheria, while almost all
of the lower animals are subject to
tuberculosis.
From what has been said, it is clear
that the sick room is not a common
means of spreading disease. Let us
suppose that one of the above named
diseases has been present in a room.
The patient is now up and out. All
bedding, carpets, rugs, curtains, and
other articles which hold dust have
been taken out and boiled or sunned.
The furniture, floors, and walls have
been scoured with soap and water.
The room is then thrown open to air
and dry. Such a room may be con-sidered
perfectly safe after two days.
A moderately well cleaned room is
safe after two weeks, while a room
that is dark and without ventilation
is never safe.
How are contagious diseases spread?
In nine cases out of ten it is by the
passing of moisture directly from the
mouth of one individual to that of an-other.
This is done by coughing or
sneezing into the faces of others; by
the use of the common drinking cup
or dipper; by the damnable habit of
promiscuous spitting; by kissing upon
the lips; by the use of towels, hand-kerchiefs,
and napkins that have been
used by others; by flies; by saliva
upon the dirty hands of persons hand-ling
food; by children carrying mar-bles
and coins in their mouths, and
by the passing of any substance from
mouth to mouth.
It may seem a simple thing to stop
all of these things. When they are
stopped it will save more than five
thousand human lives in North Caro-lina
every year.
ffOBERCULOSlS
ON EARLY DETECTION
OF TUBERCULOSIS
Case History, Temperature Record,
Sputum Analysis, and Exami-nation
Necessary
——^M———f—— J Large placards of this cut 14" x 22" may re obtained free of charge by addressing the State Board of Health, Raleigh, N. C. U^T NOTiCE 10 READER- When you finish reading this', magazine plffiL 1 place a one-cent stamp on this notice, hand same to any postal em- *'/Sl7fl Mltftliyeefand it will be placed in the hands of our soldiers or sailors Published b4 TATL^RTACARPLIrtA STATE. B?ARD s^ATiALTA This Bulletin, will be seryt free to ar\u citizen of the 5tateupoa request ! Entered as second-class matter at Postoffi.ee at Raleigh, N. C, under Act of July 16, 1894. Published monthly at the office of the Secretary of the Board, Raleigh, 2V. G. Vol. XXXII JULY, 1917 No. 4 rE :ir=ir==ir=ir=ir=nr= ir==if=i r—ii ir=ir= n CONSERVE LIFE AND HEALTH GOVERNOR T. W. BICKETT .f^ZZZ^.'^*1 ' Y17E say that human life is priceless. Yet statistics indicate that in North Carolina we are losing, yea needlessly wasting, thousands of precious human lives every year, together with the efficiency, the earning capacity and the real joy of living for tens of thousands of others. All this is preventable. Much of it is easily preventable. When shall we awaken to the full gravity of the situation? Now, if ever, in war times, every North Carolinian should be at his maximum efficiency, free from all preventable physical handicaps, and in the best physical condition, ready to do a man's full part in waging this world war to a speedy, successful conclusion. To win this war we. must conserve our health, vigor and efficiency; we must do health work, U both personal and public, as never before. ! — ii ir===ir==^ r==^r=^r=^P==^ r==i r==^r==^r====ir===i r==n i nJ TABLE OF CONTENTS Editorial Brevities 99 Vital Conservation for War... 100 What is the Red Cross 101 President Wilson and the Red Cross 102 Mason's Iron Cross 103 Protect Your Community From Contagious Diseases 105 An Old Fable 106 Controlling the Midiwfe Prob-lem 108 Don't Let This Happen to You. 109 Hot Weather Health no Rheumatism a Preventable Dis-ease H2 The Teacher's Part in Medical School Inspection 114 Chronic Constipation in Women. 115 Tuberculosis a County Problem 117 Symptoms of Tuberculosis 119 Tuberculosis a Most Curable Disease 119 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., . Statesville E. C. Register, M.D., . . . Charlotte Chas. O'H. Laughinghousk, M.D., Greenville Edward J. Wood, M.D., . . Wilmington Cyrus Thompson, M.D., . . Jacksonville P. R. Harris, M.D., . . . Henderson Official Staff W. S. Rankin, M.D., Secretary of the State Board of Health and State Health Officer. O. A. Shore, M.D., Director of the State Laboratory of Hygiene. Warren H. Booker, C.E., Chief of the Bureau of Engineering and Education. L. B. McBrayer. M.D., Superintendent of the State Sanatorium. J. R. Gordon, M.D., Deputy State Registrar. G. M. Cooper, M.D., Chief of the Bureau of Medical Inspection of Schools. A. McR. Crouch, M.D., Epidemiologist. B. E. Washburn, M.D., Director of County Health Work. FREE PUBLIC HEALTH LITERATURE The State Board of Health has a limited quantity of health literature on the subjects listed below, which will be sent out, free of charge, to any citizen of the State as long as the supply lasts. If you care for any of this literature, or want some sent to a friend, just write to the State Board of Health, at Raleigh. A postcard will bring it by return mail. No. 107. Life Saving Facts About Diph-theria. No. 116. Scarlet Fever. No. 117. Tuberculosis. No. 118. Measles. No. 119. Whooping Cough. No. 120. Hookworm Disease. No. 121. Sanitary Management of Hotels. No. 122. Poliomyelitis or Infantile Paral vsis. No. 123. Typhoid Fever. No. 126. Indigestion. Teeth, Tonsils, and Adenoids.* How to Live Long.* A War on Consumption.* Milk.* Periodic Medical Examina-tion. Typhoid Fever and How to Prevent It* Concrete Septic TanksJ Anti-Spitting Placards (5 inches by 7 inches) . Anti-Fly Placards (14 inches by 22 inches). Anti-Typhoid Placards (14 inches by 22 inches). Anti - Tuberculosis Placards (14 inches by 22 inches). Clean Up Placards (14 in. by 23 in.) •Furnished by courtesy of the Metropolitan Life Insurance Company. t Furnished by courtesy of Portland Cement Association. No. 12. PUBLI5ALD ST TML mPRTM CARPUMA 5TATE. BQMgD s^MEALTH Vol. XXXII JULY, 1917 No. 4 EDITORIAL BREVITIES Keep well—the first service you owe to your country. Are you a member of the Red Cross? Are you doing all that you can for the health and comfort of those who are fighting for you? Do you have good, made-to-measure wire screens, or at least mosquito net-ting screens at every door and window this summer? If you do not, you are missing a lot of solid comfort, greatly increasing an unnecessary summer an-noyance, and needlessly exposing the lives and health of yourself and family. Screen the flies and mosquitoes out! Every neighborhood, town, or com-munity, especially every industrial center, should have one or more classes in First Aid. All that is nec-essary to form such a class is to se-cure not less than four nor more than twenty-five members, the minimum age limit being sixteen years, and the consent of a qualified physician in act-ive practice to act as instructor. The name and qualification of the physician and the number in the