Health bulletin

              HEALTH SCIENCES LIBRARY
OF THE
UNIVERSITY OF NORTH CAROLINA
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Entered as second-clasa matter at Postoffice at Raleigh, N. C, under Act of July 16, 1894.
Published monthly at the office ef the Secretary of the Board, Raleigh, N. O.
Vol..XXXIII APRIL, 1918 No. 1
HOGS OR FOLKS, WHICH? seepages
ONLY THE PEOPLE CAN LOOSE THE BONDS
TABLE OF CONTENTS
Hogs or Folks, Which ? 3
Sentekced to Prison oe Steriliza-tion
3
Soldiers and Tobacco 4
Popular Mistakes 4
Low State Death Rate 5
Three Things to Do 5
Tanlac—The Master Medicine .... 5
Large Scars and Sore Arms Unneces-sary
6
Cancer Not Inherited 7
School Epidemics 8
Where Ignorance is Crimin.a.l 9
Play is the Thing 10
How an Epidemic Developed 11
Sex Hygiene 12
Typhoid Bacillus Carries foe Over
Forty Years 12
Open-Air Schools 12
Physician Found Guilty 13
More Intelligent Excitement
Needed 13
Paste This on Your Mirror 14
What Vaccination Will Do 14
Know How to Live 15
Spring Fever and Wheat Bran ... 16
First Aid Instructions 17
How to Stop Worrying 18
Gasoline as an Emergency Medicine 19
Don't Stand so Much 19
Safe Guide to Healthful Eating. . 19
Saving Mothers 20
Why Register a Baby? 21
Avoid Early Handicaps 21
Why Nurse Your Baby ? 21
Have Early Diagnosis 22
Symptoms of Tuberculosis 24
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. Laughinghouse, M.D.,
Greenville
Edward J. Wood, M.D., Wilmington
Cyrus Thompson, M.D Jacksonville
F. R. Harris, M.D 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 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.
107. Life Saving Facts About Diph-theria.
116. Scarlet Fever.
117. Tuberculosis.
118. Measles.
119. Whoo])ing Cough.
120. Hookworm Disease.
121. Sanitary Management of Hotels.
122. Poliomyelitis or Infantile Paraly-sis.
123. Tjphoid Fever.
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 Tankst
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 inches by
23 inches.)
*Furnished by courtesy of the Metropolitan Life Insurance Company.
JFurnished by courtesy of Portland Cement Association.
No. 12.
'M(Bm Q)»
Ell PUBU5AELD BY TME- nPRTA CAgOUhA 5TATL. BcyMgp q/^mEALTM \\{°]
Vol. XXXIII APRIL, 1918 No. 1
EDITORIAL
HOGS OR FOLKS, WHICH?
On the front cover page is our car-toonist's
conception of a little North
Carolina incident which occurred a
few months ago Avhen the State De-partment
of Agriculture, acting under
the law which protects hogs, horses,
cattle and chickens, revoked the license
of one or more companies to sell al-leged
hog-cholera preventative com-pounds
which authorities found did
not adequately protect.
We think this an excellent law.
Valuable live stock should be ade-quately
protected particularly at this
time when food products are such a
factor in the winning of this war.
Feeding worthless medicines to hogs or
live stock at a time when they are
threatened with disease is akin to put-ting
ground glass in the hay and oats
furnished the horses and mules at our
military camps. Robbing a farmer or
stock raiser of money for such nos-trums—
well, consider the folks. There
are scores of worthless nostrums cal-culated
to filch hard earned money
from the pockets of the sick and needy
for every stock food nostrum vended
and there are no laws giving the
folks protection at all comparable to
the hogs. The hogs should have such
a law. They need such protection from
the unscrupulous. All we are asking
for at present is to promote the folks
to the dignity and an equal standing
with hogs in this particular. Hogs or
Folks! Which?
SENTENCED TO PRISON OR
STERILIZATION
One of the most respected and ex-perienced
judges in the criminal court
at Chicago set a precedent, which is
said to be the first of its kind, in giv-ing
a prisoner the choice between go-ing
to prison for a crime of which he
was convicted by a jury or of sub-mitting
to sterilization. In offering
this alternative from the bench. Judge
Marcus A. Kavanaugh said to the pris-oner,
sixty-five years of age and a
married man with children:
"If I send you to the penitentiary it
means death to you in your present
health. At the same time I dare not
turn you loose upon the public, for
fear this mania with which you seem
to be affected may cause you to at-tempt
a similar crime, and then I
would be at fault. If you will submit
to an operation, with the choice of
the best surgeons by next Saturday, I
will set aside your sentence. I cannot
compel you to submit, and you will
have a week to think the matter over.
If you decide to do this, it will mean
that you do not have to begin your
sentence of from one to twenty years
in the penitentiary."
The prisoner subsequently decided
to be sterilized.
In commenting on the case the
judge said he presumed he would be
criticised for his proposition to the
prisoner, but he wished neither to
commit him to what really would be
The Health Bulletin
a death sentence nor to expose the
public to a repetition of his heinous
offenses against little girls.
"One of my reasons for rendering
the decision," he added, "was to draw
public attention to a situation which
has been disregarded too long. I be-lieve
all morons, the criminal insane
and habitual criminals, both men and
women, should be so treated. To my
mind it is a crime against society
that this class should be permitted to
propagate their kind. As for those
who commit outrages against women
and female children, I advocate even
more drastic measures, which would
make repetition of the acts impossi-ble.
It is my hope that public interest
may be aroused."—Survey.
SOLDIERS AND TOBACCO
The Institute of Hygiene reports
that James the First declared that
"No man can he thought able for ser-vice
in the wars who cannot endure
the want of tobacco," for in those
days smoking was considered "alien
to all military fitness." How does the
spending of millions in the consump-tion
of tobacco tally with recent calls
to thrift by England? "Not only must
the nation avoid the consumption of
nonessentials, but must ever restrict
the consumption of essentials to the
limits of efficiency."
Is tobacco an essential? Does it
feed the body, purify the blood, or in-crease
the mental or physical effi-ciency?
There are such things as to-bacco
cancer, tobacco blindness, to-bacco
heart, the mention of which re-minds
me that in the medical world
there is, now, much professional dif-ference
of opinion as to the cause of
heart troubles among soldiers, the key
to which may be the use of tobacco.
Before our smokers used tobacco
they never craved it, or felt any need
for it. Like the vodka, if they gave it
up long enough, they would cease to
desire it. The excuses offered for the
use of tobacco are weak, same as all
others that are made for the indulging
of the various depravities of the age.
—
Leigh Hunt Wallace, England.
POPULAR MISTAKES
One of the most frequent mistakes
among the uneducated, with regard to
medicine, is the belief that what has
done good in one case of disease is
to be equally beneficial when similar
symptoms happen in another. When
an eminent physician has been called
in, and has prescribed a medicine
v/hich has answered the purpose in-te::
ded, and to all appearance has
cured the patient, nothing is more
common than for the precious recipe
to be kept and lent to a long series
of afflicted friends. Such benevolent
quack'ery proceeds on the supposition
that a disease called by the same name
has the same symptons in every case,
and that a drug produces its effects as
infallibly as an operation in mechanics,
or a process of chemistry. It reduces
medicine to the simplicity so much
boasted by the mathematical physi-cians
of the seventeenth century, who
thought they had in many cases solved
the problem—a disease being given, to
find the remedy. But there is a pre-liminary
problem equally necessary
and difficult, that should . be first
solved: a patient being given, to as-certain
his disease.—Dr. Macaulay's
Dictionary of Medicine.
If your county is one of the lucky
thirty-five to have medical school in-spection
this fall and winter, see that
your child gets what is due him under
the medical inspection law. If his ex-amination
shows that he needs treat-ment,
see that he gets it.
The Health Bulletin
LOW STATE DEATH RATE
The most unsentimental of all busi-nesses,
that of life insurance, has just
awakened to the work that the Board
of Health has been doing in North
Carolina for several years, through
the discovery that the death rate of
the Tar Heel State is the lowest of any
of the Atlantic commonwealths. Com-piled
census figures show:
Death rates per 1,000 in 1914:
Maine, 15.6; New Hampshire, 16.3;
Vermont, 15.0; Massachusetts,
14.7; Rhode Island, 14.7; Connec-ticutt,
15.1; New York, 14.7; New
Jersey, 14.2; Pennsylvania, 13.9;
Maryland, 15.9; Virginia, 14.0;
North Carolina, 13.2.
That these figures directly reflect
the work of the health authorities in
calling attention to sanitation, in im-munizing
against disease, in preach-ing
the care of the body cannot be
doubted. When it is considered that
the population from which the show-ing
is made is one that contains a
large element of negroes among
whom the death rate, especially the
infant rate, is abnormally high, the
result is akin to the marvelous.—Ral-eigh
Evening Times.
THREE THINGS TO DO
The three most important health
matters for every householder to at-tend
to this spring is first, to thor-oughly
screen every door and window
in the house, upstairs and down stairs.
Also to screen the back porch if there
is one. The second thing to do is to
build a good first-class sanitary privy,
preferably of the pit type or the septic
tank type. The pit privy should be
sheathed to a depth of one or two feet,
made fly-tight and well ventilated. TTie
tank type should hold at least 200 gal-lons
of sewage and be well ventilated.
The third important thing to do is to
have the entire family vaccinated
against typhoid.
TANLAC—THE MASTER MEDICINE
The following facts with regard to a
much advertised medicine are supplied
by the Michigan State Board of Health:
A new panacea for the cure of "all
ailments of the stomach, kidneys, and
liver, catarrhal affections of the mu-cous
membranes, rheumatism, nervous
disorders and the like," is offered to
the public under the name of Tanlac.
The label on the bottle neatly avoids
the pure drugs act by claiming to be
only a "tonic and system purifier."
An analysis of Tanlac in the labora-tory
of the State Dairy and Food De-partment
shows the following:
Alcohol 16.4 per cent
Glycerine 2.0 per cent
Licorice Present
Aloes or cascara Present
Gentian Present
Alkaloids (Berberine) Trace
The presence of a trace of tartaric
acid shows that wine is the base of
this medicine. The 16 per cent alcohol
gives it the "kick" that makes a fellow
feel good and ought to fill a long-felt
want in "dry counties." Aloes is a
laxative. Gentian is a bitter drug, a
so-called tonic. If the reader wants
to be cured by the Tanlac route at
one-fourth the expense, let him get S
quart bottle of good cherry wine. Then
go to the local druggish and get I14
drachms of glycerine and two drachms
each of aloes, gentian, licorice, and
cascara. Mix (if you wish) and you
will have Tanlac so near that neither
you nor the manufacturer can tell the
difference. This formula will give four
times the quantity found in an ordi-nary
$1 bottle of Tanlac. We say, "mix
if you wish." For our part we dislike
to spoil a good bottle of wine by mix-ing
it with bitter drugs like aloes and
gentian. Our personal advice to all
desiring to try this panacea would be
to drink the bottle of wine and give
the drugs to the hired girl.
6 The Health Bulletin
LARGE SCARS AND SORE
ARMS UNNECESSARY
Complications Following' Smallpox
Vaccination Avoided bj' Careful
Technique
I
HE big scar and the painfully
sore arm that follows vaccina- ™ tion against smallpox in many
cases are now known to be to a large
extent preventable by observing certain
rules and methods in administering
the vaccine. Scientists say now that
a "successful take" does not neces-sarily
require either a very big scar or
a very sore arm. On the other hand
they say that these extreme results
are often due to two or three things
—
the vaccination wound is often made
too large, it often becomes infected at
the time of vaccination or soon after,
and it does not receive the proper treat-ment
during the reaction.
The United States Public Health Ser-vice
advises the following procedure in
order to secure the best results from
vaccination and to prevent possible
complications.
I, The Vaccine
The freshest possible vaccine should
be obtained. All vaccine packages,
pending use, should be kept in a metal
box in actual contact with ice.
II. The Vaccination
Vaccination should never b e per-formed
by cross-scratching or scarifi-cation,
but by one of the methods de-scribed
below. If a prompt "take" is
very necessary, as in case of direct ex-posure
to smallpox, or if the first at-tempt
has been unsuccessful, three or
four applications of the virus should
be made, but the insertions should be
at least an inch apart. Which ever
method is used a control area may be
first treated similarly, but without the
virus, in order to estimate the amount
of pressure necessary for insertion and
i n order t o demonstrate a possible
early immune reaction in previously
vaccinated individuals.
Preparation
The skin of the upper arm, in the
region of the depression formed by the
insertion of the deltoid muscle, should
be thoroughly cleansed with soap and
water if not seen to be clean, and in
any case with alcohol or ether on
sterile gauze.
After evaporation of the alcohol or
ether, a drop of the virus should be
placed upon the cleansed skin. To ex-pel
the virus from a capillary tube, the
tube should be pushed through the
small rubber bulb which accompanies
it, wiped with alcohol, and one end
broken off with sterile gauze; the
other end may be broken inside the
rubber bulb. The hole in the latter
should be closed with the finger as the
bulb is compressed to expel the virus.
The under surface of the arm is
grasped with the vaccinator's left hand
so as to stretch the skin where the
virus has been placed. The skin is
kept thus stretched throughout the
process.
Methods
(a) The method of incision, or lin-ear
abrasion.—By means of a sterilized
needle or other suitable instrument,
held in the right hand, a scratch, not
deep enough to draw blood, is made
through the drop of virus, one-quarter
of an inch long and parallel with the
humerus. The virus is then gently
rubbed in with the side of the needle or
other smooth, sterile instrument. Some
blood-tinged serum may ooze through
the abrasion as the virus is rubbed in,
but this should not be suflicient to wash
the virus out of the wound.
