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Cbe Hi&rarp ottye DttJt0ion of JE>eau& affairs Ontoersitp of Jl^octfj Carolina th 'S, day ted X-lljnXJL Q*A*&^./?Xk i n OCT 30 1965 ! Lj DIVISION OF HEALTH AFFAIRS. LIBRARY TENTH BIENNIAL REPORT c OF THI? NORTH CAROLINA / BOARD OF HEALTH 1903-1904 LIBRARY OF THI COLLEGE OF PHYSICIANS Off PHILADELPHIA TENTH BIENNIAL REP#RT •F THE N#RTH CAROLINA ••ARB #F HEALTH I9#3— 19#4 RALEIGH E. M. Uzzell & Co., State Printers and Binders 1905 MEMBERS OF THE BOARD. ELECTED BY THE MEDICAL SOCIETY OF THE STATE OF NORTH CAROLINA. S. Westbay Battle. M. D Asheville. Term expires May, 1907. Henby W. Lewis. M. D Jackson. Term expires May, 1907. J. L. Nicholson. M. D Richlands. Term expires May, 1905. W. H. Whitehead, M. D Rocky Mount. Term expires May, 1905. APPOINTED BY THE GOVERNOR. W. P. Ivey. M. D Lenoir. Term expires May, 1907. Richabd H. Lewis. M. D.. Secretary Raleigh. Term expires May, 1907. Geobge Gillett Thomas, M. D., President Wilmington. Term expires May, 1905. Francis Duffy. M. D New Bern. Term expires May, 1905. J. L. Ludlow, C. E Winston-Salem. Term expires May, 1909. COFXTY SUPEPJXTEXDEXTS OF HEALTH. Alamance Dr. EL R. Moore. Alexander Dr. C. J. Carson. Alleghany Dr. Robert Thompson. Anson Dr. J. H. Bennett. Ashe Dr. Manley Blevins. Beaufort Dr. D. T. Tayloe. Bertie Dr. II. V. Dunstah. Bladen Dr. L. B. Evans. Brunswick Dr. J. Arthur Dosher. Buncombe Dr. D. E. Sevier. Burke Dr. J. L. Laxton. Cabarrus Dr. R. S. Young. Caldwell Dr. W. P. Ivey. Camden Dr. C. G. Ferebee. Carteret Dr. F. M. Clarke. Caswell Dr. 8. A. Malloy. Catawba Dr. George H. West. Chatham Dr. T. A. Kirkman. Cherokee Dr. B. B. Meroney. Chowan Dr. T. J. Hoskins. Clay Dr. P. B. Killian. Cleveland Dr. B. H. Palmer. Columbus Dr. X. A. Thompson. Craven Dr. Joseph F. Rhem. Cumberland Dr. A. 8. Rose. Currituck Dr. H. M. Shaw. Dare Dr. W. B. Fearing. Davidson Dr. Joel Hill. Davie Dr. M. D. Kimbrough. Duplin Dr. A. J. Jones. Durham Dr. X. M. Johnson. Edgecombe Dr. W. J. Thigpen. Forsyth Dr. W. O. Spencer. Franklin I >r. R. F. Yarborough. Gaston I >r. II. F. Glenn. Gates I )r. W. < ). P. Lee. Graham Dr. Y. J. Brown. Granville Dr. S. D. Booth. Greene Dr. W. B. Murphy. Jr. Guilford Dr. Edmund Harrison. LIST OF SUPERINTENDENTS OF HEALTH. Halifax Dr. I. E. Green. Harnett Dr. O. L. Denning. Haywood Dr. J. F. Abel. Henderson Dr. J. G. Waldrop. Hertford Dr. C. F. Griffin. Hvde Dr. E. H. Jones. Iredell Dr. M. R. Adams. Jackson Dr. R. L. Davis. Johnston Dr. Thel. Hooks. Jones Dr. X. G. Shaw. Lenoir Dr. C. L. Pridgen. Lincoln Dr. John W. Saine. McDowell Dr. B. L. Ashworth. Macon Dr. W. A. Rogers. Madison Dr. W. J. Weaver. Martin : Dr. W. H. Harrell. Mecklenburg Dr. C. S. McLaughlin. Mitchell Dr. Virgil R. Butt. Montgomery Dr. M. P. Blair. Moore Dr. Gilbert McLeod. Nash Dr. J. P. Battle. New Hanover Dr. W. D. McMillan. Northampton Dr. H. W. Lewis. Onslow Dr. E. L. Cox. Orange Dr. C. D. Jones. Pamlico Dr. H. P. Underbill. Pasquotank Dr. J. B. Griggs. Pender Dr. R. J. Williams. Perquimans .Dr. C. C. Winslow. Person Dr. J. A. Wise. Pitt Dr. Zeno Brown. Polk Dr. C. J. Kenworthy. Randolph I >r. W. J. Moore. Richmond Dr. F. J. Garrett. Robeson Dr. H. T. Pope. Rockingham Dr. Sam. Ellington. Rowan Dr. W. L. Crump. Rutherford Dr. T. B. Twitty. Sampson Dr. John A. Stevens. Scotland Dr. A. W. Hamer. Stanly Dr. V. A. Whitley. Stokes Surry Dr. John R. Woltz. Swain Dr. A. M. Rennet. Transylvania Dr. ('. W. Hunt. u LIST OF SUPERINTENDENTS OF HEALTH. Tyrrell Union 1 >r. John M. Blair. Vance Dr. II. II. iiass. Wake Dr. J. J. L. Mc< 'idlers. Warren Dr. M. P. Perry. Washington Dr. W. II. Ward. Watauga Dr. II. MeD. Little. Wayne Dr Williams Spicer. Wilkes Dr. W. P. Horton. Wilson Dr. W. S. Anderson. Yadkin Dr. T. R. Harding. Yancey Dr. J. L. Ray. LETTER OE TRANSMISSION North Carolina Board of Health. Office of the Secretary, Raleigh, January 2, 1903. His Excellency, ( Jharles B. Aycock, Governor of North ( 'arolina. Sir:— In accordance with section 3, chapter 21+. Law- of l v '.'-">. I have the honor to present for transmission to the Genera] Assembly this, the Tenth Biennial Report of the North Carolina Board of Health. With great respect. Rich aim) II. Lewis, M. D., Secretary and Treasurer. TEATTH BIENNIAL KEPORT OF THE NORTH CAROLINA BOARD OF HEALTH 1903=1904 Two years ago, in the opinion of the health authorities of many of the States, our country was threatened with an epi-demic of bubonic plague. In spite of the positive assertion on the part of several of the leading bacteriologists of the United States of its presence in San Francisco, the fact was persistently denied by the Governor of California and the Board of Health of that State. In consequence, believing that the proper precautions were not being taken to prevent its spread to other sections, a sufficient number of States, including our own, requested a conference with the Surgeon General of the United States Public Health and Marine Hos-pital Service under the law governing that bureau. This was granted, and the meeting was held on January 19, 1903, the Secretary of our Board representing North Carolina. As the result of some very plain talk and the adoption of strong resolutions on the subject, the unfavorable conditions in San Francisco were remedied and the menace averted. During the past biennial period our State has been spared any unusual outbreak of disease, with the exception of the occurrence of typhoid fever in the Baptist Orphanage at Thomasville, in which there were sixty-seven cases, with two deaths, and of smallpox in many localities. While our work of educating the people in the principles of Hygiene in general, and more particularly as to the best methods of avoiding the infectious and therefore preventable diseases, has not been relaxed, special efforts have been NORTH CAROLINA BOARD OF HEALTH. made iu regard to Uncinariasis, or hook-worm disease, and tuberculosis. The work in the biological laboratory has grown in amount and consequently in value to the people of the State. The <h mands upon it at present are more than can be met with the facilities available. In the body of the report the subjects alluded to above \ be found considered at length. MEETINGS OF THE BOARD. MINUTES OF THE AXXUAL MEETING AT HOT SPRIXGS. Hot Springs, X. C., June 2, 1903. Annual meeting of the Board: Present: Drs. Thomas, Battle, Ivey, Duffy, Nicholson and R, H. Lewis. The minutes of the last meeting were read and approved. Dr. J. X. McCormack, the genial Secretary of the Kentucky Board of Health, was invited to participate in the meeting. The Secretary made a report of work done. The Treas-urer made his report. Drs. Duffy and Xicholson were ap-pointed a committee to audit the same. They reported it to be correct. There was a special discussion of vaccination and the best virus. On motion the Board adjourned to meet next day at 12 M. in conjoint session with the State Medical Society. Richard H. Lewis, Secretary. COXJOINT SESSION OF THE STATE MEDICAL SOCIETY WITH STATE BOARD OF HEALTH, HOT SPRINGS, N. C, JUNE 3, 1903. Dr. George G. Thomas, President, in the chair. Chairman : I do not desire to make any remarks in open-ing this meeting, -except to renew again the thanks which were offered to Dr. Stiles for his great help to us by pre-senting the different phases under which that serious disease, hook-worm, can be known and cared for. I think his visit is an epoch in the history of NTorth Carolina and of the South, and I think he deserves from this meeting, especially from the Board of Health, assuredly, very decided gratitude, and he may be assured of our continued esteem. Dk. Knox: I desire, as President of the Medical Society of North Carolina, to most heartily second the motion, and regret not making the same remarks lasl evening, but owing to the Doctor's leaving so soon, rather confused matters. Chairman: The report of the Secretary is now in order. The report is read by Dr. R. II. Lewis, Secretary. NORTH CAROLINA BOARD OF HEALTH. REPORT OF SEC-RETARY. JUNE 1. 1002. TO JUNE 1, 1903. A full statement in detail of the work of the Board from the time of our last meeting, consisting chiefly, in addition to the routine work of the Secretary's office, of inspections of the State institutions ami of the public water supplies, will lie found in the Biennial Report for 100] to 1002. This report, notwithstanding the fact that the copy for the same was furnished the State Printer at the usual time, is still in his hands, and I am therefore unable, much to my disappointment, to distribute it at this meeting to those interested. It will, however, be mailed to any one asking for it as soon as it comes from the pie-- TENTH BIK.WIAI. REPORT. 11 Since the beginning of the new biennial period, on January 1, 1903, our most important work has been in the line of legislation. Believing that incompetent physicians constitute one of t lie greatest menaces to the public health. I felt it to he my duty to try to obtain from the General Assembly, if possible, such an amendment to our medical license laws as would cure the defect existing therein as declared by our Supreme Court in its recent decision in State v. McKnight. We gained much, hut not all we asked. The purity of our drinking waters being one of the prime essentials of health, legislation for the better protection of our municipal water supplies was sought and obtained. Inasmuch as a full statement in regard to these two matters, together with copies of the acts, has already been printed in the monthly Bulletin, it is unnecessary to repeat them in this report. 1 also prepared a bill appropriating twelve hundred dollars to aid in our bacteriological work, and succeeded in getting a favorable report from the Committee on Appropriations of the House. But that was the last of it. It apparently fell immediately to sleep and never waked. Besides the above. I likewise assisted, at their request. the representatives of the State Nurses' Association in preparing a bill for the registration of trained nurses, and in securing its passage. The importance of thorough training on the part of the nurses is second only to that rightly demanded of the physicians, and this legislation is clearly in the interest of the public health. While not interfering with the right of any one to nurse the sick, the act. after January 1. 1904, permits the registration and the u^e of the title R. X. (registered nurse) only to those obtaining a license from the State Board of Examiners, consisting of two physicians to be elected by the State Medical Society and three trained nurses to be elected by the State Nurses' Association. Hereafter the appearance of the letters R. N. after a nurse's name will be a guarantee of her thorough training, and if our physicians will discriminate in their recom-mendations in favor of that class they will create a very strong incentive on the part of all trained nurses to enroll themselves in the future among those who will surely be recognized as the best in their calling. EIOLOGICAL LABORATORY. Learning that the State Board of Agriculture might be compelled to withdraw their most valuable aid to the cause of health in having made for us biological analyses of suspected drinking waters, sputum, etc.. on account of certain extra demands upon their income made by the last Legislature. I secured the concurrence of the State Water-works Association in certain provisions in the Act to Protect Water Supplies, requiring all water companies to have made in our labora-tory a monthly analysis of their waters, and pay five dollars for each analysis. If the water companies will comply with the law in this 12 XORTH CAROLINA BOARD OF HEALTH. respect the expense of the laboratory can be shared by us and tbe people at tbe same time be more fully protected. Upon the invitation of tbe Board of Agriculture, I appeared before them on May 30th and explained tbe situation and our ability under tbe Act to Protect Water Supplies to assist in paying part of tbe expense incident to the hygienic work which they have been so generously doing for us free of charge since December, 1S99. I proposed, speaking for tbe Board of Health, to pay one-half of the salary of the biologist and to fur-nish all new apparatus and reagents that might be required for our special work, tbe Board of Agriculture to furnish the laboratory with its permanent equipment, attendance, water and gas. At their request, I put tbe proposition in writing and it was formally accepted by a unanimous vote on their part. SMALLPOX. Smallpox, I regret to say. lias been much more prevalent during the past year than ever before, and more fatal, confirming our pre-dictions to that effect, in view of the indifference of our local authori-ties on the subject of vaccination. And unless there is a change in this respect I see no reason to anticipate anything else than a con-tinuing recurrence of smallpox until all tbe people have either been vaccinated or have had the disease. During the past year—May 1. 1902, to May 1. 1903—smallpox has occurred in fifty -eight counties, the number of cases being : White. 1.GS1 ; colored. 2,595; total. 4,456; with deaths, white. 58; colored, 105 ; total. 163. the death rate per cent being respectively. 3.12, 4.04, 3.66. For tbe first time in our experience the death rate from this disease has been Higher among the negroes than among the whites, the figures heretofore having been very much in favor of the former. A comparison by years—tbe first period, however, extending from tbe occurrence of tbe first case on January 12. 189S. to May 1. 1899. a little over fifteen months—is given in the following tabular statement: TENTH BIENNIAL. REPORT. 13 Year. 1898-1899 Death rate, per cent 1899-1900 Death rate, per cent 1900-1901 Death rate, per cent *1901-1902 Death rate, per cent 1902-1903 Death rate, per cent Total number of cases Jan. 12, 1898, May 1, 1903 Total number of deaths Death rate, per cent Number of Cases. Number of Deaths. c "S 1 = z x £ — oo o 38 162 55 731 54 530 55 616 58 1.861 3.900 554 2,075 1.415 716 2.806 1.945 1,196 1.812 2,595 4.456 7.835 11.735 8 4.93 35 4.78 15 2.83 21 3.41 58 3.12 137 3.51 -d 14 NORTH CAROLINA BOARD OF HEALTH. SMALLPOX IN NORTH CAROLINA. MAY 1. 1902. TO MAY 1. 1903. Cases. Deaths. Counties. White. Colored. Total. Alamance Anson Beaufort Buncombe Burke Cabarrus Camden Caldwell Carteret Catawba Chatham Cleveland Craven Cumberland --• Currituck Davidson Davie Durham Forsyth Gaston Gates Graham Granville Guilford Haywood Henderson Iredell Johnson Jones Lincoln Macon McDowell Mecklenburpr - Montgomery - Moore Nash New Hanover Northampton Onslow Orange Polk Randolph Richmond Rockingham-- Rowan Rutherford Sampson Stanly Stokes Surry Swain Transylvania - Union Vance Wake Wilson Yadkin Yancey 4 3 305 73 4 1 10 7 10 9 30 16 9 29 7 4 100 75 28 6 58 28 18 5 3 9 75 24 100 101 56 1 1 54 2 79 1 11 40 119 300 11 Total (in 58 counties) - Death rate, per cent. - 1 4 13 2 1 1 116 152 13 2 75 10 66 20 163 1 2 2 3 40 275 25 5 72 70 49 37 1 9 200 326 17 1 1 2 4 47 50 25 32 5 73 125 65 94 20 25 63 *4 4 172 12 3 3 4 1.861 2,595 o 3 1 421 225 17 3 85 17 76 9 50 179 1 11 31 10 44 375 100 5 28 78 128 28 67 42 4 18 83 24 300 427 17 1 6 2 11 50 50 87 33 6 127 127 144 95 31 65 182 304 4 183 12 4 7 17 2 4,456 White. TENTH BIENNIAL REPORT. 