class are then sent by the class secretary to the First Aid Division, American Red Cross, Washington, D. C, for approval, where-upon a class roll, a catalogue of sup-plies, and necessary information will be forwarded to the secretary and the class will be ready to begin work. When you dream of your work and worry over it, it is time for you to take a vacation. Don't think you can't afford it. It is cheaper and better for you to take it now than to take a longer enforced leave of absence later. A crying shame it is that it takes such an emergency as a great war to drive us to the realization that an appalling number of our young men are not physically fit to cope in battle with an enemy. If bad teeth, hook-worm disease, malaria, constipation, adenoids, defective eyes, ears, under-weight, and other equally unnecessary, sometimes disgraceful and nearly al-ways easily preventable, defects can so seriously affect our young manhood, how about our young womanhood? How about our middle-aged men and women, those that should be the real factors in the world's work? Let's put an end to such inefficiency. Medi-cal inspection of schools is the im-mediate step in providing for the fu-ture, while periodic medical examina-tions for adults and sanitation and public health work offer much hope for us of today. Don't get the idea that good health is merely absence of disease or sick-ness. It is far more. One may not feel sick at all and still be only 60, 70, or 75 per cent efficient. Good health is 100 per cent of physical efficiency. It is that physical state of being where life is a joy, and plenty of hard work is a pleasure. LOO THE HEALTH BULLETIN VITAL CONSERVATION FOR WAR Why and How We Should Conserve Our Greatest Waste at This Time W&a AR, waste, and conservation ara words that are kept ringing in our ears these days. That we are involved in the greatest war the world has ever known, that our own fate and future are absolutely and in-separably dependent upon the outcome of this war, is a certainty. If we win, democracy and freedom of peoples win. If we lose, democracy and freedom lose, autocracy wins, and we stand liable to pay tremendous indemnities to our enemies that will make our seven-billion-dollar Liberty Loan look small. There is but one solution to this situation: WE MUST WIN. But to win is going to tax our resources to the utmost. Already from far and wide are going out appeals for larger food crops and greater economy and conservation along this line. But we cannot afford to be short-sighted, penny-wise or pound-foolish. It takes more than food to win a war. It takes men and women, and money and resources of every kind to win a war. Before we can have money and resources we must have men and women that are men and women to produce and supply, and continue to produce and supply, money and food and resources of every kind. A nation of weaklings will fail, just as Rome failed, when her people, because of drunkards and debauched victims of disease, neglected to take proper care of their physical machine. Similarly, we cannot expect to win a war with a nation of young men wno do not pass even a moderately rigid physical ex-amination. Nor can we expect the physical culls and seconds left at home to supply food, munitions, money, and supplies almost without end to sustain our own and other armies of fighting men abroad. War requires men that are all men, full of physical vitality and working up to the fullest possible efficiency. In such a gigantic strug-gle as we now face, every weakling and every sick and inefficient person in our land who is not more than taking care of himself, is just that much dead weight. Similarly, every individual who is pegging along at 60, 70, or 80 per cent of his possible physical ef-ficiency lacks just that much of doing "his bit." War is a tremendous tax and ex-pense in every way upon a nation. In order to meet this tax, this terrific loss of our best manhood, money and re-sources, we must conserve, avoid every possible waste, and make for efficiency in a large way. From time imme-morial we have continued to suffer a tremendous and unnecessary loss of life, health, happiness, and efficiency from needless and easily preventable disease. Now, if ever, we must "about face" and stop this needless loss and waste. While it is estimated that North Carolina wastes annually per-haps $20,000,000 worth of food, we are at the same time wasting much more in absolutely needless sickness and loss of life, when figured in cold dol-lars and cents. For instance, it is es-timated that every year about 14,700 North Carolinians die from easily pre-ventable or postponable diseases. If we estimate a person's life to be worth only $1,700, we have an annual loss from this one item of over $24,- 000,000. It is estimated that over one per cent of our population are need-lessly sick at all times, and that their annual earning capacity is only $700. This gives us an annual time loss from sickness of 23,000 times $700, or $16,100,000. It is estimated that the average family in North Carolina THE HEALTH BULLETIN 101 spends $27 annually for medicines and doctors' bills for needless sickness— another loss for our 400,000 families of $10,800,000. The total of these three items of $24,000,000 for needless deaths, $16,100,000 for needless loss of time, $10,800,000 for doctors' bills and medicines for needless sickness, is over $50,000,000 annual health loss for North Carolina from these three items alone. There are, of course, many other items not included, such as loss of efficiency when not sick enough to stop work or call a doctor, and fur-thermore this estimate does not take into account intangible values such as broken family ties, love, friendship, or the value of pain and suffering. Is it not time to set our house in order, and not only stop this gigantic loss, but place ourselves on an effi-cient basis as never before? We can-not put in our best efforts, either in war or in civil life, while laboring under such unnecessary vital losses. To make real headway in this work means better attention to child hy-giene, the education of mothers in the matter of raising healthier, stronger, babies; it means better medical inspec-tion of school children so that they don't have to spend four years in school doing three years' work; it means better home sanitation so that we are not cursed with malaria, ty-phoid, tuberculosis, hookworm disease, etc. It means at least annual, careful, painstaking medical examinations of every adult by a competent physician to determine any oncoming diseases. In brief, it means the establishment of an active city or county health de-partment in every city and county in the State, such department to be armed with nurses, sanitary inspectors, a quarantine officer, medical inspectors, lecturers, and a