Biennial report of the North Carolina State Board of Health

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NINTH BIENNIAL REPORT
OF THE
NORTH CAROLINA
BOARD OF HEALTH,
1901-1902.
RALEIGH:
E. M. UzzELL, State Printer and Binder.
1902.
MEMBERS OF THE BOARD.
ELECTED BY THE MEDICAL SOCIETY OF THE STATE OF
NORTH CAROLINA.
S. Westray Battle, M. D. Asheville.
Term expires May, 1907.
Henry W. Lewis, M. D. Jackson.
Term expires May, 1907.
J. L. Nicholson, M. D. Richlands.
Term expires May, 1905.
W. H. Whitehead, M. D.-. Rocky Mount.
Term expires May, 1905.
APPOINTED BY THE GOVERNOR.
W. P. IvEY, M. D Lenoir.
Term expires May, 1907.
Richard H. Lewis, M. D., Secretary Raleigh.
Term expires May, 1907.
George Gillett Thomas, M. D., President Wilmington.
Term expires May, 1905.
Francis Duffy, M. D New Bern.
Term expires May, 1905.
J. L. Ludlow, C. E. Winston-Salem.
Term expires May, 1903.
LIST OF COUNTY SUPERINTENDENTS OF HEALTH IN THE
STATE OF NORTH CAROLINA, DECEMBER 31, 1902.
Alamance Dr. H. R. Moore.
Alexander Dr. C. J. Carson.
Alleghany Dr. Robt. Thompson.
Anson Dr. J. H. Bennett.
Ashe Dr. J. W. Colvard.
Beaufort Dr. John G. Blount.
Bertie Dr. H. V. Dunstan.
Bladen Dr. L. B. Evans.
Brunswick Dr. J. A. McNeill.
Buncombe Dr. E. B. Glenn.
Burke Dr. J. L. Laxton.
Cabarrus Dr. R. S. Young.
Caldwell Dr. A. A. Kent.
Camden Dr. J. L. Lister.
Carteret Dr. F. M. Clark.
Caswell Dr. S. A. Malloy.
Catawba Dr. Geo. H. West.
Chatham Dr. H. T. Chapin.
Cherokee Dr. Oscar Patton.
Chowan Dr. T. J. Hoskins.
Clay Dr. J. O. Nichols.
Cleveland Dr. B. H. Palmer.
Columbus Dr. I. Jackson.
Craven Dr. N. H. Street.
Cumberland Dr. Jno. D. McRae.
Currituck Dr. H. M. Shaw.
Dare Dr. W. B. Fearing.
Davidson Dr. Joel Hill.
Davie Dr. James McGuire.
Duplin Dr. 0. F. Smith.
Durham Dr. N. M. Johnson.
Edgecombe Dr. W. J. Thigpen.
Forsyth Dr. John Bynum.
Franklin Dr. E. S. Foster.
Gaston Dr. J. H. Jenkins.
Gates Dr. W. 0. P. Lee.
Graham Dr. R. J. Orr.
Granville Dr. S. D. Booth.
LIST OF SUPERINTENDENTS OF HEALTH.
Greene Dr. .Joseph E. Grimsley.
Guilford Dr. Edmund Harrison.
Halifax Dr. I. E. Green.
Harnett Dr. O. L. Denning.
Haywood Dr. S. B. Medford.
Henderson Dr. J. G. Waldrop.
Hertford Dr. J. H. Mitchell.
Hyde Dr. E. H.Jones.
Iredell Dr. R. A. Campbell.
Jackson Dr. R. L. Davis.
Johnston Dr. L. D. Wharton.
Jones Dr. S. E. Koonce.
Lenoir Dr. C. L. Pridgen.
Lincoln Dr. T. F. Costner.
:\IcDowell Dr. B. A. Cheek.
Macon Dr. F. L. Siler.
Madison Dr. Jas. K. Hardwicke.
Martin Dr. W. H. Harrell.
Mecklenburg Dr. C. S. McLaughlin.
Mitchell Dr. V. R. Butt.
Montgomery Dr. M. P. Blair.
]\Ioore Dr. Gilbert McLeod.
Nash Dr. J. P. Battle.
New Hanover Dr. W. D. McMillan.
Northampton Dr. H. W. Lewis.
Onslow Dr. E. L. Cox.
Orange Dr. D. C. Parris.
Pamlico Dr. H. P. Underbill.
Pasquotank Dr. J. E. Wood.
Pender Dr. R. J. Williams.
Perquimans Dr. C. C. Winslow.
Person Dr. J. A. Wise.
Pitt Dr. C. O'H. Laughinghouse.
Polk Dr. Earle Grady.
Randolph Dr. S. A. Henley.
Richmond Dr. F. J. Garrett.
Robeson Dr. H. T. Pope.
Rockingham Dr. Sam Ellington.
Rowan Dr. W. L. Crump.
Rutherford Dr. T. B. Twitty.
Sampson Dr. R. E. Lee.
Scotland Dr. A. W. Hamer.
Stanly Dr. V. A. Whitley.
Stokes Dr. W. V. McCanless.
Surry Dr. John R. Woltz.
LIST OF SUPERINTENDENTS OF HEALTH.
Swain ---Dr. J. A. Cooper.
Transylvania Dr. C. W. Hunt.
Tyrrell
Union Dr. John M. Blair.
Vance Dr. H. H. Bass.
"Wake Dr. J. J. L. McCullers.
Warren Dr. E. M. Gayle.
Washington Dr. W. H. Ward.
Watauga Dr. T. C. Blackburn.
Wayne Dr. Williams Spicer.
Wilkes Dr. W. P. Horton.
Wilson Dr. W. S. Anderson.
Yadkin Dr. M. A. Royall.
Yancey Dr. J. L. Ray.
LETTER OE TRANSMISSION.
North Carolina Board of Health,
Office of the Secretary,
Raleigh, January 3, 1903.
His Excellency, Charles B. Aycock,
Governor of North Carolina.
Sir:—In accordance witli section 3, chapter 214, Laws of
1893, I have the honor to present for transmission to the
General Assembly this, the Ninth Biennial Report of the
North Carolina Board of Health.
With great respect,
Richard H. Lewis, M. D.,
Secretary and Treasurer.
is'I^TTH BIE^^NIAL REPORT
OF THE
NORTH CAROLINA BOARD OF HEALTH,
1901-1902.
The people of our State during the past two years have
been spared any serious epidemic of disease, with one excep-tion.
This exception is small-pox, which has been with us
for just five years. A full and detailed consideration of this
subject will be found in the two annual reports of the Sec-retary
made to the conjoint sessions of the Board of Health
with the State Medical Society of 1901 and 1902, and in a
special section of this reix)rt under that heading.
While there has been progress, we think, on all sanitary
lines since our last report, slow and halting it is true, in
some directions, there undoubtedly has been an advance.
This is to be noted particularly in the biological work done
for the Board during the past two years in the laboratory and
by the Biologist of the Department of Agriculture. Although
this work Avas inaugurated within the period covered by our
last report, in December, 1900, it has been done practically
entirely during the past two years. We predicted that this
enlightened and patriotic action of the Board of Agriculture,
in extending aid to the Board of Health in the performance
of this very important work, which was beyond the latter's
resources, would be of great benefit to the people. The re-sult
has, we believe, shown this to be true.
Another advance was marked by the enactment by the
General Assembly of 1901 of the law creating the State
Board of Embalming, thereby enabling us to take our posi-
8 NORTH CAROLINA BOARD OF HEALTH.
tion with the most progressive States in the matter of prop-erly
regulating the transportation of dead bodies, especially
of those dying of contagions or infectious diseases. A copy
of this law will be found under '"Legislation." Sanitary in-spections
of State institutions, of public water supj)lies and of
municipal and private institutions, upon request, have been
made, and reports thereon are given in their proper places.
ISTo inconsiderable part of the work of the Board has
already set forth in the monthly Bulletin, which has not
failed to appear during the two years. This publication,
we have reason to believe, is much more read than formerly,
and its influence as a medium of instruction has in so far
been increased.
Reports on vital statistics, and other subjects coming within
our jurisdiction, will be found below.
MEETINGS OF THE BOARD.
MIXUTES OF THE AXXUAL MEETING OF
THE BOARD AT DUEHAM.
Hotel Carrolixa,
May 21, 1901.
The annual meeting of the Board occurred, as required
l)y law, at the same time and place as that of the State Medi-cal
Society, May 21-22, at Durham. All the members were
present. Doctors Thomas and Lewis were re-elected Presi-dent
and Secretary, resiDectively. The Secretary reported
•officially the favorable action of the State Board of Agricul-ture
on the request to have bacteriological analyses of sus-pected
drinking water made in their biological laboratory,
and the following resolution was adopted
:
Wheeeas, The State Board of Agriculture responded favorably to the
request of the State Board of Health made at its last annual meeting
to provide in its biological laboratory for the free bacteriological exami-nation
of drinking waters suspected of conveying disease, especially of
typhoid fever; and
Whereas, The work of this kind already done shows even thus early
its great value to the people, actual and prospective; now, therefore,
be it
Resolved, That the State Board of Health desires to put on record its
appreciation of this additional evidence of the progressive and enlight-ened
spirit displayed by the State Board of Agriculture in its work, and
to express its belief that the expenditure for this purpose vdW be re-turned
many fold to the people of the State in the saving of many
valuable lives and great loss of time from long illness, and in the edu-cation
of the people as to the importance and value of sanitation.
In compliance with the act of the last Legislature creating
a State Board of Embalming, to be "appointed by the State
Board of Health, three of whom shall be members of the
10 NORTH CAROLINA BOARD OF HEALTH.
State Board of Health, the remaining two shall be practical
embalmers," Messrs. J. M. Harry, of Charlotte, and H: W.
Simpson of IS^ew Bern, practical embalmers, were elected for
five and four years, and Drs. Battle, Duffy and Lewis, R. H.,
for three, two and one years, respectively. A committee of
three composed of Henry W. Lewis, M. D., J. L. Ludlow,
O. E., and the Secretary, was appointed to prepare a new
edition of the "Instructions for Quarantine and Disinfec-tion."
The Treasurer made his annual report and Drs. Ivey and
Duffy were appointed a committee to audit the same. They
reported it correct.
CONJOINT SESSION
WITH THE
STATE MEDICAL SOCIETY AT DURHAM.
MAY 22, 1901.
The conjoint meeting Avitli the State Board of Health was
called to order at 12 m. of the second day. President George
G. Thomas in the chair.
Dr. Thomas spoke as follows
:
I cannot let this opportunity pass, as the presiding officer of this meet-ing,
without saying a few words out of the fullness of my heart for the
good man, Dr. Charles J. O'Hagan. His figure was as striking as his
character. He was eminently a good loA-er and a good hater, and I
consider these good qualities. He yielded to no man in what he believed
was law and order. He loved and vipheld his friends whenever an oppor-tunity
came for the furtherance of whatever they sought to protect,
and he stood a strong barrier against the encroachment of wrong, not
only in the Society but in the world in which he lived. During the
thirty years I have been connected with this Society I have no recollec-tion
of hearing any man speak unkindly, less than lovingly and admir-ingly,
of this good man who has left us. It was my good fortune to
know him intimately, and I thank God for it. I know I am a better
and a truer man for that association.
ANNUAL REPORT OF THE SECRETARY OF
THE STATE BOARD OF HEALTH,
MAY 1, 1900—MAY 1, 1901.
The past year has been marked by greater progress in our
efforts to protect the public health than any equal period in
the history of the Board. Our work in trying to educate the
12 NORTH CAROLINA BOARD OF HEALTH.
public mind up to the importance and value of sanitation in
its various forms is beginning to tell. The evidence of this
is seen in the provision made by the Department of Agricul-ture
for the free biological analyses of suspected drinking
waters, in addition to the chemical analvses it has been mak-ing
for years ; in the valuable amendments to our health law
made bv the lae^t Leoislature—and made not sTudo-inglv but
in a liberal and enlightened spirit ; in the enactment of a law
regulating the embalming of dead bodies ; in the increase in
the number of ])ublic water supplies—eight, or thirty-three
per cent, actually, and many more j^rosj^ectively ; and in the
greater interest taken by the people generallv in such matters.
The full report of the work of the Board in detail from our
last meeting at Tarboro to January 1, 1901, will be found in
the Eighth Biennial Report, a copy of which will be gladly
mailed to any one desiring it, and to which those interested
are referred.
WATER ANALYSES.
The value of a bacteriological examination in locating the
cause of typhoid fever in contaminated or infected drinking
water is now thoroughly established. There are probably
from eight to ten thousand cases of typhoid fever in the State
every year. In many instances a number of cases following
one another at longer or shorter intervals have their origin in
a common infected well or spring. If the drinking water
supply of the first case should be promptly examined bacterio-logically,
and the fact of its infection demonstrated, a num-ber
of the later cases could be prevented. Realizing this, and
desiring to bring it directh' to the attention of the profession,
together with the fact that the examination could be obtained
free of charge, I mailed to every physician in the State the
following letter, in addition to publishing essentially the same
thing in Tlie Bulletin, which they also received
:
NINTH BIENNIAL REPORT. 13
Raxeigh, X. C, January 20, 1901.
My dear Doctor:—^As you will have noticed in The Bulletin for
December, mailed you the first of the month, the State Agricultural
Department has made provision for the bacteriological examination of
drinking waters suspected of carrying disease. Since the article in
The Bulletin was written, the Honorable Commissioner of Agriculture
has ruled that all applications for such analj^sis must be made to the
Secretary of the State Board of Health and approved by him before the
work will be done, for the purpose of guarding his laboratory against
too numerous applications based on mere curiosity. As the County
Superintendent of Health is the recognized health officer of every county,
application should first be made to him, giving the reasons for sus-pecting
the water, with request that he approve and forward to me,
and upon receipt I will, if satisfied as to the necessity for the analysis,
forward permit direct to you. In urgent cases application may be
made direct to me.