15 Chairman: Yon have heard the report. Are there any remarks to be made thereon \ If not, what is your pleasure \ I would he glad to hear from any of the members in regard to any difficulties they may meet in the performance of their duties, especially in the management of smallpox. Dr. J. M. Manning : Six years ago when smallpox made its appearance in the State, I, unfortunately, happened to be the Superintendent of Health of Durham, and the first cases occurred in Durham County. I remember the circum-stance of a man who came there from Greenville—ran the blockade from Greenville and came to Durham, his old home. Of course, when the news got out in the city that there was a case of smallpox, there was quite a scare among the citizens. We were totally unprepared to take care of a case of contagious disease. We had no pest-house. The Mayor and myself rode all over the neighborhood and the county to locate a tent, and we were met with shot-guns wherever we proposed putting a tent, but finally the county owned a small strip of land, half a mile from the County Home, and we succeeded in establishing a pest-house in the shape of a tent. With the active co-operation of the city and eountv authorities, and the management of the different manu-factories in Durham, we succeeded in vaccinating a large proportion of the citizens of the town, and that epidemic— I can hardly call it an epidemic—was stopped. We set fire, by kerosene oil, to one of these houses near the Market House, in the central part of town, and we had the water supply to prevent fire extending to other buildings. In that epidemic we only had ten cases. We succeeded in getting the epidemic stopped. Since then they have adopted a different mode of managing cases of smallpox—and a method that I can't very heartily approve. The county and city authorities share con-jointly the expense of the smallpox epidemics, and they become alarmed about the amount of it, so the plan—the method now used in Durham—is to send a case of smallpox 16 NORTH CAROLINA BOARD OF HEALTH. to the pest-house and vaccinate the other inhabitants of the house and disinfect them as much as possible, and turn them on the community. Whether that is very effective, I am not prepared to say. Those cases are kept on the quiet and you really do not know what is going on. Dr. Battle asks Dr. Carl Reynolds to give his experience, who, he says, is rather bashful. Dr. Carl Reynolds : Mr. President and gentlemen, I am a little bashful, but, as it has happened, I have had quite a little experience with smallpox in Asheville, 1ST. C, for the past five or six years. T have had three cases of confine-ment, coming to maturity, and three miscarriages, and' have never lost mother or child. In about four or five hundred cases altogether in the last five years I have only had one death, and I doubt seriously if I would have had any at all if the parents had been truthful. The eases were reported — a family of nine. I went immediately to the house of sus-pects and vaccinated them all. They claimed that every member of the family had been vaccinated. I examined them, they had scars. I revaccinated them. They smuggled under the bed clothes a child about four months of age. Three or four days thereafter this mother broke out with smallpox, and the entire family was sent to the pest-house, and on the next day, on my visit, I found this nursing babe who had never been vaccinated. I vaccinated the child in three places, neither of which was successful : the child de-veloped smallpox and died in ten days. T thoroughly be-lieve that if that child had been vaccinated with the rest of the family it would have been living to-day. My experience with smallpox for the last five years is that I have never seen a case in the pest-house that had been successfully vac-cinated, not even a case of varioloid, that had been success-fully vaccinated in the last five years. One case I vaccinated five times. Turned him out twice. It was, in my opinion, a fight between the vaccine and the smallpox. He developed TENTH BIENNIAL REPORT. LI ivelve bumps, and was well in about twelve days. Vaecina- -.11 i> the thing, gentlemen, and unless we have the hearty •-operation of all our brother physicians, both in the cities lid the counties, we will have with us forever smallpox. We e had quite a struggle in Buncombe with the outside phy-icians on account of smallpox being mild in form. They say isn't smallpox, but chickenpox, etc., and consequently do ot enter with us in the work of vaccinating the" people. But i the city of Asheville—it has been thoroughly vaccinated vice within the last five years—and I venture to say there re not 300 people in the 15,000, unless they have come into ie city within the lasl six months, that were not successfully vaccinated, and for the last eight months I have not received single case of smallpox that has not come into the city since lr last vaccination. There is one thing that I would like to »uch upon while I am on my feet. I think I wrote to Dr. ewis about it. We ought to have a law compelling the com-ion carrier, all railroads, to compel every member of their »rce t<> be vaccinated : and until we do have the railroad peo-le vaccinated that come from one place to another, carrying lese germs and dropping them down, we will continue to ive smallpox. That is very important and essential. An-other tiling, Mr. President, I would like to give a little esti-ate of my care of the smallpox, that is, relative to the ex-cise. These gentlemen who are laughing behind me know M- reason. I had in my care 227 cases of smallpox, and the cpense per capita—they stayed in the house from two to three weeks, one man was in there eight weeks—including their maintenance, food, fuel, fire, guard service, physician's hill, vaccine, formaldehyde, etc.—everything, the sum total "i- capita per diem was 40-7.10 cents per day. What do tu think of that '. I think it was very reasonable, but when tliev began to look around as'ain for a new health officer thev accused me of highway robbery—bleeding the city of Ashe- 18 NORTH CAROI.IXA BOAED OF HEALTH. ville; so I thought I would come down in this society and tell yon about it, that yon had better be careful when yon treat cases of smallpox. Forty and seven-tenths cents was my average cost for the treatment of 227 cases. Chairman: Many refuse to submit to vaccination be-cause of the serious arms which have followed the practice, and that in turn seems to have been the result of very bad vaccination. We were told by Dr. McCormack that he him-self, and probably a number of others who wore interested with him, were considerino- the return to the use of human-ized virus. Lately the Marine Hospital Service has pub-lished a bulletin setting forth some examinations made in the different outputs of manufacturers that were manufac-tured in this country. I would be glad if Dr. Stile- would tell us what he knows of the subject. Dr. Stiles: There is one principle that I hold to in life, and that is to not talk too much about that T know little about. This work was done by my colleague, Dr. Rosecrans, and to sum up his results in a very few words, he found when he began the investigations that the vaccine virus was not so free from bacteria as we had a right to expect. He presented a paper <>n the subject before the Medical Society, giving hi-results, and that stirred up the manufacturers of the virus to a considerable extent. lie made an examination a year later and found that the virus was very much more pure, so that his investigations seem to have had a very good effect upon the manufacturers, and it is certainly hoped on the part of the men interested in that particular investigation that this effect will be lasting. With reference to the rela-tive value of the bovine and human virus I have ;i decided hesitancy in discussing the subjed before men who have had so much more experience in that matter than I have. It is, really, entirely out of my special line of work, and I would not want to say anything to prejudice either the one way or the other. I think that the Board of Health i- in a notch TENTH BIENNIAL REPORT. 19 better position to speak authoritatively upon the subject than I am. Dr. Butler: Mr. President, I came to this meeting at your suggestion yesterday on the train, not with the intention of doing any talking-. I came here rather for the pleasure of listening and learning. I do n<»t know that I have anv-thing new to say on the subject that yon arc not already familiar with. You know that since last year investigations have been going on in regard to the intermissibilitv of bovine and human tuberculosis, but I do not know if anything has been done that you are not perfectly familiar with, and 1 would not wish to take up your time discussing it. The tendency is to show that the danger which was once fancied to exist from the consumption of the products of the lower animals is not nearly so great ; that there is little danger per-haps, yet I think the result of investigation shows that there is danger, and some of the recent work seems to confirm it. * The tendency of recent research was to prove that there did exist some danger, and while I am chiefly inter-ested myself from a veterinary standpoint, even if there was no possibility of communicating it to man, still 1 do not think the physician can afford not to take the advice that, has been given us, and use all precaution as to communication of bovine tuberculosis to the human family. I certainly think we ought to strictly supervise the products from the dairy. ( ! n aii;;man : Any other remarks, gentlemen \ Dr. R. H. Lewis: I would like to offer the following reso-lution: Resolved, That the conjoint session of the North Carolina Board of Health and the State Medical Society adopt, in so far as the local conditions will permit, the recommendations of the Chief Statistician of the United States Census Bureau as to collection and registration of vital statistics. Seconded and adopted. Chairman : Anv further business before the house \ 20 NORTH CAROLINA BOARD OF HEALTH. Some discussion, raised by Dr. Carl Reynolds, as to the one who should furnish certificates to be placed on coffins. Dr. Lewis states that there is no law. It is the general opin-ion of the members that the undertakers are the ones who should furnish such certificates. It is moved that the conjoint session of the State Medical Society and State Board of Health adjourn. Seconded ami carried. MINUTES OF THE ANNUAL MEETING AT RALEIGH. Raleigh, X. ('., .May 24, 1904. Annual meeting. Present: Drs. Duffy. II. W. Lewis, Ivey, If. H. Lewis and Mr. Ludlow. In the absence of President Thomas. Dr. Duffy was elected President pro tern. Idie minutes of the lust meeting were read and approved. The Secretary presented a request from Dr. McCarthy, the Biologist of the Board, for an increase of salary. It was agreed to make, on the part of the Board of Health, an in-crease equal in amount to any increase made by the Board of Agriculture, not t<» exceed a total -alary of fifteen hundred dollars per annum. The Secretary stated that it was impossible to do the work of his ofiice without the aid of a stenographer and typewriter, and asked, if it should be thought by the Board to be proper and advisable, for an appropriation of $20 a month for this purpose. On motion of Dr. Ivey the Secretary was author-ized to employ a stenographer for part of her time on the best terms possible, not to exceed $20 a month. TENTH BIKXXIAL REPOET. 21 The following committee of inspection were appointed : re Institutions at Raleigh—Ivey. Thomas, and Lewis, R. H. The University—Thomas and Lewis. R. H. The Normal and Industrial College and the A. & M. for the colored—Battle ami Lewis, R. H. The Eastern Hospital for the Insane—Duffy ami Nichol-son. The Penitentiary farms—Lewis. II. W., ami Ludlow. The convict camp in Wilkes County—Ivey. The Orphan Asylums at Oxford—Whitehead ami Lewis. R. H. On motion of Dr. H. W. Lewis, the engineer of the Board. Mr. Ludlow, was requested to assume the general supervision of the public water supplies of the State, with authority to visit and make personal inspections whenever in his judgment it might be necessary, this to take the place of the biennial inspections heretofore made. The following delegate- To sanitary meetings were ap-pointed : Annual conference with the Surgeon General of the IT. S. Public Health and Marine Hospital Service—Lewis. R. H. Xational Conference of State and Provincial Boards of Health—Duffv and Lewis, R. H. American Public Health. Association—Referred to Presi-dent and Secretary with power to appoint. It was suggested that an effort be made to give th< children in the State instruction in elementarv hygiene, also for the improvement of the sanitation of the public schools. The Secretary stated that this latter had been done in the form of a special issue of the Bulletin on School Hygiene, which had been sent to all the public-school teachers by the State Superintendent of Public Instruction. The Treasurer submitted his report with vouchers. Drs. 2'2 NORTH CAROLIXA BOARD OF HEALTH. Ivey and H. W. Lewis, appointed a committee to audit the same, reported it correct. On motion the Board adjourned to meet at 12 M. next day, in conjoint session with the State Medical Society. Richard IL Lewis, Secretary. CONJOINT SESSION OF THE MEDICAL SOCIETY OF NORTH CAROLINA AND THE NORTH CAROLINA STATE BOARD OF HEALTH, Held on Wednesday, May 25, 1904, AT RALEIGH, N. C. At this meeting' Dr. Francis Duffy of the Board of Health in the unavoidable absence of President Thomas, presided over the conjoint session. Present, the members of the Stal : Board of Health and the general meeting of the Medical Society. Dr. Lewis: Mr. President and Gentlemen, I wish to ex-press my gratitude for one encouraging feature to-day. It has been the custom for the Medical Society to promptly melt away at the mention of the joint session. It is doubly en-couraging to ns that this has not been so marked as usual. I see before me a gratifying attendance. The annual report is . - fellows : ANNUAL REPORT OF THE SECRETARY OF THE NORTH CARO-LINA BOARD OF HEALTH. MAY 1. 1903—MAY 1, 1904. As must always he the case, the work of your Secretary during the past year has been largely of the usual routine character, dealing with the common every-day affairs of sanitation. These, however, are none the less important because they are commonplace, as they practically cover the whole field of hygiene. But we have one entirely new subject as applying to our State of great interest and import-ance, viz. : UNCINARIASIS OR HOOKWORM DISEASE. I Inspired by the admirable address of Dr. Charles Wardell Stiles, Zoologist of the United States Public Health and Marine Hospital 24 vwrni Carolina board of health. Service, at our last meeting at Hot Springs, on the Uncinaria Ami caini, of which he was the discoverer, and its prevalence in our Southern States. I promptly set to work to interest our physicians the subject In several issues of the Bulletin the matter was call to their attention, a summary of Dr. Stiles' official report and otl articles being printed, and the medical reader was urged to se specimens of faeces from suspected cases to our laboratory for di; nosis. The response to this. I regret to say. has been discouragh as only thirty-two applications for the examination have been ma during the year. This, however, 'lies not represent, by any means. the work done in relation to the hookworm disease. Dr. W. S. It; kin of Wake Forest, in the early fall, offered to give a month of time to the Board without charge, other than his actual expenses making a personal investigation, proposing to visit with his mic scope the physicians in a number of our eastern counties and ma the diagnosis for them on the spot. Authority was obtained by c respondence with the members of the Board to accept Dr. Ranki offer. He began his investigation by a trip during Christmas w< to Northampton and Edgecombe counties. The results were so mi gre and discouraging, as will appear in bis report, which he will re. that we agreed that it would not pay to continue the personal wo and the spring tour of three weeks was accordingly abandoned. lie has, however, dene other work on this line by correspondence .1 among students of the college, as lie will detail to you. The physi. signs of uncinariasis are so striking and the diagnosis from the m< general appearance of a victim to it. taken together with his envir< nient. is so easy that I have no doubt the diagnosis has been made many instances without resort to the microscope and the pro] remedy administered. From the facts in our possession it is certain that uncinariasis very prevalent in our Slate, and that it is not limited to the sat section, as stiles suggests, it deserves and should receive the ca ful attention of all practitioners. Witb the lights before me I woi say unhesitatingly thai every case of pronounced anaemia, especia in young persons living in the country, should be investigated > a special view to this very harmful intestinal parasite. TUBERCTTLOS Tuberculosis continues our most fatal disease Experience 1 demonstrated that much can lie done for its prevention. We shoi therefore make an earnest effort to check its ravages as far as pos ble. I therefore bring the matter forward in order that it may discussed in the conjoint session, so that we may have the benefit the wisdom that is said to appertain to a multitude of counsellors. The question of the prevention of tuberculosis is theoretically ea but practically most difficult—very much more so in our South' TENTH BIEXA'IAL REPORT. 