(b) The drill method.— A sterile
drill, such as is used for the von Pir-quet
cutaneous tuberculin test, shaped
like a very small screw driver with a
moderately sharp end not more than 2
The Health Bulletin
millimeters wide, is held between the
thumb and middle finger, and with a
twisting motion and moderately firm
pressure, a small circular abrasion, the
diameter of the drill, is made through
the drop of virus; this should draw no
blood.
(c) The multiple puncture method.—
A sterile needle is held nearly parallel
with the skin and the point pressed
through the drop of virus so as to
make about six oblique pricks or shal-low
punctures, through the epidermis
to the cutis, but not deep enough to
draw blood. The punctures should be
confined to an area not more than one-eighth
of an inch in diameter.
With methods (a) and (b) it is ad-visable
to expose the arm after vacci-nation
to the open air, but not to direct
sunlight, for 15 minutes before the
clothing is allowed to touch it. With
method (c) the virus may be wiped off
immediately.
III. The Vaccination Wonnd
1. The original vaccination wound
should be made as small as possible,
and all injury to the vaccinated arm
should be guarded against. Any cover-ing
which is tight, or more than tem-porary,
tends to macerate the tissues
during the "take." This is to be
avoided. No shield or other dressing
should be applied at the time of vacci-nation.
Customary bathing and daily
washing of the skin may be continued,
so long as the crust does not break.
The application of moisture to the vac-cinated
area should not be enough to
soften the crust.
If an early reaction of immunity is
to be watched for, the patient should
report on the first, second, fifth, and
seventh days after vaccination. Other-wise,
the patient should report on the
ninth day, or sooner if the vesicle,
pustule, or crust breaks, Every effort
should be made to prevent such rup-ture.
However, should the vesicle,
pustule, or crust break, and the wound
thus become open, daily moist dress-ings
with some active antiseptic, such
as mercuric chloride or dilute iodine
(one part tincture of iodine in nine
parts of water) should be applied.
Under n o circumstances should any
dressing be allowed to remain on a
vaccination wound longer than 2 4
hours, and no dressing should be ap-plied
so long as the natural protec-tion
is intact.
On account of possible fouling by
perspiration and to lessen the chance
of exposure to street dust, primary
vaccination should be performed pre-ferably
in cool weather.
In order to encourage proper surgi-cal
treatment, no charge should be
made for the aftercare of a vaccina-tion
nor for revaccination in case the
first attempts should prove unsuccess-ful.
Although apparently trival, vaccina-tion
is an operation which demands
skill in performance and care in after-treatment
in order to avoid the rare,
but serious complications. For the pre-vention
of these complications vacci-nation
(a) should be performed with
strictly aseptic technique, (&) should
cover the smallest possible area for
each insertion, and (c) should be
treated without any covering which
permits maceration.
A child should be vaccinated by the
time it has reached the age of 6
months, and the operation should be
repeated at about 6 years of age and
whenever an epidemic of smallpox is
present.
CANCER NOT INHERITED
Men and women who are in anxiety
of mind on account of the appearance
of cancer in their ancestry or imme-diate
family may dismiss such anxie-ties,
as there is no statistical evidence
at the present time that the disease of
cancer is transmitted by inheritance
in mankind.
PUBLIC HEALTH
AND SANITATION
SCHOOL EPIDEMICS
How to Control Them
I
ONTAGIOUS diseases are largely
school diseases. That is, they
•^^ occur most frequently among
children of school age, they are spread
by school children and at the same
time they can be most effectually
handled through the agency of the
schools. Here are some recent facts.
Last August there were reported only
638 cases of contagious diseases in the
State. As the schools opened Septem-ber
showed 808 cases. In October this
was increased to 1,092; in November
to 1.109 cases; December, 1,567 cases;
January, 3,158 cases; February, 3,134
cases; and March, 3,600 cases.
Cold weather in itself is not respon-sible
for this alarming increase. In-fection
or the germs of contagious dis-eases
are spread with "'uch more diffi-culty
in cold than in v/irm air. Ordi-narily
the germs of such diseases flour-ish
outside the human body much bet-ter
in summer weather than in winter,
weather. This is a matter of temper-ature.
The real reasons why we have so
many more cases of contagious diseases
during school season than at other
times is not hard to find. At schools
we have assembled many children
from many families in many condi-tions
of health and sickness all in the
same room. The actual personal con-tact
is much closer and the danger of
well children breathing in the tiny par-ticles
of spray coughed, sneezed and
spit out by carriers or sick children is
far greater when they are housed up
close together, frequently in a more or
less unventilated school room, than it is
when they are living and playing out
of doors in oceans of fresh air.
In our schools as soon as cold
weather begins to come on many teach-ers
begin to close the windows to re-main
closed until the advent of warm
weather. This is all wrong. It is
wrong for two reasons. In the first
place, it shuts in any possible infection
that any of the pupils may have and
instead of having it diluted by fresh
air and wafted away through open win-dows
it becomes necessary for other
children to breathe over and over this
stale, vitiated air that should have been
quickly diluted and removed. In the
second place, by shutting off the sup-ply
of fresh air it reduces the vitality
and resistance of all the children and
quicker and more easily than they
otherwise would.
The Solntion
The remedy for such a problem is for
the most part self-evident. Have good
school sanitation. That is, have good
ventilation in the school room at all
times. Keep at least some of the win-dows
partially open at all times. Do
not be afraid the children will catch
cold. Colds are never caught from
fresh air. It is from stale, second
hand air into which some one else has
been coughing, sneezing or spitting
that colds are caught. This is a very
important fact for every teacher to
bear in mind and to endeavor to im-press
upon her pupils.
Besides providing good ventilation
the teacher should use every means at
her command to induce her pupils to
shield the mouth and nose with a hand-
The Health Bulletin
kerchief when coughing or sneezing
when in a room or near anyone else.
Teachers should also forbid the use
of the common drinking cup, dipper,
or roller towel, or exchanging bites
or eating from the same piece of food
or the putting of pencils in the mouth
or exchanging pencils at all times,
particularly when there is a possibil-ity
that a contagious disease may exist
in the community.
Since measles and some of the other
contagions are ushered in by symptoms
very similar to an oncoming cold and
since the infectious material in the
case of measles and some of the other
contagions are transmitted through the
secretion of the nose and throat teach-ers
and principals should watch care-fully
every case of possible onsetting
cold, sore throat or coughing, particu-larly
if a contagious disease is known
or suspected of being present in the
community. Furthermore, upon find-ing
a pupil who has not had measles,
or a particular contagious disease, ex-hibiting
symptons of that disease or
Indications of an oncoming cold it be-comes
the duty of the teacher or prin-cipal
to immediately exclude such a
pupil from school until the symptoms
have disappeared or at least for a
period of one week.
Likewise the teacher or principal
should exclude from school all children
who have never had measles (or any
of the contagions) who live in families
in which the disease exists.
The teacher can do much to check
the spread of an epedimic by distribut-ing
literature on the particular disease
in question which can be obtained from
the County Quarantine Officer and by
explaining the nature of the disease
and how to avoid it to the pupils.
The above suggestions and the au-thority
for enforcing them are em-bodied
in the rules governing teachers
and principals upon the appsarance of
a case of a contagious disease in the
school community and failure to en-force
them is punishable by a fine or
imprisonment.
If our teachers will follow these sim-ple
precautions contagious diseases
will affect our schools but very little
in the future as compared with the
ravages they have wrought in the past.
WHERE IGNORANCE IS CRIMOAL
Fifty years ago it was a common be-lief
that every child must have measles
and mumps, scarlet fever and whoop-ing-
cough before he "grew up," and the
earlier in life each one took his turn
the better it would be for him. Not in-frequently
mothers took their little
ones to visit a sick neighbor in order
to expose them to the disorder because
it happened the epidemic was light in
form and the season favorable. Now it
is known that children grow up
stronger and in better health if these
diseases are altogether avoided, and
that if it should happen that any are
so unfortunate as to "catch" them, the
older and stronger they are at the
time, the greater probability of going
through the disease unscathed. We
now know that whooping-cough alone
kills ten thousand children in the
United States every year, and that
others who do not die from it have
their bodies so weakened as to be un-able
to resist other serious maladies.
Measles and scarlet fever take equal
or greater toll, besides leaving their
victims with maimed ears and eyes
and throats.
"You will agree with me that it is
easier for us to keep men healthy than
it is for a physician to cure them."
—
Lord Nelson's Dispatch to the Ad-miralty.
There are constantly about 1,500,000
Americans ill with preventable dis-eases.
10 The Health Bulletin
PLAY IS THE THING
Children Must Haye More Play for
Proper Deyelopment of Health,
Character and Morals
fi sm
LAY is as essential to a child as
work is to a man. He needs it
for growth. He needs it not only
for his proper physical development,
but for his mental and moral develop-ment
as well. Someone has said that
the boy without play today is the man
without a job tomorrow. Play is no
obey orders. He can never be a leader
who cannot himself follow.
Play is a factor so important in the
health and educational life of a child
that Dr. Woods Hutchison says:
"Rather a play-ground without a school
than a school without a play-ground."
Regardless of whether one wholly
agrees with Dr. Hutchison's views or
not, the playground is what is needed
to counteract the stress and strain that
children are likely to suffer not only
from reports and conditions dealing
with the war but also from the in-longer
looked upon as a useless luxury
for children, as a time-killer for youth,
but parents, teachers, and even law-makers,
are now beginning to look
upon children's play as a necessity
—
something they 77iust have if they grow
up into strong healthy, happy men and
women.
Play teaches children team work.
Boys that can play together today can
work together tomorrow. It teaches
them fairness. Honesty is nowhere put
to the test that it meets on the play-ground.
Play on the square is the
first rule of the game. It teaches re-spect
for authority. The first marks
of a good soldier is his willingness to
creased efforts that are being required
of children to make for themselves a
more thorough mental and physical
equipment for the future. Tomorrow
will need men and women with sound
minds in sound bodies, with highly
trained intellects supported by strong,
healthy sinews and nerves. The chil-dren
of today will be the men and
women of tomorrow and whether they
be prepared to meet the more trying
problems of the war that will fall to
their lot depends largely upon the
training that is given them today.
A playground for every school, play
space for every child, and every child
playing at playtime, is the program
The Health Bulletin 11
that should be carried out at every
schoolhouse in North Carolina this
spring. The little sum of money-needed
to provide sand-boxes, swings
and teeter-boards for the little chil-dren
as shown in the accompanying
cut, and ball fields, tennis courts and
horizonal bars for the older chil-dren,
will be small indeed compared to
the vigor of mind and body that will
be readily noted in the children who
play. No school that stands for serv-ice
to the child can afford to neglect
this part of its necessary equipment
and no teacher can afford not to have
her pupils recreate their minds and
their bodies every day.
HOW AN EPIDEMIC DETELOPED
And Why It Shonld Not Derelop
Two children were unavoidably ex-posed
to measles a few weeks ago, be-came
infected and in due time devel-oped
a cold. The mother, knowing
that her children had been exposed,
said "They may have measles, I don't
know, but they haven't broke out yet."
The children were allowed to attend
school until they did "Break out." Sev-eral
families repeated the same proce-dure
and an epidemic of measles de-veloped.
No intelligent effort was
made in the beginning when the dis-ease
was most contagious to prevent
other children being infected. As in
most cases it was in the initial, doubt-ful
stage of the disease, the stage of
the oncoming cold, cough, reddened
eyes, the earliest symptoms, while the
mother was pending a confirmation of
the diagnosis by the "Breaking Out"
when so many children become exposed
and contracted the disease.
Some ignorant parents still believe
that every child must have measles
sooner or later and the sooner the bet-ter.
This is a grave mistake. These
parents do not knqw that 90 per cent
of all children who die of measles are
less than 6 years of age. But because
a large majority of deaths occur before
six years of age is no reason why moth-ers
should carelessly or intentionally
expose a child of more than 6 to such
a harmful disease. Every child who
has measles suffers and runs the risk
of losing its life.
But the killing off of a few helpless
innocent children each year in prac-tically
every county in North Carolina
from measles and other needless con-tagious
diseases represents by no
means all the havoc wrought by these
diseases in cooperation with ignorant
parents who criminally thrust their
helpless children into the jaws of such
diseases in order 'hat they may "ketch
it and have it ovei with." Such need-lessly
wanton sacrifice of child life is
comparable only to the ancient crim-inal
sacrifice of child life to idols and
the gods by the heathen. But a very
large number of the children who sur-vive
the disease itself, or its complica-tions,
are permanently injured in one
or more ways which do not manifest
themselves until years later in the
form of heart troubles, weak eyes,
deafness, weak lungs and a great many
other ills and physical defects. Why
should any parent think of needlessly
handicapping a child for life in such a
manner?
A further very important considera-tion
in connection with spreading epi-demics
from schools is the fact that
there are about as many babies and
very young children at home as there
are older children in school, and these
older children all too frequently bring
home contagious diseases to their
younger brothers and sisters which fre-quently
prove much more serious with
the younger children than the older
ones.
Since contagious diseases of child-hood
are not nearly so fatal or so seri-ous
with older as with younger chil-dren,
everything possible should b e
12 The Health BuLLETI^"
done to postpone the evil day and if
perchance they can be prevented from
having these diseases altogether, so
much the better.
SEX HYGIENE
Don't marry your cousin.
Family intermarriages have a ten-dency
to produce the blind, deaf, im-becile
and crippled children.
There are 50,000 blind children in
the United States. It is claimed that
gonorrhea is responsible for 12,000 of
them.
The father or mother who does not
believe in sex hygiene education may
invite the destruction of son or daugh-ter.
Women and children are the inno-cent
victims of venereal diseases.
There is no more reason why the
average healthy young woman should
be hauled to a hospital a few weeks
after marriage than there is a neces-sity
of a dispensary for cats.
