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BTTX-iX-ijBTXIN"
OF THE
NORTH CAROLINA BOARD OF HEALTH
Published Monthly at the Office of the Secretary of the Board, Raleigh, N. C.
G. G. Thomas, M. D., Pres., Wilmington. I Edw. C. Register, M. D., Charlotte.
Thomas E. Anderson, M. D., Statesville. | David T. Tayloe, M. D., Washington.
J. Howell Way, M. D., Waynesville. J. A. Burroughs, M. D., Asheville.
W. O. Spencer, M. D., Winston-Salem. ! J. L. Ludlow, C. E., Winston-Salem.
Richard H. Lewis, M. D.t Secretary and Treasurer, Raleigh.
Vol. XXIV. APRIL, 1909. No. 1.
CESSPOOLS.
As similar inquiries are made of this office, we print below an ex-cellent
article on the subject of cesspools from the Bulletin of the
Kansas Board of Health. We regret that we cannot reproduce the
cut referred to, but anyone wishing to install such a plant as is indi-cated
can obtain plans from a sanitary engineer.
Our position on the ordinary cesspool for sewage disposal—even
when made with cement walls, as cracks are liable to occur, or they
are sure to overflow unless regularly emptied—where the water sup-ply
is obtained from wells, has always been and is one of uncompro-mising
hostility. But when ((instructed as a septic tank, arranged
for the automatic dumping at proper intervals of the sewage which
lias been liquefied and, to a considerable extent, purified by the action
of the anserobic bacteria in that closed receptacle, into properly laid
drain tiles, thus finally disposing of it by subsurface irrigation, we
think it allowable, provided that it is located sufficiently far from the
well to prevent its possible contamination.
CESSPOOLS.
Numerous inquiries have been received by this department con-cerning
the cesspool method of disposal of house sewage. The ques-tions
involve the following propositions, viz.
:
A BULLETIN N. C. BOARD OF HEALTH.
1. Does the uncemented cesspool menace the purity of the neigh-boring
ground-water supply used for domestic purposes?
2. If s<>. how may a cesspool be constructed so as to be sanitarily
safe?
3. Should abandoned wells be used as cesspools?
4. What are the dangers, if any. from the open-vault cesspool?
The first proposition must be answered in the affirmative. Natu-rally,
the degree of pollution of a ground-water supply depends on the
nature of the soil into which the sewage discharges. If the soil is a
close sand or clay, the filtration of the liquid portions of the sewage
would be slow and a greater degree of purification obtained than if
the soil were a loose sand and gravel, permitting the cesspool to be
rapidly emptied with comparatively little filtration directly into the
water-bearing stratum. So, also, if there is an intervening stratum
of clay or rock between the drainage of the cesspool and the water-bearing
stratum, there might be an impervious barrier to the sewage
reaching the water below such formation. It must be borne in mind,
however, that the piercing of such presumably impervious stratum in
boring or digging a well, and the constant possibility of a natural
fault or fissure, subjects such barrier to a doubt, or at least indicates
the possibility of the sewage finding its way to the underlying water.
It seems, therefore, that the only safe cesspool in a community that
uses the underground water as its source of supply is the cemented,
water-tight one.
It has been proven that sewage from cesspools will in time perco-late
over 200 feet horizontally, and it must be self-evident that as
time goes on the area of infection of the surrounding soil constantly
increases: therefore it is asserted that, while a newly constructed
cesspool will for a time adequately filter or purify the sewage in a
comparatively short distance, the actual distance in which purifica-tion
takes place is increased in direct proportion to the length of time
it has been in use. assuming the sewage to be constant and similar in
character.
• The second question is a pertinent one, in that the cesspool seems
to be a necessity in the towns and cities that are without a sewage
system, for the modern house requires some system of sewage dis-posal.
This may be accomplished by the construction of a water-tight
cesspool from four to six feet wide and eight to ten feet deep,
with several drains of perforated tile near the top and running in
different directions and placed immediately below the frost line. Such
a cesspool would operate in the nature of a septic tank, much of the
organic material being broken up by anaerobic bacterial action, the
liquid portion of the sewage draining away through the perforated
tile drains, making a fine system of subirrigation for grass, trees, etc.,
and at the same time protecting the water-bearing stratum from
pollution.
BULLETIN N. C. BOARD OF HEALTH. 13
Prof. William 0. Hoacl, the board's sanitary and civil engineer,
has kindly drawn plans for a sanitary residential sewage-disposal
plant, which are herewith reproduced. It is confidently hoped that
these plans may be generally adopted throughout the State, particu-larly
in those towns located in the valleys where the ground-water
supply lies close to the surface.
XOTES OX A RESIDENTIAL SEWAGE-DISPOSAL PLAXT.
The disposal plant shown in the drawing is planned for an ordi-nary
residence, and is designed to treat the liquid wastes from the
kitchen sink, bathroom, laundry, and all other waste water coming
from the house. The principle of purification employed is that of
the septic tank followed by subsurface irrigation. The sewage first
enters the septic tank, where suspended matter is held until it is
disintegrated by the intense bacterial activity in the tank. The clari-fied
effluent then flows out into the dosing chamber where, by means
of either the tipping tray or the automatic siphon (depending upon
which device is used) it is flushed out into the distribution pipes of
the subsurface irrigation system. Here the sewage trickles out
through the open joints of the pipes into the surrounding soil, where
it becomes food material for the plant life of the lawn or field.
The drawing shows a tank built of brick, though it could be con-structed
of either stone masonry or concrete just as well. The tank
should be carefully plastered on the insi*h> so as to be water-tight.
and the inlet and outlet pipes should be set accurately to the eleva-tions
shown. The tipping tray in the dosing chamber can be made
by any tinner, while the automatic flushing siphon, which may be
used in place of the tipping tray if a somewhat better and more
permanent form of construction is desired, can be secured from the
manufacturers of automatic flushing appliances.* Whether the flush-ing
siphon or the tipping tray is used for flushing the sewage out
into the distribution pipes, the device should be tested after being
set in position, to make sure that it is in good working order.
The connection from the house to the septic tank should be of
four-inch vitrified clay pipe with bell and spigot joints, carefully laid
To a uniform grade, and having the joints well filled with cement
mortar. This careful cementing of the joints is particularly impor-tant
in case the house connection is carried through a grove of trees.
The pipes for the distribution system should be sound, hard-burned,
three-inch agricultural drain-tile, in foot lengths. They should be
laid from a foot to 18 inches below the surface of the ground, and
should be laid on a grade of 3 inches to 100 feet. The pipes should
be carefully laid so that the ends match. The matter of grade or
"fall" should receive careful attention, since, if the grade be too great
the lower end of the pipe will receive more than its fair proportion
of sewage, while if the grade be too small the upper end will receive
too much. The length of this three-inch pipe should be proportioned
according to the nature of the soil. If the soil is open ami sandy,
approximately 200 feet is sufficient for the sewage from an ordinary
residence, while if the soil is of a closer texture 300 or 400 feet will
be necessary. The system is not well adapted to very tight and
retentive clay soils, though it has been used successfully in soils of
this character.
*A three-inch siphon, arranjred to discharge under a head of fifteen inches of
"* sewage, can be purchased of the Pacific Flush Tank Company, of Chicago, for fifteen
*+> dollars.
or
4 BULLETIN N. C. BOARD OF HEALTH.
A plain board roof can be built over tbe tank, as sbown in tbe
drawing, a trap-door being left by which tbe interior of tbe tank
may b< inspected. Or, if a inure permanent form of construction is
desired and can be afforded, the walls of the tank may be made
thicker, and the whole structure arched over and covered with earth.
In this case, however, a large manhole should be left, through which
the operation of the tank and dosing chamber may be inspected, and
by means of which the tank may be cleaned out.
It should be the expectation that once in from one to four or five
years the tank will require cleaning out, the frequency depending
largely upon the character of the sewage. The sludge taken from
the tank at these cleaning periods is relatively small in amount, and
may be best disposed of by running it into a trench or furrow and
covering it over with soil. This cleaning out should be done in the
fall of the year, if possible, as at this season the sludge in the tank
possesses less odor and is less objectionable to handle than at other
times.
Particularly for those parts of the State where the rainfall is so
small that the water of the sewage, as well as its fertilizing constit-uents,
has an appreciable value, the disposal scheme outlined above
may have a considerable economic as well as sanitary value. It is
quite possible by this method to maintain in the dryest region a large,
well-fertilized and well-watered lawn. The process should be carried
on entirely without odor, though, of course. The septic tank should be
located at some little distance from the house—say a hundred feet
or more, if possible. Particularly the disposal plant should not be
near to any open well which is used as a source of water supply.
Third. The use of abandoned wells as cesspools is an extremely
dangerous practice, as the sewage is discharged directly into the
water-bearing stratum. Certainly there is no argument necessary
to support the contention that under no condition should an aban-doned
well be used as a cesspool or sewage discharged directly into
water-bearing stratum.
Fourth. The dangers from the open-vault cesspool include all those
of the deep cesspool, and in addition thereto it affords a breeding
and feeding-place for the house fly, and the very great and real
danger of flies carrying infection from such places to articles of
food and drink. It is true that the distance to ground water is
greater and therefore a greater degree of filtration purification is
obtained than in the deep cesspool, but, on the other hand, the oppor-tunities
of direct infection by the fly are so great and numerous as
to very greatly outweigh the evils of the pollution of the water.
In many of the smaller towns of this State the cesspool is coming
to be a very serious menace to the health of the community. During
the past year there is good reason to believe that in several instances
the local epidemic of typhoid fever might be attributed to the pollu-tion
of the common ground-water supply by the discharge of the
contents of cesspools directly into the water-bearing stratum. Indi-viduals
and communities are warned of the danger of this practice,
and cities are urged to pass such ordinances as will at least regulate
the cesspools in accordance with the above suggestions.
BULLETIN N. C. BOARD OF HEALTH.
REVIEW OF DISEASES FOR APRIL, 1909.
EIGHTY-SEVEN COUNTIES REPORTING.
Ninety-five counties have Superintendents of Health.
Except in the case of the more contagious and dangerous diseases,
the Superintendent has, as a rule, to rely upon his own information
alone, since few physicians can be induced to report cases of noncon-tagious
diseases to him.
Where the number of cases is not given, or the prevalence of a dis-ease
otherwise indicated, its mere presence in the county is to be
understood as reported.
For the month of April the following diseases have been reported
from the counties named
:
Measles.—Alamance, epidemic; Alleghany, 2 cases; Brunswick,
several; Burke, 2; Camden, 10; Carteret, 3; Caswell, several; Ca-tawba,
28 ; Chatham, 5 ; Cherokee, 8 ; Columbus, 3 ; Craveu, several
Davidson, many ; Durham, several ; Edgecombe, a few ; Forsyth, a
few ; Greene, 2 ; Harnett ; Jones, epidemic ; Mecklenburg ; Ouslow ;
Person, 50 ; Randolph, a few ; Richmond, 1 ; Robeson, 50 ; Surry, 15
;
Transylvania, epidemic; Wake, 2; Watauga, 10—29 counties.
Whooping-cough.—Alexander, 20 ; Alleghany, 1 ; Bertie, several
;
Bladen, a few ; Burke, in all parts ; Cabarrus, 72 ; Caldwell. 30 ; Car-teret,
a few ; Caswell, several ; Catawba, 3 ; Chatham, 10 ; Chowan,
many ; Clay, several ; Cleveland, a few ; Columbus, 2 ; Craven, many :
Cumberland ; Currituck, a few ; Davidson, many ; Davie, a few ; Dup-lin.
15; Durham, several; Edgecombe, several; Forsyth, a few; Frank-lin,
many; Granville, S; Harnett, 22; Haywood, 11; Henderson, many;
Hyde, a few ; Jackson, several ; Macon, 10 ; Mecklenburg ; Onslow
:
Randolph, several ; Rowan, many ; Rutherford, 40 ; Scotland, 36
Swain, 6 ; Transylvania, a few ; Union, a few ; Vance, a few ; Wake.
10; Watauga, 18; Wayne; Wilson; Yancey, 3—47 counties.
Scarlatina.—Alexander, 4; Bertie, 2; Caldwell, 15; Caswell, 3;
Chatham. 1 ; Cherokee, 3 ; Chowan, 7 ; Cleveland, a few ; Craven, 3
Currituck, a few ; Davidson, 4 ; Edgecombe, 4 ; Forsyth. 3 : Guilford,
1 ; Harnett, 2 ; Henderson, 1 ; Hertford, 6 ; Johnston, 3 : Lee, 2 ; Meck-lenburg
; Nash, 1 ; Wake, 20 ; Yadkin, 3—23 counties.
Diphtheria.—Alexander, 4 ; Bladen, 2 ; Carteret, 2 ; Catawba, 1
Cumberland, 1 or 2 ; Edgecombe, 2 ; Gates, 2 ; Guilford, 1 ; Harnett,
3 ; Hyde, a few ; Jones, 3 ; Lenoir, 3 ; Mecklenburg ; New Hanover.
5 ; Northampton, several ; Onslow, 1 ; Pitt, 2 ; Richmond, 1 ; Sampson,
1 ; Surry, 5 ; Vance, a few ; Wake, 4 ; Watauga, 1—23 counties.
Typhoid Fever.—Alexander. 2 ; Ashe, 3 ; Bertie, 1 ; Bladen, 1 ;
Caldwell, 1; Carteret, .several ; Chatham, 0; Cherokee, 4; Columbus,
3; Craven, 1; Duplin, 2; Durham, 3 or 4 ; Edgecombe, 1; Jackson, _'
;
6 BULLETIN N. C. BOARD OF HEALTH.
Jones, 5; Mecklenburg; Montgomery, 3; Orange, 1; Polk, 3; Ran-dolph,
a few; Robeson, 3; Rowan. 1; Swain, 2; Washington, 1: Wa-tauga,
2—25 counties.
Malarial Fever.—Caswell; Hertford; Hyde; Perquimans, in all
parts; Kobeson; Union—6 counties.
Malarial Fever, Pernicious.—Hertford, 1; Hyde, a few; Robe-son,
1.
Malarial Fever, Hemorrhagic.—Kobeson, 1.
Influenza.—Alamance; Alleghany; Ashe, in all parts; Beaufort:
Caswell; Chatham: Currituck; Davie, in all parts; Hertford; Macon;
Montgomery ; Northampton ; Randolph ; Rowan ; Surry ; Washington ;
Yadkin ; Yancey, in all parts—18 counties.
Pneumonia.—Alamance, many: Alexander. 22; Alleghany. 3; Ashe,
2 ; Bertie, several : Brunswick. 4 ; Caldwell, 10 ; Camden, S ; Caswell,
4 ; Catawba, 3 ; Chatham, 16 ; Chowan, several ; Cleveland, a few
;
Columbus, 2 ; Craven, 3 ; Cumberland, 2 or 3 ; Davidson, several
:
Davie, a few ; Duplin, 3 ; Durham, several ; Edgecombe, a few ; For-syth,
a few ; Franklin, a few ; Gates, 9 ; Greene, 6 ; Harnett, IT ; Hay-wood,
14; Henderson, 3; Hertford, 4; Hyde, a few; Jackson, several;
Johnston, many; Jones; Lee, 5; Lincoln, 6; McDowell, several; Ma-con.
6 ; Martin, 1 ; Mecklenburg ; Montgomery, 7 ; Nash, 14 ; New Han-over.
2 ; Northampton, many ; Onslow, several ; Pender, 1 ; Perqui-mans,
many; Person, 2; Polk, 1; Randolph, several; Richmond, 2;-
Robeson, 15; Rowan, 5: Rutherford, 2; Sampson, 4; Surry, 5; Swain.
2 ; Transylvania ; Union, 50 ; Wake. 35 ; Washington, 3 ; Watauga, 1
Yadkin, 2 ; Yancey—63 counties.
Meningitis, Cerebro-spinal.—Camden, 2 ; Guilford, 1 ; Rowan. 1 :
Wake, 1.
