Biennial report of the North Carolina State Board of Health

              %II^ETEEMH BIENNIAL REPORT
i)F THJE
CAROLINA
STATE BOARD OF HEALTH
92 M 922
of tt)B
Onitjcrsitp of Jl^ottb Carolina
CndotoeD hv ^^t SDialectic
ano
Pf)ilant!)copic ^otittits
WA
1
NS(o2b
1^20
-22-
NINETEENTH BIENNIAL REPORT
OF THE
NORTH CAROLINA
STATE BOARD OF HEALTH
DECEMBER 1, 1920 - JUNE 30, 1922
RALEIGH
Bykum Printing Company
1923
TABLE OF CONTENTS
Members ot" the Board 3
Preface 6
Public Health Work in North Carolina 7
Present Organization North Carolina State Board of Health 22
The Investment in Public Health 25
State Laboratory of Hygiene j. 29
Bureau of Vital Statistics 30
Work of the Bureau of Medical Inspection of Schools 33
Work of Bureau of Engineering and Inspection 35
Work of Bureau of Epidemiology 41
Bureau of Maternity and Infancy 49
Bureau of County Health Work 52
Minutes Annual Meeting North Carolina State Board of Health, 1921 56
Addenda I 57
Addenda II 80
Minutes of Meeting North Carolina State Board of Health 8 5
Minutes Annual Meeting North Carolina State Board of Health, 1922 9 3
Minutes of Meeting Executive Committee 96
h
Members of the State Board of Health
Elected by the North Carolina Medical Society
Thomas E. Anderson, M.D., Statesville
Term expires 1923
Charles O'H. Lalghinghoise. M.I>.. (ii'eenville
Term expires 19Jo
F. R. Harris, M.D.. Henderson
Term expires 1925
Cyrvs Thompson, M.D., Jacksdnville
Term expires 1925
Appointed by the Governor
J. Howell Way, M.D., Waynesville
Term expires 1923
A. J. Crowell, M.D.. Charlotte
Term expires 1923
Richard H. Lewis, M.D., LL.D., Raleigh
Term expires 1925
E. J. Tucker, D.D.S., Roxboro
Term expires 1925
Charles E. Waddell. C.E.. Aslieville
Term expires 1927
<^
Letter of Transmittal
Ealeigh, iSr. C, January 1, 1923.
His Excellency, Cameron Morrison,
Governor of North Carolina.
My dear Sir:—Under authority of chapter 118, Article I, section
7050, Consolidated Statutes of N'orth Carolina, I have the honor to
submit the Biennial Keport of the State Board of Health for the period
December 1, 1920, to June 30, 1922.
Very respectfully yours,
W. S. Rankin,
Secretary ami Treasurer.
Preface
The same principles "wliicli governed the preparation of the reports
for the past tAvo bienniums have been followed in the preparation of
this report. An effort has been made to avoid the inclusion of informa-tion
easily obtainable from other publications, and of information
largely of details and statistics of little general interest. The arrange-ment
by fairly independent sub-divisions is continued, so that it is pos-sible
to read and understand any part of the report without reading the
whole report.
Public Health Work in North Carolina
In the seventies Dr. Thomas Fanning Wood, of Wilmington, caught the
vision of the possibilities of public health work to North Carolina. How
fully he grasped the far-reaching consequences of his idea, how clearly he
saw th^ ever-growing hosts of lives saved as a result of his vision and in-spiration,
we shall never know. We do know that the vision never left
him, and that under its sway he worked, through the Medical Journal
which he edited and through the North Carolina State Medical Society,
until his influence reached the people of the State in their General Assem-bly
of 1877, with the effect that on February 12, 1877, the North Carolina
State Board of Health was born. Ours was the twelfth State board of
health to be established.
Without treating the development of the newly established board with
that thoroughness that could be termed history, we think it enough to set
down here in chronological order the principal events in the life and
growth of the North Carolina State Board of Health.
18 7 7. Board created. Consisted in the beginning of entire State Medical
Society. Society acted through a committee. Annual appropri-ation,
$100.
1878. First educational pamphlet issued. Subject, "Timely Aid for the
Drowned and Suffocated." Annual appropriation, $100.
1879. The General Assembly reconstituted the Board of Health. Made
it to consist of nine members: six appointed by the Governor
three elected by the State Medical Society. Term of office, five
years. Dr. Thomas F. Wood elected first Secretary of the Board,
May 21. Other legislative provisions: (1) Chemical examina-tion
of water, and (2) organization of county boards of health,
composed of all regular practicing physicians and, in addition,
the mayor of the county town, the chairman of the board of
county commissioners, and the county surveyor. Four educa-tional
pamphlets issued. Subjects: "Disinfection, Drainage,
Drinking-water, and Disinfectants"; "Sanitary Engineering";
"Methods of Performing Post-mortem Examinations"; "Limita-tion
and Prevention of Diphtheria." Annual appropriation,
$200.
1881. General Assembly passed a law requiring registration of vital
statistics at annual tax listing; law ineffective. Annual appro-priation,
$200.
188 5. General Assembly made county boards of health more efficient;
allowed printing privileges not to exceed $250 annually. Annual
appropriation, $2,000.
1886. Bulletin made its appearance in April. Pamphlet on "Care Eyes
and Ears," by Dr. Richard H. Lewis, printed and distributed.
Subsequent Legislature provided for extra edition of 10,000
copies for general distribution. Annual appropriation, $2,000.
8 North Carolina Board of Health
1S8S. Vellow fever epidemic in Florida and refugees to Western North
Carolina demonstrated value of a Board of Health to cope with
situation. Annual appropriation, $2,000.
1S92. Dr. Thomas F. Wood, the Secretary of the Board, died August 22.
Dr. Richard H. Lewis elected Secretary to succeed Dr. Thomas
F. Wood, September 7. Annual appropriation, $2,000.
18 9 3. Legislative provisions: (1) Laws improving the reporting of con-tagious
diseases, (2) the protection of school children from epi-demics,
(3) protecting the purity of public water supplies, and
(4) regulation of common carriers. Legislature provided that
Governor appoint Ave of the nine members of the Board of
Health, that the State Medical Society elect four, and that the
term of office of the members of the State Board of Health be
reduced from five to two years. The $250 printing limit was
removed. Pamphlet on quarantine and disinfection was pre-pared
and reprinted by many of the State papers. Annual appro-priation,
$2,000.
1894. A number of public health conferences were arranged and held in
different towns of the State. Bulletin was increased from a
mailing list of 800 to 1,200. Annual appropriation, $2,000.
18 9 5. Dr. Albert Anderson and Dr. W. T. Pate were elected bacteriologists
for the board. Annual appropriation, $2,000.
18 9 6. Board passed a resolution requiring chemical and bacteriological
examinations of municipal water supplies. Dr. Venable of Chapel
Hill undertook the chemical examination, and Drs. Anderson
and Pate the bacteriological examination. Board also directed
Mr. John C. Chase, the engineer member, to inspect all munici-pal
water plants in the State. Annual appropriation, $2,000.
18 9 7. General Assembly enacted law requiring county superintendents
of health to be elected by county commissioners, and reduced
term of office to one year. Annual appropriation $2,000.
18 99. General Assembly improved the laws protecting public water sup-plies.
Smallpox prevailed extensively in the State. Dr. Henry
F. Long, and later, on Dr. Long's resignation. Dr. Joshua Tayloe
were employed to travel over the State, consulting with and ad-vising
the local sanitary authorities as to proper means for
protecting the public. Annual appropriation, $2,000.
1900. State Board of Agriculture, on request of State Board of Health,
agreed to examine samples of water from public water supplies
until Board of Health could provide its own examiner. Annual
appropriation, $2,000.
1901. State Board of Embalmers, with representatives of State Board of
Health, established. County health work placed in the hands of
county sanitary committees composed of county commissioners
and two physicians which commissioners elected to serve with
them. Term of office of county superintendent of health made
two years. Annual appropriation, $2,000.
1903. General Assembly enacted law permitting Board of Health to charge
$5 for each analysis of a public water supply, this fee to be used
in paying Department of Agriculture for services of examiner.
Dr. C. W. Stiles, U. S. P. H. S., before the State Medical Society
XixETEEXTH Biennial Report 9
at Hot Springs, called attention to prevalence of hookworm
disease in tlie South. Dr. J. L. Nicholson and Dr. W. S. Rankin,
working under State Board of Health during fall of 1903 and
spring of 190 4, showed great prevalence of this disease in North
Carolina. Annual appropriation, $2,000.
1904. A stenographer was employed. One hundred and twenty thousand
pamphlets on tuberculosis were printed and distributed. There
was a renewal and an extension of co-operative work between
the Board of Health and the State press, a number of articles
dealing with hygienic and sanitary subjects being furnished the
papers and published in them. Annual appropriation, $2,000.
1905. General Assembly established State Laboratory of Hygiene; im-posed
water tax of $64 on all public water companies; voted
$600 annually for support of Laboratory. Small appropriation
made it necessary for the Department of Agriculture to continue
to assist State Board of Health. Annual appropriation, $2,600.
1906. The North Carolina Association for the Study and Prevention of
Tuberculosis was organized. Annual appropriation, $2,600.
190 7. Two thousand dollars appropriated for the State Laboratory of
Hygiene. Pasteur treatment provided. State sanatorium for
treatment of tuberculosis founded: $15,000 appropriated for
permanent improvements and $5,0 for maintenance. A law
requiring the separation of tuberculous prisoners from other
prisoners was enacted. Annual appropriation, $4,000.
1908. January 1, Dr. C. A. Shore became Director of State Laboratory of
Hygiene. Annual appropriation, $4,000.
1909. General Assembly provided for (1) whole-time State Health Officer;
(2) collection of vital statistics of towns having a population
of 1,000 or over; (3) that all public water companies file plans
and specifications of their plants with the State Board of Health,
and that the State Board of Health pass necessary rules and
regulations for the care of public watersheds and plants and
furnish such rules and regulations and other advice to those
having charge of public water supplies; (5) that counties pro-vide
free diphtheria antitoxin for county indigents, and (6) that
the maintenance appropriation for the Sanatorium be increased
from $5,000 to $7,500, and an additional $30,000 be granted for
permanent improvements. Dr. Richard H. Lewis resigned as
Secretary of the Board, and Dr. W. S. Rankin was elected as
his successor, beginning his official work July 1. Annual appro-priation,
$10,500.
1910. General effort to interest the people and State organizations in
public health work. Bulletin increased from 3,500 edition to
10,500 edition. Addresses on public health work delivered to
Conference of County Superintendents of Schools, State Feder-ation
of Women's Clubs, State Press Association, and Sanitary
Sunday observed in April. Dr. John A. Ferrell elected, Febru-ary,
Assistant Secretary for Hookworm Eradication; began work
under State Board of Health and Rockefeller Sanitary Commis-sion.
First effort in the eradication of hookworm disease was
to interest school teachers in the disease and through their
10 N^ORTH Carolina Board of Health
assistance examine and treat the children, and thereby reach
the community. Three bottled spring waters sold on the mar-ket
examined, found polluted, and public attention called to the
pollution. Annual appropriation, $10,500.
1911. Legislature established county boards of health to take the place of
the county sanitary committees; county board of health com-posed
of chairman board of county commissioners, county super-intendent
of schools, mayor of county town, and two physicians
selected by the three county officials to serve with them. Legis-lature
also abolished quarantine for smallpox and improved the
quarantine laws. One thousand dollars annually appropriated
to contract with antitoxin manufacturers for State supply of
high-grade diphtheria antitoxin, with result that price of anti-toxin
was cut to one-fourth former price, saving the citizens of
the State over $30,000 annually. Bulletin increased from 11,500
copies to 20,000 copies each edition; closer co-operation with
press of State developed; regular weekly press articles prepared
and sent to papers; increase in numbers of popular pamphlets
for distribution. Hookworm work this year largely educational
through the school forces and investigative through county dis-pensaries;
thousands of children found infected and treated.
Strong sentiment began to make itself felt for better health
work by counties, four counties employing whole-time county
health officers. Maintenance appropriation for State Sanatorium
increased to $12,500, with $20,000 voted for permanent improve-ments.
Annual appropriation, $22,500.
1912. Bulletin increased to 40,000 edition; number of popular pamphlets
dealing with different diseases increased; press work improved;
educational work of Board along all lines amplified. Secretary
of Board of Health called attention of conjoint meeting of State
Medical Society and State Board of Health to the relative im-portance
of health problems and the bearing of this subject upon
the proper apportionment of health funds; instrumental in pass-ing
a resolution to the effect that pellagra was an interstate
problem, not a State problem, and requesting the Federal Gov-ernment
to deal with pellagra as a Federal problem; resolution
responsible, to considerable extent, for successful effort on part
of Hon. John M. Faison's securing congressional appropriation
of $45,000 for the study of pellagra by the Federal Government.
Hookworm work extended and county funds appropriated to
supplement State and Rockefeller Foundation for this work.
Annual appropriation, $22,500.
1913. General Assembly passed Model Vital Statistics Law with $10,000
appropriation for its enforcement. County superintendents of
health changed to either county physician or county health offi-cer.
Educational efforts of Board continued and enlarged.