\Yhenever a ease of undoubted typhoid fever occurs in a family, their
drinking water should be analyzed bacteriologically as soon as possible.
By promptly having this done many cases of that disease would be pre-vented.
So, if you have any cases of typhoid fever in your practice,
send for permit, stating in your application the number of cases and
the conditions.
Very truly yours.
Richard H. Lewis,
Secretary.
]\Ij efforts in this direction liave, I regret to say, borne but
little fruit, only thirteen applications for analysis having been
made by physicians in nearly four months. The indifference
of the jDrofession in this matter I find it difficult to explain,
for while it is the duty of the physician to cure disease, it is
none the less his duty to prevent it vlien he can—as all worthy
of their calling will, of course, admit. If we do not avail our-selves
of the privilege offered us, it will, I fear, be withdrawn.
Unless the value to the people of the State of this work can be
demonstrated to the satisfaction of the Board of Agi-iculture
it will surely be discontinued, and when it is too late we will
realize w^hat we have lost. I hope, therefore, every one who
hears or reads this will make it an invariable rule in every'
ease of typhoid fever, immediately upon making the diagnosis,
to write me for a permit and a sterilized bottle. While in the
14 NORTH CAROLINA BOARD OF HEALTH.
letter, in order to show proper respect for tlie office of county
superintendent of health, and perhaps protect the Department
of Agi'iculture from occasional unnecessary work, I made it
a condition of the issuance of the permit that the application,
except in urgent cases, shoukl first be made to that official,
who would approve and transmit to me, I have since aban-doned
it as being' cumbersome and promotive of delay. As a
matter of fact, all these cases are urgent cases, and a direct
application to me will secure the permit and bottle at once.
LEGISLATIOX.
Realizing from our experience in the management of small-pox
during the past three years that our law of 1893 was de-fective
in a certain vagueness as to the duties and powers of
county authorities in matters pertaining to the public health,
I prepared and secured the passage by the General Assembly
of the act amendatory thereto given below. This was done,
I am glad to say, without difficulty, as was to have been ex-pected
of a body of men of such intelligence and character as
those composing the recent Legislature. Although nearly all
the members supported the bill, I feel that special acknowl-edgment
should be made to Senators Justice and Henderson,
of the Judiciary Committee, for legal advice, and to Dr.
Speight of Edgecombe, in the Senate, and Dr. Stevenson of
Iredell, in the House, for valuable aid.
The following is the act
:
AN ACT TO AMEXD AN ACT RELATING TO THE BOARD OF
HEALTH, CHAPTER 214, LAWS OF 1893.
The General Assembly of Xorfh Carolina do enact:
Sectiox 1. That section 2 of chapter 214, Laws of 1893, be amended
by striking out in line two the words ''two years" and inserting in lieu
thereof the following: "two for four years and two for six years and
their successors for six years," and by striking out in line five the words
"two years" and inserting in lieu thereof the following: "one for two
years, two for four years and two for six years and their successors
for six years."
NINTH BIENNIAL REPORT. 15
Sec. 2. That section 4 be amended by striking out in lines three
and four, respectively, the word '"two"' and inserting in lieu thereof the
word "six."
Sec. 3. That section 5, -as amended by chapter 201, Laws of 1897, be
stricken out and the following substituted therefor:
"Sec. 5. There shall be an auxiliary board of health in each county in
the State, whose function shall be, upon the call of the chairman of the
board of county commissioners, to advise the county authorities in all
matters pertaining to the public health. These boards shall be com-posed
of all registered physicians resident in the county. From this
board two physicians shall be selected, one by the chairman of the
board of county commissioners, and one by the mayor of the county
town, who, together with the board of county commissioners, shall con-stitute
the county sanitaiy committee, of which committee the chair-man
of the board of county commissioners shall be ex officio chairman.
Their term of ofRce shall be con-terminous with that of the commission-ers
with whom they serve, and when on duty they shall receive the
same compensation as is received by the county commissioners. The
county sanitary committee shall have the immediate care and respon-sibility
of the health interests of their county. They shall make such
rules and regulations, pay such fees and salaries and impose such pen-alties
as in their judgment may be necessary to protect and advance
the public health. And "any person violating such rules and regulations
shall be guilty of a misdemeanor, and may be fined not exceeding fifty
dollars or imprisoned not exceeding thirty days. They shall elect a reg-istered
physician, not a member of the sanitary committee, to serve two
years, with the title of county superintendent of health, and shall fix
his compensation. The duty of the county superintendent of health
shall be to carry out, as far as possible, such work as may be directed
hj the county sanitary committee and the State Board of Health. He
shall always promptly advise the Secretary of the State Board of
Health of the unusual prevalence of disease in his county, especially of
typhoid fever, small-pox and cholera. He shall make the medico-legal
post-mortem examinations for coroners' inquests, attend the inmates
of the home for the aged and infirm and the prisoners in the jail or
convict camp of his county, and make examinations of lunatics for
commitment. He shall be the sanitary inspector of the home and jail,
including convict camps of his county, making monthly reports to the
county commissioners and to the Secretary of the State Board of
Health."
Sec. 4. That section 8 be stricken out and the following substituted
therefor: "The meeting 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 1901, and every six years
thereafter; and of the ccmnty sanitary committee for the election of a
16 NORTH CAROLIXA BOARD OP HEALTH.
county superintoiident of hoallli on the first Monday in May, 1901, and
every two years thereafter."
Sec. 5. That section 14 be amended by inserting after the word '•com-missioners"
in line five the words "or cqunty sanitary committee."
Sec. 6. That section 15 be amended by inserting between the words
"town" and '•near," at the end of line two, the words "or the sanitaiy
committee of a county"; by striking out after the word "towTi" in line
fourteen, the words "or county board of health," and inserting in lieu
thereof the words "board of health or county sanitary committee"; and
by striking out after the word "town" in line twenty-one, the words
"or county board of health," and inserting in lieu thereof the words
"board of health or county sanitary committee."
Sec. 7. That section 23 be amended by striking out all of said section
from the beginning of line ten and inserting in lieu thereof the follow-ing:
"The sanitary committee of any county may make such regulations
and provisions for the vaccination of its inhabitants and impose such
penalties as they may deem necessary to protect the public health; and
any person violating such regulations shall be guilty of a misdemeanor,
and may be fined, not exceeding fifty dollars or imprisoned not exceeding
thirty days."
Sec. 8. That section 25 be amended by adding thereto the following:
"And any person violating such regulations shall be guilty of a mis-demeanor,
and may be fined not exceeding fifty dollars or imprisoned
not exceeding thirty days."
Sec. 9. That section 7 having been repealed, the number of 8 be
changed to 7, and all subsequent sections in accordance therewith.
Sec. 10. That this act shall be in force from and after its ratification.
It will be seen that, stated in a few words, to qnote from the
editorial comments thereon in The Bulletin for February,
these amendments "consist essentially : In increasino; the term
of members of the State Board of Health from two years, all
expiring at the same time, to six years, so arranged as to
expire at different times, thereby assuring a continuing
board ; in the creation of a 'county sanitary committee,' com-posed
of the board of county commissioners and two physi-cians
and endowed with definite responsibilities and powers,
and in restoring the term of office of county superintendent
of health from one to two years. Our law has always been
defective in not providing proper machinery for its adminis-tration
by counties. That defect is now remedied as satisfac-
NINTH BIENNIAL REPORT. 17
torily, we think, as the conditions obtaining in our State will
permit. It will aJso be noted that the medical profession is
recognized as far as practicable, and this we hope will revive
their interest in sanitary matters. It is true that the control
remains in the hands of the board of county commissioners, as
they will always be in a majority, but in all matters pertain-ing
to the public health, including the election of a county
superintendent of health, two physicians will have a voice."
It also appears that the State Medical Society must at this
meeting elect two members to serve for six years, and two for
four years, with the following members appointed by His
Excellency, Governor Aycock, viz. : Drs. W. P. Ivey and
Richard H. Lewis for six years, Drs. George G. Thomas and
Francis Duify for four years, and Mr. J. L. Ludlow, C. E.,
for two years.
In order that there might be no miscarriage in the organiza-tion
of the county sanitary committees, I addressed a letter on
March 2d to every board of county commissioners calling their
attention to the amended laws, at the same time mailing them
a copy, and again on March 28th I wrote to the chairman of
every board and to the mayor of every county town, reminding
them of the duty imposed upon them of each appointing a phy-sician
to serve as a member of the county sanitary committee.
Although I specially requested that I should be notified of the
appointments, and enclosed a postal card for reply, there are
still a number of counties and towns to be heard from, and it
is therefore impossible to say how many county sanitary com-mittees
have been properly organized.
The first fruits of this creation of practically a county
board of health was shown in a request from the committee of
Guilford county to your Secretary to visit Greensboro and
advise with them as to the probable cause of much malarial
fever just north of the city in recent years, and the best means
of removing it ; and in a similar request from the committee
Health 2
18 NORTH CAROLINA BOARD OF HEALTH.
of the county of Durham to go to Durham and advise with
them as to the best management of the small-pox which had
gained a foothold in the county. I complied with both re-quests.
SMALL-POX.
The history of small-pox in the State during the past year
is practically a repetition of that for the preceding two years,
although the number of cases is nearly one thousand less,
being 1,945 against 2,806 for the year 1899-1900, of whom
530 were white and 1,415 colored—a somewhat larger pro-j3ortion
of whites than heretofore. The death rate has also
been lower, 2.83 per cent, for the whites against 4.78 per
cent., and 1.63 per cent, for the colored against 1.44 per cent.
;
total 1.95 per cent, against 2.31 per cent. This decrease is
probably due to the vaccination of a considerable" proportion
of the people through the influence of previous scares, for
otherwise a reasonable expectation was that there would be
more cases instead of fewer. This explanation is rendered
more probable by the fact that this last year the disease has
prevailed chiefly in the country districts where vaccination
has not been practiced as it has been in the cities and towns,
centres of population and trade.
Some time since I received from a friend a copy of a poster
illustrated with pictures of cases of small-pox, and containing
the announcement "Vaccine Sold Here," which he had picked
up in Tennessee, and which was accompanied by a letter sug-gesting
that they might be useful in this State. It revived
a suggestion I made to the Board several years ago to placard
the State with the simple rules of health, and immediately
appealed to me, so I wrote the Mulford Company asking if
they could furnish me with similar posters signed by the
Board, and at what price. In response they kindly sent me
several thousand in the form desired without charge. I have
distributed them in a number of counties where small-pox was
NINTH BIENNIAL REPORT. 19
prevailing, and thej seem to have been. of service. The man
who would '"rather have small-]X)x than be vaccinated" stops
talking after seeing the pictures. The small-pox ins|>ectors,
whose reports are attached, have continued to be of much ser-vice,
Governor Aycock having given his consent to their em-ployment,
as required by the section of the law making a
special appropriation for use when rendered necessary by
pestilential disease. In tabulated form the small-pox state-ment
is as follows
:
TABULATED STATEMENT.
COUNTIES.
NUMBER OF CASES.
White. Colored. Total.
NUMBER OF DEATHS.
White. Colored. Total
Alamance
Alexander
Buncombe
Burke
Cabarrus
Caswell
Chatham
Cherokee
Cleveland
Craven
Cumberland—
Currituck
Davidson
Davie
Durham
Edgecombe
Forsyth
Franklin
Gaston
Gates
Granville
Greene
Guilford
Halifax
Harnett
Henderson
Hertford
Iredell
Johnston
Lenoir
Lincoln
Mecklenburg--
Moore
Nash
Nevi' Hanover
-
Orange
Pamlico
Pasquotank....
Person
Pitt
Polk
Randolph
Richmond
Robeson
Rockingham -
.
*Rutherford----
Stanly
Transylvania . -
Vance
Wake
Watauga
Wayne
Wilkes
Wilson
Yancey
Total (in 54 counties) .
Death-rate, per cent.
.
8
1
12
40
26
52
14
2
12
4
3
2
22
15
25
110
6
1
38
28
74
7
50
9
90
17
73
50
8
17
8
140
16
22
15
1
1
2
30
16
1
9
35
88
18
58
8
32
30
10
29
7
1
52
108
3
2
35
59
28
166
13
2
40
31
106
7
58
10
102
17
75
50
48
17
34
192
30
24
27
5
1
5
15
1
2
118
18
74
9
41
30
10
40
7
9
10
1
52
143
15 21
3
10
10
2
71
4
17
5
81
10
4
17
40
530 1,415 1,945 15
2.83
23
1.63
36
1.95
*Number of cases not reported ; deaths only. The county of Wilson has been omitted
from the above table for the reason that the figures could not be obtained from the
County Superintendent of Health, because, in his opinion, there had been no small-pox.
In his reply to my letter asking for his report on small-pox for the year he writes :
"Our discussion to-day before our County Society was the eruptive disease that has
prevailed in this county for the past three months, and it was the unanimous opinion
that it is not small-pox. I suppose there have been 500 cases in the town and county
and only one death, and that in an old man who was sick with la grippe nine days before
he broke out."
On the other hand the small-pox inspector for that section of the State, who was sent
to the county at the request of a member of State Board of Health living there, says
the disease was small-pox (see report of Dr. Tayloe, infra), and two of the leading
physicians of the county in a letter to the inspector dated May 11, 1901, say: "We
believe there has been small-pox in the county in the practice of other physicians, and
we know there are cases of small-pox we have seen."
