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Library of
The University of North Carolina
COLLECTION OF
NORTH CAROLINIANA
ENDOWED BY
JOHN SPRUNT HILL
of the Class of 1889
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This book must not be
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Published b4 TfXLN°KJf\ CAR9LI^A STATE. B?ARD s>7\E<tt
This Bulletin will be -sent free to any citizen of the 5tateupor\ request j
Entered as second-class matter at Postoffice at Raleigh, N. C, under Act of July 16, 1894.
Published monthly at the office of the Secretary of the Board, Raleigh, N. C.
Vol. XXXVII JANUARY, 1922 No. 1
r^>f issued)
•-V
"^ c/ean toof/i never decays.'' Take care of the teeth of
the children, and when they grow up into manhood and woman-hood
such care will repay them a thousandfold. Neglect of
the teeth, on the other hand, means frequently serious impair-ment
of health.
MEMBERS OF THE NORTH CAROLINA STATE BOARD OF HEALTH
J. Howell Way, M.D., Pres._WaynesviIle Chaeles O'H. Laughxnghouse, M.D.,
Richard H. Lewis, M.D., L.L.D. -Raleigh Greenville
Chas. E. Waddell, C.E Asheville Cyrus Thompson, M.D Jacksonville
Thomas E. Anderson, M.D Statesville F. R. Harris, M.D Henderson
A. J. Crowell, M.D Charlotte E. J. Tucker, D.D.S Roxboro
. EXECUTIVE STAFF
W. S. Rankin, M.D., Secretary State Board of Health and State Health Officer.
Ronald B. "Wilson, Assistant to the Secretary.
C. A. Shore, M.D., Director State Laboratory of Hygiene.
L. B. McBrayer, M.D., Superintendent of the State Sanitorium for Treatment of
Tuberculosis and Chief of Bureau of Tuberculosis.
G. M. Cooper, M.D., Chief of Bureau of Medical Inspection of Schools.
K. E. Miller, M.D., Director of County Health Work.
Miss Rose M. Ehrenfeld, R.N., Chief of Bureau of Public Health Nursing and Infant
Hygiene.
H. E. Miller, C.E., Chief of Bureau of Engineering and Inspection.
F. M. Register, M.D., Deputy State Registrar of Vital Statistics.
J. S. Mitchener, M.D., Chief of Bureau of Epidemiology.
FREE HEALTH LITERATURE
The State Board of Health has available for distribution without
charge special literature on the following subjects. Ask for any that
you may be interested in.
Whooping-cough Clean-up Placards Smallpox
Hookworm Disease Don't Spit Placards Adenoids
Public Health Laws Sanitary Privies Measles
Tuberculosis Laws Water Supplies German Measles
Tuberculosis Eyes Typhoid Fever
Scarlet Fever Flies Diphtheria
Infantile Paralysis Colds Pellagra
Care of the Baby Teeth Constipation
Fly Placards Cancer Indigestion
Typhoid Placards Pre-natal Care Venereal Diseases
Tuberculosis Placards Malaria Catarrh
FOR EXPECTANT MOTHERS
Rose M. Ehrenfeld, R.N., director of the Bureau of Public Health
Nursing and Infant Hygiene, has prepared a series of monthly letters of
advice for expectant mothers. These letters have been approved by the
medical profession. They explain simply the care that should be taken
during pregnancy and confinement, and have proved most helpful to a
large number of women. If you want them for yourself or a friend send
name to the State Board of Health, and give approximate date of
expected confinement.
THE HEALTH BULLETIN
The Health Bulletin is sent monthly without charge to all persons in
the State who care to receive it. If you have friends or neighbors who
will be interested, suggest that they write the State Board of Health,
asking for The Bulletin each month. When you have finished with your
copy, give it to some one else, thereby increasing its usefulness.
Vol. XXXVII JANUARY, 1922 No. 1
RELATION OF STATE AND COUNTY IN PUBLIC
HEALTH WORK
By Dr. W. S. Rankin
GENERAL PRINCIPLES
The powers and duties of the state are constitutional; the powers and duties
of the county are all other functions of government not delegated to the state.
Just as an individual is averse to yielding supervision and direction to some
other individual or social group, so counties yield to the states the power of
supervision and direction over their local affairs with considerable reluctance;
moreover, let it be kept in mind that these larger supervisory powers of the
state over the county are grated by persons elected by the individual counties
and not by persons elected at large by the state. The counties control the
state and not the reverse; the county is the master and the state is the
servant.
FUNCTIONS OF THE STATE
The larger and more important functions of the state may be expressed under
two subdivisions: First the state should deal with those problems of general
interest which either in character or in cost of handling are such that the
individual counties cannot undertake. Among such problems may be listed:
(1) fixing and equalizing taxes; (2) operating the courts; (3) maintaining
and supervising a system of popular education; (4) protecting and develop-ing
the natural resources of the state, such as agriculture, forestry, water
power, and manufacturing; (5) building and maintaining a state system of
highways; (6) caring for the defective and the delinquent; and (7) preserving
and promoting the public health. Second, the state should discover, formulate,
advocate and secure the adoption of standard methods of efficient administra-tive
procedure. This purpose results from the opportunity which the central
agency of government has, through its general point of view and through its
extensive knowledge of various methods of procedure in operation in the
different counties, to differentiate efficient from inefficient methods. In this
way the state becomes a clearing house of information for the counties in
improving their local administration. So it is that the state acquires a
leadership which, properly developed, should constitute one of its larger pur-poses.
4 The Health Bulletin
LIMITATIONS OF THE STATE
The state has no powers except those delegated to it by the counties through
their representatives. The counties have reserved for themselves the right
of administering their internal affairs, among which may be enumerated: (1)
maintaining the county roads which do not form a part of the system of
state highways; (2) caring for the poor; (3) maintaining law and order
through officers for the arrest and detention of disturbers of the peace; (4)
imposing special taxes and collecting the general taxes; (5) supervising the
schools; (6) conducting elections; and (7) improving local health conditions.
RELATION OF STATE TO COUNTY
Of course there are many functions of government which are strictly state
functions and others which are strictly county functions, and, in discussing
the relation of state and county, we may leave out of consideration these
activities for which administrative responsibility is single and not dual. On
the other hand it is obvious that the state and counties have many mutual
interests and that there are numerous and closely related, overlapping re-sponsibilities.
In dealing with these matters of mutual interest it is im-portant,
for the sake of harmony and efficiency, that definitely understood and
mutually satisfactory working relations be established. There are two main
principles upon which such satisfactory relations may be developed.
The first principle is that of the segregation of responsibilities and activities,
as for example: In the levying of taxes it is possible, and it is the practice
in many states, to separate the sources of revenue from which the state is
to derive funds from those sources of revenue from which the county is to
derive its funds; in the building of roads it is possible, and in many states a
practice, for the state to build the highways that are more generally used
and for the county to build and maintain the highways of less general use,
that are constructed more for local purposes.
The second principle for satisfactorily relating state and county activities
consists in the establishment by the state of standard practices of adminis-trative
procedure, and the development of such standard practices by official
machinery or personnel elected and controlled by the county and maintained
jointly by local and state funds. Standards of work created by the state should,
wherever possible, relate to definite objects to be obtained rather than to
budgets to be expended, personnel to be employed, or methods of procedure
to be followed. In short, standards should be directed to results; not to
methods.
RELATION OF STATE AND COUNTY IN PUBLIC HEALTH WORK
State Activities
The state, that is, the federation of counties, is rightly held responsible by
all other states and counties for the condition of its death rats. In discharging
this responsibility, two main avenues of service lie open:
First, the state should assume those public health activities that can be
carried on, practically speaking, only on a state-wide scale and through state
administative machinery. Without entering into a discussion of the more
important state-wide public health activities they may be classified and listed
as follows:
A. Activities of common interest to all the counties and impracticable of
county handling, such as:
The Health Bulletin 5
1. State supervision over communicable diseases, for the reason that infec-tion
and contagion do not respect county boundaries;
2. The registration of births and deaths according to a standard system,
for the reason that birth rates and death rates as between counties
to have comparative value must be established by uniform practices; and
3. The protection of the purity of streams from which public water supplies
are taken, for the reason that many streams flow through several
counties before reaching the one or the ones whose citizens make use
of such for domestic purposes.
B. Activities which for economic reasons, for rendering unnecessary dupli-cation
and multiplication of officials, machinery, and equipment, belong properly
to the state, such as:
1. The preparation and publication of educational bulletins pamphlets, and
leaflets needed in public health administration, for the reason that the
additional expense necessary for each county to prepare and publish
such material would be alike unncessary and extravagant; and
2. Maintenance of common laboratory facilities by the state for the same
reason as that for maintaining central common equipment for the
preparation of educational equipment.
C. Activities concerned with disease factors of such exceptional importance
that the state cannot neglect them at the same time carry the responsibility
for a state-wide reduction in death rates, such as:
1. A state policy for dealing with tuberculosis;
2. A state policy for dealing with venereal diseases;
3. A state policy for dealing with the factors of infant mortality; «<nd
4. A state policy for dealing with the common physical defects of school
children.
Second, the state in discharging its responsibility for the death' rate should
make use of its central position and its federated authority to tactfully, pro-gressively,
and persistently lead (not drive) the counties to a clearer recog-nition
of their opportunities and responsibilities for local health conditions.
County Activities
The county can be made to understand that, after the state has gone its
full length in dealing with public health conditions by general measures, the
county may do much more in a local and more intense manner for the
preservation and promotion of its own health conditions—just as the intelli-gent
individual, after both state and county have done all in their power to
protect his health, may still do much more for himself than both governments
combined. The county should feel the same interest in its death rate and the
same responsibility for maintaining a death rate that compares favorably with
that of other counties that the state feels in maintaining a favorable compara-tive
state rate.
MUTUAL HEALTH INTEREST OF STATE AND COUNTY
A reduction in the death rate of a county is an object of mutual interest
to both state and county governments. On the one hand, the greater the
activities of the county in the reduction of its local death rate the more pro-nounced
will be the reduction of the general death rate of the state; on the
other hand, the more efficient the state-wide general measures for improving
health conditions, the less the danger of diseases invading a particular county
from other counties. It is clear then, that a state reduction in death rates
6 The Health Bulletin
is achieved through a reduction of local county rates and a reduction by
counties is reflected in a lower state rate. The interest of state and county in
local health conditions is mutual.
Those who recognize local health work as a matter of mutual interest to
both central and local governments will concede the right of the state to use
every means to encourage county activity. They will go further. They will
take the position that a matter of mutual interest should be developed,
dealth with and financed if necessary by both agencies concerned. County
health work, then, is a problem calling for the cooperative relation of state
and county.
As pointed out in the general discussion of the relation of state and
county, it is always best, where possible, for the fields of activity of two
governments to be clearly defined. This means, when the nature of the
work permits, a separation of activities. In local health work, however, the
nature of the work is such as not to permit of the principle of separate or
segregated duties, and, as likewise pointed out, in such cases it falls to the
lot of the central government to develop standard plans to assist and en-courage,
not direct, the local governments in their execution.
COOPERATION STATE AND COUNTY IN
HEALTH WORK
THE OLD PLAN
Cooperation Based on Prospective Service
The State Board of Health, in their meeting held recently in Raleigh,
adopted resolutions which make an important change in the relation between
the State Board of Health and county health departments. This change is
designed to more adequately insure the wise expenditure of funds by both
the State and counties in public health work which is of mutual interest to
both State and county and which is carried on largely through county officers.
This change is also designed to develop a larger degree of local interest, re-sponsibility,
and control in public health matters. The alteration in policy
represents the product of some ten years' experience on the part of the Board
in dealing with local health problems, and the Board feels that in this new
policy it has completed the foundation for efficient local health service.
This new relation of State to county in public health work is believed to be
of such a character and importance that the public will find the following
statement by Dr. W. S. Rankin, Secretary of the State Board of Health,
interesting reading:
Until within recent months the State Board of Health and county authorities
of twenty-two counties have attempted to deal with their local public health
problems on budgets representing the pooled financial interests of the counties,
the State, and certain allied agencies, namely, the International Health
Board, the American Red Cross, and the United States Public Health Service.
There have been two general principles of understanding which controlled the
expenditure of these budgets. The first principle was that each financial
participant should have the right to approve the personnel employed. The
The Health Bulletin 7
second principle was that the plan of work to be followed should be definitely
stated in writing and likewise receive the approval of each of the financial
participants.
Under the above plan it was the priviledge of any one of the interested
agencies, state, county, or allied agency, to nominate the personnel or to
propose the plan. In a few instances the counties have nominated their
personnel and in every such instance the other participants have approved. In
most instances, however, the county authorities have asked the state to find
and propose the personnel to be employed, not being able themselves to
find satisfactory officials for the available salary. The local authorities have
had the right to suggest their own plan of work, but in practically all instances
the State has been asked to prepare and submit the plan to be followed, and,
except in a very few cases, the plan submitted by the State has been adopted
without amendments.
Disadvantages of Old Plan
The plan of work followed until within recent months appears on its face to
be, and, as a matter of fact, is, both reasonable and fairly satisfactory to all
parties concerned. However, nothing is permanently satisfactory that can be
improved. There are several disadvantages in the former plan of work which,
if possible, are to be avoided.
