Bulletin of the North Carolina Board of Health

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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., 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., Secretary and Treasurer, Raleigh.
Vol. XXIII. APRIL, 1908. No. 1.
WANTED—A PHYSICIAN.
We are in receipt of a letter from Mr. J. P. Cox. Bolivia, N. C, ask-ing
our aid in securing a physician for his neighborhood. We quote
from his letter : "There is no doctor nearer than sixteen miles. When
we need a doctor we have to send that distance, and then very often
do not get him. We feel assured that a paying practice could be built
up here in a short while. We are situated near the center of Bruns-wick
County, at the junction of the proposed Brunswick and Southern
Railway." Any one interested will please write to Mr. Cox.
GENERAL DIRECTIONS FOR THE ARTIFICIAL FEEDING
OF INFANTS.
BY JOSEPH W. SCHEEESCHEWSKY,
Past Assistant Surgeon, in Bulletin No. 41, Hygienic Laboratory, U. S. P. H. and M. H. S.
For children one month-old or over.—First, weigh tin- child. Allow
a daily quantity of <-<>\v"s milk of one-seventh body weight for infants
up to 3 months of age, one-eighth the body weighl from :: months to
<; months, and after that from one-ninth to one-tenth.
2 BULLETIN N. C. BOARD OF HEALTH.
Quality of milk to be used.—Use nothing but clean, fresh, bottled
milk, "certified," if possible. If this cannot be had, use bottled milk
from a high-grade dairy, making sure that the fat content does not
exceed 3.50 per cent. If it is greater than this it must be reduced to
this figure by dipping the cream out of the top of the bottle in the
amounts given in the following table, and then mixing thoroughly the
remainder.
Note.—A cow's milk of this percentage of fat—3.50—has a heat
value of 653.5 calories per kilogram, or about the average caloric
value of woman's milk.
Table showing quantities of top milk that must be removed from top
of quart bottles of milk in order to reduce the percentage of fat to
8.50 per cent.
Original percentage of fat in the milk.
BULLETIN N. C. BOARD OF HEALTH. 6
milk that has been commercially pasteurized or sterilized should uot
be used, as it may have been imperfectly kept by the dealer after the
process.
Reasons for the sterilization and pasteurization of milk.—Apart
from the safety the sterilization or the pasteurization of milk confers
by virtue of the destruction of all its nonspore-bearing bacteria (the
word "sterilization" is not used here in the laboratory sense, but refers
merely to measures which will destroy ordinary pathogenic organ-isms),
there is abundant and incontrovertible evidence to show that
by these measures both the morbidity and the mortality of infants
from gastro-intestinal disease have been greatly reduced.
There are also additional and important reasons, in the case of
infants of less than three months of age, which render the steriliza-tion
of the milk for their use especially desirable. Russell has shown
that beating the milk destroys the tendency of the fat globules to
coalesce, and distributes them uniformly throughout the milk. This.
combined with the partial inhibition of the curding action of the gas-tric
juices upon the casein of heated milk, prevents the formation of
large fat-containing curds in the stomach.
Now, the gastric capacity of young infants is both 'absolutely and
relatively very small. During the act of nursing, when the stomach
has been filled, a portion of its contents is passed on into the duode-num.
That this must take place is readily shown by consulting the
records of Feer's investigations and by comparing the amounts taken
at single nursings with the absolute gastric capacity of infants of that
age. as determined by Ffaundler.
The soft, flocculent, diffluent curd of heated milk readily permits
this action to occur as the stomach reaches the point of physiological
distension.
Objections to the use of sterilized milk.—The use of sterilized milk
for the feeding of infants has often been objected to—first, on account
of supposedly greater difficulty in digestion; and second, because of
the danger of producing infantile scurvy thereby. The first objection
is founded upon misapprehension, as can readily be shown by com-paring
the action of rennet ferment on raw milk and on milk that has
been previously heated. The raw milk coagulates firmly, while the
heated milk has a soft, almost diffluent clot. Moreover, careful inves-tigations
of the digestive absorption of the constituents of heated milk
have shown evidence of a considerably greater degree of completeness
in such absorption than is the case in unheated milk. This, conjoined
with the favorable experience of the French clinicians with heated
milk, must he regarded as conclusive evidence of the superiority both
sterilized and pasteurized cow's milk presents over raw cow's milk
in this respect. The second objection- -that of causing infantile
scurvy—I believe, can be demonstrated to reside, in all probability, in
qualities inherent in the milk used, and not attributable to the mere
fad of its sterilization. Scurvy has been seen, not only as the result
4 BULLETIN JST. C. BOARD OF HEALTH.
of pasteurized or sterilized milk, but also in breast-fed children and in
those fed on raw cow's milk. We may, therefore, infer that certain
constituents necessary to the nutrition of the body were not being sup-plied.
At Professor Budin's clinic in Paris, at all the numerous milk
depots ("Gouttes de Lait") scattered throughout France, where noth-ing
but unsophisticated, sterilized cow's milk is used for the artificial
feeding of infants from the earliest age, infantile scurvy is practically
unknown. Budin tells us of a visiting physician who was unable to
convince himself that sterilized milk did not produce scurvy. Budin
invited him to inspect the infants who presented themselves, with
their mothers, for their weekly inspections and weighings, as they are
obliged to do. Every babe was stripped, and the visitor was able to
verify for himself that not one presented signs of scurvy or even of
rickets in the slightest degree.
I would put forth tentatively the following development of Ralfe's
theory as to the causation of scurvy as a possible explanation of the
etiology of infantile scurvy, and tending to remove the odium from
whole, sterilized cow's milk, not too rich in fat, in this connection.
On theoretical grounds, scurvy may be regarded as a pathological con-dition,
caused by the diminution in the body of those alkaline bases
which are necessary for the maintenance of a normal condition of
health. These are ordinarily supplied in our food in the form of
salts of the alkaline bases, especially potassium. Now, I would go a
step farther and say that, in order to undergo absorption during
digestion, these salts must be supplied in combination with an acid
radical which can be set free by the action of the digestive juices, such
as phosphoric, citric, malic, and similar acid radicals. The negative
proof of this contention is the rapidity with which scurvy is cured
when the system is freely supplied with such salts.
I think two causes often going hand in hand are mainly responsible
for the production of scurvy in infants. The first is an absolute in-sufficiency
of the salts alluded to, and the second is a relative insuffi-ciency
of these salts when compared with the fat present in the diet.
In regard to the latter condition, we have seen how a diet excessive
in fat may draw upon the alkaline bases of the body for the purposes
of saponification. When they are being inadequately supplied in the
food as well, it is easy to see that the time would not be long in com-ing
when the available supply would be. depleted, radical changes
wrought in the composition of the bodily tissues, and the constitu-tional
symptoms would follow.
In many of the cases of infantile scurvy caused by sterilized milk
the formula used seems to have been the causative factor, i. e., low
proteids, or low proteids and high fat. Now, all such modifications
are derived from the dilution of top milks and creams with water.
This implies that the quantity of the mineral salts present in the milk
is greatly diminished, as, in order to produce this relative proportion
BULLETIN N. C. BOARD OF HEALTH.
of fat and proteid, small amounts of these top milks and creams are
diluted with large volumes of water.
Thus a modified milk mixture of the following formula: fat, 3;
sugar. 0. and proteid, 1, is obtained by diluting G ounces of 10 per cent,
cream with 12 ounces of water and adding 1 ounce of milk sugar.
This has at once the effect of reducing the mineral salts in this mix-ture
to one-third the amount present in a similar amount of whole
milk. When higher fat modifications derived from cow's milk are
used without increasing the proteid, or when the proteid percentage
is to be reduced, a richer cream must be taken in smaller amount and
diluted with a greater volume of water. On the other hand. I would
attribute the occurrence of cases of scurvy which have been observed
to result from the use of whole sterilized cow's milk to the presence
of an excessive amount of fat in the milk, which, by reason of the
greater digestibility of sterilized milk, when compared to raw milk,
was ingested without causing acute gastro-intestinal disturbance.
It is easy to see. then, how a milk modification in which the mineral
salts are greatly reduced, or even a rich whole milk which, by virtue
of its sterilization, is thereby made easier of digestion, may, on the
one hand either by deficient supplying of alkaline bases, and on the
other by their excessive abstraction from the body for the purposes of
saponification, produce in the long run the alteration of the body tis-sues
and fluids which may result in scurvy. It may, however, be
objected that the proprietary foods and condensed milk, which are
anything but rich in fat. are themselves the most prolific causes of
infantile scurvy.
This objection may be met by the fact that these are concentrated
foods, and, for use, are diluted with large volumes of water. In the
case of condensed milk, at least, this has the effect of reducing the
salts far below the limit required by the body. Thus, condensed milk,
when diluted with 6 parts of water, contains 0.17 per cent., with 12
parts 0.10 per cent., and with IS parts 0.07 per cent, of these salts.
These are the dilutions ordinarily used in the feeding of infants.
Taking woman's milk as a standard of infant needs in this respect in
maternal nursing, at least, we find, according to Von Bunge, that
potassium and sodium are by far the preponderating alkaline bases
in its salts, and that the child requires of them 0.07 and 0.025 per
cent., respectively, in its food.
This, however, may be said to be true only when lactation is well
established. During the first weeks of lactation the percentage of
mineral salts present is higher than this, which may have the effect
of increasing the reserve supply. As these salts are present in whole
cow's milk in the proportions of 0.17 and 0.05 per cent., it will be
seen that the dilution of condensed milk as given above reduces them
to Infinitesimal amounts—in the case of the first dilution 0.00:100 and
0.00085 of each. Nor does it necessarily follow that an amount of
6 BULLETIN X. C. BOARD OF HEALTH.
these salts similar to that furnished with human milk will be adequate
when supplied in conjunction with other foods, as much depends upon
the conditions governing absorption. In the case of the proprietary
foods, scurvy has been met with in those cases where they have been
used as a complete substitute for milk. In some of these foods, such
as Xcstle's, Eskay's, Ridge's food, and Imperial Granum, the amount
of inorganic salts present, differing but little or being much less than
those In condensed milk when diluted to the extent required for use,
predicates a similar condition on their part. When we come to con-sider
artificial foods in general. I think we are justified in assuming
that they should contain an amount of inorganic salts at least equal
to that of the food. i. e., cow's milk, which has been the most success-ful
in the artificial feeding of infants. When we reduce cow's milk
to the basis of the relative proportion of its solid constituents to each
other, we find that cow's milk has the following average composition
:
Fat 31.2:1
Sugar 35.1G
Proteid 27.34
Salts 6.25
100.00
There seems to be no proprietary food on the market that ap-proaches
cow's milk in the respect of its content of inorganic salts in
proportion to its other ingredients, the nearest being in the case of a
food (Carinick's) which contains 4.42 per cent, of inorganic salts, and
of which considerably over one-half of its content of carbohydrate is
insoluble, a condition which must certainly be taken into account
when considering the availability of such salts for absorption.
We may, therefore, with reason, I think, dismiss our fears of the
production of infantile scurvy by the use of sterilized or of pasteur-ized
cow's milk, administered in suitable quantities, provided its in-organic
salts are not reduced too greatly by dilution, nor its fat con-tent
excessive (over 3.50 per cent.). If these conditions are complied
with. I am convinced that the dangers of scurvy from its use have
been greatly overestimated. At all events, the danger involved from
the use of sterilized or of pasteurized milk with respect to scurvy is
so small, under these conditions, in comparison with the advantages
to be derived, that they may be disregarded. As an additional
prophylactic, when desired, however, we may avert all danger by the
administration two or three times a day of a small quantity of orange
juice (say 15 to 30 cubic centimeters), one hour or so before feeding.
It is needless to say that the juice so administered must be from per-fectly
fresh fruit and strained free from particles of skin.
BULLETIN N. C. BOARD OF HEALTH. I
Pasteurization of milk.
This consists in the heating of milk to G0° C. (140° F.) for twenty
minutes. While insufficient for the complete sterilization of milk, it
destroys most of the nonspore-forining micro-organisms, including the
pathogenic germs, besides not altering materially the taste of the milk.
It is, therefore, recommended for milk to be used in feeding infants
from the third month on, at least during the summer months.
METHOD OF PASTEURIZING MILK.
Water is brought to a boiling point in some utensil with a close-fitting
lid. The utensil is then removed from the stove and placed on
some nonconductor of heat, as a square of asbestos or a board. The
feeding bottles are stood up to the level of the milk in them in the
water, the utensil covered, and the whole left for twenty minutes.
The milk bottles are then rapidly cooled by the use of cold water on
the exterior of the bottles, and are kept on ice until required.
It is highly important to remember that neither sterilization nor
pasteurization will make bad or stale milk good, and that, once steril-ized
or pasteurized, it requires the same care in preservation as raw
milk. Very convenient forms of apparatus, such as Arnold's or
Soxhlet's. for sterilization, or Freeman's for pasteurization of milk,
can be bought at the shops.
ARTIFICIAL FEEDING OF INFANTS UNDER ONE MONTH OF AGE.
When we consider the composition of woman's milk in the early
period of lactation, we are impressed with the fact that, while the
proteids are high, the sugar and fat are lower than at subsequent
times. This has the effect of reducing its caloric value, and is doubt-less
dependent upon the needs of the infant in this respect.
We can, therefore, more easily imitate the provisions of nature by
feeding skimmed milk to infants in the first month of life. Walls
has found* that sterilized undiluted skimmed milk is entirely digesti-ble,
even by premature infants. As the energy quotient required by
infants does not become high until the second week, it may be assumed
that skimmed milk will more nearly meet their requirements at this
age than whole cow's milk.
Skimmed milk is obtained either as eentrifugally skimmed milk
from the dairy or by siphoning off the under half of a quart bottle of
milk whose cream has risen.
Skimmed milk has the following average composition :
Per cent.
F; ,t 0.50 to 1.00
Proteid 3.50
Sugar 4.50
Salts 0.75
Water 90.75 to 90.25
Caloric value per kilogram, ."574.." to 421.
*F. X. Walls. Jour. Am. Med. Assn., 1907, Vol. XLVIII. pp. 1389-1392.