25 oiintry than elsewhere on account of the large number of negroes. The infectious principle being existent only in sputum and other dis-iharges from tuberculosis cases and in the infected milk and meat of the lower animals, the thing to do, of course, is to destroy the sputum nd prevent the sale and consumption of the tuberculous milk ami neat. But hoic to accomplish this in actual practice to more than a mst superficial extent is the question. The answer to this question is, by the thorough education of the public mind on the subject. So the practical problem is how to reach and influence the people, espe ally tbose having the disease and their immediate families who necessarily are in close and constant contact with them. The first step in the solution of this problem is to locate the tuber-llous patients. To accomplish this a few States and cities have sorted to legislation requiring compulsory notification of tubercu-isis as of otber contagious diseases, so that the proper instructions ay be given, inspections made and disinfection practised. This looks ell on paper, and in large cities with thoroughly organized health and police departments and sufficient money to support them it is no doubt of much practical value. But in communities such as our State, the population of which is chiefly rural or resident in small iies. towns and villages without the full facilities for enforcement u Heated, we cannot expect very much from this means. Especially this true of the colored people. Their temperament, training and ivironment make the solution of the problem in their case, to all intents and purposes, hopeless—for many years to come, at any rate, .uul it is among them the disease is most prevalent, in the proportion of nearly three to one of the whites. That we cannot expect much the more apparent when we call to mind the fact—the most dis-couraging fact—that a very large percentage of our physicians, although required to do so by law. will not report the more actively utagious diseases, such as scarlet fever, diphtheria and even small- ; »x. although tbe last-named disease is, we believe, generally reported, it not so much because tbe law requires it as because the doctor p ants to get rid of it. In tbe present state of public sentiment the indisposition to report tuberculosis will be much greater. At the me time it is desirable to have this done if it can be brought about. We are glad to say that our own city of Raleigh has enacted strin- >nt legislation on this line, and the results will be watched with uch interest, as it is the first movement in the State for compulsory • itification, although anti-spitting ordinances have been in force veral years, first in Asheville and later in Raleigh. The methods usually resorted to for the education of public senti-ent are tuberculosis congresses, the organization of anti-tubercu-losis societies, public addresses, newspaper articles, the distribution the individual of literature bearing on the subject and the estab mment of special sanatoria. And this crusade has evidently borne uit, for the decrease in the death-rate from tuberculosis has been 26 NORTH CAROLINA BOARD OF HEALTH. much more marked in the decade 1891-1900 than in any similar period previously. It is interesting to rote, however, that the death-rate had been steadily diminishing in our larger cities before Koch's dis-covery of the bacillus and the demonstration of its contagious charac-ter. This is attributable to the improvement in the condition of the masses, better housing, better food, shorter hours of labor, the bicycle, athletic out-door games and the open-air life has come to be the vogue, thereby begetting greater resisting power. In these respects the advance has beeu much greater in the past decade than before, and it is no doubt to no inconsiderable degree responsible for the decreased death-rate. In the prevention of infection with the tubercle bacillus there are three principal objects to be sought : 1. The building up of greater resisting power in the individual. 2. The prevention as far as pos-sible of the development of the bacilli. .'!. The prevention of their distribution by their prompt destruction. 1. The dangers of the inspiration <>r ingestion of the bacilli are so great that it is a matter of doubt if any one living even a few years has not at one time or another taken them into his system, and yet only about one-ninth of the population, it is estimated, become fatally infected. This is due to the protective or resisting power inherent in every one to a greater or less extent. It is well estab-lished that this power to resist disease, to repel it entirely, or to over-come it is greater in those who are in vigorous health. And this state of vigorous health is to be attained and preserved by living in accordance with the principles of hygiene, special stress being laid upon the paramount importance of pure, fresh air in the greatest abundance and at all times as near an out-doer life as possible. 2. The prevention of the development of the bacilli is to be accom-plished chiefly by an early diagnosis, when the disease is a pure tuber-culosis and before the degenerative changes which constitute con-sumption have taken place. In the former the bacilli, being tied up in the unbroken tubercles, are not thrown off to any extent, while in the latter they are discharged in the sputum by the million. I would earnestly commend to your careful perusal a very able article, appear-ing originally in the A< vc York Medical Journal and reprinted in our January Bulletin, on the subject of "The Relation of Early Diagno-sis and Treatment to the Prevention of Tuberculosis." by Dr. I'otten-ger, president of the Anti-Tuberculosis League of Southern California. He estimates that from 75 to 95 per cent, of early cases, with proper 'ire. should be cured, thereby preventing the development and dis-tribution of the myriads upon myriads of bacilli from the same cases going on in the consumptive sta.i,re. Dr. Pottenger says that the ex-pert in tuberculosis "should be able to determine the presence of the disease in the vast majority of cases before bacilli appear in the spu-tum by the clinical history and physical examination. If not by these." he goes on to add. "the tuberculin test can be used with con- TENTH BIENNIAL, REPORT. -( Science and safety." I beg to emphasize this last statement, for while I know that some object to the use of the tuberculin test in the human, claiming that it is sometimes harmful, the early diagnosis in the tuberculosis stage is of such overwhelming importance to both the patient and the public that inasmuch as it will enable the compara-tively inexpert to make the diagnosis with certainty, the little risk, if there be any, should, in my judgment, be taken in doubtful cases. In any event, there can lie no excuse for failure to resort at once to the microscope in every suspicions case for the detection of the bacilli upon their first appearance in the sputum, for the examination will be made free of charge for any physician applying to the laboratory of the Board of Health. 3. The prevention of the distribution of the bacilli must be accom-plished by the patient himself. lie can do this by the invariable habit of expectorating only into spittoons partially filled with some disinfectant, or into the tire when in the house, and by the use of a pocket spittoon, bits of cloth or paper napkins (never the handker-chief) that can be burned, when out of doors. In a word, he must never let his sputum get away from him except into a disinfectant or the fire ; never turn it loose to dry and assume the form of dust, especially in the house. Having thus outlined the problem very inadequately, but as fully as the limits of tins report and your time permits, we now come to the all-important qnestion as to how we can best solve it. The most conspicuous movement at present is towards the estab-lishment by the State of special sanatoria for the tuberculous. Expe-rience has demonstrated their great success, not only in curing the disease in its incipient stage—in over fifty per cent.—but chiefly as educators of the people, for every patient returning to his home thor-oughly trained in the proper management of his case, so as to prevent the reinfection of himself and the infection of others, is an educator for his neighborhood. But at present, and doubtless for some years to come, we cannot hope for an appropriation by the State for this purpose. The other methods generally employed to educate the peo-ple and prevent the spread of disease by compulsory notification, dis-tribution of literature, organization of societies, etc., have already been referred to. but it seems to me that the most effective method of reaching and attacking the very citadel of the enemy has never been sufficiently emphasized. This method I believe to be through the family physician. It is the family physician who first locates the case of tuberculosis; it is he who is sought for advice by the patient and his friends—no one can get so near to the problem as he. and no one can have such influence as he in securing the proper management of the case. on the part of both the patient and family. No health official nor organization can compare with him in the practical accom-plishment of this work if he can be induced to do it. Even if all the cases of the disease could be located and the proper instructions for 28 NORTH CAROLINA BOARD OF HEALTH. prevention furnished—a manifest impossibility without his aid—they would make but little impression unless re-inforced by his endorse-ment and earnest personal advice. He is the medium—and the only medium in the vast majority < f cases—through whom the principles of preventive management can effectively reach the individual case. It would be superfluous to argue this matter further. It is self-evident that the solution of this great and difficult problem, the greatest health problem of this or any age. turns chiefly on the attitude of the attending physician. The practical question before us. then, is: How can we arouse his interest and secure his cordial co-operation in the work? It is this particular question that I wish to hear discussed, that I may be helped in the performance of my official duty in the premises. I would respectfully suggest that this body, composed of a very large proportion of the leading physicians of the State, put itself on record by adopting some such resolutions as the following: Whereas, tuberculosis, of all diseases the most fatal, being the cause of death in about one-ninth of all who die. is a contagious and therefore preventable disease: and Whereas, its prevention depends upon the early diagnosis, upon the strict observance of certain precautions in the relations between the patient and his associates and upon a mode of life in accordance with the well-established principles of hygiene: and Whereas, these matters come within the immediate jurisdiction of the attending physician, whose influence in securing their observance is far greater than all other influences combined: therefore, be it Resolved, That it is the sense of the .Medical Society of the State of North Carolina and of the North Carolina Hoard of Health in con-joint session assembled, that the spread of tuberculosis, the greatest scourge of mankind, can be most effectively prevented only with the active aid and cordial co-operation with the health authorities of the family physician. Resolved, That not only every member of this body, but every physi-cian in the State, is earnestly requested to use every effort, profes Sional and personal, to promote this great work fpr humanity. I would also suggest the propriety of adopting the following: Resolved, That it is the sense of Hie State Board of Health and of the State Medical Society in conjoint sessii a assembled, that pro-vision should he made in our hospitals for the insane and in the State's Prison, and in the county jails as far as practicable, for the separation of tuberculous cases from the other inmates uninfected with the disease. (Both resolution- were adopted unanimously). TENTB BIENXIAL REPORT. 29 SMALLPOX. As was anticipated in our last report, smallpox has continued with us to an increased extent. The total number of cases during our smallpox year—May 1st to May 1st—is r..::T< *. as against 4,456 the year before. Of this number 2.840 were white and 2,530 colored, with 35 and 34 deaths, respectively. It will be noted that for the first time the disease was mure prevalent among the whites. The death-rate was the smallest in the history of the recent outbreak, being 1.23 per cent, among the whites and 1.34 per cent, among the colored. We have experienced the same difficulties in the management that have confronted us all along, due chiefly to the extreme mildness of the disease, although they have been somewhat less than heretofore. At the recjuest of the authorities of the city of Durham, who were experiencing much opposition to vaccination, I visited that city and addressed the people on the subject, with good results following. The general smallpox outlook seems to be the same it was a year ago. It will continue from year to year until all the people have been successfully vaccinated or bad the disease- The following is a report in detail for the past year: 30 NORTH CAROLINA BOARD OF HEALTH. REPORT OF SMALLPOX FROM MAY, 1903, TO MAY, 1904. Number of Cases. Counties. Number of Deaths. White. Colored. Total. White. Colored. Total. Alamance Alleghany Anson Ashe Bertie Bladen Buncombe Burke Cabarrus Caswell- Catawba Chatham Cherokee Chowan Cleveland Columbus Cumberland Davidson Davie Duplin Durham Edgecombe Forsyth Gaston Greene Granville Guilford Harnett Haywood Henderson Iredell Jackson Johnston McDowell Macon Madison Mecklenburg Montgomery Moore New Hanover Pender Perquimans Person Pitt -- Polk Randolph Richmond Robeson Rockingham Rowan Rutherford Sampson Scotland Stanly Surry Swain Union Vance Wake Warren Wayne Wilkes Wilson Yadkin Yancey Total (in 65 counties) Death rate, per cent TENTH BIENNIAL REPORT 31 LABORATORY. The following is the report of Dr. McCarthy, the Biologist, in detail of the work done for the Board of Health in the joint laboratory of the Department of Agriculture and the Board of Health during the past year : Report of Biologist. Raleigh, May 5, 1904. Dr. Richard H. Lewis, Secretary North Carolina State Board of Health. Raleigh, N. G. Dear Sir:—I herewith submit a detailed report of the work done in the laboratory of the Board of Health during the twelve months included in the period from May 1, 1903, to April 30, 1904. Total number of analyses and determinations 522 These include the following samples, to-wit : Public water supplies, monthly analj ses 2iV; Analyses of water for physicians and health officers of counties. . 136 Examinations of sputum for physicians 57 Examinations of throat exudates, diphtheritic 53 Examinations of blood for Plasmodium malaria? In Examinations of faeces for hookworm 32 Total 522 The official examinations of public water supplies, under the law passed by the last Legislature, was begun in May. 1903. No work was done in the laboratory during June. The full num-ber of analyses required of the water companies under the law was therefore eleven. This number was actually taken by only four companies; the others, by carelessness or other causes, falling below the requirements of the law. as shown by the annexed list: No. of Analy - No. of Analy- Water Companies. ses Taken. Water Companies. ses Taken. Asheville 7 Raleigh 11 Concord - Reidsville 6 Charlotte 10 Rocky Mount 10 Dunn 1 Roxboro ''< Durham 10 Salem '•> Fayetteville (municipal ) . . . . 