The first disadvantage of the former plan of work was that, as a rule,
where the local work was a failure the county authorities were in a position
to take advantage of the responsibility assumed by the State in having
either approved or, as is usually the case, recommended personnel and plan.
Local criticism was answered by the statement that the county authorities fol-lowed
the advice of the State Board of Health. In short, the old plan
of work, where the State exercised the right of approval of the personnel
and plan, placed the Board of Health in the position of having to accept, or
at least having placed upon it, responsibility for most of the failures.
The second disadvantage of the former plan of cooperation with the county
•was that the subsidy by the State was conditioned very largely upon the
establishment of a budget, the creation of an office, and the employment of
officers who might or might not carry the mutually agreed upon plan of work
into satisfactory execution. The expenditure by the State was based upon
office holding over a definite period of time. The State paid for time and not
necessarily for service.
The third disadvantage was that the work, being of a scientific and tech-nical
character, could not be appraised by the average intelligent citizen,
so that it was difficult for those who paid the health officer to know whether
cr not he was rendering adequate service. Some simpler, more easily under-stood
index of efficiency than that embodied in the old plan was most desir-able
in order that health officials might be made more responsive to those
who can employ them. Some common denominator of service, some expression
cf value that is intelligent to the average man was needed.
The State Board of Health has, for some time, recognized these disad-vantages
of their former plan of state and county cooperation, and has been
keenly sensitive to the strong sentiment in North Carolina for the very
highest possible degree of local government with a minimum of state super-vision
and direction. For two years the Board has been at work on a few
principles of cooperation that: (1) will permit the state to leave entirely to
the counties the determination of both personnel and plan and at the same
time protect the State from a wasteful expenditure of funds; and (2) will
8 The Health Bulletin
necessitate the assumption by the local authorities of larger and more defin-itely
fixed responsibilities for the management of their local health problems.
THE NEW PLAN
Cooperation Based on Completed Service
There is an old saying to the effect that there are two bad ways in which
to pay a debt; one not to pay it; the other to pay it in advance. As a rule
the public pays in advance, pays not for service rendered but for service in
prospect. Public officers are employed to do certain things. Some do the
things for which they are employed and others fail to perform their pros-pective
duties.
The old plan of state and county cooperation in health work, like prac-tically
all public service, involved payment in advance of service, that is,
an appropriation conditioned on the employment of personnel and the approval
of a plan of work which might or might not be carried into effect. The
new plan makes the state appropriation for county health work conditioned
not on service to be rendered but on service that has been rendered. To do
this it is necessary: (a) to analyze carefully the work of county health de-partments
and to break down the general work of these departments into
separate, individual, constituent pieces, and (b) to find a figure representing
the reasonable cost for the performance of each item.
Values Difficult But Costs Easily Determined
Note carefully that the effort is not to determine the value of an item of
work, but to find a reasonable cost for having it done. Cost and value are
terms with very different meanings. Values are difficult to determine, but
costs, relatively speaking, are easily determined. To illustrate: It is very
difficult to determine the value of vaccinating persons against typhoid fever.
Such a determination would involve considerations of (a) the earning capacity
of the average person vaccinated, (b) the relative expectancy of the average
person vaccinated as against the average unvaccinated person—very difficult
factors to estimate. On the other hand, to determine the cost of vaccination
it is only necessary to know the sum of money expended for vaccinating a
large number of people. If, in a certain county, five thousand persons are
vaccinated in a campaign, the total cost of which is two thousand dollars,
the cost of each vaccination is 200,000 cents * 5,000 persons = 40c each.
If this experience is found to hold for such work generally, then it may be
accepted that the average cost for vaccinating against typhoid fever is ap-proximately
forty cents. But suppose we have no such basis of experience on
which to determine the average cost of a certain item of health work. How
then shall we proceed in determining costs ? In such a case we have to
resort (a) to estimating the time of the officer consumed in the doing of the
item, and (b) in determining from the salary paid the official the value of
his time which is usually required in the performance of the item. To illustrate:
A health officer receives $3,600 a year as a salary. He works 10 hours a day
or 60 hours a week, which is 3120 hours a year. By dividing his total salary
by the total number of hours which he gives to public service (360,000 cents
-T-- 3,120 hours = 1.15 dollars) we find that the officer receives about $1.15 per
hour. Now, suppose we find further that a particular item of work, the cost
equivalent of which we are trying to determine, requires as a rule about an
hour or an hour and a quarter. This would mean that the item would be
assigned a cost figure of $1.25 or $1.50. The presumption that the official
The Health Bulletin 9
will sacrifice quality of work for quantity of work would be reasonable if it
were not possible to carefully define in official regulations, the scope and de-tail
involved in each item and to check the officer's record both as to quantity
and specifications.
PIECE WORK PRINCIPLE APPLIED TO HEALTH WORK
The application of the piece work principle to the work of county health
departments is possible when three conditions are fullfilled: (1) a list of
established items of local health work; (2) cost figures determined for each
item; and (3) a system of records and reports by the local officer provided
which will show the number of each item performed for a given period of time.
With these conditions complied with, the cost value of a local health officer's
work may be arrived at by simply adding his total cost credits. In dividing
his total cost credits by his total expenditures (as illustrated in three following
paragraphs) for the value of the work performed with the dollar expended
is determined.
THE TEST OF EFFICIENCY
By reducing the work of a number of health officers to this common denom-inator,
the earning on the dollar expended, we may recognize the relative
efficiency of the various officers whose work is considered.
This principle of comparison operates regardless of variations in the size
of budgets. For example: If a health officer expends $500 in doing a month's
work and performs $625 worth of work, measured in terms of cost, his earn-ing
is $1.25 on the dollar expended. Again, if a health officer expends $5,000
during a month and performs $6,250 worth of work, his earning on the dollar
is the same, that is, $1.25. The principle operates regardless of variations
in the sum of expenditures for given periods of time.
And again, the principle of comparison operates regardless of the character
of the work performed by different health officers. For example: One health
officer may spend his whole time in dealing with items of work which are
concerned with the problem of tuberculosis, venereal diseases and contagious
diseases; another health officer may spend his entire time on items of work
concerned with the problems of malaria, infant hygiene, and contagious
diseases, and yet, the work of both of these health officers may be measured in
terms of cost credits and the work of each reduced to the amount earned on
the dollar expended. There is, in the cost equivalent principle, as applied to
health work, a basis for comparing the efficiency of health officers, a basis
for promoting or demoting according to the merits of the individual officer,
and a principle which operates regardless of variations in budget or of varia-tions
in the character of work performed.
INFLATED OR DEFLATED VALUES MAKE LITTLE DIFFERENCE
Another matter that it is well enough to call attention to in passing is that
the standard by which the work of any particular health officer is measured
under this scheme, is not the $1 that he earns on the $1 expended, but it is
the average earning upon the $1 expended by a number of health officers.
For example: Twenty health officers during the month of X averaged an
earning of $1.38 on the $1 expended. Health officer Y in the county of Z
earned $1.56 on the $1 expended. In forming an opinion as to the efficiency
of health officer Y, we compare his earning of $1.56 on the $1 expended, not
with the $1, but with the $1.38 which was the average earning of the twenty
health officers for the month under consideration. Now, keeping in mind the
10 The Health Bulletin
fact that the standard of comparison is the average earning capacity on the
dollar, it is apparent that it makes little difference in the application of the
principle whether our system of cost equivalents represent an inflated or
a deflated currency. For example: If we double the cost equivalents
for the various items, the comparisons of amount earned on the $1 expended,
that is, the relative figures, remain unchanged. Suppose we double the cost
equivalents in the illustration given above. Then the average earning capacity
of the twenty health officers referred to would be $1.38 x 2 = $2.76, and the
earning of health officer Y of the county of Z would be $1.56 x 2 = $3.12. It
is, therefore, clear that so far as estimating the value of the work of any
particular health officer is concerned, it is not important whether the cost
figures assigned to the various items are a little too high or a little too low.
It would make little difference in our commercial relations whether the yard
stick is thirty-six inches or forty inches, or a pound fourteen ounces or eigh-teen
ounces provided everybody bought and sold by the same yard stick and
by the same pound. The important thing is the standard.
The first value, then, of the piece work basis, applied to public health ad-ministration,
is that it affords a means of satisfactorily estimating the relative
efficiency of health officers; it gives the voter some way of checking up an
official whose work is of such a character, so highly scientific and technical,
as not to be susceptible of satisfactory appraisement by the average man.
STATE ASSISTANCE BASED ON SERVICE NOT OFFICE HOLDING
Then, there is this second, and, from the standpoint of state administration,
this even greater advantage to be derived from this principle of piece work
applied to local health problems: The State can condition its appropriation
for county health work upon the county health department's earning a dollar
on every dollar expended. The State can pay over to the county the whole
amount of the allotment for it, but in case the local administration fails to
earn $1 for each $1 expended, the State may correspondingly reduce the
potential state appropriation for that particular county. For example: A
county health department has an annual budget of $6,000. The State Board
of Health conditionally participates in that budget to the extent of $2,400.
This health department should earn, therefore, Vn of $6,000 each month.
That is to say, measured in terms of costs, the health department should do
$500 worth of work each month. When this is accomplished the State should
send its check for 500/6000 or M2 of its conditional appropriation of $2,400
to the county, that is, $200. If, on the other hand, the amount of work per-formed
by the county health department for one month amounted to only
$400 then the State should send its check for 400/6000 or #5 of its conditional
appropriation, that is, a check for $160 to the county. In short, in the pro-portion
that the local health department fails to earn a dollar's worth of
work for every dollar expended so does it lose its subsidy from the State.
With the State's assistance conditioned upon service rendered and not upon
the creation of office, the election of officers, and the adoption of plans of
work, the State is in a position to entirely relieve the county authorities of
the necessity of securing the State's approval of their personnel or plan. The
county may elect whoever it please and adopt any sort of a plan that suits it.
The State cannot lose its money through the election of inefficient personnel
or the adoption of an unwise plan for the State bases its appropriation to the
county on services rendered, and not on services to be rendered. In propor-tion
as the county fails to render service, in exactly like proportion does the
county fail to receive its subsidy.
The Health Bulletin 11
WHY THERE ARE NO EDUCATIONAL ITEMS AND VALUES
There are no cost credits allowed the health officer or nurses for approach-ing
an individual on the street or elsewhere and suggesting to him that he
bring his family to the dispensary and have them vaccinated; or for talking
to him ten minutes on the subject of vaccination in order to so impress him
that he and his family are subsequently vaccinated; or for writing him on the
subject of vaccination which results later in his being vaccinated; or for talk-ing
to a hundred individuals on the subject of vaccination and persuading a
number to be vaccinated; or for writing to several thousand individuals through
a newspaper column on the subject of vaccination, but the health officer's pay
for all the educational work which he does with the individual, or with the
group, or with the mass by explanation, demonstration, conversation, lecture,
placard, handbill, newspaper, etc., is the credit allowed him on the EFFECT
of his educational effort. If his educational efforts are worth anything, peoule
are vaccinated, parents have their children's adenoids and tonsils removed,
people report contagious diseases, people go to the venereal disease dispensary,
people make it possible for him to do all of the items of health work for which
he is credited. And, if on the other hand, his educational work is relatively
worthless, the items of work performed fall off correspondingly. Education
is a means and not an end in itself and, in bringing about the ends, items
of health work rendered, the educational effort is rewarded in proportion to
its efficiency.
EQUIPPING A CLINIC WITHOUT COST
By Millard Knowlton, M.D., C.P.H.
Regional Consultant, United States Public Health Service
Formerly Director Bureau of Venereal Diseases,
North Carolina State Board of Health.
Difficulty in raising several hundred dollars for equipping a clinic need not
cause delay in cleaning up a community of syphilis by the treatment of in-fected
patients. This observation is based on a visit to a clinic in Oxford, N. C,
on July 22, 1921, where I saw neo-arsphenamine administered to twenty-three
patients with equipment that cost $24.04. After all everything depends upon
the personal equation, and the powers behind the Oxford clinic are Dr. J. A.
Morris, Health Officer, and Mr. J. R. Jackson, Superintendent of Public
iWelfare.
Oxford is a town of about 3600 population and is the county seat of Gran-ville
County which has a total population of about 26,000, approximately half
white and half colored. It happens that Dr. Morris and Mr. Jackson share the
same office space in the little courthouse at Oxford and this gives them an
opportunity to discuss matters of common interest to the Health and Welfare
Departments.
The presence of venereal disease was so frequently noted among cases
coming to the attention of the Welfare Officer that he found the welfare
interests of the community coincide with the health interests of the community
in demanding measures for combating these diseases. As the Health Officer
has always realized the importance of such work, it was but natural that the
12 The Health Bulletin
combination of Health Officer and Welfare Officer working together, both of
whom appreciate the damage wrought by venereal diseases and the necessity
for combating them, should result in some concrete effort directed to that end.
Syphilis was attacked first as that appeared to be the easiest way to get
started.
The way the combination works is that the Welfare Officer gets the cases
and the Health Officer treats them. For this purpose the combination office
occupied by the two men is converted into a treatment room every Friday
afternoon while the wide corridor of the courthouse outside the office door is
used as a waiting room. A six foot office table with a chair cushion for a
pillow is covered with a cloth and used as a treatment table. A small table
is cleared of papers and covered with sterile towels upon which the meagre
but sufficient supply of instruments and materials are spread. In connection
with the use of typhiod vaccine and other public health activities the Health
Officer had need for alcohol, tincture of iodine, carbolic acid, a hand wash
basin, towels and a sterilizer consisting of a pan of water over an electric
beater.