The above is a simple statement of the facts in the possession of the Secretary, and
the candid reader can draw his own conclusions, relying in doing so on the good char-acter
and sincerity of all the parties to the controversy.
NINTH BIENNIAL REPORT. 21
REPORT OF THE SMALL-POX INSPECTORS.
REPOET OF SMALL-POX INSPECTOR L. HARRILL, M. D.
Statesville, N. C, May 15, 1901.
Dr. R. H. Lewis, Secretary State Board of Health, Raleigh, N. C.
Sir:—I send the following report of visits made as small-pox inspec-tor
during last year:
June 13, 1900.—Went to Lincolnton and examined a suspected case,
but did not find small-pox.
December 13.—Went to Taylorsville, found one case in 'discrete form,
a negro.
January 6, 1901.—Went to King's Mountain, where I saw two eases,
both white men.
Februarj 3.—Went to Gastonia and found three cases, all whites.
February 5.—Went to Triangle, Lincoln county, and saw one case,
a white man.
February 9.—Went to Shelby and saw one case, a young white man.
Other cases were reported in the county among negroes, but I did not
see them.
March 2 to 5.—Went to Burnsville, but did not see a single new case.
Many cases had recovered. Two deaths in Yancey county.
March 6.—Went to Durham, where I saw one case, a white man in
town, and three other white men at the hospital. Also eleven cases, all
negroes, at the hospital. Other cases were reported in the county at
that time, but I did not see them.
Respectfully submitted,
L. Harrill, M. D.,
Inspector.
report of small-pox inspector JOSHUA tayloe, m. d.
Washington, N. C, May 10, 1901.
Dr. R. H. Lewis, Secretary State Board of Health, Raleigh, N. C.
Sir:—I submit herewith to the State Board of Health the following
report of my worlc as small-pox inspector, from May 1, 1900, to May 7,
1901. In this report I give the towns, counties, number of cases exam-ined,
how managed and by whom, also what precaution had been taken
up to the time of mj^ inspection.
January 9 and 10.—I visited Fayetteville and Manchester, this being
my first inspection for this year. I examined sixteen cases, thirteen
colored, three white. One white suffered from the confluent form of the
disease. These cases were managed by Dr. McGougan, Superintendent of
Health. Some precautions had been taken.
22 NORTH CAROLINA BOARD OF HEALTH.
February 8 and 9.—I visited some points in Robeson county, and
examined five eases of the mild type of the disease, which were under
the care of Superintendent of Health, Dr. Pope, necessary precautions
having been taken.
February 10.—I inspected the condition in Greene County. I exam-ined
twelve colored, two whites. jNIany other cases existed that I did not
examine. This county was sadly neglected, and no precautions had
been taken until after my inspection. Drs. Grimsley and Green took
charge of this much neglected section.
February 10.—I made an inspection in Wilson county, examining one
case shown me by the Superintendent of Health, Avhich was a well
marked case of variola. I examined nine other cases shown me by a
local physician equally as well marked. All these were colored. I
was informed that the disease then existed among many whites, which
I did not have the opportunity to see. In the house of the one cas'?
sho^^^^ me by the Superintendent of Health the patient informed me that
she had just lost her son with the same disease; in another house,
pointed out to me by a local physician, in which I found six members
constituting the family, all suffered from the disease except one, who
had been successfully and recently vaccinated. Very slight precautions
had been taken.
February 14.—Near Weldon, in Halifax county, I made an inspection
of one case, white, confluent in character and quite an ill patient-
Saw three colored cases which had about recovered from the disease.
To say these cases were in the care of Dr. Green, Superintendent of
Health, is a sufficient warrant that they were well managed and all
precautions taken.
February 19.—I examined some suspects at Ayden, Pitt county, and
finding they did not have variola they were dismissed.
March 5.—At Farm^-ille, Pitt county, I examined six cases, all negroes,
suflfering from a discrete form of small-pox. These cases were under the
care of Dr. Laughinghouse, Superintendent of Health, and well man-aged.
April 18.—-At Benson I examined seven cases, five white and two
colored. Of these one white and one colored suffered from the confluent
type; others were the mild form of the disease, well cared for by Dr.
G. E. Parker.
April 19.—I visited Dunn and Four Oaks and advised with the proper
authorities relative to effective quarantine on account of the disease
being near by. Also urged thorough vaccination.
May 7.—I made inspection at Smithfield. Examined one case, col-ored;
had confluent smallpox; was well managed by Dr. Wharton,
Superintendent of Health.
At many points I visited in the State I did not examine all the cases,
but only a sufficient number to satisfy myself and local authorities.
NINTH BIENNIAL REPORT. 23
Small-pox has existed during this epidemic in all its varieties, from
the mild, modified and seemingly insignificant type to the confluent
form with all its horrors. In each town or county where I made inspec-tions
I would submit to the town and county commissioners and local
health board my report, giving therein diagnosis and advising as to the
best possible means of stamping out and controlling the disease. Also
described the full technique for caring for patients and handling sus-pects,
suggesting as thorough vaccination as possible in every section
which I visited.
We are free to admit that a large majority of the cases seen in the
present epidemic are of the mild type of the disease, yet that is no
evidence that the eruptive fever is not genuine variola, as the same
type of disease is now and has been prevalent in a great many of our
States for the past two or three years.
This eruptive fever that is now prevalent seems to answer to every
description of small-pox as described by the best authors. Its clinical
history, progress and infection, along with the typical eruption, excludes
a reasonable probability of any other disease.
The fact that this epidemic has been characterized by extreme mild-ness
has, in some instances, led to uncertainty in the minds of a few
physicians who had seen but a case or two without a knowledge of the
condition elsewhere, or else who failed to correctly observe or interpret
the true nature of the case with which he dealt.
Again, in a few other cases, physicians have denied the existence of
variola from, to say the least, rather questionable motives. In fact,
we have knowledge of more than one case in which written reports
denying the existence of the disease in certain localities have been
signed by physicians who are known never previously to have seen a
case of variola, nor ever to have visited one of the cases the nature of
which they were discussing. Comment in such cases is, of course,
unnecessary.
Joshua Tayloe,
Small-pox Inspector.
The Secretary called attention to the fact that there was a
difference of opinion between the County Superintendent of
Health on the one hand and the State Small-pox Inspector and
a resident member of the State Board of Health on the other
as to the nature of an eruptive disease prevalent in Wilson
county, the former claiming that it was not small-pox, and the
latter that it was, and asked for the views of the session as to
how it should be reported.
24 NORTH CAROLINA BOARD OF HEALTH.
Dr. W. S. A^tdersox : The case that occurred in town I
watched closely from the time I was called until the patient
was w^ell. The eruption came out ahout the second day, the
fever continued until the fourth or fifth day. The eruption
came out in consecutive crops and not a single one of these
eruptions went to suppuration, and hence no secondary fever.
I have never seen a case of small-pox where the vesicles did not
suppurate and the patient have a secondary fever. You cannot
find an author, young or old, hut that says it has an incipient
course to nm, that at about the eighth or ninth day the pus-tules
erupt and produce secondary fever. I have studied the
cases of my county since January and have not seen a single
case where a single vesicle suppurated. In all good con-science
I did not feel like pronouncing it small-pox when I
knew it was not. The gentleman sent for the expert, and pos-sibly
before he saw the case said he knew it was small-pox, and
when I took him to the place the pustules were still hard, and
he said : "Oh ! yes, it is small-TX)x." I said "Doctor, I do not
believe there is an exi^ert under heaven who can tell it until
it has time to develop and the fever develops." I wrote Dr.
Lewis if there was any symptom whereby small-pox could be
diag-nosed other than secondary fever, I wanted to know it.
One of the town physicians took this expert into the country
five miles without consulting me at all. The expert told me
there were six or seven cases of small-pox there, one typical
one. He said she had secondary fever. I went there at once,
put my thenuometer in her mouth, and her temperature was
99.5. I went back next morning and her temperature was
normal, and that was the ninth day. There are a number of
cases in our to^\Ti that all the doctors call chicken-pox, and
that is one reason why it is so hard to quarantine. The doc-tors
who complained the most would treat negi'oes for small-pox
and white people for chicken-pox. I would (luarantine
the negro. A good many people would go about there on the
streets working, broken out.
NINTH BIENNIAL REPORT. 25
As for its being small-pox, we have had all those cases and
only one death, and that was an old man who had a chill and
was sick nine days before the eruption. The ehainnan of
the Sanitary Board came over to consult with myself and I
asked the chairman of the Board of County Commissioners
to get all the doctors together and let's discuss the matter, and
I believe with unanimous consent, one doctor not giving his
full consent to the action, we agreed that the thing to do was
to let the matter go. Mr. Chainnan, it is the right of every
man in this hall to know how to diagnose small-pox, and he
can do it.
Dr. H. W. Lewis : This question of diagnosis illustrates
the fact that doctors will disagree. In Portsmouth, Va., the
same question arose. There is where ISTorth Carolina got the
small-pox, though they claim they got it from us. Whenever
they have had small-pox the question exists. I would like to
ask the doctor if these eruptions appeared in people who had
been successfully vaccinated.
Dr. Anderson : Yes, sir.
Dr. Lewis : Then I would ask him how did he know they
were successfully vaccinated. Vaccination is one of the most
deceptive things we have to contend with. People with sore
arms, and even scars, have been shown not only to be suscep-tible
to small-pox but to re-vaccination time and again. The
vaccination to be thorough must exhibit the constitutional
symptoms.
Dr. Anderson: Two years ago we vaccinated about 1,500
people in our town. One of my boys did not take well, and I
"vaccinated him again when this scare came. It took well this
time. Both my boys had this eruption, and just before I left
home an old negro woman told me she had nursed small-pox
in the war and had had this eruption on her. In the case of
this woman who had the case which the expert pronounced
genuine small-pox, I thought I had a test case there. Her two
children had been vaccinated, her baby had not been. One of
26 NORTH CAROLINA BOARD OF HEALTH.
the cliildren and tlie unvaccinated child took it at the same
time. I never could get but one of the doctors to go but one
time to see that case. On the eighth or ninth day the erup-tions
were nearly dry. The unvaccinated child had slight
spasms.
Dr. H. W. Lewis : I do not deny the existence of chicken-pox
in the town of Wilson. Vaccinated people are frequently
not vaccinated. Last year a convict was discharged from the
penitentiary farm, having been previously vaccinated. He
went to jSTorfolk and returned to ISTorth Carolina with a
case of small-pox. Upon that man's arm were two large scars
inflicted by vaccination he had received at the State farm.
He had a very severe case of small-pox. He got well but
came out thoroughly pitted, his face honey-combed. A cer-tain
proportion of cases will have variola. They sent in l^or-folk
and Portsmouth for Marine Hospital experts, and this
disease, without a dissenting voice, was pronounced small-pox.
It was as mild as the epidemic which has been described inWil-son.
When a man is thrown in contact with eruptions such a&
severe cases of chicken-pox there is but one thing to do—quar-antine
the town. The more fuss you make the better. Some
deaths are necessary to make people rush to vaccination for
protection.
Dr. Fletcher : For some time after we had some cases in
our county I labored under the same delusion under which
Dr. Anderson is laboring. I expected something more severe
and formidable. From those mild cases we had there devel-oped
confluent cases of small-pox. I was forced to change my
diagnosis.
Dr. Anderson : I think we must rely on some authority as
to what these things are. Every physician at Wilson who saw
the epidemic here said it was not small-pox, the laymen said
they did not think it was small-pox. They told me that this
man, five miles in the country, had confluent small-pox; it
never became confluent at all. When the pustules fail to run
NINTH BIENNIAL REPORT. 27
together it is discrete. There has not been a confluent case in
mj county. The difference in New York small-pox and mine
is that thev die 20 to 25 per cent in ISTew York, and in mine
only one ease.
Dr. R. H. Lewis: That is not the kind of small-pox that
we have in l^orth Carolina and over the United States. In
Ohio, Michigan and elsewhere the death rate is about 1 per
cent. The epidemic that we have had in this country for the
last three or four years has been very irregular, but it is
undoubtedly small-pox. If the disease occurred in an adult
the presumption was that it was small-pox.
Dr. Booth : May not the Board of Health recommend that
this careless mode of treating small-pox be discontinued ?
Let us get up a recommendation and try to stop this loose
acting in our State. I am by the expert like I am by the
Board of Censors, men who are competent to know have put
him there. When he says a man has small-pox I am going
to accept it as small-pox.
Dr. S. W. Battle: I think it will be conceded that we
have in this country a disease closely resembling gmall-pox,
and if it is small-pox it is a mild form. I believe Dr. An-derson
is thoroughly conscientious, but I move that we get at
the sentiment of this bodv as to whether it is reasonable to
think that Wilson county Avould be immune from this disease
that prevails over this State and the United States.
Dr. R. IT. Lewis : I think the proper thing to do will be to
put a foot-note at the bottom of the tabulated statement.
Print Dr. Anderson's letter to me and print the opinion of
the ex}D€rt.
Dr. S. W. Battle: I will say I do not think that all
discrete cases of small-pox have secondarj^ fever. I think
Osier says so.
Dr. Anderson : I think he does not, sir.
Dr. Archie: Some time in the early part of the year I
found a man sitting on my door-steps and I invited him in.
28 NORTH CAROLINA BOARD OF HEALTH.
He told me lie liad been to Lynchburg, Va., for two or three
weeks, but there was no small-pox there. I told him to go
immediately home and not leave the house. He had a genu-ine
case of discrete small-pox ; father, mother, seven or eight
brothers and sisters had it. Other cases, mild in type, were
developed. There was no case that could have been mistaken
for anything else than small-pox. He had secondary fever.