8 Sanford 6 Fayetteville (old system) .... Salisbury 10 (iastonia 9 Southern Pines 9 Goldsboro 10 Statesville 7 Greensboro 11 Tarboro 7 Henderson S Waynesville 6 Ilendersonville •"> Washington 7 High Point G YVadesboro 3 Lumberton 6 Wilson 11 Monroe 8 Wilmington 11 New Bern 5 Winston 10 32 NORTH CAROLINA BOARD OF HEALTH. It must be said in justice to a few of these water companies thi they began business during the year, and could not therefore tal the full number of analyses. The companies included in this lath category are Dunn, Hendersonville, Roxboro. The law directs the Board of Health to make these analyses £< a charge of $5 each. The usual cost of biological analyses of wati is $10 each. When we began this work it was with the idea of ma ing only the biological analyses in the laboratory of the Board ol Health, the chemical analyses to be made, if possible, by the Depai ment of Agriculture. But. in fact, the chemical work was not doi except in a very irregular way. The Department of Agriculture i supported by a special tax levied upon the farmers of the State. It is supposed t<> devote its energies entirely to strictly agricultur work. What work the Department can do iu other lines must d pend upon the chemists being unengaged. Water analyses, to be of much value, must be made regularly and systematically. It was therefore determined to do the chemical as well as the biological work in the laboratory of the Board of Healt Soon after starting the chemical work we found that the Iarg part of the water companies were using too much alum in their filters and passing a part of this into the filtered water. The various com-panies were notified of this fact. and. though there was at first son indignation expressed upon the imputation cast upon their waters, the companies soon improved their services a ml apparatus, so t!i the last or April series of analyses showed for the entire State bur two supplies giving the reaction for alum, and both these for only very minute quantities. We are now fully justified in stating th no State or country anywhere has municipal water supplies superior to that of North Carolina—so far as regards freedom from polluth and injurious chemical compounds. There are thirty public wati companies in the State. The water of all is very soft, and. witli few exceptions, is free from organic matter. All of the supplies derived from deep wells—in number, five—contain much dissolve earthy matter, and a few approach the quality of mineral watei The deep waters are much harder than the surface waters. The quality and safety of the public or municipal water supplii of the State i< enormously superior to the average quality of tl well waters sent to the laboratory. So great is the difference th the Biologist, as the result of four years" work in this line in North Carolina, is disposed to say that no incorporated town having l.<i<"' inhabitants can afford to permit its citizens to be supplied by private wells of the ordinary shallow type. The danger of typhoid ban. like the sword of Damocles over every community getting water from shallow wells. This danger is minimized for communities having common supply which is closely guarded and the quality kept up the standard by monthly analyses, such as our State law requires It would therefore stem to be the duty of health officers and phys TENTH BIENNIAL REPORT. 33 cians to advise even small towns to abandon shallow private wells for a common public water supply. As regards the samples of well water sent by physicians and comity ealth superintendents, I am able to say that the average quality is iperior to that received during the preceding year. There were swer grossly polluted samples. Of the fifty-seven samples of sputum received, about one-third were tree from bacillus tuberculosis. The samples showing the bacillus une from different parts of the State, but chiefly from the Central and Piedmont regions. Of diphtheritic exudates fifty-three were received, and all but two lowed the bacillus. Nearly all samples of exudates were described • attending physicians as •"tonsillitis" or "membranous croup." De-rminations of diphtheritic exudates were given precedence over all other lines of work in the laboratory, and the result is. in all eases where the physician can be reached by telegraph so transmitted. sually within one hour after sample reaches the laboratory. We old handle more of this class of work. In examinations of blood for the malaria parasite our facilities are not yet appreciated by the medical profession, or else the type of ilaria found in North Carolina is easily diagnosed clinically. Only .rhteen samples came in. and the larger part of these were free from the germ. Only the tertian parasite has been found. Of feeces we have received thirty-two samples, and all but four itained the hookworm or its eggs. Most of the samples also rwed large quantities of sand, indicating recent geophagism. The es of the patients as given by physicians varied between six and sixty-one years. The larger part were under twenty-five years. e samples came from the following counties: Caldwell. Iredell. anville, Johnston. New Hanover. Mecklenburg. Nash. Stokes and Wake. During the past twelve months, as in the preceding period, a few ilications were received for the Widal test for typhoid fever. At isiderable trouble and expenditure of time and materials, the ilogist stocked suitable cultures for this work at three different imes in the two years, but the demand for this work proved too all to justify us in keeping up the cultures. The average demand only about four per year. For the Widal test the culture of bacil-typhosus must be virulent and not over four or five months, at longest, from the spleen of a person dead of typhoid. The culture must also be transferred from tube to tube at least once a week, thus entailing much labor and consumption of material. With so much other work pressing upon the laboratory, we could not afford for the small demand to keep up typhoid culture as required, so at present we decline applications for the Widal test. The clinical alternative is usually between typhoid and malaria, and an examination of the blood by microscope will determine whether or not it is malaria. 3 34 XORTH CAROLINA BOARD OF HEALTH. A part of the Biologist's time is given to the work of the State Department of Agriculture. The work of the Board of Health alone is more than enough to occupy the entire time of one man. There-fore, until such time as the Legislature sees fit to provide for the entire support of the laboratory, no further extension of the work is possible. Respectfully submitted, Gerald McCarthy, D.Sc, Biologist. It will be observed that many of the public water supplies have been quite derelict in the matter of monthly analyses. The act to protect water supplies requires every company selling water to the public to have an analysis made every month by the Board of Health or in such laboratory as it may select, and yet in a total of 334 analy-ses required only 226 sent samples. I have tried faithfully to induce them by gentle means to send the samples regularly and promptly. My last letter has borne fruit, but there are some still that neglect this duty. While the law provides a penalty for failure to have the analyses made, it is manifestly undesirable to resort to the courts. Public opinion is the best lever to employ, and if the physicians living in cities and towns having public supplies would interest themselves in the matter the companies would be more apt to respond. It is of great importance that they should, not only as a guarantee to con-sumers of the purity of the water sold them, but also as a means of support to the laboratory. Thanks to an enlightened, broad-minded Board of Agriculture and a Commissioner cordially in sympathy with this work for the people, we have been enabled to do the very creditable amount of work for the public health shown in the report, but times change and men change with them, and the support of the laboratory is extremely precarious. It should lie sustained by a direct appropriation by the State for the purpose, and it is to be hoped that it may be made by the next Legislature. While Dr. McCarthy, having no assistance, could hardly do more work than he has done, still it is discouraging to note how compara-tively few of our physicians avail themselves of the privileges offered free of cost beyond a few cents of postage. The number, however, is growing, and will no doubt increase more and more as time passes. In conclusion. I appeal to the members of our noble profession to lend their interested support in this great work in which we are engaged. While some are disposed to sneer, and while it must he admitted that the spirit of commercialism which pervades all call-ings at the present time has not left lis untouched, it still remains true that, excepting perhaps the sacred ministry, there is no body of men whose hearts are so open to the cry of distress or whose minds and hands are so ready to administer to its relief without pecuniary reward as the physicians of our country. It is a noble profession, and on the principle of noblesse ol>li</r it is the duty of every physi-cian, and should be his pleasure, not only to cure disease and suffer-ing, but also to aid in their prevention. TENTH BIENNIAL REPORT. 35 Chairman: The report is before the house. Any discus-sion of it ? Dr. Stephens: I want to say just one word as to tuber-culosis. The worthy Secretary, in calling attention to the prevention of tuberculosis, speaks of education of the laity in regard to preventative measures. These things are mat-ters of importance, but there is one thing even greater—the educating of the family physician in those things which are necessary to make early diagnosis. If the family physician is qualified to do this the education of the laity will follow. The family physician needs to have impressed upon him the fact that it is his duty to examine the sputum of a patient having a cough of more than one week. It is his duty to examine the chest carefully in every case of declining health and not let false ideas of modesty stand in the way. It is his duty to see that an examination is made. I would also suggest that the figures mentioned in the resolutions >ug- 2,'ested bv our worthy Secretarv be changed to this effort. He mentions the fact that one-seventh of the deaths is due to tuberculosis. Our last census makes it between one-ninth and one-tenth, and the last census of our own State gives the figures as 11.15-100 per cent, of the total mortality of the State. Dr. : I wish to call attention to the fact that something should be done for the prevention of infection in the public institutions. This is a crying need and one in which the people of the State and the physicians should be in-terested. It is appalling to see the number of necessity in-fected in the public hospitals. Dr. Paquix : It is rather a source of congratulation to me that our Secretary has so emphasized the matter to which I called the attention of the Societv on vestordav. It is the most important subject in the domain of medicine to-day. It is true that prevention is the key to the situation. The practical solution of this question is the great desideratum 36 NORTH CAROLINA BOARD OF HEALTH. in our State. How shall we succeed in combating this enemy '. As I said on yesterday, let every man of you con-stitute himself a committee of one to go home and teach the community at large how to prevent, and himself how to diagnose, the disease. A great many physicians fold their arms and say they can not diagnose that disease. They say, "What can't be cured must be endured." The microscope is only confirmatory of the opening >ymptoms of the disease. There arc signs and symptoms by which the ordinary physi-cian can diagnose the disease in its early stages. What arc they? Physical examination of the chest, the temperature and tuberculin test. By these three methods you can tell whether the disease is tuberculosis or consumption. Let us go home and perfect these methods. It is useless for me to go into details. If you will make a diagnosis early while yet in its incipiency, this cruel disease will not carry so many to an untimely grave, and prevent the infection being dis-tributed in different portions of the country. "Therefore, in view of this, I move that we adopt the resolutions as sug-gested by our worthy Secretary. Xow, gentlemen, I move for the adoption of these resolutions as a whole, unless some one calls for them separately. The motion was carried. Dr. Lewis: There is a fault with a great many of us— that of being a little too kind-hearted sometimes and of not being perfectly candid in informing the patient or family that it is a case of tuberculosis. It is a very painful thing to do to tell the patient or family that it is a case of tuberculosis, but it is important that they should know and take necessary steps to cure it. Chairman: Any further discussion '. Dr. Faison: I think it is right to make a diagn< -'- early. I think a law should be passed preventing any one having tuberculosis from coming within our borders. Dr. Lewis: I think it would be helpful when the Legis-lature meets if a resolution should be adopted by this body TEXTH BIENNIAIi REPORT. ?>~i for an appropriation by the State for a biological laboratory. I think it would be helpful to us. Dr. Ivey : I move that this body ask the Committee on Legislation to approach the coming Legislature in reference to that point. The motion was made and carried. Dr. Lewis: I have not received the advice I want—the 1 m sst practical method of reaching the family physician. You are all family physicians. You can tell me very much better than I can how to reach yourselves. Make me some sugges-tion by which I can reach the profession and I will be very much obliged. How would a personal letter with a two-cent stamp on it do '. Leave off the heading of "Board of Health." Have it directed bv a ladv and it would be opened and read. Dr. Staxcile : I would like to suggest an evangelist from the State Board of Health making a visit to the family physi-cians. In the long run it would pay. Dr. Lewis : I thought that idea was ventilated some years ago. If we could act the State to appropriate for an evangel-ist it would be the best plan, but it is impracticable. Dr. Roberts : There are in every county men who are competent to write up these subjects. Dr. Lewis is ac-quainted with the medical profession, and he knows who to apply to in each county. Let us ask each physician in each county to write up on these subjects which he wants investi-gated. I know it would not be successful in every case, but it will accomplish something. I think a great deal can be done through the County Medical Societies, and if you reach one in ten you have done something. * * * It is only by line upon line, precept upon precept, that you can do anything along this line. Dr. Lewis : It is the intention to put literature on this >ubject in the letter to the physician. 38 NORTH CAROLINA BOARD OF HEALTH. Dr. : We are better prepared than ever to cope with this disease. We have County Societies in every State, and with the assistance of the State Board of Health in sending literature and letters to the physicians in the county and waking them up to the importance of this subject, this matter may be worked out at our home in the County Medical Societies. There is no remedy for the prevention of tuber-culosis unless it commences at home among the people and among the doctors—the doctors that go in and out among the families. The Society should select some man to write and read a paper and work up an interest in the County .Medi-cal Societies. Chairman : We have the report of the Secretary that re-quires adoption. Motion was made to adopt the Secretary's report. Motion carried. Motion was made for adjournment of the conjoint session. Motion carried, and the conjoint session was adjourned. REPORT OF BIOLOGIST. The biological work of the State Board of Health as at present carried on was begun in 1901, when by the liberality of the State Board of Agriculture the Secretary of the Board of Health was per-mitted to send samples of suspected drinking-water to the biological laboratory which the Board of Agriculture had recently established for its own particular work. The great hygienic value of biological analyses, especially in regard to drinking-water, soon became appar-ent, and June 1. 