8 BULLETIN N. C. BOARD OF HEALTH.
The amounts to be taken are determined as previously explained.
After the end of the first week one-third whole milk and two-thirds
skimmed milk can be given; after the end of the second, one-half
whole milk and one-half skimmed milk ; at the end of the third week,
three-quarters whole milk and one-quarter skimmed milk, passing to
whole milk at the beginniug of the first month.
FEEDING OF OLDER INFANTS.
The seventh month of infancy marks the time when it is desirable
to supplement exclusive milk feeding by some other food. This should
take the form of some cereal broth, and should be added to the milk
in the proportion of one-third broth to two-thirds milk.
The preparations recommended for this purpose are dextrinized
gruels, oatmeal jelly, and barley water.
Dextrinized gruel.—Make a thin paste of cold water and 1 or 2
heaping tablespoonfuls of barley, wheat or rice flour, add 1 quart of
boiling water, and boil for fifteen minutes in a double boiler. When
the gruel is cool enough to be easily tasted, dextrinize by adding 1 tea-spoonful
of diastase solution. An active solution of diastase may be
prepared by soaking a tablespoonful of crushed malted barley grains
in sufficient cold water to cover them (about 2 tablespoonfuls) and
placing the mixture in the refrigerator overnight. In the morning
the liquid, which resembles weak tea, is strained off. A tablespoonful
of this fluid will dextrinize a pint of gruel in fifteen minutes. Or, a
good commercial preparation of diastase may be used.
Oatmeal jelly.—To 2 tablespoonfuls of oatmeal add 1 quart of water
and boil for three hours, keeping up the quantity to 1 quart by the
addition of water as it boils away. Strain through coarse muslin. As
this forms a jelly when cold, it should be added warm to the food.
Barley water,—This is prepared in the same way. Barley grains
or barley flour may be used. If the former, soak the grains in water
overnight.
METHOD OF INCREASING THE INFANT'S DIET.
As long as an infant is making satisfactory gains, no change in the
daily quantity of food is required. To this end, all artificially fed
infants should be carefully weighed each week and the weights noted
for future reference. When the rate of gain for a week has suffered
diminution, in the absence of other symptoms to account for it, we are
to know that the time has come for an increase in the diet. The
amount of this increase is determined along lines previously laid down,
i. e., by weighing the infant and giving it that proportion of food to
its body weight indicated by its age.
We should be watchful for symptoms of overfeeding with every in-crease
instituted in the quantity of the daily food. As long as the
stools are normal in number, color, quantity and consistency, and the
urine remains limpid, no fear of overfeeding may be entertained.
BULLETIN N. C. BOARD OF HEALTH. 9
When, however, loss of appetite is manifest, the bowels are consti-pated,
pale, formed and dry. the infant is being overfed, and a rever-sion
to the former amount of his diet, or the substitution of skimmed
milk for a few days, must be employed until these symptoms dis-appear.
PRECAUTIONS TO BE OBSERVED IN THE ARTIFICIAL FEEDING OF INFANTS.
Every utensil used in the preparation of infant food should be clean.
This does not mean a mere microscopical cleanliness, but surgical
cleanliness as well. Vessels used to hold the infant's food during its
preparation should be scalded with boiling water after previous Thor-ough
cleansing. Feeding bottles are to be cleaned after use.- first,
with cold water, and then with warm water and some alkaline soap
powder. Adhering particles of milk are to be removed with a bottle
brush. The bottles are to be sterilized by boiling them in water, and
storing them in an inverted position, when empty, to prevent the
access of dust to their interior. When new nursing bottles are bought.
in order to prevent them from cracking from the extremes of cold
and heat to which they are subject, they should be annealed. Tbis
is accomplished by placing them in cold water, bringing the water to
a boil, and allowing the bottles to remain in tbe water until it is cold.
Only rubber nipples fitting on the necks of the bottles should be
used. One should be able to turn them inside out for cleansing pur-poses.
The hole in the top should be just large enough to allow the
milk to drop rather rapidly when the bottle is inverted. If it issues
in a stream the hole is too large. Nipples, before use. should be boiled,
and may be kept in a saturated solution of boric acid. In feeding the
child, care should be taken to hold it in such a positiou that it can
easily take its food. A child should not be coaxed to take more food
than it desires at the time, and its wishes in this matter should be
treated with respect. Any portion of food left after a feeding should
he thrown away, and on no account should it be used again.
While, as a rule, it may be postulated that no infant is horn with
a digestion congenitally weak, still, as the result of inadequate feed-ing,
both maternal and artificial, we do encounter infants whose
digestive processes are a law unto themselves. The efficient nutri-tion
of such infants often presents a problem which must lie attacked
upon individual lines. The investigations of Teixeira <le MattOS,*
Salget and others have shown that fat-free buttermilk, or equal parts
of buttermilk and malted cereal broths, are in many instances digesti-ble
with apparent satisfaction by such infants. As skimmed milk
also is closely related to buttermilk in'ils composition, its use as an
article of diet (sterilized), under these circumstances, is warmly
recommended. As soon as tolerance for cow's milk in this form is
•Teixeirai de Mattos. Die Buttermilch als Sauglingsnahrunsr, Jahrbuch f. Kinder-heilk.,
1902, pp. 1-61.
tB. Salge Buttermilch as Sauglingsnahrung. Jahrb. f. Kinderheilkunde, 1902, 157-161.
10 BULLETIN N. C. BOAKD OF HEALTH.
established, it must, however, be supplanted by a gradual return to
whole cow's milk, as both buttermilk and skimmed milk are too poor
in nutritive elements to furnish the basis for any long-continued
scheme of artificial feeding.
It should not be forgotten that atrophic infants require a greater
energy quotient than the normal child of the same weight. This is
due to two reasons—first, by reason of the greater radiation of heat
on account of their deficiency in bodily fat ; and second, because their
proportion of living body cells is greater in respect to their weight
than is the case in infants of normal nutrition. In the latter. 8 to 12
per cent, of their weight consists of fat, whose function in the meta-bolic
processes of the organism consists only in furnishing a store-house
for energy and in conserving the bodily heat. In the emaciated
child of the same weight the body consists almost entirely of cells
performing vital functions, all of which require nutriment for their
proper performance. In view of these facts, in such cases the food
given may be increased above the normal, both in quantity and in
caloric value, taking care, however, not to provide such an excess that
the digestion is thereby embarrassed, and to reduce the nourishment
to amounts appropriate to the weight and age of the child as the nor-mal
average of weight for age is approached.
It is also important to remember that cow's milk, when compared
with human milk, is essentially an alien food. Both its fats and its
proteids are different in composition from those of human milk, and,
being adapted to the nourishment of an animal on a different zoologi-cal
plane, must of necessity be regarded as substances foreign to the
human infantile digestive tract. As a consequence, greater energy
is required for its digestion and assimilation, and it is of the highest
importance that the infant metabolism be not further strained in this
connection by the imposition upon it. in addition to this task, of the
conversion of a milk whose digestibility is further impaired by fer-mentative
changes due to its improper preparation and preservation
as a food.
While we can never hope to vie with natural nursing, an applica-tion
of the principles briefly expounded in this paper will go far. I
am convinced, toward eliminating the excessive complexity and un-certainty
which have hitherto characterized the whole subject of
infant feeding, and, in the main, be productive of better results than
we can obtain by other methods.
BULLETIN H". C. BOABD OF HEALTH. 11
REVIEW OF DISEASES FOR MARCH, 1908.
SEVENTY-NINE COUNTIES REPORTING.
Ninety-two 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 March the following diseases have been reported
from the counties named :
Measles.—Ashe, a few cases; Bladen, a few; Brunswick, several;
Cabarrus, 4; Caldwell. 2o ; Camden, epidemic; Chatham, 1; Chowan,
several; Cleveland, many: ("raven, several; Cumberland; Currituck, a
few: Davidson, 6; Davie, several; Duplin, 75; Edgecombe, a few; For-syth,
a few; Gates, many; Guilford, inany; Harnett, epidemic; Hyde.
a few : Jackson, 50 ; Johnston ; Lincoln, 20 ; McDowell, several ; Macon,
epidemic in the eastern part; Madison; Mecklenburg: New Hanover,
many: Orange, 2: Pender, many; Perquimans, 2: Person. 1; Ran-dolph,
a few ; Richmond, several ; Rowan, a few ; Rutherford, G
Sampson, several; Surry. 5; Swain. 12: Transylvania, a few; Union,
a few; Wake. 25; Washington, many; Watauga. 15; Yadkin, a few
—
-17 comities.
Whooping-cough.—Alamance, many: Alleghany, several; Ashe,
many; Bladen, a few; Brunswick, epidemic; Caldwell, 15; Chatham,
1 ; Cleveland, many ; Cumberland ; Duplin, 25 ; Edgecombe, several
;
Forsyth, a few ; Gaston, a few ; Granville, S ; Guilford, many : Har-nett,
12; Haywood, a few; Iredell, several; Jackson, 11; Lincoln, 25;
Macon, epidemic in eastern part; Mecklenburg; New Hanover, sev-eral
; Orange, many : Perquimans, many : Person. 10 ; Richmond, sev-eral
; Rowan. 1: Sampson, a few: Scotland. 6; Surry. 10; Union, a
few; Wake, 45; Watauga, 10—34 counties.
Scarlatina.—Cleveland, a few: Davidson. 3; Davie, 2; Guilford, 1;
Harnett. 4; Haywood, 5; Johnston. 1 ; Macon; Mecklenburg; Ruther-ford,
; Union, 1—11 counties.
Diphtheria.—Alamance. 1; Craven. 1: Gates, 2; Greene, 1; Guil-ford,
at least 4; Mecklenburg: New Hanover. 1 ; Pitt. 1 ; Randolph, 4;
Wake, 2—10 counties.
Typhoid Fever.—Alamance, 1; Craven, 1 : Hertford. 2; Jackson. 2:
Martin; Montgomery, 4: New Hanover. 1: Person, 0; Randolph. 6;
Rutherford, 3; Swain. :; ; Union, 1—12 counties.
Malarial Fever.—Hyde. many.
Malarial Fever, Pernicious.—Hyde, a few.
12 BULLETIN K. C. BOAKD OF HEALTH.
Meningitis, Cerebrospinal.—Chowan, 1 : Duplin, 2 ; Jackson, 1
;
New Hanover, 1 ; Randolph, 1 ; Surry, 1—6 counties.
Mumps.—Randolph; Sampson; Warren.
Influenza.—Beaufort ; Bertie, in all parts; Brunswick; Burke;
Carteret, in all parts ; Chowan, in all parts ; Clay, many ; Currituck,
many; Davie, Harnett, in all parts; Henderson; Hyde, in nearly all
parts; Macon, a few; Montgomery; New Hanover, Randolph, Rich-mond,
Surry, Washington, Wilkes, Yadkin, in all parts—21 counties.
Pneumonia.—Alleghany, 2; Ashe, many; Beaufort; Bertie, many;
Brunswick, several; Cabarrus, 13; Caldwell. 1: Carteret, a few;
Catawba, 4; Chatham, 3; Chowan, many; Clay, 1; Cleveland, a few;
Craven, 4: Cumberland; Currituck, 1; Davidson, 9; Davie, a few;
Duplin, 15 ; Edgecombe, several ; Forsyth, a few ; Gaston, 1 ; Gates, ;
Harnett, 15; Haywood, many; Hertford, 10; Hyde, 1; Iredell, several;
Jackson, 25; Johnston; McDowell, several; Martin, a few; Mecklen-burg;
Montgomery, 7; Nash, 7; New Hanover, a few; Onslow, many;
Orange, 3 ; Pasquotank, several ; Pender, 2 ; Perquimans, in all parts
;
Person, 36; Randolph, 20; Rowan, 3; Sampson, a few; Surry, 5;
Swain. 6; Transylvania, a few; Union, a few; Wake, 54; Washington,
many; Wilkes, a few; Wilson; Yadkin, a few; Yancey, several—55
counties.
Roseola.—Edgecombe; Martin, epidemic.
Rl-isella—Franklin, epidemic; Gates; Onslow, epidemic: Sampson.
Yaricella.—Sampson, a few.
Smallpox.—Bertie, 1; Buncombe, 4; Cabarrus, 12; Camden, 10;
Chatham, 12 ; Chowan. 5 ; Cleveland, 1 ; Davie, IS ; Forsyth, 2 ; Gates.
1; Guilford, 1; Jackson, 25; Johnston, many; McDowell, 3; Macon, 3;
New Hanover, 4; Pasquotank, 1; Perquimans, 2; Rowan, 15; Ruther-ford,
14 ; Wake, 2 ; Wilkes, 25 ; Yadkin, 5—23 counties.
Cholera, in Hogs.—Iredell.
Rabies, ln Dogs.—Transylvania, a few.
No diseases reported from Durham, Graham, Polk, Robeson and
Vance.
No reports received from Alexander, Anson, Caswell, Cherokee. Co-lumbus.
Halifax. Lenoir. Mitchell, Moore, Northampton, Rockingham,
Stanly and Wayne.
BULLETIN N. C. BOARD OF HEALTH. 13
SUMMARY OF MORTUARY REPORTS FOR MARCH, 1908.
TWENTY-THREE TOWNS.
White.
Aggregate population 147.550
Aggregate deaths 152
Representing temporary annual death
rate per 1,000 12.4
Causes of Death.
Typhoid fever
Diphtheria 1
Whooping-cough 1
Measles
Pneumonia 35
Consumption 27
Brain diseases 8
Heart diseases 9
Neurotic dieases
Diarrhoeal diseases 2
All other diseases 65
Accident 4
Suicide
Violence
152
Deaths under Ave years 29
Still-born 10
Colored.
14 BULLETIN N. C. BOARD OF HEALTH.
mortuary Report for March, 1908.
Towns
and Reporters.
Asheville I
A. G. Halyburton, C.C. I
Charlotte I
Dr. F. 0. Hawley. I
Durham I
Dr. T. A. Mann. I
Kdenton I
Dr. H. M. S. Cason. f
Klizabeth City )
Dr. C. B. Williams. )
Fayetteville !