Hookworm work along same line as year before increased in
amount. Dr. John A. Ferrell resigned as Assistant Secretary
to accept position with the central office of the Rockefeller Sani-tary
Commission in Washington, D. C. Dr. C. L. Pridgen suc-ceeded
Dr. Ferrell. The movement for improved county health
Nineteenth Biennial Report 11
work had by this time resulted in ten counties electing whole-time
county health officers. The State Sanatorium for Treat-ment
of Tuberculosis turned over by Extra Session of 1913 to
the management of State Board of Health. Annual appropria-tion
$40,500.
1914. Preceding work of the Board continued. Board of Health took over
management of Sanatorium; started out under many difficulties
on account of the institution owing many debts and the appro-priation
being limited. Hookworm work changed to community
work directed to the installation of sanitary privies in all homes.
Laboratory began to produce and distribute free anti-typhoid
vaccine. Dr. C. L. Pridgen resigned as Director Hookworm
Eradication, and Dr. W. P. Jacocks succeeded him. Annual ap-propriation,
$40,500.
1915. General Assembly makes State vital statistics law conform to
National model by requiring burial permits in rural communi-ties;
enacts legislation permitting county commissioners and
towns and cities to appropriate money for support of tuberculous
citizens in State Sanatorium; provides $15,000 for purchase and
building of anti-toxin plant; appropriates $60,000 for payment
of Sanatorium debts and new buildings and other improvements,
and $25,000 annually for maintenance and $10,000 for exten-sion
anti-tuberculosis work. Educational work greatly ex-tended:
Bulletin now 47,000; traveling public health exhibit
shown at fairs and other assemblages; press work greatly de-veloped
through employment of journalist for whole time; stock
lectures with lantern slides supplied public speakers in different
parts of the State. Community soil pollution work under Dr.
W. P. Jacocks stops in May, and Bureau of County Health Work
with Dr. G. M. Cooper at its head, succeeds, beginning work in
June. Considerable amount of work done for improvement of
prison conditions. The unit system of county health work gets
a good start: over 52,000 people given three complete vaccina-tions
against typhoid fever, and medical inspection of schools
put on in one county. Annual appropriation, $50,500.
1916. North Carolina was admitted to the Registration Area for deaths.
To the educational agencies of the Board was added a self-supporting
moving picture health show. Many saw this show
during the year, and, seeing, believed in health work as never
before. Bulletin had to be discontinued temporarily for lack of
printing funds, but before discontinuance reached 51,000 edition.
Co-operation with University in developing a plan and putting
on a home post-graduate course in medicine, giving first course
to 169 doctors. Put into operation an optional system of hotel
inspection, with grading and publishing scores. Continued unit
system of county health work, giving three anti-typhoid injec-tions
to 48,000, making 10 0,000 immunized in summers of 1915
and 1916. Did complete medical inspection of five counties and
with inspection a large amount of educational work as to sani-tary
and hygienic living. Secured effort by Federal Children's
Bureau to develop unit of child hygiene work, the Bureau using
12 N^OKTH Carolina Board of Health
two employees to work in Cumberland and Swain counties for
about eight months. Laboratory of Hygiene buys land and
erects its own building. Sanatorium making a decided impres-sion
on the State. Annual appropriation, $55,500.
1917. The General Assembly passed the following important health legis-lation:
Chapter 263, entitled "An act to prevent and control the
occurrence of certain infectious diseases in North Carolina";
chapter 244, entitled "An act to provide for the physical exami-nation
of the school children of the State at regular intervals";
chapter 276, entitled "An act for the co-operative and effective
development of rural sanitation"; chapter 2 5 7, entitled "An
act to prevent blindness in infancy, designating certain powers
and duties and otherwise providing for the enforcement of this
act"; chapter 66, entitled "An act to provide for the sanitary
inspection and conduct of hotels and restaurants"; chapter 28 6,
entitled "An act to regulate the treatment, handling and work
of prisoners."
Following the enactment of this legislation, administrative
machinery, consisting of a Bureau of Epidemiology under the
direction of Dr. A. McR. Crouch, a Bureau for the Medical In-spection
of Schools under the direction of Dr. Geo. M. Cooper,
and a Bureau for County Health Work, under the direction of
Dr. B. E. Washburn, was established. Dr. Washburn, an officer
of the International Health Board, was loaned to the State with-out
cost and the International Health Board, in addition to fur-nishing
Dr. Washburn, appropriated $15,000 annually for rural
sanitation in accordance with the provisions of clfapter 2 76.
The United States Public Health Service in February, 1917,
detailed Dr. K. E. Miller to study county health work in different
sections of the country and to establish for demonstration pur-poses,
in Edgecombe County, department of health on an eco-nomic
basis easily within the financial reach of the average
county.
The State Laboratory of Hygiene moved into its own building
January 15, 1917.
The State was admitted to the registration area of the Union
for births in January, 1917, the Bureau of the Census having
found after investigation that our birth registration was 9 6 per
cent complete.
The special campaign against typhoid fever, begun so satis-factorily
in 1915, was continued. Free vaccination of the people,
however, was interferred with by the difficulty in securing medi-cal
officers to do the work, the preparedness program of the
Government having caused many physicians and nurses to enter
the Army and Navy; nevertheless, a total of 30,000 citizens of
the State were vaccinated as a direct result of the Board's activi-ties,
and many thousands of others were vaccinated by the phy-sicians
of the State as a result of the educational work of the
Board directed to impressing the people with the value of vacci-nation
as a means of prevention for typhoid fever.
Nineteenth Biennial Report 13
In December, 1917, life extension work as developed by the
Life Extension Institute of New York, which consisted briefly of
the free physical examination of interested citizens for the pur-pose
of advising them as to their physical condition and needed
hygienic reform and medical treatment, was begun on a county
basis. The funds necessary for this work were appropriated
partly by the State and partly by the counties in which the life
extension work was carried out. Dr. Amzi J. Ellington, who at
the time was a resident physician in the New York City Hospital
and who had during his residency in that institution studied
the methods of the Life Extension Institute under Dr. Eugene
Lyman Pisk, was employed and placed in charge of the work.
Life extension work was carried out in Vance, Alamance, Lenoir
and Robeson counties, and resulted in the full physical examina-tion
of 4,000 citizens. This work was very favorably received,
and the outlook for its continued development seemed excellent
when, with the declaration of war and the call for physicians
to enter the militarj'^ service of the country. Dr. Ellington en-listed
in the Medical Corps of the Army. For this reason, and
for the further reason that it has been almost impossible to
secure health officers during the past two years, the work was
not resumed.
The educational work of the State Board of Health consisted
in the issuance of eight Bulletins, each monthly edition amount-ing
to 45,000, and a daily newspaper health article. The Bureau
continued its moving picture show exhibit and, in addition, pre-pared
probably the best three-dimension educational exhibit in
the United States. In 1917 the following exhibits were given:
motion picture entertainments, 23 6; traveling public health ex-hibits,
32; special exhibits, 58; stereopticon entertainments, 3
—
to a total of 9 5,00 people. Arrangements were made for the
preparation of newspaper plate, which was sent to and exten-sively
used by 202 papers having a total circulation of 303,000.
A large part of this newspaper material was prepared by the
well-known authority and publicist in matters of sanitary and
hygienic education, Dr. W. A. Brady, of Elmira, New York.
The annual appropriation for the State Board of Health was
.$60,772.16. The annual appropriation for the State Laboratory*
of Hygiene was $12,500, and this, in addition to $9,087.22 in
fees permitted under the laws of the State to be paid to the
Laboratory for special work, provided the Laboratory with a
total annual budget of $21,587.22.
1918. Much of the work this year was influenced by the war and had to
do with preparedness. The State Health Officer visited Wash-ington,
at the request of the Council of National Defense and
as chairman of a committee of State Health Officers, on a num-ber
of occasions for conferences with respect to preparedness
measures, provisions for the control of venereal diseases,
arrangements for co-ordinating the control of infectious diseases
in the civilian population with their control in cantonments,
and to arrange, if possible, with the Public Health Service and
14 INToRTH Carolina Board of Health
the Surgeon General of the Army for preserving the personnel of
State health departments during the war. The State Health
Officer also made a visit to the States of South Carolina, Georgia,
Alabama and Florida for the Council of National Defense in
order, if possible, to interest the Governor, the State Board of
Health, and the State Council of Defense in venereal disease
control.
Considerable time was given to assisting Major John W. Long,
Medical Aide to the Governor, in the work of organizing the
Medical Advisory Boards and in interesting physicians in enter-ing
the medical service of the Army and Navy, and, later in the
year, in inducing the physicians of the State to become members
of the Volunteer Medical Service Corps.
Partly as a result of these activities, the Surgeon General of
the Army assigned Major Joseph J. Kinyoun to assist the State
Board of Health in the control of communicable diseases, the
Board being under no financial obligation for Major Kinyoun's
assistance; and as a result of the successful termination of the
activities of various interests looking to a more effective con-trol
of venereal diseases, the Kahn-Chamberlain Bill passed
Congress, and made available to the State of North Carolina,
and without condition $23,988.61 for venereal disease work.
The Laboratory during this year began the distribution of a
high grade of diphtheria antitoxin.
The Bureau of Medical Inspection of Schools developed, and
with a degree of success that we may say established, free dental
clinics for the public schools of the State. The Bureau also
developed to a successful extent an arrangement in the form of
adenoid and tonsil clubs for the practical and economic treat-ment
of public school children suffering from these defects.
The Bureau of Epidemiology employed two third-year medical
students, equipped them with motorcycles, and put them into
the iield to investigate infringements of the quarantine law.
Sufficient convictions were obtained to impress the medical pro-fession
with the determination of the State to enforce its health
laws, and a fairly satisfactory compliance with the laws regard-ing
the reporting of communicable diseases was brought about.
The Bureau of Venereal Diseases, paid for by the Federal
appropriation, was established in September under the director-ship
of Dr. James A. Keiger, of Charlotte, N. C.
Mr. Warren H. Booker, for the last seven years the efficient
director of the Bureau of Engineering and Education, left in
September for Red Cross work in France, the work of his Bureau
being continued, with the exception of the engineering work,
by Mr. Ronald B. Wilson. As a result of Mr. Booker's leaving*,
certain funds became available, and a Bureau of Infant Hygiene,
under the directorship of Mrs. Kate Brew Vaughn, was organ-ized
late in 1918.
Perhaps the most outstanding feature of the health work
during the year 1918 was the epidemic of influenza. The epi-demic
began early in October and caused in October alone 6,056
Nineteenth Biennial Report 15
deaths; in November 2,133 deaths; and in December 1,497
deaths, a total during the last three months of 9,68 6 deaths.
The annual appropriation for the State Board of Health for
1918 was $73,210.38.
The annual appropriation for the State Laboratory of Hygiene
was $12,500. The Laboratory, during this year, collected
$8,532.48 in fees for special work, so that the total income of
the Laboratory for this year was $21,03 2.48.
1919. The General Assembly passed the following important health legis-lation:
chapter 71, entitled "An act to prevent the spread of
disease from insanitary privies"; chapter 192, entitled "An act
to provide for the physical examination and treatment of the
school children of the State at regular intervals"; chapter 206,
entitled "An act for the prevention of venereal diseases"; chap-ter
213, entitled "An act to require the provision of adequate
sanitary equipment for public schools"; chapter 214, entitled
"An act to obtain reports of persons infected with venereal
diseases"; chapter 215, entitled "An act for the repression of
prostitution"; and chapter 288, entitled "An act to amend chap-ter
671, Public-Local Laws of 1913, relating to the injunction
and abatement of certain nuisances."
The Bureau of Engineering and Inspection was organized in
April. The engineering work of the Board had been suspended
with the resignation of Mr. Warren H. Booker in September,
1918, Mr. Booker having gone to France to engage in tubercu-losis
work under the direction of the Red Cross. Between
September, 1918, and April, 1919, the engineering problems
coming before the Board had been referred and very kindly and
effectively taken care of by Col. J. L. Ludlow, of Winston-Salem.
Mr. H. E. Miller, an engineer and a graduate of the University
of Michigan, was placed in charge of the new bureau, and his
brother. Dr. K. E. Miller, of the United States Public Health
Service, was detailed by the Service to assist him in the organi-zation
of his work. Mr. H. E. Miller and Dr. K. E. Miller spent
the spring and summer and a part of the fall in studying various
types of privies, in preparing plans for the construction and
maintenance of privies, and in preparing the necessary notices
and literature to inform the people of the objects and require-ments
of the new privy law.
On May 1st Dr. A. J. Warren, health officer of Rowan County,
was appointed to and accepted the position of Assistant Secre-tary
of the Board.
On July 1st Mr. R. B. Wilson accepted the position of Director
of Public Health Education.
On August 1st Dr. A. McR. Crouch, Director of the Bureau of
Epidemiology , resigned to accept a position with the city of
Wilmington. Dr. F. M. Register, whole-time health officer of
Northampton County, succeeded Dr. Crouch as director of the
bureau.
In September Dr. J. R. Gordon, Director of the Bureau of
Vital Statistics since 1914, resigned on account of impaired
16 North Carolina Board of Health
health, and on October 1st the Bureau of Epidemiology and the
Bureau of Vital Statistics were combined and placed under the
direction of Dr. Register.
In September Mrs. Kate Brew Vaughn, Director of the Bureau
of Infant Hygiene, resigned. The bureau was reorganized under
an understanding with the American Red Cross and was en-larged
to include, in addition to infant hygiene, the problem of
public health nursing, the name of the bureau being changed
to that of "Bureau of Public Health Nursing and Infant Hy-giene."