laboratory. With such we will begin to see results with-in a year or two. The death rate will decline and the whole physical and moral tone of the city, county, and State will improve. Will we do it? Will we take this step to win the war and to make life fuller and richer after the war? It is up to us now as never before. WHAT IS THE RED CROSS? Good Samaritan to all People in Trouble—Our Part in the Great War s^7|HE Red Cross is to the men of ^-^ the army what the "Good Sa- **™° maritan" was to the man who "fell among thieves, which stripped him of his raiment and wounded him. and departed, leaving him half dead." The American Red Cross is a branch of the great international organization and has recognition from all for-eign governments. It is chartered by Congress, has the President of the United States as its president, and has its accounts audited by the United States Treasury Department. It is the only volunteer relief agency auth-orized by the government to render aid to its land and naval forces in time of war. Its services are guaranteed to reach the needy and render aid in the most efficient way. The Red Cross grew out of the generous impulse of the human heart to relieve human suffering met by war or disaster. It has grown from a lonely nurse dressing the wounds of soldiers on the battlefield to the great-est humanitarian society in the world. It is altogether a philanthropic or-ganization, is supported by voluntary subscriptions, and is neutral in war, knowing no race, sect, or religion. It is indeed the Good Samaritan to all folk in their darkest hour. The work of the Red Cross in time 102 THE HEALTH BULLETIN of war consists in all forms of relief work, from administering to the wounded and suffering of the army and navy to taking care of the dependent families of soldiers and sailors and se-curing employment for men disabled in the country's service. In time of peace it not only prepares for war, but maintains that state of prepared-ness that enables it to relieve distress caused by disaster in the quickest and most efficient way possible. Every chapter has its workrooms and auxiliaries. It furnishes trained instructors for the making of medical and surgical supplies and gives courses in accident and disease pre-vention, as well as in rendering first aid to the injured. It also provides courses in home care of the sick, home dietetics, and various means of disease and accident prevention. The purpose of what has above been said concerning the Red Cross is to commend it, its work and its support, to the readers of the Health Bulletin, as the Red Cross is the big brother to the medical profession and all health workers. We believe that every town and community in the State should form either a chapter or an auxiliary, which is a branch of a chapter, and should actively engage in this great work of relief and mercy by making medical and surgical supplies for hos-pitals, by learning how to care for the sick and wounded and by giving of their means to support this work. It is the only way those who do not go to the front have of showing their appreciation for, and giving aid to, those who are doing the fighting. The Government provides for their food, clothing and ammunition, but it leaves it to us to provide for their lives in case they are wounded or sick, and for their families in case they leavr them dependent and helpless. Information for forming a Red Cross chapter, an auxiliary, or a class in First Aid may be had by writing to the American Red Cross at Wash-ington, D. C. Write for further information and circulars today and proceed at once with the work in your own community among your neighbors and friends. They will appreciate your taking the lead. It is a small part of your pa-triotic duty and theirs. Do it now. PRESIDENT WILSON AND THE RED CROSS Earnestly Recommends it to the Con-fidence and Support of the People j^lELIEF work is undoubtedly ahead ffL of us," was asserted by President Wilson in a letter sent to the Washington branch of the American Red Cross, saying that as the official volunteer aid organization of the Uni-ted States the society should receive the generous support of the American people. "In order that the relief work, which is undoubtedly ahead of us, should be made thoroughly efficient," wrote the President, "it is most desirable that it should be coordinated and concen-trated under one organization. "Having been made the official vol-unteer aid organization of the United States, the American Red Cross comes under the protection of the treaty of Geneva and has received due recogni-tion from all foreign governments. Its status both at home and abroad is thus definitely determined and assured. "The surgeons general of the War and Navy Departments are members of the executive committee of the Amer-ican Red Cross. By act of Congress medical officers of both branches of the service are detailed for service with it in order that its military relief may be so organized as best to supplement THE HEALTH BULLETIN 103 the medical services of our fighting forces. "Until the civilian relief is under a trained and experienced personnel es-pecially fitted to care for soldiers' families and other non-combatants, the accounts of the association are audited by the War Department in order thoroughly to safeguard the funds con-tributed by the public. "Recent experience has made it more clear than ever that a multi-plicity of relief agencies tends to bring about confusion, duplication, de-lay, and waste. Moreover, it affords temptations to dishonest persons to take advantage of the general willing-ness of the public to subscribe to such agencies to defraud subscribers and rob the soldier of the assistance he so much needs. Wherever in the present war sufficient volunteer aid has been rendered either to soldiers or to non-combatants it has been ren-dered under a well organized central body. Experience is certainly the most convincing teacher, and we should learn by these European ex-amples how to conduct our own relief work with the most thorough efficiency and system. With its catholicity and its democracy the Red Cross is broad enough to embrace all efforts for the relief of our soldiers and sailors, the care of their families, and for the as-sistance of any other non-combatants who may require aid. "As the president of the American Red Cross, our branch of the great in-ternational organization, I most earn-estly commend it to your confidence and your support. Upon your aid, upon the amounts and promptness of your gifts and cooperation must de-pend the fulfillment of the duties that are imposed upon it. It serves so noble and beneficent a purpose that it must appeal to all who love their country and love humanity." MASON'S IRON CROSS Valerie D. Ohrenstein sends us this poser from Chicago: "Have we any right