LIBRARY
University of NortH Carolina
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This book must not
be token from the
Library building.
Form No. 471
FOURTEENTH BIENNIAL REPORT
OF THE
NORTH CAROLINA
STATE BOARD OF HEALTH
1911-1912
M
RALEIGH
Edwards & Broughton Printing Co., State Printers and Binders
1913
Members of the State Board of Health
Elected by tlie JVorth Carolina Medical Society:
David T. Tayloe, M.D., Washington.
Term expires 1913.
J. E. AsHCKAFT. M.D., Monroe.
Term expires 1913.
Thomas E. Axderson, M.D., Statesville.
Term expires 1917.
Chas. O'H. Laughinghouse, M.D., Greenville.
Term expires 1917.
Appointed by the Governor:
Richard H. Lewis, M.D., Raleigh.
Term expires 1913.
Edvfaed C. Register, M.D., Charlotte.
Term expires 1913.
J. L. Ludlow, C.E., Winston-Salem.
Term expires 1915.
J. Howell Way, M.D., Waynesville.
Term expires 1917.
W. O. Spencer, M.D.. Winston-Salem.
Term expires 1917.
J
County Superintendents of Health
Alamance Dr. Geo. W. Long Graham.
Alexander Dr. S. T. Crowson Taylorsville.
Alleghany Dr. Jas. L. Doughton Sparta.
Anson Dr. E. S. Ashe Wadesboro.
Ashe Dr. J. W. Colvard Jefiferson.
Avery Dr. J. R. Sutton Elk Park.
Beaufort Dr. E. M. Brown Washington.
Bertie Dr. John L. Pritchard Windsor.
Bladen Dr. L. B. Evans Clarkton.
Brunswick Dr. J. Arthur Dosher Southport.
Buncombe Dr. D. E. Sevier Asheville.
Burke Dr. E. W. Phifer Morganton.
Cabarrus Dr. R. M. King Concord.
Caldwell Dr. C. B. McNairy Lenoir.
Camden Dr. W. W. Sawyer Shiloh.
Carteret Dr. Ben F. Royal Morehead City.
Caswell Dr. S. A. Malloy Yanceyville.
Catawba Dr. H. E. Rowe Newton.
Chatham Dr. L. E. Farthing Pittsboro.
Cherokee Dr. J. N. Hill Murphy.
Chowan Dr. H. M. S. Cason Edenton.
Clay Dr. P. B. Killian Hayesville.
Cleveland Dr. T. E. McBrayer Shelby.
Columbus .Dr. H. B. Maxwell Whiteville.
Craven Dr. J. F. Rhem New Bern.
Cumberland Dr. Wm. S. Jordan Fayetteville.
Currituck Dr. Stuart Mann Moyock.
Dare Dr. W. B. Fearing Manteo.
Davidson Dr. David J. Hill Lexington.
Davie Dr. J. W. Rodwell Mocksville.
Duplin Dr. J. O. Newell Kenansville.
Durham Dr. N. M. Johnson Durham.
Edgecombe Dr. Spencer P. Bass Tarboro.
Forsyth • Dr. John Bynum Winston-Salem.
Franklin Dr. J. E. Malone Louisburg.
Gaston Dr. L. N. Glenn Gastonia.
Gates Dr. G. D. Williams Gatesville.
Graham Dr. Geo. F. Brock Brock.
Granville Dr. S. D. Booth Oxford.
Greene Dr. W. B. Murphy Snow Hill.
Guilford Dr. W. M. Jones Greensboro.
Halifax Dr. I. E. Greene Weldon.
Harnett Dr. J. W. Halford Chalybeate Spgs.
Haywood Dr. J. R. McCracken Waynesville.
Henderson ur. J. S. Brown Henderson ville.
Hertford Dr. Geo. E. Harrell Murfreesboro.
Hoke Dr. G. W. Brown Raeford.
Hyde Dr. R. E. Windley Swan Quarter.
Iredell Dr. A. Campbell Statesville.
Jackson Dr. D. D. Hooper Sylva.
Johnston Dr. A. H. Rose Smithfield.
Jones Dr. A. F. Hammond Pollocksville.
Lee ; . . . .Dr. J. P. Monroe Sanford.
Lenoir Dr. Albert D. Parrott Kinston.
Lincoln Dr. J. W. Saine Lincolnton.
McDowell Dr. Guy S. Kirby Marion.
Macon Dr. P. L. Siler Franklin.
Madison Dr. Chas. N. Sprinkle Marshall.
Martin Dr. Wm. E. Warren Williamston.
Mecklenburg Dr. C. S. McLaughlin Charlotte.
Mitchell Dr. V. R. Butt Bakersville.
Montgomery Dr. C. Daligny Troy.
Moore Dr. A. C. Bethune Aberdeen.
Nash Dr. Jas. P. Battle Nashville.
New Hanover Dr. W. D. McMillan Wilmington.
Northampton Dr. H. W. Lewis Jackson.
Onslow Dr. Cyrus Thompson Jacksonville.
Orange Dr. C. D. Jones Hillsboro.
Pamlico Dr. D. A. Dees Bayboro.
Pasquotank Dr. Zeno Fearing Elizabeth City.
Pender Dr. R. H. Bradford Burgaw.
Perquimans Dr. T. S. McMullen Hertford.
Person Dr. W. A. Bradsher Roxboro.
Pitt Dr. L. C. Skinner Greenville.
Polk Dr. Earle Grady Tryon,
Randolph Dr. L. M. Fox Asheboro.
Richmond Dr. L. D. McPhail Rockingham.
Robeson Dr. B. W. Page Lumberton,
Rockingham Dr. Sam Ellington JVentworth.
Rowan Dr. M. L. Smoot Salisbury.
Rutherford Dr. A. A. Kucker Rutherfordton.
Sampson Dr. Geo. M. Cooper Clinton.
Scotland Dr. Peter McLean Laurinburg.
Stanly Dr. J. N. Anderson Albemarle.
Stokes Dr. J. W. Neal R. 3, Walnut Cove.
Surry Dr. John R. Woltz Dobson.
Swain Dr. A. M. Bennett Bryson City.
Transylvania Dr. C. W. Hunt Brevard.
Tyrrell Dr. C. A. Flowers Columbia.
Union Dr. H. D. Stewart Monroe.
Vance Dr. E. F. Fenner Henderson.
Wake Dr. J. J. L. McCullers McCullers.
Warren Dr. M. P. Perry Macon.
Washington Dr. Alpheus W. Disosway Plymouth.
Watauga Dr. J. W. Jones Boone.
Wayne Dr. T. M. Bizzell Goldsboro.
Wilkes Dr. J. M. Turner N. Wilkesboro.
Wilson Dr. W. S. Anderson Wilson.
Yadkin Dr. M. T. Royall Yadkinville.
Yancey Dr. J. B. Gibbs Burnsville.
Letter of Transmittal
North Carolina State Board of Health,
Office of the Secretary,
Ealeigh, J^. C, December 11, 1912.
His Excellency, W. W. Kitchin,
Governor of North Carolina.
My Dear Sir :—Under the authority of Section 3, Chapter 62, of the
Public Health Laws of North Carolina, as amended by the General
Assembly of 1911, I have the honor to submit the Biennial Report of
the State Board of Health for the years of 1911 and 1912.
It should be most grattifying to you to reflect, in retiring from your
high ofiice, upon the progress made in the health work of this State
during _your administration, as indicated in this and the preceding
Biennial Eeport of the North Carolina State Board of Health. Your
real appreciation of this fundamental public problem—the health of
the people of the State—your hearty sympathy with the work of the
Board of Health, your cordial cooperation whenever your services have
been asked, and your strong and effectual suppoi't of needed legislation
and more adequate appropriations wall always be a gratefid memory
to the State Board of Health.
Very respectfully yours,
W. S. Rankin,
Secretary and Treasurer.
Progress During the Last Two Years in the State
Health Work
Legislative Enactment
The General Assembly of 1911 is deserving of the appreciation of the
people of North Carolina for the constructive legislation pertaining to
public health which it enacted. Many of the public health laws were
so amended as to make them of more practical value and of easier
enforcement. The appropriation for State Health work was increased
from $8,500 to $22,500.
PUBLIC HEALTH LAWS OF NORTH CAROLINA AS AMENDED BY
THE GENERAL ASSEMBLY OF 1911
The General Assembly of North Carolina do enact:
Section 1. State Board of Health, how elected.
The Medical Society of the State of North Carolina shall choose Election and
,, . ,. 1 , i, ^ „ appointment of
from Its members by ballot four members and the Governor or board,
the State shall appoint five other persons (one of whom shall be
sanitary engineer), and they shall constitute the North Carolina
Board of Health.
Sec. 2. Term of office; vacancies, how filled.
The members of the board of health elected by the State Medi- Terms of office.
cal Society shall be chosen to serve for six years. Their term of
office shall begin immediately upon the expiration of the meeting
at which they were elected. Those appointed by the Governor
shall serve for six years, their term of office beginning with the
first regular meeting of the board after their appointment. In Vacancies,
case of death or resignation, the board shall elect new members
to fill the unexpired terms: Provided, the Governor shall fill such Proviso: vacancies
T ... filled by governor.
vacancies as may occur where he has made appointments.
Sec. 3. Duties of the State Board of Health.
The Board of Health shall take cognizance of the health inter- Co?nizance of
ests of the people of the State; shall make sanitary investigations ""'^
' '" ^^^^ ^'
and inquiries in respect to the people, employing experts when
necessary; shall investigate the causes of diseases dangerous to investigations and
the public health, especially epidemics, the sources of mortality, '"'^"'"es.
the effect of locations, employments, and conditions upon the pub-lic
health. They shall gather such information upon all these Distribution of
matters for distribution among the people, with the especial pur-'"f°""''^*'°°-
pose of informing them about preventable diseases. They shall Medical advisers.
be the medical advisers of the State, and are herein specially
provided, and shall advise the Government in regard to the loca- Location, con-tion,
sanitary construction, and management of all State institu- management of
tions, and shall direct the attention of the State to such sanitary ^^"^^ institutions,
matters as in their judgment affect the industries, prosperity,
8 NORTH CAROLINA BOARD OF HEALTH
Inspections.
Biennial reports.
health and lives of the people of the State. They shall make an
inspection once in each year, and at such other times as they may
he requested to do so by the State Board of Charities, of all pub-lic
institutions, including all convict camps under the control of
the State's Prison, and make a report as to their sanitary con-dition,
with suggestions and recommendations, to their respective
boards of directors or trustees; and it shall be the duty of the
officials in immediate charge of said institutions to furnish all
facilities necessary for a thorough inspection. The secretary of
the board shall make biennially to the General Assembly, through
the Governor, a report of their work.
Jurisdiction in
times of epidemic.
Bulletins of out-break
of disease.
Inquiries into
outbreaks
Compensation of
members on duty.
Officers.
Terms of office.
Executive com-mittee.
Executive office.
Residence of
secretary.
State health
officer.
Compensation.
Special assistant.
Sec. 4. May make regulations in times of epidemics.
In times of epidemics of smallpox, yellow fever, typhoid fever,
scarlet fever, diphtheria, typhus fever, bubonic plague, and cholera
the State Board of Health shall have sanitary jurisdiction in all
cities and towns not having regularly organized local boards of
health, and are hereby empowered to make all such regulations
as they may deem necessary to protect the public health, and to
enforce them by suitable penalties.
Sec. 5. Bulletins of diseases issued; rules made to check dis-ease;
pay of members for.
Bulletins of the outbreak of disease dangerous to the public
health shall be issued by the State board, whenever necessary, and
such advice freely disseminated to prevent and check the invasion
of disease into any part of the State. It shall also be the duty
of the board to inquire into any outbreak of disease, by personal
visits or by any method the board shall direct. The compensa-tion
of members on such duty shall be four dollars a day and all
necessary traveling and hotel expenses.
Sec. 6. Officers of; salary of secretary; pay of members.
The State Board of Health shall have a president, a secretary
who shall also be treasurer, and an executive committee, said
executive committee to have such powers and duties as may be
assigned it by the board of health. The president shall be elected
from the members of the board and shall serve six years; the
secretary-treasurer shall be elected from the registered physicians
of the State and shall serve six years. The executive committee
shall be composed of the president, the engineer member of the
board, ex officio, and one other member of the board to be elected
from those composing it. The executive office of the board shall
be in the city of Raleigh, and the secretary shall reside there.
The secretary shall be the executive officer of the board and shall,
under its direction, devote his entire time to public health work,
and shall be known as the "State Health Officer." He shall re-ceive
for his service such yearly compensation as shall be fixed
by the board, not to exceed three thousand dollars and his actual
traveling and hotel expenses when engaged in the work of the
board. The board may in its discretion elect as a special assist-
FOURTEENTH BIENNIAL REPORT 9
ant to the State Health Officer, for the antituberculosis work, the
Secretary of the State Association for the Prevention of Tuber-culosis,
at an annual salary not to exceed six hundred dollars. Salary.
The members of the board shall receive no pay, except that each Members of
member shall receive four dollars and necessary traveling and ^"'^^
'
hotel expenses when on actual duty in attending the meetings of
the board or of the executive committee or in pursuing special
investigations in the State; excepted further, that the board, in its Consulting
, „ , , , engineer.
discretion, may employ the engineer member of the board as a
consulting engineer for such compensation as may be agreed
upon; but when attending important meetings beyond the limits Delegates,
of the State, the number of delegates thereto being limited to one,
in addition to the secretary, only actual traveling and hotel ex-penses
shall be allowed. These sums shall be paid by the treas-urer
on authenticated requisition, approved and signed by the
president.