Under the agreement with the Red Cross this bureau
was to have an available appropriation of $12,000 a year, half
of which was to be furnished by the American Red Cross and
half by the State Board of Health. The personnel of the bureau
and its plan of work, under the agreement, was made contingent
upon the approval of both participating agencies, the American
Red Cross and the State Board of Health. In December Miss
Rose M. Ehrenfeld took charge of the new bureau and began its
organization and work.
On October 1st Dr. Jas. A. Keiger, Director of the Bureau of
Venereal Diseases, resigned and Dr. Millard Knowlton was ap-pointed
to succeed him.
The typhoid campaign, carried on during the summer through
previous years, was continued in the summer of 1919, using third
year medical students, furnished either with automobile or
motorcycle for getting about. Campaigns were carried out in
the following counties: Bertie, Cabarrus, Chatham, Chowan,
Columbus, Craven, Hertford, Iredell, Johnston, Lincoln, Onslow,
Pasquotank, Perquimans, Randolph, Richmond, Rockingham,
Stanly, Union, Warren, Wayne. A total of 49,076 were given
complete vaccinations.
The educational work of the Board consisted of the publica-tion
of a 48,000 monthly edition of the Bulletin, and the distri-bution
of about 350,000 pieces of public health literature.
The funds available during this fiscal year amounted to $198,-
549.14, of which $102,301.98 was from State appropriations and
the remainder from outside sources.
The appropriation for the State Laboratory of Hygiene for
this year was $28,500; in addition to this, the Laboratory col-lected
in fees for special work, for antitoxin, and in water taxes
a total of $14,344.02, making a total of $42,844.02 available
for work of Laboratory.
1920. During this year there was a Special Session of the General Assem-bly,
lasting twenty days and held in the latter part of August.
This Special Session passed an act amending the vital statistics
law, making the fees for local registrars 50 cents instead of 25
cents for each certificate properly filed with the State Board of
Health.
On January 1st Dr. B. E. Washburn, who had had general
direction of the co-operative county health work and who had
rendered most acceptable service, was recalled by the Interna-tional
Health Board and detailed to take charge of their inter-
N^INETEENTH BlENNIAL RePOET 17
ests in Jamaica. Dr. K. E. Miller, of the United States Public
Health Service, who had been detailed in January, 1917, to
organize a model county health department in Edgecombe
County and then, in 1919, to assist his brother, Mr. H. E. Miller,
in organizing the work of the new Bureau of Engineering and
Inspection, to which was assigned the duty of enforcing the
State-wide privy act, succeeded Dr. Washburn as Director of the
Bureau of County Health Work.
In January a co-operative effort with the United States Public
Health Service and the International Health Board to demon-strate
the possibilities and advantages of the eradication of
malaria from certain towns and cities in the eastern part of the
State was begun. The terms of co-operation were that the Inter-national
Health Board and the State Board of Health were to
pay one-half of the expenses of the local work and the town or
city in which the work was done the other half, the Public
Health Service furnishing, as its part, expert supervising per-sonnel.
The towns and cities chosen for this work were Golds-boro,
Farmville, and Greenville, the budgets for each munici-pality
being, respectively: Goldsboro, $13,670.98; Farmville,
$5,000; and Greenville, $9,000, a total investment in this work
of $27,670.98. Mr. A. W. Fuchs, Associate Sanitary Engineer,
was detailed by the Service to have supervision of the work.
In February Dr. A. J. Warren, Assistant Secretary of the State
Board of Health, resigned his position in order to accept the
appointment of city health officer of Charlotte, North Carolina.
In the winter and spring of 1920, the North Carolina Land-owners
Association, under the progressive leadership of Mr.
W. A. McGirt, of Wilmington, undertook a very extensive educa-tional
campaign against malaria, which was carried on through
the public schools of thirty-eight counties in Eastern North
Carolina. A series of county and State prizes for the best essay
on malaria by public school children were offered as an induce-ment
to the school children to interest and inform themselves,
and, indirectly, their parents, with regard to the importance of
this disease. To make possible this work by the school children
7 5,000 malaria catechisms, prepared by Dr. H. R. Carter, of the
United States Public Health Service, were distributed through
the public schools of the eastern part of the State to the school
children. Thousands of essays were written, and it is reason-able
to believe that the campaign was one of the most successful
public health educational attempts yet undertaken.
In June it was found advisable to separate the Bureau of
Epidemiology and the Bureau of Vital Statistics which had, on
account of the scarcity of health officers, been placed under the
directorship of a single bureau chief. Dr. F. M. Register. Dr.
Register was appointed Director of the Bureau of Vital Statis-tics
and Dr. J. S. Mitchener was appointed Director of the Bureau
of Epidemiology.
In April the Interdepartmental Social Hygiene Board assigned
to the State Board of Health several workers for making a study
18 XoRTH Carolina Board of Health
of vice conditions in North Carolina towns and cities and for
taking such steps as were found expedient for decreasing prosti-tution.
This group of workers was withdrawn in September, on
account of differences developing between them and Dr. Knowl-ton,
chief of the Bureau of Venereal Diseases, with the under-standing
that another group of workers would be assigned to
this work at a later date.
J
In June arrangements were made with the United States Pub-
1" lie Health Service and the American Social Hygiene Association
for the development of an elaborate educational unit on sex
hygiene and venereal diseases designed to reach rural meetings
through the use of picture films and a portable truck. An outfit
consisting of several lecturers and a moving picture truck began
work in Cumberland County in August, and from its very begin-ning
met a most cordial reception and gave every promise of
developing into one of the most useful agencies for dealing with
the venereal disease problem.
During the year the anti-tjiphoid vaccination campaign was
continued in Alamance, Bladen, Columbus, Duplin, Franklin,
Gaston, Harnett, and Mecklenburg counties. Co-operative cam-paigns,
in which the counties furnished the working personnel,
were also carried on in Anson, Johnston and Rutherford coun-ties.
A total of 29,4.35 citizens have been vaccinated against the
disease, and this does not include Columbus County, in which
the work was just beginning when this report was completed.
The educational work of the State Board of Health during
this year consisted of a 48,000 monthly edition of the State
Board of Health Bulletin and the distribution of approximately
350,000 pieces of public health literature.
The funds available during this fiscal year amounted to $.3 4 2,-
284.33, of which $176,152.61 was State appropriation and the
remainder from outside sources:
The appropriation for the State Laboratory of Hygiene for
this year was $25,000; in addition to this, the Laboratory col-lected
in fees for special work, for antitoxin and in water taxes,
a total of $13,698.89, making a total of $38,698.89 available
for the work of the Laboratory. The above amount being insuf-ficient,
the Special Session of the Legislature authorized a loan
of $15,000 to enable the work of the Laboratory to be carried
on, making a total of $53,698.89 available for the work of the
Laboratory during this year.
1921. The Legislature meeting early in January of this year was asked
by the Board to amend the State law restricting the salary of
the executive officer of the Board to $3,000 annually, so as to
make the salary $5,000. Such an amendment was passed. A
further request from the Board was that legislation be enacted
removing the inspection tax of forty cents from privies coming
under the supervision of the Board of Health. Such an amend-ment
to the State-wide Privy Law was also enacted. A bill was
introduced in this session of the General Assembly under the
initiative of Hon. Emmet H. Bellamy requiring a physical
N^INETEENTH BlENNIAL RePOKT 19
examination of all applicants for marriage and making issuance
of license contingent upon the physical qualifications of the
applicant. The State Board of Health approved and supported
Mr. Bellamy's bill, realizing, as did the author of the bill, that
the proposed legislation was but a step in the right direction
and was, therefore, rather loosely drawn and left many things
to be desired. The bill finally passed in amended form as chap-ter
12 9, Public Laws of 1921.
The general health of the State for 1921, as indicated in the
vital statistical records for that year, published by the United
States Bureau of the Census, was good, and there was an im-provement
in reduced death rates for a number of diseases, as
well as a reduction in the general death rate over previous
years.
Another general condition of State-wide importance with a
vital bearing on the work of the Board of Health which had
to be taken into account was a considerable amount of mis-understanding
between respectful groups of the medical pro-fession
and the Board of Health regarding matters of policy.
Many physicians, men in good standing professionally and men
with high civic ideals, seemed to feel that the Board of Health
had no well-considered and reasonable objectives in the field of
public health as it is related to that of private practice. This
general condition was responsible for the Board of Health seek-ing
and availing itself of opportunities to meet the profession,
both in counly, district and State societies, and to discuss with
the profession what it conceived to be the proper relation be-tween
public health activities and professional practice. This
subject was presented to and considered by the State Medical
Society in its conjoint meeting with the State Board of Health
at Pinehurst in April, 19 21. See transactions Medical Society
of the State of North Carolina, pages 472-506. As a result of
these various conferences between representative men engaged
in public health work and the profession, the general condition
of misunderstanding and some little friction had disappeared
to a large extent by the latter part of the year. Nevertheless,
the results of contact between those engaged in social medicine
and private practice were such as to encourage further confer-ences
and efforts to bring about a fuller recognition of mutual
interests on the part of the public and the profession, and the
ultimate adoption of a program of relations which would be to
the mutual advantage of both parties.
Perhaps the most important change inaugurated in State
health administration during this year was the adoption of a
cost basis for standardizing and measuring the efficiency of
public health work in those counties in which the State par-ticipated
financially. This new principle is fully described in
the State Board of Health Bulletin for January, 1922, and a
further discussion of cost basis for public health work is unneces-
20 iN^ORTH Caroliica Board of Health
sary here except, perhaps, to say that it is apparently at least
one of the first attempts to introduce the cost system of industry
into government.
The Bureau of Venereal Diseases, in charge of Dr. Millard
Knowlton, established as a part of the war-time activities of
the Board in co-operation with the Bureau of Venereal Diseases
of the Federal Government, was combined with and made a
part of the work of the Bureau of Epidemiology, under the
general direction of Dr. J. S. Mitchener.
Details of the activities of the Board are enumerated else-where.
Funds available during this fiscal year and their distribution
are shown in the following tabulation:
1921
Receipts
State Appropriations $275,000.00
International Health Board 13,077.24
U. S. Public Health Service 15,164.81
American Red Cross 6,987.72
Bureau of the Census 3,499.17
Counties 111,996.71
License Fees 6,366.40
Miscellaneous 7,092.37
Total $43 9,184.42
Disti'ibiition
Executive Department $ 54,517.50
Bureau County Health Work 178,569.31
Bureau Engineering and Inspection 55,374.15
Bureau Epidemiology 13,978.86
Bureau Medical Inspection of Schools 60,665.41
Bureau Public Health Nursing and Infant Hygiene__ 13,487.72
Bureau Venereal Diseases 38,360.73
Bureau Vital Statistics 24,230.74
Total $43 9,18 4.42
1922. In order to bring the records of this department into harmony with
those of other State departments, in accordance with the act of
the General Assembly of 19 21. changing the fiscal year of the
State so as to begin on July first each year, this report ends
with June 30, 19 22. It, therefore, covers a period of nineteen
months; one full fiscal year from December 1, 19 20, to Novem-ber
30, 1921; seven months from December 1, 1921, to June
30. 1922. Effective February 1, the American Red Cross Society
abrogated the agreement existing since 1919 by which it jointly
financed, with the Board of Health, the Bureau of Public Health
Nursing and Infant Hygiene. This bureau was reorganized
April 1 as the Bureau of Maternity and Infancy, for its main-tenance
the State receiving $27,259.66 annually from the United
States Government in accordance with the Sheppard-Towner
Act for the promotion of the welfare of mothers and infants.
IS'lNETEENTH BlENNIAL. RePORT 21
Dr. K. P. B. Bonner, of Morehead City, was secured as the
director of the reorganized Bureau, with Miss Rose M. Ehrenfeld
as supervisor of nursing and Mrs. T. W. Bickett in charge of
educational work.
The funds available during this period, and their distribution,
were seven-twelfths of the amounts set out under the tabulation
for 1921.
The appropriation for the State Laboratory of Hygiene for the
nineteen months between December 1, 19 20, and June 30, 19 22,
was $87,083.33; in addition to this, the Laboratory collected in
fees for special work, for antitoxin, and in water taxes, a total
of $30,872.51, making a total of $117,955.84 available for the
work of the Laboratory.
22 !N"oRTH Carolina Board of Health
PRESENT ORGANIZATION OF THE NORTH CAROLINA STATE
BOARD OF HEALTH
The North Carolina State Board of Health consists of the Board proper
and the executive staff.
The Board of Health, as indicated diagramatically on page 24, consists
of nine members, five of whom are appointed by the Governor and four
of whom are elected by the North Carolina State Medical Society. The
organization of this body includes two important administrative principles:
(1) stability of organization and permanency of policies; (2) partner-ship
of the State and the medical profession in the conservation of human
life.
The stability of the organization of the Board of Health depends
fundamentally upon flie Board's freedom from political tinkering. The
divorcement of the State Board of Health from politics depends largely
upon the manner of selecting the members of the Board. Sudden and
marked changes in the personnel of the Board under the present plan
of organization are impossible: First, because the members of the Board
of Health are appointed for terms of six years and the terms of service
of different members expire, not in the same year, but in different years.