to expect any-thing from Congress which is idealis-tic, or for the good of the many, as opposed to the immediate benefit of the few, when we elect men of the type of ex-Senator William E. Mason [now a member of the House of Representa-tives from Illinois], who is willing to sell his title for the price of a patent-medicine testimonial? The inclosed advertisment appeared in the Chicago 'American.' . . ." Miss Ohrenstein takes too blue a view of the case. Chicago has, to be sure, a Mason in Congress, a Thomp-son in the mayor's chair, but there are cities with better mayors, and Chicago itself has better representatives than Mason. Mason is a hold-over from the patent-medicine school of American politics, and as a young nation we must not be too impatient with our elders. Collier's Chicago friend in-closes in her letter the "American's" three-column advertisement, with its far-flung headline telling how Mason says NUXATED IRON INCREASED HIS POWER AND ENDURANCE SO MUCH THAT IT OUGHT TO BE MADE KNOWN TO EVERY NERVOUS, RUN-DOWN, ANEMIC MAN, WOMAN AND CHILD. If that's so, it's a pity that the ex-senator didn't take some "Nuxated Iron before telling Congress, on the eve of the war declaration, that "Ger-many had given us no cause for war." "Nuxated Iron," if it is much good, ought to have kept him from saying: "I am against this war because . . . it is a dollar war." It might have kept him, after the declaration, from counseling delay in respect to war measures: "Gentlemen, we have plenty of time. . . ." Mason's tribute to 104 THE HEALTH BULLETIN "Nuxated Iron" starts like this: "I have often said I would never recom-mend medicine of any kind—" and on second thought he hasn't broken his pledge, either. "Nuxated Iron" con-tains only about a five-hundredth of a grain of nux vomica alkaloids to a tab-let, and a twenty-fifth of a grain of iron—which is shown in an analysis by the American Medical Association. "Nuxated Iron" comes about as near to being a medicine and to having "valuable blood, nerve force, and tis-sue- building properties" (see the wrap-per) as Mason comes to being a pa-triot and a statesman. The other day Mason had an article by Mayor Thomp-son of Chicago attacking the Govern-ment's war loan and its food-regula-tion plans printed as an "extension of remarks" in the Congressional Record. Only a few days later Mr. Hastings of Oklahoma was reported to have charged him with treason because of certain remarks on our military law and policies. (Later the word "trea-sonable" was expunged from the Rec-ord.) Chicago is not fortunate in all its statesmen, but Chicago is a big city after all, and we think Miss Ohren-stein need not be much depressed just because Herr Mason has earned a "Nuxated" Iron Cross.— Collier's Weekly. PATRIOTISM AND YOUR HEALTH Why not add at least 3 or 4 per cent to your personal efficiency so as to be better able to meet all coming needs? The sanitary sharps agree that the average citizen loses between nine and twelve working days each year because of preventable sickness. Now, if this war is to mean anything to the average man, it ought to mean shaking off only semisensible habits and living up to his best. No one is even suggesting a tax on water; why not drink it and have more money to buy war loan securities? Air is as free as ever—take your full share. Fewer of us will be in danger of over-eating these next few years, and there will be work enough to make us all sleep when bedtime comes. Now is a good chance to get rid of any foolish-ness about clothes; shoes that curse the feet, collars that cut the wind, and any other nonsensical items in be-tween. This is a 100 per cent war, and we can ill afford to carry the burden of preventable sickness. Tak-ing care of yourself is more than sense now—it is a duty.—Collier's Weekly. There never has been a time when there were so many reasons why one should keep well and do all in his power to prevent disease as now. The first and the last reason, perhaps, is that sickness is expensive; it costs both time and money, to say nothing of the valuable human life that it wastes annually; and if this country is to win in this great war, it cannot afford to have any of its resources spent on anything so unnecessary as disease. On the other hand, it would be better to spend money to prevent disease. Disease is no respecter of persons. There is not one kind of consumption for the white people and another kind for the black. A town is like the sky at night: for as a flash of lightning in one quarter of the heavens lights up all the rest, so disease in the poorest section of the town reaches out its fingers and blights the remote home of the wealthy. As to pellagra, a safe conclusion of the whole matter is that the farm that has a good cow, a pea patch, and a hen coop will not have pellagra on it. :: : i , ' :: ^ PUBLIC HEALTH and SANITATION PROTECT YOUR COMMUN-ITY FROM CONTAGIOUS DISEASES Ten Righteous People Can Do It I ND the Lord said, If I find in ^J Sodom fifty righteous within the ^ma city, then I will spare all the place for their sakes." "And he (Abraham) said, . . . Peradventure ten shall be found." "And He (the Lord) said, I will not destroy it for ten's sake." The salvation of communities still and always, as in the days of Sodom, depends upon a few righteous, respon-sive individuals, and not upon the mul-titude, the irresponsive herd—the shepherd saves the flock. To every township with from three to five interested, responsive citizens and to every town or city with one or two interested, responsive citizens for each thousand of the population, North Carolina, under a law which went into effect August 1st, can promise safety from unnecessary contagion. This does not mean all contagion, but it does mean a very large proportion of it. On the other hand, the State is helpless to protect those communities where nobody knows, or, which is worse, where nobody cares. Won't you, in this vital matter of protecting the health and lives of your disinter-ested neighbors and of their helpless children, be one of the ten righteous? Will you make and keep a trade with your conscience, unconditioned on any supplementary pay from the crowd? If so, you can effectually assist our State in protecting your community from epidemics. But before you should be expected to do this, the State and county must make it possible, first, for you to be able to recognize violations of the State quarantine law, and, sec-ond, for you to report such violations without becoming involved in legal en-tanglements or social embarrassments. How You May Recognize Unmistaka-ble Violations of the Quarantine Law If you know of a home in which there is a person sick with whooping cough, measles, diphtheria, scarlet fever, smallpox, infantile paralysis, ty-phoid fever, or cerebro-spinal menin-gitis and on the front of which there is not fastened a large yellow placard with the name of the disease printed thereon, you may know positively that the quarantine law is being violated. When the law is violated, one of three parties is guilty—the quarantine offi-cer, the attending physician, or the householder. When the Quarantine Officer is Guilty.