We had Dr. Henry Long from Statesville, the small-pox
expert. Dr. Anderson is, in my opinion, mistaken. I vacci-nated
the First ^orth Carolina Eegiment three times. I
have seen the worst sort of arms, sores nearly to the bone,
and yet the vaccination liad not taken.
Dr. Macon : I would like to know if this disease which is
spreading in North Carolina is not small-pox, what is it ? It
is a disagreeable disease, and if it is not small-pox I think the
people of the community should be quarantined anyhow.
They may be used to scratching in the eastern part of jSTorth
Carolina from the mosquitoes, but we people in our high,
healthy mountains do not love to be scratching so much.
AVliat is the opinion of the expert worth if it is not to be
regarded ? If he proclaims small-pox, what are you going to
do about it? If there is no law behind him backing him,
take him out of the field and save the expense, and if there is
a law let him enforce it.
It is the business man that objects to small-pox; he pats
the doctor on the shoulder and says you will ruin our town.
Take a stand promptly against these business people and they
will be the first to come over and help you out. All discrete
forms of small-pox do not have secondary fever. This dis-ease
should be exterminated from Xortli Carolina, and it can
be done.
Dr. Anderson : I want to say I had fourteen to sixteen
placards of "Small-pox" nailed up all over the town for three
months. I wrote the Secretary I did not think it was small-pox,
but was doing it because the expert said so.
NINTH BIENNIAL REPORT. 29
There are some people who are not much susceptible ; have
to be vaccinated several times before it will take. I reported
that fact to the sanitary committee and they reported the fact
to the State Board of Health, and he wrote to them saying that
we had it in our hands to manage that—but we have not.
Dr. R. H. Lewis : You can, if you want to.
Dk. Booth : The fine points about the diagnosis of small-pox
are sometimes very pretty- to talk about and very tire-some
to listen to. There is an eruptive disease in N^orth
Carolina that whoever has it does not want to have it again.
Vaccination prevents it; it has been proven that vaccination
prevents it. I have very likely seen more small-pox than any
man in Xorth Carolina. I saw 7,000 cases in 1864-'65.
We have a much milder form of small-pox here than we had
there in 1865. Still the characteristic symptoms are the
same. We all know from the days of Jenner until now, if
vaccination had been properly resorted to small-pox would
have been exterminated from the earth. There is a spirit of
carelessness now existing among the doctors that is deplor-able.
I wanted to make a report to the County Commis-sioners
in my county about the various counties in Xorth
Carolina and Virginia, and wrote to the different counties to
get the statistics. From Durham I got the reply : "When the
disease made its appearance we established a pest-house and
a house of detention. We had to establish another house of
detention, as the negi'oes exposed themselves in order to get
fed."
We adopted this plan: "\Mien a man became a suspect we
vaccinated him and kept our eye on him.
The great point the authors strain over is the last point.
There is not an author I can find any^vhere that says they have
a secondary fever.
Dr. Herring: All this small-pox that we have had here
the last few years was largely caught from negroes. Every-body
knows that this disease we have been discussing and dis-
30 NORTH CAROLINA BOARD OF HEALTH.
turbing ourselves so much about has not been so terribly fatal
as small-pox used to be. It may be because it comes from the
negroes. All you gentlemen know that to catch syphilis from
a negro woman does not hurt you as bad as to catch it from
a white woman.
Dr. Battle: I think the doctor has raised a very inter-esting
point in regard to the racial origin of the disease.
There is no doubt but that the disease in this country is
largely here from the returning soldiers from Cuba and Porto
Eico. The soldiers have gone to their homes and scattered
it all over the country. It may be that this disease is mild
because it was mild in Porto Pico and Cuba.
Dr. Archie : All the soldiers of Cuba were thoroughly vac-cinated
before going to Cuba, again in Cuba and again on
their return.
Dr. H. W. Lewis : The classical symptoms of a great num-ber
of these cases ai'e absent, nevertheless the consensus of
opinion of men calculated to judge, men who have been
trained, particularly Marine Hospital experts, is that the dis-ease
is small-pox. Their opinion must be regarded, and we
must of course look to some authority outside medical books.
The discussion was then closed and the following members
were elected to serve on the Board of Health
:
Dr. S. Westray Battle of Asheville, six years.
Dr. H. W. Lewis of Jackson, six years.
Dr. W. H. Whitehead of Rocky Mount, four years.
Dr. John L. J^icholson of Pichlands, four vears.
Dr. p. H. Lewis: The Surgeon-General of the United
States Army has sent out a letter making inquiries as to lep-rosy.
If any of the gentlemen come in contact with any dis-ease
which suggests leprosy he will help them in making the
diag-nosis. So far as I know, there is no leprosy in this State.
The conjoint session then adjourned.
NINTH BIENNIAL REPORT. 31
MINUTES OF THE ANNUAL MEETING OF THE
STATE BOARD OF HEALTH AT WRIGHTS-VILLE,
JUNE 11, 1002.
The annual meeting of the Board was held at Wrig'htsville
on June 11th, Drs. Thomas, Ivey, Duffy, Whitehead, Nichol-son
and R. H. Lewis being present.
The rules and regulations for the transj^ortation of the
dead, as amended by the Conference of State and Provincial
Boards of Health of North America at its meeting at Niagara
Falls in September, 1901, were adopted, and the Secretary
was ordered to have the same printed for distribution to the
transportation companies and to the embalmers and under-takers
of the State.
The short term of Dr. K. H. Lewis as a member of the
State Board of Embahning having expired, he was re-elected
for the full term, as the law requires.
Committees of two were appointed to complete the inspec-tion
of the public institutions of the State.
A general inspection of all the public water supplies of the
State by the Engineer of the Board was ordered.
The Seci'etary of the committee appointed to revise the
Instructions for Quarantine and Disinfection submitted their
report, which was approved and adopted.
Tuberculosis was discussed and suggestions made wath a
view to a more active fight against that dread disease.
The Treasurer submitted his report, which was audited
and found correct.
CONJOINT SESSION
WITH THE
STATE MEDICAL SOCIETY AT WRIGHTSVILLE,
JUNE 12, 1902.
The conjoint session with the State Medical Society was
called to order, President Tliomas of the Board of Health
in the chair.
Dr. Lewis stated that Dr. Tait Butler, the State Veteri-narian,
was present by invitation, and moved that he be of-fered
the privilege of the floor. Motion carried.
President Thomas, on assuming the chair, said
:
I feel on account of the lateness of the hour it is hardly proper that
I should take from the time that belongs to the State Society in its
present pressed condition for time by any extended address.
The President of the State Society has recommended that some steps
be taken by the Society at large looking to the apprehension, if I may
so name it, of the illegal practitioners in North Carolina. The laws
as they stand now are sufficient, providing they were effectually carried
out. The duty of bringing these illegal practitioners to the notice of
the grand juries stands with the solicitors. For reasons sufficient to
themselves, I regret to say not always good ones, these men are not
presented to grand juries, and all over this broad land of ours, in many
countries, there are one or more men who are practicing without the
color of law.
Many of us interested in the best welfare of the medical profession in
North Carolina have seriously thought of means to prevent this misde-meanor,
as the law denominates it, and no good plan up to this time
has presented itself.
Your President, the President of the State Society, has in his address
brought this thing to your notice, and anticipating the report which
the committee is to bring in on the address of the President, I wish
to say that the State Board of Health realizes that its functions involve
everything that looks to the well-being of the citizens of North Caro-
NINTH BIENNIAL REPORT. 33
lina, and among its duties is the protection of the healtli and lives of
the citizens from the dangers attendant upon ill-prepared men who are
posing as physicians and surgeons, that is, men who have not legally
been licensed to make a living in accordance with the law. Therefore,
the Secretary of the State Board of Health now stands ready (there
are onlj^ a few of you here—and I wish you to take this and spread it
among the other members of the Society) to have presented to him
the name of any illegal practitioner in North Carolina, that is to say,
any man in North Carolina claiming himself a physician who has not
the license of the law, provided that when that name is sent in to him
you send with it competent testimony of his illegally practicing and
such other evidence as may be necessary to his conviction. The Secre-tary
of the State Board of Health will then present that to the solicitor
of the district in which that man practices.
One of the great objections to the Society of the State undertaking
tlie correction of these evils has been, that wherever a doctor or an
aggregation of doctors appeared as witnesses or as prosecutors in the
mildest sense against any illegal practitioner, immediately the defend-ant
set up the cry of persecution and jealousy—and all of the work fell
to the ground, because juries seldom convicted as long as the physicians
made the prosecution. The State Board is out of that, they are part of
the State's police, are regularly commissioned by the State to care for
the welfare of its citizens, and I believe it is well within their duties
to undertake this woik. With his usual generous, earnest endeavor to
do what is best for all matters pertaining to the State Board of Health,
the Secretary oflfers to take up this arduous labor. It lies then with
you, the practitioriers in North Carolina, wherever you know a man is
illegally practicing, to secure his accurate name and residence, his
post-office address, and the evidence that he is practicing, and if
necessary a certificate from the clerk tliat he is not registered in
the county in which he is practicing, send this to the Secretary of
the State Board of Health and he will take charge of it and as far
as possible push the case to a determination and have this man brought
before the law. I think that is the best plan I know of which has been
presented for the correction of this evil.
In matters more accurately pertaining to the State Board of Health
and its work, I wish to suggest for another year that the health officers
of each county should make a more careful examination as to the
causes of the spread of typhoid fever. The investigations of the com-missioners
sent out by the Government to look into the outbreak of
typhoid fever in the camps of the United States troops, especially at
Chicamauga, seem to have demonstrated that the infection was carried
more by flies than through drinking water—so it comes about that an
ample opportunity is now offered to any active superintendent of health
Health 3
34 NORTH CAROLINA BOARD OF HEALTH.
in his county to begin to study the question of drinking water and flies
as sources of infection. I would suggest that each superintendent of
health shall keep a close record of the cases occurring in his county,
beginning from this meeting, and mark the first case that occurs in his
county as Xo. 1, locating it on a map, and then tracing carefully to the
next case if it is in the immediate neighborhood, near enough for the
infection to have been carried by flies, or by bacteriological examination
determine if it has come through the water supply. This will prove
to him that the doctor in charge of that case has or has not been doing
his duty to the family of the infected person or to the neighbors of the
infected lot by having the discharges of the patient properly and effectu-ally
disinfected. If it is too far away, see what communication there
has been between the houses, and, if any, note all happenings to visitors
and the communication between the houses. In that way. it seems to
me, a good deal could be learned.
Early in undetermined cases of fever located in one neighborhood,
when tlie diarrhoea appears before the actual fever is declared, it may be
well to urge the physicians to report this for the study of the case by
the Superintendent of Health. The plan seems to me to be an easy one,
and in Wilmington it has worked very well. We last year took a map
of the town, and marking a case wlien tliis method was begun by tlie
Board of Health, No. 1, and the next case Xo. 2, and so on, so that by
the numbers on the tags we can trace up the fever as it occurs. Certain
it is that deaths from typhoid fever ouglit to be lowered and the disease
ought to be more carefully looked after.
The delegate from the Tuberculosis Congress this year will no doubt
give you some useful information concerning tuberculosis—this dreaded
''great white plague."
ANNUAL EEPOET OF THE SECRETARY OF THE
NORTH CAROLINA BOARD OF HEALTH,
1901—1902.
The work of the Board during- the past year has been
chieflv routine in character, but none the less useful on that
account we hope. Since the more imixtrtant items have been
previously published in the HuUetin, which is mailed every
month to every physician in the State, and since a full report,
in detail, for the vears 1901-1902 will be made to the next
NINTH BIENNIAL REPORT. 35
Legislature, which meets early in Januarv, 1903, it is un-necessary
and inadvisable to take up the limited time at our
disposal by a report of that character on this occasion. I
will, therefore, confine myself to a statement, in a general
way, of the more important work. This is mainly included
under sewerage investigations, inspections of some of the
State's institutions, bacteriological work, the organization of
the State Board of Embalming and efforts to control small-pox.
SEWERAGE.
At the request of the City Board of Health of Wilmington
an investigation of tlie method of sewering that city, proposed
by the Wilmington Sewer Company, was made by Colonel
Shaffer, the engineer of the Board at that time, and recom-mendations
made by the committee appointed by the Presi-dent
of the Board. The result was a modification of the
plans in accordance with the suggestions made.
In compliance with an act of the Legislature, referring
the settling of a controversy between the municipal authori-ties
of Blowing Rock and the two leading hotels of that sum-mer
resort, a committee of the Board investigated and settled
the matter.
INSPECTION OF STATE INSTITUTIONS.
The State Hospital and the School for tlie Deaf and Dumb,
at Morganton, were inspected and found in excellent condi-tion.
By request of the proprietors an inspection of the
private sanatorium, known as Broadoaks, more especially its
water supply, was also made. The other State institutions
will receive their usual biennial inspection before the meet-ing
of the next General Assemblv.