The appointment of new members of the Board is, therefore, gradual and
not sudden. Second, the Board of Health is selected by two parties: one,
the Governor, and the other, the State Medical Society. It is far less likely
that two parties naming a Board would be dominated by political con-siderations
than where one party names the Board. This division of the
appointive and elective power and this provision for the gradual exercise
of that power by two parties guarantee the State Board of Health against
the sudden changes of personnel and policy associated with a purely
political organization. The Board of Health is stable; its individual mem-bers
come and go, but as an organized body it stays.
This stability of organization is the responsible factor for the perma-nency
of policies adopted by the Board. Political boards elected or ap-pointed
for two years or four years are naturally inclined to adopt two
and four-year policies, to attempt to make the best showing possible
during the short term of their official life. Their administrative thoughts
and plans are largely defined by the time limitations of their administra-tion.
This is not true of a self-perpetuating body such as the Board of
Health; that, as legally constituted, has no limit to its life.
The second administrative principle included in the organization of the
State Board of Health is the recognition by the State of the fundamental
relation of the medical profession to the work of disease prevention. The
State recognizes (1) the debt of society to that profession by which nearly
all of the experimentation and discovery on which disease prevention is
based, with the exception of the work of Pasteur, was contributed; (2)
the interest of organized medicine in the conservation of human life and
the peculiar ability of organized medicine to advise the State as to the
methods of prevention, and (3) the necessity of securing from the medical
profession, first, information in regard to the occurrence of deaths and
their causes, and the appearances of epidemics.
Nineteenth Biennial Report 23
The executive staff of the State Board of Health may be divided into
tlie executive office and tlie various bureaus or special divisions.
The Executive Office.—The executive officer of tlie State Board of Health
should be a man with technical training and experience, and, therefore,
should be selected on account of his technical rather than his political
qualifications. It is, therefore, right that the Secretary of the State Board
of Health, the executive officer, should be selected by a specially qualified
committee, that is, the State Board of Health, and not elected in a general
election, as would be the case if the office were a political one. The six-year
term of office for which the Secretary is elected is in accordance with
the idea of permanency of policies.
The Bureaus or Special DivLsions of the Executive Staff.—The work of
the State Board of Health is large and varied, and is, therefore, appor-tioned
among eight bureaus. These bureaus are each directed by an
officer with special talent and training. The different bureaus and their
more important problems are fully and clearly indicated in the diagram
on page 24.
The Correlation of the AVork of the Board.—This is also clearly indi-cated
in the diagram on page 2 4. The division of the executive staff into
special bureaus has the advantage of giving individualism to the work of
each bureau and thereby creating a laudable pride and a healthy rivalry
among the various bureaus engaged in the general work of the Board.
While each bureau is separate and independent of other bureaus, as indi-cated
in the diagram, the work of the entire executive staff is co-ordinated,
the work of the Board being given compactness, by the relation of the
bureaus to one another through the executive office of the Board.
CD
N'iNETEENTH BlENNIAL RePORT 25
THE INVESTMENT IN PUBLIC HEALTH
North Carolina today holds rank as one of the most healthful States
of the Union. For the past two years this State has maintained the
highest birth rate, and at the same time has had a death rate below the
average death rate of the United States registration area which now com-prises
approximately 8 per cent of the population of the country. Coin-cident
with the tremendous development of agriculture and industries
during the years of the l^resent century has been an improvement in
general health conditions no less remarkable.
On account of its geographical location the State is especially susceptible
to two semi-tropical diseases, malaria and hookworm disease. On account
of its predominating rural population typhoid fever and other fecal borne
diseases have largely affected the public health. Yet today hookworm
disease is becoming rare in the State; malaria is making a last stand in
certain sections of the State as yet undrained or only partially developed
agriculturally; and typhoid fever has been removed as a major factor
In the public health.
The vital statistics records for the State as compared with those of the
nation show that North Carolina has made a greater degree of improve-ment
in the health of its people since 1900 than has the country as a
whole. In 19 00 the death rate for the registration area was 17.6 per
thousand of population. At that time North Carolina had no accurate
records, but it is estimated that the death rate for the State was approxi-mately
22 per thousand of population. This very high death rate has
been steadily decreased year by year until in 1921 the State had a rate
of 11 per thousand of population as compared with a rate of 11.7 for the
country as a whole.
This marked reduction in the death rate is the more noteworthy when
considered in connection with the high birth rate. In 1921 the latter
was 33.4 per thousand of population, for the second successive year being
the highest rate in the United States. This means an addition annually
to the population of a large group which is most susceptible to a number
of fatal diseases. Despite this large annual infant population, however,
the mortality rate among infants has been reduced, and the State stands
well toward the top in this particular.
Tuberculosis, which holds a place throughout the world as one of the
major causes of death, in 1921 claimed more than a thousand less victims
in this State than in 1914, the first year for which dependable records are
available. The total number of deaths from this cause in 1921 was 2,641,
giving the State a rate of 9 8.4 per hundred thousand, or slightly under
the rate for the registration area. This enviable record was made despite
the fact that nearly five hundred deaths from this cause were of non-residents,
patients at government or private hospitals maintained in
North Carolina because of its excellent climatic conditions. This rate is
far under that of any other Southern State, with the single exception of
Florida.
Sustaining the records of the vital statistics of the State were the find-ings
of the United States Government in connection with medical exami-nations
made of men called for military duty under the Selective Service
2Q XoETH Carolina Board of Health
Act. Figures are now available on the basis of a total of 2,510.791 men
examined, of which number 49,350 men were from North Carolina. This
study gives a cross-section of the phyBical condition of the male population
at an age when physical defects that may shorten life are beginning to
appear, and may be taken as a good picture of the general physical condi-tion
of the people.
These statistics show that North Carolina averaged fewer rejections
than the country as a whole, and on individual points ranked well above
the average. As compared with the entire country, there were in this
State fewer defects per thousand, fewer defective men per thousand,
fewer mechanical defects, less hernia, less underweight, fewer defects of
the eyes, of the ears, of the throat, less organic heart disease, and less
defective and deficient teeth.
The State today is perhaps the best sanitated State in the Union, con-sidering
its predominant rural population. It is the only State having
State laws requiring the sanitary disposal of human excreta. Practically
the entire urban population is now served with public water supplies and
water sewerage. The semi-urban and village and a large portion of the
rural population is protected by a system of sanitary privies which are
required to be built and maintained in accordance with plans and specifi-cations
approved by the State Board of Health.
Twenty-nine counties of the State now have efficient county health
departments, directed by trained men who devote their whole time to the
public health interests of their respective communities. In sixteen addi-tional
counties public health nurses are doing valuable work. These
counties comprise about 60 per cent of the population of the State.
The Money Outlay
To carry forward the program of public health work a total annual
appropriation of approximately $58 0,000 is available. This is made up
of the following sums: appropriated by the State for the Board of Health
and its several divisions $275,000; appropriated by the State for the
Laboratory of Hygiene $55,000; appropriated by the counties $250,000.
This is exclusive of sums appropriated by the State for hospitals, including
the sanatorium for the treatment of tuberculosis, and of sums appropri-ated
by counties and municipalities for local hospitals.
Specific Returns
Item 1, The State Laboratory of Hygiene made examinations and fur-nished
biological products to citizens of the State to a total value of
$925,162.70. That is, if this State agency had not been in existence, the
work done by it at current commercial rates would have cost that sum.
Item 2. During the past nineteen months the State Board of Health,
through its officers and in co-operation with the physicians of the State,
has given complete anti-typhoid vaccinations to 125,684 citizens. These
immunization treatments without the activity of the Board would have
cost $2 each, a total of $251,368. Through the same means 35,609 people
were vaccinated against smallpox, at a cost value of $35,609. During
the same period 20,8 88 children were given toxin-antitoxin to render them
immune from diphtheria, at a cost value of $62,664. The vaccinations,
!^^I^'ETEENTH BlENNIAL RePOET 27
then, against typhoid fever, smallpox and diphtheria, carried out under
the direction of the Board of Health, otherwise would have cost $349,641.
Item 3. During this period S5.000 open-back, disease-spreading, insani-tary
privies have been replaced either with privies of an approved type
properly maintained under inspection, or by sewer connections. On the
basis of experience it costs about $2.50 to reach and persuade the average
citizen to build a sanitary privy. Applying this cost figure this piece of
work would have a cost equivalent of $212,500.
Item 4. Through the system of medical inspection of schools main-tained
for finding defective school children, 44,002 children received free
dental treatment in the public school clinics; 51,294 permanent fillings
were placed; an additional 6,000 children were examined by the dentists
but not treated. This work, if done at prevailing dental rates, would have
cost the parents of these children $220,010.
Item 5. Following up the preliminary examinations made by teachers,
134,093 school children were re-examined by specially trained phj^sicians
or nurses. Of those discovered suffering with diseased tonsils or adenoids,
5,093 were operated upon at a cost not exceeding $12.50, while approxi-mately
one-half were treated without any charge. The ordinary cost
would have been $178,255, or a saving of $146,424.
Item 6. In clinics under the supervision of the Board 63,75 6 treat-ments
for indigents suffering from venereal diseases were given, at a cost
value of $127,500.
Item 7. Outside agencies have been interested in financially aiding
health work in the State. Included in contributing agencies have been
the International Health Board, the United States Public Health Service,
the American Red Cross, the Children's Bureau of the U. S. Department
of Labor, and the counties of the State. The gross sum so secured has
been approximately $32 0,000.
Concluding briefly, the saving in cost values alone to the people of the
State, with numerous minor items not considered, has been $2,301,237.
Cash Dividends Paid
On the annual basis of $580,000 available for public health work, the
amount for the period of nineteen months, the period covered by this
report, would be $918,333. On this investment on seven major items of
work there is shown a return in value of $2,301,237. The cash dividend
paid to the citizens of the State has been at the rate of $2.50 for every
dollar spent.
Dividends in Vitality
While cash dividends have been earned at a gratifying rate there has
been an even greater earning in terms of vitality that are difficult to
reduce to dollars and cents. On certain items of work it is easy to arrive
at a value. If the Laboratory does a certain number of Wassermann
examinations the usual charge for such service can be ascertained, and
the value of such work accurately calculated. On the other hand there
are many returns which are just as definite but are difficult if not impos-sible
of being calculated in terms of money value. When typhoid fever
and smallpox have been almost entirely eliminated from the State every
one realizes that an enormous cash saving has been effected in bills not
28 K'oRTH Carolina Board of Health
incurred to physicians, nurses, druggists, and undertakers, and an even
greater amount saved in wages earned and continued life and liealth.
Economists liave calculated the average cost of illness at $2 per day,
and the economic value of the average life at $4,000. On tliis basis some
idea of the economic saving to the State brought about by the reduction
in tlie death rate, and the consequent lessening of illness, may be obtained.
As compared with 1916, there were in 1921 4,979 less deatlis in the
State, though the population had shown during the five years a substan-tial
increase. Experience has shown that for every death in a population
group there are 700 days of sickness. Then there was not only a saving
to the State of 4,979 lives for the years, but also of 3,485,600 days of
illness.
On the basis of values previously set forth, this means a saving to the
State during the year of $26,886,600.
Intangible Dividends
There are manyi important items of work of the Board which will not
admit of being grouped among those earning a cash dividend, or among
those directly earning a vital dividend. Yet these items are essential, and
tliey earn a return of such a nature that it may be listed only as intangible.
A few of these are here given:
Item 1. During the past nineteen months the Bureau of Vital Statistics
has supervised and directed the work of 1,419 local registrars; lias kept
in close touch with the 2,300 physicians of the State, the 4,000 midwives,
and the 600 casket dealers, that is, those immediately concerned in a
business way with births and deaths; has recorded and classified, accord-ing
to location, county, town, township, according to race, age, and accord-ing
to 189 causes of death certificates for 48,112 deaths, 137,070 birtlis,
and 12,658 still-births. This is the bookkeeping work of the Board. To
do intelligent work it is essential to know how many deaths there are
annually, where they occur, their cause, and the age and race of the
decedents. To know the natural growth of the population, tlie location
of the growth, and the race, is equally as essential. The records, more-over,
have an important legal value.
Item 2. The Board now has under supervision 13 7 water supply sys-tems
serving approximately 600,000 people and valued at $35,000,000;
during the past nineteen months 31 sets of municipal plans were examined
and approved, valued at $3,250,000; complete overhauling of filter plants
is in progress or authorized at Albemarle, Elkin, Fayetteville, Henderson,
Lumberton, Raleigh, Winston-Salem, Wilmington; complete rebuilding
of water plants in progress or authorized at Charlotte, Forest City, Greens-boro,
Hendersonville, Hertford, Newton, Lexington, Gastonia, Wadesboro;
repairs and additions in progress at Chapel Hill, Shelby, Hamlet; steriliza-tion
treatment plants installed at Black Mountain, Brevard, Andrews,
Bryson City, Marion, Murphy, Tryon, Aberdeen, Carthage, Weaverville,
Hazelwood.
Item 3. A total of 9,3 23 expectant mothers, and 10,05 2 mothers with
infants, have been aided through a system of correspondence and with
carefully prepared literature in protecting themselves and their unborn
children against the dangers of pregnancy and labor, and advised as to the
I^INETEENTH BlENNIAL RePOET 29
raising of their infants. The number of mothers applying for this service
has been constantly growing, indicating the appreciation and need for it.
