Biennial report of the North Carolina State Board of Health

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FIFTEENTH BIENNIAL REPORT
OF THE
NORTH CAROLINA
STATE BOARD OF HEALTH
1913-1914
(>
RALEIGH
Edwards & Broughton Printing Co.
State Printers and Binders
1915
CONTENTS
PAGE
Members of the State Board of Health 3
Whole-time county health officers. 4
County physicians 4
Letter of transmittal .-- 7
Progress of health work in North Carolina for the biennial period 1913-
1914 9
Public health laws of North Carolina 30
Minutes of State Board of Health meetings 62
Special report of the Secretary on visit to Canal Zone 119
Inspections of State institutions 127
Opinions of the Attorney-General 133
Report of the State Laboratory of Hygiene 140
Report of the Hookworm Commission 142
Report of the Bureau of Engineering and Education 144
Report of the North Carolina Sanatorium 148
Financial statement North Carolina Sanatorium 162
Report of Treasurer, State Board of Health 186
Tabulated vital statistics for 1913 271
Table I. Deaths by sex, conjugal condition, general nativity and
nativity of parents for towns of over 1,000 population 272
Table II. Deaths by month of occurrence for towns by races 280
Table III. Deaths by age for towns of over 1,000 by races 285
Table IV. Deaths from certain causes for certain towns by races 292
Table V. Deaths and death rates from certain important causes for
towns having a population of over 5,000, by races 332
Table VI. Deaths from various causes for the registration area of
North Carolina by ages and races 336
Table VIII. Statistical study of pellagra 356
Table IX. Occupied males: Number and distribution by important
causes of death of males engaged in certain specified occupations
by races ^^^
Table X. Occupied females: Number and distribution by important
causes of death of females engaged in certain specified occupations
by races 2^^
Table VII. Deaths from important causes by months of occurrence.... 362
Members of the State Board of Health
Elected by the North Carolina Medloal Society:
Thomas E. Anderson, M.D., Statesville.
Term expires 1917.
Chas. O'H. Laughinghouse, M.D., Greenville.
Term expires 1917.
A. A. Kent, M.D., Lenoir.
Term expires 1919.
Cyrus Thompson, M.D., Jacksonville.
Term expires 1919.
Appointed by the Governor:
J. L. Ludlow, C.E., Winston-Salem.
Term expires 1915.
J. Howell Way, M.D., Waynesville.
Term expires 1917.
W. O. Spencer, M.D., Winston-Salem.
Term expires 1917.
Richard H. Lewis, M.D., Raleigh.
Term expires 1919.
Edward J. Wood, M.D., Wilmington.
Term expires 1919.
0^
Whole-time County Health Officers
New Hanover Chas. T. Nesbitt Wilmington.
Robeson B. W. Page Lumberton,
Durham Arch Cheatham Durham.
Guilford W. M. Jones Greensboro.
Johnston H. H. Utley Smithfield.
Rockingham S. W. Hurdle Reidsville.
Forsyth E. F. Strickland Winston-Salem.
Sampson G. M. Cooper Clinton.
Columbus G. S. Cox Tabor.
Buncombe D. E. Sevier Asheville.
Nash B. E. Washburn Nashville.
Vance D. C. Absher Henderson.
County Physicians
Alamance Geo. W. Long Graham.
Alexander S. T. Crowson Taylorsville.
Alleghany J. L. Doughton Sparta.
Ashe J. W. Colvard Jefferson.
Beaufort E. M. Brown Washington.
Bertie John L. Pritchard Windsor.
Bladen L. B. Evans Clarkton
Brunswick J. A. Dosher Southport.
Buncombe D. E. Sevier Asheville.
Burke E. W. Phifer Morganton.
Cabarrus R. M. King Concord.
Caldwell C. B. McNairy Lenoir.
Camden C. G. Ferebee Shiloh.
Carteret C. S. Maxwell Beaufort.
Caswell S. A. Malloy Yanceyville.
Catawba H. E. Rowe Newton.
Chatham L. E. Farthing Pittsboro.
Cherokee J. N. Hill Murphy.
Clay J. M. Sullivan Hayesville.
Cleveland T. E. McBrayer Shelby.
Columbus G. S. Cox Tabor.
Craven J. F. Rhem New Bern.
Cumberland Wm. S. Jordan Fayetteville.
Currituck S. M. Mann Moyock.
Davidson E.J. Buchanan Lexington.
Davie J. W. Rod well Mocksville.
Duplin J. M. Farrior Kernersville.
Durham Arch Cheatham Durham.
COUNTY PHYSICIANS
Edgecombe W. W. Green Tarboro.
Forsyth E. F. Strickland Winston-Salem.
Franklin J. E. Malone Louisburg.
Gaston L. N. Glenn Gastonia.
Gates G. D. Williams Gatesville. •
Graham Geo. F. Brock Tuskegee.
Granville Samuel D. Booth Oxford.
Greene W. B. Murpx^y Snow Hill.
Guilford W. M. Jones Greensboro,
Halifax I. E. Green Weldon.
Harnett J. W. Halford Lillington.
Haywood J. R. McCracken Waynesville.
Henderson A. B. Drafts Hendersonville.
Hertford George Havrell Murfreesboro.
Hoke G. W. Brown Raeford.
Hyde R. E. Windley Swan Quarter.
Iredell A. Campbell Statesville.
Johnston H. H. Utley Smithfield.
Jones C. S. Barker Trenton.
Lee J. P. Monroe Sanford.
Lenoir A. D. Parrott. .
.' Kinston.
Lincoln C. D. Thompson Lincolnton.
Madison Chas. N. Sprinkle Marshall.
Martin W. E. Warren Williamston.
McDowell G. B. Justice Marion.
Mecklenburg C. S. McLaughlin Charlotte.
Mitchell Virgil R. Butt Bakersville.
Montgomery C. Daligny Troy.
Moore G. McLeod Carthage.
Nash J. P. Battle Nashville.
New Hanover W. D. McMillan Wilmington.
Northampton H. W. Lewis Jackson.
Onslow Cyrus Thompson Jacksonville.
Orange C. D. Jones Hillsboro.
Pamlico Geo. S. Attmore Stonewall.
Pasquotank Zenas Fearing Elizabeth City.
Pender ; . . . R. H. Bradford Burgaw.
Perquimans T. S. McMullan Hertford.
Person W. A. Bradsher Roxboro.
Pitt L. C. Skinner Greenville.
Polk Dr. Grady Tryon.
Randolph L. M. Fox Asheboro.
Richmond A. C. Everett Rockingham.
Robeson B. W. Page Lumberton.
Rockingham Samuel Ellington Wentworth.
Rowan E. W. Currie Salisbury.
Rutherford A. A. Rucker Rutherfordton.
Sampson G. M. Cooper Clinton.
Scotland Peter McLean Laurinburg.
Stanly J. N. Anderson Albemarle.
Stokes J. Walter Neal Walnut Cove.
G COUNTY PHYSICIANS
Surry John R. Woltz Dobson.
Transylvania C. W. Hunt Brevard.
Union S. A. Stevens Monroe.
Vance E. P. Fenner Henderson.
Wake J. J. L. Mc';^ullers Raleigh.
Warren M. P. Perry Macon.
Washington W. H. Ward Plymouth.
Watauga J. W. Jones Boone.
Wayne T. M. Bizzell Goldsboro.
Wilkes J. M. Turner N. Wilkesboro.
Wilson W. S. Anderson Wilson.
Yadkin S. L. Russell Yadkinville,
Yancey T. B. Gibbs Burnsville.
*From North Carolina Year Book, 1914.
{
Letter of Transmittal
Ealeigh, N. C, January 1, 1915.
His Excellency, Locke Craig,
Governor of North Carolina.
My Dear Sir:—Under authority of section 3, chapter 62, Public
Laws of North Carolina, as amended by the General Assembly of 1913^
I have the honor to submit the Biennial Report of the State Board of
Health for the years 1913 and 1914.
Very respectfully yours,
"W. S. Rankin,
Secretary and Treasurer.
Progress of Health Work in North Carolina for the
Biennial Period 1913-1914
Legislation
The General Assembly of 1913 enacted, with the single exception of
the Act organizing the State Board of Health, the most important legis-lation
ever enacted by a N"ortli Carolina General Assembly. This piece
of legislation was known as the Vital Statistics Bill and it contained all
the important provisions of the "Model Bill" drawn up by representa-tives
of the Bureau of the Census of the United States Government, the
American Medical Association, the American Bar Association and the
American Public Health Association. The bill requires and provides
for the registration of all deaths and births in this State and also for
the more important data relating to the death of the decedent such as
age, social condition, cause of death, etc. The enactment of this piece
of legislation has committed irrevocably the State of I^orth Carolina to
efficient health work.
The principle of this last statement is easy to see when we recall that
with the establishment of the correct death rate from all causes and a
correct death rate from the different diseases, the people and the political
parties have a right to demand as a result of an expenditure of public
funds for health work' a reduction in the death rates, both general and
special. Should the Democratic party, which has been for some time
and still is responsible for the administration of the State Government,
and should the Kepublican party, which is responsible in certain coun-ties
for county government, fail to decrease their death rates, in one
case the State death rate and in the other case the county death rate,
the opponents of the party in power and the people as a whole are jus-tified
in condemning such government as inefficient in its most impor-tant
branch or department, to wit, the department that deals with life
itself.
It is, therefore, apparent that regardless of who shall be in power
hereafter, the people, through their known death rate, are going to be
able to fix responsibility and going to be able to demand results in health
work. And this is a good thing, for it is better that politicians and
administrations. Democratic and Kepublican, should die and change
than that thousands of men and women and children should die
needlessly.
The time is not far distant in ISTorth Carolina when the death rate of
a State will be a political issue; either the Democratic party that is
responsible for the death rate will point with pride to the decrease in
the death rate under its administration, or the Republican party will
effectively charge the Democratic party with inefficiency in govennnent
for a nonreduction in death rates. The fundamental value, then, of the
Vital Statistics LaAV is in fixing responsibility and in measuring the
degree of discharge of responsibility, and measuring even to the decimal
point the efficiency of gOA'emment in a certain department.
10 NORTH CAROLINA BOARD OF HEALTH
Too great credit camiot be given the General Assembly of 1913 and
especially Hon. R. R. Williams in the House and Hon. F. P. Hobgood
in tlie Senate, the respective fathers of the Vital Statistics Bill, for this
fundamental piece of health legislation.
Another important piece of legislation enacted by the General Assem-bly
was the General Amendments Bill, which amended several sections
of the old health law and increased the appropriation to the State Board
of Health $10,000 annually. The new work made possible through the
increase in the ap]n'opriation is by far the most important feature of
this last piece of legislation.
Another change in the General Amendments bill, which is important
enough to deserve mention in this connection, has to do with the title
of the county health official : Where counties employ physicians to
give a pinch of their time to treating diseases, such a physician will be
known officially as the county physician. On the other hand, where
the county employs a man to give three hundred and sixty-five days a
year of his time to the health work of the county, such an employee
will be known as the county health officer. This official distinction
between county physician and county health officer, replacing the old
term "county superintendent of health," that applied to both the man
employed for part of his time and the man employed for his full time,
is imyjortant. If a county employs a man for part of his time to treat
its sick convicts and prisoners in the convict camp and jail, and its de-pendents
in the county home, and to make one or two post-mortem
examinations a year for the coroner, and one or two commitments to the
insaiie asylums of the State, such an employee has no more right to the
title of health officer than has the sheriff or jailer of the county. His
work is that of a physician treating the least important part of the
population. Hereafter, by statute, he Avill be known as the county
physician, and the people of such a county will not be misled by the
term "county superintendent of health" into believing that their county
is doing health woi'k. Where, on the other hand, the county employs a
man to give his entire time to the health interests of the county, ninety-five
per cent of his duties will have to do with the prevention of diseases.
His work as a physician, that is in treating and attempting to cure
disease, will be of little consequence as compared with his work as a
health officer in the prevention of disease. Hence such an official will
be known hereafter as the county health officer.
Tbe Organization of the State Board of Health
The State Board of Health, in accordance with the spirit of con-servatism
for which our State has a just if not an enviable reputation,
has evidenced itself in the slow development of the health activities of
the State. It was in 1877 that the State of North Carolina took her
first step in health work. In that year she created the State Board of
Health. Two years later, in 1879, she gave the starving infant an
annual appropriation of $100. In 1881 the appropriation, was raised to
$200 annually. Twelve years later, in 1893, the $200 was raised to
$2,000; in 1899 to $4,000'; in 1909 to $10,500; in 1911 to $22,500; and
in 1913 to $40,500.
FIFTEENTH BIENNIAL KEPORT 11
With the adjournment of the General Assembly of 1913, and more
especially with the increase in appropriation, the Board of Health
found itself developed to that stage where a certain amount of differ-entiation
or specialization in health work seemed advisable. During
the year 1913, then, the Board was reorganized after the plan shown in
the illustration. One of the laws of life and of growth is that which
keeps the proportion between mass and surface constant through a dif-ferentiation
and division of labor. An institution or department that
grows in accordance with the wisdom of this natural and, therefore,
divine, law will differentiate its work into departments or bureaux as
the demand and capacity for the work increases.