Mumps.—Catawba ; Columbus : Greene, epidemic : Onslow ; Ran-dolph—
5 counties.
Roseola.—Tyrrell, 5.
Varicella.—Columbus ; Greene, many.
Smallpox.-—Bertie, 1; Caldwell, 90; Cherokee, 1; Craven, 10; Cur-rituck,
a few; Duplin, 10; Forsyth, 5; Harnett, 4; Johnston, 16;
Jones, 40 ; Lee, 4 ; Nash, 3 ; Onslow, 6 ; Pasquotank, 17 ; Perquimans,
3; Pitt, 1; Rowan, 1; Scotland, 6; Wake, 1; Warren, 5; Wayne, 3;
Yancey—22 counties.
Cholera, in Hoes.—Cleveland, Currituck, Hertford. Onslow, Tyr-rell—
5 counties.
No diseases reported from Buncombe, Graham, Iredell and Madison.
No reports received from Anson, Gaston, Halifax, Mitchell, Moore,
Rockingham, Stanly and Wilkes.
BULLETIN N. C. BOARD OF HEALTH.
SUMMARY OF MORTUARY REPORTS FOR MARCH, 1909.
TWENTY-FOUR TOWNS.
White. Colored.
Aggregate population 155,650 97,050
Aggregate deaths 134 151
Representing temporary annual death rate
per 1,000 10.3 18.7
Causes of Death.
Typhoid fever 1
Scarlet fever 3
Malarial fever 1 1
Whooping-cough 1 1
Measles 1
Pneumonia 17 24
Consumption 22 23
Brain diseases 16 9
Heart diseases 15 13
Neurotic diseases 2 2
Diarrhoeal diseases 2 6
All other diseases 46 66
Accident 3 2
Suicide 3
Violence 2 3
134 151
Deaths under 5 years 19 44
Stillborn 17 32
Total.
252,700
285
13.5
1
3
2
2
1
41
45
25
28
4
8
112
5
3
5
285
63
49
BULLETIN K". C. BOARD OF HEALTH.
Mortuary Report for March, 1909.
Towns
BULLETIN N. C. BOARD OF HEALTH.
County Superintendents of Health.
Alamance Dr. H. M. Montgomery.
Alexander Dr. 0. L. Hollar.
Alleghany Dr. Robert Thompson.
Anson Dr. E. S. Ashe.
Ashe Dr. J. T. Testerman.
Beaufort Dr. D. T. Tayloe.
Bertie Dr. John L. Pritchard.
Bladen. Dr. L. B. Evans.
Brunswick Dr. J. Arthur Dosher.
Buncombe Dr. D. L. Laxton.
Burke Dr. J. R. Anderson.
Cabarrus Dr. R. S. Young.
Caldwell. Dr. C. L. Wilson.
Camden Dr. C. G. Ferebee.
Carteret Dr. W. E. Headen.
Caswell Dr. S. A. Malloy.
Catawba Dr. Geo. H. West.
Chatham Dr. J. H. Taylor.
Cherokee Dr. S. C. Heighwav.
Chowan Dr. H. M. S. Cason.
Clav Dr. P. B. Killian.
Cleveland Dr. T. E. McBrayer.
Columbus Dr. H. B. Maxwell.
Craven Dr. Joseph F. Rhem.
Cumberland Dr. A. S. Rose.
Currituck Dr. H. M. Shaw.
Dare
Davidson Dr. Joel Hill.
Davie Dr. M. D. Kimbrough.
Duplin Dr. John A. Ferrell.
Durham Dr. N. M. Johnson.
Edgecombe Dr. W. J. Thigpen.
Forsyth Dr. S. F. Pfohl.
Franklin Dr. R. F. Yarborough.
Gaston Dr L.N.Glenn.
Gates Dr. Geo. D. Williams.
Graham Dr. M. T. Maxwell.
Granville Dr. S. D. Booth.
Greene Dr. W. B. Murphy.
Guilford Dr. Edmund Harrison.
Halifax Dr. I. E. Green.
Harnett Dr. J. W. Halford.
Haywood Dr. J. F. Abel.
Henderson Dr. J. G. Waldrop.
Hertford Dr. J. H. Mitchell.
Hyde Dr. R. E. Windley.
Iredell Dr. M. R. Adams.
Jackson Dr. A. S. Nichols.
Johnston Dr. L. D. Wharton.
Jones Dr. H. G. Monk.
Lee Dr. J. P. Monroe.
Lenoir Dr. C. L. Pridgen.
Lincoln Dr. J. W. Same.
McDowell Dr. M. L. Justice.
Macon Dr. S. H. Lvle.
Madison Dr. W. J. Weaver.
Martin Dr. W. E. Warren.
Mecklenburg Dr. C. S. McLaughlin.
Mitchell . Dr. Virgil R. Butt.
Montgomery Dr. J. B. Shamburger.
Moore Dr. Gilbert McLeod.
Nash Dr. J. P. Battle.
New Hanover- __Dr. W. D. McMillan.
Northampton-.. Dr. H. W. Lewis.
Onslow Dr. Cyrus Thompson.
Orange Dr. C. D. Jones.
Pamlico
Pasquotank Dr. J. B. Griggs.
Pender Dr. Robt. H. Bradford.
Perquimans Dr. T. P. McMullen.
Person Dr W. A. Bradsher.
Pitt Dr. Joseph E. Nobles.
Polk Dr. Earle Gradv.
Randolph Dr. S. A. Henle'v.
Richmond Dr. N. C. Hunter.
Robeson Dr. H. T. Pope.
Rockingham Dr. Sam Ellington.
Rowan Dr. I. H. Foust.
Rutherford Dr. E. B. Harris.
Sampson Dr. Frank H. Holmes.
Scotland Dr. K. A. Blue.
Stanly Dr. J. N. Anderson.
Stokes
Surry Dr. John R. Woltz.
Swain Dr. J. A. Cooper.
Transylvania Dr. Goode Cheatham.
Tyrrell Dr. W. W. Stancell.
Union Dr. Henrv D. Stewart.
Vance Dr. John'Hill Tucker.
Wake Dr. J. W. McGee, Jr.
Warren Dr. M. P. Perry.
Washington Dr. W. H. Ward.
Watauga Dr. J. M. Hodges.
Wayne Dr. T. L. Ginn.
Wilkes Dr. John Q. Myers.
Wilson Dr. W. S. Anderson.
Yadkin Dr. S. L. Russell.
Yancey Dr. W. B. Robertson.
Dr I H Manning
OF THE
NORTH CAROLINA BOARD OF HEALTH
Published Monthly at the Office of the Secretary of the Board, Raleigh, N. C.
G. G. Thomas, M. D., Pres., Wilmington. Edw. C. Register, M. D., Charlotte.
Thomas E. Anderson, M. D., Statesville. David T. Tayloe, M. D., Washington.
J. Howell Way, M. D., Waynesvilie. J. A. Burroughs, M. D., Asheville.
W. O. Spencer, M. D., Winston-Salem. J. L. Ludlow, C. E., Winston-Salem.
Richard H. Lewis, M. D., Secretary and Treasurer, Raleigh.
Vol. XXIY. MAY, 1909. No. 2.
HOT-WEATHER CARE OF INFANTS AND YOUNG CHILDREN.
(Circular of the Department of Health, City of Chicago.)
Prepared by F. W. Reilly, M. D., Assistant Commissioner of Health.
This Circular was first issued in June. 1895—thirteen years ago. During
the previous twelve years there had been 106.524 deaths of infants and
children under 5 years of age in Chicago. During the last twelve years
there-have been only 101,802 such deaths.
Had the death rate of the earlier period been maintained during the
last twelve years, there would have been 205.920 deaths among children
under five years of age. whereas only 101,802 actually occurred.
Taken in connection with the increased population—nearly doubled in
the twelve years—this reduced death rate means, therefore, a saving of
104.US lives in this period.
In the belief that the advice herein contained has had something to do
with this gratifying showing, this Fourteenth edition has been prepared
for gratis distribution.
About oxe-quarter of the total yearly deaths of infants and young
children in this city occur in the two hottest months of the year—July
and August.
Heat kills off babies and young children largely because it spoils their
milk and other food quickly. Even breast milk, when the mother is ovafa
12 BULLETIN N. C. BOARD OF HEALTH.
heated, may give the baby colic or "summer complaint." If a mother is
very hot she should draw a teaspoonful or so from the breast before nursing
her baby. If the breast has not been given for two hours or more it should
be drawn off in the same way. And if the mother has been badly fright-ened
or very angry or excited, it is not safe to srive the breast a1 all; it
should be drawn and the milk thrown away.
The proper food for babies is mother's milk. No sensible mother
needs advice on this point. If she is fairly healthy her breast will give all
the nourishment the child should have until it begins to cut its teeth—the
sixth or eighth month. Up to this time it is a sin to give an infant one
morsel of solid food of any kind, or anything but breast milk (if the mother
is healthy i. except water in moderate quantity occasionally, but never soon
after nursing.
Many infants are killed every year by bringing them to the table with
the family and giving them a little bit of this, that and the other—meat,
vegetables, pie, pickles, etc., which the little stomach is not fitted for.
They are killed just as surely, though not so quickly, as if they had been
fed poison out of a drug store.
When the baby that is fed this way sickens and dies it is said that the
baby died of "diarrhea," or "dysentery," or "cholera infantum," or "sum-mer
complaint," or "teething." or "convulsions," or "brain fever."
But these are only names for the result of poisoning with unfit food.
Wait till the baby gets its teeth before you put food into its mouth that nee Is
to be chewed.
If the breast milk gives out, or becomes thin or watery, or if the
mother has consumption or any other long-standing sickness, the baby
must be put on the bottle and fed with cow's milk.
Get the best milk you can afford, and if it isn't good, or "sours" too
soon, or doesn't give enough cream, send word to the Health Office, 21")
Madison Street. Be sure to give your name and address and a Milk In-spector
will be sent to find out where the trouble is.*
*Pure, wholesome milk for sick children in the congested districts can be obtained
at a price below cost at any of the following station- maintained by the Milk Cotn-mission
of the Children's Hospital Society:
West Side—Chicago Commons, C.rand ave. and Morgan St.; Association Home,
575 W. North ave.; Northwestern University Settlement, Augusta and Noble sts.;
Lit tit- Wanderers' Day Nursery, 283 X. Oakley ave.; St. Elizabeth Day Nursery.
655 N. Ashland ave.*; Settlement House, 7>s3 Armitage ave.: Hidl House. 335 S.
Hal-ted st.: Maxwell Settlement, 485 S. Clinton St.; United Hebrew Charities Dis-pensary,
Maxwell and Morgan sts.; Cad's Hill Center. Robey and 22d sts.; Rush
Medical Dispensary, 759 W. Harrison st.
South Side—Children's South Side Free Dispensary, 6236 Jackson Park ave.;
Jackson Park Sanitarium, 64th st. and the lake: Little Wanderers' Day Nurs-erv.
833 W. 19th st.; refectorie- of the following park-: Armour Square, 33d st. and
5th ave.; Cornell Square, 50th and Wood sts.; Davis Square, 44th st.and Marshfield
ave.; Jackson Park; Mark White Square, 29th and Hal-ted sts.; Ogden Park, 64th st.
and Center ave.; Sherman Park, 52d st. and Center ave.: Washington Park.
North Side—Christopher House, 120 E. Fullerton ave.; Olivet House, 46 Ved-der
.-t.
BULLETIN N. C. BOARD OF HEALTH. 13
As --oon as the milk is received take what is to be used for the baby and
"scald" it. Don't let it boil.
A good way is to set a pan of cold water on the stove and put the vessel
containing baby's milk into this pan; just as soon as the water comes to a
boil take it off. This amounts to what is called "sterilizing" or ''pas-teurizing"
the milk.
If the milk was sweet and hadn't begun to "turn" when it was received
it will keep sweet for twenty-four hours or more after being treated this
way, even in hot weather. But. of course, it should be kept in a close-covered
vessel or fruit jar or stoppered bottle. Whatever it is kept in
should be thoroughly scalded—cover, stopper and all—just before the
milk is put in.
If you have an ice-box or refrigerator to put the milk in, or can in any
other way keep it from "turning," it is better to let it stand for about six
hours and then pour off the upper half for the baby's milk. This should
then be "scalded." If you can't do this, a little cream should be added
to the baby's milk—say one tablespoonful of cream to two or three of
the milk.
To make this nearly like breast milk add two cups of water that has
been boiled to each cup of milk and enough white sugar to make it as
sweet as breast milk.
(Milk sugar, if perfectly pure, is better than white or cane sugar.)
If this mixture is too rich the baby will throw it up in curds or lumps,
or it will pass through the bowels in white flakes and shreds. If this
happens add more boiled water to the mixture until you find just what
strength the baby's stomach will stand—what it can digest.
When the baby is about a month old barley water should be used
instead of plain water. Put two tablespoonfuls of pearl barley in four
cups of cold water: boil an hour or more—down to two cups; strain through
a close cloth; add a pinch of salt and sweeten to breast-milk taste. Add
this to a cup of "scalded" cow's milk treated as before described and begin
feeding this strength.
Gradually use more milk and less barley water, until at about six months
of age the child is getting two-thirds milk and one-third barley water.
Xext to healthy breast milk this will make as good food as the infant
can get during teething and weaning. Then comes the pure milk—always
'"scalded"—bread and milk, baked potato and milk, oatmeal porridge
—
which can't be boiled too long, never less than two hours—and always
eaten with milk, and the milk always "scalded," not boiled.
Don't overfeed the baby. Once in two or three hours is often enough
to suckle or feed a baby until it is four or five weeks old; after that do
not feed so often.
14 BULLETIN N". C. BOARD OF HEALTH.
When a baby is about six months old it will generally thrive best if fed
only once during the night and four or five times regularly during the
day. It is bad for a baby's stomach and bowels to feed it too often or too
much at a time—especially in hot weather.
A new-born baby's stomach will hold from two to three tablespoonfuls,
and not more than this amount—rather less—should be given at a time
during the first Aveek or so of a bottle-fed baby's life.
As the baby grows the quantity should be gradually increased, so that
at the end of the first month it may lie taking about four tablespoonfuls
at a meal. Some children will require more and others will not stand so
much
—
but there is more danger of giving too much ut n time than tun little.
Don't stick the nipple in the baby's mouth every time it cribs.
If the baby is properly fed at regular times it won't get hungry enough to
make it cry, and it is foolish to feed it whenever it cries instead of trying
to find out the trouble. It may be only thirsty and a -wallow or two of
cold water—not a big drink—will stop it; or its clothes may be uncom-fortable,
or its napkin need changing.
Try to find out what makes it cry, and then use '-mother wit." And
don't be afraid of giving the baby a drink of water. It needs water
as much as milk. It needs more water in proportion to its size and weight,
and oftener, than its mother does. Thirst causes more needless suffering
to babies than anything else. Give the baby a drink!—but be sure the
water is pure, by having been either boiled or filtered.
Don't feed the baby with a spoon. Sucking is the natural way that
a baby takes its food. It needs the sucking action of the lips and mouth
and tongue to mix its food with the fluids of the mouth and to keep it
from getting into the stomach too fast.
Spoon feeding doesn't do this.
Use a plain common bottle for feeding, with a rubber nipple and
no tube.
Fancy nursing bottles, with long rubber tubes and patent contrivances,
besides costing money, can't be cleaned easily, and babies don't do well
with them in other ways. The more simple the bottle and the nipple,
the better for the baby. The rubber-tube bottle is a device of the Evil
One for lazy mothers. It's bad enough when a mother can't suckle her
own infant at her own breast; let her at least take it in her arms and hold
the bottle and "mother" it while it feeds.
Take the nipple off after each feeding and <d once boil both bottle and
nipple for at least ten minutes. Before using again rinse the bottle and
nipple in^water that has been boiled—about a quart of water with halt
a teaspoonful of soda in it; or keep them in a pan of soda and water when
not in use.