With this equipment already available and utilizing a pair of dressing for-ceps
left over from medical practice days, a few pint bottles for distilled
water, a druggist's graduate for dissolving the drug, and a piece of rubber
tubing for a tourniquet, the additional equipment actually purchased for
administering neo-arsphenamine was very limited. The items are as follows:
One copper still with alcohol heater and with top section adapted for
sterilizer ., $19.75
One gravity arsphenamine outfit with needle, including parcel post
charges 4.29
Total $24.04
It is with this equipment that neo-arsphenamine was administered to twenty-three
patients on July 22. On former clinic days the neo-arsphenamine had
been administered with a Luer syringe. On the 22d, the new gravity outfit
was used for the first time. The twenty-three patients were treated in a
little over three hours or at the approximate rate of seven patients per hour.
The twenty-three patients treated were all negroes of whom five came
from the country and eighteen from the city of Oxford. All the patients
were men. It will be noted that the eighteen negro men residing in Oxford
who were treated represent approximately one per cent of the negro popula-tion
of that city. Assuming an equal distribution of the sexes this would
be two per cent of the males or a still higher percentage of the males belonging
to the same age group.
Upon inquiring as to the difficulties encountered in getting these men to
come for treatment I was told that very little difficulty was experienced in
this direction. On the other hand it was necessary to turn down a number
of men who applied for treatment and who upon examination did not present
evidence warranting a diagnosis of syphilis. The reason for this is that the
men taking treatment would tell their friends how much better the treatment
made them feel and their friends would apply for shots of "606" whether they
had syphilis or not. From this situation one may conjure up the picture of
a syphilis clinic in a small town putting up bars to keep patients away from
the treatment table until an examination can be made to determine whether
or not treatment is needed.
The next step in equipping this clinic which has just begun its work will
be the purchase of a syringe for mercury. With this additional outlay the
The Health Bulletin 13
total cost of equipment will still not exceed $30.00. Since physicians charge
as high as $25 and even $50 per dose for administering arsphenamine it does
not appear that $30 for equipment is a very large outlay. Incidentally the
twenty-three treatments given on the one day I visited the clinic, if charged
for at $25 per treatment, would have cost the patients $575 had they been
able to pay for this service.
The main point in the whole matter is that the provision of treatment
for indigent syphilitics need not depend upon the outlay of large sums for
equipment. After all the personal equation is by far the largest factor in
the situation. If two or three men willing to work will go about the matter
in a commonsense sort of way there is no reason why adequate treatment
should not be given to all indigent syphilitics in any town. The main factor
of cost is the cost of arsphenamine or neo-arsphenamine, and this drug is
furnished by the state.
This clinic at Oxford is a good illustration of the old proverb, "Where
there's a will there's a way." The people would profit if officials and medical
men of other counties would read this story and then follow the injunction,
"Go thou and do likewise."
HOME CARE FOR TUBERCULOSIS
By A. W. Snow
While waiting for the completion
of the negro division of the Sana-torium
for the Treatment of Tuber-culosis,
which was appropriated for
by the last General Assembly, quite
a few colored tuberculous patients
are building make-shifts and perma-nent
sleeping porches for home
treatment.
Sleeping porch No. 1 is occupied
by four patients who were diagnosed
as tuberculous at the clinic held in
Edgecombe County by the North
Carolina Tuberculosis Association.
The County Public Health Nurse,
Miss Clara Ross, is due credit for
bringing these people to the clinic
and securing examination. After
they were diagnosed as actively tu-berculous,
she was enabled to secure
the erection of these sleeping
porches and to see that methods were
employed to prevent others becoming
infected and aid them in taking
treatment at home.
Sleeping porch No. 2 is not much
to be proud of as an architectural
structure but it is far better than
allowing the patient to sleep in the
kitchen, as was done before the
nurse arrived on the scene. This is
a two-room house occupied by eight
persons, one of whom has active
tuberculosis. It has been our experi-ence
that an active case of tubercu-losis,
living in such conditions as this
will infect four out of five of the
other members of the family unless
proper precautions are taken.
The first care of the nurse was,
therefore, to see that the patient's
sleeping quarters were removed from
the other members of the family. She
merely instructed them to "get some
boards and build a shack for the
sick girl," and they followed instruc-tions
as far as material for building
permitted.
Sputum cups for making safe dis-posal
of the sputum are being fur-nished
these patients and every ef-fort
is made to teach them the pre-cautions
necessary to prevent others
becoming infected.
Fresh air and sunshine is Nature's
remedy for tuberculosis; this
coupled with proper nourishment
and rest under the direction of a
competent physician will mean re-stored
health if diagnosis is made
and treatment begun before the
disease is so far advanced as to be
incurable.
Sleeping porches are of prime im-portance
in the treatment of tuber-culosis.
They are good for the tuber-culous
patient because they aid in
the fight back to health and they are
good for you because they might
mean the difference between health
and sickness.
14 The Health Bulletin
i1
' ' .
"
..
' '
,
'
;
EDGECOMBE SLEEPING PORCH
Sleeping porch occupied by four people—father, mother and two children—three of whom
were diagnosed as having tuberculosis. County nurse was instrumental in having examinations
made but not in planning porch, which was built for nine-year-old before four-year-old and
mother were diagnosed at State clinic.
ANOTHER SLEEPING PORCH
In Edgecombe County, sleeping porch built as an addition to two-room house already
housing six when a tuberculous woman and her child were added to the family. Nurse found
patient sleeping in kitchen. Three days later she occupied this porch.
The Health Bulletin 15
THE GATEWAY TO HEALTH
By C. J. Johnson, D.D.S.
Good habits are best established in
early life, and this law may be ap-plied
beneficially in care of the child's
teeth. The child is the foundation
upon which a nation is built. The
progress of nations depends on the
health standard of the child. We
can't expect as much of the future
men and women of this age of defects
if we ignore the developing age. The
great call to-day is for strong men
and women. Defects should be sought,
and means to remedy, studied. They
should be strong and healthy in body
during the developing age to make
strong men and women mentally,
morally. I believe one of the hardest
problems confronting education to-day
is the backward child. There
is generally some cause for backward-ness
in the work of the school child,
and I believe the larger per cent is
from broken down decayed and per-manent
teeth of which home con-ditions
and habits play a big part.
We find a great number physical
wrecks, and we so often hear it said
they will outgrow their trouble. Ir.
some cases we do see a marked im-provement
in the child after they
have started to grow, but what the
child might have been if they had
not had the several years of stand-still?
It stands to reason that a
child during its developing age should
have nothing to retard its progress in
grasping things to cultivate, and
make a full grown developed brain.
Can that be done from a weakened,
poisoned body? I have asked teachers
in different schools about some child
I happened to notice far below the
standard physically, and they would
invariably tell me the child wasn't
making any progress, and was a re-peater
every year. Upon examination
of his teeth 95 per cent would be de-fective.
In some of these cases there
is lack of encouragement, and in great
many lack of proper knowledge of oral
hygiene which so many teachers so
woefully neglect in teaching. It is
very clear we can't do too much for
children with defects of which our
country's success depends on future
generations to make it foremost of
all others. The most important of
all is before school age is reached.
To be successful in school the child
should enter strong in body, mind and
spirit. The proper foundation is the
keystone to success, and children
failing to get it in the early stages
of school life are handicapped through-out
life's journey. School teachers
should learn more the importance ot
giving instructions in oral hygiene,
and advising children of having their
teeth attended to by competent den-tists.
Lack of this will cause a great
many sub-normal children, which not
only causes more work for the teacher
but holds others back in their pro-gress,
which causes loss of interest
and fail to get all they need in equip-ment
for life's work. And I believe
a majority of these sub-normal cases
could be made normal if taken in
time even before they begin school.
We have thousands in our State
who have reached their teens as well
as maturity who never have owned
a tooth brush nor have ever been in-side
a dentist's office. What more
can we expect of men and women
broken down physically and mentally
before they reach the prime of life?
The mouth is the gateway to health,
and if we fail to start in time to keep
it in the best possible healthy condi-tion
we can expect nothing else. So
it behooves the parents, health de-partments,
and teachers of the va-rious
schools to teach and train
the children the importance of oral
hygiene that they may grow up
strong physically and mentally; that
they may have children they can
teach to observe the laws of "Health
and Hygiene," and make them fit sub-jects
to perform the duties as strong
men and women that will reflect
credit on their parents, schools and
State.
16 The Health Bulletin
CLEAN UP
!
Cleanliness Is Nexl To Godliness
Does your
Back Yard
look
like
this?
Open-top
Wells
admit.
Filth and
Drainage.
Use a Pump
withcementtop
and have all
drainage away
fiomyourwelL
Is
your Privy
a
Disease
Spreader?
Is it Fly-tight,
placed
1
cVer^aPit &
lOOyards
fromyourweD?
srf-
,vL
Doesyour
Kitchen
look
like
this?
—Or
is it
Screened
Clean 8-
Convenient?
Dirty.
Dusty,
living Rooms
cause
PoorHeaJth
Keep
the House
Clean
Screened &
Comfortable.
Do you
buy
Food
from stores
like this?
Or
doyou
buy
only
Clean rood?
[
KEEP CLEAN
Stale Board of Health . Raleigh, N.C.
Published b4 T/^7*°R,m CftR?LIrtA 5TATL5?ARD<^AE^LTA
This £)u]klir\ will be ser\t free to ar\\j citizen of the 5tcrteupoa request!
Entered as second-class matter at Postoffice at Raleigh, N. C, under Act of July 16, 189J,
Published monthly at the office of the Secretary of the Board, Raleigh, N. C.
Vol. XXXVII FEBRUARY, 1922 No. 2
MEMBERS OF THE NORTH CAROLINA STATE BOARD OF HEALTH
J. Howell Way, M.D., Pres. . Waynesville
Richard H. Lewis, M.D., LL.D. Raleigh
Chas. E. Waddell, C.E. . . . Asheville
Thomas E. Anderson, M.D. Statesville
A. J. Crowell, M.D Charlotte
Charles O'H. Lauohinghouse, M.D.,
Greenville
Cyrus Thompson, M.D. . . Jacksonville
F. R. Harris, M.D Henderson
E. J. Tucker. D.D.S Roxboro
EXECUTIVE STAFF
W. S. Rankin, M.D., Secretary State Board of Health and State Health Officer
Ronald B. Wilson, Assistant to the Secretary.
C. A. Shore, M.D., Director State Laboratory of Hygiene.
L. B. McBrayer, M.D., Superintendent of the State Sanatorium for Treatment ol
Tuberculosis and Chief of Bureau of Tuberculosis.
G. M. Cooper, M.D., Chief of Bureau of Medical Inspection of Schools.
K. E. Miller, M.D., Director of County Health Work.
Miss Rose M. Ehrenfeld, R.N., Chief of Bureau of Public Health Nursing and Infant
Hygiene.
H. E. Miller, C.E., Chief of Bureau of Engineering and Inspection
F. M. Register, M.D., Deputy State Registrar of Vital Statistics
J. S. Mitchener. M.D., Chief of Bureau of Epidemiology.
FREE HEALTH LITERATURE
The State Board of Health has available for distribution without
charge special literature on the following subjects. Ask for any that
you may be interested in.
Whooping-cough
Hookworm Disease
Public Health Laws
Tuberculosis Laws
Tuberculosis
Scarlet Fever
Infantile Paralysis
Care of the Baby
Fly Placards
Typhoid Placards
Tuberculosis Placards
Clean-up Placards
Don't Spit Placards
Sanitary Privies
Water Supplies
Eyes
Flies
Colds
Teeth
Cancer
Pre-natal Carb
Malaria
Smallpox
Adenoids
Measles
German Measlus
Typhoid Fever
Diphtheria
Pellagra
Constipation
Indigestion
Venereal Diseases
Catarrh
FOR EXPECTANT MOTHERS
Rose M. Ehrenfeld, R.N., director of the Bureau of Public Health
Nursing and Infant Hygiene, has prepared a series of monthly letters of
advice for expectant mothers. These letters have been approved by the
medical profession. They explain simply the care that should be taken
during pregnancy and confinement, and have proved most helpful to a
large number of women. If you want them for yourself or a friend send
name to the State Board of Health, and give approximate date of
expected confinement.
THE HEALTH BULLETIN
The Health Bulletin is sent monthly without charge to all persons In
the State who care to receive it. If you have friends or neighbors who
will be interested, suggest that they write the State Board of Health,
asking for The Bulletin each month. When you have finished with your
copy, give it to some one else, thereby increasing its usefulness.
Inteair mm
PUBLI5AE1D BY THE. riPRTM CAROLINA 5TATC. B°Al?D s^MEALTM
vol. xxxvn FEBRUARY, 1922 No. 2
THE GORGAS MEMORIAL
By W. S. Rankin, M.D.
A world-wide campaign is being
organized and carried on for the pur-pose
of establishing a memorial to
William Crawford Gorgas. General
Gorgas was born in Alabarna, was
educated a physician, enlisted in the
army and rose to the rank of Major
General, did notable work in dis-ease
prevention in Havana and Pan-ama,
and through that work rendered
a lasting service to all humanity.