In the illustration on page 103 the board is seen to be a body in touch
on the one hand with the Governor through five lines that signify his
five appointees on the Board ; and in touch on the other hand with the
State Medical Society through four lines that signify the four members
of the Board elected by the State Medical Society. Your Board of
Health, therefore, represents jointly the State Government and the
State profession, and stands as an official recognition of the natural_ part-nership
between society and the medical profession in the conservation of
human life.
Under the Board is an executive office through which the Board is in
touch with all divisions of its Avork. ISTote that each department or
bureau is independent of all other bureaus. In placing all the bureaus
on the same plane, the stimulus of individuality and the advantages of
specialization are preserved to each bureau, while the symmetry of the
Board's activities is maintained through the connection of all the
bureaus or departments with the executive office.
I shall now touch briefly upon the work of each bureau or depart-ment
during the past year.*
The State Laboratory of Hygiene
The two charts show the work and the growth of the Laboratory of
Hygiene during the past five years. In preparing these charts a clas-sification
of the work into the regular work of the Laboratoiy and into
the irregular and new work of the Laboratory was deemed advisable for
the sake of clearness.
The first chart shows the different kinds of work that the Laboratory
has pursued uninterruptedly for the last five years. Please note espe-cially
the following interesting facts
:
*This is copied from report made in June, 1914.
12 NORTH CAKOLINA BOARD OF HEALTH
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FIFTEENTH BIENNIAL REPORT 13
(a) A coutinuous growth during the last five years in sputa, AYidal,
rabies and malarial examinations.
(h) A marked growth during the last five years, with slight annual
fluctuations, in Avater, diphtheria, urine, gonococci, miscellaneous and
pathological examinations.
(c) That the last year's work was the largest year's work in the
history of the Laboratory.
(d) That there has been an average annual gain or growth in the
Laboratory work for the last five years of 26.6 per cent.
(e) That during the last five years the Laboratory work has more
than doubled.
IRREGULAR AND NEW WORK OF THE STATE LABORATORY OF HYGIENE FOR LAST
FIVE Y^EARS.
Y'ears
14 NORTH CAROLINA BOARD OF HEALTH
The Bureau of Hookworm Eradication
jSTearly a j^ear ago,* Dr. John A. Ferrell, one of the ablest health
officers in this country, was called from the Bureau of Hookworm Dis-ease,
which he had founded, to very responsible duties in the central
offices of the Rockefeller Sanitary Commission in Washington. Dr.
C. L. Pridgen succeeded Dr. Ferrell as State Director of the work for
the eradication of hookworm disease. Dr. Pridgen resigned in May
of this year to take up private practice, and Dr. W. P. Jacocks, utility
man of the Commission, is temporarily filling the vacancy created by
Dr. Pridgen's resignation. The work of the Rockefeller Commission,
as shown by the official reports of the Commission, is indicated on the
chart.
HOOKWORM WORK.
FIFTEENTH BIENNIAL REPORT 15
Bureau of Engineering- and Education
This is the educational agency of the Board, and the bureau to Avhich
all engineering problems are referred. This Bureau is under the direc-tion
of Mr. Warren H. Booker, C.E.
The place of educational work in the field of public health is funda-mental
and is universally admitted to be so. To decrease the death
rate means to change the customs of people and thereby improve sani-tary
conditions and to change the habits of people and thereby improve
hygienic conditions. Customs and habits are not changed by law, but
by persuasion and education. When customs and habits have changed
to a degree that a majority of people understand the social effect of bad
customs and bad habits, then the educational propaganda directed to-wards
the improvement of such customs and habits become crystallized
in the form of law. The activities of the Bureau during the last year*
have been as follows
:
(a) Preparation, publication and distribution of a forty thousand
monthly edition of the BuUetin to the leading citizens of the State.
(b) On special request of interested citizens and officials, the distri-bution
of about one million pieces—pamphlets or leaflets—of health
literature.
(c) Of mailing letters from the Governor of the State and also from
the Board of Health, together with a pamphlet on the care of babies, to
each mother whose baby's birth is registered in the Bureau of Vital
Statistics.
(d) Supplying the noAvspapers of the State with regular, nontechni-cal,
popular weekly newspaper articles on health subjects.
(e) Giving a health exhibit in connection with a baby contest at the
State Fair, Avhich, according to newspaper reports, was one of the prin-cipal
features of the Fair and of considerable educational value.
(f) Giving advice or supplying assistance to thirty-three cities and
towns for installing or altering their public water supplies or sewage
disposal plants, and in advising a number of individuals about sewerage
for their homes.
(g) Passing upon the quarterly reports of the sanitary conditions of
the watersheds of all the surface water supplies of the State, in connec-tion
with the Laboratory's findings showing the chemical and bacteri-ological
conditions of the Avater, and in calling the attention of the
proper State and local authorities to any danger indicated through such
reports and findings.
Bureau of County Health Work
TAvelve counties in N'orth Carolina, to wit : Buncombe, Columbus,
Durham, Forsyth, Guilford, Johnston, ISTash, ISTcav Hanover, Robeson,
Rockingham, Sampson and Vance have employed whole-time county
health officers. While there are several States employing more whole-time
health officers than ISTorth Carolina, our State leads the States
of the Union in having the largest number of whole-time county health
officers.
*This is copied from report made in June, 1914.
16 NORTH CAROLINA BOARD OF HEALTH
The county health problem offers at once greater difficulties and
greater possibilities than any other health problem. The difficulties
are worthy of the patience of Wood, the diplomacy of Lewis, and the
persistence of Ferrell. Unlike any other State health policy, unlike the
laboratory policy, the hookworm policy, the educational policy, the
engineering policy, the vital statistics policy and the tuberculosis policy,
all of which are under the sole jurisdiction of the State, the county
health policy is under the double government of the State and county, a
divided jurisdiction. Along the hazy boundary between State and
county jurisdiction lies the danger zone to the full development of
county health work. If the State does not go as far as it can in help-ing
the county, the best possible results are not obtained ; if the State
goes too far, the county resents it. The most fundamental principle of
our government, that of local self-government, is involved in handling
the county health problem.
In accordance Avith the fundamental purposes of the Board of Health,
a Bureau of County Health "Work has been established. The work of
the Bureau is
:
(a) To assist interested individuals and organizations in county
campaigns for whole-time health officers.
(b) To prepare and furnish health literature, placards, pamphlets
and multigraphed letters to county health officers.
(c) To attempt to correlate, systematize and standardize the work
of county health officers.
The Bureau of County Health Work had to be dropped in July of
1914 on account of lack of funds. It is most important that a thor-oughly
equipped bureau to develop and direct and assist in county
health work should be organized at the earliest possible date.
Bureau of Vital Statistics
We 'have already touched upon the fundamental importance of accu-rate
vital statistics and also pointed out the strong features of the
N"orth Carolina Vital Statistics Law. This law went into effect in
Xorth Carolina July 1, 1913. The first five or six months—that is,
from July 1st to December or Jantiary 1st—was spent in getting out the
necessary blank forms and literature and in securing the appointment
of 1,400 local registrars by boards of county commissioners and in
obtaining an accurate index of the doctors, undertakers, midwives, local
registrars and others concerned in the proper enforcement of the law.
When one considers that State registration depends upon the intelli-gent,
prompt, and cordial cooperation of 1,400 local registrars, 1,700
doctors, 1,300 midwives, and 700 imdertakers; and consists in securing
a total of 11,000 birth and death certificates each month, or 130,000
birth and death certificates each year, he can readily understand that
satisfactory registration cannot be obtained in a day, a month, or sev-eral
months. Mississippi, with one of the best registrars in the United
States, has been under the model law for two years, and is now only
recording about one-half of her actual death rate, that is, about ten
deaths per 1,000 of her population. Virginia, under registration for
the past eighteen months, is recording a death rate of only thirteen
FIFTEENTH BIENNIAL REPORT 17
and a fractiou per thousand, far from complete, as compared with the
average death rate for the United States and southern cities.
This Eureaii is under the eflicient direction of Dr. J. R. Gordon, who
has so faithfully and ably served his State in the General Assemblies
during the last ten or tAvelve years. The complete work of the Bureau
of Vital Statistics is to be found on page 271 and following, this report.
Let me call attention to the fact that the State Board of Health by
careful investigations in the counties and examination of records has
found the mortality registration to be accurate in the following coun-ties,
which comprise 1,150,000 of the State's population :
Alamance 12.6 Iredell 12.9
Buncombe 15.3 Martin 11.4
Chowan 14.1 Mecklenburg 16.3
Clay 14.3 New Hanover 23.5
Dare 11.6 Pasquotank 16.8
Craven 17.0 Perquimans 13.1
Cumberland 16.0 Person 12.4
Davidson 10.8 Rowan 14.5
Durham 15.5 Scotland 13.1
Edgecombe 19.3 Transylvania 12.0
Forsyth 17.9 Union 8.9
Gaston 13.5 Vance 16.0
Granville 9.1 Wake 17.2
Guilford 15.1 Warren ' 15.8
Halifax 16.2 Wayne 16.1
Henderson 13.2 Wilson 15.5
The average death rate in these counties is 14.5 per thousand. This
area which we have been able to check will hereafter be used as the
determined death rate from which to measure progress in health work
dui'ing the next year or two. Other counties will be annexed to this
area just as soon as the State Board of Health investigate and find
their records correct.
Bureau of Tuberculosis and Sanatorium
This Bureau was established on the principle that tuberculosis is a
State problem and not a municipal or county problem. In support of
this fundamental principle in the administration of health work I
desire to quote from a recent address before the Southern Medical As-sociation
in Richmond, Ya.
:
'*Tn the day of its last judgment, a State board of health must stand
or fall by what it has done for the State's death rate. This fundamental
responsibility belongs to the State board of health and cannot be shared
with the subsidiary boards of health of the counties and municipalities,
for the general death rate of a State is beyond their sphere of influence.
It is then the duty of the State board of health to circle this central
point of its activity, to consider its general death rate from all sides,
preliminary to finding its direct course through the adoption of definite
State health policies. Such an examination of the general death rate
2
18 NORTH CAROLINA BOARD OF HEALTH
would show it to be divided, into two main parts—the nonpreventable
and preventable death rate ; the latter rate, the preventable death rate, to
consist of factors of varying importance, some of such minor importance
as to be negligible and some of snch major importance as to deserve
to he kept as a fixed and guiding point ever in the mind of the health
officer. Of these major factoi's in the preventable death rate, tuber-culosis
stands preeminent. This one disease cjjuses one-fourth of the
entire piT.ventable death rate. This one disease offers the State board
of health one-fourth of its total opportunity. This one disease places
upon the board of health one-fourth of its entire responsibility. No
State board of health can leave or delegate so great a responsibility to
the weaker and, in this particular matter, ineffectual and irresponsible
subsidiary boards of health of the counties and towns. Tuberculosis is
therefore clearly and distinctively a State health problem of such mag-nitude
as to call for a definite and comprehensive State policy for its
control.
THE state's ability TO BEAR THE BURDEN OF TUBERCULOSIS.
The burden of responsibility for controlling tuberculosis being recog-nized
as belonging primarily to the State, the first question is. Can
ISTorth Carolina bear this burden? This question resolves itself into a
consideration first of the financial strength of our State, and second, of
the weight of the burden. The World Almanac says that North Caro-lina
in wealth is the twenty-first State in the Union. The annual
income of North Carolina is approximately $3,000,000. Out of this
limited revenue the State must pay the multiple and necessary expenses
of its government, which no one can truly appreciate without looking
over the State Auditor's report. So much for the financial strength
of the State.
The weight of the burden of tuberculosis becomes apparent when w^e
understand that there are all the time 18,000 visibly active cases of
tuberculosis in North Carolina ; that there are from 2,000 to 4,000 of
these consumptives who will die for lack of proper treatment if left
dependent upon their own resources; that recent investigations show
that the average cost a day a patient in the average sanatorium of the
United States is $1.66; tliat the 2,000 to 4,000 consumptives of our
State treated in sanatoria would therefore cost the State each day from
$3,320 to $6,640, or for the year $1,211,800 to $2,423,600. On the
principle that wholesale prices are cheaper than retail prices, on the'
principle that the State in one large sanatorium could give this treat-ment
at a much lower figure, we mav, for the purpose of this paper, con-clufle
that the above fig-ures could be reduced to between $750,000 and
$1,500,000 a year. Even then the problem of tuberculosis would cost
the State, at the lowest estimate, one-fourth of its entire income. Evi-dently
North Carolina cannot bear the burden of tuberculosis in this
form.
Changing the form of the burden, we may think briefly of a combi-nation
of sanatorium and dispensary, such as the State of Pennsylvania
maintains out of its annual income of $28,000,000. Any clearly defined,
comprehensive policy of this kind for the State to deal with tuberculosis
FIFTEENTH BIENNIAL REPORT 19
will likewise be found to impose a burden with wliicli Xorth Carolina
cannot get started.
Once more, a purely educational propaganda against tuberculosis is
too diffusive a remedy, not specific enougli and far too weak in its effect
to be depended upon solely for treating so grave a State problem as
tuberculosis.
In conclusion, it appears that the burden of tuberculosis is too heavy
in undivided form for the State to bear.
Divide the Burden.
A burden that cannot be carried undivided, in bulk, by a single
agency, can be easily carried when divided among multiple agencies.