Dr. A. S. Rose. J
<3oldsboro I
Robt. A. Creech, Esq. f
Greensboro I
Dr. Edmund Harrison, i
High Point I
Dr. C. E. Reitzel. f
Lexington )
J. H. Moyer, Mayor. J
Maiion 1... J
Dr. M. L. Justice. t
New Bern I
Dr. Charles Duffy. f
Oxford I
Dr. S. D. Booth. f
Raleigh. I
T. P. Sale, Clerk B. H. I
Reidsville 1
J. F. Smith, City Clerk, J
Rocky Mount I
Dr. L. C. Covington. (
Salem I
F. H. Vogler, Mayor, f
Salisbury I
Dr. H. T. Trantham. 1
Southport I
Dr. J. A. Dosher. 1
Tarboro I
Dr. W. J. Thigpen. f
Weldon I
J. T. Gooch, Mayor. i
Wilmington )
Dr. Charles T. Harper, f
Wilson I
Dr. W. S. Anderson, f
Popula-tion.
pq
11,000
5,000
18, 000
12,000
12,000
6,000
3,000
3,000
6,000
4,000
3,500
2,500
6,000
4,000
10,000
6,000
9,200
2,000
3,000
600
1,500
100
6,500
7,500
2,000
2,000
13,000
9,000
4,000
2,000
5,000
3,000
3,400
400
7,400
3,600
1,000
600
1,500
1,500
750
750
16,000
14,000
3,800
3,000
ouu
()()i.
000
000
ooo
Tem-porary
Annual
Death-rate
per
1,000.
pq
6,000
10,000
16,000
11,200
3,600
1,600
14,000
4,000
22,000
6,000
,00o
3,800
11,000
1,600
3,000
1,500
30,000
6,800
17.4
21.6
13.3
20.0
10.0
40.0
8.0
20.0
14.0
23.0
10.3
28.8
10.0
21.0
13.2
24.0
9.1
30.0
4.0
0.0
8.0
120.0
11.0
28.8
0.0
0.0
16.6
26.7
9.0
6.0
2.4
16.0
21.2
0.0
9.7
30.0
12.0
0.0
16.0
24.0
16.0
48.0
15.0
24.8
15.8
8.0
18.0
18.0
20.0
14.0
18.0
18.0
11.4
17.2
12.8
3.3
15.0
20.6
0.0
20.7
8.0
7.5
18.9
16.4
7.5
20.0
32.0
19.3
12-3
2-2 g Spll-Q
•S' ft £ &
£.5 Q -5
a.o § Ph o M;W £P
J W ""
< lis
O H «
hp a
<m>w
40
23
24
N. B.—The reporters for the cities and towns printed in Black Type have signed this certificate :
"I hereby certify that this report gives the whole number of deaths occurring within the corporate
limits during the above month."
BULLETIN N. C. BOARD OF HEALTH. 15
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. B. O. Edwards.
Beaufort Dr. D. T. Tayloe.
Bertie Dr. H. V. Dunstan.
Bladen Dr. L. B. Evans.
Brunswick Dr. J. Arthur Dosher.
Buncombe Dr. D. E. Sevier.
Burke Dr. J. L. Laxton.
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. W. A. Graham.
Chowan Dr. H. M. S. Cason.
Clay 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. A. Nichols.
Johnston Dr. L. D. Wharton.
Jones
Lenoir Dr. C. L. Pridgen.
Lincoln Dr. R. W. Petrie.
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. 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 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.
Transylvania Dr. Goode Cheatham.
Tyrrell
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. J. B. Gibbs.
r 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. 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., Secretary and Treasurer, Raleigh.
Vol. XXIII. MAY, 1908. No. 2.
I. THE DANGEROUS HOUSE-FLY.
THE APPALLING PROLIFICACY AND DISEASE-SPREADING HABITS OF A
FILTHY PEST-THE BEST METHODS FOR FIGHTING HIM.
BY W. FEOST AND C. T. VOEHIES.
In our Northern cities, beyond the common habitat of the yellow-fever
and malaria-bearing varieties, the mosquito is only a disagree-able
insect. The house-fly, however, is not only disagreeable, but
dangerous.
The term house-fly to the layman conveys the idea of a noisy,
buzzing pest, particularly persistent and disagreeable when one has
just turned over for the final morning doze. The common house-fly
(Musai domestica) cannot bite, as its month parts are not formed
for piercing. The mistake arises from the fact that a biting fly, the
stable fly (Stomooeys calcitans), very closely resembles it. The fly is
not uncommon in houses, being second in numbers to the house-fly.
It may be distinguished by its narrow, pointed proboscis, thai of
Musca being broad at the end for lapping up liquids. This broadened
proboscis of the house-fly may be readily observed when the fly is
feeding. When the fly is caught, the mouth parts are folded up in a
groove in the head and can be seen only by applying pressure to the
head between the finger nails, when the mouth will protrude. The
number of true house-flies in a room may be determined at. night
18 BULLETIN N. C. BOARD OF HEALTH.
very readily, as they will be found resting with heads down, while
all others rest on the wall with heads upward. Several other species
of flies are also present in the house, but are not of great importance,
on account of their comparatively small numbers.
A knowledge of the life history of the organism in question is
absolutely necessary to the inauguration of intelligent methods of
control. A few adults, which have hibernated in some sheltered
crevice, come forth in the first warm days of spring to start the
brood. The eggs, tiny, white objects, about .04 to .05 of an inch long
by one-fourth as broad, are deposited in large numbers. Dr. Packard
observed that one fly, kept in a bottle, deposited 120 eggs in fourteen
hours. In twenty-four hours, or, under favorable conditions, in eight
or nine hours, these eggs hatch, giving rise to small, white larvae or
maggots. The larval stage is comparable to the "caterpillar" stage
of the butterfly or the "wiggler" stage of the mosquito. The young
larvae have slender, somewhat conical, bodies with a rudimentary
head at the pointed end. They grow with great rapidity. In twenty-four
hours they have outgrown their first skins, which are then cast
off, or molted. One day later they molt again. Three days later, or
five days after hatching, they round up and the larval skins form
hard, protecting cases, which gradually change color through brown
to black. A single case is known as a puparium, and is about the
size and shape of a grain of wheat.
In such a case the second, or pupa, stage of the fly is passed. It
corresponds to the chrysalis, or cocoon, stage of the butterfly, and
lasts from five to seven days.
The adult fly makes its entrance into the world by pushing off
one end of the puparium, which opens like a lid, and thus, only ten
to fourteen days after egg laying, a new generation of flies is ready
to perpetuate the race. It will be left to the reader to compute, if
he cares to do so, the number of progeny which may be the offspring,
during the summer, of a single pair, provided sufficient food supply
be available.
Sufficient food supply, did we say? Aye, there lies the point of the
whole story, for the house-fly proper, as well as several other flies
commonly so-called, lives its larval life almost exclusively in horse
manure. Excrement of human beings and cow dung also serve to
some extent as food for the larvae, but stables and their attendant
piles of refuse are the most important breeding places. Where stables
are left uncleaned for days at a time, the litter directly under the
horses' feet, where tightly packed down, will be found swarming
most thickly with thousands of larva?.
The house-fly carries disease germs in a passive way. The mos-quito
bites a sick person, or animal, and from the blood secures the
infectious agent, which may then by another bite be inoculated into
a second individual. Some of the biting flies also carry infection in
this way, but the house-fly, not being able to bite, does not carry the
BULLETIN N. C. BOARD OF HEALTH. 19
inoculated disease. It is, however, responsible for the distribution
of certain diseases whose causal agents enter the body through the
food. In other words, it aids in the distribution of intestinal dis-eases.
The flies do this by carrying the disease germs from the de-jecta
of the sick to the food of the well.
The disease germs which they carry are Asiatic cholera, typhoid
fever, dysentery and tuberculosis. In this country typhoid fever is
undoubtedly the most important of the fly-borne diseases, although we
are very ignorant in regard to the part which they play in the dis-tribution
of dysentery and tuberculosis. The fly gets the germs from
the discharge of the patients where disinfection has not been properly
performed. It may also become infected by crawling over the pa-tient
or the soiled clothing which may have been left untreated. In
the country districts, where adequate means of sewage disposal are
rare, and in towns where sewage systems are absent or imperfect, the
danger is greatest. The flies get their feet and mouth parts covered
with the material and may thus carry it to the food which they visit.
From laboratory experiments it seems probable that a fly once con-taminated
with the typhoid germ may retain this germ in a living
condition for at least three weeks. Thus a contaminated fly may be
the means of carrying the infection for a considerable distance, if it
has an opportunity to travel. Germ-laden material may also be eaten
by the fly. and in such a case it has been shown that the typhoid
germ may pass through the intestinal tract of the insect and still
remain alive. A "fly-spot" left by such an insect is dangerous. This
is not theory alone, but in Chicago, where typhoid fever was unusu-ally
prevalent, Miss Hamilton caught flies in districts where the
sewage system was poor, and the typhoid germ was isolated from
such flies in five out of eighteen trials.
It is known that flies devour the sputum of consumptives, and
the germ of tuberculosis has been found many times in the intestinal
contents of these insects. How important it is as an agent in the
distribution of tuberculosis we do not know, but probably it is not as
important as in the case of typhoid.
A simple, practical, and quite successful plan for fighting the pest
is that of throwing the manure each morning into a small room
screened against flies and sprinkling upon it a small amount of chlo-ride
of lime as a precautionary measure. Various modifications of
this to suit the size of the stable would certainly be feasible, such ;is
a tightly closed can or box for the accumulations of a small stable.
Of course, this would require that the manure be carted off and dis-posed
of every few days, instead of being allowed to accumulate for
months, as it often does. When spread upon the fields, it will dry
out so completely as to prevent the deposition of eggs or the develop-ment
of the larva*, to which warmth and moisture are essential. A
few cities require closed receptacles for manure.
20 BULLETIN N. C. BOARD OF HEALTH.
The fly problem really resolves itself into three
:
First, and most fundamental, is the one of preventing the breeding
of the pests.
The second is that of preventing contamination of existing flies by
making access to the more important sources of infection impossible.
Third and last, but by no means least, is the problem of preventing
their access to food supplies. This end should be sought, not only
by careful screening of houses to protect dining-rooms and kitchens,
but by screening all food exposed for sale. The dust of the streets
settling upon exposed foods is bad enough, but when we add the
danger of infection by crawling flies, we may well wonder that more
illness does not result.
II. FIGHTING THE HOUSE-FLY.
BY E. V. WILCOX.
Flies furnish an uncanny and unsavory subject to discuss, but
they will not be tabooed. They force themselves upon the attention
of the housekeeper and the sanitarian. Flies follow civilization, like
many another of our pests, and readily adapt themselves to the
habits of man. For this reason their distribution is almost universal.
Not long ago we were commonly taught that flies were scavengers
and, therefore, beneficial insects. We were made to believe that they
helped to destroy the waste incident to civilization. Now we know
better, although the old notion still lingers in many quarters. The
fact in the case is that flies merely help to distribute this filth and
carry it in our houses. Recently the necessity of fighting flies in a
systematic manner has become more and more apparent. The mere
filthiness of the creature is enough to bring about such action, quite
aside from the fact that flies carry disease germs. It is not enough
to keep them out of the parlor ; the kitchen is where flies do most of
their harm. But it is not enough to keep them out of the house en-tirely.
If there are thousands of flies looking for the opportunity,
some of them will get into the house every day and the warfare
against them becomes perpetual.
The common house-fly breeds only in filth. In plain words, this
means if we have flies we are not clean ; that we are leaving filth
and waste matter exposed somewhere. In country districts flies
occur in swarms in and about every group of farm buildings. They
worry the live-stock and the attendants who care for them. They
make journeys to and fro between the stable and the kitchen. Flies
follow the stock to pasture and annoy them from daylight to dark.
Cities and towns seem to be just as badly overridden with flies.
They are on the pavements and walls of the buildings, in restaurants
BULLETIN N. C. BOARD OF HEALTH. 21
and other public places, and in private bouses. In most public
market places flies literally swarm.
On account of their omnipresence, the task of getting rid of the
flies would seem too great. Fortunately the matter is much simpler
than we might expect. The housewife has many methods of attack-ing
flies, some of them being very effective as regards the adult flies,
but they do not touch the everlasting source of infestation. They
merely destroy or drive away the advance guard of the swarm,
which is beiug constantly recruited. Where do flies come from? By
preference, they breed in horse manure, but, this failing, they will
breed in almost any waste or decaying substance. The whole
scheme of fly extermination should, therefore, be based on properly
disposing of the waste materials in which the flies breed. And this,
in turn, is merely one phase of a scientific regime of sanitation.
On farms there is no excuse for allowing manure to accumulate in
places where flies can get to it. Better fertilizing value is obtained
from it when it is hauled and spread on the land every day or, at
the outside, every week. This one operation would remove the chief
breeding ground of iiies, and, incidentally, is good farm practice.
Where this is not possible, the manure should be treated at frequent
intervals with common lime, chloride of lime, or crude oil. Other-wise,
the manure pit must be screened in and kept inaccessible to
flies. Such a procedure will not only relieve the live-stock from the
worry caused by clouds of flies, but will also prevent the infestation
of houses with flies fresh from the filth of the stable.
In cities the abatement of the fly nuisance should be much easier
than on the farm. In every town and city it should be a misdemeanor
to leave horse manure exposed to flies for more than a week at the
outside. Carelessly kept livery stables are fruitful sources of fly
infestation in all cities, as is the waste material in the neighborhood
of large public markets.
So far we have spoken particularly of the larger and more con-spicuous
breeding places for flies. In private houses temporary meas-ures
are still necessary and will be so for some time to come. It will
take a little effort to discover all the breeding places of flies. Then
we have to consider the neighbor, who may not be quite so well con-vinced
as to the desirability of fly extermination. Some patience,
some missionary work, will be required, but, above all. scientific ami
scrupulous cleanliness. Screens, sticky papers, fly poisons will still
be in demand, but we should remember that these remedies are only
temporary; that they do not strike at the root of the matter. Flies
will breed in an incredibly small amounl of moisl organic substance.