BULLETIN N. C. BOARD OF HEALTH. 15
More babies get "sore mouth" and "wind colic" and "summer com-plaint,"
for want of care of the nursing bottle than from any other one
cause. A little stale milk around the neck of the bottle or in the nipple
will set up a ferment which is poison to the delicate lining of a baby's
mouth and throat and stomach.
Keep flies away from baby's food—flies are frequently con-veyors
OF DISEASE germs.
Of course, the baby's bottle food should be warm—about the same as
breast milk, or "blood heat"; that is, as warm as the inside of the mouth.
Keep the baby clean and it will stand the heat better. When
the thermometer is at eighty or ninety in the shade it isn't easy to keep
the baby cool. But it can always be kept clean, and will then be more
comfortable and have a better chance of living through the hot weather.
It should have at least one full bath every day and oftener during extreme
heat. Never bathe within one hour after feeding it. Bathe first; feed
afterwards.
Dress as lightly as possible. It will be better stark naked—except for
a napkin and binder—some hours a day during the hot weather when
indoors. But keep it in the open air, out of the hot sun, as much as you
can between sunrise and sunset. The outdoor air, even of a dirty street,
is fresher and better than the air in the house.
Fresh air is the breath of life in a baby's nostrils. Take it or send it to
the parks, or open squares, or the lake shore as often as you can.
In the changeable summer climate of Chicago, care must be taken
against sudden chilling. A thin soft flannel binder, wound two or three
tunes around the body will do more to guard against this chilling than
the ordinary full dress of frock, vest, skirts, drawers, socks, etc.
This binder should be only wide enough to cover the belly, an inch or
so above the navel and a couple of inches below. It should be wound
smooth and free from creases or folds, and fitted with a few stitches of
soft darning cotton—not pins.
This binder and a napkin are all the dress a baby needs during the heat
of the dav in the house in summer.
Do NOT LET THE BABY SLEEP IN THE SAME BED WITH ANY OTHER PER-SON.
If there is no crib, the mother should put a couple of chairs at her
bedside, with any sort of soft covering on them—not feather pillows or
hot woolen stuffs—and let the baby sleep there. It will be more com-fortable
on a summer night than lying against the hot body of its mother,
and will not be so apt to disturb or be disturbed.
16 BULLETIN N. C. BOARD OF HEALTH.
The backs of the chairs will keep the baby from falling, and the mother
can readily reach over to care for it when necessary.
Screen the baby's bed so that flies cannot annoy and possibly
infect it while asleep.
Do not drug the baby. If after all your care the baby should fall
sick, do not "pour drugs of which you know nothing, into a body of
which you know less."
There is no mother in the city of Chicago that cannot get the best of
medical treatment for her sick baby without money and without price,
if she is unable to pay. Call a doctor instead of spending money for patent
medicines, "soothing syrups" or "cure-alls," which will probably do your
baby more harm than good.
Although this advice is more directly for babies during the first year
of life, the sense of it applies quite as well to older children.
Don't overfeed them, and don't let them overfeed themselves.
Don't give them rich food—meats, gravies, pastries, cake, etc.—nor a
great variety. The simpler and plainer the better—plenty of milk, whole-wheat
bread, oatmeal, baked potatoes, baked apples and fresh fruit of all
kinds, in season, but be sure the fruit is ripe and fresh. Roasts and stews
and made dishes and
—
pie will come soon enough, and so will dyspepsia.
Keep up the daily full bath until it becomes a fixed habit.
Keep them out in the open air as much as possible the whole year
round, and send them into the country whenever you can do so, but only
to places where the water is pure.
If a baby or child is worth having it's worth saving, and more than half
of the babies and young children that die in Chicago every year could be
saved, by following the advice here given.
BULLETIN N. C. BOARD OF HEALTH. 17
PREPARATION OF MILK FOR THE BABY.
Home Pasteurization.
In previous talks we have had something to say about care of babies in
hot weather. This week we want to talk about milk.
All mothers understand that great care must be taken at all times in
feeding the baby. Also that it is of especial importance that this be done
during the summer months. The trouble is that so many mothers, and
especially young mothers, do not know what is best to do. This is wiry
the Department of Health has hacl prepared the circular, printed in many
languages, which gives a great deal of good advice on this subject.
As has already been explained, in former talks, the baby's only article
of diet is milk. So, if the milk is not clean and wholesome, there is small
chance for the baby to live and thrive as it should and as it has a right
to do.
The Department believes that if milk is properly treated before being
fed, there will be much less sickness among the babies, and, as a matter of
course, a material reduction of the number of deaths during the milk-feeding
period. It has been thoroughly demonstrated that heating or
pasteurizing the milk makes it more digestible and therefore more easily
assimilated.
For home pasteurization of milk, the following method is recommended:
Take a bottle of milk with the cap or stopper in it, just as it comes from
the milkman. Place the bottle on a saucer or small plate in a pan or
boiler filled with cold water, which should come up to within two inches
of the top of the bottle. It should then be placed over the fire and allowed
to remain until the water around the bottle begins to boil. Then take
it off the fire and set aside to cool.
The water must not be allowed to boil for any length of time, and the
milk must be cooled in the water, the entire process consuming about forty
or forty-five minutes.
This treatment will destroy practically all the bacteria present, espe-cially
the pathogenic ones, such as typhoid bacilli, which we have care-fully
studied and have been able to destroy by this method. Such a bottle
of cooked milk, if kept in the ice box, will remain sweet for over a week.
If careful attention is paid to the above directions, the milk will have
only a very slight, if any, suggestion of "cooked" taste, while its nutritive
and digestible qualities will not be impaired.
The Department advises that this method be pursued in the preparation
of all milk (except "certified"), intended to be fed to infants and the
young.
—
Chicago Health Department Talks (No. 28).
18 BULLETIN N. C. BOARD OF HEALTH.
STATE ASSOCIATION OF COUNTY SUPERINTENDENTS OF
HEALTH.
The organization of men engaged in the same work into a society
or association of their own is always of benefit to the work with
which they are charged. Although general rules may be laid down
for the performance of their duties, the conditions are not always the
same, and the interchange of ideas and of experience, even if no set
papers are read, are sure to be helpful.
Acting upon the suggestion of Dr. Glenn, the Superintendent of
Health of Gaston County, we have requested all the Superintendents
who can do so to attend the meeting of the State Medical Society at
Asheville. which convenes June 16th, for the special purpose of form-ing
a State Association. There are, however, two serious obstacles
in the way of getting a large number of them present at any definite
time. First, the difficulty that every general practitioner finds in
leaving his practice—generally cases of confinement for which he is
engaged—and, second, in this particular instance, the location of the
place of meeting, in the extreme western portion of the State. The
combination of engagements, loss of time and expense, we fear, will
deter a good many. But Asheville and our beautiful mountain coun-try
are always attractive and the added inducement of the meeting
of the Medical Society will, we trust, bring together a large propor-tion
of the Superintendents.
It is particularly desirable to have such a meeting this year be-cause
of the fact that, under the law, all the Superintendents were
elected or re-elected on the first Monday of May. A number of them
are sure to be new men. and they would find such a conference with
their fellows and with the Secretary of the Board of Health espe-cially
helpful. Dr. Rankin, the newly elected Secretary of the Board,
who takes office .Tidy 1st. will also be present, and it not only would
lie pleasant but profitable to meet him and become personally ac-quainted
with the man with whom they are to work in the future.
We can say for the outgoing Secretary that it would be a pleasure
to him to meet as many of his fellow-laborers as possible. So we
hope a goodly number will be present at Asheville, and that the pro-posed
association may be started off in good shape.
BULLETIN N. C. BOARD OF HEALTH. 19
REVIEW OF DISEASES FOR APRIL. 1909.
EIGHTY-ONE COUNTIES REPORTING.
Ninety-three counties have Superintendents of Health.
Except in the case of the more contagious and dangerous diseases,
the Superintendent has. as a rule, to rely upon his own information
alone, since few physicians can he induced to report cases of non-contagious
diseases to him.
Where the number of cases is not given, or the prevalence of a dis-ease
otherwise indicated, its mere presence in the county is to he un-derstood
as reported.
For the month of April the following diseases have heen reported
from the counties named
:
Measles.—Alamance, epidemic ; Ashe. 10 cases : Bladen, a few ;
Buncombe, 2; Burke, 90; Caldwell. 1; Camden. 5; Carteret, several;
Caswell, several ; Catawba, 15 ; Cherokee, 7 ; Craven, several ; Dare,
a few: Davidson. 5; Durham, a few: Edgecombe, a few; Forsyth, a
few : Gaston, many ; Granville, 2 ; Greene, 2 ; Guilford, 1 ; Harnett.
2 ; Jackson, several ; Mecklenburg ; Onslow ; Richmond, 1 ; Robeson,
GO ; Rowan, a few ; Surry, 20 ; Transylvania, in all parts ; Union, a
few : Watauga, S ; Wilkes, 10 ; Yadkin, a few—35 counties.
Whooping-cough.—Alamance, several; Alexander, 30; Alleghany.
1 ; Beaufort, several ; Burke, a few ; Cabarrus, 20 ; Caldwell, 40 ; Car-teret,
a few : Caswell, several ; Catawba, 3 : Clay, a few : Cleveland, a
few : Cumberland ; Currituck, a few ; Davidson. 25 ; Duplin, 10 ; Dur-ham,
a few ; Edgecombe, several ; Forsyth, a few ; Franklin, a few
;
Gaston, a few; Graham, several: Granville, 2; Greene. 10: Harnett,
23; Henderson, many: Iredell, several: Lee, 1; Lincoln. 4: Macon,
10; Mecklenburg; Mitchell, many; Onslow; Person, 5; Polk. 1; Ran-dolph,
a few ; Richmond. 1 ; Robeson. 20 ; Scotland, many ; Transyl-vania,
a few; Tyrrell, a few; Union, a few; Vance, several; Wash-ington,
many; Watauga, 10; Wilkes. 5: Yancey, many—±8 counties.
Scarlatina.—Buncombe. 2; Chowan, 10; Cleveland, a few: Craven.
7; Davidson; Edgecombe, 2; Forsyth. 2; Gaston, many: Harnett. 1;
Iredell, 2; Macon. 5: Mecklenburg: Rowan. 1; Union, a few; Wash-ington.
4—14 counties.
Diphtheria.—Alamance, 2; Bladen, 2; Buncombe, 3; Carteret, 2;
Craven. 1 ; Cumberland, 3 : Edegecomhe, 1 ; Gates. 3 ; Guilford. 1
:
Harnett, 1 : New Hanover. 2 ; Northampton. 1 or 2 ; Onslow. 2 ; Per-quimans,
1 : Pitt, 1—15 counties.
Typhoid Fever.—Alexander. 2: Ashe. 4: Beaufort, 4; Bladen, i'
:
Brunswick. 4: Caldwell, 2; Carteret, several: Caswell. 1; Cherokee,
2; Cumberland; Durham. 2 or 3; Edegecomhe. a few: Forsyth. 2:
20 BULLETIN N. C. BOARD OF HEALTH.
Gaston, 1; Guilford, 1; Iredell, 1; Jackson, 4: Johnston, 1: Macon,
1: Martin. 2; Mecklenburg; Mitchell, a few: Montgomery, a few;
New Hanover, 1: Person, 2: Polk, 2; Randolph. 4: Richmond, 1;
Robeson, 1: Rowan, 2; Rutherford, 2; Scotland; Watauga, 'J: Yad-kin,
a few—34 counties.
Malarial Fever.—Currituck, Hyde. Lincoln. Martin. Montgomery,
Perquimans.
Malarial Fever, Pernicious.—Hyde, a few ; Martin. •"..
Malarial Fever. Hemorrhagic.—Martin, 1.
Bowel Diseases.—Currituck. Davidson. Edgecombe, Richmond.
Influenza.—Alamance; Alleghany; Caswell, in all parts; Curri-tuck;
Harnett; Northampton; Pender; Person; Randolph: Yadkin,
in all parts; Yancey, in all parts—11 counties.
Pneumonia.—Alexander, ::: Alleghany, 3; Beaufort, several ; Bruns-wick,
4: Buncombe, 1; Burke. 2; Cabarrus, 3; Caswell, several: Ca-tawba,
2: Chowan, 2: Cleveland, many: Cumberland: Currituck. 10;
D.uc. a few; Davidson, 5; Duplin, 4; Edegcombe. several: Forsyth,
several: Franklin: Gaston, 6; Granville. 4; Guilford; Harnett. IS;
Henderson, 4: Hyde, a few: Iredell, several; Jackson. 5 : Lee. :'.
Macon. 4; Madison, 1; Martin. 1: Mecklenburg; Mitchell, a few;
Nash: New Hanover, 3: Northampton; Onslow; Pender. 1: Person.
1: Polk. 1: Randolph. 4: Richmond, 2; Robeson. 50; Rowan. 1;
Rutherford, 2 : Sampson, a few ; Surry. 4 ; Transylvania ; Tyrrell, 2
;
Union, many; Washington, 5; Yadkin. 4: Yancey, 1—55 counties.
Meningitis, Cerebro-spinal.—Alamance, 2 ; Alleghany. 1 : Gaston,
1; Gates. 1: Guilford. 1; Harnett, 1: Robeson. 1—7 counties.
Mumps.—Catawba, Gaston and Watauga.
Roseola.—Tyrrell.
Scabies.—Randolph.
Smallpox.—Bladen. 5; Buncombe, 1; Caldwell. 16: Camden. 15;
Carteret. 1: Craven, G; Duplin, 0; Johnston, 2; Lee. 6: Mitchell, sev-eral:
Onslow. 2; Pasquotank, 14; Pitt, 2: Sampson. 5; Wake, 2;
Wilson. 1 : Yancey. 3—17 counties.
Hydrophobia, in Dogs.—Burke. 1 ; New Hanover, 2.
Spinal Meningitis, in Cattle.—Caldwell.
No diseases reported from Haywood, McDowell. Orange and War-ren.
Xii reports received from Anson. Beaufort. Chatham. Columbus,
Davie. Halifax, Hertford, Lenoir. Moore, Rockingham. Stanly. Swain
and Wayne.
BULLETIN N. C. BOARD OF HEALTH. 21
SUMMARY OF MORTUARY REPORTS FOR APRIL, 1909.
White. Colored. Total.
Aggregate population 160,500 105,200 271. TOO
Aggregate deaths 134 173 307
Representing temporary annual death rate
per 1,000 9.6 19.7 13.6
Causes of Death.
Whooping-cough 2 1 3
Measles 1 3 4
Pneumonia 16 22 38
Consumption 22 33 55
Brain diseases 11 6 17
Heart diseases 11 15 26
Neurotic diseases 2 5 7
Diarrheal diseases 7 4 11
All other diseases 54 79 133
Accident 3
Suicide 2 1 3
Violence 1 1
134 173 307
Deaths under 5 years 34 52 86
Stillborn 7 IS 25
22 BULLETIN X. C. BOARD OF HEALTH.
Mortuary Report for April, 1909.
Towns
and Reporters.
Popula-tion.
ra
Tem-porary
Annual
Death
Rate per
1,000.
BULLETIN X. C. BOARD OF HEALTH.
County Superintendents of Health.
Alamance Dr. H. M. Montgomery.
Alexander Dr. 0. L. Hollar.
Alleghany Dr. Robert Thompson.
Anson Dr. E. S. Ashe.
Ashe Dr. J. T. Testerman.
Beaufort Dr. D. T. Tayloe.
Bertie Dr. John L. Pritchard.
Bladen Dr. L. B. Evans.
Brunswick Dr. J. Arthur Dosher.
Buncombe Dr. D. L. Laxton.
Burke Dr. J. R. Anderson.
Cabarrus Dr. R. S. Young.
Caldwell Dr. C. L. Wilson.