Item 4. An educational campaign against preventable disease has been
waged through the Health Bulletin, a monthly publication with a circu-lation
of 53,000 copies, and the distribution of 3,500,000 pieces of litera-ture
on various health subjects.
Item 5. Health departments under the direction of trained men have
been organized in eight counties, increasing the total number of counties
in the State having efficient whole-time health departments to twenty-nine.
In addition an important demonstration in malaria control has
been inaugurated in an eastern county.
STATE I^ABORATORY OF HYGIENE
The following is a report of the work of the State Laboratory of Hygiene
from December 1, 1920, to June 30, 1922:
Specimens examined:
Sputum 3,323
Swabs for diphtheria 3,745
Widal Agglutination tests 1,801
Malaria 508
Intestinal parasites 2,146
Brains for rabies 1,083
Wassermann tests , 30,182
Gonococci 1,072
Water 5,031
Tumors 264
Miscellaneous 833
Total 49,988
Vaccines and antitoxins made and distributed:
Diphtheria Antitoxin (units) 19 8,794,000
Pasteur Antirabic Treatments (21 doses each) 1,17 8
Tvphoid Vaccine (doses) 862,765
Smallpox Vaccine 212.928
Whooping Cough Vaccine (doses) 28,721
Tuberculin (cc) 54
Autogenous Vaccines 73
Vaccines and antitoxins distributed (not made in this Laboratory) :
Tetanus Antitoxin (units) 3,313,500
Diphtheria Toxin-Antitoxin Mixture (doses) 114,8 60
Pneumococcus Vaccine (doses) 522
No attempt is made, nor can be made, to estimate the value of the
preservation of life and health which may have been accomplished by the
work just outlined, but some of the results can be given a definite and
accurate financial value. If there had been no State Laboratory of
Hygiene in existence, this work would have cost the citizens of the State
the following amounts:
30,182 Wassermann tests @ $5 $150,910.00
5,031 water examinations @ $5 25,155.00
14,775 other examinations, averaged @ $2.50 36,937.50
862,765 doses Typhoid Vaccine @ 50c 431,382.50
30 XoKTH Carolina Board of Health
28,721 doses Pertussis Vaccine @ 50c 14,360.50
212,928 doses Smallpox Vaccine @ 15c 31,939.20
522 doses Pneumococcus Vaccine @ 50c 2uj..00
114,860 doses Toxin-Antitoxin @ 50c 57,430.00
1,178 Pasteur Antirabic Treatments @ $25 29,450.00
2.209 packages Tetanus Antitoxin @ $3.50 7,731.50
i
Diphtheria Antitoxin:
5,921 1,000 unit packages @ $2.00 $ 11,842.00
786 3,00 unit packages @ $3.50 2,751.00
5,293 5,000 unit packages @ $5.00 26,465.00
14,473 10,000 unit packages @ $7.50 108,547.50 149,605.50
Total $92 5,162.70
For these nineteen months the receipts are as follows:
Appropriation $ 87,083.33
Water taxes 12,423.26
Sales biological products 16,377.38
Fees 2,071.87
Total $117,95 5.8 4
Bl REAL OF VITAL STATISTICS
Character of Woi'k
OBJECTIVES
The objective of the Bureau of Vital Statistics is to secure a permanent
record of the more important facts concerning the birth and death of every
citizen of the State of North Carolina, and from such records to prepare
card indices and tabular classifications in such manner as to make readily
available, on inquiry, the following information:
1. (a) The total number of births occurring annually in the State;
(b) the birth rate of the State, that is, the number of births per thousand
of the population; (c) the birth rates by races, white and colored; (d) the
number of illegitimate births; (e) the number of still-births attended by
physicians; (f) the number of still-births attended by midwives; (g) the
number of white l)irths attended by physicians; (h) the number of white
births attended by midwives; (i) the number of colored births attended
by physicians; (j) the number of colored l)irths attended by midwives;
(k) all of the foregoing data as to births with respect to each county
and city. These facts permit of comparisons of one part of the State
with another, of the birth rate of the two races, and of the birth rate of
this State with that of the other States and other countries. Such informa-tion
is necessary in forming conclusions as to vital conditions in North
Carolina and in the enactment of suitable legislation for dealing with
these conditions.
2. (a) The number of deaths occurring in the State of North Carolina
annually; (b) the death rate, that is, the numl)er of deaths per thousand
of the population; (c) the number of deaths, by races, and the death rates
by races in North Carolina; (d) the number of deaths among infants and
young children as compared with the births, and the total deaths as com-pared
with the total births, with net gain in population; (e) the total
number of deaths by months and year from each of the 209 causes appear-ing
in the International List of Causes of Death; (f) the number of
deaths according to age and to occupation; (g) the number of "seasonal"
deaths according to months; (h) all of the foregoing data classified
according to county, town and city. This information is absolutely neces-sary
to understand vital conditions in the State; to know where health
Nineteenth Biennial Eeport 31
work is needed, against what causes of death health measures should be
directed; and whether the work of health departments is associated with
a decrease or no decrease in death rates.
3. Under one and two, information necessary for the public welfare,
and available under the operation of the vital statistics law, has been
briefly indicated. But the vital statistics law not only supplies information
to legislatures. State and county commissioners, and other administrative
bodies, which is necessary for framing conservation measures for human
life, but it also records facts which may at any time become of great value
to the individual. In matters of tracing ancestry, birth records are invalu-able;
also in matters of proving age where the fact of age is in question,
as for voting, as for the right to marry, as for the right to enter certain
industries, as to entering school, as to liability for military service, etc.
METHODS
The Bureau of Vital Statistics secures the birth and death certificates
for the births and deaths occurring in North Carolina through approxi-mately
fourteen hundred local registrars, appointed by the chairmen of
the boards of county commissioners for the various townships and by the
mayors for the various incorporated towns and cities of the State. The
duties and powers of the local registrars are defined in chapter 10 9, sec-tion
2 2, Public Laws of 191.3. The county pays the local registrar fifty
cents for each birth and death certificate furnished by them to the office
of the State Registrar at Raleigh. The vital statistics law makes it the
duty of the doctors and midwives in attendance on a birth to file a birth
certificate with the local registrar of the district in which the birth occurs
and makes the undertaker, or person acting as undertaker, responsible for
the filing of the death certificate. The birth and death certificates filed
with the local registrars of the State are sent to the State Regisrar on the
fifth of the month succeeding the month in which the birth or death
occurred. The certificates received in the office of the Bureau of "Vital
Statistics are examined, and if incorrect or incomplete (as a large per cent
of them are), effort is made to secure the information necessary to com-plete
them. Every parent of a legitimate child whose birth is reported
to this office is sent a card advising them of the date of birth and whether
or not name appears on the certificate. This gives the parent an oppor-tunity
to send us name of the child in case it does not appear on certifi-cate,
or to make such change in name or date of birth necessary to make
certificate an accurate record of birth. The certificates are then classified
and tabulated according to county, townships and registration districts,
according to races, according to age at death, according to cause of death,
according to death rates and birth rates, etc., in order to make readily
available, upon request, the information mentioned under the heading of
Objective.
ROUTINE WORK OF BUREAU
The routine work of the Bureau of Vital Statistics is indicated in the
following table: This covers period from December 1, 19 20 to June 30,
19 22, inclusive.
Letters received 19,674
Casket dealers' reports received 8,279
Supplemental reports received 3,662
Cards received giving names of children 24,099
?.2 North Carolina Board of Health
Violation blanks received
Report cards received from local registrars
Acceptance papers received (local and deputy)
Appointment cards received
Appointment sheets received from chairman__
Individual letters written
Form letters sent
Postals sent
Packages of supplies sent
. Certificates received:
Births
Deaths
Still-births
165
19,576
2,275
690
100
15,515
21,821
70,981
7,852
137,070
48,112
12,658
Total 197,8 40
Indexing:
Cards made 192,573
Cards proof-read 192,599
Cards assorted 219,574
Cards filed 207,780
Cards copied on sheets for permanent index 82,086
No. sheets (75 cards to sheet) proof-read for permanent index 2,749
Credit certificates sent to local registrars 4.197
Certified copies made 3,471
Tables made 123
Cards punched and proof-read 35,486
Cards assorted for tabulation 31,758
Letters multigraphed 35,796
Transcripts made and proof-read 175,065
Transcripts and certificates stamped with serial number 80,912
Cards furnished Dr. Mitchener giving names of decedents from
reportable diseases 1,332
Cards furnished Dr. McBrayer giving names of decedents from
tuberculosis 3,841
Tabulation of births 15 Months Complete
Physician's record of births (by name) 3 Months Complete
Names of decedents sent in by casket dealers checked with
death certificates on file in this office approximately 17,784
Number certifications made in triplicate 4,200
RESULTS OBTAINED
Without going into unnecessary detail, it may be said that the objective
of this Bureau, as aforestated, has been reached, and that all of the
information with its vital bearing upon the public health needs of the
State and with the public health accomplishments of the State is readily
and completely available.
As a mere indication of the practicable value of the work of this
Bureau, we may point out the fact that the birth rate of North Carolina
Is very high, the highest in the United States, and that the death rate in
North Carolina, notwithstanding the high birth rate, giving us an excep-tionally
large age group of tender years with high fatalities, is exception-ally
low, one of the lowest of any State on the Atlantic or Gulf Coast.
To be brief, the vital records of the State show that North Carolina is one
of the healthiest States in the Union.
(Note.—Cai
34 North Carolina Board of Health
Method for Objective 2. The methods devised to discover the defective
children are: (2) The teacher, after consultation with the parents when
necessary and after personal studyi of each child, records on a prepared
card the findings of such preliminary examination; (b) The cards are
sent to the Bureau of Medical Inspection of Schools of the State Board of
Health at Raleigh. The Bureau has competent agents who carefully
study and classify these cards into two groups, those representing sup-posedly
normal or supposedly defective children. Immediately following
this study this agent, generally a trained nurse, visits the county and
makes a re-examination of all children reported suffering from common
defects: (c) Those of the children thought to be greatly in need of medi-cal,
surgical or dental service are advised of the fact together with their
parents, but before treatment is finally arranged for competent medical
examination is made; (d) Special arrangements are made for club opera-tions
and dental treatment, results of which are described under the head
of Results Obtained of this department.
ROUTINE WORK
(Nineteen months period ending June 30, 192 2.)
Letters received 5,093
Letters written—Individual 4,397 —Multigraph 5,570
Total 9.967
Articles written—Bulletin 3 words 21,300 —Other publications 14 words S,5S0
Pamphlets prepared, 1 words 16,000
Days spent out of the office on official business 55 Vq
Pieces of literature distributed 551,128
Addresses delivered—Number 1,679
Attendance 102,645
MONTHLY AVERAGE
Letters received 268
Letters written—Individual 231 —Multigraph 293
Total 524
Articles written 1 -^^
Days spent out of office on official business 3
Pieces of literature distributed 29,006
Addresses delivered—Number 88
Attendance 5,402
FORCE EMPLOYED
Director of Bureau, one full-time physician, six full-time dentists,
twelve part-time dentists, six full-time trained nurses, six part-time trained
nurses, one stenographer, one part-time clerk, one hospital orderly and
truck driver.
BUDGET
Annual amount received from Executive Department $9,758.92
Annual amount received from special State funds 40.000.00
Amount received from counties 3,069.14
N^INETEEIS'TH BlENJflAL RePORT 35
RESULTS OBTAINED
Some of the tangible results of the work of this department may be
enumerated as follows:
1. Through the system of medical inspection organized and maintained
by this department for finding defective school children, 44,002 children
have received free dental treatment in the public school clinics during
this period, paid for entirely by funds expended through this division of
the State Board of Health; 51,294 permanent fillings have been placed,
thereby saving that many permanent teeth which would have been other-wise
lost. The economic value of this specific assistance, as well as the
educational influence on those children treated and the more than 6,0 00
additional children examined by the dentists but not treated, cannot be
worth less than $10 per child treated or $440,020. The dental clinics
were conducted in 64 counties.
2. Following up the preliminary examination first made by the teachers
and reported on the proper cards, specially trained nurses sent out by
this department have re-examined 92,566 school children. These children
had been reported by the teachers as possibly suffering from common
defects. Most of them were found to have one or more of the common
physical defects, such as decayed teeth and diseased throats. No possible
estimate of the immense educational value can be placed on this service
to public school children by teachers and nurses.
3. Tonsil and adenoid clubs have been originated and put into opera-tion
by this bureau for the purpose of following the examinations with
treatment when needed. This activity has embraced 21 counties in which
clinics have been held. A total of 1,8 7 school children have been oper-ated
on in these clinics without the loss of a single life. The financial
equivalent of one of these operations negotiated through private methods,
without considering the far-reaching effect on the whole life of the child
of neglecting to have this important operation done, cannot be less than
$50. In fact the operation alone costs more in many places of the State.
Thus the total money value of 1,870 successful operations is certainly not
less than $93,500. But the most important consideration is that a very
small percentage of the children so essentially helped could even have
had the opportunity otherwise.
WORK OF THE BUREAU OF ENGINEERING AND INSPECTION
Character of AVork
This Bureau was created by an act of the General Assembly, February
24, 1919. The Bureau was organized May 1, 1919. Active field agents
began work October 1, 1919. The activities of the Bureau are dual in
nature and will therefore be described under two headings: that work
which is purely engineering in nature and the activities of the Sanitary
Inspection Section.