In the Southern States damp cellars cause much trouble in this
regard. I have several times observed the almosl complete abate-ment
of the fly nuisance by such a simple device as scattering lime
about in the cellar. Crude oil and kerosene arc perhaps, the most
penetrating and effective of all contact insecticides. They will kill
22 BULLETIN N. C. BOARD OF HEALTH.
eggs, larvae, pupae or adults. Kerosene is everywhere and always
available for the use of treating organic material for the destruction
of fly eggs and maggots. It will also kill any other vermin with
which it comes in contact.
Incidentally, it would be well to keep flies away from persons ill
with contagious diseases, and to kill every fly that strays into the
sick room.
One uniform method cannot be adopted everywhere for the eradi-cation
of flies, but some of the following set of rules will apply in
every locality and will prove effective:
I. Do not allow any decaying organic material of any sort to accu-mulate
on your premises. Abolish all antiquated sewerage systems
and install new.
II. If your cellar is damp, clean out the dark corners at frequent
intervals and apply lime.
III. Pour kerosene into the drains and on all waste material not
intended for fertilizing purposes.
IV. Kitchen waste intended for food for hogs or other animals
should be removed and used daily.
V. If kitchen waste is deposited in large cans, it should be col-lected
at least once a week.
VI. Haul out the manure and spread it on the soil every day or,
at the outside, every week.
VII. If inconvenient to haul the manure out at short intervals,
screen the pile so as to exclude flies, or treat it with kerosene or
lime.
VIII. Keep up the work of destroying adult flies by the usual
methods.
—
From "Country Life in America.'"
MEETING OF THE BOARD OF HEALTH.
The State Board of Health will hold its annual meeting, at Win-ston-
Salem, on the evening of Tuesday, June 16th. On Wednesday,
at 12 M., the conjoint session with the State Medical Society will be
held, at which, among other things, valuable and interesting ad-dresses
will be delivered by Dr. Charles W. Stiles, Chief of the De-partment
of Zoology of the United States Public Health and Ma-rine
Hospital Service, on "Soil Pollution in its Relation to Hook-worm
Disease," and on "Milk Supply in Relation to the Public
Health" by Dr. Tait Butler, our State Veterinarian. Both these gen-tlemen
always have something worth hearing to say, and always say
it well.
We hope as many of our county superintendents of health and city
health officers as possible will attend this meeting, that we may com-pare
notes and prepare for greater progress in sanitary matters.
BULLETIN N. C. BOARD OF HEALTH. 23
REVIEW OF DISEASES FOR APRIL, 1908.
EIGHTY-ONE COUNTIES REPORTING.
Ninety-two 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 be
understood as reported.
For the month of April the following diseases have been reported
from the counties named :
Measles.—Alexander, 9 cases ; Bladen, a few ; Brunswick, several
;
Caldwell, 20 ; Chatham, 10 ; Cleveland, a few ; Currituck, a few ; Da-vidson,
a few; Davie, a few; Duplin. 50; Edgecombe, a few; For-syth,
a few ; Guilford, a large number ; Harnett, 31 ; Henderson,
many; Lincoln, 10; McDowell, a few; Macon; Mecklenburg; Mitchell,
a few ; Montgomery, 20 ; New Hanover, a few ; Onslow ; Orange, 3
;
Pender, many ; Person, 2 ; Randolph, a few ; Richmond, a few
;
Rowan, a few ; Rutherford, 200 ; Sampson, many ; Surry, 5 ; Swain, 3 ;
Transylvania, several ; Union, a few ; Wake, 14 ; Washington, many ;
Watauga, 10 ; Yadkin, in all parts—39 counties.
Whooping-cough.—Alamance, in all parts ; Alexander, S ; Alleghany,
in all parts; Bladen, a few; Brunswick, many; Caldwell, 30; Cam-den,
15; Carteret; Cleveland, many; Duplin, 25; Edgecombe, sev-eral
; Guilford, a large number ; Haywood, a few ; Jackson, 15 ; Lin-coln,
4 ; Macon ; Madison ; Mecklenburg ; Mitchell, a few ; New Han-over
; Onslow, many ; Orange, several ; Pender, several ; Polk, 3
;
Randolph, several ; Richmond, in all parts ; Robeson, a few : Rowan,
10; Sampson, many; Surry, 5; Union, a few; Wake, 30; Watauga, 4;
Wayne; Wilkes, 5—35 counties.
Scarlatina.—Alexander, 4 ; Davidson, 1 ; Iredell, 1 ; Macon ; Meck-lenburg;
Richmond; Rutherford, 10; Watauga, 1; Yadkin, 1—9 coun-ties.
Diphtheria.—Alamance, 1; Caldwell, 4; Craven, 1: Edgecombe, 3;
Forsyth, a few; Gates, 2; Macon, 1; Martin, 12; Mecklenburg; Pen-der.
1: Randolph, 8—11 counties.
Typhoid Fever.—Alexander, 1; Bertie, 1; Bladen, 2; Brunswick.
1; Caldwell, 1; Chatham, 5; Duplin, 1; Edgecombe, 1; Forsyth, 1;
Franklin, a few; Gaston, 1; Iredell, 1; Jackson, :'.
: McDowell, 2;
Mecklenburg; Mitchell, many; Montgomery. 5; Pender, 1; Person. 11;
Polk, 1; Randolph, 5; Richmond, 2; Rutherford, 5; Swain, S;
Wake, 2—25 counties.
24 BULLETIN N. C. BOARD OF HEALTH.
Malabtal Fever.—Brunswick, a few ; Currituck, a few ; Halifax
;
Hyde ; Martin ; Perquimans, in all parts—G counties.
Malarial Fever, Pernicious.—Hyde, a few ; Martin, 2.
Mumps.—Richmond, in all parts; Transylvania.
Influenza.—Beaufort ; Davie, in all parts ; Washington, in all
parts.
Pneumonia.—Alamance, several ; Alexander, 6 ; Beaufort ; Bertie,
1 ; Cabarrus, 11 ; Chowan, 5 ; Cleveland, a few ; Currituck, 1 ; David-son,
several ; Davie, a few ; Duplin, 4 ; Durham, a few ; Edgecombe, 1
Forsyth, a. few ; Gaston, 3 ; Gates, 5 ; Greene, 2 ; Harnett, 9 ; Hay-wood,
in all parts ; Hyde, a few ; Iredell, several ; Jackson, 5 ; Mc-
Dowell, a few; Martin, several; Mecklenburg; Nash, 4; Onslow;
Orange, 2 ; Pasquotank, several ; Pender, 1 ; Perquimans, 10 ; Person,
6 ; Polk, 1 ; Randolph, 4 ; Richmond, 5 ; Robeson, a few ; Rowan, 2
;
Rutherford, 9 ; Surry, 2 ; Swain, 3 ; Transylvania, a few ; Wake, 19
Washington, many ; Yadkin, 2 11 counties.
Roseola.—Alleghany, in all parts ; Martin, epidemic.
Rubeola.—Craven, several; Gates; Onslow, many; Wayne.
Meningitis, Cerebro-spinal.—Gates, 2 ; Harnett, 1 ; Wayne, 1.
Bowel Diseases.—Halifax ; Harnett ; Scotland ; Wayne.
Varicella.—Gates.
Smallpox.—Cabarrus, 28 ; Camden, 5 ; Chatham, 2 ; Chowan, 11
;
Cleveland, 8 ; Davie, 4 ; Forsytb, 1 ; Gates, 3 ; Guilford, 6 ; Johnston,
43 ; Mecklenburg. 1 ; New Hanover, 4 ; Orange, 2 ; Rowan, 25 ; Ruth-erford,
12 ; Wayne, 5 ; Yadkin, 2—17 counties.
Cholera, in Hogs.—Iredell.
Rabies, in Dogs.—Transylvania.
No diseases reported from Buncombe, Burke, Catawba, Clay, Cum-berland,
Graham, Granville, Hertford, Pitt, Vance, Warren and Wil-son.
No reports received from Anson, Ashe, Caswell, Cherokee, Colum-bus,
Lenoir, Moore, Northampton, Rockingham and Stanly.
BULLETIN N. C. BOARD OF HEALTH. 25
SUMMARY OF MORTUARY REPORTS FOR APRIL, 1908.
TWENTY-THREE TOWNS.
White. Colored. Total.
Aggregate population 151,350 96,650 248,000
Aggregate deaths 113 154 267
Representing temporary annual death rate
per 1,000 8.9 19.1 12.9
Causes of Death.
Typhoid fever 1 1
Malarial fever 1 1
Diphtheria 1 1
Whooping-cough 2 2
Pneumonia 11 20 31
Consumption 16 38 54
Brain diseases 7 8 15
Heart diseases 11 12 23
Neurotic diseases 1 6 7
Diarrhoeal diseases 10 14 24
All other diseases 53 50 103
Accident 2 2 4
Suicide 10 1
113 154 267
Deaths under 5 years 28 43 71
Still-born 11 19 30
26 BULLETIN N. C. BOARD OF HEALTH.
Mortuary Report for April, 1908.
Towns
and Reporters.
Popula-tion.
Tem-porary
Annual
Death
Rate per
1,000.
U > 01
fa » fa
fa —
ft £ E
a' .2 £0 5-b 8
j a *
HO
•C rt
H|w § Q ^;§,fa
^ ri "^ •-
11° § I, Q <•< to > M
S -/. c
o * *
. a) 's
« Q oa
Asheville
A. G. Halyburton, C.C.
Charlotte
Dr. F. O. Hawley.
Durliam
Dr. T. A. Mann.
Idcntoii
Dr. H. M. S. Cason. I
Elizabeth City 1
Dr. C. B. Williams. I
Fayetteville 1
Dr. A. S. Rose. J
tjoldsboro I
Robt. A. Creech, Esq. I
Greensboro I
Dr. Edmund Harrison. I
Henderson 1
Dr. A. S. Pendleton. I
High Point I
Dr. C. E. Reitzel. I
Marion I
Dr. M. L. Justice. I
Kew Bern I
Dr. Charles Duffy. f
Oxford I
Dr. S. D. Booth. 1
Raleigh. I
T. P. Sale, Clerk B. H. f
Reidsville \
J. F. Smith, City Clerk. J
Rocky Mount I
Dr. L. C. Covington. I
Salem 1
F. H. Vogler, Mayor. I
Salisbury I
Dr. H. T. Trantham. f
Sonthport I
Dr. J. A. Dosher. I
Tarboro I
Dr. W. J. Thigpen. f
Weldon I
J. T. Gooch, Mayor. I
Wilmington I
Dr. Charles T. Harper. I
Wilson I
Dr. W. S. Anderson. I
15,000
7,000
22,000
18, 000 Qn
12,000 "^ ooo
12,000
6,000,
3,000
3,000
6, ooo!
4,000
3,500'
2,500
18, 000
6,000
10,000
6,000
6,000 , n
4,000
lu ' 000
10,000
6,000
3,200
2,800:
16,000
6,000
9,200 t1
2,000
"'
1,500 , ,
100
1,t
2nn
6,500
7,500
2,000i .
2.000
*'
13,000
9,000
4,000
2,000
5. 000 1
3,000
3,000
400
7,400
3,600
1,000
500
1,500
1,500
750
750
16,000
14,000
3,800
3,000
14,000
1100
22,000
6,000
8,000
3,400
11,000
1,500
3,000
1,500
30 ,000
,800
11.2
24.0
8.3
23.0
10.0
24.0
12.0
12.0
6.0
27.0
10.3
38.4
10.0
12.0
4.8
12.0
0.0
8.6
10.4
6.0
16.0
120.0
3.7
6.4
6.0
6.0
18.5
17.3
0.0
30.0
2.4
12.0
8.0
0.0
8.1
16.7
12.0
24.0
8.0
24.0
0.0
32.0
9.7
25.7
3.1
16.0
15.3
12.0
14.7
12.0
14.4
22.0
10.8
7.5
4.0
9.6
22.5
5.1
6.0
17.7
10.0
6.0
7.0
10.9
16.0
16.0
16.0
17-2
8.8
N. B.—The reporters for the cities and towns printed in Blacfc Type have signed this certificate
:
"I hereby certify that this report gives the whole number of deaths occurring within the corporate
limits during the above month."
BULLETIN N. C. BOARD OF HEALTH. 27
County Superintendents of Health.
Alamance Dr. H. M. Montgomery.
Alexander Dr. 0. L. Hollar.
Alleghany Dr. Robert Thompson.
Anson Dr. E. S. Ashe.
Aehe Dr. B. O. Edwards.
Beaufort Dr. D. T. Tayloe.
Bertie Dr. H. V. Dunstan.
Bladen Dr. L. B. Evans.
Brunswick Dr. J. Arthur Dosher.
Buncombe Dr. D. E. Sevier.
Burke Dr. J. L. Laxton.
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
Chowan Dr. H. M. S. Cason.
Clay 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. A. Nichols.
Johnston Dr. L. D. Wharton.
Jones
Lee Dr. J. P. Monroe.
Lenoir Dr. C. L. Pridgen.
Lincoln Dr. R. W. Petrie.
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. 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 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.
Transylvania Dr. Goode Cheatham.
Tyrrell
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 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. 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., Secretary and Treasurer, Raleigh.
Vol. XXIII. JUNE, 1908. No. 3.
ANNUAL MEETING OF THE STATE BOARD OF HEALTH.
The annual meeting of the Board was held at the Zinzendorf Hotel,
Winston-Salem, on the evening of June 16th, all the members except
one being present. Dr. Thomas E. Anderson was elected a member
of the State Board of Embalming, to succeed Dr. Edward C. Register,
whose term expired and who declined a re-election.
Dr. Shore, Director of the State Laboratory of Hygiene, was present
by invitation. After consultation with him, the Board ordered the
inauguration, as soon as possible, of the prophylactic treatment of
hydrophobia, in accordance with the act of the last Legislature. The
employment of an assistant bacteriologist was authorized.
On the following day (Wednesday) the conjoint session with the
State Medical Society was held. The attendance was good and the
interest in the proceedings manifest. Dr. Stiles, of the United States
Public Health Service, upon our invitation, read a very interesting
and valuable paper on "The Medical influence of the Negro In Con-nection
with Anemia in the White." Also, upon our Invitation, Dr.