Every man and woman should make
a confidant of some reputable physician
and seek advice on questions that can
best be answered by such physicians.
"Syphilis" was the name of a shep-herd
in an old Latin play. He was
cursed with an ugly disease for offend-ing
the gods. The word means "dear
hog." This disease has proved a "dear
hog" to an unfortunate humanity.
—
Buffalo Sanitary Education.
TYPHOID BACILLUS CARRIERS
FOR OVER FORTY YEARS
Some years ago, as the result of an
epidemiological investigation of an ex-tensive
outbreak of milk-borne typhoid
fever in New York City, an outbreak
embracing more than three hundred
cases of the disease, a typhoid bacillus
carrier was discovered in the person of
a dairyman operating in a small vil-lage
in Central New York. The note-worthy
feature of the case was the
fact that this carrier had had his
typhoid infection forty-six years pre-viously
when a young man. He was
kept under observation both by the
City Health Department and the local
health officer for four or five years,
when he died of heart disease. But
bacteriological stool examinations
made from time to time during this
period of observation showed that he
remained a carrier.
As the result of an investigation of
a recently reported case of typhoid
fever occurring in this same city,
there has been discovered another
typhoid bacillus carrier in the person
of the mother of the patient, a woman
aged 76 years, who had typhoid fever
forty-nine years ago. No other mem-bers
of the patient's family, friends,
or relatives, gave a history of typhoid
fever, and it is very probable that this
carrier constituted a source of infec-tion
in this case. The bacteriological
stool examinations were made by the
Research Laboratory of the New York
City Health Department.
These two cases indicate how
searching must be the investigation of
a suspected carrier's history and how
long a time the carrier state may per-sist.
OPEN-AIR SCHOOLS
It has been computed that more than
two hundred open-air schools and
classes for tuberculous and anemic
children were in operation at the open-ing
of the school term last year.
Massachusetts led the list with eighty-six,
eighty of them in Boston; New
York had twenty-nine and Ohio 21.
North Carolina had but two or three.
It is estimated that there should be in
the cities one open-air school for every
15,000 population. According to this
statement North Carolina should have
a dozen or more.
The Health Bulletust 13
PHYSICIAN FOUND GUILTY
A physician of Buffalo, New York,
was convicted in city court for failing
to report a case of scarlet fever. The
father of the patient conducted a store
on the premises, and apparently did
not want his business injured or his
family inconvenienced, so no physician
was called until the patient was dying
from acute nephritis. From the his-tory
and condition of the child the
•doctor readily made a diagnosis of
scarlet fever. The child died soon
after the doctor saw it. When an in-spection
was made by the Department
of Health another child was found to
be desquamating from scarlet fever.
In court the doctor justified his ac-tion
in not reporting the case on the
grounds that he did not treat the pa-tient
for scarlet fever, but for one of
the sequellae, but the court promptly
found him guilty of violating the law
which requires every physician to re-port
to the local health officers all
cases of communicable diseases with-in
twenty-four hours from the time
when the case is first seen by him.
As a result of the failure to report
this case the house was filled with
people who had come to see the dead
child and who did not know the cause
of death.
MORE INTELLIGENT
EXCITEMENT NEEDED
Tor 3Ieasles, Whooping Cough, Diph-theria
and Scarlet Fever
G
SDfl
HERE has been much ado, there
has been much running to and
fro, much offering of prizes for
miraculous cures developed on short
notice, and much newspaper and other
talk over the alleged presence of an
epidemic of anterior poliomyelitis. It
is quite right that there should be
active agitation over this disease, but
the only reason that there is this unus-ual
stir is that infantile paralysis is
'
uncommon, and that its epidemics are,
for this country, comparatively new.
We have had diphtheria and measles
and scarlet fever with us for a long
time, and yet, we believe, no large
prizes have been offered for their cure,
no specialists have been hurried to
the scene of the epidemic to see what
could be done to check its spread, and
the National Government has never
had a hand in its suppression. Even
local authorities have seldom taken
the trouble to clean up on a large
scale in order to check an epidemic of
these diseases. Yet the death toll from
diphtheria is still approximately 25,000
for the United States each year, the
mortality from scarlet fever is six
times that from anterior poliomyelitis,
while its annual incidence in all our
cities usually far surpasses that of the
w^orst outbreaks of the more unusual
malady. Even tuberculosis, about
which there was a wave of excitement
some time ago, is fairly holding its
own with a death-rate reduced only
from 201 to 147. Infantile paralysis is
always present in the community, but
it leaves a large percentage of crip-ples
in its wake, and so seems the
more dreadful. Doubtless this has
something to do with our fear of it,
but the crippling from scarlet fever
alone, the impaired hearing, damaged
kidneys, and heart defects, if not so
evident, is more serious than an abbre-viated
and weakened limb, and the
army of scarlet fever cripples is larger
than we realize. The same is true of
measles, diphtheria, whooping cough,
typhoid, and malaria.
We become attached to old acquaint-ances,
especially those that Avere once
believed to have been sent for our
chastisement and the correction of our
evil ways, and perhaps, after all, we
like to have the plagues (no one calls
14 The Health Bulletin^
them such) of the good old infections
with us. At any rate, no one is mak-ing
any great fuss about them com-mensurate
with that which is being
made over this less common and less
destructive disease.
Our dollars and cents seem very
precious and we use them for other
purposes than health protection. We
cannot, or at any rate do not, afford
even a national department of health,
though we do have a department much
devoted to the health of plants and
animals. We often have no local
health departments, and where we
have them they are usually badly ham-pered
for lack of both funds and moral
support. If popular agitation over
the presence of anterior poliomyelitis
could only help to open the eyes of
the public to the more disastrous but
more familiar sources of untimely in-jury
and death—to our other annual
disease plagues—we might even be
thankful for it.
PASTE THIS ON TOUR MIRROR
The soldier has twenty-nine chances
of coming home to one chance of being
killed.
He has ninety-eight chances of re-covering
from a wound to two chances
of dying.
He has only one chance in 500 of los-ing
a limb.
He will live five years longer because
of physical training.
He is freer from diseases in the
army than in civil life.
He has better medical care at the
front than at home.
In other wars from ten to fifteen
men died from disease to one from bul-lets.
In this war one man dies from dis-ease
to every ten from bullets.
This war is less wasteful of life
than any other in history.
WHAT VACCINATION WILL DO
One part of the land surface of the
globe under the care of the United
States has no anti-vaccination society.
The reason is that they have had a
chance to see what a vast change for
the good has been effected by universal
vaccination.
In the Philippines under Spanish
rule there were about 40,000 small-pox
deaths yearly, and 6,000 in Ma-nila
every year. Although the people
were at first bitterly opposed to it,
measures for vaccination have been
carried out in a most successful man-ner.
So rapid were the results that
since 1906 there has not been a single
death from smallpox in Manila, and
the mortality in all the islands has
dropped from 40,000 to 700 per year.
Over 10.000,000 of Filipinos have
been vaccinated without a single
death, and where originally they
fought the measure viciously, they
have now learned to attribute the re-sults
to it, and seek vaccination with
avidity.
Sixty Thousand Dollars has been ap-propriated
by Governor Stevens of Cali-fornia
from the State War Emergency
Fund, for the suppression of venereal
diseases. The State Health Officer. Dr.
Sawyer, has directed county sup9rvi-sors
of health to provide in their an-nual
budget for hospital facilities for
the care and isolation of persons suffer-ing
from venereal diseases. This is
certainly an advanced step and Cali-fornia
deserves high commendation.
We especially commend Governor Stev-ens
for the beneficent forward step he
has taken.
People who will not get vaccinated
are welcome to their smallpox and
their quarantine.
KNOW HOW TO LIVE
Bad Personal Habits Responsible for
Wear-and-Tear Disease.
The wear and tear diseases are the
by-product of civilization. For in-stance,
one of the boasts of civilization
is the abundance and variety of the
foods it provides, and yet it is to this
very abundance and variety that we
must attribute a large number of the
degenerative diseases which afflict the
human organism. For instance, it is
through soft foods that our teeth be-come
diseased and invite disease
throughout the body, because the teeth
lack exercise.
Again, civilization boasts of the ad-vantages
of houses. But as an offset
to these advantages we have the dread-ful
scourge of tuberculosis, a house
disease, especially frequent where
overcrowding and dark-roomed tene-ments
abound.
And so the invention of the chair
which affords great comfort is, at
least, partly responsible for nervous
prostration and other breakdowns, be-cause
the chair is not made to fit the
curve of the back; and even when it
does, the person sitting in it does not
take the trouble to place himself prop-erly.
The possibilities of self-improve-ment
through learning how to live are
far beyond what any one who has not
gone over the evidence realizes. The
evils of bad air, bad food, imperfect
teeth, wrong posture, improper cloth-ing,
constipation, self-drugging, alco-holism,
etc., are now overlooked by
ninety-nine persons out of a hundred.
Four Rules for Hygienic Living
The first step toward the hygienic
life for the individual is the under-going
of a thorough physical exami-nation.
The next step is to learn the
lesson of that examination, to find out
the slightest impairment and correct
it. The third step is to learn the rules
of hygienic living and apply them so
faithfully that no further impairments
will develop. The Life Extension In-stitute,
through its Hygienic Reference
Board of ninety specialists, has form-ulated
such a set of rules for the di-rection
of the individual who wishes
to live a hygienic life. If lived up to
conscientiously, one may feel satisfied
that he is following the best knowl-edge
of the day. These rules are:
I. Air: Ventilate every room you
occupy; wear light, loose and porous
clothes; seek out-of-door occupations
and recreations; sleep out, if you can;
breathe deeply.
II. Food: Avoid overeating and
overweight; eat sparingly of meats
and eggs; eat some hard, some bulky,
some raw foods; eat slowly.
III. Poisons: Evacuate tho"oughly,
regularly and frequently; stand, sit,
and walk erect; do not allow poisons
and infections to enter the body; keep
the teeth, gums, and tongue clean.
IV. Activity: Work, play, rest and
sleep in moderation; keep serene.
—
Prof. Irving Fisher of Yale Univer-sity.
16 The Health Bulletin"
SPRING FEVER AND WHEAT BRAN
The cause of about two-thirds of all
this so-called "Spring Fever" is that
the victim has been gorging himself
all winter long with heavy, concen-trated,
constipating foods, or "throw-ing
in too much brickbats and mor-tar,"
as a busy physician remarked re-cently,
and when spring comes along
these sluggish physical machines are
all clogged and gummed up with last
winter's debris and are not geared up
at all for spring and summer condi-tions.
To relieve this tired, sluggish, lazy
feeling there is probably nothing so
generally effective as good, free, healthy
bowel action at least once a day
—
many prefer twice a day. Pills, castor
oil, salts, and the whole line of pur-gatives
are just so much dope. They
stimulate and excite action for the
time being, but they leave the source
of the trouble worse than before. A
real cure will be effected only when the
individual corrects his habits of living,
particularly his habits of diet and ex-ercise.
Let him drink eight or ten
glasses of water daily, or even more
in hot weather; let him get plenty of
exercise, particularly the kind that ex-ercises
the muscles of the abdomen,
and above all, let his diet consist of
fruits, vegetables, and bulky material.
In regard to a very valuable bulky
diet, we can do no better than quote
a few paragraphs from an article by
Dr. A. M. Hughes, of New York City:
"Every woman should know that if
wheat bran is taken daily it will clear
up the so-called 'liver-spotted' skin.
It is, in reality, a better beautifier than
any cosmetic, face powder, or other ex-ternal
compound on the market. Bran
beautifies the skin by correcting the
trouble that has brought about the
poor condition of the skin. A poor
complexion is caused by stomach trou-ble
or by some trouble that is pri-marily
brought about by poor diges-tion,
and especially by constipation.
"Wheat bran is the king of laxatives.
There are stronger laxatives that
should be used in various emergencies,
but for a laxative that can never harm
you in the least, nothing compares with
wheat bran. There are other ailments,
all allied with the stomach, that wheat
bran will cure; and It is now admitted
that this simple laxative will actually
improve anemia.
"There are a good many ways to
take wheat bran. The simplest way is
to stir two tablespoonfuls in a glass
of cool water and drink it every morn-ing.
Another method is to mix it half
and half with your cereal and eat it
in that manner; or, better still, pour
a rich cream over the dry wheat bran
in a saucer, sprinkle with a bit of salt
and eat it without sugar. There is
nothing unpleasant about it, and peo-ple
get so that they are really fond
of it, although at first it seems insipid,
dry and tasteless.
"If children do not care for it in
this form, make it into a gruel for
them, and also serve it in a soup.
You may also mix it thoroughly with
marmalade, honey, maple syrup, or
other suitable table syrups, and spread
it on bread for children.
"For constipation, one may take as
much as a cupful daily until relieved;
but for a general clearing of the skin
four heaping tablespoonfuls daily will
suffice. Do not expect that after you
have taken this three or four days you
are going to look into the mirror and
find that you have the complexion of
Lillian Russell. Wheat bran is a laxa-tive
and a beautifier, but not a miracle
worker. Take your wheat bran every
day without fail for six months. Then
look in the glass and you will notice
a difference. You will also notice a
difference in your health, and this dif-ference
will be to your advantage, for
nothing serves as well as wheat bran
to keep the bowels in order.
The Health Bulletin 17
"Pure wneat bran makes such a per-fect
laxative because it is made up for
the most part of indigestible cellulose,
which is non-absorbable. For this rea-son
the bran takes up a large amount
of water and swells, which adds to the
bulk in the stomach and intestines, and
thus quickly and easily removes all
the deadly toxins or poisons that
gather in the stomach and intestines.
In brief, this wheat bran overcomes
and prevents putrefaction and absorbs
the poison.