The work of Gorgas takes on
world-wide character through two in-evitable
effects which it has had and
will continue to have. In the first
place, General Gorgas demonstrated
the possibilities of man's control over
disease and death in reducing the
death rate of the Canal Zone from
sixty-four to sixteen per thousand
population. He demonstrated to all
the civilized world a new meaning of
that primary commission to man,
"Ho shall have dominion." Perhaps
more than any other man he trans-formed
the theory of prevention into
the outstanding fact of prevention.
His clear-cut demonstration of man's
power to control disease and, there-fore,
man's responsibility for uncon-trolled
disease, has had an influence
in all the civilized world, in the
United States, here in North Caro-lina,
of developing greater support
for public health work, of enlarging
public health appropriations, of ac-celerating
death rate reduction. So
it is that the work which he did in
Panama is local only in the place
where the work was performed; in
effect the work is world-wide. In
the second place, General Gorgas ren-dered
the whole world a service in
making possible the extension of civ-ilization
to tropical lands. He opened
the tropics to the white man. He
annexed to the arable lands of the
world the world's most fertile fields,
great productive areas where crop
may follow crop without seasonal in-terruption.
So the work of Gorgas
has made more abundant the clothing
and food supply not of the tropics
alone, but of the whole world, for
steam and electricity transform local
abundance into general distribution.
Of course we speak somewhat in
terms of futurity, but as the coun-tries
and as the world counts time
the future realization of the influence
of Gorgas on food and clothing is not
so very distant, not over twenty-five
or fifty years. High authority has
pointed out that while the United
States is at present an exporting na-tion,
shipping food and clothing to
others, that in the course of twenty-five
years our country will become an
importing nation. Certain it is that
in no distant time we shall need
more food and shelter for our larger
population than we can produce in
our own country, and at that time
with the tropics opened and produc-tive,
made possible through the work
of Gorgas, we shall begin to realize
anew the world-wide character of
his work.
The name of Gorgas in world
thought will probably be associated
The Health Bulletin
with that of Pasteur, and perhaps in
the mind of his country will come to
occupy a position similar to that of
Pasteur in France. A few years ago
one of the large Parisian papers took
a vote of the French people as to who
was the greatest Frenchman. Pas-teur
led the list, outranking the great
Napoleon. The French remembered
that it was Pasteur who found the
cause and the remedy for acid fer-mentation
of wines and saved that
great industry of the country; that
it was Pasteur that discovered the
cause and remedy for a disease of
the silk-worm that was destroying
the silk-worm industry of France as
the boll weevil threatens the cotton
industry of this country; that it was
Pasteur who laid the foundation for
disease prevention and made possi-ble
the work of Lister in establishing
antiseptic surgery. In short, where
Napoleon had destroyed thousands
of lives, Pasteur had saved tens of
thousands. It is the constructive
forces of the world that last. Gorgas
did a great creative work, work
which in character gives the doer of
it even to the imperfections of mortal
vision something of the likeness of
Him whose primary attribute is that
of creation. So his work will last.
for it partakes of the essence of that
which is permanent.
A memorial to the man and his
work will help to preserve, perpetu-ate,
and extend his influence. And
let us remember here that a memo-rial
is something for the living, not
for the dead. It is an expression of
gratitude on the part of the individ-ual,
on the part of a people, for some
great service and noble example, and
the effect of such expression is to
keep the example alive in the heart,
to keep its influence active in the
inspiration and shaping of character.
The form of the memorial to General
Gorgas is such as not only to keep
alive the memory of the man and his
work as might be done with a marble
shaft, but also to continue and to
expand the great interest of his
heart—the prevention of disease and
death in the tropical world and the
opening up of that world to all the
possibilities of civilization, economi-cal,
mental, and spiritual.
The proposed memorial is an ob-ject
in which every good citizen, cer-tainly
all those whose interest
reaches beyond their own epidermis,
their own front gate, their own town
limits, their own state borders,
should have an interest and take a
part.
GORGAS—REDEEMER OF THE TROPICS
By John Bassett Moore
Judge of the Permanent Court of International Justice
(Reprinted from The American Review of Reviews.)
I have often told the story of how.
more than ten years ago, during the
building of the Interoceanic Canal,
when the Culebra cut was still a
problem and the Gatun dam was in-complete,
I found myself one day in
the Tivoli Hotel on the Isthmus of
Panama. I was on the last lap of a
long journey, in which I had visited
many countries and traversed many
seas. and. palled by the flatness or
frenzipd by the sparkle, as the case
might be. of perhaps more than fifty-seven
well-advertised varieties of
mineral beverages. I longed for a
glass of plain fresh water. Seating
myself at a table I seized a carafe
and, as I filled a tumbler, inquired
of a waiter whether the contents
could safely be drunk. The waiter,
with a tone of proud assurance, re-plied:
"Sir, that water is certified by
Dr. Gorgas."
Never did words carry a greater
import. In a region whose name
had been a synonym of pestilence
and death, the connection of the two
great oceans by the Panama Canal,
often called the dream of the ages,
was then in course of prompt and
The Health Bulletin
confident realization. The jungle
had been robbed of its terrors, and in
place of the "reeking miasma" that
had formerly risen from the softened
ground the hills and valleys were
swept with salubrious airs, in which
men worked with security and com-fort.
This marvelous transformation
had been wrought by the genius and
devotion of one man, William Craw-ford
Gorgas, Surgeon General of the
United States Army, and it may be
said that while the Panama Canal
stands today as a monument to Goe-thals
and his associates, it was Gor-gas,
the Redeemer of the Tropics,
who made possible its safe and hu-mane
construction.
Gorgas's achievement at Panama
was, however, only a culminating
point in a continuous life-work which,
far from ending on the Isthmus, was
incessantly carried on, without abate-ment
of energy or of aspiration, to
the day of his death. He died in
harness; and it now remains for a
grateful world, instructed in the be-neficence
of his labors, to provide for
their perpetuation and development
through all time.
Imbued with this sentiment, it was
the happy fortune of Dr. Belisario
Porras, President of the Republic of
Panama, and an intimate friend of
Gorgas, to initiate a movement for
the creation of a unique memorial,
which should at once symbolize the
life-work of the great world physi-cian,
and permanently extend its ben-efits
to all parts of the globe. This
was nothing less than the establish-ment
'at the City of Panama of an
institution to be known as the Gorgas
Memorial Institute of Tropical and
Preventive Medicine. This proposal
was doubly felicitous, for, while the
memorial is to be associated with the
scene of Gorgas's most notable tri-umph,
the installation of the scien-tific
laboratories, not only in the
heart of the tropics, but also on the
line of the interoceanic canal, is con-ceived
to be ideal from the point of
view of combined practical conven-ience
and scientific effectiveness.
Opening Tropical Empires
Gorgas's victory over tropical fa-tality
in Panama demonstrated the
possibilities which the Gorgas Memo-rial
Institute will advance to their
logical conclusion, opening up for
high and diversified industrial devel-opment
some of the richest parts of
the earth, both in the Western and
in the Eastern Hemispheres. Under
favorable sanitary conditions, this
would inevitably result from the
pressure of population as well as
from the desire for riches. Gorgas
himself declared: "I believe that
again great tropical empires will be
known, such as Egypt and Babylon;
that from the period of Panamanian
sanitation will be dated the begin-ning
of the great white civilization
in these parts."
The scientific laboratories of the
Gorgas Memorial Institute, situated
at Panama, will afford specialists
from all parts of the world an op-portunity
to conduct researches in
tropical and preventive medicine.
The institute will also permit a lim-ited
number of graduate medical stu-dents
from American and foreign
colleges to specialize in tropical med-icine
by making investigations in the
tropics themselves. Of at least equal
importance is the plan of the insti-tute
to make practical application of
the means of prevention of all dis-eases
through the maintenance of
health standards and scientific sani-tation.
This will lead to the sending
of scientific expeditions to such coun-tries
as may be afflicted with epidem-ics
of the diseases in the prevention
of which the institute will specialize.
Work in Our Own South
In connection with the Gorgas Me-morial
Institute at Panama, perma-nent
provision is at the outset to be
made in the southern portion of the
United States for the training of men
and of women who will become work-ers
in the county units of the South-ern
States health organizations. Up
to the present time health and sani-tary
work in the South has been
hampered by the lack of a skilled
personnel to carry it on. Men with
medical degrees from leading uni-versities
have been disinclined to
take up work of that kind for the
small salaries paid.
The Health Bulletin
With a view to meet the immedi-ate
need for county health officers,
sanitary engineers, and health nurses
possessing a knowledge of Southern
problems and of health and sanitary
measures, it is proposed to establish
the Gorgas School of Sanitation at
Tuscaloosa, Alabama. This, the first
field extension to the institute, is a
very fitting tribute to General Gor-gas,
who was himself a native of
Alabama. His mother was for years
the librarian of the University of
Alabama, and his sister now holds
the same position. The University
of Alabama has offered the Gorgas
School of Sanitation the use of a
building for the beginning of class-work,
as well as the free use of all
university facilities for the students
of the school.
Career of General Gorgas
The nature of the plans now in
course of fulfillment, for the creation
of a memorial which shall at once
typify the life of Gorgas and perma-nently
benefit the world, renders pe-culiarly
appropriate a brief sketch of
his career, which was so strikingly
characterized by the constant effort
to do good to his fellow-men.
William Crawford Gorgas was born
on October 3, 1854, in Mobile, Ala-bama.
His father, Josiah Gorgas, a
graduate of the United States Mili-tary
Academy, served with distinc-tion
during the Civil War as Chief of
Ordnance of the Confederacy, resid-ing
in that capacity at Richmond,
Virginia, and became at the close of
the war the vice-chancellor of the
University of the South at Sewanee,
Tennessee, and later president of the
University of Alabama.
In this way it happened that the
son, William Crawford, spent part of
his boyhood at the Confederate capi-tal,
and afterward studied at the
University of the South at Sewanee.
Subsequently he attended the Belle-vue
Hospital Medical College, now a
part of New York University, and,
after a year spent as an interne at
Bellevue, he was appointed Assistant
Surgeon in the United States Army,
with the rank of First Lieutenant.
Nothing is known of these earlier
years to presage the dramatic inter-est
of his later career.
It is not many years since our
Southern States were every now and
then visited with scourges of yellow
fever. The epidemic of 1878 is esti-mated
to have cost more than 13,000
lives in the Mississippi Valley alone,
together with a loss of more than
$100,000,000. It was in 1882 that
Gorgas, in Texas, had his first con-test
with yellow fever.
At Havana in the Spanish War
But it was in Havana in 1898, as a
Major in the Medical Corps of the
United States Army, during the war
with Spain, that he again found him-self
in a struggle with the dread dis-ease
on a large scale. When the
United States Army went to Havana
in 1898, yellow fever was still
thought to be a "filth disease," and
no actual method of prevention was
known.
"The military authorities [Gorgas
wrote] concluded that Havana of-fered
the opportunity that the United
States had been awaiting for the past
hundred years. Thinking that yel-low
fever was a filth disease, they
believed that if we could eliminate
Havana as a focus of infection, the
United States would cease to be sub-ject
to epidemics. This meant so
much to the United States financially
and otherwise that the authorities
determined to make all other efforts
secondary to this sanitary effort.
"By the middle of 1900 I believed
that Havana was cleaner than any
other city had ever been up to that
time, but in spite of all this work
and care, yellow fever had been
steadily growing worse ever since we
had taken possession of the city, and
in 1900 there was a greater number
of cases than there had been for sev-eral
years. The Cubans twitted us
with the fact that all our cleaning
up and expenditure not only had not
bettered things, but had even made
them worse. They called attention
to the fact that the very cleanest and
best kept portions of the city were by
far the worst sufferers from yellow
fever, and the evidence was so star-ingly
before our eyes that we had to
acknowledge the truth of what they
The Health Bulletin
said. The health authorities were at
their wits' end. We evidently could
not get rid of Havana as a focus of
infection by any method we then
knew."
Discoveries of the Reed Board
Into this settled and seemingly
hopeless gloom there soon came a
ray of light. The demonstrations of
the Reed Board, appointed by the
Secretary of War, William Howard
Taft, to investigate the cause and
the means of transmission of yellow
fever were as convincing as they
were spectacular, and proved beyond
doubt "that the only means by which
yellow fever is conveyed from man
to man is by the bite of the female
Stegomyia mosquito; and that this
mosquito, to become infected, must
suck the blood of the yellow fever
patient within the first three days of
his disease; that after biting the pa-tient,
twelve to twenty days must
elapse before the mosquito herself is
able to convey the infection; that
after the non-immune human being
has been bitten by the infected Ste-gomyia
mosquito, an incubation pe-riod
of from three to six days elapses
before the man begins to show symp-toms
of yellow fever; that the dis-ease
itself is caused by a parasite,
and that the parasite is sub-micro-scopic."