1903. the Board of Health arranged with the Board of Agriculture to share the expenses and facilities of the laboratory already established. The principal line of work carried on on the part of the Board of Health is water analysis. A large amount of work is. however, done in examining pathological samples, including sputum for bacillus tuberculosis; throat exudates for bacillus diphtheriae; feces for iin-cinaria ; and blood for the parasite of malaria. As showing the increase in volume of work and in the interest and favor with which the work is regarded by the medical profession, the following figures showing the total number of samples examined in the laboratory for each of the four years are hereto appended: Total samples for 19(>1 294 Total samples for 1902 3.17 Total samples for 1003 4TH Total samples for 1904 785 Approximately two-thirds of these samples were water. The re-mainder were pretty evenly divided between the different classes of pathological samples above-named. The Legislature of 1003 amended the law governing public water companies so that the Board of Health was required to make a monthly biological analysis and a quarterly chemical analysis of each water supply. The Board was empowered by this act to charge a fee of $5 for each biological analysis, but no provision was made for pay-ing for the chemical analyses, which are therefore made free by the biologist. The fees received from the water companies and one-half the salary of the biologist paid by the Board of Agriculture, consti-tute at present the sole income of the laboratory, notwithstanding the fact that about one-half our laboratory work is done free of charge for physicians of the State. The practical value of the monthly analyses of the public water supplies cannot be overestimated. These systematic examinations serve to assure the patrons of water companies that no pollution of 41) NORTH CAROLINA BOARD OF HEALTH. the supply can occur without being quickly detected. A good illUi tration of the value of regular and frequent examinations of a pub-lie water supply is furnished by the experience of the town of Imt-ler. Pa. This town has a population of 18.000. It had an apparently efficient system of water-works, but made no regular biological exami-nations of the water. During the summer of 1903 some accident oc-curred to the filter which remained for a time undetected, and for that time passed into the service mains water practically unfilte The first warning the water company had of the break-down in filter was the outbreak of typhoid fever among the water constin A severe epidemic ensued, resulting in the death of 111 persons a the serious illness of 1.348 others. First and last, the expense: this epidemic, besides loss of life, were estimated to be not less t $40,000. The experience with typhoid fever in Butler. Ithaca. W; town. Plymouth, and other cities having public water supplies but not controlled by frequent and regular biological examinati proves conclusively that typhoid fever may be spread to a most astrous extent by such waters, and that without efficient control biological analysis no consumer can feel safe in using such wate The monthly analyses of water supplies now provided for by die law governing water companies in North Carolina enable the bi gist to detect even the smallest trace of pollution, and by prom advising the responsible officers of the water companies concert the source of the contamination can be discovered and the pollu stopped before the health of the water consumers is affected, this manner the public health is safeguarded and at the same t the interests of the water companies protected. Reports of pollu are treated confidentially so long as the companies show the pr< zed in remedying the trouble. More than one water company in N< Carolina could certify to the assistance the Board of Health's lain tory has been to them in protecting the health of their patrons i by preventing panic among patrons, the financial interests of * ompanies. In a general way. we can say that no State now has a purer, n wholesome or better-guarded system of water supplies than N< Carolina. The mechanical system of filtering water is exelusn used in this state. Alum is employed to coagulate suspended ma and clear the water. When we made our first chemical analyses these waters we found that a large proportion of the water c panics were passing free alum in notable quantities into the filt< waters. We at once notified these companies, and with commend. promptness most of the companies improved their methods in so that for some time past the average alum content of filtered wi has been not more than one part per million. This amount is entii negligible. So long as the aluin'process of filtration is used, by practicable method can the filtered water be entirely freed from this substance. Some complaints have been made by boiler inspectors I TENTH BIENNIAL, REPORT. 41 the free alum in Altered water was injurious to steam boilers. Bui it is apparent that such an infinitesimal proportion of alum in the water as we have named can have no appreciable effect upon the steel shells of boilers unless the boilers remain run-leaned for very long periods. .Most unfiltered waters contain notable quantities of magnesia, soda and other substances which affect steam boilers injuriously. From these substances most of our filtered waters are almost wholly free. Of the total number of water samples analyzed in the laboratory ibout one-third are physicians' samples of well-water from houses where typhoid fever has prevailed and where the well is suspected of being the source of the infection. Our earlier work in this line showed a most unfortunate condition of affairs, since the great ma-jority of the samples received were badly polluted. During the last car. however, the majority of samples of well-water analyzed have been of very fair quality and free from fecal contamination. It is the general custom in villages and farm-houses to have an open privy or pit within one hundred feet of the house. Where flies abound they pass from the house to the privy and back, carrying upon their feet and frequently deposit upon food-stuffs small particles of fecal mat-ter, which may contain the germs of typhoid. Such germs are ex-creted in enormous numbers by all typhoid patients and by convales-cents for some weeks after recovery. It is both practicable and easy to use closed receptacles in privies, or to cover dejections as soon as deposited with dry earth, ashes or lime. Houses having water-closets should have wire screen-doors to keep out flies. Finally, every house in which there is a case of typhoid should be required to use disinfectants freely upon all excrementitious matter and upon all clothing soiled by the patient. Beginning in the summer of 1903 a vigorous campaign has been carried on by the Board of Health against the Hook-worm parasite. Uncinaria Americana. The presence of this parasite was first brought to the knowledge of the physicians of the State by Dr. ( '. W. Stiles of the United States Public Health and Marine Hospital Service, at the meeting of the State Medical Society in 1903. This loathsome and lestruetive parasite has been shown by our work to lie present in all the counties of the State east of the Piedmont section. So far no sample of Uncinaria-infected feces has been received from beyond the Blue Ridge. There is a constant all-the-year demand upon the laboratory for xaminations of sputum from suspected cases of tuberculosis. The .neater part of such samples received do in fact show the germ of tuberculosis. Tuberculous sputum is the most dangerous class of samples received at the laboratory. We are sorry to say that not a few physicians are so reckless as to send such samples in containers not authorized by the Board of Health and which are forbidden by United States law to be carried in the mails. Such physicians fre- 42 NORTH CAROLINA BOARD OF HEALTH. quently excuse themselves by saying they are in a hurry and cannot wait for the authorized mailing cases supplied by the Board for this use. These physicians seem to forget that there may be a hundred other physicians wanting similar work done, and all equally in a hurry. The rules of the Board of Health governing the laboratory, and the rules of the United States Post-office regulating the trans-mission of infectious matter through the mails, are very reasonable and are in fact necessary to safeguard the health of those who must handle the samples. The routine of our laboratory aims to treat every physician alike, and to take up samples in their regular order. Physicians who deliberately disregard our rules have only themselves to blame when their samples are consigned, unexamined, to the fire. Verbum sap. satis.' From the time when the public schools open in the fall until about May 1. the examination of throat exudates from suspected cases of diphtheria form a very considerable part of the work of the labo-ratory. The type of diphtheria prevalent in North Carolina seems to be of a very mild form, in so far that physicians generally refuse to diagnose the disease from the clinical symptoms. Most of the samples sent to the laboratory are labeled "Tonsillitis*' or "Croup." Yet the great majority of these samples show the true Bacillus (ii)ih-therics. The bacteriological process does not distinguish between virulent and feeble varieties of the germ. Very few physicians who have secured a positive original diagnosis of Bacillus diphtherias send samples from the convalescent patient as recommended by the National Conference of State and Provincial Boards of Health in the following words: "Resolved, That the isolation of any person affected with diphthe-ria or so-called laryngeal or mehranous croup, and of the nurse or nurses attendant upon such person, shall he absolute and shall he governed by the following regulations: * * * "Whenever the presence of the Bacillus diphtherias is in any man-ner reported by an approved bacteriologist, the bouse should forth-with be quarantined and a plainly printed notice thereof, including the name of the disease, should lie posted in a conspicuous place thereon, and guards stationed if necessary. "After proper disinfection, quarantine shall be removed from those houses in which diphtheria has been diagnosed, when synchronous cultures taken from the noses and throats of all persons quarantined have been pronounced to be free of diphtheria bacilli by a bacteriolo-gist approved by the state Board of Health. "After the laboratory diagnosis of diphtheria has been given, ir shall lie the duty of the health officer to see that specimens from both nose and throat of the patient are forwarded by himself or the attending physician to a laboratory approved by the State Board of Health, once ;i week after clinical symptoms have subsided, until negative reports for both nose and throat are obtained." TENTH BIENNIAL REPORT. 43 It is probable that the spread of this disease in epidemic form is very largely due to the neglect of isolating the patient until the germ has disappeared from throat and sputum. A comparatively small number of samples of blood are sent to the laboratory for examination for the parasite of malaria. Most of the samples received are free from the parasite. This seems to indicate that physicians either use quinine before taking the samples or else send only from cases of obscure continued fevers which are not ma-larial. The laboratory receives a very few demands for the Widal Test for typhoid. The Widal test is easily made, but for trustworthy re-sults the culture of the typhoid bacillus used to agglutinate must be fresh and virulent. To procure and keep up such cultures requires too much labor for the trifling demand for this work, so at present we decline to make the Widal test. The laboratory receives an occasional freak sample supposed to contain the "germs" of cancer or scarlet fever. While the biologist is always willing to give a brief answer to a courteous request, with our facilities already overtaxed, physicians must understand that no samples requiring special research can be accepted. The germs (if germs there be) of cancer and scarlet fever are not known to science. It is not the business of our laboratory to search for unknown germs. With present facilities and lack of sufficient financial support, there is little prospect of broadening the scope of our work. With increased means the laboratory might, with great benefit, add to its present lines of work biological diagnosis of rabies and of pneumonia. It might also undertake to test the qualities of the drugs and medicines usually prescribed by physicians. Those States which have investi-gated the quality of drugs sold, especially in the smaller towns. have found a most alarming condition of affairs. For example: Massachusetts has found that practically all the "diabetic flour" sold in that State at about fifty cents per pound was little better than ordinary whole wheat Hour. This is one of the most despicable impositions practiced upon a credulous and helpless public. All the medicinal wines were found to be spurious aud most aromatics below standard strength. Unless the physician can depend upon the purity and strength of the drugs he prescribes, no amount of skill will avail to save his patient, and the reputation of the physician must suffer. This is a very serious matter and should have the earnesl consideration of the Board of Health as well as of practicing physi-cians. It is necessary to call your attention and the attention of the physicians of the State to the insufficient and precarious support of the biological laboratory. There seems to be a loose impression among the profession that the whole power and wealth of the State is back of the laboratory and that the amount of work to be had for the asking is practically unlimited. The fact is that the State does •14 NORTH CAROLINA BOARD OF HEALTH. not contribute one cent to the support of the laboratory. Our sole source of income is the fees received from public water companies. These companies are supposed to get their work done at the actual cost, and if we consider that for an annual payment of $60 each company receives twelve bacteriological analyses and four chemical analyses, it is apparent that there can be little profit to the labora-tory. The biologist has made free of charge for physicians and the gen-eral public during the last twenty months. 850 analyses. It will be impossible to continue this work unless the State appropriate suffi-cient to cover the actual cost of this work. The laboratory needs at least $1,500 per annum above what it earns in fees. With such State aid we will be able to continue our free work and to extend it by adding to our present list the biological diagnosis of rabies and some other diseases, and possibly we may give some attention to medico-legal work, as in examination of blood stains, etc. The salary of the biologist is insufficient: he needs an assistant and a clerk or stenographer. The biologist has for over a year accepted an excessive amount of work, being anxious to prove the practical value of bacteriological diagnosis as an aid to the practicing physician. This value has now been very fully demonstrated, and it seems to be the duty of the State or the public to provide for this work in the future. All of which is respectfully submitted, Gerald McCaethy, D. Sc, Dr. Richard H. Lewis, Biotogist. Secretary X. C. Bonn] of Health. SANITARY INSPECTION OF STATE INSTITUTIONS. PUBLIC BUILDINGS. the capitol. The Council of State. Gentlemen:—The undersigned, a committee from the State Board of Health, visited the Capitol Building and carefully inspected the property, so far as sanitary points connected with it are concerned. We respectfully suggest that the bath-rooms now in use should be ventilated. They are built under the stair-cases and are lighted by gas, and the water for bathing purposes is heated by an instantaneous gas heating apparatus. There is no proper ventilation for these rooms, and we respectfully suggest that this is not a sanitary arrange-ment, and one not conducive to the welfare of those who are to use these bath-rooms. A coat of paint or whitewash over the walls of these rooms would certainly add much to their looks, and we respect-fully think that it would make them healthier. In the Senate Cham-ber and the House of Representatives, we beg leave to repeat the warning that during the sessions of the Legislature, when both of these rooms are crowded by members of this body, and by persons in the lobby, fires should be kept in all the fire-places, to promote good ventilation of these rooms. Yours very truly. G. G. Thomas. M. D.. Richard H. Lewis, M. D.. Committee. the agricultural building. State Board of Agriculture. Raleigh, X. C. Gentlemen :—The undersigned, a committee of the State Board of Health, visited the Agricultural Building and inspected the plumbing and the sanitary arrangements generally in use about the building. Most of this plumbing is in the old building, and none of it appears to us to be first-class work. It is in as good shape, generally, as can be expected of plumbing of this character. We do not think the ventilation of any of the closets was properly looked after when the 46 XOETH CAROLINA BOARD OF HEALTH. plumbing was installed. We suggest tbat you have a competent plumber to go over the work and remodel that which is now rather badly constructed. Yours very truly, G. G. Thomas, M. D.. Richard H. Lewis. M. D.. Committee. the supreme court building. The Council of State. Gentlemen :—The undersigned, a committee of the State Board of Health, visited the Supreme Court Building and inspected the plumb-ing and the sanitary arrangements generally in use about the build-ing. We beg leave to heartily approve the removal of the closets from the first floor of this building to the basement. This seems to be a move in tbe right direction. Generally speaking, the sanitary condition of this building is very good, but the closets, opening in the balls above, are entirely without any ventilation. Windows should be cut in the outside wall, both for light and air for these rooms. The building was clean, and we see no other recommenda-tion to be made regarding tbe sanitary conditions. Yours very truly, G. G. Thomas. M. D.. Richard II. Lewis. M. D.. Committee. EDUCATIONAL INSTITUTIONS. state university. Board of Trustees. University of North Carolina. Gentlemen:—The undersigned, a committee from tbe State Board of Health, visited the University and have carefully gone over the sanitary arrangements of the institution. Generally speaking, these were found in excellent condition. The water supply seemed suffi-cient, and it has been reported of excellent character. From all re-ports received while there, we are convinced tbat this water Supply will be most carefully protected from contamination, and will be ample for the purposes of the University. Tbe plumbing in tbe Carr Building appeared lei us to lie of poor character. It certainly needs careful overhauling, and in many places repairing. Slate floors, or some impermeable material, should TENTH BIENNIAL REPORT. 