"Expectant mothers are, in almost
every instance, constantly in need of
a proper laxative. To keep their bow-els
in a proper condition is one of the
most important things they can accom-plish,
and only in very recent years
have physicians taken advantage of the
perfect qualtities of wheat bran and
ordered its use.
"Eruptions of the skin with the ado-lescent
is the rule rather than the
exception. This is frequently caused
as a result of too rapid growth, which
gives them a body out of proportion to
their natural blood supply, and the
blood, working to supply the over-grown
body, becomes poor. There is
nothing better than wheat bran to
overcome this. For such young peo-ple
one of the very best ways to tsaie
wheat bran is to stir four tablespoon-fuls
in a large glass of milk and drink
it before the bran has an opportunity
to settle. By doing this the young
person couples the advantages of the
laxative with the health-giving prop-erties
of the milk, and milk, it should
be known, contains every element of a
perfect food.
"Do not make the mistake so many
people are making today, that is, of
disregarding a remedy merely because
it is so simple. 'Good Old Doctor
Wheat Bran' may be simple, but there
is nothing more effective for putting
the bowels and stomach, and even the
blood, into a healthful condition.
FIRST AID INSTRUCTIONS
Dr. C. W. Hopkins, chief surgeon of
the Chicago and Northwestern Rail-way,
gives the following instructions
in regard to first aid to the injured:
Open Wounds.—Don't touch open
wounds with bare hajids.
Don't disturb blood clots or wash
them away.
Don't try to cleanse and wash
wounds.
Don't use a quid of tobacco or spider
webs to stop bleeding.
Heiuorrliage.—To control hemor-rhage
place the compress on the bleed-ing
part and make firm pressure with
the cambric bandage. Elevate the
limb. If this fails, place a bandage
around the limb, above the bleeding
point, and twist with a stick until the
bleeding stops. Secure the stick in
position.
Don't use a tight bandage around
the limb unless hemorrhage is active.
Burns and Scalds.—-Burns and scalds
should be treated in the same manner
as open wounds. Cut the clothing
away if necessary.
Don't attempt to remove pitch, var-nish,
or wax from a burn.
Don't use oils on burns.
Shock.—A person in shock has pale,
clammy skin, weak pulse, sighing res-piration.
Place patient on his back. Cover
him up. Move him to the best place
of shelter at once. If possible, apply
external heat by means of blankets or
hot water bottles or hot bricks. Be
careful not to burn the patient.
Hot Avater, hot tea, or hot coffee, beef
tea or broth are the best stimulants.
Don't give him whiskey or other alco-holic
stimulants.
Fractures.—If an arm or leg is bro-ken,
use splints composed of folded
newspapers, pieces of board, or heavy
pasteboard and secure in position with
bandages or handkerchiefs. If the
18 The Health Bulletin"
arm is broken, place it in a sling. If
the leg is broken, tie the legs together
If no splint is available.
Don't try to set broken bones.
Straighten to relieve pain, then apply
splints.
Don't allow fractured limb to dangle
in handling the p*atient.
Fits.—A person suffering from a fit
should be kept quiet on the back.
Loosen the clothing about the neck
and abdomen, and be careful he does
not injure himself.
A wedged handkerchief or piece of
wood or cork should be placed between
the teeth to prevent injury to the
tongue.
Heat Exhaustion and Sunstroke.
—
In heat exhaustion the skin will be
cold and clammy and the condition
will be the same as shock; the same
treatment will be required.
In case of sunstroke the body feels
hot to the touch; is dry. Cloths wet
in ice water, or in the coldest water
at hand, should be at once applied to
the head and body, and along the spine
from the head downward, and fre-quently
renewed. For the head, the
application of cracked ice in a towel
is recommended.
Foreign Body in Eye.—Foreign bod-ies
should be removed from the lids
only.
Don't touch the eye with dirty fin-gers
or unclean cloths.
Don't try to remove a foreign body
from the eyeball. Dirty toothpicks or
dirty instruments are dangerous, and
may cause serious results.
In General
Don't try to do too much.
Don't apply bandages too tightly.
Don't tell an injured person his con-dition
is dangerous.
Don't uncover a wound after it has
been bandaged. If it bleeds apply
more bandages.
Don't apply a sling or splint until
the wound has been dressed.
Don't soil dressings.
The two welfare movements, "Safety
First" and "First Aid," on the part of
organized combinations of industrial
workers, must have their influence on
less vrell organized industries and on
legislation affecting workmen's com-pensation
and on the organization of
hospitals provided with facilities for
the economic and efficient care of in-dustrial
workers.
HOW TO STOP WOERYING
Not all worry is preventable, but
for the most part it can be avoided.
Most of our fears are never realized,
and, as a rule, if we meet our troubles
day by day as they come without
worrying about them before they ar-rive
or fretting over them after they
have passed, we will find that we have
the strength to rise above them.
Worry undermines the health to a
certain extent. It really weakens the
mental forces by tiring them out by
doing nothing. Usually the relief
from worry rests with the victim of
this unhappy habit himself, but some-times
the real causes are not the ones
which seem to explain the condition
and we must go deep into our lives or
have the assistance of those who are
skilled in unravelling mental pro-cesses.
The best antidote for worry is a
change of mental occupation, a get-ting
away from the scenes which pro-voke
worry, exercise in the open air,
a good book, a pleasant recreation, or
a temporary change of occupation. As
a matter of mental health every suf-ferer
from this unfortunate condition
owes it to himself to discover some
simple means of getting away from
this habit which is destructive to
health and peace of mind alike.—U. S.
Public Health Service.
The Health Bulleti:^? 19
GASOLIXE AS A]V EMERGENCY
MEDICDiE
Gasoline is a good disinfectant for
the treatment of wounds in emergency
cases. In fact, gasoline is such an
effective disinfectant that Dr. Dorothy
Childs, in her lectures to classes in
hygiene in the University of Kansas,
strongly urges that an eight-ounce bot-tle
of gasoline be kept in the family
medicine closet for use in treating cuts
and scratches.
The value of gasoline in cleansing
wounds has been demonstrated on the
European battlefields, Doctor Childs
said, and it is especially good if the
wound is lacerated or if the skin was
dirty when the wound was made.
After washing the wound with gaso-line,
paint with a tinctui^ of iodine,
suggests Doctor Childs. Use a small
wad of absorbent cotton for the iodine
"paint brush."
Every family should have a supply
of emergency remedies at hand, and
Doctor Childs suggests this list for
the home medicine shelf:
Two-ounce bottle aromatic spirits
of ammonia. This is a stimulant and
good to use in case of fainting. Use
as an inhalation, or put one-half tea-spoonful
in one-quarter glass of water
and give internally. Eight ounces of
gasoline, to be used freely to cleanse
wounds. Two ounces tincture iodine
to paint wounds and kill germs. One
yard sterile gauze. One yard zinc ox-ide
adhesive plaster, two inches wide.
One yard zinc oxide adhesive plaster,
one inch wide. One-fourth pound ster-ile
absorbent cotton. One-half dozen
gauze bandages, assorted sizes. Eight-ounce
bottle saturated boric-acid so-lution
to use as an antiseptic wet
dressing for wounds and as an eye
wash. Eight-ounce bottle peroxide of
hydrogen, not to be relied on for se-rious
wounds. One hot-water bag. One
fountain syringe. One ice bag.
DON'T STAND SO MUCH
To many women it never occurs that
much of the work they do can be done
seated. In fact, many women feel that
they are lazy unless they are standing
up at their work.
How many women sit in a chair at a
table with a pan of water in front of
them when they have potatoes to wash
and peel?
How many women sit down to wAsh
or wipe dishes, even though a high
chair must be made for this purpose?
How many women arrange so that
they may be seated when they are iron-ing
little things like handkerchiefs,
that require no hard pressing?
Think it over, and learn to sit down.
SAFE GUIDE TO HEALTHFUL
EATING
Is it necessary to know how many
calories you are getting each day, or
how many ounces of protein?
By no means.
The following rules will make it
possible for you to feed yourself and
your family without weighing your
food or counting your calories:
Weigh yourself twice a month. If
you are above the average weight, you
need less fuel. If you are very light
in weight, and losing weight, you need
more fuel.
Try to have some bulky food, some
raw food, some whole cereal, some
fruit and some milk in your diet each
day.
^ Eat high protein foods (meat, fish,
fowl, eggs) only once a day in mod-erate
amount. Have at least one or
two meatless days a week. Cold
weather and active physical labor calls
for more heat and energy producing
foods, while warm weather and seden-tary
habits usually call for more bulky
fruits and vegetables containing less
heat and energy and more bulk for the
bowels to act upon.
SAVING MOTHERS
More 3Iothers Die From Incidents of
Maternity Than From Any Disease—
>eglect at C'liildbirtii the Cause
ORE women from 15 to 45 years
of age die from conditions con-nected
with childbirth than from
any disease except tuberculosis. About
15,000 deaths from maternal causes
occur annually in the United States,
and the available figures for this coun-try
show no decrease in the maternal
death rate since 1900. Maternal deaths
are largely preventable by proper care
and skilled attendance.
These 15,000 deaths do not measure
the full extent of the waste. They are
merely a rough index of unmeasured
preventable illness and suffering
among mothers. Furthermore, cer-tain
diseases of early infancy are
closely connected with the health of
the baby's mother and the maternity
care she has received, and these dis-eases
cause about one-third of all the
deaths occurring among babies under
one year of age. More than 75,000
babies die each year from this group
of diseases because they do not have
a fair start in life. «
The life and health of the mother
are in every way important to the
well-being of her children. Breast
feeding through the greater part of
the baby's first year is his chief pro-tection
from all diseases, and mothers
are much more likely to be able to
nurse their babies successfully if they
receive proper care before, at, and
after childbirth.
The expectant mother should at once
consult a physician. She should re-main
under supervision so that any
dangerous symptom may be discov-ered
as soon as it appears. She
should learn how to take care of her-self,
and she should have proper food
and rest and freedom •from anxiety.
Yv'hen the baby is born the mother
needs trained attendance. A difficult
maternity case is one of the gravest
surgical emergencies. Many people
do not seemrto understand that in any
case complications may arise which
can be met safely by prompt and
skillful scientific care, but which at
the hands of an unskilled attendant
may cost the life of mother or child
or both. Even after confinement the
mother needs continued supervision
and rest until her strength has re-turned.
Thousands of mothers, both in city
and country, do not have the essen-tials
of safety, partly, perhaps chiefly,
because they do not realize the dan-gers
involved in lack of care, or else
accept the dangers as unavoidable.
Many women are at present unable
to obtain proper care, but when all
women and their husbands under-stand
its importance and demand it
for every mother, physicians will fur-nish
it, medical colleges will provide
better obstetrical training for physi-cians,
and communities will see to it
that mothers are properly protected.
Little has been done as yet to show
women that much of the waste of
mothers' lives and health is unneces-sary.
Even less has been undertaken
by communities to provide protection
The Health Bulletin 21
for them. Many communities which
have studied their typhoid and tuber-culosis
death rates and have under-taken
costly measures to reduce them
have been heedless of the death rates
among mothers. It is not strange,
therefore, that since 1900 the typhoid
rate for the country as a whole has
been cut in half, and the rate from
tuberculosis has been markedly re-duced,
while the death rate from ma-ternal
causes has shown no demon-strable
decrease.
WHY REGISTEE A BABY?
The registration of a child's birth
forms a legal record that is frequently
useful and may be of the greatest im-portance.
It establishes the date of
birth and the child's parentage. It
may be required to establish the child's
age for attendance at public schools
or for a working certificate in States
where restrictions are placed upon
child labor; to show in courts of law
whether a girl has reached the age of
consent, or whether individuals have
attained the age when they may marry
without the parents' permission; to
establish age in connection with the
granting of pensions, military and jury
duty, or voting. It may be important
in connection with the bequeathing
and inheritance of property, or to fur-nish
acceptable evidence of genealogy.
ATOID EARLY HANDICAPS
Farmers dread having their grow-ing
crops dwarfed, stunted, or "set
back" during the early growing sea-son,
and stock raisers avoid, if possi-ble,
any interference with the very
best and fullest growth of their young
livestock during the growing period.
Why, then, should we not give our
very best attention to the most perfect
and unobstructed growth of our grow-ing
boys and girls? It Is a sad com-mentary
that many fond parents are
unconscious that their little boys and
girls are laboring under the handicap
of defective hearing, bad teeth, poor
vision, hookworm disease, malaria,
anemia, etc., which is not only making
mediocre or backward children out of
them now, but which is permanently
handicapping them in the long, hard
race of life. Give your children a fair
chance by encouraging medical inspec-tion
of schools and prompt treatment
of defects found.
WHY NURSE YOUR BABY?
Because
Breast milk is always ready and is
never sour.
Breast milk does not have to be pre-pared
or measured.
It is nature's method and was in-tended
for your baby.
It will make your baby strong and
healthy.
It is absolutely free from germs and
dirt.
It protects your baby from many in-f-
nt diseases.
It is safer for the baby. Ten bottle-fed
babies die to one fed on the breast.
It is the only perfect food for the
baby.
It contains the proper elements of
food in the right proportion for the
growing child.
Breast-fed babies seldom have bowel
trouble, which is so fatal in bottle-fed
babies, especially during hot weather.
Your baby will have the best chance
of living if breast fed.
"Maternity is woman's exclusive pro-fession.
Like genius in any art or
profession, successful motherhood is
founded on efficiency and joy in the
chosen work, and the greater of these
is joy."
—
Anna Steese Richardson.