While the State cannot carry her burden of tuberculosis, she can have
it carried. The State can divide the burden into many parts; the
State can carry the larger part, a part large enough to encourage by her
example the cooperation and assistance of all the political, fraternal,
religious, business, social and insurance organizations within her realm
;
she can correlate and direct the cooperative efforts of these multiple
agencies and so bring to bear concerted attack all along the retreating
line of the greatest enemy of our people.
In order that the burden be properly divided and apportioned, in
order that we may understand just Avhat it consists of, in order that we
may effectually appeal Avith definite facts and figures to the various
possibly cooperative agencies, a State law requiring the reporting of
every case of tuberculosis to a central office on a suitable blank form is
the first essential. These report forms would furnish such information
as to enable the central ofiice to say just how many cases of tuberculosis
there were in each county, how many cases of tuberculosis were mem-bers
of the Ifethodist church or of the Presbyterian church, how many
cases of tuberculosis were members of Masonic lodges, etc., and of these
tuberculous members how many were incipient, how many moderately
advanced, how many advanced, how many self-supporting, how many
carried insurance, in Avhat companies and how much, and other perti-nent
facts.
Having properly grasped and apportioned the tuberculosis problem,
the following plan of attack is proposed. This consists of two parts
:
A cooperative sanatorium and a correspondence school for tuberculosis.
THE CO-OPERATIVE SANATORIUM.
Construction hy the State.
With the State's existing equipment, consisting of a farm of about
1,300 acres and a sanatorium of 90 available beds and 35 beds available
after slight repairs to buildings, a construction budget of $50,000 a
year for the next six years would provide a sanatorium with a capacity
of 500 beds which would care each year for 1,000 of the State's incipient
and moderately advanced consumptives, or about one-seventh of the
white consumptives of the State. This seems reasonably within the
State's means. Such a building appropriation would provide a sana-
20 NORTH CAROLINA BOARD OF HEALTH
toriinn of about 250 beds capacity by 1917, an enlargement to 350 beds
by 1919, and a full grown 500-bed sanatorium by 1921, six years bence.
Maintenance by the State and Cooperative Agencies.
Tbe total amount of funds for maintenance to be derived from tbe
State, patients, and all local governmental, religious, fraternal and social
organizations wbicb migbt be interested in tbe care of their members
would be, for an institution of 100 beds $60,000 annually, or $1.64 per
capita per diem; for an institution of 250 laeds, $130,000 annually, or
$1.42 per capita per diem; and for an institution of 500 beds, $225,000
annually, or $1.23 per capita per diem. This maintenance expense
would pi'obably be borne somewhat as follows
:
1. By the State, from $40,000 to $50,000 annually for the first two
years—that is, 1915 and 1916—and for the next four years $50,000
annually. Certainly the State can afford this part of the maintenance
budget. It will be seen then that the total State approjiriation, con-struction
and maintenance called for in this budget amounts to about
$100,000 a year for six years.
2. The sanatorium will receive $1 a day for each patient from either
the patient himself or from some organization, political (county or
town) or religious, fraternal, business or social, to which the patient be-longs,
or from the patient and organization jointly. Those patients
who can aiford the $1 a day will pay it themselves and will then be
securing sanatorium treatment for one-third of what it would cost them
in the average sanatorium. It will be the business of the Bureau for
Tuberculosis and the Correspondence School, hereinafter described, to
find and interest various organizations that may be appealed to in be-half
of particular patients. The total amount of funds from patients
and other organized interests would be as follows: For 100 patients,
$36,500 a year; for 200 patients, $73,000 a year, and for 500 patients
$182,500 a year. The organizations that may be appealed to to assist
patients are as follows
:
(a") The political units of the State, the counties and towns, can well
afford to endow from one to ten beds at from $365 to $3,650 a year,
where from two to twenty of their needy and deserving consumptive
citizens can be seut by the county or municipal authorities for proper
treatment.
(b) The fraternal orders, two of which, the Masonic Order and the
Odd Fellows, are already contributing to the sanatorium, can be inter-ested
in making appropriations or endowing beds for the care of their
consumptive members.
(c) The various religious denominations and certain strong indi-vidual
churches can be effectively appealed to for partial or full sup-port
of their consumptive members.
rd) Large corporations, especially cotton mill corporations, can be
apj)ealed to effectively for endowing beds for deserving operatives.
(e) Various social organizations, particularly women's clubs, can be
interested in securing contributions to pay the expenses of needy and
deserving consumptive citizens of their community.
(f) Insurance companies can be interested in providing treatment
for policyholders.
fifteejStth biennial report 21
Two Principles in the Plan of Cooperation.
The f-rst principle is that through the law requiring that all cases of
tuberculosis in the State shall be reported by the householder and phy-sician
to the central bureau, it will be possible in appealing to any
county, to any town, to any fraternal order, to any church or denomina-tion,
or to any corporation, to state exactly the number of consumptives
and the condition of the consumptives, financial and physical, sex, age,
etc., within the organization appealed to. To make this point clear,
let me illustrate: If the Sanatorium desired to go before the Grand
Lodge of Masons with a view of interesting the Grand Lodge in the care
of its consumptive brethren in the State Sanatorium, it could furnish
the Grand Lodge the names and addresses of the consumptive Masons of
the State, the number of these Masons in the incipient stage of the dis-ease
and the number dependent upon outside help for proper treatment.
The appeal could be made on exact facts.
The second principle is that all of the cooperative agencies, including
the State, will be asked in making their contributions to the maintenance
fund to make their appropriation of such amount and with such condi-tions
attached as to encourage further contributions from other sources.
For example, the State, in furnishing a sanatorium and contributing a
certain amount for its maintenance, brings its advantages not to, but
easily within the financial grasp of the Grand Lodge ; the Grand Lodge
in making its contribution for taking care of consumptive Masons makes
it a condition that the local lodge of which the consumptive applicant
for sanatorium treatment is a member shall put up a certain amount,
and perhaps the local lodge agrees to put up a certain amount if the
patient himself will put up a certain amount. In short, the principle is
to distribute the burden.
The construction and maintenance of the cooperative sanatorium, as
above outlined, reaches, even when completely developed, only about
1,000 of the 18,000 consumptives in the State, and, as one can readily
see, falls very far short of reaching the heart of the problem. However,
the cooperative sanatorium is the lesser of the two agencies suggested
for dealing with the problem of tuberculosis in this State. The major
agency is-
THE CORRESPONDENCE SCHOOL.
The correspondence school will be run in connection with the sana-torium
and will require from $8,000 to $10,000 a year out of the main-tenance
funds for its support. The correspondence school will do three
things
:
1. It will receive the reports of cases of tuberculosis in the State
under the law requiring that such reports be made; that is to say, the
correspondence school will get into touch with from 10,000 to 15,000 of
the 18,000 consumptives of our State.
2. The correspondence school will bring the needy incipient and mod-erately
advanced consumptive and the organization of one kind or
another that has an interest in hira together.
3. The correspondence school will matriculate all cases of tuberculosis
not in the Sanatorium as members of the school, and will develop an
educational course through intelligently sympathetic, unofiicious letters
22 NORTH CAROLINA BOARD OF HEALTH
with all evidence of circular form and multigraph disguised in their
strong personal flavor that will teach these 10,000 to 15,000 consumptives
how to live and let live.
In order to arrive at some intelligent opinion as to what the effect of
this specific and rather personal educational work will have on the con-sumptive
death rate of the State, we may note that the general and
rather sporadic educational efforts to reduce the death rate of tubercu-losis
heretofore pursued in other places has resulted in the following
reduction of the consumptive death rate : A 49 per cent reduction dur-ing
the last fifty years throughout the civilized world; a 63 per cent
reduction during the last fifty years in the State of Massachusetts ; an
18 per cent reduction in five New England States during the last thir-teen
years, and a 16^^ per cent reduction in ISTew York State during
the last ten years.
Advantages of Combination of Sanatorium and School.
1. The combination of the two gives the State an educational organi-z;
ation analagous to the ideal system of education in operation in the
State of Wisconsin. The cooperative sanatorium in this system is the
central university where about one-tenth of the consumptive population
is treated, and is tavight what constitutes the right kind of treatment for
consumption. These alumni on returning home and seeing other cases
not being properly treated, enable the sanatorium reflexively to improve
the medical supervision of consumptives throughout the State. The
correspondence school, an adjunct of the central university or sana-torium,
puts the State government in almost personal touch with its
entire tubercular population.
2. The combination of sanatorium and school is of mutual advantage,
the one developing the other. The sanatorium provides out of its
maintenance funds a small percentage that can hardly aifect the per
capita per diem cost, but which will easily make possible an effective
correspondence school, while this school, in touch not only with the
consumptives of the State, but with all the organized interests, political,
fraternal, religious, business and social which may be interested in
these consumptives, will abundantly nourish a strong sanatorium.
Debits and Credits iu Health Work
The State of ]^orth Carolina appropriates $40,500 for public health
work. In addition to this, exclusive of it, the State pennits the Board
to have free printing up to an amount of $4,000 and each public water
company of the State pays into the State Laboratory of Hygiene for the
monthy analyses of its water $64 per year, amounting all told to about
$6,000. So much for revenue.
HOW THIS MONEY IS USED.
Item ISTo. 1.—The State Laboratory of Hygiene examines annually
4,000 microscopic specimens, which Avould cost the people and the phy-sicians
of this State, if examined in other laboratories, $6,000. This
$6,000 is the first dividend that is paid on the State's investment of
$44,500 in the State's health.
FIFTEENTH BIENNIAL KEPORT 23
Item Xo. 2—The State Laboratory of Hygiene examined last year*
3,000 samples of drinking water. These analyses made by other State
laboratories, or by private laboratories, would have cost our State $15,-
000. This is the second dividend paid on the State's investment of $44,-
500 in the State's health.
Item ISTo. 3.—The State Laboratoiy of Hygiene treated last year*
371 citizens of Xorth Carolina who had been bitten by rabid animals.
The efficacy of the treatment of the State Laboratory may be judged
from the fact that as a rule one person out of every 250 applying for
Pasteur treatment dies from rabies. The State Laboratory has now
treated *1,200 patients bitten by rabid animals without a single death.
It would have cost the 371 citizens of the State $24,000 to have been
given the Pasteur treatment outside of the State. This $24,000 is then
the third dividend paid on the State's investment of $44,500 in the
State's health.
Item 1^0. 4.—The General Assembly of 1911 gave the State Board
of Health the authority to contract witli manufacturers of diphtheria
antitoxin, that hold a United States license, for a State supply of anti-toxin
to be purchased from the lowest bidder by the State Laboratoiy
of Hygiene and distributed through antitoxin stations in the various
counties to the people at exactly the cost of the antitoxin to the State.
We might say right here that the quality of the antitoxin is guaranteed
by the United States government. Antitoxin is sold in packages, which
are graded according to the units of potency per package, in packages
of 1,000, 3,000, and 5,000 units. The prices of these packages of anti-toxin,
before this arrangement was made, were as follows
:
1,000 units $2.00
3,000 units 5.00
5,000 units 7.50
Under the present arrangement the same antitoxin can be purchased
in N'orth Carolina at the following prices
:
1,000 units $0.50
3,000 units I.35
5,000 units I.95
Estimating the amount of saving on this vital necessity from the
amount of antitoxin distributed per 100,000 population by States keep-ing
such records, and on the difference in cost of antitoxin, this law is
saving the State annually at least $30,000. This is the fourth dividend
paid on the State's investment of $44,500 in the State's health.
Item ISTo. 5.—Before the State Laboratory began to supply typhoid
vaccine free to the people, every immunization cost $1.50, and conse-quentl.
y relatively few people were immunized. With free vaccine there
will probably be at least 50,000 to 60,000 vaccinations this year,* on
which will be saved $1.50 each, or a total of not less than $75,000, which
is the fifth dividend on the State's investment of $44,500 in the State's
health.
*This is copied from Democratic Hand-Book of 1914.
24 NOKTII CAKOLINA BOARD OF HEALTH
Item jSTo. 6.—In 1911 the State Board of Health was instrumental in
securing from the General Assembly a law making the quarantine of
smallpox optional with the counties, and giving the right to the State
Board of Health of advising that no quarantine be established, except
under exceptional circumstances. An inquiry sent to county physicians
the year before this law was passed showed that there were annually
7,500 cases of smallpox in ISTorth Carolina, with a cost for quarantine of
$66,000 a year. An inquiry sent out to county physicians one year
after this law wont into effect showed a decline in the number of cases
of smallpox from 7,500 to 3,300 and a decline in the public cost of the
disease from $66,000 to $2,600. It is reasonable to conclude that
through the enactment of this law the State Board of Health is saving
the State every year something like $50,000, and at the same time more
effectually controlling the disease. This $50,000 may therefore be con-sidered
as the sixth dividend paid on the State's investment of $44,500
in the State's health.
The dividend paid on the six items above enumerated makes a total of
$200,000 on the investment of $JfJi.,600 per annum.
There are other items saved which space will not permit us to men-tion.