Tait Butler, State Veterinarian, read a paper on "Milk Supplies in
Relation to the Public Health." This was extremely practical and
useful, and, supplemented by additional remarks in the Doctor's ear-nest
and vivacious style, evidently made an Impression.
We print below the annual report of the Secretary and Dr. Stiles'
paper. We will print Dr. Butler's next month.
30 BULLETIN N. C. BOARD OF HEALTH.
ANNUAL REPORT OF THE SECRETARY OF THE NORTH CARO-LINA
BOARD OF HEALTH—MAY 20, 1907, TO MAY 20, 1908.
The health conditions of our State during the past year have been
marked by nothing out of the common run, and the work of your Sec-retary
has been chiefly routine. There have been some small epi-demics
of typhoid fever, and an investigation by the Board was re-quested
by County Superintendent of Health Evans of one at Coun-cil,
in Bladen County, and by Mayor Montgomery, of Reidsville, of
an outbreak in that town. The former was investigated by President
Thomas and the latter by Engineer Ludlow. Their respective reports
are appended.
Tuberculosis has lost nothing in importance or interest. Our dis-tribution
of literature on the subject has, I believe, borne fruit in the
education of the people as to the best methods of preventing its
spread. In August last, at the request of the authorities, a committee
of the Board visited the State Hospital at Morganton and advised
with the management as to the location of special quarters for tuber-culous
patients. Their report is appended.
Although not under the control of the Board of Health, its secretary
is. ex officio, a member of the Board of Directors of the State Sana-torium
for Tuberculosis, and a review of the health conditions of the
State would not be complete without reference to it. Its establish-ment
was authorized by the last Legislature, but it has been un-avoidably
delayed by the inability to secure a site suitable to the per-manent
establishment of so important an undertaking. Fortunately,
the necessary abandonment of one or more locations fixed upon, owing
to the inability to secure a sound title, finally resulted in the selection
and purchase of as nearly an ideal site as can well be imagined.
Situated in the sandhills of Cumberland County, about eight miles
from Aberdeen, it is traversed by the Aberdeen and Roekfish Railroad,
and is, therefore, easy of access. The purchase contains about nine
hundred acres, and its highest point, which has been selected for the
location of the buildings, overlooks a wide panoramic view of at least
three-fourths of a circle of miles upon miles of rolling pine forest.
Work has been begun on the buildings, and it is hoped, I am told by
Dr. Brooks, the superintendent, that patients can be received in the
early fall.
The International Congress on Tuberculosis, which is to meet in
Washington, September 21st to October 12th, is an event of world-wide
interest and will well repay a visit. I hope that many of our
health officers and physicians will attend.
Smallpox has been slightly more prevalent than during the pre-ceding
year, the record being 2,011 cases, with 8 deaths, against 1,968
cases and 6 deaths in 100G-'07. During the past year the disease has
been much more prevalent among the whites than among the negroes,
which is just the reverse of the year before. To state it accurately
:
BULLETIN Is'. C. BOAKD OF HEALTH. 31
Iii 190G-'07 there were 620 white cases, with 2 deaths, and 1,34S col-ored
cases, with 4 deaths; while during the past year there were
1,16S white cases, with 6 deaths, and S43 colored cases, with 2 deaths.
The number of counties infected was just the same in each year—48.
Owing to its continued mildness, and the fact that it has become such
an old story—just ten years old—-it produced little concern and prac-tically
no interference with business. The following is a tabulated
statement, by counties
:
Smallpox Report.
Counties.
Number of Cases.
White. Colored. Total
Number of Deaths.
White. Colored. Total
Alamance*
Alleghany
Beaufort
Bertie
Buncombe
Burke
Cabarrus
Catawba
Chatham
Chowan
Cleveland
Columbus
Cumberland —
Currituck
Davidson
Davie
Durham
Edgecombe*--
Forsyth
Gaston
Gates
Guilford
Halifax
Harnett
Iredell
Jackson*
Johnston
McDowell
Madison
Mecklenburg -
Mitchell
New Hanover
Nash
Orange
Pasquotank —
Pender
Randolph
Robeson
Rockingham--
Rowan
Rutherford---
Sampson
Wake
Warren
Watauga
Wayne
Wilkes*
Wilson
Yadkin
Total in 48 counties-
Death rate per cent
4
89
1
20
100
8
2
1
32
7
9
10
75
150
3
37
16
40
9
2
5
20
35
125
3
20
1,168
3
100
192
135
6
7
6
3
4
111
1
23
200
8
3
1
49
7
55
2
12
206
6
5
181
1
13
10
75
225
3
37
21
40
28
2
30
2
3
14
4
62
93
16
3
80
6
20
39
130
3
20
2,011
*Estimated.
32 BULLETIN N. C. BOARD OF HEALTH.
In compliance with the instructions of the Board, I have prepared
a new and up-to-date edition of Instructions for Quarantine and Dis-infection,
and it will be mailed to all the physicians of the State as
soon as I can get a complete and accurate list of them. This work is
now in progress.
The chief and most important work of the year has been the re-organization
and refitting of the State Laboratory of Hygiene, which,
while a separate entity, is placed by the law under the control of the
State Board of Health. Upon the retirement of Dr. McCarthy, we
were fortunate in securing as director of the laboratory a man well
educated academically and well trained technically, an M. S. of our
own University and an M. D. of Johns Hopkins, with a biological
laboratory experience of nearly ten years—Dr. C. A. Shore, who, by
the way, is a citizen of this goodly town. We have been likewise no
less fortunate in securing as chemist Miss Daisy B. Allen, who, I am
assui*ed by Dr. Herty, professor of chemistry at the University, has
never been excelled, if equaled, by any graduate of that department
during his incumbency. Thanks to the generosity of the Legislature,
we were enabled to thoroughly refit the laboratory with the most ap-proved
apparatus, and first-class work can be expected.
Those who have read the monthly Bulletin regularly will remem-ber
that the last General Assembly authorized the preventive treat-ment
of hydrophobia by the director of the laboratory, when the
Board of Health should think it wise to undertake it, provided the
funds at their disposal should justify it without interfering with the
regular work. With the $2,000 annually appropriated by the last
Legislature, in addition to the tax on public water companies, I be-lieve
this could now be done, to the great relief of many of our poorer
citizens, unable to afford the expensive treatment of the various Pas-teur
institutes. This, however, would necessitate the employment of
a competent assistant, as the director, even now, has all his time
occupied in the general work ; but we can now afford it, and we recom-mend
it. The report of the director of the laboratory accompanies
this. As the laboratory is intended for the benefit of the people,
through the medical profession, it is hoped that the physicians will
freely avail themselves of its help.
BULLETIN N. C. BOARD OF HEALTH. 33
THE MEDICAL INFLUENCE OF THE NEGRO IN CONNECTION
WITH ANEMIA IN THE WHITE.
By Ch. Wardell Stiles, Ph. D.,
Chief of Division of Zoology, Hygienic Laboratory, U. S. Public Health and
Marine Hospital Service.
Me. President and Gentlemen:—In responding to your kind invi-tation
to return to North Carolina and to address your meeting, I
invite your attention to a certain phase of the same subject upon
which I spoke before you several years ago. In my former address
I discussed the general subject of hookworm disease. To-day I wish
to speak on the negro as a factor iu the spread of this malady, and
his resulting influence upon the health of the white race. In bringing
this subject before you, it is needless for me to state that I appeal to
no race prejudice, but that I simply bring forward certain harsh, cold,
scientific facts, which must be faced, not only in the interest of the
white, but in the interest of the negro as well.
As many of you know, I have for some years past been especially
interested in studying medico-zoological conditions in the rural dis-tricts
of the South, and this work has led me to spend about a year
living among the tenant whites. During these studies I have made
inquiries among all classes of people regarding their ideas relative to
the origin of the present impoverished financial and physical condition
of the "crackers," "sandhillers" and "barrenites," and the information
obtained, combined with my own investigations, has led me to a con-ception
of these people which is not altogether in harmony with the
general opinion entertained regarding them. So far as I can analyze
the subject, these people are the joint product of certain medical and
industrial conditions, as follows :
In ante-bellum days, if a man was wealthy enough to own slaves,
he was wealthy enough to own good plantation land. If not wealthy
enough to own slaves, it is not reasonable to assume that he could buy
the better class of farms. The latter people, therefore, would natu-rally
be forced into the poorer lands, if owners, or to serve as over-seers,
to become tenants and, in general, to compete with slave labor.
Such seems to me to be the most reasonable of the several explana-tions
I have heard regarding the origin of these people. In different
parts of the South they are known as ••shad-bellies." "poor I'.ukra."
"poor whites," "crackers," "sandhillers," "sand Billies," "barrenites,"
"poor Johns," etc.
The old-time negro had a great contempt for the white man who
could not own a slave, and this contempt culminated in the expression,
•poor white trash." This same contempt is reflected in the negro
song. "I'd rather be a nigger than a poor while man."
The expression, "poor white trash." has become very well known,
34 BULLETIN N. C. BOARD OF HEALTH.
despite its offensive character, and, unfortunately, the average more
fortunate whites, both those who know these people and those who
have not seen them, have too commonly allowed their judgment of
these people to become somewhat clouded by the judgment formed by
the old slaves. In fact, very few persons have any sympathy for
these people, who have been repeatedly referred to in my presence as
"lazy," "shiftless," "good for nothing," "indolent" "untrustworthy,"
etc. One Southerner whom I recently met stated that he had had
twenty-five years' experience with them, and that he considered "they
were not worth trying to help." He was kind enough to inform me
that I was wasting my time in living among them and studying their
conditions. This reflects in an exaggerated form the average opinion
I have encountered during my studies among these people, now car-ried
on at various intervals for nearly six years, the total study
amounting to about one year's time.
Actual experience among them for the purpose of scientific study,
and actual association with them, involving sleeping in their homes,
boarding with the "dirt eater" and "snuff dipper." playing with their
children, visiting their schools, seeing them on farms, in mines, in
mills, hospitals and orphanages, have led me to a conception of them
which is different from the opinions just mentioned, and I am forced
to take radical issue with any person who looks upon them as "lazy."
"indolent" or "good for nothing." and I cannot refrain from expressing
surprise that any man should have twenty-five years' experience with
them and use so little intelligence and acumen as to come to the con-clusion
that they are "not worth trying to help."
Since these people are peculiar to the South, in order to understand
them it is necessary to understand certain other factors which are
peculiar to this same region. There are three factors in particular
which come into consideration, namely: (1) the area under discus-sion
presents the most intense negro population of any part of the
country; (2) this area also presents the area of most intense hook-worm
infection; and (3) the same area presents- the most intense
malaria infection of any portion of the country. The question now
arises
:
In what relation do these four factors (the tenant white people, the
negroes, hookworms, and malaria) stand to one another?
I need not argue to you the fact that both hookworm disease and
malaria are found both in the white and in the negro, for this is well
established. I may, however, invite your especial attention to an
important point, too often overlooked, namely, that these two great
anemia-producing diseases which are so severe on the white are rela-tively
less severe on the negro race. This fact, that (he negro pre-sents
a relative immunity to the physical effects of these two infec-tions
which are so common to his race, is one of very great impor-tance,
for it points us to a conclusion from which there is no escape,
BULLETIN N. C. BOARD OF HEALTH. 35
namely, that the negro race forms a great reservoir for the supply of
these infections.
Take malaria, for instance. It is a well-established fact that the
malaria parasite is exceedingly common in the blood of negroes. It is
a fact of common knowledge, which can be easily verified by any
doubting Thomas, that the negro does not trouble himself very much
to screen against mosquitoes. What is the result? Siuce the negro
does not suffer from the effects of this infection so severely as does
the white, the negro is not so likely as the white to come under medi-cal
treatment; accordingly, he is more likely to form a source of
infection to the mosquito; add to this the fact that he does not screen
against mosquitoes so much as does the white, and it is clear that rela-tively
he forms a greater source of infection to the mosquito than
does the white. Now, let a white man take what precautions he will
against malaria in his family, the mosquitoes in the negro's house on
the back street still form for this white man's family a source of
danger, over which lie has practically no control. The conclusion is
evident : Theoretically and practically, the negro race, living side by
side with the white race. is. when viewed from the standpoint of
malaria, a great and serious reservoir of infection.
Take next hookworm disease. A given infection with this disease
may put a white person in his grave or may make him so sick that
he remains at home, and it is likely to bring him under medical treat-ment.
Thus this infection is either brought to an end or it is more
or less cotffined to the immediate premises of this particular family.
That same infection will produce less serious physical results on the
negro, who will, therefore, not be so likely to be confined at home,
and he will not be so likely to come under medical treatment. The
conclusion naturally is that, relatively, the negro is, and from theo-retical
conditions necessarily must be, a greater spreader of hook-worm
disease than is the white man.
The immense importance of this latter fact can be seen when we
compare the white and the negro as a soil polluter. In this connec-tion
I would state that I have collected statistics for 3G6 farmhouses
in North Carolina. South Carolina. Georgia and Alabama, and I find
that of these 3GG cases only 11.1 houses, or 31.4 per cent., were pro-vided
with privies of any sort; in other words, 251 of these houses, or
68.5 per cent., had no privy, and on lliis account the soil pollution on
these premises reached a theoretical maximum. Of the 366 farm-houses
in question my records show thai 73 were occupied by whites
and S3 by negroes, but I have no record of the race of the occupants
of the remaining 210 houses. Of the 73 houses occupied by whites
56.1 per cent., or 41 houses, had privies, and 43.8 per cent., or 32
houses, were without privies. Of the S3 negro houses 20.4 per cent.,
or 17 houses, had privies, while 79.5 per cent., or 66 houses, had no
privy. In other words, the theoretical maximum of soil pollution was
reached in 43.8 per cent, of the houses occupied by whites and in 70.0
36 BULLETIN N. C. BOARD OF HEALTH.
per cent, of the houses occupied by negroes. From these statistics it
would appear that the negro is nearly twice the soil polluter that the
white man is, and this conclusion is iu harmony with what we know
of the generally poorer condition of the negro privy, when one is pres-ent,
and also with the complaints so often made regarding the pollu-tion
of alleys in cities by the negro.