As stated in my last report, at Durham, the State Board
of Agriculture, at its meeting in December, 1000, at our
request, agreed to have certain bacteriological work done for
36 NORTH CAROLINA BOARD OF HEALTH.
the Board in its laboratory. At first this was limited to
examinations of suspected drinking waters, bnt was later
extended so as to inclnde specimens from diphtheria cases,
blood in donbtful cases of fever, and sputum. This gener-ous
action on the part of the Board of Agriculture, I am
sorry to say, has not been appreciated, or at least availed of,
by the profession, as was hoped and expected. According to
the report of the Biologist of the Department, Mr. McCarthy,
the total number of biological analyses made in the past six
months was 141—35 pathological, mostly of sputum, 48 of
drinking water and 58 of milk—a total of S3, or an average
of only 14 a month. When we consider the fact that there
are about 1,500 physicians in the State it Avill be seen that
less than one per cent, take advantage of the valuable privi-lege
offered. The Board of Agriculture can hardly be ex-pected
to do this work for us indefinitely, and the time will
come when we must apj:>eal to the Legislature for an appro-priation
for it. The way to obtain this is to show conclu-sively
the value and importance to the j^eople of the work, and
the extent to which the laboratory is patronized would be an
index of the opinion of the medical profession as to its value.
It is to be hoped, therefore, that our physicians will avail
themselves more freely of these opportunities. It is inter-esting
to note that only one sample of milk was found in-fected
with the tubercle bacillus, and further investigation
showed that to have been accidental.
BOARn OF EMBALMING.
The General Assembly of 1901 passed an act creating the
State Board of Embalming, consisting of five (5) members
—
three from the State Board of Health and two practical
embalmers, all to be elected by the Board of Health. At the
last annual meeting, in compliance with the act, Drs. Battle,
Duffy and K. H. Lewis, of the Board, and Messrs. J. M.
NINTH BIENNIAL REPORT. 37
Harry and II. W. Simpson, practical embalmers, were elected.
The Board of Embalming thus created, organized on July
5, 1901, by electing Mr. J. M. Harry of Charlotte, President,
and Mr. H. W. Simi>son of !Xew Bern, Secretary and Treas-urer.
Since that time three meetings have been held for
examination of applicants for license to practice embalming,
and sixty-three licenses have been granted. This action put
us abreast, on this line, of the most progTCSsive and advanced
boards of health of the country. The importance of having
this work, in cases of infectious diseases, done by one com-petent,
not only to embalm, but to properly disinfect the room
and its effects, is self-evident. In order to impress upon the
undertakers of the State the importance of thorough disin-fection,
and to set forth clearly 'for their benefit the best
methods, I read a paper entitled "The Embalmer in His
Relation to Infectious Diseases" at the annual meeting last
month of the State Funeral Directors and Embalmers' Asso-ciation,
which seemed to be appreciated, and which, I liO}5e,
will 1)G productive of good. It was printed in the Bulletin
for May, as you may have seen,
SilALL-POX.
As was anticipated and predicted, small-pox has continued
to prevail in the State. Owing to the fact that no small-pox
was reported from Wilson county from May 1. 1001, to
January 1, 1002, the Superintendent of Health, considering
the eruptive disease widely prevalent in the county to be
chicken-pox, it is impossible to give an accurate statement
for the whole State. Omitting Wilson county for the pres-ent,
and confining ourselves to the other ninety-six counties,
the totals are as follows: Xumber of counties infected (in-cluding
Wilson), 55; number of cases (excluding Wilson),
whites G18, colored 1,197—-total 1,814; number of deaths,
whites 21, or 3.40 per cent. ; colored 27, or 2.25 per cent.
—
38 NORTH CAROLINA BOARD OF HEALTH.
total 48, or ::J.()4 })or cent. The figures for the preceding
year are: Cases, white 3:30; colored 1,415—total 1,945;
deaths, wliito 15, or 2. S3 per cent.; colored 23, or 1.63 per
cent.—total 30, or 1.05 per cent. From this it appears that
the death-rate during the past year has been slightly higher
than the year before, but not so high as the year preceding
that, when it was 4.78 for the whites^ 1.44 for the colored.
The chief difficulty in the management of the disease has
been the same as heretofore—mistaken diagnosis as chicken-pox.
This was the trouble in Wilson county, the authorities
not admitting it to be small-pox until an exi>ert from the
Marine Hospital Service, kindly sent at our request by Sur-geon-
General Wyman early in January, declared it to be
unquestionably small-pox; and representatives from contigu-ous
counties at a meeting held at Eocky Mount on the 14th
of January threatened to quarantine against Wilson imless
the -precautions proper against small-pox were immediately
taken by that county. From that time the disease was re-ported
to me regularly as small-pox, the total number of
cases, not classified as to color, being 333, with 6 deaths from
January 1st to May 1st. Prior to this period the Chair-man
of the County Sanitary Committee of Wilson told
me, in a personal interview, that in his opinion there had
been, up to the time of our conversation, 1,500 cases. So it
is safe to say that, including the 333 cases reported after
January 1st, there were during the past small-pox year be-tween
1,500 and 2,000 cases in that one county. Adding
this to the 1,817 cases reported from the rest of the State
would make between 3,000 and 3,500 cases, the largest num-ber
ever occurring in the State in the same length of time.
Three counties, Camden, Pamlico and Tyrrell, failed to
comply with the law requiring the election of a Superintend-ent
of Health. An outbreak of small-pox in Camden county
last month, however, demonstrated the utter helplessness of
the authorities to control the disease, and this fact, strongly
NINTH BIENNIAL REPORT. 39
re-inforced by the excellent work of Inspector Tayloc, broiiy,lit
about a prompt election of a Superintendent by the County
Sanitary Committee. So that now there are only two coun-ties
in the State that are without that important official. We
hope to secure action in these counties before we meet again.
The two Small-pox Inspectors, Drs. Tayloe and Ilarrill,
have rendered good service, though their services, owing to
previous exj^erience with the disease on the part of the local
authorities, have been less in demand than heretofore. A
tabulated statement by coimties of small-pox in the State from
May 1, 1901, to May 1, 1902, is appended.
While nothing especially brilliant has been accomplished
during the past year, the work of the Board, I think we can
claim, is more appreciated than over before.
40 NORTH CAROLINA BOARD OF HEALTH.
SMALL-POX IN NORTH CAROLINA-MAY
1, 1902.
-MAY 1, 1901, TO
NUMBER OF CASES. NUMBER OF DEATHS.
COUNTIES.
Alamance
Beaufort
Buncombe.
Burke
Cabarrus
Caldwell.
Carteret
Caswell
Catawba
Cherokee
Cleveland
Cumberland
Davie
Duplin
Durham
Edgecombe
Forsyth
Franklin
Gaston
Graham
Granville
Greene
Guilford
Halifax
Harnett
Haywood
Henderson
Iredell
Johnston
Lenoir.
Lincoln
McDowell
Madison
Martin
Mecklenburg
Nash
New Hanover
Orange
Person
Polk
Randolph
Richmond
Rockingham
Rowan
Rutherford
Sampson
Stanly
Stokes
Surry
Swain
Union
Wake
Wayne
*Wilson
Yadkin
Total (in 55 counties)
Death-rate, per cent,
48
2.64
*Report incomplete, and not included in totals in this table.
NINTH BIENNIAL REPORT. 41
REPORT OF SMAET.-POX INSPECTORS.
REPORT OF DR. .lOSlIlA TAYLOE.
Washington. N. C. May 17. 1!)02.
Dr. R. li. Lkwis,
Secretary i^tate Board of Health, Raleigh, N. C.
Sir:—I submit berewitli to the State Board of Health the following
report of my work as Small-pox Inspector. fro7n ^Nlay 1. 1901, to May
17. 1002. In this report I give the towns, counties, number of cases
examined, how managed and Ijy whom, also what precaution had been
taken up to tlie time of my inspection:
May 18th. lOth and 20th.—1 visited Goldsboro; examined one case
of varoloid in a colored person. This case was in charge of Dr. W. H.
Cobb, Jr.. and was well cared for.
January IG. 1902.—I visited Clinton. X. C. examined several cases,
all white, two confluent. There were several exposures at the time of
my visit to Clinton who afterwards developed small-pox. This out-break
was fortunately in charge of Dr. II. E. Lee. who managed it very
skilfully.
April 10.—I examined one case in Beaufort county of confluent form,
the patient lived only a few days. The outbreak in this county was
skilfully managed by Dr. -John G. Blount. His efforts in stamping out
and preventing a further spread of the disease were both skilful and
highly satisfactory.
May 10.—Made an inspection in Camden county. I examined three
cases of a discrete form of the disease, one death recorded at the time
of my visit there. There was absolutely no management, as the county
was without a Superintendent of Health. I succeeded in having the
Commissioners appoint a health officer, who soon got things, under con-trol.
Dr. Lister took charge of the condition of this county.
At many points I visited in the State I did not examine all the cases,
but only a sufficient number to satisfy myself and local authorities.
Small-pox has exi.sted during this epidemic in all its \-arietifs. from
the mild, modified and seemingly insignificant type to the confluent
form, with all its horrors. In each town or county where I made inspec-tions
I would submit to the Town and County Commissioners and local
Health Board my report, giving therein diagnosis and advising as to
the best possible means of .stamping out and controlling the disease.
Also, described the full technique for caring for patients and handling
suspects, suggesting as thorough vaccination as possible in every sec-tion
which I visited.
We are free to admit that a large majority of cases seen in the
present epidemic are of the mild type of the disease, yet that is no
42 NORTH CAROLINA BOARD OF HEALTH.
evidence that the eiujitive fever is not genuine variola, as the same
type of the disease is now and has been i^revalent in a great many of
our States for the past two or three years.
Til is eruptive fever that is now prevalent seems to answer to every
description of smallpox, as described by the best authors. Its clinical
history, progi-ess and infection, along with the typical eruption, excludes
a reasonable probability of any other disease.
Tiie fact that this epidemic has been characterized by extreme mild-ness
has, in some instances, led to uncertainty in the minds of a few
physicians \\ho liad seen but a case or two, without a knowledge of
the condition elsewhere, or else who failed to correctly observe or inter-pret
the true nature of the case with which he dealt.
Again, in a few other eases physicians have denied the existence of
variola from, to say the least, rather questionable motives. In fact,
we have knowledge of more than one case in which written reports,
denying the existence of the disease in certain localities, have been
signed by physicians who are known never previously to have seen a
case of variola, nor ever to have Aasited one of the cases the nature of
whicli they were discussing. Comments in such cases are, of course,
unnecessary.
Joshua Tayloe, M. D.,
^ Small-pox Inspector.
REPORT OF DR. L. HARRILL.
Statesville, N. C, January 1, 1903.
Dr. R. H. Lewis, Secretary State Board of Health, Raleigh, N. C.
Sir:—I send you the following report of visits made as Small-pox
Inspector since my report to the annual meeting of the Board of Health
in June, 1902.
March 2 to 5, 1901.—Visited Burnsville, Yancey county, but did not
see a single new case. Many cases had recovered, and some of the pa-tients
carried unmistakable signs of small-pox. There had been two
deaths from the disease previous to my visit. I met with the County
Commissioners for consultation and advice.
March 6.—Visited Durham, where I inspected one case discrete small-pox
in town, a white man, and three other white men at a hospital
owned by the county. Also eleven eases, all negroes, at the hospital.
Two or three cases were confluent in form, the balance were discrete
in form.
July 15.—Visited Hendersonville and examined about fifteen cases of
small-pox, several of them mild, but four or five cases were of confluent
form. Other cases were reported in different parts of the county, but
I did not see them. Xo decided quarantine regulations had been estab-lished,
and the disease was gradually spreading through the community.
NINTH BIENNIAL REPORT. 43
January 15, 1902.—I visited Madison and examined one typical case
of discrete small-pox at about the tenth day of the eruption. Dr. Sam
Ellington, Superintendent of Health of Rockingham county, had recog-nized
this case as small-pox, but the family physician insisted that it
was chicken-pox, and I left him still persisting in that opinion.
February 4.—Visited Lineolnton and examined one well defined ease
of discrete small-pox in a white man, the superintendent of a depart-ment
in a cotton mill.
April 19.—I went to Yadkinvilk', and about twelve or fifteen miles in
the country I found three cases small-pox.
September 1.—1 visited Wadesboro, and six miles out of town exam-ined
a white man forty to fifty years old with a well defined case of
ohicken-pox, with the eruption about four days old and drying rapidly.
September 8.—Visited Kernersville, Forsyth county. At this place
small-pox had been called herpes, and previous to my visit there had
been at least twenty to thirty mild eases. 1 examined several cases and
found all to be smallpox.
October 31 and November 1.—Visited Oxford and examined one case
that was found to be chicken-pox. This made the fourth case of well
developed and typical chicken-pox the writer has seen during the year
among grown-up people, three of them being men over thirty years old.
Xovember 10.—1 visited Bryson City and examined a woman who had
just returned from a visit to friends on Hazel creek in Swain county.
The eruption had not made its appearance, but her physician reported
to me on the 12th that she had a well marked case of small-pox.
Xovember 11 and 12.—I visited Ivobbinsville. Graham county, and
twelve miles in the country, in the direction of Hazel creek in Swain
county, I saw a family of five persons. Three of them had small-pox,
the others had not been attacked. The citizens of a large section of the
two counties, adjoining territory, covering ten to twenty miles square,
had been afflicted with small-pox for several months. This was all
caused by the escape of one man from quarantine at Ducktown nearly
one year ago. Number of cases estimated at from seventy-five to one
luuidred.
Xovember 29.—At the request of citizens of Marion I visited that
lilace and saw six cases of small-pox. three of them in negroes convales-cent.
The other cases, two of them white men and one negro, all typical
cases.
December 9.—I visited Lineolnton, where 1 found three cases small-pox
then and several others convalescent. These cases were at two
whiskey distilleries in the county, and I found many visitors around
the premises.