^^
TUBERCULOSIS
HAVE EARLY DIAGNOSIS
Don't Wait Until You Are Sick to be
Examined—"Delays Hare
Dangerous Ends"
v^ UBERCULOSIS—the most com-
^Jl^ mon disease and the one which
^"^ causes more deaths than any
other— is rarely recognized until it is
moderately advanced. If it is diag-nosed
early, it is curable. If not diag-nosed
early, it is terribly fatal.
the sand and believe that the disease
cannot see them. The chief difference
between knowing that you have tuber-culosis
and not knowing that you have
tuberculosis is that, in the first case,
you have a good chance of getting
well; in the second, you have little
chance of getting well.
If Ton Tire Easily and are "all
played out," don't dope yourself with
so-called "tonics" and stimulants. See
your doctor and insist upon having a
''There should be no uncared-for tuberculous patient in any
civilized community. The untrained and uncared-for tubercu-lous
individual, whether he lives in a palace or in a tenement
house, in a first-class hotel or a lodging house, will constitute
a center of infection/' S. Adolphus Knopf, M.D.
Early tuberculosis or beginning tu-berculosis
is curable. The time to
cure it, however, is in the earliest
stage. The symptoms at that time
may not cause one to suspect that
there is anything the matter with the
lungs. Without careful examination,
the disease is not detected. When
the patient waits until he believes he
has "lung trouble," it is often too
late for cure. The man with the ear-liest
diagnosis is the one with the best
chance of getting well.
Some people delay seeing the doc-tor
because they do not want to be
told that they have tuberculosis. Like
the ostrich, they stick their heads in
thorough examination. Weariness is
usually the first sign of tuberculosis.
If Ton "Catch Cold" easily, if your
voice gets "husky," if you have "ca-tarrh,"
or
—
If Ton Congh frequently, or have to
"clear your throat"—don't take "cold
cures" or "cough medicines." See your
doctor and be examined. Consump-tion
usually gains its foothold while
the victim is doctoring himself and
deceiving himself.
If Tonr Appetite is poor or "finicky"
—good one meal and poor another
—
don't take "appetizers," "stomach
medicines," or "tonics"; but see your
doctor and find out why.
The Health Bulletin 23
If Ton Haye Indigestion, don't de-lude
yourself with "dyspepsia tablets"
or any other medicines. Even if they
give relief, they do not remove the
cause of your trouble.
If You are a Little FeTcrish in the
afternoon, don't guess at the cause.
Don't believe it is "just a little ma-laria."
. See your doctor.
If Tou Spit Blood, don't assume
that it is from the gums or your
throat. Probably it is not. Spitting
blood is too important a matter to
guess about. See your doctor and find
out the cause.
If Tou are Losing Weight or are be-low
your natural weight, there is some
cause for it. Do not feed your stom-ach
with oils and fats and other "fat-tening
foods." See your doctor.
to strip to the waist before examining
your chest. Do this cheerfully. He
may want to make tuberculin tests.
These can do no harm and may give
valuable information about your case.
The best physician in your commun-ity
is none too good to determine the
condition of your health. If you want-ed
a mechanic to repair a high-priced
automobile, you would select the best
mechanic you could find. A healthy
body is worth more to you than the
best automobile ever built.
Any one of the symptoms named
above may be the first evidence of
tuberculosis. If, after careful exami-nation,
your doctor tells you that you
have tuberculosis, your chance of get-ting
well is excellent, since the diag-nosis
is made early. If your doctor
That every person in North Carolina suffering with tubercu-losis
must he discovered and must he so supervised and cared
for that he will have the hest possible opportunity for recovery,
and so that he will not he a menace to his family and friends
or the stranger that is within our gates.
Bureau of Tuberculosis, State Board of Health.
If Tou are Neryous, or have had a
nervous breakdown, be sure there is
not a physical cause—like tuberculo-sis—
at the bottom of it. Nervousness
is often the only sign of very early
tuberculosis.
If Tou Haye Any One or More of
These Conditions, do not try to doctor
yourself. See your doctor and be ex-amined.
See that you get a thorough
examination.
A careless examination is worse than
no examination. A thorough examina-tion
will take your time and the doc-tor's
time. He will make a careful
history of your case. Answer his ques-tions
accurately. He will require you
tells you that you have not tubercu-losis,
that assurance will be worth
much to you.
Many of the wisest and most promi-nent
men in the country have their
doctors examine them at frequent in-tervals.
Through careful examination
when you are not sick, the first evi-dence
of trouble may be detected and
much trouble prevented.—Illinois
Health Bulletin.
"Before any real progress will be
made in the battle against the Great
Plague, we must get the whole people
aroused to fight -this enemy which
threatens the integrity of the race."
—
Dr. J. H. Kellogg.
24 The Health Bulleti:n^
SYMPTOMS OF TUBERCULOSIS
Many people die of tuberculosis be-cause
they don't know they have it un-til
it is in an advanced and practically
incurable stage. The earlier tubercu-losis
is recognized and the cure begun
the easier it is to cure. It has been
found that of the very early cases of
tuberculosis found and promptly and
properly treated, 91 1/^ per cent recov-ered.
Of the moderately advanced
tions of the laws of hygiene reduce
one's physical vitality and render him
much more susceptible to tuberculosis'
or other diseases.
Any one or more of the following •
symptoms are suggestive of tubercu-losis
and call for a thorough examina-tion
by a careful physician.
1. Loss of weight without any other
apparent cause.
2. Tiring easily after ordinary exer-tion.
SYMPTOMS OF TUBERCULOSIS
BE EXAMINED IF YOU NAVE ONE OR.MORE OF THESE
^cough
lasting longer man
three weeks is ver^ suspicious
io55 of weighb or Tiring easily;
suggests tuberculosis
-^ conlinued temperature
of 98.° or less in the
morning and an afternoon
temperature of 99.5 or
more are strong indi-cations
of tuberculosis.
J? low blood pressure
may mean tuberculosis, ir you have any one or more oF these
symptoms be examined by a careful
physician at once.
cases 661/^ per cent recover and of the
advanced cases only 18 1/^ per cent re-cover.
One should be suspicious of tubercu-losis
if he has been living with, or in
close contact with, a tuberculous per-son
who has been a careless cougher.
sneezer, and spitter. Frequent colds or
a "bad case of grippe" with a persist-ent
cough or sore or swollen lymph
glands or kernels in the neck, are
causes for suspicion. Dissipation, over-work,
intemperance, or other viola-
3. A cough that lasts more than
three weeks.
4. A temperature of 98.0 or less in
the morning, and an afternoon tem-perature
of 99.5 or more.
5. A low blood pressure is suggestive.
6. A hemorrhage from the lungs
means tuberculosis without exception.
Germs of tuberculosis in the sputum
are a sure but a late sign of tubercu-losis.
The diagnosis should have been
made and treatment begun long before
the case reaches this advanced stage.
APY
DURHA^
) t TRIN I TY COLL fG I
^ NOTICE TO READER—When you finish reading this magazine
place a one-cent stamp on this notice, hand same to any postal em-ployee
and it will be placed in the hands of our soldiers or sailors
atthe front. NO WRAPPING—NO ADDRESS.
Publislyedb^ T/\E. ^9Km CARPLI^^A 5'IKm.B<?ARDs^AmLTA
This Bulletin, will be aeni: free to grxg citizen of the 5tate vipbn, 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. XXXjf/ AUGUST, 1918 No. 2
ANNOUNCEMENT
A change has been made in the management of the Health
Bulletin. Mr. Warren H. Booker, who has been Editor of
the Bulletin and in charge of the educational work of the
Board for nearly five years, is leaving to undertake similar
work in France. Arrangements have been made to have the
Bulletin appear regularly. Hereafter Dr. B. E. Washburn,
director of the Bureau of County Health Work, will be
responsible for the section of the Bulletin on Personal
Hygiene; Dr. George M. Cooper, director of Medical Inspec-tion
of Schools, will be responsible for the section on Child
Hygiene, which will include school sanitation and medical
inspection of school children; Dr. L. B. McBrayer, superin-tendent
of the State Sanatorium, will be responsible for the
section on Tuberculosis; and Dr. W. S. Rankin, secretary of
the State Board of Health, will be responsible for the section
on Public Health and Sanitation. Editorials will be contrib-uted
by the Executive Staff of the State Board of Health and
signed by their initials.
TABLE OF CONTENTS
Complete Mobilization 27
The Spirit of the Times 29
The County Health Officer is Right 29
Federal Government Assists State
IN Enforcing Quarantine Laws. . 31
Personal Hygiene and First^Aid
Medicine 32
Prosecutions Brought by the State
Board of Health During Month
OF June, 1918 33
Why Publish the Names of the
Guilty? 33
Prosecuting Doctors 34
North Carolina's Typhoid Problem 36
The Sanitary Index of North Caro-lina
36
North Carolina Winning in the
Fight Against Typhoid 37
Responsibility for Typhoid Fever. . 37
Monthly Typhoid Deaths in North
Carolina for the Four Years 1914,
-1915, 1916, AND 1917 38
Monthly Variation Typhoid Deaths 39
Rules for Mothers 40
Value of Life Extension Work. ... 41
Danger in Ill-Fitting Shoes 42
Constipation 42
Hygienic Value of Gardening 43
A Confession 43
Preventive Dentistry 44
Necessity for Prevention 44
Frequency of Dental Decay 44
Proof That This State of Affairs
Can Be Prevented 45
Results op Neglect of Teeth 45
Need for Dental Education 45
A Plan of Campaign 45
Logic of This Procedure 46
Support op Leading Dentists an Ab-solute
Essential 47
Difference Between Trade and Pro-fession
47
Reward 47
How to Get Tuberculosis 48
FREE PUBLIC HEALTH LITERATURE
The State Board of Health has a limited quantity of li
free distribution. If j-ou are interested in one or more of
same sent to a friend, write to the State Board of Health
ticular subject.
Whooping-cough
Hookworm Disease
Public Health Laws
Tuberculosis Laws
Tuberculosis
Scarlet Fever
Infantile Paralysis
Care of the Baby
Fly Placards
Typhoid Placards
Tuberculosis Placards
Clean-up Placards
Spitting Placards
Sanitary Pr^'ies
Residentl\l Sewage
Disposal Plants
Eyes
Flies
Colds
Teeth
Cancer
Malaria
iterature on health subjects for
the following subjects, or want
for free literature on that par-
Smallpox
Adenoids
Measles
German Measles
Typhoid Fevee
Diphtheria
Pellagra
Constipation
Indigestion
SEX HYGIENE BULLETINS
Set a—For Young Men
A Reasonable Sex Life for Men.
Sexual Hygiene for Young Men.
Vigorous Manhood.
Smash the Line. (The case against the re-stricted
district.)
List of Reliable Pamphlets.
Set B—For Public Officials and
Business Men
Public Health Measures in Relation to Ve-nereal
Diseases.
Venereal Diseases—A Sociologic Study.
Smash the Line. (The case against the re-stricted
District.)
The Need for Sex Education.
A State-Wide Program for Sex Education.
List of Reliable Pamphlets.
Set C-Vigorous
Manhood.
-For Boys
(Especially for boys 12
years of age and over.)
NoTE.^—For boys under 12, see "When
and How to Tell "the Children" (Set D) ;
portions of "Vigorous Manhood" also may
be read to younger boys. Boys 15 years
and over may be given Bulletin "A Rea-sonable
Sex Life for Men" (see Set A),
at the discretion of the parent.
Sexual Hygiene for Young Men.
List of Reliable Pamphlets.
Any of the above will be sent without charge,
which vou have definite use.
Set D—For Parents
When and How to Tell the Children.
Venereal Diseases—A Sociologic Study.
The Need for Sex Education.
List of Reliable Pamphlets.
Set E—Foe Girls and Young Women
Your Country Needs You. (Especially for
girls 11 years of age and over.)
Note.—For girls under 11, see "When
and How to Tell the Children" (Set D) ;
])ortions of "Your Countrj' Needs You"
also may be read to younger girls. Girls
15 and over may be given "The Nation's
Call to Young Women" at the discretion
of the parent.
The Nation's Call to Young Women.
List of Reliable Pamphlets.
Set F—For Teachers
The School Teacher and Sex Education.
Sex Education in the Home and High
School.
Venereal Diseases—A Sociologic Study.
Smash the Line.
The Need for Sex Education.
List of Reliable Pamphlets.
Please send for only those bulletins for
EDWARDS ft BROUGHTON PRINTING CO.. RALEIGH. N C
*TS7
B
Q)M
PUSUaAED BYTAE, nORJA CAROUMA 5TATL. BQMgP s^AEALJA
Vol. XXXIV AUGUST, 1918 No. 2
EDITORIAL
COMPLETE MOBILIZATION
Entire Medical Profession to be at the
Call of the Country During
the War
In England and France, and in Ger-many,
too, for that matter, physicians
of all ages, sexes, and physical condi-tions
serve, wherever they are, at the
will of their country. So it is to be
here. So it should be. The medical
profession of America will not be
found one whit less patriotic than
their brethren across the water.
The plan now in the making is the
organization of a Volunteer Medical
Service Corps. The President Oi the
United States, through his agency, the
Council of National Defense, will
shortly ask each and every physician
in the United States to apply for mem-bership
in the Volunteer Medical Serv-ice
Corps. The membership of this
Corps bind themselves to be subject to
the direction of a Federal Board (rep-resenting
the Surgeons General of the
Army. Navy, and Public Health Serv-ice,
and the Council of National De-fense)
with respect to serving their
Government in the following capaci-ties:
(1) to remain in their present
post of civilian practice; or (2) to ap-ply
for and accept, in case it is granted,
a commission in the Medical Reserve
Corps of the Army or the Navy; or (3)
to accept service with the Public
Health Service of the United States;
or (4) to accept service with a state
health agency; or (5) to accept serv-ice
in some state institution, as an in-sane
asylum or a tuberculosis sana-torium.