We shall content ourselves with mentioning only one more, to-wit,
the saving to the municipalities of North Carolina through the law
which requires that all towns and cities in this State, before installing
waterworks or sewerage, shall submit their plans and specifications to
the State Board of TIealth for approval. Through this law our mu-nicipalities
are safeguarded against the work of cheap engineers and
contractors, and against investing their money in waterworks and sew-erage
systems of little value. We know, for example, of one town that
constructed a public water supply before this law was in operation,
without first submitting their plans and specifications to the State
Board of Health, and that found after its waterworks had been installed
that they had lost something like $15,000 in the venture.
Such is the value of public health ruorh from a purely business stand-point.
The Real Value of the State Board of Health
is humanitarian; its chief end is not to save dollars, but lives. The
true ledger of the State Board of Health is kept, not in dollars and
cents, but in death rates. The real test and the value of the State
Board of Health can be measured best by its effect on the State's death
rate—either in the reduction of a high death rate or in the maintenance
of an average or low death rate. If this State had had a registration
law for the past five years, we could see probably a decline in the State's
death rate, that is, in the number of deaths per thousand population
from year to year, that would be the pride of ISTorth Carolina.
Fortunately the General Assembly of 1913, recognizing the need of a
vital statistics law for the purpose of knowing how the general death
rate of ISTorth Carolina compared Avith the death rate of other registra-tion
States, how the death rate of ISTorth Carolina changed from year
to year as the result of public activities, how the death rate of various
counties compared with each other, what the principal sources of mor-tality
were, and for the many other usages of registration of births and
, FIFTEENTH BIENNIAL REPORT 25
deaths, passed llie vital statistics law. From now on, therefore, the
State will be able to show, not only the dollars it has saved through
public health as a business, but the number of lives saved as a humani-tarian
obligation.
The humanitarian purposes of the State Board of Health or the saving
of human life are best subserved through the educational work of the
Board. It undertakes the instruction of all the people through the press,
sanitary addresses, and special literature in regard to the important
causes of death and the means of avoiding them. During the past vear*
the State Board of PTealth has issued 40,000 regular monthly bulletins,
carrying life-saving information to 200,000 people, or about one white
family out of seven. The Board, through the kind assistance and co-operation
of the ]H-ess of the State, through the weekly and daily papers,
has reached a large part of the population with sanitary information.
Another important principle in the plan of State health work is the
development of efficient county health administrations. The same argu-ment
that establishes the county unit of government as distinct from the
State government will apply to the establishment of a county sanitary
division of government as distinct from the State sanitary administra-tion.
The State Board of Health in the last two years* has assisted in
securing the adoption of the principle of whole-time county health of-ficer,
the first step in the direction of the county health government, by
eleven North Carolina counties. The proper development of county
systems of public health will serve to bring sanitary instruction and
sanitary government closer to the people, and Avill result in the saving of
thousands of lives that would be lost without active and effective county
sanitary administration.
The Present Needs of the State Board of Health
NEED NO. l: AN EFFICIENT BUREAU OF COUNTY HEALTH WORK.
There should be created and maintained under the Board of Health
a bureau for county health Avork. Such a bureau would consist of a
bureau chief and a stenographer. The bureau chief should be a physi-cian
who has had some practical experience in county health work. The
work of this bureau would be
:
(a) To interest counties in the equipment and maintenance of effi-cient
county departments of health. There are many counties in North
Carolina with very high death rates—that is, with death rates far in
excess of the average death rate of the United States of fourteen deaths
a thousand a year—that are amply able to spend some of their re-sources
in the reduction of their death rates. Manifestly, if it is the
duty and responsibility of the State Board of Health to reduce the
State's death rate, such a reduction will be bi-oiight about more surely,
readily, and decidedly by securing the active cooperation of the counties.
Many counties could be interested in their health problem if there were
some agency that gave its entire time to the study of the county health
problems of the diiferent counties for the purpose of presenting such
problems in definite form Avith reasonable recommendations to the
county authorities.
•This is copisd from Democratic Hand-Book of 1914.
26 NORTH CAROLINA BOARD OF HEALTH
(b) After securing tiie adoption of the necessar^^ provisions for ef-fective
county health work, it would be the duty of the bureau of county
health work to assist the county authorities and the newly elected health
official to plan and inaugurate the county health work in the most ef-fective
manner.
(c) Lastly, it would be the duty of this central bureau of county
health work to keep in close touch with the various methods pursued
by those counties employing whole time county health officers for the
purpose of keeping all counties informed in regard to efficient methods
of health work undertaken and demonstrated by the different counties.
In this way. each county would receive the benefit of the experience of
all the counties, and this would result eventually in the correlation and
systematization of county health work.
NEED NO. II : AN INSPECTION AND EPIDEMILOGICAL SERVICE.
An insiDection and epidemilogical service is badly needed in this State.
It can be obtained cheaply by utilizing the new graduates of our best
medical schools. These men could be given practical training luider the
older and experienced men on the staff of the Board. The probable
work of this service would be as follows
:
(a) The probable inspection and improvement of sanitary conditions
in hotels, cafes and restaurants. This would depend upon the adoption
of the hotel inspection bill by the General Assembly. This bill will be
brought fonvard by the Travelers Protective Association of Xorth
Carolina. These inspections would be recorded in the form of score
cards, hoteL cafe, or restaurant rated according to its score, and the
rates of the hotels, restaurants and cafes inspected published in the
Bulletin and the newspapers every month. The publicity given an un-sanitai-
y hotel would be sufficient to correct evil conditions. Moreover,
it is but fair to those hotels that are doing right in the matter of sanita-tion
that they should be given public credit for their efforts. The clean
hotels, those meeting the proper sanitary requirements, are, without
some sort of inspection and public acknowledgment, at a disadvantage
with the hotel that disregards its obligations to the public by permitting
unsanitary conditions.
Hotel inspection by State officers is entirely logical and in accord
with the principles of good government. Hotels are not local institu-tions
except in location and are not private institutions except in owner-ship.
They are State institutions from every other consideration.
Those who live in the hotels are not the people of the town in which the
hotel is located, but people from other towns and counties and other
States. An unsanitary hotel may easily serve as the distributing station
of dangerous diseases over a large territory, while a sanitaiy hotel is a
lesson in sanitation that its guests carry with them to their scattered
homes.
(b) The inspection and epidemilogical service would inspect all State
institutions and State convict camps, as at present required of the State
Board of Health, and in addition, would inspect the county convict
camps and jails, which as a iiile are not in as good sanitary condition
as the State camps. Convict camps would, like the hotels, be inspected
according to score card methods, and the scores of the various camps in-
FIFTEENTH BIENNIAL BEPOBT 27
spected during the month puhlished in the Bulletin. This kind of pub-licity
Avill he all that is needed to stimulate badly needed sanitary re-form
in the management of prisoners.
(c) The same inspection service that would inspect the hotels, res-taurants,
cafes, convict camps and jails in a county would also enforce
the vital statistics law in the county and in that way materially aid in
the accurate registration of births and deaths in iSTorth Carolina, upon
which the whole fabric of intelligent health work is based.
(d) This inspection force would be trained in the proper manage-ment
of outbreaks of the various contagious and epidemic diseases, and
would be assigned to assist the counties and towns of the State upon
the requests of the towns and counties.
(e) This inspection force might also, if it is found that time Avill
permit, open and maintain vaccine stations for the free vaccination of
the citizens of different counties against typhoid fever. In doing this it
might be possible to obtain some remuneration for this service from the
counties in which the vaccine stations were held and in this way assist in
paying for the inspection and epidemilogical service.
(f) Probably the most important piece of work that this inspection
service ^A'ould render Avould be in assisting the bureau of county health
work in organizing or inaugurating systems of county health work in
the counties desiring the assistance of the Board. For example, a
county decides to employ a whole time county health officer and re-quests
the State Board of Health to send an agent or one of its officers to
set up the machinery of county health government, to develop an effi-cient
plan or system of county health work, to begin the work and run it
for six weeks or two months, until everything is moving smoothly and
satisfactorily, at which time the county official employed by the county
authorities assumes control.
(g) The inspection and epidemilogical service can be of great assist-ance
in the work of the Board by developing and carrying on a popular
educational plan of work connected with their other work. For ex-ample,
each one of the inspectors would be equipped with a lantern and
a full set of slides and in going about over the State could give many
popular illustrated health lectures as prearranged and provided by the
central office.
In addition to the above opportunities, other opportunities for valu-able
service would develop as the inspection and epidemilogical service
of the Board carried on their work.
NEED NO. Ill : ASSISTANCE FOK VITAL STATISTICS BUREAU.
The original Vital Statistics bill which the General Assembly of 1913,
to its great credit, passed, called for an appropriation of $12,000 an-nually.
That appropriation would have been sufficient to secure com-plete
records of births and deaths from all the counties of the State.
The General Assembly, however, saw fit to cut the appropriation from
$12,000 to $10,000, which has so seriously handicapped the bureau that
for a considerable section of the State the birth rates and death rates
cannot be accepted as accurate. The bureau has done a tremendous
amount of work, which is very well shown in its report on pages
It should be understood that a Vital Statistics bill is most difficult and
28 NORTH CAKOLINA BOARD OF HEALTH
most expensive to operate during tlie first three or four years; that after
the people become accustomed to its operations and understand its re-quirements,
the cost of securing the certificate is lowered. The Vital
Statistics Bureau is badly in need of an additional $2,000 appropria-tion—
that is, an appropriation as originally called for. Unless this ap-propriation
is forthcoming it will be impossible to secure accurate regis-tration
from the Avhole State. A half or three-quarters of the popula-tion
will be all that the Vital Statistics Law can include in its operations.
NEED NO. IV : ASSISTANCE TO STATE LABORATORY.
The State Laboratory of Hygiene during the last five years has been
meeting a constantly increasing public demand for laboratory work. The
average annual increase in the demand and work of the laboratory for
the last five years has been 26.6 per cent. To meet this increased de-mand,
to keep the laboratory adequate to supply the needs of the people,
an additional appropriation of not less than $2,500 will be necessary.
NEED NO. V : ASSISTANCE TO BUREAU OF EDUCATION.
The most fundamental piece of work, with the exception of securing
an accurate registration of births and deaths, which the State Board of
Health of North Carolina is performing, is its educational work. The
Avork is carried on through the Bulletin, properly edited newspaper ma-terial,
exhibits, and stock lectures. This bureau cannot begin to meet
the demands that are made upon it. There are many opportunties for
educational work that would surely tell in a reduction in the State's
death rate if this bureau were financially able to grasp such opportuni-ties.
The bureau should be given increased funds adequate to the op-portunities
open to it.
Costs
HEALTH BUDGET DURING LAST BIENNIAL PERIOD.
Total annual State Health appropriations $40,000.00
Total annual Rockefeller Commission appropriation 15,675.97
Combined or total annual health budget $55,675.97
NECESSARY ALTERATIONS IN HEALTH BUDGET DURING NEXT
BIENNIAL PERIOD.
On March 31st, 1915, the Rockefeller Sanitary Commission go out of
existence and their annual appropriation of $15,675.97, which has as-sisted
in the health work in JSTorth Carolina, will be discontinued. The
State Board of Health will have, unless the General Assembly makes up
the deficit, only $40,000 a year for health work during the next two
years.
Of the $40,000 appropriated by the State, $8,000 is designated to be
spent in connection with the hookworm campaigii. It is desired that
this $8,000 shall be a part of the general health budget rather than a
specific appropriation, so that the Board may use this fund for assist-ing
the counties in developing their health work. The State Board of
Health asks that the deficit of $15,675.97 be partially replaced by an
FIFTEENTH BIENNIAL KEPORT 29
additional appropriation from tlie General Assembly of $10,000, which,
added to the $40,000 now appropriated, will make the State Health
Budget exactly $50,000 annnally.
This amount is not a large health appropriation. It amounts to a per
capita expenditure of practically 2 cents a year on the health of our
people. The cities of the United States are now spending on the health
of the urban people $1.65 per capita per year. Surely 2 cents is not too
much for rural Xorth Carolina. United States government statistics
show three cities with populations of less than 100,000 expending on
health and sanitation the following sums:
Health and
City. Population. Sanitation
Appropriation.
Brookline, Mass 27,792 % 76,100
Lawrence, Mass 85,892 229,008
New Bedford, Mass 96,652 228,357
United States government statistics also show the following cities with
populations between 100,000 and 200,000 with health appropriations
as follows
:
Health and
City. ' Population. Sanitation
Appropriation.
Atlanta, Ga 154,839 $345,832
Cambridge, Mass 104,839 252,257
Fall River, Mass 119,295 163,319
Worcester, Mass 145,986 261,411
Grand Rapids, Mich 112,571 151,632
Syracuse, N. Y 137,249 308,511
Richmond, Va 127,628 286,147
The same statistics show that the smallest appropriation for health
and sanitation of any city in the United States with a population be-tween
100,000 and 200,000 is the appropriation of $125,810 by Bridge-port,
Conn., with a population of 102,054.
The additional $10,000 will be needed for the following purposes:
For inspection service and epidemilogical work $2,000
For the Bureau of Vital Statistics 2,000
For the Bureau of Education and Engineering 3,000
For the State Laboratory of Hj'giene 3,000
In conclusion, let us remember that the death rate is of equal political
significance, or is soon to be of equal political significance, with the tax
rate; that in conflicting considerations where the two rates are involved
human life should have precedence over dollars and cents.
"Ill fares the land, to hastening ills a prey,
When wealth accumulates and men decay."