Camden Dr. C. G. Ferebee.
Carteret Dr. W. E. Headen.
Caswell Dr. S. A. Malloy.
Catawba Dr. Geo. H. "West.
Chatham Dr. J. H. Taylor.
Cherokee Dr. S. C. Heighwav.
Chowan Dr. H. M. S. Casoh.
Clay Dr. P. B. Killian.
Cleveland Dr. T. E. McBraver.
Columbus Dr. H. B. Maxwell.
Craven Dr. Joseph F. Rhem.
Cumberland Dr. A. S. Rose.
Currituck Dr. H. M. Shaw.
Dare Dr. S. C. Heighway.
Davidson Dr. Joel Hill.
Davie Dr. M. D. Kimbrough.
Duplin Dr. John A. Ferrell.
Durham Dr. N. M. Johnson.
Edgecombe Dr. W. J. Thigpen.
Forsyth Dr. S. F. Pfohl.
Franklin Dr. R. F. Yarborough.
Gaston Dr L. N. Glenn.
Gates Dr. Geo. D. Williams.
Graham Dr. M. T. Maxwell.
Granville Dr. S. D. Booth.
Greene Dr. W. B. Murphy.
Guilford Dr. Edmund Harrison.
Halifax Dr. I. E. Green.
Harnett Dr. J. W. Halford.
Haywood Dr. J. R. McCracken.
Henderson Dr. J. G. Waldrop.
Hertford Dr. J. H. Mitchell.
Hvde Dr. R. E. Windley.
Iredell Dr. M. R. Adams.
Jackson Dr. A. S. Xichols.
Johnston Dr. L. D. Wharton.
Jones Dr. H. G. Monk.
Lee Dr. J. P. Monroe.
Lenoir Dr. C. L. Pridgen.
Lincoln Dr. J. W. Saine.
McDowell Dr. M. L. Justice.
Macon Dr. S. H. Lyle.
Madison Dr. W. J. Weaver.
Martin Dr. W. E. Warren.
Mecklenburg Dr. C. S. McLaughlin.
Mitchell Dr. Virgil R. Butt.
Montgomery Dr. J. B. Shamburger.
Moore Dr. Gilbert McLeod.
Nash Dr. I. P. Battle.
New Hanover.. .Dr. W. D. McMillan.
Northampton Dr. H. W. Lewis.
Onslow Dr. Cyrus Thompson.
Orange Dr. C. D. Jones.
Pamlico
Pasquotank Dr. J. B. Griggs.
Pender Dr. Robt. H. Bradford.
Perquimans Dr. T. P. McMullen.
Person Dr W. A. Bradsher.
Pitt Dr. Joseph E. Nobles.
Polk Dr. Earle Grady.
Randolph Dr. S. A. Henley.
Richmond Dr. N. C. Hunter.
Robeson Dr. H. T. Pope.
Rockingham Dr. Sam Ellington.
Rowan Dr. I. H. Foust.
Rutherford Dr. E. B. Harris.
Sampson Dr. Frank H. Holmes.
Scotland Dr. K. A. Blue.
Stanly Dr. J. N. Anderson.
Stokes
Surry Dr. John R. Woltz.
Swain Dr. J. A. Cooper.
Transvlvania Dr. Goode Cheatham.
Tyrreil Dr. W. W. Stancell.
Union Dr. Henry D. Stewart.
Vance Dr. John Hill Tucker.
Wake Dr. J. W. McGee, Jr.
Warren Dr. M. P. Perry.
Washington Dr. W. H. Ward.
Watauga Dr. J. M. Hodges.
Wayne Dr. T. L. Ginn.
Wilkes Dr. John Q. Myers.
Wilson Dr. W. S. Anderson.
Yadkin Dr. S. L. Russell.
Yancey Dr. W. B. Robertson.
Mitchell Sei Society
BTTX-iX-iESOri^T
OF THE
NORTH CAROLINA BOARD OF HEALTH
Published Monthly at the Office of the Secretary of the Board, Raleigh, N. C.
Entered as second-class matter at Post Office at Raleigh, N. C, under Act March 3, 1879.
G. G. Thomas, M. D., Pres., Wilmington.
Thomas E. Anderson, M. D., Statesville.
J. Howell Way, M. D., Waynesville.
W. O. Spencer, M. D., Winston-Salem.
Edw. C. Register, M. D., Charlotte.
David T. Tayloe, M. D., Washington.
J. A. Burroughs, M. D., Asheville.
J. L. Ludlow, C. E., Winston-Salem.
Richard H. Lewis, M. D., Secretary and Treasurer, Raleigh.
Vol. XXIV. JUNE, 1909. No. 3.
HAIL AND FAREWELL.
With this issue the writer retires as secretary and treasurer of the
State Board of Health and as editor of the Bulletin, after a service
of nearly seventeen years. No one realizes more clearly than himself
his shortcomings in both capacities and the inadequacy of his efforts,
but in justice it should he said that the time available from an active
and busy professional life for the public health work has necessarily
been limited. lie is gratified, however, by the kind assurances he has
received from those competent to judge that during his incumbency
material advance has been made in sanitation in our State, and that
a strong public sentiment favorable to the cause of the public health
has been built up.
A thoroughly equipped and ably manned laboratory of hygiene has
been established on a solid basis. The laws relating to the public
health have been greatly amplified and improved, and will now com-pare
favorably with those of the States most advanced in preventive
medicine.
In helping to bring about the amendment of the health laws increas-ing
the annual appropriation two hundred per cent, still inadequate,
but sufficient to justify and permit the employment of all the time of
a competent secretary, and in finding and securing on his nomination
the unanimous election by the Board of Health of such a man, the
outgoing secretary feels that in this, his last, he has done his best
work for the cause of the public health.
26 BULLETIN N. C. BOARD OF HEALTH.
While it is with a natural feeling of regret that he gives up the
active work in so great a cause in which he has been engaged for
many years, he believes, as he has said elsewhere, that it is best for
the work's sake as well as for his own. As long as life lasts he will
continue to take a deep interest in. and to aid in every way he can.
the noble work of promoting the public health, averting sickness and
saving life.
It is with great pleasure that we introduce and commend to the
people of North Carolina and to the medical profession in particular,
who must be his supporters and co-workers, Watson S. Rankin,
M. D., who, on July 1st, assumes the duties and responsibilities of
secretary and treasurer of the State Board of Health and Registrar
of Vital Statistics.
Although just thirty years of age. Dr. Rankin has already "made
good," and with his natural ability, good training, energy, enthusiasm
and an ambition to accomplish results he will, we feel sure, in the
coming years do great things for our people. Hold up his hands.
REPORT OF THE SECRETARY, MAY 20, 1908, JUNE 11, 1909.
Your secretary, in this, his last report, is much gratified at being
able to say that his last year of service has witnessed the greatest
advance of the cause of preventive medicine in our State, in a like
period of time, since the establishment of the State Board of Health.
For several years he has realized that, owing to the exactions of
bis private professional work, the time he could give to the work of
the board was- entirely inadequate. He believed also, that, owing to
the very small salary allowed the secretary, on account of the meager
appropriation, no one else could be expected to give more attention to
it and make a proper living, and so he waited before taking action
until, in his judgment, the outlook was favorable for an attempt at a
forward movement. Upon the assembling of the last Legislature the
conditions, in his opinion, justified making a trial for better things.
Consequently, having found a man whom he believed to be well quali-fied
for the position and having obtained from him a positive promise
to accept an election, if tendered him by the board, your secretary
prepared a bill, while incidentally legislating himself out of office, as
he could not afford to abandon his private practice, that would pro-vide
the means for work far in advance of anything heretofore at-tempted
for the public health. The essential feature of the bill was
an increase of the annual appropriation from two to ten thousand
dollars, authorizing the payment to the secretary of a salary of three
thousand dollars a year and requiring him to give his entire time to
public health work. While the Legislature cut down the appropria-
BULLETIX X. C. BOARD OF HEALTH. 2<
tion asked for to six thousand dollars, it still left an increase of 200
per cent and a sum sufficient to secure all the time of a competent
secretary, the one thing absolutely essential to any marked progress.
As you already know, the present incumbent, at a call meeting on
March 30th last, tendered his resignation, which was accepted, to
take effect July 1st, and Dr. Watson S. Rankin, Dean of the Medical
School at Wake Forest College, was unanimously elected as his suc-cessor.
The public health laws were also materially and advantageously
amended in many other respects, particularly those sections relating
to the control of public water supplies by the Board of Health, in the
preparation of which latter amendments invaluable aid was rendered
by the engineer of the board, Col. J. L. Ludlow.
Section 3057 of the Revisal of 1905, relating to the State Laboratory
of Hygiene, was amended by specifically requiring analyses of drink-ing
waters sold in bottles or other packages and imposing upon those
selling them an annual tax, graduated in proportion to the gross re-ceipts
from sales. While the original act imposed an annual tax of
$64 upon all individuals, firms and corporations selling water to the
people, it was found, upon investigation, that in many instances this
was out of proportion to the business done, and it was deemed both
right and wise to make the tax equitable and at the same time to
make it perfectly clear that bottled waters came within the law.
The necessity for analysis of this class of waters was startlingly
shown by analyses your secretary had made in the laboratory in the
general cause of the public health and for the purpose of supplying
ammunition with which to meet an attack upon the law, threatened
by the president of one of the companies selling a water .of this class.
Of sixty-one samples from twenty-nine springs thirty-two were found
to be infected with colon bacilli. Although the gentleman referred to
passed away before the General Assembly met, the information thus
obtained was of service in securing the desired legislation. The sec-tion
was further amended so as to require analyses of the waters of
springs "maintained and treated as an adjunct to any hotel, park or
resort for the accommodation or entertainment of the public," and
an annual tax of $15 was imposed upon all such sources of water
supply, with an additional tax on all waters sold therefrom in bottles,
in accordance with the schedule referred to above.
Probably the weakest spot in our sanitary legislation has been the
lack of reliable vital statistics. The only statistics we have had
heretofore have been those collected by some twenty-odd cities and
towns in various and manifestly, in some instances. verjr imperfect
ways, and incomplete and inaccurate vital statistics are practically
worthless. A model vital statistics bill for States was sent us by
both the Bureau of the Census and by the American Medical Associa-tion.
Theoretically, it was an excellent bill, and for densely popu-lated,
highly organized communities doubtless practicable, but for
28 BULLETIN X. C. BOARD OF HEALTH.
our State, with its large, widely scattered rural population, and one-third
of that negroes, it would have been little short of absurd.
After a very careful consideration of the subject it was decided that
any attempt at the collection of reliable vital statistics holding out
the least hope of success, for the present at least, would have to be
limited to incorporated towns. So. desiring that our statistics might
fit in with those of the United States Census Bureau, a request was
made of Dr. Cressy L. Wilbur, Chief Statistician, to have prepared
for us a bill applying only to cities and towns of one thousand popu-lation
and over. Taking the bill he kindly and promptly sent as a
basis, it was modified to fit our conditions. After its passage in its
completed state it was very gratifying to learn from Dr. Wilbur that
it was the first practical vital statistics law to be enacted in the
South, and. moreover, that it contained a provision for the enforce-ment,
new to him and in his opinion valuable. This provision was
placing the responsibility for carrying out the law solely upon the
mayor, and making him liable to a fine of not less than $10 for fail-ure
of duty in this respect ; and at the same time making it manda-tory
upon the solicitor to institute a criminal action for its collection,
upon complaint of the State Registrar or Secretary of the State
Board of Health. It really looks nowr as if vital statistics of real
value, though necessarily partial, were in sight.
The high price of diphtheria antitoxin being prohibitory to the
poor, the propriety of making provision for its supply free to indi-gent
cases of the disease should not be questioned by any humane
person. The suggestion of the advisability of such legislation came
from Dr. B. E. Reeves, of Alleghany County, in a letter, accompanied
by a tentative bill, to Senator R. L. Doughton, of the same county.
The suggestion was cordially received, and at his request Dr. Reeves's
bill was modified and amplified into the law as we now have it.
Another forward step was the increase in the annual appropriation
for the support of the State Sanatorium for Tuberculosis, from $5,000
to $7,500, and the appropriation of $30,000 for improvements. This
institution, which is ideally located, was opened for patients in Xo-vember
last, and promises to be of much value in the campaign
against tuberculosis.
The most gratifying and encouraging thing in connection with the
health legislation by the late General Assembly is that, with the ex-ception
of the cutting down of the appropriation of ten thousand dol-lars
asked for to six and an immaterial amendment to the bill relat-ing
to the Laboratory of Hygiene, requiring reciprocity in the matter
of analyses of bottled waters with other States having similar labo-ratories
and requirements, all the bills relating to the public health
in any way were passed without amendment and without a single
vote in the negative. This signifies a remarkable growth in favorable
public opinion and justifies the hope of more rapid progress in the
near future.
BULLETIN N". C. BOARD OF HEALTH. 29
As this report is made to the conjoint session of the Board of
Health with the Medical Society, and as nothing is of more import-ance
to the public health than well-qualified physicians, reference to
the strictly medical legislation is in order.
A bill, prepared by the Board of Medical Examiners, the essential
feature of which was the requirement of a preliminary education
equal to graduation from a high school of all applicants for license,
was introduced in the House by one of its most influential members.
The requirement was certainly a most reasonable one, and. as a matter
of fact, of special value to the prospective student of medicine, but it
was bitterly fought with the usual demagogic arguments of "Medical
Trust," "poor boy," and, after three hot contests, was finally defeated
by one majority.
The amendment to the license law, authorizing the Board of Medi-cal
Examiners, in its discretion, to modify the requirements of the law
and to grant a limited liceuse, when the conditions in the neighborhood
from which the applicant came demanded it, met with no opposition.
Special acts licensing certain physicians had been introduced and
the indications were that they would be passed. To prevent this kind
of legislation, which would mean in the end the practical destruction
of our license law, this amendment was suggested as a compromise
and accepted by the introducers of the bills. This action on the part
of those having the matter in charge has been criticised in some
quarters, but it should be said that a copy of the amendment was
sent to every member of the Committee on Legislation and of the
Board of Medical Examiners and was approved or assented to by
all, with the exception of a single member of the Board of Medical
Examiners. Those on the ground and familiar with the conditions as
they actually existed in the Legislature felt no doubt whatever as to
its wisdom.
Before leaving the subject of legislation acknowledgment should
be made of the valuable assistance rendered by Dr. Albert Anderson
of the committee.
After nearly seventeen years of active and loving service your
secretary lays down the work with regret, although he realizes
that it is best for the work's sake as well as for his own. He is con-scious
of many things left undone that ought to have been done, and
perhaps some things have been done that ought not to have been
done, but he has tried to be of some service to the State.
In conclusion, he wishes to express his deep and heartfelt appre-ciation
of the unfailing and unvarying kindness and courtesy he has
received at your hands, and to most cordially commend to you his
successor, Dr. Rankin. Dr. Rankin he believes to be a man of char-acter,
ability, energy, enthusiasm and possessed of the altruistic
spirit so helpful in work of this kind. If the profession in the State
30 BULLETIN X. C. BOARD OF HEALTH.
will hold up bis hands and give him their cordial support and co-operation
he will do great things in the corning years for North Caro-lina.
The Laboratory of Hygiene is proving of greater and greater value
to the people and to the medical profession as time passes. The pro-fession
is showing increasing interest and appreciation and seems to
be well satisfied with the work done therein, and not a word of criti-cism
of either methods or results has come to the office of the secre-tary.
The amount of work accomplished by Dr. Shore, the director, and
his two assistants. Miss Allen, Chemist, and Mr. Kellogg, Biologist,
when compared with that of some other laboratories, is, to say the
least, unusual. A perusal of the report of the director, which is ap-pended
hereto, will show this. Twenty-three hundred and ninety-two
examinations of specimens of various kinds and the administration
of the Pasteur treatment to eighty-three patients in addition, in one
year, by so small a force, is most gratifying. This could not have
been done but for the kindness of the United States Hygienic Labo-ratory
in furnishing us the virus free of charge. Not a case has died,
and our records, so far, could not be bettered.