Under the plan of medical mobiliza-tion
as followed previous to the adop-tion
of the proposed plan, the indi-vidual
physician, while directly ap-pealed
to by the President through his
agency, the Council of National De-fense,
to offer his services to his coun-try,
has been governed by the feeling
that enough physicians without him-self
would yield to the call of the coun-try
to supply its military needs. Like
those in Luke 14:18-20, some did not
respond because they had bought a
piece of ground; others because they
had to prove a new automobile; and
others because they had married a
wife. Under the plan as heretofore
carried out. only enough physicians
have responded to supply the military
necessities of the country and, there-fore,
all of those who have volunteered
have had to be used regardless of the
importance of the field which they va-cated.
As a result, many communities
are without physicians; medical col-leges
have become considerably disor-ganized
through large numbers of their
faculties entering the military service;
such governmental agencies as are
manned by medical officers, as insane
asylums, tuberculosis sanatoria, city
and State health departments, have
been and are being seriously disorgan-ized
through the medical officers of
these institutions leaving their civilian
duties at the call of their country and
accepting commissions in the Army or
28 The Health Bulletin
Navy. The writer knows of a state
board of health, in an adjoining state
that has lost three-fourths of its per-sonnel;
and of another state board of
health in a neighboring state that has
lost even a greater per cent of its per-sonnel;
of another state employing in
its engineering staff twelve engineers,
and during the last year has lost four-teen
engineers, the entire staff and two
of the second crop; of another division
in a state board of health that for
eight months has been trying to find
six medical officers, and in the last
three months obtained three medical
officers only to lose two of these in the
last six weeks. Examples might
be continued almost ad infinitum, but
these illustrations are sufficient.
The lesson to be drawn from all of
this is: There must be discrimina-tion
in the distribution of the medical
profession to meet both the military
and civilian exigencies of the war.
Discrimination is impossible so long
as the number of doctors volunteering
is but slightly in excess of the mili-tary
needs. Discrimination becomes
possible just in proportion as the call
of the country meets with the whole-hearted
response of the profession.
Discrimination will not only become
possible, but will force itself when the
profession offers the full measure of its
service. The plan as outlined, which
contemplates complete mobilization,
takes care of this important principle
of discrimination through which, and
only through which, both the civilian
and military needs of our country can
be adequately cared for.
All will be called to volunteer; none
will be slighted. All will be asked to
leave it to their country to determine
their place of service during the war.
The country, in making the proposed
appeal to the medical profession for
100 per cent mobilization, takes the
profession at its word: The country
assumes that the soul of the profession
is the humanitarian ideal; that the
medical profession recognizes the hu-manitarian
character of this war; that,
with the mass of the profession, hu-manitarian
ideals control. Of course,
the country realizes that there is a
small percentage of tradesmen that
have secured license to practice medi-cine,
and that, like a small amount of
fatty infiltration or degeneration o f
higher tissue, these inert, oily, slippery
globules will not respond; but even
these, it is believed, will be squeezed
into their own places by the pressure
of an irresistible public sentiment.
There will be some physicians who
will hesitate to leave to an agency,
even though that agency speak for
their country, the right to keep them
in their place or to assign them to
some of the military or public duties
above mentioned. These men should
remember that our boys "in the army
have not stood back on the possibility
of their being placed under an incom-petent
commander. They know that
whoever their commander is, he is to
them the voice of their country. So
in the coming call for 100 per cent
volunteers in the Volunteer Medical
Reserve Corps, let the individual phy-sician
trust his country and submit
himself to its authorized agency for
direction. By this faith lies the way
of salvation, now and hereafter, but,
oh, ye of little faith!
And when this call comes, let every
NORTH CAROLINA physician recog-nize
not only his opportunity for him-self
in a prompt response, but let him
also recognize his individual part in
grasping the opportunity of placing
his State FIRST in the completeness
and the promptness of its mobilization.
How proud an achievement if North
Carolina will lead all the states in
meeting intelligently and justly the
medical demands of these great times!
It will be up to you, doctor, to do your
part in placing your profession and
your State in the right place.
W. S. R.
The Health Bulletin 29
THE SPIRIT OF THE TIMES
A Letter from a Young Medical Officer
who has been Attached to the
British Army in France for
the Past Year
[An officer in the Surgeon General's
office has received a letter from a
young medical officer who has been
with the British Expeditionary Force
for one year and who has been
wounded. The letter in part runs as
follows:]
"At present I am very impatient and
dissatisfied with my lot, for I have
been forced to be out of tli'3 game,
owing to a wound received some twelve
weeks ago. My regiment had been in
for a particularly heavy attack and
barrage, and while making my way
along a ridge to get to some of my
wounded lads, about 300 yards from
the boche. a machine gun opened on
me. I was unfortunate enough to get
a bullet through the back. It passed
between the spinous process. To make
a long story short, I have had a rotten
time of it, with blood poisoning and
three operations. However, the wounds
are now healed and I am going about
London. My back is getting stronger
and of more use daily.
"I am hoping to get back to France
soon. I am more than tired of being a
patient, and my only desire is to get
back to my lads, to share everything
with them in this time of crisis. How
I do love my boys of the Fifth Duke
of Wellington Regiment! They are
Yorkshire men, and to my mind the
best boys, finest fighters, and the most
cheerful men I have ever known. 1
have no hesitation in saying I love
them—the love of one strong man for
other strong, brave, and true men. I
will not be happy until I get back to
them, and I love the game in spite of
its dangers and discomforts, because it
is a man's game and calls for the best
that is in one. The experience is
worth everything. One has the chance
to have served at a time like this, to
have gven of one's best, to have lived
for an ideal. There is nothing better.
True, there are many drawbacks and
dangers, but we can only live once, and
if I 'go West' I will have solved the
great mystery all the sooner.
"I am very proud of my military
cross, which the British Government
awarded to me for gallantry and devo-tion
to duty. It means a lot to me
—
the knowledge of work well done and
an. inspiration to give of my best."
THE COUNTY HEALTH OFFICER
IS RIGHT
"State Board of Health,
"Raleigh, North Carolina,
"Gentlemen:
"Permit me to say that it might not
be expected from one who, perhaps,
has the largest number of vaccinations
to his credit of any physician in North
Carolina, to demur to anything said
in favor of anti-typhoid vaccination,
but the following paragraph in your
press article on Typhoid, released for
the papers on July 3, should be re-written.
The paragraph referred to
reads as follows:
" 'To combat the prevalence of Ty-phoid,
the State Board of Health urges
anti-typhoid vaccination, the screening
of houses to protect from flies, and the
installation of sanitary privies. The
disease can be entirely prevented by
the first measure, while the last two
named would insure a very great re-duction
in the number of cases.'
"It should have read 'The disease
can be entirely prevented by sanitary
privies, while the other two would in-sure
a very great reduction in the
number of cases.' Sanitary privies in-deed,
should have occupied first posi-tion
in the paragraph instead of last.
"Now it is time, and high time, that
the truth about this whole business
should be made clear to the lay people
of North Carolina, who must suffer
until they learn the truth and con-form
their habits thereto, and the
truth about Typhoid is that it, with
other intestinal diseases, will remain
with us until doomsday unless human
excrement is safeguarded, and this
truth should be so impressed upon
people until, like Banquo's ghost, it
will not down.
"With human excrement carefully
and properly safeguarded, the two
other measures can be dispensed with,
and flies turned loose; but then, may
the Lord have mercy upon baldheaded
men!
"It is now time to put over in North
Carolina a compulsory sanitary privy
law and a state sanitary inspector in
the field, and I am now announcing
my candidacy for that position.
30 The Health Bulletin
"With best wishes for the Board in-dividually
and collectively, but more
especially for the executive and heads
of bureaus, I am,
"Very truly,
••County Health Officer.'"
VACCINATE YOUB FAMILY AGAINST
TYPHOID FEYER
Typhoid fever is dangerous; it kills.
If it does not kill, it keeps you sick
for a long time. It is therefore ex-pensive.
It takes at least two of your
family to have the disease, one who is
sick and the other to wait upon him.
It therefore means the loss of the serv-ices
of two persons.
Typhoid fever is a reflection on your
community, just as much so as a case
of smallpox. Both can be surely pre-vented
by vaccination. A case of ty-phoid
fever in your family at this time
means the stopping or lessening of
your earning capacity. You become an
expense rather than a producer, and,
moreover, when the State and Nation
need the full productive capacity of
every one. Typhoid fever is an ally of
the Hun. One sick with typhoid is
as much incapacitated as if shot by a
Hun bullet or poisoned with his gas.
So, don't have it! Swat the fly, keep
clean, keep well, be vaccinated against
typhoid fever Do all you can for the
men who "tote the gun" and use the
gun against the despised Hun.
We can't do our full part when we
are sick or have any of our family
sick with typhoid fever. So keep well.
Kuy Liberty Bonds, War Savings and
Thrift Stamps with what you would
lose in time, in doctor's bill, medicines,
and funeral expenses. Last year there
were 6,000 cases of typhoid fever in
North Carolina. Enough time lost by
patients and those nursing them to
have fully trained a regiment, not to
speak of over 600 of these who will
never hear the bugle call to the colors
—only Gabriel's trumpet of the Resur-rection
morn.
The army has vaccinated all the men
called to the colors. There is no ty-phoid
fever in the army. So follow the
example set for you. It is safe, sure,
not painful; it requires three inocula-tions,
a week apart. Now is the time;
don't delay! J. J. K.
FEDERAL OFFICERS AFTER DOC-TORS
FAILING TO REPORT
THEIR TYPHOID FEYER
CASES
Invariably our attention is directed
to epidemics of typhoid fever when the
epidemic is not in its inception, but in
full blast, and frequently when the
height of the epidemic is passed. To
illustrate: in the epidemic at Canton
last year, where there was a total of
over 150 cases, we know nothing of the
occurrence of the epidemic until some
60 or 70 persons had become infected.
This was true again at Greensboro in
1915, when a milk epidemic of 45 cases
occurred. And, again, it was true of
the epidemic in Wilmington in 1911.
It has always been true of epidemics
in this State—we are called after the
horse is stolen.
If doctors would report promptly
their cases of typhoid fever (and all
cases of recognizable typhoid are
treated by doctors), this office would
be apprised of epidemics in their in-ception.
We could immediately apply
the methods of control and prevent
many cases of typhoid and save many
lives. For example, if last year this
office had known of the Canton epi-demic
when only ten cases occurred, we
could have had a man on the job and
prevented not less than 50 cases and
at least 5 deaths. Just recently our
official attention has been directed to
the occurrence of 12 cases of typhoid
fever in the small village of Landis,
North Carolina, a village of not over
200 people. If these cases had been
promptly reported, the Board of Health
would have been able to act a week or
The Health Bulletin 31
ten days earlier than it did with its
delayed information, and in this way
could have prevented a number of
absolutely unnecessary cases and, per-haps,
some deaths. The doctor who
fails to report his typhoid fever cases
promptly is guilty of the same kind of
negligence as the citizen who sees the
beginnings of a conflagration and neg-lects
to call the fire department. At
present, doctors are not reporting
more than 80 per cent of their typhoid
fever cases.
The Federal Government, by a well
thought out system of correspondence
in which the franking privilege serves
to great advantage, is getting in touch
with the households from which there
are reported cases of typhoid fever,
and through these householders are
ascertaining the existence of unre-ported
cases in the community. The
unreported cases are turned over to
the State Health Officer with a request
from the Federal Grovernment that
prosecutions be instituted. The prose-cutions
will be instituted. "We hope
that with this notice the Federal offi-cers
will find very few unreported
cases. We shall have no option but to
enforce the law. W. S. R.
FEDERAL GOVERNMENT ASSISTS
STATE I> ENFORCING QUAR-ANTINE
LAWS
Infectious diseases must be handled
under State laws, but this does not
mean that public and governmental in-terest
in this class of diseases is re-stricted
to the State in which the dis-eases
are present. There is some-thing
like 15.000 miles of North Caro-lina
in infectionable contact with
neighboring states. There are 500,000
persons, potential conveyors of infec-tion,
leaving this State by common car-riers
every year for other common-wealths
near and distant; and thus
our ills fly to fields we know not of.
The Federal Government's interest in
effective state control of contagions is,
therefore, most reasonable.
This interest of the Federal Govern-ment
in State control of contagions
has always existed, but in these criti-cal
times there are many additional
reasons to emphasize the interest of
the Federal Government in the State's
handling of contagion. There are in
our State, and there are coming to
our State in ever-increasing numbers,
soldiers and workers in war indus-tries,
both equally important to the
cause of civilization. These, our
guardians and visitors, are citizens of
other states. We owe them protection,
the protection that we ask of other
states where our own soldier boys are
sojourning.
Contagion must not be permitted. to
pass from the civilian population into
the camps and industrial settlements.
The sanitary officer of the camp must
know, when men. apply for furloughs,
in what counties of North Carolina
contagions exist, in order that men
may not be furloughed to counties in
which there are epidemics and from
which epidemics may be transplanted
by the returning soldiers to the camps.
The special interest of the Federal
Government in state control of con-tagion
is, therefore, at this time, fully
justified.
Both the United States Public Health
Service and the Surgeon General of
the Army are now assisting our State
in running down and prosecuting vio
lations of the quarantine law. Negli-gence
on the part of physicians to
report their cases of contagion, and
on the part of householders to report
measles and whooping cough not un-der
the care of physicians, and to re-spect
the quarantine laws, cannot and
will not be tolerated. The United
States Public Health Service, through
its officers and by a regular system
of correspondence with homes in
which contagion has been reported to
exist, is securing reports from house-
32 The Health Bulletin
holders of unreported cases of con-tagion
in their communities. These
unreported cases are referred to this
office; this office is asked by the Fed-eral
Government to enforce the State
law (1) for the protection of our
own people; (2) for the protection of
our own army, and (3) in considera-tion
of at least $15,000 worth of assist-ance
on the part of the Federal Gov-ernment
in a praiseworthy and sincere
effort to make the quarantine law of
North Carolina effective. The Board
of Health will soon have from four to
five additional field men at work in-vestigating
violations of this quaran-tine
law, especially failure on the part
of the physicians to report contagious
diseases. A 1 1 violations will be
promptly and fully prosecuted. An
embarrassing but unavoidable obliga-tion
to bring these prosecutions rests
upon the Board of Health.