Sec. 7. Time of meeting to elect officers.
The meetings of the State Board of Health for the election of J'"]"
°f ^feting
to elect officers.
officers shall be on the second day of the annual meeting of the
Medical Society of the State of North Carolina in the year one
thousand nine hundred and one and every six years thereafter.
Sec. 8. Tivie of special and regular meetings.
Special meetings of the State Board of Health may be called Special meetings.
by the president through the secretary. The regular annual meet- Annual meeting.
ing shall be held at the same time and place as the State Medical
Society, at which time the secretary shall submit his annual re- Annual report.
port. The executive committee shall meet at such times as the Meetings of execu-president
of the board may deem necessary, and he shall call
'^®°°™"'
such meetings through the secretary.
Sec. 9. County board of health, icho constitutes ; election county
superintendents of health.
The chairman of the board of county commissioners, the mayor Members of
of the county town, and in county towns where there is no mayor heaHh'
^°'*'^'^' °^
the clerk of the Superior Court, and the county superintendent of
schools shall meet together on the first Monday in April, one
thousand nine hundred and eleven, and thereafter on the first
Monday of January in the odd years of the calendar, and elect
from the regularly registered physicians of the county, two physi-cians,
who, with themselves, shall constitute the county board of
health. The chairman of the board of county commissioners shall Organization.
be the chairman of the county board of health, and the presence Quorum.
of three members at any regular or called meeting shall consti-tute
a quorum. The term of office of members of the county board Tf™ of office.
of health shall terminate on the first Monday in January in the
odd years of the calendar, and while on duty they shall receive ^^y-four
dollars per diem, to be paid by the county. The county Health interests
, , of countv.
board of health shall have the immediate care and responsibility
of the health interests of their county. They shall meet annually -'^'*°"^i meetings.
10 NORTH CAROLINA BOARD OK HEALTH
Called meetings.
Powers.
Proviso: expendi-tures
approved
by county com-missioners.
County superin-tendent
of health.
Term of office.
Proviso- appoint-ment
on failure of
county board to
elect.
Compensation.
Violation of rules
and reiiulations a
misdemeanor.
Punishment.
Duties of county
superintendents
of health.
Monthly inspec-tions
and reports.
Proviso: power to
employ and pay
other physicians.
Proviso: liability
of county super-intendent.
in the county town, and three members of the board are author-ized
to call a meeting of the board whenever in their opinion the
public health interest of the county requires it. They shall make
such rules and regulations, pay such fees and salary, and impose
such penalties as in their judgment may be necessary to protect
and advance the public health: Provided, that all expenditures
shall be approved by the board of county commissioners before
being paid. At their first annual meeting on the second Monday
of May, one thousand nine hundred and eleven, and thereafter on
the second Monday of January in the odd years of the calendar,
they shall elect the county superintendent of health, who shall
serve thereafter until the second Monday in January of the odd
years of the calendar: Provided, that if the county board of
health of any county shall fail to elect a county superintendent of
health within two calendar months of the time set in this section,
the Secretary of the State Board of Health shall appoint a regis-tered
physician of good standing in the said county, who shall
serve the remainder of the two years, and shall fix his compensa-tion,
to be paid by the said county in proportion to the salaries
paid by other counties for the same service, having in view the
amount of taxes collected by said county.
Sec. 10. Rules of county board of health.
If any person shall violate the rules and regulations made by
the county board of health he shall be guilty of a misdemeanor,
and fined not exceeding fifty dollars or imprisoned not exceeding
thirty days.
Sec. 11. Duties of county superintendent of health; penalty for
nonperformance.
The duties of the county superintendents of health shall be to
make the medico-legal post mortem examinations for the coroners'
inquests, to make examinations of lunatics for commitment, to
render professional service to the sick inmates of the convict
camp, jail, and county home, upon request of the superintendent
or the keeper of these institutions, and to determine the nature of
any particular disease, upon the request of the quarantine or
deputy quarantine officer; to make monthly inspections of the
aforesaid institutions, and to report, upon blank forms supplied
and in accordance with directions furnished therewith by the
State Board of Health, the result of these monthly inspections to
the chairman of the board of county commissioners, and to the
Secretary of the State Board of Health, not later than the fifth
day of the following month: Provided, that the county superin-tendent
of health shall have the right to employ and to fix the
compensation of any other regularly registered physician of his
county, to perform any or all of the duties pertaining to the jail,
county home, or convict camp, when in his judgment it is desira-ble
to do so: Provided, however, that the county superintendent of
health shall still be liable for any failure on the part of the physi-cian
contracted with to carry out the provisions: Provided fur-
FOURTEENTH BIENNIAL REPORT 11
ther. that if a county superintendent of health shall be employed Proviso: duties of
!_!• 1 lii- 1 v,„ Pountv superin-to
devote his entire time to the county public health work, he indent exdu-shall
perform, in addition to the aforesaid duties, the duties of "^'^'''y employed.
quarantine officer, and the following additional duties; he shall Examina^ion^of^
make a sanitary examination during the summer months of every and grounds.
public school building and grounds in the county, and no school
committee or teacher shall make use of any school building or
grounds until the county superintendent of health shall certify in
writing that said building and grounds have been inspected and
found to be in a satisfactory sanitary condition within four
months of the date of the certificate. He shall examine every Examination oi
-, , i, J. 1 children.
school child that has previously been examined by the teacher
according to methods furnish said teacher by the county super-intendent
of schools, and reported to said county superintendent
of schools as probably defective in the condition of its eyes, ears,
nose or throat, and he shall further endeavor to have examined Examinations for
' nooKwornis.
the feces of every child whom he suspects of having hookworm
disease. He shall notify on blank forms and in accordance with Notification to
P3. 1 tr II Lo •
instructions furnished by the State Department of Public Instruc-tion,
every parent or guardian of a child having any defect of the
aforesaid organs, or hookworm disease, and he shall suggest to
said parent or guardian the proper course of treatment and urge
that such treatment be procured. He shall cooperate fully with ^^o-f^pe^j^^tmn with
the county board of education, the county superintendent of officers,
schools, and the teachers in the public schools, to the end that
children may be better informed in regard to the importance of
health and the methods of preventing disease. He shall, through Educational work,
the county press, public addresses, and in every available way,
endeavor to educate the people of his county to set a higher value
on health, and to adopt such public and private measures as will
tend to a greater conservation of life. Any violation of this sec- Violation of sec-
.1 111, 1. i. ^T- 1 tion a raisde-tion
shall constitute a misdemeanor, and shall subject the de- meanor.
fendant to a fine of not less than ten dollars nor more than fifty Punishment.
dollars.
Sec. 12. Abatement of nuisances.
Whenever and wherever a nuisance shall exist which in the Notification to
opinion of the county superintendent of health is dangerous to the '^^J^im nuisance.
public health, it shall be his duty to notify in writing the parties
responsible for its continuance, of the character of the nuisance
and the means of abating it. Upon this notification, the parties Abatement of
shall proceed to abate the nuisance: Provided, however, that if
the party notified shall make oath or affirmation before a justice
of the peace of his or her inability to carry out the directions of
the superintendent, it shall be done at the expense of the town,
city, or county in which the offender lives. In the latter case the i^imit of expense,
limit of the expense chargeable to the city, town, or county shall
not be more than one thousand dollars in any case: Provided, proviso: due
further, that nothing in this section shall be construed to give the p^^o^ss of law.
superintendent the power to destroy or injure property without a
due process of law as now exists for the abatement of nuisances.
12 NORTH CAROLINA BOARD OF HEALTH
Failure to abate
nuisance a mis-demeanor.
Punishment.
Election of
municipal health
officer.
Regulations, sal-aries
and penal-ties.
Duties of munic-ipal
health officer.
Health officer
exclusively
employed.
Violation of sec-tion
a misde-meanor.
Punishment.
Duties of quar-antine
officer.
Persons eligible to
appointment.
Appointment.
Sec. 13. Nuisance; failure to abate.
If any person, firm, corporation, or municipality responsible for
the existence and continuance of a nuisance, after being duly
notified in writing by the county superintendent of health to abate
said nuisance, shall fail to abate the same for twenty-four hours
after such notice prescribed, he shall be guilty of a misdemeanor,
and shall be fined two dollars a day as long as said nuisance
remains.
Sec. 14. Election of ynunicipal health officer; provision for mu-nicipal
health.
The authorities of any city or town, not already authorized in
its charter, are hereby authorized to elect a municipal health offi-cer
when, in their judgment, municipal health would be improved
thereby, and to make such regulations, pay such fees and salaries,
and impose such penalties as in their judgment may be necessary
for the protection and the advancement of the public health.
Sec. 15. Duties of the municipal health officer; penalty for non-perfq^
mance.
The duties of the municipal health officer, within the jurisdic-tion
of the town or city for which he is elected, shall be identical
with those of the county superintendent of health for the county,
with the exception of the duties of the county superintendent of
health pertaining to the jail, convict camp, and county home.
The authorities of any city or town shall have the power to as-sign
the duties of quarantine officer to the municipal health offi-cer,
and in such cases the municipal health officer shall faithfully
perform the duties of the quarantine officer as prescribed in sec-tions
twenty and twenty-one of this act, and shall be subject to
the penalties of the aforesaid sections for refusal or nonperform-ance
of duty. If the municipal health oflacer shall be employed
to devote his entire time to the public health interests of his
town or city, he shall also discharge all the duties pertaining to
the public schools of his town or city which are assigned in
section twelve to the county superintendent of health. Any one
violating any of the provisions of this section shall be guilty of a
misdemeanor, and subject to a fine of not less than ten dollars
nor more than fifty dollars.
Sec. 16. Quarantine ; quarantine officers.
All laws pertaining to the reporting, recording, and quarantine
of the diseases mentioned in section eighteen, and all laws per-taining
to disinfection, shall be faithfully enforced by the quaran-tine
officer. The county superintendent of health, the municipal
health officer, or any other citizen shall be eligible to this office
after presenting satisfactory evidence to the State Board of
Health of his ability to discharge the duties of quarantine officer
and after being approved by said board. After such approval
the chairman of the board of county commissioners on the first
Monday in May, one thousand nine hundred and eleven, and
FOURTEENTH BIENNIAL REPORT 13
thereafter on the second Monday of January in the odd years of
the calendar, shall appoint a quarantine officer for his county, who Term of office.
shall serve thereafter until the second Monday in January of the
odd years of the calendar: Provided, that if the chairman of the Appointment by
, ,t ^ , ^ -J. State board.
board of county commissioners of any county shall fail to appoint
a quarantine officer within one calendar month of the time set in
this section, the State Board of Health shall appoint said officer,
who shall serve the remainder of two years.
Sec. 17. Reporting of infectious diseases by householder.
If a householder knows that a person within his family is sick Householders to
, give immediate
with smallpox, diphtheria, scarlet fever, measles, whooping cough, notice of infec-yellow
fever, typhus fever, cholera, or bubonic plague, he shall ^'^°^ iseases.
immediately give notice thereof to the quarantine officer or the
deputy quarantine officer.
Sec. 18. Reporting of infectious diseases hy physicians.
If a physician suspects that a person whom he is called to visit Physicians to
notify quarantine
is infected with smallpox, diphtheria, measles, whooping cough, officer of suspects.
scarlet fever, typhus fever, yellow fever, cholera, or bubonic
plague, he is hereby empowered and authorized to quarantine the
Individual of the household according to the quarantine rules and
regulations of the State Board of Health, and he shall immedi-ately
give notice thereof to the quarantine officer or deputy quar-antine
officer.
Sec. 19. Reporting of infectious diseases hy quarantine officer.
The quarantine officer shall record on duplicate forms supplied Quarantine
by the State Board of Health and in accordance with instructions reports.*"
^^'^°^
furnished therewith, all diseases reported in pursuance of sec-tions
eighteen and nineteen. The said officer receiving notice of Reports by quar-the
diseases named in sections eighteen and nineteen shall make
the following report: First, the quarantine officer shall notify the Report to State
Secretary of the State Board of Health, by telegram, within board,
twenty-four hours after receiving information of the presence of
yellow fever, cholera, typhus fever, or bubonic plague, of the ex-istence
of every case of the aforesaid diseases; second, the quar- Report to school
antine officer shall notify the teacher or principal in the school ai^thonties.
attended by members of the family of the sick child, on blank
forms furnished by the State Board of Health, within twenty-four
hours after receiving information of the presence of yellow fever,
cholera, typhus fever, bubonic plague, diphtheria, scarlet fever,
measles, or whooping cough, of the existence of every case of the
said diseases; third, the quarantine officer shall mail to the Secre- Monthly reports
tary of the State Board of Health, not later than the fifth day of ^° ^^''^ ^°''^'^-
the following month, the original record of all cases of yellow
fever, smallpox, measles, cholera, typhus fever, bubonic plague,
diphtheria, scarlet fever, and whooping cough, for the preceding
month: Provided, that the quarantine officers are hereby em- proviso: deputy
powered to appoint, if they desire, one deputy quarantine officer
quarantine officers.
in each township of the county; the tenure of office of such deputy
14 A'OKTH CAROLINA BOARD OF HEALTH
Deputies to notifj-
Pay of deputy.
Liability of quar-antine
officer.
Violation of sec-tion
a misde-meanor.
Punishment.
Penalty.
Responsibility for
enforcement.
Failure a misde-meanor.
Punishment.
Solicitor to pros-ecute.
Inland quaran-tine
and disinfec-tion.
Proviso: quaran-tine
of ports.
Proviso: care and
custody of chil-dren.
Failure to dis-charge
duties a
misdemeanor.
Punishment.