Gorgas, who was then Chief Sani-tary
Officer of Havana, immediately
grappled with the problem of the
practical application of the discover-ies
of the Reed Board. Vaccination
was first tried, but its inefBcacy was
soon demonstrated. Gorgas then pro-ceeded
to screen private homes and
hospitals so as to prevent the mos-quito
from biting anyone afflicted
with yellow fever, besides fumigating
the entire vicinity wherever the fever
developed. Following this, he at-tacked
the mosquitoes themselves,
destroying their breeding places and
killing them in the larval stage by
pouring oil on all bodies of water,
from the backyard pools and the
puddles in the gutters upon the roofs
to the large lakes and ponds. For the
ten years preceding the American
occupation of Havana there had been
more than 5,000 deaths per year from
yellow fever. In February, 1901,
Gorgas inaugurated his sanitary
measures, with the result that the
plague rapidly disappeared, the last
case occurring in September of the
same year.
In addition to the campaign
against the yellow fever mosquito,
Gorgas directed equally effective at-tacks
on the Anopheles mosquito,
which was the cause of malaria. Prior
to 1901 Havana averaged 300 to 500
deaths per year from malaria, but
from that time on the number sharply
declined, until in 1912 only four
deaths from malaria occurred in the
city.
Cleaning Up the Canal Zone
It was but natural that the United
States Government, recognizing the
great work of Gorgas in Havana in
stamping out yellow fever and mala-ria,
should place him in charge of
the sanitation of the Canal Zone.
When in the middle of the last cen-ture
the Panama railway was con-structed,
it was commonly said that
the laying of every cross-tie cost a
human life. The fundamental rela-tion
of sanitation to the digging of
the canal can best be understood
when it is realized that the French in
their earlier attempt to build it lost
each year about one-third of their
white force by deaths from yellow
fever.
It was the loss of life rather than
lack of skill, of machinery or of
money, that brought disaster to their
efforts. If under the American ad-ministration
the same ratio of loss by
disease had occurred, it is estimated
that this would have meant the loss
of approximately 3,500 American
lives a year, the effect of which on
public sentiment and the progress
and eventual completion of the work
can only be conjectured. Gorgas
keenly realized the great responsibil-ity
of his assignment as Chief Sani-tary
Officer of the Canal Zone. As
Frederic J. Haskin has well said:
"Not mountains to be leveled, nor
wild rivers to be tamed, nor yet ti-tanic
machinery to be installed, pre-sented
the gravest obstacles to the
canal builders. Their most feared
enemies were none of these, but the
8 The Health Bulletin
swarm of mosquitoes that bred in
myriads in every lake, in every tiny
pool, in every clump of weeds on the
rain-soaked, steaming tropical land.
Each mosquito was a messenger of
death. The buzzing, biting pests had
defeated the French in Panama with-out
the French ever having recog-nized
the source of the attack."
Fully understanding the situation,
Gorgas planned accordingly. He di-vided
the Zone into twenty-six sani-tary
districts, each in charge of a
sanitary inspector having from twen-ty
to one hundred laborers with the
necessary foremen. The well-known
Gorgas system of sanitation was then
applied to eliminate the breeding
places of mosquitoes; and by the
autumn of 1905 he had completely
stamped out yellow fever and sub-dued
malaria in Panama.
The ridding of the Canal Zone of
yellow fever and malaria will be re-corded
for all time as an epoch in
the annals of preventive medicine.
Taking for comparison the previous
French death rate, the work of the
Sanitary Department under Gorgas
during the building of the canal may
be said to have saved 71,370 human
lives, while the financial saving to
the Government of the United States
in keeping the American forces well
and fit for duty is estimated at more
than $39,000,000.
But to the far-seeing mind of Gor-gas,
the great significance of these
two factors, immediately important
as they were, lay in the fact that even
in the Canal Zone, for centuries re-puted
to be one of the world's worst
pest-holes, yellow fever had been
completely crushed and malaria
placed in subjection; and that it had
beyond all doubt been demonstrated
that tropical diseases could be pre-vented
or controlled, and that it lay
within the reach of governments to
assure the health and prosperity of
the vast tropical lands in Central
and South America, by the applica-tion
of sanitary methods such as he
had used at Havana and at Panama.
Exterminating Disease the World
Over
The story of the life of Gorgas re-veals
how step by step each achieve-ment
led him on to a greater one.
Following up his triumph at Havana
he made an even greater conquest of
disease at Panama. This accom-plished,
he advanced to the problem
of extirpating yellow fever every-where.
Nor were his activities con-fined
to this object. His reputation
was world-wide, and he had become
an international figure. While still
Chief Sanitary Officer at Panama, he
was invited to advise and assist va-rious
countries and their govern-ments
in matters of sanitation. In
of Mines of Johannesburg, he went
1913, at the request of the Chamber
to South Africa to investigate the
cause of the high pneumonia rate in
the Witswatersrand mines; and it
was there that he received notice
that he had been made Surgeon Gen-eral
of the United States Army. In
1912 and 1913, on the request of the
Ecuadorean Government, and again
in 1916, as a member of the Commis-sion
of the International Health
Board of the Rockefeller Foundation,
he conducted the campaign against
yellow fever in Ecuador.
As Surgeon General of the Army,
when the United States entered the
World War, Gorgas had direct charge
of the health of all our troops, and
it thus fell to him to organize the
Medical Department of the Army into
a body that could efficiently care for
the health of more than four million
men. To this end he associated with
him men of prominence in the medi-cal
profession throughout the United
States, and with their co-operation
there was created the splendid medi-cal
organization which cared for our
sick and wounded in France, as well
as for the recruits in the training
camps in the United States.
He retired from the Army in 1918;
and he then associated himself with
the International Health Board of
the Rockefeller Foundation to take
charge of the yellow fever work, and
prosecute his plan for the complete
extinction of that disease.
A Citizen of the World
Gorgas died in London on July 4,
1920, in the midst of his labors,
while on the way to the West Coast
of Africa. The King of England had
The Health Bulletin
expressed a desire to grant him a
decoration in recognition of his great
work, and hearing of his illness came
personally to his bedside and there
bestowed upon him the Cross and
Star of Knight Commander of the
Order of St. Michael and St. George.
Other nations had previously paid
him their tributes. France had made
him Commander of the Legion of
Honor, and the King of Italy had
awarded him the Grand Cross of the
Order of the Crown of Italy. He was
also the recipient of honors from
leading universities, both at home
and abroad, holding some eight de-grees
of Doctor of Science and five
of Doctor of Laws. He was further-more
awarded, because of his partic-ularly
eminent services to humanity,
a number of special medals, including
the Mary Kindsley Medal of the Liv-erpool
School of Tropical Medicine,
the medal of the National Academy
of Sciences, the Damson Medal of the
University of the South, the Buchan-an
Medal of the Royal Sanitary
Institute, London, and the Harbin
Medal of the Royal Institute of Pub-lic
Health, London.
But Gorgas is not to be remem-bered
for his scientific accomplish-ments
alone. As a man, he equally
commands our admiration and re-spect.
A quiet and modest demeanor
attested his unassuming greatness,
while his ever-ready kindness be-spoke
the warmth of his human sym-pathy.
Newton D. Baker, former Secretary
of War, well expressed the sentiment
of many when he said that it was
appropriate that Gorgas should die
on foreign soil, for he had truly be-come
a citizen of the world.
Function of the Memorial Institute
Gorgas's life-work is not of the
kind that can perish. Its results are
destined to endure and to grow. It
rests with men and women of humane
and generous impulses, of imagina-tion
and vision, in all climes, to see
to it that this is so. In the Gorgas
Memorial Institute of Tropical and
Preventive Medicine we see a noble
and confident initiative, reassuring
and full of promise. Its benefits are
to be extended to all countries.
Through President Porras, the Re-public
of Panama, in testimony of its
gratitude, has offered the funds for a
building and necessary equipment.
The institute has already been incor-porated
in the United States, under
the laws of the State of Delaware,
the incorporators being: President.
Rear Admiral W. C. Braisted, Sur-geon
General U. S. Navy (Retired) :
vice-president, Dr. Franklin H. Mar-tin,
Director General American Col-lege
of Surgeons; directors, Dr. Beli-sario
Porras, President of the Rep-,
lie of P :• "vv • "tidpr: •
'
Boyd : ' ...gical Service, San-to
i..uc ^ospital, Panama; Dr.
Frank Billings, Secretary board of
Trustees, American Medic; associa-tion;
Surgeon General Hugo S. Cum-ming,
U. S. Public Health Service;
Dr. Oscar Dowling, Health Officer of
the State of Louisiana; Dr. Seale Har-ris,
President of the Southern Medi-cal
Association; Surgeon General
Merritt W. Ireland, U. S. Army; Hon-orable
John Ba^sett Moore, Judge of
the Permanent '. ourt of International
Justice; Dr. Lc S. Rowe, Director
General of the 1 an-American Union;
Surgeon General Edward R. Stitt.
U. S. Navy; Dr. E. G. Williams,
Health Officer of the State of Vir-ginia.
The Board of Directors has chosen
Dr. Richard P. Strong as Scientific
Director.
The Advisory Board, of which Sec-retary
of State Charles Evans Hughes
is a member, consists of the diplo-matic
representatives of practically
all the Central and South American
countries affected by tropical dis
eases, as well as of a number of emi-nent
physicians and surgeons, and of
health officers of the United States,
acting as committees of the leading
medical, surgical and public-health
associations.
Through the completion by the
Government of Panama, at a cost of
$2,000,000, of the new Santo Tomas
Hospital, adjoining the site of the
Gorgas Memorial Institute, excellent
laboratory facilities will be provided
for the beginning of the international
work in the very near future, without
awaiting the erection of the insti-tute's
own building. We have here-
10 The Health Bulletin
tofore mentioned the generous offer
by the University of Alabama of the
use of one of its buildings for the
Gorgas School of Sanitation at Tus-caloosa.
With the raising of the en-dowment
fund required for the main-tenance
of the Gorgas Memorial In-stitute
and its branches the work will
proceed in its entirety, and it is
expected that the autumn of 1922
will find most of it in progress.
The importance, both scientific and
practical, of the work thus to be un-dertaken,
is universally recognized.
The Medical Corps of the United
States Army and Navy and the Uni-ted
States Public Health Service have
given assurance of their active par-ticipation
and co-operation. Harvard
and other leading universities of the
United States interested in the pre-vention
of tropical diseases have ex-pressed
a desire to send representa-tives
to aid in research and in the
practical application of the scientific
principles established. Secretary of
State Hughes, in his acceptance of a
place on the Advisory Board, ex-pressed
the belief that the fulfillment
of the institute's great design would
materially assist in cementing the
friendship of our sister republics.
Conceived in the faith that the work
to which Gorgas devoted his life is
not for a day, but for all time, the
Gorgas Memorial Institute of Tropi-cal
and Preventive Medicine has ac-cepted
as a sacred trust the task of
following the trail which he blaz-oned,
its motton being—"health to
all people, in all lands."
NOT BETTER "BABY CONTESTS"—WHY?
By Rose M. Ehrenfeld
Bureau Public Health Nursing and Infant Hygiene, N. C. State Board of Health
We believe better baby contests,
initiated some years ago, served their
purpose in focusing the limelight on
the baby—giving publicity to and
stimulating interest in the Infant
Hygiene Movement.
When carefully formulated score
cards were equally as carefully used,
they had an educational value. How-ever,
better baby contests appealed
largely to mothers of babies least in
need of medical observatio-n or at-tention,
as the award was made for
the "best baby." Usually, at the
close of the day all except the prize-winner
had disappointed mothers in
whose minds arose many questions.
And what of the babies most in need
of medical observation? They were
not featured on such occasions
—
probably lucky for the babies escap-ing
the crowd and possibility of con-tagions,
but what of the mother's
reaction—should her child not be
given a chance because of a slight
disadvantage?
For two years the Bureau of Pub
lie Health Nursing and Infant Hy-giene
has discouraged what are com-monly
known as "baby contests,"
believing the only basis on which we
could officially endorse competitive
features of this nature would be
—
I. Baby (or child) Improvement
Contests.
II. Better Mothers' Contests.
We cannot encourage the bringing
of babies long distances in the sum-mer
heat and dust and the offering of
a "prize" on an initial weighing for
what is sometimes pronounced on
such occasions as "a perfect physical
specimen," so termed because the
height and weight correspond with
the standard for a child of that age.
We have known of awards being
made on such a superficial basis—in
some instances the event commer-cialized
or used as advertising fea-ture
or drawing card for large public
gatherings—the last place children
of tender age should be gathered in
groups—to crawl and sprawl and
bawl—in the limelight.
Recognizing the significance of
weight as an index to growth and
development, we recommend system-atic
weighing at regular intervals
throughout infancy and childhood for
The Health Bulletin 11
all children. If there must be com-petitive
events, why not make awards
at some future date for normal de-velopment
or physical progress dur-ing
a given time? Better to exhibit
stunted, puny, undeveloped specimens
in a Poor Baby Contest (as the Chi-cago
Department of Health sug-gests),
letting parents learn what
standard physical and moral meas-urements
sbould be. It is the booby
prize winners with fellow-rivals we
want entered in the race towards
better babyhood—and an opportunity
of pointing out errors of dressing,
feeding, bathing, sleeping, etc., and
a chance to later note changes, if any,
for better or worse—and why.
"Why?" That is the question moth-ers
are now asking—they have
passed the primer stage and are
ready for a reader.
The Child Health Conference is
the substitute we would offer for any
type of contest. These to include
with the babies the overlooked two-to
six-year child, usually in a class
by himself, sharing neither benefits
of infants nor of school children.
Why discriminate? Should any
child in North Carolina be neglected?