47 be placed under the urinals in the closets, as the floor is now badly soiled by the urine falling on it. and soaking in. and is a source of discomfort, and may be a source of disease. All these wooden floors should be replaced by marble or slate, with ample drainage for any overflow or dripping. We respectfully call your attention to the fact that the chemical laboratory and lecture-rooms are badly overcrowded, and the re-moval of the hoods to make room for students has affected the venti-lation of the building. This is not only detrimental to the health of the students, but is taking away from the chemical department an opportunity to do the good work which has been so signally per-formed by it in the past. The graduates of this department have been in demand, and it will be a serious blow to the University to have any neglect of this department and impair the high grade of teaching which has so far marked the chemical work at the Univer-sity of North Carolina. Yours very truly, G. G. Thomas. M. D.. Richard H. Lewis. M. D.. Committee. state normal and industrial college. The Board of Trustees, State Normal and Industrial College.. Greensboro, N. C. Gextlemex :—The undersigned, representing the State Board of Health, in accordance with section 3 of an act relating to said Board, made on the loth inst. a sanitary inspection of the college under your charge. It gives me pleasure to report that I found the institution in an excellent condition, from a sanitary point of view. Of the many water-closets scattered through the various buildings, all were as they should be. with a single exception in the partially occupied Students' Building. Its water supply was cut off, but it did not ap-pear to be in use. The President, who was with me. made a note of it for correction. I note, however, in the lavatories of the Spencer Building that privacy was secured by opaque window-shades. They should be discarded and the windows painted or frosted, for light in abundance is especially desirable in such places. I was pleased to note the continued use of the Forbes water ster-ilizers. The output on the second floor of the Spencer Building was not satisfactory as to quantity. I would, therefore, suggest the installation of an additional sterilizer of such capacity as to supply, not barely enough, hut more than enough water. One of the chief troubles in the hygienic management of people—women especially—is 4:8 XOETH CAROLINA BOARD OF HEALTH. to get them to drink water enough. The free and easy working of the vital functions is greatly helped by drinking large quantities of pure water. Its generous use. therefore, should be encouraged in every way. The Infirmary is too small. I think—certainly incomplete—in that no provision is made for contagious diseases. Owing to the occur-rence of three cases of diphtheria in the past few weeks the second floor was cut off from the remainder of the building for their accom-modation, and in consequence the quarters for the ordinary sick were at one time overcrowded. This is. of course, inadmissible in the proper care of even the well, and ample provision should be made to avoid it. A separate building for contagious diseases should I erected, or an annex to the present Infirmary, connected by a <o ered way with open sides, should be built. A still better plan, it" possible, would be to use the present Infirmary for other purposes and bin Id a new one in a more retired part of the grounds. The cold-storage plant, I was informed, is only rented—a temp rary arrangement, no doubt due to lack of funds. It should be pui chased, or. in any event, made a permanent fixture of the institution. It occasionally happens that under the influence of heat certai organic poisons, known as ptomaines, are developed in milk ami meats and cause serious illness. This should be guarded against. Very respectfully, Richard H. Lewis. M. I). college of agricii.tike and the mechanic arts. The State Board of Agbicultube. Gentlemen:—Having made a sanitary inspection of the Colleg of Agriculture and the Mechanic Arts, the undersigned, appointed l> the State Board of Health to make the inspection, beg leave, as n quired by the act relating to the Board of Health, to report to yon honorable body as follows: The sanitary condition of the College as a whole is good, and w< found only one thin- to criticise. We refer to the surface privj the same, with the exception of the water-closets in the hospital, being the only convenience of the kind for the large student-bod \ As a surface privy it is well arranged and well cared for. but it i-the method of disposal of human feces to which we object. For such an institution in this day of sanitary progress it is an anachronisn It is. however, as a possible source of disease that it is to be con demned. Typhoid fever is the one of all the more serious diseases p which the young adult is most susceptible. Most frequently it is conveyed by infected drinking-water, but its transmission by flies i now a well-established fact. As the College is a military school, ih TENTH BIENNIAL REPORT. 49 lost apt illustration we can suggest is the experience of our troops uring the recent Spanish war. In some of our camps, notably at 'hickamauga. typhoid fever became such a scourge that the gov-rnment appointed a commission composed of three of the most dis-inguished sanitarians in the country to investigate the matter. After most careful and thorough inquiry they reported the cause of the pread to be chiefly flies, excluding the drinking-water, which they found to be pure. The germs of the disease are found in the dis-harge from the bowels and bladder. The flies crawling over the sur-ace of the pits infected their feet and afterwards planted them on the food in the kitchen and mess tents. Thousands of oases were a used in this way. On a smaller scale the same thing might happen t the College. In our opinion, in order to avoid this danger a sys-em of sewerage should be installed and the surface privy abandoned. George (i. Thomas, M. D.. Richard H. Lewis, M. D.. Committee. agricultural and mechaxical college for the colored race. The Board of Trustees, A. and J/. Colleye for the Colored Race, Greensboro, N. C. Gextlemex:—Having been designated by the State Board of Health for the purpose, I made a sanitary inspection of the College on the 15th inst. I found it in as good condition as the nature of he plant will permit. I note the absence of any provision for taking care of the sick. "ins should be remedied by all means, by the erection of a separate infirmary, so that in case of the appearance of contagious disease the proper isolation could be carried out. The bathing facilities could be enlarged to advantage, I think. The surface privy, while apparently fairly well kept, should he ihandoned and a system of sewerage substituted. This can lie done it comparatively small expense by the method known as subirriga lion, as most of the work could he done by the students themselves nd tbe amount of sewer-pipe required would he small. I comment7 this matter to your careful consideration. Respectfully. Richard H. Lewis. M. D.. Secretary of State Board of Health. 50 NORTH CAROLINA BOARD OF HEALTH. schools for the deaf .vxd dumb and the blind, at raleigh. The Board of Directors. Schools for the Deaf. Dinah and the Bit ml. Raleigh, N. G. Gentlemen:—In compliance with the provisions of section 3 of an act relating to the Board of Health, the undersigned, a committee appointed by the said Board for the purpose, made on November 30th a sanitary inspection of the two schools under your charge. As we purposely avoided giving notice of the intended visit, the conditions found, we take it. fairly represent those usually prevailing. Tin s, -l/ool for the White Blind. As regards the more important sanitary features—general cleanli-ness, water supply and plumbing—we found the school in excellent condition. We think, however, that it would he an improvement of the lavatory in the southern wing of the girls' building to transpose the bath-tubs and water-closets. The latter are now located in a small inside room without an opening upon the outer air. and is con-sequently dark and not properly ventilated, while the bath-tubs oc-cupy quarters that are both well-lighted and ventilated. It is much more important that the former should have the benefit of an abund-ance of light and air than the latter. We noted the very small and totally inadequate inside play-room for the children in had weather. For reasons given in the concluding paragraph, this is a defect which should he remedied. This could easily he done by utilizing the basement, which is now so much waste space, the only thing required being a good concrete floor. This would also be an improvement on general sanitary principles, inas-much as it would prevent the rising of the ground air which, from the health standpoint, is objectionable. The arrangements for the sick, we think, could be much improved. Each of the rooms in the two wings of the girls' building set apart for the <-ascs of ordinary sickness are too far from the general lavato-ries. A bath-tub and water-closet should be installed in the immedi-ate proximity of each of them. This need is too manifest to require further discussion. But the crying need of the institution is some provision for the proper isolation of contagious diseases, and we earnestly repeat the recommendation in regard to this matter made by the committee of inspection two years ago. The third floor in the center of the main building. Vicing cut off from other parts, except a stairway from below, is well located for the purpose and could easily lie transformed into two wards, one for each sex. This should be done by all means. The State cannot afford to subject the mosl pitiable and helpless of its wards to the dangers of an epidemic of infections and therefore preventable disease. TENTH BIENNIAL EEPOET. .".1 The rooms on the west side of the girls' building are too dark. The number of windows is insufficient, and the trouble, especially on the second floor, is aggravated by the root' of the veranda. This defect should be remedied. Leaving out other considerations, the blind, from a purely physical point of view, are heavily handicapped by their special infirmity. Except to a limited extent they are debarred from the active out-door exercise which is so important to healthy childhood. They can-not romp and run. and participate in athletic games, and in con quence they lack, as a class, the glow of vigorous health to be found in those blessed with sight. You have doubtless observed the pallor which generally characterizes fhein. For these reasons it is espe-cially important that everything possible in the way of air and light and play-room should be provided for them. Thr School for the Colored Deaf and Blind. We found both departments of this school in a most exemplary state of cleanliness, and those in charge are deserving of commenda-tion. Some of the water-closets are of a rather antiquated pattern, but are in good working order and answer the purpose very well. The school as a whole is in excellent sanitary condition. Geokge G. Thomas. M. D.. Richard H. Lewis. M. D.. Committet . SCHOOL for the deaf axd dumb, at morgaxtox. Board of Directors. School for the Deaf and Dumb, Morganton, N. ('. Gextlemex :—Having made a sanitary inspection of your school, in compliance with the act relating to the Board of Health, the under-signed committee from said Board take pleasure in reporting that they found everything in excellent condition. We would suggest, however, the advisability of changing the brick floor of the basement to one of concrete as soon as practicable. While not unsanitary, it is a source, we were informed, of much dust which finds its way to the floor above. Very respectfully. George G. Thomas. M. D.. Richard PI. Lewis. M. D.. Committee. 52 NORTH CAROLINA BOARD OF HEALTH. oxford orphan asylum. Board of Directors. vford Orphan Asylum. Gentlemen:—The committee from the State Board of Health vis-ited the Oxford Asylum and made a careful investigation of the sani-tary condition of the property under your charge. It affords us great pleasure to report that we found the buildings in excellent con-dition, so far as the sanitary arrangements were concerned. The cleanliness was so marked a feature as to excite our unstinted admi-ration. We nowhere found any evidence of neglecl of the premises or want of daily care of all the property under the control of your Superintendent. Colonel W. J. Hicks, and his efficient helpers. The children bore the evidence of the well-directed care which is exercise, 1 over this institution. We wish, however, to call your attention to two points which see.n to us of marked importance: We found that everywhere the chil-dren were sleeping two in a bed, and it is with great earnestness that we advise you to separate these children, giving each one a single bed. This is a suggestion which is the result of long observation among those best titted to judge of such necessities. Evil habits of pro-nounced character are often begotten in dormitories where two chil-dren sleep together. The presence of a bad child in a dormitory may work an amount of mischief which may be of serious detriment to the future lives of these little oi.es over whom you are otherwise exercising such beneficent care. We respectfully submit that the present air supply in these sleeping-rooms is hardly sufficient, and if possible, it would be well to scatter the children more. As we found it. the air supply was not over 255 cubic feel per head, being less than half of the minimum amount supposed to be necessary for the best health in sleeping-rooms. With the exception of the two above-named exceptions, this committee wishes to express again its great satisfaction at finding a charity of this sort so administered as to bring happiness and health to the inmates of the institution, and to insure among these helpless little ones, not only comfort during their stay, but a feeling of admiration, which is the outgrowth of gratitude, toward the institution which gave them an opportunity to become useful men and women. Yours very truly. G. G. Thomas. M. D.. Richard H. Lewis, M. I>.. CommitU . TENTH BIENNIAL REPORT. 