W. S. R.
PERSONAL HYGIENE AND FIRST
AID MEDICINE
Personal Hygiene is a subject in
which every citizen of North Caro-lina
should be vitally interested at the
present time. Our Nation is taking
an increasingly important part in the
greatest war of all history. We are
called upon to defend the essential
things underlying our government, the
great principles of democracy. The
health of the Nation is one of the
most important phases of national de-fense.
While in ordinary times there
is a responsibility resting upon every
citizen to maintain good health, in
time of war this responsibility is
enormously increased. The extent to
which we, as a Nation, live up to this
responsibility may even determine the
outcome of the war. President Wilson
has said: "It is not an army that
we must shape and train for war; it
is a nation."
The individual citizens of North
Carolina have never been as interested
in personal hygiene as they should
have been. There is a reason for this.
Horace Greeley once said that people
were interested only in the unusual,
and not in the usual. He gave an
illustration of this. "Mr. Smith went
down the street yesterday, met a dog,
and the dog bit him." This, he said,
is not news and does not interest, be-cause
it is the usual thing for dogs
to bite. But, if "Mr. Smith went down
the street yesterday, met a dog, and
bit the dog," it would be news and
of interest because it is unusual.
It has always been the usual thing
for individuals to neglect their health
and become defectives, and nobody
—
not even one of the individuals—was
interested. But at present the per-sonal
health of the individual has be-come
an important factor in the life of
the Nation, and it has become more
than ever the patriotic duty of every
citizen to observe the rules of personal
hygiene and keep in good health.
Under the new plan of editorship
of the Bulletin it is our aim to make
the Department of Personal Hygiene
very practical. Each month there will
be items of interest regarding the
more important phases of the sub-ject,
and instances of benefit secured
through the practice of personal hy-giene
will be cited, and attention will
be given to First-Aid Medicine. There
will also be news regarding the prog-ress
of health work in the State,
especially as it relates to measures by
which individuals may acquire and
preserve their health. In a word, the
object of the department will be the
same as that of all public health
work—the prolongation of life and the
improvement in the health and happi-ness
of all the people.
B. E. W.
The Health Bulletin
IN THE TOILS OF THE LAW
33
PEOSECUTIONS BROUGHT BY THE STATE BOARD OF HEALTH DURING
THE MONTH OF JUNE, 1918
Cause
34 The Health Bulletin
against Dr. J. B. Smith, of Pilot Moun-tain,
North Carolina. Dr. Smith was
indicted for not reporting three cases
of measles and one case of typhoid
fever. The public, having no official
knowledge of these four foci of infec-tion,
had taken no action to restrict
the spread of the diseases. It is im-possible
to know, and it would be very
interesting to investigate and find out,
just how many secondary cases, and
possibly deaths, resulted from these
four uncontrolled foci of infection.
The justice of the peace before whom
the indictment was brought was a
man named R. E. Smith, of Pilot Town-ship,
Surry County. His Honor's judg-ment
was: "Judgment suspended upon
payment of cost and during good be-havior."
The cost was 95 cents; that
is to say. 23->4 cents per violation. The
Board of Health in this case was rep-resented
by a young man who had not
had much experience in bringing in-dictments.
"What should have been
done in this case was to bring an in-dictment
against the doctor on one
count, and the representative of the
Hoard of Health should have stated to
the justice that unless a fine of not
less than $5 or $10 and cost was im-pocad,
the Board would bring three
more indictments and before some
other justice of the peace or, perhaps,
appeal to the Superior Court. How-ever,
the least we can do under the
circumstances is to hold up this jus-tice
of the peace by calling out his
name in public for whatever credit
his acute sense of justice may bring to
him.
Then there are two reasons. Doctor,
why the State. Board of Health insists
on publishing the names of persons
violating the State health laws: (1)
To warn and protect others disposed
to be careless with respect to obeying
the public health laws: (2) to let the
people see how some justices of the
peace are assisting their State Board
of Health in protecting them against
contagion.
Now, frankly. Doctor, do you not
think we ought to publish names?
Very truly yours,
W. S. Raxkin, M.D.,
Secretary.
PROSECUTING DOCTORS
Reply to a Letter from a Physician
Convicted of Violating the Quar-antine
Law
Deau Doctor:—I have your letter of
July 10. and appreciate the fine spirit
of the letter.
I regret very deeply to learn that
one of the inspectors of the State
Board of Health was enabled to secure
evidence sufficiently convincing before
the courts to prove that you had vio-lated
the State quarantine law.
The Board of Health (1) is required
by the laws of the State to enforce
the quarantine law; (2) having ac-cepted
about $15 000 worth of assist-ance
from the Surgeon General of the
United States Public Health Service
and the Surgeon General of the Army
for the enforcement of the quarantine
law, the Board is obligated to these
Federal agencies to enforce this law;
(3) the Board is bound, by ordinary
moral considerations, to see that the
public is protected against the spread
of contagion in so far as the State laws
can give this protection.
The inspectors of this Board are
sent out instructed to investigate and
find violations, and NEVER to dis-criminate
in bringing indictments, but
to indict every doctor found guilty
of a violation of the quarantine law.
We have indicted ex-presidents of the
State Medical Society, members of the
State Board of Medical Examiners,
some of our best friends in the profes-sion,
physicians to whom we are ob-ligated
for both official assistance in
building up the health work of the
State and physicians to whom we are
personally obligated. We make no dis-criminations.
Executive officers rarely
ever get into trouble by enforcing
The Health Bulletin 35
laws; the danger in the administra-
} tion of law is in discrimination, in
I treating one man differently from an-
] other. As long as we are able to say
{ that we prosecute every KNOWN vio-lation
of the quarantine law regardless
of the standing of the physician, we
can keep our heads above water. But
if we prosecute this man because he
has no influence in the medical pro-fession
and in the State, and avoid pro-secuting
the man who has such in-fluence,
we would soon become hope-lessly
submerged; moreover, you can
readily see that the State cannot per-mit
the question of motive to deter-mine
recourse to the courts, for mo-tive
is a factor that can be accepted
or rejected only by what a man says,
and unscrupulous physicians, the type
that should feel the hand of the law,
would all escape.
In your letter you say that you are
"persuaded that hundreds of cases go
unrep'^''*^pd through ignorance or neg-lect—
I think few. if any. through
maliciousness—on the part of the phy-sicians
of North Carolina." It is not
ignorance. Doctor. Families may fail
to report their cases of contagion on
account of ignorance, but physicians
are not ignorant. They are taught in
the medical colleges, they are taught
in the text-books that they read in
their offices daily that they must re-port
their contagious diseases to some
public official for quarantine; that
quarantine is a public function. Phy-sicians
have been notified time and
again by letters, by newspaper articles,
and Sulletin statements from this of-fice,
of their duty with reference to
reporting contagious diseases. They
are not ignorant. In discussing the
reasons why physicians do not report
their cases. I stated in my recent an-nual
report as follows:
"The failure of physicians to report
cannot be excused on this ground
[ignorance]. The medical profession
would resent it. There are two rea-sons
why physicians do not report
communicable diseases. One reason is
carelessness. Carelessness is the rea-son
the high-class, law-respecting, ethi-cal
physician fails to report his com-municable
diseases. Some of the finest
spirits of the profession fail to report
because they are careless in this mat-ter
of public duty. Carelessness is
such an inherent part of the nature
of all of us that we all sympathize
with its mistakes; however, we should
not be blind to its effects. Carelessness
is that which often robs tender in-fancy
of its only support and closes
the eyes of the young mother on a new
world of bliss. Carelessness is the
thing that burned Chicago; that caused
the Baltimore conflagration; that burns
up millions of dollars worth of prop-erty
every year. Carelessness causes
practically all epidemics. Carelessness
in the form of national indifference is
the only danger that confronts democ-racy
in this judgment day of govern-ments.
"The other reason for the failure of
physicians to report communicable dis-eases
which occur in their practice is
a more sinister one. There are a few
mercenary physicians who deliberately
attempt to capitalize the socially near-sighted
and ignorant by not reporting
them for quarantine. In this way the
mercenary places the ethical physician
at a gross disadvantage, for it is
grossly disadvantageous for law abid-ing
doctors to have their patients
placed under quarantine restrictions
while the patients of law-evading doc-tors
are permitted their full and accus-tomed
liberties. Under such a lop-sided
administration of law the near-sighted
and the ignorant family leaves
the better for the worse class of phy-sicians,
and law becomes an impedi-ment
to virtue instead of an obstruc-tion
to vice.
"In conclusion, it may be stated that
the rigid enforcement of quarantine
laws has two objects in view: (1)
protection of the people against un-necessary
contagion; (2) the protec-tion
of ethical, law-abiding physicians
against mercenary, law-evading physi-cians.
The first object of quarantine
administration is the public health;
the second object of quarantine admin-istration
is justice within the medical
profession."
Very truly yours.
W. S. R.\NKiN. M.D..
Secretary.
PUBLIC HEALTH
i^ND SANITATION
JSORTH CAROLINA'S
TYPHOID PROBLEM
North Carolina's Typhoid Rate Com-pared
^Vith That of Other
States
The following table is compiled from
the death rates of the states of the
Union that are sufficiently advanced in
intelligence and sanitation to appre-ciate
the importance o f properly
drafted and enforced vital statistics
laws—in short, those states with vital
records that are accepted as correct by
the Bureau of the Census of the Fed-eral
Government. The rates quoted
are the average rates for the last
three years for which reports are avail-able,
namely, the years 1913, 1914, and
1915:
1. Wisconsin 6.7
2. Massachusetts 7.4
3. New Jersey 8.1
4. Rhode Island 8.8
5. New York 8.9
6. Minnesota 9.2
7. Washington 9.3
8. New Hampshire 9.4
9. "Vermont 10.8
10. Connecticut 12.6
11. California 13.0
12. Maine 13.8
13. Michigan 13.8
14. Pennsylvania 14.4
15. Kansas 14.5
16. Colorado 15.5
17. Montana 16.9
18. Virginia 18.1
19. Ohio 18.7
20. Indiana 20.4
21. Mississippi 21.2
22. Maryland 27 1
23. NORTH CAROLINA. 31.9
24. Kentucky 38.2
"Thank the Lord for Kentucky."
THE SANIT.4RY INDEX OF NORTH
CAROLINA
"Typhoid fever is everywhere an
INDEX of the sanitary INTELLIGENCE
OF A COMMUNITY."
—
Sanitary axiom.
Average typhoid fever death rate by
North Carolina counties for the years
1914, 1915, 1916, and 1917:
Rate for St.\te . . . 30.3
Ashe 7.8
Jones 8.3
Yadkin 12.2
Polk 12.5
Alleghany 12.9
Caswell 13.4
Cherokee 14.3
Montgomery 14.5
Jackson 14.5
Randolph 14.8
Northampton 15.2
Moore 15.5
Alexander 18.8
Alamance 18.9
Burke 19.1
Brunswick 19.6
Stanly 19.9
Graham 2^
Sampson 20.9
Rutherford 21.3
Wilkes 21.6
Anson 21.7
Yancey 22.
Madison 22.3
Surry 22.3
New Hanover 22.5
Iredell 22.7
Transylvania 23.3
Carteret 23 i
Gates 2,'?.
8
Granville 23.8
Union 23.9
Franklin 24.2
Buncombe 24.4
Craven 24.5
Davie 24.6
Lincoln 24.8
Bertie [ 25^5
Dare 25.5
Stokes 25.8
Bladen 26.
Chatham 26.5
Nash 27.
Rockingham 27.3
Vance 27.4
Person 28.
Tyrrell 28^
Macon 28.5
Harnett 28.6
Henderson . . 28.6
Cleveland ... 28.7
Johnston 28.8
The Health Bulletin 37
Haywood 29.2
Hertford 29.6
Pender 29.9
Cumberland 30.1
Hoke 30.1
Robeson 30.1
Onslow 31.
Orange 31.1
Watauga 31.1
Wake 31.8
Clay 31.9
Mitchell 32.
Halifax 33.6
Davidson 33.6
Hyde 33.9
Mecklenburg 33.9
Gaston 34.1
Beaufort 34.3
Edgecombe 34.3
Rowan 34.6
Warren 34.7
Camden 34.9
Duplin 34.9
Catawba '. 35.
Avery 35.5
Cabarrus 36.1
Guilford 36.7
Washington 37.3
Forsyth 37.6
Caldwell 38.6
McDowell 39.1
Columbus 39.2
Pitt 40.1
Pamlico 40.5
Greene 41.9
Pasquotank 42.4
Swain 43.
Richmond 43.1
Durham 43.4
Wilson 46.
Currituck 47.8
Scotland 51.6
Lenoir 52.8
Wayne 54.3
Chowan 54.6
Lee 59.2
Perquimans 60.2
Martin 61.
PfORTH CAROLINA WI>M>G IN
THE FIGHT AGAINST TYPHOID
In 1914. 839 deaths in the State
from typhoid; rate 35.4
In 1915, 744 deaths in the State
from typhoid; rate 31.3
In 1916, 700 deaths in the State
from typhoid; rate 29.1
In 1917. 626 deaths in the State
from typhoid; rate 25.7
The above table is the silver lining
to the typhoid shadow that rests upon
our State. It means that the cloud
that casts the shadow is limited; that
the light of intelligence is shining
upon this cloud and is gradually,
steadily dissipating its noxious vapors;
that the shadow is lifting.