In January last the Laboratory was moved to very commodious
quarters : it has been thoroughly furnished with the most approved
apparatus and manned by a force as good as any, and we can confi-dently
expect its increasing usefulness.
The following is the report of examinations made in the State Labo-ratory
of Hygiene from May 20, 190S. to May 20, 1900 :
143 Examinations of feces
—
Positive. Negative.
Hookworm 65 50
Oxyuris vermieularis 1
Ascaris liunbricoides 2
Amoeba coli 2 1
Fly larvae 3
Taenia saginata 1
Tubercle bacilli 2 9
Blood 4 2
Cancer cells . . 1
277 Examinations of sputum for tubercle bacilli. 10S 169
271 Examinations for diphtheria bacilli 169 102
43 Examinations for malaria 9 34
135 Examinations for Widal reaction 56 79
IS Examinations for gonococci 7 11
65 Examinations of brains for rabies 47 IS
2 Examinations, bacterial, of pus.
6 Differential leucocyte counts.
122 Specimens of urine, with a variety of bacterial and chemical de-terminations.
BULLETIN N. C. BOARD OF HEALTH. 31
74 Examinations of pathological tissue, as follows
:
Carcinoma 15
Chronic inflammation 19
Benign hypertrophies 11
Sarcoma 6
Chondroma 1
Colloid, goitre 2
Tuberculosis 10
Pyaemia 2
Verruca 1
Necrosis 1
Doubtful (tissue not well preserved) 1
Placenta 2
2 Examinations of gastric fluid.
1.234 Examinations of water.
2,392
Eighty-three patients received Pasteur treatment at this laboratory.
Of these, 65 were bitten by dogs in which the disease was dem-onstrated
either by microscopic examination, inoculation experiments
in laboratory or by subsequent death of other animals from a bite ; in
17 cases only a clinical history of rabies in the attacking animal was
obtained; in 1 the history was found to be erroneous and treatment
was discontinued ; 13 of these cases paid for treatment and the re-maining
70 were given free treatment.
32 BULLETIX X. C. BOARD OF HEALTH.
SMALLPOX REPORT.
Counties.
Number of Cases.
White. Colored. Total
Anson
Ashe
Bertie
Bladen
Buncombe
Cabarrus
Caldwell
Camden
Carteret
Catawba
Cherokee
Chowan
Craven
Currituck
Duplin
Edgecombe—
Forsyth
Guilford
Harnett
Johnston
Jones
Lee
McDowell
Madison
Mitchell
Nash
New Hanover
Onslow
Pasquotank —
Perquimans —
Pitt
Polk
Richmond
Rowan
Rutherford
Sampson
Scotland
Wake
Warren
Watauga
Wilson
Yancey
Total in 42 counties
-
Death rate per cent
1
106
15
1
3
1
12
2
85
25
23
10
12
14
60
110
1
14
1
7
11
6
Ml
5
553
16
15
6
7
1
1
106
95
1
3
1
24
16
145
135
1
37
1
23
85
46
44
5
5
25
13
7
9
105
28
3
3
2
3
17
37
26
2
8
15
1
4
Nlimber of Deaths.
1,127
White. Colored. Total
3
.05
BULLETIN M". C. BOAED OF HEALTH. 33
REVIEW OF DISEASES FOR MAY, 1909.
EIGHTY-ONE COUNTIES REPORTING.
Ninety-six out of ninety-eight counties have superintendents of
health.
Except in the case of the more contagious and dangerous diseases,
the superintendent has, as a rule, to rely upon his own information
alone, since few physicians can be induced to report cases of non-contagious
diseases to him.
Where the number of cases is not given, or the prevalence of a dis-ease
otherwise indicated, its mere presence in the county is to be
understood as reported.
For the month of May the following diseases have been reported
from the counties named :
Measles.—Alainanee, several cases ; Burke, SO ; Carteret ; Caswell,
several ; Catawba, a few ; Chatham, 6 ; Craven, many ; Davidson, 10
Duplin, 8; Durham, a few; Forsyth, several; Greene, 12; Guilford. 1
Harnett, several ; Macon, 5 ; Mecklenburg ; Onslow, 1 ; Pamlico, 20
Randolph, a few ; Robeson, epidemic ; Wake, 4 ; Wilkes, several ; Yad-kin—
23 counties.
Whooping Cough.—Alamance, a few ; Bertie, several ; Bladen, many
;
Caldwell. 15; Caswell, several; Catawba, many; Cleveland, a few;
Cumberland, several ; Davidson, 150 ; Davie, a few ; Edgecombe, 4
Forsyth, a few ; Franklin, many ; Granville, 30 ; Haywood, a few ; Ire-dell,
many ; Jackson, 5 ; Lee, 3 ; Lenoir, 10 ; Lincoln, 10 ; Macon, epi-demic
; Mecklenburg ; Mitchell, several ; Pamlico, 30 ; Randolph, a few
Robeson, a few; Rowan, several; Transylvania, a few; Union, many:
Vance, several ; Wake, 16 ; Wayne, a few ; Wilkes, a few ; Yancey, 9
—
34 counties.
Scarlatina.—Cabarrus, 2 ; Caldwell, 2 ; Chatham, 6 ; Chowan, 1
;
Cleveland, a few ; Davidson, 1 ; McDowell, 2 ; Macon, 2 ; Mecklenburg
Nash, 2 ; Orange, 3 ; Pascpiotank, 1 ; Rowan, 1 ; Wake, 4 ; Washington,
8—15 counties.
Diphtheria.—Alamance, 1 ; Cherokee, 1 ; Chowan, 1 ; Craven, 1
Cumberland, 2 ; Duplin, 3 ; Edgecombe, 4 ; Gates, 2 ; Guilford, 1 ; Le-noir,
3 ; Madison, 1 ; Onslow, 3 ; Pasquotank, 1 ; Pender, 1 ; Perquim-ans,
1 ; Washington—16 counties.
Typhoid Fever.—Alamance, 2 ; Alexander, 7 ; Ashe, 4 ; Beaufort,' 3 ;
Bertie, 4 ; Bladen, a few ; Brunswick, 2 ; Cabarrus, 1 ; Caldwell, 5
Camden, 5 ; Caswell, 1 ; Catawba, a few ; Chatham, 2 ; Cleveland, sev-eral
; Craven, 5 ; Cumberland, a few ; Davie, a few ; Duplin, 10 ; Dur-ham,.
2 or 3; Franklin, a few; Gates, 1; Graham, 1; Granville. 1;
Guilford, 5; Harnett, several; Henderson, 1; Jackson, 3; Lee, 3; Le-
34 BULLETIN N. C. BOARD OF HEALTH.
noir, 5; McDowell. 1 : Macon, 3; Mecklenburg; Mitchell, a few; Mont-gomery,
2; New Hanover, 7; Onslow, 1; Orange, 2; Pamlico, 2; Per-quimans,
1 ; Person, 1 ; Randolph, a few ; Robeson, a few ; Rowan, 2 ;
Sampson, 3 ; Scotland, 6 ; Tyrrell, 1 ; Union, 2 ; Wake, 9 ; Washington,
2; Watauga, 10; Wilkes, 2; Yadkin, a few; Yancey, 1—53 counties.
Malarial Feveb.—Cabarrus; Caswell, in all parts; Currituck, a
few; Hyde; Onslow; Pamlico; Perquimans, in all parts; Pitt; Union
—
9 counties.
Malarial Fever, Pernicious.—Hyde, 4; Pitt, 1.
Malarlal Fever, Hemorrhagic.—Bertie, 1 ; Pamlico, 1.
Bowel Diseases.—Alamance, in all parts; Alleghany; Ashe, in all
parts ; Cabarrus, a few ; Caldwell ; Currituck, a few ; Davie, in all
parts; Graham, in all parts; Guilford, in all parts; Haywood, in all
parts; Macon, in all parts; Onslow; Pender, in all parts; Perquimans,
in all parts ; Person ; Randolph, in nearly all parts ; Robeson, in all
parts ; Transylvania, in all parts ; Wilkes, in all parts—19 counties.
Influenza.—Montgomery, in all parts ; Randolph, in all parts.
Pneumonia.—Ashe, 3; Bertie, 2; Bladen, 1; Caldwell, 3; Catawba,
a few ; Chatham, 1 ; Cleveland, a few ; Davidson, 2 ; Davie, a few
;
Duplin, 1 ; Durham, a few ; Forsyth, a few ; Gates, 1 ; Harnett, sev-eral
; Henderson, 1 ; Jackson, 6 ; Lee, 1 ; Lenoir, 2 ; McDowell, 1
;
Mecklenburg; Mitchell, several; Montgomery, 5; New Hanover, 3;
Pamlico, 2 ; Pender, 1 ; Perquimans, 1 ; Pitt ; Randolph, several ; Rob-eson,
several ; Rowan, several ; Wake, G ; Washington, 1 ; Wilkes, 2 ;
Yadkin, 2—35 counties.
Meningitis, Cerebro- Spinal.—Alamance, a good many; Gates, 2;
Jackson. 1 ; Montgomery, 1.
Mumps.—Cabarrus; Cumberland; Edgecombe, in all parts; Onslow.
Smallpox.—Caldwell, 2 ; Camden, 30 ; Craven, 1 ; Cumberland, 1
;
Duplin, 10 ; Madison, 1 ; Mecklenburg. 2 ; Pamlico, 4 ; Pasquotank, 1
Pitt, 7 ; Rowan, 9 ; Sampson, 42 in extreme northern part ; Transyl-vania,
5 ; Wayne, 14 ; Yancey, 5—15 counties.
Cholera, in Hogs.—Beaufort.
No diseases reported from Buncombe, Hertford, Martin, Polk, Ruth-erford,
Warren and Wilson.
No reports received from Anson, Clay, Columbus, Gaston, Halifax,
Johnston, Jones, Moore, Northampton, Person, Richmond, Rocking-ham.
Stanly, Surry and Swain.
BULLETIN N. C. BOARD OF HEALTH. 35
SUMMARY OF MORTUARY REPORTS FOR MAY, 1909.
White. Colored. Total.
Aggregate population 156,700 96,300 253.000
Aggregate deaths 174 182 356
Representing temporary annual dath rate
per 1,000 13.3 23.7 16.9
Causes of Death.
Malarial fever 1 3 4
Diphtheria 2 2
Whooping Cough 2 3 5
Measles 4 4 S
Pneumonia 9 13 22
Consumption 21 29 50
Brain diseases S 12 20
Heart diseases 14 13 27
Neurotic diseases 3 3
Diarrheal diseases 29 29 5S
All other diseases 76 72 148
Accident 5 5
Suicide 2 2
Violence 1 1 2
174 182 356
Deaths under five years 47 55 102
Stillborn 21 32 53
36 BULLETIN N. C. BOARD OF HEALTH.
Mortuary Report for Ma>
BULLETIN X. C. BOARD OF HEALTH. 37
County Superintendents of Health.
Alamance Dr. H. M. Montgomery.
Alexander Dr. B. 0. Choate.
Alleghany Dr. Robert Thompson.
Anson Dr. E. S. Ashe.
Ashe Dr. J. C. Testerman.
Beaufort Dr. P. A. Nicholson.
Bertie Dr. John L. Pritchard.
Bladen Dr. L. B. Evans.
Brunswick Dr. J. Arthur Dosher.
Buncombe Dr. D. E. Sevier.
Burke Dr. J. R. Anderson.
Cabarrus Dr. J. M. Wallace.
Caldwell Dr. C. L. Wilson.
Camden Dr. C. G. Ferebee.
Carteret Dr. W. E. Headen.
Caswell Dr. S. A. Mallov.
Catawba Dr. T. C. Blackburn.
Chatham Dr. L. E. Farthing.
Cherokee Dr. J. F. Abernethy.
Chowan Dr. H. M. S. Cason.
Clav Dr. J. M. Sullivan.
Cleveland Dr. T. E. McBrayer.
Columbus Dr. H. B. Maxwell.
Craven Dr. Joseph F. Rhem.
Cumberland Dr. A. S. Rose.
Currituck Dr. H M. Shaw.
Dare
Davidson Dr. E. J. Buchanan.
Davie Dr. M D. Kimbrough.
Duplin Dr. John A. Ferrell.
Durham Dr. N. M. Johnson.
Edgecombe Dr. Spencer P. Bassy.
Forsyth Dr. J. K. Pepper.
Franklin Dr. R. F. Yarborough.
Gaston Dr L.N.Glenn.
Gates Dr. Geo. D. Williams.
Graham Dr. M. T. Maxwell.
Granville Dr. S. D. Booth.
Greene Dr. W. B. Murphy.
Guilford Dr. Edmund Harrison.
Halifax Dr. I. E. Green.
Harnett Dr. L. J. Arnold.
Haywood Dr. J. R. McCracken.
Henderson Dr. J. G. Waldrop.
Hertford Dr. J. H. Mitchell.
Hvde Dr. R, E. Windley.
Iredell Dr. M. R. Adams.
Jackson Dr. A. S. Nichols.
Johnston Dr. L. D. Wharton.
Jones
Lee Dr. J. P. Monroe.
Lenoir Dr. N. A. Whitaker.
Lincoln Dr. J. W. Saine.
McDowell Dr. Geo. S. Kirby.
Macon Dr. S. H. Lyle.
Madison Dr. W. J. Weaver.
Martin Dr. W. E. Warren.
Mecklenburg Dr. C. S. McLaughlin.
Mitchell Dr. Virgil R. Butt.
Montgomery Dr. C. Deligney.
Moore Dr. Gilbert'McLeod.
Nash Dr. J. P. Battle.
New Hanover___Dr. W. D. McMillan.
Northampton Dr. H. W. Lewis.
Onslow Dr. Cyrus Thompson.
Orange Dr. C. D. Jones.
Pamlico Dr. Daniel A. Dees.
Pasquotank Dr. H. T. Aydlett.
Pender Dr. Robt. H. Bradford.
Perquimans Dr. T. P. McMullen.
Person Dr. W. T. Long.
Pitt Dr. W. M. Fountain.
Polk Dr. W. R. Engel.
Randolph Dr. J. V. Hunter.
Richmond Dr. N. C. Hunter.
Robeson Dr. H. T. Pope.
Rockingham Dr. Sam Ellington.
Rowan Dr. M. L. Smoot.
Rutherford Dr. E. B. Harris.
Sampson Dr. A. M. Cooper.
Scotland Dr. K. A. Blue.
Stanly Dr. J. N. Anderson.
Stokes
Surry Dr. John R, Woltz.
Swain Dr. J. A. Cooper.
Transvlvania Dr. Goode Cheatham.
Tyrrell Dr. J. L. Spruill.
Union____ Dr. Henry D. Stewart.
Vance Dr. E. F. Fenner.
Wake Dr. J. J. L. Meddlers.
Warren Dr. M. P. Perry.
Washington Dr. W. H. Ward.
Watauga Dr. J. M. Hodges.
Wayne Dr. T. M. Bizzell.
Wilkes Dr. John Q. Mvers.
Wilson Dr. W. S. Anderson.
Yadkin Dr. S. L. Russell.
Yancey Dr. W. B. Robertson.
Mitchell sci Society
OF THE
NORTH CAROLINA BOARD OF HEALTH
Published Monthly at the Office of the Secretary of the Board. Raleigh, N. C.
Entered as second-class matter at Post Office at Raleigh, N. C, under Act March 3, 1879.
G. G. Thomas, M. D., Pres., Wilmington.
Thomas E. Anderson, M. D., Statesville.
J. Howell Way. M. D., Waynesville.
Edw. C. Register, M. D., Charlotte.
David T. Tayloe, M. D., Washington.
J. A. Burroughs, M. D., Asheville.
W. O. Spencer, M. D., Winston-Salem. J. L. Ludlow, C. E., Winston-Salem.
Richard H. Lewis, M. D., Raleigh. N. C.