53 asylum for colored orphans. Board of Directors. Colored Orphan Asylum, Oxford, X. C. Gentlemen:—The committee from the State Board of Health vis-ited this institution and found everything under the control of your Superintendent. Rev. Mr. Shepherd, well cared for. The house was clean and the children looked to be in good condition. Little or no sickness was reported, and there was every evidence of a thorough disposition to do the best for the inmates of the institution, under the care of the Superintendent and his corps of teachers and helpers. While it is not strictly a part of our inspection to look after the furni-ture in these buildings, we would respectfully recommend that these buildings be supplied with new bedsteads and mattresses, as they seem to be in bad shape. Yours very truly. G. G. Thomas. M. P.. Richard H. Lewis. M. D.. Committee. STATE HOSPITALS FOR THE INSANE. central hospital. at raleigh. The Board of Directors. State Hospital for the Insane. Raleigh, A. ('. ( Gentlemen :—The undersigned, assigned by the State Board of Health to this work, have made a sanitary inspection of the hospital, and respectfully beg leave to report : We found the institution clean and in excellent sanitary condition. We would Dote, however, two wants, the supply of which would, in our opinion, conduce to the healthfulness of the patients. One of these is the want of verandas, enclosed, of course, with wire netting. Fresh air and sunshine in abundance are of the first importance, from the health point of view, to all persons, especially to children and invalids. The insane are below par in physical as well as mental health, and as the condition of many of them requires restraint of their liberty, they are debarred from outdoor exercise. Wire-enclosed verandas in good weather would in effect be outdoor wards and therefore of great benefit to many of the patients. We would recommend the constructions of such verandas on the west side of the hospital. The other want is the lack of provision for the isolation of tubercu-lous patients. The transmissibility of tuberculosis is thoroughly es-tablished, the chief avenue of transmission being the sputum. The 54 NORTH CAROLINA BOARD OF HEALTH. proper care of the sputum in this class of patients is simply out. of the question, and the clanger of infection is. therefore, much greater than it would be among sane people. This is a crying need that should be met at once by the establishment of a special colony for the tuberculous, or by such other method as in the judgment of your honorable body would best solve the problem. Very respectfully, George G. Thomas, M. D., Richard II. Lewis. M. D.. Committee. state hospital. at morgantox. Board of Directors. State Hospital, Morganton, X. C. Gentlemen:—The undersigned, representing the State Board of Health, having made a sanitary inspection of the Hospital, beg leave to report : We found the institution in excellent sanitary condition. There is. however, in our judgment, a serious defect in the arrangements, and that is the lack of some provision for the isolation of the tuber-culous patients. In view of the well-established fact of the com-municahility of the disease through the sputum and the manifesl impossibility of securing its proper care from the irresponsible insane, it is particularly important that such provision should be made for them. We were much pleased with the colony for men and believe this arrangement will be materially helpful to the general health and ipso facto to the special malady of its members. We would recom-mend the extension of this plan as far as possible. Very respectfully, Geokge <;. Thomas, M. P.. Richard II. Lewis. M. !>.. CommitU < . STATE HOSPITAL. AT GOLDSP.ORO. To tin Board of Directors. State Hospital, Goldsporo, Y. C. Gentlemen:—On October 27th. without previous notice to your Superintendent, we. a committee of the State Board of Health, made a sanitary inspection of the Hospital under your care. We respect-fully beg leave to report as follows: The economy and efficiency used in the management of the institu-tion are unmistakable, as shown by the small annual per capita ex- TENTH BIENNIAL REPORT. 00 penditure, the valuable enlargement and improvement of plant in many respects, and the fairly low death-rate of the inmates as com-pared with that of other hospitals for the colored insane. The arrangements for the preparation and preservation of food was found to be admirable; the newly added cold-storage, dancing-hall, dining-room, as well as other improvements, displayed wise and needful investments of the State funds. The floors to the halls and most of the wards, made clean by fre-quent dry-sand seourings. and the walls made white by periodic ap-plications of liquid lime, together with the remarkable absence of dust, gave evidence that neatness and cleanliness were conditions striven for by Dr. Miller and his subordinates. While, therefore, the buildings and the management are in many respects a credit alike to them and the State, the sanitary condi-tion is not ideal, is not above reasonable criticism. The white floors, made of soft and inferior wood, certainly in the main building, are worn and rough in many places and further marred by large dirt-filled cracks. With insane people for your population, such floors must sooner or later, in spite of all effort, become contaminated with feces, sputa, urine and other elements of filth. Floors made of hard wood properly polished, and with periodic ap-plications of enamel paint, would be well-nigh non-absorbent, easily washed and in every way more healthful. Walls with smooth hard finish, properly painted, suited to disin-fectant sprayings, washings and fumigation, are much to be pre-ferred from a sanitary standpoint. The mortality in your Hospital for the last twelve months, as we are informed, is a fraction less than 7 per cent., winch is much lower than it was last year, and even lower than is usual among the colored insane of other asylums. While it is gratifying to know this. it is a fact sad to realize that onr pr< ventabJe disease—tubercu-losis— is responsible for about 30 per cent, of this death rate. Two years ago our report showed quite 35 per cent, of your mortality was due to the same cause. As is known, doubtless, to most if not all of you. tuberculosis is a contagious disease. As a contagion it is slow in its onset, and can. with proper precaution, be avoided even in close proximity with its victim. Its contagion is closely associated with the home, the hospital and the prison. An inclosure of some form is necessary to make it effective. "The house is the granary of the tubercle bacillus. It is the place in which tuberculous matter is kept vital until the bacillus can find a new host." The increasing susceptibility to con-sumption among the negroes of the South seems to be a well-estab-lished fact. 56 XORTH CAROLINA BOARD OF HEALTH. According to recent report, at the autopsies on all negroes dyii \ the Georgia Insane Asylum in 1901, over 50 per cent, gave ui takable evidences of the presence of this disease. The relation between consumption and insanity in the negi from the very nature of things, a question of much interest to Board. The evidence at our command seems to point to the idea that insanity, in most instances, precedes the onset of consumption. Granting the truthfulness of these propositions, the freest possi hie ventilation of the wards, with the greatest liberty to outdoor are matters of the highest concern to the well-being of your popu-lation. Besides these precautions, we are assured by your Superintet that systematic bichloride washings and formaldehyde fuinigati practiced in infected wards. To our minds, the most effective m left you whereby you may greatly diminish this heavy sac-rift life is that of complete separation of the tubercular patients froi other inmates. Such a course was urged in our former report. are glad to know that Dr. Miller, by means of a little profit re;.! from brick-making, has been enabled recently to effect such a rangement among the female patients. There still remains s» tubercular patients closely associated in every-day life with 217 inmates. Surely our legislators will not longer remain indiffen your needs for the proper removal of this evil condition. With but a few exceptions, the defective closets in the sew system, to which your attention was called in a former report, been replaced by splendid automatic flushing closets. The fi expenditure of a very small sum will give an ideal condition o line. When the filthy and mischievous habits of many of inmates are remembered this becomes a matter of no little i tance. In our report of two years ago we called attention to imperfe in the water supply. As the same conditions prevail now as tic again call attention to matters discussed in that report : excep we are informed by the management that the well near the s continues to afford good water, as determined both by practic and by occasional analyses. Two years more of use of this with good results causes us to be less apprehensive of it. y regard it as a possible source of infection, and if used shot analyzed from time to time. Respectfully. I'u\\< i- I n i iv. .M. D. J. L. Nicholson, M. 1 Cornmi TUBERCULOSIS. Tuberculosis, usually appearing in the pulmonary form and then popularly known as consumption, is the most fatal dis-ease in North Carolina as it is in other parts of the civilized world. Since its organization the Board of Health has been working in a general way to prevent its spread, but no special concentrated effort to secure its prevention has been made until the present year. The Secretary of the Board, in his annual report made to the conjoint session of the Board with the State Medical Society at its meeting in Raleigh in May last, called particular attention to the importance of the sub-ject and the difficulties appertaining to the solution of the problem, and earnestly requested of the physicians sugges-tions as to the best methods of procedure. The interested reader is referred to this report and the suggestions made in its discussions, which will be found on preceding pages. The execution of the campaign was delegated to the Secre-tary, who gave it most careful consideration before taking-action. The fundamental object to be obtained was the educa-tion of the people. The most effective way of reaching the people he believed to be through the family physician, whose immediate personal advice and influence would be worth all other agencies combined. For the purpose of this educa-tional work a six-page pamphlet on "The Causes and Pre-vention of Consumption" was carefully prepared, special pains being taken to make it concise, yet essentially complete ; positive and definite, yet plain and simple, and, notwithstand-ing the handicap, to make it, if possible, interesting. The pamphlet will be found below. But the mere distribution of literature is not enough. A most important part of tin- problem is to secure the reading of it. To secure that end as far as possible by interesting the 58 NORTH CAROLINA BOARD OF HEALTH. recipient enough to get him to read the pamphlet, a series of letters addressed to different special classes of the people asking, in addition to the perusal of the article, the interested co-operation of the reader in securing its wide distribution and in general helping to stir up an interest in the subject, were prepared. A copy of these letters was and is to be mailed with each pamphlet, for the distribution is by no means finished, only about 25,000 having so far been sent out. The first was sent to all the newspapers in the State that it might be widely advertised. The response on the part of the editors was encouraging, and as a result much interest has been excited and the call for the pamphlet has been very gratifying, the demand not being limited to our own State, but extending from Indiana to Texas. The other letters are respectively to physicians, ministers, school-teachers of both races, managers of various enterprises having numbers of em-ployee-, and to the general public. The greatest interest in this work has so far been shown by ministers of the gospel, many undertaking to distribute the pamphlet by the hundred. In order to set forth fully the scheme adopted by the Board in its campaign against consumption, these letters are also printed below. It will be noted that a special Letter was prepared for the colored teachers. This was deemed necessary for the reason that consumption is much more fatal to the colored than to the white race, the death-rate, so far as our limited mortuary statistics show, being in the proportion of about two and a half to one. Besides, owing to their ignorance and poverty as a class, to their habit- and environment and the difficulty of reaching them except through the leaders among their own people, special efforts in their behalf are required. In fact, the colored elemenl in our population greatly enhances the difficulties of successfully solving this, the mosl stupendous task, under the most favorable circumstances, which confronts the sanitarian. It is our hope, however, that something can TENTH BIENNIAL REPORT. 59 be done through the physicians, ministers and readier- of their race. It is not The intention of the Board to limit its efforts against tuberculosis to this method, but as far as possible to avail itself of others that are useful, such as the organization of anti-tuberculosis societies in our cities and towns, the securing of public addresses on the subject, and when it be-comes feasible the establishment of a special sanatorium for consumption. These latter methods, while helpful, are neces-sarily verv limited in their scope, but by the free use of printer's ink ami postage stamps we hope at comparatively small expense to plant the seed of knowledge of this subject in every neighborhood in the State, in the confident belief that it will bring forth fruit. But after all is said, the family physician remains the most effective agency in the solution of the problem, and by repeated appeals directly to every individual practitioner in the State we hope to arouse and keep alive his interest and secure his active co-operation. CAUSES AND PREVENTION OF CONSUMPTION. (Tuberculosis, Phthisis, Pulmonary Consumption) . Pulmonary tuberculosis (consumption) is the most common form of tuberculosis, about 95.5 per cent, of all kinds, it is said. The other principal forms of tuberculosis are scrofula (of the glands), white swelling (of the bones and joints), and lupus (of the skin). These are milder in character, and not so dangerous as the pulmonary form. Consumption is the most fatal of all diseases and is aptly called "The Great White Plague." It is estimated that one-seventh of nil deaths from every cause in the civilized world are due to it. One-fourth of all who die in adult life—the most useful period—it is said, are the victims of this disease. In North Carolina, according to the last census report, about one-tenth of all deaths were attributed to consumption. In other words, between four and five thousand of our people die every year of a disease that can he prevented. 60 NORTH CAROLINA BOARD OF HEALTH. CAUSES. It is a communicable disease, which means that it is transmitted from one case to another. The essential element in the transmission is a germ known as the tubercle bacillus, an extremely minute rod-like body, one-ten-thousandth of an inch long and one-fifty-thousandth of an inch in thickness. In common with all communicable diseases, it is a preventable disease. The causes of consumption are of two classes, predisposing and exciting. Predisposing Causes.—In every constitution there is. in varying degrees, a certain power of resistance to the inroads of disease germs. most pronounced in those in vigorous health. While it may be said that the disease itself is very rarely if ever inherited, the lack of this resisting power, just as any other constitutional peculiarity, is inher-ited, hence the great susceptibility of those belonging to consumptive families. This is greatly increased by intermarriage between such, which should not occur. But resistance is weakened by lowered vitality from any cause, as insufficient and impure air from over-crowding, especially in dark. damp, sunless, poorly ventilated apart-ments: insufficient or improper food: other diseases of a wasting character, as dyspepsia and typhoid fever, for example; overwork. worry, dissipation, etc. It is a mistaken notion that alcohol is a preventive or curative of consumption. The habitual user is an easier victim. As about three-fourths of the nourishment of the body is furnished by the oxygen taken in with the air breathed, a deformed or imperfectly developed chest, with the corresponding deficiency of lung expansion, is a predisposing cause. For the same reason, those having normal chests but who do not expand them by exercise in the open air are more susceptible. The improved general health of the people resulting from the advance in hygiene, and the outdoor life that has come to be largely the vogue in recent years, is doubtless to no small degree responsible for the marked reduction in the death-rate from consumption. Exciting Cause.