30 NORTH CAROLINA BOARD OF HEALTH
Election and
appointment of
board.
Terms of office.
Vacancies.
Proviso
:
vacancies filled
governor.
Cognizance of
health interests.
Investigations and
inquiries.
Distribution of
information.
Medical advisers.
Location, con-struction,
and
management of
state institutions.
Inspections.
Biennial reports.
PUBLIC HEALTH LAUS OF NORTH CAROLINA
[Chapter 62, Public Laws of 1911, As Amended by Chapter 181,
Public Laws of 1913.]
The General Assembly of North Carolina do enact:
Sectiox 1. State Board of Health, hotv elected.
The Medical Society of the State of North Carolina shall choose
from its members by ballot four members and the Governor of
the State shall appoint five other persons (one of whom shall be
sanitary engineer), and they shall constitute the North Carolina
Board of Health.
Sec. 2. Term of office; vacancies, how filled.
The members of the board of health elected by the State Medi-cal
Society shall be chosen to serve for six years. Their term of
office shall begin immediately upon the expiration of the meeting
at which they were elected. Those appointed by the Governor
shall serve for six years, their term of office beginning with the
first regular meeting of the board after their appointment. In
case of death or resignation, the board shall elect new members to
fill the unexpired terms: Provided, the Governor shall fill such
vacancies as may occur where he has made appointments.
Sec. 3. Duties of the State Board of Health.
The Board of Health shall take cognizance of the health inter-ests
of the people of the State; shall make sanitary investigations
and inquiries in respect to the people, employing experts when
necessary; shall investigate the causes of diseases dangerous to
the public health, especially epidemics, the sources of mortality,
the effect of locations, employments, and conditions upon the pub-lic
health. They shall gather such information upon all these
matters for distribution among the people, with the especial pur-pose
of informing them about preventable diseases. They shall
be the medical advisers of the State, and are herein specially
provided, and shall advise the Government in regard to the loca-tion,
sanitary construction, and management of all State institu-tions,
and shall direct the attention of the State to such sanitary
matters as in their judgment affect the industries, prosperity,
health and lives of the people of the State. They shall make an
inspection once in each year, and at such other times as they may
be requested to do so by the State Board of Charities, of all pub-lic
institutions, including all convict camps under the control of
the State's Prison, and make a report as to their sanitary con-dition,
with suggestions and recommendations, to their respective
boards of directors or trustees; and it shall be the duty of the
officials in immediate charge of said institutions to furnish all
facilities necessary for a thorough inspection. The secretary of
the board shall make biennially to the General Assembly, through
the Governor, a report of their work.
FIFTEENTH BIENNIAL REPORT 31
Sec. 4. May make regulations in times of epidemics.
In times of epidemics of smallpox, yellow fever, typhoid fever, Jurisdietion in
, , . , , , , times of epidemic.
scarlet fever, diphtheria, typhus fever, bubonic plague and cholera
the State Board of Health shall have sanitary jurisdiction in all
cities and towns not having regularly organized local boards of
health, and are hereby empowered to make all such regulations
as they may deem necessary to protect the public health, and to
enforce them by suitable penalties.
Sec. 5. Bulletins of diseases issued; rules made to check disease;
pay of 7nembers for.
Bulletins of the outbreak of disease dangerous to the public Bulletins of out- ,,,,,,. T , ^1 r-,^ i 1, J 1 J break of disease.
health shall be issued by the State board, whenever necessary, and
such advice freely disseminated to prevent and check the invasion
of disease into any part of the State. It shall also be the duty inquiries into
of the board to inquire into any outbreak of disease, by personal
visits or by any method the board shall direct. The compensa- Compensation of
, , , ,, , .. 1 ,, T J 11 members on duty.
tion of members on such duty shall be four dollars a day and all
necessary traveling and hotel expenses.
Sec. 6. Officers of; salary of secretary; pay of members.
The State Board of Health shall have a president, a secretary, officers.
who shall also be treasurer, and an executive committee, said
executive committee to have such powers and duties as may be
assigned it by the board of health. The president shall be elected Terms of office,
from the members of the board and shall serve six years; the
secretary-treasurer shall be elected from the registered physicians
of the State and shall serve six years. The executive committee Executive com-shall
be composed of the president of the board, ex officio, and
two other members of the board to be elected from those com-posing
it. The executive office of the board shall be in the city Executive office,
of Raleigh, and the secretary shall reside there. The secretary secretary.
shall be the executive officer of the board and shall, under its
direction, devote his entire time to public health work, and shall
be known as the "State Health Officer." He shall receive for .state health officer.
his services such yearly compensation as shall be fixed by the compensation,
board, not to exceed three thousand dollars, and his actual
traveling and hotel expenses when engaged in the work of the
board. The board may in its discretion elect as a special assist- Special assistant,
ant to the State Health Officer, for the antituberculosis work, the
Secretary of the State Association for the Prevention of Tuber-culosis,
at an annual salary not to exceed six hundred dollars, salary.
The members of the board shall receive no pay, except that each Members of board,
member shall receive four dollars and necessary traveling and
hotel expenses when on actual duty in attending the meetings of
the board or of the executive committee or in pursuing special
investigations in the State; but when attending important meet-ings
beyond the limits of the State, the number of delegates Delegates,
thereto being limited to one, in addition to the secretary, only
actual traveling and hotel expenses shall be allowed. These
32 NORTH CAROLINA BOARD OF HEALTH
Time of meeting
to elect officers.
Special meetings
Annual meeting.
Members of county
board of health.
sums shall be paid by the treasurer on authenticated requisition,
approved and signed by the president.
Sec. 7. Time of meeting to elect officers.
The meetings of the State Board of Health for the election of
officers shall be on the second day of the annual meeting of the
Medical Society of the State of North Carolina in the year one
thousand nine hundred and one and every six years thereafter.
Sec. 8. Time of special and regular -meetings.
Special meetings of the State Board of Health may be called
by the president through the secretary. The regular annual meet-ing
shall be held at the same time and place as the State Medical
Annual report. Society, at which time the secretary shall submit his annual re-
Meetings of execu- port. The executive committee shall meet at such times as the
tive committee. president of the board may deem necessary, and he shall call
such meetings through the secretary.
Sec. 9. County hoard of health, icho constitutes; election of
county physician or county health officer.
The chairman of the board of county commissioners, the mayor
of the county town, and in county towns where there is no mayor
the clerk of the Superior Court, and the county superintendent of
schools shall meet together on the first Monday in April, one
thousand nine hundred and eleven, and thereafter on the first
Monday of January in the odd years of the calendar, and elect
from the regularly registered physicians of the county, two physi-cians,
who, with themselves, shall constitute the county board of
health. The chairman of the board of county commissioners shall
be the chairman of the county board of health, and the presence
of three members at any regular or called meeting shall consti-tute
a quorum. The term of office of members of the county board
of health shall terminate on the first Monday in January in the
odd years of the calendar, and while on duty they shall receive
four dollars per diem, to be paid by the county. The county
board of health shall have the immediate care and responsibility
of the health interests of their county. They shall meet annually
in the county town, and three members of the board are author-ized
to call a meeting of the board whenever in their opinion the
public health interest of the county requires it. They shall make
such rules and regulations, pay such fees and salary, and impose
such penalties as in their judgment may be necessary to protect
and advance the public health; Provided, that all expenditures
shall be approved by the board of county commissioners before
being paid. The board of health shall meet on the first Monday
of July, one thousand nine hundred and thirteen, and thereafter
on the second Monday of January in the odd years of the calen-dar,
and elect either a county physician or a county health offi-cer,
who shall serve thereafter until the second Monday in Janu-ary
of the odd years of the calendar: Provided, that if the
county board of health of any county shall fail to elect a county
physician or county health officer within two calendar month?
Organization.
Quorum.
Term of office.
Pay.
Health interests
of county.
Annual meetings.
Called meetings.
Powers.
Proviso: expendi-tures
approved
by county com-mifs'oners.
Election of county
physician or coun-ty
health officer.
Term of office.
Proviso: appoint-ment
on failure of
county board to
elect.
FIFTEENTH BIENNIAL REPORT 33
of the time set in this section, the Secretary of the State Board
of Health shall appoint a registered physician of good standing
in the said county to the office of county physician, who shall
serve the remainder of the two years, and shall fix his compen- Compensation.
sation to be paid by the said county, in proportion to the
compensation paid by other counties for like service, having in
view the amount of tax collected by said county.
Sec. 10. Rules of county board of health.
If any person shall violate the rules and regulations made by Violation of rules
the county hoard of health he shall be guilty of a misdemeanor, ^L'^i Jf£nlfli°°^
^
and fined not exceeding fifty dollars or imprisoned not exceeding Punishment,
thirty days.
Sec. 11. Duties of county physicians and health officers; pen-alty
for nonperforviance.
The duties of the county physician shall be to make the medico- Duties of county
legal post mortem examinations for the coroners' inquests, to
make examination of lunatics for commitment, to render pro-fessional
service to the sick inmates of the convict camp, jail,
and county home, upon request of the superintendent or the •
keeper of these institutions, and to determine the nature of any
particular disease, upon the request of the quarantine or deputy
quarantine officer: Provided, that the county physician shall Proviso: power to
have the right to employ any other regularly registered physi-other*physicians.
cian of his county, to perform any or all of the duties pertaining
to the jail, county home, or convict camp, when in his judgment
it is desirable to do so: Provided, hoiuever, that the terms under
which such physician is employed by the county physician shall
be approved by the board of county commissioners. The duties Duties of county
of the county health officer shall be to devote his entire time
to the county public health work, and he shall perform the
duties of the county physician, the duties of quarantine oflacer,
and the following additional duties: he shall make a sanitary Examination of
examination during the summer months of every public school ^^J^°^'y^^j||fg°=^
building and grounds in the county, and no school committee
or teacher shall make use of any school building or grounds
until the county superintendent of health shall certify in writing
that said building and grounds have been inspected and found
to be in a satisfactory sanitary condition within four months
of the date of the certificate. He shall examine every school Examination of
child that has previously been examined by the teacher according
^
to methods furnished said teacher by the county superintendent
of schools, and reported to said county superintendent of schools
as probably defective in the condition of its eyes, ears, nose, or
throat, and he shall further endeavor to have examined the Examinations for
feces of every child whom he suspects of having hookworm 'lookworms.
disease. He shall notify on blank forms and in accordance with Notification to
instructions furnished by the State Department of Public Instruc-p**"^"*^-
tion, every parent or guardian of a child having any defect of the
aforesaid organs, or hookworm disease, and he shall suggest to
3
34 :XOKTH CAROLINA BOAKD OF HEALTH
said parent or guardian tlie proper course of treatment and urge
Co-operation with that such treatment be procured. He shall cooperate fully with
officers. the county board of education, the county superintendent of
schools, and the teachers in the public schools, to the end that
children may be better informed in regard to the importance of
Educational work, health and the method of preventing disease. He shall, through
the county press, public addresses, and in every available way,
endeavor to educate the people of his county to set a higher value
on health, and to adopt such public and private measures as will
Violation of sec- tend to a greater conservation of life. Any violation of this sec-meanor
™'^^^ tion shall constitute a misdemeanor, and shall subject the de-
Punishment, fendant to a fine of not less than ten dollars nor more than fifty
dollars.
Notification to
persons maintain-ing
nuisance.
Abatement of
nuisance.
Limit of expense.
Proviso: due
process of law.
Sec. 12. Ahatonent of nuisances.
Whenever and wherever a nuisance shall exist which in the
opinion of the county physician or county health officer is dan-gerous
to the public health, it shall be his duty to notify in writ-ing
the parties responsible for its continuance, of the character
of the nuisance and the means of abating it. Upon this notifica-tion,
the parties shall proceed to abate the nuisance: Provided,
however, that if the party notified shall make oath or affirmation
before a justice of the peace of his or her inability to carry out
the directions of the county physician or county health officer,
it shall be done at the expense of the town, city, or county in
which the offender lives. In the latter case the limit of the ex-pense
chargeable to the city, town, or county shall not be more
than one thousand dollars in any case: Provided, further, that
nothing in this section shall be construed to give the county
physician or county health officer the power to destroy or injure
property without a due process of law as now exists for the
abatement of nuisances.
Failure to abate
nuisance a mis-demeanor.
Punishment.
Sec. 13. Nuisance; faiUt,re to abate.
If any person, firm, corporation, or municipality responsible for
the existence and continuance of a nuisance, after being duly
notified in writing by the county physician or county health
officer to abate said nuisance, shall fail to abate the same for
twenty-four hours after such notice prescribed, he shall be
guilty of a misdemeanor, and shall be fined two dollars a day as
long as said nuisance remains.
Sec. 14. Election of municipal physician or health officer; pro-vision
for municipal health.
Election of The authorities of any city or town, not already authorized in
municipal phy?]- ., charter are hereby authorized to elect a municipal physician
cian or heaith .-,., ^ . • i
officer. or municipal health officer when, m their judgment, municipal
Regulations, sain health would be improved thereby, and to make such regulations,
ries and penalties. ^^^, ^vich. fees and salaries, and impose such penalties as in their
judgment may be necessary for the protection and the advance-ment
of the public health.