W. S. Rankin, M. D., Secretary and Treasurer, Raleigh.
Vol. XXIV. JULY, 1909. No. 4.
RESOLUTIONS ADOPTED BY THE STATE MEDICAL SOCIETY
ON THE RETIREMENT OF DR. RICHARD H. LEWIS
AS SECRETARY OF THE BOARD OF HEALTH.
Whereas our former and most efficient secretary of the Board
of Health. Dr. R. H. Lewis, has decided it necessary to resign from
the position; and whereas, for the long period of seventeen years
of most arduous and difficult labor, he has accomplished so much,
by unfaltering zeal and devotion, for the upbuilding and the honor
of the profession, both of the State of North Carolina and the nation;
and whereas he has so carefully safeguarded the people against the
threatened inroad of disease as to save innumerable lives, the suf-fering
incident thereto, and great pecuniary loss; and whereas,
during these strenuous years, we have seen and appreciated the re-sults
of his great labors: now. wishing to express the esteem in
which he is held, not alone by the profession, but the laity, lie it
hereby
Resolved first. That this society express its conviction that he has
ilone more, both in his official and individual capacity, than would
have been possible for any other one to have done.
Resolved second, That we with reluctance accept his resignation.
realizing that we lose in some measure his great capabilities and far-reaching
influence.
40 BULLETIN N. C. BOARD OF HEALTH.
Resolved third, That lie, having been such a potent factor with the
Legislature, has saved us from Impending adverse legislation and
secured such salutary measures as are responsible for our present
advanced position in sanitary work.
Resolved fourth. That we earnestly implore him to give us yet his
wise counsel and help in time of difficulty and threatened legislation.
Resolved fifth, That it is our sincere wish and prayer that he.
having done so much for sanitation and the health of others, may
himself be Messed with many future years of vigorous health and
abundant enjoyment of the blessings and happiness of life.
AN APPRECIATION.
In the retirement of Dr. Richard H. Lewis as their secretary, the
State Board of Health has lost a most efficient officer and the pub-lic
a most devoted servant.
Dr. Lewis' tenure of office has bridged an important stage in the
development of public health work. Our understanding of the true
nature of communicable disease had its beginning in the discovery
of Van Loewenhoek, a lens polisher, of Delf, Holland, in 1683. From
its lie-inning, in that year, to 1S50, the idea that minute germs caused
disease was but a theory, and but little more than theory, supported
by only circumstantial evidence, till 1880, when Robert Koch trans-formed
the theory into a scientific fact, and in so doing laid the sure
foundation for preventive medicine and public health. For the next
ten years these new facts filtered slowly through the medical pro-fession,
reaching the general public about 1800, when the public be-gan
to grasp the true meaning of preventive medicine.
As Dr. Lewis was elected secretary of the Board of Health in 1892,
the beginning of his official life was coincident with the real begin-ning
of preventive medicine. It therefore became his task to nurse
this great movement in its early and tender years, in the years so
important to future development, when the foundation so essential to
what is to follow is being laid. How well he has performed this task
is not for the writer to say. for on this question the present status
of public health in North Carolina and the best public health author-ities
in America have handed down an opinion.
As the present condition of public health in North Carolina is
largely the result of Dr. Lewis' labors, in conjunction with the Board
of Health, it may be taken as the best evidence of his ability as a
sanitarian. His best work is probably recorded in the statute books
of the State. With the exception of the act establishing the State
Sanatorium for Tuberculosis and an act separating the tuberculous
prisoners from the well, he either drew up entirely or materially
BULLETIN X. C. BOARD OF HEALTH. 41
modified before introduction all the laws bearing mi public health,
and was active in securing their passage by the various Legislatures.
In this connection credit is due Col. J. L. Ludlow, the able sanitary
engineer of the board, for preparing the sections in the amendment
to the Revisal of 1905 adopted by the last Legislature, giving the
board more power in controlling public water supplies and in sug-gesting
the advisability of analyzing the waters of springs at resorts
while open for the entertainment of the public. As long ago as 1902
North Carolina was recognized by the American Public Health As-sociation
as one of four of the foremost States in water legislation.
Dr. Lewis, with the concurrence of the Board of Health, developed
the Laboratory of Hygiene upon the original plan of taxing all cor-porations
or individuals selling water to the public for its support,
supplemented by an annual appropriation of $2,000 which he secured
from the Legislature of 1907. Another law very much to his credit
is our new vital statistics law. Dr. Creesy L. Wilbur. Chief Statis-tician
of the United States Bureau of the Census, has said of this
law that it was "the first practical vital statistics law enacted in
any of the Southern States." As correct vital statistics form the
very basis of intelligent public health work, the value of this law is
at once evident. As law is the result of public sentiment, and public
sentiment the result of education, these laws are the result of an
effectual educational campaign for the improvement of public health.
To this Dr. Lewis has contributed through his editorial work in the
Bulletin of the State Boaro of Health and through many note-worthy
publications and addresses. Anions these may be mentioned
his "Drinking Water in Relation to Malarial Diseases.*' which
started the change in Eastern Carolina, in the domestic water supply
from open wells to driven pumps; his "Instructions for Quarantine
and Disinfection"; his leaflets on typhoid and malaria; his pamphlet
on the prevention of tuberculosis, pronounced by good judges to be
the best of its kind. A leading health officer of the State of New
York has said that 90 per cent of the anti-tuberculosis work in that
State was based upon Dr. Lewis' presidential address before the
National Conference of State and Provincial Boards of Health of
North America.
The opinion of the great health officials of America of Dr. Lewis
is shown by the recognition they have accorded him in having made
him president of both the great national public health associations.
In 1905 he was president of the National Conference of State and
Provincial Boards of Health of North America, and in 1907 he was
president of the American Public Health Association. It is therefore
very evident that the retiring secretary is a national figure in pub-lic
health work.
When it is remembered that the small amount of $2,000, out 'of
which clerk's hire. etc.. was to be taken, was nil appropriated by
4:2 BULLETIN X. C. BOABD OF HEALTH.
our State, it can readil: be seen that the secretary's service was
largely a labor of love. Forced on account of this small appropriation
to practice his profession, as an oculist, to earn a living, he has given
his resting hours to the service of his country, thereby showing a
selfi-sacrifice for public weal which should always be an inspiration to
those who follow him.
The writer fully realizes the embarrassment he lakes upon himself
in calling attention to the high standard set by his predecessor, but
a sense of gratitude and duty, both as an individual and as a public of-ficial,
will he satisfied with nothing less. In assuming' his official
cloak I shall always he mindful of him who wore ir so worthily.
THE PUBLIC HEALTH IN ITS APPEAL TO THE PEOPLE.
"Dead, your Majesty. Dead, my lords and gentlemen. Dead. Right
Reverends and Wrong Reverends of every .order. Dead, men and
women, horn with Heavenly compassion in your hearts. And dying
thus around us every day."
—
Bleak House.
Dead last year in the United States, dead in this age of boasted
altruism and enlightenment, 150,000 from tuberculosis, 30, ) from
typhoid fever. 35,000 from diphtheria. 10,000 from measles. 10,000
from scarlet fever and 10,000 from whooping cough, making a total
of aboul 250,000; and dying to-day. 690 more: dying this very hour.
2! I more, and every two minutes.' 1 more.
But for these diseases, you and I. our friends and neighbors would
have about sixty-six chances in a hundred instead of the thirty-three
we now have to live our allotted timt
—
i. < .. the sixty or seventy
years our Maker constructed the temple of the soul to last. The
average duration of life, now about thirty-eight years, would he in-creased
seven and one-half years.
These enormous figures bearing their unwelcome message, are
usually set aside as mere bugaboo. The public, in so disposing of
them, has long remained at ease, in "blissful ignorance" of the public
health, disregarding the duty imposed by God when He held an in-quest
over the first dead body and made man his brother's keeper.
These figures hear the Stamp of truth, and in the name of humanity
claim the attention of every true citizen. They are taken from the
mortality statistics of the Bureau of the Census of the United States
Government, which is the same department that estimates the popula-tion
of our country. Nearly all accept, without doubt, this estimate
of our population; comparatively few accept this estimate of our
death rate. The difference in the reception given to these two
statements cannot he explained on the ground that they come from
different authorities; the explanation must rest upon a difference in
BULLETIN N. C. BOARD OF HEALTH. 43
the nature of the two facts: One is a source of pride and imposes no
responsibility: the other is not a source of pride and does impose
responsibility.
The appeal to the heart by these death figures is not their only
appeal. They appeal to the purse as well. And as there are many
whose ears are more sensitive to the jingle of coin than to the cry
of the bereaved, we may for their sakes convert this pain, grief and
death into the coin of the realm. This has been done so well by
l>r. ('has. A. L. Reed thar I quote him verbatim:
"I now appeal to the larger number who, I grieve to say. think
only in terms of dollars and cents. So let us translate consumption
and typhoid, malaria and pneumonia, cancer and plague into their
equivalents, into the coin of the realm. But let us begin with a
few primary postulates.
"In the first place, the most valuable natural resource of this
country, fields and mines not excepted, is the productive energy of
the people. In computing the worth of this resource, a human life,
rather than an acre, a load or a tree, must be the basis of reckoning.
What is it worth V Let us see.
"A man's life is his capital. What he earns is the interest on his
capital. Then suppose a man works 300 days in a year, at $1.25 a
day. and that his money thus earned. $375 a year, represents 5 per
cent on his capital, which on that basis would amount to $7,500;
then multiply this by 150,000 for tuberculosis, 30,000 for typhoid,
and so on through the list, which foots up at about a quarter of a
million, and add it all together, and you will only have begun. You
are to add to this the loss of productive* energy of something like
700,000 people constantly ill for a whole year from tuberculosis, and
nearly half that number ill for sixty days from typhoid, and so on
through the list, at $1.25 a day for each one. Then, ignoring the
fact that the lives of many are worth thousands and hundreds of
thousands of dollars a year, exclude the nonproducers—women, chil-dren
and dependents—by dividing the result by two; then still to
be on the safe side, divide the result again by two, and the re-maining
figure, if translated into the coin of the realm and placed
in our National Treasury, would not only pay for a properly equip-ped
national department of public health, but would in addition pay
the current expenses of the army and navy, duplicate our armament
on the seas, fortify our coasts, deepen our inland water ways, and
in ten years would pay for the Panama Canal and wipe out our
national debt."
So far we have endeavored to establish one fact—the great annual
loss in lives and money to our country.
If we have succeeded in this endeavor, we have completed exactjy
one-half the case for public health: for. manifestly, if this loss is
inevitable, impossible To prevent by any practical means, then the
less we think and worry about it the better for us. On the other
44 BULLETIN X. C. BOARD OF HEALTH.
hand, if this loss is preventable, it al mice becomes the imperative
duty lit' those with this preventive power to stay this unchecked march
hi' death. The question, then, at this point resolves itself into this:
Are tins, diseases preventable?
The answer to this question is the second of tin- two facts which
completes the case for public health. This loss is easily preventable.
This last fad. as the first one, is ton important to leave propped by
mere dogmatism. To have the persuasive power over those concerned
that it should have, it must be firmly established mi a hasis of truth.
To this cud it is asked that our readers pardon what may seem to be
unnecessary details, being unwilling to count details when life is in
the balance.
The mind may settle a question in two ways: First, by an in-dividual
study of the principles upon which a proposition may rest:
second, by accepting as authority those known to have made this
study. If the second method be chosen, the larger the number of
authorities and the more unanimous their opinion the more certain
we may feel that the truth has been attained.
Now the establishment of this fact, that the aforesaid diseases
an- preventable, by our first method of settlement would require a
brief course in the science of disease or pathology, altogether too
much for the purpose of this paper. For our present purpose we
select the second method, the appeal to authority.
In regard to this particular question there are ten thousand who
have thoroughly investigated the preventability of these diseases, and
without a dissenting voice they all positively declare that they are
preventable. In the face of this, what egotism to claim the right
to a different opinion when an investigation such as would entitle
to an opinion has not been made
!
The problem of public health therefore rests on tiro thoroughly
established facts: First, the great annual loss of our country in lives
unit money. Second, this loss is preventable.
The problem of public health is preventive medicine. But while
preventive medicine is a problem for the public, it is a concern of
every individual; for sooner or later the germ of tuberculosis, the
germ of typhoid or some other agent of death shall call at your
dour and levy his tax: and you, unwillingly enough, shall pay this
tax—some time with your own suffering or life: some time with
the suffering or life of your wife or child or children.
It is a public problem, because K can lie applied only by the public.
It is a possession of the many that may be used or abused by the
few. A man residing in an isolated rural district may set tire to his
house and inflict an individual loss which concerns the public but
to a very slight extent: but if this same man. living in a city, should
fire a store that he owned in a business block, he would inflict more
than an individual loss. In addition to his own loss he would en-danger
his neighbors
—
i. e., the public.
BULLETIN X. C. BOARD OF HEALTH. 45
A i ase of typhoid fever in the country is a menace to a family,
and the public are in comparative safety; a case of this same disease
in town is a menace to the public, a public danger, because, unless the
family are very careful, flies may carry the poison to neighbors living
within a radius of two hundred yards.
People who handle the discharges of typhoid fever carelessly do
not disinfect them: people who breed flies in unclean horse stables,
pig pens and open privies; people who raise inoscjuitoes in standing
water, in tin cans or old barrels, or what not; people who expectorate
tubercular sputa anywhere in their houses or on the streets, are
curses to public health, to public life, and any community is far
1 letter off without them than with them.
It is therefore readily seen tha.t the public health is a communistic
interest.. And again it will readily be admitted that communistic
interest can only be protected by law. But law depends both for
its legislation and enactment upon a favorable public sentiment. Thus.
ultimately, health legislation and health protection rest on a favorable
public sentiment. This public sentiment, so dangerously weak for
the support of the large number of lives dependent on it. is in the
hands of the educator.
When the majority of our people understand the principles of
preventive medicine, when they have once settfously considered the
awful obligation resting upon them as citizens for the protection of
health and life, then will communicable disease cease to levy its tax
of pain and death.
So great is the immediate need of this life-saving education, so
general is the obligation to protect life and health, and so general
are the benefits to be obtained by co-operation to this end. that every
individual influence, howsoever humble it may be. and every organized
influence, howsoever powerful it may be. should contribute their full
quota. The great influences of the medical profession, the public-school
system, the press and the pulpit owe it to humanity to unite
in this great work.
The principal work of this office for some time will be to assist
in every way possible in this co-operative educational campaign for
the improvement of our public health.
DANGEROUS WATER.
Under chapter 808 of the Laws of 1909', the public are hereby
officially. notified that the water sold by the Buffalo Lithia Springs
Water Company, of Buffalo Lithia Springs, Ya.. has been found in
three successive analyses made by the state Laboratory of Hygiene to
l»e dangerous to the public health.
46 BULLETIN N. 0. BOAKD OF HEALTH.
REVIEW OF DISEASES FOR JUNE, 1909.
EIGHTY-SIX COUNTIES REPORTING.
Ninety-six our of ninety-eight counties have superintendents of
health.
Except in the case of the more contagious and dangerous diseases,
the superintendent has, as a rule, to rely upon his own information
alone, since few physicians can be induced to report cases of non-contagious
diseases to him.
Where the number of cases is not given, or the prevalence of a dis-ease
otherwise indicated, its mere presence in the county is to be
understood as reported.
For the month of June the following diseases have been reported
from the counties named
:
Smallpox.—Beaufort, 1 ; Caldwell. 1; Camden. 25; Craven. 1: Dup-lin.
0; Harnett. 3: Madison. G; 2s
T
ash, 1; Pitt, 8; Robeson. S: Rowan,
7: Sampson, 4; Watauga, 12—13 counties.