Engineering Section
OBJECTIVES
1. The installation of public water supplies and sewerage systems for
communities that have not heretofore had the advantage of such health
protection and conveniences.
36 jSTorth Carolina Board of Health
2. The stimulation of improvements in existing water supply and sewer-age
systems for the better protection of the puljlic health.
3. Safeguarding against unsafe, unsuitable, inefficient, inadequate or
otherwise faulty installations of public water supply and sewerage im-provements.
4. Assisting municipalities in the development of safer, more effective
and more efficient methods of operation of water purification plants.
5. The education of the public and the officers of municipalities to a
more comprehensive understanding of the Importance of the proper selec-tion,
development and supervision of public water supplies.
METHODS
In discussing the methods of this section it will be necessary to refer
to the aforementioned objectives.
Method for Objective 1. Every possible opportunity for the stimulation
of public sentiment for the installation of public water supply and sewer-age
systems is embraced. This objective is closely related to and assisted
by the sanitary privy inspection. The sanitary improvement effected by
the installation of sanitary privies stimulates a desire for permanent
sanitation of the convenience afforded by sewerage which very often
results in the installation of water and sewerage systems. City officials
are interviewed and clubs, chambers of commerce and mass meetings are
addressed in the interest of these improvements.
Method for Ob.iective 2. The improvement of water purification equip-ment
has received the principal attention of this section during the period
covered by this report. A detailed survey was made of all the public
water supplies in the State, in which special study was made of the'
adequacy, completeness, suitability and effectiveness of purification plant
equipment. A study was also made of the methods and efficiency of
operation. This information obtained is studied, together with the plans
and specifications in our files, and the records of tests made of samples
of water submitted monthly by the different water supplies afforded a
basis for judging the deficiencies of the various plants in equipment and
operation. It was found that there are 137 public water supply systems
in North Carolina serving the homes of 600,000 persons or one-fourth of
the entire population of the State. Twenty-two of these supplies are
obtained from surface drainage and are unfiltered, 51 are obtained from
surface drainage and are filtered, and of the remainder, 10 are shallow
ground water supplies and 5 4 are deep well supplies. The 2 2 unfiltered
surface water supplies, located in the mountain section where the streams
are clear and free from sediment, serve the homes of 51.000 persons. The
51 filtered surface water supplies found through the central and eastern
portion of the State serve the hohaes of 415,000 persons, thus constituting
the source of about three-fourths of the water furnished by all the public
water supplies of the State, while the entire 64 ground water supplies
serve only 133,340 persons, the 10 shallow ground water supplies serving
18,180 persons, and the 54 deep well supplies serving 115,260. Since the
surface water supplies constitute the source of three-fourths the water
supply, including all the largest cities of the State and most of second
size cities, work was begun first on this class of supplies.
iN'lXETEENTH BlEXXIAL RePOET 37
After careful studies of each plant, along lines already mentioned, a
full and complete report, stating the defects in the plant equipment,
together with recommendations, is prepared and submitted to the board of
aldermen or commissioners. The important recommendations are gone
over with the superintendent of waterworks and chairman of the water
committee or the mayor before or after official submission of the report,
and whenever possible a representative of the Bureau attends the board
meeting at which the report is presented.
Method for Objective 3. All plans and specifications for water supply
and sewerage improvements are required by law to be submitted to the
State Board of Health for approval. The plans and other data are care-fully
studied and checked, with particular reference to the public health
features involved and the adequacy of—tlie proposed improvements to
meet future demands. In giving our decisionttre^rinciples of the best
modern standard practice are rigidly adhered to. In this connection the
engineers have been asked to co-operate with us by adhering rigidly to
recognized standards in water purification plant design and equipment,
and urge their clients not to install makeshifts which, although curtailing
immediate expenditure, do not afford adequate public health protection
and result finally in a loss greater than the immediate saving.
Method for Ob.jective 4. The matter of securing most efficient results
in the operation of water purification plants is so closely related to and
dependent upon equipment that the entire discussion in paragraph two
of this section applies in the methods obtaining this objective with equal
force. The final and ultimate objective of the work of this department
is to raise the standard of operation methods to highest degree of effi-ciency.
Our survey of the water supplies, however, revealed the equip-ment
of the water purification plants in general to be incapable of the
most efficient operation. In brief, 3 7 of the 51 filter plants required either
complete rebuilding or extensive overhauling, while in the remaining 14,
minor defects of equipment were found. Intensive work on operation,
therefore, was not undertaken until sufficient reconstruction and over-hauling
to make effective operation possible had taken place. Inasmuch
as the survey disclosed also that there is over $35,000,000 invested in
water supply and sewerage systems in North Carolina, and the annual cost
of operation is between three and four million dollars, it is evident effi-cient
operation of these utilities is an important economic consideration to
municipalities, in addition to the public health protection afforded. Our
efforts are therefore directed toward the inauguration of accurate control
and supervision of the larger plants, aided by simple tests, conducted at
the plant for the exact determination of the chemical and bacteriological
condition of the raw water and water in the various stages of purification
as it passes through the plant. The eflficiency or capability of pumps,
generators and other machinery to effectively handle the working load and
peak loads imposed upon them is sufficiently evident to be detected by a
good mechanic, but the operating efficiency of a water purification plant,
especially a filter plant, can only be determined by constant chemical and
bacteriological record of the plant's accomplishments, conducted by an
operator sufficiently familiar with the principles involved and of suffi-
38 XoRTH Carolina Board of Health
cient experience to properly interpret these results. In the case of the
smaller plants a program of intensive instruction of the plant operators
has been undertaken.
Although attention has been devoted principally to the filtered surface
water supplies, since such supplies constitute the source of supply for
three-fourths of the 600.000 persons directly served by public water
supply, attention has also been given to the unfiltered surface water sup-plies
and the ground water supplies which constitute the other 25 per
cent of the public water supply service of the State.
In the case of the unfiltered surface water supplies the watershed regu-lations
have been made more rigid; sterilization treatment for all such
supplies is now required. Surveys of all watersheds of this class of
supply have been made and recommendations submitted to the respective
municipal officials. All ground water supplies have been investigated,
and wherever necessary, recommendations for more effective protection.
of the source have been submitted.
Methods for Objective 5. The procedures for obtaining objectives 2, 3
and 4 are of equal importance in promoting a general understanding of
the importance of protective measures in safeguarding public water sup-plies.
The realization of this objective is further aided by bulletins,
articles and addresses to public gatherings.
Sanitary Inspection Section
OBJECTIVE
1. The elimination of the filth-borne diseases due to fly carriage.
METHODS OF OBTAINING OBJECTIVE
1. Intensive education through personal interviews of householders and
public officials by sanitary inspectors.
2. Rigid enforcement of the State sanitary laws, with respect to the
sanitary construction and maintenance of privies, the sanitary manage-ment
of hotels, cafes, jails, convict camps and State institutions.
ROUTINE WORK
Office ActiAities
Letters and postals received 7,492
Letters written 4,115
Articles multigraphed 31,405
Magazines and bulletins received and reviewed 417
Articles written 20
Forms, etc., prepared 25
Vouchers issued : 547
Telegrams received 193
Telegrams sent ' 238
Watershed inspection reports received and examined 58
Water analysis reports received and reviewed (polluted) 458
Pamphlets, leaflets, bulletins distributed 126,973
Licenses, unlawful signs and other supplies 168,559
Articles copied 353
Reports on water supply investigations written (11 months) 95
Plans and specifications approved (water) 16
Plans and specifications approved (sewerage) 15
Nineteenth Biennial Report 39
Plans and specifications disapproved (water)
Plans and secifications disapproved (sewerage) 1
Days out of office on official business (director) 153
Hours spent in conference 313
Field Activities
Sanitary Inspection Section:
Number inspections made 151,796
Number prosecutions 834
Number hotels and cafes inspected (11 months) 537
Number State institutions inspected 26
Engineering Section:*
Number water supphi investigations 271
Number sewerage investigations 8
Number special water supply investigations of two to four days'
duration for operation instruction, etc 46
MONTHLY AVERAGE
OfHce Activities
Letters and postals received 394
Letters written 217
Articles multigraphed 1,653
Magazines and bulletins received and reviewed 22
Articles written 1
Forms, etc., prepared 1
Telegrams received 11
Telegrams sent 13
Watershed inspection reports received and examined 4
Water analysis reports received and reviewed (polluted) 26
Pamphlets, leaflets, bulletins distributed 6,683
Licenses, unlawful signs and other supplies 8,871
Articles copied 18
Reports on water supply investigations written 9
Plans and specifications approved (water) 1
Plans and specifications approved (sewerage) 1
Days out of office on official business (director) 8
Hours spent in conference 17
Field Activities
Sanitary Inspection Section:
Number inspections made 7,989
Number prosecutions 44
Number hotels and cafes inspected (11 months) 49
Engineering Section:
Number water supply and sewerage investigations 19
Number special water supply investigations of two to four days'
duration for operation instruction, etc 3
Results Obtained
ENGINEERING SECTION
1. Eight towns have installed water supply and sewerage systems.
Two other towns having water systems but no sewerage systems have
installed systems of sewerage.
Active field work in this division began May, 1921.
40 jNTorth Carolina Board of Health
2. The work done by the Bureau in connection with securing improve-ments
in water purification plant equipment has met with ready response
and co-operation on the part of town and city officials. In the case of the
following nine towns complete rebuilding of the water plants is either in
progress or authorized: Charlotte, Forest City, Greensboro, Henderson-ville,
Hertford, Newton, Lexington, Gastonia, and Wadesboro.
Complete overhauling of the following plants is either in progress or
authorized: Albemarle, Elkin, Fayetteville, Henderson, Lumberton,
Raleigh, Winston-Salem. Wilmington.
Repairs and additions are being made to the following plants: Chapel
Hill, Shelby and Hamlet.
Sterilization treatment as an additional safeguard in the protection of
the water supply has been provided in all but four of the water purifica-tion
plants.
Sterilization treatment is also practiced in connection with the following
unfiltered surface water supplies: Black Mountain, Brevard, Andrews,
Bryson City, Marion, Murphy, Tryon, Aberdeen, Carthage and Weaverville,
and the installation has been authorized on several other supplies of this
nature, also one deep well system became polluted and sterilization treat-ment
was promptly installed.
3. The towns have been safeguarded in water supply and sewerage
installations by the action of the Bureau in rejecting or calling for re-visions
of plans for proposed improvements. Thirty-one sets of plans
have been approved. In several instances long controversies took place
with representatives of the towns concerned, but in each instance the
plans for proposed improvements were finally made to conform to recog-nized
principles of best engineering practice.
4. The work done by the Bureau in improving operation methods and
supervision of water purification plants has met with excellent co-opera-tion
on the part of the towns concerned. The following filter plants are
now conducted under best recognized syctems of control under the super-vision
of specially qualified operators: Charlotte, Wilmington, Winston-
Salem, Proximity and High Point. A partial system of control, but a
great improvement over former methods, has been effected in the follow-ing
plants: Chapel Hill, Durham, and Raleigh. Complete control sys-tems
have been authorized for the following towns: Goldsboro and Greens-boro.
The public health value of these measures involved is intangible, and
since its great value is protective or in the nature of public health insur-ance,
cannot be estimated in mere dollars and cents. There results, how-ever,
a real economic saving to the municipalities in greater operation
efficiency. As an illustration, it has been found in one of the large towns
mentioned above that a saving of $7,000 in filter chemicals alone was
effected as compared with the previous year, in addition to providing the
city officials with an absolute knowledge at all times of the quality of
water delivered to consumers. In another instance it was found that a
saving of one filter washing per day on the average was effected. This
item alone amounted to $5.16 per day or $1,883.40 per year.
5. Returns from educational measures in the promition of a more com-prehensive
understanding of the importance of proper selection, develop-
N^INETEENTH BlENNIAL RePOET 41
ment and supervision of public water supplies are, ])y nature of the prob-lem,
not immediate. The results set forth in paragraphs 2, 3 and 4 are
only a partial measure of what has l)een accomplished, since there are
many other improvements, both in operation and equipment, that are
being seriously contemplated but are not yet officially authorized, and
cannot therefore be credited at this time.
SANITARY INSPECTION SECTION
1. As a result of hotel and cafe inspection the hotels and cafes of the
State that were found violating the sanitary regulations are receiving
general cleaning and overhauling. The standard of hotels and cafes on
the basis of cleanliness and sanitary management has improved to a
marked extent.
2. As a result of the sanitary privy inspection, 113,222 homes hereto-fore
provided in most instances with open surface privies or no privies
at all for the disposal of human excreta have been afforded the protection
against filth disease that sanitary privies conducted in accordance with
the regulations of the State Sanitary Privy Law provides. Surveys show
that 6 6 per cent of these privies are perfect in the respect of complying
with the regulations in every respect. Thus 74,727 of these foci of disease
have been eliminated. This affects directly the health of 5 6 6,110 persons,
and indirectly more than twice this many persons or approximately one-half
of the entire population of the State.
WORK OF THE BUREAU OF EPIDE>IIOLOGY^
(Including Venereal Disease Control Work)
Character of Work
OBJECTIVES
To prevent and control the occurrence of whooping cough, measles,
diphtheria, scarlet fever, infantile paralysis, cerebro-spinal meningitis,
chicken-pox, septic sore throat, German measles, smallpox, typhoid fever,
trachoma, syphilis, chancroid, gonorrhea, and ophthalmia neonatorum
(sore eyes in the new-born).