—The quarantine officer has sworn "that he will well and duly exe-cute and perform all the duties as county quarantine officer prescribed by chapter 263 of the Public Laws of 1917, and such duties as are now or may hereafter be prescribed in and by the regulations promulgated by the North Carolina State Board of Health under the authority conferred by sec-tion 10, chapter 263, of the Public Laws of 1917." Under this oath it is the duty of the quarantine officer to see that every home in which one of the aforementioned diseases has been reported to exist shall receive a yellow placard with the name of the disease printed thereon, and shall receive the law and the rules and regulations re-quiring the posting of the placard and 106 THE HEALTH BULLETIN prescribing other necessary precau-tions for public safety to be carried out by the householder. It is hardly conceivable that the quarantine officer, under the obligation of a solemn oath and with a full realization of the im-portance of prompt and effective quarantine, has failed to do his duty. When the Attending Physician is Guilty.—If the physician in attend-ance upon a case of whooping cough, measles, diphtheria, scarlet fever, When the Householder is Guilty.— First, if one of the above mentioned diseases is so mild as not to have necessitated the calling in of a physi-cian, the householder, under the re-quirements of the law, should have re-ported the case of sickness to the quarantine officer. If he has not done so, he has, either ignorantly or know-ingly, violated the law; and if he has willfully violated the law, he is guilty of a misdemeanor. Second, if the AN OLD FABLE /^VNCE UPON A TIME there was a city with a street ^-^ running along a cliff. In dark and stormy weather so many people were injured by falling over the edge that the citizens gathered together to see what they could do about it. They decided to use their resources to build a hospital at the foot of the cliff so that the injured might receive immediate attention. Now, it chanced that a great physician visited their land, and the inhabitants showed him the hospital with great pride. But he, looking up at the cliff, said : "Wouldn't it have been cheaper in lives and money to build a wall of protection along the cliff?" smallpox, infantile paralysis, typhoid fever, or cerebro-spinal meningitis fails to report the case to the quaran-tine officer, he has failed to perform his duty and is guilty of a misde-meanor. Practically all physicians are interested to a sufficient extent in the prevention of disease and realize suf-ficiently the vital importance of well-enforced quarantine laws to cause them to report the "catching" diseases. Occasionally, however, physicians are careless or forgetful in performing this their most important civic obli-gation. householder has not posted the yellow placard received from the quarantine officer and has not complied with the rules and regulations furnished him in writing by the quarantine officer, he is guilty of a misdemeanor. How You Can, Without Expense, In-convenience, or Embarrassment, See That Violations Are Investigated and Punished. First, you can notify the quarantine officer of your county, whose name and address appear on page 107 of this Bulletin, of probable violations of the quarantine law. The quarantine THE HEALTH BULLETIN 107 officer should regard the information you supply him as strictly confiden-tial. He should investigate the possi-ble violation, and if he finds the law has been violated he should, in accord-ance with his oath, indict the guilty parties. In investigating the complaint and in bringing the indictment, the quarantine officer can secure the nec-essary evidence without involving his assistant and informer in legal pro-ceedings or social embarrassment. The Control of Contagion Rests Pri-marily on Complete Reporting of Contagious Diseases A fire department can't put out a fire until it is notified. The State and county machinery for restricting the spread of contagion cannot be put into operation until the disease is reported. The reporting of contagious diseases, every case, is the first and absolutely necessary step in any system of con-trol. After the disease is reported, the BROUGHT UP TO DATE ONCE UPON A TIME a great country went to war and needed her strong men to fight her battles. But when her sons were called together only half of them were found fit to do battle, the others being deficient in health and lacking in physical strength. What shall we do?" said the people. "Unless our men are strong in body they will lose in battle. Let us ask Congress to appropri-ate a great sum and build hospitals where they may receive treatment and be cured of their diseases." And this Con-cress approved. , But some said: "A pity it is that great sums of money should be spent for this purpose now, whereas small sums spent a few years ago when these were boys would have made this unnecessary and saved the country s manhood from this blight of ill health and inefficiency. And the people said, "Yea, truly ! A poorer nation, but a wiser one, will we be when the war is over. Second, if you do not care to report direct to your county quarantine offi-cer, you can report to the State Epi-demiologist, Raleigh, North Carolina. The State officer will regard your in-formation as confidential, and will im-mediately communicate with your county quarantine officer in regard to the probable violation of the law, and in doing so will not use your name. The State Board of Health would ad-vise, however, that wherever possible interested citizens cooperate directly with their local authorities in the en-forcement of the quarantine law. responsibility for controlling its spread rests largely with the State and coun-ty, and in the order mentioned. NAMES AND ADDRESSES OF QUARAN-TINE OFFICERS. Counties. Alamance Dr. Alexander Dr. Alleghany Dr. Anson ..Dr. Ashe Avery Beaufort Dr. Bertie Bladen Dr. Brunswick Dr. Buncombe Dr. Burke Cabarrus Dr. Caldwell Dr. Camden Dr. Carteret. Dr Caswell Mr. Catawba Dr. Name. Address. C. T. Vernon Burlington. S. T. CrowBon—Taylorsville. J. L. Doughton.. Sparta. J. H. Bennett Wadesboro. J. G. Blount Washington. G. F. Bullard Elizabethtown. J. A. Dosher Southport. D. E. Sevier Asheville. R. M. King Concord. L. H. CofTev Lenoir. C. G. Ferebee Camden. P, B. Loftin Beaufort; Henry S. Turn< r.Yaneeyville. ( ieoige W . Shipp.Newton. 