FIFTEENTH BIENNIAL REPORT 35
4458. Powers of Local Boards Not Affected.—Nothing in this Power of local
chapter shall operate as a repeal or abridgment of powers con-abiidged*by chap-ferred
by any special act on any local board of health. ^'^^ ^^
Sec. 15. Duties of the viunicipal physician or health officer;
penalty for nonperform<ince.
The duties of the municipal physician, within the jurisdic- Pities of munic-tion
of the town or city for which he is elected, shall be identical
with those of the county physician for the county, with the ex-ception
of the duties of the county physician pertaining to the
jail, convict camp, and county home. The authorities of any
city or town shall have the power to assign the duties of quaran-tine
officer to the municipal physician or health oflBcer, and in
such cases the municipal health officer shall faithfully perform
the duties of the quarantine officer as prescribed in sections
twenty and twenty-one of this act, and shall be subject to the
penalties of the aforesaid sections for refusal or nonperformance
of duty. If the physician is employed to devote his entire time Duties of munic-to
the public health interests of his town or city, he shall be
'^'^
known as the municipal health officer, and he shall discharge
all the duties pertaining to the public schools of his town or
city which are assigned in section twelve to the county health
officer, and such other duties as may be assigned him by the
municipal board of health. Any one violating any of the provis- Violation of sec-ions
of this section shall be guilty of a misdemeanor, and subject meanor.
to a fine of not less than ten dollars nor more than fifty dollars. Punishment.
Sec. 16. Quarantine ; quarantine officers.
All laws, with the exception of section twenty of this chapter,
pertaining to the reporting, recording and quarantining of dis-eases,
and all laws pertaining to disinfection, shall be faithfully
enforced by the quarantine officer. The county physician, county Persons eligible to
health officer, municipal physician or municipal health officer "^g'^^j^^^^^'"^'^"
shall be eligible to this office. The county board of health, on
the first Monday of July, one thousand nine hundred and thirteen,
and thereafter on the second Monday of January in the odd years
of the calendar, shall elect a quarantine officer for their county,
and arrange with such officer to accept and discharge the duties Duties of quaran-assigned
in this chapter to such official, and any other duties j-e-'"^^
°®*^''^"
lating to the control of infectious diseases which may be assigned
him by the county board of health. The quarantine officer shall Term of office,
serve until the second Monday in January of the odd years of
the calendar.
Sec. 17. Rules and regulations for quarantine and disinfection
;
penalty.
Inland quarantine and disinfection shall be under the control inland quarantine
of the quarantine officer, who shall faithfully enforce the rules ^""^ disinfection.
and regulations governing quarantine and disinfection as pre-scribed
by the local, county or municipal, board of health:
Provided, that nothing in this section shall interfere with the
execution of section twentv of this chapter: Provided, that the''.'"'*^'''''-
a"aran-
' tme of ports.
36 NORTH CABOIJNA BOARD OF HEALTH
quarantine of ports shall not be interfered with, but the officers
of the local and State board shall render all aid in their power
to quarantine officers in the discharge of their duties, upon the
Proviso: care and request of the latter: Provided, further, that any child or other
person may remain in custody and care of parents or family. The
failure on the part of the quarantine officer to perform the duties
imposed in this section shall be a misdemeanor, and he shall be
punished for each offense by a fine of not less than ten dollars
nor more than fifty dollars.
cuKtotly of chil
dren.
Failure to dis-cliarge
duties a
misdemeanor.
Punishment.
Neglect or refusal
to comply with
quarantine a mis-demeanor.
Punishment.
Sec. 18. Penalty for refusal or neglect to carry out quarantine.
If any person shall neglect or refuse to comply with the rules
and regulations governing quarantine and disinfection, as pre-scribed
by the local, county, or municipal board of health, he
shall be deemed guilty of a misdemeanor, and upon conviction
shall be fined not less than five dollars nor more than fifty dol-lars,
or imprisoned not less than ten days nor more than thirty
days, at the discretion of the court. In case the offender be
stricken with the disease for which he is quarantinable, he shall
be subject to the penalty on recovery, unless in the opinion of
the Secretary of the State Board of Health it should be omitted.
Sec. 19. The control of smallpox.
Control of small
pox.
Notification to
public.
Certificates of
immunity.
On the appearance of a case of smallpox in any neighborhood,
town, or city, the quarantine officer shall use all due diligence to
warn the public of its existence and to notify the public of the
proper means for preventing its spread; the said .warning and
notification to be according to the instructions of the State Health
Officer. The board of health of any town, city, or county shall
have authority to require children attending the public schools
to present certificate of immunity from smallpox either through
Persons permitting? recent vaccination or previous attack of the disease. If any
violation guilty of parent, guardian, school committee, principal, or teacher shall
permit a child to violate such a requirement of the aforesaid
Punishment. authorities, he or she shall be guilty of a misdemeanor, and
fined not less than ten dollars or more than fifty dollars.
Smallpox warning. 4451. Vaccination.—On the appearance of a case of smallpox
in any neighborhood, due warning of the existence of the disease
shall be given, and all persons not able to pay shall be vaccinated
free of charge by the county physician or health officer or by the
municipal physician or health officer, and the county physician
or health officer shall vaccinate every person admitted into a
public institution, jail or county home as soon as practicable,
unless he is satisfied, upon examination, that the person is al-ready
successfully vaccinated; the money for vaccine to be fur-nished
by county commissioners. The board of health of any
Vaccination rules, city, town, or county may make such regulations and provisions
for the vaccination of the inhabitants of their city, town or
county, and Impose such penalties as they may deem necessary
to protect public health.
Free vaccination.
Vaccination of
inmates of public
institutions.
Countv commis-sioners
to pay for
FIFTEENTH BIENNIAL REPORT 37
Sec. 20. Control of yellow fever, plague, cholera, and typhus
fever.
Any householder who knows that a person within his family Notification for
or house, and any physician who suspects that a person whom pfague, cholera
he is called to treat is sick with yellow fever, bubonic plague, "•I'i typhus fever.
Asiatic cholera, or typhus fever, shall immediately give notice
thereof to the quarantine officer, and the quarantine officer in
turn shall immediately notify, by telegram, the Secretary of the
State Board of Health thereof. The Secretary of the State Board State health officer
of Health shall personally assume control of the quarantine of ° ^ ^ ^ ^""se-the
aforesaid diseases and shall promulgate such rules and regu-lations
governing their control as he deems wise. Any one vio- Penalty for
lating this section or the rules and regulations made by the Sec-retary
of the State Board of Health, as directed by this section,
shall be, upon conviction, guilty of a misdemeanor, and fined not
less than fifty dollars ($50) nor more than two hundred dollars
($200), or imprisoned not less than ten (10) nor more than sixty
(60) days.
Sec. 21. Precaution against contamination.
In the interest of the public health, every person, company, or Protection of
municipal corporation or agency thereof selling water to the pub- tamfnation!
"^"^
lie for drinking and household purposes shall take every reason-able
precaution to protect from contamination and assure the
healthfulness of such water, and any provisions in any charters
heretofore granted to such persons, companies, or municipal cor-porations
in conflict with the provisions of this section are hereby
repealed. The State Board of Health shall have the general over- Oversight and
sight and care of all inland waters, and shall from time to time, as ^^ater"^
miand
it may deem advisable, cause examinations of said waters and Examination of
their sources and surroundings to be made for the purpose of as- ^^^''®'^®"
certaining whether the same are adapted for use as water supplies
for drinking and other domestic purposes, or are in a condition
likely to impair the interests of the public or of persons lawfully
using the same, or to imperil the public health. For the purpose Expert assistants,
aforesaid, it may employ such expert assistants as may be neces-sary.
The said board shall make such reasonable rules and regu- Rules and reguia-lations
as in its judgment may be necessary to prevent contamina-''°^^'
tion and to secure other purifications as may be required to safe-guard
the public health. Any individual, firm, corporation, or Failure to comply
municipality, or the person or persons responsible for manage- '"^ ™'sdemeanor.
ment of the water supply, failing to comply with said rules and
regulations, shall be guilty of a misdemeanor, and upon convic-tion
shall be fined or imprisoned, or both, at the discretion of the P"'^^^^'^^'^*-
court. The State Board of Health shall from time to time consult Consultation with
with and advise the boards of all State institutions, the authori-J"^^nicjp°iities and
ties of cities and towns, corporations or firms already having or private parties
on water systems,
intending to introduce systems of water supply, drainage or sew-erage,
as to the most appropriate source of supply, the best prac-tical
method of assuring the purity thereof; or of disposing of
their drainage or sewage, having regard to the present and pros-
38 NORTH CAROJ-INA BOARD OF HEALTH
Plans to be sub
mitted to state
board.
made by state in
Ktitutions or
municipalities
until plans
approved by
state board.
Plans of water
systems to be
filed.
pective needs and interests of other cities, towns, corporations, or
firms which may be affected thereby. All such boards of direc-tors,
authorities, corporations, and firms are hereby required to
give notice to said board of their intentions in the premises and
to submit for its advice outlines of their proposed plans or
schemes in relation to water supplies and disposal of sewage, and
no contract shall be entered into by any State institution or town
No contract to be for the introduction of a system of water supply or sewage dis-posal
until said advice shall have been received, considered, and
approved by the said board. That for the purpose of carrying
out the general provisions of this section, every municipal or pri-vate
corporation, company, or individual supplying or authorized
to supply water for drinking or other domestic purposes to the
public shall file with the Secretary of the State Board of Health,
within ninety days after the receipt of notice from said secretary,
certified plans and surveys, in duplicate, pertaining to the source
from which the water is derived, the possible source of infections
thereof, and the means in use for the purification thereof, in
accordance with the directions to be furnished by the said secre-tary.
Failure on the part of any individual, firm, corporation, or
municipality to comply with this section shall be a misdemeanor,
and upon conviction those responsible therefor shall be fined not
less than fifty dollars nor more than one hundred dollars, at the
discretion of the court.
Sec. 22. Condemnation of lands.
Power to condemn All municipalities operating water systems and sewer systems,
^^^'^^- and all water companies operating under charter from the State
or license from municipalities, which may maintain public water
supplies, may acquire by condemnation such lands and rights in
lands and water as are necessary for the successful operation and
protection of their plants, said proceedings to be the same as
prescribed by law for acquiring right of way by railroad com-panies.
Sec. 23. May enter upon lands to lay pipes, etc.
For the purpose of providing water supplies, the directors or
other lawful managers of any public institution of the State may
enter upon the lands through which they desire to conduct their
Entry for repairs, pipes for said purpose, and lay them underground, and they at all
times shall have the right to enter upon said lands for the purpose
of keeping the water line in repair and do all things to that end.
Noncompliance
with section a
misdemeanor.
Punishment.
Proceedings for
condemnation.
Entry of land for
laying pipes.
Assessment of
damages.
Inspections of
watersheds.
Sec. 24. Compensation for land.
If damages shall be claimed for the use of such lands, and the
parties can not agree as to the amount of compensation to be
paid, they may proceed in the manner now provided by law for
railroad companies to procure right of way.
Sec. 25. Inspections of watersheds.
Any waterworks tha.t derive their water from a surface supply
shall have a quarterly sanitary inspection of the entire watershed,
except in those cases where the supply is taken from large creeks
FIFTEENTH BIENNIAL KEPOKT 39
or rivers that have a minimum daily flow of ten million gallons,
in which case the inspection shall apply to the fifteen miles of
watershed above the waterworks intake. Sucli water companies inspection of
, ,, ^ , , -J. ^- c i- 1 „ localities specially
shall cause to be made a sanitary inspection of any particular 5,^5pggtgj
locality on said watershed at least once in every week, whenever
in the opinion of the board of health of the city or town to which
the water is supplied, or, when there is no such local board of
health, in the opinion of the county superintendent of health or in
the opinion of the State Board of Health, there is special reason
to apprehend the infection of the water from that particular
locality by the germs of typhoid fever or cholera. The inspection inspection
of tlie entire watershed as herein provided for shall include a par-*^*^
ticular examination of the premises of every inhabited house on
the watershed, and, in passing from house to house, a general
inspection for dead bodies of animals or accumulation of filth. It
is not intended that the term "entire watershed" shall include Entire watershed
uninhabited fields and wooded tracts that are free from suspicion. ^ °^ "
The inspection shall be made by an employee of and at the ex- inspection by
. . , ^ . J .., II- employee of and
pense of said water company in accordance with reasonable m- ^t expense of
structions as to methods, scope, and details, to be furnished by the i^ater company.
Instructions.
Secretary of the State Board of Health. The said sanitary in-spector
shall give in person to the head of each household on said householders*
watershed or, in his absence, to some member of said household,
the necessary directions for the proper sanitary care of his prem-ises.
It shall further be the duty of said inspector to deliver to Literature on san-each
family residing on the watershed such literature on perti- ^^^'^y subjects.
nent sanitary subjects as may be supplied him by the municipal
health officer or by the Secretary of the State Board of Health.
Full report in duplicate of all such inspections shall be made Reports of inspec-promptly
to the Secretary of the State Board of Health and their
accuracy certified to by the affidavit of the inspector, or such Affidavits,
officer or person as the said secretary may direct.
Sec. 26. Inspections of watersheds ; penalty for failure.