METHODS
Section 1—-The County Unit
A quarantine officer for each county and city having a separate health
department in the State is appointed to be the Bureau's representative in
the local field. His duties are as follows:
(a) To secure reports from parents, teachers, and physicians of all
cases of communicable diseases.
(b) To keep an accurate record in his office of all reports.
(c) To transmit all reports daily to the Bureau of Epidemiology.
(d) To supply the parent, guardian, or householder, when the disease
is reported, with rules and regulations governing that person, with a
placard to be posted on the house, and with a pamphlet descriptive of the
disease, its dangers, cause, mode of infection, and methods of control.
42 Worth Carolina Board of Health
(e) To inform the teachers in the community where the disease exists
that the disease is present, and to supply them witli rules and regulations
governing the school, and with a pamphlet descriptive of the disease, its
dangers, cause, mode of spread, and methods of control, to be distributed
through the children to the parents represented in the school.
(f ) To make the presence and locations of diseases known to the public
by publishing notices in the county paper when the disease appears and
advising methods of prevention.
(g) To furnish householders forms to report diseases in their com-munity
which have not previously been reported.
(h) To investigate all cases of suspected contagions which have not
been reported to determine the nature of the disease.
(i) To enforce the laws, rules and regulations governing the control of
communicable diseases.
(j) To make monthly reports to the Bureau of Epidemiology of all the
work—educational, administrative, or otherwise—done during the month.
Compiled Monthly Report of County Quarantine Officers
Counties reporting 1,861
Number cases reported by householders 9,897
Number cases reported by nurses and health officers 4,850
Number cases reported by physicians 29,389
Number cases reported by teachers 2,746
Total number of cases reported 51.552
Homes placarded 33,018
Articles published 1,674
Teachers' certifications 5,714
Indictments 125
Section 3—The State Unit
To give the reader a fair idea of the work done by the oihce and field
staff of the Bureau, such is discussed under the following heads: (1) office
work, being a resume of what is done by the director, stenographers and
clerks in the office; (2) field work being the results of the investigations,
etc., as done by the director or any member of the staff away from the
office; (3) special work for the prevention of typhoid fever; (4) special
work for the prevention of diphtheria; (5) special work for the prevention
of venereal diseases; (6) special work for the prevention of sore eyes in
the new-born.
I. Office Work
1. The daily reports of each of the communicable diseases are recorded
by the Bureau of Epidemiology by the counties in which they occur.
These are permanent records of the Bureau and they show the number,
location, and increase or decrease in the number of cases of each disease
from month to month and from year to year.
2. Weekly telegraphic and monthly written reports of all cases of infec-tious
and contagious diseases reported to the Bureau of Epidemiology
are made to the Surgeon General, United States Public Health Service,
Washington, D. C.
3. Deaths from reportable diseases registered with the Bureau of Vital
Statistics are checked each month to ascertain if "case reports" are filed.
Nineteenth Biennial Repokt 43
The quarantine officer is queried as to the "negatives" to remove possible
error. If he states that no report was made to him, a personal letter is
written to the physician by the director of the Bureau. Frequently, when
the physician's record justifies it, he is prosecuted.
4. Upon especially prepared record sheets each doctor is credited with
every report of reportable diseases he makes. If he signs a death cer-tificate
when the cause or contributory cause was a reportable disease, he
is given credit if such was reported as a case or demerited if it was found
from the procedure mentioned above that no report was made. By this
plan we can readily see the record of each physician so far as reporting
diseases is concerned.
5. Monthly news letters are issued by the Director of the Bureau to the
county quarantine officers. These serve a two-fold purpose: (a) They
give "points" of interest on quarantine work to each county quarantine
officer and establish contact between all; (b) They remind them of the
monthly report being due.
6. Monthly reports of the quarantine officers are given a detailed ex-amination
by the Director, and, where it is seen necessary, letters are
written to the quarantine officer and the county commissioners of the non-performance
of duty.
7. All report cards, blank forms, educational posters, placards, and
literature on the reportable diseases, and all rules and regulations govern-ing
the control of the diseases, are prepared by the Secretary and the Epi-demiologist
of the State Board of Health, and distributed to the various
quarantine officers by the Bureau of Epidemiology.
8. Each diphtheria, typhoid fever, ophthalmia neonatorum and tra-choma
case reported receives, in addition to forms sent out by the quaran-tine
officer, special forms from this Bureau concerning the disease.
l^iiinDiar!/ of Office Warl:
Letters and postals received 16,765
Letters written—Individual 18,887 —Multigraph 234,889
Total 253,776
Questionnaires returned 2,542
Oaths of of^ce received 80
Telegrams received 200
Telegrams sent 341
Letters prepared for quarantine officers, number of forms 38
Articles prepared for publication by quarantine officers, number
of forms 15
Number articles prepared for publication based on information
from this Bureau 224
Number articles prepared for Bulletin material 33
Number form letters, records, bulletins, placards, etc., prepared 106
Cases of contagious diseases reported and recorded 51,345
Number of deaths investigated from reportable diseases (De-cember,
1920, to June 30, 1922) 1,288
Bulletins sent out 225,470
Packages of supplies sent out 7,222
Number typhoid campaigns directed 30
Number toxin-antitoxin campaigns directed 22
44 XoKTH Carolina Boaed of Health
II. Field Work
The Director or an assistant frequently visits the counties to confer
with quarantine officers, pliysicians, medical societies, or others regarding
the prevention and control of diseases under the supervision of the Bureau.
The quarantine officer is interviewed to determine:
(a) If the county quarantine officer is doing his duty. His records are
examined and he is questioned as to his knowledge of quarantine work.
Several cases recently reported are visited to see if proper literature has
been supplied to the family and if quarantine was established. Through
this intimate contact with the quarantine officers much interest in the
work has been created among them with good results.
(b) If the physicians are reporting promptly all cases. These are
visited to ascertain the nature of the disease and the reason they were
not reported. The person found responsible for neglecting to make the
report is dealt with according to law.
(c) The findings in the investigations of counties have been prepared,
submitted to the editors, and published in the county papers. These
publications give the people an opportunity to know what is going on
in the county in disease prevention, and often they inspire some con-scientious
person to inform us of unreported cases which need to be
dealt with.
Epidemics are handled in the following way:
(a) The people in the community are notified by news articles, an-nouncement
at meetings, etc., of the presence of the disease and are given
instructions as to how to prevent the development of further cases.
(b) A history of each case is solicited so as to show the relation of
the case to the usual sources of infection.
(c) In epidemics of typhoid fever, diphtheria, or small-pox, arrange-ments
are made for having the susceptible people of the community pro-tected
against the disease by vaccination. The people are notified of such
arrangements and are encouraged to avail themselves of the opportunity.
(d) An investigation of the sanitary and hygienic conditions in the
immediate vicinity of each case is made.
(e) The facts in the history of the cases and the findings of the sani-tary
and hygienic conditions are tabulated according to epidemiological
methods so that the exact sources of infection are determined.
(f) Recommendations of the necessary measures for the control and
prevention of the diseases are made to the proper authorities.
(g) When the nature of the disease is such that public gatherings are
permissible, a public meeting is held to advise the public as to the modes
of infection, dangers, and measures necessary for the control of the
disease, for it is through the co-operation of the public that diseases are
controlled.
(h) State-wide publicity is given epidemics to warn the people of the
presence of the disease, to force the local authorities to take action to stop
its spread, and to educate the people in disease prevention.
><iimm<ir!/ of Field Work
Days out of office on official business 179
Counties visited 173
Quarantine officers visited 177
I^INETEENTH BlENNIAL RePOF.T 45
Quarantine officers interviewed 162
Doctors, ni'rses, county officials, and druggists interviewed 273
Unreported cases, non-use silver nitrate investigated 1
Reporters interviewed 35
Indictments 2
Convictions 1
Addresses delivered 22
Total audience 2,270
Epidemics investigated 5
III. Special Wokk for Prevemtion of Typhoid
Campaigns for giving free treatment to prevent typhoid fever and
diphtheria are conducted after the following plan:
1. An agreement is signed by the chairman of the county board of com-missioners
to pay to the State Board of Health 8 1-3 cents for each dose
given. This contract is presented to the Board upon its approval by the
medical society or the majority of the physicians after a personal inter-view.
2. The State Board of Health directs these campaigns.
(a) Several days previous to the beginning of the campaign, which
lasts four weeks, a representative of the State Board of Health is sent to
the county for publicity purposes. Many of the local physicians co-operate
in this by lecturing at schools, mills, etc. Such contributes largely to the
success of the work. By posters, press articles, newspaper advertise-ments,
announcements, public lectures, letters, etc., the danger of the
disease is shown to the public to awaken their interest.
(b) Physicians who assist in the campaigns give the treatments in
their offices and at points in the rural sections convenient to the country
people.
Results
Prior to 1921, almost always a medical student or an outside physician
was sent into a county to give the treatments. The policy was changed,
using local physicians mainly to identify them with preventive medicine.
It was hoped that the public would by this method be awakened to the
fact that the one to keep them well was the family doctor and not the
State Board of Health.
During the year of 1921, twenty-five campaigns were conducted in the
counties to be named. In twenty-two of these, one or more local men
gave the treatments. This enabled the Board to establish two new
records—the number of campaigns conducted and the number receiving
three treatments during one year. Such could hardly have been done
under the old plan of work. This report included only five counties for
the year of 19 22, inasmuch as it closes June 30 and not November 3 as
formerly.
TnJtJr S}io}chi(/ Ri'siilfs of TjntJioid CiiDifxtUiux
No. Taking
County Three Doses
1. Alexander 1,320
2. Anson 3,855
3. Beaufort 2,292
4. Brunswick 2,779
5. Burke 3,585
46 North Carolina Board of Health
No. Taking
County Three Doses
6. Caldwell 5,155
7. Camden 1,164
8. Carteret 1,166
9. Chowan 2,203
10. Currituck 532
11. Davie 2,669
12. Greene 4,529
13. Harnett 2,103
14. Hertford 3,226
15. Hoke 1,024
16. Hyde 1,698
17. Johnston 5,023
18. Martin 3,868
19. Montgomery 378
20. Pasquotank 4,020
21. Perquimans 2,136
22. Person 3,717
23. Randolph 2,988
24. Richmond 2,657
25. Rockingham 2,093
26. Rutherford 2,851
27. Stanly 5,325
28. Union 9,566
29. Warren 3,504
30. Watauga 2,912
Total 90,3 3 8
IV. Special Wokk for the Preve.ntiox of Diphtheria
For the first time, in our State or in any other State so far as known,
toxin-antitoxin campaigns for the prevention of diphtheria were conducted
in 19 21 simultaneously with typhoid campaigns and again in 192 2. The
counties and number taking complete treatments are listed in the follow-ing
table. Children between six months and six years were advised to take
the treatment as in this age group seventy-five per cent of our deaths from
diphtheria occur and most of them are susceptible to the disease. That
such large numbers were treated has been noticed and commented upon
by public health workers out of the State. None other than the family
doctor could have immunized so many babies.
TahJr i^hoirinf/ Results of To.rin-Anfito.rin Campaigns
No. Taking
County Three Doses
1. Alexander 371
2. Anson 1,530
3. Beaufort 427
4. Burke 498
5. Caldwell 552
6. Chowan 78
7. Davie 560
8. Greene 1,238
9. Harnett 389
10. Hertford 525
11. Hoke 247
12. Johnston 844
13. Martin 329
Nineteenth Biennial Report 47
No. Taking
County Three Doses
14. Montgomery 262
15. Person 481
16. Randolph 624
17. Richmond 322
18. Rockingham 481
19. Rutherford 1,083
20. Stanly 877
21. Union __l 904
22. Warren 505
Total 13,127
V. Venereal Disease Control Unit
The effort to control venereal diseases has been along two lines—edu-cational
and remedial. Between the date of the last report and June 30,
1921, lecturers were in the field to talk to each race and each sex. Much
of the work was in the high schools making use of exhibits. With the
adult population films have been used.
The work of the clinics in Asheville, Charlotte, Fayetteville, Raleigh,
Wilmington, and Winston-Salem was continued, the State aiding by fur-nishing
arsphenamine or neoarsphenamine, but no pay for personnel.
However, the clinics were supplying a comparatively small area in our
State inasmuch as only six of our larger cities had them. To try to remedy
this, to get treatment for syphilis available to those residing in small
towns, and to see to what extent syphilis was prevalent among people
unable to pay a private physician for treatment, an assistant was secured
to conduct "itinerant clinics."
The medical society was met in every county when possible, to explain
the work and to ask that an invitation be extended us to make the study,
and that they co-operate by visiting the clinic and referring any case
they did not wish to treat. We were to treat only the indigent approved
by physicians. Fortunately, this point caused no difficult situation as no
others came to the clinic. The idea was endorsed in each of the follow-ing
counties and demonstrations were conducted: Anson, Bertie, Beau-fort,
Craven, Edgecombe, Guilford, Halifax, Lenoir, Pitt, Richmond, Robe-son,
Sampson, Union, Rockingham, Wayne, Johnston, Northampton, and
Wilson. ,
From four to six weeks are allotted to a series of clinic points, spend-ing
one or two days each week in a town. After we retire an effort is
made to establish the work permanently. The assistant visited his first
county November 1, 1921, and since then has made 4,008 Wassermanns,
573 of which were positive (the Laboratory failed to examine about 1,200
of the 4,008 specimens because of large numbers taken during one month),
and has given 1,437 doses of neoarsphenamine. With but two exceptions,
the work has been continued in every county, and in several, very active
clinics have resulted.