—The Tubercle Bacillus. This is found, with the exception of infected meat and milk, winch we believe to lie rare so far in our State, only in the pus or matter thrown off by a tuberculous patient in the sputum or spit from the diseased lungs, or discharged in the other forms of tuberculosis. It is said that the number of the bacilli or germs thrown off in twenty-four hours in the advanced stage mount up sometimes into the billions. The sputum, therefore, is the chief source of the poison, and consequently its management is the most important item in the problem of the prevention of consump-tion. Although the germs may find their way into the system by being swallowed in infected food, tuberculous milk or meat, or eat-ables over which tli"^ fresh from sputum have crawled, from kissing a consumptive on the lips, by putting infected articles in the mouth. TENTH BIENNIAL REPORT. 61 as for example, coins that have been handled by a consumptive, etc., they are generally taken in with the breath in the form of dust. As long as the spit remains moist it is innocent in this regard, as the germs cannot be dislodged and floated into the air. For the same reason the breath of a consumptive is not dangerous, but the germs are sometimes found in the tine spray of saliva expelled to a dis-tance of several feet in eoughing, sneezing, loud talking ami laugh-ing. The germs cannot live for any length of time exposed to sun-shine, fresh air. and rain. They retain their vitality sometimes for months when protected from these agencies. Consumption is there-fore essentially a house disease. In a room occupied a large part of his time by a consumptive, the germs are not only more abundant but mi iic persistent in action than elsewhere, and the darker and more badly ventilated the room the more so. Moreover, persons who live an indoor life are more susceptible. PREVENTION. # From what has been said above, the following specific rules of con-duct are deduced : The sputum or spit of a consumptive should always he destroyed h< fore it can dry and assume the form of dust. Indoors he should spit directly into the open tire, if there be one. or into a spittoon or spit-cup containing some disinfectant. ."» per cent, carbolic acid. 2 per cent, formaldehyde or one to two thousand corrosive sublimate. Plain water would be much better than nothing, as it would keep the sputum moist and for so long a time innocuous. The contents of the spittoon should be burned or buried and the vessel scalded with boil-ing water. Away from home, especially in public places of all kinds, he should religiously abstain from spitting on the floor or the side-walk. He should always use some form of pocket spittoon, of which there are many varieties that can be obtained at a trifling cost, or expectorate upon pieces of rag or soft paper, which should be kept wrapped up in paraffin paper or other impervious material until they are burned. He should never spit into his handkerchief, lest the dry sputum be distributed in the air when he pulls it out. Special care should lie taken not to soil the hands, face or cloth-ing with the sputum. A consumptive should never cough, sneeze, talk loudly or laugh towards any one near at hand, hut turn away his face, or hold his handkerchief in front of his mouth. No consumptive should ever be kissed upon the lips—better not at all. Regard for the safety of his dear ones ought to make him re-fuse absolutely to he kissed. Persons waiting upon consumptives should wash their hands fre-quently, always before eating. They should abstain from sharing 62 KOETH CAROLINA BOAED OF HEALTH. with them articles of food sent to their rooms. They should, of course, keep constantly in mind the rules of prevention. The tuberculous patient should have his owu toilet articles, table-ware and linen, and no one else should use them. In cleansing them they should be boiled, or at least washed with boiling water. His underclothes, night-clothes and bed-linen should never be mixed with the linen of the family, but immediately upon removal be dropped into a tub of water and kept wet until they can be boiled and washed. His room should be as airy and bright with sunshine as possible. having a southern exposure when feasible. It should be kept thor-oughly ventilated with at least one window open day and night, win-ter and summer. It should be simply furnished, without carpet, cur-tains, furniture upholstered in cloth of any kind—all dust-catchers, in short. It should never be swept or dusted, but wiped with a damp doth, which should immediately afterwards lie burned, boiled, or soaked in a disinfecting solution. Xo one, if it can be avoided, should sleep in the same room with a consumptive, never in the same or another bed very close to his. Besides the risk of catching the disease, the second person would consume a large part of the oxygen of the air which he so much needs. Children, who have a habit of handling everything and putting their fingers in their mouths, ought not to be allowed in the room. This applies with special force to the crawling ;ilv. A room vacated by a consumptive should never be occupied by an-other until it has been disinfected. Renters ought to refuse to take a house in which such a patient has lived until this has been done. In cities the municipal authorities should require the immediate disin-fection of every house from which one dead of consumption has been buried. It would be best for the city to have this done by its own officials trained in the work. In order to reach these cases every town should forbid the burial or removal of any corpse except upon the presentation of a death certificate stating the cause of death. signed by the attending physician. Progressive towns do this any way in order to make an accurate record of their vital statistics. A consumptive bouse servant or dairy hand is a source of danger that can and should be avoided. It would work no hardship, for a different life would lie better for the patient. This warning applies especially to the South, for the reason that the disease is very much more prevalent in the colored than in the white race. The outer clothes of a consumptive and the woolen skirts of all women which have trailed over the floors of infected houses, of public halls, of street-cars and over the sidewalks should be brushed out of-doors, and the brusher should avoid, as far as possible, inhaling the dust, always breathing through the nose. Dark petticoats, often TEXTH BIENNIAL REPORT. 63 tucked or flounced at the bottom, which are never washed and which accumulate filth month after month, are very objectionable. The danger from tuberculous meat is slight because the germs are killed in cooking, but it is much greater from milk which is taken raw. and which, besides, is mure liable to infection. Milk from a cow with a diseased udder should never he used. Cities and towns ought to require of every dairyman selling milk to their people a lice granted only upon the observation of the proper sanitary rules, including the tuberculin test, and revocable upon violation of these rules. Every municipality should adopt and enforce an ordinance against spitting on the sidewalks and on the floors of public places. Compulsory notification would he very helpful, especially in the case of the very poor. It is the plain duty of every consumptive, to his loved ones and the public, once in possession of the facts above set forth, t" observe all the precautions laid down, and of those intimately associated with him to see that he does it. It is likewise the duty of every physician to see that tins, farts are impressed upon his consumptive patients <///</ their families. The interested co-operation <>f the attending physician is by for the must important eh nu nt in th* solution of this difficult and dreadful prob-lem. Without it comparatively little can b< done, with it wonders can in accomplish< d. It should he borne in mind that a consumptive taking the precau-tions above set forth in the management of his sputum is not at all a source of danger to others, and need not be avoided. It would be unnecessary cruelty to treat him like a leper. But his friends should see that he does take the precautions. OFFICES AND SHOPS. In business offices, shops, factories, or any other places where a number of persons are shut indoors together, the danger of infection is increased. The managers of such offices or factories, for their own protection as well as that of their employees, should see that the proper precautions are observed. Free ventilation should he had and a rigid anti-spitting rule should he enforced. Spittoons containing water under all circumstances, and a disinfectant if there he present a known case of consumption, should he provided and their invaria-ble use insisted upon. Book-keepers should never moisten the finger to turn a page. The Michigan Board of Health reports twenty suc-cessive cases of consumption in one office in Detroit as originating from one case who
Object Description
|Biennial report of the North Carolina State Board of Health
|Other Title
|Report of the North Carolina State Board of Health.
|North Carolina. State Board of Health.
|1903; 1904
North Carolina. State Board of Health--Statistics--Periodicals
Public health--North Carolina--Statistics--Periodicals
Public Health--North Carolina
|North Carolina, United States
|Time Period
|(1900-1929) North Carolina's industrial revolution and World War One
|Report covers two calendar years (13th-18th); (19th) covers Dec. 1, 1920-June 30, 1922; thence each covers July 1-June 30 years.; Printer: 13th (1909/10)-18th (1919/20) by Edwards & Broughton; 19th (1921/22)-20th (1923/24) by Bynum; 21st (1925/26)-<44th (1970/72)> unnamed.
|Raleigh :The Board,1911-
|North Carolina Department of Health and Human Services
|State Document see http://digital.ncdcr.gov/u?/p249901coll22,63754
|Physical Characteristics
|v. ;24 cm.
|Health Sciences Library, University of North Carolina at Chapel Hill
|Digital Characteristics-A
|126 p.; 6 MB
|Biennial report of the North Carolina State Board of Health
|Digital Collection
North Carolina Digital State Documents Collection
N.C. Public Health Collection
|Digital Format
|Related Items
|Printer: 13th (1909/10)-18th (1919/20) by Edwards & Broughton; 19th (1921/22)-20th (1923/24) by Bynum; 21st (1925/26)-<44th (1970/72)> unnamed.
|Pres File Name-M
|Pres Local File Path-M
|Full Text
Cbe Hi&rarp
DttJt0ion of JE>eau& affairs
Ontoersitp of Jl^octfj Carolina
X-lljnXJL Q*A*&^./?Xk
c OF THI?
Off PHILADELPHIA
E. M. Uzzell & Co., State Printers and Binders
S. Westbay Battle. M. D Asheville.
Term expires May, 1907.
Henby W. Lewis. M. D Jackson.
Term expires May, 1907.
J. L. Nicholson. M. D Richlands.
Term expires May, 1905.
W. H. Whitehead, M. D Rocky Mount.
Term expires May, 1905.
W. P. Ivey. M. D Lenoir.
Term expires May, 1907.
Richabd H. Lewis. M. D.. Secretary Raleigh.
Term expires May, 1907.
Geobge Gillett Thomas, M. D., President Wilmington.
Term expires May, 1905.
Francis Duffy. M. D New Bern.
Term expires May, 1905.
J. L. Ludlow, C. E Winston-Salem.
Term expires May, 1909.
Alamance Dr. EL R. Moore.
Alexander Dr. C. J. Carson.
Alleghany Dr. Robert Thompson.
Anson Dr. J. H. Bennett.
Ashe Dr. Manley Blevins.
Beaufort Dr. D. T. Tayloe.
Bertie Dr. II. V. Dunstah.
Bladen Dr. L. B. Evans.
Brunswick Dr. J. Arthur Dosher.
Buncombe Dr. D. E. Sevier.
Burke Dr. J. L. Laxton.
Cabarrus Dr. R. S. Young.
Caldwell Dr. W. P. Ivey.
Camden Dr. C. G. Ferebee.
Carteret Dr. F. M. Clarke.
Caswell Dr. 8. A. Malloy.
Catawba Dr. George H. West.
Chatham Dr. T. A. Kirkman.
Cherokee Dr. B. B. Meroney.
Chowan Dr. T. J. Hoskins.
Clay Dr. P. B. Killian.
Cleveland Dr. B. H. Palmer.
Columbus Dr. X. A. Thompson.
Craven Dr. Joseph F. Rhem.
Cumberland Dr. A. 8. Rose.
Currituck Dr. H. M. Shaw.
Dare Dr. W. B. Fearing.
Davidson Dr. Joel Hill.
Davie Dr. M. D. Kimbrough.
Duplin Dr. A. J. Jones.
Durham Dr. X. M. Johnson.
Edgecombe Dr. W. J. Thigpen.
Forsyth Dr. W. O. Spencer.
Franklin I >r. R. F. Yarborough.
Gaston I >r. II. F. Glenn.
Gates I )r. W. < ). P. Lee.
Graham Dr. Y. J. Brown.
Granville Dr. S. D. Booth.
Greene Dr. W. B. Murphy. Jr.
Guilford Dr. Edmund Harrison.
Halifax Dr. I. E. Green.
Harnett Dr. O. L. Denning.
Haywood Dr. J. F. Abel.
Henderson Dr. J. G. Waldrop.
Hertford Dr. C. F. Griffin.
Hvde Dr. E. H. Jones.
Iredell Dr. M. R. Adams.
Jackson Dr. R. L. Davis.
Johnston Dr. Thel. Hooks.
Jones Dr. X. G. Shaw.
Lenoir Dr. C. L. Pridgen.
Lincoln Dr. John W. Saine.
McDowell Dr. B. L. Ashworth.
Macon Dr. W. A. Rogers.
Madison Dr. W. J. Weaver.
Martin : Dr. W. H. Harrell.
Mecklenburg Dr. C. S. McLaughlin.
Mitchell Dr. Virgil R. Butt.
Montgomery Dr. M. P. Blair.
Moore Dr. Gilbert McLeod.
Nash Dr. J. P. Battle.
New Hanover Dr. W. D. McMillan.
Northampton Dr. H. W. Lewis.
Onslow Dr. E. L. Cox.
Orange Dr. C. D. Jones.
Pamlico Dr. H. P. Underbill.
Pasquotank Dr. J. B. Griggs.
Pender Dr. R. J. Williams.
Perquimans .Dr. C. C. Winslow.
Person Dr. J. A. Wise.
Pitt Dr. Zeno Brown.
Polk Dr. C. J. Kenworthy.
Randolph I >r. W. J. Moore.
Richmond Dr. F. J. Garrett.
Robeson Dr. H. T. Pope.
Rockingham Dr. Sam. Ellington.
Rowan Dr. W. L. Crump.
Rutherford Dr. T. B. Twitty.
Sampson Dr. John A. Stevens.
Scotland Dr. A. W. Hamer.
Stanly Dr. V. A. Whitley.
Surry Dr. John R. Woltz.
Swain Dr. A. M. Rennet.
Transylvania Dr. ('. W. Hunt.
Union 1 >r. John M. Blair.
Vance Dr. II. II. iiass.
Wake Dr. J. J. L. Mc< 'idlers.
Warren Dr. M. P. Perry.
Washington Dr. W. II. Ward.
Watauga Dr. II. MeD. Little.
Wayne Dr Williams Spicer.
Wilkes Dr. W. P. Horton.
Wilson Dr. W. S. Anderson.
Yadkin Dr. T. R. Harding.
Yancey Dr. J. L. Ray.
North Carolina Board of Health.
Office of the Secretary,
Raleigh, January 2, 1903.
His Excellency, ( Jharles B. Aycock,
Governor of North ( 'arolina.
Sir:— In accordance with section 3, chapter 21+. Law- of
l v '.'-">. I have the honor to present for transmission to the
Genera] Assembly this, the Tenth Biennial Report of the
North Carolina Board of Health.
With great respect.
Rich aim) II. Lewis, M. D.,
Secretary and Treasurer.
Two years ago, in the opinion of the health authorities of
many of the States, our country was threatened with an epi-demic
of bubonic plague. In spite of the positive assertion
on the part of several of the leading bacteriologists of the
United States of its presence in San Francisco, the fact was
persistently denied by the Governor of California and the
Board of Health of that State. In consequence, believing
that the proper precautions were not being taken to prevent
its spread to other sections, a sufficient number of States,
including our own, requested a conference with the Surgeon
General of the United States Public Health and Marine Hos-pital
Service under the law governing that bureau. This was
granted, and the meeting was held on January 19, 1903, the
Secretary of our Board representing North Carolina. As the
result of some very plain talk and the adoption of strong
resolutions on the subject, the unfavorable conditions in San
Francisco were remedied and the menace averted.
During the past biennial period our State has been spared
any unusual outbreak of disease, with the exception of the
occurrence of typhoid fever in the Baptist Orphanage at
Thomasville, in which there were sixty-seven cases, with two
deaths, and of smallpox in many localities.
While our work of educating the people in the principles
of Hygiene in general, and more particularly as to the best
methods of avoiding the infectious and therefore preventable
diseases, has not been relaxed, special efforts have been
made iu regard to Uncinariasis, or hook-worm disease, and
The work in the biological laboratory has grown in amount
and consequently in value to the people of the State. The