Fees to quaran-tine
officer.
shall be terminable at the pleasure of the quarantine officer. The
deputy quarantine officer, upon receiving notice of the existence of
any of the diseases mentioned in sections eighteen and nineteen,
shall at once notify the quarantine officer, upon suitable blank
forms supplied him for this purpose, and he shall enforce the
rules and regulations governing quarantine and disinfection as
prescribed by the State Board of Health. The compensation of
the deputy quarantine officer shall be such as is agreed upon
between himself and the quarantine officer, who shall be responsi-ble
for the compensation of the deputy. The quarantine officer
shall be liable for the neglect or refusal of his deputy to carry out
the provisions of this act. Any householder, physician, quaran-tine
officer, or any other person who violates the provisions of this
section, shall be guilty of a misdemeanor, and upon conviction
thereof shall be liable to a fine of not less than ten dollars nor
more than fifty dollars, or imprisonment for not less than ten nor
more than thirty days, and shall be liable to a penalty of twenty-five
dollars in favor of any person who shall sue for the same.
The chairman of the board of county commissioners shall be re-sponsible
for the enforcement of sections eighteen, nineteen, and
twenty of this act in his jurisdiction. Failure on his part to en-force
its provisions shall be a misdemeanor, and he shall be liable
to a fine of not less than ten dollars nor more than fifty dollars,
and it shall be the duty of the solicitor of the judicial district in
which he resides, upon complaint of the Secretary of the State
Board of Health, to institute criminal action for the enforcement
of said fine.
Sec. 20. Rules and regulations for quarantine and disinfection;
penalty.
Inland quarantine and disinfection shall be under the control
of the quarantine officer, who shall faithfully enforce the rules
and regulations governing quarantine and disinfection as pre-scribed
by the State Board of Health: Provided, that the quaran-tine
of ports shall not be interfered with, but the officers of the
local and State board shall render all aid in their power to quar-antine
officers in the discharge of their duties, upon the request
of the latter: Provided further, that any child or other person
may remain in custody and care of parents or family. The fail-ure
on the part of the quarantine officer to perform the duties
imposed in this section shall be a misdemeanor, and he shall be
punished for each offense by a fine of not less than ten dollars
nor more than fifty dollars.
Sec. 21. Compensation of quarantine officers.
The county, town, or city treasurer, as the case may be, shall
pay twenty-five cents each, or more if necessary, for the execution
of this act, to the quarantine officer upon presentation of a certi-fied
statement from the Secretary of the State Board of Health
of the number of cases of the diseases mentioned in section nine-teen
reported to the said secretary for the preceding month. He
FOURTEENTH BIENNIAL KEPORT 15
shall also be paid one dollar, or more if necessary, for the execu-tion
of this act for every premises quarantined by him during
the preceding month. He shall further be paid at the rate of one
dollar and fifty cents, or more if necessary, for the execution of
this act for each single room disinfected and one dollar for every
additional room disinfected. All expenses of quarantine and disin- Expense borne by
town or county.
fection shall be borne by the town or county employing a quaran-tine
officer: Provided, that if the chairman of the board of county of^chLlnnaTor
commissioners can secure the execution of the provisions of this county commis-sioners.
act for less than the aforesaid fees, he is hereby empowered to
do so.
Sec. 22. Penalty for refusal or neglect to carry out quarantine.
If any person shall neglect or refuse to comply with the rules Neglect or refusal
to comply with
and regulations governing quarantine and disinfection, as pro- quarantine a mis-vided
in section twenty-one, he shall be deemed guilty of a mis-demeanor,
and upon conviction shall be fined not less than five
Punishment,
dollars nor more than fifty dollars, or imprisoned not less than
ten days nor more than thirty days, at the discretion of the court.
In case the offender be stricken with the disease for which he is
quarantinable, he shall be subject to the penalty on recovery,
unless in the opinion of the Secretary of the State Board of
Health it should be omitted.
Sec. 23. The control of smallpox.
On the appearance of a case of smallpox in any neighborhood. Control of small-town
or city, the quarantine officer shall use all due diligence to
^°'^'
warn the public of its existence and to notify the public of the
proper means for preventing its spread: the said warning and Notification to
..„ . pubhc.
notification to be according to the instructions of the State Health
Officer. The authorities of any town, city, or county shall have Certificates of
., ., , . , ., T ,, ,. , , immunity.
authority to require children attending the public schools to pre-sent
certificate of immunity from smallpox either through recent .
vaccination or previous attack of the disease. If any parent, Persons permit-guardian,
school committee, principal, or teacher shall permit Lu1uy°o'f m^de-a
child to violate such a requirement of the aforesaid authorities, "^e='^"°'"-
he or she shall be guilty of a misdemeanor, and fined not less Punishment.
than ten dollars or more th^n fifty dollars.
Sec. 24. Precaution against contamination.
In the interest of public health, every person, company, or Protection of
municipal corporation or agency thereof selling water to the pub-lic
for drinking and household purposes shall take every reason-able
precaution to protect from contamination and assure the
healthfulness of such water, and any provisions in any charters
heretofore granted to such persons, companies, or municipal cor-porations
in conflict with the provisions of this section are hereby
repealed. The State Board of Health shall have the general over- Ovensight and
sight and care of all inland waters, and shall from time to time, as waterl
"''''"''
it may deem advisable, cause examinations of said waters and Examination of
their sources and surroundings to be made for the purpose of as-
'^''**""^-
water from con-tamination.
16 NORTH CAROLINA BOARD OF HEALTH
Expert assistants.
Rules and regu-lations.
Failure to comply
a misdemeanor.
Punishment.
Consultation with
institutions,
municipalities and
private parties
on water systems.
Plans to be sub-mitted
to State
board.
No contract to
made by State
institutions or
municipalities
until plans
approved by
State board.
Plans of water
systems to be
filed.
be
Noncompliance
with section a
misdemeanor.
Punishment.
Power to condemn
lands.
certaining whether the same are adapted for use as water supplies
for drinking and other domestic purposes, or are in a condition
likely to impair the interests of the public or of persons lawfully
using the same, or to imperil the public health. For the purpose
aforesaid, it may employ such expert assistants as may be neces-sary.
The said board shall make such reasonable rules and regu-lations
as in its judgment may be necessary to prevent contamina-tion
and to secure other purifications as may be required to safe-guard
the public health. Any individual, firm, corporation, or
municipality, or the person or persons responsible for manage-ment
of the water supply, failing to comply with said rules and
regulations, shall be guilty of a misdemeanor, and upon convic-tion
shall be fined or imprisoned, or both, at the discretion of the
court. The State Board of Health shall from time to time consult
with and advise the boards of all State institutions, the authori-ties
of cities and towns, corporations or firms already having or
intending to introduce systems of water supply, drainage or sew-erage
as to the most appropriate source of supply, the best prac-tical
method of assuring the purity thereof; or of disposing of
their drainage or sewage, having regard to the present and pros-pective
needs and interests of other cities, towns, corporations, or
firms which may be affected thereby. All such boards of direc-tors,
authorities, corporations, and firms are hereby required to
give notice to said board of their intentions in the premises and
to submit for its advice outlines of their proposed plans or
schemes in relation to w-ater supplies and disposal of sewage, and
no contract shall be entered into by any State institution or tow-n
for the introduction of a system of water supply or sewage dis-posal
until said advice shall have been received, considered, and
approved by the said board. That for the purpose of carrying
out the general provisions of this section, every municipal or pri-vate
corporation, company, or individual supplying or authorized
to supply water for drinking or other domestic purposes to the
public shall file with the Secretary of the State Board of Health,
within ninety days after the receipt of notice from said secretary,
certified plans and surveys, in duplicate, pertaining to the source
from which the water is derived, the possible source of infections
thereof, and the means in use for the purification thereof, in
accordance with the directions to be furnished by the said secre-tary.
Failure on the part of any individual, firm, corporation, or
municipality to comply with this section shall be a misdemeanor,
and upon conviction those responsible therefor shall be fined not
less than fifty dollars nor more than one hundred dollars, at the
discretion of the court.
Sec. 25. Condemnation of lands.
All municipalities operating water systems and sewer systems,
and all water companies operating under charter from the State
or license from municipalities, which may maintain public water
supplies, may acquire by condemnation such lands and rights in
lands and water as are necessary for the successful operation and
FOUKTEEiS'TH BIENNIAL REPORT 17
protection of their plants, said proceedings to be the same as Proceedings for
. . , condemnation.
prescribed by law for acquiring right of way by railroad com-panies.
Sec. 26. May enter upon lands to lay pipes, etc.
For the purpose of providing water supplies, the directors or Entry ofland for
^ '^ ^ ^ rx- 7 laying pipes.
other lawful managers of any public institution of the State may
enter upon the lands through which they desire to conduct their
pipes for said purpose, and lay them underground, and they at all Entry for repairs.
times shall have the right to enter upon said lands for the purpose
of keeping the water line in repair and do all things to that end.
Sec. 27. Compensation for land.
If damages shall be claimed for the use of such lands, and the Assessment of
parties can not agree as to the amount of compensation to be
paid, they may proceed in the manner now provided by law for
railroad companies to procure right of way.
Sec. 28. Inspections of icatersheds.
Any waterworks that derive their water from a surface supply inspections oi
watersheds.
shall have a quarterly sanitary inspection of the entire watershed,
except in those cases where the supply is taken from large creeks
or rivers that have a minimum daily flow of ten million gallons,
in which case the inspection shall apply to the fifteen miles of
watershed above the waterworks intake. Such water companies inspection of
localities specially
shall cause to be made a sanitary inspection of any particular suspected,
locality on said watershed at least once in every week, whenever
in the opinion of the board of health of the city or town to which
the water is supplied, or, when there is no such local board of
health, in the opinion of the county superintendent of health or in
the opinion of the State Board of Health, there is special reason
to apprehend the infection of the water from that particular
locality by the germs of typhoid fever or cholera. The inspection inspection
defined.
of the entire watershed as herein provided for shall include a par-ticular
examination of the premises of every inhabited house on
the watershed, and, in passing from house to house, a general
inspection for dead bodies of animals or accumulation of filth. It Entire watershed
defined.
is not intended that the term "entire watershed" shall include
uninhabited fields and wooded tracts that are free from suspicion.
The inspection shall be made by an employee of and at the ex- inspection by
„ . , . . J . ,, 1.1 • employee of and
pense of said water company in accordance with reasonable in- ^t expense of
structions as to methods, scope, and details, to be furnished by the
i'n^*,^ur°™ifg*°^
'
Secretary of the State Board of Health. The said sanitary in- Directions to
householders.
spector shall give in person to the head of each household on said
watershed or, in his absence, to some member of said household,
the necessary directions for the proper sanitary care of his prem-ises.
It shall further be the duty of said inspector to deliver to Literature on san-each
family residing on the watershed such literature on perti- '
"^ ^" ^^'^ ^'
nent sanitary subjects as may be supplied him by the municipal
health officer or by the Secretary of the State Board of Health.
Full report in duplicate of all such inspections shall be made ^'^^'"*^ °^ ^'^p^''"
18 NORTH CAROLINA BOARD OF HEALTH
Affidavita.
Failure to make
inspections a mis-demeanor.
Punishment.
Proviso: reason-able
excuse.
Superior officer
preventing inspec-tion
guilty.
Punishment.
promptly to the Secretary of the State Board of Health and their
accuracy certified to by the affidavit of the inspector, or such
officer or person as the said secretary may direct.
Sec. 29. Inspections of waterworks ; penalty for failure.
Failure on the part of those having in charge the management
of public water supplies to comply with the law requiring sani-tary
inspections of watersheds shall be a misdemeanor and pun-ished
by a fine of not less than twenty-five dollars nor more than
one hundred dollars, or by imprisonment for not less than ten nor
more than thirty days: Provided, the said ofl^cial does not prove
to the satisfaction of the court that, in spite of reasonable effort
and diligence on his part, he was prevented, directly or indirectly,
by his superiors from doing his duty in this respect; in which
case the said superior officer shall be deemed guilty of a misde-meanor
and punished by a fine of not less than fifty dollars nor
more than two hundred dollars, or by imprisonment for not less
than one nor more than six months.
Sec. 30. Inspectors may enter upon premises.
Each sanitary inspector herein provided for is authorized and
empowered to enter upon any premises and into any building
upon his respective watershed for the purpose of making the
inspections required.
Sec. 31. Residents on watersheds to obey instructions.
Every person residing or owning property on the watershed of
a lake, pond, or stream from which a drinking supply is obtained
shall carry out such reasonable instructions as may be furnished
him in the matter hereinbefore set forth directly by the municipal
a m\3deme°nOT^°*
health officer or by the State Board of Health. Any one refusing
or neglecting to comply with the'requirements of this section shall
be guilty of a misdemeanor and fined not less than ten nor more
Punishment. than fifty dollars, or imprisoned for not less than ten nor more
than thirty days.
Inspectors may
enter on premises.
Residents on
watershed to obey
instructions.
Defilement or cor-ruption
of water
supply a misde-meanor.
Defilement or cor-ruption
defined.
Injury to water-works
a misde-
Discharge of sew-age
forbidden
Sec. 32. Damage to water supply.
If any person shall defile, corrupt, or make impure any well,
spring, drain, branch, brook, creek, or other source of public water
supply by collecting and depositing human excreta on the water-shed,
or depositing or allowing to remain the body of a dead ani-mal
on the watershed, or in any other manner, and if any person
shall destroy or injure any pipe, conductor of water, or other
property pertaining to an aqueduct, or shall aid and abet therein,
he shall be guilty of a misdemeanor.