108 THE HEALTH BULLETIN Counties. Name. Address. Chatham Dr. L. E. Farthing. ..Pittsboro. Cherokee Dr. H. J. Tilson Murphy. Chowan Dr. J. S. Mitchener ..Edenton. Clay Cleveland Dr. E. B. Lattimore.. Shelby. Columbus Dr. R. C. Sadler Vineland. Craven Dr. J. F. Rhem New Bern. Cumberland .Dr. J. W. McXeilL—Fayetteville. Currituck - Daie ..Dr. Franklin P.Gates Manteo. Davidson Dr. E. F. Long. Lexington. Davie ..Dr. J. W. Rodwell Mocksville. Duplin Dr. J. W. Fairior Kenansville. Durham Dr. Arch Cheatham..Durham. Edgecombe.. .Dr. K. E. Miller Tarboro Forsyth Dr. A. C. Bulla Winston Salem. Franklin Dr. J. E. Malone Louisburg. Gaston Dr. L. N. Glenn Gastonia. Gates Graham Granville Dr. B. K. Hays Oxford. Greene ...Dr. W. B. Murphy.. .Snow Hill. Guilford Dr. W. M.Jones Greensboro. Halifax. Dr. I. E. Green Weldon. Harnett Dr. J. W. Halford ...Chalybeate Springs. Haywood Dr. J. R. McCracken.Waynesville. Henderson ...Dr. J. F. Cranford ...Hendersonville. Hertford Dr. \V. B. Pollard.. ..Winton. Hoke Dr. R. T. Wilkins ....Raeford. Hyde. Dr. L. H. Swindell.. .Swanquarter. Iredell Dr. R. S. McElwee...Statesville. Jackson Johnston .Dr. Thel. Hooks Smithfiend. Jones.. Lee Dr. Lynn Mclver Sanford. Lenoir Dr. G. S. Mitchener.. Kinston. Lincoln Dr. J. W. Sain. Lincolnton. Macon. ..Dr. H. T. Horsley ...Franklin. Madison. Dr. Frank Roberts. ..Marshall. Martin Dr. W. E. Warren Williamston. McDowell Dr. J. F. Jones Marion. Mecklenburg. Dr. C. S. McLaughlinCharlotte. Mitchell Dr. C. C. Smith Toecane. Montgomery. Dr. C. Daligny.. Troy. Moore Dr. A. McN. Blue Carthage. Nash Dr. Ambler Speight.. Nashville. New HanoverDr. C. T. Nesbit Wilmington. NorthamptonDr. F. M. Register Jackson. Onslow Dr. R. H. Noell. Swansboro. Orange Dr. A. J. Warren Hillsboro. Pamlico Dr. G. S. Attimore... Stonewall. Pasquotank.. Dr. Zenas Fearing ...Elizabeth City. Pender Dr. P. E. Lucas Burgaw. Perquimans. -Dr. F. S. McMillan. ..Hertford. Person Dr. Arch Bradsher__.Roxboro. Pitt. Di. M. T. Edger-ton, Jr. Greenville. Polk.. ..Dr. Earle Grady Tryon. Randrlph Dr. L. M. Fox Asheboro. Richmond Dr. J. M. Maness Ellerbe. Robeson Dr. B. W. Page Lumberton. Roc ki:igham Rowan Dr. C. W. Woodson. .Salisbury Rutherford Sampson Dr. E. T. Hollings-worth Clinton . Scotland Dr. Peter McLean Laurinburg. Stanly Dr. J N. Anderson..Albemarle. Stokes ..Dr. W. L. McCauless.Danbury. Surry Dr. Ira S. Gambill.-.Dobson. Swain. Dr. P. R. Bennett Bryson City. Transylvania Dr. C. W. Hunt Brevard. Tyrrell Dr. C. A. Flowers Columbia. Union .Dr. S. A. Stevens Monroe. Vance.. Wake Dr. Z. M. Caviness...Raleigh. Warren Dr. Ghas. H. Peete...Warrenton. Washington ..Dr. W. H. Ward Plymouth. Watauga Dr. M. G. Anders Boone. Wayne Dr. W. H. Smith Goldsboro. Wilkes Dr. J. M. Turner No. Wilkesboro. Wilson Dr. J. C. Braswell.Jr. .Wilson. Yadkin Dr. V. F. Couch Yadkinville. Yancey Dr. J. B. Gibbs Burnsville. CONTROLLING THE MID-WIFE PROBLEM Rocky 3Iount Board of Health Re-quires all Midlives to Pass Satisfactory Examination qjOCKY MOUNT has led all other ^^ towns in the State, and prob-ably in the South, for all we know, in conducting a school for mid-wives, even to the extent of requiring them to stand an examination and make a satisfactory grade in order to obtain a permit to practice their work. The city board of health passed an ordinance making it unlawful for any midwife in the city to practice her profession after January 1, 1917, with-out having passed a satisfactory ex-amination in the elementary principles of midwifery. Free instructions were given by the city health officer, no fee being charged for the examination or for issuing the permit. The result has been, according to the city health officer, a noticeable falling off in the infant death rate, while at the same time an increase in the birth rate has been noticed, due to complete birth registration, the im-. portance of which was one essential made known to the midwives. The place filled by widwives in this country, from a health standpoint, is a big problem. The question is, how shall the midwife be so trained and controlled as to become of greatest value, rather than a menace, to those who from ignorance, traditions, en-vironment, or for financial reasons, still seek her services? This, it is believed, can be achieved through training, licensure, and control by State and local boards of health, as the city board of health of Rocky Mount has recently found out. The extent to which the midwife problem affects North Carolina is seen THE HEALTH BULLETIN 109 through the following figures: Last year there were 55,512 white births in North Carolina and 24,408 colored births, a total of 79,920. Of the white births, 80 per cent were attended by physicians and 20 per cent by mid-wives, while 80 per cent of the colored births were attended by midwives and only 20 per cent by physicians. That almost twice as many colored babies in North Carolina die during the first \veek of life as white babies, accord-ing to figures from the Vital Statistics Department, is thought to be largely due to the ignorant midwife. That more women from fifteen to forty-four years old die from conditions caused by child-birth than from any disease except tuberculosis is also thought to be largely due to the ignorant mid-wife. These facts point to the need of stricter laws governing midwives, par-ticularly as it affects their training and ability. D0>'T LET THIS HAPPE> TO YOU OK TOUR HOUSEHOLD The doctor said "TYPHOID!" How you dread that word! It strikes ter-ror to you now as you hear, in your imagination, the muffled tread of foot-steps and low voices near the bedside of the stricken patient, and you ask what cause has brought such sorrow to your unsuspecting household! Your own home had sanitary facil-ities, sewers and screens, perhaps, and clean, well-kept grounds, and yet typhoid came unbidden—the unwel-come guest. WHY? you ask. Look about you for the reason. Watch that little fly buzz-ing harmlessly near the sick-room door. Where does he come from and what is his business here? Ah! You have it! Over in yonder hollow is a plain, ordinary, outdoor privy. Nothing un-usual about it. You have seen it be-fore. Perhaps there are others nearer or even farther away! BUT THERE IS THE CAUSE! One little fly regaled himself in yonder closet, took his fill of filth and cov-ered his body and legs with the deadly typhoid germs, then came to your own kitchen and dining-room to walk upon the butter, feast upon the cake, or scrape his feet on the rim of the baby's bottle; and found you and your family disarmed. But how? You had promised yourself that when this summer came, you and your household would be vaccinated against typhoid fever; but did you? You kept putting it off till a more convenient season, and already the doctor has said "typhoid"! What would you not give to have that peace of mind that comes from having done one's duty? You saw yours, but you neglected