Sanitary ignorance and carelessness
(but carelessness is the child of ig-norance)
cause typhoid, and, con-versely,
sanitary intelligence and the
proper appreciation of human life (but
the latter goes with sanitary intelli-gence)
will eliminate typhoid fever
from the list of diseases.
RESPONSIBILITY FOR TYPHOID
FEVER
What Are Responsible
The most important fact for any one
to know about typhoid fever is that
the disease is caused by the swallow-ing
of human excreta, and is con-tracted
in no other way. It is true
that the excreta is usually in such
small amounts as not to be detectable.
The excreta is taken in through the
mouth in either water or food.
Water may be contaminated with
human excreta (a) when the well or
spring is so placed and so imperfectly
constructed and protected that surface
washings during a rain from a place of
deposit of human excreta flow toward
and enter the water supply; (b) by
percolation or infiltration through the
soil from an open privy toward a well
or spring located dangerously near,
that is, within 75 feet; (c) by the drop-ping
of visible or invisible amounts of
human excreta from soiled shoes or
feet through a n imperfectly c o n-structed
well cover on which those us-ing
the well may stand.
Food may be contaminated (a) with
small amounts of excreta brought to
the food by the hands of some person
who has been nursing a case of ty-phoid
fever; or (&) by the hands of
some person who has had typhoid fever
in recognizable or unrecognizable form
years before and who still carries and
discharges the typhoid germs from his
38 The Health Bulletix
intestines, that is, by a "typhoid car-rier";
(c) by flies contaminated with
the human excreta from some open
privy within from 200 to 500 yards of
the exposed food.
The next most important fact for
any one to know about typhoid fever
is this: THE DANGER OF TYPHOID
FEVER TO ANY UNVACCINATED
PERSON IS IN DIRECT PROPOR-TION
TO THE NUMBER OF OPEN
PRIVIES AND THE NUMBER OF
FLIES WITHIN 500 YARDS OF
THEIR EATING PLACE. This fact
explains the variation in the typhoid
death rate in (1) different communi-ties
in North Carolina and (2) dur-ing
the different months of the year.
Relation of Typhoid Fever to Priv-ies.—
The lowest death rate in North
Carolina occurs where there are fewest
privies in proportion to the population,
that is, in the sewered section of our
larger cities. In these communities
there are no open privies. The next
lowest death rate from typhoid fever
in North Carolina occurs where there
are next fewest open privies in propor-tion
to the population, that is, in the
purely rural sections of the State.
Here there is but one privy within
fly range (within from 200 to 500
yards) of the average home. The
highest death rate from typhoid fever
occurs where there are the largest
number of open privies in proportion
to the population, that is, in the small,
unsewered towns and cities of the
State and in the suburban, unsewered
sections of our larger cities, where,
'instead of one privy being within fly
range of a home, there are from six
to a dozen privies so located.
The above statement with respect
to the variation in typhoid death
rates, in so far as the privy factor is
concerned, is in full accord with the
evidence contained in the table show-ing
the typhoid death rates of differ-ent
counties, on page 36 of this BrL-LF.
Tix. One familiar with the distri-bution
of the population of this State
will recognize that the counties with
lowest death rates are counties with
the largest percentage of purely rural
residents. The counties with medium
death rates are counties in which the
low rate of sewered communities off-set
the high rate of unsewered subur-ban
districts and small towns and
cities. The counties with highest
rates are those in which the highest
percentage of unsewered village and
town populations live.
Relation of Typhoid Fever to Flies.—
Typhoid fever in North Carolina comes
and goes with this messenger of death,
the typhoid fly. In support of this
statement are the facts of the fol-lowing
table:
MONTHLY TYPHOID DEATHS IN NORTH CAROLINA FOR THE
FOUR YEARS 1914, 1915, 1916, AND 1917
1914 1915 1916 1917 Total
January
February.-
March
April
May
June
July
August.
September.
October
November.
December. _
Totals.
31
The Health Bulletin 39
In this table we see the smallest
number of typhoid deaths during the
flyless months, November, December,
January, February, March, and April
—
typhoid deaths due to cases contracted
from polluted water supplies, from
the hands of persons contaminated
from some case of typhoid fever that
such a person has nursed, or from the
hands of a person who is a "carrier."
During these flyless months the aver-age
number of deaths from typhoid
fever in North Carolina is 29 deaths
per month. Then come the flies,
steadily increasing until toward the
latter part of August, when they de-crease
in number, and during these
six fly months the average number of
deaths from typhoid fever in North
Carolina per month is 95 as against
29 during the flyless months. See
illustration below. The case against
the fly is overwhelmingly conclusive.
But the fly would be harmless if he
were unarmed. He gets his deadly
ammunition from open, unsanitary
closets; thus we see that THE PRI-MARY
FACTOR IN NORTH CARO-LINA'S
TYPHOID RATE IS THE
OPEN-BACK PRIVY. The secondary
factor is the ordinary house-fly.
The time is ripe, overripe, when the
State, through its General Assembly,
should outlaw the open, unsanitary
privy. The next Legislature is likely
to be asked to do this.
Who Are Responsible?
The county commissioners are the
most responsible people in North Caro-lina
for typhoid fever. That is a
severe charge, and one that ought not
to be made unless the facts will war-rant
it. What are the facts?
Well, first, the larger responsibility
of county commissioners: County
commissioners are responsible for
rural North Carolina, and rural North
Carolina is 90 per cent of the popula-tion
of the State. The responsibility
Monthly Variation in Typhoid Deaths
(N. Coverage for 4 years)
High rate in summer and fall due largely +o flies
cominq from open-back privies +o unscreened houses.
138 >4I
Jan. Feb. Mar Apr. May Jun. July Aug. Sep. Oct. Nov. Dec.
40 The Health Bulletin
of county commissioners to the rural
people is for both property and life,
but responsibility for human life takes
precedence over responsibility for
property, for is not life more than
meat, and the body more than raiment?
County commissioners are responsi-ble
for typhoid fever because they
could prevent it, or prevent a large
part of it, i/ they would. The method
of prevention is cheap; it is simple.
It is too cheap and too easy for any
board of county commissioners to be
able to say that they could not do it.
Let us see if this is not so.
A board of county commissioners
can employ some doctor living in the
county, at $1.50 an hour for 4 hours a
week, that is, $6 a week, and this for
fifty-two weeks in the year is $312, to
vaccinate citizens of .the county who
apply for free typhoid vaccination.
The State will furnish the vaccine
without charge. The county commis-sioners
can arrange with the doctor
doing the vaccinations for him to meet
the people in several places in the
county instead of having all of the
people to come to the county seat.
For a little additional cost for some
newspaper notices and for some prop-erly
gotten up placards, the people of
the county can be told of their oppor-tunity
for free typhoid vaccination
and what this means in typhoid pre-vention.
Certainly, for a total sum
not exceeding $500 a year, the average
county can carry out a very compre-hensive
plan of typhoid vaccination.
So we see that the reason county
commissioners do not protect their
people by anti typhoid vaccination is
not money. It is not ignorance. No
county in North Carolina at this time
has a board of county commissioners
that do not know something about ty-phoid
vaccination. They know that
there is not an army in the world that
is not protected, absolutely protected,
in this way, and they ought to know
(as a matter of fact, they do know)
that what is good protection for the
army is good protection for the civil-ian.
Then, if it is not money and it is
not ignorance, why do the county com-missioners,
when they can reduce
their typhoid death rate, not do it?
Simply because they are not interested.
But this absence of interest on their
part does not in any way modify the
fact that they can greatly reduce their
county's typhoid death rate, and that
if they do not reduce it, they are re-sponsible
for its being unnecessarily
high.
Mr. Citizen, if you agree with your
State Hoard of Health, cut this out
and mail it to one of your county com-missioners.
It may do some good
—
and it may not; however, the world
do move; no harm in trying, and a
chance only costs a 3-cent postage
stamp.
RULES FOR 3I0THERS
Don't pin on baby's diaper or band
too tightly, as it may cause deformity
and is often the cause of vomiting.
Don't handle the baby too much.
Don't let little children sit on the
floor on cold days, or in a draft be-tween
open door and window.
Don't walk the floor with your baby.
Don't let him lie in a wet napkin.
Don't give him solid foods before he
is one year old and then only spar-ingly.
Don't feed the baby too often or too
much.
Don't pick him up every time he
cries.
Don't put too many clothes on the
baby during warm weather or too few
during the cold weather.
Don't let baby's hands and feet get
cold.
Don't let a child put playthings or
other objects in his mouth.
Don't use milk unless you are sure
that it is clean and pure.
Don't give medicines or drugs with-out
the doctor's advice.
Avoid soothing syrups.
TALUE OF LIFE EXTENSION WORK
In the examinations of the first draft
about one-third of all the young men
called and examined were rejected be-cause
of physical defects. The causes
of rejection were many, chief among
them being eyes, teeth, underweight,
feet, heart, overweight, ears, tubercu-losis,
undersize, injured and amputated
limbs, syphilis, debility, hemorrhoids,
and rheumatism. A study of the
causes shows that probably three-fourths
of the conditions could have
been prevented by proper personal
hygiene or by medical or dental treat-ment
if this could have been obtained
in time. It should be remembered
that the above statistics are for young
men between the ages of 21 and 31
years. If the higher age groups (31 up
to 61 years) of both sexes should be
examined, there is no doubt that the
number of those found defective would
be much larger.
Among our many weaknesses that
have been brought to our attention by
the war. none is more alarming and in
need of correction than the fact that
a large majority of our citizens in the
very prime of life are physical defec-tives
principally because of neglect of
personal hygiene. This is a more seri-ous
problem than it appears to be.
The mental devolopment is largely de-pendent
upon the physical condition,
and the loss in efficiency which must
result from such physical conditions
is no doubt a serious handicap to our
educational and industrial develop-ment.
The necessity of having every adult
examined regularly in order that he
may know if there is any incipient dis-ease
or any defects which may impair
his health and decrease his working
capacity is evident. And in order to
meet this necessity the State Board of
Health is preparing to inaugurate in
the counties cooperating with the Bu-reau
of County Health Work a unit
known as Life Extension Work.
The Life Extension Unit is closely
modeled after the work being done by
the Life Extension Institute. The
health officer sets aside one or more
days each week for the examination of
citizens who may apply at the health
department. The purpose of the ex-amination
is to detect disease in its in-cipiency,
to find minor defects which
may impair the citizen and decrease
his working capacity, and urge medi-cal
attention before the condition may
become serious or permanent. Where
medical o r surgical attention i s
thought necessary, the patient is re-ferred
and chooses his own physician.
Of course, no treatment is given by
the health officer, but each person ex-amined
is given a report, with verbal
and printed advice together with suit-able
literature on the health conditions
in which he is interested.
At present the following nine coun-ties
are cooperating with the State
Board of Health in the development
of county health departments: David-son,
Forsyth, Lenoir, Nash, Northamp-ton,
Pitt, Robeson, Rowan, and Wilson.
42 The Health Bulletin
DANGER I> ILL-FITTING SHOES
A recent publication of the Life Ex-tension
Institute of New York (-How
To Live" for May, 1918) has the fol-lowing
to say about shoes:
"Foot arches should never be worn.
They bring no real benefit, but in-crease
the weakness and disability and
are not permitted in the army. The
exercise most highly regarded in the
treatment of flat foot among soldiers
is as follows:
'•Stand with feet parallel and some-what
apart with great toes firmly grip-ping
the ground. Without bending the
knees or moving the feet, rotate the
thighs outward repeatedly. This is
chiefly done by strong contraction of
the great muscles of the back of the
thigh and seat.
"Exercises that involve curving in-ward
of the feet and raising of the
inner margin of the foot are particu-larly
valuable. Most foot arches found
in the shops exert a contrary effect.
The modern treatment is by proper
exercise, manipulation of the foot to
overcome adhesion, stiffness, etc, and
the practice of proper posture in daily
walking,
'In measuring the feet for shoes the
soldier stands with his full weight
on one foot on a flat board with a slid-ing
block. Measurement is also taken
with a forty-pound weight on his back.
A shoe two sizes larger than the actual
measurements of the foot is chosen to
allow proper foot play and for sock.
In the shops the sizes are deceptive.
To cater to vanity they are numbered
somewhat smaller than the actual size,
also the measurement is taken with
the customer sitting, and does not al-low
for the expansion of the foot or
bearing the weight of the body. The
army shoe, Munson last, is a good shoe
and can now be found in the shops.
Its inner edge is not exactly straight,
but it is a decided improvement over
the conventional shoe. Other types of
shoes conforming to the normal foot
can be had if you insist upon it. Those
approved by the American Posture
Leiague can be procured by any shoe-maker.
"Take a shoe census on the trolley
car. Note how few people have shapely
feet free from large joints; note how
few wear proper shoes with straight
inner edge and no outward curve.
You will then understand why it is
necessary to take so much trouble to
train the soldiers in the care of their
feet and the correction of foot trouble.
Note that bad as the men's shoes are.
the women's are far worse and palpa-bly
deforming.
"It is a woman's duty to be a good
angel, and most of our women are, God
bless them! But crude as it may
sound, it is a woman's duty to be a
good animal as well as a good angel,
and no woman is a good animal who
has deformed, unsightly, feeble, feet
that jangle her nerves.
"Men and women who stand a great
deal should keep the feet well apart
and parallel, pointing straight for-ward.
Rest first on one foot and then
on the other; much fatigue wall thus
be avoided."
CONSTIPATION
Very few people recognize the seri-ousness
of constipation, and a still
smaller