Sec 33. Sewage not discharged in.
No person, firm, corporation, or municipality shall flow or dis-charge
sewage above the intake into any drain, brook, creek or
river from which a public drinking water supply is taken, unless
the same shall have been passed through some well known system
of sewage purification approved by the State Board of Health;
FOURTEENTH BIENNIAL BEPOKT 19
and the continued flow and discharge of such sewage may be Remedy by
injunction.
enjoined upon application of any person.
Sec. 34. Discharging sewage into certain streams.
If any person, firm, or corporation, or other officer of any Discharge of sew-
*^ ^ age into water
municipality having a sewerage system in charge shall violate the supply a misde-provision
of the law relating to discharging sewage into streams
from which public water is taken, he shall be guilty of a misde-meanor.
Sec. 35. Towns, etc., not having sewerage systems.
All schools, hamlets, villages, towns, or industrial settlements f^^^^^f.^^f "^^f ^^^
1 US Lixuii ons Ou
which are now located or may be hereafter located on the shed of watershed to
. , , . , , maintain system
any public water supply, not provided with a sewerage system, for disposal of
shall provide and maintain a reasonable system approved by the excreta.
State Board of Health for collecting and disposing of all accumu-lations
of human excrement within their respective jurisdiction or
control. Any one refusing or neglecting to comply with the re- Refusal or neg-
•^ £3 = o r jgpj. ^ jjiigdemeanor.
quirements of this section shall be guilty of a misdemeanor and Punishment,
fined not less than ten dollars nor more than fifty dollars or im-prisoned
for not less than ten nor more than thirty days.
Sec. 36. State Laboratory of Hygiene; analysis of loater, sputum.
Mood, etc., appropriation for; tax against water companies.
For the better protection of the public and to prevent the state laboratory
of hvfficnG.
spread of communicable diseases, there shall be established a
State Laboratory of Hygiene, the same to be under the control and
management of the State Board of Health, and it shall be the duty Examinations of
of the State Board of Health to have made in such laboratory ^^;a*«".
monthly examinations of samples from all public water supplies
of the State, of all waters sold in bottle or other package and of
all spring waters that are maintained and treated as an adjunct
to any hotel, park, or resort for the accommodation or entertain-ment
of the public: Provided, that in the case of springs in con- Proviso: springs
in connection with
nection with hotels, parks, or resorts intermittently operated, resorts.
examinations of the water shall be made monthly during the
period only that they are open for the accommodation and enter-tainment
of the public; but if upon the examination of the water
of any such spring it shall be found to be infected or contami-nated
with intestinal bacilli or other impurities dangerous to
health, examination shall be made weekly until its purity and eximkie(fweeWy
safety are shown. The board shall also cause to be made exami- vvell and spring
nations of well and spring waters when in the opinion of any ^'^t^'^-
county superintendent of health or any registered physician there
is reason to suspect such waters of being contaminated and dan-gerous
to health. The board shall likewise have made in this Qther examina-tions.
laboratory examinations of sputum in cases of suspected tuber-culosis,
or throat exudates in cases of suspected diphtheria, of
blood in cases of suspected typhoid and malarial fever, of feces
in cases of suspected hookworm disease, and such other examina-tions
as the public health may require. For the support of the Appropriation.
20 NORTH CAROLINA BOARD OF HEALTH
Annual tax.
Proviso: tax on
sales from springs
and wells.
Reports filed by-water
purveyors.
Double tax for
failure to file
report.
Failure to trans-mit
sample a
misdemeanor.
Punishment.
Transportation
charges.
Analyses of pur-chased
samples.
Collection of tax.
Printing and sta-tionery.
License to foreign
water sellers.
Proviso: evidence
of purity.
said laboratory the sum of four thousand dollars annually is
hereby appropriated and an annual tax of sixty-four dollars, pay-able
quarterly, by each and every water company, municipal,
corporate, and private, selling water to the people: Provided,
that the said annual tax for waters from springs or wells sold in
bottles or otherwise shall be as follows: For springs or wells the
gross annual sales from which for the previous calendar year are
less than two thousand and more than one thousand five hundred
dollars, fifty dollars; less than one thousand five hundred and
more than one thousand dollars, forty dollars; less than one thou-sand
and more than five hundred dollars, thirty dollars; less than
five hundred and more than two hundred and fifty dollars, twenty
dollars, and less than two hundred and fifty dollars, fifteen dol-lars;
and for any spring maintained and treated as an adjunct
to any hotel, park, or resort for the accommodation and enter-tainment
of the public, fifteen dollars, and an additional tax for
water sold in bottle or other package from said spring in accord-ance
with the above schedule. Every corporation, firm, or person
selling water in the manner set forth in this proviso shall file
with the Treasurer of the State Board of Health, within sixty
days after the passage of this act, and annually thereafter in the
month of January, an affidavit as to the gross amount received
from sale of water for the previous calendar year, and upon this
affidavit the tax for the current year shall be based. Failure to
so file said affidavit within the time prescribed shall subject the
said corporation, firm, or person so failing to file said affidavit to
double the tax for the current year. Failure to transmit sample
within five days after receipt of sterilized bottle or container from
the Laboratory of Hygiene shall be a misdemeanor, and upon con-viction
shall subject the delinquent to a fine of twenty-five dollars.
Transportation charges, by mail, shall be paid by the sender; by
express, by the laboratory. When deemed advisable, the said
Laboratory of Hygiene shall analyze samples purchased by it in
the open market, in lieu of those sent direct from the spring. The
said tax shall be collected quarterly by the sheriff as other taxes,
and shall be paid by the said sheriff directly to the Treasurer
of the State Board of Health. The printing and stationery neces-sary
for the laboratory shall be furnished upon requisition upon
the State Printer. Any person, firm, or corporation not a citizen
of the State of North Carolina who shall sell or offer for sale any
water in bottle or other package for consumption by the people of
the State of North Carolina shall obtain a license from the
Treasurer of the State Board of Health, and shall pay for said
license the sum of sixty-four dollars per annum, or less amount,
equal to the tax paid by springs of the same class within the
State, upon compliance with the conditions applying to them, pay-able
in advance: Provided, that satisfactory evidence of purity
furnished by the State laboratory of other States agreeing to
reciprocate in this matter with this State shall be accepted in lieu
of the said license tax. If water sold by any person, firm, cor-
FOURTEENTH BIENNIAL REPOKT 21
poration, or municipality shall be discovered by three successive
analyses made by the State Laboratory of Hygiene to be danger-ous
to the public health, publication of that fact shall be made in Publication of
infection.
the monthly Bulletin of the State Board of Health. The result information of
of said analyses shall be immediately forwarded by mail to the result of analysis.
person, firm, corporation, or municipality selling the water so
analyzed. When upon subsequent analyses the water shall be
found no longer dangerous to health, a certificate thereof shall be
furnished the person, firm, corporation, or municipality offering
the said water for sale, and publication of the fact shall be made
in the said monthly Bulletin: Provided, that this act shall not Proviso: thera-apply
to the therapeutic waters so medicated as to render them p^"*''' waters.
sterile, the question of their sterility to be decided by the director
of the State Laboratory of Hygiene.
Sec. 37. Duties of solicitors to prosecute infringements.
That for every violation of sections twenty-five, twenty-six, Solicitors to pros-twenty-
seven, twenty-eight, twenty-nine, thirty, thirty-one, thirty-
''''"** offenders,
two, thirty-three, thirty-four, thirty-five, thirty-six, and thirty-seven
it shall be the duty of the solicitors of the several judicial
districts, upon the complaint of the Board of Health, or any of
its officers, or of any individual injured or likely to be injured, to
institute criminal action against the person, firm, corporation, or
municipality charged with such violation in their respective dis-tricts,
and prosecute the same.
Sec. 38. Annual appropriation.
For carrying out the provisions of this act as to the duties of Appropriation,
the Board of Health, eighteen thousand dollars, or so much there-of
as may be necessary, is hereby annually appropriated, to be
paid by the State Auditor on requisition, to be signed by the
secretary and president of the State Board of Health, and the Printing and sta-printing
and stationery necessary for the board to be furnished
"°°"y-upon
requisition upon the State Printer: Provided, that one Proviso: diph-thousand
dollars of this appropriation be used annually by t^e
^hena antitoxin.
State Board of Health to arrange for a supply of diphtheria anti-toxin,
which shall be available to the citizens of this State at
contract prices. A yearly statement shall be made to the Gov- Yearly state-ernor
of all moneys received and expended in pursuance of this ™ents.
act.
Sec. 39. Contingent fund.
A contingent fund of five thousand dollars is appropriated, sub- Contingent appro-ject
to the Auditor's warrant, upon the recommendation of the
""^*'°°-
Governor, to be expended in pursuance of the provisions of this
act, when rendered necessary by the visitation of cholera or any
other pestilential disease.
Sec. 40. That all laws and clauses of laws in conflict with
this act are hereby repealed.
Sec. 41. That this act shall be in force from and after its
ratification.
Ratified this the 7th day of March, A. D. 1911.
22 NORTH CAROLIXA BOARD OF HEALTH
AN ACT TO PROVIDE FOR THE REGISTRATION OF DEATHS
IN MUNICIPALITIES OF FIVE HUNDRED POPULATION
AND OVER IN THE STATE OF NORTH CAROLINA.
The General Assembly of North Carolina do enact:
Sectiox 1. Registration towns and local registrars.
Registration towns. That all deaths that occur in cities or towns having a popu-lation
of five hundred or over by the last preceding Federal census
shall be registered by the clerks or other officials designated by
the board of aldermen or town commissioners thereof, who are
Local registrars. hereby Constituted local registrars of deaths, within three days
after the occurrence of said deaths and before the bodies are
removed, interred or otherwise disposed of: Provided, that in
cities or towns now having satisfactory registration of deaths
under their ordinances the health officer or other official now
acting as local registrar shall continue as such, but shall conform
to the provisions of this act and to the regulations of the State
Board of Health, adopted thereunder.
Sec. 2. Death certificates and burial or removal permits.
Certificate of death. That a certificate of death, of standard form, provided by the
State Board of Health shall be filed with the local registrar, by
the undertaker or other person in charge of the removal, inter-ment
or other disposal of the body of the deceased person, and a
Burial permit issued permit shall be issued by said local registrar for such removal,
whin?''^
'''^'^*'^'''^' interment or other disposal of the body only after such a certifi-cate
of the cause of death, signed by the attending physician or,
, in case there shall be no attending physician, by the health officer
or, in case there is no health oflBcer of the city or town, by the
local registrar, who shall give the medical cause of death as
nearly as he can determine it after full inquiry, in regard thereto,
of the householder in whose family the death occurred: Provided,
that under no circumstances shall the local registrar sign the
death certificate when there has been an attending physician or
No interment or there is a municipal health oflficer. No sexton or superintendent
re?i^iT^
^*^°'^* °^ ^ cemetery in cities and towns having a population of five
hundred or over shall permit interment, and no railway company
or other common carrier shall transport a body of a deceased
person whose death occurred in this State unless accompanied
by the local registrar's permit.
Sec. 3. Duties of local and State registrars.
Duties of local That the local r-egistrar shall number each certificate as re-registrar.
ceived, record it in a local register of deaths, and promptly by
the fifth day of the following calendar month send all of the
original certificates to the Secretary of the State Board of Helath
State registrar. at Raleigh, who is hereby constituted State Registrar of Vital
Duties of State Statistics. The State Registrar, with the approval of the State
registrar. Board of Health, shall maintain in his office a bureau of vital
statistics, preserve, index and compile the original returns and
FOURTEENTH BIENNIAL KEPOKT 23
make copies thereof for legal or other purposes as may be neces-sary,
which copies, when officially certificated, shall be prima
facie evidence of the facts therein set forth in all the courts of
the State for all purposes of this act. The State Registrar shall
prepare and distribute all blanks and instructions necessary for
the execution of this act, and shall see that the provisions of
this act are faithfully enforced, and the solicitors of the several Solicitors and
. , , . , . Attorney-General
districts and the Attorney-General shall aid him, upon his re- to aid.
quest, and enforce the penalty of the law in case of its violation.
Each of the said local registrars shall be entitled to a fee of Local registrar's
twenty-five cents for his service under this section, to be paid by
the city or town.
Sec. 4. Penalty for non-performance of duty.
That any undertaker, sexton or superintendent of a cemetery, violation by under-agent
of a transportation company, local registrar, or other per- p^rtation com-son
who violates the provisions of this act, and any attending pany, local regis-physician
who fails or neglects to certify to the cause of death
when the certificate is presented to him for the purpose, and
every local registrar who shall neglect to perform any of the
duties required of him by section three of this act, shall be guilty
of a misdemeanor, and upon conviction thereof shall be liable to Penalty,
a fine of not less than five dollars nor more than fifty dollars or
imprisonment for not less than ten nor more than thirty days,
and shall also be liable to a penalty of twenty-five dollars in favor
of any person who shall sue for the same.
Sec. 5. Mayors responsible for enforcement of this act.
The mayor of each city or town of five hundred or more inhabi- Mayor responsible,
tants shall be responsible for the enforcement of this act in his
jurisdiction. Failure on his part to so enforce its provisions
shall be a misdemeanor, and he shall be liable to a fine of not pjne
less than ten dollars nor more than fifty dollars; and it shall be g^ju^jt^^g ^^ p^^sg.
the duty of the solicitor of the judicial district in which the city cute.
or town is situate, upon complaint of the State Registrar or of
the Secretary of the State Board of Health, to institute a criminal
action for the enforcement of said fine.
Sec. 6. That this act shall be in force from and after its
ratification.