Comparing the white and the negro, numerically, as an inhabitant,
we find that in the States of Virginia, North Carolina, South Carolina,
Georgia, Florida, Alabama, Mississippi and Louisiana the average
ratio is 1,000 whites to 833 negroes. The ratio in these States varies
between 1,000 whites to 494 negroes in North Carolina and 1,000 whites
to 1,415 negroes in Mississippi.
From the foregoing data it is seen that in the area under discussion
we have the following combination :
(1) Two races (whites and negroes) are living side by side.
(2) As inhabitants they bear the ratio of 1,000 whites to S33 negroes
(a proportion of negroes far in excess of what exists in otber States).
(3) As soil polluters they bear the ratio of 438 (in whites) to 795
(in negroes).
(4) Two diseases (hookworm disease spread by soil pollution, and
malaria spread by mosquitoes) are present in high percentages.
(5) These anemia-producing diseases are especially severe on the
white, but relatively less severe on the negro.
To my mind, the foregoing combination of facts leads inevitably to
the conclusion that the white race in the South is living under a
hygienic handicap which is not paralleled in any other part of the
country, and, were it not for the greater intelligence and better finan-cial
condition of the whites, whereby they are able to protect them-selves
more or less against these diseases by sanitary measures, it
would be only a question of a few generations before this handicap
would exterminate the whites from those portions of the South which
are especially favorable to these infections.
The whites of higher education and in better financial condition are
able to protect themselves against this handicap, the burden of which
has, therefore, fallen more especially upon that class (namely, the
rural white tenant class) which has been kept in financial impoverish-ment
through generations of competition with negro labor ; and the
result is exactly what theory demands it should be, namely, the pres-ent
impoverished physical condition of so many thousands of the ten-ant
white people, especially those living in the sandy and mountainous
districts, where the sanitary arrangements are so inferior.
The physical condition of these people can be appreciated only by
persons who have been among them. Those of us who have lived
among them need not be surprised to find their blood from 10 to 70
per cent, below normal, nor need we be surprised, upon entering a
poor farm hovel, to foresee death, in many instances, in 40 per cent,
of the children (namely, 2 of the 5, or 4 of"the 10 children of the
BULLETIN 2s
T
. C. BOARD OF HEALTH. .37
family) before they reach twenty-one years of age. I visited one
farm on which I found father, mother, five children, and fifteen chil-dren's
graves. I asked the physician what had killed these fifteen
children, and he replied: "I do not know what the disease is, but if
you can tell me what is killing that girl there, you will know what
killed the other fifteen children." "TJvat girl there" was a severe case
of hookworm disease, in the dirt-eating stage. Think of it, gentlemen
;
75 per cent, of the rising generation of this family had already paid
the extreme penalty of soil pollution, and one further member of the
family already had one foot in the grave!
Gentlemen, let any one call me a theorist if he will, but, in all fair-ness
to the tenant white class of the rural sand and piney-woods dis-tricts
of the South, let him first see the sights I have seen before he
makes fun of those people and before he jokes about their sick and
dying women and children. Before any man who claims to be hu-mane
considers these people "lazy," "good for nothing" and "not
worth trying to help," let him reflect upon the following statistics,
based ou about 10,000 examinations I have recently made among this
class of people
:
(1 i At least 13 per cent, (women over 20 years) to 18 per cent.
(girls 1G to 20 years) of these women of maternity age are suffering
from the anemia-producing hookworm disease, which prevents them
from properly nourishing their babes.
(2) Of the girls under 16 years, at least 1S.7 per cent, have this
same infection, which thus adds a serious strain upon their bodies (in
addition to the strain incident to their sex) and which tends to re-tard
their physical development, so that many of them reach maturity
two to live years late; and even after they have reached maturity this
disease renders them irregular in their menstrual functions.
(3) Of the boys under 1G years, at least 20.4 per cent, have this
same infection, which inhibits both their physical and their mental
growth.
(4) Of the boys 1G to 20 years, 20.7 per cent., and of the males over
20 years, 5.8 per cent., show these same symptoms, which decrease
their labor capacity and their military efficiency.
Now, my friends, in all kindness, let me submit to you a question
for thoughtful consideration : Nearly half a century ago the country
freed the slaves, but in these decades that have elapsed since then
what has our country done in order to better tin" conditions of the
tens of thousands of Hie rural tenant whites who have been kept in
financial poverty through competition with negro labor, and in physi-cal
poverty through the tiro great anemia-producing diseases for
which tiif negro forms the great reservoir of injection.'
All honor to the few noble men and women who, by meat personal
sacrifice, are struggling to support efforts looking to a betterment of
their condition; all honor to the few physicians who have let it be
known that they will treat hookworm cases among these people with-
38 . BULLETIN H". C. BOARD OF HEALTH.
out professional fee; all honor to the Southern cotton mill which is
enabling thousands of these people to earn an honest living and thus
to uplift themselves. But think a moment. In comparison with what
this country is doing for the negro of the South, for the Chinaman in
Asia, and for other people of different races, what is our country
doing in order to derate these tens of thousands of people of our own
race in our own country.'
Does it tend to elevate them if we refer to them as "lazy" and as
"good for nothing"? Would it not help them more if we could send
to the chain gang people who indulge in that kind of pseudo-wit?
Gentlemen, there is a rational solution to the problem before us, and
I submit to you for consideration a plan which I maintain is well
founded from a theoretical point of view, and feasible from a practi-cal
point of view. It is the same plan which I submitted a few days
ago to the Alabama State Medical Association, and which that Asso-ciation
has unanimously endorsed. It is this:
Let us start out on the general principle that it is much easier to
teach children than adults. With this truth in mind, I propose the
introduction of a "Public Health Week" into every schoolroom in the
South. During fhis week let us utilize the class in physiology, in
order to teach to the children the three great and fundamental princi-ples
of public health so important for the South. These principles
are
:
First. Do not spit on the floor, for this habit spreads tuberculosis
and diphtheria.
Second. Do not pollute the soil, for this habit spreads typhoid fever
and ground itch, with its resulting hookworm disease.
Third. Protect against 'mosquitoes, for mosquitoes spread malaria,
yellow fever, dengue, and elephant foot.
Besides working through the schools, let us use every other means
by which we can carry on a merciless campaign against soil pollution.
In the last analysis, soil pollution is an evil in itself; it is in the
nature of "malum in se" ; it is an "aggravated offense against the pub-lic
welfare" ; hence it should be prohibited and made a crime, and any
person guilty of polluting a highway or back alley should be sent to
the chain gang.
Let us extend this campaign to the farms especially, and, if possible,
persuade, but, if necessary, compel, the farmer to build a sanitary
privy and to keep it clean.
Let us appeal to the clergy, to the lawyers, to the business men, and
especially to the school teachers and the mothers, to join in this cam-paign.
If I can gain the mothers of the South for this movement, and
be given a chance to do so, I will agree to practically eradicate hook-worm
disease from the South in one generation's time, and by this
eradication I will agree to elevate the condition of the rural tenant
whites.
In conclusion, gentlemen, let me emphasize a very important point
BULLETIX X. C. BOAED OF HEALTH. 39
iii the plan I propose, namely, that it is absolutely necessary to avoid
any distinction between the whites and the negroes in this campaign
of sanitary education, fur
—
(a) The white man who fails to recognize the important necessity
of improving the sanitary conditions under which the negro is living
•fails to go to the root of the evil, and he unconsciously invites disease
and death, especially to the women and children of his own race;
while—
(b) The negro who fails to recognize the important necessity of
improving the sanitary conditions under which the negro is living
overlooks the fact that he is placing a very serious handicap in the
way of a higher mental development of his race; for the point must
not he forgotten that hookworm disease, in addition to its physical
effects, to which the negro is relatively immune, has also a serious
effect upon the mentality, and it has not been shown that the negro is
immune to this latter effect.
REVIEW OF DISEASES FOR MAY, 1908.
EIGHTY COUNTIES REPOKTIXG.
Ninety-two 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.—Bladen, many cases: Brunswick-, several: Caldwell. 6;
Chowan, many: Cleveland, a few; Cumberland; Davie, a few; Duplin.
58; Durham; Edgecombe, in all parts; Forsyth, a few; Gaston, a few:
Guilford, many; Harnett, 20; Henderson, several; Lincoln. 25; Mc-
Dowell, several; Mecklenburg; Montgomery, »'>: New Hanover, a few;
Onslow: Orange, many: Pender, several; Person, 4: Randolph, a few-
Rutherford. 2~> : Sampson, many: Transylvania, s : Wake, 10; Wa-tauga,
15; Yadkin, in all parts—:;i counties.
Whooping-cough.—Alamance, several; Bertie; Bladen, a few;
Brunswick, epidemic; Cabarrus. I.".; Caldwell. 15; Camden, in all
parts; Carteret, several: Caswell, 25; Chowan, many: Cleveland, a
few: Cumberland; Davie, a few; Duplin. 84; Edgecombe, a tew: Gas-ton.
a few: Haywood, a few: Henderson, several: Iredell, a few;
Jackson. ::r»; Lincoln, 20; Madison: Mecklenburg; Onslow; Perquim-
40 BULLETIN N. C. BOARD OF HEALTH.
ans, 10; Randolph, several; Rowan. 1; Sampson, many: Wake, 20;
Watauga. 2—30 counties.
Scarlatina.—Alexander, 2; Anson, 12: Caldwell, 1; Chowan. 1:
Forsyth, 1 ; Gaston, a few ; Guilford. 25 ; Mecklenburg ; Onslow ; Per-quimans,
10 ; Transylvania, 7 ; Union, 1 ; Watauga, 1—13 counties.
Diphtheria.—Cabarrus, 2 ; Caldwell, 1 ; Durham, 4 ; Edgecombe. 1
;
Gates, 4 ; Mecklenburg ; Nash. 1 ; New Hanover, 1 ; Person, 1 ; Union,
1—10 counties.
Typhoid Fever.—Alamance, 1; Alexander, 4; Alleghany, 1; Anson,
2 ; Beaufort ; Bertie, 1 ; Bladen. 2 ; Brunswick, 1 ; Caldwell, 2 ; Cam-den,
2: Clay. 2; Cleveland, a few; Columbus, 3; Craven. 2: ('umber-land
; Duplin, 5 ; Edgecombe, a few ; Franklin, several ; Gaston. 1
;
Gates, 5; Granville, 4; Guilford. 3; Harnett. 14: Haywood, 2; Hert-ford.
2; Iredell. 1; Jackson, 3: Martin, a few; Mecklenburg; Mont-gomery.
3; Nash. 3; New Hanover, 5; Onslow, 6; Pender. 2; Person,
G; Randolph, 3: Richmond, a few; Robeson, a few; Rowan. 5 : Samp-son,
a few; Scotland, 2; Swain. 2; Transylvania. 1; Union, several;
Vance, a few ; Wake, 12—46 counties.
Malarial Fever.—Camden ; Caswell ; Currituck, in many parrs :
Gaston, not so many as in former years, on account of better drain-age
: Hyde ; Perquimans— counties.
Malarial Fever, Perxicious.—A few.
Malarial Fever. Hemorrhagic.—Camden, 4.
Bowel Diseases.—Alleghany, Brunswick, Burke. Caswell, Catawba.
Clay. Currituck, Graham, Granville, Guilford, Harnett. Henderson,
Hertford, Johnston, Lenoir, Montgomery, Orange, Pender, Person,
Randolph, Robeson—21 counties.
Mumps.—Guilford, many.
Pxeumoxia.—Alexander. 2 : Anson, 2 ; Brunswick. 1 ; Cabarrus. 4
Clay, 2 ; Cleveland, a few ; Columbus, 1 ; Duplin, 6 ; Edgecombe, a few
Gates, 3; Greene, 2; Harnett. 14; Henderson, 2; Iredell, several
Jackson, 3; McDowell, a few; Mecklenburg; Montgomery. 3; Nash. 1
Onslow; Perquimans, 2; Randolph, 2; Swain. 4; Transylvania, 1
Union, 1 ; Wake, 2 ; Washington, 2 ; Watauga, 2—2.8 counties.
Mexixgitis. Cerebro-spixal.—Caswell, 2 ; Gaston, 1 ; Gates, 2
:
Wake, 1—4 counties.
Rubella.—Anson, Columbus, Onslow.
Smallpox.—Anson, 30; Cabarrus. 10; Chowau, 2; Johnston, sev
eral : New Hanover. 2 ; Orange, 1 ; Richmond, 1 ; Rowan, 1—S counties
Cholera, in Chickexs.—Clay.
Hydrophobia, ix Dogs.—Gaston.
No diseases reported from Buncombe. Davidson. Pasquotank, Pitt
Polk, Surry, Warren, Wilkes .and Wilson.
No reports received from Ashe, Chatham, Cherokee, Halifax, Macon
Mitchell, Moore, Northampton, Rockingham and Wayne.
BULLETIN X. C. BOARD OF HEALTH. 41
SUMMARY OF MORTUARY REPORTS FOR MAY, 1908.
TWKXTY-THREE TOWNS.
White.
Aggregate population 151,550
Aggregate deaths 169
Representing temporary annual death rate
per .1,000 13.4
( 'a uses of Death.
Typhoid fever 2
Malarial fever
Diphtheria
Whooping-cough 2
Measles 1
Pneumonia 8
Consumption 17
Brain diseases 14
Heart diseases 12
Neurotic diseases 4
Diarrhoeal diseases 41
All other diseases 62
Accident 5
Violence 1
169
Deaths under five years 58
Still-born 7
Colored.
42 BULLETIN N. C. BOARD OF HEALTH.
Mortuary Report for May, 1908.
Towns
and Reporters.
Asheville
A. S. Halyburton, C.C.
Charlotte
Dr. F. O. Hawley.
Dnrham
Dr. T. A. Mann.
Edenton
Dr. H. M. S. Cason.
Elizabeth City
Dr. C. B. Williams.
Fayetteville
Dr. A. S. Rose.