The general principles of the child
health conference are:
I. Non-competitive events.
II. A medical examination by ap-pointment
to begin with (eliminat-ing
an undesirable wait and needless
contact with the crowd).
III. Medical advice of the charac-ter
that will help mothers to keep
well babies well—and
IV. Examination sufficiently thor-ough
to locate causes of retarded
progress.
V. Individual instruction of moth-ers
and encouragement to remedy
the cause.
Last summer the Bureau of Public
Health Nursing and Infant Hygiene
co-operated with a few of the coun-ties
in holding Child Health Confer-ences,
where examinations were made
by health officer or members of local
county medical society, using the rec-ord
card of the U. S. Public Helath
Service. The absence of a competi-tive
feature proved their value, as
many children needing attention
were found and referred to their fam-ily
physician—some with remedial
defects or disabilities that could and
should be corrected before the open-ing
of school.
The following five conditions gener-ally
recognized as contributing fac-tors
to malnourishment among
young children give some idea of the
extent to which the causes of this
particular handicap can be removed
by the mother's influence in the
home.
REASONS FOR MALNUTRITION
1. Physical defects, particularly
obstructions of the breathing pass-ages.
(The removal of these physical
defects to make the child "free to
gain" should precede the work of
the nutrition or health class.)
2. The lack of home control
(This reminds one of Dr. Anna How-ard
Shaw's quizzical statements that
there is just as much obedience in
the present age as there was in the
old days—only now the process is
reversed. It is "Parents, obey your
children!" instead of the Bible in-junction,
"Children, obey your pa-rents!")
3. Over-fatigue, from lack of sleep
and other causes. (Over-stimula-tion,
the work required for classes
outside of school hours, "movies,"
nervous excitement of all sorts are
quite as disastrous in their effect on
the children of the well-to-do fami-lies
as are the crowded conditions
and the noise of tenement homes.)
4. Defective feeding. (Under this
head may be put lack of food, im-proper
food, and faulty food habits
—
that is, eating too fast or under
wrong conditions, eating when over-fatigued,
etc.)
5. Faulty health habits—for ex-ample,
insufficient fresh air, lack of
cleanliness, too little sunshine, or
too little playtime out of doors.
The real purpose of the Child
Health Conference is
—
1. To stimulate interest in devel-oping
permanent local centers, where
permanent infant hygiene work may
be done (instead of spasmodic ef-forts),
where scales are available for
12 The Health Bulletin
regular weighings—with health edu-cational
exhibit open to the public
—
where demonstrations in baby and
child care may be given and the
mothers (also expectant mothers)
taught to more intelligently co-oper-ate
with physicians in the Infant
Hygiene Movement.
2. To locate and place children
needing medical attention under the
supervision and care of the physician
of the parents' preference.
It is in justice to both babies and
mothers that we advocate for this
year in North Carolina either Child
Health Conferences, with examining
physician and the use of U. S. Public
Health Service card (which admits
of tabulation of findings)—or Better
Mothers' Contests.
A few of the latter were held by
the county public health nurses last
year, and their success indicates that
North Carolina mothers can be count-ed
on for co-operation. The method
of rating described in the following
article, "Are You a 100% Mother?"
by Dr. W. R. P. Emerson, is what we
recommend for determining your rat-ing
as a mother.
(The U. S. P. H. S. cards—or
mothers' rating cards—will be sup-plied
by this office on request.)
r
The Health Bulletin 13
normal physical condition. Do not
let a single item escape you.
If the child is a mouth breather,
or there are enlarged glands, or other
signs of inflammatory processes, let
nothing stand in the way of correct-ing
every defect. Do not be one of
those mothers who grasp at every
excuse for delay, saying, "It will be
better to wait until a more conven-ient
time before having the condition
corrected": or, "The summer is a
better time, and vacation is only a
few months off"; or, "I just can't
bear the idea of an operation!" Ex-cuses
of this kind are responsible for
the continued suffering and ill health
of thousands of children in every
community.
In considering your rating as a
mother, your child's physical condi-tion
must be the first consideration,
not only for its own sake, but because
it is the groundwork and foundation
of all other development.
It is part of your duty as an effi-cient
mother to see that the good
physical care which your child was
given during the days of infancy is
continued through the pre-school age
and throughout the years of school
life, when there is a tendency to focus
attention upon other forms of train-ing.
No factor in the child's devel-opment
can be isolated, but his
health should claim the mother's
first attention.
II. HOW MANY POINTS FOR HOME
CONTROL?
It would not be too much to say
that good home control is "half the
battle" in the proper nutrition and
growth of children; but as I wish to
be fair in acknowledging the honest
intention of all mothers to do their
best in this matter, I am rating this
important factor at only twenty-five
per cent. In this section let me re-late
a few incidents out of my experi-ence
with mothers and children, and
perhaps some of these extreme cases
will help you to check yourself up in
this regard.
I think it will be unquestioned that,
the first moral training a ;hild should
receive is the duty of obedience. The
act is so instinctive in the relations
between mother and child that it
might almost be said to be automatic,
where the mother has not blindly
surrendered her natural authority.
Yet I have had a mother say to me
when I told her to bring her little
son to my office, "I'll bring him if he
will come!" He weighed less than
forty pounds; she weighed more than
one hundred and fifty; but she could
not see the absurdity of her position.
The maintenance of the mother's
authority depends upon firmness
from the earliest years, and upon say-ing
to the child exactly what she
means in every case. It is fatal to
say, "If you do that again I will
punish you," and then fail to do so.
The mother who surrenders to the
child for the sake of avoiding a fuss,
or to secure "peace at any price," not
only finds the price steadily advanc-ing,
but soon fails to get peace at all.
I frequently ask a mother, "Have
you spoiled your child?" And all too
often the answer is. "I'm afraid I
have." Sometimes this over-indul-gence
is the result of the illusion that
the child is supersensitive, and that
nothing must be done to hurt his
feelings, even when his best interests
are thus sacrificed. Pride in a child
may easily lead to the habit of mak-ing
an exhibit of him. The old idea
that "children are to be seen and not
heard" was one extreme, but no
worse for the child than the present
tendency to "feature" him. If you
have been spoiling your child, stop it.
Begin to exact obedience, and you
will be surprised how soon your dif-ficulties
will diminish.
DISCIPINE BY OTHERS
The mother of a spoiled child is
apt to complain about the efforts of
others to discipline her child. She
accuses her husband of "interfering,"
instead of backing up the father in
his proper assumption of authority.
Some mothers think they can capital-ize
mother-love by leading the chil-dren
to look to them alone for con-trol.
In one household where the chil-dren
are my patients, the father has
been told to "keep his hands off the
children until they are twelve years
14 The Health Bulletin
o\<X." This mother is very sure of her
ability to manage her children alone,
yet when her own mother came to
pay her a visit she was so exhausted
from the lack of discipline in the
family that at the end of a week she
was obliged to take a room in a hotel,
and actually slept through most of
the first twenty-four hours from
sheer fatigue!
This same resentment against any
share in authority over the children
is shown in other relations. A serv-ant
is often forced to adopt methods
for restraining a child which are dis-astrous
to the character, however ef-fective
in the immediate result. But
this difficulty would be less if nurse-maids
were selected with due regard
to their fitness, and trained to co-operate
with the mother's system of
discipline.
In one of our large cities an inves-tigation
was made to find what be-came
of a large number of girls of
limited intelligence, some of whom
were actually feeble-minded, who
had left school as soon as the law
allowed. A large proportion of these
girls were found employed by fami-lies
in comfortable circumstances,
where they had charge of little chil-dren.
In speaking of her nursemaid,
one mother said, "I tried to have her
help with the dishes, but she broke
three times as many as even the cook
does, so now she gives all her time
to the children." The most import-ant
work in the world left to one
incompetent to wash dishes!
GIVE YOUR CHILD RESPON-SIBILITY
Next to obedience, the most im-portant
point for the child is training
in responsibility. All children should
have some definite work suited
to their ability, for which they
should be held strictly to account.
Even a toddling child has a natural
instinct to help, which should be en-couraged
if only by teaching him to
put away his playthings or to pick up
articles dropped. Many mothers say,
"It is so much easier to do it my-self";
but the child should not be
deprived in this way of the satisfac-tion
of achievement.
There are many ways in which
growing boys and girls can help in
the household tasks. A simple task
daily gives a sense of responsibility,
and an opportunity for early train-ing
in neatness and efficiency. A
boy who is given a bicycle can be re-quired
to take proper care of it, and
will not grow up like the son of one
of my patients, who was given an
automobile and let it stand outdoors
all night with the lights on! Pos-sessions
which are bought with
money actually earned by the child
are usually prized beyond the richest
gifts that come without effort!
Back of most of the factors deal-ing
with proper home control stands
the question, "Do you allow your
feelings to prevail over your judg-ment?"
Is the basis of your control
the desire to insure the child's high-est
development, or are you swayed
by the influences and prejudices of
your friends and neighbors? For ex-ample,
do you choose a school for
the character of the person in charge,
or is your choice dictated by super-ficial
and social reasons?
HI. TWENTY-FIVE POINTS FOR
THE DAILY ROUTINE
The 100-per-cent mother follows
the daily program of her child with
close attention, making a forty-eight-hour
list of his activities and occu-pations,
to learn the unnecessary oc-casions
of fatigue. She acquaints
herself with even the seemingly un-important
details of his daily life, ob-serves
the amount of play and work
he is attempting, and realizes the
weak points at which friction is most
likely to occur. She makes the ac-quaintance
of his teachers, and sees
to it that music and language are
omitted if he is not able to carry
extra studies without losing weight.
The same watchful supervision is
exercised over the child's amuse-ments.
She must determine what
activities are within the range of a
reasonable expenditure of energy,
and help the child to live within his
resources, while exercising his facul-ties
to the fullest extent.
By carefully checking up the
child's food and health habits she
The Health Bulletin In
will see that he has favorable con-ditions
for growth and a sufficient
daily total amount of the right kind
of food. Earlier articles have out-lined
the essential points to be ob-served
in these matters, but it is not
easy to keep in mind day after day
the importance of eating slowly,
avoiding sweets between meals,
sleeping with the windows wide open,
and breaking away from a book or
favorite indoor occupation to get the
necessary amount of exercise in the
open air.
IV. THE BALANCE OF THE SCORE
Character is closely associated
with health, for it requires character
not only to get well but to keep well.
The remaining 2 5 per cent, therefore,
depends upon your answer to the
question, "What are you doing to
help your child develop high ideals,
which are the basis of character
building?"
The answer to this question will de-pend
largely upon the quality of your
own ideals. Are you keeping your
influence, which is the strongest in
the life of your child, true to its best
possibilities as you see them? One
of the finest things repeatedly said
by mothers is, "I have a struggle to
live up to the ideals of my child."
There are ideals of having a good
time, of having one's own way, ideals
of dress, and ideals of living up to
social requirements. To these ideals
the health of thousands of children
are offered yearly as a willing sacri-fice.
It requires character to forego
pleasures for the sake of health, to
resist the tide of social custom, to
answer the question: "Jack and Lou-ise
do this, why can't I?" It requires
character to control the simple habits
of eating and drinking, to take rest
periods when other children are at
play, to observe good hours for sleep.
It requires character to plan and fol-low
out a sane, wholesome program
for the growing child, instead of fol-lowing
lines of least resistance.
Many parents, in an effort to give
their children an "easier" time than
they have had themselves, try to
shield them from every form of hard-ship.
They forget that many fine
qualities are developed in the hard
school of experience. Both study
and work are necessary to the de-velopment
of mental and physical
power. Shielding children from work
makes them weaklings, and shield-ing
them from study makes them
simpletons.
Health education, then, furnishes
one of the best means for sound
character building.
In closing this article I cannot
forbear to say that in the task at
which I am working—the better care
of growing children—the one sup-port
that has never failed me has
been the interest and patience of the
mothers. It has been necessary at
times to admonish, to insist, to speak
very plainly, but I have met with no
resentment, for when this is done in
order to get a child well the mother
can be counted on to understand.
HOW TO FIND YOUR RATING
I. 25 points if your child is "free to gain."
Deduct five if you do not know whether he is under weight;
Deduct ten if he is under weight and has not had a complete phys
ical-growth examination;
Deduct ten if the physical examination showed physical defects,
and you have not had them corrected.
D. 25 points for home control.
Deduct ten if your child has not been trained to obey
;
Deduct five if you interfere with his proper discipline by others;
Deduct five if you have not trained him to have a sense of respon-sibility;
Deduct five if you allow your feelings to prevail over your judg
ment.
16 The Health Bulletin
III. 25 points for a good daily program.
Deduct five if you do not know the causes of over-fatigue in his
school program or his outside activities:
Deduct five if you do not know whether he has proper food habits;
Deduct five if you do not know whether he has good health habits;
Deduct ten if you have not made the necessary adjustments in his
program, and if you have not brought him up to average weight
for his height.
IV. 25 points for training in ideals.
Mark yourself as liberally as your conscience will allow. (There
are many 100-per-cent mothers.) Give yourself honest credit
for all that you can claim.
Find your total, which will answer the question
Are You a 100-Per-Cent Mother?
i The idea of a numerical rating for mothers was suggested by a plan
tor a similar rating for the nutrition of children, worked out in great
detail by Dr. Caroline Hedger. of the Elizabeth McCormick Memorial
Fund. Chicago.)