24 NORTH CAROLINA BOARD OF HEALTH
State Public Health Appropriations
North Carolina now appropriates $22,500 annually for tlie cause of
public healtli. This appropriation entitles our State to the twenty-seventh
place in the list of states in respect to our total appropriations,
Taut, on a per capita basis, and this is the proper Avay to compare the
efforts of our State, as indicated by her appropriations, with the efforts
of other states in behalf of public health, we are thirty-seventh in the
list. We spend one cent per capita on our public health; twenty-four
states spend more than twice that much per capita; fourteen states
more than three times that much; eleven states more than four times that
much. Utah spends three cents per capita; Idaho five cents per capita;
Nevada twelve cents per capita; Florida eleven cents per capita; Penn-sylvania
twenty-four cents per capita; District of Columbia thirty-one
cents per capita; Porto Rico forty-four cents per capita, and Hawaii
$2.15 per capita.
Let no one suppose that there is any good reason why our State, one
of the original thirteen, the fourteenth in population, and the twenty-third
in wealth, should spend less on health work than such new and
unsettled states as Idaho, Utah, and Nevada, or the comparatively
uncivilized people of Porto Rico and Hawaii. If North Carolina's
need for health work is to be determined by a comparison of the number
of her people dying per thousand per year as compared with other states,
the small one cent per capita appropriation finds still less justification.
There are twenty states in the Union whose death rates, that is, the
number of people dying annually of the population, are known. These
twenty states have registration laws which require the registration of
all deaths within their borders. North Carolina has had a registration
law in force for three years, which applies only to towns with a popula-tion
of five hundred or over, and whose combined population includes
about one-sixth of the State's population. The death rate for this part
of our State's population is shown, in comparison with the death rates
of the twenty states referred to, in the following table:
CHART C.
Registration States and Their Death Rates.*
Average 15.
1 Washington 10.0 12 Connecticut 15.6
2 Montana 10.6 13 Pennsylvania 15.6
3 Utah 10.8 14 Vermont 16.0
4 Minnesota 10.9 15 Maryland 16.0
5 Wisconsin 12.0 16 New York 16.1
6 California 16.5 17 Massachusetts 16.1
7 Indiana 13.5 18 Maine 17.1
8 Ohio 13.7 19 Rhode Island 17.1
9 Colorado 13.8 20 New Hampshire 17.3
10 Michigan 14.1 21 North Carolinaf 18.4
11 New Jersey 15.5
•Number of deaths per 1000 of population.
fNorth Carolina not accepted by United States Census because of incomplete registration.
FOURTEENTH BIENNIAL REPORT 25
It is, therefore, perfectly apparent tliat .health conditions in North
Carolina do not justify the small appropriation for public health pur-poses
that still obtains in our State.
OTHER PUBLIC HEALTH FUNDS : WATER TAXES.
Our State is blessed with a law which requires all persons, corpora-tions,
and towns supplying water to the public to send samples of their
water to the State Laboratory of Hygiene monthly for examination,
and for these monthly examinations the water companies are required
to pay to the Treasurer of the State Board of Health the sum of
$64.00 a year. The total amount of water taxes amount to about
$4,000 annually. Including these water taxes as State Board of Health
funds it is seen that the Board has a revenue basis of $26,500 annually.
Another source of income that should probably be mentioned in this
connection is the $15,000 annually appropriated by the Rockefeller
Sanitary Commission for their work in this State. This money should
not be considered as State public health funds for two reasons: First,
it is given by an individual; second, it is Jiot directed primarily to
general State health Avork, but, by the terms of the bequest, its use is
restricted to special work—the eradication of hookworm disease. While
it is true that no disease can be attacked without exerting a more or less
general influence against all preventable diseases, the Rockefeller Sani-tary
Commission has.' so far, refrained from alloAving their funos to be
used for general health purposes.
HOW THE HEALTH FUNDS ARE APPORTIONED.
Of the total funds, the Executive Office of the State Board of Health
spends annually on the executive and educational work of the Board,
$12,000.
The State Laboratory of Hygiene spends annually, for laboratory
assistance, apparatus, and chemical materials necessary for analyzing
samples of water, sputum, swabs from the throat, administering the
Pasteur treatment, and for distributing a State supply of antitoxin,
$10,000.
The Rockefeller Sanitary Commission in their work on the eradication
of hookworm disease receive $5,000 of the State's $26,000 public health
funds, which, with the $22,000 appropriated by the Commission, gives
them an annual expenditure in their work of $27,000.
DIVIDENDS FROM THE STATE's INVESTMENT IN PUBLIC HEALTH.
Item No. 1.—The State Laboratory of Hygiene has examined during
the last two years, exclusive of hookworm examinations, 5,137 microscopic
specimens. These specimens consist of particles of expectoration from
suspected consumptives, mucus from throats of suspected diphtheria
patients, blood from suspected typhoid and malarial patients, brains from
suspected mad dogs, and pus or matter from discharging membranes. A
minimum cost of these 5.137 microscopic examinations in other labora-tories
would be $7,705. You may consider, then, that this $7,705 is one
dividend paid by the State Board of Health to the people of the State
on the $26,500 entrusted to the Board.
•2(i NORTH CAROLINA BOARD OF HEALTH
Item Xo. 2.—During the past two years 4,547 water analyses were
made by the State Laboratory of Hygiene. The cost of an analysis
of drinking water varies in different laboratories from $5 to $10 for an
analysis. Taking the smaller figure for a conservative estimate it would
have cost the State $22,735 to have had this work done elsewhere.
$22,735, then, may be considered the second dividend paid on the
State's investment of $26,500 a year.
IteTYi No. 3.—During the last two years 364 people have been given tht
Pasteur treatment administered by the State Laboratory of Hygiene.
The efficacy of the treatment administered by our Laboratory may be
judged from the fact that the average Pasteur Laboratory loses the
life of one patient out of every 250 treated, while our Laboratory has
treated over 500 patients without a single death. The minimum cost
for which these people threatened with hydrophobia may obtain the
treatment elsewhere is $65 a patient. It would, therefore, have cost the
364 patients at this figure $23,660 to have obtained this treatment, and
in addition to this they saved something in railroad fares in coming to
Raleigh rather than going to Richmond or Baltimore. These 364
patients have paid into the State for this treatment $740, which deducted
from $23,660 leaves $22,920, which m-ay be considered the third dividend
paid to the people of the State by the State Board of Health on their
annual iuA-estment of $26,500.
Item Xo. Jf..—The General Assembly of 1911 gave the State Board
of Health authority to contract with the manufacturers of reliable
diphtheria antitoxin for a State supply of antitoxin, to be purchased
from the lowest bidder, and to be distributed to the people through the
State Laboratory of Hygiene and through antitoxin distributing stations
in the counties at just what it cost the State to buy it. We may say right
here that the quality of all antitoxin is guaranteed by the United States
Government. Antitoxin is sold in packages which are graded according
to the number of units of potency per package into packages of 1,000,
3,000, and 5,000 units. The prices of these packages of antitoxin,
before this arrangement on the part of the State was made were as
follows
:
1,000 $2.00
3,000 5.00
5,000 7.50
Under the present arrangement the same antitoxin can be purchased
anywhere in IN^orth Carolina at the following prices
:
1,000 $0.50
3,000 1.35
5,000 1.95
This law went into effect September 1, 1911. The following table
shows the amount of antitoxin distributed and the saving to the State
for the fourteen months of the operation of this new law:
Number Size
Packages. Packages. Former Cost. Present Cost. Saving.
2,502 1,000 $5,004.00 $1,251.00 $3,753.00
1,952 3,000 9,760.00 2,635.20 7,124.80
2,478 5,000 18,585.00 4,642.10 13,942.90
FOURTEENTH BIENNIAL KEPORT 27
Total saving in fourteen months $24,820.70
Monthly saving 1,772.90
Yearly saving 21,274.80
As a matter of fact, this law is saving to the State nearer $40,000
a jear than $21,274.80, for just as soon as the State supply of antitoxin
was available at these lower rates practically all antitoxin manufacturers
reduced their product to about the same figure, so that the purchaser
does not always get the State supply, but buys the antitoxin of other
manufacturers, on which he gets practically the same reduction in price
as he would in buying the State antitoxin. There is probably as much
antitoxin sold by other manufacturers in North Carolina as is dis-tributed
by the State. This would bring the saving on this one item
to somewhere in the neighborhood of $40,000 a year, but to be consist-ently
overconservative in computing all of these items of economy let us
put down just $21,274.80 as a fourth dividend paid by the State Board
of Health to the people on their annual investment of $26,500.
Item No. 5.—The State Board of Health was instrumental in securing
from the General Assembly of 1911 a new law for the control of small-pox.
A blank form sent out to the county superintendents of health,
filled out and returned to this office, where the data Which had been
called for were compiled, shows : That for five years previous to the
operation of the new law there was an average annual number of 7,500
cases of smallpox in the State, and that the total cost to the counties of
the State of handling the disease averaged $66,000 a year ; that for the
first year's operation of the new law there were 3,300 cases of smallpox
in the State and the total cost was $2,600. This $2,600, deducted from
the $66,000, leaves an annual saving of $63,400, which ftiakes the fifth
dividend the State Board of Health pays on the $26,500 turned over to
it.
The five items above enumerated and considered amount to an annual
saving of $111,723 on an investment of the State's health work of only
$26,500. Health work appears to be a good business, and these fignires
bear out the saying of Emerson that "The first wealth is health."
There are other items saved to the State which space will not permit
us to discuss. "We shall content ourselves with mentioning only one
more, viz., the saving to the municipalities of North Carolina by the
law requiring plans and specifications for proposed public water supplies
and sewerage systems to be submitted, examined, and approved by the
State Board of Health before being adopted by the town or city. The
towns and cities have by this law been safeguarded against the
work of cheap engineers and contractors and against spending their
money in building waterworks and sewerage systems of little value.
"We know of one to^^'n that constructed a public water supply before this
law was in operation, the plans of Avhich never have been approved by the
State Board of Health, and after completing the watei-works found
that their plant was of little value and that they had lost something
like $15,000 in the venture.
THE GREAT WORK OF THE STATE BOARD OF HEALTH.
Its chief end is not the saving of dollars, but the saving of lives.
The real ledger of a state board of health is kept not in dollars and cents,
28 NORTH CAROLINA BOARD OF HEALTH
but in death rates. While we take a great pride in the economic showing
set forth in the preceding figures, be it far from us to leave even the
suggestion that our conception of a board of health is an economic
institution.
The real test of the value of a state board of health is shown by its in-fluence
on the state's death rate-—either a reduction of a death rate higher
than the average state death rate or in the maintenance of an average or
lower than the average state death rate. Unfortunately, there is no State
law (and this is the great need of the health work in North Carolina) re-quiring
the registration of deaths. There is a law requiring the registra-tion
of deaths for one-sixth of the population of the State that has been
in force only two years, and that carries Avith it insufficient appropriation
to permit of its enforcement to a degree of completeness that will permit
rigid conclusions based upon the deaths registered during the last two
years. We believe that if we had had a registration law thoroughly
enforced in this State for the past three years, we would be able to show
a reduction in the death rate from which we could estimate exactly the
unmber of lives saved and the number of days of sickness prevented.
And we believe further that, in that showing, the State Board of Health
would most impress our people with its value.
Provisions for facilitating quick and accurate diagnosis through
the microscopic examinations of specimens submitted to State experts,
close supervision of public water supplies and the safeguarding of the
people by a monthly analysis of all public water supplies against drink-ing
polluted water, the more easily obtainable Pasteur treatment and
diphtheria antitoxin, all operate in their more important spheres of
action, not to save money, but to make prevention and treatment quicker
and more effective and death rates lower.
But effective as these provisions must have been in reducing death
rates, the most valuable work of the Board in saving life has been the
instruction of all the people through press, special literature, and sani-tary
addresses as to the cause of the more important preventable diseases
and the way to avoid them.
Growth of Work of the State Board of Health
The word "growth" is used advisedly here. The public's apprecia-tion
of the value of an institution is expressed in the increasing de-mands
made upon it. If an institution is of a public nature, and com-plies
with the demands of its constituency, the work of the institution,
the force engaged to do the work, and the money necessary to obtain
the requisite force for the growing work, must be gradually increased
;
in other words, the growth of a useful public institution is as natural
as that of a plant and can not be retarded without interfering with a
natural and useful process.
The subjoined tabulations show the growth of the ISTorth Carolina
State Board of Health.
FOURTEENTH BIENNIAL KEPORT 29
GKOWTH OF THE WORK OF THE EXECUTIVE OFFICE.
(On a revenue basis of ?12,000.)
Nature of Work. 1909 1910 1911 1912
Correspondence (letters*) 2,544 2,826 4,437 6,075
Per cent increase 11% 57% 36.9%
Bulletins 3,000 11,500 20,000 40,000
Per cent increase 283% 73.8% 100%
„ . ( Weekly 3 mos. 3 mos. 12 mos.
Press service -'
„ ^ ^ n ^
I Daily 6 wks.
Treasurer—fund handled $11,940.06 $27,447.57 $46,128.79 $55,245.42
GROWTH OF THE STATE LABORATORY OF HYGIENE.
(On a revenue basis of $10,000.)
Years. Specimens Examined.
1908 1,569
1909 2,902
1910 3,702
1911 4,939
1912 5,085
(In addition to these specmens, 38,648 specimens of feces were examined in
this laboratory for intestinal parasites. These examinations were made in
large part by microscopists employed by the Hookworm Commission, but they
were under the direction of the Director of the Laboratory.)
Years. Pasteur Treatment.