At all of these places I have urged the people to be vaccinated, and
at every place there was established rigid quarantine regulations. The
only hope of stamping out the disease is by vaccination. It should be
44 NORTH CAROLINA BOARD OF HEALTH.
iiKulc coiiiiiulxiiy. and no child slioidd he permitted to entei' tlie jnihlic
schools except upon the certificate of some reputal)le physician saying
he had l)een successfully vaccinated.
Respectfully submitted,
L. Haisrill,
Inspector.
Report approved and a<ln|)to(l.
Dk. l.KWTs: I think perhaps, Mr. President, it would he
well to ])ass a resolution requesting- an appropriation on the
part of the Legislature for the bacteriological work. It may
he of some help when the Legislature meets. I think we will
have to get an appropriation from the Legislature. The
Board of Agriculture has been very kind and has done a great
deal of good, and is disposed to do more, hut there are a great
many claims upon it, and I think it is our duty to get money
from the Legislature for tliis pur])ose if we can, and a resolu-tion
on the part of the Conjoint Session of the Board of
Healtli and of the Medical Societv would at least have more
or less weight with the Legislature to secure the appropriation
of a sufficient sum to continue the bacteriological examina-tions
now being made.
Dr. Walton offered the following resolution:
Resolved, That it is the opinion of this Conjoint Session of tlie Board
of Health and Medical Society of Xorth Carolina that the best interests
of the State will be served by the appropriation by the General Assem-bly
of a sum of money sufficient to conduct the bacteriological work now
being done by the Department of Agriculture in Raleigh for the Board
of Health.
Carried.
Du. Lewis: I would like to call your attention to this bac-teriological
work. You will realize the fact that these privi-leges
have not been appreciated by the profession as they
should have been when I state that only 141 examinations
w^ere nuide during the past six months—35 pathological, blood
and sputtnn, and 48 ^of suspected drinking water at the re-quest
of physicians, the remaining 58 being of the milk of
NINTH BIENNIAL REPORT. 45
public dairies instituted ])\ tlie Board of Health. I am })ar-ticularly
anxions that the demand upon the laboratory shall
be heavier for the next six months. The wavI/toOget monevf
from the Legislature is the Avav to oet it from anv other set
of sensible men. If you go to a man and demonstrate the
worthiness of the object you have in view and prove it is a rea-sonable
and proper thing, if he has the money to spare and a
liberal spirit, he will give you the money. He will not give
the money unless he is satisfied that it is a worthy object and
can be carried out. The Legislature is the same way. If 3'ou
prove to the Legislature that this work is of importance and
value to the people, and show a demand for it on the part of
the peoj^le by reference to the work actually done, and call
their attention to the fact that on account of this work doubt-less
many lives have been saved and much sickness of the
people prevented, you will stand some chance of getting the
money.
I would like to call the attention of the Conjoint Session
to the lamentable want of aj^preciation on the part of the
health officers of the kState of these privileges. I don't flatter
myself you read the Bulletin, although it is sent to you every
month, but if you do you have seen therein that on several
occasions I have offered to deposit with the Superintendent of
Health or the medical health officer of any city or town suit-able
containers or carriers, so that if a physician has a case of
urgent character, which ought to be decided very promptly,
he will not have the delay of having to write to Raleigh for a
permit to get a bottle. Sixteen have finally been persuaded
to ask for them. I felt it would be the proper thing to ask
the Board to buy these things, so the Board of Health has
bought 500 of them, and more of them are still (tn lumd and
ready for distribution u^wn request. I went so far as to say
if one single physician in a county would make a request for
the deposit in his county of these carriers that I would send
them to the Superintendent of Health, but notwithstanding
46 NORTH CAROLINA BOARD OF HEALTH.
tliat I (inly liot up to sixteen. I repeat the offer. If yon
wish to have these things at hand and will make a request of
me officially, I will see to it that the deposit is made with the
Superintendent of Health. We do not deposit bottles for
drinking water, nor carriers for sputum, for the reason that
there is no hurry whatever in sputum, and in the ease of
water, while it is desirable to have it done as soon as possible,
the danger of the abuse of that privilege is so great—so many
people want the water examined from mere curiosity—and
as we have only one bacteriologist we don't want to ovenvork
him entirelv, we restrict it in that wav.
Dr. Tait Butler, the State Veterinarian, who was present
by invitation, was introduced to the session and made the fol-lowing
remarks on bovine tuberculosis
:
;Mr. Presidext and Gentlemen:—1 don't know that I have any spe-cial
message to bring to this meeting, but there was one point touched
upon in the report of your Secretary that ouglit possibly to be more fully
explained. It stated that out of fiftj'-nine samples of milk examined
during the year by the bacteriologist of the Board only one contained
tubercle bacilli. My object in referring to this matter is to call atten-tion
to the fact that this is in no sense a true index of the prevalence
of tuberculosis in the dairy herds of the State. Only a very small per-centao;
e of even tuberculous cows give milk in which the bacillus of
tuberculosis is present. On the other hand, I have examined several
dairy herds in the State^ and out of 17-5 head nearly forty per cent,
have reacted to the tuberculin test. I would not haA'e you take this,
either, as a true index of the prevalence of the disease, for these were
undoubtedly exceptions; still, it shows that the dairy herds of the
State are not free from the disease, and the question is one that may
well command the attention of this meeting. The disease is, no doubt,
rare among the cattle of the general farmer, and while this condition
exists is the most opportune time to deal with the danger.
Of course, since Koch sought to reverse himself, and the opinion of the
medical profession generally, on the basis of nineteen incomplete and
defective negative experiments, it seems to have been popular to ques-tion
even the possibility of conveying tuberculosis to the human con-sumer
of milk and flesh, but it seems to me the question raised by the
noted bacteriologist is being rapidly settled against him. Only recently
Behring, who stands as high in the medical world as Koch, has stated
in the advanced sheets of a book which he is publishing that he has
NINTH BIENNIAL REPORT. 47
positively produced fatal tuberculosis in bovines with the human bacil-lus.
Moreover, we did not need Koch to tell us that it was difficult
to produce tuberculosis of a progressive or fatal type in cattle with the
genu of human tuberculosis, for Smith of Harvard, Dinwiddle of Ar-kansas
and others had demonstrated the fact several years before.
They also demonstrated another fact which should not be lost sight of,
namely, that the bovine germ is more virulent to a large number of the
lower animals, and by inference possibly to the human as well.
In short, it is not necessary for us to go to Germany to obtain a
knowledge of the relations of human and bovine tuberculosis. Wo
know as much about that question as the Germans or any other people,
and while the personal interests of some and the desire of all is to credit
the statement of Koch, the facts are against his dogma, and we should
as medical men seek to avoid the dangers of indifference which are
likely to follow such an utterance from such an authoritative source.
On the other hand, there is also good reason to avoid the opposite
extreme to which many veterinarians and physicians of human medi-cine
have gone, and while we should teach that the danger to the human
from the consumption of tuberculous milk and flesh is slight, we must
not forget that such a danger does exist, and that there is an urgent
necessity for manufacturing a correct public opinion on the subject.
It is the duty of this Board, as stated by your President, to protect
the health of the people of the State, and it seems to me that probably
the State Board of Health and the Department of Agriculture might
find some plan for co-operative work in dealing with this question. The
larger public dairies should have such supervision as will prevent the
sale of milk from tuberculous cows, or cause it to be sufficiently heated
to kill the tubercle bacilli, which is about 160 F. for ten minutes.
This, while sufficient to kill the bacilli and spores, if they form such,
is not sufficient to give even a cooked flavor to the milk. However, the
disposition of the animals which react to the tuberculin test is the
difficult part of the problem. It is an easy matter to determine the
presence of the disease. I say this advisedly, for while I would not
agree to find ten per cent, of the eases of tuberculosis in a herd by a
physical examination, by the tuberculin test I can find practically all
of them. Not only is tuberculin the most marvelously accurate diag-nostic
agent known to the veterinarian, but some day you practitioners
of Innnan medicine will learn a lesson from us and use it extensively for
the early diagnosis of tuberculosis in your patients.
But, as stated, the difficult problem demanding solution is the dispo-sition
of the tuberculous animals determined by the tuberculin test.
Can this meeting offer a solution that is practicable?
Dk. Lewis : I would like to express my appreciation of the
excellent remarks of Dr. Bntler, and to say for his informa-
48 NORTH CAROLINA BOARD OF HEALTH.
tion, and also to the Conjoint Session, that the control of pub-li-
e milk supplies comes within the jurisdiction of the local
authorities, and tlioso authorities have been advised to take
action. The best plan would be to have the law amended so
as to require the State Veterinarian to pass npon all of the
dairy cattle in the State.
Dr. Butlee : Mr. President, I would like to explain that
while the Department of Agriculture will for the present
make tul>erculin tests of dairy herds on request of the owners
or local health boards, still that is perhaps not desirable unless
those animals that react to the test are properly controlled.
To cause these animals to be scattered over the State because
of the fact that thev had reacted to the test would do more
*j
lianu than not to make the test at all.
Wluit we need is for you gentlemen to manufacture a cor-rect
public sentiment that will enable the authorities to deal
with these animals in a scientific and sensible way. Those
animals that are only slightly affected should not be sacri-ficed
completely. Their flesh is fit for food, although at
present no large number of persons in the State would buy it
if they knew it. What Ave want is that you educate the
people to a correct and reasonable view of the subject, and
then, when such public sentiment has been manufactured,
it will be possible to deal with the question.
In the Government inspection of meats, in the large slaugh-ter-
houses of the countiw, those animals not extensively dis-eased
and those in which the disease has not become general-ized
are passed for food. When two separate and distinct
organs are diseased it is considered to indicate a tendency to-wards
generalization, and the carcass is condemned. But
with our conditions, where the reacting animals must go on
the local market, it is impossible to dispose of them in that,
way, and this difficulty will require time and a diffusion of
correct knowledge among the people for its solution.
Dk : I wdidd like to ask the Secretarv of tlio State
NINTH BIENNIAL REPORT. 49
Board of Health what action the city authorities could taice
in regard to cattle that are in the country ?
Dr. Lewis: It is altoo-ether with the City Boards of
Health. They should require all persons selling milk to ob-tain
a license only on one condition : that the herds should
be tested and kept ])nre.
I feel sure, gentlemen, that you have all realized that our
State has been fortunate in securing Dr. Butler as our State
Veterinarian. He will be a valuable help to us in the work
we liave to do.
Adjournment.
Health-
SANITARY INSPECTION OF STATE INSTITUTIONS.
PUBLIC BUILDINGS.
CAPITOL, SUPKEME COURT AM) AGKICULTURAL BUILDINGS.
To THE Council of State.
Gentlemen:—The undersigned, a committee from the Board of
Health, inspected the Capitol Building and the buildings occupied by
the Agricultural Department and the Supreme Covirt.
The only suggestion with regard to the Capitol that occurred to us
was that more effective ventilation of the Senate Chamber and the
House of Representatives could be secured by keeping fires in tKe open
fire-places during the sessions of the Legislature. The chimneys would
be thereby convertetl into ventilating shafts for these rooms, and the
drafts provided by the presence of the fires would overcome the com-plaints
of dampness and mustiness, if not entirely, in a very great
measure. This seems to be the only feasible scheme for the betterment
of these two large rooms, unless the whole system of heating and ven-tilating
is changed, which would involve the expenditure of a large
sum of money.
The buildings of the Agricultural Department and the Supreme -Court
are both in good condition. We would suggest, however, that the
water-closets in the Supreme Court be provided with ventilation and
light, which could be done by windows opening out into the rear of the
building.
Respectfully submitted.
G. G. Thomas, M. D.,
W. H. Whitehead, M. D.,
Committee.
EDUCATIONAL INSTITUTIONS.
the state university.
BoABD OF Trustees,
University of North Carolina.
Gentlemen:—The undersigned, representing the State Board of
Health, having made a sanitary inspection of the University, respect-fully
begs leave to report:
1
i
NINTH BIENNIAL REPORT. 51
With the exception of one water-closet in (lie Carr Building and one
or two in the "battery" of closets nnder the Library, wiiich did not
flush as freely as they ought, I found nothing to criticise from the
health point of view.
I was glad to see that the suggestion made in a former repor.t that
a pump with tiglit co\er be substituted for the bucket and chain in the
open well used for drinking purposes, had been carried out. While an
innovation which does violence to the sentiment which has cluns- to the
old well for a century, it is clearly in the interest of health.
The University is to be congratulated upon the completion of its
water-works and upon the source of supply—Boiling's creek, with its
wooded and sparsely settled water-shed. The careful monthly inspec-tion
of the water-shed and the analyses, both chemical and biological,
made in your laboratories several times during the session, leave little
to be desired in your water supply. Still, in rainy weather the water
sometimes becomes too muddy to filter satisfactoiily, and as a remedy
for tliat defect and at the same time an almost absolute guarantee
against infection are both within easy reach, I would recommend its
adoption as soon as practicable. I refer to the utilization of the beau-tiful,
clear stream coming down a rocky ravine from several bold
springs in the Iron Mine hill. A small dam for impounding it, I was
informed by Prof. Gore, could be advantageously located within about
500 feet of the pumping station. The whole cost of making this change,
including the purchase of a small amount of land to render the little
water-shed practically unassailable, would not exceed a thousand dol-lars,
and would probably be less. 1 was gratified to learn that a danger
which threatened the water supply in the shape of certain claims as to
water rights of a mill below the intake had been averted, the very day
of my visit, by the acceptance on the part of the mill owner of a propo-sition
from the University, ^^^len the spring water, whicli can be sup-plemented
by the present supply whenever it may be rendered neces-sary
by a larger demand, is utilized, the water prolilem will be finally
and most satisfactorily settled.