it. Oh, yes, you will never let it occur again. You and the remainder of your household will at once be vaccinated. But it may be too late to save you. It certainly will not save the stricken patient from suffering weeks and per-haps months of burning fever. It may not save you of, perhaps, a funeral, but it could have saved you all. Talk Health. The dreary, never-changing tale Of mortal maladies is worn and stale. You cannot charm or interest or please By harping on that minor chord — disease. "Whatever the weather may be," says he— "Whatever the weather may be, It's the songs you sing and the smiles you wear, That's a-making the sun shine every-where." HOT WEATHER HEALTH How to Keep Cool, Comfortable, and Healthy During Hot Weather OON'T dread or worry about the __ hot weather. That makes its "^ coming all the worse. Recognize that it is coming, then get ready for it. Much can be gained by really get-ting ready for hot weather. For in-stance, did it ever occur to you what a tremendous drain it is on your nerve force, in other words, your "pep," in hot weather to be bothered with house flies crawling over and tickling your anatomy by day, to say nothing of the mosquitoes by night? Without screens flies materially disturb one's rest or prevent us from getting our full eight hours sleep each day. To successfully battle against hot weather requires that we get a full eight hours good sleep out of every twenty-four, and if this is shortened or disturbed by flies, even this handicap may be enough to spell the difference between health and sickness during the hot weather. Good screens or even mosquito netting at every door and window would solve this problem for the entire family all summer long. Furthermore, if good wire screens are installed they may confidentally be expected to last for five to ten years. Now one more word about that "full eight hours of good sleep." You can hardly expect to be living, working, and feeling at your best if you have to retire to a hot, stuffy bedroom with one or two small windows where it is so hot you have to swelter for hours until it cools off enough to permit you to get to sleep, only to have to get up before you have been fully refreshed. The remedy is simple: Knock out one or two sides of your old-fashioned room and replace them with windows. Then you'll have a modern sleeping-porch, and then you will be able to sleep in comfort and rise in the morn- SCREENS WOULD SAVE ALL THIS, AND MORE. ing feeling like the proverbial "two-year- old." Just before retiring, a tem-perate or cool bath about seventy-five to eighty-five degrees forms a splendid "night cap" after a hot day. It is a splendid introduction to a good night's sleep, although many find a cool bath, plunge or dip in the morning as an "eye-opener" even more to the point to start the day off right. At all events, get a bath every day at least in summer. What one eats and drinks has a lot THE HEALTH BULLETIN 111 to do with the way one feels during hot weather. Fat meats, concentrated foods, and heat and energy producing foods were certainly not intended for summer use. This is the time to elimi-nate meats and heat and energy foods, or at least reduce them to a minimum and live on fruits and vegetables. Learn to eat "greens" and all kinds of THE BEST KIND OF A NIGHT-CAP OR AN EYE-OPENER TOR HOT WEATHER "garden sas." Keep the bowels moving freely at least once or twice a day by means of a fruit and vegetable diet, lots of cool (not cold) drinking water, and a little bran gruel, if necessary. Avoid the ice-cold soft drinks of all kinds. "Adam's ale," the pure, unadul-terated kind and in large quantities, is far better. Don't overdress in summer. Save your clothes for winter wear. A bit of good summer advice along this line is to wear as little as the law of the land will allow, and that is mighty little these days—equal rights for men. Much of our summer discomfort may be avoided by the proper planning of our work. By a little forethought house-wives can arrange to minimize the time spent over a hot kitchen stove, and do much of the ironing, preparing of vegetables, sewing, etc., on a shady porch or in the breezy, fresh air. Work that has to be done in hot places can usually be done during the coolest parts of the day. Finally, one should not try to go through a summer physically handi-capped in any way, unless absolutely necessary. Life is rough enough and hard enough in places, anyway, with-out having to bear any unnecessary physical ills. For any person to ex-pect to keep up, to say nothing of win-ning, in this fierce race of life while handicapped by some physical dis-order, is the height of folly. It is just as impossible and as ridiculous for a man or woman to try to live up to his rated efficiency while handicapped by bad teeth, constipation, or any one or more of a score of needless ailments, as it is to expect a horse to win a race on three legs or an automobile "hitting on three cylinders." Get fixed up. Go to the best doctor you can find, put your case entirely in his hands. Have him find out what is wrong with you. In the vast majority of cases it will probably be some simple living habit. Correct that habit, hit on all four cylinders, and you will be sur-prised to see how work and difficulties disappear before you and how much real comfort and joy there is in life in the Good Old Summer Time. A healthful, well balanced diet calls for a liberal allowance of vegetables. This is why, both for health and economy's sake, we should plant gar-dens. If people all over the country will only plant gardens and not be so largely dependent on city markets for their table vegetables, not only will there be a big reduction in prices, but a correspondingly big increase in the good health and happiness of the peo-ple generally. 112 THE HEALTH BULLETIN RHEUMATISM A PREVENT-ABLE DISEASE Pus Poisoning From Teeth, Gums or Tonsils Often the Source of Infection By EDWARD J. WOOD, M.D., Wilmington Y focal infection is meant an ac-cumulation of pus somewhere in the body which is discharged into the circulation, producing certain damaging changes to vulnerable parts. All tissues of the body are not equally resistant to this pus poisoning. The parts which are more apt to suffer are the lining membrane of the heart, in-cluding the valves, the kidneys, and the joints. Recently it has been found that the heart muscle is often danger-ously affected by infections of this kind without producing any visible signs for the doctor to observe until the damage is beyond repair. One Cure for Rheumatism Dr. Osier said only a few years ago that rheumatism was a reproach to the medical profession because no progress had been made in the dis-covery of its cause; hence, no remedy could be intelligently applied. But today any case of rheumatism calls for a searching investigation