Measles.—Bladen, a few; Carteret, a few; Caswell, several; Ca-tawba,
a few: Cleveland, a lew; Craven, many; Davidson. 2; Davie,
a few; Duplin. 4; Forsyth, several; Harnett, several: Macon, 4;
Mecklenburg; Orange, a few; Robeson, a few; Watauga; Wilkes,
a few; Yadkin, several—18 counties.
Whoopixg Cough.—Alexander. 5; Bertie, several; Bladen, many;
Brunswick, several ; Caldwell. 35 ; Caswell, several ; Catawba, a few
;
Cleveland, a few: Cumberland, several; Davidson, 50; Davie, several:
Forsyth, a few: Franklin, many; Graham, 5; Granville. 10; Greene,
6; Guilford; Haywood, 5; Iredell, many; Jackson, several; Lee. 5;
Lenoir. 5: Lincoln, 10; Mecklenburg; Montgomery. 10: Polk, 1;
Randolph, a few; Robeson, 2; Rowan, several; Union, many; Vance,
a tew: Watauga, 15; Wilkes, a few; Yancey—34 counties.
Scarlatina. -Caldwell, 1; Camden. 5; Cleveland, a few: Forsyth,
:!; Hyde, a few: McDowell. 1 ; Macon, a few; Orange, 12; Rutherford,
4 ; Tyrrell, 7 ; Yadkin, 1—11 counties.
Diphtheria.—Alamance. 1; Alleghany. 1; Caldwell. 0: Caswell. 1;
Craven. 1 ; Cumberland, 3; Duplin, 3: Durham. 3 or 4; Edgecombe, 5;
Granville, 1: Halifax. 1: Hyde. 2; Jackson, 1; Mecklenburg: Mont-gomery,
1; Rutherford, 2; Vance. 3—17 counties.
Typhoid Fever.—Alamance, several: Alexander. 24; Alleghany, 5;
Ashe. 11 ; Beaufort, o or <">: Bertie, several: Bladen, a few: Brunswick,
2: Burke, a few: Cabarrus, several: Caldwell, several; Camden, 30;
Catawba, prevalent: Chatham. 15; Cherokee. 2: Clay. 4: Cleveland.
good many; Columbus. 11; Craven. 10: Cumberland, several: Davie,
BULLETIN N. C. BOARD OF HEALTH. 4 (
several; Duplin, 20; Durham, 2 or 3; Edgecombe. 2; Forsyth, a
few; Franklin, a few; Gates, 7; Graham, 2; Granville. 1; Greene,
12; Guilford, 4; Halifax, several; Harnett, several; Haywood. 6;
Henderson, ('»; Iredell. 14; Jackson, S; Lee, 4; Lenoir, 2; Lincoln.
12: McDowell, 1: Macon, 5; Madison. :, : .Martin, several: Mecklen-burg;
Mitchell: Montgomery, 3: New Hanover. 5; Onslow, a few:
Orange, 6; Pamlico, 1: Pender, 2: Person, 0; Pitt, 7; Polk. 4: Ran-dolph,
several: Richmond. 1; Robeson, several; Rowan, several;
Rutherford. 0; Sampson, a few; Scotland. G; Surry, 10; Swain. 1:
Union, several; Vance. 4: Warren. 2: Watauga, 8; Wayne, a few;
Wilkes, several ; Yadkin. 5—71 counties.
Malarial Fever.—Currituck; Guilford; Henderson; Northampton:
Onslow ; Washington— counties.
Malarial Fever, Pebnicious.—Beaufort, 1; Bertie, several; Hyde,
several: Mecklenburg, a few: Montgomery, 2—5 counties.
Pneumonia.—Alamance. 4; Alexander, 1; Bladen. 1; Brunswick,
1: Catawba, a few; Chatham. 4; Cleveland, a few; Duplin. 2; Edge-combe,
1: Halifax, 1; Harnett. 1; Henderson. 2; Jackson, several:
Lincoln, 1: Mecklenburg: Montgomery, 2: New Hanover, 1; Rich-mond.
3; Rowan. 2; Warren, 1 : Washington. 1 ; Watauga. 1; Wilkes.
2: Yadkin, 2—24 counties.
Cebebeo-spinal Miningitis.—Alamance, several among children:
Camden. 2; Cherokee. 4: Gates. 2; Jackson, 1; Lenoir, 1—6 counties.
Varicella.—Cherokee, 2.
I m'uhxza.—Montgomery. 4.
Cholera, in Hogs.—Martin.
Distemper.—Watauga, epidemic.
Xo reports received from Anson. Dare. Gaston. Johnston. Jones.
Moore. Perquimans, Rockingham, Stanly, Stokes. Transylvania and
Wake.
No diseases reported from Buncombe, Chowan. Hertford. Pas-quotank
and Wilson.
48 BULLETIN X. C. BOARD OF HEALTH.
SUMMARY OF MORTUARY REFORTS FOR JUNE, 1909.
White. Colored. Total.
Aggregate population 141.100 01.200 232.300
Aggregate deaths '. 170 ] T* ". 352
Representing temporary animal death rate
per 1,000 • 14.8 22 18.1
Causes of Death.
Typhoid fever 14 4 18
Scarlet fever 1 1
Malaria 5 5
Diphtheria 1 1 2
Whooping cough 3 2 .">
.Measles 2 2
Pneumonia •"! 7 lo
Consumption 28 26 -"4
Brain diseases 9 7 16
Heart diseases 12 6 18
Neurotic diseases 4 4
Diarrhoea] diseases 19 30 4'.i
All other diseases 7 s- 77 155
Accident 3 6 9
Suicide 1 2 3
Violence 1 1
176 170 352
Deaths under live years 123
Stillborn 43"
BULLETIN N. C. BOARD OF HEALTH. 49
Mortuary Report for June, 1909.
Towns
50 BULLETIN N. C. BOARD OF HEALTH.
County Superintendents of Health.
Alamance Dr. H. M. Montgomery.
Alexander Dr. B. O. Choate.
Alleghany Dr. Robert Thompson.
Anson___" Dr. E. S. Ashe.
Ashe Dr. J. C. Testerman.
Beaufort Dr. P. A. Nicholson.
Bertie Dr. John L. Pritchard.
Bladen Dr. L. B. Evans.
Brunswick, Drv J. Arthur Dosher.
Buncombe Dr. D. E. Sevier. .
Burke Dr. J. R. Anderson.
Cabarrus Dr. J. M. Wallace.
Caldwell Dr. C. L. Wilson.
Camden Dr. C. G. Ferebee.
Carteret Dr. W. E. Headen.
Caswell Dr. S. A. Malloy.
Catawba Dr. T. C. Blackburn.
Chatham Dr. L.E. Farthing.
Cherokee Dr. J. F. Aberneihy.
Chowan Dr. H. M. S. Cason.
Clay Dr. J. M. Sullivan.
Cleveland Dr. T. E. McBrayer.
Columbus Dr. H. B. Maxwell.
Craven Dr. Joseph F. Rhem.
Cumberland Dr. A. S. Rose.
Currituck Dr. H M.Shaw.
Dare
Davidson Dr. E. J. Buchanan.
Davie Dr. M. D. Kimbrough.
Duplin Dr. John A. Ferrell.
Durham Dr. N. M. Johnson.
Edgecombe Dr. Spencer P. Bass.
Forsvth Dr. J. K. Pepper.
Franklin Dr. R. F. Yarborough.
Gaston Dr L.N.Glenn.
Gates Dr. Geo. D. Williams.
Graham Dr. M. T. Maxwell.
Granville Dr. S. D. Booth.
Greene... Dr. W. B. Murphy.
Guilford Dr. Edmund Harrison.
Halifax Dr. I. E. Green.
Harnett Dr. L. J. Arnold.
Haywood Dr. J. R. McCracken.
Henderson Dr. J. G. Waldrop.
Hertford Dr. J. H. Mitchell.
Hyde Dr. R. E. Windley.
Iredell Dr. M. R. Adams.
Jackson Dr. A. S. Nichols.
Johnston Dr. L. D. Wharton.
Jones Dr. A. F. Hammond.
Lee Dr. J. P. Monroe.
Lenoir Dr. N. A. Whitaker.
Lincoln Dr. J. W. Saine.
McDowell: Dr. Geo. S. Kirby.
Macon Dr. S. H. Lyle.
Madison Dr. W. J.. Weaver.
Martin Dr. W. E. Warren.
Mecklenburg Dr. C. S. McLaughlin.
Mitchell Dr. Virgil R. Butt.
Montgomery Dr. C. Deligney.
Moore Dr. Gilbert McLeod.
Nash _Dr. J. P. Battle.
New Hanover.—Dr. W. D. McMillan.
Northampton ___Dr. H. W. Lewis.
Onslow Dr. Cyrus Thompson.
Orange Dr. C. D. Jones.
Pamlico Dr. Daniel A. Dees.
Pasquotank Dr. H. T. Avdlett,
Pender Dr. Robt. H. Bradford.
Perquimans Dr. T. P. McMullen.
Person Dr. W. T. Long.
Pitt Dr. W. M. Fountain.
Polk Dr. W. R. Engel.
Randolph Dr. J. V. Hunter.
Richmond Dr. N. C. Hunter.
Robeson Dr. H. T. Pope.
Rockingham Dr. Sam Ellington.
Rowan Dr. M. L. Smoot.
Rutherford Dr. E. B. Harris.
Sampson Dr. A. M. Cooper.
Scotland Dr. K. A. Blue.
Stanly Dr. J. N. Anderson.
Stokes
Surry Dr. John R. Woltz.
Swain Dr. J. A. Cooper.
Transvlvania Dr. Goode Cheatham.
Tyrreil Dr. J. L. Spruill.
Union Dr. Henry D. Stewart,
Vance Dr. E. F. Fenner.
Wake Dr. J. J. L. McCullers.
Warren Dr. M. P. Perrv.
Washington Dr. W. H. Ward.
Watauga Dr. J. M. Hodges.
Wayne. Dr. T. M. Bizzell.
Wilkes Dr. John Q. Myers.
Wilson Dr. W. S. Anderson.
Yadkin Dr. S. L. Russell.
Yancev Dr. W. B. Robertson.
Mitchell Sei Society
:sTTTJU^n:x2^r
OF THE
NORTH CAROLINA BOARD OF HEALTH
Published Monthly at the Office of the Secretary of the Board, Raleigh, N. C.
Entered as second-class matter at Post Office at Raleigh, N. C, under Act March 3, 1879.
G. G. Thomas, M. D., Pres., Wilmington. j Edw. C. Register, M. D., Charlotte.
Thomas E. Anderson, M. D., Statesville. David T. Tayloe, M. D., Washington.
J. Howell Way. M. D., Waynesville. ; J. A. Burroughs, M. D., Asheville.
W. O. Spencer, M. D.. Winston-Salem. i J. L. Ludlow, C. E., Winston-Salem.
Richard H. Lewis, M. D., Raleigh, N. C.
W. S. Rankin, M. D., Secretary and Treasurer, Raleigh.
C.A.Julian, M. D., Assistant Secretary for Tuberculosis, Thomasville.
Vol. XXIV. AUGUST, 1909. No. 5.
THE ANTITOXIN LAW.
The Legislature of 1909 passed an act providing that the State
Board of Health supply diphtheria antitoxin to the boards of county
commissioners and boards of aldermen, who would agree to pay for
its use in indigent cases of diphtheria occurring in their respective
counties and towns.
The State Board of Health is pleased to announce that they have
arranged with one of the most reliable producers of antitoxin in this
country to supply antitoxin at the following low rates
:
1,000 units ! .$ .50
3,000 units 1.30
5,000 units 1.90
This is not quite one-third the regular selling price of antitoxin,
and of course can be supplied, as provided in the law. to the indigent
only, at these low figures.
As yet only twenty-one counties, and three towns, have decided to
take advantage of this act. These counties and towns will receive a
supply of antitoxin within the next few days.
The County Superintendents of Health should see to it, that their
county commissioners are aware of this law and understand its im-
52 BULLETIN X. C BOABD OF HEALTH.
portant provisions. See that your county commissioners do not lose
sight of the following important facts connected with this law:
First. The antitoxin is for the indigent only, and should therefore
be supplied to those who would otherwise be without it.
Second. Diphtheria untreated with antitoxin kills from thirty-three
to sixty-six in every hundred of those who have it. Diphtheria
treated with antitoxin kills less than live in every hundred of those
who have it. Can a great county afford to he careless of the life of
even one helpless child? Is life cheaper than 3,000 units of antitoxin
ai $1.30?
'I'h i nl. Diphtheria antitoxin is not only a curative agent for the
sick, hut an agent for the protection of the public. It prevents the
extension of the disease, thereby avoiding epidemics that would close
the doors of schools and fetter the hands of industry.
Fourth. The commissioners pay only for what is used, returning
what remains out of date to the State Board of Health.
TWO REPRINTS.
The Editor respectfully begs leave to call attention to two reprints
in this issue of the Bulletin.
As every physician is a guardian of the public health, the conscien-tious
discharge of his responsihilities cease not with the application
of curative agents to the diseased individual, but extend further to
the protection of public health by the application of the means of
prevention of disease. To this end it is important that he should
understand the origin of disease and its means of propagation.
The paper by Dr. Anderson is timely on account of the approach-ing
season of maximum typhoid prevalence, and more especially on
account of rather recent observations on typhoid epidemiology, the
importance of which demands greater publicity.
Typhoid fever, always due to a specific germ, the Bacillus typhosus,
may he conveyed to .the hody by four principal methods: By water.
by milk, by flies or by contact. The features characterizing an epi-demic
of this disease differ, according to the origin and mode of
propagation of the epidemic. These features, or groups of features.
are as characteristic for epidemics due to Hies, or milk, or water, or
contact, as a symptom, or group of symptoms, is characteristic for
an individual disease like pneumonia or typhoid. This is well
brought out in Dr. Anderson's paper.
The typhoid tourniquet, which originated with the Minnesota State
Board of Health, has proven so life-saving in the suppression of
epidemics of typhoid fever, that its use should he understood and
BULLETIN N. C. BOARD OF HEALTH. 53
appreciated by every physician who realizes his duties to the public
health. For this reason we reproduce it in this issue of the Bulletin.
at the same time cherishing the hope that it will receive the careful
attention from the profession to which its value entitles it.
THE DIFFERENTIATION OF OUTBREAKS OF TYPHOID FEVER
DUE TO WATER, MILK, FLIES AND CONTACT.*
By John F. Anderson,
Passed Assistant Surgeon <nt<l Assistant Director Hygienic Laboratory
V. S. Public Health ami Marine Hospital Service, Washington,
D. C.
Gentlemen:—When I received the invitation from our Honorable
President. Dr. Lewis, to read a paper before this association on the
differentiation of Typhoid Fever outbreaks due to infected water,
milk. etc.. I fully realized my limitations in dealing with the subject.
However, I thought that a few observations I had made while investi-gating
in my official capacity several epidemics of Typhoid Fever
might be of some interest and perhaps profit to you.
It is a serious reflection upon the people of the United States that,
according to the census report for 1900. there were 35,379 deaths in
the United States that year from Typhoid Fever—a preventable dis-ease.
This loss of life,, according to Whipple's calculation, repre-sented
money loss to the community of $212,000,000 for that year
alone.
The average Typhoid death rate in cities of the United States is
about 35 per 100,000. Whipple states that in the cities about 40 per
cent of the Typhoid Fever is due to water, 25 per cent to milk.
30 per cent to contagion—including fly-transmission, and only about
5 per cent to all other causes. The Board of Officers of the Pub-lic
Health and Marine Hospital Service investigating Typhoid Fever
in the District of Columbia found in 1906, that of the cases studied
by them about 11 per cent were indefinitely attributed to milk infec-tion,
about 7 per cent to infection by contact: in 1907. they definitely
attributed about !) per cent to milk and about 19 per cent to contact.