I was very much pleased with the new heating plant, which has been
installed since our last inspection. The heating of all the buildings
of the University in every part by a forced current of hot water from
one central plant, at which point the amount of heat can be regulated
to suit the weather, combined with the fact that proper ventilation is
supplied by the open fire-places in the old buiUlings and by the venti-lating
flues whicli have been provided in the new buildings, and espe-cially
when combined with the fact that in practice it "works" satis-factorily,
justifies the statement that it is effective, economical and
sanitary. Respectfully,
Richard H. Lewis, M. D..
For the Board of Health.
52 NORTH CAROLINA BOARD OF HEALTH.
state formal axd i>-dustrial college, at greensboro.
Board of Trustees,
State Norntal and Lidusfiial College.
Gentlemen :—Acting for the State Board of Health, under section
3 of the law governing the same, I made on the loth inst. a sanitary
inspection of your institution, and respectfully beg leave to report my
observations and recommendations "as follows:
I found the general conditions, viewed from the sanitary stand-point,
to be excellent. I was pleased to learn from President :McIver that the
suggestion made in a former repoit from this Board, that double beds
be abandoned and only single ones be used, had been followed. Also
that Peabody Park had been gratly improved, especially in the matter
of roads and walks, thus proA'iding on the College grounds, together
with tennis and basket-ball courts, ample facilities for the outdoor exer-cise
so necessary to the health of the young, particularly those sub-jected
to the confinement of student life. These should be supplemented
by a thoroughly equipped modern gymnasium, in which special exer-cises
under a competent instructor may be given, in order to strengthen
the weak points and fully round out the physical woman, at the same
time impressing upon many future teachers and mothers the funda-mental
principles of right living as it relates to the body. It is easy
to see what an influence for promoting the cause of health in the State
they would become.
Remembering the condition of affairs wlien I made a special investi-gation
to ascertain the cause of the very serious epidemic of typhoid
fever in 1899, I leai-ned with much gratification that not a single case
of typhoid had occurred among the students resident in the College since
that time. As you will recollect, the cause of that outbreak was found
in tlie infected central well, the water of which was used by all the
girls at their meals. The abandonment of wells and tlie installation
of apparatus for sterilizing all drinlving water has apparently borne
good fruit in this clean record as regards the most serious of all the
diseases of adolescence. An unfortunate but instructive contrast to
this is afforded in the occurrence this fall of five cases of typhoid
among eight of the students boarding in the city and getting their
drinking water from the same well. Such experiences will doubtless
be repeated from time to time as long as present conditions obtain, and
it constitutes another strong reason why you should have more dormi-tory
room. The propriety and advisability, from the health as well
as every other point of view, of your having the young women com-mitted
to your charge entirely under your care and supervision are so
manifest that it would be superfluous to argue the question.
The present water supply, I was informed, is unsatisfactory, both as
to quality and service, and I cordially endorse the suggestion of at
NINTH BIENNIAL REPORT. 53
least investigating the feasibility of getting your own supply fioui a
system of gang-wells. I am a thorough l)eliever in the advisability of
every public institution of any size liaving its own independent water
supply whenever practicable.
I noted the fact that you were still without a cold-storage plant.
Its consideration as a matter of domestic economy and convenience does
not come within the scope of a report of this character, but leaving that
aspect of the subject aside, it is of importance as a conservator of
health. In our comparatively warm climate the development in milk
and meats of what are known as ptomaines, poisons resulting from the
growth of certain bacteria of decomposition, is a menace to health that
should be guarded against. The occurrence last year of a large number
of cases of poisoning from this cause in an institution in our State
similar to yours points the moral.
To recapitulate, in conclusion I would say that the immediate sani-tary
needs of the College are: Sufficient dormitory room, a thoroughly
equipped gymnasium, a better water supply and cold-storage plant.
Respectfully,
Richard H. Lewis, M. D..
For the Board of Health.
college of agricultire and mechanic arts. raleigh.
The Board of Trustees.
A. t£- J/. College, Raleigh.
Gentlemen :—In obedience to the instructions of the State Board of
Health, in accordance with the provisions of section 3 of the act rela-ting
to the Board of Health, the undersigned have made a sanitary
inspection of the institution under your charge, and respectfully beg
leave to report
:
We found the general sanitary conditions to be very good, but in one
most important particular very defective. V\e refer to the lack of a
sewerage system, and the use in lieu thereof of surface privies. Since
the demonstration of the conveyance of typhoid fever by flies, which
after crawling over the dejecta fly into the kitchen or dining-room and
with their feet infect the food, all surface privies are liable to become
at any time a menace to health. This is especially true where the
young are segregated together, for typhoid fever is essentially a dis-ease
of adolescence. From the sanitary point of view this is, in our
judgment, the crving need of the College, and a complete sewerage .sj's-tem
should be supplied as soon as possible.
In some of the rooms there are, we think, too many inmates. Over-crowding
slowly saps the vitality and makes its subjects more suscep-tible
to disease and less able to withstand its ravages when once at-
54 NORTH CAROLINA BOARD OF HEALTH.
t;u-kc(l. This danger is greater in tlie dormitories heated by steam
than in those ^vith open fire-places, for the reason that the ventilation
in the former is not so good and the air is not changed so frequently.
We feel it to be our duty to caution you against this danger, especially
in view of the large number of applications for admission.
Respectfully yours,
(Signed) Geo. Gillett Thomas, M. D.,
EiCHARD H. Lewis, M. D.,
Committee.
agricultural and mechanical college for the colored
race, at greensboro.
The Board of Trustees,
A. & M. College for the Colored Race, at Greenshoro.
Gentlemen:—Representing the State Board of Health, in compliance
with section .3 of the act relating to the Board of Health, I made on the
15th inst. a sanitary inspection of the institution under your care, and
respectfully beg leave to report:
The general sanitary conditions were good. I was particularly
pleased with the location and general siirroundings of the well from
whicli the drinking water supply is chiefly obtained. While, as a rule,
well-waters are more apt to become contaminated than public supplies,
it is difficult to see how this well, located as it is" with drainage away
from it in every direction, can become infected, unless from the surface
privy now in use or from some future sewer that may be placed too
near it and laid with imperfect joints. This danger should be borne
in mind in any work on this line hereafter.
I bea to call vour attention to two matters which 1 think deserve
attention, namely, tiie surface privy and the lack of ventilation in the
dormitories.
1. The surface privy.—Surface privies are always, to a greater or less
extent, according to their location and the care taken of them, a menace
to health. This is especially true where numbers of young people who
are peculiarly liable to typhoid fever are gathered together. I would
therefore recommend that you make a connection as soon as practi-cable
with the city sewerage system and abandon the privy. If this
for any good reason be not feasible, I would advise the adoption of the
water-tight tub and dry-earth system in place of the present plan of
defecating directly upon the ground. Although the danger of contami-nating
the well is extremely remote, there is a possibility of it under
the present arrangement. This possibility would be removed by the
adoption of the tub system, while at the same time the students would
be given an object lesson in Ihe proper care of such privies as they will
NINTH BIENNIAL REPORT. 55
nearly all use in after life. An abundant supply of diy earth and a
scoop should always be kept in the house, and every evacuation be imme-diately
and completely covered with the dust.
2. Lock of ventilation in the dormitories.—The building, it appears,
was constructed with a view to heating by steam or hot water, but no
proA'ision was made for ventilation. The installation now of a com-plete
ventilating system would be troublesome and expensive, but the
present conditions could be greatly improved at a very .small cost, in
this way: Put in a transom, hinged at the bottom, over every door,
raise the lower sash of at least one window in each room and place
tliereunder a plank six inches wide cut to fit. By this arrangement
fresh air from outside would enter between the panes with an upward
rush, thereby preventing direct draughts, and the general air of the
room would find its way out through the transom. Or an opening might
be made through the outside wall opposite a radiator so that the fresh
air would be somewhat warmed. Or, still better, direct-indirect radia-tors
might be substituted for those now in use. I trust that in the
construction of the proposed new dormitory the question of ventilation
will receive the consideration its importance deserves. The negro race
since emancipation has developed a peculiar susceptibility to consump-tion,
the death-rate among them from tuberculosis, as compared with the
whites, being about three to one. Xothing is more effective in increas-ing
this susceptibility than impure air, and proper ventilation, therefore,
is specially indicated for the colored people.
Respectfully,
Richard H. Lewis, ]M. D..
For the Board of Health.
INSTITUTION FOR THE DEAF, DUMB AND THE BLIND AT RALEIGH.
To THE Honorable the Board of Directors,
North Carolina Institution for the Deaf,
Dumb and the Blind at Raleigh.
Gentlemen:—The undersigned, a committee from the Board of
Health, A-isited the institution for white and colored children under
vour care, and were given every facility by Mr. Ray for inspecting the
buildings.
In the asylum for white children the additions that have been neces-sarily
made to the original building have made it a difficult matter for
the Superintendent to maintain the health standard, but judging from
his reports he has succeeded admirably in protecting the inmates of
the house under his care, and he has kept his little charges in excellent
condition. The plumbing was in fairly good shape, and the ventilation
was probably made very eflFective by the rather loose fitting doors and
56 NORTH CAROLINA BOARD OF HEALTH.
windows. There is one great need in the institution, however, that we
feel called upon to suggest, that is the prompt pro\-ision somewhere in
the building of rooms approaching the size and construction of the
ward for the sick ones, and two or more rooms for isolation of children
sick with infectious diseases, as scarlet fever, diphtheria, and so forth.
The inmates of this institution every summer are dispersed widely over
the State and mingle freely with the people in their respective neigh-borhoods.
They are exposed to the diseases prevalent in these com-munities
or settlements, and it must be accounted a fortunate circum-stance
that so far these little ones have not brought back to the institu-tion
from their homes one or more diseases which would seriously im-pair
the best interests of the asylum. It is hardly safe, however, to
hope for a continuance of this happy condition, and it seems that an
early provision for the care of such of the inmates as may be stricken
do\vn with a serious sickness is certainly called for. It is needless to
say that if a case of infectious disease should appear there should be
ample provision for isolation of the sick of such character as would
insure the safety of the other inmates. The rooms now used for sick
wards are very imperfectly fitted for the purpose. We respectfully
submit that these rooms be enlarged by taking in the passages going
each way from the head of the stair-case. The closets should be inclu-ded
in the rooms. The walls should be replastered and covered with a
water-proof finish, so that they can be washed, if necessary, without
marring them. The ceiling of iron should be removed and replaced
bj^ a smooth surface ceiling covered by the same, water-proof material as
the side walls. No more wood-work should show than is necessary, and
if practicable all the corners of the walls, ceilings and wood-work should
be rounded. The rooms on the front of the same floor might be made
into isolation chambers for infectious diseases; the same rules being
followed regarding the walls, ceiling and wood-work. It would be wise,
if the size would admit of it, to have each one of tlicin provided with
a vestibule, which would allow the nurse in charge of a sick inmate to
have an ante-chamber in which to deposit the clotliing, discharges and
dishes from a sick room, the outer door of this ante-chamber closing
tightly on the passage, and the ante-chamber itself be cared for by some
one especially charged with the work.
We wish to commend the cleanly condition in which we found the
buildings and piemises.
The institution for colored children was in generally good condition,
and needs only the same provision as that suggested for the asylum for
the white children.
Respectfully submitted,
W. H. Whiteuead, M. D.,
G. G. Thomas, ]\r. D.,
Comttiittee.
NINTH BIENNIAL REPORT. 57
school for the deaf and dumb, at morganton.
The Boakd of Directors,
School for the Deaf and Dtiinb, Morganton.
Gentlemen:—Having made a sanitary inspection of your institu-tion,
we are pleased to report that we find everytliing coming within
our jurisdiction in good condition. From what we have seen we have
reason to believe that the health interests of the afflicted children com-mitted
to your care are well looked after by your Superintendent and
attending physician.
Respectfully yours,
Geo. Gillett Thomas, M. D.,
Richard H. Lewis, M. D.,
Coiinnlttce.
oxford orphax asylum.
The Board of Directors,
Oxford Orphan Asi/lnm.
The undersigned visited the white and colored Orphan Asylum in
Oxford as a committee from the Board of Health. It gives me great
pleasure to say that everything about the Asylum was clean, comfort-able
and in a generally excellent condition under the wise superinten-dence
of Colonel Hicks and his employees. They were extremely anxious
that I should see all the property under their control. It behooves me,
however, to say. that at the time of my visit the water supply of the
institution was taken largely from a certain number of springs in the
hillside to the west of the buildings. These springs, it seemed to me,
were by no means protected against probable infection from the wash-ings
of this hillside. I understood that a certain part of the drinking
water of this institution was, at the time of my visit, procui-ed from
an open well ou the premises. There was certainly one case of typhoid
fever in the hospital building and several more cases of fever not suf-ficiently
definite at that time to be declared typhoid. . While I am aware
of the fact that these children are scattered during certain seasons of
the year over many parts of the State, and that new ones are constantly
coming in from widely separated communities, and that all of them
run the risk of being affected during their absence from the Asylum
and exhibiting it bj- falling down with fever after their return, at the
same time the water supply is probablj- partly to blame for the condi-tion
that existed at the hospital. However, by this time, probably,
this has been corrected, inasmuch as Colonel Hicks told me that within
a short time all the water that was used by the institution would
be drawn from a deep well, bored, as we understood, through imper-
58 NORTH CAROLINA BOARD OF HEALTH.
vious layers of clay and rock, which would preclude any danger of
infection from surface water.