on the part of the physician, for there is locked up somewhere in the body one or more pockets of pus which must be removed to prevent a further rheumatic in-volvement and also to cure the present trouble. All of the hitherto used rem-edies for rheumatism only relieved ant" never cured. There can be only one cure, and that calls possibly for the combined attack of a good nose ant" throat specialist, a modern dentist who works for a higher purpose than the outward appearance of the teeth and who will intelligently use the help of the X-ray when needed, and a con-scientious physician who is not content to have as the rule of professional ac-tivity, "What is to be must be." If the physician does his part the patient will be directed to the proper dentist and the proper nose and throat man, their findings will be brought together in an intelligent manner and the pa-tient will find relief. The reader will be impressed with the expensive nature of this investi-gation. If the patient lives in the country, it becomes necessary to gc to the city for the X-ray part of the work, at least. While it is costly, it is much cheaper than the numerous se-cret remedies advertised, and which will only relieve pain at best, and that often at the expense of kidney irrita-tion or heart depression Toothbrush and Dentist Best Preventives It would be far better to prevent all of this trouble, and it can be in the next generation, by a little education, which had better be done in the public schools. The one preventive measure above all others is the use of the tooth-brush. Like all other things, the use of the toothbrush must be made care-fully and thoroughly and the child must not be expected to have been born with a knowledge of its use. Many people think that the use of a toothbrush is a part of respectability. While this may be true, from a med-ical point of view, the average tooth-brush used in my practice is almost worse than nothing at all. The tooth-brush has only a limited life, and it is worse than useless after it is worn out. Again, a toothbrush to retain its stiff-ness must be dried out between usings, and should, therefore, not be kept in a toothbrush container. Each indi-vidual should have two or more of these useful articles in constant use and should be careful to use them in rotation in order to favor drying and a return of the normal stiffness of the THE HEALTH BULLETIN 113 bristles. But, in spite of all this, the individual must not expect to keep the mouth normal without the help of a competent, conscientious, patient dentist, who is not too busy or too prosperous to have time to practice preventive dentistry. Everyone should visit such a dentist every three or six months and have him carefully ex-amine every tooth. If there are no cavities, he will, at least, clean the teeth of the deposit known commonly as tartar, which cannot be removed except with a sharp instrument, which must be applied skilfully even below the gum. This is sometimes called scaling. If the teeth are kept dentally clean by this scaling process, as deep down as the dentist finds necessary, pyorrhea or Rigg's disease will soon become a negligible factor. The idea in the minds of the laity that the use of the ipecac preparations, as emetine, by the mouth or hypodermically will prevent and cure this gum condition is very fallacious. Without the dental cleaning of the teeth such a drug is entirely wasted and should never be used except by the dentist's advice as an aid to what he will do with his instruments. As a physician it is now my custom to begin all examinations with an ex-amination of the teeth. It is often a very embarrassing duty to have to tell intelligent patients that their mouths are dirty, uncared for by themselves, and needing dental treatment. It is surprising to find how few well dressed people are acquainted with the personal touch of the toothbrush. Tonsils Often Source of Infection The next important focus of this kind of infection is the tonsils. Many tonsils that apparently are normal or that cannot be seen on the ordinary examination are "submerged," and when drawn out by the throat spec-ialist's instrument are found to be exuding pus. Such tonsils probably cause more trouble than the large tonsils, which are usually removed. A case recently under my care was strongly suspected of tuberculosis, but after the removal of the tonsils the little fever immediately ceased and the patient is now well. Tonsils are •very important in any study of the source of rheumatism, heart disease, or kidney disease. I recently had under my care two young women with acute Bright's disease which had its origin in infection of the tonsils. There are other cavities in the head which become infected, especially after colds, which may be the sources ol focal infections and require expert attention. Anything but the best at-tention in such cases is worse than useless. Fortunately for most of us this is the least common source of trouble. It emphasizes the real need for a more thoughtful consideration of the danger of colds. Colds lower the resistance and prepare the way for many infections. Many focal infec-tions would be prevented if we would protect ourselves from colds. There are other sources of focal in-fection to be found in certain cases, but these cannot concern us here ex-cept in a general way. The public must learn that rheumatism is a pre-ventable disease; that the doctor must find the focus or direct them to some place where the investigation can be made; that the charge so often made that this new teaching is a fad had better be suspended until a fair trial is made. In conclusion, let me say that no sin-gle development in medicine and hy-giene can rank in importance with this. It opens up a new field which will almost immediately increase the normal expectation of life. By this means it is reasonable to expect a marked decrease in rheumatism, in heart disease, in Bright's disease, and in other conditions. Many cases of 114 THE HEALTH BULLETIN neurasthenia or nervous prostration are curable by this means and still more cases of neuralgia and eye strain cease to exist after the patient has been conscientiously studied in this way. THE TEACHER'S PART IN MEDI-CAL INSPECTION OF SCHOOLS Sometime ago when a physician was explaining the few simple but im-portant items which relate to the teacher's part in the medical inspec-tion of schools under the law enacted by the General Assembly of 1917, a teacher was overheard to remark in a loud whisper, "Who is going to pay the teacher for this?" That teacher has been teaching for twenty-two years, and has never taught more than five months in any one year, and her highest salary at any time has been forty dollars per month. She has prob-ably been paid entirely too much for the service rendered, if that sp |