Failure on the part of those having in charge the management Failure to make
- , _. , ,. . 1 -i.! ii 1 • • • inspections a mis-of
public water supplies to comply with the law requiring sani- (demeanor.
tary inspections of watersheds shall be a misdemeanor and pun- Punishment.
ished by a fine of not less than twenty-five dollars nor more than
one hundred dollars, or by imprisonment for not less than ten nor
more than thirty days: Provided, the said official does not prove proviso:
to the satisfaction of the court that, in spite of reasonable effort
reasonable excuse.
and diligence on his part, he was prevented, directly or indirectly,
by his superiors from doing his duty in this respect; in which Superior officer
case the said superior officer shall be deemed guilty of a misde- Pj^®Jty*i\°|
'°^P®'='
meaner and punished by a fine of not less than fifty dollars nor Punishment.
more than two hundred dollars, or by imprisonment for not less
than one nor more than six months.
Sec. 27. Inspectors may enter upon premises.
Each sanitary inspector herein provided for is authorized and Inspectors may
,, , . j-i ,.,,. enter on premises, empowered to enter upon any premises and into any building
40 NORTH CAKOLINA BOARD OF HEALTH
upon his respective watershed for the purpose of making the in-spections
required.
Sec. 28. Residents on loatersTieds to obey instructions.
Residents on wa- Every person residing or owning property on the watershed of
inst'iuctions!
^^ ^ lake, pond, or stream from which a drinking supply is obtained
shall carry out such reasonable instructions as may be furnished
him in the matter hereinbefore set forth directly by the municipal
Refusal or neglect health ofScer or by the State Board of Health. Any one refusing
or neglecting to comply with the requirements of this section shall
Punishment. ^,g guilty of a misdemeanor and fined not less than ten nor more
than fifty dollars, or imprisoned for not less than ten nor more
than thirty days.
Defilement or cor-ruption
of water
supply a misde-meanor.
Defilement or cor-ruption
defined.
Injury to water-works
a misde-meanor.
Sec. 29. Damage to loater supply.
If any person shall defile, corrupt, or make impure any well,
spring, drain, branch, brook, creek, or other source of public water
supply by collecting and depositing human excreta on the water-shed,
or depositing or allowing to remain the body of a dead ani-mal
on the watershed, or in any other manner, and if any person
shall destroy or injure any pipe, conductor of water, or other
property pertaining to an aqueduct, or shall aid and abet therein,
he shall be guilty of a misdemeanor.
Discharsre of sew-age
forbidden.
Remedy by in-junction.
Sec. 30. Sewage not discharged in.
No person, firm, corporation, or municipality shall flow or dis-charge
sewage above the intake into any drain, brook, creek or
river from which a public drinkink water supply is taken, unless
the same shall have been passed through some well known system
of sewage purification approved by the State Board of Health;
and the continued flow and discharge of such sewage may be
enjoined upon application of any person.
Discharge of sew-age
into water
supply a misde-meanor.
Sec. 31. Discharging sewage into certain streams.
If any person, flrm, or corporation, or other ofiicer of any
municipality having a sewerage system in charge shall violate the
provision of the law relating to discharging sewage into streams
from which public water is taken, he shall be guilty of a misde-meanor.
Settlements and
institutions on
watershed to
maintain system
for disposal of
excreta.
Refusal or neglect
a misdemeanor.
Punishment.
Sec. 32. Towns, etc., not having sewerage systems.
All schools, hamlets, villages, towns, or industrial settlements
which are now located or may be hereafter located on the shed of
any public water supply, not provided with a sewerage system,
shall provide and maintain a reasonable system approved by the
State Board of Health for collecting and disposing of all accumu-lations
of human excrement within their respective jurisdiction or
control. Any one refusing or neglecting to comply with the re-quirements
of this section shall be guilty of a misdemeanor and
fined not less than ten dollars nor more than fifty dollars or im-prisoned
for not less than ten nor more than thirty days.
FIFTEENTH BIENNIAL KEPOBT 41
Sec. 33. State Laboratory of Hygiene; analyses of ivater, sputum,
blood, etc., appropriation for ; tax against water companies.
{Preventive treatment of rabies, chapter eight hundred and
ninety-one. Laics of one thousand nine hundred and seven.)
For the better protection of the public and to prevent the state laboratory
spread of communicable diseases, there shall be established a
State Laboratorj' of Hygiene, the same to be under the control and
management of the State Board of Health, and it shall be the duty
of the State Board of Health to have made in such laboratory
monthly examinations of samples from all public water supplies Kxaminations of
of the State, of all waters sold in bottle or other package and of
all spring waters that are maintained and treated as an adjunct
to any hotel, park, or resort for the accommodation or entertain-ment
of the public: Provided, that in the case of springs in con- Proviso: springs
nection with hotels, parks, or resorts intermittently operated, lesorrs?^*^*'*"*
^'*
examinations of the water shall be made monthly during the
period only that they are open for the accommodation and enter-tainment
of the public; but if upon the examination of the water
of any such spring it shall be found to be infected or contami-nated
with intestinal bacilli or other impurities dangerous to
health, examinations shall be made weekly until its purity and infected waters
safety are shown. The board shall also cause to be made exami- ''"'^^™"^^ ^^^ ^'
nations of well and spring waters when in the opinion of any ^^"eil and spring
county superintendent of health or any registered physician there
is reason to suspect such waters of being contaminated and dan-gerous
to health. The board shall likewise have made in this '^^t^er examina-
, , . . . „ . tions.
laboratory examinations of sputum m cases of suspected tuber-culosis,
or throat exudates in cases of suspected diphtheria, of
blood in cases of suspected typhoid and malarial fever, of feces
in cases of suspected hookworm disease, and such other examina-tions
as the public health may require. For the support of the Appropriation,
said laboratory the sum of four thousand dollars annually is Annual tax.
hereby appropriated and an annual tax of sixty-four dollars, pay-able
quarterly, by each and every water company, municipal,
corporate, and private, selling water to the people: Provided, Proviso: tax on
that the said annual tax for waters from springs or wells sold in and^weU™
^^^'°^^
bottles or otherwise shall be as follows: For springs or wells the
gross annual sales from which for the previous calendar year are
less than two thousand and more than one thousand five hundred
dollars, fifty dollars; less than one thousand five hundred and
more than one thousand dollars, forty dollars; less than one thou-sand
and more than five hundred dollars, thirty dollars; less than
five hundred and more than two hundred and fifty dollars, twenty
dollars, and less than two hundred and fifty dollars, fifteen dol-lars;
and for any spring maintained and treated as an adjunct
to any hotel, park, or resort for the accommodation and enter-tainment
of the public, fifteen dollars, and an additional tax for
water sold in bottle or other package from said spring in accord-ance
with the above schedule. Every corporation, firm, or person Reports filed by
selling water in the manner set forth in this proviso shall file
^^^*^'' Purveyors,
with the Treasurer of the State Board of Health, within sixty
42 NORTH CAROLINA BOARD OF HEALTH
Double tax for
failure to file
report.
Failure to trans-mit
sample a mis-demeanor.
Punishment.
Transportation
charges.
Analyses of pur-chased
samples.
Collection of tax.
Printing and
stationery.
License to foreign
water sellers.
Proviso: evidence
of purity.
Publication of
infection.
Information of
result of analysis.
Proviso: thera-peutic
waters.
days after the passage of this act and annually thereafter in the
month of January, an allidavit as to the gross amount received
from sale of water for the previous calendar year, and upon this
affidavit the tax for the current year shall be based. Failure to
so file said affidavit within the time prescribed shall subject the
said corporation, firm, or person so failing to file said affidavit to
double the tax for the current year. Failure to transmit sample
within five days after receipt of sterilized bottle or container from
the Laboratory of Hygiene shall be a misdemeanor, and upon con-viction
shall subject the delinquent to a fine of twenty-five dollars.
Transportation charges, by mail, shall be paid by the sender; by
express, by the laboratory. When deemed advisable, the said
Laboratory of Hygiene shall analyze samples purchased by it in
the open market, in lieu of those sent direct from the spring. The
said tax shall be collected quarterly by the sheriff as other taxes,
and shall be paid by the said sheriff directly to the Treasurer
of the State Board of Health. The printing and stationery neces-sary
for the laboratory shall be furnished upon requisition upon
the State Printer. Any person, firm, or corporation not a citizen
of the State of North Carolina who shall sell or offer for sale any
water in bottle or other package for consumption by the people of
the State of North Carolina shall obtain a license from the
Treasurer of the State Board of Health, and shall pay for said
license the sum of sixty-four dollars per annum, or less amount,
equal to the tax paid by springs of the same class within the
State, upon compliance with the conditions applying to them, pay-able
in advance: Provided, that satisfactory evidence of purity
furnished by the State laboratory of other States agreeing to
reciprocate in this matter with this State shall be accepted in lieu
of the said license tax. If water sold by any person, firm, cor-poration,
or municipality shall be discovered by three successive
analyses made by the State Laboratory of Hygiene to be danger-ous
to the public health, publication of that fact shall be made in
the monthly Bulletin of the State Board of Health. The result
of said analyses shall be immediately forwarded by mail to the
person, firm, corporation, or municipality selling the water so
analyzed. When upon subsequent analyses the water shall be
found no longer dangerous to health, a certificate thereof shall be
furnished the person, firm, corporation, or municipality offering
the said water for sale, and publication of the fact shall be made
in the said monthly Bulletin: Provided, that this act shall not
apply to the therapeutic waters so medicated as to render them
sterile, the question of their sterility to be decided by the Director
of the State Laboratory of Hygiene.
Solicitors to prose
cute offenders.
Sec. 34. Duties of solicitors to prosecute infringements.
That for every violation of sections twenty-five, twenty-six,
twenty-seven, twenty-eight, twenty-nine, thirty, thirty-one, thirty-two,
thirty-three, thirty-four, thirty-five, thirty-six, and thirty-seven
it shall be the duty of the solicitors of the several judicial
districts, upon the complaint of the Board of Health, or any of
FIFTEENTH BIENNIAL KEPORT 43
its officers, or of any individual injured or likely to be injured, to
institute criminal action against the person, firm, corporation, or
municipality charged with such violation in their respective dis-tricts,
and prosecute the same.
Sec. 35. A7inual appropriation.
For carrying out the provisions of this act as to the duties of Appropriation,
the Board of Health, twenty-six thousand five hundred dollars,
or so much thereof as may be necessary, is hereby annually ap-propriated,
to be paid by the State Auditor on requisition, to be
signed by the Secretary and President of the State Board of
Health, the same to be apportioned as follows: four thousand to
the State Laboratory of Hygiene, eight thousand to the cam-paign
against the hookworm disease, and fourteen thousand five
hundred dollars to the executive officer of the State Board of
Health, and the printing and stationery necessary for the board printing and sta-to
be furnished upon requisition upon the State Printer: Pro- "°'^®^'''
videcl. that one thousand dollars of this appropriation be used
annually by the State Board of Health to arrange for a supply
of diphtheria antitoxin, which shall be available to the citizens thwTa^'antitoxin.
of this State at contract price. A yearly statement shall be made yearly state-to
the Governor of all money received and expended in pursuance ments.
of this act.
Sec. 36. Contingent fund.
A contingent fund of five thousand dollars is appropriated, sub- Contingent appro-
. priation.
ject to the Auditor's warrant, upon the recommendation of the
Governor, to be expended in pursuance of the provisions of this
act, when rendered necessary by the visitation of cholera or any
other pestilential disease.
Sec. 37 That all laws and clauses of laws in conflict with
this act are hereby repealed.
Sec. 38. That this act shall be in force from and after its
ratification.
Ratified this the 12th day of March, A. D. 1913.
[Chapter 891, Laws of 1907.]
Ax Act Authorizhstg the State Board of Health to Provide for
THE Preventive Treatment of Hydrophobia.
Section 1. Preventive treatment for rabies.
That the State Board of Health is hereby authorized and em- Treatment for
powered to provide for and have conducted under its direction the
preventive treatment of hydrophobia or rabies, whenever in its
judgment circumstances, financial and otherwise, will justify it.
To meet the expenses of this treatment the said board is hereby Board may sup-
-, „ „ „ plement revenue,
given authority to supplement the revenue derived from fees for
the treatment by such sums from the treasury of the State Labora-tory
of Hygiene as may be necessary: Provided, that the useful- ^^•'^''^^'^.^'^'^'^^•'y
not impaired.
ness and efficiency of the said laboratory is not thereby impaired.
44 NORTH CAKOT.INA BOARD OF HEALTH
Sec. 2. Arrangements to meet expenses of treatment.
Free to indigent. That the benefits of said treatment shall be given free of charge
to all residents of the State who shall present to the Secretary of
the State Board of Health or its representative having in charge
the management of this special work an affidavit of inability to
pay, duly sworn to and subscribed before a justice of the peace or
if the case be a minor, such an affidavit by the parent or guardian.
ment^'^"''^''*^
P'"^J- To meet as far as may be the expenses of this special work, the
State Board of Health is hereby authorized and directed to de-mand
from those able to do so the payment in advance of a rea-sonable
fee, not to exceed in any case the usual charge made by
the reputable Pasteur institutes of this country.
[Chapter 567, Laws of 1907.]
An Act Providing for the Separation of Prisoners Suffering
With Tuberculosis From Other Prisoners.
Section 1. Tuberculous county prisoners to he kept separate.