Tlie little unfortunates who are here protected and cared for, as well
as prepared for the struggle of life, seemed happy and contented, and
were, generally speaking, hearty children. It was a source of pleasure
to know that a charity of this sort existed in our State, and that the
money expended for its maintenance was so wisely disbursed.
Geo. G. Thomas, M. D.,
For the Board of Health.
STATE HOSPITALS FOR THE IXSAXE.
centra!, hospital, at raleigh.
The Board of Directors,
Central Hospital for the Insane.
Gentlemen:—The undersigned, a committee appointed by the State
Board of Health to inspect your institution and "make a i-eport as to
its sanitary condition, with suggestions and recommendations to your
honorable body in compliance with section 3 of the act relating to the
Board of Health." resj)ectfully beg leave to report:
It gives us pleasure to say that we foimd the institution generally
in good sanitary condition^—buildings and grounds clean and well kept,
and the plumbing in a good state of efficiency. But in one particular,
and that probably the most important from the sanitary point of view,
to-wit, the water supply, in part at any rate, the state of affairs is bad.
^^'e refer to that portion of your supply which is taken from Rocky
Branch. This small stream, as you are well aware, receives, a short
distance above your intake, not only the drainage from two slaughter
pens, but also that from the A. & M. College, including a certain amount
of sewage, and sewage of the inost dangerous character, as it comes
from the hospital of the institution. Although the situation is greatly
relieved by your excellent supply for drinking puiposes derived from the
bored wells, still the idea of using water so defiled, even for bathing
purposes, especially for irresponsible persons who may at any time
drink thereof, is abhorrent to one's sense of decency, as well as to sound
sanitary principles. This condition of things, we take it, all interested
are agreed must be remedied, and the ])ractical question, tlierefore is.
How ?
\Miile the suggestion to take watei- from tiie Wake ^^"ater Company
meets with our approval (as somewhat modified below), when we con-sider
it solely in relation to the health of the patients we feel that our
NINTH BIENNIAL REPORT. 59
duty as representatives of the State requires us to look at tlie matter
from all the points of view of interest and importance to the State.
As we are informed, the cost to the Hospital of makinf;- a connection
with the water company would be $4,500 and the estimated minimum
annual water rental from the company would be $1,200. This siun
capitalized at four per cent., the rate of interest paid by the State,
would represent an investment of $30,000. in addition to the $4.o00.
This, it will be borne in mind, is based on the minimum estimate for the
present population, which is sure to be increased in the near future.
Hospitals for the insane, more perhaps than any other institutions,
require a water supply not only good in quality but superabundant in
quantity when feasible. Too great economy in their use of water is to be
deprecated, and when every gallon of water used has to be paid for, the
disposition to save in tliis respect, in the generally economical manage-ment
of the institution which is necessary, would be hard to resist.
Experience on the part of individual householders shows that they
rarely ever Tise water as freely by meter as they do by the ilat rate.
This, to our mind, is the sanitary objection to buying water, provided,
of course, a larger supply of good water belonging entirely to the hos-pital
can be obtained. \Yhether this can be satisfactorily accomplished
through a system of gang-wells in an adjacent bottom, or by the instal-lation
of a small water-works plant with pump and filter on Rocky
Branch,' with intake above the Fair Grounds, above which point the
water-shed is of much the same character as that of Walnut Creek, or
by getting water from a source not yet suggested. Is a question that
should be answered by an expert sanitary engineer. Inasmuch as sec-tion
18 of the Health Law makes it obligatory upon the Board of Health
to advise boards of directors or trustees of all State institutions in
legard to water supplies and sewerage systems, and equally obligatory
upon the latter not to take action in the premises until such advice is
received, this report will be completed by a supplementary one from the
Engineer of the Board, who has had a large experience in work of this
character. We received every courtesy and assistance from tlie man-agement.
Eespectfully,
Geo. Gillett Thomas, M. D.,
Richard H. Lewis, M. D.,
Committee.
Wixston-Salem, X. C, December 3. 1002.
The Board of Directors,
Central Eospital for the Insane, Raleigh, X. C.
Gentlemen:—At the request of Dr. Lewis, Secretary State Board of
Health, I visited the Central Hospital for the Insane on November 25th
for the purpose of investigating and reporting on the most feasible and
60 NORTH CAROLINA BOARD OF HEALTH.
practicable means of obtaining a pure water supply for the institution.
As a result of my investigation I have the honor of submitting the fol-lowing
report
:
The present water supply, at least that portion of it which is drawn
from Rocky Branch, should be abandoned. The conditions surrounding
this source of supply at the present point of intake are such that it can-not
possibly be of sufficient purify to be safely introduced into the insti-tution
for any purpose whatever. Xeither is there any point further up
the branch where a sufficient quantity of water could be obtained where
the quality of tlie water is not seriously impaired by the sewage and
drainage from the public institutions and dwellings which occupy the
water-shed, which is apjjarently in a direct line of development for occu-pancy
by homes, industrial and other enterprises. The sources of
pollution on this water-shed are so numerous and extensive as to render
it a totally unfit water supply for the institution, even though it might
be treated by the most modern practical means of purification.
I find that there are two sources from which a suitable water supply
for the institution can be obtained, viz. : From the Wake Water Com-pany,
which supplies the city of Raleigh, and an independent works to
be established by the institution with the south fork of Walnut Creek,
which enters \^'alnut Creek a short distance above the intake of the
Wake Water Company, as a source of supply. For the first plan I am
advised that the proper connections can be made to the pipes of the
Wake Water Company to deliver water to the institution at an esti-mated
cost of $4,500, and that the company will furnish water to the
institution at the rate of eight cents per thousand gallons. Such a
price for water is quite i-easonable, and the quality of the water that
will be furnished the institution, judging from the source of supply and
the character of the filtration plant and the care with which it is opera-ted
by the water company, should be entirely satisfactory, and, in my
judgment, of exceptional purity.
The other source of supply which appears to be available for devel-opment
and operation by the institution, possesses all the elements
essential to make it a very desirable and highly satisfactory source of
supply. The development and installation of a water supply from this
source should include a filtration plant, and the ownership of at least a
portion of the Avater-shed would be desirable. This water-shed appears
to have no bad exposure at present, and apparently no probability of
such in the future. If the entire water-slied of this small stream could
be owned by the institution and be allowed to grow up in timber, it
would constitute an ideal source of water supply. The development of
a water supply from this source would be somewhat more expensive
than the connection to the Wake Water Company, but it would have the
advantage of being owned and operated and safeguarded by the institu-tion
itself, which is manifestly a very desirable condition.
NINTH BIENNIAL REPORT. 61
The relative economy of the two sources of supply is a proper matter
for investigation before making a choice. The economic study should
include a careful estimate of the cost of installing the independent water
supply and tlie interest account on the cost, together with tlie cost of
plant and the depreciation. Tliis should be compared willi the same
functions that would attach to taking the water from the \\'ake Water
Company. Such a study as this being beyond the province of the State
Board of Health to advise upon, I have not entered into it for the pur-pose
of this report.
Either of the two plans suggested above would secure to the institu-tion
a very desirable and satisfactory water supply for all purposes, and
except for the consideration of the desirability of such an institution
owning and operating its own water supply, and the apparent less lia-bility
of contamination that attaches to the south fork of Walnut
Creek than to Walnut Creek itself, the choice between the two plans
above outlined is purely a question of economics, invoUnng the cost of
installation and operation.
Very respectfully submitted,
(Signed) J. L. Ludlow,
Engineer Member X. C. State Bfiard of Health.
Executive Committee,
Central Hospital, Raleigh, A". C.
Gentlemen:—In compliance with your request for an investigation
by the Board of Health of the question of tuberculosis in your herd of
cattle and advice in regard to the proper action on your part under the
circumstances, the President of the Board appointed the undersigned to
make the investigation.
By ajipointment with Superintendent McKee I visited the Hospital
on the 26th instant. He first submitted to me the reports of the vet-erinarian
who tested the cows and of the Biologist of the Department
of Agriculture, who made a biological examination of specimens from
two of the cows which had been killed. We then made a general inspec-tion
of the infected animals. Although they appeared to be healthy
and in excellent condition, they are undoubtedly tuberculous according
to the reports referred to, as they reacted to the tuberculin test, ^vhich
is generally regarded as proof positive of the existence of tuberculosis;
and the tubercle bacilli were demonstrated in the specimens from one of
the two cows, so that it is unnecessary to discuss the question of their
infection. That may be regarded as settled in the affirmative. The
practical question now before us, thei-efore, is: What shall be done with
the cows and their milk? This question has two sides to it, the eco-
62 NORTH CAROLINA BOARD OF HEALTH.
noinic and the humanitarian and sanitary. We will consider it from
both points of view.
1. The economic.—Some high authorities, notably Professor Koch of
Berlin, according to his recent address to the British Tuberculosis Con-gress,
and the eminent American Veterinarian, Dr. Edward ]\Ioore, the
tuberculosis of cattle is not transmissible to man. This position is,
however, strongly controverted, and the weight of authority is to-day
against it. For myself, I have always doubted the transmission of the
disease to the human through the milk of tuberculous cows whose udders
were healthy. All are agreed, however, that milk, even if infected, can
be made harmless by pasteurization, and the meat by thorough cooking,
With these precautions, therefore, there would be no practical danger
in continuing the use of the infected herd, even if tuberculosis were
certainly transmissible from them to the patients.
2. The humanitarian and sanitary.—Tuberculosis is the greatest
enemy of mankind. No trouble or expense sliould be spared to prevent
its spread. In those communities in which there has been the greatest
advance in the practical application of sanitary science it is the rule
to forbid the sale of tuberculous milk and meat and to order the killing
of all cattle proved to be infected with the disease. As long as the
weight of authority continues to favor this course that is undoubtedly
sound practice. For years we have been striving to educate public
opinion in the State up to an appreciation of the value and importance
of preventive medicine. If the State should deliberately, solely for the
purpose of saving a few hundred dollars, refuse to follow the approved
course under such circumstances, the effect upon public opinion \vould
be bad, and the cause of sanitation injured. Feeling on the subject
would be accentuated by the fact that in this particular instance the
State stands in loco parentis to the patients, the insane being entirely
irresponsible, and to all intents and purposes children. This feeling
would be more intense among the relatives and friends who in all con-fidence
have committed their stricken loved ones to the fostering care
of the State. Should cases of consumption develop among the patients,
as they will surely do from time to time in spite of all precautions,
many relatives would almost surely attribute them to the use of the
milk from the tuberculous cows and feel aggrieved at the management.
Few of us woiild deliberately set before our own children milk from a
cow known to be tuberculous, whether it were pasteurized or not, and
if that be true we cannot deny that there would be grounds for com-plaint
if it should be served to the insane.
Since the publication of Koch's address, investigators the world over
have set actively to work to settle the question of the transmissibility
of bovine tuberculosis to man. In view of this fact it might be thought
advisable to hold the infected cows until it is settled, but this cannot
be done in a day, and before a ceilain conclusion, which after all might
NINTH BIENNIAL REPORT. 63
be unfavorable, will have been readied, the cows will consume in food
more than enough to replace them with sound cattle.
Considering the subject in all its aspects I would respectfully rec-ommend
:
1. That all infected cattle be killed.
2. That the stable occupied by them be thoroughly disinfected by
spraying with a 1-1000 solution of bichloride of mercury and white-
Avashing, and be used for other purposes.
3. That the uninfected cattle be moved to new quarters; tliat they be
tested every two or three months with tuberculin, and that every animal
reacting be promptly slaugh.tered.
Respectfully yours,
Richard H. Lewis, 31. D.
. August 31, 1901.
state hospital, at >rorgaxtox.
The Board of Directors,
State Hospital, Morgauton, X. C.
Gentlemen:—In compliance with a request from the Superintendent
of the Hospital to investigate as soon as practicable a limited outbreak
of tjphoid fever in and near the institution in order, if possible, to
check promptly what might grow into a serious epidemic of that dis-ease,
we anticipated somewhat our usual biennial inspection and visited
the Hospital on July 22d, spending two days there.
The Typhoid Fever.
We took up first the consideration of the fever problem. The facts
we learned from the Superintendent and Assistant Physicians were:
The first case occurred June 20th and the last began about .July loth,
one week before our arrival. The total number of cases was si.Y. Of
this number two were patients, one male and one female, and one a
nurse in the Hospital; and three, including the first case, were in a
row of private residences on a ridge just beyond the public road run-ning
by the north-eastern side of the Hospital and about three hundred
yards distant. As you are aware, these houses are not in any way
connected with the Hospital. Of the tliree cases belonging to the insti-tution,
two, the male patient and the nurse, were exposed to outside
influences, including drinking water possibly from the infected wells
of the private houses referred to, especially one near the barn, while
of the three on the ridge, one, a visitor from a neighboring town where
the disease was very prevalent, we feel quite sure brought it with her.
According to bacteriological examinations made a short time before our
visit in tlie biological laboratory- of the Department of Agriculture on
64 NORTH CAROLINA BOARD OF HEALTH.
application of Dr. Murphy through the Secretary of the State Board
of Health, the main water supply of the Hospital from the mountain
was pure, that from the bored or gang-wells contained bacteria, which,
while innocent in themselves, showed contamination from the surface.
As this demonstrated a connection between the surface and the water
of these wells, and therefore a constant danger of infection with dis-ease
germs, this supply had, very wisely we think, been cut off before
our arrival. All the wells on the ridge referred to were foimd to be
infected with the colon bacilli, which means that they had been con-taminated
by the bowel discharges of man or animals. The manage-ment
of the Hospital is, of course, not responsible for these wells.
So much for the water supplies.
Previous to the thorough and elaborate study of typhoid fever in our
army during the Spanish