The bureau has recently inaugurated a follow-up system to try to keep
patients under care of physicians. This has met with the approval of
the medical men and results have been satisfactory to all. The physician
is requested by letter every month to advise us if each patient is return-
48 XoRTH Carolina Board of Health
ing for treatment. If not, we mail the doctor a signed letter for him to
forward the patients. It sets forth the fact that the law requires one to
be treated in many instances, and the patient is urged to be sure he is
within the law. The fact that physicians answer about 4 5 per cent of
the inquiries shows they think the plan a good one. Occasionally letters
reach us saying the patients returned for treatment.
Sidinniir!/ of Venereal Disease Work-
1. Medical:
(a) Requests for arsphenamine:
Clinics 268
Plivsicians 262
Total 530
(b) Ampules of arsphenamine distributed:
Clinics 14,041
Plivsicians 1,606
total 15,647
(c) Venereal disease reports received from physicians:
Gonorrhea 5,794
Syphilis 5,004
Chancroid 364
Balanitis 7
Total 11,169
(d) Sales reports from druggists 3,127
(e) Number sales of V. D. remedies reported by druggists-
_
8,184
2. City Clinics:
(a) Number of city venereal disease clinics 6
(b) Number cases under treatment:
Syphilis 7,570
Gonorrhea 2,729
Chancroid 305
Balanitis 21
Total 10,625
(c) Number of visits to clinic for treatment, examination or
advice 37,001
3. Co-operative Clinics:
(a) Number co-operative V. D. clinics (February 1922, to
June 30, 1922) 15
(b) Number Wassermanns taken 6,046
(No examination made on about 1,200 specimens.)
(c) Number Wassermanns positive 1,239
(d) Number doses arsphenamine administered 4,864
(e) Number treatments for gonorrhea, chancroid, etc 202
4. Educational Work:
(a) Lectures given to white audiences (December 1, 19 2 0, to
July 30, 1921) 372
(b) Lectures given to colored audiences (December 1, 1920,
to July 30, 1921) 125
Total 497
(c) Attendance at lectures (white) 23,411
(d) Attendance at lectures (colored) 38,623
Total 62,034
(e) Motion picture exhibitions 83
(f) Attendance at motion picture exhibitions 28,386
(g) "Keeping Fit" exhibits made 331
(h) Attendance at "Keeping Fit" exhibits 18,141
Nineteenth Biennial Repoet 49
YI. Special Work for the Prevextiox of Blindness
The State law requires that silver nitrate be instilled in the eyes of the
new-born babies. To assist midwives and physicians who attend labor
cases, the State Board of Health, through the Bureau, furnishes a one
per cent solution of silver nitrate in waxen ampules. The physicians and
midwives must register their names and addresses with the State Board
of Health.
In order to stimulate registration among midwives, a certificate of regis-tration
(not one of efficiency) on which is set forth certain things which a
midwife must do is given her when she has complied with the law regard-ing
registration. If one midwife sees another with a certificate, she in-quires
how to get one herself. The fact that so many have sent in, want-ing
certificates renewed at the expiration of one year assures us that this
plan has been worth while.
The Bureau, with the help of nurses from the Bureau of Public Health
Nursing and Infant Hygiene and county health officers or nurses working
under their direction, has held meetings from time to time giving the
midwives more careful instruction about the use of silver nitrate and the
conduct of a normal labor.
The following table is a resume of the work of this unit:
Midwives registered 2,244
Ampules of silver nitrate distributed 81,666
Cases of ophthalmia neonatorum reported 25
Meetings held for midwives 91
BUREAU OF MATERNITY AND INFANCY
Since the publication of the eighteenth biennial report of the State
Board of Health, in the early months of 1921, many changes have taken
place with and concerning the work in which this Bureau is directly con-cerned.
On April 1, 1922, immediately following the ratification of the
Federal Sheppard-Towner Bill, this Bureau was organized under the
above name. It succeeded the department known as the Bureau of Public
Health Nursing and Infant Hygiene that had been carrying on the work
of maternal and infant hygiene for some years. This Bureau differs in
many ways from the Bureau it succeeded. The old Bureau was limited
in budget, having a yearly income of $12,000 contributed equally by the
American Red Cross and the State Board of Health. The present Bureau
is made possible as a result of act of Congress, and is therefore supported
jointly by Federal and State funds. With a change in the source of sup-port
comes greatly increased revenue until now the annual budget is about
five times that of the old Bureau. The enlarged income has made pos-sible
and has brought many changes, principally among which may be
mentioned the increase in personnel. The Bureau as now constituted is
in charge of a director who is a medical man; the limited budget of the
preceding Bureau made this impossible. As organized, it has two divis-ions
under the direct control of division chiefs. Enlarged plans have
necessitated an increase in the clerical force also. Perhaps the greatest
changes, as between the old and the new bureaus, may be found in the
50 J^ORTH Carolina Board of Health
nature and policies of the work. The work of the Bureau of Public Health
Nursing and Infant Hygiene, while specially interested in health items
having a direct bearing upon maternity and infancy, did not limit its field
to these, but in addition thereto encouraged school nursing, communicable
diseases, industrial nursing, and the care of the sick. It might be said
that its work dealt with a general public health nursing program. The
new Bureau is restricted entirely to a program dealing with the promotion
of the welfare of maternity and infancy. This is due to the fact that the
activities of this Bureau are limited to items approved by the Children's
Bureau that has in charge the administration of the Sheppard-Towner Act.
It might be of more than passing interest to note right at this point that
the registration of midwives and distribution of solution of silver nitrate
will be handled by this Bureau as approved items, being transferred from
the Bureau of Epidemiology.
Aims and Purposes
The object of the work is to conserve and promote the welfare of expec-tant
mothers and of infants. It is the desire of this Bureau to reduce
preventable deaths in these classes to the vanishing point and to assure
those spared a more comfortable physical state. That there is an urgent
need for this work cannot be doubted since approximately 35 per cent
of all the deaths in the State occur in the short period from birth to the
close of the second year. There are two significant facts in connection
with the infant mortality: the relatively high mortality in rural counties,
in some cases amounting to 50 per cent or more of the total, and the large
proportion of still-births in the total deaths. The high rural infant
mortality is obviously due to a lack of the knowledge of the underlying
principles of infant care. The high mortality at birth is to a great degree
due to a lack of prenatal education.
]\Ietho(ls
These may be said to be educational in character, since the success of
all public health procedure is dependent upon raising the general average
of the knowledge of the whole citizenship upon these questions. This
educational campaign is being undertaken in three different ways: (a)
educational literature mailed from the Bureau, press articles, and pu!)li-cations;
(b) lectures delivered by representatives of the Bureau to the
public; (c) county programs that contemplate a permanent restricted
plan of work having to do with maternity and infancy items only and in
charge of a nurse specially trained in this work. The Bureau of Maternity
and Infancy is now at work with the Bureau of Tuberculosis on a county
program that will include the welfare of childhood through adolescence.
The one great handicap of childhood is faulty nutrition, and if perfected
this combined program will embrace this important feature. When com-pleted,
local activities will probably follow these lines. In this manner
it will be possible to reach the great majority of the population in each
county directly.
jSTixeteenth Biex^tial Report 51
Routine Work
Letters received 5,752
Letters sent—Individual 4,923 —Multigrapli 67,896 — 72,819
Bureau publications (with Children's Bureau) supplied on re-quest
290,596
*Days out of office on official business 689
*Addresses delivered (formal) 54
Total attendance 4,383
Reports prepared 84
Articles written—For Health Bulletin, 3 words 3,479 —Other publications, 12 words 11,018
Pamphlets prepared 1
*By Director and two assistants.
Bureau Staff
Director of Bureau, two division chiefs, chief stenographer and assist-ant
stenographer and clerk.
Budget
The funds for the annual support of the Bureau are derived from two
sources:
North Carolina State Board of Health $ 22,259.66
Federal Government 27,259.66
$ 49,519.32
Exhibit of Special Activities
1. During the period covered by this report, 9,3 23 prenatal cases have
been reported and have been supplied with suitable literature. These
cases have been referred through various agencies, among which may be
mentioned physicians, health officers, public health nurses, midwives,
county welfare workers, county home demonstration agents and others,
as well as a number of direct requests from the patients themselves.
2. Babies to the number of 10,052 have been reported and supplied
with literature during the same period. The agencies instrumental in
bringing these cases to the attention of the Bureau are practically identi-cal
with those reporting prenatal cases.
3. Infant diagnostic clinics have been held in 14 places, during which
time 407 examinations were made.
4. Conferences were held at 105 points in 88 counties, during which
contact was made with 1,471 midwives.
. 5. Public health nurses have been placed in 15 counties in the State,
and 9 public health nurses assigned to cities or towns.
6. Among miscellaneous items accomplished during the period may be
mentioned tuberculosis diagnostic clinics, which the Bureau (through
county public health nurses under its supervision) assisted the Bureau
of Tuberculosis in organizing and holding throughout the State. Within
the first 16 months of this biennial period 2 6 such clinics were held at
69 points in 21 counties; a total of 2,485 persons having been examined.
A supervising nurse from the Bureau staff was present at 2 4 of these
clinics.
52 North Carolina Board of Health
BUREAU OF COUNTY HRAUTH WORK
The objective of this department has been the supervision and direction
of the programs of worlt developed in those counties having a co-operative
agreement with the State Board of Health under which a health depart-ment
is maintained with the financial assistance of the State. The work
has been done with a director and one field supervisor, together with the
necessary office clerical help.
During the period covered by this report a total of twenty-six counties
in the State have had such health departments. At the beginning of the
period there were twenty counties. During the nineteen months the
health departments of two were discontinued, and departments were
established in six additional counties. The net gain for the period, there-fore,
has been four counties.
During the period a comprehensive plan embodying the piece-work
principle was formulated and applied. This was made possible by listing
the established items of local health work, determining cost figures for
each item, and providing a system of records and reports by the local
health officer showing the number of each item of work performed for
each month. The system has worked well, and for the first time it has
been possible to measure public health work in various sections by an
accurate scale.
Under the contracts made with the County Board of Commissioners of
each county maintaining a co-operative health department the Siate
agrees to supply $1,000 toward the local budget without condition. An
additional sum of $1,50 is appropriated by the State conditional upon the
earning of a dollar in cost equivalents of work performed for each dollar
expended. In not a single county has the health officer failed to make the
earning required. While the amounts varied somewhat the average for
the period has been an earning of $1.70 for each $1.00 of expenditures,
a net dividend of seventy cents on the dollar. The average monthly ex-penditures
of the counties has been $504.8 2. The average cost equiva-lent
earned has been $8 63.03.
County Budgets and Expenditures
Budget Expenditure
Bertie $ 4,933.33 $ 5,126.88
Beaufort 2.850.00 3.209.84
Bladen 4,117.50 4,005.60
Cabarrus 2,661.18 2,827.83
Chatham 2,000.00 1.350.00
Columbus 6,325.00 5,857.32
Craven 8,500.00 8,401.51
Cumberland 17,004.33 15,234.82
Davidson 11.675.00 11.411.96
Edgecombe 12,500.00 12,421.18
Forsvth 13,245.74 12,943.58
Granville 6,597.73 6.407.74
Halifax 10,000.00 10,093.81
Lenoir 10,775.00 10.322.88
Mecklenburg 3,500.00 3,480.13
Northampton 10,000.00 8.156.45
Pitt 10,000.00 9,923.19
XlXETEEXTH BlEXXIAL RePORT 53
Budget Expenditure
Robeson $ 9,730.73 $ 9.462.40
Rowan 12,750.00 13,198.43
Sampson 3,400.00 2,949.73
Surry 11,350.00 9,306.04
Vance 8,342.36 8,811.05
Wake 44,493.85 41,509.15
Wayne 14,128.15 10,955.63
Wilkes 6,825.00 6,104.23
Wilson 15,970.77 15,912.96
Totals $263,675.67 $249,384.34
(The above report covers a period of two months for Chatham, five
months for Beaufort, seven months for Mecklenburg, twelve months each
for Bladen, Cabarrus, and Sampson, sixteen months for Columbus and
Craven, and nineteen months for each of the other counties.)
Detail Report of Work
The following shows in detail the average amount of work accomplished
for the counties covered per month by item, together with the cost of each
item and the cost equivalent of each for the month.
I. COMMUNICABLE DISEASE CONTROL
1. Contagious Diseases: Number
Quarantine by mail 528
Quarantine by visit 603
Visit to and instruction of schools 108
Instruction of schools thru' teachers 9 6
Epidemiological investigation 141
Vaccination, typhoid, complete 1,860
Vaccination, smallpox 1,874
Toxin-antitoxin, complete 408
Vaccination, pertussis, complete 82
2. Venereal Disease Control:
Cases reported 216
Cases returned for treatment 29
Treatments, indigent cases 823
V. D. prescription inspection 8
3. Tuberculosis Control:
Cases registered 89 .-25 22.25
Tuberculous homes visited and in-stru