Goldsboro
Robt. A. Creech, Esq.
Greensboro
Dr. Edmund Harrison.
High Point
Dr. C. E. Reitzel.
Lexington
J. H. Moyer, Mayor.
Marion
Dr. M. L. Justice.
New Bern
Dr. Charles Duffy.
Oxford
Dr. S. D. Booth.
Raleigh _
T. P. Sale. Clerk B. H.
Reidsville
J. F. Smith, City Clerk.
Rocky Mount
Dr. J. P. Battle.
Salem
F. H. Vogler, Mayor.
Salisbury
Dr. H. T. Trantham.
Sonthport
Dr. J. A. Dosher.
Tarboro
Dr. W. J. Thigpen.
Weldon
J. T. Gooch, Mayor.
Wilmington
Dr. Charles T. Harper.
Wilson
Dr. W. S. Anderson.
Popula-tion.
w.
c.
w.
I
j
c.
\k:
l W.
I c.
I w.
I c.
i w.
J
I w.
I c.
I w.
f c.
! w.
I
}5-
I w.
i c.
I w.
I c.
I w.
t c.
I w.
1
c-
1 w.
i c.
I w.
I c.
I w.
i c.
I w.
I
I w.
f c.
I w.
I c.
I w.
I c.
I w.
\ c.
) w.
I c.
15,000
7,000
18, 000 Qn
12,000i
du'
12,000 1S
6,000
ls '
Tem-porary
Annual
Death
Rate per
1,000.
M
22,000
3,000
3,000
6,000
4,000
3,500
2,500
6,000
10,000
6,000
6,000 , n
4,000l
iu '
icoooL
6,000
Lb
9,200
2,000
3,000
600
1,500
100
6,500
7,500
2,000
2,000
13,000
9,000
4,000
2,000
5,000
3,000
3,400
400
7,400
3.600
1,000
600
1,500
1,500
750
750
16.000
14,000
3,800
3,000
11,200
3,600
1,600
14,000
4,000
22,000
6,000
8,000
3.800
11,000
son
15.2
13.7
14.0
18.0
24.0
52.0
4.0
4.0
8.0
24.0
10.3
91.2
22.0
15.0
18.0
26-0
10.4
0.0
4.0
20.0
0.0
120.0
9.2
20.8
12.0
24.0
13.8
32.0
0.0
6.0
4.8
16-0
3.5
30.0
8.1
23-3
12.0
0.0
16.0
40.0
0.0
96-0
17.2
27.4
19.0
12.0
fa fl fa 3 a>
a X.
Q - Q
*< W w fc 5 . ,
*i O TS S ? C M
Q-B
2l1lo
to —
J £ ?,
< 5 S
O H *
i § e
*^ ~« "»2 Gr Sto 'o " S JS -Q
1 1 .: s r> ^ :, TO .^L . w c ft t, w w .*« — tw> 3 •— i^ii .*» ^ Jj
H HM§Q^SfaOKKZQ<!<!!M>MMQ:W
^1^ TO =
rrt /~\ 2Z
14.7
15.5
33.3
4.0
14.4
44.0
19.2
21.0
8.6
6-7
7.5
15.4
18.0
21.3
2.0
9.0
6.3
13.1
7.5
28.0
48.0
47.1
15.9
2
1
2
1
1...
1 2
4 3
1 1
19L.
21 „
q
13!
18
dy
7
24
50
10
26
ou
7
1
3
23 „ 10
32
55
15
6
3
N. B.—The reporters for the cities and towns printed in Black Type have signed this certificate
:
"I hereby certify that this report gives the whole number of deaths occurring within the corporate
limits during the above month."
BULLETIN X. C. BOARD OF HEALTH. 43
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. M. Blevins.
Beaufort Dr. D. T. Tayloe.
Bertie Dr. H. V. Dunstan.
Bladen Dr. L. B. Evans.
Brunswick Dr. J. Arthur Dosher.
Buncombe Dr. D. E. Sevier.
Burke Dr. J. L. Laxton.
Cabarrus Dr. R. S. Young.
Caldwell Dr. C. L. Wilson.
Camden Dr. C. G. Ferebee.
Carteret Dr. W. E. Headen.
Caswell Dr. S. A. Mallov.
Catawba Dr. Geo. H. West.
Chatham Dr. J. H. Taylor.
Cherokee
Chowan Dr. H. M. S. Cason.
Clay 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. X. 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. A. Nichols.
Johnston Dr. L. D. Wharton.
Jones
Lee Dr. J. P. Monroe.
Lenoir Dr. C. L. Pridgen.
Lincoln Dr. R. W. Petrie.
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. 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 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.
Transylvania Dr. Goode Cheatham.
Tyrrell
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 I H Maiming
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. i 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., Secretary and Treasurer, Raleigh.
Vol. XXIII. JULY, 1908. No. 4.
HYDROPHOBIA.
By act of the last Legislature the State Board of Health was
"authorized and empowered to provide for and have conducted, un-der
its direction, the preventive treatment of hydrophobia or rabies."
We now announce our readiness to give this treatment. For partic-ulars
address Dr. C. A. Shore, Director, State Laboratory of Hy-giene,
Raleigh. In our next issue we will set forth this matter more
in detail.
OUR MILK SUPPLY AND SOME OF ITS RELATIONS TO
PUBLIC HEALTH.
By Tait Butler. State Veterinarian, Raleigh, N. C.
[Read at the Conjoint Session of the State Board of ll> alth and thi
Medical Society at Winston-Salem, June 17, 190S.]
[We earnestly commend this admirable article of Dr. Butler's in all
our readers. Nearly everybody is interested in the purity of milk, the
attainmenl of which is one of the mosl Lmportanl of all sanitary prob-lems.
Lend a hand and gel your town to supervise ils milk supply.
The regulations suggested by Dr. Butler are sensible and reasonable
and, with the exception of temperature, can be carried out as well in
the dairies of North Carolina as they can be anywhere.—Editor.]
46 BULLETIN N. C. BOARD OF HEALTH.
In accepting the invitation of your Secretary, Dr. Lewis, to read a
paper at this meeting on the public or market milk supply of the State.
I did so with a distinct purpose in view. It is, perhaps, telling no
secret, and it is certainly not meant offensively, if I state that the
aA'erage practicing physician is none too familiar with the real prob-lems
involved in putting into the hands of consumers a wholesome
milk supply. But this, in my opinion, is not of great importance. It
is not necessary, however desirable, that the physician possess expert
dairy knowledge or that he be capable of performing the duties of a
scientific dairy inspector. A much more important matter, as affecting
any effort for the improvement of our milk supply, is that he have a
full and accurate knowledge of the real importance of pure milk for
the consumption of those under his care.
Many of tbose bere have given special study to this subject. Others
who are investigators have full knowledge regarding certain phases
of it, but the general practitioners have not given that attention to the
subject which its importance demands. Moreover, the general prac-titioner
gets closer to the public than any other man, and it is through
him that the general public can be best reached ; therefore, in this
paper I have decided to talk to the general practitioner and to assume
the part of an agitator rather than an educator.
All freely admit the importance of a wholesome milk supply as a
general proposition. But how many know fully and accurately the
awful results of our criminal neglect in the past along this line?
How many have an accurate knowledge of the quality, or lack of
quality, of the milk now being sold throughout the State? How many
realize the full measure of lilth which it carries, and what that means
in misery and death to the innocent babes which must consume it?
Gentlemen, it is not the ravings of a fanatic nor the extravagance
of a sensationalist, but a conservative statement of terribly serious
facts when I say to you that the almost total ignorance of dairy
science on the part of our milk producers, the lack of knowledge of
what constitutes first-class milk, and the care it should receive on the
part of consumers, and the almost criminal indifference and inertia of
the medical profession, who are the accepted guardians of the public
health, are seeds, the awful but legitimate harvest of which are ill
health, misery and death to hundreds upon hundreds of innocent con-sumers
during our long, hot summers.
The indifference of the public generally, and the indifference and
inactivity of the medical profession in particular, along the lines of
milk and meat inspection, are little short of tragic, and 1 wish I
might say something that would help, in a small way at least, to
arouse and increase interest in this long-neglected branch of sanita-tion.
BULLETIN N. C. BOARD OF HEALTH. 47
There are three general ways in which the milk supply may have a
direct relation to the public health :
1. It may be a means of carrying and transmitting disease from man
to man—such, for instance, as typhoid fever, diphtheria, scarlet fever,
cholera, etc. ; but of these phases of our subject I shall take for
granted you are better informed than I, and omit their discussion.
2. Milk may be a means of carrying and transmitting disease from
cows to man, such as tuberculosis, anthrax, foot and mouth disease,
cowpox. etc. Of these, one aloue is common—tuberculosis—of which
I shall have something to say later.
3. Milk may cause disease in man by conveying disease-producing
agents or materials, such as filth and the conditions which it favors
for the growth of bacteria and the development of toxins and other
deleterious substances ; also the products of mammitis and other septic
troubles.
Of the distinct diseases affecting the cow, which also affect man and
which may be communicated from one to the other, tuberculosis is of
first importance.
When Koch discovered the bacillus of tuberculosis and proclaimed
the identity of bovine and human tuberculosis, there was little hesi-tancy
in accepting a conclusion so closely in harmony with the experi-ence
and observation of scientific workers in both human aud veteri-nary
medicine. Later investigators called attention to the difficulty
in transmitting human tuberculosis to bovines, and still later the fact
was pointed out that the bacilli from bovine and human sources often
possessed morphological and cultural peculiarities suflicient to differ-entiate
them : but when Koch followed, in 1901, with the remarkable
declaration that bovine and human tuberculosis were different and not
intercommunicable, few scientific investigators were willing to accept
the dictum on the insufficient evidence produced, and at once investi-gations
were started all over the civilized world to determine the truth
or falsity of Koch's declaration. In the meantime progress towards
preventing the communication <>f bovine tuberculosis to man received
a decided setback.
The results of the investigations, stimulated by Koch's dogma, indi-cate,
as clearly as the nature of the case will permit, that bovine
tuberculosis may be and is communicated to man.
It has been shown that the bacillus from human tuberculosis Is
capable of producing tuberculosis in many animals, but for no animal.
unless in;' n is the sole exception, is it so virulent as the bovine germ.
If the bovine bacillus is more virulent for all other animals, including
monkeys and apes, it very logically follows that it probably is also
more virulent for man than the human bacillus.
Of course, Koch has not recanted. Ho still maintains the position
taken in 1901, but the fact is now pretty generally recognized that
bovine tuberculosis may he a source of danger to man.
48 BULLETIN N. C. BOARD OF HEALTH.
The next question to arise was, naturally, To what extent is bovine
tuberculosis a source of infection to man?
In their efforts to show that bovine tuberculosis was rarely com-municated
to man, the fact of the greater frequency of pulmonary
than abdominal tuberculosis was pointed out, and the claim that intes-tinal
tuberculosis of children, the greatest consumers of milk, was
rare, were made much of.
Recently much evidence has been developed showing that intestinal
or abdominal tuberculosis of children is not so rare as claimed by
those who maintain that bovine and human tuberculosis are not inter-communicable.
And still further to the dismay of those who cling to old beliefs
because they are old, even the time-honored assumption that the chief
mode of entrance of the infection agent is through the inhalation of
germ-laden dust particles has been challenged and met with an array
of facts and reason which may well receive serious consideration by
all those interested in the question of the relation of the milk supply
to the public health.
It has been clearly shown that the introduction of the bacillus into
any part of the body—blood vessels, intestines, abdominal cavity, or
even a part so remote as the tail of the cow—is generally followed by
thoracic tuberculosis, instead of necessarily tuberculosis at the point
of entrance or of nearby organs.
Again, when tuberculosis of the intestines is found, especially in
children, the bovine germ, which may be recognized, is frequently
found in these cases of human tuberculosis. Is this not more tban
passing strange if the bovine germ does not produce tuberculosis in
the human?
In short, recent investigations show plainly that not only is bovine
tuberculosis communicated to man, but that this is probably not so
uncommon as the comparative infrequency of abdominal tuberculosis
was thought to indicate.
To question the old inhalation theory of the entrance of the tubercle
germ from sputum, pulverized, is, I know full well, among the medical
men here, likely to lessen the respect which you will have for the
other statements I may make, but I cannot resist the temptation to
state that it never did have any scientific evidence worthy of con-sideration
to support it.
It is an old, well-known fact that drying and sunlight rapidly kill
tubercle bacilli. One hour of sunlight will kill tubercle bacilli in
transparent layers of sputum, while five hours exposure to sunlight
will kill the bacilli in thick opaque layers. Sputum is mixed with
mucous, is tenacious and hard to pulverize, unless thoroughly dried.
Yet we accept the statement that tubercle bacilli resist this drying and
pulverizing process to such an extent that this way, and this way
almost exclusively, is tuberculosis thought to be introduced into the
human system. The theory is not only not supported by facts, but is
BULLETIN N. C. BOARD OF HEALTH. 49
most unreasonable. Furthermore, if the tubercle germs enter by way
of the air cells, why is it that tuberculosis starts in the capillaries
instead of in the air cells? Why is it that tuberculosis starts in the
apex of the lung, where there is a smaller proportion of air cells than
in the base of the lungs?
Another discovery has recently been made, namely, that probably
before the tubercle bacilli are expelled from the body in any con-siderable
numbers through other channels, they may exist in large
numbers in the manure. Years ago, I remember reading in Novy's
"Laboratory Work in Bacteriology" that there was a bacillus fre-quently
found in cow manure that stained like the tubercle bacillus
—
very much like it, indeed, because it probably was the tubercle bacillus.
Now, the chief filth in milk is cow manure. That cowy odor is
usually plain, vulgar, filthy cow dung.
In the face of these facts, what is our position? We know that
tuberculosis exists in our dairy herds; we know that when tuber-culosis
exists in a herd, owing to the passage of the bacilli through
the udder, and through the intestines and manure, which almost
always contaminates the milk more or less, milk from such a herd is
almost certain to contain tubercle germs. We know that infants, the
largest consumers of milk, have intestinal tuberculosis more fre-quently
than adults, and that the bacillus causing this disease is fre-quently
of the bovine type. In short, we know that our neglect to
exclude tuberculous cows from our herds is causing the death of many
human beings, and yet we are doing nothing, literally nothing, to
prove ourselves worthy the title of guardians of the public health.