In -the study of an outbreak of Typhoid Fever it is of vital impor-tance,
first of all, to determine whether the disease is really Typhoid
Fever. For this purpose, in addition to the usual bedside methods,
two other procedures may and should be employed in all doubtful
cases. I refer to the Widal reaction and to blood cultures. The blood
culture is of more value than the Widal test in that cultures can be
*Read before the American Public Health Association at Winnipeg, August, 1908.
.">-!: BULLETIN X. C. BOARD OF HEALTH.
obtained in the firsi days of the disease. For the examination of the
blood we have found the bile enrichment method, followed by plating
on Endo medium, the most satisfactory. By this method, cultures
taken in the first week of the disease will give positive results in 90
to 100 per cent of the cases.
Having determined that the disease prevailing with undue fre-quency
is Typhoid Fever, it is necessary that each case be studied in
detail from an epidemiological standpoint. In places which require
the reporting of Typhoid Fever, the study is much easier than in
those where it is not done. The essential data can only be obtained
by competent persons visiting the patients and obtaining all possible
information from the patient, nurse and family, and by an inspection
of the premises.
It is well to have a map of the city and. as the data for each case
are collected, to indicate the location on the map b*y sticking in a
large pin. A glance at this will readily show it' the cases are confined
to any particular locality.
All data collected should be at once tabulated and carefully studied
as to the hearing of the various probable sources of infection.
I shall now take up in detail the special characteristics of out-breaks
of Typhoid Fever due to infected water and milk, and to
transmission by flies, etc.
CHARACTERISTICS OF OFTBREAKS DUE TO WATER.
The striking characteristics of outbreaks of Typhoid Fever due to
water are
:
1. General distribution of cases tJi/roughoui tin 1 area supplied by a
particular water.
The incidence of cases is independent of social conditions, occupa-tion
and age, except that very young children as a rule are not
affected in equal proportion to other ages. due. perhaps, to the differ-ence
in susceptibility and to taking less water.
2. Explosive onset of tin outbreaks.
When the water supply previously good becomes suddenly infected,
as in the case of Plymouth or Butler. Pa., the outbreak begins with
great suddenness and violence. There is a sudden and great increase
in the number of cases reported : this increase may continue until the
sources of infection of the water are removed or the water supply
changed. If the former be the case there is a more gradual decline
in the number of cases than when the supply is suddenly replaced by
a pure one. in which case the decrease is sudden and marked. Second-ary
cases from contacts may keep the number above normal for a
time.
When there is a continuance of the source of the infection, as in
the case of the Lowell and Lawrence outbreaks of 1890 and 1892,
the onset is not usually so explosive in character and the decline is
BULLETIN N. C. BOARD OF HEALTH. 55
more gradual. In Pittsburg, where there is a continual infection of
the water supply, the disease is more prevalent in the fall and winter.
which may be due in part to other causes than water.
When a water supply, such as a river, is subject to continual infec-tion
the increase in the number of eases in late summer and fall
may be attributed to the fact that, as the number of cases increase
which supply infection for the stream, the amount of infection is cor-respondingly
increased.
3. Seasonal prevalence; spring or late winter.
Outbreaks of Typhoid due to infection of a water supply previously
good usually occur in the late winter or spring. This is due, as in the
case of the Plymouth and New Haven epidemics, to the fact that
infected discharges are thrown on the frozen ground and when thaws
or floods come the infection is suddenly washed into the stream.
When a supply becomes infected by the failure of the purification
methods used or by a change in the source, the outbreak is. of course,
independent of season.
4. Comparative freedom from the disease of persons not using the
suspt cU (1 water.
When there is more than one water supply or where persons use
pure bottled water or boil the water, the comparative freedom of
such persons from the disease is*striking. This was well shown in the
P>utler epidemic, where a large part of the first ward of the city re-ceived
their water from deep driven wells: in this ward, with an
equal population to the other four wards, there were only about one-half
as many cases.
5. Inspection of the watershed shows evident sources of infect inn.
An inspection of the watershed may show that it is being continu-ously
infected by discharges of Typhoid Fever cases. In some cases,
as at Butler and other places, the discharges may actually have been
allowed to go directly into the stream from privies overhanging it.
fi. Tin outbreaks nun/ have begun or ended, following a change of
the water supply.
When a previously good water is replaced for any good reason by
an unknown water or a suspected water is replaced by one of un-doubted
purity, the consequent beginning or discontinuance, as the
case may be. of an outbreak of Typhoid would properly be laid to
water.
7. Bacteriological and chemical examination reveals evidences of
poll 111 in,,.
While it is practically hopeless to expect to find the typhoid bacillus
in water, still the finding of B. coli in small amounts of water and
chemical evidences of pollution are additional evidence against the
water.
8. Exclusion of all other probable causes.
This means the exclusion of milk, food, contact, fly transmission.
and other possible sources of infection.
56 Bl I.I.KT1X X. C. BOAKD OF HEALTH.
OUTBREAKS DUE TO MILK.
on investigating an outbreak of Typhoid Fever, the following
points would indicate very strongly that the infection was being in-troduced
througb the milk :
1. Sudden outbreak of mi unusual number of cases followed by <i
rapid </' dine.
The outbreak is frequently sudden in its onset: a large number of
cases occurring on a certain milk route within a few days. If the
infection be introduced only once, as by flies, there is a sudden rise
followed by a sudden decline in the number of cases. If there is a
continuance of the infection, as from a bacillus-carrier, the onset may
he more gradual and the decline will he delayed.
In dairies which do not practice sterilization of bottles, the milk
may become infected througb bottles delivered at houses where there
are cases of Typhoid Fever; these infected bottles are returned to
the dairy, refilled, and delivered to other customers. Where the milk
becomes infected by washing the cans with infected water, as in
I he Palo Alto outbreak, the number of cases is usually much greater
than when infected in other ways. After the usual incubation period
secondary cases from contacts begin to appear.
2. T7ie appearance of mi unusual number of cases among customers
of a certain dairy.
The appearance of an unusual number of cases without a general
increase elsewhere on the route of a dairy should at once direct espe-cial
attention to the milk. Of course Typhoid Fever due to infection
from other sources may occur among persons supplied by a particular
dairy, but they will not be found to be chiefly consumers of the milk.
It is often very striking how the consumers of a dairy whose milk is
infected may be picked out by the unusual proportion of cases on
that milk route. Very frequently cases may lie traced in persons
not directly supplied by the suspected dairy, but who have taken this
milk al the home of some friend or at a restaurant. An increase in
i he number of cases on a certain route associated with a decrease
generally throughout the city is particularly su^ostive of milk infec-tion.
:;. Unusual inci<i< nee of cases among users of milk.
It will be found that there is unusual prevalence of Typhoid Fever
among the users of milk : the nonconsumers escape or develop second-ary
cases. As women and children generally use more milk than
men. an unusual prevalence of the disease among them is a common
feature of milk-borne outbreaks. Those families on the suspected
route who make a practice of pasteurizing their milk escape, except
from infection as secondary cases.
4. More cases among the well-to-do than among the poor.
In a milk outbreak there are usually more cases among the well-off.
due to the fact that they are more able to buy milk and use it in
BULLETIN N. C. BOARD OF HEALTH. 57
larger quantities than the pool*, while in fly-borne outbreaks the poor
and those living under insanitary conditions are more often attacked.
.".. The finding of the typhoid bacillus in the suspected milk.
This is practically hopeless, as the milk rarely conies under suspi-cion
for at least three weeks after having become infected. In addi-tion,
the technical difficulties are so great that it is an almost hope-less
procedure, though the isolation of the organism should be at-tempted.
If successful, it is absolutely conclusive.
CHARACTERISTICS OF THE OUTBREAKS DUE TO CONTAGION AND
TRANSMISSION BY FLIES.
It is Impossible to state definitely the characteristics of outbreaks
of Typhoid Fever due- to transmission by flies and to contacts as in
the case of milk and water outbreaks. A final conclusion in regard
to the source of the infection can only lie reached by a consideration
of all the factors involved.
For purposes of convenience I shall discuss the characteristics of
outbreaks of Typhoid Fever due to contagion and transmission by
flies at the same time. The great part played by flies in the trans-mission
of Typhoid Fever was first emphasized in the masterly Re-port
of the Origin and Spread of Typhoid Fever in United States
Military Camps during the Spanish War. by Reed. Vaugban and
Shakespeare. They concluded that "flies were undoubtedly the most
active agents in the spread of Typhoid Fever. Flies alternately vis-ited
and fed on the infected fecal matter and the food in the mess
tents. More than once it happened when lime bad been scattered
over the fecal matter in the pits, flies with their feet covered with
lime were seen walking over the food. Typhoid Fever was much less
frequent among members of messes who bad their mess tents screened
than it was among those who took no such precaution. Typhoid
Fever gradually died out in the fall of 1808. in the camps at Knoxviile
and Mead with the disappearance of the fly, and this occurred at a
time of year when in civil practice Typhoid Fever is generally on the
increase. The first pits at Knoxviile contained, before the first
twenty-four hours had passed after the arrival of the troops, fecal
matter infected with the Typhoid bacillus. Flies swarmed everywhere.
Instead of abating, the disease increased. The soldiers were using
the same water used exclusively by the inhabitants of West Knox-viile.
and among the latter there was not at that time a case of
Typhoid Fever. Certainly the disease was not disseminated through
the drinking water.*
Alice Hamilton! investigated in 1902 an outbreak of fever in the
Nineteenth Ward of the city of Chicago. This ward, which only con-tained
about one thirty-sixth of the total population of the city, had
*\ Journal Am. Med. Assn., vol. 40, 1902, p. 576.
58 BULLETIN X. C. BOARD OF HEALTH.
between one-sixth and one-seventh of all the deaths from Typhoid
Fever. It seemed to her that, while the water was undoubtedly tlfe
causative factor in the epidemic throughout the city, there must he
some local cause Cor its undue prevalence in the Nineteenth Ward.
The sanitary arrangements in this ward were found to he very had
and on those streets with the worst sanitary arrangements there
were the largesl Dumber of deaths from Typhoid Fever, irrespective
of the poverty of the inhabitants.
Flies caught in two undrained privies, on the fences of two yards,
on the walls of two houses, and in the room of a Typhoid patient.
were used to inoculate 18 tubes; from five of these tubes the Typhoid
bacillus was isolated. In this outbreak the chain of evidence impli-cating
the fly in the spread of the disease was certainly convincing
and almosl complete.
The outbreak in the city of Winnipeg, in August, 1904. investigated
by Dr. E. O. Jordan, which was confined almost entirely to the poorer
pari of the City, was attributed to transmission by flies and contacts.
Outbreaks due to direct contact are seen especially in institutions
where there are Typhoid Fever cases and in houses where the family
and friends visit and assist in the care of the patient. In these cases
the infection is conveyed either directly by the future patient or indi-rectly
by the nurse to food consumed by others.
Typhoid-carriers, such as the one reported by Soper in the person
of a cook, who was responsible for at least 28 cases of Typhoid Fever
in families in whose employ she had been, are instances in which the
infection is conveyed by a third person.
The bacilli have been found in practically all of the excretions of
Typhoid Fever cases and it is only by the most scrupulous care on
the part of the attendant that infection can be avoided for himself
and others. The Board of Officers of the Public Health and Marine
Hospital Service, studying Typhoid Fever in the District of Columbia,
attributed about 7 per cent of the cases in 1906, and about 10 per
cent in 1907, to contact infection from other cases.
The chief characteristics, then, of outbreaks of Typhoid Fever due
to transmission by flies and by contact are their local character, their
appearance in places where the sanitary conditions are poor or where
they are neglected, occurring during the fly season in the case of fly
transmission and among those most closely associated with the pa-tient.
BULLETIN N. C. BOARD OF HEALTH. 59
THE TYPHOID TOURNIQUET.
If the simplest epidemiological information could be substituted
for the so prevalent old wives' fables relating to wells and water.
Typhoid Fever could be cut in half merely because then the physician
and the health officer would begin to act without waiting for water
analyses, or even for a list of the Typhoid cases. The first duty of
the health officer, who knows that Typhoid exists in a community is
not to make an investigation, but is to face the actual status—to
treat the emergency symptoms, without waiting for the discovery
of the ultimate cause. If a man is spurting blood from a wounded
thigh, the surgeon does not wait to determine the exact nature and
extent of the lesion—nor even the exact vessel concerned—he throws
a tourniquet around the whole limb to stop the how—and then at
leisure he investigates, finds the vessel or vessels concerned, and ties
it or them in a systematic fashion according to approved surgical
canons. Exactly parallel is the condition of a community suffering
from Typhoid. Instead of laboriously searching for the particular
source—a search which may take weeks, years, or even, as in Wash-ington.
D. C. a decade—the proper course is to stop the existing
epidemic. To do this requires an immensely vigorous publicity cam-paign,
but it can be done. In Minnesota our first gun is fired—not
at the water supply, for we cannot know at first that the water is
infected—not at the milk supply, for we cannot know at first that the
milk is infected—not at the raw food, or riies—we cannot know at
first that these are responsible—not at fingers even, although it is
always safe to assume that fingers are a factor in every outbreak.
We cannot attack any one of these, when first called in. because at
that time we do not know which is the cause. We attack every one
at once, as the surgeon in the parable ligatures the whole limb. Later
we pick out at leisure the particular source and cut that oft".
The method is very simple. On finding a Typhoid outbreak in a
town, we issue in the papers, display on the streets and address to
every householder the following placard:
To tin Citizens of Blank.
Typhoid Fever is epidemic in Blank.
The Minnesota State Board of Health is investigating this epi-demic
to find its exact source. Meantime govern yourselves as fol-lows
:
1. Typhoid Fever is contracted solely by the mouth. If you do not
put the poison of Typhoid Fever into your mouth you trill never con-tract
Typhoid Fever. Therefore, watch the mouth.
2. Do not cat or drink anything i water, milk, oysters, fresh vege-tables
or anything else) miles* it has been first boiled, broiled, baked,
roasted, fried or otherwise thorotlghly heated through and through.
60 BULLETIN X. C. BOARD OF HEALTH.
::. ho without nil food or drink which lms not first been thus
beated. (Canned or bottled foods or drinks (other than milk or
water I are not included in tins.)
5. If living in the same house with a Typhoid Fever patient. <1<>
not handle your own food, or food intended for anyone else, even if it
has been heated, except with hands that have been thoroughly washed
with soap and very hot water. (Preferably also with antiseptic—ask
yonr physician about the antiseptic to use.) Wash before every meal
in this way and before cooking, serving or eating anything or putting
tin fingers in flu 1 mouth.
.".. If there are Hies about, see that all food and drink is protected
from them at all times. Flies often carry Typhoid poison to foods
and drinks.
c. The poison of Typhoid Fever does not show itself for two weeks
after it enters the body. Therefore for the next two weeks. Typhoid
cases may develop from Typhoid poison already taken in. But any
case which develops on and after (a date two weeks later than
the date of the placard I will be due solely In neglect of this notice
and failure to carry out minutely the directions here given.
Later more detailed information is published or mailed concerning
contact, convalescents, etc.. from time to time. The physicians of the
community are visited separately or when possible addressed at a
meeting convened for the purpose; in both cases, with the object of
posting them on the simple essentials of epidemiology—contact Ty-phoid,
flies, milk, dangers from convalescents, etc. The successful stop-ping'of
a Typhoid outbreak depends on the vigor with which the pub-lic,
but particularly the physicians, can lie impressed with facts which
neither physicians nor public usually believes—that Typhoid Fever
is not necessarily a matter of infected water—and is not even a mat-ter
of garbage piles, sloughs, damp cellars or sewer gas—but is a
matter of Typhoid discharges reaching mouths. Trained nurses are
sent to circulate amongst the poor families, not to nurse but to teach
by demonstration how to avoid secondary infection, and every re-ported
case is investigated to determine if the source of infection he
primary or secondary, in order to cut off the latter.
After getting out this notice, seeing the physicians, etc.. as above
outlined, lists of the cases to date are obtain