1908 42
1909 157
1910 159
1911 151
1912 224
Diphtheria antitoxin has been distributed by the Laboratory since August,
1909. The amount distributed annually is as follows:
1,000
Years. units.
1909 821
1910 457
1911 1,171
1912 1,553
3,000
30 NOETH CAROLINA BOARD OF HEALTH
1910.
Number of persons treated by phy-sicians
and reported 8,000
Number of persons treated by State
Board of Health and field staff. . .
Number of persons treated by phy-sicians
and field staff 8,000
Number of microscopic examinations
made 7,949
Number of counties making appro-priations
for free dispensaries. . .
.
Amount appropriated by counties...
Still available
Counties worked
Amount of county funds actually
spent
Note.—The county surveys were completed in part in 1911 and partly in
1912. The number of microscopic examinations rather than the number of
persons treated denotes the growth of the work. To illustrate: In 1911, out
of 37,328 examinations, 29,172 persons were treated; whereas, in 1912, out of
135,876 examinations only 42,132 were treated. In 1911 the work was con-ducted
in the most heavily infected areas; in 1912 in lighter infected areas.
More time is required to examine a person who is not infected than one who is
infected, and on the average it is most difficult to get a large attendance on
the dispensaries in areas where the infection is lighter.
1911.
FOURTKENTH BIEXNIAL REPOET 31
amongst us, coming we know not whence. When a surgeon rushes into
a railroad wreck, he wisely attends first to those whose lives are in the
greatest danger. A health department should do likewise—it should
direct its life-saving efforts into those places where its work is most
demanded—by what?—hy high death rates. Where are such places in
Korth Carolina? What section of our State, what county, is sickest?
Or, to recast that question, what section of the State or what counties
of the State have the highest death rate from all causes? What county
has the highest tuberculosis death rate? In what county is typhoid
fever most rife? In what counties are deaths of children from the con-tagions
most frequent, or, in other words, in what counties are proper
quarantine laws most needed? Xo man knows nor can know, without a
registration law, the answer to these vital questions. The State Health
Officer, in treating diseases of unknown location in the body politic, is
like a doctor treating a patient with a complication of diseases, know-ing
neither which organ is most involved nor which of the group of
diseases he should treat first.
The following incident, that actually occurred in the executive office
of the Xorth Carolina State Board of Health, illustrates the preceding
paragraph:
A short time ago a gentleman came into the office and introduced
himself as representing the Baron Hirsch fund of millions of dollars,
which was bequeathed for the social and industrial advancement of im-migrant
Jews to the United States. The visitor stated that he was en-gaged
in investigating agricultural and health conditions in the South-ern
States, and would devote eight or nine months to his task. Some
time previously a colony of Jewish immigrants had been placed in
Texas; the colony had not been there long before several of them died
of malarial fever. Being unaccustomed to malaria the disease had all
the terrors to the new colonized immigrants of a new and strange dis-ease.
The colony at once disbanded and left, and the property had to
be sold at a loss. The board of directors of this fund were, therefore,
interested in the health conditions of the South, as well as in her agri-cultural
resources.
The gentleman stated that they would locate several colonies, and
each colony would be composed of from fifty to one hundred Jewish
families and equipped with cooperative banks, stores, and other con-veniences
of a thoroughly modern, progressive community. He said
that they proposed to purchase from 5.000 to 50.000 acres of land and
to invest from $500,000 to $1,000,000 in each colony.
This gentleman had begun his investigation in Washington. He had
first gone to the Department of Agriculture and secured very full and
satisfactory information with regard to agricultural conditions in the
Southern States. He had been directed to call on Dr. Cressy L. Wilbur,
Chief Statistician of the Bureau of the Census, as the man from whom
he could get information as to the comparative healthfulness of differ-ent
sections of the country and States. When he made this request of
Dr. Wilbur that official pointed to a large map of the United States
hanging near at hand on the wall. Said he, "You see the map is made
up of some States in red and others in white ; ask me anything you wish
abovit the health of the States in red and I can give you exact informa-
32 - NOKTH CAROLINA BOARD OF HEALTH
I
tion. As to the health of the States shown on the map in white, there
is no man on the face of the earth that can tell you anything." The red
States were in the northeast and west, and the white States in the
south.
From Washington this gentleman began a tour of the Southern
States. When he arrived in Raleigh he first called upon the Commis-sioner
of Agriculture and obtained information from that official re-garding
the agricultural resources of different parts of this State. Fol-lowing
his visit to the Department of Agriculture he called at the office
of the State Board of Health to inquire about health conditions of the
different sections and of the various counties of North Carolina. After
the usual introductory remarks our visitor began to ask some very
direct and significant questions. The writer will, as near as he can
remember, reproduce these questions and the answers that he made to
them.
''Which is the healthiest section of ISTorth Carolina?"
"There are no facts at hand to justify an answer to that question."
"Which is the healthiest and which is the unhealthiest county in
:N"orth Carolina?"
"I don't know."
"Do you mean to say that this office, representing the State of North
Carolina, entrusted with the heavy responsibility of studying health
conditions in the State with a view of informing the public about the
prevalence of the different diseases, and suggesting appropriate reme-dies,
admits that it does not even know the distribution of diseases in
the State, does not know the county most needing assistance of the
State Board of Health, the county least needing this assistance, the
county where the most tuberculosis exists, the county where the most
typhoid exists, the county where most babies are dying, etc., etc. ?"
"I am ashamed to admit that this is true."
"Well, why don't you know these things?"
"The information which you seek can only be obtained through a law
requiring the registration of all deaths on a regular blank form which
gives, in addition to the cause of death, the race, sex, age, social con-dition,
and a few other less important data concerning the decedent.
If all deaths occurring in the State were so registered and properly
compiled in a central office, then I could tell you the county in which
the largest number of people per thousand of the population die annu-ally
; the county in which the smallest number per thousand of the popu-lation
die annually; I could tell you the county in which the average
age attained at death was greatest, and the county in which the average
age attained at death was least; I could tell you the county Avhere the
deaths for a given numbei"* of the population was greatest from con-sumption
or from typhoid fever, or from malaria, etc. ; I could tell you
the counties freest from these diseases, etc. ; in short, I could give you
the facts about the comparative health of the different sections and
various counties of this State on which any intelligent person could
reach positive conclusions regarding the healthfulness of any part of
North Carolina."
"How can you do satisfactory health work without this knowledge?"
"We can't. All we can hope to do is to enforce the State laws pro-
FOURTEENTH BIENNIAL REPORT 33
tecting public water supplies, to maintain a State Laboratory to analyze
the public water supplies, to consult witb and advise county and munici-pal
authorities about local health matters, and to carry on a general
educational campaign along sanitary lines, trusting that widely dissem-inated
information as to the methods of preventing the more important
diseases is resulting in the saving of many lives, and hoping some day
to get the people to the point of seeing the importance of the knowledge
that you seek. Treating a sick public without the facts that you desire
is just about as unsatisfactory as a physician's treatment of a patient
Avhose symptoms are 'unobtainable."
''I see. What you need then in JSTorth Carolina is a vital statistics
law requiring the registration of all births and deaths. Such a law
would give you the information that I want, and information that is
absolutely necessary to the intelligent prosecution of the work of the
State Board of Health."
"Exactly. Vital statistics are to the health officer just what symp-toms
of diseases are to a physician. Through the presence of symptoms
he recogTiizes disease and studies the etfect of his treatment; through
vital statistics the health officer recognizes the sick social organism,
the sick town, county, or State, and estimates the effect of health admin-istrations
by the reduction of death rates."
Conclusion : The vital phenomena of the social organism, of the pub-lic,
are its vital statistics. The vital statistics of a community, town,
county, or state are the only known means of reaching intelligent con-clusions
regarding the health thereof.
Reason Xo. 2.
As the first step toward spiritual salvation is a recognition of one's
sins, so the first step toward sanitary salvation is the recognition by the
sick town or county of its sickness. It is characteristic of communities
with death rates far in excess of the average that they do not know that
they are sick.
The health officer's first duty in treating a sick body politic, a sick
county, town, or State is to restore consciousness. That unconsciousness
of disease of the body politic is a characteristic symptom of such a con-dition,
I wish to illustrate with the following example:
Case 1.—A city of 20,000 population, one of the best cities in this
State, the health conditions of which are shown in the following charts.
Were the people of that city conscious of the condition shown on the
charts? Let's see. Five of the most representative and intelligent citi-zens
of the city were called over the telephone and asked to answer two
questions without requesting any explanations from their interrogator.
One of the five was a college president, another a State official, another
a practicing physician, another a banker, and the other one a leading-merchant.
The first question asked each of them, independently, was:
What is your opinion of the health of your city? As if it were a grave
sin against their patriotism to consider such a question for even a
moment, they all unhesitatingly answered "Good." The second ques-tion,
which immediately folloAved their answer to the first was : How
manv people would you say died in your city last year? With some
verbal sparring, with noticeable hesitation, all the five realizing that
34 NORTH CAROLINA BOARD OK HEALTH
their answer to the first question presupposed ability to answer the
second, the answers came. Three said there were 60, one 100, and one
300 deaths a year. As a matter of fact there were 508 deaths, but 73
less than the sum of the guesses. These were representative citizens
and their answers to the questions propounded show how unconscious
the ])eople of that city were of their real health situation.
iSTow, the way to restore consciousness is to administer the remedy of
applied vital statistics in the form of charts, similar to those following,
which illustrates the health condition of Case 1
:
DEATH BATES OF CASE I COMPARED WITH DEATH BATE OF AVERAGE TOWN.
In average city of the
Death rates. Case I. United States.
General 27.6 15
White 25
'
15.5
Colored 40 26.2
Tuberculosis 270 160.3
Typhoid fever 55 23.5
Diarrhceal diseases (under two years) 215 100.8
Whooping cough 50 11.4
Measles 25 12.3
Scarlet fever 11.6
Diphtheria 20 21.4
TOTAL DE.'VTHS OF CASE I COMPARED WITH TOTAL DEATHS OF AVERAGE TOWN.
Would occur vnth
Causes. Occurring, average death. Excessive.
All causes 508 300 208
White population 326 208 118
Colored population 280 112 168
Tuberculosis 54 33 21
Typhoid fever : . . . 11 5 6
Diarrhoeas (under two years) 43 19 24
Whooping cough 11 2 8
Measles 5 2 3
Diphtheria 4 4
Scarlet fever 2 Credit, 2 lives.
AGES OF DECEDENTS FOB CASE I AND AVEBAGE TOWN.
Percentages of deaths. Case I. For United States.
Children under 15 30.5 30.5
Wage earners, 15-50 32 28
Above 50 37.2 41.4
Above 60 23.4 31.3
The facts of the charts may not start to ferment at once, but sooner
or later they will break into the editorial sanctum ; they will even invade
the holy precincts of the pulpit, they will get into teachers' meetings,
break out in schools, pervade and eventually move the sick community
or county. Such a statement of unheal thfulness, based upon unde-
FOURTEENTH BIENNIAL KEPORT 35
niable facts, is necessary to secure the interest and cooperation of the
popuhition of a sick community or county. Only a registration law
can furnish the facts necessary for such sanitary awakening and
repentance.
As a result of the publication of the facts of these charts the author-ities
of the town designated Case I, have within the last three or four
months let a contract for a model abattoir, employed a graduate veter-inarian,
who is an experienced meat and milk inspector, adopted mod-ern
and comprehensive meat and milk ordinances, extended their sewer
districts, and directed the construction of sanitary privies in large dis-tricts
where at present open, unsanitary, disease-breeding privies exist.
Case 1, as an illustration, is susceptible of general application.
Reason No. 3.
The public health work, to be efficient under a democratic form, of
government, must be placed under the control of the people.
It seems providential that the department of government, the health
department, which in the very nature of the case is concerned more
directly than any other department with human life, and operates on
complex biological principles, difficult of mental grasp, without special
study, shall be, nevertheless, more than any other department of gov-ernment,
susceptible to the control of the people. A good citizen may
not be able to say that his State Department of Education, or his State
Insurance Department, or his State Corporation Commission is efficient
or not, but he should be able to say that his Health Department is
efficient or inefficient. That requires no special training. The death
rate test is the simple and true efficiency test that any one can apply
to a health department. The differences in the death rate (that is, the
annual number of deaths per 1,000 of the population! from all causes,
and annual number of deaths per 1,000 population from such special
causes as the more important preventable diseases), at the time the
health department assumed control, and at the time it is judged, tells,
to the decimal point, what it has accomplished in saving human life.
It is of no consequence how much literature a health department may
prepare and distribute, how many instructive addresses on health topics
it has given, how many health exhibits it has held, how many hook-worm
treatments it has administered, and how many other things it
has done, if these things are without perceptible effect on death rates
;
the method of health work is incidental ; the effect, a reduction of death
rates, is fundamental.
Under present conditions in liorth Carolina, with no registration of
births and deaths, neither the jDCople nor their State Board of Health
can or do know what is being accomplished with the public funds ex-pended
in health work. This ought not to be so.
Let us give the people the facts, and at the same time the means of
reducing death rates; put them in charge, through a vital statistics law,
and let them have dominion over preventable diseases.
Reason No. J^ and Plus.
There are many other strong reasons, principally of a legal nature,
why we should make permanent official record of the births and deaths
of our people. An official record of the circumstances of every death,
36 NORTH CAROLINA BOARD OF HEALTH
signed bj^ a physician or coroner, will prevent hasty burials of bodies
of persons who, after decomposition has done its work, are discovered
to have died under suspicious circumstances. Without registration of
births, children are sent prematurely, by unscrupulous parents, under
the yoke of servitude ; without a system of birth registration, the com-pulsory
school laAV, which in the next six years will apply to a large
part of the population of the State, will prove defective at its very
source, in the matter of determining by official record the ages of chil-dren
; without registration of births, justice often blunders or falls
down altogether in determining questions of citizenship, suffrage and
marriage privileges, in awarding inheritances and fixing damages.