Separate cells for That the board of county commissioners of the respective coun-prisoners.
ties of North Carolina shall provide in the jail house, or in any
camp or place where prisoners are committed for keeping or
sentenced to a term of imprisonment in any county in the State
of North Carolina, separate cells or rooms or a place in which
shall be confined any prisoner or prisoners who may be committed
for keeping or sentenced to said prison or place of confinement
for a term of imprisonment who has been examined by the county
superintendent of health and pronounced by the said county super-intendent
of health as being affected with tuberculosis.
Sec. 2. County superintendent of health to examine tuberculous
suspects.
When sheriff That it shall be the duty of any sheriff of any county, when a
suspects tuberculo . -ij-i. ^i^i, ^ ,
sis county superin Prisoner is placed in his custody for the purpose of being com-tendent
to mltted to jail or any place of confinement mentioned in this
examine. .< i-act
who, said sheriff has been informed or has any reason to
believe or suspect, is suffering with tuberculosis, to have any
such prisoner examined by the county superintendent of health,
and if such prisoner shall be pronounced by the said county
superintendent of health as a tuberculous prisoner, then said
prisoner shall be separated from the other prisoners and confined
in a separate cell or place provided for by this act.
Sec. 3. Ttiherculous State prisoners to be kept separate.
Separate cells. That it shall be the duty of the Board of Directors of the State's
Prison to provide separate cells or apartments in the said State's
Prison in which shall be kept any prisoner or prisoners who may
be sentenced to that institution for a term of imprisonment, who,
after being examined, are pronounced by the physician in charge
as being affected with tuberculosis.
FIFTEENTH BIENNIAL KEPORT 45
Sec. 4. Management of cells for the tuberculous.
That the cells and places of confinement provided for in this Cells for tubercu-
. , T . , . •.,,• , i 'ous to be used by
act for prisoners affected with tuberculosis shall be kept ex- no others,
clusively for said tuberculous prisoners, and under no circum-stances
or conditions shall any other prisoner committed or
sentenced to the institutions and places of imprisonment men-tioned
in this act, who is well and not affected with tuberculosis,
be confined in the cells or places of confinement therein provided
for tuberculous prisoners: Provided, further, that when said ^lay be used for
otlier pru oners
cells or places of confinement provided for in this act, either in after disinfection,
the county jails or camps or the State's Prison, have been used
and occupied by any prisoners affected with tuberculosis, the
said cells or places of confinement shall not be used for any other
prisoners until the county superintendent of health or the phy-sician
in charge and health authorities of the State's Prison have
been notified and the said cells or places of confinement have
been thoroughly fumigated and disinfected under the supervision
of the said county superintendent of health or the physician in
charge and the health authorities of said State's Prison, in the
manner prescribed and required by the State Board of Health.
Sec. 5. Authorities of jails and prisons knowing or suspecting
that a prisoner has tuberculosis must have him examined.
Whenever any prisoner or prisoners shall be committed to any Authorities to
„,, . , „ „ .-,. ,-,.,,. J ..have tuberculosis
of the prisons or places of confinement designated m this act, it .suspects examined,
shall be the duty of the sheriff of the county or the warden of the
State's Prison, as the case may be, in the event any such prisoner
or prisoners be known or suspected by said authorities to be
suffering with tuberculosis, to have any such prisoner or pris- Time limit for
oners examined by the county superintendent of health or the examination.
physician in charge within five days after they have been com-mitted
or sentenced to said prison.
Sec. 6. All prisoners may be worked together.
That nothing contained in this act shall be so construed as to
interfere with or prevent the county or State authorities from
working together all prisoners on public works as now provided
for by law.
Sec. 7. Violation of this act a misdemeanor.
That any person or persons violating any of the terms or pro-visions
of this act shall be guilty of a misdemeanor, and upon
conviction shall be punished in the discretion of the court.
Sec. 8. This act shall be in force from and after August 1,
1907.
Ratified this the 4th day of March, A. D. 1907.
46 NORTH CAROLINA BOARD OF HEALTH
Passenger cars
be cleaned.
to
Toilet rooms for
male and female.
Railroads to
enforce law.
Penalty for fail-ure.
Conductor guilty
of misdemeanor:
when.
[Chapter 474, Laws of 1907.]
An Act Requiring Railroad Companies to Keep Their Passenger
Cars and Toilet Rooms Clean and Decent.
Section 1. Passenger cars to be cleaned and provided with
toilets.
That every person or railroad company, whether incorporated
or not, engaging in the regular business of carrying passengers
on its railroad cars in this State, shall have the passenger cars on
their roads cleaned, brushed and dusted and the windows washed,
if needed, at least once each day, and have in each car in which
male and female passengers are carried therein a toilet room for
each sex and have the same kept clean.
Sec. 2. Railroad authoi'ities to enforce this law.
Any person or corporation engaged in the business described in
section one of this act who shall willfully or negligently fail or
refuse to give orders to their agent or agents in charge of such
cars and comply with the requirements of this act shall forfeit
twenty dollars for each day that it refuses, to be recovered by
any person suing for said penalty.
Sec. 3. Conductors and managers responsible.
That the willful or negligent refusal or the failure on the part
of the conductor or manager of any such passenger car as named
in section one to comply with said section one shall be received as
evidence of such failure or refusal of such person or railroad
company to give such orders, and moreover, such conductor or
manager shall be guilty of a misdemeanor if he fails or refuses to
carry out said orders of the person or company mentioned in
section one of this act.
Sec. 4. That this act shall take effect from and after the first
day of May, 1907.
Dates for appor-tionment.
An Act to Amend Certain Sections of Chapters 81 and 89 of
the Revisal of 1905 of North Carolina, and Certain Chap-ters
of the Public Laws of 1907, 1909, and 1911 of North
Carolina, Being Parts of the Public School Law.
The General Assembly of North Carolina do enact:
Section 1. That chapter eighty-nine of The Revisal of one
thousand nine hundred and five be, and the same is, hereby
amended as follows:
(a) Strike out section four thousand one hundred and sixteen
and insert in lieu thereof the following:
"4116. Apportionment of school funds; reservation of contin-gent
fund. The county board of education shall, on the first Mon-day
in January and the first Monday in July of each year, appor-tion
the school fund of the county to the various school districts;
FIFTEENTH BIENNIAL REPORT 47
but it shall, before apportioning the school fund, reserve as a Contingent fund.
contingent fund an amount sufficient to pay the salary of the
county superintendent and per diem and expense of the county
board of education; and may further reserve as a fund for build- Reserve for buiid-
- .. T-ii ji^ • i- i- '"S and repairs.
ing and repairing schoolhouses and for equipment, m counties
with a total school fund of five thousand dollars or less, not more
than twenty per centum thereof; in counties with a total school
fund of over five thousand dollars and not more than ten thou-sand
dollars, not more than sixteen per centum thereof; in coun-ties
with a total school fund of over ten thousand dollars and not
more than twenty-five thousand dollars, not more than ten per
centum thereof; in counties with a total school fund of over
twenty-five thousand dollars, not more than seven and a half per
centum thereof, to be used as directed in section four thousand
one hundred and twenty-four. It shall be the duty of the county Apportionment
board of education to distribute and apportion the school money
so as to give to each school in the county for each race the same
length of school term, as nearly as may be, each year. In making Grade of work
the apportionment the board shall have proper regard for the o"\eachers^^
'""^
grade of work to be done and the qualifications of the teachers re-quired
in each school for each race. As soon as the apportion- Notice of appor-ments
are made, it shall be the duty of the board to notify the
^^"""^"^"^ •
school committeemen and the treasurer of the county school fund
of the amount apportioned to each school, designating each school
by number, and stating whether for white, colored or Indian, and
naming the township and county. Funds unused by any district Surplus returned
during any year shall, if still unused at the January meeting sub- ^^"^'^eapportion-sequent
to the close of the school year, be returned to the general
school fund for reapportionment, unless such district shall have
been prevented from using such funds during that year by provi-dential
or other unavoidable causes: Provided, that in the dis- Proviso: reserve
cretion of the county board of education it may also reserve sutfi- of^ph™']|°an.'^^*
cient funds, after first providing for a six months' school term in
every school district, to pay a part of the cost, not to exceed
one-half, necessary to employ a capable physician for his entire
time as county health officer, whose election meets with the ap-proval
of said board and whose duties shall be specified by the
county board of health to embrace those provided for in that part
of section eleven, chapter sixty-two, of the public health laws of
one thousand nine hundred and eleven relating to the medical
inspection of schools and school children; and he shall lecture to Lectures to teach-the
teachers in their meetings and supply them with printed in-"'''
^^' P^y^'*=>'*°^-
structions regarding measures for the proper care of the body, the
recognition and prevention of disease, the recognition, prevention
and correction of physical defects, etc.; and he shall keep an ac- Records and
curate daily record of the work he does under the provisions of
'"*'-'°''^*-
this act and make weekly, monthly or quarterly reports giving
such information as may be called for by blanks to be furnished
by and returned to both the county board of education and the
State Superintendent of Public Instruction; and if the county withdrawal of
health officer should neglect for a period of ninety days to carry ^^^-
48 NORTH CAEOLINA BOARD OF HEALTH
out the spirit of this act, unless his entire time should be required
to fight an epidemic of some contagious or infectious disease, the
county board of education may, in its discretion, withdraw its
financial aid in his employment."
State Board of
Health given
charge.
Instructions,
forms and blanks.
Local and central
registration.
Uniform and
thorough enforce-ment.
Recommendation
for additional
legislation.
State Registrar.
Central bureau.
Fireproof space.
Registration
districts.
Appointment of
local registrars.
Notification to
State Registrar.
Term of office.
[Chapter 109, Public Laws 1913.]
An Act to Provide foe the Registration of All Births ani>
Deaths in the State of North Carolina.
The General Assembly of North Carolina do enact:
Section 1. That the State Board of Health shall have charge
of the registration of births and deaths, shall prepare the neces-sary
instructions, forms and blanks for obtaining and preserving
such records, and shall procure the faithful registration of the
same in each local registration district as constituted in section
three of this act, and in the central bureau of vital statistics at
the capital of the State. The said board shall be charged with
the uniform and thorough enforcement of the law throughout
the State, and shall from time to time recommend to the General
Assembly any additional legislation that may be necessary for
this purpose.
Sec. 2. That the Secretary of the State Board of Health shall
be State Registrar of Vital Statistics, and shall have general
supervision over the central bureau of vital statistics, which is
hereby authorized to be established by said board. Adequate
fireproof space in one of the State buildings for filing cases for
the death and birth certificates made and returned under this
act shall be provided by the Committee on Public Buildings and
Grounds.
Sec. 3. That for the purposes of this act the State shall be
divided into registration districts as follows: Each city, each
incorporated town, and each township shall constitute a local
registration district.
Sec. 4. That within ninety days after the taking effect of this
act, or as soon thereafter as possible, the chairman of every board
of county commissioners in the State of North Carolina shall ap-point
a local registrar of vital statistics for each township in his
county, and the maj^or of every incorporated town or city in the
State of North Carolina shall appoint a local registrar of vital
statistics for his town or city, and the chairmen of the boards of
county commissioners and the mayors of the cities or towns shall
notify the State Registrar, in writing, of the name and address
of each local registrar so appointed. The term of office of each
local registrar so appointed shall be four years, beginning with
the first day of January of the year in which the local registrar
is appointed, and until his successor has been appointed and has
qualified, unless such office shall sooner become vacant by death,
FIFTEENTH BIENNIAL REPORT 49
disqualification, operation of law, or other cause: Provided, that Proviso: city
, ,.-, j^ ,, ixi • 1 • ii- j_ Health officers as
in Cities where health officers or other officials are, in the judg-i.^,gistrars.
ment of the State Board of Health, conducting effective registra-tion
of births and deaths under local ordinances at the time of the
taking effect of this act, such officials may be appointed as
registrars in and for such cities, and shall be subject to the rules
and regulations of the State Registrar, and to all the provisions
of this act. Any vacancy occurring in the office of local registrar vacancies,
of vital statistics shall be filled for the unexpired term by a local
registrar appointed by the same official who appointed the local
registrar whose retirement creates the vacancy. Any chairman N'otification to
of a board of county commissioners or mayor of a city or town ' *^'^ egistrar.
who appoints a local registrar to fill a vacancy in the office of
local registrar shall notify the State Registrar, in writing, of the
name and address of the local registrar so appointed. At least Appointment of
ten days before the expiration of the term of office of any such "
local registrar, his successor shall be appointed by the chairman
of the board of county commissioners for the township local reg-istration
office, and by the mayor of the city or town for the town
or city registration office.
Any local registrar who, in the judgment of the Secretary of ilemoval by
the State Board of Health, fails or neglects to discharge efficiently ^'^^'® Registrar,
the duties of his office as laid down in this act, or who fails to
make prompt and complete returns of all births and deaths, as
required thereby, shall be forthwith removed from his office by
the Secretary of the State Board of Health and such other penal-ties
may be imposed as are provided under section twenty-two
of this act.
Each local registrar shall, immediately upon his acceptance of Local registrars to
appointment as such, appoint a deputy, whose duty it shall be to
'^^1^°'^ '^^^
act in his stead in case of absence, illness or disability, and such veceptance by
deputy shall in writing accept such appointment, and be subject '^'^p^*^^-
to all rules a