CLASSIFICATION orDISEASES S^-rS PREVENTIVE MEDIC NE,
/old age
( diabetes
\ GANCEB (?;
f
/
EYE SECRETIONS
MOUTH and NOSE
SECRETIONS
PINK ETE
TBACHBMA
SPRAY BORNE
INFLUENZA
COLDS
. GRIPPE
{ MEASLES
1 WHOOPING'COOII
PNEUMONIA
V TUBERCULOSIS
BY
\
v
(VIOLENCE
POISONING
-J ACCIDENTS
/ WOUND INFECTION
1 SEPSIS (BLOOD POISONING)'
{OCCUPATIONAL DISEASES
VDIETETIC DISEASES
NON-SPRAT BORNE /'DIPHTHERIA
7 SCARLET fEKI
(TTPHDID FEVER \SgITK
DYSENTERY
vmmh" n
SUMMER COMPLAINT
CHOLERA
infantile paralysis
hookworm and
other intestinal
parasites
/syphilis
IMMORALITY (gonorrhoea
\ CHANCROID
(LICE
I ITCH
SKIN \ RINGWORM
] SMALL POX
V CHICKEN POX
f MALARIA
SUCTORIAL INSECTS
mL0W ™
(animals
)V
TYPHUS
\ BUBONIC PLAGUE
I RABIES
{ TAPE WORM
\TRICHINOSIS
Published b4 TAE,N°gm CARSlIflA STATLDPARDs^AE^LTA
This Bulklia will be -sent free to ar\g citizen of "the 5tateupor\ request. |
Entered as second-class matter at Postoffi.ee at Raleigh, N. C, under Act of July 16, 189b.
Published mouthy at the office of the Secretary of the Board, Raleigh, N. C.
'
vol. xxxvn MARCH, 1922 No. 3
GOVERNOR MORRISON'S AMBITION
"Some people say that I want to be known as the 'Good Roads Governor
of North Carolina.' This is not true. My ambition is to be known—at least
for a while—in the traditions of North Carolina as the 'Health Governor.'
Good roads are very important, and I hope to see ours the finest system of
highways to be found in the Republic; but good roads are not of any account
to sick or dead folks. It is much more important to have a healthy popu-lation."
MEMBERS OF THE NORTH CAROLINA STATE BOARD OF HEALTH
J. Howell Way, M.D., Pres Waynesville Charles O'H. Laughinghouse, M.D.,
Richard H. Lewis, M.D., LL.D Raleigh Greenville
Chas. E. Waddell, C.E Asheville Cyrus Thompson, M.D Jacksonville
Thomas E. Anderson, M.D Statesville F. R. Harris, M.D Henderson
A. J. Crowell, M.D Charlotte E. J. Tucker, D.D.S Roxboro
EXECUTIVE STAFF
W. S. Rankin, M.D., Secretary State Board of Health and State Health Officer.
Ronald B. Wilson, Assistant to the Secretary.
C. A. Shore, M.D., Director State Laboratory of Hygiene.
L. B. McBrayer, M.D., Superintendent of the State Sanatorium for Treatment of Tuber-culosis
and Chief of Bureau of Tuberculosis.
G. M. Cooper, M.D., Chief of Bureau of Medical Inspection of Schools.
K. E. Miller, M.D., Director of County Health Work.
H. E. Miller, C.E., Chief of Bureau of Engineering and Inspection.
F. M. Register, M.D., Deputy State Registrar of Vital Statistics.
J. S. Mitchener, M.D., Chief of Bureau of Epidemiology.
K. P. B. Bonner, M.D., Chief of Bureau of Maternity and Infancy.
FREE HEALTH LITERATURE
The State Board of Health has available for distribution without
charge special literature on the following subjects. Ask for any that
you may be interested in.
Whooping-cough
Hookworm Disease
Public Health Laws
Tuberculosis Laws
Tuberculosis
Scarlet Fever
Infantile Paralysis
Care of the Baby
Fly Placards
Typhoid Placards
Tuberculosis Placards
Clean-up Placards
Don't Spit Placards
Sanitary Privies
Water Supplies
Eyes
Flies
Colds
Teeth
Cancer
Pre-natal Care
Malaria
Smallpox
Adenoids
Measles
German Measles
Typhoid Fever
Diphtheria
Pellagra
Constipation
Indigestion
Venerevl Diseases
Catarrh
FOR EXPECTANT MOTHERS
The Bureau of Maternity and Infancy has prepared a series of
monthly letters of advice for expectant mothers. These letters have
been approved by the medical profession. They explain simply the
care that should be taken during pregnancy and confinement, and have
proved most helpful to a large number of women. If you want them
for yourself or a friend, send name to the State Board of Health, and
give approximate date of expected confinement.
THE HEALTH BULLETIN
The Health Bulletin is sent monthly without charge to all persons
in the State who care to receive it. If you have friends or neighbors who
will be interested, suggest that they write the State Board of Health,
asking for The Bulletin each month. When you have finished with
your copy, give it to some one else, thereby increasing its usefulness.
fnteair mmm
l2j\\ PUBLI5AE.D BY TMC HORTA CAeOLIhA 5TATL EPAl^D °XHEALTH | B
vol. xxxvn MARCH, 1922 No. 3
AN APPEAL TO THE PEOPLE
FOR
INCREASED FOOD PRODUCTION
By Governor Cameron Morrison.
NORTH CAROLINA has been
pushed to a high comparative
position among the States of the
Union in the production on our farms
of money crops for the market; but
our whole agricultural life is weak-ened
by the fact that we have neg-lected
the production of sufficient
food on the farms of the State to
make our agricultural life independ-ent,
and give it strength to stand the
periodic vicissitudes of misfortune to
the money crops, due to slump in
prices, or other causes sure to occur.
Much improvement has been made in
the last few years in this well under-stood
weakness of the State, but
there is yet much to be done. It is
hard to "get out of a rut."
A hightly competent authority de-clared
recently: "There is not a sin-gle
county in the State in which there
is raised enough food in value or
quantity for the human and animal
life of the county."
Fight Weevil With Food
Independently of the approach of
the boll weevil, this phase of our
agricultural life should be strength-ened
throughout the State; but the
approach of the boll weevil threatens
a serious blight to a large area of
the State, particularly the great areas
devoted largely to the growth of cot-ton.
If the boll weevil should have
the devastating effect upon the crops
this year in the cotton sections of the
State that it has had in some of the
States to the south of us, and if the
people in the cotton sections of the
State do not raise more food supplies
for themselves and their animals
than they have heretofore raised, it
will certainly result in widespread
suffering and destitution. This
threatened danger and distress can
be largely averted, if it comes, as
there is reasonable ground to fear it
may, and at the same time a policy
adopted in the agricultural life of the
State which will greatly strengthen
the whole life of our people, not only
in the cotton sections, but in the en-tire
State.
We must so order our agriculture
as not to require the immense outlay
of money rendered necessary largely
to buy the food upon which the peo-ple
live who grow money crops in the
State for the market. The small
farmers and tenants cannot stand the
periodic slumps which occur from
various causes, and the wealthier
men and large landowners caunot
withstand the boll weevil blight, if it
comes, and feed their tenants and
farm laborers through it. Buying
our food elsewhere and raising
money crops requires too much capi-tal,
and is too hazardous lor our peo-ple
to engage in on an extensive
scale.
The Health Bulletin
Departments Co-operating
I have made every effort to excite
the interest and active* efforts of the
State College of Agriculture and En-gineering,
the Agricultural Depart-ment,
the Department of Education,
and the Health Department of the
State government to lead the people
to organize and prepare without de-lay
to increase the production of food
raised in the State for home con-sumption,
not only in the threatened
areas, but in the whole State. These
great departments of our State gov-ernment
are splendidly organized and
equipped to help the people in this
all-important matter, and they are
now moving with energy through
their splendid organization of expert
men to help. I appeal to the people
of the whole State for their active
co-operation in the movement.
We Must Increase Our Home Supply
of Meat
We cannot raise beef profitably in
a large part of the State, but we can
raise hogs and poultry of every de-scription
on account of our long
summer seasons as easily and cheap-ly
as it can be done anywhere in the
Union. We must increase our meat
supply through hogs and poultry. We
can raise vegetables of almost every
known variety; and keep and main-tain
milch cows probably more
cheaply than it can be done elsewhere
in the Union. If we would but real-ize
the importance of this matter, we
could make hog meat, chicken, tur-key
and other fowl meat, eggs, butter
and milk so plentiful in the State,
particularly on the farm, that our
food bill would be trifling compared
to the enormous outlay, with the
business hazards accompanying it,
which we now annually pay.
Independently of the boll weevil
threat, because of the periodic slumps
in the prices of cotton and tobacco,
now raised at such enormous hazard
upon purchased supplies, the State
ought to tremendously increase hog
and poultry raising, home gardening,
and the supply of milk, butter and
eggs in the State, not for the purpose
of making them our money crops,
but in order to have abundant, whole-some
and cheap food, whatever vicis-situdes
may overtake the money
crops; but the approach of the boll
weevil makes it absolute folly not to
do so.
And further, our illiterate and un-informed
people ought to be made
more generally aware of the supreme
importance to health of the balanced
ration, and of an enlightened world's
knowledge of the necessity of nutri-tious
and varied foods.
Appeal to All the People
In furtherance of the foregoing'
purposes, and in co-operation with
the State College of Agriculture and
Engineering, the Board of Agricul-ture,
the Department of Health, and
the Department of Education, I ap-peal
to the people of the State to
have community meetings, and give
consideration to this important mat-ter;
and to quickly organize for the
purpose of promoting a State-wide
program for more and better home
gardens, a heavy increase of the poul-try
and eggs and milk and butter
supply, and the raising of more hog
meat in the State.
We urge the people of the State to
a careful study of how to make this
increase in food in the State econom-ically,
and that they adhere to it, not
only during the threat of the boll
weevil disaster, but until Xorth Caro-lina
becomes a great food-raising
State, independent of the threat of
periodic disaster through failure to
make profit on the money crops.
I do not think it will be wise for
our people generally to undertake at
first to raise foodstuffs for the mar-ket;
they will not be successful at
first in making money, and will be-come
discouraged and stop. In course
of time, through study and experi-ence,
we are quite sure these foods
can be raised by our people for the
market profitably; but present efforts
had best be confined to supplying the
family and feeding the labor raising
the money crops.
We ought, also, to raise every
pound of food necessary for our ani-mals.
The annual bill of North Caro-
The Health Bulletin
lina for food purchased elsewhere for
our animals is enormous. We must
raise it all. It is pure speculation to
buy food for men and animals upon
which to raise cotton and tobacco in
North Carolina. Let us organize and
learn how to raise all the food we
need to feed the animal life of our
State, as well as the people. For
years we have known this would
make the State rich and independent,
and yet we have failed to do it.
We suggest no new thing, but we
are moving with great hope that we
can arouse the people to do what
they have long known ought to be
done.
THE NATURE OF MILK AS A FOOD
By D. R. Mendenhall, M.D.
MILK is often stated to be a per-fect
food. By this we mean
that it contains all the essential ele-ments
for normal human growth and
development.
The adequacy of a food or diet de-pends
briefly on its containing:
1. Enough of the right sort of ma-terial
to build up and repair the liv-ing
tissues of the body. These body-building
substances in the food are
called proteins, and are found espe-cially
in milk, meat, fish, eggs, and
in certain vegetables, especially beans
and peas.
2. Enough substances to furnish
the required energy of the body.
Fats, starches and sugars are the
chief energy foods, and are trans-formed
in the body into energy for
work and into body-heat.
3. A variety of mineral substances,
which are needed in the growth and
functioning of the parts of the body,
such as the skeleton, the brain, the
blood, etc.
4. An adequate amount of certain
substances whose nature is not yet
fully known, but whose presence in
the diet has been demonstrated to
affect body growth in animals or
man. These substances, known as
vitamines, growth determinants, or
the unknown dietary factors, are
therefore essential elements in our
food.
5. No substance poisonous to the
average individual nor one which
will not allow of normal digestive
processes.
In addition, to be properly digest-ed
and of the utmost nutritive value,
articles of diet must also be of pleas-ing
taste, palatable, and preferably
of a consistency and appearance sim-ilar
to the foods in customary use
by the race.
Clean milk fulfills all of these re-quirements
for an adequate food bet-ter
than any other single foodstuff.
Milk is, then, in a sense, a com-plete
food; if used as a sole food it
will sustain life and allow growth.
It is used as an exclusive diet for
young children, but after infancy
supplementary foods need to be in-cluded
in the diet for the best de-velopment.
For one reason, milk
—
which, in respect to all its ingredi-ents,
ranks among the most digesti-ble
of all animal foods—is so com-pletely
digested that there is practi-cally
no waste. Though this com-plete
digestibility renders milk one
of the most efficient foodstuffs, a cer-tain
amount of nondigestible mate-rial
in the food—so-called roughage —is necessary to regulate the dis-charges
from the digestive tract. For
this reason, and for several others, a
mixed diet after the first year of
life is better than an exclusive milk
diet.
Milk has in the curd a protein of
a more valuable nature in regard to
its ability for building or renewing
body tissues than that found in vege-tables,
or even in meat. There is no
other animal protein procurable at
so low a price.