Finally, when a pure blooded horse or cow or dog or hog is born, its
birth is registered, even if its birthplace is in Xorth Carolina. Histo-rians
tell us that our children are of the purest blooded white stock on
the continent. Are they not entitled to as much consideration in the
matter of birth registration as we give fine blooded horses and dogs?
NEED NUMBER TWO.
From an examination of the increase in the work of the various de-partments
under the management of the State Board of Health, it is
perfectl}^ apparent that the demands for work upon these departments
are much greater than they were two years ago, and it stands to reason
that the work now demanded, of us by the public, to say nothing of
desirable lines of extension that opportunity offers, can not be met on
the same appropriation that the Board has been running on. On the
present basis of work it will be necessary to have the General Assembly
increase the general appropriation of $18,000, annual appropriation,
to $25,000. This is a conservative estimate, and the Secretary realizes
his liability to severe criticism from many well informed, influential
people interested in the advancement of our public work, for not asking
for a greater increase. At the same time we recognize the claim of
other institutions on the appropriation committee, and the meaning of
the State's deficit, and the additional fact that the vital statistics law,
which we have placed here as "JSTeed Number One," will carry its own
appropriation of $12,000.
NEED NUMBER THREE.
We recommend that the General Assembly of 1913 enact an ade-quate
law for the inspection and sanitary conduct of hotels, restau-rants,
railroad stations, and coaches, with a section of this law requir-ing
that the hotels pay a graduated tax, depending upon the number of
rooms in the hotels. This law could be made self-sustaining and at
the same time place no financial embarrassment upon the hotels of
the State. Such a sanitary supervision of the hotels, restaurants, rail-road
stations and coaches Avill result not onlv in increasing the comfort
and convenience of the traveling public but in eradicating many sources
of disease.
NEED NUMBER FOUR,
The great educational value of a sanitary exhibit has been thoroughly
demonstrated by the work of the State Boards of Healili in Louisiana
and California. If the State of J^orth Carolina would appropriate the
FOURTEENTH BTEXXTAL REPORT 37
sum of $3,000 annually, for two years, the work of sanitary education
could be carried through models, charts, illustrated lectures, moving
pictures on sanitary subjects, and other modern methods of popular
education of the masses, directly into the homes of the people.
We believe that such an exhibit, transported by the railroads without
cost to the State, as the railroads hare kindly done in other States,
would have a tremendous life-saving effect, .and would impress the
people with the value of health legislation and public hygiene as much
as anything the General Assembly of 1913 could do. We therefore
urgently recommend that an appropriation of $3,000 annually, for the
next two years, be made by the General Assemblv of 1913, for equip-ping
and maintaining a State traveling public health exhibit.
Meetings of the Board
Charlotte, X. C, Selwtn Hotel, June 20, 1911.
The Annual Meeting of the State Board of Health was called together
in the room of the Secretarv bv the President at 3 :30 p. m. All mem-bers
were present.
President Thomas then asked the Secretary to read the minutes of
the last meeting. The Secretary asked whether he should also read
the minutes of the meeting of the Executive Committee. The President,
with the approval of the Board, instructed the Secretary to omit the
reading of the minutes of the Executive Committee. The minutes of the
1910 meeting of the Board at Wrightsville were read and approved.
The President next requested the Secretary to state to the Board any
matters which he desired to have them consider. The Secretary stated
that there were several matters of importance which he desired to lay
before the Board. He asked the Board to consider first the proposed
sewerage plans of Wilmington.
Mr. R. C. Cantwell, Superintendent of the Wilmington Water and
Sewerage Department, explained the proposed plan and requested the
Board, if possible, to permit, without modification, the execution of the
last plan submitted which carried the sewerage 3.4 miles below the
waterworks intake.
The Secretary then stated that he had written the Department of
Water and Sewerage, and said that the Board would approve the plan
which carried the sewage outlet 3.4 miles below the waterworks intake,
provided that a sewage purification plant be installed to sterilize the
sewage before turning it loose in the river ; but that, if the Department
did not wish to do this without appealing to the full Board at its meeting
in Charlotte in June, it would be agreeable to him to wait until then.
The question, therefore, Avas simply this : Shall the plan referred to
above be approved with or without the sewage purification plant ?
Mr. Warren H. Booker, the Assistant to the Secretary, was then
asked to state the results of a recent investigation of the public water
supply and sewerage of Wilmington. Mr. Booker submitted to the
Board a comprehensive report, illustrated mth photographs, a copy of
38 NOR £11 CAROLINA BOARD OF HEALTH
whicli is on file in the office of the Secretary. His remarks were based
mainly on the conclusion of this report.
Colonel Ludlow then stated that he would not approve the present plans
without a sterilizing plant, unless there were submitted to him data
showing that the tidal reflux did not carry sewage from the point of the
proposed outlet to the waterworks intake. He was also strongly of the
opinion that there wo'uld be such a reflux of sewage material, and that the
present proposed plan without a sterilizing plant would be dangerous.
Dr. Lewis then moved that the present plan for emptying the sewage
3.4 miles below the intake be approved, provided a sewage sterilization
plant, approved by the Board, be added.
Dr. Thomas dissented from Dr. Lewis' motion, believing that the
Board should direct that the sewerage system proposed be proceeded
with, and that, during the construction of the system, the data showing
the effect of the tidal reflux on the sewage should be collected, and, if the
data collected should prove that there was no danger from tidal sewage
reflux, that the sterilization plant should not be required.
Dr. Lewis replied that the cost of collecting such data would in all
probability exceed the additional cost of a sterilizing plant. Colonel
Ludlow agreed that the cost of collecting the data would be considerable.
Mr, Cantwell stated that he thought the collecting of the necessary
data would prove, in the long run, more economical than the continuous
expense of operating a sterilizing plant.
Dr. Lewis then restated his original motion; it was seconded, put,
and unanimously can*ied.
The Secretary then asked the Board if any member had any suggestion
to make relative to handling the present danger, which will necessarily
continue until the new sewerage is installed. It was suggested by several
members of the Board that the people of Wilmington should be notified
from time to time of the danger of using the water without boiling it.
The Secretary then handed to the members of the Board the following
synoptical statement of the running expenses of the Board
:
Salaries $560.00
Rent 35.00
Telephone 6.50
Fuel 5.00
Bulletin 40.00
Postage 60.00
Express 45.00
Traveling expenses of office force 75.00
Meetings of Board and Executive Committee 50.00
Dr. Julian's salary 50.00
Total per month $926.60
Total per year $11,119.20
He requested the members of the Board to suggest any saving possible,
stating that he could recommend economy only in one item of expense,
namely, the saving of the salary or a large part thereof of the Assistant-
Secretary of Tuberculosis. This was made possible through a recent
FOURTEENTH BIENNIAL KEPORT 39
arrangement of the Board of Directors of tlie State Sanatorium for the
Treatment of Tuberculosis, Avhereby they agree to cooperate with the
State Board of Health in an educational campaign against tuberculosis.
The Sanatorium will furnish most of the time of one man for this work.
Dr. Way then moved, first, that the office of the Assistant-Secretary
for Tuberculosis be abolished, and, that the work heretofore carried on
by that officer be done though the cooperation of the Secretary and the
Sanatorium authorities; and, second, that one hundred dollars annually
shall be paid to the Secretary of the Xorth Carolina Society for the
Study and Prevention of Tuberculosis to defray the clerical expenses
of his office. Dr. Spencer seconded Dr. "Way's motion. The motion
was then voted upon, and carried unanimously.
Dr. Lewis then moved that the President appoint an auditing com-mittee
to audit the accounts and to recommend such retrenchments as
the accounts would indicate. This motion was seconded by Dr. Spencer,
and, when submitted to the Board was carried unanimously. The Presi-dent
appointed Colonel J. L. Ludlow and Dr. W. 0. Spencer an Auditing
Committee to carry into effect Dr. Lewis' motion. The accounts, re-ceipted
bills, canceled checks and financial statements were then turned
over to the above Committee.
Dr. Lewis then called attention to the fact that Mr. John M. Harry's
term of service on the Board of Embalmers had expired, and moved
that he be reelected. This motion was seconded by Dr. Anderson. The
President then submitted the motion to a vote and Mr. Harry was unani-mously
reelected.
The Secretary then called the Board's attention to the fact that when
Dr. Ferrell was secured for the work he is in charge of, he accepted, on
condition that, with an increase in the appropriation by the State Legis-lature,
he be paid $500 annually by the State, in addition to the $2,500
annually paid him by the Rockefeller Sanitary Commission. Dr. Fer-rell
now asks that this increase be made. Dr. Lewis moved that Dr.
Ferrell be paid the additional $500 annually out of the public health
appropriation, this increase to begin March 1st, 1911. This motion was
seconded by Dr. Register and was unanimously can-ied.
The Secretary then called attention to Dr. Shore's efficiency and length
of semace and that Dr. Shore asked a similar increase in his salary.
On motion of Dr. Lewis, seconded by Dr. Register, this increase of $500
annually of Dr. Shore's salaiy to begin July 1st, 1911, was likewise
voted.
The Secretary next called attention to the situation in Wake County
with reference to the election of a County Superintendent of Health.
The Board, however, declined to take action as the time set in the law
for the Board to appoint a County Superintendent of Health had not
expired.
The Secretary then called attention to the appointment by the Execu-tive
Committe of Mr. Warren H. Booker as Assistant to the Secretary.
He stated that Mr. Booker was a civil engineer by profession, and had
been connected with the work of Ohio State Board of Health. He had
filed very fine testimonials of his integi'ity and ability, and an associa-tion
of one month justified the Secretary in saying that he thought the
40 NORTH CAROLINA BOARD OF HEALTH
clioiee of the Executive Committee a most fortunate one. He asked
the Board's approval of the action of the Executive Committee, This
was unanimously and unreservedly given.
The Secretai-y next asked the Board to consider the present rules and
regulations governing the control of measles and whooping cough.
Though no formal action was taken it seemed to be the consensus of
opinion that the two diseases should not be quarantined, but only
placarded.
The Secretary called the attention of the Board to the practice of
different heads of departments or subdivisions in the work in soliciting
separate appropriations for their individual work, and asked that the
Board express its attitude in regard to such practice. The Secretary
was of the opinion that it was of serious consequence, and would endanger
properly organized or coordinated public health Avork. The Secretary
said that he thought this practice had been engaged in by the man
engaged in the hookworm eradication work. He asked that Dr. Ferrell
be heard in regard to this question. Dr. Ferrell said that he would
make no effort to have a separate appropriation made for the hookworm
work before the next annual meeting of the Board. The Board deferred
taking action until the next annual meeting.
A motion to adjourn was offered by Dr. Spencer. The motion was
then seconded and unanimously carried.
"W. S. Rankin, Secretary.
Charlotte, iST. C, Selwyn Hotel, June 21, 1911.
The Board was called to meet at 6 p. m., in the room of the Secretary
at the Selwyn Hotel. When the Board assembled, the Secretary called
the meeting to order and asked the Board to elect a President, as that
office was vacant.
Dr. Way moved that Dr. Lewis be elected temporary chairman. Dr.
Ashcraft seconded Dr. Way's motion. The motion was unanimously
carried. Dr. Lewds then took the chair.
Colonel Ludlow moved that we proceed with the election of a Presi-dent.
Dr. Tayloe seconded Colonel Ludlow's motion. This motion was
carried.
Dr. Anderson nominated Dr. J. Howell Way for President. Dr.
Tayloe and Colonel Ludlow seconded Dr. Anderson's motion, which was
passed unanimously, and the Secretary was instructed to cast the vote
of the Board. The Secretarj^ announced that he was pleased to cast
the vote of the Board for the election of Dr. Way as President of the
State Board of Health.
The President then took the chair.
The question then came up as to how long the President should hold
office. Colonel Ludlow moved that the term of the President be con-terminous
with liis official tenure, provided that this did not exceed six
years. This motion was seconded by Dr. Lewis and unanimously
adopted.
Dr. Spencer moved that the member of the Executive Committee which
the law leaves to the election ofk»'the Board be elected. The President
held that this position was now held by Dr. "Lewis, and that his official
FOURTEENTH BIENNIAL REPORT 41
tenure as a member of tlie Executive Committee would not expire until
his term of office as a member of the Board expired.
Dr. Lewis then moved that Dr. Julian, who had asked to be heard
relative to the change voted in the appropriation for tuberculosis, be
given the privilege of the floor. This motion was seconded and carried.
Dr. Julian was then invited to speak. He said that he was in close
touch with the people of the State who were interested in the problem
of tuberculosis and was sure that they did not wish the office abolished
or the Avork changed.
It was explained to Dr. Julian that the financial condition of the
office necessitated our saving money, and a recent understanding with
the Board of Directors of the State Sanatorium would permit our
saving part- of the salary of the Assistant Secretary, and, at the same
time allow the work which he had been doing, to be carried on.
Dr. Spencer moved that the Secretary state in the Bulletin the
change in the management of the anti-tuberculosis work, and the reasons
therefor, and also state the Board's appreciation of Dr. Julian's work.
Dr. Anderson then moved that we. adjourn. This motion was sec-onded
and unanimouslv endorsed.
W. S. Rankin, Secretary.
Conjoint Session State Board of Health with the State
Medical Society.
Dr. G. G. Thomas, President, in the Chair.