The tuberculin test is the only means of detecting tuberculosis be-fore
the products of the cow are likely to be infective, but we are not
forcing the dairymen of the State to do what is to their own financial
interest to do—test their cattle and exclude the tuberculous animals.
Tuberculosis is not over common in this State, except in the dairy
herds, and is not as prevalent there as in many States, but it will
steadily increase unless controlled. Moreover, if we admit its exist-ence
even, and the possibility of its communication to the consumer of
milk, we have no right to stand idly by and permit any human being
to take that chance, no matter how small the chance may be.
In my opinion, diseases of the udder and those conditions of milk
included under the general term "filthy" are the most fruitful source
of injurious effects upon the consumers of milk. All forms of garget,
mammitis or other diseases resulting in pus and other Inflammatory
products entering the milk are unquestionably the source of much of
the diarrhceal troubles of infants resulting from the consumption of
impure milk. Filth, manure from the cows and stables, which Is the
most abundant and common contaminating material of unclean milk,
has not. in my opinion, been given its full share of responsibility Cor
the high death rate from diarrhoea! diseases, so fatal to young chil-dren.
Especially is this so in North Carolina.
50 BULLETIN N. C. BOARD OF HEALTH.
In short, tuberculosis, diseased udders and filth are the three main
sources of danger to the consumers of milk in this State.
How are these conditions to be corrected? In the first place, clean
milk is worth more than dirty milk, and it costs more to produce it.
Are our people willing to pay for clean milk? I believe we are now
paying a price—eight to ten cents a quart—which entitles us to a
fairly good quality of milk. If this is not enough to enable the pro-ducers
to put clean milk on the market, then you, the guardians of
the public health, must educate the public up to the point where it will
pay for good milk.
In the second place, few of our dairymen know sufficient of dairy
science and practice to enable them, unassisted, to put clean milk on
the market. The general supply of milk can be improved, but for
many years yet cannot be brought up to the standard necessary for
the feeding of infants and sick people. Comparatively few men any-where
are able to put such a quality of milk on the market. What is
to be done?
First, start here to-day such a campaign for pure milk as will
arouse public opinion, stimulate dairymen to greater efforts, and result
in a competent milk inspection and supervision in every town of 3.000
population in the State. This can be done, and will improve the gen-eral
condition of the milk supply. In every town where the demand
will justify let a certified milk commission be established to encourage
some one or more men to produce and put upon the market a first-class
milk product. And. last, as a temporary and doubtful expedient,
if filthy milk must still be consumed by many, establish under munici-pal
control, where conditions render it practicable, a pasteurizing
plant, where all milk below a certain standard must be pasteurized
before being sold. Pasteurizing will not make unclean milk clean,
but it may lessen its injurious effects. If generally adopted, it is
likely to encourage filthy practices rather than correct them. It prob-ably
lessens the digestibility of the milk, and is only advisable as the
lesser of two evils. As between reasonably clean milk and pasteur-ized
milk, there is no question in my mind of the superiority of the
former, but if it is still necessary to put up with dirty milk, then by
all means pasteurize. The chief objection to it is that its use is likely
to prevent as great an effort to secure clean milk as would be made
were pasteurizing not practiced.
How is the general quality of the milk supply to be improved?
First, by a proper system of inspection. Three forms of knowledge
are requisite for competent milk inspection—first, a knowledge of
cows in health and disease—possessed by the veterinarian; second, a
knowledge of dairy science and practice, which should be possessed
by the so-called practical dairyman, but in our State rarely is ; third,
a knowledge of milk, bacteriologically. chemically and microscopically.
The milk inspection of a municipality may well be administered by
a milk commission ; but if so, it should be made up of men chosen for
BULLETIN N. C. BOARD OF HEALTH. 51
their knowledge of the work. For such a commission a physician, a
practical dairyman and a veterinarian are logically competent men.
Or the administrative part of the work may be left to the city health
officer ; but the success and efficiency of any system of milk inspection
depends on the efficiency of the inspector and the quality of the
laboratory work done.
First, there should be a frequent and thorough veterinary inspection
of the cattle. The inspector should also be a practical, scientific
dairyman who has had experience in dairying. If it is claimed that
such a man cannot be employed, then the milk inspection will fall
short of a full success just to the extent that the inspector falls short
of these requirements.
Our dairymen are not desirous of putting filthy milk on the market,
but they don't know. The inspector must be able to teach and lead,
rather than try to force rapid changes.
In most instances too much importance or reliance is placed on
laboratory examinations. These are essential, but they will not take
the place of frequent and competent inspections of the dairies and the
manner of handling the milk. Bacteriological examinations should be
made, for unquestionably a high bacterial content is indicative of a
high filth content. If there be a high bacterial content, then the
inspector must seek the cause and correct it. He must have accurate
dairy knowledge and practical experience to do this.
A microscopic examination may be made, for a high leucocyte and
streptococci content, with the presence of fibrin, indicates inflamma-tion
of the udder, but this is of most value when examinations are
made of the milk of individual cows.
In the city of Raleigh we have a so-called milk inspection, which is
practically nothing more than a bacteriological examination and pub-licity
of the results or findings. No competent inspector is employed,
no tuberculin test is made of the cattle, and a violation of the regula-tions
does not usually mean any sort of punishment ; but, with all this,
good has been accomplished. For instance, in 1900, after a complete
neglect of duty for three mouths, the commission was forced to make
a pretense of doing its duty by public criticism through the press, and
from March 27 to April 27, 1906, fifty samples, the first taken after
this period of neglect, gave twenty with a bacterial count of over
1,000,000 per cc. From March 27 to April . .. 1007, fifty samples gave
seven with a bacterial count of over 1,000,000 per cc. From March 26
to April 28, 1908, fifty samples gave eight with a count of over
1,000,000. In September. 1905, ten samples gave an average bacterial
count of 1,111,500 per cc. In September, 1906, ten samples gave an
average count of 840,000 per cc. In September, L907, ten samples gave
an average count of 104,000 per <•<•. In August, L906, twenty-three
samples gave an average count of 2,570,000. In August. L907, nine
samples gave an average count of S9< ),<)(»<> per cc.
52 BULLETIN N.. C. BOARD OF HEALTH.
An improvement, but what filth still exists ! Fancy, during the
months of March and April, milk from three to five hours old, in
which sixteen per cent, of the samples have from one to two million
bacteria to the cc.
!
A bacteriological examination of milk is of importance, but its chief
value is lost unless supplemented by and done in co-operation with an
intelligent dairy and cattle inspection. A high bacterial count means
either age or filth, and large numbers of liquefiers mean in all proba-bility
filth, and, where dairies are not of fairly good grade, dairy prac-tice
rather than age influences most the bacterial count.
We must keep in mind that a healthy cow gives a wholesome
product of fairly uniform quality. If the milk is put on the market in
bad condition or of greatly varying composition, it means bad dairy
practice. Very frequently I hear of this physician or that one who
insists that the cow shall receive no cotton-seed meal, or no silage, or
some other excellent food is tabooed. I have heard of this sort of
thing in our city of Raleigh, and yet our system of handling milk
makes it almost certain that the fat content of the milk from any one
dairy may vary from 2.5 to 8 per cent.
This has actually occurred, and is due to the fact that milk is sold
from a large can instead of being bottled at the dairy. The faucet
being at the bottom of the can, and the cream rising to the top, the
customers first served get the 2.5 per cent. milk, while the last get
milk containing 8 or 10 per cent, butter fat. No sort of feeding will
produce a change of over one-half of one per cent, in the butter fat
content. In fact, it is doubtful if any effect on the fat content can be
regularly and consistently produced by any sort of feeding ; therefore,
it will avail most to give more attention to the handling of the milk,
for it will certainly mean discomfort, if nothing more serious, to any
delicate infant to receive 2.5 per cent, milk to-day and 8 per cent, milk
to-morrow.
Good milk will not be put on the market until the dairyman is re-quired
to bottle it at the dairy, under proper sanitary and dairy con-ditions.
Some of the points that need attention in our North Carolina dairies
are:
1. Test all cows with tuberculin, and exclude the diseased ones.
The North Carolina State Department of Agriculture will do that
free of charge, on certain reasonable conditions.
2. Institute an intelligent inspection of the cows, and exclude all
those with any disease of the udder.
3. Prohibit the selling of milk except in bottles, and require that
the milk be kept below a certain temperature.
4. Prohibit feeding during or just before milking.
5. Compel dairymen to keep their cattle clean. Cows can be
cleaned, but milk cannot.
BULLETIN N. C. BOARD OF HEALTH. 53
6. Compel dairymen to wear clean clothes and wash their hands
before milking.
7. Wipe the udders off with a damp cloth and use a covered milk
pail.
These can only be brought about by an inspection capable of lead-ing
and teaching. We cannot have entirely clean milk at once, but
we might have cleaner milk with an intelligent effort.
As an illustration of how the cleanliness of milk is influenced by
dairy practice, as indicated by the bacterial count, I desire to presenl
the following charts, the data for which have been taken from bulle-tins
No. 42 and No. 48 of the Stores (Connecticut) Agricultural Ex-periment
Station.
It lias been stated as an excuse for the filthy milk which so many
of our dairymen are putting on the market that, from lack of knowl-edge,
capital or other facilities, they could not produce and put clean
milk on the market. These charts show that certain practices pro-duced
a wonderful improvement in the quality of the milk, as indi-cated
by the bacterial count, and yet all these things could be done by
our dairymen. They are all simple, practicable and inexpensive.
MILKED BEFORE FEEDING.
MILKED AFTER FEEDING.
Diagram showing relative bacterial content of milk drawn before
and after feeding hay and grain.
54 BULLETIN N. C. BOARD OP HEALTH.
MILKED
BULLETIN N. C. BOAL'D OF HEALTH. 55
UDDERS AND FLANKS WIPED.
UDDERS AND FLANKS NOT WIPED.
Diagram showing relative bacterial content of milk drawn immedi-ately
after the udders and flanks of the cows had been wiped with a
damp cloth, and when they were not wiped.
EDUCATED MILKER.
REGULAR MILKERS.
Diagram showing relative bacterial contenl of milk drawn by an
educated dairyman and that drawn by regular milkers.
56 BULLETIN N. C. BOARD OF HEALTH.
COVERED PAIL.
OPEN PAIL.
Diagram showing relative bacterial content of milk drawn into a
Stadtmueller covered pail and into an ordinary open pail, in a dairy
where extra care is given to cleanliness.
COVERED PAIL.
OPEN PAIL.
Diagram showing relative bacterial content of milk drawn into a
Stadtmueller covered pail and into an ordinary pail, in a dairy where
considerable care is given to cleanliness.
BULLETIN N. C. BOARD OF HEALTH. 57
COVERED PAIL.
OPEN PAIL.
Diagram showing relative bacterial content of milk drawn into a
Stadtinueller covered pail and into an ordinary pail, in a dairy where
little care is given to cleanliness.
In all of the experiments furnishing the data upon which these dia-grams
are based, more than ordinary care was taken to follow correct
dairy practices. In all experiments, except in the ones comparing
open and covered pails, the Stadtmueller covered pail was used, and
all other conditions except those being tested were as near alike in
all cases as it was possible to make them. In dairies where little
regard is paid to cleanliness the results would still more forcibly
demonstrate the effects which the methods of handling the milk has
on its cleanliness and the bacterial count.
REVIEW OF DISEASES FOR JUNE, 1908.
EIGHTY COUNTIES REPORTING.
Ninety-one 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 >»*'<- 1 1 reported
from the counties named :
58 BULLETIN N. C. BOARD OF HEALTH.
Measles.—Caswell, several cases ; Chatham, a few ; Cleveland, a
few ; Cumberland ; Davidson, several ; Davie, many ; Duplin, 25 ; Dur-ham,
a few ; Edgecombe, a few ; Forsyth, many ; Granville, 4 ; Guil-ford;
Harnett, 3; Lee, S; Lenoir, several; Lincoln, 6; Mecklenburg;
Randolph, a few ; Rutherford, 10 ; Transylvania, a few ; Warren, 1
;
Watauga, 4 ; Yadkin, a few—23 counties.
Whooping-cough.—Cabarrus, 17: Camden, 10; Carteret, several;
Chowan, a few ; Cleveland, a few ; Columbus, 2 ; Cumberland ; David-son,
several; Davie, many; Duplin, 40; Durham, a few; Edgecombe,
a few; Forsyth, a few; Franklin; Gaston, 1; Guilford, many; Har-nett.
5 ; Henderson, several ; Hertford, 3 ; Jackson, 45 ; Lee, 16 ; Le-noir,
many ; Lincoln, 8 ; Mecklenburg ; Onslow ; Randolph ; Rowan, 1
;
Sampson, a few; Scotland; Swain, 10; Vance, a few; Wake. 47:
Watauga. 15 ; Wilkes, 10—34 counties.
Scarlatina.—Camden, 2 ; Chatham, 1 ; Durham, a few ; Forsyth, 2 ;
Gaston, 3 ; Greene, 1 ; Guilford, many ; New Hanover, 2 ; Swain, 1
—
9 counties.
Diphtherl\.—Alamance, 1 ; Alexander, 1 ; Cabarrus, 4 ; Caldwell, 1
Durham, 5 or 6 ; Gates, 1 ; Lenoir, a few ; Nash, 1 ; New Hanover, 1
;
Onslow, 1 ; Rowan, 1 ; Watauga, 40 ; Wayne, 1—13 counties.
Typhoid Fever.—Alamance, several ; Alexander, 15 ; Ashe, 6 ; Beau-fort
; Bladen, a few ; Brunswick, 1 ; Burke, 20 ; Cabarrus, 8 ; Caldwell,
several: Catawba, 2; Chatham, 10; Chowan, 0; Cleveland, many;
Columbus. 8 : Craven, 5 ; Cumberland, a few ; Davidson, a few ; Davie,
a few ; D