Milk as a source of energy, or as a
fuel for the body, compares most fav-orably
with other foods. The energy
value of a quart of milk is about
equivalent to that of a pound of lean
meat or to eight eggs. As a source
6 The Health Bulletin
of energy cereals are, however, far
cheaper than either milk, meat or
eggs; and, therefore, cereal and milk
is the ideal combination of foods to
furnish body energy in childhood.
Calcium salts (lime), supplied in
our food, are necessary not only for
bone formation, but for the develop-ment
of the important organs of the
body, especially the glands of in-ternal
secretion.
Of all foodstuffs milk is the cheap-est
and most abundant source of
calcium, and milk also provides other
important mineral salts, such as po-tassium
and phosphorus. Therefore,
since growth is measured by bone
formation, and since the child must
have a steady, abundant supply of
these essential minerals, milk should
be included in every child's diet.
Unfortunately, cow's milk is low
in iron content, even as compared
with human milk, and this important
mineral must be supplied in other
foods. The prolonged exclusive use
of milk after early infancy tends to
produce an anemia from lack of iron
in the blood. Iron can best be in-troduced
into the diet through the
early use of fruit, vegetables and
whole cereals.
The abundance, character and di-gestibility
of its proteins and its
large mineral content make milk, as
we have shown, a most desirable
food; but, after all, the most valu-able
properties of milk lie in its con-taining
an abundance of the un-known
dietary factors—the vita-mines
which control growth and
health. One such substance is found
chiefly in milk fat and the organic
fat of certain other animals, but is
not present in vegetable oils or in
pork fat. Eggs and green vegeta-bles,
such as spinach and chard, do
contain appreciable amounts of this
vitamine, but milk is our chief
source. The cream of a quart of
milk contains as much of this vital
substance as is found in all the skim
milk left after the cream is removed.
A second recognized vitamine is pres-ent
in all food consumed in their nat-ural
state and in sufficient abundance
to maintain health. In the manufac-turing
of purified foodstuffs, such as
the polishing of rice or in the milling
of flour, this substance may be lost,
and a diet made up entirely of dena-tured
foods may cause disease or
even death, due to a deficiency in this
essential substance.
A food like milk which, given in
moderate amounts, combines enough
of both of these vitamines to allow
of normal growth and development,
has a value in the human dietary
greater than that of any other single
food.
It is true that appetite in many
cases has to be considered, and an
exclusive diet of any single food sub-stance
becomes distasteful to the
large majority of us and tends to
lower digestive processes and to
cause impaired nutrition. However,
this does not mean that the child
should be allowed to refuse milk as
a substantial part of his daily diet, if
the diet includes, as it should, sev-eral
other forms of food. All normal
children are better for at least one
and a half pints of milk a day. Pov-erty,
of course, may prevent this
amount being provided for every
child, but, if her means permit, the
mother who does not furnish suffi-cient
milk for her children and train
them to drink it is not fulfilling her
duty. Healthy children can be made
to like a varied diet, to eat what is
good for them, and to finish the en-tire
meal provided. Patience, per-sistence
and tact are needed to teach
proper food habits to the young, and,
to be effective, this discipline must
be maintained from birth.
Milk may be given to the child in
cooked form, as soup, weak cocoa, or
flavored milk-shake. If used as a
drink, it should be taken toward the
last of the meal, for many children
will not take sufficient other food if
they fill themselves up first with
milk.
Children who have too rich or too
abundant diet may seem to do bet-ter
with less or even without any
milk, but here the fault is not pri-marily
the quantity of milk, but the
total amount of food. On the other
hand, an exclusive milk die after the
first year is ultimately harmful, and
milk should not be included in the
The Health Bulletin
diet of the child to such an extent
as to prevent the taking of an ordi-nary
amount and variety of food.
Many children can take and thrive on
a quart or more of milk a day. Very
rarely a child has an idiosyncrasy for
milk protein and is made violently
ill by milk.
FOOD AND THE HOME
By Mrs. Jane McKimmon.
I
ONCE heard a long, lean man say,
"I bear in my body now and will
to my dying day the marks of having
been the thing upon which my wife
practiced when she was learning to
cook," and as I looked about the
audience I thought I could see in
other bodies victim after victim who
was marked with the results of some-body's
ignorance.
Not all the marking was done by
bad cooking; something decidedly
more appetizing was required to
round out those ample waist lines, to
put that extra roll on the back of the
neck, and to add so many chins to
the one nature gave.
The woman who feeds her family
the too-common diet of meat and
potatoes, rice and bread, pie and cof-fee,
and does not know what food
factors this diet lacks, as surely
marks her family as does the woman
who has little knowledge of how to
prepare foods properly.
No matter what other job a woman
has, in nine case out of ten the job
of feeding the family is thrust upon
her.
If she knows the food require-ments
of the body and how to use
what is available, things are easy,
she can manage to keep herself in
good condition and start the family
on the road to health. If she does
not know, there is going to be some
marking done.
With a cow and a garden the wom-an
on the farm has the most import-ant
parts of nourishing meals right at
hand.
The city woman can do almost as
well with the supervised dairies and
her back-yard garden.
People all over the country are
eating too much meat, sweets, starch
and fat, and it is time to stress the
advantage gained by substituting
milk for some of the meat and let-ting
garden vegetables furnish a big
part of the daily food provided.
If one is young enough to still be
building the body, he will need
more building material in the shape
of milk, eggs, meat, etc.; but if the
body is already built he must be care-ful
that he provides just enough
building material for repairs. Any
thing over means trouble for the
machinery of digestion and elimina-tion.
I wonder how many people who
read the yeast advertisements know
that the same vitamine heralded
there can be found in milk, cereals,
vegetables and other foods in a much
more palatable form?
Most interesting experiments in
nutrition have brought to us a knowl-edge
of what the vitamine does for
the body and in what foods it may
be found.
For want of a better way of indi-cating
the three vitamines thus far
discovered, they are called fat solu-ble
A, water soluble B, and water
soluble C.
A and B are the important growth-promoters
and are found in many of
the same foods.
A is called the antirachitic vita-mine,
or the preventer of rickets. It
is also a specific in certain eye dis-eases.
B is the antineuritic vitamine, and
the lack of it in the diet causes terri-ble
scourges of beri-beri in some
parts of the world.
C is the antiscorbutic, or the pre-venter
of scurvy.
Fortunately, these vitamines are
found in our common foods. Milk
contains all three of them and is
particularly high in the growth-pro-moters,
A and B.
The Health Bulletin
It is in the cream of milk that A,
the fat soluble, is found, and butter,
eggs, the glandular organs of ani-mals
(liver, kidneys, etc.) furnish
rich sources.
Cod liver oil is said to contain 2 50
times as much as any other source,
and doctors universally administer
it in cases of rickets. However,
spinach, turnip greens, cabbage, col-lards,
lettuce, string-beans, okra,
asparagus and other leafy and succu-lent
vegetables contain the rickets-preventing
vitamine, and with milk
furnish in the dietary the common
sources from which we obtain pro-tection
for children.
When one realizes that in addition
to the easily assimilated fat and su-gar
which milk contains, it supplies
vitamines for growth, lime and phos-phorus
for bones and teeth, and fur-nishes
just about the highest quality
protein for body-builder in existence,
one is in full sympahty with the
nutrition specialists who are urging
one pint of milk per day for adults
and one quart for children.
Because a cow has no power with-in
her body to manufacture vita-mines,
it is very necessary that she
be allowed to feed upon the green
things that are so rich in these food
factors, if her milk is to contain the
valuable growth-promoting vita-mines.
Let her graze on grass, clover,
alfalfa and other green and leafy
things, in addition to feeding on the
grains and other dry foods.
Equally bad would it be to deprive
a nursing mother of green and leafy
vegetables. Let no old-wives tales
influence her to restrict her diet for
fear of giving the baby the colic.
I was once in a state where a num-ber
of boarding school pupils com-plained
of a certain eye trouble. The
wise examining physician felt that
the number so suffering was too large
in proportion to the number of pupils
in the school, and he immediately
called upon the dietitian to show
what she was providing for the daily
meals.
Potatoes, cereals, bacon, molasses,
some muscle-meat, bread and oleo-margarine
comprised the bill of fare;
no milk, no green vegetables, no
fruit, and a substitute for butter.
The physician ordered a pint of
milk and a green salad every day
for each girl affected, and in a short
time a great percentage of the eye
trouble disappeared.
In a town where the animal indus-try
division of the state college and
the division of home demonstration
work were putting on a milk-for-health
campaign school children were
weighed and measured and the
amount of malnutrition indicated was
recorded. In one school where the
children of well-to-do parents were
examined malnutrition affected six-teen
per cent. In a school for negro
children on the outskirts of town
only fifteen per cent were affected.
The negro children had no more
milk than the whites, but I attribute
that lowering by one per cent to the
little vegetable garden out behind
almost every negro cottage; to the
collard and the turnip greens, the
cornfield peas and onions; and to the
generous amount of pot-liquor and
cornbread which they consumed.
Pot-liquor and vegetable soup save
for us much of the mineral salts and
water-soluble vitamines that are usu-ally
poured off in the water in which
vegetables are cooked.
Vitamine B is found in so many
of our common foods that almost all
of us would take in enough for
health's sake if we ate the ordinarily
well-planned meals.
Cereals which do not have all of
the outer covering or embryo re-moved
from the grain (and this in-cludes
bread made with brown flour),
milk, eggs, glandular organs, nuts,
green vegetables with spinach at the
top, and yeast, all contain B. It is
highly concentrated in yeast, and un-der
certain conditions it may be ad-visable
to administer it in this form;
but any of the things mentioned
above will keep us well supplied if
we use them in our daily meals. In
cooking vegetables never use soda in
the water, as alkali destroys vita-mines.
Physicians frequently advise the
feeding of well-steamed spinach to in-fants.
This provides them with both
The Health Bulletin
of the growth-promoting vitamines,
and if the vegetable is mashed
through a sieve before serving it is
not difficult of digestion.
The homely old cabbage as well as
turnip salad furnishes favorite North
Carolina dishes. They are grown in
almost every garden, and can be
served to suit almost any palate.
Cabbage contains all three of the
vitamines in quantity, but it is only
when served raw that we get the
benefit of C, the scurvy preventer.
This vitamine is affected by heat, and
cabbage in the form of cold slaw is
one of our chief sources. It can hold
its own with oranges, grapefruit,
lemons and tomato juice as a scurvy-preventer.
Raw onions, celery and
to a small extent pears, apples and
grapes are also sources of C.
But you are saying the people of
this country do not suffer with
scurvy. It is only men on long arctic
voyages and soldiers shut off entirely
from green things who are affected.
I am not so sure of that. Perhaps
we do not have scurvy in its usually
severe and recognizable form, but
there are people all around us who
are showing mild scurvy symptoms.
Those infants fed on sterilized milk
without the addition to the diet of
orange or tomato juice; those adults
who come through a fall and winter
with practically no raw fruit or green
vegetables, all are manifesting the
lack and it is interesting to note how
readily these symptoms respond to
proper diet. Try raw fruit and vege-tables
all through the winter for
"that tired feeling" in spring.
Immature pods, such as string
beans and okra, and fleshy leaves and
shoots, like asparagus, have a vita-mine
value the same as leafy vege-tables.
Don't forget in planning your daily
meals to add those roots which fur-nish
water and fibrous material to
help keep the bowels properly emp-tied.
We need the stringy and fib-rous
foods as well as the bran of
grains to sweep down the sides of
the intestines, and a liberal amount
of these should help us reduce the
size of our medicine shelf.
Our old friends, parsnips and car-rots,
beets and turnips, will do their
best to help in this particular.
Neither corn at the milky stage, on
the cob or in the many other delecta-ble
dishes, nor garden nor field peas,
need a boost to get them on the fam-ily
table.
Potatoes of both kinds are even
more popular. In fact, there is dan-ger
of their being used so freely as
to exclude other necessary vegeta-bles.
The Irish potato is a valuable
vegetable because of its universal
use. It contains mineral salts, espe-cially
iron, and an easily digested
starch, if that starch is well cooked,
but its vitamine value' is not high.
The sweet potato contains some of
the growth-promoting vitamines, as
well as starch and sugar. It contains,
also, phosphorus, iron and lime.
Having all these things in mind,
what shall we have for breakfast,
dinner and supper?
Begin the day with an orange, or
half grapefruit, a raw tomato, or
some of our orchard fruit, raw. This
will furnish the scurvy-preventer.
Follow with oat-meal, puffed wheat,
or any other grain which retains some
of its outside covering or embryo.
Pour over this cream or the top of
the milk.
In the grain we have vitamine B
and in the cream vitamine A, both
growth-promoters.
If your appetite is vigorous, con-tinue
with an egg and bacon, if you
like. Drink a glass of milk, even if
it has to follow that soul-satisfying
cup of coffee.
At dinner eat for a body-builder or
repairer whatever meat pleases you,
or it might be poached egg, or a milk
dish, and serve with it a leafy vege-table,
a juicy and fibrous root, and,
if possible, a lettuce or other green
vegetable salad. You can provide as
an energy-producer whatever starch
suits you in the way of potatoes,
bread, rice or macaroni, and choose
your dessert from any of the follow-ing:
stewed fruits, ice cream, pud-dings,
fruit pies, or jellies.
If dinn