Dr. Thomas : The conjoint session of the State Board of Health with
the i^orth Carolina Medical Society will now come to order.
Dr. Rankin: Mr. President and Gentlemen—With this meeting of
the Society two of the terms of the members of the State Board of
Health expire, and there are now two vacancies on the State Board of
Health that the law provides shall be filled by the members of this
Society. This is one of the most important matters before us and I
suppose should be taken up at once.
Dr. Thomas : I will ask that nominations be made to fill these two
vacancies that occur in the State Board of Health.
Dr. LArcrHiNGHorsE : Mr. President—Do I understand you to say
that nominations on the State Board of Health are now in order?
Dr. Thomas : Yes, sir. The idea is that this should take place imme-diately.
Dr. Laughinghoi'se : The State Board of Health in Xorth Carolina,
representing conjointly the State of J^orth Carolina and this organized
Society, organized not many years ago, has been watched by us with
interest and satisfaction, as it has accomplished great things. ]^ot only
has it met the expectations of the profession in Xorth Carolina, but
business men, educators, and legislators have had it impressed upon
their attention enough to listen to and abide by and assist this organiza-tion
with their brains and with their money. Such an organization as the
State Board of Health, as it is today, strikes me as being one that could
42 NOKTH CAROLINA BOARD OF HEALTH
be considered as among the State's great assets. It is for this reason,
Mr. Chairman, that to my mind the filling of the positions on this
Board should be gone at in a very careful manner. We need, men on
this Board not only of intelligence but of experience ; men who can
serve the State of North Carolina and the profession and sanitation in
every capacity, and men who will be found in no way wanting.
I have in mind a man who by experience, education, ability, and be-cause
of the fact that he is associated with interests in North Carolina
ihat carry him here and there through the State, and because of the
fact that he has long given splendid service to the State and to the
Board, I believe will be, of all men, the proper man for this place.
Without regard to personal friendship, without regard to the paying off
of any past obligation, without regard to anything except the good of the
State Board of Health and the profession of North Carolina, and North
Carolina's people, I place before you the nai;ae of Dr. George G. Thomas.
(Applause.)
Dr. Mann : Mr. Chairman—The speaker who has just preceded me
has veiy well covered the ground. I am not, and never will be, the equal
in oratory of Dr. Laughinghouse, but I would like to second the nomina-tion
of Dr. Thomas to succeed himself on the Board of Health. (Ap-plause.)
Dr. a. H. Moore : Mrr Chairman—Please allow the county of Pam-lico,
situated in the remotest section of North Carolina, to state to this
intelligent assembly of men that we are not unmindful of the advantages
of Dr. Thomas, and therefore I wish to second most heartily Dr. Laugh-inghouse's
nomination of Dr. Thomas.
Dr. R. J. Noble : I wish to second the nomination of Dr. Thomas.
Dr. McBrayer : Of all the foremost men, men of culture, refinement
of intellect, and of character, Ave have no man in the medical profession
of North Carolina that exceeds my good friend. Dr. Thomas. He is a
gentleman of the old school; he is a Southern gentleman—and that
leaves nothing more to be said.
I attended Dr. Mayo's clinic on one occasion, and you know things are
a little crowded in there, and the noted gentlemen, with all their dignity,
were jamming each other to get a little better place to see. I got back
in the rear and when I got in the operating room I couldn't see a thing.
Some of the gentlemen laughed and said : ''You will get over that in a
little while." They have a monitor or reporter who goes first, and he is
to report the operations, and at the meeting in the afternoon he is to
open the discussion. No one is allowed to get in front of him. It
happened that upon this occasion there were two or three ladies. One
was connected with a hospital in Chicago; they were all of note, but
these- dignified surgeons from all over the United States, who were the
personification of dignity at home, paid no attention to the ladies. They
shoved them back and got good places. It happened to come my turn
one day and I put the ladies in front of me and let them march in and
get good seats, and some one remarked : "He is a ladies' man." I said
:
"He is a Southern gentleman." (Applause.)
Dr. Thomas is a Southern gentleman, and fortunately the Southern
gentleman is not decreasing but is increasing in the South and in North
Carolina in ratio without population, and may it always be so, but the
FOURTEENTH BIENNIAL REPORT 43
peculiar type of Southern gentleman before tlie war is decreasing. Dr.
Thomas is a before-the-war Southern gentleman. He has done an im-mense
amount of Avork to uphold the dignity and advance the interests
of the medical profession in Xorth Carolina, and when I say that I
mean that he has done an equal amount of good and of benefit to the
people of N^ortli Carolina, because those are synonymous terms.
This Society has tried to honor Dr. Thomas, and well it should have.
Way back yonder—not so long ago, of course, but before I began to
attend the sessions of this Society—the Doctor had all the minor offices
—
that he would call minor offices noAv ; some of us think they are of great
magnitude—but he was Essayist, Orator, Vice-President, etc., and later
was elected on the Board of Medical Examiners, when that was in its
formative state, so to speak ; and he made history for our State, of which
we are all proud. Later- he was exalted to the honorable position of
President of this Society—probably the highest honor in jSTorth Caro-lina,
excepting none. Later—twenty-one years ago or more—he was
placed upon this Board of Health of ISTorth Carolina, which position he
has held for all these years. He succeeded, I believe, to the Presidency of
the State Board of Health, the late Doctor West—another honored name
in ISTorth Carolina medical circles, and he has succeeded him with honor.
He, too, has done an immense amount of work on the State Board of
Health, of which he may feel justly proud, and of which the medical
profession of Xorth Carolina and the people of IN^orth Carolina feel
justly proud.
He has had all these honors. He has had every honor that the State
Medical Society of J^orth Carolina could heap upon him. If there were
any honors left I would be in favor of piling them upon his head until
they reached as high as the summit of Mount Pisgah, or the summit
of the tower of Babel, and there is nothing too good for him ; but it seems
to me that while he has done a great work, while he has been in the har-ness
for lo, these many years, while he has been ever in the vanguard of
progress, in medicine and in public health, worked for nearly half a cen-tury,
that it is not fair to him that we should impose upon him the burden
and heat of the day forever. The public health work in Xorth Carolina
is no farmer's dream, if you will excuse the expression. We are up
against it. It means work. Back yonder twenty years ago there was
not very much to do. It was just as important as it is today. It Avas
necessaiy to look into the future with the prophetic vision and see what
was coming and plan for it and work to it and lead and educate the peo-ple
just as we are doing today, but today the health work in l^orth
Carolina, in the South, and in the United States, is a hurricane. It is
jDroceeding with the force of an avalanche, and I feel that the young
men of [North Carolina should throw themselves in the breach and bear
the burdens of this work.
In thinking of that my mind wanders back to the days when another
leading character in medicine and in the histoiy of our State attended
our meetings, a man who was as lovable, who had a great influence,
whose life is an important part: of the liistoiy of medicine in North
Carolina, which must needs be, and is, a histoiy of iSTorth Carolina. I
refer to the late lamented, the distinguished O'Hagan. He was the
same leader, the same gentleman, the same scholar. He worked hand in
44 ' NORTH CAROLINA BOARD OF HEALTH
hand with our lovable and much loved Dr. Thomas, but as I have said,
it seems to me that Avhile Ave "will continue as long as life lasts to bestow
all the honors possible upon Dr. Thomas and his colleagues, it does seem
that we ought to relieve them of the burdens of the day, as we would in
any other walk of life ; and in thinking of that, methinks one can see the
mantle of our late lamented Dr. O'PIagan, even as the mantle of Elija
fell upon the shoulders of Elisha, fall upon the shoulders of one of the
noble young sons of JSTorth Carolina. He is educated, competent, able
and beloved; he has the courage of his convictions; he, too, is a gentle-man
in every sense of the word, and he comes by all these traits honestly.
They are handed down, as was the mantle of Elija, from our late
lamented and much loved O'Hagan, and I am quite sure 'that they will
rest with equal grace and be worn with equal dignity by his grandson. I
refer and take pleasure in placing in nomination for this position on
the State Board of Health, the grandson of our much loved and lamented
Dr. O'Hagan—Dr. Charles O'Hagan Laughinghouse. (Applause.)
Dr. David Tayloe : I wish to name a man who has been a painstak-ing
member of the Board of Health of IvTorth Carolina for the past sev-eral
years—I refer to Dr. Thomas E. Anderson, Statesville. (Ap-plause.)
Dr. I. W. Faison : As a member of this Society for thirty years—
a
man who has been in and out among the Society for that long, a man
who has not gone through the long list of office holding in this Society, a
man who never asked for but one position in this Society. In 1896 I
did not have anv better sense than to be a candidate for a member of the
Board of Medical Examiners. I have been soriy from that day to this
that I was fool enough to be a candidate. I will never be a candidate
for any other position. But in 1896 when I was a candidate, when some
men didn't come up to the scratch, as I thought they ought to have done,
Dr. O'Hagan—who is dead and gone, whose memoi-y I love—stood up
like a man for me, and on that account, outside of the fact that he is a
gentleman, particularly, I want to stand here and second the nomination
of Dr. Laughinghouse as a member of the Board of Health, (iipplause.)
Dr. Julian and -Dr. R. M. Adams second nomination of Dr. Anderson.
Dr. a. J. Crowell : Mr. President—I listened with a great deal of
l^leasure to the words of Dr. Laughinghouse, to the Avords of Dr.
McBrayer, realizing thoroughly the truthfulness of every word they said.
I haA-e known and loved Dr. Thomas eA^er since I have been in the
medical profession, will continue to love Dr. Thomas, but Dr. Thomas
has been honored, as Dr. McBrayer said, by being elected to every posi-tion
that the State Society could give him; he has served us for twenty
years on the State Board of Health, I understand, and I feel quite sure
he Avould be very glad to lay this on the shoulder of some younger man.
I therefore take delight in seconding the nomination of Dr. Laughing-house.
Dr. Booth: Mr. Chairman—I must say, occupying a central position
in the State, as I do, as my county does, having Avatched closely the
workings of this Society, being Superintendent of Health in my county,
I feel like Ave can not give up Dr. Thomas. We knOAV these other men
are good; AA'e A'erily believe they are good; we knoAv Dr. Thomas has Avon
the highest honor of the profession. Xoav it is the profession we Avaut
to uphold. We are not trying to honor any man, particularly. It is the
FOURTEENTH BIENNIAL REPORT 45
Board of Health of ISTorth Carolina that we want to serve—the people
of North Carolina, and we hope you will permit Dr. Thomas to continue
the office he now holds.
Dr. Laughinghouse : Mr. President—I want to express my apprecia-tion
of the kindly words that have been said concerning the memory of
Dr. O'Hagan. I do not know whether it is by inheritance or by cultiva-tion,
but I was never anxious to obtain honor and distinction on the
merits of another man. (Applause.) And while feel keenly—too keenly
for words to express—the appreciation that is rightfully due my grand-father,
yet until the time comes for me to hold the position in this
Society or even a warden's office in my little town, on account of my own
personality, rather than the personality of others, I feel that I am not
the proper man to hold that place.
I have been sitting here likening myself to a new potato. It seems to
me, with all due respect to my grandfather, that the best part of me is
in the ground.
I also wish it distinctly understood, gentlemen, that I had no idea
that my name would be placed in nomination for this position. I have
never accomplished an act, I have never said a word, I have never done
anything by innuendo that would lead any man to believe that I 'was an
aspirant to this position.
Gentlemen, I believe that the Medical Society of Xorth Carolina will
cement itself, strengthen itself, be an organ in the State of Xorth Caro-lina
that will push it forward and lift it up, when it eliminates every
single solitary characteristic and thought and idea from offices in North
Carolina except that of earned proficiency. (Applause.) The proficient
man, the man of character, the man who is able, by a clean record and
ability to fill the place, is the man for the place, regardless of everything
else. (Applause.)
Dr. J. M. Parrott: Mr. President—Since listening to Dr. Laughing-house,
I am glad to say the true Southern gentleman still lives. The
words spoken by Dr. Laughinghouse are the words of a man. Dr.
Laughinghouse does not desire, as I gather from his remarks, this posi-tion.
I believe that this position is one of the most important, if not the
most important, which the profession in Xorth Carolina is called upon
to fill. In this good hour, Avhen Xorth Carolina is stepping forward
along all lines and is keeping step with the progress of the times,- as Dr.
McBrayer said, we have come up against it in health matters, and if Ave
ever needed, in the history of Xorth Carolina, the wise counsel and the
splendid advice of a cool, thinking, experienced head, that hour is now,
and with that purpose in view, it gives me especial pleasure to present
the idea to this good body that it is extremely unwise to swap horses in
the middle of a stream ; therefore I second the nomination of Dr.
Thcmas and Dr. Anderson.
Dr. H. D. Stewart : I am in favor of going out into the field
and compelling them to come in, because the most suitable people do
not run for offices. These people that are forever and eteniallv running
are not the most suitable fellows. I know enough of Dr. Thomas to
know what he has done, and I don't want to give him up ; and I know
enough of Dr. Laughinghouse to know what he can do ; therefore I want
to second the nomination of Dr. Thomas and of Dr. Laughinghouse.
46 NORTH CAROLINA BOARD OF HEALTH
Dk. Thomas : I would state that there are in nomination Dr.
Thomas, Dr. Laiighinghouse and Dr. Anderson. I will ask you to pre-pare
your ballots, and will ask Dr. Eose, Dr. Parrott and Dr. Young to
act as tellers.
Dr. Adams: As Dr. Anderson has no opposition, I move that his
nomination be closed bv acclamation.
Dr. Thomas : I don't know how you will do that, gentlemen. There
will have to be a second ball